COVID-19 Publications by UMass Chan Authors

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ABOUT THIS COLLECTION

This collection showcases journal articles, preprints, and other publications and presentations about the SARS-CoV-2 coronavirus and COVID-19 by faculty, students and researchers at UMass Chan Medical School in Worcester, MA, USA.

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Reasons for COVID-19 vaccination late in the pandemic: A qualitative study
(2025-04-04) Fisher, Kimberly A; Goldthwait, Lydia; Desrochers, Ollie; Zemel, Melanie; Saphirak, Cassandra; Malin, Jeremy; Stone, Rosalie Torres; Singh, Sonal; Crawford, Sybil; Mazor, Kathleen M; Medicine; Tan Chingfen Graduate School of Nursing; Family Medicine and Community Health
This study elicited reasons for initiating COVID-19 vaccination in April 2022 or later. We interviewed patients (n = 51) from 2 healthcare systems in central Massachusetts. Participants were 66.7 % female, 39.2 % White non-Hispanic, 15.7 % Black non-Hispanic, and 39.2 % Hispanic. The most common reason for vaccination was that it was required for something the participant wanted to do, cited by 40/51 participants as the main reason for vaccination. Social influences, reported by 27/51 participants, were mostly (n = 22/27) described as secondary reasons. Increased disease risk appraisal and/or increased confidence in the vaccine were noted by 24/51 participants, also predominantly as secondary reasons (n = 14/24). Requirements to be vaccinated for work, school, or to participate in activities are an important lever for promoting COVID-19 vaccine uptake. Commonly cited as secondary reasons, social influences and factors that increase disease risk appraisal and/or vaccine confidence may serve to create a foundation for vaccine requirements.
Molecular mechanisms of drug resistance and compensation in SARS-CoV-2 main protease: the interplay between E166 and L50
(2025-04-04) Zvornicanin, Sarah N; Shaqra, Ala M; Flynn, Julia; Carias Martinez, Heidi; Jia, Weiping; Moquin, Stephanie; Dovala, Dustin; Bolon, Daniel N; Kurt Yilmaz, Nese; Schiffer, Celia A; Biochemistry and Molecular Biotechnology
The SARS-CoV-2 main protease (Mpro) is essential for viral replication and is a primary target for COVID-19 antivirals. Direct-acting antivirals such as nirmatrelvir, the active component of Paxlovid, target the Mpro active site to block viral polyprotein cleavage and thus replication. However, drug resistance mutations at the active site residue Glu166 (E166) have emerged during in vitro selection studies, raising concerns about the durability of current antiviral strategies. Here, we investigate the molecular basis of drug resistance conferred by E166A and E166V mutations against nirmatrelvir and the related PF-00835231, individually and in combination with the distal mutation L50F. We found that E166 mutations reduce nirmatrelvir potency by up to 3,000-fold while preserving substrate cleavage, with catalytic efficiency reduced by only up to twofold. This loss of catalytic efficiency was compensated for by the addition of L50F in the double-mutant variants. We have determined three cocrystal structures of the E166 variants (E166A, E166V, and E166V/L50F) bound to PF-00835231. Comparison of these structures with wild-type enzyme demonstrated that E166 is crucial for dimerization and for shaping the substrate-binding S1 pocket. Our findings highlight the mutability of E166, a prime site for resistance for inhibitors that leverage direct interactions with this position, and the potential emergence of highly resistant and active variants in combination with the compensatory mutation L50F. These insights support the design of inhibitors that target conserved protease features and avoid E166 side-chain interactions to minimize susceptibility to resistance. Importance: Drug resistance remains a great challenge to modern medicine. This study investigates SARS-CoV-2 main protease variants E166A and E166V which confer nirmatrelvir resistance. These variants can retain considerable enzymatic activity through combination with the compensatory mutation L50F. For single- and double-mutant variant enzymes, we assessed catalytic efficiency, measured loss in potency for nirmatrelvir and its analog PF-00835231, and cocrystallized with inhibitors to investigate drug resistance caused by these mutations. Our results contribute toward understanding of molecular mechanisms of resistance and combinations of mutations, which pushes toward resistance-thwarting inhibitor design. These principles also apply broadly to many quickly evolving drug targets in infectious diseases.
