COVID-19: Expert Review of Relevant and Emerging Literature

COVID-19: Expert Reviews of Relevant and Emerging Literature2020-08-04T06:44:14-04:00
Published on :  | By Maria Brann

Review: Talking your team through a crisis

This article provides steps for physicians to effectively communicate with their teams during the COVID-19 pandemic.

Communicating during uncertainty is an essential leadership skill, regardless of whether one is in a formal leadership position. The author provides five steps for health care providers to be effective at communicating with team members about COVID-19 and to help reduce anxiety:

  • Pause and breathe (calm yourself before communicating with others)
  • Put yourself in their shoes (think about what you would want to know if you were in their position)
  • Do your research (use credible sources to avoid misinformation)
  • Speak clearly and confidently (and be honest about what you know)
  • Have specific next steps (provide tangible action items they can take)
Published on :  | By Megan McHenry

COVID Cuts: A brief summary of this week’s COVID-19 clinical research

Vaccine Update: 

The mRNA-1273 vaccine (from Moderna and NIAID) induced anti-SARS-COV-2 immune responses (anti-Spike-2P glycoprotein antibody) in all participants and no trial-limiting safety concerns were identified.

Epidemiology:

During hospital-wide SARS-CoV-2 antibody (Ab) screening in healthcare workers (HCW) and staff in Belgium, 6.4% had IgG antibodies for SARS-CoV-2

During hospital-wide SARS-CoV-2 Ab screening in HCW and staff at Mass Gen Hospital (performed in 3 phases), 12.9% had positive results for SARS-CoV-2, and universal masking policy was associated with a significantly lower rate of SARS-CoV-2

Overall SARS-CoV-2 PCR- positivity rates of HCW in a pediatric setting in Paris was 2.3% (compared to 2.8% in an associated adult setting)

Treatment:

Within a retrospective review of critically ill adults with SARS-CoV-2 pneumonia, no difference was found between hydroxychloroquine or lopinavir/ritonavir compared to standard of care

Case Reports: 

Child with Guillain-Barre syndrome after COVID-19

Child receiving remdesivir during induction chemotherapy for newly diagnosed pediatric acute lymphoblastic leukemia with concomitant SARS-CoV-2 infection

Child with oral ulceration as an early feature of multisystem inflammatory syndrome in children (MIS-C)

Two children with COVID-19 positive PCR swab upon MIS-C presentation

Immunology:

Humoral and circulating follicular helper T cell responses in a cross-sectional adult cohort who had recovered from COVID-19 infection

Description of a rapid antibody discovery platform that isolated hundreds of human monoclonal antibodies again SARS-CoV-2 spike protein

SARS-CoV-2-specific T cell immunity in cases of COVID-19 and SARS, and uninfected controls

Impaired type I interferon activity and inflammatory responses in severe COVID-19 patients

 

Published on :  | By Daniel Orenstein

Ethics, Law & Policy Roundup: Staff, Stuff, Space & Systems

Facilities & Providers

In response to case surge in Arizona, hospitals in the state requested waiver of several legal requirements that generally protect patients against abuse, neglect, and discrimination, as detailed in this Arizona Republic article. The state health department responded by waiving 16 of the 35 provisions highlighted by the hospital association. Among the requirements waived were mandates that hospitals post patient rights language in all facilities, provide written patient rights statements upon admission, and provide privacy during communications with social services. Among the provisions the state declined to waive were those requiring hospitals to provide emergency services to all individuals who request them, to ensure that all medical and nursing personnel are CPR qualified within 30 days of start date, and rules governing patient transfers.

This Acta Biomedica article by Capolongo et al. proposes 10 strategies for new hospitals and refurbishment of existing hospitals to improve resilience and ability to adapt quickly to new challenges. The authors structure the strategies in two tiers: design and operations. Design strategies discussed are: Strategic Site Location; Typology Configuration; Flexibility; Functional program; and User-centeredness. Operations strategies discussed are: Healthcare network on the territory; Patient safety; HVAC and indoor air quality; Innovative finishing materials and furniture; and Healthcare digital innovation.

