Eddie Dominguez, professor in the School of Art, Art History and Design, recently completed a two-segment public art project for Bryan Health Systems to commemorate the communitys experiences during the COVID-19pandemic.
A 12-foot-by-22-foot mosaic mural located at Bryan East includes a cluster of clouds with words submitted by hospital staff, who were asked to reflect on their experiences during the pandemic. The second work, located at Bryan West, includes three nine-foot pillars with mosaics. The first has geometric patterns featuring colors and shapes. The second is a sky with eagles, swans and flowers cascading into a lower landscape. The third includes more of the collected words onclouds.
They had put a call out that they were interested in looking for an artist that would do a COVID memorial to honor the first responders at the hospital, Dominguez said. I dont generally respond to calls like that, but when I saw this, there was a calling a feeling that I had about the way I function in public art work projects, and I thought this was a venue for that philosophy, so I went ahead andapplied.
Bob Ravenscroft, system vice president and chief marketing and development officer at Bryan Health, said shortly after the availability of a COVID-19 vaccine and between surges of hospital utilization, they were approached by a handful of people with an affinity for art who were interested in funding a permanent thank you for what they called the heroic effort of our team. Bryan Health wanted something that would be meaningful to their team since they saw thousands of patients at both Bryan East and Bryan Westcampuses.
Eddie responded to the RFP, and his proposal easily emerged as the best concept, Ravenscroft said. Eddie suggested commissioning sculptures that would very directly incorporate the voice of our team, engaging with doctors, nurses and support staff that cared for critically ill and dying patients and what they felt during this challengingtime.
The sculptures turned out beautifully. We often see staff and visitors reflecting on the words embedded in the beautiful tile work. While it was created to memorialize efforts here in Nebraska during a worldwide pandemic, it seems to work for just about any feeling people have when they or a loved one is hospitalized and for those who work every day to care forthem.
The project offered a different way for Dominguez to engage with thecommunity.
The hospital gave me all of the vocabulary that I used in the image, so in that way, it was community engaged without people being physically connected to the work, and I was satisfied with that, Dominguezsaid.
He also worked with six University of NebraskaLincoln students throughout the two-year project, including two who were not artmajors.
I had a nice range of people, and we had a real nice time learning all about how to make it work together, Dominguez said. I think they really loved it and got invested in it. We all bonded in a really beautifulway.
Clouds are featured in both pieces, which was an inspiration forDominguez.
I think that when we look up into the sky, theres always this kind of optimism and hope, he said. And when we look up at the clouds, theyre fleeting and drifting. Ive always had a thing for clouds. I put the words in the clouds, and I think it kind of feels like sending up prayers. Theres a native philosophy like that when people look up into the sky. And maybe it wasnt completely my intention, but you allow the creativity to express itself, and this is how it came out. I have a garden at the bottom, and then the clouds falling out of that. I think theyre really pretty beautiful images, and they have a lot ofsentiment.
Dominguez had his own health issues during the making of the pieces and found himself in and out of hospitals at times throughout theprocess.
I felt like I was in it physically, he said. Its odd how that worked out, but I began to understand by being in these situations what the staff did, what the nurses did, what everybodys job was and how meaningful and important everybodys positions are in hospitals. I was grateful to witness that with a greater understanding because I think that it fed thisproject.
Being a part of this project meant a lot to Dominguez, especially since it was an opportunity to give back to thecommunity.
This provided an opportunity for me to do that to leave something for my community that Im a part of, he said. And the hospital is just a few blocks from my house, so it even felt like it was in my neighborhood. It was a rewarding feeling. And thats why I think public art is important because we can generate community interest in it, through it, withit.
Allison Achtenhagen (Bachelor of Fine Arts 2023) worked on the pieces with Dominguez from August 2022 to July 2023. She is now an artist-in-residence at the Kansas City ClayGuild.
Id briefly had one or two conversations with Eddie prior to him approaching me to work on this project, she said. Id seen the beginning of it through social media, and it looked absolutely amazing, so when I was given the opportunity to become a part of it, it was an easyyes.
I worked on this project with him throughout my senior year, which was a time of huge change, big decisions and questioning what comes next for me, so being able to talk with Eddie as we worked and get his perspective and opinions was life-changing. I also loved watching him navigate all of the issues that came up throughout this process and feeling like he trusted us to help in those trickiermoments.
Luke Keilig, a senior art major, has worked with Dominguez through UCARE for twoyears.
I was involved from the start of the making process, he said. I helped glaze tiles, fired them in the kiln and helped sort them into the design he envisioned. I also helped during the installation process. Working with Eddie was an experience I will never forget. He is a unique and caring individual who cares deeply about the community and his students. I learned a lot about ceramics, but he has also taught me things about life and evencooking.
While the words within the works are expressions from the pandemic, they are are universal, too, Dominguezsaid.
Like all poetry or language, it can have several meanings, he said. Maybe the umbrella was that it was a memorial to the COVID experience, but I think it was also speaking to what goes on in a hospital. I was really grateful to have the opportunity to do it. I got more out of it than I could haveimagined.
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Following early implementation and national responses to suppress the spread of COVID-19, Singapore reported one of the lowest mortality rates in the world25. Having experienced two pandemics previously, the severe acute respiratory syndrome (SARS) in 2003 and influenza A (H1N1) in 2008, the government developed the DORSCON risk assessment to facilitate containment measures across sectors26. The government responded swiftly by activating the risk assessment to the second highest level of DORSCON Orange just 15days after the first case was reported. Early efforts to contain the virus focused on reducing the risk of transmission.
