[COVID-19 vaccination status among nurses and associated factors in long-term care facilities : Results of a cross-sectional survey within the Covid-Heim project]

BACKGROUND

Nurses working in long-term care facilities were vaccinated first before residents as a matter of priority to protect the latter. Although the vaccination rate of nursing staff eventually rose due to a facility-based vaccination requirement, studies on associated factors of vaccination status are currently not available for the long-term care setting in Germany.

OBJECTIVE

Associated factors of COVID-19 vaccination status among nursing staff in long-term care facilities were explored.

METHODS

An online survey was conducted between October 26th 2021 and January 31st 2022. A total of 1546 nurses working in long-term care in Germany responded to questions concerning the Covid-19 vaccination campaign. Logistic regression analyses were performed.

RESULTS

In this study 8 out of 10 nurses were vaccinated against COVID-19 (80.6%). Approximately 7 out of 10 nurses thought at least a few times about quitting their job since the pandemic began (71.4%). A positive COVID-19 vaccination status was associated with older age, full-time employment, COVID-19 deaths at the facility and working in northern or western Germany. Frequent thoughts of quitting their job were associated with negative COVID-19 vaccination status.

CONCLUSION

The present findings provide evidence on factors associated with the COVID-19 vaccination status of nurses in long-term care facilities in Germany for the first time. Further quantitative as well as qualitative studies are necessary for a more comprehensive understanding of the COVID-19 vaccination decision-making among nurses in long-term care, in order to implement target-oriented future vaccination campaigns in this care setting.

Impact Of The Vaccination Against Covid-19 On Frontline Health Workers

INTRODUCTION

Brazil has been facing the pandemic of COVID-19 since march 2020. To date, more than 540,000 people have died from this disease in the country. There are estimates that indicate that the population exposed to SARS-CoV-2 represents 1 to 20%, however, these data are questionable due to the number of asymptomatic and untested individuals. As a result, vaccination for COVID-19 has become the main means of achieving herd immunity.

OBJECTIVES

To demonstrate, through local sampling, that broad and rapid vaccination may decrease the rate of COVID-19 detection in individuals potentially exposed to the SARS-CoV-2 virus.

RESULTS

A total of 1,128 individuals were studied, including students and health professionals from Centro Universitário FMABC, who received the two doses of the vaccine for COVID-19 (Oxford/Astrazeneca ® and CoronaVac®). There was a 41% reduction in the demand for RT-PCR test after vaccination, in the studied period. And a 78.3% reduction in positive results after vaccination started Conclusion: The results of this study showed that, even vaccinating a population with higher exposure to the risk of contamination, there was a significant reduction in test positivity and in the demand to perform these tests. Emphasizing that vaccination is the best strategy to achieve herd immunity and to reduce the spread of the disease.

Trained Immunity: An Overview and the Impact on COVID-19

Effectively treating infectious diseases often requires a multi-step approach to target different components involved in disease pathogenesis. Similarly, the COVID-19 pandemic has become a global health crisis that requires a comprehensive understanding of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) infection to develop effective therapeutics. One potential strategy to instill greater immune protection against COVID-19 is boosting the innate immune system. This boosting, termed trained immunity, employs immune system modulators to train innate immune cells to produce an enhanced, non-specific immune response upon reactivation following exposure to pathogens, a process that has been studied in the context of in vitro and in vivo clinical studies prior to the COVID-19 pandemic. Evaluation of the underlying pathways that are essential to inducing protective trained immunity will provide insight into identifying potential therapeutic targets that may alleviate the COVID-19 crisis. Here we review multiple immune training agents, including Bacillus Calmette-Guérin (BCG), β-glucan, and lipopolysaccharide (LPS), and the two most popular cell types involved in trained immunity, monocytes and natural killer (NK) cells, and compare the signaling pathways involved in innate immunity. Additionally, we discuss COVID-19 trained immunity clinical trials, emphasizing the potential of trained immunity to fight SARS-CoV-2 infection. Understanding the mechanisms by which training agents activate innate immune cells to reprogram immune responses may prove beneficial in developing preventive and therapeutic targets against COVID-19.

COVID-19 Ignited a Successful Growth Spurt in Pediatric HIV Differentiated Service Delivery Programming

Purpose of Review

Pediatric HIV differentiated service delivery (DSD) programming has historically lagged behind adult care despite WHO recommendations to include family-friendly alternatives for children and caregivers. This review explores the status of Pediatric DSD programming before the COVID-19 pandemic and then reviews published differentiated approaches that developed during the pandemic.

