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The global spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) since 2019 has led to a continuous evolution of viral variants, with the latest concern being the Omicron (B.1.1.529) variant. In this study, classical molecular dynamics simulations were conducted to elucidate the biophysical aspects of the Omicron spike protein's receptor-binding domain (RBD) in its interaction with human angiotensin-converting enzyme 2 (hACE2) and a neutralizing antibody, comparing it to the wildtype (WT). To model the Omicron variant, 15 in silico mutations were introduced in the RBD region of WT (retrieved from PDB). The simulations of WT spike-hACE2 and Omicron spike-hACE2 complexes revealed comparable binding stability and dynamics. Notably, the Q493R mutation in the Omicron spike increased interactions with hACE2, particularly with ASP38 and ASP355. Additionally, mutations such as N417K, T478K, and Y505H contributed to enhanced structural stability in the Omicron variant. Conversely, when comparing WT with Omicron in complex with a neutralizing antibody, simulation results demonstrated poorer binding dynamics and stability for the Omicron variant. The E484K mutation significantly decreased binding interactions, resulting in an overall decrease in binding energy (∼-57 kcal/mol) compared to WT (∼-84 kcal/mol). This study provides valuable molecular insights into the heightened infectivity of the Omicron variant, shedding light on the specific mutations influencing its interactions with hACE2 and neutralizing antibodies.

Vaccinating patients receiving dialysis may prevent morbidity and mortality in this vulnerable population. The National Forum of End-Stage Renal Disease Networks (the Forum) published a revised vaccination toolkit in 2021 to update evidence and recommendations on vaccination for patients receiving dialysis. Significant changes in the last 10 years include more data supporting the use of a high-dose influenza vaccine, the introduction of the Heplisav-B vaccine for hepatitis B, and changes in pneumococcal vaccines, including the approval of the PCV15 and PCV20 to replace the PCV13 and PPSV23 vaccines. Additional key items include the introduction of vaccines against severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019 (COVID-19), and a new vaccine to prevent respiratory syncytial virus disease. Historically, influenza and pneumococcal vaccinations were routinely administered by dialysis facilities, and because of possible risks of hematogenous spread of hepatitis B, dialysis providers often have detailed hepatitis B vaccine protocols. In March 2021, COVID-19 vaccines were made available for dialysis facilities to administer, although with the end of the public health emergency, vaccine policies by dialysis facilities against COVID-19 remains uncertain. The respiratory syncytial virus vaccine was authorized in 2023, and how dialysis facilities will approach this vaccine also remains uncertain. This review summarizes the Forums vaccination toolkit and discusses the role of the dialysis facility in vaccinating patients to reduce the risk of severe infections.

The ongoing global pandemic caused by viral pathogens like SARS-CoV-2 (COVID-19) underscores that viral transmission is not confined by geographical boundaries. Thus, the development of novel antiviral therapies is critical to mitigate this crisis. Pyranopyrazoles have gained significant attention in medicinal chemistry due to their bioactive properties. In this study, we present a new series of pyranopyrazoles and their annulated derivatives, which were assessed for antiviral activity using a validated QSAR model and tested for their inhibitory effects against the viral 3CLpro enzyme. The findings were corroborated by various in silico techniques, including molecular docking, molecular dynamics simulations, and DFT calculations. Additionally, ADME studies were conducted to evaluate the pharmacokinetics and pharmacodynamics of the novel lead compound 2. These investigations identified a series of metabolically stable pyranopyrazoles and their annulated derivatives as effective inhibitors of the SARS-CoV-2 3CLpro enzyme, offering a promising therapeutic option for COVID-19. We believe that pyranopyrazoles warrant further evaluation and chemical optimization for potential use in COVID-19 treatment. [ABSTRACT FROM AUTHOR]

AbstractOver the past three years, conflicting evidence has emerged regarding the impact of COVID-19 on executive functions and the frontal lobe. In this study, we evaluated executive functions in individuals from the state of Jalisco who had contracted COVID-19. Sixty individuals with a history of mild COVID-19 were included and compared to historical controls from the Mexican population, who had been assessed prior to the pandemic during the validation of the Trail Making Test Form B, the Stroop Color and Word Test, and the Modified Wisconsin Card Sorting Test (M-WCST). The post-infection group exhibited lower scores only on the M-WCST. Therefore, we concluded that individuals who have recovered from mild COVID-19 do not display widespread impairments in executive functions, with the exception of deficits observed on the M-WCST. This suggests possible neurophysiological alterations in the prefrontal cortex during SARS-CoV-2 infection, given that cognitive flexibility is primarily mediated in this region. These findings contribute to the growing body of evidence indicating that even non-hospitalized COVID-19 patients can experience executive function deficits, providing a foundation for further neurophysiological research into the mechanisms underlying this phenomenon. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the association of baseline coagulation proteins with hospitalization variables in COVID-19 patients admitted to ICU, as well as coagulation system changes after one-year post-discharge, taking into account gender-specific bias in the coagulation profile. Methods: We conducted a prospective longitudinal study on 49 ICU-admitted COVID-19 patients. Proteins were measured using a Luminex 200™. The association between coagulation protein levels and hospitalization variables was carried out by generalized linear models adjusted by the most relevant covariates. Results: At ICU admission, lower factor XII, antithrombin, and protein C levels were linked to the need for invasive mechanical ventilation (IMV) or its duration (p=0.028; p=0.047 and p=0.015, respectively). Likewise, lower factor XII, antithrombin, and prothrombin levels were associated with longer ICU length of stay (ICU LOS) (p=0.045; p=0.022; p=0.036, respectively). From baseline to the end of the follow-up, factor XII, antithrombin, prothrombin, and protein C levels notably increased in patients with longer ICU LOS. One-year post-discharge, differences were found for factor IX, aPTT, and INR. Gender-stratified analysis showed sustained alterations in males. Conclusions: Depleted specific coagulation factors on ICU admission are associated with increased severity in critically ill COVID-19 patients. Most coagulation alterations recover one-year post-discharge, except for factor IX, aPTT and INR, which remain reduced. [ABSTRACT FROM AUTHOR]

