Implementation of SARS-CoV-2 monoclonal antibody infusion sites at three medical centers in the United States: Strengths and challenges assessment to inform COVID-19 pandemic and future public health emergency use

Monoclonal antibody therapeutics to treat COVID-19 have been authorized by the U.S. Food and Drug Administration under Emergency Use Authorization (EUA). Many barriers exist when deploying a novel therapeutic during an ongoing pandemic, and it is critical to assess the needs of incorporating monoclonal antibody infusions into pandemic response activities. We examined the monoclonal antibody infusion site process during the COVID-19 pandemic and conducted a descriptive analysis using data from three sites at medical centers in the U.S. supported by the National Disaster Medical System. Monoclonal antibody implementation success factors included engagement with local medical providers, therapy batch preparation, placing the infusion center in proximity to emergency services, and creating procedures resilient to EUA changes. Infusion process challenges included confirming patient SARS-CoV-2 positivity, strained staff, scheduling, and pharmacy coordination. Infusion sites are effective when integrated into pre-existing pandemic response ecosystems and can be implemented with limited staff and physical resources.

Saliva-Based, COVID-19 RT-PCR Pooled Screening Strategy to Keep Schools Open

Background: As of March 2020, governments throughout the world implemented business closures, work from home policies, and school closures due to exponential increase of coronavirus disease 2019 (COVID-19) cases, leaving only essential workers being able to work on site. For most of the children and adolescent school closures during the first lockdown had significant physical and psychosocial consequences. Here, we describe a comprehensive Return to School program based on a behavior safety protocol combined with the use of saliva-based reverse transcriptase-polymerase chain reaction (RT-PCR) pooled screening technique to keep schools opened. Methods: The program had 2 phases: before school (safety and preparation protocols) and once at school (disease control program: saliva-based RT-PCR pooled screening protocol and contact tracing). Pooling: Aliquots of saliva from 24 individuals were pooled and 1 RT-PCR test was performed. If positive, the initial 24-pool was then retested (12 pools of 2). Individual RT-PCR tests from saliva samples from positive pools of 2 were performed to get an individual diagnosis. Results: From August 31 until December 20, 2020 (16-wk period) a total of 3 pools, and subsequent 3 individual diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease were reported (2 teachers and 1 staff). Conclusion: Until COVID-19 vaccine can be administered broadly to all-age children, saliva-based RT-PCR pooling testing is the missing piece we were searching for to keep schools opened.

Recruitment, Readiness, and Retention of Providers at a Field Hospital during the Pandemic

In response to the coronavirus disease 2019 (COVID-19) pandemic, the State of Maryland established a 250-bed emergency response field hospital at the Baltimore Convention Center to support the existing healthcare infrastructure. To operationalize this hospital with 65 full-time equivalent (FTE) clinicians in less than four weeks, more than 300 applications were reviewed, 186 candidates were interviewed, and 159 clinicians were credentialed and onboarded. The key steps to achieve this undertaking involved employing multidisciplinary teams with experienced personnel, mass outreach, streamlined candidate tracking, pre-interview screening, utilizing all available expertise, expedited credentialing, and focused onboarding. To ensure staff preparedness, the leadership developed innovative team models, applied principles of effective team building, and provided ‘just in time’ training on COVID-19 and non-COVID-19 related topics to the staff. The leadership focused on staff safety and well-being, offered appropriate financial remuneration and provided leadership opportunities that allowed retention of staff.

Knowledge about biosafety measures in clinical setting during the COVID-19 pandemic: a cross-sectional study with Brazilian dental students

Objective: To evaluate the knowledge of Brazilian dental students about biosafety measures that should be adopted in the clinical setting during the coronavirus disease-2019 (COVID-19) pandemic. Methods: A cross-sectional study with 1,050 dental students was conducted. A semi-structured questionnaire was shared with students. Mean knowledge score on biosafety guidelines during the COVID-19 pandemic was the outcome, with a maximum of 8 scores. Explanatory variables included sociodemographic and educational characteristics, aspects related to biosafety education, actions adopted by the dental schools during the pandemic, and sources of biosafety information. Multivariate linear regression analyses were performed. Results: Mean knowledge score was 5.19 (1.28). Female students (β=0.346; 95%CI:0.154–0.539), those enrolled in the intermediate (β=0.525; 95%CI:0.167–0.883) or final (β=0.569; 95%CI:0.200–0.937) stage of course, and those who had already received theoretical-practical training in biosafety (β=0.464; 95%CI:0.063–0.866) presented higher mean knowledge scores. Students who did not receive guidance on aerosol control measures before the pandemic (β=-0.324; 95%CI:-0.519–-0.130) had the lowest score. Conclusion: Students presented a medium level of knowledge about dental biosafety measures in the COVID-19 pandemic. Sociodemographic characteristics and those related to the institutional profile of the participants, and access to orientation and training in biosafety may influence their knowledge.