Recent Findings

Differentiated service delivery programming for adults living with HIV has increased worldwide, and patient outcomes from these programs have been positive. Pediatric DSD programming has lagged, with many children ineligible for multi-month refills. Despite WHO recommendations to space ART visits for children, limited access to viral load monitoring and a lack of viral suppression among children have left them out of this more convenient care option. Community ART groups historically were not structured to include children. Furthermore, after-hours clinics and teen clubs with ART dispensing have not reached the majority of CLHIV.

Summary

This review highlights programs that developed out of necessity during the lockdowns of the pandemic. Ingenuity and creativity forced programmers to provide care to their patients with less patient-clinician interaction. Children became eligible for multi-month dispensing as programs loosened eligibility criteria. Technology helped provide virtual psychological support, and unique ART delivery methods were developed. This rapid expansion or growth spurt, of pediatric DSD programming sped up the inclusion of children into care options that were less burdensome to the family. As we move away from the pandemic and adjust to a new standard, we will remain diligent in ensuring that CLHIV outcomes remain stable or perhaps, improve.

Efficacy and Safety of Convalescent Plasma for COVID-19: A Systematic Review and Meta-analysis

Convalescent plasma is currently being used in the treatment of COVID-19. Recommendations regarding use convalescent plasma in COVID-19 requires systematic summaries of available evidence. We searched the databases Medline, Embase, Cochrane CENTRAL, Epistomonikos, Medrxiv and Biorxiv. Title/abstract screening, full text screening and data abstraction were carried out in duplicate by two reviewers. Pooled effect sizes and 95% confidence intervals were calculated using random effects meta-analysis. GRADE tool was used to rate the certainty of evidence. Twenty two studies were found eligible for inclusion: nine randomized controlled trials and thirteen cohort studies. Low certainty evidence from eight RCTs showed inconclusive effects of convalescent plasma on mortality at 28 days (OR 0.85, 95% CI 0.61 to 1.18). Low certainty evidence from thirteen cohort studies showed a reduction in mortality at 28 days (OR 0.66, 95% CI 0.53 to 0.82). The pooled OR for clinical improvement was 1.07 (95% CI 0.86 to 1.34) representing low certainty evidence. Evidence from three RCTs showed inconclusive effect of CP on the need for mechanical ventilation (OR 1.20, 95% CI 0.72 to 1.98). Four cohort studies reporting unadjusted estimates suggested a reduction in the need for mechanical ventilation with convalescent plasma (OR 0.80 95% CI 0.71 to 0.91, low certainty). Pooled estimates from 2 RCTs showed inconclusive effects of convalescent plasma on the proportion of patients with nondetectable levels of virus in nasopharyngeal specimens on day 3 (OR 3.62, 95% CI 0.43, 30.49, very low-quality evidence). The present review reports uncertain estimates on the efficacy of convalescent plasma in the treatment of COVID-19. There is low certainty evidence of a possible reduction in mortality and mechanical ventilation, a faster viral clearance and the absence of any serious adverse events. However, its efficacy for these outcomes requires evidence from good quality and adequately powered randomized controlled trials.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12288-021-01417-w.

Critical STEM Literacy and the COVID-19 Pandemic

The COVID-19 pandemic has resulted in unprecedented amounts of information communicated to the public relating to STEM. The pandemic can be seen as a 'wicked problem' defined by high complexity, uncertainty and contested social values requiring a transdisciplinary approach formulating social policy. This article argues that a 'Critical STEM Literacy' is required to engage sufficiently with STEM knowledge and how science operates and informs personal health decisions. STEM literacy is necessary to critique government social policy decisions that set rules for behaviour to limit the spread of COVID-19. Ideas of scientific, mathematical and critical literacy are discussed before reviewing some current knowledge of the SARS-CoV-2 virus to aid interpretation of the examples provided. The article draws on experience of the pandemic in the United Kingdom (UK), particularly mathematical modelling used to calculate the reproductive rate (R) of COVID-19, communication of mortality and case data using graphs and the mitigation strategies of social distancing and mask wearing. In all these examples, there is an interaction of STEM with a political milieu that often misrepresents science as activity to generate one dependable truth, rather than through careful empirical validation of new knowledge. Critical STEM literacy thus requires appreciation of the social practices of science such as peer review and assessment of bias. Implications of the pandemic for STEM education in schools requiring critical thinking and in understanding disease epidemiology in a global context are discussed.