This commentary by Sharma et al. discusses particular challenges faced by health care providers in rural and underserved areas, including limited health care infrastructure, distance to advanced care, and population characteristics such as tobacco use, hypertension, obesity, and age. The authors offer guidance to address these issues using alternative ventilator strategies, novel PPE, and common therapeutic options. Alternative ventilator strategies include conversion of non-invasive ventilators and anesthesia machines. Novel PPE includes use of anesthesia masks with HEPA filters, sewing masks from sterile wrapping material from surgical instruments, and using 3-D printing to produce masks and face shields. Therapeutic options discussed include convalescent plasma and remdesivir, as well as potentially tocilizumab with appropriate IRB oversight if data supports this. The article also recommends use of clear drapes or intubation boxes for high-risk airway procedures to reduce HCW exposure, as well as expanded screening of HCWs and nursing home residents.

 

Supplies

This CNN article and this STAT article discuss challenges currently facing hospitals regarding distribution of remdesivir. According to hospitals, distribution to hotspot locations has not kept pace with the number of hospitalized patients, while other states and locations have more than they currently need. Phamaceutical manufacturer Gilead Sciences donated 940,000 vials to the U.S. government, and the administration has secured a further supply for 500,000 patients and is distributing according to states according to case data.

This AJPH article by Sinha, Burgeois & Sorger address community-level responses to shortages of PPE and other supplies to address supply chain fragility. The authors discuss local fabrication of a variety of items with emphasis on regulatory considerations, including: ventilators, vent splitters, N95 respirators, mask frames, surgical/cloth masks, nasopharyngeal swabs, PAPRs, face shields, PPE sanitizing techniques, surgical/procedure gowns, hand sanitizers, and scrubs.

 

Resource Allocation

This article by Han and Koch in Disaster Medicine and Public Health Preparedness, written by staff members of the New York State Task Force on Life and Law involved in the group’s Ventilator Allocation Guidelines Project, compares the 2007 and 2015 versions of the guidelines with emphasis on incorporation of advances in medicine and societal values.

Both versions rely on the same ethical principles (duty to care, duty to steward resources, duty to plan, distributive justice, and transparency) and apply clinical criteria to evaluate likelihood to survival in order to allocate ventilators during scarcity (applying first exclusionary criteria, then assessment using SOFA score, then periodic clinical assessments). Key changes from the 2007 to 2015 guidelines include limiting definition of survival to short-term survival (limiting impact of personal bias or quality of life assessments), restricting exclusionary criteria to those associated with immediate and near-immediate mortality that can be assessed with appropriate accuracy, and clarification on use of SOFA scores and periodic clinical assessments.

The authors also discuss recommendations released by other entities, including those specific to COVID-19, and how they compare to the New York guidelines, including rejection of exclusionary criteria.

 

This Pediatrics article by Antiel et al. (currently a peer reviewed pre-publication version) addresses whether pediatric patients should be prioritized for scarce life-saving treatments (specifically ECMO) during the COVID-19 pandemic. The article presents comments by a variety of experts in critical care, end of life care, bioethics, and health policy. Reflecting the diversity of opinion on this issue, the comments offer a variety of approaches:

  • Antiel & Curlin: 3-part rationing approach using prognosis first, followed by age as a tie-breaker, then random lottery for roughly equivalent cases
  • Persad & White: age-based prioritization for pediatric patients based on “fair innings” theories (young patients have had the least opportunity to live through all stages of life), but distinguished from general prioritization by life expectancy
  • Zhang, Clickman & Emanuel: multi-principle framework (based on the principle that any individual allocation principle will be flawed and insufficient standing alone) that incorporates pediatric prioritization as one among several factors for allocation that also considers prognosis, saving the most lives, lottery, and prospective instrumental value during a crisis.
  • Lantos: priority for pediatric patients as reflecting fairness from a life stage perspective and distinct from other prohibited discriminatory factors such as social worth, race, disability, gender, wealth, or fame.

This commentary proposes a cultural framework for community-engaged global communication responses to COVID-19.

Community engagement requires knowledge of culture in framing COVID-19 messages to reduce collective risks. Structural inequity is evident is minority communities nationally and globally and therefore must be considered when encouraging community engagement for collective actions. Although messages about COVID-19 prevention behaviors (e.g., social distancing) may be the same globally, framing strategies differ across cultures and communities (e.g., individualist versus collectivist). The authors argue for using the PEN-3 cultural model developed in 1989 to engage communities in communication about COVID-19 mitigation efforts. The model consists of three domains with three factors that form the acronym PEN:

  • Cultural identity: person, extended family, neighborhood
  • Relationships and expectations: perceptions, enablers, nurturers
  • Cultural empowerment: positive, existential, negative

Using this model, the focus on cultural decision making about the pandemic is about what societal reasoning and rationale are at the foundation of each message and which populations and communities are the intended audience for the tailored messages. Reframing COVID-19 communication messages must include the community has a collective and not just individual decisions.