At the start of the pandemic, the public was advised to exercise social responsibility if feeling unwell by seeking medical attention immediately. To ensure primary care remains accessible and affordable in times of national emergency, the government activated the Public Health Preparedness Clinics (PHPC) scheme involving more than 900 general practitioners on 18 February 202027. In addition to polyclinics, patients with respiratory symptoms were offered subsidised treatment and medications at PHPC, where the wait times are usually shorter. This reduces the load of patients with acute conditions on polyclinics as similar treatment options were available at PHPC. At the same time, pre-emptive measures were also put in place. Patients with respiratory symptoms were issued with mandatory five days of sick leave and they were legally required to stay home and only leave to seek additional medical attention28. However, for patients who were sick but had work attendance incentives tied to sick leave, this policy could have deterred them from seeking treatment, overall reducing the number of acute visits29.
Non-pharmaceutical interventions, such as mask-wearing, good hygiene practices and social distancing, were also encouraged to reduce the transmission of COVID-19. These measures were found to reduce the transmission of other viral respiratory infections with similar modes of transmission as COVID-1930,31. Additionally, travel restrictions also limited the spread of other respiratory infections across national borders32. In Singapore, the implementation of non-pharmaceutical interventions was associated with a reduction in the prevalence of respiratory viruses such as influenza, which consistently remained low until the end of 202033.
In the early stages of the pandemic, primary care was used to test for suspected cases before they were referred to hospitals for further treatment. Despite efforts to mitigate the risk of cross-infection between patients by setting up segregation zones and triaging patients by their COVID-19 risk profile, patients may be reluctant to visit the doctor lest they be exposed to infected cases34. A study conducted in Singapore revealed that 40% of patients with chronic conditions missed their healthcare appointments during the outbreak, with 72% doing so voluntarily due to a greater perceived risk of infections at a healthcare institution35. This sentiment was also prevalent in other countries36. Studies elsewhere have shown that patients with underlying chronic conditions did not seek medical care for fear of exposure to COVID-1937. These could have led to a drop in overall primary care visits.
As the number of cases started to spike, the government imposed Circuit Breaker to keep cases under control. The public was advised to avoid going out unless necessary as work-from-home arrangements became the default and schools shifted to home-based learning. Non-essential services were deferred while essential services were scaled down whenever possible. For patients who required medication refills, these were done through a medication delivery service if applicable38. All social gathering events were also banned, which reduced the spread of acute respiratory infections.
Our analysis revealed a contrasting pattern in the reduction of acute and chronic visits associated with Circuit Breaker in the unadjusted and adjusted models. In the unadjusted model, we observed a larger reduction in acute visits, while the adjusted model showed a greater reduction in chronic visits. Notably, patients were 0.85years older during Circuit Breaker compared to DORSCON Orange (average age: 60.9 vs. 60.1years, p<0.001), a demographic factor that likely contributed to the increased reduction in chronic visits in the adjusted model. This divergence in the reduction of acute and chronic visits, evident across both models, highlights the vulnerability of specific patient populations, particularly those older and with chronic conditions. This underscores the need for targeted interventions and strategic resource allocation during public health crises.
During this period, there was also a push for telehealth services39. This may have resulted in the conversion of some face-to-face primary care visits from polyclinics to telehealth visits, which could have freed up some of the appointments in polyclinics to be reallocated to patients with chronic conditions. Towards the end of Circuit Breaker, primary healthcare services in hospitals were allowed to resume in phases where patients with chronic medical conditions were attended to first to ensure continuity of chronic care22. This might also have encouraged patients with chronic medical conditions to seek care in polyclinics, as the fear of seeking primary care subsided. Thus, the proportion of daily chronic visits appears to increase faster than acute visits during Circuit Breaker.
Similar findings have been observed in other countries. Following the lockdown in the UK, there was a significant reduction in virtual and face-to-face primary care consultations related to specific health conditions, including acute respiratory and cardiovascular conditions40. Three months after the restriction was lifted, remote and in-person consultations were still lower than pre-lockdown levels. Other studies conducted in the UK also reported substantial reduction with slow recovery in primary care attendance associated with asthma exacerbation and chronic obstructive pulmonary disease41,42,43. The authors hypothesise that the reduction in primary care visits may have been due to the reprioritisation of primary health services in which general practitioners (GPs) were required to balance COVID-19 infection care with primary care services coupled with fears associated with COVID-19 infection. To protect the patients, GPs were advised to minimise the number of in-person consultations. Across the world, healthcare services for other conditions were scaled back as resources were redirected to care for COVID-19 cases. This has caused delays in healthcare delivery for other conditions. This delay or avoidance of seeking care can increase morbidity and mortality44.
There are limitations to this study. The data used in this study is limited to a cluster of public primary care clinics. Primary healthcare services in Singapore are delivered through a network of public primary care clinics and private general practitioner clinics. At the time of this study, 20 public primary care clinics were in operation, comprising only 20% of the sector45. Additionally, the distribution of chronic care needs addressed by public clinics is significantly imbalanced, with 80% of chronic care needs addressed by public care clinics45. Likewise, the proportion of acute care needs addressed by private clinics is much higher. Furthermore, telemedicine played a crucial role in providing primary care services during the pandemic while minimizing physical contact. The inherent variation in attendance patterns between public clinics, private clinics, and telemedicine may introduce complexities in generalizing the findings across the primary care landscape in Singapore.
While our study shed light on the impact of DORSCON Orange and Circuit Breaker on primary care utilisation, the impact may not be directly attributable to these policies as there were other nationwide measures concurrently rolled out such as public education and enforcement of non-pharmaceutical interventions. Additionally, the reprioritisation of primary care services also affected other primary care services that were not examined in this study. Moreover, as the relaxation of the Circuit Breaker measures occurred gradually in a phased approach, our model may only partially encapsulate the complete impact of these policies on primary care visits.
Lastly, primary care manages more than just acute and chronic medical conditions; it includes preventive health screening, immunisation, and dental services.
Despite these limitations, this study provides an understanding of primary care utilisation in the face of the COVID-19 national response. The unintended effect of restrictive measures may have been overlooked and understanding it can help inform future policy discussions on balancing infectious disease care and essential primary care services.