Microbiota Modulation of the Gut-Lung Axis in COVID-19

COVID-19 is an infectious disease caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), and according to the World Health Organization (WHO), to date, SARS-CoV-2 has already infected more than 91.8 million people worldwide with 1,986,871 deaths. This virus affects mainly the respiratory system, but the gastrointestinal tract (GIT) is also a target, meanwhile SARS-CoV-2 was already detected in oesophagus, stomach, duodenum, rectum, and in fecal samples from COVID-19 patients. Prolonged GIT manifestations in COVID-19, mainly the diarrhea, were correlated with decreased richness and diversity of the gut microbiota, immune deregulation and delayed SARS-CoV-2 clearance. So, the bidirectional interactions between the respiratory mucosa and the gut microbiota, known as gut-lung axis, are supposed to be involved in the healthy or pathologic immune responses to SARS-CoV-2. In accordance, the intestinal dysbiosis is associated with increased mortality in other respiratory infections, due to an exacerbated inflammation and decreased regulatory or anti-inflammatory mechanisms in the lungs and in the gut, pointing to this important relationship between both mucosal compartments. Therefore, since the mucous membranes from the respiratory and gastrointestinal tracts are affected, in addition to dysbiosis and inflammation, it is plausible to assume that adjunctive therapies based on the modulation of the gut microbiota and re-establishment of eubiosis conditions could be an important therapeutic approach for constraining the harmful consequences of COVID-19. Then, in this review, we summarized studies showing the persistence of SARS-CoV-2 in the gastrointestinal system and the related digestive COVID-19 manifestations, in addition to the literature demonstrating nasopharyngeal, pulmonary and intestinal dysbiosis in COVID-19 patients. Lastly, we showed the potential beneficial role of probiotic administration in other respiratory infections, and discuss the possible role of probiotics as an adjunctive therapy in SARS-CoV-2 infection.

Metabolic Syndrome, Alzheimer's Disease, and Covid 19: A Possible Correlation

Age and comorbidities are key indicators of hospital admission, serious illness, and mortality in COVID-19 patients. Patients with age-related comorbidities, such as cardiovascular disease, hypertension, diabetes, chronic kidney disease, NAFLD, obesity, and metabolic syndrome, are more likely to require hospitalization and suffer severe sickness of COVID-19. Patients with Alzheimer's disease and risk factors associated with dementia may also be more vulnerable to serious COVID-19 infection. Peripheral inflammation, including in patients who recover from illness, may promote the course of neurodegenerative disorders through neuroinflammatory pathways. The aim of this study is to examine the impact of COVID-19 on immunity in patients with age-related diseases such as metabolic syndrome and Alzheimer's disease and also to hypothesize the possible correlation between metabolic syndrome, Alzheimer's disease, and COVID-19. Identifying the mechanisms that explain the complicated interaction between metabolic syndrome, Alzheimer's disease, COVID-19, inflammation, and immunity could be crucial to designing effective pharmacological therapies and procedures. This study adds to our basic information about the new coronavirus by synthesizing current knowledge of these linkages. To reduce inflammation and enhance immunity, patients should acquire good lifestyle practices. Walking, breathing exercises, and a nutritious diet all help in improving lung capacity and immunity. Future research into novel therapeutics for patients with metabolic syndrome, Alzheimer's disease, and COVID-19 inflammation and immunology is encouraged by this paper.

[Six cases of acute pulmonary embolism associated with COVID-19]

Rising from the province of Wuhan in China, the new coronavirus SARS-CoV-2 broke out in winter 2019, causing a global pandemic. In most cases reported, COVID-19 symptoms include cough, dyspnea, myalgia and asthenia. In some cases, the disease can also cause severe respiratory distress syndrome, requiring intensive care. Recent studies suggest that SARS-CoV-2 infection predisposes to thromboembolic event such as pulmonary embolism. Moreover, there is an overlap between signs and symptoms of pulmonary embolism and COVID-19, which brings a challenge for the diagnosis and could potentially be fatal. Nevertheless, the incidence rate of pulmonary embolism in cases of COVID-19 is currently not known. In this paper we describe six cases of pulmonary embolism associated with COVID-19.

