The coronavirus disease 2019 (COVID-19) pandemic had a substantial effect on surgeons and patients who require surgical care. Providing care for patients with surgical disease requires a unique and intimate relationship between patients and surgeons, and this interaction and contact in many scenarios cannot be replaced by telehealth. As such, the surgical workforce has faced distinct challenges compared with nonsurgical specialties during the COVID-19 pandemic.
Our hospital implemented a new policy during the COVID-19 pandemic to protect the patient and the hospital staff and to limit the spread ofthe COVID-19infection. This was done by providing personal protective equipment (PPE) such as masks and gowns, decreasing the length of hospital stay, saving intensive care unit (ICU) hospital beds and other resources needed for the care of hospitalized patients withthe COVID-19infection, and directing all available resources to control the COVID-19 pandemic.
Our hospital COVID-19 protective measures and staff reallocation in preponderance for surgery led to:
There is a shortage of hospital staff (anesthesia doctors, nursing staff, and surgical doctors) due to many reasons. As some of the staff were assigned to work on the COVID-19 team, the anesthesia doctors divided themselves into many teams to decrease exposure risk and isolate infected staff at home.
Shortage of hospital beds as the pediatric surgical beds were assigned to COVID-19 patients care and our surgical patients were admitted in the medical pediatric ward.
Preoperative preparation of urgent cases like acute appendicitis takes longer as COVID-19 PCR takes 972h to be released at the start of the pandemic, but this duration has decreased to 12h after that.
Lack of a CO2 filter in laparoscopic surgery changed our policy from laparoscopic to open procedure with its unsatisfactory outcome and drawbacks.
Therefore, we were obliged to apply the medical management for simple acute appendicitis after approval from the hospital ethical committee as the first-line treatment. The aim was to reduce the length of hospital stays, decrease costs, and save hospital resources. It also aimed to reduce exposure risk and surgical complications, decrease stress and the psychological effects of surgery on parents and children, and reduce the rate of negative appendectomies.
We faced many problems with the implementation of this modality of treatment: a small number of cases, a short period of follow-up, staff resistance, and a lack of experience and confidence. We overcame those problems by conducting many lectures with a review of recent literature, which strongly supported this modality of treatment with close observation and serial examination of patients during admission. Keeping patients in the hospital until we are sure that they are symptom-free and ready to go home with close follow-up at the virtual clinic. The length of hospital stay decreased gradually from 72 to 12h due to the initial positive outcome of gaining confidence and experience in medical treatment.
Patients were discharged after a minimum of 12h of intravenous antibiotics, and patients should tolerate oral feeding and antibiotics before being discharged home. During the first 6months of our study period, there were six cases (17%) that converted to surgical management due to fear of complications and a lack of clinical judgement in medical management. The intraoperative finding was that the appendicular inflammation was resolving. In the next 7months, conversion was zero. The follow-up of patients ranged from 1 to 6months with a mean period of 3.5months, and we had four recurrences and operated upon admission. These results showed that the application of the non-operative treatment increased the resolution of symptoms and the improvement of inflammatory markers. Besides, it decreases the psychological stress on children and families, especially in the situation of the COVID-19 pandemic. Certainly, this compares well with other reports applying non-operative management in acute appendicitis to be associated with a shorter hospital stay and a low risk of short-term recurrence15,16,17.
Though there is a report15 showing a 40% recurrence rate after 5years of follow-up, likewise, Salminen et al., 2018 study16, which is an observational multicenter randomized clinical trial that also includes follow-up for 5years, also showed a recurrence rate of 39.1% at 5years. This obviously revealed the need for a second-phase follow-up to evaluate the role of non-operative therapy in treating acute appendicitis.
We strongly support NOTA to decrease costs, and it is a feasible modality of treatment for simple acute appendicitis in children. We decided to adopt NOTA in our center as the standard management of appendicitis in the pediatric age group, even after the COVID-19 pandemic. We found the results of our research promising, and NOTA significantly decreased hospital stays, costs, and psychological stress.
The study still has many limitations; it is a single-center study with a small number of cases and a short period of follow-up. Staff still have resistance, a lack of experience, and confidence in the new approach. Also, there is resistance from the guardian to NOTA, and they prefer the surgery over medical treatment. There is a lack of data on complications, readmission, recurrence, parents stress, etc. So, the conclusion on safety needs more follow-up and more cases.
With a cool nip in the weather, winter is finally here. Its the time of the year for food, festivities, and even vacations and trips. "While we enjoy this season and its festivities, we cannot ignore the fact that this winter also brings with it its ugly side and hence also referred to as flu season," says Dr. Sachin D Consultant - Interventional Pulmonology Critical Care & Sleep Medicine, Fortis Hospital, Bengaluru. Respiratory infections like the common cold (Rhinitis) and Flu are very common in wither season. These infections are mostly caused by viruses although this can lead to secondary bacterial infections and pneumonia. Dr. Sachin shares valuable information on common cold, the symptoms and preventive measures for it.