Effect of Covid-19 pandemic on azithromycin, chloroquine/hydroxychloroquine and ivermectin outpatient consumption in Brazil: a joinpoint regression analysis
(2025-04-03) Caetano, Michele Costa; Emmerick, Isabel Cristina Martins; Campos, Mônica Rodrigues; Pires, Débora Castanehira; Wirtz, Veronika J; Luiza, Vera Lucia; Surgery
Background: The endorsement of unproven COVID-19 treatment marked the political bias in Brazil's pandemic response. This study aimed to analyze the trends in the consumption of azithromycin (AZI), chloroquine/ hydroxychloroquine (CQ/HCQ), and ivermectin (IVM) considering COVID-19 cases and key political events. Methods: A retrospective cohort study was conducted to analyze the weekly outpatient dispensing records of AZI, CQ/HCQ, and IVM from the National Database of Actions and Services of Pharmaceutical Services in SUS (BNAFAR) and the COVID-19 incidence rates from January 2019 to December 2021. A joinpoint regression analysis was employed to assess shifts in COVID-19 incidence rates and AZI, CQ/HCQ, and IVM consumption in outpatients, expressed as Defined Daily Dose per 1,000 inhabitants per day (DID), in Brazil and its five geographical regions taking into consideration the timing of three political events. Results: There was a significant increase in AZI, CQ/HCQ, and IVM consumption during the COVID-19 pandemic in Brazil of 62.8%, 504.6%, and 525.7%, respectively. Adults and women had higher DID; however, a higher proportional rise was observed among men, especially for CQ/HCQ. A notable increase in the consumption of CQ/HCQ during the first COVID-19 wave, IVM in the second, and AZI in both waves was more pronounced in the South, Midwest, and North of Brazil. This pattern coincided closely with the timeline of COVID-19 incidence rates and showed an upward trend in all three medicines after key political events that endorsed their use, particularly in these three regions. No corresponding downward trend in COVID-19 cases was observed despite the increased use of these medicines. A significant reduction in consumption nationwide was observed after an increase in vaccination coverage, resulting in a DID near pre-pandemic levels. Conclusion: The study provides substantial evidence on the relationship between COVID-19 incidence, political events, and the consumption of AZI, CQ/HCQ, and IVM during the pandemic in Brazil. The findings suggest that consumption trends were aligned with regional political affiliations and the COVID-19 incidence rates. These highlight the importance of political determinants of inappropriate medicine utilization that wastes scarce resources and increases the risk of adverse health outcomes and antimicrobial resistance.
Characteristics and Medication Use Patterns of Pregnancies With COVID-19 Ending in Live-Birth in the Sentinel System
(2025-03-26) Shinde, Mayura; Cosgrove, Austin; Lyons, Jennifer G; Kempner, Maria E; Mosley, Jolene; Cole, David; Hoffman, Emma; Messenger-Jones, Elizabeth; Hernández-Muñoz, José J; Stojanovic, Danijela; Wong, Benedict H W; Zhao, Yueqin; Sahin, Leyla; Andrade, Susan E; Toh, Sengwee; Hua, Wei; Medicine
Background: Pregnant women are at high risk for developing severe illness related to COVID-19. We adapted the "COVID-19 infectiOn aNd medicineS In pregnancy" (CONSIGN) study protocol as part of an international collaboration to examine medication use patterns among pregnancies in the US. Methods: We identified eligible women aged 12-55 years with documented live-birth deliveries in the Sentinel Distributed Database who had at least one qualifying diagnosis for COVID-19 or a positive-confirmed test for SARS-CoV-2, by trimester of COVID-19 infection. We conducted two sets of analyses comparing medication groups and COVID-19 treatment utilization in the 30 days prior to or after COVID-19 among pregnancies with COVID-19 to: (1) pregnancies without COVID-19 during 6 months prior to or during pregnancy; and (2) non-pregnancy episodes with COVID-19. Results: From 2020 to 2022, we identified 52 355 pregnancies with COVID-19 matched to 52 355 pregnancies without COVID-19 (assigned same matched COVID-19 date), and 40 518 matched non-pregnancy episodes with COVID-19. Outpatient medication use in the 30 days prior to or after the COVID-19 date (or matched date) was quite low (< 15%) among pregnancies with and without COVID-19. Non-pregnancy episodes with COVID-19 had higher use of all medication groups in 30 days prior to COVID-19. However, in the 30 days post-COVID-19, anti-bacterials, anti-inflammatories such as NSAIDs, and analgesics were more common, and COVID-19-specific medications were less frequently used (< 1%) among pregnancies with COVID-19. Assessing COVID-19 severity, more pregnancies had a non-severe COVID-19 diagnosis than non-pregnancy episodes with COVID-19 (87.2% vs. 79.9%). Conclusions: In this retrospective evaluation, selected medication utilization was higher post-COVID-19 among pregnancies with COVID-19, compared to those without COVID-19 and to non-pregnancy episodes with COVID-19. However, the low use of COVID-19-specific medications underscores the need for a safety evaluation of therapies used for COVID-19 management in the pregnant population.