The global number of COVID-19 deaths has reached 7 million, with 4% of these deaths occurring in children and adolescents. In Brazil, around 1500 children up to 11 years old died from the disease. The most common symptoms in children are respiratory, potentially progressing to severe illnesses, such as severe acute respiratory syndrome (SARS) and MIS-C. Studies indicate that comorbidities and genetic factors, such as polymorphisms in immune response genes, can influence the severity of COVID-19. This study investigates the occurrence of single-nucleotide polymorphisms (SNPs) in innate immune response genes in children with COVID-19. Seventy-three samples were analyzed from children under 13 years old hospitalized at João Paulo II Children's Hospital due to COVID-19. The evaluated SNPs were tlr8 (1) (rs3764879), tlr8 (2) (rs2407992), tlr7 (rs179008), tlr3 (rs3775291), tirap (rs8177374), and mcp-1 (rs1024611), considering four categories of severity: mild, moderate, severe, and critical COVID-19. To identify the SNPs, PCR and sequencing were performed. The frequencies of the SNPs obtained were not discrepant when compared to the frequencies described in the Global ALFA, Global 1000 Genomes, Global gnomAD, American 1000 Genomes, and American gnomAD databases, except for the SNP in TLR7. Comparing severe and critical cases to mild and moderate cases, we found a higher relative risk associated with mutations in tlr8 (1), tlr7, tlr3, and tirap (p < 0.05). No association was found for SNPs in tlr8 (2) and mcp-1. Our analyses suggest an association between SNPs in innate immune response genes and severity of symptoms in children with COVID-19 (or SARS-CoV-2 infected children). [ABSTRACT FROM AUTHOR]

Copyright of Folia Cardiologica is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In a period globally known as long COVID, several post-acute infection sequelae and vaccination effects have been discussed. Objectives: This study aimed to identify the effects of COVID-19 infection and vaccines on the menstrual cycle of adolescents attending higher education and to verify the association between personal health factors and changes in their menstrual cycle after contact with the virus SARS-CoV-2 via infection or via the vaccine. Methods: A cross-sectional study was conducted using a questionnaire for data collection, applied online to Portuguese higher education adolescents aged between 18 and 24. The sample included 401 individuals. The statistical analysis of data was performed using SPSS. Results: More than half of the sample had a COVID-19 infection only once and took two doses of the vaccine. The mRNA Comirnaty 30 µg BioNTech vaccine was administered to 73.1%. The most common menstrual changes were an increase in blood clots, the blood becoming darker, shorter menstrual cycles, scarcer blood flow, and more irregular cycles. Menstrual changes correlated significantly with vaccination but not with infection. Conclusions: This study showed a lower percentage of women affected than other studies carried out closer to the pandemic period, which could mean that the effects are diminishing over time. Thus, adolescents' menstrual health should be monitored. [ABSTRACT FROM AUTHOR]

Objective: In the past 5 years, a large number of serological assays for large‐scale detection of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) antigen emerged. Serological assays for SARS‐CoV‐2 were needed to support clinical diagnosis and epidemiological investigations. However, there were limited data on the diagnostic accuracy of these serological assays. We aimed to compare the diagnostic accuracy of 11 commercial serological assays for coronavirus disease‐2019 (COVID‐19) by taking the reverse transcriptase polymerase chain reaction (RT‐PCR) assays as the reference standard, which served as the control arm to conduct an indirect comparison of diagnostic accuracy for 11 different SARS‐CoV‐2 serological assays. Methods: This meta‐analysis was conducted following the PRISMA 2020 reporting guideline. Electronic searches were performed using the Cochrane Library, PubMed, Embase, Web of Science, Chinese Biological Medicine Database (CBM), China National Knowledge Infrastructure (CNKI), WANFANG, and Chinese Weipu (VIP) databases. Fifty‐seven articles, including 11 serologic‐based IgG, IgM, and total antibodies assays for SARS‐CoV‐2, published before June 2024, were included in this meta‐analysis. The main outcome of this meta‐analysis used to evaluate the performance of 11 assays included pooled diagnostic odds ratio (DOR), area under the summary receiver operating characteristic (AUC), and summary receiver operating characteristic curve (SROC). The R software was used for adjusted indirect comparison to calculate the relative diagnostic odds ratio (RDOR) with corresponding 95% confidence intervals (CIs), and indirect comparison forest plots showed the results. Results: A total of 57 articles met the eligibility criteria for inclusion in our meta‐analysis. The pooled DOR and the AUC for access SARS‐CoV‐2 IgG were 564.28 (95% CI 229.58−1386.91) and 1.00, and as for EDI novel coronavirus COVID‐19 IgG those were 85.27 (95% CI 53.99−134.68) and 0.95, for EDI novel coronavirus COVID‐19 IgM were 49.42 (95% CI 16.47−148.30) and 0.86, for iFlash‐SARS‐CoV‐2 IgG were 652.31 (95% CI 362.32−1174.41) and 0.97, for iFlash‐SARS‐CoV‐2 IgM were 36.72 (95% CI 12.42−108.54) and 0.76, for MAGLUMI 2019‐nCoV IgG were 145.44 (95% CI 59.37−356.30) and 0.90, for MAGLUMI 2019‐nCoV IgM were 21.59 (95% CI 14.27−32.67) and 0.59, for ortho‐clinical anti‐SARS‐CoV‐2 IgG were 719.46 (95% CI 262.34−1973.13) and 1.00, for ortho‐clinical anti‐SARS‐CoV‐2 total were 1104.60 (95% CI 395.64−3083.99) and 1.00, for Siemens SARS‐CoV‐2 total (COV2T) were 1143.37 (95% CI 316.49−4130.62) and 0.99, for Wantai SARS‐CoV‐2 total Ab were 1014.98 (95% CI 618.48−1665.66) and 1.00. The pooled DOR for assays‐based IgG (n = 43), assays‐based total antibody (n = 35), and assays‐based IgM (n = 20) was 242.88 (95% CI 157.66−374.16), 1215.90 (95% CI 547.14−2702.07), and 40.99 (95% CI 22.63−74.25). The diagnostic accuracy of assays‐based total antibody performed better than those of assays‐based IgG and assays‐based IgM; assays‐based IgG performed better than assays‐based IgM. Conclusion: This study suggested that the Siemens SARS‐CoV‐2 total (COV2T), ortho‐clinical anti‐SARS‐CoV‐2 total, and Wantai SARS‐CoV‐2 total had the best overall diagnostic accuracy. The diagnostic efficacy of the assays‐based total antibody had statistically significantly higher accuracy than those of assays‐based IgG and assays‐based IgM for COVID‐19. [ABSTRACT FROM AUTHOR]

