Listening to community concerns in the COVID-19 infodemic: A WHO digital approach

Background

The Infodemic (too much information including false or misleading information in digital and physical environments) during the COVID-19 pandemic has led to confusion, risk-taking and behaviors that can amplify outbreaks, and reduce effectiveness of pandemic response efforts. To address this challenge, the WHO Information Network for Epidemics (EPI-WIN), in collaboration with research partners, developed a public health Infodemic intelligence analysis methodology for weekly analysis of digital media data to identify, categorize, and understand key concerns expressed in online conversations.

Methods

Thirty-five keyword-based searches (per language) using Meltwater Explore and Google Trends were created and grouped according to a set of pandemic public health taxonomy categories developed specifically for this analysis. The taxonomy has five thematic categories of conversation about COVID-19 and public health response: (1) the cause of the illness, (2) the illness, (3) the treatment, (4) the interventions and (5) Information.

Results

The two most recurring topics to attract increasing interest were Vaccines and Asymptomatic transmission followed by Immunity, Cause of the virus, Vulnerable communities and Reduction of movement, and Risk factors based on demographics and risk of misinformation.

Conclusions

The application of this taxonomy to online social listening week-on-week resulted in a better in-time understanding of the evolution and dynamics of high velocity conversations about COVID-19 globally during the pandemic and proposes a quantifiable approach to support planning of risk communication response.

Key messages

Describe widespread innovation in social listening methods for greater accountability to affected populations. Formulate insights into how digital media can be better utilized for more rapidly responding to the evolving needs of communities.

WHO public health research agenda for managing infodemics

Background

Following the World Health Organization's initial infodemic consultation in April 2020, a major infodemic conference was organised virtually in June-July 2020. Hundreds of experts participated to define science of infodemiology and build a public health research agenda that serves as a playbook for conducting relevant researches. Research Agenda provides guidance to invest in research and innovation so that we have better interventions and tools to understand, measure and respond to infodemics, and steer people towards timely, accessible, understandable information for good health choices.

Methods

The research agenda was developed during a virtual meeting, followed by research question prioritization exercise. It consisted of eight days spread out over four weeks. These were made up of: public preconference meeting; scientific conference, consisting of opening/closing plenary meetings either side of four separate “topic sprint” days; final public meeting to present the meeting outcomes.

After the meeting, a process took place to gather and rank research questions based on the research agenda created during the meeting.

Results

The following five streams and 65 research questions were developed. Measuring and monitoring the impact of infodemics during health emergencies Detecting and understanding the spread and impact of infodemics Responding and deploying interventions that protect against the infodemic and mitigate its harmful effects Evaluating infodemic interventions and strengthening resilience of individuals and communities to infodemics Promoting the development, adaptation and application of tools for managing infodemics.

Conclusions

Five streams with 65 research questions were developed and prioritized to structuralise infodemic management based on evidence. The conference yielded on the development of an infodemiology glossary, which can be used by the community of research.

Key messages

Discuss investments in research and innovation to enable a whole-of-society response to infodemics. Explain the practice of infodemic management as a discipline.

Advances in real-time social listening for an adaptive public health response: WHO’s EARS platform

Background

COVID-19 pandemic was accompanied by an Infodemic (overabundance of information, including misinformation and disinformation, both online and offline); in response to this Infodemic, WHO launched the EARS platform (Early AI-assisted Response with Social Listening), showing real-time information about how people are talking about COVID-19 online. This information is intended to serve health information professionals to understand narratives and needs of the general public, in order to inform policy or communications decisions.

Methods

Data is collected daily from online conversations in publicly available sources, including Twitter, online forums, and blogs in English, French, Spanish and Portuguese, for 20 pilot countries. Once the data is collected, it is processed and classified into 39 categories, according to a set of pandemic public health taxonomy. The classification is made based on semi-supervised machine learning.

Results

Top 5 categories across regions are Covid-19 vaccine, Transmission settings, Personal measures, Testing and Industry (industry refers to the impact of the pandemic on the economy). We find that conversations around Covid-19 vaccines usually rank in the second or third position in all regions and represent 9%-12% of the conversation.

Conclusions

The configuration and application of the EARS platform has enabled progress towards more scalable and sustainable social listening to inform Infodemic management and response, compared to previous methods which were more manual, required data scientists in the team, or had fewer analytics capabilities. Future work will focus on gradually adding more data sources which can expand coverage and representativity.

Key messages

Discuss social listening methods for greater accountability to affected populations. Formulate insights into how digital media and information technology can be better utilized for more rapidly responding to the evolving needs of communities.

50 Global Actions to Manage the COVID-19 Infodemic: A WHO Framework

Issue

The World Health Organization describes an infodemic as an “overabundance of information - good or bad - that makes it difficult for people to make decisions for their health.”