This brief report highlights the need for an increased public health presence on social media to educate community members about COVID-19 myths.

This study assessed COVID-19 knowledge among educated individuals and determined that survey respondents were generally not knowledgeable about most COVID-19. Even college-educated individuals had low health literacy levels, which contributes to misunderstanding of COVID-19 information. The participants valued information from public health experts more so than government officials and accessed most of their information from the Internet and social media, suggesting that health educators, medical personnel, and public health practitioners should develop communication strategies for online dissemination to improve knowledge. The study highlights the need for continued high-frequency communication with all populations, but particularly high-risk communities, through frequently accessed online sources.

This article discusses the opportunities offered by various social media platforms for health care providers to disseminate essential health information related to COVID-19 to other providers and the public.

Although much of the communication about COVID-19 has been communicated to health care providers via email, it is recommended to make better use of multiple social media platforms for this information. This can be more efficient than flooded inboxes without filtering capabilities and that are prone to spam messages. Virtual communities by health care professionals are increasing on Facebook, which creates an opportunity for collaboration in discussion forums. Additionally, many physicians, for example, are influencers who can use social media platforms like Facebook and Instagram to communicate with the public. This provides more trustworthy sources of information for the public to gather information via channels they are most comfortable. Reddit is another platform that health care providers could use for discussion forums, not only with their colleagues but also with an interested public. Finally, TikTok allows providers to create short mobile videos to provide information, particularly demonstrating specific recommendations such as how to properly wash hands, use a mask, or social distance. Health care providers need to provide supportive communication, clear guidance, and accurate information using outlets that people are using, which includes more social media than traditional media platforms.

Published on :  | By Maria Brann

Review: Supporting your team during a global pandemic

In this Nursing Management Leadership Q&A, senior vice president and CNO of Thomas Jefferson University Hospitals in Philadelphia provides advice for leaders to support their health care teams to minimize feelings of stress and being overwhelmed.

When asked by an overwhelmed and overstressed leader how to support one’s team, the following advice was given:

  • Recognize that you are not alone
  • Practice complete transparency
  • Communicate in an open, honest, and direct manner
  • Care for yourself so you are able to care for others
  • Know your limits and ask for help when needed
  • Celebrate successes, even the small ones
  • Spread gratitude

Communicating not only factual information but also supportive and appreciative comments is essential for health care members to reduce stress and anxiety.

Published on :  | By Maria Brann

Review: Health literacy and early insights during a pandemic

This commentary highlights the need to focus on health literacy when designing messages to reach the most vulnerable populations affected by COVID-19.

A significant proportion of adults in industrialized countries have low health literacy and numeracy skills. It is important, therefore, to make information accessible by paying attention to tone and voice, organization of information, vocabulary, numbers, and data presentation. When doing this, health communicators and educators should consider the following steps when designing health messages:

  • Commit to rigor and test COVID-19 information before releasing those messages to the public
  • Apply evidence-based organizational and stylistic approaches that increase comprehension
  • Use everyday language with helpful explanations for anything new
  • Explain and provide meaningful context and interpretation of numbers
  • Highlight protective health behaviors and provide specific instructions

Following these recommended guidelines can help individuals create clear, understandable messages. By focusing on health literacy, disparities and inequities during the COVID-19 pandemic may be reduced.

Published on :  | By Maria Brann

Review: COVID-19: Lessons in risk communication and public trust

This editorial highlights the need for more nuanced and targeted messaging to be effective with the public as the COVID-19 pandemic evolves.

The public’s response to the COVID-19 pandemic has depended on a high level of trust in government information. Governments that heeded public health advice and provided clear messages have controlled the virus the best. Unfortunately, many governments did not provide clear and consistent messages, which led individuals to seek alternative unreliable sources of information that have led to confusion. General social marketing campaigns that may have been effective at the beginning of the pandemic must evolve to include more nuanced and targeted messaging that uses a wider range of messages and media channels than before. The government must be more proactive in tackling risk communication challenges.

