Public Awareness of and Support for the Use of Wastewater for SARS-CoV-2 Monitoring: A Community Survey in Louisville, Kentucky

The majority of sewer systems in the United States and other countries are operated by public utilities. In the absence of any regulation, the public perception of wastewater monitoring for population health biomarkers is an important consideration for a public utility commission when allocating resources for this purpose. We conducted a survey in August 2021 as part of an ongoing COVID-19 community prevalence study in Louisville/Jefferson County, KY, US. The survey comprised seven questions about wastewater awareness and privacy concerns and was sent to approximately 35 000 households randomly distributed within the county. A total of 1220 adults were involved in the probability sample, and data from 981 respondents were used in the analysis. A total of 2444 adults additionally responded to the convenience sample, and data from 1751 respondents were used in the analysis. The samples were weighted to obtain estimates representative of all adults in the county. Public awareness of tracking the virus that causes COVID-19 in sewers was low. Opinions strongly support the public disclosure of monitoring results. Responses showed that people more strongly supported measurements in the largest areas (>50 000 households), typically representing population levels found in a large community wastewater treatment plant. Those with a history of COVID-19 infection were more likely to support highly localized monitoring. Understanding wastewater surveillance strategies and privacy concern thresholds requires an in-depth and comprehensive analysis of public opinion for continued success and effective public health monitoring.

The impact of the COVID-19 pandemic on colorectal cancer services in England

Purpose: To assess the impact of the COVID-19 pandemic in England on diagnoses and treatments for colorectal cancer (CRC), and evaluate the variation in deficit of diagnoses and major resections by age and deprivation Methods: Rapid Cancer Registrations Data were used, linked to Hospital Episode Statistics, the Systemic Anti-Cancer Therapy Dataset and the National Radiotherapy Dataset. 33,814 patients newly diagnosed with CRC 1 January 2019 to 31 March 2021 were included Results: There was a large deficit in new CRC diagnoses and treatments early in the pandemic. There was still an 8.6% deficit in new CRC diagnoses by March 2021, a 17.6% deficit in major resections by end 2020, a 21.9% deficit in adjuvant chemotherapy by February 2021, but little deficit in curative radiotherapy for rectal cancer by March 2021. By March 2021 those just below and just above screening age had the largest deficits of new diagnoses. The most deprived patients had the largest deficit of diagnoses and major resections (20 to 21% deficit in major resections in the two most deprived quintiles compared to 16 to 17% in the other quintiles) Conclusion(s): Ongoing efforts to promote and raise awareness of bowel cancer signs and symptoms should continue to try to mitigate the delays in bowel cancer diagnoses during the pandemic, with particular focus on the most deprived and on those just below and just above screening age. Further work is needed to understand the reasons for the association between socioeconomic deprivation and deficit in diagnoses and major resections.

Maternity services' responses to the COVID-19 pandemic: how Public Health England guidance was implemented in practice.

INTRODUCTION: The rapidly evolving COVID-19 pandemic required systemic change in how healthcare was delivered to minimize virus transmission whilst maintaining safe service delivery. Deemed at 'moderate-high risk', maternity patients are an important patient group that require consideration. Public Health England (PHE) issued national guidance on how to adjust these services. AIM: To explore how maternity units in England implemented PHE guidance. METHODS: An online survey of 22 items was distributed to individuals that had worked on an England-based maternity unit during the COVID-19 pandemic. The questionnaire was designed and tested by the multidisciplinary research team. Data was collected from November 2020 to July 2021. FINDINGS: Forty-four participants across 33 maternity units responded. Ninety-three percent were able to test all women requiring an overnight stay for COVID-19. Only 27% reported birth partners were tested for COVID-19. Only 73% reported they were able to isolate all COVID-19-positive patients in single rooms. Eighty-four percent stated they were aware of current PHE guidance on personal protective equipment (PPE) and 82% felt 'confident' in donning/doffing of PPE. Priorities for the future include rapid testing and a focus on community service provision. CONCLUSIONS: PHE COVID-19 guidance was implemented differently in maternity units across England due to the varying resources available at each trust leading to variable ability to test and isolate patients as recommended. More specific, tailored guidance for infection control measures against COVID-19 is needed for maternity settings due to their unique position.

