Utah will see the greatest increase in COVID-19 case rates by July 4, while Delaware will see the greatest decrease in cases, according to forecasts from Rochester, Minn.-based Mayo Clinic.
COVID-19 cases and hospitalizations have been rising in the U.S. since mid-April, driven by the highly transmissible omicron subvariants, though emerging data suggests this trend may be slowing. The nation's seven-day average of new COVID-19 cases was 108,215 as of June 27, marking just a 1 percent increase in the last 14 days, according to data tracked by The New York Times. Mayo Clinic's COVID-19 map forecasting tool projects the nation's case rate will rise slightly from 33.6 cases per 100,000 on June 26 to 34.8 per 100,000 on July 4.
COVID-19 case trends are just one measure of virus activity and likely represent an undercount given the increasing use of rapid, at-home COVID-19 tests. Hospitalizations were up 6 percent nationwide in the last 14 days, with a daily average of 31,720 people hospitalized with COVID-19 as of June 27 according to the Times.
Becker's calculated the rate at which COVID-19 case rates are expected to increase or decrease between June 26 and July 4 using current and predicted figures from Mayo Clinic's tool.
Five states projected to see the largest jump in daily cases by July 4:
Five states projected to see the largest fall in daily cases by July 4:
Note: Mayo Clinic uses a Bayesian statistical model to forecast cases that automatically updates as new data becomes available. Forecasts were unavailable for Alaska and Hawaii. There is an uncertainty interval for forecast values, with lower and upper bounds that are not included in the calculations in this table. To learn more about the data Mayo Clinic uses to forecast hot spots, click here. Becker's pulled the forecast values at 9:30 a.m. CDT June 28.
06/28/2022
SUNY Cortlands COVID-19 Safety Information page has been updated to reflect new policies and procedures for the 2022-23 academic year.
The page is available online.
Information is divided into three main sections: Quick answers, information for students and information for employees.
Important changes that are now reflected on the page include:
The COVID-19 Safety Information page will be regularly updated. Any new policies will also be communicated to students, faculty and staff by email. The university will continue to work with guidance from the state Department of Health, the State University of New York and the Cortland County Health Department.
All the medical educational innovation that has taken place amid the COVID-19 pandemic has come with a price in the form of the tremendous strains exerted upon the physicians, faculty educators and other health professionals who have so expertly shepherded medical students and resident physicians through this trying period.
These strains may be less visible to the public because medical education is often unseen and imperfectly understood, but they are no less severe. Addressing this less visible crisis will require a systemic response, which is why the AMA created a new resource with organizational steps to support medical educators (PDF).
A session at the spring meeting of the AMA Accelerating Change in Medical Education Consortium explored the recommendations in this new resource, and medical school faculty and administrators shared what they and their physician colleagues have noted are obstacles to implementing the recommendations.
Solving this challenge is not just an ethical or moral responsibility. It may be necessary to ensure that the new and productive ways of education learned during the pandemic arent lost, and to prevent a mass exodus from undergraduate medical education that could lead to an even greater workforce shortage.
It is imperative to preserve the capacity for creativity among educators and avoid reversion to historical practices out of sheer exhaustion and change fatigue, the resource says. This is not an issue of individual resilience. Health care organizations and educational institutions must take action to avoid mass abandonment of educational duties and loss of educational leaders.
The AMA resource features seven key recommendations to help institutions support educators as they recover from the pandemic:
Read more about the recommendations in detail.
What it will take
For these recommendations to gain traction, medical schools and residency programs will need to embrace a systemic, democratic process, the presenters at the session noted.
Often when institutions undertake major change efforts, the people with boots on the ground aren't part of that discussion, said Allison Knight, PhD, assistant vice dean of student affairs and director of student wellness at Eastern Virginia Medical School. So the solution sometimes creates more problems than it solves.
Indeed, many administrators have heard from educators that they feel they havent been at the table over the last year, said Maggie Rea, PhD, director of student and resident wellness and clinical professor of emergency medicine at the University of California, Davis, School of Medicine.
If you're telling me as a faculty member that I get a half a day a week for my protected time, to teach or to write or to put in a grant, often there isn't the broader conversation of: Has my clinical load been switched or shifted? Rea noted.