 

This article expands existing health communication principles based on lessons learned from the unique challenges introduced by the COVID-19 pandemic.

Researchers adapted key principles of health communication from the 2014 Ebola crisis and the mad cow disease outbreak in the mid-1990s in light of the challenges that have emerged during the COVID-19 pandemic. Three general areas of capacity building for health communication have emerged from the ongoing pandemic:

  • Be proactive (compete for attention, establish trusted leadership, fight false information)
  • Plan ahead, but acknowledge uncertainty (consider growing scientific evidence)
  • Focus on people (be aware of health and media literacy)

Health communicators must take into consideration the new challenges not seen before in previous health crises: an unprecedented infodemic, communication of risk and uncertainty, the instantaneous nature of social media and its effect on health-information behaviors, the relationship between health literacy and media literacy, the effects of the pandemic on other mental and physical health issues, and the need for flexibility as the pandemic changes. In light of these new challenges, the authors proposed the following principles for effective health communication:

  • Set shared goals
  • Establish coordinated responses
  • Devise a communication strategy
  • Implement the communication plan
  • Be ready to adapt

The article provides a checklist of communication practices for each of these principles. It is essential for health communicators to be proactive in addressing these new challenges to increase societal COVID-19 resilience.

Published on :  | By Aaron Carroll

ICYMI – The COVID-19 week in review (July 10, 2020).

This will be an ongoing, weekly post that will highlight the things you should have read (at least in MY opinion).

Articles you might have missed:

  1. The Pandemic Experts Are Not Okay. Always read Ed Yong.
  2. Months Into Virus Crisis, U.S. Cities Still Lack Testing Capacity, by Sarah Mervosh and Manny Fernandez.
  3. The Fullest Look Yet at the Racial Inequity of Coronavirus, by Richard A. Oppel Jr., Robert Gebeloff, K.K. Rebecca Lai, Will Wright and Mitch Smith.
  4. 239 Experts With One Big Claim: The Coronavirus Is Airborne, by Apoorva Mandavilli

Documents for your review:

What I’m reading:

Published on :  | By Casey Cummins

Review: COVID-19 infection post recovery: Reinfection or reactivation?

As we begin to move toward a new normal while still in the midst of an ongoing pandemic, we are faced with the question of how to protect ourselves from an initial infection, and a possible reinfection of the virus known as COVID-19. We know little about the novel coronavirus that has impacted the world, many questions remain on how long viral shedding lasts, when someone is most infectious, and if a person can recover completely and then become re-infected with the virus. Research is currently being done to determine if those who are found to be positive after an initial recovery are due to reinfection, or if reactivation of the virus is occurring.

There have been reports of patients testing positive a second or even third time after recovering from an initial COVID-19 infection. A recent retrospective study examined a case series in the U.S. consisting of 11 virologically confirmed patients, who were experiencing a second acute COVID-19 episode. Reinfection and reactivation were contemplated as the cause as individuals were closely examined for outcomes. In these cases, the second confirmed case occurred on average, >21 days from the first infection. The median duration of symptoms in the first episodes were 18 days, and 10 days for the second episode. Four health care workers in this group had mild cases and complete recovery, 3 were re-exposed at work and one at home. All had a clinical relapse after a median symptom-free interval of 9 days. Of the seven additional patients, two died from ARDS and one from heart failure. All patients had a second confirmed test from respiratory samples after a complete recovery period. During the second episode, four of the seven older adults had worsening CT scans. In this study, reinfection was suspected among the healthcare workers due to the exposure to COVID-19 in their workplace. Among the older patient population, viral reactivation is suspected due to the chronic comorbidities experienced by the group in addition to suboptimal treatment during the infection, allowing for viral replication.

A small study of 9 patient’s revealed greater clinical severity produced higher antibody titers in these individuals, however, this was not always correlated with clinical improvement. The viral burden peaked early on in the illness and then declined as the body responded to antibody production and the viral load decreased. This study proposed that detection of viral RNA weeks after recovery does not likely relate to a meaningful risk in the absence of symptoms. Most importantly, this study used other coronaviruses as a model for relevance and understanding. In the other coronaviruses, IgG remained high over 4-5 months while slowly declining over time (2-3 years), which concludes that detection of antibodies is not indicative of durable immunity. Although no evidence of post recovery transmission was discovered, it may not be ruled out.