Background To help inform COVID-19 vaccination recommendations, we evaluated the impact of age and dosing interval on clinical benefit of a third dose of mRNA-1273. Methods Approximately 17 000 participants from the phase 3 Coronavirus Efficacy trial who previously received 2 doses of 100 µg mRNA-1273 were evaluated for COVID-19 between September 2021 and April 2022 during uptake of a third booster dose of 50 µg of mRNA-1273. Cox models assessed booster relative efficacy of a third dose. Results Initial booster relative efficacy against Delta COVID-19 was 83% (95% confidence interval, 60–93) 14 days postdose and 83% (67–91) 60 days later. Initial booster efficacy against Omicron COVID-19 was 56% (44–65) at 14 days postdose and 4% (−27 to 28) 120 days later. For those aged ≥65 years, initial booster efficacy against Omicron COVID-19 was 86% (69–93) compared with 50% (36–61) for those <65 years. Placebo crossover to 2 doses of mRNA-1273 induced a median 5-month difference from the second to third dose between the original randomized arms. Postboost, the mRNA-1273 arm had a 24% (16%, 32%) lower risk of Omicron COVID-19 compared to the placebo-mRNA-1273 arm. Modeling predicted a 41% postboost reduction in Omicron COVID-19 for a 15- versus 7-month interval between the second and third doses. Conclusions Boosting reduced Delta COVID-19 risk by 83% through 2 months and reduced Omicron COVID-19 risk by 56% but declined by 4 months. A 15- versus 7-month dosing interval predicted a 41% postboost reduction in Omicron COVID-19 but increased preboost risk. Primary Funding Source The National Institutes of Health/National Institute of Allergy and Infectious Diseases. Registration for the COVE Trial.  ClinicalTrials.gov ID# NCT04470427 [ABSTRACT FROM AUTHOR]

A significant proportion of patients after SARS-CoV-2 infection suffer from long-lasting symptoms. Although many different symptoms are described, the majority of patients complains about neuropsychological symptoms. Additionally, a subgroup of patients fulfills diagnostic criteria for ME/CFS. We analyzed a registry of all patients presenting in the out-patients clinic at a German university center. For patients with more than one visit, changes in reported symptoms from first to second visit were analyzed. A total of 1022 patients were included in the study, 411 of them had more than one visit. 95.5% of the patients reported a polysymptomatic disease. At the first visit 31.3% of the patients fulfilled ME/CFS criteria after a median time of 255 days post infection and and at the second visit after a median of 402 days, 19.4% still suffered from ME/CFS. Self-reported fatigue (83.7–72.7%) and concentration impairment (66.2–57.9%) decreased from first to second visit contrasting non-significant changes in the structured screening. A significant proportion of SARS-CoV-2 survivors presenting with ongoing symptoms present with ME/CFS. Although the proportion of subjective reported symptoms and their severity reduce over time, a significant proportion of patients suffer from long-lasting symptoms necessitating new therapeutic concepts. [ABSTRACT FROM AUTHOR]

Research into innovative non-pharmacological therapeutic routes via the utilization of natural elements like zinc (Zn) has been motivated by the discovery of new severe acute respiratory syndrome-related coronavirus 2 (SARS-COV2) variants and the ineffectiveness of certain vaccination treatments during COVID-19 pandemic. In addition, research on SARS-COV-2's viral cellular entry and infection mechanism has shown that it may seriously harm reproductive system cells and impair testicular function in young men and adolescents, which may lead to male infertility over time. In this context, we conducted a narrative review to give an overview of the data pertaining to Zn's critical role in testicular tissue, the therapeutic use of such micronutrients to enhance male fertility, as well as in the potential mitigation of COVID-19, with the ultimate goal of elucidating the hypothesis of the potential use of Zn supplements to prevent the possible harmful effects of SARS-COV2 infection on testis physiological function, and subsequently, on male fertility. [ABSTRACT FROM AUTHOR]

The lungs are exposed to a hostile environment from both sites: the airways and the vasculature. However, an efficient gas exchange of oxygen (O2) and CO2 is only possible through a very thin alveolo‐capillary membrane. Therefore, maintaining cell barrier integrity is essential for respiratory health and function. On the vascular site, endothelial cells form a natural barrier, while in the airways epithelial cells are most important for protection of the lung tissues. Moreover, fibroblasts, by transforming to myofibroblasts, are essential for wound closure after mechanical and chemical microinjuries in the respiratory tract. Along this line, loss of cell resistance in vascular endothelial and lung epithelial cells enhances invasion of pathogens (e.g., SARS‐CoV‐2) and results in pulmonary edema formation, while increasing barrier function of pulmonary (myo)fibroblasts blocks gas exchange in patients with pulmonary fibrosis. Therefore, electrical cell‐substrate impedance sensing‐based quantification of changes in cell barrier function in lung endothelial and epithelial cells as well as fibroblasts after application of harmful triggers (e.g., hypoxia, receptor agonists, and toxicants) is a convenient and state‐of‐the‐art technique. After isolation of primary cells from mouse models and human tissues, changes in cell resistance can be detected in real time. By using lung cells from gene‐deficient mouse models, microRNAs or the small‐interfering RNA technology essential proteins for cell adhesion, for example, ion channels of the transient receptor potential family are identified in comparison to wild‐type control cells. In the future, these proteins may be useful as drug targets for novel therapeutic options in patients with lung edema or pulmonary fibrosis. [ABSTRACT FROM AUTHOR]