One of the core issues underlying the ongoing threat to making system-level change is that everybody is already working at maximum capacity, said Richard Van Eck, PhD, associate dean for teaching and learning in the Office of Education and Faculty Affairs at the University of North Dakota School of Medicine and Health Sciences.
Faculty and staff need to be empowered to identify which things don't need to be done anymore, even if its the deans pet project), which things dont have a high enough return on investment, and which things can be deferred in order to make space for high-quality education and well being, Van Eck said.
Which points to the need for involvement at the highest levels.
I can't say enough about administrative buy-in, said Eboni Anderson, DHEd, director of community oriented primary care and assistant professor of public health at A.T. Still University-School of Osteopathic Medicine in Arizona. Not just talking about it, but actually coming with some ideas to make those changes.
And dont forget that learners have valuable insights too, Anderson added.
They can also speak to these changes we need to make when it comes to well-beingnot just from their perspective on what they're doing and what they're learning, but from what they see amongst the faculty and the staff, she said.
People can use the COVID-Taser website to predict their likelihood of severe illness or death
Are you more likely to die from COVID-19 or in a car accident? A new risk assessment tool can help you figure that out.
Created by Cameron Byerley at the University of Georgia, the online tool is called COVID-Taser, and it allows users to adjust age, vaccine status and health background to predict the risks of the virus.
Byerley, an assistant professor in UGAs Mary Frances Early College of Education, said that most people assess risk based on their experience of the world.
Like if youre trying to decide how dangerous it is to drive, you might think about how out of all your friends and all your family members, you know two people who died of driving in the past 20 years. So, its risky enough that you should wear a seatbelt and drive sober, but its not so risky that you shouldnt drive to a friends house.
That way of thinking helps people compare unknown risks with known ones they interact with every day. The COVID-Taser capitalizes on those comparisons to give people a better idea of their risks of dying from COVID-19 or having adverse side effects from vaccination. Website visitors can then see how those risks stack up to others like dying in a car crash or being struck by lightning in their lifetime.
Sponsored by a Rapid Grant from the National Science Foundation, the website is part of a larger project that aims to investigate how people interpret media using quantitative data representations like graphs and charts.
After conducting surveys in both the U.S. and South Korea, the team created several tools and a series of K-12 lesson plans to help citizens and students use mathematical representations of COVID-19 to make data-informed decisions about their health.
A big focus of the project is thinking about how to communicate information, said Byerley. Were really interested in risk communication and providing information so people can make decisions for themselves by comparing COVID risks and vaccination risks to more familiar risks they have a sense of.
People can also use the Relative Risk Tool to toggle between different ages to see how the risk of being hospitalized or dying from COVID-19 changes according to age groups.
Additionally, the tool can be used to compare the risk of dying from the coronavirus for vaccinated people versus unvaccinated people, as well as unvaccinated people with various health conditions like rheumatoid arthritis, lupus, psoriasis and other immunosuppressive conditions.
My dream goal is that people will see that the risk of vaccination is low compared to other risks that theyre willing to take, said Byerley. Theyll see that vaccination is safer than driving, pregnancy, playing professional soccer and just safer than lots of things theyre willing to do already. Its also far, far safer than getting a COVID infection the benefits of vaccination far outweigh the risks.
Byerley is currently working on incorporating information on immunocompromised people who are both vaccinated and unvaccinated into the Relative Risk Tool.
COVID-Tasers projection tool, which was designed to explain models from the Institute of Health Metrics and Evaluation (IHME), is an educational resource that teaches people the difference between cumulative deaths, which is the total number of people who have died and a figure that will always increase over time, and average daily deaths, which can increase or decrease over time.
Byerley noted that media outlets cause confusion when they include graphs labeled total deaths with numbers decreasing over time when they really should be labeled average daily deaths because total deaths cannot decrease.
In addition to showing total deaths and daily deaths separately on the projection tool, IHME models also predict how deaths will either increase or decrease in the U.S. depending on whether mask mandates are implemented.
We want people to understand what a model is and how its kind of like what happens on your phone when youre using Google Maps to predict how long a trip will take, which is based on some sort of algorithm, said Byerley. Its usually pretty good, but its never perfect and it changes. So we want people to understand that epidemiological modeling is very helpful, even though those estimates arent perfect. They still help people plan and are helpful tools.