One study out of China examined 37 patients in the Wanzhou district who had confirmed RT-PCR testing and no relevant symptoms in the 14 days prior to hospitalization. In this group, the median duration of viral shedding was 19 days. Surprisingly, the asymptomatic patients had a significantly longer duration of viral shedding when compared to the group who were symptomatic. Asymptomatic individuals had a reduced IgG and neutralizing antibody level when compared to symptomatic patients, and overall have a weaker immune response to the virus. This information is relevant to the topic as it lends information to how long viral shedding may take place during an initial infection. This study insinuates that a person may have viral shedding for longer than originally anticipated.  Current recommendations suggest that a positive individual isolate/quarantine for 14 days under the time-based strategy. This study suggests that the viral shedding period lasts approximately 5 days longer than the current recommended quarantine period of 14 days. In addition, asymptomatic carriers are shedding longer than those who are symptomatic which indicates they may be exposing a much greater number of individuals prior to receiving a positive COVID-19 test. Of course, further research would be needed for this to be solidified by evidence. This could greatly influence an asymptomatic individual’s ability to re-infect and/or re-expose others.

Although the literature is lacking solid evidence that reinfection is possible, there are several mentions of the possibility among the current research:

In one report out of Guangong Province: 14% of discharged/recovered patients were tested positive. For example, one woman specifically discussed tested positive after a hospital discharge although she had two prior consecutive negative tests at day 26 and 28 (Kang, Wang, Tong, et al, 2020).

Another retrospective study evaluated one patient whom was hospitalized three times during 108 day timeframe. The viral shedding in this individual lasted 65 days. The time from symptom onset to disappearance was 95 days. Throughout the duration of this observation period, the patient had abnormal erythrocyte indicators, abnormal liver function and serum lipid metabolism. In this patient’s case, viral shedding lasts far longer than what is typically discussed in the current literature. If others have prolonged viral shedding, this may influence the results of a retest, may increase risks of exposure to another individual, and may increase the infection rates in an area.

The CDC states that many recovered individuals do not have detectable levels of SARS-CoV-2 RNA in their URT specimens, but after two negative tests, end up testing positive later. We know that viral RNA can be detected for weeks in some individuals, however, studies have not proven how long a person remains infectious to others. Typically, after the onset of illness, detectable viral burden declines over time. After a week or more, anti-SARS-CoV-2 immunoglobulin is detectable and antibody titers increase (CDC, 2020). Studies to isolate live virus from URT specimens have been unsuccessful when the infection is >10 days from onset. No solid evidence exists to prove that antibody titers are successful in protecting a patient from reinfection. If a patient tests positive for COVID-19 after an initial recovery, they should again be quarantined until further studies determine if a person with detectable antibodies are immune to reinfection. Once again, further investigation and robust studies are needed to support the likelihood of re-infection or viral reactivation after an initial COVID-19 recovery.

 

References

Batisse, D., Benech, N, Botelho-Nevers, E., et al. (2020). Clinical recurrences of COVID-19 symptoms after recovery: Viral relapse, reinfection, or inflammatory rebound? Journal of Infection (2020). Doi: https://doi.org/10.1016/j.jinf.2020.06.073

CDC. (2020). Clinical Questions about COVID-19: Questions and Answers. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html#:~:text=The%20immune%20response%2C%20including,is%20not%20yet%20understood.

CDC. (2020). Test for Past Infection. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/testing/serology-overview.html

Kang, H., Wang, Y., Tong, Z., and Liu, X. (2020). Retest positive for SARS-Co-2 RNA of “recovered” patients with COVID-19: Persistence, sampling issues, or re-infection? DOI: 10.1002/jmv.26114

Kirkcaldy, R., King, B., & Brooks, J. (2020). COVID-19 and Postinfection Immunity: Limited evidence, many remaining questions. doi:10.1001/jama.2020.7869

Liu, F., Cai, Z., Huang, J., et al. (2020). Positive SARS-CoV-2 RNA recurs repeatedly in a case recovered from COVID-19: Dynamic results from 108 days of follow-up. Doi: 10.1093/femspd/ftaa031

Long, Q., Tang, X., Shi, Q., et al. (2020). Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections. https://doi.org/10.1038/s41591-020-0965-6

Okhuese, A., (2020). Estimation of the Probability of Reinfection with COVID-19 by the Susceptible-Exposed-Infectious-Removed-Undetectable-Susceptible Model. https://publichealth.jmir.org/2020/2/e19097/

This article is a preprint and has not been peer-reviewed. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.