Perceptions of sources of transmission among hospital employees infected with severe acute respiratory coronavirus 2 (SARS-CoV-2) in an urban tertiary care hospital: a qualitative study to inform future pandemic management
(2025-03-14) Luo, Ziyue; Kent, Daniel E; Shah, Pooja; Poplausky, Dina; MacRae, MacKenzie Clark; Boomsma, Cassidy; Jasper, Jacob M; Wurcel, Alysse G; Byhoff, Elena; Tang, Alice M; Doron, Shira; Subbaraman, Ramnath; Medicine
Objective: Hospital employees are at risk of severe acute respiratory coronavirus 2 (SARS-CoV-2) infection from patient, coworker, and community interactions. Understanding employees' perspectives on transmission risks may inform hospital pandemic management strategies. Design: Qualitative interviews were conducted with 23 employees to assess factors contributing to perceived transmission risks during patient, coworker, and community interactions and to elicit recommendations. Using a deductive approach, transcripts were coded to identify recurring themes. Setting: Tertiary hospital in Boston, Massachusetts. Participants: Employees with a positive SARS-CoV-2 PCR test between March 2020 and January 2021, a period before widespread vaccine availability. Results: Employees generally reported low concern about transmission risks during patient care. Most patient-related risks, including limited inpatient testing and personal protective equipment availability, were only reported during the early weeks of the pandemic, except for suboptimal masking adherence by patients. Participants reported greater perceived transmission risks from coworkers, due to limited breakroom space, suboptimal coworker masking, and perceptions of inadequate contact tracing. Perceived community risks were related to social gatherings and to household members who also had high SARS-CoV-2 infection risk because they were essential workers. Recommendations included increasing well-ventilated workspaces and breakrooms, increasing support for sick employees, and stronger hospital communication about risks from non-patient-care activities, including the importance of masking adherence with coworkers and in the community. Conclusions: To reduce transmission during future pandemics, hospitals may consider improving communication on risk reduction during coworker and community interactions. Societal investments are needed to improve hospital infrastructure (eg, better ventilation and breakroom space) and increase support for sick employees.
A community-engaged implementation mapping approach to increase SNAP participation in a diverse Latine community
(2025-01-16) Byhoff, Elena; Rudel, Rebecca K; Burgun, Rachel; Silva, Sandra; Lichkus, Jonathan; Drainoni, Mari-Lynn; Medicine
Background: The Supplemental Nutrition Assistance Program (SNAP) is an underutilized program. SNAP uptake is limited in Latine households in particular due to concerns about immigration eligibility, even when there are SNAP-eligible household members. Implementation strategies are urgently needed to increase SNAP participation rates among those who are eligible. Purpose: We used collaborative planning and implementation mapping to design implementation strategies to increase SNAP participation. Methods: Collaborative planning and implementation mapping included: (i) identify a shared priority; (ii) review relevant data to identify determinants of SNAP participation; (iii) design strategies to accomplish the priority goal; (iv) reach consensus and pilot-chosen strategies and workflows; and (v) evaluate implementation success based on chosen outcomes. Using the Practical Robust Implementation and Sustainability Model, we identified two implementation strategies, a community and a policy strategy, to pilot from January to December 2023. Results: The community strategy leveraged an existing food program to identify participants who were not already enrolled in SNAP. This resulted in 69 referrals and 4 new SNAP enrollees. The policy strategy leveraged the existing policy context to link SNAP enrollment with Medicaid insurance reenrollment at the end of the COVID-19 public health emergency protections. This resulted in an unknown number of referrals due to data workflow barriers. Conclusions: Despite considering context in the design and piloting of two implementation strategies, success was limited. Future success will require including the perspectives of those with lived experience to inform processes to identify eligible individuals without creating additional stigma or furthering distrust among those who may be ineligible.