Common cold presents as runny or stuffy nose, sneezing and might lead to sore throat and coughing. Symptoms usually last for a few days to a week. Flu presents as fever with chills, extreme fatigue, body ache along with cold. Symptoms may last for a few weeks. Without proper care these may cause complications like bronchitis (infection of airway causing yellow phlegm and wheezing), Pneumonia (Infection in lungs causing chest congestion and breathing difficulty), worsening of underlying medical conditions (Asthma, heart, and lung diseases), dehydration, ear and sinus problems.
Since most of these infections are caused by viruses like Rhino virus, Adeno virus, Respiratory syncytial virus, Influenza, and parainfluenza virus among others, these can be highly contagious and spread from person to person via aerosols or contact. When a person coughs or sneezes, the droplets release into the air carry viruses which get inhaled by nearby contacts leading to spread of infection. It can also spread by close contact and fomites (used handkerchiefs, towels etc.)
Strokes are more common in women: Signs every woman should pay attention to
Keep your health at check. If you notice any changes in routine health or symptoms of early flu, consult your specialist.
Avoid stress and take adequate rest.
Its best to eat home food and avoid outside or street foods this season.
Adequate hydration is to be maintained.
Eat lots of green leafy vegetables and fruits to keep antioxidants ample in your body to fight infections.
Keep your immunity good by a healthy diet and regular exercises.
Wear a mask in public places/ crowded gatherings, preferably a surgical mask or at least a cloth mask.
Cover your nose and mouth when coughing/sneezing. Use a tissue or your elbow and not hands. Always wash your hands after coughing, sneezing, or blowing nose. Used tissues to be discarded immediately.
Wash hands often with soap and water, scrubbing for at least 20 seconds. Alcohol based sanitizer (at least 60% alcohol) can be used when there is no access to soap and water.
Avoid touching nose, mouth, and eyes.
Stay away from people who has respiratory infections and limit close contact with others if you are sick.
Avoid sharing personal items such as handkerchiefs, towels etc.
Avoid social gatherings and crowds during this season.
Maintain a clean-living environment.
Avoid smoking and dont let people smoke near you.
Ideally should be taken care in separate rooms if feasible.
Care givers to maintain proper hand hygiene.
Proper disinfection of home at regular intervals
Care givers to wear mask when encountering sick person.
Maintain social distancing 3-6 feet.
Avoid close contact like shaking hands, touching, kissing, hugging etc. except as necessary to give care and support.
Influenza vaccine: Commonly called flu shot protects from Influenza. New influenza vaccines are produced every year to cover up for the change in the viral strains that happen naturally. This vaccine is available as quadrivalent to cover the most comer influenza strains of viruses. This vaccine is given annually during the flu season (October- December) to the target people. This vaccine can be taken by all healthy adults and is mandatory for those with chronic heart/lung conditions. Consult your doctor for the need of this vaccine which can reduce the flu rates by 80-90 %.
Pneumococcal vaccine: There are 2 types of pneumococcal vaccine which protects from Streptococcus pneumoniae (bacteria) which can lead to pneumonia, sepsis, and meningitis. This is a severe lung infection which starts as sore throat and spreads rapidly to lungs and then into the bloodstream affecting brain and its coverings. If severe and not treated promptly can also result in death of infected persons. Luckily, we have the pneumococcal vaccine (PCV13 and PPSV23) which can significantly protect against this deadly disease and reduce the severity of infection. This vaccine is usually given to all adults above 65 years of age and below 65 years with underlying medical conditions/ low immunity. Hence its imperative to consult your specialist regarding the requirement of this vaccine if elderly people or those with chronic medical conditions are present in the family.
Covid 19 vaccine: Following the Covid 19 pandemic all healthy adults were given covid 19 vaccine to protect from the severe disease caused by SARS Co V. There are 2 most common types of vaccine in India, Viral killed vaccine or Vector based vaccine both of which have a significant protection rate against severe disease forms of Covid19. If not vaccinated kindly consult your specialist and take the benefit of this vaccine.
All common colds and Flu require antibiotics: Most of the common colds and Flu are caused by respiratory viruses which do not respond to antibiotics which are given for bacterial infections. Irrational and Self medication with antibiotics during flu will not only be futile but can also cause severe reactions and complicate the viral infections. Antibiotics to be taken only after consulting a specialist who prescribes it for secondary bacterial infections or concomitant bacterial infections.
Common colds and Flu subside on their own and doesnt require medical attention: Although most respiratory viral infections subside within few days to few weeks, they can result in complications of underlying medical conditions and can be fatal sometimes. Hence its important to consult and take proper treatment at an early stage to avoid these scenarios.
Home remedy and steam inhalation for colds is sufficient: Most of the home remedies and excessive steam inhalation can be harmful during colds. Using hot water and warm chest compresses while minimal steam inhalation and saltwater gargling is recommended, avoid using excessive steam inhalation and use of kadas and other mixtures which may cause gastritis and cause problems especially when associated with stomach flu.