ACT NOW a new diabetes foot educational and risk assessment tool for people with diabetes and health care professionals

Background: When a person with diabetes (PwD) develops a foot problem there is often a delay in receiving specialist help, which may result in amputation and health care professionals (HCP) may be accused of medical negligence. Aim: Our aims were to develop an educational tool to recognise the warning signs of foot complications that might lead to amputation and to disseminate the tool and seek endorsement. Method: The delay to specialist help was analysed by the iDEAL group (Insights for Diabetes Excellence, Access and Learning), a multidisciplinary team of diabetes specialists together with a person with diabetes and recommendations were made. Results: An acronym ACT NOW has been devised to act as an educational tool ACT NOW stands for Accident (recent trauma to foot) Change in colour or shape, Temperature change -hot or cold, New pain, Oozing and Wound. The acronym was devised firstly, to help PwD and HCPs recognise the warning signs of foot complications, leading to potential amputation, and secondly, to trigger early and prompt referral to specialist care. On recognising one or more of these features, the PwD can gain confidence, especially during the COVID 19 pandemic, to seek specialist help either directly from a diabetes foot service or through a first contact HCP who can then refer. An ACT NOW tool was also created consisting of the acronym and a a checklist which prompts the PwD, their carers and HCPs to enquire and document the ACT NOW! symptoms or signs and to take possible further information such as a digital photo. The checklist can then be used as a document to facilitate referral to specialist care. Alternatively, the check list can be used when PwDs present for routine assessment with their HCPs. The ACT NOW tool has been disseminated through digital and traditional media and endorsement granted from many organisations, including the IDF. Discussion: Foot ulcers are highly susceptible to infection which can spread rapidly, causing overwhelming tissue destruction or gangrene, necessitating major amputation. The progression from an initial ‘scratch’ to gangrene can take as little as 48 hours. A lack of knowledge and education can lead to a lack of urgency among PwD, carers and HCPs, who may not recognise that they have a foot related problem requiring urgent referral or care interventions. If there are difficulties in accessing a HCP appointment, there is a risk of critical delay in PwD receiving appropriate assessment and treatment. ACT NOW is designed to promote timely referral and save limbs. iDEAL seeks to reduce amputations by 50% in 5 years by encouraging people to use ACT NOW. Prompt assessment and early referral can help reduce this unnecessary suffering. ACT NOW also seeks to reduce stigma often experienced by PwD regarding complications and remove any blame or shame associated with diabetes complications. These changes can be created through encouraging and enabling an environment of education, knowledge and trust using language that enables PwD.

Implementation of Public Health England infection prevention and control guidance in maternity units in response to the COVID-19 pandemic.

BACKGROUND: This study aimed to explore the successes and barriers to the implementation of Public Health England (PHE) infection prevention and control guidance in English maternity units during the COVID-19 pandemic. METHODS: Qualitative semi-structured interviews with obstetricians, midwives and neonatologists who worked in a maternity unit in England, UK, between March 2020 and July 2021. A thematic analysis was performed. RESULTS: Successes to the implementation of PHE guidance were related to existing infrastructure, training satisfaction, and organisational culture where subthemes considered the importance of a multidisciplinary approach, COVID-19 dedicated roles and hospital-wide communication. Barriers to implementation related to the applicability of the guidance with subthemes highlighting contradictions between updates, specialties and hospitals, undesirable timings and frequency of guidance updates, reductions in staff compliance and delayed implementation. Finally, the layout of some units made it difficult to implement various aspects of the guidance (e.g., social distancing), and many detailed issues related to information technology compatibility, a lack of availability and accessibility to appropriate personal protective equipment (PPE), and variations in testing arrangements between units. CONCLUSIONS: This research provides information on the experiences of healthcare professionals working on maternity units during the COVID-19 pandemic. Findings illustrate the importance of effective hospital-wide communication and the need for consistent, easily understood guidance. These results will be used to inform the content of an expert panel consensus meeting.

Unlocking growth options in surgical education and training during the pandemic

Introduction: The COVID-19 pandemic brought widespread disruption to structured surgical education and training. The knee-jerk reaction is often pessimism about surgical training's future, particularly in the Improved Surgical Training (IST) pilot's context. However, Einstein famously once said, “In the midst of every crises lies great opportunity”. Unlocking growth during periods of high uncertainty is a premise of real options theory;one utilised by supply chain managers and decision scientists, but novel to medical education. This study explores the growth options that have resulted from new operational models during the pandemic. Methods: Using a qualitative case study approach, data were obtained from interviews with core surgical trainees across Scotland. Data coding and inductive thematic analysis were undertaken. Results: Forty-six trainees participated. Analysis from trainees' perspective revealed: unexpected fulfilment from redeployment to non-surgical specialties, benefits to personal development from the unintended broad-based training across surgical specialties, improved collaborative teamworking between specialties and allied healthcare professionals, and enhanced supervised learning opportunities. Institutional growth options reported by trainees included: rapid uptake of telemedicine and digital technology, implementation of single hospital episode encounters for minor conditions, streamlined processes in theatre and acute admissions, and changes in working culture towards rationalising and teamworking. Conclusion: Growth options have been deliberately and unintentionally unlocked due to individual and institutional adaptions and innovations in response to the exogenous disruption. While some changes may be temporary, hopefully structured reflection on these changes and responders to them will drive surgical education and training into a new sustainable and resilient post-pandemic era.