Our findings add to the growing body of literature on the impact of the COVID-19 national response on healthcare utilisation. Understanding the impact of national responses on primary care is especially crucial as primary care serves as the first point of contact with patients, not just in the face of COVID-19 but also in the growing burden of chronic conditions. It is important to recognise the challenges that other patients may face. Disruption in essential primary care services, particularly chronic care management, may lead to profound health consequences. Further studies with a longer observation period may be needed to understand the prolonged impact of COVID-19.
The study was approved by the ethics committee of the National University of Singapore Institutional Review Board (NUS-IRB-2021-611). All methods were carried out in accordance with relevant guidelines and regulations. Informed consent was obtained from all subjects and/or their legal guardian(s).
Niazkar, H. R., Zibaee, B., Nasimi, A. & Bahri, N. The neurological manifestations of COVID-19: A review article. Neurol. Sci. 41, 16671671 (2020).
Article PubMed PubMed Central Google Scholar
Stefanou, M. I. et al. Neurological manifestations of long-COVID syndrome: A narrative review. Ther. Adv. Chronic Dis. 13, 20406223221076890. https://doi.org/10.1177/20406223221076890 (2022).
Article PubMed PubMed Central Google Scholar
Kurushina, O. V. & Barulin, A. E. Central nervous system lesions in COVID-19. Neurosci. Behav. Physiol. 51, 12221227. https://doi.org/10.1007/s11055-021-01183-2 (2021).
Article CAS PubMed Google Scholar
Khalil, M. et al. Neurofilaments as biomarkers in neurological disorders. Nat. Rev. Neurol. 14, 577589. https://doi.org/10.1038/s41582-018-0058-z (2018).
Article CAS PubMed Google Scholar
Barro, C. et al. Serum GFAP and NfL levels differentiate subsequent progression and disease activity in patients with progressive multiple sclerosis. Neurol. Neuroimmunol. Neuroinflamm. 10, e200052. https://doi.org/10.1212/NXI.0000000000200052 (2022).
Article PubMed PubMed Central Google Scholar
Andreasson, U., Blennow, K. & Zetterberg, H. Update on ultrasensitive technologies to facilitate research on blood biomarkers for central nervous system disorders. Alzheimers Dement. 3, 98102. https://doi.org/10.1016/j.dadm.2016.05.005 (2016).
Article Google Scholar
Frontera, J. A. et al. Comparison of serum neurodegenerative biomarkers among hospitalized COVID-19 patients versus non-COVID subjects with normal cognition, mild cognitive impairment, or Alzheimers dementia. Alzheimers Dement. 18, 899910. https://doi.org/10.1002/alz.12556 (2022).
Article CAS PubMed Google Scholar
Plantone, D. et al. Brain neuronal and glial damage during acute COVID-19 infection in the absence of clinical neurological manifestations. J. Neurol. Neurosurg. Psychiatry 93, 13431348. https://doi.org/10.1136/jnnp-2022-329933 (2022).
Article PubMed Google Scholar
Verde, F. et al. Serum neurofilament light chain levels in COVID-19 patients without major neurological manifestations. J. Neurol. 269, 56915701 (2022).
Article CAS PubMed PubMed Central Google Scholar
Virhammar, J. et al. Biomarkers for central nervous system injury in cerebrospinal fluid are elevated in COVID-19 and associated with neurological symptoms and disease severity. Eur. J. Neurol. 28, 33243331. https://doi.org/10.1111/ene.14703 (2021).
Article PubMed PubMed Central Google Scholar
Ameres, M. et al. Association of neuronal injury blood marker neurofilament light chain with mild-to-moderate COVID-19. J. Neurol. 267, 34763478. https://doi.org/10.1007/s00415-020-10050-y (2020).
Article CAS PubMed PubMed Central Google Scholar
Woo, M.S., Malsy, J., Pttgen, J., Seddiq Zai, S., Ufer, F. et al. Frequent neurocognitive deficits after recovery from mild COVID-19. Brain Commun. 2(2), fcaa205 https://doi.org/10.1093/braincomms/fcaa205 (2020).
Taskiran-Sag, A. et al. Subacute neurological sequelae in mild COVID-19 outpatients. Tuberk Toraks 70(1), 2736. https://doi.org/10.5578/tt.20229904 (2022) (English).
Article PubMed Google Scholar
Apple, A. C. et al. Risk factors and abnormal cerebrospinal fluid associate with cognitive symptoms after mild COVID-19. Ann. Clin. Transl. Neurol. 9(2), 221226. https://doi.org/10.1002/acn3.51498 (2022).
Article CAS PubMed PubMed Central Google Scholar
Hellmuth, J. et al. Persistent COVID-19-associated neurocognitive symptoms in non-hospitalized patients. J. Neurovirol. 27(1), 191195. https://doi.org/10.1007/s13365-021-00954-4 (2021).
Article CAS PubMed PubMed Central Google Scholar
Owens, C. D. et al. Vascular mechanisms leading to progression of mild cognitive impairment to dementia after COVID-19: Protocol and methodology of a prospective longitudinal observational study. PLoS One. 18(8), e0289508. https://doi.org/10.1371/journal.pone.0289508 (2023).
Article CAS PubMed PubMed Central Google Scholar
Arnetz, J. E., Arble, E., Sudan, S. & Arnetz, B. B. Workplace cognitive failure among nurses during the COVID-19 pandemic. Int J Environ Res Public Health 18, 10394. https://doi.org/10.3390/ijerph181910394 (2021).
Article CAS PubMed PubMed Central Google Scholar
Mattioli, F. et al. Neurological and cognitive sequelae of Covid-19: A four-month follow-up. J Neurol 268, 44224428. https://doi.org/10.1007/s00415-021-10579-6 (2021).
