Outcomes of COVID-19 Vaccination Efforts in Florida from December 14, 2020 to March 15, 2021 on Older Individuals

Per-capita, Florida ranks second in those 65 years of age and older (20.5%) with more than 4,500,000 individuals in this category. COVID-19 vaccine was allocated in a phased roll-out beginning December 14, 2020. Phase 1A included health care personnel with direct patient contact, and residents and staff of nursing homes (NHs) and assisted living facilities (ALFs). Following this initial phase, individuals 65 years of age and older became eligible for vaccination, along with individuals determined by hospital providers to be extremely medically vulnerable to COVID-19. This strategy was based on the desire to most immediately reduce morbidity and mortality, as COVID-19 morbidity and mortality is age-related. Through March 15, 2021, 4,338,099 individuals received COVID-19 vaccine, including 2,431,540 individuals who completed their vaccination series. Of all those vaccinated, 70% were 65 years of age and older, and 63% of those 65 years of age and older. Beginning February 1, 2021, the decline in the number of new cases per week became greater in those 65 years of age and older than those younger. By March 15, 2021, the number of new cases, hospitalizations, and deaths per day for those 65 years of age and older relative to mid-January, were 82%, 80%, and 92% lower respectively. In comparison, the number of new cases, hospitalizations, and deaths per day for those younger than 65 years of age were 70%, 60%, and 87% lower respectively. Reductions in rates in those 65 year of age and older, were thus greater than in those who were younger (p <0.01; Wilcoxon test). These data show that vaccination efforts directed at those 65 years of age and older results in accelerated rates of overall declines in COVID-19 hospitalizations and mortality.

Cross-disciplinary perspectives on the transition to remote education

The COVID-19 pandemic has prompted the cancellation of clinical attachments and face-to-face teaching at medical schools across the world. Experiential learning—through simulation or direct patient contact—is essential for the development of clinical skills and procedural knowledge. Adapting this type of teaching for remote delivery is a major challenge for undergraduate medical education. It is also an opportunity for innovation in technology enhanced learning and prompts educators to embrace new ways of thinking. In this article, the authors explored how educators from different disciplines (medicine, music and performing arts) are using technology to enhance practical skills-based learning remotely.The authors, five experienced educators from different fields (surgery, medicine, music and magic), jointly documented the transition to technology enhanced remote teaching through a series of five structured conversations. Drawing from literature on distance learning in medicine and professional experience in education, the authors identified seven practice-enhancing recommendations for optimising teaching of procedural knowledge and skills. These are: (1) make a virtue out of necessity; (2) actively manage your environment; (3) make expectations clear; (4) embrace purposeful communication; (5) use digital resources; (6) be prepared for things to go wrong and (7) personalise the approach. The authors argue that widening the discourse in technology enhanced learning to include cross-disciplinary perspectives adds richness and depth to discussions. This article demonstrates a cross-disciplinary approach to addressing challenges in technology-enhanced medical education.

Community prevalence of SARS-CoV-2 in England: Results from the ONS Coronavirus Infection Survey Pilot

Objective: To estimate the percentage of individuals infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) over time in the community in England and to quantify risk factors. Design: Repeated cross-sectional surveys of population-representative households with longitudinal follow-up if consent given. Setting: England. Participants: 34,992 Individuals aged 2 years and over from 16,722 private residential households. Data were collected in a pilot phase of the survey between 26 April and 28 June 2020. Main outcome measures: Percentage of individuals in the community testing positive for SARS-CoV-2 RNA using throat and nose swabs. Individuals were asked about any symptoms and potential risk factors. Results: The percentage of people in private-residential households testing positive for SARS-CoV-2 reduced from 0.32% (95% credible interval (CrI) 0.19% to 0.52%) on 26 April to 0.08% (95% CrI 0.05% to 0.12%) on 28 June, although the prevalence stabilised near the end of the pilot. Factors associated with an increased risk of testing positive included having a job with direct patient contact (relative exposure (RE) 4.06, 95% CrI 2.42 to 6.77)), working outside the home (RE 2.49, 95% CrI 1.39 to 4.45), and having had contact with a hospital (RE 2.20, 95% CrI 1.09 to 4.16 for having been to a hospital individually and RE 1.95, 95% CrI 0.81 to 4.09 for a household member having been to a hospital). In 133 visits where individuals tested positive, 82 (61%, 95% CrI 53% to 69%) reported no symptoms, stably over time. Conclusion: The percentage of SARS-CoV-2 positive individuals declined between 26 April and 28 June 2020. Positive tests commonly occurred without symptoms being reported. Working outside your home was an important risk factor, indicating that continued monitoring for SARS-CoV-2 in the community will be essential for early detection of increases in infections following return to work and other relaxations of control measures.

Test, track, and trace: How is the NHSX Covid app performing in a hospital setting?