Vaccines for flu is only for sick: Flu shot is recommended for all healthy adults annually. Kindly consult your specialist for the same.
My immunity is good and hence I dont have to worry about flu: In fact, its noted that some viruses use the body immunity as a leap to attack the body and hence its imperative to consult and take proper treatment at an early stage.
Although Winter is the best season to enjoy festivities and vacation, caution to be exercised as this is also the flu season which can impact your life during this beautiful weather. Be aware of it and consult promptly if symptoms arise and dont wait for the disease to take over you this winter.
Ever since the pandemic theres been a lot of money for health-related issues coming down the pipeline from the federal government and the State of North Carolina.
Guilford County health officials are very happy to see that money continue to come in.
On Thursday, Nov. 2, when the Guilford County Board of Commissioners meets again, the board will vote to accept more than $1.7 million for various health initiatives. Many of those are related to COVID 19 even though the disease isnt grabbing the headlines it once was.
Guilford Countys public health programs getting funds include the following:
Reducing Infant Mortality in Communities ($20,000). This is additional funding meant to establish one or more funded partnership with a non-profit organization or similar community-based organization to provide program services.
Covid-19 Cares Activities ($44,600). This will be used by the health department to work to prevent and prepare for new coronavirus threats by carrying out surveillance, epidemiology, laboratory capacity, infection control, mitigation, communications, and other preparedness and response activities. The money will also support community COVID-19 awareness and allow the county to buy additional clinical services equipment.
Epidemiology and Laboratory Capacity Enhancing Detection ($314,131). These funds will in part be used to prevent, prepare for, and respond to coronavirus by supporting testing, case investigation and contact tracing, surveillance, containment, and mitigation. That may include providing more testing for the virus, putting more mobile testing units on the streets, or other activities, such as COVID-19 testing and case investigation.
Communicable Disease Pandemic Recovery ($422,559). This will provide the health department the ability to grow its communicable disease surveillance, detection and prevention efforts to address not just COVID-19 but also other communicable diseases.
Tuberculosis Control ($1,500). This money is meant to strengthen Guilford Countys response to this disease with the ultimate goal of eliminating tuberculosis as a public health threat in the county and the state.
COVID-19 School Health Team Workforce ($718,584). This funding is meant to provide more health positions in Guilford County Schools such as school nurses, health educators and school mental health professionals.
Public Health Workforce ($211,777). These dollars will be used to recruit, hire, and train employees who fill critical gaps in Guilford Countys public health infrastructure.
Researchers have genetically engineered the first mice that get a humanlike form of COVID-19, according to a study published online November 1 in Nature.
Led by researchers from NYU Grossman School of Medicine, the new work created lab mice with human genetic material for ACE2a protein snagged by the pandemic virus so that it can attach to human cells as part of the infection. The mice with this genetic change developed symptoms similar to those of young humans infected with the virus causing COVID-19, instead of dying upon infection, as had occurred with prior mouse models.
That these mice survive creates the first animal model that mimics the form of COVID-19 seen in most peopledown to the immune system cells activated and comparable symptoms, said senior study author Jef D. Boeke, PhD, the Sol and Judith Bergstein Director of the Institute for Systems Genetics at NYU Langone Health. This has been a major missing piece in efforts to develop new drugs against this virus.
Given that mice have been the lead genetic model for decades, added Dr. Boeke, there are thousands of existing mouse lines that can now be crossbred with our humanized ACE2 mice to study how the body reacts differently to the virus in patients with diabetes or obesity, or as people age.
The new study revolves around a new method to edit DNA, the 3 billion letters of the genetic code that serve as instructions for building our cells and bodies.
While famous techniques like CRISPR enable editing DNA just one or a few letters at a time, some challenges require changes throughout genes that can be up to 2 million letters long. In such cases, it may be more efficient to build DNA from scratch, with far-flung changes made in large swaths of code preassembled and then swapped into a cell in place of its natural counterpart. Because human genes are so complex, Dr. Boekes lab first developed its genome writing approach in yeast, one-celled fungi that share many features with human cells but that are simpler and easier to study.
More recently, Dr. Boekes team adapted their yeast techniques to the mammalian genetic code, which is made up not only of genes that encode proteins but also of many switches that turn on different genes at different levels in different cell types. By studying this poorly understood dark matter that regulates genes, the research team was able to design for the first time living mice with cells that had more humanlike levels of ACE gene activity. The study authors used yeast cells to assemble DNA sequences of up to 200,000 letters in a single step, and then delivered these naked DNAs into mouse embryonic stem cells using their new delivery method, mSwAP-In.