Article CAS PubMed PubMed Central Google Scholar
Alicandro, G., Gerli, A. G., Remuzzi, G., Centanni, S. & La Vecchia, C. Updated estimates of excess total mortality in Italy during the circulation of the BA.2 and BA.45 Omicron variants: April-July 2022. Med Lav 113, e2022046. https://doi.org/10.23749/mdl.v113i5.13825 (2022).
Article PubMed PubMed Central Google Scholar
Stufano, A. et al. Oxidative damage and post-COVID syndrome: A cross-sectional study in a cohort of Italian workers. Int J Mol Sci. 24(8), 7445. https://doi.org/10.3390/ijms24087445 (2023).
Article PubMed PubMed Central Google Scholar
Global Burden of Disease Long COVID Collaborators. Estimated global proportions of individuals with persistent fatigue, cognitive, and respiratory symptom clusters following symptomatic COVID-19 in 2020 and 2021. JAMA 328(16), 16041615. https://doi.org/10.1001/jama.2022.18931 (2022).
Article PubMed Central Google Scholar
WHO Working Group on the Clinical Characterisation and Management of COVID-19 Infection. A minimal common outcome measure set for COVID-19 clinical research. Lancet Infect. Dis. 20, e192e197 https://doi.org/10.1016/S1473-3099(20)30483-7 (2020).
CDC. Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention https://www.cdc.gov/alcohol/checkyourdrinking/index (2023).
Corsi, G., Nava, S. & Barco, S. Un nuovo strumento per misurare lo stato funzionale globale a lungo termine dei pazienti con malattia da coronavirus 2019: la scala PCFS (Post-COVID-19 Functional Status) [A novel tool to monitor the individual functional status after COVID-19: the Post-COVID-19 Functional Status (PCFS) scale]. G Ital. Cardiol. (Rome) 21, 757. https://doi.org/10.1714/3431.34198 (2020).
Article PubMed Google Scholar
Mazzotti, E. et al. II Patient Health Questionnaire (PHQ) per lo screening dei disturbi psichiatrici: Uno studio di validazione nei confronti della Intervista Clinica Strutturata per il DSM-IV asse I (SCID-I). Ital. J. Psychopathol. 9, 122 (2003).
Google Scholar
Stratta, P., Rinaldi, O., Daneluzzo, E. & Rossi, A. Utilizzo della versione Italiana del Cognitive Failures Questionnaire (CFQ) in un campione di studenti: uno studio di validazione. Riv. Psichiatr. 41, 260265 (2006).
Google Scholar
Kroenke, K., Spitzer, R. L. & Williams, J. B. The PHQ-9: Validity of a brief depression severity measure. J. Gen. Intern. Med. 16, 606613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x (2001).
Article CAS PubMed PubMed Central Google Scholar
Broadbent, D. E., Cooper, P. F., FitzGerald, P. & Parkes, K. R. The Cognitive Failures Questionnaire (CFQ) and its correlates. Br. J. Clin. Psychol. 21, 116. https://doi.org/10.1111/j.2044-8260.1982.tb01421.x (1982).
Article CAS PubMed Google Scholar
Benkert, P. et al. Serum neurofilament light chain for individual prognostication of disease activity in people with multiple sclerosis: A retrospective modelling and validation study. Lancet Neurol. 21, 246257. https://doi.org/10.1016/S1474-4422(22)00009-6 (2022).
Article PubMed Google Scholar
Bergman, J. et al. Neurofilament light in CSF and serum is a sensitive marker for axonal white matter injury in MS. Neurol. Neuroimmunol. Neuroinflamm. 3, e271. https://doi.org/10.1212/NXI.0000000000000271 (2016).
Article PubMed PubMed Central Google Scholar
Pezzini, A. & Padovani, A. Lifting the mask on neurological manifestations of COVID-19. Nat. Rev. Neurol. 16, 636644. https://doi.org/10.1038/s41582-020-0398-3 (2020).
Article CAS PubMed PubMed Central Google Scholar
Zetterberg, H. & Blennow, K. From cerebrospinal fluid to blood: The third wave of fluid biomarkers for Alzheimers disease. J. Alzheimers Dis. 64, S271S279. https://doi.org/10.3233/JAD-179926 (2018).
Article PubMed Google Scholar
Papa, L. et al. Time course and diagnostic accuracy of glial and neuronal blood biomarkers GFAP and UCH-L1 in a large cohort of trauma patients with and without mild traumatic brain injury. JAMA Neurol. 73, 551560. https://doi.org/10.1001/jamaneurol.2016.0039 (2016).
Article PubMed PubMed Central Google Scholar
Thelin, E. P. et al. Serial sampling of serum protein biomarkers for monitoring human traumatic brain injury dynamics: A systematic review. Front. Neurol. 8, 300. https://doi.org/10.3389/fneur.2017.00300 (2017).
Article PubMed PubMed Central Google Scholar
Welch, R. D. et al. Modeling the kinetics of serum glial fibrillary acidic protein, ubiquitin carboxyl-terminal hydrolase-L1, and S100B concentrations in patients with traumatic brain injury. J. Neurotrauma 34, 19571971. https://doi.org/10.1089/neu.2016.4772 (2017).
Article PubMed PubMed Central Google Scholar
Baig, A. M., Khaleeq, A., Ali, U. & Syeda, H. Evidence of the COVID-19 virus targeting the CNS: Tissue distribution, hostvirus interaction, and proposed neurotropic mechanisms. ACS Chem. Neurosci. 11, 995998. https://doi.org/10.1021/acschemneuro.0c00122 (2020).
Article CAS PubMed Google Scholar
Boroujeni, M. E. et al. Inflammatory response leads to neuronal death in human post-mortem cerebral cortex in patients with COVID-19. ACS Chem. Neurosci. 12, 21432150. https://doi.org/10.1021/acschemneuro.1c00111 (2021).