BACKGROUND CONTEXT: COVID-19 has been shown to adversely affect multiple organ systems, yet little is known about its effect on perioperative complications after spine surgery or the optimal timing of surgery after an infection. We used the NIH National COVID Cohort Collaborative (N3C) database to characterize the risk profile in patients undergoing spine surgery during multiple time windows following COVID-19 infection. METHODS: We queried the National COVID Cohort Collaborative, a database of 17.4 million persons with 6.9 million COVID-19 cases, for patients undergoing lumbar spinal fusion surgery. Patients were stratified into those with an initial documented COVID-19 infection within 3 time periods: 0 to 2 weeks, 2 to 6 weeks, or 6 to 12 weeks before surgery. RESULTS: A total of 60,541 patients who underwent lumbar spinal fusion procedures were included. Patients who underwent surgery within 2 weeks of their COVID-19 diagnosis had a significantly increased risk for venous thromboembolic events (OR 2.29, 95% CI 1.58-3.32), sepsis (OR 1.56, 95% CI 1.03-2.36), 30-day mortality (OR 5.55, 95% CI 3.53-8.71), and 1-year mortality (OR 2.70, 95% CI 1.91-3.82) compared with patients who were COVID negative during the same period. There was no significant difference in the rates of acute kidney injury or surgical site infection. Patients undergoing surgery between 2 and 6 weeks or between 6 and 12 weeks from the date of COVID-19 infection did not show significantly elevated rates of any complication analyzed. CONCLUSIONS: Patients undergoing lumbar spinal fusion within 2 weeks from initial COVID-19 diagnosis are at increased risk for perioperative venous thromboembolic events and sepsis. This effect does not persist beyond 2 weeks, however, so it may be warranted to postpone non-urgent spine surgeries for at least 2 weeks following a COVID-19 infection or to consider a more aggressive VTE chemoprophylaxis regimen for urgent surgery in COVID-19 patients.

Multisystemic inflammatory syndrome (Mis-C) has emerged in May 2020 as a serious complication of coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). A total of 6 children presented to tertiary care hospitals with Mis-C, of which 5 (83%) have died during hospitalization. All included patients presented with respiratory symptoms (ranged from mild to severe acute respiratory distress syndrome) and gastrointestinal symptoms. Most of the patients are known to have medical illnesses. Pediatric Risk of Mortality (PRISM) IV score ranged from 3 to 87. All patients developed acidosis and varying stages of acute kidney injury and electrolyte disturbances. All were treated for coagulopathy, thrombocytopenia, bacterial infections as well as antiviral medications (either ritonavir or lopinavir). Most patients had chest X-ray changes either unilateral or bilateral lung changes. Multisystemic inflammatory syndrome is a rare, yet serious complication of SARS-CoV2 infection in children. Multisystem involvement should be anticipated and promptly treated. [ABSTRACT FROM AUTHOR]

Background & Aims: COVID-19 is one of the most significant diseases of recent years, spreading globally through human-to-human transmission. The purpose of this study is to investigate the seroepidemiological titers of SARS-CoV-2 antibodies in the urban population of Urmia city based on samples from individuals who referred to local laboratories. This study aims to provide new insights into the epidemiologic behavior of COVID-19 in society. Materials & Methods: Approximately 4,000 people who referred to the laboratories of Urmia participated in this study. Plasma levels of IgM and IgG antibodies were measured, and the frequency of positive antibody titers in the entire population was calculated based on demographic characteristics such as age and gender. IgM and IgG levels were compared between the two genders. Additionally, IgM and IgG levels were compared across age groups: children and adolescents under 20 years old; young adults (20–40 years old); middle-aged individuals (40-60 years old); and the elderly (60 years and older). Results: In this study, the frequencies of IgM+ and IgG+ were determined as well as the frequency of (IgM/IgG+) among the participants. Plasma levels of IgG were not different between women and men, whereas IgM levels were higher in women than in men. The plasma levels of antibodies in the age groups of children and young people were lower than in the middle-aged and elderly age groups. Conclusion: The findings of this study highlight that older adults and individuals with confirmed infections mounted a stronger antibody response. Additionally, the differences in IgM levels between genders warrant further research to explore their potential clinical significance.

Abstract The first outbreaks of coronavirus CoV, SARS-CoV and MERS-CoV have occurred in China and Saudi Arabia over the past decade, respectively. From the end of 2019, a great battle began by the world scientific community against SARS-CoV-2, the virus that caused COVID-19, a pathology that generated devastating consequences on all existing continents. Several mutations have already been detected in the structure of the virus, which have been responsible for the generation of many types of variants since the detection of the first COVID-19 virus identified in China. The worrisome mutations arising from the first genome of SARS-CoV-2 have been intensively studied. Some mutations increase the transmissibility of the disease through Spike, the protein responsible for binding the virus in the human cell. Among the numerous strains, the most discussed are called by the WHO as “variants of concern”. This study aims to review if COVID-19 severity may be variant dependent. Our study found tree publications that associate severity of COVI-19 symptoms to different SARS-CoV-2 variants. The most part of publications do not establish which variant is being expressed during studies. More studies with this focus are needed for a better understanding of the disease and respective variants.

Louis Chhor,1,2 Stefan Saggese,2 Garun S Hamilton,1,3 Martin Ian MacDonald1 1Monash Lung, Sleep, Allergy & Immunology, Monash Health, Melbourne, Victoria, Australia; 2Department of General Medicine, Monash Health, Melbourne, Victoria, Australia; 3School of Clinical Sciences, Monash University, Melbourne, Victoria, AustraliaCorrespondence: Louis Chhor, Department of General Medicine, Dandenong Hospital, 135 David St, Dandenong, VIC, 3175, Australia, Tel +61 3 9544 1000, Email louis.chhor2@easternhealth.org.auObjective: To compare clinical characteristics and outcomes of hospitalized acute exacerbations of COPD (AECOPD)s secondary to SARS-CoV-2 versus other respiratory viruses amongst a highly vaccinated population in the Omicron era.Design: Retrospective cohort study; analysis of hospital medical records and linked pathology and radiology reports.Setting: Tertiary health network in Victoria, Australia; January 2022–August 2022.Main Outcome Measures: Key clinical information including comorbidities, vaccination status, treatments administered and outcomes such as hospital length of stay, ICU admission, non-invasive ventilation usage and inpatient mortality.Results: One hundred ninety-nine viral AECOPDs - 125 SARS-CoV-2 and 74 other viruses were identified. Of the SARS-CoV-2 group. 13.6% were unvaccinated, 17.6% partially and 68.0% fully vaccinated. The SARS-CoV-2 group were older (77.2 vs 68.9, p < 0.00001) with more comorbidities (1[1– 2] vs 1[0– 2], p = 0.008) and lower candidacy for full resuscitation (25.6% vs 56.8%, p < 0.0001). Mortality tended to be higher among SARS-CoV2 admission (9.6% v 2.7%, p = 0.066) but rates of ICU admission (10.4% v 13.5%, p = 0.507), length of hospitalisation (5[3– 8] vs 5[3– 9], p = 0.9) and readmission within 30 days (25% vs 33.3%, p = 0.184) were similar.Conclusion: In a highly vaccinated population in the Omicron era, COPD patients requiring hospitalisation with SARS-CoV-2 are older with more comorbidities than those admitted with other respiratory viruses. Length of hospitalisation and ICU utilisation was similar. Inpatient mortality may be higher.Keywords: SARS-CoV2, coronavirus, COPD, viral exacerbations

