Network analysis of England single parent household COVID-19 control policy impact; a proof-of-concept study

Lockdowns have been a key infection control measure for many countries during the COVID-19 pandemic. In England first lockdown, children of single parent households (SPHs) were permitted to move between parental homes. By the second lockdown, SPH support bubbles between households were also permitted, enabling larger within-household networks. We investigated the combined impact of these approaches on household transmission dynamics, to inform policymaking for control and support mechanisms in a respiratory pandemic context. This network modelling study applied percolation theory to a base model of SPHs constructed with population survey estimates of SPH family size. To explore putative impact, varying estimates were applied regarding extent of bubbling and proportion of Different-parentage SPHs (DSPHs) (in which children do not share both the same parents). Results indicate that the formation of giant components (in which Covid-19 household transmission accelerates) are more contingent on DSPHs than on formation of bubbles between SPHs; and that bubbling with another SPH will accelerate giant component formation where one or both are DSPHs. Public health guidance should include supportive measures that mitigate the increased transmission risk afforded by support bubbling among DSPHs. Future network, mathematical and epidemiological studies should examine both independent and combined impact of policies.

Rapid inactivation of SARS-CoV-2 by titanium dioxide surface coating

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission occurs via airborne droplets and surface contamination. Titanium dioxide (TiO2) coating of surfaces is a promising infection control measure, though to date has not been tested against SARS-CoV-2. Methods: Virus stability was evaluated on TiO2- and TiO2–Ag (Ti:Ag atomic ratio 1:0.04)-coated 45 x 45 mm ceramic tiles. After coating the tiles were stored for 2–4 months before use. We tested the stability of both SARS-CoV-2 Spike pseudotyped virions based on a lentiviral system, as well as fully infectious SARS-CoV-2 virus. For the former, tile surfaces were inoculated with SARS-CoV-2 spike pseudotyped HIV-1 luciferase virus. At intervals virus was recovered from surfaces and target cells infected. For live virus, after illuminating tiles for 0–300 min virus was recovered from surfaces followed by infection of Vero E6 cells. % of infected cells was determined by flow cytometry detecting SARS-CoV-2 nucleocapsid protein 24 h post-infection. Results: After 1 h illumination the pseudotyped viral titre was decreased by four orders of magnitude. There was no significant difference between the TiO2 and TiO2–Ag coatings. Light alone had no significant effect on viral viability. For live SARS-CoV-2, virus was already significantly inactivated on the TiO2 surfaces after 20 min illumination. After 5 h no detectable active virus remained. Significantly, SARS-CoV-2 on the untreated surface was still fully infectious at 5 h post-addition of virus. Overall, tiles coated with TiO2 120 days previously were able to inactivate SARS-CoV-2 under ambient indoor lighting with 87% reduction in titres at 1h and complete loss by 5h exposure. Conclusions: In the context of emerging viral variants with increased transmissibility, TiO2 coatings could be an important tool in containing SARS-CoV-2, particularly in health care facilities where nosocomial infection rates are high.

Patient Perspectives of Inpatient Telemedicine During COVID-19: A Qualitative Assessment (Preprint)

BACKGROUND Telemedicine has been adopted in the inpatient setting to facilitate clinical interactions between on-site clinicians and isolated hospitalized patients for the purpose of infection control during the COVID-19 pandemic. Such remote interactions have the potential to reduce pathogen exposure and use of personal protective equipment but may also pose new safety concerns given prior evidence that isolated patients can receive suboptimal care. Formal evaluations into the use and practical acceptance of inpatient telemedicine amongst hospitalized patients are lacking. OBJECTIVE We aimed to evaluate the experience of patients hospitalized for COVID-19 with inpatient telemedicine introduced as an infection control measure during the pandemic. METHODS To understand the patient perspective on inpatient telemedicine use, we performed a qualitative evaluation in a COVID-19 designated non-intensive care hospital unit at a large academic health center (Stanford Health Care). Semi-structured qualitative interviews were conducted October 2020 through January 2021 primarily by phone and focused on patient experience, impact on quality of care, communication, and mental health. Purposive sampling were used to recruit participants representing diversity across varying demographics until thematic saturation was reached. Interview transcripts were qualitatively analyzed using an inductive-deductive approach and presented using an implementation outcomes framework. RESULTS Interviews with 20 hospitalized patients suggested non-emergency clinical encounters comprised the majority of inpatient telemedicine use. Nurses were reported to enter the room and call on the tablet far more frequently than physicians, who typically entered the room at least daily. Patients accepted the technology, citing reduced fear and anxiety, given their isolation status but preferred in-person care if given the choice. Suboptimal factors were noted including low volume, shifting tablet location, and inconsistent verbal introductions from the clinical team. Quality of care was believed to be similar to in-person care with the exception of a few patients who wanted more frequent in-person examinations. CONCLUSIONS Patient experiences with inpatient telemedicine were largely favorable. Although most patients expressed a preference for in-person care when possible, telemedicine was acceptable given the circumstances. Technical and protocol improvements may enhance acceptability. Further evaluation is needed to understand the impact of inpatient telemedicine and the optimal balance between in-person and virtual care in the hospital setting.