The IHME model predicted that, during the middle of the pandemic, areas without mandates involving masks, large gatherings and shutdowns would likely experience an increase in daily deaths. On the other hand, if mask mandates were implemented across the entire U.S., the model predicted that daily deaths would decrease. These predictions were verified by varying death rates in states and other countries with different public health policies.
Although models are not exact, they still show the impact of masking and vaccination in reducing death from COVID-19, Byerley said.
Im hoping these tools can serve as a template for medical communication, said Byerley. And when numbers are hard for people to understand, it helps them see the relative size of things even if they dont know percentages or place values or information like that from school. I want these tools to help people understand that the risk of COVID infection is worse than the risk of vaccination and that the risk of vaccination is lower than other things they already do.
AUSTIN (KXAN) COVID-19 metrics, including hospitalizations, are starting to trend upward again in Austin-Travis County. The local health authority attributed the uptick to the BA.4 and BA.5 offshoots of the omicron variant in a Travis County commissioners court meeting Tuesday.
Those mutations are starting to show up in both wastewater and in variant surveillance locally, according to the health authoritys report. They could be more severe than previous mutations.
With each mutation, it [COVID-19} is becoming adept at evading our immune systems defenses and that is why these two particular variants are starting to become more predominant. Dr. Desmar Walkes said.
As of Monday, Walkes reported there are nearly 100 people in area hospitals with COVID-19, 18 of those people are in intensive care units. Roughly half of the people hospitalized are there primarily for COVID-19.
More people that are requiring oxygen and starting to require life support, Walkes said, noting that research done on BA.4 and BA.5 shows the mutations may impact lung tissue more than previous mutations. She also said for people who had COVID-19 during the winter omicron surge, reinfection with BA.4 and BA.5 could be more severe.
With each subsequent infection, there is an increase in the impact, Walkes said. Reinfection is not benign.
Travis County is presently in the medium level of risk based on the Centers for Disease Control and Preventions risk tracker. Under that level, APH is recommending people at high risk, and people who live with someone who is high risk, wear a mask in public.
For people who had COVID-19 during the original omicron surge, immunity is likely waning. The UT COVID-19 Modeling Consortium talked about that when case numbers started to trend upwards earlier this month.
Its been four or five months after the first omicron wave, where we had so many infections, and so we expect that there will be many people losing immunity at a rapid speed, said Anass Bouchnita, a postdoctoral fellow with the consortium.
People who previously had COVID-19 may also be at greater risk of getting seriously sick if they do catch COVID-19 again, Walkes explained. Staying up-to-date on vaccinations are still the best protection against the virus, she said.
We are still seeing good coverage and protection that is offered to people who are vaccinated from severe illness, hospitalization and death. We are still recommending vaccinations and boosters for those who are eligible, Walkes said.
By Kitt Tovar Jensen
Not only did the novelty of the pandemic cause national concern, but so did shortages of food and other basic supplies. Although a multitude of brands and meat products flood stores, there are relatively few companies providing the products. In fact, 85 percent of U.S. cattle are slaughtered by just four companies.
While the current large-scale meat processing system is both effective and efficient, any processing plant closure creates a ripple effect throughout the entire meat product supply. Due to the mechanics of a processing plant as well as consumer taste, livestock must be slaughtered by a certain weight or age. This leaves livestock producers with relatively few markets in which to sell their products.
As COVID-19 vaccines became available, the pandemic appeared to near its end. Residual supply chain issues, however, still plague product accessibility. Coupled with rising inflation rates and international disputes, many consumers have begun to turn towards smaller, local meat lockers.
In response to the pandemic-caused disruptions, many states are working to address meat product supply chain issues. Iowa and South Dakota have enacted legislation to provide grants for small establishments processing locally raised livestock. The purpose of this funding is to relieve pressure on the meat supply chain by expanding meat locker space, assisting small meat locker owners with purchasing new equipment, and creating new curriculum to establish an artisanal butchery program.
Other states, such as Oregon, are trying to address supply chain issues by applying for a State Meat Inspection Program with the USDA. Establishing a state inspection program would create more opportunities for livestock producers, as there are less than 15 federally inspected meat processing plants in the state.