Abstract Background Over the past decade, numerous studies on potential factors contributing to ventilation-induced lung injury have been carried out. Mechanical power has been pointed out as the parameter that encloses all ventilation-induced lung injury-contributing factors. However, studies conducted to date provide data regarding mechanical power during the early hours of mechanical ventilation that may not accurately reflect the impact of power throughout the period of mechanical ventilatory support on intensive care unit mortality. Methods Retrospective observational study conducted at a single center in Spain. Patients admitted to the intensive care unit, > o = 18 years of age, and ventilated for over 24 h were included. We extracted the mechanical power values throughout the entire mechanical ventilation in controlled modes period from the clinical information system every 2 min. First, we calculate the cutoff-point for mechanical power beyond which there was a greater change in the probability of death. After, the sum of time values above the safe cut-off point was calculated to obtain the value in hours. We analyzed if the number of hours the patient was under ventilation with a mechanical power above the safe threshold was associated with intensive care unit mortality, invasive mechanical ventilation days, and intensive care unit length of stay. We repeated the analysis in different subgroups based on the degree of hypoxemia and in patients with SARS CoV-2 pneumonia. Results The cut-off point of mechanical power at with there is a higher increase in intensive care unit mortality was 18 J/min. The greater the number of hours patients were under mechanical power > 18 J/min the higher the intensive care unit mortality in all the study population, in patients with SARS CoV-2 pneumonia and in mild to moderate hypoxemic respiratory failure. The risk of death in the intensive care unit increases 0.1% for each hour with mechanical power exceeding 18 J/min. The number of hours with mechanical power > 18 J/min also affected the days of invasive mechanical ventilation and intensive care unit length of stay. Conclusions The number of hours with mechanical power > 18 J/min is associated with mortality in the intensive care unit in critically ill patients. Continuous monitoring of mechanical power in controlled modes using an automated clinical information system could alert the clinician to this risk.

Abstract Background The architecture and dynamics of T cell populations are critical in orchestrating the immune response to SARS-CoV-2. In our study, we used T Cell Receptor sequencing (TCRseq) to investigate TCR repertoires in 173 post-infection COVID-19 patients. Methods The cohort included 98 mild and 75 severe cases with a median age of 53. We amplified and sequenced the TCR β chain Complementary Determining Region 3 (CDR3b) and performed bioinformatic analyses to assess repertoire diversity, clonality, and V/J allelic usage between age, sex and severity groups. CDR3b amino acid sequence inference was performed by clustering structural motifs and filtering validated reactive CDR3b to COVID-19. Results Our results revealed a pronounced decrease in diversity and an increase in clonal expansion in the TCR repertoires of severe COVID-19 patients younger than 55 years old. These results reflect the observed trends in patients older than 55 years old (both mild and severe). In addition, we identified a significant reduction in the usage of key V alleles (TRBV14, TRBV19, TRBV15 and TRBV6-4) associated with disease severity. Notably, severe patients under 55 years old had allelic patterns that resemble those over 55 years old, accompanied by a skewed frequency of COVID-19-related motifs. Conclusions Present results suggest that severe patients younger than 55 may have a compromised TCR repertoire contributing to a worse disease outcome. Graphical Abstract

Abstract Background Few data are available on the long-term mortality and functional status of geriatric patients surviving after hospitalization for COVID-19. We compared the mortality and functional status 18 months after hospitalization for geriatric patients who were hospitalized for COVID-19 or another diagnosis. Methods This was a multicentric cohort study in Paris from January to June 2021. We included patients aged 75 years and over who were hospitalized with COVID-19 or not during this period and compared their vital and functional status 18 months after hospitalization. Results We included 254 patients (63 hospitalized for COVID-19). As compared with patients hospitalized for other reasons, those hospitalized for COVID-19 were younger (mean [SD] age 86 [6.47] vs. 88 [6.41] years, p = 0.03), less frail (median Clinical Frailty Scale score 5 [4–6] vs. 6 [4–6], p 0.007) and more independent at baseline (median activities of daily living score 5.5 [4–6] vs. 5 [3.5–6], p 0.03; instrumental activities of daily living score 3 [1–4] vs. 2 [0–3], p 0.04). At 18 months, 50.8% (n = 32/63) of COVID-19 patients had died versus 66% (n = 126/191) of non-COVID-19 patients (p 0.03). On multivariate analysis, COVID-19 positivity was not significantly associated with 18-month mortality (adjusted hazard ratio 0.67, 95% confidence interval 0.40 to 1.13). At 18 months, the two groups did not differ in activities of daily living or frailty scores. Conclusions In this multicenter study of long-term mortality in geriatric patients discharged alive after hospitalization, positive COVID-19 status was not associated with excess mortality.