The Continuing Impact of the COVID-19 Pandemic on Diabetic Retinopathy Screenings
(2024-07-31) Bilsbury, Evan; Mautner Wizentier, Marina; Wood, Emma; Doherty, Sean; Ledwith, James; Ding, Juan; Family Medicine and Community Health; Ophthalmology and Visual Sciences
Purpose: This retrospective observational study of health claims data seeks to quantify the prolonged impact of the COVID-19 pandemic on DR screening rates in central Massachusetts. Methods: Retrospective claims data from the UMass Memorial Managed Care Network were collected for the years of 2018-2022. Comprehensive and DR screening exams were identified using CPT codes for patients with diabetes. Data were derived from claims submitted by the UMass Memorial Managed Care network to four insurance programs via CPT billing code for comprehensive and DR screening exams for patients with diabetes. Over one million claims for the years 01/2018-05/2022 were collected. Results: We found a significant decrease in unadjusted DR screening rates in the post-lockdown period compared to the pre-COVID-19 period (p < 0.001). Bivariate analysis revealed a 15.1% decrease in weekly DR screenings during post-lockdown (RR = 0.849, 95% CI = 0.811, 0.888). After adjusting for seasonal variation, the mean weekly DR screening rate was 12% lower in the post-lockdown period, with a 95% CI of 6.1% to 17.5% decrease (Adjusted RR = 0.880, 95% CI = 0.825, 0.939 Stratified analysis based on patient status revealed a significant decrease in adjusted DR screening rates for established patients post-lockdown compared to pre-pandemic (p < 0.0001), while no significant difference was observed for new patients (p > 0.05). Conclusion: The impact of COVID-19 on DR screening and treatment rates persisted even after the resumption of non-essential care services, with a discrepancy between new and established patients. Future research should work to identify and overcome the barriers to DR screening.
Health Concerns of Youths From Historically Marginalized Communities During the Postacute Phase of COVID-19
(2025-03-03) Jones, Melissa A; Jones, Margaux; Mazor, Kathleen M; Linas, Benjamin P; Medicine
This survey study uses text message surveys to explore the behaviors, perspectives, and health concerns of youths from historically marginalized racial and ethnic groups in Boston, Massachusetts, during the postacute phase of the COVID-19 pandemic.
Awake Prone Positioning in Adults With COVID-19: An Individual Participant Data Meta-Analysis
(2025-03-10) Luo, Jian; Pavlov, Ivan; Tavernier, Elsa; Perez, Yonatan; Kharat, Aileen; McNicholas, Bairbre; Roca, Oriol; Vines, David L; Ibarra-Estrada, Miguel; Alhazzani, Waleed; Lewis, Kimberley; Simpson, Steven Q; Rampon, Garrett; Liu, Ling; Sun, Qin; Qiu, Haibo; Yang, Yi; Lapadula, Giuseppe; Qian, Edward Tang; Gatto, Cheryl L; Rice, Todd W; Parhar, Ken Kuljit S; Weatherald, Jason; Walkey, Allan J; Bosch, Nicholas A; Nay, Mai-Anh; Boulain, Thierry; Fossat, Guillaume; Harris, Tim R E; Thwaites, C Louise; Phong, Nguyen Thanh; Bonfanti, Paolo; Yarahmadi, Sajad; Hashemian, Seyed Mohammadreza; Jayakumar, Devachandran; Taylor, Stephanie Parks; Johnson, Stacy A; Guerin, Claude; Laffey, John G; Ehrmann, Stephan; Li, Jie; Medicine
Importance: The impact of awake prone positioning (APP) on clinical outcomes in patients with COVID-19 and acute hypoxemic respiratory failure (AHRF) remains uncertain. Objective: To assess the association of APP with improved clinical outcomes among patients with COVID-19 and AHRF, and to identify potential effect modifiers. Data sources: PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov were searched through August 1, 2024. Study selection: Randomized clinical trials (RCTs) examining APP in adults with COVID-19 and AHRF that reported intubation rate or mortality were included. Data extraction and synthesis: Individual participant data (IPD) were extracted according to PRISMA-IPD guidelines. For binary outcomes, logistic regression was used and odds ratio (OR) and 95% CIs were reported, while for continuous outcomes, linear regression was used and mean difference (MD) and 95% CIs were reported. Main outcomes and measures: The primary outcome was survival without intubation. Secondary outcomes included intubation, mortality, death without intubation, death after intubation, escalation of respiratory support, intensive care unit (ICU) admission, time from enrollment to intubation and death, duration of invasive mechanical ventilation, and hospital and ICU lengths of stay. Results: A total of 14 RCTs involving 3019 patients were included; 1542 patients in the APP group (mean [SD] age, 59.3 [14.1] years; 1048 male [68.0%]) and 1477 in the control group (mean [SD] age, 59.9 [14.1] years; 979 male [66.3%]). APP improved survival without intubation (OR, 1.42; 95% CI, 1.20-1.68), and it reduced the risk of intubation (OR, 0.70; 95% CI, 0.59-0.84) and hospital mortality (OR, 0.77; 95% CI, 0.63-0.95). APP also extended the time from enrollment to intubation (MD, 0.93 days; 95% CI, 0.43 to 1.42 days). In exploratory subgroup analyses, improved survival without intubation was observed in patients younger than age 68 years, as well as in patients with a body mass index of 26 to 30, early implementation of APP (ie, less than 1 day from hospitalization), a pulse saturation to inhaled oxygen fraction ratio of 155 to 232, respiratory rate of 20 to 26 breaths per minute (bpm), and those receiving advanced respiratory support at enrollment. However, none of the subgroups had significant interaction with APP treatment. APP duration 10 or more hours/d within the first 3 days was associated with increased survival without intubation (OR, 1.85; 95% CI, 1.37-2.49). Conclusions and relevance: This IPD meta-analysis found that in adults with COVID-19 and AHRF, APP was associated with increased survival without intubation and with reduced risks of intubation and mortality, including death after intubation. Prolonged APP duration (10 or more hours/d) was associated with better outcomes.