Determining the frequency of microbial growth “in?use” detergent products in various dental clinics: A microbiological research

Clean hands are hands and as a part of dental clinic infection control measure hand washing by a dental health professional before having contact with a patient’s oral cavity becomes a fundamental duty. Most detergents claim a 99.99% efficacy in killing bacteria however, there is paucity in literature if there will be a microbial growth “in use” detergents. Thus, the aim of this study was to evaluate bar soap and liquid soap from liquid soap from dental clinics for microbial contamination while it was in use.The study period was 2- month, dentists and dental assistants were the participants of the study. A total of 25 handwashing place samples from 12different dental clinics were collected. All the test tube samples of bar soap and liquid soap were all transferred to the microbiology laboratory for microbiological analysis. data was analyzed using a one- sample paired t-test and independent students t-test. 6 different microbial species were identified. The abundance of staphylococcus aureus was highest compared to other microorganisms in both soaps. Further, the mean number of microorganisms was found similar (P > 0.05) in liquid soap. the microbial load of a mixed flora of Gram-positive bacteria, Gram-negative bacteria, aerobes, and fungi were found in both the in-use bar soap and liquid soap. Thus, the results indicate that the bar soap ‘in-use’ condition harbors a greater number of microorganisms as compared to that of liquid soap.

Infection spread simulation technology in a mixed state of multi valiant viruses

ATLM was extended to simulate the spread of infection in a mixed state of mutant virus and conventional virus. It is applied to the 4th wave of infection spread in Tokyo, and (1) the 4th wave bottoms out near the end of the state of emergency, and the number of infected people increases again. (2) The rate of increase will be mainly by L452R virus, while the increase by N501Y virus will be suppressed. (3) It is anticipated that the infection will spread during the Olympic Games. (4) When mutant virus competes, the infection of highly infectious virus rises sharply while the infection by weakly infectious ones has converged. (5) It is effective as an infection control measure to find an infected person early and shorten the period from infection to quarantine by PCR test or antigen test as a measure other than vaccine.

Point-of-Care (POC) diagnostics for coronavirus disease 2019 (COVID-19) and their potential impact on dentistry

It is clear that the coronavirus disease 2019 (COVID-19) pandemic, due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) will be with us for the foreseeable future, possibly entrenched as an endemic infection. This poses a grave threat for clinical dental practice as asymptomatic (viral) carriers unknowing of their status, may attend for treatment with the possibility of resultant disease spread to non-immune individuals in the clinic. Even if one is immune through vaccination, the temporal waning of protective antibodies may lead to mild–moderate variant-induced infection, as shown in a number of recent studies. Hence, it is likely that rapid and accurate identification of COVID-19 patients at the point-of-care (POC), that is in the clinic or during the pre-attendance period, will be a critical imperative in the foreseeable future, as a secondary safeguard, in addition to successful vaccination. There are now an array of POC diagnostic tests to detect SARS-CoV-2, and here we summarize their salient features, and the potential utility as an infection control measure in dentistry. CPD/Clinical Relevance: To describe the currently available POC diagnostic tests for COVID-19, and their utility as a critical infection control measure during dental care delivery in the immediate post-pandemic period.