 

This article presents an easily accessible COVID-19 “quicksheet” to provide frontline workers with the most up-to-date information.

Because the rate of influx of information about COVID-19 is fast and from multiple sources, the authors created a one-page centralized document (previewed in the article) to include the most up-to-date and relevant information for frontline workers. It is a condensed summary of longer, more detailed protocols. The most pertinent items include a header, updates, PPE recommendations, consult policies, emergent airway management, coverage policies, and self-monitoring. The quicksheet is updated on a daily basis by an appointed person who reviews daily information and distills it to the most important information. This central, interdepartmental communication tool is a useful template for a safety reference for frontline workers during a time of tremendous change and uncertainty.

Published on :  | By Daniel Orenstein

Ethics, Law & Policy Roundup: Staff, Stuff, Space & Systems

Vulnerable Populations

A webinar TODAY (Thursday, July 9 at 3pm EST) from the Network for Public Health Law addresses the impact of the COVID-19 pandemic on diverse vulnerable populations, including Black/African Americans and Latinx, persons with disabilities, immigrants, persons who are incarcerated, older adults, nursing home residents, and persons who are homeless. The central role of palliative care across all systems will be addressed and a trauma-informed perspective in working with those affected by the pandemic, as well as the critical importance of workforce education and training.

 

Facilities

This article by Noble et al. details the ED and health system response at UCSF in preparation for COVID-19 surge in San Francisco in February 2020, providing a comprehensive example and potential model for other EDs facing surge. A focus is the rapid deployment of “accelerated care units” (two negative-pressure treatment shelters), including associated communication, security, testing, staffing, leadership, and workflow needs.

This Health Affairs blog by Chernew et al. addresses the decline in health care services utilization in response to COVID-19 and what its effects on facilities and patient health mean for value and efficiency in structuring alternative payment models to prepare for future outbreaks.

 

Supplies: PPE

This AP article and this NY Times article describe the continued shortages of PPE as the toll of the pandemic and resurgence in hospitalizations have depleted critical stocks. Initial shortages were widely reported but were most acute at large urban hospitals in particular areas. But continuing demand now affects a wide range of facilities nationally, as only limited federal coordination of procurement or distribution has materialized and has been criticized for distribution strategies. PPE shortages have led to nonstandard reuse (e.g., of disposable N95 masks) and use of less protective options (e.g., surgical masks vs. N95s; in some cases garbage bags vs. gowns) that may increase infection risks for frontline health care workers. Shortages have also caused continued closure of practices and office, resulting in significant delays in patient care, including for serious but currently non-life-threatening conditions.

This systematic review and meta-analysis evaluated the available evidence to date regarding physical distancing, face masks, and eye protection to prevent spread of COVID-19.

The authors identified 172 observational studies across 16 countries and six continents, with no randomized controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). Within these studies, they found:

  • Viral transmission was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10,736, pooled adjusted odds ratio [aOR] 0.18, 95% CI 0.09 to 0.38; risk difference [RD] -10·2%, 95% CI -11.5 to -7.5; moderate certainty)
  • Protection increased as distance was lengthened (change in relative risk [RR] 2.02 per m)
  • Face mask use could result in a large reduction in risk of infection (n=2,647; aOR 0.15, 95% CI 0.07 to 0.34, RD -14.3%, -15.9 to -10.7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar
  • Eye protection also was associated with less infection (n=3,713; aOR 0.22, 95% CI 0.12 to 0.39, RD -10.6%, 95% CI -12.5 to -7.7; low certainty).
  • Unadjusted studies and subgroup and sensitivity analyses showed similar findings

These findings suggest the use of non-pharmaceutical interventions, such as physical distancing of more than about 3 feet and wearing a medical mask and eye goggles, to reduce COVID-19 transmission. However the authors also note that the certainty of the evidence for face and eye mask protection is low and other measures, like physical distancing, are by far the most effective at reducing spread of coronavirus. They call for robust randomized trials and proper risk assessments of control measures, rather than casual assumptions.