The Impact of COVID on Early Intervention Parenting Support for Mothers in Recovery from Substance Use Disorder
(2024-04-05) Peacock-Chambers, Elizabeth; Pillai, Rajapillai L I; Jurkowski, Briana L; Kangas, Savannah; Borelli, Jessica L; Feinberg, Emily; Zayde, Amanda; Lowell, Amanda F; Friedmann, Peter D; Byatt, Nancy; Psychiatry
COVID-19 adversely impacted parents with substance use disorders (SUDs) as evidenced by increased overdoses. This study used a qualitative approach to examine COVID's impact on experiences and perceptions of a parenting program designed for mothers in recovery from SUDs, "Mothering from the Inside Out" (MIO), implemented through Early Intervention (EI) home-visiting services. Four EI programs participated in training and implementation of MIO. Subjects included 10 eligible EI providers trained in August 2019 or August 2021 and 11 mothers in recovery from SUDs. More mothers completed MIO during the pandemic compared to before. We conducted inductive thematic analysis of exit interviews and field notes, along with interpretation of process measures of intervention implementation. Initially, the switch to telehealth negatively impacted the provider-parent relationship but made engagement logistically easier for some mothers. Parent and provider participants reported the need for additional psychosocial support due to increased stressors, as well as ways that MIO helped them cope during the pandemic. COVID made EI enrollment of families more difficult in general; however once enrolled, telehealth improved retention in MIO, meeting a critical need during the pandemic.
Central-variant posterior reversible encephalopathy syndrome in association with adrenal insufficiency: A case report
(2025-02-21) Srichawla, Bahadar S; Kipkorir, Vincent; Lalla, Rakhee; Neurology
Rationale: Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic condition often linked to hypertension, eclampsia, or renal failure. PRES typically presenting with seizures, headaches, visual disturbances, and altered mental status. A rarer form, the central variant of PRES, involves atypical radiologic findings such as edema in central brain structures. PRES has not been previously associated with adrenal insufficiency, making this case novel and significant. Patient concerns: A 59-year-old woman with a history of hypertension, chronic obstructive pulmonary disease, and previous COVID-19 infection presented to the emergency department with seizures and altered mental status. She exhibited a fluctuating systolic blood pressure (79-195 mm Hg) and had a Glasgow Coma Scale (GCS) score of 7. Diagnoses: Initial imaging and laboratory tests were inconclusive. Continuous electroencephalogram indicated focal cortical irritability, raising concerns about seizures. Brain magnetic resonance imaging revealed increased T2-weighted signals in the bilateral cerebellar hemispheres, consistent with central variant PRES. Endocrine evaluation showed primary adrenal insufficiency, confirmed by low AM cortisol levels and a positive cosyntropin stimulation test. Interventions: The patient was started on levetiracetam for seizure management and hydrocortisone for adrenal insufficiency. She was intubated for airway protection but later extubated as her condition stabilized. Outcomes: Follow-up magnetic resonance imaging showed progressive resolution of the cerebellar T2 hyperintensities. The patient was discharged on day 15 with no residual neurological deficits. At a 3-month follow-up, she remained seizure-free and continued oral hydrocortisone and levetiracetam. Lessons: This case highlights adrenal insufficiency as a possible novel precipitant of the central variant of PRES, emphasizing the need for prompt diagnosis and treatment to prevent serious neurological outcomes. The underlying pathophysiological mechanism of PRES from adrenal insufficiency is most likely labile blood pressure causing rapid alterations in cerebral perfusion pressure (CPP) precipitating PRES.