Article CAS PubMed Google Scholar
Gupta, A. et al. Extrapulmonary manifestations of COVID-19. Nat. Med. 26, 10171032. https://doi.org/10.1038/s41591-020-0968-3 (2020).
Article CAS PubMed Google Scholar
Peluso, M. J. et al. Plasma markers of neurologic injury and inflammation in people with self-reported neurologic postacute sequelae of SARS-CoV-2 infection. Neurol. Neuroimmunol. Neuroinflamm. 9(5), e200003. https://doi.org/10.1212/NXI.0000000000200003.PMID:35701186 (2022).
Article PubMed PubMed Central Google Scholar
Kanberg, N. et al. Neurochemical signs of astrocytic and neuronal injury in acute COVID-19 normalizes during long-term follow-up. EBioMedicine 70, 103512. https://doi.org/10.1016/j.ebiom.2021.103512 (2021).
Article CAS PubMed PubMed Central Google Scholar
Newcombe, V. F. J. et al. Post-acute blood biomarkers and disease progression in traumatic brain injury. Brain 145(6), 20642076. https://doi.org/10.1093/brain/awac126 (2022).
Article PubMed PubMed Central Google Scholar
Bark, L. et al. Central nervous system biomarkers GFAp and NfL associate with post-acute cognitive impairment and fatigue following critical COVID-19. Sci. Rep. 13(1), 13144. https://doi.org/10.1038/s41598-023-39698-y (2023).
Article ADS CAS PubMed PubMed Central Google Scholar
Liu, T. C. et al. Perceived cognitive deficits in patients with symptomatic SARS-CoV-2 and their association with post-COVID-19 condition. JAMA Netw. Open 6, e2311974. https://doi.org/10.1001/jamanetworkopen.2023.11974 (2023).
Article PubMed PubMed Central Google Scholar
Tavares-Jnior, J. W. L. et al. COVID-19 associated cognitive impairment: A systematic review. Cortex 152, 7797. https://doi.org/10.1016/j.cortex.2022.04.006 (2022).
Article PubMed PubMed Central Google Scholar
Ferrucci, R. et al. Brain positron emission tomography (PET) and cognitive abnormalities one year after COVID-19. J. Neurol. 270, 18231834. https://doi.org/10.1007/s00415-022-11543-8 (2023).
Article CAS PubMed PubMed Central Google Scholar
Hosp, J. A. et al. Cognitive impairment and altered cerebral glucose metabolism in the subacute stage of COVID-19. Brain 144, 12631276. https://doi.org/10.1093/brain/awab009 (2021).
Article PubMed Google Scholar
Henneghan, A. M., Lewis, K. A., Gill, E. & Kesler, S. R. Cognitive impairment in non-critical, mild-to-moderate COVID-19 survivors. Front. Psychol. 17(13), 770459. https://doi.org/10.3389/fpsyg.2022.770459.PMID:35250714;PMCID:PMC8891805 (2022).
Article Google Scholar
Tavares-Jnior, J. W. L. et al. COVID-19 associated cognitive impairment: A systematic review. Cortex 152, 7797. https://doi.org/10.1016/j.cortex.2022.04.006 (2022).
Article PubMed PubMed Central Google Scholar
Baseler, H. A., Aksoy, M., Salawu, A., Green, A. & Asghar, A. U. R. The negative impact of COVID-19 on working memory revealed using a rapid online quiz. PLoS One 17(11), e0269353. https://doi.org/10.1371/journal.pone.0269353 (2022).
Article CAS PubMed PubMed Central Google Scholar
Quan, M. et al. Post-COVID cognitive dysfunction: Current status and research recommendations for high risk population. Lancet Reg. Health West Pac. 5(38), 100836. https://doi.org/10.1016/j.lanwpc.2023.100836 (2023).
Article Google Scholar
Beck, J. W. & Flow, A. The effects of contracting COVID-19 on cognitive failures at work: Implications for task performance and turnover intentions. Sci. Rep. 12, 8826. https://doi.org/10.1038/s41598-022-13051-1 (2022).
Article ADS CAS PubMed PubMed Central Google Scholar
Lu, X., Yu, H. & Shan, B. Relationship between employee mental health and job performance: Mediation role of innovative behavior and work engagement. Int. J. Environ. Res. Public Health 19(11), 6599. https://doi.org/10.3390/ijerph19116599 (2022).
Bonham and her collaborators wanted to better understand why this scarring occurs, determine if it is similar to progressive pulmonary fibrosis and see if there is a way to identify patients at risk.
Researchers followed 16 UVA Health patients who survived severe COVID-19, including 14 who were hospitalized and placed on a ventilator during treatment. All had trouble breathing and suffered fatigue and abnormal lung function at their first outpatient checkup.
After six months, researchers found that the patients could be divided into two groups. One groups lung health improved, prompting the researchers to label them early resolvers. The other group, dubbed late resolvers, continued to suffer lung problems and pulmonary fibrosis.
Looking at blood samples taken before the recovery paths diverged, the team found that late resolvers had significantly fewer immune cells known as monocytes white blood cells that play a critical role fending off disease circulating in their blood. The cells were abnormally depleted in patients who continued to suffer lung problems compared both to those who recovered and healthy control subjects.
The decrease in monocytes also correlated with the severity of the patients ongoing symptoms. That suggests that doctors may be able to use a simple blood test to identify patients likely to suffer long-haul COVID and to improve their care.
About half of the patients we examined still had lingering, bothersome symptoms and abnormal tests after six months, Bonham said. We were able to detect differences in their blood from the first visit, with fewer blood monocytes mapping to lower lung function.
The researchers also wanted to determine if severe COVID-19 could cause progressive lung scarring like idiopathic pulmonary fibrosis. They found the two conditions had very different effects on immune cells, suggesting that even though symptoms were similar, the underlying causes were very different. This held true in patients with the most persistent long-haul COVID-19 symptoms.