Purpose: Secondary opportunistic coinfections are a significant contributor to morbidity and mortality in intensive care unit (ICU) patients, but can be difficult to identify. Presently, new blood RNA biomarkers were tested in ICU patients to diagnose viral, bacterial, and biofilm coinfections. Methods: COVID-19 ICU patients had whole blood drawn in RNA preservative and stored at −80°C. Controls and subclinical infections were also studied. Droplet digital polymerase chain reaction (ddPCR) quantified 6 RNA biomarkers of host neutrophil activation to bacterial (DEFA1), biofilm (alkaline phosphatase [ALPL], IL8RB/CXCR2), and viral infections (IFI27, RSAD2). Viral titer in blood was measured by ddPCR for SARS-CoV2 (SCV2). Results: RNA biomarkers were elevated in ICU patients relative to controls. DEFA1 and ALPL RNA were significantly higher in severe versus incidental/moderate cases. SOFA score was correlated with white blood cell count (0.42), platelet count (−0.41), creatinine (0.38), and lactate dehydrogenase (0.31). ALPL RNA (0.59) showed the best correlation with SOFA score. IFI27 (0.52) and RSAD2 (0.38) were positively correlated with SCV2 viral titer. Overall, 57.8% of COVID-19 patients had a positive RNA biomarker for bacterial or biofilm infection. Conclusions: RNA biomarkers of host neutrophil activation indicate the presence of bacterial and biofilm coinfections in most COVID-19 patients. Recognizing coinfections may help to guide the treatment of ICU patients. [ABSTRACT FROM AUTHOR]

Purpose: Outbreak of SARS-CoV2 and the COVID-19 pandemic had posed a threat to the healthcare system. The world had witnessed the failure of the healthcare system in the diagnosis, surveillance, and development of therapeutics effective against COVID-19. Hence, research emphasis has been given to technological inventions in developing robust and effective tools to fight against respiratory viral outbreaks, including SARS-CoV2. Methods: The scientific literature was searched and retrieved from PubMed, PubMed Central, the Cochrane Central Register of Controlled Trials (CENTRAL), and Scielo databases. The scientific literature was screened and selected based on recent studies in the area of nanotechnology based inventions and applications in developing diagnostics, surveillance tools, PPE kits, therapeutics, and vaccines. Results: Based on the scientific literature, there are enormous developments in designing robust diagnostics, surveillance tools, therapeutics, and vaccines. These findings show an increasing demand for nanotechnology-based inventions to tackle zoonotic spillover. Nanotechnology remains a growing area as interdisciplinary science and technology- enable a variety of inventions used in the COVID-19 pandemic. PPE design is a classic example where nanotechnology-driven materials are extensively used. Masks and other fabrics were also developed using nanotechnology-based materials. Conclusion: The study provides insights into nanotechnology based inventions in the fight against respiratory viral pathogens, including SARS-CoV2, and associated diseases. The study showed the application of nanotechnology in the development of diagnostics, surveillance tools, therapeutics, and vaccines. [ABSTRACT FROM AUTHOR]

Copyright of Revista Latinoamericana de Hipertension is the property of Revista Latinoamericana de Hipertension and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Despite the progress in medical data collection the actual burden of SARS‐CoV‐2 remains unknown due to under‐ascertainment of cases. This was apparent in the acute phase of the pandemic and the use of reported deaths has been pointed out as a more reliable source of information, likely less prone to under‐reporting. Since daily deaths occur from past infections weighted by their probability of death, one may infer the total number of infections accounting for their age distribution, using the data on reported deaths. We adopt this framework and assume that the dynamics generating the total number of infections can be described by a continuous time transmission model expressed through a system of nonlinear ordinary differential equations where the transmission rate is modeled as a diffusion process allowing to reveal both the effect of control strategies and the changes in individuals behavior. We develop this flexible Bayesian tool in Stan and study 3 pairs of European countries, estimating the time‐varying reproduction number (Rt$$ {R}_t $$) as well as the true cumulative number of infected individuals. As we estimate the true number of infections we offer a more accurate estimate of Rt$$ {R}_t $$. We also provide an estimate of the daily reporting ratio and discuss the effects of changes in mobility and testing on the inferred quantities. [ABSTRACT FROM AUTHOR]

Background: Over the past decade, numerous studies on potential factors contributing to ventilation-induced lung injury have been carried out. Mechanical power has been pointed out as the parameter that encloses all ventilation-induced lung injury-contributing factors. However, studies conducted to date provide data regarding mechanical power during the early hours of mechanical ventilation that may not accurately reflect the impact of power throughout the period of mechanical ventilatory support on intensive care unit mortality. Methods: Retrospective observational study conducted at a single center in Spain. Patients admitted to the intensive care unit, > o = 18 years of age, and ventilated for over 24 h were included. We extracted the mechanical power values throughout the entire mechanical ventilation in controlled modes period from the clinical information system every 2 min. First, we calculate the cutoff-point for mechanical power beyond which there was a greater change in the probability of death. After, the sum of time values above the safe cut-off point was calculated to obtain the value in hours. We analyzed if the number of hours the patient was under ventilation with a mechanical power above the safe threshold was associated with intensive care unit mortality, invasive mechanical ventilation days, and intensive care unit length of stay. We repeated the analysis in different subgroups based on the degree of hypoxemia and in patients with SARS CoV-2 pneumonia. Results: The cut-off point of mechanical power at with there is a higher increase in intensive care unit mortality was 18 J/min. The greater the number of hours patients were under mechanical power > 18 J/min the higher the intensive care unit mortality in all the study population, in patients with SARS CoV-2 pneumonia and in mild to moderate hypoxemic respiratory failure. The risk of death in the intensive care unit increases 0.1% for each hour with mechanical power exceeding 18 J/min. The number of hours with mechanical power > 18 J/min also affected the days of invasive mechanical ventilation and intensive care unit length of stay. Conclusions: The number of hours with mechanical power > 18 J/min is associated with mortality in the intensive care unit in critically ill patients. Continuous monitoring of mechanical power in controlled modes using an automated clinical information system could alert the clinician to this risk. [ABSTRACT FROM AUTHOR]