ObjectiveTo assess the uptake and use of the trial contact tracing app developed by NHSX by healthcare workers.DesignCross-sectional study using survey questionnaire.SettingHealthcare industry: St Mary’s Hospital, a small NHS district hospital on the Isle of Wight, United Kingdom.ParticipantsNHS staff members employed by the Isle of Wight NHS Trust.ResultsOf 3100 eligible staff members, 462 (~15%) responded to the survey. Of the respondents, 90% were aged between 31 and 65, and half had direct patient contact through their job role. Almost three quarters (73%) used social media apps on their smartphones. 421 out of 460 respondents had no trouble downloading and installing the NHSX Covid app on their smartphones. 20% of respondents were left confused by instructions to turn off Bluetooth when wearing PPE. Only 35 people either had to report symptoms or received an alert of contact with a suspected covid case. Of these over 20% were not clear what to do in such a situation.ConclusionsThe trial app has been embraced and adopted well. Many have experienced no problems with it. However, some healthcare workers have been unable to download or install the app due to compatibility issues and some have been left confused by having to turn off Bluetooth whilst wearing PPE.This raises questions as to the effectiveness of the app for its intended purpose in contact tracing efforts.RecommendationsWe recommend that the wording of alerts and guidance provided by the app be made clearer and more accessible. We also recommend developments to the app to facilitate use by healthcare workers in a clinical setting. We also propose that ‘app instructors’ be made available in hospitals to ensure that patients and staff can access help and advice on use of the app.

Factors Influencing US Allopathic Medical Students to Choose Pathology as a Specialty

The SARS-CoV-2 pandemic has highlighted the crucial role of pathologists in the health care system at a time of significant decline in the number of US medical students matching to pathology residency positions. To understand this decline, a national survey of fourth-year US allopathic medical students was conducted to assess experiences, knowledge, and attitudes of pathology and factors that impact specialty choice. Participating in a separate pathology course did not increase the probability of choosing pathology. Experiences significantly associated with choosing pathology included clinical or research opportunities in pathology during the last 2 years of medical school, autopsy observation/participation, and participation in pathology interest groups. Many respondents felt they were not sufficiently exposed to pathology to consider it as a specialty. Those who considered pathology but did not choose it were less likely to report understanding the activities of pathologists and being recruited by pathology faculty and more likely to express a preference for more direct patient contact as compared to those entering pathology. In general, respondents agreed that pathology has a good work–life balance and a satisfying degree of intellectual challenge. On the other hand, respondents generally agreed that information on social media and perception of the pathology job market do not seem to be positive and few agreed that pathology is a highly regarded specialty. We identify steps to address these issues and increase the number of US medical students choosing pathology as a specialty crucial to the future of medicine and public health.

Hidden Reservoir: An Outbreak of Tuberculosis in Hospital Employees with No Patient Contact

We describe an outbreak of tuberculosis (TB) in the food preparation area of a hospital, which demonstrates that employees in healthcare settings may serve as potential risks for spread of TB even if they have no direct patient contact.Infect Control Hosp Epidemiol 2016;37:1111–1113

Transmission of Ebola Viruses: What We Know and What We Do Not Know

ABSTRACT Available evidence demonstrates that direct patient contact and contact with infectious body fluids are the primary modes for Ebola virus transmission, but this is based on a limited number of studies. Key areas requiring further study include (i) the role of aerosol transmission (either via large droplets or small particles in the vicinity of source patients), (ii) the role of environmental contamination and fomite transmission, (iii) the degree to which minimally or mildly ill persons transmit infection, (iv) how long clinically relevant infectiousness persists, (v) the role that “superspreading events” may play in driving transmission dynamics, (vi) whether strain differences or repeated serial passage in outbreak settings can impact virus transmission, and (vii) what role sylvatic or domestic animals could play in outbreak propagation, particularly during major epidemics such as the 2013–2015 West Africa situation. In this review, we address what we know and what we do not know about Ebola virus transmission. We also hypothesize that Ebola viruses have the potential to be respiratory pathogens with primary respiratory spread.

Description and evaluation of a novel service for “difficult to manage” psychiatric in-patients

Purpose – A new service was developed to provide transitional care between acute and secure services for people with serious mental illness who are considered “difficult to manage”. The purpose of this paper is to evaluate the work of the service by examining referrals made, strategies employed for each referral, and patient outcomes, as well as investigating issues in the service's development and implementation. Design/methodology/approach – A retrospective descriptive study by review of 38 case notes, and qualitative interviews of 47 staff within the service and those referring to the service. Findings – In the first eight months, 38 patients were referred due to violence, aggression and management problems. Most interventions provided by the service involved working with referring staff, rather than direct patient contact. Subsequently, 16 per cent required referral to higher levels of security. Interviews showed the team's aims needed to be more clearly established, but that ward staff found the service to be a useful and productive resource. Research limitations/implications – The study is descriptive and retrospective, but showed that the service provided appropriate interventions for managing patients with serious mental illness and challenging behaviour. Practical implications – A transitional service may have value in keeping patients in the least restrictive setting. Careful planning is needed in designing novel interventions, ensuring clear aims and effective management. Originality/value – The service under study was novel, and may be useful in facilitating successful transfer from, or preventing admission to, secure services.

Are personal accessories safe in hospital settings?

The main goal of this study was to find out whether personal accessories of Health Care Workers (HCWs) harbored microbes which would inhibit good hand hygiene, and would act as breeding grounds for various disease causing microorganisms. Twenty six culture swabs were taken from the bangles, watches and rings of HCWs. We observed the growth of micrococcus species and coagulase negative staphylococci in 50 % of the samples. Of the positive bacterial growth, 45.5% were in bangles, 60% in watches and 40% in rings. Health Care workers have solemn responsibility to safeguard their patients as well as themselves by complying with good hand hygiene compliance by not wearing these accessories during direct patient contact and washing their hands according to WHO Hand Hygiene guidelines. DOI: http://dx.doi.org/10.3126/jcmc.v4i2.10858 Journal of Chitwan Medical College 2014; 4(2): 29-31