At the same time, consumers are increasingly interested in learning how their food is grown and are seeking to buy local products. Due to several key federal laws, Americans are accustomed to relatively few foodborne illnesses and outbreak. Consumers should be able to confidently support small, artisanal butcheries without sacrificing food safety and quality.
Federal Regulation and Inspection
Although rare, foodborne illnesses and outbreaks do occur and can cause a staggering amount of physical and financial damage in a relevantly short time. Because few Americans grow their own food, safety regulations necessarily focus on the commercial production and sale of meat and poultry products. In 1906, Congress enacted the Federal Meat Inspection Act (FMIA) to protect consumers from adulterated or misbranded meat products. The FMIA requires all meat products sold through interstate commerce to be processed in sanitary conditions and inspected. The Poultry Products Inspection Act sets similar national standards for poultry products.
The United States Department of Agriculture, through the Food Safety and Inspection Service (FSIS), manages the federal inspection of such meat and poultry processing establishments in order to ensure the health and safety of consumers. To achieve this goal, FSIS has established various regulations. For example, all applicable meat and poultry processing establishments must develop and establish written Sanitization Standard Operating Procedures (SSOP). SSOPs ensure that each meat and poultry processing establishment have sanitary conditions. FSIS also requires applicable establishments to develop a Hazard Analysis and Critical Control Point (HACCP) program. HACCP programs serve as a control system designed to prevent foodborne illnesses.
If FSIS detects a violation, it may immediately remove the product in order to protect consumer health, stop production at the facility, or it may withhold inspection services. Without inspection services and approval, a meat or poultry processing plant cannot sell its products into interstate commerce. In a severe situation, FSIS may refer the violation to the U.S. Attorneys office for criminal prosecution.
Consumers will be glad to know that these laws and regulations have relatively few violations. For the 2021 fiscal year, FSIS reported a 98.7 percent compliance rate. In 2021, FSIS investigated 11 outbreaks. The United States is able to provide a safe food system, because of regulations, investigations and recalls.
State Inspection
The FMIA allows individual states to enter into a cooperative agreement with FSIS and operate their own meat and poultry inspection (MPI) program. Any meat and poultry product from such a facility is limited to sales within the state. The State MPI program must establish enforcement requirements at least equal to the applicable federal regulations. Currently, 27 states have elected to do create MPI programs.
A State MPI offers protections similar to the federal programs as federal regulations set the baseline of safety and animal welfare. Additionally, FSIS requires each state with its own MPI program to conduct a yearly self-assessment demonstrating that its program is at least equal to federal inspection regulations. Under the assessment process, FSIS will evaluate each states statutory and regulatory authority, sampling procedures, and inspection coverage. In 2020, FSIS found that 26 of the self-assessments demonstrated that the State MPI programs have laws, regulations, and programs at least equal to the federal laws. One state received a provisional at least equal to status. In addition to the yearly self-assessment, each states MPI program is subject to a triennial on-site review.
About 1,900 state inspected meat processing establishments exist throughout the country. Under USDA regulations, establishments with 10 to 499 employees are considered to be small and establishments with fewer than 10 employees are considered very small. In addition to meat inspection requirements, small-scale meat plants frequently need licensing for waste water disposal, business operation, and construction. Despite their size, small and very small meat processing plants offer additional options for livestock producers and consumers while simultaneously following food safety practices.
Inspection Exemptions
Because the prevention of large-scale foodborne illness outbreaks is a primary government objective, FSIS did establish several inspection exemptions for noncommercial meat processing establishments. First, FSIS allows a personal use exemption for anyone who slaughters her own livestock and will use the meat products only for herself, her family, or nonpaying guests.
Second, any individual or establishment who slaughters and prepares livestock for the exclusive use of a livestock owner is able to receive the custom use exemption. Custom-exempt establishments do not require daily FSIS inspections. However, establishments in this category are still subject to adulteration and misbranding regulations and must maintain sanitary conditions.
Conclusion
The impact of COVID-19 on the supply chain highlights the needs for a stable and consistent source of meat and poultry products. Such work is physically difficult and, unsurprisingly, the biggest issue many small-scale meat locker owners face is a lack of a trained worked force. However, by supporting small and medium size meat processing establishments, the pressure on the meat products backlog is able to be reduced.