Idiopathic pulmonary fibrosis is progressive and kills patients within three to five years, Bonham said. It was a relief to see that all our COVID patients, even those with long-haul symptoms, were not similar.
Because of the small numbers of participants in UVAs study, and because they were mostly male (for easier comparison with idiopathic pulmonary fibrosis, a disease that strikes mostly men), the researchers say larger studies with other medical centers are needed to bear out the findings.
Still, they are hopeful that their new discovery will provide doctors a useful tool to identify COVID-19 patients at risk for long-haul lung problems and help guide them to recovery.
We are only beginning to understand the biology of how the immune system impacts pulmonary fibrosis, Bonham said. My team and I were humbled and grateful to work with the outstanding patients who made this study possible.
The researchers havepublished their findings in the scientific journal Frontiers in Immunology. The research team consisted of Grace C. Bingham, Lyndsey M. Muehling, Chaofan Li, Yong Huang, Shwu-Fan Ma, Daniel Abebayehu, Imre Noth, Jie Sun, Judith A. Woodfolk, Thomas H. Barker and Bonham. Noth disclosed that he has received personal fees from Boehringer Ingelheim, Genentech and Confo unrelated to the research project. In addition, he has a patent pending related to idiopathic pulmonary fibrosis. Bonham and all other members of the research team had no financial conflicts to disclose.
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The UVA research was supported by the National Institutes of Health, grants R21 AI160334 and U01 AI125056; NIHs National Heart, Lung and Blood Institute, grants 5K23HL143135-04 and UG3HL145266; UVAs Engineering in Medicine Seed Fund; the UVA Global Infectious Diseases Institutes COVID-19 Rapid Response; a UVA Robert R. Wagner Fellowship; and a Sture G. Olsson Fellowship in Engineering.
Stanford researchers aim to get ahead of coronavirus evolution by designing antiviral drugs that continue to work on Paxlovid-resistant mutants. (Image credit: Getty Images)
Although COVID-19 has faded from the headlines, SARS-CoV-2 the coronavirus behind the pandemic is still rampantly infecting people around the world. Public health officials fear as the virus continues to evolve, it will eventually hit upon a diabolical mutation that renders current treatments ineffective, triggering a new wave of severe infection and social disruption.
In pursuit of new therapies to avoid this dark fate, researchers at Stanford have now unveiled a compound that measures up as a potentially powerful anti-coronavirus drug, detailed in a paper published March 13 in Science Translational Medicine. Dubbed ML2006a4, the compound works in the same way as Paxlovid the most effective oral drug available to date by binding to coronavirus particles and preventing the virus from making copies of itself. Compared to Paxlovid, though, ML2006a4 binds more tightly and durably, courtesy of the Stanford team custom-crafting the compound atom-by-atom.
In preclinical experiments, the compound prevented deadly infections in mice at a superior rate compared to Paxlovid. In addition, the new compound is potent enough that it could likely be formulated without an additional component present in Paxlovid that poses severe drug interaction concerns. Importantly, ML2006a4 also performed well against coronavirus variants that have already evolved degrees of resistance to Paxlovid, suggesting the compounds honed affinity makes it less vulnerable to mutant virus strains.
At this point entering the fifth year of the pandemic, Paxlovid is our only really good drug against SARS-CoV-2, but its proven fairly easy for the virus to evolve resistance to it, said Michael Lin, the senior author of the study, who is an associate professor of neurobiology and of bioengineering in the schools of Medicine and Engineering and a member of Stanford Bio-X. As new waves of coronavirus keep crashing down, we need to have alternative drugs that are more tolerant of mutations and not as easy for the virus to defeat.
For the study, Lin worked closely with lead author Michael Westberg, now an assistant professor at Aarhus University in Denmark. From 2018 until 2022, Westberg worked in Lins lab as a visiting scholar at Stanford Bio-X, funded by the Novo Nordisk Foundation, through a joint program designed to strengthen international collaborations and the exchange of scientific expertise between Stanford and Denmark.
Before the pandemic outbreak in 2020, Lins lab had already been investigating the broad class of drugs known as viral protease inhibitors. These drugs target protease enzymes that viruses need for disassembling bulky viral proteins as part of their replication cycle. Like a key fitting into a lock, protease inhibitors occupy the spaces, or active sites, where proteases normally link up with those bulky proteins, thus nipping replication in the bud.
Specifically, the Stanford researchers had gained familiarity with hepatitis C virus protease, which has similarities to coronavirus versions. Although Westberg had come to Stanford to work on other projects, the global emergency prompted a pivot. When the pandemic hit, we asked if we could put our expertise to good use, said Lin.
Their early research, posted online in September 2020, demonstrated that a hepatitis C drug, boceprevir, slotted reasonably well into the coronavirus protease site. Other scientists built off those findings, including at the pharmaceutical company Pfizer, which ultimately created Paxlovid and received regulatory approval for its use in December 2021. We knew then that we were on the right track, said Lin, and we were motivated to keep going and make an even more effective drug.
The Lin lab pooled its collective chemical knowledge to design improvements to their iterative boceprevir-based compounds. Much of the work involved modifying the compound on the atomic scale in intricately detailed computer models to fit more snugly in the coronavirus protease active site.
Basically, you put your drug in the active site and you look for gaps where it doesnt tightly fit. Then you fill those gaps, said Lin.
The Stanford researchers approached this challenge in a rational way by adding different configurations of atoms of carbon, nitrogen, and oxygen to the compounds as permitted by the laws of biochemistry.
Theres a lot of creativity and intuition involved because everyone is working with the same three atoms, but there are essentially infinite ways to arrange them, said Lin. Making these modifications, its like playing atomic Tetris.
The resulting compounds were then tested against actual coronavirus particles at the Stanford In Vitro Biosafety Level 3 Service Center. After multiple rounds of honing, Lins team arrived at the compound designated ML2006a4.