COVID-19 vaccine evaluations are mainly focused on antibody analyses, but there is growing interest in measuring the cellular immune responses from the researchers evaluating these vaccines. The cellular responses to several COVID-19 vaccines have been studied using the enzyme-linked immunospot (ELISPOT) assay for IFN-γ. However, the ELISPOT assay is no longer used only for research purpose and so the performance of this assay must be validated. Since the bioanalytical validation of ELISPOT-IFN-γ is essential for evaluating the method's effectiveness and establishing confidence in a vaccine's immunogenicity, the present work validates the ELISPOT-IFN-γ assay's performance in determining the frequency of IFN-γ-producing cells after stimulation with the SARS-CoV-2 spike protein. The validation was performed in peripheral blood mononuclear cells from volunteers immunized with anti-COVID-19 vaccines. According to the findings, the LOD was 17 SFU and the LLOQ was 22 SFU, which makes the method highly sensitive and suitable for evaluating low levels of cellular responses. The procedure's accuracy is confirmed by the correlation coefficients for the spike protein and anti-CD3+, being 0.98 and 0.95, respectively. The repeatability and intermediate precision tests were confirmed to be reliable by obtaining a coefficient of variation of ≤25%. The results obtained in this validation enable the assay to be employed for studying antigen-specific cells and evaluating cellular responses to vaccines. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to see if the CHA2DS2-VASc score (Cardiac failure or dysfunction, Hypertension, Age ≥ 75 [Doubled], Diabetes, Stroke [Doubled]—Vascular disease, Age 65–74 and Sex category [Female] score) could have potential clinical relevance in predicting the outcome of hospitalization time, need for ICU hospitalization, survival time, in-hospital mortality, and mortality at 3 and 6 months after discharge home. Materials: A retrospective analysis of 2183 patients with COVID-19 hospitalized at the COVID-19 Centre of the University Hospital in Wrocław, Poland, between February 2020 and June 2021, was performed. All medical records were collected as part of the COronavirus in LOwer Silesia—the COLOS registry project. The CHA2DS2-VASc score was applied for all subjects, and the patients were observed from admission to hospital until the day of discharge or death. Further information on patient deaths was prospectively collected following the 90 and 180 days after admission. The new risk stratification derived from differences in survival curves and long-term follow-up of our patients was obtained. Primary outcomes measured included in-hospital mortality and 3-month and 6-month all-cause mortality, whereas secondary outcomes included termination of hospitalization from causes other than death (home discharges/transfer to another facility or deterioration/referral to rehabilitation) and non-fatal adverse events during hospitalization. Results: It was shown that gender had no effect on mortality. Significantly shorter hospitalization time was observed in the group of patients with low CHA2DS2-VASc scores. Among secondary outcomes, CHA2DS2-VASc score revealed predictive value in both genders for cardiogenic (5.79% vs. 0.69%; p < 0.0001), stroke/TIA (0.48% vs. 9.92%; p < 0.0001), acute heart failure (0.97% vs. 18.18%; p < 0.0001), pneumonia (43% vs. 63.64%; p < 0.0001), and acute renal failure (7.04% vs. 23.97%; p < 0.0001). This study points at the usefulness of the CHA2DS2-VASc score in predicting the severity of the course of COVID-19. Conclusions: Routine use of this scale in clinical practice may suggest the legitimacy of extending its application to the assessment of not only the risk of thromboembolic events in the COVID-19 cohort. [ABSTRACT FROM AUTHOR]

Introduction: The high prevalence of deep vein thrombosis (DVT) in patients admitted to intensive care unit (ICU) for COVID-19-related acute respiratory distress syndrome (ARDS) would justify systematic screening of these patients or higher therapeutic dose of heparin for thromboprophylaxis. Material and method: We performed a systematic echo-Doppler of the lower limb proximal veins during the first 48 h (visit 1) and from 7 to 9 days after visit 1 (visit 2) in consecutive patients admitted to the ICU of a university-affiliated tertiary hospital for severe proven COVID-19 during the second wave. All patients received intermediate-dose heparin (IDH). The primary objective was to determine DVT incidence on venous Doppler ultrasound. Secondary objectives were to determine whether the presence of DVT modifies the anticoagulation regimen, the incidence of major bleeding according to International Society on Thrombosis and Haemostasis (ISTH) criteria, and the mortality rate of patients with and without DVT. Results: We included 48 patients (30 [62.5%] men) with a median age of 63 years [IQR, 54–70]. The prevalence of proximal deep vein thrombosis was 4.2% (2/48). In these two patients, after DVT diagnosis, anticoagulation was changed from intermediate to curative dose. Two patients (4.2%) had a major bleeding complication according to ISTH criteria. Among the 48 patients, 9 (18.8%) died before hospital discharge. No DVT or pulmonary embolism was diagnosed in these deceased patients during their hospital stay. Conclusion: In critically ill patients with COVID-19, management with IDH results in a low incidence of DVT. Although our study is not designed to demonstrate any difference in outcome, our results do not suggest any signal of harm when using intermediate-dose heparin (IDH) COVID-19 with a frequency of major bleeding complications less than 5%. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic underscores the critical need to integrate immunomics within the One Health framework to effectively address zoonotic diseases across humans, animals, and environments. Employing advanced high-throughput technologies, this interdisciplinary approach reveals the complex immunological interactions among these systems, enhancing our understanding of immune responses and yielding vital insights into the mechanisms that influence viral spread and host susceptibility. Significant advancements in immunomics have accelerated vaccine development, improved viral mutation tracking, and broadened our comprehension of immune pathways in zoonotic transmissions. This review highlights the role of animals, not merely as carriers or reservoirs, but as essential elements of ecological networks that profoundly influence viral epidemiology. Furthermore, we explore how environmental factors shape immune response patterns across species, influencing viral persistence and spillover risks. Moreover, case studies demonstrating the integration of immunogenomic data within the One Health framework for COVID-19 are discussed, outlining its implications for future research. However, linking humans, animals, and the environment through immunogenomics remains challenging, including the complex management of vast amounts of data and issues of scalability. Despite challenges, integrating immunomics data within the One Health framework significantly enhances our strategies and responses to zoonotic diseases and pandemic threats, marking a crucial direction for future public health breakthroughs. [ABSTRACT FROM AUTHOR]

Background: Few data are available on the long-term mortality and functional status of geriatric patients surviving after hospitalization for COVID-19. We compared the mortality and functional status 18 months after hospitalization for geriatric patients who were hospitalized for COVID-19 or another diagnosis. Methods: This was a multicentric cohort study in Paris from January to June 2021. We included patients aged 75 years and over who were hospitalized with COVID-19 or not during this period and compared their vital and functional status 18 months after hospitalization. Results: We included 254 patients (63 hospitalized for COVID-19). As compared with patients hospitalized for other reasons, those hospitalized for COVID-19 were younger (mean [SD] age 86 [6.47] vs. 88 [6.41] years, p = 0.03), less frail (median Clinical Frailty Scale score 5 [4–6] vs. 6 [4–6], p 0.007) and more independent at baseline (median activities of daily living score 5.5 [4–6] vs. 5 [3.5–6], p 0.03; instrumental activities of daily living score 3 [1–4] vs. 2 [0–3], p 0.04). At 18 months, 50.8% (n = 32/63) of COVID-19 patients had died versus 66% (n = 126/191) of non-COVID-19 patients (p 0.03). On multivariate analysis, COVID-19 positivity was not significantly associated with 18-month mortality (adjusted hazard ratio 0.67, 95% confidence interval 0.40 to 1.13). At 18 months, the two groups did not differ in activities of daily living or frailty scores. Conclusions: In this multicenter study of long-term mortality in geriatric patients discharged alive after hospitalization, positive COVID-19 status was not associated with excess mortality. [ABSTRACT FROM AUTHOR]