Cardiac Rehabilitation Among Veterans: A Narrative Review
(2025-02-26) Varghese, Merilyn S; Wu, Wen-Chih; Drwal, Kariann R; Burg, Matthew M; Kazi, Dhruv S; Gaffey, Allison E; Mattocks, Kristin M; Brandt, Cynthia A; Bastian, Lori A; Gandhi, Parul U; Population and Quantitative Health Sciences
Purpose: Cardiac rehabilitation (CR) is a valuable secondary preventive intervention for Veterans given their increased risk of cardiovascular disease. Adults cared for in the Veterans Affairs (VA) healthcare system are a unique population that receives healthcare from the largest integrated care network in the United States. Yet, this group faces distinct challenges in utilizing CR. In this review, we evaluated the existing data regarding CR utilization and outcomes among U.S. Veterans. Review methods: A literature search was conducted using PubMed and Scopus for cardiac rehabilitation and U.S. Veterans. Summary: Veterans have 3 potential options for attending CR: in-person at their local VA medical centers, home-based CR through their local VA medical centers, and in-person at community CR centers. However, participation remains low. A significant barrier to participation is transportation to in-person CR. Home-based CR shows promise in addressing this barrier and has demonstrated resilience in the face of pandemic restrictions. Cardiac rehabilitation outcomes among Veterans who participate include improved exercise capacity, fewer depressive symptoms, and decreased mortality. Despite its benefits for secondary prevention among Veterans, there remains a paucity of data about the current uptake of CR, the impact of mental health on uptake, possible sex-based or racial disparities, and long-term outcomes.
Changes to Parental Consent Requirements for Abortion in Massachusetts and Impact on Timeliness of Care for Adolescents Aged 16 to 17 Years
(2025-03) Fulcher, Isabel; Kimball, Kara; Rosen, Zarah; Fortin, Jennifer; Arunkumar, Namita; Gelfand, Danielle; Janiak, Elizabeth; Ireland, Luu; Obstetrics and Gynecology
To measure the effect of the ROE Act on abortion timing for adolescents aged 16 to 17 years in Massachusetts. The primary outcome was gestational duration at abortion for individuals aged 16 to 19 years at Planned Parenthood League of Massachusetts from 2017 to 2022. Our control group included individuals aged 18 to 19 years undergoing abortions. In our primary analysis, we used a comparative interrupted time series with a linear model to capture temporal trends, seasonality, whether an abortion was undergone during the acute phase of the COVID-19 pandemic, previous abortion, and race/ethnicity categories. Minors aged 16 to 17 years underwent 749 abortions during the study. Individuals aged 18 to 19 years underwent 2773 abortions. The ROE Act resulted in a 5.46-day decrease in gestational duration at abortion among minors (95% confidence interval = -11.82, 0.91). Removal of the parental involvement requirement for adolescents aged 16 to 17 years in Massachusetts led to minors undergoing abortions at earlier gestational durations, highlighting the importance of potential impacts of similar legislation to decrease barriers to abortion access for minors. (. 2025;115(3):397-402. https://doi.org/10.2105/AJPH.2024.307918).
Prevalence and Co-Detection Rates of SARS-CoV-2, Influenza, and Respiratory Syncytial Virus: A Retrospective Analysis
(2025-03) Pratt, George W; Wong, Carlene L; Rao, Lokinendi V; Pathology
In late 2022, there was a significant increase in the prevalence of RSV in the northeastern United States. This surge occurred concurrently with the beginning of the traditional influenza season and the ongoing circulation of SARS-CoV-2. We retrospectively analyzed respiratory testing data at a regional reference laboratory from September 2022 to April 2024 to characterize the prevalence and incidence of co-detection of RSV, influenza A, influenza B, and SARS-CoV-2 in the northeastern United States. The positivity rates were found to be 16.68% for SARS-CoV-2, 11.66% for influenza A, 0.83% for influenza B, and 9.11% for RSV during the study period. Co-detections were observed in 0.49% of samples, with SARS-CoV-2/influenza A co-detection being the most common. Co-detections occurred less frequently than expected based on individual positivity rates. During the study period, influenza B positivity increased over 10-fold, SARS-CoV-2 positivity decreased by 60%, and co-detection was more prevalent in the pediatric population.