In studies with SARS-CoV-2-infected mice, ML2006a4 worked as well as Paxlovid in promoting survival, while offering better protection of the rodents lungs and lowering overall virus load in the body.
The researchers attribute this success to ML2006a4s extremely refined fit inside coronavirus protease, where the compound boasted a 20-fold higher binding affinity than Paxlovid. That better fit equates to stronger chemical bonds, meaning the drug can stay bound to the protease for a longer time. In this temporal regard, ML2006a4 indeed proved quite sticky: The inhibitor remained attached for approximately330minutes, or greater thanfivehours, whereas the corresponding Paxlovid inhibitor typically fell off its target in just abouttwo minutes.
From a medication perspective, such staying power translates to spaced-out, smaller doses that can still prevent disease from worsening while giving the immune system a chance to kill off the invaders. The long-lived drug-enzyme complex helps ensure that the virus doesnt escape and replicate before your next medication dose, said Lin.
In this way, ML2006a4 offers other advantages compared to Paxlovid. Technically, Paxlovid is two drugs packaged together: nirmatrelvir, the actual protease inhibitor, and ritonavir, a drug that prevents the liver from quickly breaking down nirmatrelvir, boosting nirmatrelvirs performance. Yet the slowing of the livers metabolism by ritonavir means that other drugs can toxically build up, forcing patients to take the risk of temporarily stopping their normal medications.
According to Lin, an oral pill based on ML2006a4 might not require ritonavir to prop up drug levels enough between typical 12-hour administrations to effectively keep coronavirus in check, but this would need to be tested to make sure, said Lin. We also continue to make improved versions of ML2006a4 with better potency and duration of activity, he added.
For the promising compounds to move forward, Lin and colleagues are seeking additional investment. So far, their funding has mostly consisted of small grants geared toward early-stage drug discovery. The group now feels their compounds are ready for expanded preclinical testing with an eye toward clinical trials in human patients.
Were very excited how far weve come and how successful our drug discovery has been on a shoestring budget, said Lin. We hope to see this promising compound developed further to stay ready for what SARS-CoV-2 throws at us next.
Additional Stanford co-authors on the paper include Shirit Einav, professor of medicine infectious diseases and of microbiology and immunology; Catherine Blish, the George E. and Lucy Becker Professor in Medicine and professor of medicine infectious diseases; Jaishree Garhyan, director of Biosafety Level 3 (BSL3) Service; Daniel Fernandez, director of crystallography; Puja Bhavesh Patel, research professional; Chenzhou Hao, research scientist; doctoral student Yan Wu; postdoctoral scholars Xinzhi Zou, Chieh-Wen Lo, and Marwah Karim; instructor in medicine Arjun Rustagi; former postdoctoral scholars Yichi Su and Lin Ning; and former researcher Aimee Beck. Lin is also an associate professor, by courtesy, of chemical and systems biology, and a member of the Cardiovascular Institute, the Maternal & Child Health Research Institute, Sarafan ChEM-H, the Stanford Cancer Institute, and the Wu Tsai Neurosciences Institute.
Funding for the research was provided by Stanfords Sarafan ChEM-H and the Innovative Medicines Accelerator, a Harrington Scholar-Innovator Award, Emergent Ventures at the Mercatus Center at George Mason University, a Stanford-Coulter Translational Research Grant, the National Institutes of Health, the Denver Foundation, the Novo Nordisk Foundation and the Stanford Bio-X Program, a Bio-X Stanford Interdisciplinary Graduate Student Fellowship, the Houston EM Foundation, and the PhRMA Foundation.
To read all stories about Stanford science, subscribe to the biweekly Stanford Science Digest.
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U.S.marriages have reboundedto pre-pandemic levels with nearly 2.1 million in 2022.
Thats a 4% increase from the year before. The Centers for Disease Control and Prevention released the data Friday but has not released marriage data for last year.
In 2020, the first year of the Covid-19 pandemic, there were 1.7 million U.S. weddings the lowest number recorded since 1963. The pandemic threw many marriage plans into disarray, with communities ordering people to stay at home and banning large gatherings to limit the spread of Covid-19.
Marriages then rose in 2021, but not to pre-pandemic levels. They ticked up again in 2022 and surpassed 2019 marriage statistics by a small margin.
New York, the District of Columbia and Hawaii saw the largest increases in marriages from 2021 to 2022. Nevada home to Las Vegas famous wedding chapels continued to have the highest marriage rate in the nation, though it slightly decreased from 2021.
The number and rate of U.S. divorces in 2022 fell slightly, continuing a downward trend, the CDC said.
Overall,marriagesremain far less common than they once were in the U.S.
According to data that goes back to 1900, weddings hit their height in 1946, when the marriage rate was 16.4 per 1,000 people. The rate was above 10 in the early 1980s before beginning a decades-long decline. In 2022, the marriage rate was 6.2 per 1,000 population.
The Associated Press
The Associated Press
A new study published in The Lancet reveals never-before-seen details about staggeringly high mortality from the COVID-19 pandemic within and across countries. Places such as Mexico City, Peru, and Bolivia had some of the largest drops in life expectancy from 2019 to 2021. The research, which presents updated estimates from the Global Burden of Disease Study (GBD) 2021, provides the most comprehensive look at the pandemics toll on human health to date, indicating that global life expectancy dropped by 1.6 years from 2019 to 2021, a sharp reversal from past increases. Among GBDs other key findings, child mortality continued to drop amid the COVID-19 pandemic, with half a million fewer deaths among children under 5 in 2021 compared to 2019. Mortality rates among children under 5 decreased by 7% from 2019 to 2021.
