COVID-19 Misinformation on Social Media: A Scoping Review.

Social media allows for easy access and sharing of information in real-time. Since the beginning of the coronavirus disease (COVID-19) pandemic, social media has been used as a tool for public health officials to spread valuable information. However, many Internet users have also used it to spread misinformation, commonly referred to as "fake news." The spread of misinformation can lead to detrimental effects on the infrastructure of healthcare and society. The purpose of this scoping review was to identify the sources and impact of COVID-19 misinformation on social media and examine potential strategies for limiting the spread of misinformation. A systemized search of PubMed, Embase, and Web of Science electronic databases using search terms relevant to the COVID-19 pandemic, social media, misinformation, or disinformation was conducted. Identified titles and abstracts were screened to select original reports and cross-checked for duplications. Using both inclusion and exclusion criteria, results from the initial literature search were screened by independent reviewers. After quality assessment and screening for relevance, 20 articles were included in the final review. The following three themes emerged: (1) sources of misinformation, (2) impact of misinformation, and (3) strategies to limit misinformation about COVID-19 on social media. Misinformation was commonly shared on social media platforms such as Twitter, YouTube, Facebook, messaging applications, and personal websites. The utilization of social media for the dissemination of evidence-based information was shown to be beneficial in combating misinformation. The evidence suggests that both individual websites and social media networks play a role in the spread of COVID-19 misinformation. This practice may potentially exacerbate the severity of the pandemic, create mistrust in public health experts, and impact physical and mental health. Efforts to limit and prevent misinformation require interdisciplinary, multilevel approaches involving government and public health agencies, social media corporations, and social influencers.

Managed care COVID-19 outcomes in a population health program.

OBJECTIVES: To determine (1) factors linked to hospitalizations among managed care patients (MCPs), (2) outcome improvement with use of outpatient off-label treatment, and (3) outcome comparison between MCPs and a mirror group. STUDY DESIGN: Retrospective cohort study comparing MCPs with an age- and gender-matched mirror group in Florida from April 1, 2020, to May 31, 2020. METHODS: A total of 38,193 MCPs in a Florida primary care group were monitored for COVID-19 incidence, hospitalization, and mortality. The highest-risk patients were managed by the medical group's COVID-19 Task Force. As part of a population health program, the COVID-19 Task Force contacted patients, conducted medical encounters, and tracked data including comorbidities and medical outcomes. The MCPs enrolled in the medical group were compared with a mirror group from the state of Florida. RESULTS: The mean (SD) age among the MCPs was 67.9 (15.2) years, and 60% were female. Older age and hypertension were the most important factors in predicting COVID-19. Obesity, chronic kidney disease (CKD), and congestive heart failure (CHF) were linked to higher rates of hospitalizations. Patients prescribed off-label outpatient medications had 73% lower likelihood of hospitalization (P < .05). Compared with the mirror group, MCPs had 60% lower COVID-19 mortality (P < .05). CONCLUSIONS: MCPs have risk factors similar to the general population for COVID-19 incidence and progression, including older age, hypertension, obesity, CHF, and CKD. Outpatient treatment with off-label medicines decreased hospitalizations. A comprehensive population health program decreased COVID-19 mortality.

A Crucial Role for Antimicrobial Stewardship in the Midst of COVID-19.

As the world deals with a pandemic, there remains another global challenge that cannot be ignored. Use of broad-spectrum antibiotics may be justified as we are trying to treat a novel disease condition, which in turn could lead to an increase in antimicrobial resistance. We can decrease morbidity, mortality, and health care costs by controlling antimicrobial resistance, but it requires antimicrobial stewardship. Major components of effective and timely antimicrobial stewardship are diagnostic stewardship, infection prevention and control, and integration of COVID-19 specific flags into electronic health records, all of which may be integrated into current strategies of COVID-19 mitigation and management. Going through the influenza season of 2020, implementation of antimicrobial stewardship education efforts in the United States can help us contend with influenza in addition to COVID-19 and any bacterial co-infections or secondary infections. Additional solutions include the development of vaccines, alternative therapies such as antibodies, and advanced diagnostics using advances in genomics and computer science.

Psychological correlates of arbovirus preventive health behaviour.