In addition to supply chain issues, the consolidation of the meat processing industry has created further concerns about the industrys vulnerability to cyber-attacks and allegations of antitrust law violations. There are over 6,200 federally regulated meat and poultry slaughter and processing establishments throughout the United States. Comparatively, state inspected meat processing facilities involve a minute number of establishments. However, these facilities, although small, receive the same level of food safety and quality oversight while simultaneously providing new job opportunities throughout many rural areas of the state.
https://www.fsis.usda.gov/sites/default/files/media_file/2021-11/qer-q4-fy2021-tables.pdf
4. Methodology for Performing Scheduled and Targeted Reviews of State Meat and Poultry Inspection Programs Revision 2, FSIS Directive 5720.3 (Nov 10, 2016).
5. 9 C.F.R. 303.1(a).
About the author: Kitt Tovar Jensen is a Staff Attorney at Iowa State Universitys Center for Agricultural Law and Taxation. She focuses on areas of agricultural law including farm succession planning, environmental and natural resource law, regulatory law, and farm policy.
Prior to joining CALT, Kitt worked as an undergraduate research assistant in the Animal Production department at the University of Lleida in Catalonia, Spain, and interned with the international trade department for the National Pork Producers Council in Washington, D.C. While in law school, Kitt served as the Associate Editor for the Drake Journal of Agricultural Law and clerked at the Iowa Farm Bureau Federation.
Kitt earned her B.S. in Animal Science from Iowa State University and her J.D., with honors, from Drake University while completing certificates in Food and Agricultural Law and Legislative Practice. Kitt is an LL.M candidate at the University of Arkansas School of Law.
COVID-19 cases and deaths are up this week after a several-week decline. Hospitalizations, however, are little changed.
In the last week, Michigan has reported 14,353 new and confirmed COVID-19 cases and 174 confirmed and probable deaths, according to the Michigan Department of Health and Human Services, which updated its data on June 28.
Tuesdays total includes 12,008 confirmed cases and 146 confirmed deaths. The state is averaging for the last seven days, 1,715 confirmed cases and 20 deaths a day.
Numbers are up from last week. On June 21, the state was averaging 1,588 confirmed cases and eight deaths per day for seven days.
As of April 6, the state Department of Health and Human Services began including both probable and confirmed cases in its totals. (A case is confirmed only when there is a positive PCR test. Cases are classified probable when there was no such tests but a doctor and/or an antigen test labeled them COVID.)
Last week, the state moved its weekly update from Wednesday to Tuesday.
In total, there have been more than 2.6 million confirmed and probable cases, and 36,918 confirmed and probable deaths since the start of the pandemic in Michigan. Of them, 2,263,417 cases and 33,869 deaths are confirmed. About 343,014 cases and 3,049 deaths are probable.
Below is a chart that indicates the seven-day average for new cases reported per day throughout the pandemic. (Cant see the chart? Click here.)
Cases by counties
All counties reported new cases since June 21.
The following 10 counties have seen the most new, confirmed cases per 100,000 people in the last seven days: Gogebic (271), Iron (249), Kalamazoo (177), Washtenaw (170), Kalkaska (151), Keweenaw (147), Oakland (147), Macomb (144), Calhoun (139), and Ontonagon (138).
Without adjusting for population, these 10 counties have seen the greatest number of new cases since June 21: Wayne (2,362), Oakland (1,868), Macomb (1,270), Kent (790), Washtenaw (632), Kalamazoo (463), Ingham (373), Genesee (357), Ottawa (348) and Saginaw (209).
Kalamazoo, Macomb, Oakland and Washtenaw counties are on both lists, indicating higher case numbers.
The arrows and colors on the map below show per-capita cases compared to the previous week in Michigans 83 counties. Hover over or tap on a county to see the underlying data. (Hint: Drag the map with your cursor to see the entire Upper Peninsula.)
Cant see the map? Click here.
The chart below shows new cases for the past 30 days by county based on onset of symptoms. In this chart, numbers for the most recent days are incomplete because of the lag time between people getting sick and getting a confirmed coronavirus test result, which can take up to a week or more.
You can call up a chart for any county, and you can put your cursor over or tap on a bar to see the date and number of cases.
Cant see the chart? Click here.
Hospitalization
As of Tuesday, there were 754 adults and 19 pediatric patients with confirmed or suspected cases of COVID-19 in hospitals across the state. Of them, 90 adults are in intensive care and 30 are on ventilators.