An accompanying editorial highlights several of the review’s findings, including a subanalysis that found N95 respirators were 96% effective, considerably more so than other mask types.

Published on :  | By Erika Cheng

Review: Challenges estimating total lives lost in COVID-19 decisions

This Viewpoint discusses how COVID-19–related policy decisions lead to trade-offs between medical, economic, social, and psychological outcomes, and emphasizes the need to account for deaths associated with unemployment and depression when estimating excess mortality.

The author believes that with new unemployment claims in the US alone reaching 40 million, and with unemployment associated with all-cause mortality, it may be time to more seriously, and quantitatively, take the social, economic, and psychological consequences of policies into account in decision-making when calculating total lives lost from the COVID-19 pandemic.

He urges researchers and policy makers to consider other factors associated with mortality  such as delayed treatments, for example, for heart disease or cancer, and prolonged absence of preventive health care and vaccinations. It would be a mistake to ignore these other considerations, he argues, because there may come a point at which the number of lives lost from economic, social, and psychological consequences of different policy decisions will outweigh the number of lives lost from infection.

Published on :  | By Erika Cheng

Review: COVID-19 cases and deaths in federal and state prisons

This study describes COVID-19 case rates and deaths among federal and state prisoners in the United States and compares them with the general population. Results show that COVID-19 case rates have been substantially higher and escalating much more rapidly in prisons than in the US population, with infection rates exceeding 65% in several facilities.

The authors also found that by June 6, 2020:

  • There had been 42 ,107 cases of COVID-19 and 510 deaths among 1,295,285 prisoners
  • The case rate was 3,251 per 100,000 prisoners, which was 5.5 times higher than the US population case rate of 587 per 100 ,000
  • The crude COVID-19 death rate in prisons was 39 deaths per 100,000 prisoners, which was higher than the US population rate of 29 deaths per 100,000
  • Individuals aged 65 years or older comprised a smaller share of the prison population than of the US population (3% vs 16%, respectively) and accounted for 81% of COVID-19 deaths in the US population
  • The adjusted death rate in the prison population was 3.0 times higher than would be expected if the age and sex distributions of the US and prison populations were equal
  • The COVID-19 case rate was initially lower in prisons but surpassed the US population on April 14, 2020
  • The mean daily case growth rate was 8.3% per day in prisons and 3.4% per day in the US population
Published on :  | By Maria Brann

Review: The coronavirus infodemic

This article provides best practices for assessing information about COVID-19.

The author provides best practice, common sense, and fact-checking questions to ask when evaluating health information:

  • Are multiple outlets reporting the same information?
  • What is the most credible source of information?
  • Do multiple articles report contradictory information?
  • What is the underlying source material?
  • Is the source of the original research one of the leading, peer-reviewed journals in the field?
  • Are the charts and graphs an accurate representation of the scientific research presented in the article?
  • Is the information plausible
  • Is the article headline a variation on the theme of “The Secret That Even Doctors Won’t Tell You”?
  • If the breakthrough is a drug claim, has it been used in human trials?
  • Does the article have a comments section?
  • What happens if you do your own research on the topic, along with other keywords such as “myth,” “hoax,” “scam,” “false,” “clickbait,” and “junk science”?

This editorial provides new perspectives from four continents to better understand how to mitigate the impact of controversial health and science topics on public engagement.

Digital media, especially online social networks, facilitate and foster mis/disinformation about health and science. The current infodemic has circulated false, life-threatening information about the origins of, and potential cures for, COVID-19. Many of the conspiracy theories are actually not new, but are recycled stories applied to the COVID-19 pandemic. This confirms that it is not technology alone that has created the infodemic problem; it is simply a catalyst for spreading mis/disinformation. The fundamental issue is that people are still willing to believe unmistakably unscientific or counterintuitive messages, especially when politicians, celebrities, and online influencers help perpetuate the falsehoods. Exploring how to effectively frame messages is key to reducing the acceptance of this mis/disinformation.

This study determined that officials need to balance alarming messages with reassurance to better manage crises.

By analyzing alarming and reassuring tweets of official communication sources during the COVID-19 outbreak, researchers provide insights about how messages change when retweeted. Knowing the difference in the way social media users retweet messages provides officials important information to managing a virus outbreak. For example, educational or awareness campaigns flagging highly alarming messages and providing reassuring and informative messages to reduce chaos and uncertainty could be employed.

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