Overcoming the size limits of past methods, mSwAP-In delivered a humanized mouse model of COVID-19 pathology by overwriting 72 kilobases (kb) of mouse Ace2 code with 180 kb of the human ACE2 gene and its regulatory DNA. To accomplish this cross-species swap, the study method cut into a key spot in the DNA code around the natural gene, swapped in a synthetic counterpart in steps, and with each addition, added a quality control mechanism so that only cells with the synthetic gene survived. The research team then worked with Sang Y. Kim, PhD, at NYU Langones Rodent Genetic Engineering Laboratory, using a stem cell technique called tetraploid complementation to create a living mouse whose cells included the overwritten genes.
In addition, the researchers had previously designed a synthetic version of the gene Trp53, the mouse version of the human gene TP53, and swapped it into mouse cells. The protein encoded by this gene coordinates the cells response to damaged DNA, and it can even instruct cells containing it to die to prevent the buildup of cancerous cells. When this guardian of the genome itself becomes faulty, it turns into a major contributor to human cancers.
Whereas the ACE2 experiments had swapped in an unchanged version of a human gene, the synthetic, swapped-in Trp53 gene had been designed to no longer include a combination of molecular code letterscytosine (C) next to guanine (G)known to be vulnerable to random cancer-causing changes. The researchers overwrote key CG hot spots with code containing a different DNA letter, adenine (A).
The AG switch left the genes function intact, but lessened its vulnerability to mutation, with the swap predicted to lead to a ten- to fiftyfold lower mutation rate, said first author Weimin Zhang, PhD, a postdoctoral scholar in Dr. Boekes lab. Our goal is to demonstrate in a living test animal that this swap leads to fewer mutations and fewer resulting tumors, and those experiments are being planned.
Along with Dr. Boeke and Dr. Zhang, NYU Langone study authors were Ran Brosh, PhD; Aleksandra Wudzinska, MPhil; Yinan Zhu; Noor Chalhoub; Emily Huang; and Hannah Ashe in the Institute for Systems Genetics and Department of Biochemistry and Molecular Pharmacology; Ilona Golynker; Luca Carrau, PhD; Payal Damani-Yokota, PhD; Camille Khairallah, PhD; Kamal M. Khanna, PhD; and Benjamin tenOever, PhD; in the Department of Microbiology; and Matthew T. Maurano and Dr. Kim in the Department of Pathology.
The work was funded by National Institutes of Health CEGS grant 1RM1HG009491 and Perlmutter Cancer Center Support Grant P30CA016087. Dr. Boeke is a founder of CDI Labs Inc., a founder of Neochromosome Inc., a founder of ReOpen Diagnostics LLC, and serves or has served on the scientific advisory boards of Logomix Inc., Modern Meadow, Rome Therapeutics, Sample6, Sangamo Therapeutics, Tessera Therapeutics, and the Wyss Institute. Dr. Boeke also receives consulting fees and royalties from Opentrons and holds equity in the company. These relationships are managed in accordance with the policies of NYU Langone Health.
Greg Williams Phone: 212-404-3500 Gregory.Williams@NYULangone.org
In a recent study published in the Canadian Medical Association Journal, researchers evaluated age-stratified hospitalization and mortality risks from incident severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in British Columbia (BC), Canada, during the SARS-CoV-2 Delta variant of concern (VOC) and Omicron VOC predominance.
Study:Risk of hospital admission and death from first-ever SARS-CoV-2 infection by age group during the Delta and Omicron periods in British Columbia, Canada. Image Credit:FamVeld/Shutterstock/com
Studies have reported that individuals with a prior history of SARS-CoV-2 vaccination and infection have a reduced risk of coronavirus disease 2019 (COVID-19) severity outcomes compared to those without exposure, and identifying the fraction of uninfected individuals is crucial for ongoing risk evaluation.
In the initial phase of COVID-19, male sex and older age have been reported as independent estimators of COVID-19 severity. Seroprevalence estimates help capture and quantify infections, but their generalizability depends on the sample population.
The British Columbia Centre for Disease Control (BCCDC) performed eight population-level, cross-sectional SARS-CoV-2 seroprevalence surveys from March 2020 to August 2022.
The surveys indicated that COVID-19 incidence was 10% during the sixth survey in September 2021, 40% during the seventh survey in March 2022, and 60% during the eighth survey in July 2022.
In the present study, researchers conducted serosurveys 9.0 in December 2022, followed by serosurvey 10 in July 2023, respectively, to assess changes in SARS-CoV-2 seroprevalence, particularly in the elderly, and evaluate severe COVID-19-related outcome risk from incident COVID-19 during the inter-survey periods.
Cumulative COVID-19-induced seroprevalence, severe outcomes, population count, discharge abstracts, and vital statistical data were used to estimate infection hospitalization ratios (IFRs) and infection fatality ratios (IFRs) by gender and age during the period between serosurveys 6.0 and 7.0 (Delta VOC/Omicron VOCs BA.1 sub-VOC), serosurveys 7.0 and 8.0 (BA.2 sub-VOC/BA.5 sub-VOC), and serosurveys 8.0 and 9.0 (BA.5 sub-VOC/BQ.1 sub-VOC) inter-survey periods.