This is little changed from one week ago.
As of June 21, hospitals statewide were treating 750 adult and 27 pediatric patients with confirmed or suspected cases. This included 93 adult patients in intensive care and 37 on ventilators.
On Jan. 10, at the worst of the omicron surge, the state had about 5,000 total patients, including about 860 in intensive care and about 540 on ventilators.
Deaths
The seven-day average of deaths are up 150% this week compared to one week ago.
Wayne County reported the most with 26. Oakland County reported 21. Macomb County had 19, Kalamazoo County reported seven, Kent and Ingham counties each reported five and Washtenaw, Genesee and Livingston counties each reported four.
Below is a chart that tracks the states seven-day average for reported COVID-19 deaths per day over the course of the pandemic. (These are based on the date reported, not necessarily on the date of death.)
Cant see the chart below? Click here.
Testing
In the last seven days, 12.5% of tests statewide were positive for SARS-CoV-2.
On Monday, June 27, about 13.4% of about 14,400 tests were positive. A week earlier, on June 20, about 12.5% of about 10,200 tests were positive.
Cant see the chart? Click here.
The interactive map below shows the seven-day average testing rate by county. You can put your cursor over a county to see the underlying data.
COVID-19 vaccinations
As of Wednesday, June 22, 66.4% of residents five and older have received at least one COVID-19 vaccine shot, according to Michigan health department data. The previous week, the rate was about 66.3%.
About 60.9% of residents 5 and older have completed their initial series, and 34.8% of those five and older have received a booster dose. Of those who are fully vaccinated, 58.3% have gotten a booster shot.
On June 18, federal authorities approved Moderna and Pfizer vaccines for children 6 months to 4. This is the last age group to gain vaccine eligibility. However, this data does not yet reflect that change.
Below is a chart that shows vaccination rates by county for people 5 and older. (Cant see the chart? Click here.)
For more statewide data, visit MLives coronavirus data page.
To find a testing site near you, check out the states online test find send an email to COVID19@michigan.gov, or call 888-535-6136 between 8 a.m. and 5 p.m. on weekdays.
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Nurses and midwives feel 'forever altered' by the impact of Covid-19 and remain deeply affected by what they experienced, new research from the University of Surrey reports. None felt they came through the last two years unscathed.
Researchers say that there is an urgent need to tackle stigma to create a psychologically safe working environment and have called for a national Covid-19 nursing workforce recovery strategy to retain nurses and help restore their psychological well-being.
Nurses and midwives put their own health and psychological wellbeing on the line for the public during the pandemic and many unfortunately lost their lives. Others experienced burnout, high levels of moral distress and PTSD. We have a duty as a society to take care of frontline staff who experienced such extreme psychological and emotional distress during this pandemic."
Jill Maben, Professor of Health Services Research and Nursing, University of Surrey
"To prevent a mass exodus of our nursing and midwifery workforce, it is important that they are offered the care and support that they need. A new national strategy focussing on their wellbeing is essential. The support currently offered is a good start in improving wellbeing, however more needs to be done at organizational levels (not just letting the responsibility rest with the individual nurse or midwife) as a one size fits all approach does not work."
The findings are published in the International Journal of Nursing Studies, as part of the ongoing Impact of Covid on Nurses (ICON) longitudinal interview study which arose from the ICON survey, researchers examined the impacts of the pandemic on frontline nursing staff's psychological and emotional wellbeing during the second wave of the Covid-19 pandemic.
Interviewing nurses and midwives from across the country, researchers identified high levels of distress amongst participants about the lack of compassionate care they were able to offer patients during this time.
One nurse, spoke about her distress and embarrassment about the care her patients received whilst she was redeployed, and her hope that investigations would be launched into patient care after the pandemic.
Redeployment was also found to have caused trauma to nurses, with many being unaccustomed to caring for high numbers of critically ill patients and being witness to such high numbers of patient deaths. A lack of trust between existing and redeployed nurses was also identified with many experiencing distress when forced to carry out tasks that they felt insufficiently trained to do and were concerned that their professional registration may be endangered.