Geographic Accessibility to Clinical Trials for Head and Neck Cancers in the United States
(2025-02-14) Sharma, Shiven; Alkurdi, Dany; Alkurdi, Ezdean; Patel, Dev; Alani, Omar; Sharma, Keshav; Saran, Ekambir; Carr, Michele M; Radiology
Head and neck cancers (HNCs) are becoming more common, thereby gaining greater attention within the medical community. This retrospective trend analysis examined geographical access to HNC clinical trials in the United States from 2005 to 2024, utilizing Census data and the Haversine formula. A search of ClinicalTrials.gov identified 23,450 trial sites, with 18,394 initiated before 2020. Although linear regression revealed a slight annual increase in trial initiation (37.947 trials/year, R² = 0.014, P = .625), most observed trends did not reach statistical significance. The proportion of the population residing within 1 mile of the trials saw a minor increase (0.328%/year, R² = 0.178, P = .064). Accessibility remained consistent throughout the COVID-19 pandemic, despite a decline in trial initiation during 2020. Enhancing access to trials, especially for marginalized populations, could improve patient engagement and clinical results.
Suicide and the COVID-19 pandemic: A qualitative study of discourse on an online pro-choice for suicide discussion forum
(2024-03-11) Kheibari, Athena; Lawson, Spencer G; Szechy, Kathryn; Sheehan, Robert; Psychiatry
The COVID-19 pandemic had a widespread impact on millions of individuals. Many turned to social media as an outlet for sharing personal experiences, such as the impact of the pandemic on suicidality. The purpose of this study was to understand the pandemic's impact on individuals who discuss their suicidality on social media. Keywords were used to search for discussion threads ( = 118) related to the pandemic on an online pro-choice for suicide forum. Using reflexive thematic analysis, six themes related to the pandemic's impact on mental health, suicidality, living conditions, and optimism were identified. Examination of the content from pro-choice for suicide forums may yield authentic information on the impact of the pandemic on those considering suicide. This study contributes to our understanding of the nuances of factors impacting mental health and suicidality during the pandemic, including unique risk and protective factors.
Social Determinants, Mental Well-Being, and Disrupted Life Transitions Among Young Adults with Disabling Mental Health Conditions
(2025-01-13) Cook, Judith A; Jonikas, Jessica A; Burke-Miller, Jane K; Aranda, Frances; Mullen, Michelle G; Davis, Maryann; Sabella, Kathryn; Psychiatry
This study sought to understand how young adults (age 18-25) with histories of mental health disorders are coping with disrupted transitions to adulthood during the COVID-19 pandemic. A cross-sectional web survey was conducted in March-June 2021 of 967 US young adults with pre-pandemic psychiatric disability to assess their current psychiatric status, interrupted transitions, and associations with social determinants including income, community participation, and social context. Mental health was assessed with the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and PTSD Checklist-Civilian Version. Social determinants were identified with the Epidemic-Pandemic Impacts Inventory. Interrupted transitions were measured with the Young Adult Disrupted Transitions Assessment. Multivariable logistic regression models predicted four types of transition disruptions and associations with current mental health, social determinants, and demographic factors. Disruptions were reported by 81.1% including interrupted education completion (38.3%), employment careers (37.6%), residential independence (27.7%), and intimate partner relationships (22.9%). Many screened positive for major depressive disorder (81.7%), PTSD (85.5%), or GAD (58.6%). Disruption in establishing intimate partner relationships was associated with depression, anxiety, and PTSD. Interrupted residential independence was associated with anxiety. Interrupted education completion was associated with PTSD. Interrupted employment was associated with anxiety. Social determinants significant in these models included social connections, community participation, income, and racial/ethnic identification. Results illuminate ways that current mental health and social determinants affect transition interruptions during the pandemic. Findings suggest the need for interdisciplinary approaches, integrated models of care, and assistance accessing treatment, rehabilitation, and community support services from adult service systems.