BACKGROUND: Current arbovirus preventive health interventions do not take social and personality variables into account. Social cognition models posit that people engage in preventive health behaviour (PHB) after an assessment of the perceived risk of disease, an analysis of potential consequences and an evaluation of self-efficacy. METHODS: In a sample of 385 undergraduate and medical students, we examined the association between social relationships, conscientiousness and mosquito repellent use. Data were analysed in a series of stepwise regression analyses. RESULTS: Social relationships influenced the association between conscientiousness and mosquito repellent use. As expected, perceptions of positive social relationships and conscientiousness are positively linked with mosquito repellent use. Conversely, perceptions of negative social relationships are linked to an inverse association between conscientiousness and mosquito repellent use. CONCLUSIONS: Future interventions designed to increase perceptions of social relationships might be helpful in increasing arbovirus preventive health behaviour such as using mosquito repellents. Since the present study was concurrent correlational in nature, future research would benefit from experimental interventions designed to directly examine the effect of enhancing positive relations and social support on arbovirus preventive health behaviour.

The role of Neuropilin-1 in COVID-19.

Neuropilin-1 (NRP-1), a member of a family of signaling proteins, was shown to serve as an entry factor and potentiate SARS Coronavirus 2 (SARS-CoV-2) infectivity in vitro. This cell surface receptor with its disseminated expression is important in angiogenesis, tumor progression, viral entry, axonal guidance, and immune function. NRP-1 is implicated in several aspects of a SARS-CoV-2 infection including possible spread through the olfactory bulb and into the central nervous system and increased NRP-1 RNA expression in lungs of severe Coronavirus Disease 2019 (COVID-19). Up-regulation of NRP-1 protein in diabetic kidney cells hint at its importance in a population at risk of severe COVID-19. Involvement of NRP-1 in immune function is compelling, given the role of an exaggerated immune response in disease severity and deaths due to COVID-19. NRP-1 has been suggested to be an immune checkpoint of T cell memory. It is unknown whether involvement and up-regulation of NRP-1 in COVID-19 may translate into disease outcome and long-term consequences, including possible immune dysfunction. It is prudent to further research NRP-1 and its possibility of serving as a therapeutic target in SARS-CoV-2 infections. We anticipate that widespread expression, abundance in the respiratory and olfactory epithelium, and the functionalities of NRP-1 factor into the multiple systemic effects of COVID-19 and challenges we face in management of disease and potential long-term sequelae.

Current Understanding of COVID-19 Clinical Course and Investigational Treatments.

Importance: Currently, there is no unified framework linking disease progression to established viral levels, clinical tests, inflammatory markers, and investigational treatment options. Objective: It may take many weeks or months to establish a standard treatment approach. Given the growing morbidity and mortality with respect to COVID-19, this systemic review presents a treatment approach based on a thorough review of scholarly articles and clinical reports. Our focus is on staged progression, clinical algorithms, and individualized treatment. Evidence Review: We followed the protocol for a quality review article proposed by Heyn et al. (1). A literature search was conducted to find all relevant studies related to COVID-19. The search was conducted between April 1, 2020, and April 13, 2020, using the following electronic databases: PubMed (1809 to present); Google Scholar (1900 to present); MEDLINE (1946 to present), CINAHL (1937 to present); and Embase (1980 to present). The keywords used included COVID-19, 2019-nCov, SARS-CoV-2, SARS-CoV, and MERS-CoV, with terms such as efficacy, seroconversion, microbiology, pathophysiology, viral levels, inflammation, survivability, and treatment and pharmacology. No language restriction was placed on the search. Reference lists were manually scanned for additional studies. Findings: Of the articles found in the literature search, 70 were selected for inclusion in this study (67 cited in the body of the manuscript and 3 additional unique references in the Figures). The articles represent work from China, Japan, Taiwan, Vietnam, Rwanda, Israel, France, the United Kingdom, the Netherlands, Canada, and the United States. Most of the articles were cohort or case studies, but we also drew upon other information, including guidelines from hospitals and clinics instructing their staff on procedures to follow. In addition, we based some decisions on data collected by organizations such as the CDC, FDA, IHME, IDSA, and Worldometer. None of the case studies or cohort studies used a large number of participants. The largest group of participants numbered <500 and some case studies had fewer than 30 patients. However, the review of the literature revealed the need for individualized treatment protocols due to the variability of patient clinical presentation and survivability. A number of factors appear to influence mortality: the stage at which the patient first presented for care, pre-existing health conditions, age, and the viral load the patient carried. Conclusion and Relevance: COVID-19 can be divided into three distinct stages, beginning at the time of infection (Stage I), sometimes progressing to pulmonary involvement (Stage II, with or without hypoxemia), and less frequently to systemic inflammation (Stage III). In addition to modeling the stages of disease progression along with diagnostic testing, we have also created a treatment algorithm that considers age, comorbidities, clinical presentation, and disease progression to suggest drug classes or treatment modalities. This paper presents the first evidence-based recommendations for individualized treatment for COVID-19.