Stigma was a factor in some nursing staff not accessing counselling services during the first wave of the pandemic. Some participants referred to the notion that nurses seeking counselling would be viewed as a 'sign of weakness.' Those who did seek out counselling often did so through anonymous sources such as charities or Trade Unions suggesting a lack of trust in the confidentiality of resources offered by employers.
Professor Maben added:
"These interviews were some of the most challenging of my career. We felt immensely privileged as a research team to bear witness to the selflessness and skilful work of nurses and midwives during the pandemic, while also hearing their often harrowing stories. We were often in awe of their work and felt their stress and distress deeply. However, interviewees suggested that by listening to their stories we provided some therapeutic space and comfort, with many very grateful that we were undertaking this work and recording their experiences for posterity."
Source:
Journal reference:
Maben, J., et al. (2022) You can't walk through water without getting wet UK nurses distress and psychological health needs during the Covid-19 pandemic: A longitudinal interview study. International Journal of Nursing Studies. doi.org/10.1016/j.ijnurstu.2022.104242
A study of 10,775 high-risk adult patients during the COVID-19 delta variant surge in late 2021 finds that treatment with one of three anti-spike neutralizing monoclonal antibodies for mild to moderate symptoms led to low rates of severe disease, hospitalization, ICU admission and mortality, according to Mayo Clinic researchers.
Among patients treated at Mayo Clinic in Minnesota and Wisconsin from Aug. 1 to Dec. 1, 2021, who received bamlanivimab/etesevimab, casirivimab/imdevimab or sotrovimab, 287 patients, or 2.7%, developed severe disease that led to hospitalization, oxygen supplementation or death within 30 days of treatment. The rates of severe disease were 1.2% for patients treated with bamlanivimab/etesevimab, 1.6% for patients with sotrovimab, and 2.9% for casirivimab-imdevimab.
The slightly higher rate of severe outcomes among patients treated with casirivimab/imdevimab may be related to a significantly lower COVID-19 vaccination rate in that group of patients, according to Raymund Razonable, M.D., a Mayo Clinic infectious diseases specialist and first author of the study, published in Mayo Clinic Proceedings. Data show that unvaccinated patients are at higher risk of serious disease. ICU admission was comparable among patients treated with the three anti-spike monoclonal antibody products.
Anti-spike neutralizing monoclonal antibodies are effective in reducing the risk of hospitalization and severe disease due to COVID-19. The improved clinical outcomes are shown for all three monoclonal antibodies that were used during the delta surge. That surge has passed, and we're now dealing with omicron and its variants. But the lessons learned from the delta experience are still true: Diagnose early, treat early with monoclonal antibodies, and the risk of severe disease will be reduced."
Raymund Razonable, MD, Study First Author and Clinic Infectious Diseases Specialist, Mayo Clinic
The delta COVID-19 variant is nearly twice as contagious as earlier variants and may cause more severe illness. The greatest risk of transmission is among people who are unvaccinated. People who are fully vaccinated still can be infected and spread the virus to others, though it appears that vaccinated people spread COVID-19 for a shorter period than unvaccinated people do.
Patients in the Mayo Clinic study were not confirmed as having the delta variant, but Dr. Razonable says the assumption is that patients were infected with that variant.
"We do not routinely perform genetic testing for all patients, but based on tracking by the Centers for Disease Control and Prevention, almost all cases were delta during the study period," he says.
Only patients treated at Mayo Clinic locations in Minnesota and Wisconsin were included in the study. This allowed for more accurate comparison of the three antibody products, given similar circulating variants in those communities.
The specific monoclonal antibody administered to an eligible patient was based only on the product that was available at the infusion facility on the date of treatment. No clinical criteria favored one product over another, and all patients received education about the monoclonal antibody product, the potential benefits and adverse effects, and the investigational status of the drug. The monoclonal antibody product was administered within 10 days of symptom onset.
During the 30 days after monoclonal antibody infusion, most patients who progressed to severe disease were not fully vaccinated. Of the 104 patients who required ICU level of care, 69% were not fully vaccinated. Twenty-five patients died within 30 days after infusion, and all were not fully vaccinated.
The authors note that most patients in the study were non-Hispanic white people who sought care at a large academic medical center. The results may not be generalizable to underrepresented populations.
"Monoclonal antibodies work," says Dr. Razonable. "They work best when given early. The most benefit can be gained by people at highest risk of disease progression. The key takeaway for health care professionals and patients is: Test early so we can treat early."