Nurses indispensable role during COVID-19

There is a new public health crisis threatening the world with the emergence and spread of 2019 novel coronavirus (2019-nCoV) or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as it is now called, is rapidly spreading from its origin in Wuhan City of Hubei Province of China to the rest of the world. Coronaviruses are enveloped positive-sense RNA viruses that are diversely found in humans and wildlife originated in bats ranging from 60 nm to 140 nm in diameter with spike-like projections on its surface giving it a crown-like appearance under the electron microscope, hence the name coronavirus. A total of six species have been identified which are known to infect the neurological, respiratory, enteric, and hepatic systems. The epicenter of infection was linked to seafood and exotic animal wholesale markets in the city. SARS-CoV-2 is highly contagious and has resulted in a rapid pandemic of COVID-19. As the number of cases continues to rise, it is clear that these viruses pose a threat to public health. The disease is transmitted by inhalation or contact with infected droplets and the incubation period ranges from 2 to 14 days. The symptoms are usually fever, cough, sore throat, breathlessness, fatigue, and malaise among others. The disease is mild in most people; in some (usually the elderly and those with comorbidities), it may progress to pneumonia, acute respiratory distress syndrome (ARDS), and multiorgan dysfunction. Many people are asymptomatic. The case fatality rate is estimated to range from 2 to 3%. Treatment is essentially supportive; role of antiviral agents is yet to be established. Prevention entails home isolation of suspected cases and those with mild illnesses and strict infection control measure at hospitals that include contact and droplet precautions. The global impact of this new epidemic is yet uncertain. We conducted a literature review of publicly available information to summarize knowledge about the pathogen and the current epidemic. In this literature review, the causative agent, epidemiology, pathogenesis, diagnosis, and nurses role regarding disease, control, and prevention strategies are all reviewed. It will also provide a means to raise awareness among primary and secondary health-care providers during the current pandemic.

Physicians’ Perceptions on the Role of Telemedicine in Cancer Care During and Post-COVID-19 Pandemic

Objectives. This study aims to determine perceptions of physicians in our institution on the role of telemedicine in cancer care during the COVID-19 pandemic and to assess its perceived benefits and barriers. Methods. This is a cross-sectional study of physicians involved in cancer care in a tertiary referral hospital in the Philippines. We administered a 21-item online survey questionnaire between August to October 2020. Results. We received and analyzed 84 physician responses. Ninety-six percent of physicians currently use telemedicine, an increase from 59% pre-pandemic. Eighty-nine percent use telemedicine for follow-up virtual consults, while 75% use telemedicine for case discussions in multidisciplinary meetings. The mean number of monthly patient consults conducted through telemedicine increased to 29.5 (SD: 24.8) from a pre-pandemic mean of 7.7 (SD: 18.7). Eighty-four percent of respondents perceived its main benefit as an infection control measure. The other perceived benefits of telemedicine include convenience (78%), accessibility to cancer care (72%), cost-effectiveness (68%), and time efficiency (44%). A quarter of the respondents believed that telemedicine has the potential to improve cancer outcomes. Ninety-two percent of the respondents expressed that they will use telemedicine occasionally in their practice. Conclusion. Telemedicine was perceived by Filipino physicians in a tertiary hospital as an acceptable solution for the provision of cancer care during and after the COVID-19 pandemic. Tele-oncology should be further investigated to maximize patient and physician satisfaction and improve cancer outcomes. Data from this study can be used to improve oncology practice and service delivery to suitable patients during and after the COVID-19 pandemic.

Rapid inactivation of SARS-CoV-2 by titanium dioxide surface coating

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission occurs via airborne droplets and surface contamination. Titanium dioxide (TiO2) coating of surfaces is a promising infection control measure, though to date has not been tested against SARS-CoV-2. Methods: Virus stability was evaluated on TiO2- and TiO2–Ag (Ti:Ag atomic ratio 1:0.04)-coated 45 x 45 mm ceramic tiles. After coating the tiles were stored for 2–4 months before use. We tested the stability of both SARS-CoV-2 Spike pseudotyped virions based on a lentiviral system, as well as fully infectious SARS-CoV-2 virus. For the former, tile surfaces were inoculated with SARS-CoV-2 spike pseudotyped HIV-1 luciferase virus. At intervals virus was recovered from surfaces and target cells infected. For live virus, after illuminating tiles for 0–300 min virus was recovered from surfaces followed by infection of Vero E6 cells. % of infected cells was determined by flow cytometry detecting SARS-CoV-2 nucleocapsid protein 24 h post-infection. Results: After 1 h illumination the pseudotyped viral titre was decreased by four orders of magnitude. There was no significant difference between the TiO2 and TiO2–Ag coatings. Light alone had no significant effect on viral viability. For live SARS-CoV-2, virus was already significantly inactivated on the TiO2 surfaces after 20 min illumination. After 5 h no detectable active virus remained. Significantly, SARS-CoV-2 on the untreated surface was still fully infectious at 5 h post-addition of virus. Overall, tiles coated with TiO2 120 days previously were able to inactivate SARS-CoV-2 under ambient indoor lighting with 87% reduction in titres at 1h and complete loss by 5h exposure. Conclusions: In the context of emerging viral variants with increased transmissibility, TiO2 coatings could be an important tool in containing SARS-CoV-2, particularly in health care facilities where nosocomial infection rates are high.