Introduction: Since COVID-19 first surfaced in 2019, it has seriously threatened public health. The most prevalent symptoms are respiratory ones. This study aimed to present the correlation between the severity of the clinical presentation of the disease and the results of respiratory function tests conducted within 6 months after hospital discharge. Methodology: This retrospective study included 99 patients with confirmed SARS-CoV-2 virus infection. Of all patients 24.2% had accentuated bronchovascular pattern, 9.1% had unilateral, and 29.3% had bilateral pneumonia. In comparison, 35.4% patients had diffuse changes, which were described as acute respiratory distress syndrome (ARDS) on computed tomography (CT). Results: Patients with unilateral, bilateral pneumonia or diffuse lung damage had significantly lower forced vital capacity (FVC) values. They were treated with non-invasive mechanical ventilation (NIV) or invasive mechanical ventilation (MV) and had lower FVC values (0.039). A negative, weak correlation existed between CT findings during the infection and Diffusing capacity for carbon monoxide (DLCO) measured after the infection (0.003). A negative, weak correlation was found between oxygen therapy, the use of NIV, and MV findings during the infection with DLCO. A negative correlation was noted between leukocyte values during the infection and forced expiratory volume in the first second (FEV1) and FVC after the infection. Conclusions: Patients with COVID-19 infection who need oxygen support and MV continue to suffer from loss of respiratory function after the resolution of COVID-19 infection. These findings highlight the negative predictive value of pulmonary tests in the long-term follow-up for the development of PC-ILD as well as decreased pulmonary capacity. [ABSTRACT FROM AUTHOR]

Purpose: Although some immune protection from close contact with individuals who have coronavirus disease 2019 (COVID-19) has been documented, there is limited data on the seroprevalence of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in individuals who were in lockdown with confirmed COVID-19 cases. This study investigated immunogenicity against SARS-CoV-2 in household members and people who lived near home-quarantined patients with COVID-19. Materials and Methods: This cross-sectional study was conducted during the community-based care that took place during lockdowns in District 10, Ho Chi Minh City, Vietnam from July to September 2021. SARS-CoV-2 antibody levels were determined in index cases of COVID-19, household contacts, and a no-contact group from the same area. Results: A total of 770 participants were included (355 index cases, 103 household contacts, and 312 no contacts). All index cases were unvaccinated, but >90% of individuals in the household and no-contact groups had received ≥1 vaccine dose. SARS-CoV-2 neutralizing antibodies (Nabs) were present in >77% of unvaccinated index cases versus 64%/65.4% in the household/no-contact groups (p=0.001). Antibody concentrations in unvaccinated index cases were significantly higher than those in household contacts and no contacts, with no difference between the latter groups. In all cases, antibody levels declined markedly ≥6 weeks after infection, and failed to persist beyond this time in the household and no-contact groups. Conclusion: Community-based care may have helped to create community immunogenicity, but Nabs did not persist, highlighting a need for vaccination for all individuals before, or from 6 weeks after, infection with SARS-CoV-2. [ABSTRACT FROM AUTHOR]

Background: The architecture and dynamics of T cell populations are critical in orchestrating the immune response to SARS-CoV-2. In our study, we used T Cell Receptor sequencing (TCRseq) to investigate TCR repertoires in 173 post-infection COVID-19 patients. Methods: The cohort included 98 mild and 75 severe cases with a median age of 53. We amplified and sequenced the TCR β chain Complementary Determining Region 3 (CDR3b) and performed bioinformatic analyses to assess repertoire diversity, clonality, and V/J allelic usage between age, sex and severity groups. CDR3b amino acid sequence inference was performed by clustering structural motifs and filtering validated reactive CDR3b to COVID-19. Results: Our results revealed a pronounced decrease in diversity and an increase in clonal expansion in the TCR repertoires of severe COVID-19 patients younger than 55 years old. These results reflect the observed trends in patients older than 55 years old (both mild and severe). In addition, we identified a significant reduction in the usage of key V alleles (TRBV14, TRBV19, TRBV15 and TRBV6-4) associated with disease severity. Notably, severe patients under 55 years old had allelic patterns that resemble those over 55 years old, accompanied by a skewed frequency of COVID-19-related motifs. Conclusions: Present results suggest that severe patients younger than 55 may have a compromised TCR repertoire contributing to a worse disease outcome. [ABSTRACT FROM AUTHOR]

Copyright of Medical Journal of Ankara Training & Research Hospital is the property of Medical Journal of Ankara Training & Research Hospital and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

During and subsequent to a natural disaster, there is an expectation that certain elements of society will continue to operate with a degree of normalcy. For example, it is expected that emergency medical services will continue to function and remain reliable for the community served. Expectations such as these are based on the presumed reliability of government and the assumption that those responsible for the relevant infrastructure will have made plans to ensure it remains functional and taken steps to mitigate known weaknesses. The COVID-19 pandemic provides a case in point. Specifically, data captured during the pandemic are now the subject of ongoing review and analysis, and the findings from such studies are being used to inform planning and preparedness for the next public health disaster. This particular study was conducted in response to circumstantial evidence indicating that frontline workers in the healthcare profession may share some of the same ambivalence towards transmission mitigation as seen in the general population when confronted with new and emerging communicable diseases. This is a concern, as when medical personnel are either unable or unwilling to take reasonable steps to protect themselves and their patients, it undermines the readiness of the essential service. To explore this situation in greater depth, the study examines the real-time responses from a sample of frontline personnel interviewed during the pandemic. The results indicate that there are a number of opportunities to improve workforce readiness to assure reliable continuity during the next outbreak, epidemic or pandemic. [ABSTRACT FROM AUTHOR]