Similar research also is nearing completion on patients treated during the omicron surge, comparing the efficacy of sotrovimab and bebtelovimab, he says. Omicron spreads more easily than the original COVID-19 virus and the delta variant, but while it appears to cause less severe disease, it has developed mutations that reduced the effectiveness of some monoclonal antibody treatments.
Scientists from China have recently deciphered the genetic network and biological mechanisms associated with coronavirus disease 2019 (COVID-19) myocarditis using bioinformatic methods. They have published their findings in the journal PLOS ONE.
A growing pool of evidence has highlighted the association between COVID-19 and myocarditis. The spike protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative pathogen of COVID-19, binds to the host receptor angiotensin-converting enzyme 2 (ACE2) to initiate viral entry. The organs with higher expression of ACE2, including lung, heart, and kidney, are, thus, particularly susceptible to SARS-CoV-2 infection.
According to the available literature, binding of SARS-CoV-2 spike protein to ACE2 results in downregulation of ACE2 expression, which in turn is responsible for tissue injury. For instance, a low level of ACE2 expression in the cardiac tissue is a known risk factor for heart diseases, including myocarditis.
In the current study, the scientists have conducted bioinformatics-based analysis to identify critical genes and biological pathways associated with COVID-19 myocarditis.
The scientists identified myocarditis-related genes by analyzing the datasets of SARS-CoV-2-infected cardiac stem cell and SARS-CoV-2-infected patients with myocarditis. They matched the identified genes with differentially expressed genes to identify the common genes.
To identify vital biological pathways related to COVID-19 myocarditis, they performed Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis and Gene Ontology (GO) analysis for the common genes.
A total of 850 differentially expressed genes were identified. Of these genes, 449 were upregulated and 401 were downregulated.
A total of 10 co-expression modules, with each containing over 80 genes, were identified. Of these modules, one showed significant positive association with COVID-19 myocarditis. Based on the cut-off criteria set in the study, a total of 46 common genes with high connectivity in the module were identified.
The GO analysis of genes revealed that the common genes are significantly related to the cell cycle/cell division pathways. Moreover, microtubule cytoskeleton and chromosome showed significant involvement in the common genes.
The KEGG analysis of genes revealed significant association of common genes with cell cycle, oocyte meiosis, progesterone-mediated oocyte maturation, ubiquitin-mediated proteolysis, and mismatch repair.
A protein-protein interaction network between 46 common genes was prepared in the study. A bioinformatics-based analysis of the network identified six critical genes related to COVID-19 myocarditis.
Considering these critical genes, transcription factor-gene and transcription factor-miRNA networks were identified. A total of 25 miRNAs and 64 transcription factor genes were identified that co-regulated the critical genes.
As mentioned by the scientists, identified critical genes could act as potential biomarkers for the diagnosis and treatment of COVID-19 myocarditis.
Considering the critical genes, COVID-19 myocarditis-related drugs were identified from the Drug Signatures Database, which is a gene-set resource that relates drugs to their target genes. Based on the statistical significance, ten COVID-19 myocarditis gene-targeted drugs were selected, including Etoposide, Methotrexate, Lucanthone, Troglitazone, Ciclopirox, STL264925, Thalidomide, Genistein, Dmnq, and Testosterone.
Among these drugs, Etoposide, Methotrexate, and Troglitazone have been found to have anti-SARS-CoV-2 effects, including inhibition of viral replication and suppression of infection-related hyperinflammation (cytokine storm).
The study identifies six critical genes related to COVID-19 myocarditis, including cyclin-dependent kinase 1 (CDK1), kinesin family member 20A (KIF20A), PDZ binding kinase (PBK), kinesin family member 2C (KIF2C), cell division cycle 20 (CDC20), and ubiquitin conjugating enzyme E2 C (UBE2C). These genes might serve as potential biomarkers for the diagnosis of COVID-19 related myocarditis.
Moreover, the study reveals that SARS-CoV-2 increases the risk of myocarditis by modulating a number of biological processes including cell cycle and ubiquitin-mediated protein hydrolysis.
Importantly, the study identifies top ten drug compounds that may have potential therapeutic impact on COVID-19 related myocarditis.