Surgical treatment and outcomes of colorectal cancer patients during the COVID-19 pandemic: A national population-based study in England

Aims: The pandemic has affected the diagnosis and treatment of CRC patients worldwide. Little is known about the safety of major resection. This study aimed to compare the management and outcomes of colorectal cancer (CRC) patients during the first two months of the COVID-19 pandemic with the preceding six months. Methods: A national study in England used administrative hospital data for 14,930 CRC patients undergoing surgery between 1st October 2019 and 31st May 2020. Mortality of CRC resection was compared before and after 23rd March 2020 ('lockdown' start). Results: The number of elective CRC procedures dropped sharply during the pandemic (from average 386 to 214 per week) whereas emergency procedures were hardly affected (from 88 to 84 per week). There was little change in characteristics of surgical patients during the pandemic. Laparoscopic surgery decreased from 62.5% to 35.9% for elective and from 17.7% to 9.7% for emergency resections. Surgical mortality increased slightly (from 0.9% to 1.2%, P = 0.06) after elective and markedly (from 5.6% to 8.9%, P = 0.003) after emergency resections. The observed increase in mortality was similar in 'cold' and 'hot' sites (P > 0.5 elective and emergency procedures). Conclusion: Surgical resection is the mainstay of treatment for non-metastatic CRC. The pandemic resulted in a 50% reduction in elective CRC procedures during the initial surge, and a substantial increase in post-operative mortality, concerning for patients with CRC and clinical services alike. This demonstrates the importance of maintaining CRC services and minimising the risk of peri-operative COVID-19 infection.

The impact of the first peak of the COVID-19 pandemic on colorectal cancer services in England and Wales: A cross-sectional national mapping exercise

Aim: We studied how National Health Service hospitals in England and Wales aimed to maintain effective and safe colorectal cancer (CRC) services during the first peak of the COVID-19 pandemic period (April 2020). Methods: A mapping exercise was performed among all 148 hospitals providing CRC services. Information was collected about changes in referrals, diagnostic, staging and therapeutic procedures, as well as whether there was access to a 'cold site' (hospital facility free of COVID-19). Clinicians in each hospital were also asked to give the 'single most important lesson learned' about keeping services safe and effective. Results: Full responses were received from 123 (83%) hospitals and information about 'cold sites' was available for 146 (99%). 80 hospitals (54%) had access to a 'cold site' and this was increased in regions with higher COVID-19 infection rates (P = <0.001). Of the 123 responding hospitals, 105 (85%) indicated referrals of patients with suspected CRC had dropped by at least 30%, and 69 (56%) indicated that treatment plans were altered in at least 50% of CRC patients. However, 'cold site' availability protected capacity for diagnostic colonoscopy (P = 0.013) and CRC resection (P = 0.010). Many 'lessons learned' highlighted the importance of adequate structural service organisation, often mentioning 'cold sites' and regional coordination as examples, good communication, and triage of patients based on clinical urgency. Conclusion: Access to 'cold sites', as well as regional coordination, clear communication, and strong leadership, were found to be pivotal in maintaining diagnostic and treatment CRC capacity during COVID-19 surge.

A new diabetes foot educational and risk assessment tool for people with diabetes and health care professionals has been created: ACT NOW: Accident, Change, Temperature, New pain, Oozing, Wound, an acronym to recognise warning signs of foot complications, and reduce delays in much needed and timely specialist intervention(s) to avoid amputation

Aims: When a person with diabetes (PwD) develops a foot problem there is often a delay in receiving specialist help, which may result in amputation and this may be blamed on medical negligence. Our aims were to develop an educational tool to recognise the warning signs of foot complications that might lead to amputation and to disseminate the tool and seek endorsement. Methods: The delay to specialist help was analysed by the iDEAL group (Insights for Diabetes Excellence, Access and Learning), a multidisciplinary team of diabetes specialists together with a PwD and recommendations were made. Results: An educational tool based on the acronym ACT NOW: Accident (recent trauma to foot), Change in colour or shape, Temperature-hot or cold, New pain, Oozing and Wound) was devised to help PwDs and health care professionals (HCPs) recognise the warning signs of foot complications, leading to potential amputation, that should trigger referral to specialist care. On recognising one or more of these features, the PwD can gain confidence, especially during the covid-19 pandemic, to seek specialist help either directly from a diabetes foot service or through a first contact HCP who can then refer. An ACT NOW checklist was also devised to aid the HCP in making the referral. The tool has been disseminated through digital and traditional media and endorsement granted from the Foot in Diabetes UK (FDUK), the English Diabetes Footcare Network and the Primary Care Diabetes Society. Conclusion: ACT NOW has been accepted as an innovative educational tool to reduce delay of foot referral to specialist care.