The derived IHRs and IFRs represented severe COVID-19-related outcome risk from incident infections during the predetermined inter-survey periods. COVID-19 was confirmed using nucleic acid amplification tests (NAATs). The sample population included individuals presenting for blood draws at the LifeLabs diagnostic outpatient center.
The LifeLabs Center provided BCCDC researchers with sera from 2,000 anonymized BC residents, including 200 serum samples for all age groups (zero to four years, five to nine years, and 10-year categories through 80years and older).
Samples obtained for COVID-19 testing from long-term care recipients, individuals with assisted living, and prisoners were excluded.
Antibodies against the SARS-CoV-2 spike protein subunit 1 (S1) and nucleocapsid (NP) protein were detected using chemiluminescent immunoassays. Non-orthogonal testing was performed in serosurveys 9.0 and 10, and observations from serosurveys 6.0 to 8.0 were similarly re-analyzed.
Bayesian analysis was performed to estimate seroprevalence, adjusting for gender, health authorities, and age.
On August 24, 2023, the team extracted COVID-19 severity outcome data from the British Columbia coronavirus disease 2019 cohort (BCC19C), including the discharge abstract database (DAD), the provincial vital statistical database, and the British Columbia Centre for Disease Control integrated surveillance data for cases of COVID-19 confirmed by NAAT and the International Classification of Diseases, 10th Revision, Canadian version (ICD-10-CA) codes.
The median participant age was 40 years, and 50% were female. The cumulative SARS-CoV-2 seroprevalence rate through December 2022 was 74%, and through July 2023 was 79%, surpassing 80% among individuals below 50 but persisting below 60% among individuals aged 80 years.
Period-specific infection hospitalization and fatality ratios remained consistently under 0.30% and 0.10%, respectively.
Age-stratified infection hospitalization and fatality ratios were mostly below one percent and 0.1%. However, there were exceptions. Individuals aged between 70 and 79 years in the period between serosurveys 6.9 and 7.0 had an IHR and IFR of three percent and one percent, respectively.
Among the elderly aged 80 years during all inter-survey periods, IHRs were five percent, two percent, and four percent. IFRs for this age group were three percent, one percent, and one percent in the periods between serosurveys 6.0 and 7.0, 7.0 and 8.0, and 8.0 and 9.0, respectively. The pattern for severe COVID-19 outcome risks by age was J-shaped.
In the period between serosurveys 8.0 and 9.0, the team estimated one COVID-19-related hospitalization per 300 children aged below five years with incident COVID-19 vs. one hospitalization per 30 adult individuals aged 80 years with incident infection, with no COVID-19-related mortality in children but one death among every 80 adults with incident infection among individuals aged 80 years during the period.
The exploratory analyses showed some gradation in the risks of hospitalization and mortality per incident infection between individuals aged 60 to 64years (one per 1,400 and 10,000, respectively) vs. 65 to 69years (one per 500 and 2500, respectively).
Based on the study findings, through July 2023, the researchers estimated that 80% of BC residents were infected by SARS-CoV-2, with low risks of hospitalization or death from COVID-19 in the context of high vaccine coverage contributing to hybrid protection.
However, 40% of elderly individuals did not develop the SARS-CoV-2 infection but had a heightened severe outcome risk.
The findings indicated that incident infections among elder individuals might contribute considerably to the COVID-19 burden on healthcare systems, highlighting that health authorities must continue prioritizing the elderly for COVID-19 vaccinations and consider them during healthcare planning.
DMEPhotography/iStock
From 46% to 61% of adults receiving mpox vaccination at two US public health clinics reported a decrease in sexual behaviors tied to viral transmission, including one-time encounters, sex partners, dating app or sex venuebased sex, and group sex, according to a study published late last week in Sexually Transmitted Diseases.
The study, led by Centers for Disease Control and Prevention (CDC) researchers, involved 711 adults seeking mpox vaccination at two clinics in Washington, DC, who completed questionnaires from August to October 2022.
Median participant age was 32 years, 52.0% were White, 20.5% were Black, 14.6% were Hispanic, 7.9% were Asian, 2.0% were multiracial, 0.3% were American Indian/Alaska Native, and 9% had HIV. Most participants were men who have sex with men (MSM) (61.0%), 27.0% were women, and 3.8% were men who have sex with only women.
During the 2022 multicountry mpox outbreak, more than 30,000 mpox cases were reported, mainly among MSM. "Decreases in U.S. mpox cases were likely accelerated by a combination of vaccination and modifications to sexual behaviors associated with mpox virus transmission," the researchers wrote.
Many participants reported fewer one-time sexual encounters (60.8%), sex partners (54.3%), less dating app or sex venuefacilitated sex (53.4%), and less group sex (45.6%). A total of 39% to 54% reported no change in these behaviors, and 0.4% reported an increase.
While reported cases of mpox continue to be low, individuals may return to behaviors and practices that they engaged in prior to the outbreak. In turn, behavior mitigation strategies may only be implemented as temporary protective measures, underscoring the importance of mpox vaccination for continued protection.