Association between menstrual cycle pattern regularity and changes in menstrual bleeding following COVID-19 vaccination: secondary analysis of an observational study
(2024-12-31) Boniface, Emily R; Darney, Blair G; van Lamsweerde, Agathe; Benhar, Eleonora; Han, Leo; Matteson, Kristen; Male, Victoria; Cameron, Sharon; Alvergne, Alexandra; Edelman, Alison; Obstetrics and Gynecology
Safety and Immunogenicity of an mRNA-1273 Booster in Children
(2024-12-17) Berthaud, Vladimir; Creech, C Buddy; Rostad, Christina A; Carr, Quito; de Leon, Liberation; Dietrich, Monika; Gupta, Anil; Javita, David; Nachman, Sharon; Pinninti, Swetha; Rathore, Mobeen; Rodriguez, Carina A; Luzuriaga, Katherine; Towner, William; Yeakey, Anne; Brown, Mollie; Zhao, Xiaoping; Deng, Weiping; Xu, Wenqin; Zhou, Honghong; Girard, Bethany; Kelly, Roxanne; Slobod, Karen; Anderson, Evan J; Das, Rituparna; Miller, Jacqueline; Schnyder Ghamloush, Sabine; Program in Molecular Medicine; Center for Clinical and Translational Science
Background: A 2-dose mRNA-1273 primary series in children aged 6 months-5 years (25 µg) and 6-11 years (50 µg) had an acceptable safety profile and was immunogenic in the phase 2/3 KidCOVE study. We present data from KidCOVE participants who received an mRNA-1273 booster dose. Methods: An mRNA-1273 booster dose (10 µg for children aged 6 months-5 years; 25 µg for children aged 6-11 years; age groups based on participant age at enrollment) was administered ≥6 months after primary series completion. The primary safety objective was the safety and reactogenicity of an mRNA-1273 booster dose. The primary immunogenicity objective was to infer efficacy of an mRNA-1273 booster dose by establishing noninferiority of neutralizing antibody (nAb) responses after a booster in children versus nAb responses observed after the mRNA-1273 primary series in young adults (18-25 years) from the pivotal efficacy study. Data were collected from March 2022 to June 2023. Results: Overall, 153 (6 months-5 years) and 2519 (6-11 years) participants received an mRNA-1273 booster dose (median age at receipt of booster: 2 and 10 years, respectively). The booster dose safety profile was generally consistent with that of the primary series in children; no new safety concerns were identified. An mRNA-1273 booster dose elicited robust nAb responses against ancestral SARS-CoV-2 among children and met prespecified noninferiority success criteria versus responses observed after the primary series in young adults. Conclusions: Safety and immunogenicity data support administration of an mRNA-1273 booster dose in children aged 6 months to 11 years. Clinical trials registration: NCT04796896 (Clinicaltrials.gov).
Relationship Between Acute Severe Acute Respiratory Syndrome Coronavirus 2 Viral Clearance and Long Coronavirus 2019 (Long COVID) Symptoms: A Cohort Study
(2024-12-18) Herbert, Carly; Antar, Annukka A R; Broach, John; Wright, Colton; Stamegna, Pamela; Luzuriaga, Katherine; Hafer, Nathaniel; McManus, David D; Manabe, Yukari C; Soni, Apurv; Medicine; Center for Clinical and Translational Science; Emergency Medicine; Program in Molecular Medicine; Population and Quantitative Health Sciences
Background: The relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral dynamics during acute infection and the development of long coronavirus disease 2019 (COVID-19), or "long COVID," is largely unknown. Methods: Between October 2021 and February 2022, 7361 people not known to have COVID-19 self-collected nasal swab samples for SARS-CoV-2 reverse-transcription polymerase chain reaction testing every 24-48 hours for 10-14 days. Participants whose first known SARS-CoV-2 infection was detected were surveyed for long COVID in August 2023. Their slopes of viral clearance were modeled using linear mixed effects models with random slopes and intercepts, and the relative risk (RR) of long COVID based on viral slopes was calculated using a log binomial model, adjusted for age, symptoms, and variant. Sex-based interaction terms were also evaluated for significance. Results: A total of 172 participants were eligible for analyses, and 59 (34.3%) reported long COVID. The risk of long COVID with 3-4 symptoms (adjusted RR, 2.44 [95% confidence interval, .88-6.82]) and ≥5 symptoms (4.97 [1.90-13.0]) increased with each unit increase in slope of viral clearance. While the probability of long COVID increased with slowed viral clearance among women, the same relationship was not observed among men (interaction term: P = .02). Acute SARS-CoV-2 symptoms of abdominal pain (adjusted RR, 5.41 [95% confidence interval, 2.44-12.0]), nausea (3.01 [1.31-6.89]), and body aches (2.58 [1.26-5.30]) were most strongly associated with long COVID. Conclusions: We observed that slower viral clearance rates during acute COVID-19 were associated with increased risk and more symptoms of long COVID . Early viral-host dynamics appear to be mechanistically linked to the development of long COVID.

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