Description of the problem

On April 7-8, 2020, the WHO Information Network for Epidemics (EPI-WIN) held a global online to crowdsource ideas from an interdisciplinary group of experts to form a novel COVID-19 infodemic response framework. The online consultation comprised of four plenary sessions and a brainstorming session conducted entirely online. Nearly 1500 individuals from over 100 countries and territories spanning social scientists, epidemiologists, staff from ministries of health and institutes of public health, registered for the consultation.

Results

A set of 50 proposed actions for a framework for managing infodemics in health emergencies was developed that will provide guidance for governments and public health institutions to take in five key areas of action that emerged from the consultation:

strengthening evidence and information

simplifying and explaining what is known fact-checking and addressing misinformation

amplifying messages and reaching the communities and individuals who need the information

quantifying and analysing the infodemic, including information flows, monitoring the acceptance of public health interventions, and assessing factors affecting behaviour at individual and population levels

strengthening systems for infodemic management in health emergencies

Lessons

Everyone has a role to play

Read the Call for Action

Sign the Call for Action

https://www.who.int/news/item/11-12-2020-call-for-action-managing-the-infode

Key messages

The confusion due to Infodemic can lead people to ignore public health measures and take risks that can cause serious harm.

Recognizing this WHO convened an interdisciplinary group of experts 7-8 April 2020 virtually to form a novel COVID-19 infodemic response framework.

The impact of COVID-19 pandemic on access to treatment for children with cancer in India and treating center practices

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic led the Indian government to announce a nationwide lockdown on March 23, 2020. This study aimed to explore the impact of the pandemic on the accessibility of care for children with cancer and to view strategies adopted by hospitals for service delivery.

METHODS

Weekly average of childhood cancer (≤18 years) patient registrations during pre-lockdown period (January 1 to March 23, 2020) were compared with post-lockdown period (March 24 to May 31, 2020). The effect on the scheduled treatment was investigated for post-lockdown period. A survey of health care providers was conducted to determine centers' adopted strategies.

RESULTS

In 30 participating centers, 1146 patients with childhood cancer (797 pre-lockdown period and 349 post-lockdown period) were registered. The weekly average registration was 67.3 and 35.5 patients during pre-lockdown and post-lockdown respectively (decline of 47.9%). Although most centers experienced this decline, there were 4 that saw an increase in patient registrations. The distribution of patients registered post-lockdown was found significantly different by age (lesser older age, P = .010) and distance (lesser travel distance, P = .001). 36.1% of patients, who were scheduled for any of the treatment modalities (chemotherapy, surgery, radiotherapy, and hematopoietic stem cell transplantation) during the post-lockdown period, experienced delays. Centers adopted several strategies including modifications to treatment protocols, increased use of growth factors, and increased support from social organizations.

CONCLUSIONS

This multicenter study from India suggests that the COVID-19 pandemic and the lockdown impacted 2 out of 3 children with cancer. The effect of this on survival is yet to be established.

Treating early-stage Hodgkin lymphoma in resource-limited settings: InPOG-HL-15-01 experience

BACKGROUND

Hodgkin lymphoma (HL) in childhood is an eminently curable disease. Excellent outcomes can be achieved even in resource-limited settings and increasingly, the focus is on limiting long-term toxicity. Contemporary treatment incorporates a risk-stratified, response-adapted approach using multiagent chemotherapy with or without low-dose radiotherapy (RT). Many developing countries continue to use ABVD (adriamycin, bleomycin, vinblastin, and dacarbazine)-based regimen owing to limited acute toxicity, cost, and ease of delivery. We report outcomes of children with early-stage HL using limited cycles of ABVD-based treatment in the first prospective multicentric collaborative study from India InPOG-HL-15-01.

METHODS

Children <18 years with biopsy-proven HL were enrolled. Patients with stages I and IIA with or without bulky disease were classified as having early-stage disease. Patients were planned to receive four cycles of ABVD subject to satisfactory early response assessment (ERA) scheduled after two cycles of chemotherapy. RT was limited to patients with bulky disease or those with suboptimal ERA.

RESULTS

Four hundred ten patients were enrolled over 30 months from 27 centers. One hundred thirty-four were classified as having early-stage disease. Fifty-three (40%) of these had bulky disease. One hundred ten (83%) of this cohort achieved complete or very good partial ERA. Fifty-four (40%) received RT. At a median of 52 months since diagnosis, 5-year event-free survival (EFS) and overall survival (OS) is 94% and 95.5%, respectively. Treatment-related mortality and abandonment were <1%.

CONCLUSION

Limited cycles of ABVD with RT to selected patients is a very effective option for patients with early-stage disease in resource-limited settings.