A greater proportion of Black participants reported decreases in all four behaviors since learning about mpox (61% to 76%), compared with White participants (41% to 54%). Also, a higher percentage of participants with HIV than those without HIV said they were engaging less in these activities (72% to 82% vs 43% to 59%).
"While reported cases of mpox continue to be low, individuals may return to behaviors and practices that they engaged in prior to the outbreak," the authors wrote. "In turn, behavior mitigation strategies may only be implemented as temporary protective measures, underscoring the importance of mpox vaccination for continued protection."
Before COVID-19, Pakistan has not formal existing mechanism of multisectoral public health emergency response coordination. Most of the agencies engaged in the pandemic response, faced legal, financial, administrative challenges in developing and maintaining operational support for the emergency. Existing record within the agencies, suggest that an informal and ad-hoc inter-agency coordination strategies were established during COVID-19 response which extended during whole period. Interagency coordination system was backed by the strategic heads of government but not on the basis of on agreements or understandings. Findings reveal some of the agencies and departments were engaged in multiple tasks whereas a few were not clear in their roles and concepts of operations during COVID-19 response. Most of the emergency response coordination arrangements were made on need basis which supported response objectives at national and intermediate level.
It was found that since inception of pandemic Pakistan started emergency response coordination by engaging some relevant sectors especially Point of Entries (POEs), NDMA, NEOC, Central Health Establishment (CHE), WHO country office, UKHSA, CDC and other partners18. As the incident escalated the PHEOC expanded coordination and collaboration with all relevant agencies in both, health and other than health sectors. The developmental partners including WHO, UKHSA, JSI, UNICEF and many others supported government agencies in maintaining coordination, workforce capacity building and tactical operations during pandemic response.
The study results highlighted that almost all of the organizations faced challenges in developing their routine capacities in emergency response coordination. Main problem was with legislative and financial support (Fig.2) in the implementation of activities. Studies have demonstrated that financial and logistics challenges have also been observed for many of the departments and sectors engaged in COIVD-19 response19,20. Most of the organizations were not having dedicated funds to support day to day COVID-19 response activities (including testing, surge staff and deployment, quarantine, door to door vaccination etc.)21. For immediate nature of tasks, NCOC has coordinated with national and international developmental partners for logistic support in surveillance, medical countermeasure and lab services12. The World Banks PPR Tool assesses pandemic preparedness in various countries, revealing similar financial and logistics gaps in areas like surveillance, laboratory capacity, and risk communication in Kenya, Cameron and Nigeria22.
NIH took the initiative of planning for COVID-19 and developed the National Action Plan for COVID-19 by coordination with stakeholders in March 202023. Although plan including various activities of prevention, detection and response but not facilitate the partner organizations roles, involvement level, financial regulation, and resources utilization with a clear concept of operation24. In May 2020, MoNHSR&C developed a draft of the Pakistan Preparedness and Response Plan for COVID-19, including funding details12. It aimed to strengthen disease surveillance, detection, case management, risk communication, infection prevention, and control and provided the ways to reduce coordination gaps. NDMA also developed a Stakeholder Engagement Plan (SEP) under Pandemic Response Effectiveness in Pakistan in May 202025. The plans developed by the agencies facilitated pandemic response but could not fulfill all requirements emergency response coordination26,27. Results of present study also reveal that most of the agencies in health sector, faced challenges in developing agreements, activities and timeline, and a clear concept of operations for COVID-19 emergency.
Most of the organizations engaged in pandemic management have different functions and strengths. Prior to COVID-19, the concept of operations and level of engagement for other branches/departments of government organizations and other partners was not clear in Pakistan28. Evidence revealed that COVID-19 related planning and operations were being supported by the different ministries and departments including, animal health, law enforcement agencies, information and broadcast, agriculture, civil administration and finance etc.25.
The roles and responsibilities were assigned on need basis from the strategic level authorities. There was no clear framework of actions and task assigned to each of the response organization notified in the NAP23. Only few of the organizations have defined emergency response activities, parallel to normal day-to-day business.
None of the agencies had endorsed the concept of operations plan or level of engagement for other than health agencies. Evidence from the present study (Table 2) demonstrates that it was unclear how different agencies engaged its branches in the absence of a shared comprehensive response plan. Thus, the unavailability of the documented concept of operations affected the overall planning and emergency response operations collectively.
Prior pandemic, health agencies were deficient in existing coordination for emergency response in Pakistan29. At the strategic level, the government of Pakistan constituted a high-level National Coordination Committee chaired by the Prime Minister of Pakistan24,30. The aim was to enhance coordination of information and actions required by all national and provincial level agencies31,31. Later, NCOC developed effective coordination mechanism among all partners in addition to the COVID pandemic response. Although many agencies involved in coordinated response to COVID, but there was very little evidence on joint planning for the emergency response. During desk review it was found that MOUs with the different departments and partners were not in place at national level.