Strategies for efficient adaptation in a pandemic: A decision-making flowchart from an integrative oncology wellness center

Objective: To support implementation at other integrative health institutions, this poster describes the processes and tools necessary to rapidly establish virtual and distance healthcare options for a variety of integrative treatment modalities to serve as a template for other healthcare facilities. Methods: The Wellness and Integrative Health Center (WIHC) at Huntsman Cancer Institute (HCI) provides primarily in-person and hands-on patient visits for supportive oncology services. With the COVID-19 pandemic dramatically changing the landscape of in-person healthcare, The WIHC worked to quickly roll-out virtual and telemedicine appointments for most of its offerings over the course of only two weeks in March and April 2020. This poster visually showcases key decision-making processes and workflows to prepare and implement necessary technologies, documents, staff trainings, and other key components for a successful and swift transition to telehealth and virtual wellness services. The poster will also display ideas and strategies for utilizing and retaining staff and funding for hands-on modalities that cannot translate to a virtual alternative. Results: The WIHC successfully transitioned physician physical assessments, supervised exercise prescriptions, nutrition, music therapy, art therapy, and group fitness classes to virtual and online alternatives with a high rate of patient retention and satisfaction. Full-time acupuncturists and massage therapists were reassigned to work-fromhome tasks or other administrative and COVID-safety related tasks within the HCI building. Conclusion: The COVID-19 pandemic prompted many healthcare facilities to quickly adapt healthcare treatments and day-to-day operations into online and telehealth offerings. The in-person and hands-on modalities found at Huntsman Cancer Institute's WIHC forced our team to utilize creative and unprecedented measures to ensure continuity of care for our patients. The WIHC team and its leadership hope that by sharing its rapid and adaptable response to clinical and supportive services it can help other wellness programs and healthcare facilities adapt to future emergency and disaster situations. Education Research.

Study-abroad in Japan under COVID-19: Emerging parallels with a course on environmental pollution

The Coronavirus hit Japan during our study-abroad semester in Kyoto. Here we present similarities in Japanese societal response to chemical pollutants throughout the long twentieth century and to COVID-19, as they became apparent to us through a chemistry course on Japanese industrial pollution. © 2020, Japan Focus. All rights reserved.

Early trends for SARS-CoV-2 infection in central and north Texas and impact on other circulating respiratory viruses. (Special Issue: New coronavirus (2019-nCoV or SARS-CoV-2) and the outbreak of the respiratory illness (COVID-19): part-VI.)

Rapid diagnosis and isolation are key to containing the quick spread of a pandemic agent like severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), which has spread globally since its initial outbreak in Wuhan province in China. SARS-CoV-2 is novel and the effect on typically prevalent seasonal viruses is just becoming apparent. We present our initial data on the prevalence of respiratory viruses in the month of March 2020. This is a retrospective cohort study post launching of SARS-CoV-2 testing at Baylor Scott and White Hospital (BSWH), Temple, Texas. Testing for SARS-CoV-2 was performed by real-time reverse transcription polymerase chain reaction assay and results were shared with State public health officials for immediate interventions. More than 3500 tests were performed during the first 2 weeks of testing for SARS-CoV-2 and identified 168 (4.7%) positive patients. Sixty-two (3.2%) of the 1912 ambulatory patients and 106 (6.3%) of the 1659 emergency department/inpatients tested were positive. The highest rate of infection (6.9%) was seen in patients aged 25 to 34 years, while the lowest rate of infection was seen among patients aged <25 years old (2%). County-specific patient demographic information was shared with respective public health departments for epidemiological interventions. Incidentally, this study showed that there was a significant decrease in the occurrence of seasonal respiratory virus infections, perhaps due to increased epidemiological awareness about SARS-CoV-2 among the general public, as well as the social distancing measures implemented in response to SARS-CoV-2. Data extracted for BSWH from the Centers for Disease Control and Prevention's National Respiratory and Enteric Virus Surveillance System site revealed that Influenza incidence was 8.7% in March 2020, compared with 25% in March 2019. This study was intended to provide an initial experience of dealing with a pandemic and the role of laboratories in crisis management. This study provided SARS-CoV-2 testing data from ambulatory and inpatient population. Epidemiological interventions depend on timely availability of accurate diagnostic tests and throughput capacity of such systems during large outbreaks like SARS-CoV-2.