Missed training, collateral damage from COVID 19?

Background: during the COVID-19 pandemic a total lockdown was enforced all over Italy starting on March 9th. This resulted in the shrinking of economic activities. In addition, all formal occupational security-training courses were halted, among them the 81/08 law lectures and Basic Life Support-Defibrillation (BLS-D) laymen training courses. The aim of the study was to evaluate the impact of the pandemic on BLS-D laymen training courses in the Lombardy region. Methods: BLS-D training courses records for the Lombardy region were analysed. The analysis was conducted from 2016 to 2020 as part of the Hippo project. Results: between 2017 and 2019 BLS-D trained laymen kept increasing, moving from 53,500 trained individuals up to 74,700. In 2020 a stark reduction was observed with only 22,160 individuals trained. Formal courses were not halted completely during 2020. Still, in the months available for training, the number of individuals enrolled showed a sharp 50% reduction. Conclusions: laymen training courses for emergency management are a fundamental component of primary prevention practice. The 81/08 and 158/12 Italian laws have decreed this practice mandatory on the workplace. Following the enforcement of the lockdown and the subsequent interruption of emergency management courses, efforts will be necessary to re-establish and guarantee the high quality training of the pre-pandemic period.

Knowledge, Attitudes and Practices of Undergraduate Nursing towards Novel Corona Virus (COVID 19)

Background: The emerging respiratory disease is caused by the novel type of corona virus which is named as COVID-19. This respiratory illness has received international attention and it is categorized as highly threaten disease in the US by the Centers for Disease Control and Prevention. The purpose of the study was to assess the knowledge, attitude and practice of undergraduate nursing students towards COVID-19. Methods: Descriptive cross-sectional design was used to assess knowledge, practice and attitudes of 255 undergraduate nursing students towards COVID-19. Study participants were recruited from the nursing college in King AbdAziz University between April and July 2020. Results: The results of study participants showed that undergraduate nursing students had moderate knowledge towards COVID-19. Also, participants had high level of knowledge regarding nature of diseases and precautionary measures by health care providers dimensions. However, they expressed limited knowledge towards mode of transmission. Moreover, study participants demonstrated an optimistic attitude toward disease and good practice towards COVID-19. Conclusions: The study results revealed that study participants demonstrated good knowledge with favorable and accepted practice. This study suggests the importance of emphasis on infectious disease in nursing curriculum

Countermeasures for Healthcare Disruptions During Lockdowns

Many countries did not have alternative healthcare arrangements during their initial COVID-19 lockdowns. This is surprising as partial and full lockdowns have been previously used to manage terrorism and the SARS outbreak of 2002-2003. This paper examines how lockdowns disrupt normal healthcare services and discusses countermeasures that can be used during lockdowns regardless of the emergency that engendered them. Solutions are discussed pragmatically with front-line clinicians, healthcare managers, and policymakers in mind. Mental health services are used as a case in point with generalizable lessons for other healthcare specialties.

Factors preventing nosocomial outbreak following a single case of COVID-19 diagnosed during hospitalization: A retrospective review

Objective: Our hospital experienced a hospital shutdown and quarantine for two weeks after one case of COVID-19 was diagnosed during hospitalization. We analyzed the reopening process following hospital closure and possible factors that prevented hospital spread. Methods: We retrospectively reviewed the confirmed patient’s medical records and results of epidemiological survey available from the infection control team of our hospital. Results: A total of 117 hospital staff members were tested, 26 of whom were self-isolated. Of the 54 inpatients tested, 28 on the same floor and two close contacts in the endoscopic room were quarantined in a single room. Finally, all quarantined hospital staff, inpatients and outpatients were tested for COVID-19 on the 14th day of close contact. The results were all negative, and the hospital work completely resumed. Conclusion: Although closing and isolating the hospital appeared to have played a useful role in preventing the spread of COVID-19 inside the hospital and to the local community, it is still debated whether or not the duration of hospital closure or quarantine was appropriate. The lessons from the two-week hospital closure suggest that wearing a mask, hand hygiene and the ward environment are important factors in preventing nosocomial outbreaks of COVID-19.