During the COVID-19 pandemic, Pakistan faced challenges in the field of technical professionals and logistics to manage the emergency33. Data show that most of agencies expect developmental partners have a lack of workforce and technical resources for response and coordination (Fig.1). Literature and departmental record reveal that NCOC is also lacking in permanent trained human resources support to perform all its functions.
Inter-agency human resources exchange was also a big challenge. Pakistans Joint External Evaluation (JEE) indicates that Pakistan lags behind in strategic emergency planning, preparedness, resource identification, and mapping34. NIH facilitated in capacity building of provincial and regional health departments to generate trained human resources for the emergency response coordination in 2020 and 202135. But the national level response organizations were lacking in capacity for their human resources to be engaged in emergency response at time of escalation. Most of the agencies did not deploy permanent liaison staff at operations center on regularly basis but called for specific assignments.
In a recent study published in Scientific Reports, researchers examined the effects of employment on geriatric health during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak.
Study:Impact of employment on the elderly in a super-aging society during the COVID-19 pandemic in Japan. Image Credit:Cryptographer/Shutterstock.com
Due to the aging population and the necessity to complement the working-age population, Japan's older population is becoming more employed. This occupation is viewed as a means of preventing cognitive deterioration and lowering the chance of mortality.
The COVID-19 pandemic, on the other hand, has underlined the necessity to research the impact of work on the health of elderly individuals. Elders have avoided going out due to the severity of COVID-19 and the related mortality risk.
A fear has arisen that if individuals do not go out, their activity levels will decline, and their health may deteriorate. Maintaining high levels of physical and mental activity can lower the likelihood of frailty, and being active in social engagements such as work may benefit geriatric health throughout the SARS-CoV-2 outbreak.
However, it is uncertain whether continuing to work during COVID-19 improved cognitive and motor abilities compared to regular periods.
In the present analysis, researchers explored the cognitive and motor functional implications of employment during COVID-19 among elderly individuals.
The study included 144 individuals aged65 years and older who undertook medical examinations at three centers (i.e., Hamate District Public Hall, Yamate District Public Hall, and Health and Welfare Center) in the Kaizuka city of Osaka Prefecture over six days between August and September 2021. The individuals were divided into employed and non-employed groups.
A one-to-one survey was conducted, querying the employment status and income of the participants. The motor function was assessed based on the skeletal muscle index (SMI), 2.4-meter walking speed (m/s), bone mineral density, and a two-step test.
General cognitive function was assessed using the Mini-Mental State Examination-Japanese edition (MMSE-J), and attention function (selection, persistence, distribution, and transfer) was assessed using the Trail Making Test-Parts A and B (TMT-A/B).
In addition, frailty (weakness, weight loss, exhaustion, slowness, and low activity level) was assessed using the modified Japanese edition of the Cardiovascular Health Study (J-CHS) criteria. Univariate analysis and logistic regression models were used to determine the odds ratios (ORs), adjusting for gender and age. The team excluded individuals restricted from exercising by health professionals and those with inadequate data.
The mean walking speed was determined based on the duration of completing a 2.0-meter walk at regular speed. The dominant hands grip strength was measured by grip strength meters, and the SMI values were determined based on body composition, height, and bio-impedance. The heel bone density (right side) was determined ultrasonically and compared to the corresponding bone density values for young adults.
Among the study participants, the mean age was 76 years; 33 (23%) were employed, and 111 (77%) were unemployed. Among employed individuals, 16 (49%) were female, whereas among those unemployed, 87 (78%) were female.
Concerning employment reasons, ten individuals (30%) worked for health, five (15%) for social connections, five (15%) for income, four (12%) for survival, three (nine percent) for additional income, two (six percent) for having plenty of time to spare, and four (12%) for other reasons.
Concerning employment type, one individual (three percent) worked full-time, 18 (55%) worked part-time, eight (24%) were self-employed, and six (18%) were categorized as other employment types.
The univariate analysis showed significantly higher SMI values and grip strength among employed individuals, likely due to the skewed gender ratio among the groups.
Concerning motor function, non-significant differences were observed in the locomotive two-step test, frailty, and walking speed between the groups.TMT-A was an independent factor for employed individuals (OR, 0.96). Working individuals were significantly more attentive than non-working individuals, as indicated by significantly less time on the TMT-A.
Overall, the study findings showed significantly higher attention among employed individuals than their unemployed counterparts during COVID-19, likely because attention is required to execute job-related tasks.
In addition, an individual needs to process visual data and write while performing jobs. Future studies must investigate the component of the attention function impacted by employment, considering underlying medical conditions affecting motor and cognitive functions and including larger sample sizes to improve the generalizability of the study findings.
The COVID-19 vaccination campaign in 141 countries averted 2.4 million excess deaths by August 2021 and would have saved another 670,000 more lives had vaccines been distributed equitably, estimates a working paper from University of Southern California (USC) and Brown Universityresearchers.