For adults worldwide, the COVID-19 pandemic has had a more profound impact than any event seen in half a century, including conflicts and natural disasters, says co-first author Dr. Austin E. Schumacher, Acting Assistant Professor of Health Metrics Sciences at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. Life expectancy declined in 84% of countries and territories during this pandemic, demonstrating the devastating potential impacts of novel pathogens.
"For adults worldwide, the COVID-19 pandemic has had a more profound impact than any event seen in half a century, including conflicts and natural disasters."
Researchers from IHME identified high mortality during the COVID-19 pandemic in places that were previously less recognized and/or reported. For example, the study reveals that after accounting for the age of the population, countries such as Jordan and Nicaragua had high excess mortality due to the COVID-19 pandemic that was not apparent in previous all-age excess mortality estimates. In analyzing subnational locations not previously investigated, the South African provinces of KwaZulu-Natal and Limpopo had among the highest age-adjusted excess mortality rates and largest life expectancy declines during the pandemic in the world. Conversely, the places with some of the lowest age-adjusted excess mortality from the pandemic during this period included Barbados, New Zealand, and Antigua and Barbuda.
During the COVID-19 pandemic, mortality among older people worldwide rose in ways unseen in the previous 70 years. While the pandemic was devastating, killing approximately 16 million people around the globe in 2020 and 2021 combined, it did not completely erase historic progress life expectancy at birth rose by nearly 23 years between 1950 and 2021.
GBD 2021 analyzes past and current demographic trends at global, regional, national, and subnational levels. The study provides globally comparable measures of excess mortality and is one of the first studies to fully evaluate demographic trends in the context of the first two years of the COVID-19 pandemic. In estimating excess deaths due to the pandemic, the authors accounted for deaths from the virus that causes COVID-19, SARS-CoV-2, as well as deaths associated with indirect effects of the pandemic, such as delays in seeking health care.
Employing innovative methods to measure mortality, excess mortality from the COVID-19 pandemic, life expectancy, and population, the study authors estimate that the pandemic caused global mortality to jump among people over age 15, rising by 22% for males and 17% for females from 2019 to 2021.
GBD 2021 goes beyond assessing the impact of the first two years of the COVID-19 pandemic. As the authors note, it also offers implications for the future of health-care systems, economies, and societies and ... a valuable foundation for policy evaluation, development, and implementation around the world.
GBD 2021 indicates that, despite early warnings that COVID-19 could threaten the gains that the world had made in saving childrens lives, these improvements continued during the pandemic, albeit at a slower pace. Still, stark differences in child mortality persist between regions. In 2021, one out of every four children who died worldwide lived in South Asia, while two out of every four children who died lived in sub-Saharan Africa.
Our study suggests that, even after taking stock of the terrible loss of lives the world experienced due to the pandemic, we have made incredible progress over 72 years since 1950, with child mortality continuing to drop globally, said co-first author Dr. Hmwe Hmwe Kyu, Associate Professor of Health Metrics Sciences at IHME at the University of Washington. Now, continuing to build on our successes, while preparing for the next pandemic and addressing the vast disparities in health across countries, should be our greatest focuses.
"Even after taking stock of the terrible loss of lives the world experienced due to the pandemic, we have made incredible progress over 72 years since 1950."
The GBD 2021 study also assessed population trends. Beginning in 2017, the rate of global population growth began to drop following years of stagnation. Then, during the COVID-19 pandemic, these declines accelerated. As of 2021, 56 countries have reached peak population. Now, these countries are seeing their populations shrink. However, rapid population growth has continued in many lower-income countries. In addition, populations around the world are aging. Between 2000 and 2021, the number of people who were 65 and older grew faster than the number of people under age 15 in 188 countries and territories.
Slowing population growth and ageing populations, along with the concentration of future population growth shifting to poorer locations with worse health outcomes, will bring about unprecedented social, economic, and political challenges, such as labor shortages in areas where younger populations are shrinking and resource scarcity in places where population size continues to expand rapidly, says Dr. Schumacher. This is worth restating, as these issues will require significant policy forethought to address in the affected regions. As one example, nations around the world will need to cooperate on voluntary emigration, for which one source of useful guidance is the UNs Global Compact for Safe, Orderly and Regular Migration.
For interview requests, journalists may contact [emailprotected].
The Institute for Health Metrics and Evaluation (IHME) is an independent research organization at the University of Washington (UW). Its mission is to deliver to the world timely, relevant, and scientifically valid evidence to improve health policy and practice. IHME carries out its mission through a range of projects within different research areas including the Global Burden of Diseases (GBD), Injuries, and Risk Factors; Future Health Scenarios; Cost Effectiveness and Efficiency; Resource Tracking; and Impact Evaluations.
IHME is committed to providing the evidence base necessary to help solve the worlds most important health problems. This requires creativity and innovation, which are cultivated by an inclusive, diverse, and equitable environment that respects and appreciates differences, embraces collaboration, and invites the voices of all IHME team members.
The Global Burden of Disease Study (GBD) is the largest and most comprehensive effort to quantify health loss across places and over time. It draws on the work of more than 11,000 collaborators across more than 160 countries and territories. 2021 the newly published most recent round of GBD results includes more than 607 billion estimates of 371 diseases and injuries and 88 risk factors in 204 countries and territories. The Institute for Health Metrics and Evaluation coordinates the study.
TODAY: 4 years since former Nevada governor declared shutdown due to COVID-19
by News 3 Staff
KSNV
LAS VEGAS (KSNV)
Today marks four years since former Nevada Governor Steve Sisolak announced our state was closing down because of the COVID-19 pandemic.
"We don't have time to waste. At this time, we must act aggressively and decisively to protect ourselves, our families, and our community," said Sisolak.
Las Vegas soon later went dark.
Many workers in our state were forced from their jobs without knowing what was next, and many were in the service industry.
There was also tension within our local schools after students were forced to attend classes remotely.
At last check, CDC data shows more than 12,000 Nevadans died from COVID-19 since the start of 2020.
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