Impact of pyriproxyfen on virus behavior: implications for pesticide-induced virulence and mechanism of transmission.

BACKGROUND: More than 3 years since the last Zika virus (ZIKV) outbreak in Brazil, researchers are still deciphering the molecular mechanisms of neurovirulence and vertical transmission, as well as the best way to control spread of ZIKV, a flavivirus. The use of pesticides was the main strategy of mosquito control during the last ZIKV outbreak. METHODS: We used vesicular stomatitis virus (VSV) tagged with green fluorescent protein (GFP) as our prototypical virus to study the impact of insecticide pyriproxyfen (PPF). VZV-GFP infected and uninfected Jurkat, HeLa and trophoblast cells were treated with PPF and compared to untreated cells (control). Cell viability was determined by the MTT assay. Cell morphology, presence of extracellular vesicles (EVs), virus infection/GFP expression as well as active mitochondrial levels/localization were examined by confocal microscopy. RESULTS: PPF, which was used to control mosquito populations in Brazil prior to the ZIKV outbreak, enhances VSV replication and has cell membrane-altering properties in the presence of virus. PPF causes enhanced viral replication and formation of large EVs, loaded with virus as well as mitochondria. Treatment of trophoblasts or HeLa cells with increasing concentrations of PPF does not alter cell viability, however, it proportionately increases Jurkat cell viability. Increasing concentrations of PPF followed by VSV infection does not interfere with HeLa cell viability. Both Jurkats and trophoblasts show proportionately increased cell death with increased concentrations of PPF in the presence of virus. CONCLUSIONS: We hypothesize that PPF disrupts the lipid microenvironment of mammalian cells, thereby interfering with pathways of viral replication. PPF lowers viability of trophoblasts and Jurkats in the presence of VSV, implying that the combination renders immune system impairment in infected individuals as well as enhanced vulnerability of fetuses towards viral vertical transmission. We hypothesize that similar viruses such as ZIKV may be vertically transmitted via EV-to-cell contact when exposed to PPF, thereby bypassing immune detection. The impact of pesticides on viral replication must be fully investigated before large scale use in future outbreaks of mosquito borne viruses.

Uveitis as a Predictor of Predisposition to Autoimmunity.

The right environmental trigger can lead to immune system activation, which, in turn, can create an autoimmune reaction. Although each autoimmune disease is characterized by specific symptoms, many nonspecific symptoms can make these conditions difficult to diagnose. In this literature review, we seek an association between immunization-induced uveitis and an autoimmune diagnosis and/or autoimmune flare-up in patients. Our goal is to consider adverse reactions to vaccines as a possible warning sign of current or future autoimmune disease. If an immunization-induced adverse reaction is known to be a predictor of an autoimmune disease, the clinician could raise suspicion for autoimmune disease when a patient presents with vaccine-associated uveitis. While no direct correlations can be made yet, our review supports closer scrutiny of the association of immunizations and autoimmune disorders. The occurrence of uveitis across several autoimmune diseases could mean a possible link between vaccine-induced uveitis and undiagnosed autoimmune disease. Researchers can, therefore, perform retrospective studies on vaccinated patients and investigate the occurrence of uveitis, along with the timeframe of resolution and presenting symptoms at the time of the diagnosis of autoimmune disease.

Academic Advising Using Theoretical Approaches for Medical Students Who Are Struggling in Preclinical Years.

Theoretical approaches provide a foundation for helping students in academic settings. The application of learning theories in medical education is also well documented. However, very few studies have applied a theoretical framework to academic advising for struggling students in the preclinical years of their medical education. This article summarizes key learning theories and their application to commonly found problems among first- and second-year medical students. The authors review current advising processes based on widely used theories in medical education and cite examples from their practices about how these theories can be used in effective academic advising. They also discuss the importance of using a holistic approach while helping students overcome academic barriers during their time in medical school.