The National Bureau of Economic Research circulated the nonpeer-reviewed working paper for discussion and comment this week. The researchers estimated the real-world effectiveness of the global COVID-19 vaccine rollout on all-cause death rates, including both the direct and indirect effects of the pandemic.
"Within eight months, over 2 billion people were vaccinated globally, making it the largest public health campaign in history," the study authors wrote.
"To the best of our knowledge, this is the first study that estimates the effect of COVID-19 vaccines on the global all-cause mortality using observational data. Second, unlike existing studies, this study considers the waning effect of vaccines instead of assuming a constant effectiveness of vaccines over time."
In 43 countries included in the main regression analysis based on The Economist COVID-19 excess deaths tracker GitHub, vaccination saved an estimated 1.14 million lives from January to August 2021, a roughly 26% reduction in deaths compared with a scenario without the global vaccination campaign.
By extrapolating the results to the 141 countries, the researchers estimated that 2.36 million lives were saved in the first 8 months of the global COVID-19 vaccination campaign. The averted deaths were economically valued at $6.5 trillion, roughly equivalent to 9% of the combined gross domestic product (GDP) of the 141 countries.
In terms of absolute numbers, India and United States benefitted the most from the campaign, with 451,778 and 429,486 lives saved, respectively. Together, they made up 37% of the total lives saved in the 141 countries.
"Due to diminishing marginal health benefits of vaccination, redistributing vaccines from countries with high vaccination rates to countries with low vaccination rates can increase the number of deaths averted," the researchers wrote.
Had the vaccine been equitably distributed among the 141 countries, the COVID-19 vaccination campaign would have saved 3.03 million all-cause deaths during the study period. The deaths averted had an economic value, based on country- and region-specific estimates of the value of statistical life (VSL), of about $4.69 trillion.
These findings leave us with an unanswered question at the intersection of economics and public health: should we seek to maximize the number of lives saved or maximize the economic value of lives saved?
VSL estimates ranged from $0.06 million in Afghanistan to $9.4 million in Switzerland. The average American VSL was $7.2 million, compared with the global VSL estimate of $1.3 million. While India and the United States saved similar numbers of lives with vaccination, the Indian deaths averted were valued economically at $90 billion, making up just 1.4% of the total VSL among the 141 countries.
"Therefore, relative to the status-quo, we estimate that an additional 670,000 lives would have been saved, but with a $1.8 trillion decrease in the total economic value of deaths averted," the authors wrote.
"These findings leave us with an unanswered question at the intersection of economics and public health: should we seek to maximize the number of lives saved or maximize the economic value of lives saved?" they added. "We leave answering this question as an important future endeavor for ethicists and economists."
The results suggest that COVID-19 vaccination and treatments are much more effective at preventing death than other efforts aimed to contain SARS-CoV-2, such as lockdowns and mask mandates, the researchers said.
"Our study shows the enormous health impacts of COVID-19 vaccines, which in turn have huge economic benefits," coauthorChristopher Whaley, PhD, said in a Brown University news release. "In terms of lives saved and economic value, the COVID-19 vaccination campaign is likely the most impactful public health response in recent memory."
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More than 50% of long-COVID patients failed to improve 1.5 years after their initial diagnosis, according to a new study based on cases seen at a Danish post-COVID clinic, both before and after the Omicron variant period. The study was published yesterday in the International Journal of Infectious Diseases.
The analysis included 806 patients who were infected with the wild-type strain, Alpha, Delta, or Omicron strain. All case-patients had been referred to a long COVID clinic with symptoms persisting at least 12 weeks from onset of COVID-19. Seventy percent of participants were female, with a median age of 48.
Patients were given a post-COVID symptom questionnaire (PCQ), and standard health scores, four times between enrollment and 18 months of follow-up. The first clinic visit for long COVID occurred an average of 7 months after acute infection. Patients were grouped according to the period of transmission of predominant SARS-CoV-2 variants, with 69% of patients infected during the wild-type period and 9%, 7%, and 15% infected in the Alpha, Delta, and Omicron periods, respectively.
The authors found that patients infected in the Delta period had significantly more severe long COVID initially, with a mean PCQ score of 43, compared with 38 for patients infected in the wild-type period.
Patients infected in the Omicron period did not differ in PCQ score (median 40) compared to wild-type patients (median 38) or to pre-Omicron patients (median 38). However, patients infected with Omicron had a lower health-related quality of life compared to patients infected with wild-type strain.
At 1.5 year after infection, patients had no clinically meaningful decline in severity of long COVID.
"At 1.5 year after infection, patients had no clinically meaningful decline in severity of long COVID, and 57% (245/429) of patients failed to improve 1.5 years after infection, with no differences between variants," the authors wrote.
Overall, PCQ scores fell 7 to 10 months post-infection, then plateaued between 10 and 18 months, Overall median PCQ score declined from 38 at 7 months to 33 at 18-month follow-up.
"In some patients, long COVID may last for more than 2 years after infection, which is supported by our data," the authors concluded.