Shared care for children with cancer in India through social and healthcare partnerships during the COVID-19 pandemic

Background

The COVID pandemic posed a challenge for the tertiary centers to continue treatment. Some tertiary centers were designated as COVID‐only hospitals, making it difficult for existing childhood cancer patients to continue their treatment at those centres. The need for shared care in childhood cancer was perceived by Cankids and its partnering childhood cancer‐treating centers in North and East India.

Aim

We aim to show how Cankids upscaled its shared care model to ensure that COVID designated hospitals connected with other hospitals who have to continue to provide care to childhood cancer patients in the pandemic and thus ensured the continuation of treatment for these patients.

Methods and result

The need assessment of the beneficiaries was done in discussion with the hospital of origin and destination hospital. The need for shared care was also discussed with the families and consent was taken before shifting their children. Cankids with the help of advisors identified cases of high risk that need immediate attention, proactive regular monitoring, and help in care planning with the perspective and recommendation of the multiple providers. The shared care unit came forward with reasonable and discounted packages for treatment.

There was a total of five hospitals requiring shared care, and 55 children were supported from April to November 2020. The median age was 8 years and their hospital of origin are in Bihar, Uttar Pradesh, West Bengal, and Delhi. The expenditure on the treatment of the 55 patients was INR 61 61 636 ($ 84 843), with a median of INR 41765 (IQR 19491–174 129) on each patient. Total 291 trips for the transport were arranged and all the patients combined stayed 174 days at Cankids accommodation facility.

Conclusion

The shared care helped the patients access standard treatment and reduce the financial burden.

Early Detection and Rescue of an Unusual Case of Pediatric Acute Liver Failure Associated with Secondary Hemophagocytic Lymphophagocytosis: Case Report from a Liver Transplant Center in India

Hemophagocytic lymphohistiocytosis (HLH) is a rare, multisystem, potentially fatal clinicopathologic syndrome. HLH presenting predominantly as pediatric acute liver failure (PALF) has been rarely reported. Early recognition is imperative to initiate life-saving treatment but is often hampered due to the rarity of this syndrome, variable clinical presentations, and nonspecific clinical and laboratory findings. In this article, we reported a case of secondary HLH (H1N1 and RSV positive) presenting as PALF from India. A previously healthy 22-month-old boy presented with fever, vomiting, and altered sensorium for 10 days. He had coagulopathy and deranged liver functions. He was evaluated for underlying etiology and managed on lines of PALF. Due to persistent bicytopenia and excessively high ferritin levels, HLH was strongly suspected though he did not fulfill all clinical criteria for the diagnosis of HLH. Presence of seizures and cerebrospinal fluid analysis was suggestive of central nervous system involvement. There was no evidence of primary HLH on genetic evaluation. Real-time polymerase chain reaction amplifications were positive for RSV and influenza A H1N1, confirming the causative triggers. After the administration of immunosuppressants and oseltamivir, the patient's symptoms improved dramatically and he recovered completely. To the best of our knowledge, this is the fourth case reported worldwide till date of successful rescue of ALF in a child associated with HLH completely without resorting to liver transplantation. Clinical vigilance is crucial for possible presence of HLH with varied initial presentations in PALF despite incomplete diagnostic criteria, with detailed etiological workup for commencing life-saving therapy in time.

A study analyzing the health-related quality of life of retinoblastoma survivors in India

Purpose

: Retinoblastoma (RB) is the commonest intraocular tumor in children. Despite high cure rates, data on health-related quality of life (HRQoL) of RB survivors are limited. This study aimed to analyze parent's perspective and self-report of HRQoL of RB survivors, using healthy siblings as controls. It also evaluated the impact of socio-economic status (SES), gender, disease laterality, treatment modality, duration since diagnosis, and visual outcomes, on HRQoL.

Methods

Ninety-two RB survivors were enrolled in this observational, cross-sectional questionnaire-based study conducted at a tertiary care center. QoL was analyzed in four dimensions: physical, emotional, social, and school, using both self-report (for children >6 years) and parent proxy report (for children 2-18 years) using Pediatric Quality of Life Inventory™ (PedsQL^TM) 4.0 Generic Core Scale. Seventy-seven healthy siblings served as controls.

Results

The mean age of both cohorts was 5.7 years. Thirty-six (39%) patients had bilateral RB. Of the 92 survivors, 43 (47%) had undergone enucleation. The HRQoL of RB survivors was significantly lower compared to sibling controls (P < 0.01) in all four domains, the physical domain being most affected followed by social domain. Parents reported an inferior QoL than patient's self-report. Vision <6/18 in the best eye and enucleation had a negative impact on HRQoL whilst gender, disease laterality, duration since diagnosis and SES had no impact.