RAPID, RELEVANT CLINICAL GUIDELINES IN A PANDEMIC: ONE INSTITUTION'S EXPERIENCE

SESSION TITLE: Education, Research, and Quality Improvement Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: In March 2020, the World Health Organization declared Coronavirus Disease 2019 (COVID-19) a global pandemic. Standards of care are typically determined by consensus guidelines, informed by a large body of evidence, and iteratively improved over years. In contrast, COVID-19 necessitated that medical centers create clinical guidelines within days, with limited evidence. Our medical center formed a task force on March 13 to devise clinical guidelines for COVID-19 management. 6 days later, we made our institutional guidelines publicly available and later reviewed how the website was used. METHODS: The task force includes physicians in all stages (students, residents, fellows, faculty) and allied fields (nursing, respiratory therapy, pharmacy) to synthesize established and emerging evidence, often as pre-prints or case series. Because these protocols require interdisciplinary expertise beyond our standard critical care community, we recruited over 100 contributors and experts in 22 divisions and departments within our center. The task force developed initial consensus using video conferencing and document-sharing technology;we review practice-changing updates in biweekly interdisciplinary virtual conferences. Departing from our prior practice, our single-institution guidelines were widely disseminated at CovidProtocols.Org. The website, created in collaboration with volunteer web developers, utilizes Google Docs for rapid content editing and is mobile-adapted to facilitate internal and public use. Website utilization analysis was performed with Google Analytics. RESULTS: During the first week of website data availability (1 week after website creation), the site received 115,530 users, comprising 160,689 sessions and 195,748 page views. 54.8% of users were in the United States, with 5.6% in Brazil, 5.0% in the Philippines, 3.7% in India, 2.8% in Greece, and 2.6% in Canada. 76.8% used mobile devices, 21.4% computers, and 1.8% tablets. 74.5% accessed the website using a direct link, with 21.4% accessing through social media. Qualitative email feedback was notable for the comprehensive nature of the site and the value to community hospitals that were unable to quickly generate their own evidence-based practices. CONCLUSIONS: During the early phase of the COVID-19 pandemic, clinical protocols for one institution were made publicly available within 6 days and became a resource for clinicians around the globe. Development, dissemination and revision of these protocols have been facilitated by many factors, including interdisciplinary partnerships, collaborations between junior and senior clinicians, technological innovations, and user feedback. CLINICAL IMPLICATIONS: For hospitals preparing for a pandemic, the public dissemination of clinical protocols from a large single institution may bridge the gap between general society guidelines and specific practices useful for the frontline clinician. DISCLOSURES: No relevant relationships by Caitlin Cohen, source=Web Response No relevant relationships by Edy Kim, source=Web Response No relevant relationships by Katherine Walker, source=Web Response

Maternal transmission of SARS-COV-2 to the neonate, and possible routes for such transmission: a systematic review and critical analysis.

BACKGROUND: Early reports of COVID-19 in pregnancy described management by caesarean, strict isolation of the neonate and formula feeding. Is this practice justified? OBJECTIVE: To estimate the risk of the neonate becoming infected with SARS-CoV-2 by mode of delivery, type of infant feeding and mother-infant interaction. SEARCH STRATEGY: Two biomedical databases were searched between September 2019 and June 2020. SELECTION CRITERIA: Case reports or case series of pregnant women with confirmed COVID-19, where neonatal outcomes were reported. DATA COLLECTION AND ANALYSIS: Data were extracted on mode of delivery, infant infection status, infant feeding and mother-infant interaction. For reported infant infection, a critical analysis was performed to evaluate the likelihood of vertical transmission. MAIN RESULTS: Forty nine studies included information on mode of delivery and infant infection status for 655 women and 666 neonates. In all, 28/666 (4%) tested positive postnatally. Of babies born vaginally, 8/292 (2.7%) tested positivecompared with 20/374 (5.3%) born by Caesarean. Information on feeding and baby separation were often missing, but of reported breastfed babies 7/148 (4.7%) tested positive compared with 3/56 (5.3%) for reported formula fed ones. Of babies reported as nursed with their mother 4/107 (3.7%) tested positive, compared with 6/46 (13%) for those who were reported as isolated. CONCLUSIONS: Neonatal COVID-19 infection is uncommon, rarely symptomatic, and the rate of infection is no greater when the baby is born vaginally, breastfed or remains with the mother. TWEETABLE ABSTRACT: Risk of neonatal infection with COVID-19 by delivery route, infant feeding and mother-baby interaction.