[The COVID-19 pandemic : a real opportunity for digital health]

Nowadays, we are facing a global health crisis. The infectious agent, the virus SARS-CoV-2, has some clinical and pathological characteristics which have been described extensively throughout published medical literature. The pandemic outbreak arises in a very particular period. Never before, our political disorganization and lack of collaboration has been highlighted as it was during the present health care crisis. Our health care system is shaking because of the lack of sufficient human and financial resources. However, technological changes, and especially remote health (teleconsultations and remote monitoring) are disrupting the whole ecosystem. We intend to illustrate that the COVID outbreak offers a unique opportunity to accelerate acceptance of these rapid technological changes, which are anyway unavoidable. Teleconsultations and remote monitoring, which both appeared as a devil out of the box from nowhere, at least for some care providers in the health care landscape, are there to stay.

[COVID-19 inside dialysis units]

COVID-19 has been the center of global attention and concern for the last months. Patients undergoing dialysis and especially those treated at the hospital are likely to be infected, due to their mandatory presence at the hospital several times a week and due to their intrinsic fragility in regard of chronic kidney disease, often an older age, and the presence of many associated comorbidities. Thereby, patients with chonic kidney disease treated by haemodialysis have higher odds of a more severe COVID-19 infection with a high mortality rate. Prevention is thus a high priority for these patients.

[Chest radiological lesions in COVID-19 : from classical imaging to artificial intelligence]

In the course of the pandemic induced by the appearance of a new coronavirus (SARS-CoV-2; COVID-19) causing acute respiratory distress syndrome (ARDS), we had to rethink the diagnostic approach for patients suffering from respiratory symptoms. Indeed, although the use of RT-PCR remains the keystone of the diagnosis, the delay in diagnosis as well as the overload of the microbiological platforms have led us to make almost systematic the use of thoracic imaging for taking in charge of patients. In this context, thoracic imaging has shown a major interest in diagnostic aid in order to better guide the management of patients admitted to hospital. The most common signs encountered are particularly well described in thoracic computed tomography. Typical imaging combines bilateral, predominantly peripheral and posterior, multi-lobar, ground glass opacities. Of note, it is common to identify significant lesions in asymptomatic patients, with imaging sometimes preceding the onset of symptoms. Beyond conventional chest imaging, many teams have developed new artificial intelligence tools to better help clinicians in decision-making.

[Coagulopathies, thrombotic risk and anticoagulation in COVID-19]

Clinical observations indicate that COVID-19 often provokes coagulopathies, which have been associated with high morbidity and mortality rates. These coagulopathies likely result from Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection-elicited systemic inflammation and endothelial damage. Patients with severe COVID-19 are at high risk of venous and arterial thromboembolic diseases; they can also develop disseminated intravascular coagulation in the most advanced stages of the disease. Medical Organisations on Thrombosis and Hemostasis, among which the Belgian Society on Thrombosis and Haemostasis (BSTH), have formulated recommendations for the prophylaxis and treatment of COVID-19-related venous thromboembolism in ambulatory and hospitalised patients, as well as for the anticoagulation of COVID-19 patients in need of long-term anticoagulation for unrelated cause.These recommendations provide every hospital and primary care physicians with an easy-to-use clinical guidance; they mainly rely on limited level of evidence and are likely to evolve with knowledge of COVID-19 pathophysiology and availability of data from ongoing clinical trials.

[The COVID-19 breaker : PCR to the rescue !]

Chronicle of a crisis management at the Clinical Microbiology Laboratory of CHU Liège The SARS-CoV-2 outbreak in December 2019 in China and its expansion across the world and Europe have requested the participation of clinical laboratories as major players in the diagnosis of COVID-19, to perform PCR tests mainly on nasopharyngeal swabs. In Belgium, the first confirmed COVID-19 patient was diagnosed in early February, the first of many, especially travelers returning from winter sports. In order to meet the ever-increasing demands for testing, the Clinical Microbiology Laboratory of the CHU of Liege had to adapt to this situation: firstly, by developing manual PCR tests and then automated solutions, permitting to increase the number of analyzes by ensuring a short turnaround time of results. Then, a system for the communication of results on a large scale has been set up, and finally solutions to deal with the lack of sampling devices have been found. This first wave of the pandemic has also highlighted an unprecedented solidarity within the institution. In this article, we recount the chronology of the management of this unprecedented health crisis within the Clinical Microbiology Laboratory of the CHU of Liege.