Conclusion

: QoL assessment is often neglected but an important aspect of survivorship. Results of our study will help in formulating awareness of the domains affected and allow timely advocacy of initiatives for addressing each issue individually. Remedial measures aimed at optimizing QoL should be incorporated as part of their rehabilitation.

Is the right ventricular function affected by permanent pacemaker?

Funding Acknowledgements

Type of funding sources: None.

Background

The effect of right ventricular (RV) pacing on left ventricular (LV) function has been extensively evaluated, and so has the effect of the RV pacing lead on tricuspid valve function. However, the effects on RV function per se have not been evaluated systematically.

Purpose

We aimed to assess the RV dimensions and RV function six months after dual chamber pacemaker implantation

performed for atrioventricular (AV) block by detailed echocardiography, including three-dimensional (3D) echocardiography.

Method

All adult patients undergoing dual chamber pacemaker from January 2018 to March 2019 for symptomatic AV block with a structurally normal heart were included in the study. They underwent pre-procedure detailed echocardiography specifically directed at measuring RV dimensions and function [including 3D RV ejection fraction (EF)] and a repeat detailed echocardiogram at six-month follow-up, by the same echocardiographer. The echocardiographic parameters at baseline and after six-month follow-up were compared.

Results

All patients had more than 75% ventricular pacing in these six months. At six-month follow-up, there was no significant change in LVEF, while there was a mild decrease in RVEF as outlined in the Table 1. While there was some overlap between RVEF range of values at baseline and after six months, 23 (38.3%) patients showed a drop in RVEF by &gt;5%.

Conclusion

Our study shows a change in several RV function parameters in a majority of patients six months after

pacemaker implantation for AV block.

RV Function at six month follow-up Parameters Pre-procedure Six-Month Follow-up p value (Paired t-test) PASP (mm Hg) 20.2 ± 1.3 26.1 ± 12.2 &lt;0.001 FAC (%) 42.6 ± 3.4 39.4 ± 6 &lt;0.001 TAPSE (mm) 18.4 ±3.8 15.6 ± 4.7 &lt;0.001 RIMP 0.66 ± 0.09 0.61 ± 0.11 0.003 RV E/E’ 9.4 ± 2.1 7.7 ± 2.1 &lt;0.001 RV S’ 13.6 ± 2.4 10.7 ± 2.4 &lt;0.001 RVEF % [By 3D Echocardiography] 47.7± 5.1 44.9 ± 7.4 &lt;0.001 TR Jet Area (cm2) 0.03 ± 0.26 0.55 ± 0.96 &lt;0.001 RV= Right Ventricle; RA= Right Atrium; RVOT = Right Ventricular Outflow Tract; PASP = Pulmonary Artery Systolic Pressure; FAC= Fractional Area Change; TAPSE= Tricuspid Annular Plane Systolic Excursion; RIMP = Right Ventricular Index of Myocardial Performance; TR = Tricuspid Regurgitation S’ = Peak Systolic Annular Velocity; RVEF = Right Ventricular Ejection Fraction; 3D = Three Dimensional Abstract Figure. Change in RVEF in 6 months

Safe administration of high-dose methotrexate with minimal drug level monitoring: Experience from a center in north India

BACKGROUND

High-dose methotrexate (HDMTX) is recommended to be administered with serial monitoring of methotrexate (MTX) levels, which may not be universally feasible in resource-limited settings. In this study, we evaluated the overall experience of administration of HDMTX at our center by monitoring a single drug level at 54 h from the start of MTX infusion.

METHODS

This retrospective study was performed at a tertiary level hospital in north India, over a 5-year period (2011-2015). All patients <18 years of age with newly diagnosed acute lymphoblastic leukemia (ALL) and T-non-Hodgkin lymphoma (T-NHL) were enrolled in the study. Details of HDMTX and all significant toxicities requiring prolonged or repeat hospitalization were retrieved from the medical records. All eligible patients received HDMTX as per the recommendations followed by at least three doses of leucovorin rescue, before drug levels were sent at 54 h. Subsequent leucovorin doses were adjusted accordingly.

RESULTS

The records of 598 cycles of HDMTX in 184 patients were reviewed. A total of 531 of 598 cycles (88.7%) were managed with monitoring only a single plasma drug level at 54 h from the beginning of infusion. Delayed MTX clearance was seen in 260 of 598 cycles (43.5%). Only three episodes (0.5%) were associated with significant toxicity. There were no deaths.

CONCLUSIONS

The strategy of monitoring MTX concentration at 54 h was safe in our cohort. Although recommended, dynamic monitoring of plasma drug levels may not always predict toxicity.