Author Interviews, Brigham & Women's - Harvard, COVID -19 Coronavirus, Occupational Health / 03.11.2020
Study Finds High Rate of Asymptomatic COVID-19 Infection Among Retail Workers
MedicalResearch.com Interview with:
Fan-Yun Lan, MD, MS
PhD candidate in Population Health Sciences | Environmental Health
Graduate School of Arts and Sciences & T.H. Chan School of Public Health
Harvard University
MedicalResearch.com: What is the background for this study?
Response: Existing evidence has indicated that essential workers are heavily affected by the COVID-19 pandemic, as they are not able to benefit from mitigation policies. Their occupational exposures increase their own risk to SARS-CoV-2 infection, and increase the risk of secondary transmissions to their colleagues, families and communities. Research, however, has largely focused on healthcare workers with relatively limited literature investigating non-healthcare essential workers.
Dr. Sachdev[/caption]
Darpun D. Sachdev, M.D.
Case investigation and Contact tracing Branch Chief
SFDPH Covid Command Center
San Francisco Department of Public Health
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The ultimate goal of contact tracing is to rapidly identify and isolate contacts who are COVID-19 positive before they have time to transmit to others. As mentioned in the published research letter by SFDPH, through JAMA, during early shelter-in-place (from April to June 2020), our contact tracing program successfully reached greater than 80% of cases and contacts within a median timeframe of 6 days from the onset of their case’s symptoms. Approximately 10% of named contacts were newly diagnosed with COVID-19 (compared to 2% positivity during this time period). Household contacts made up approximately 80% of all identified contacts, but 90% of contacts who tested positive lived in the same household as the case. Secondary cases (contacts who were found to be newly diagnosed with COVID-19) were traced and quarantined within 6 days of the case’s symptom onset.
With that said, the 6-day time difference between symptom onset and contact notification raises concern regarding the overall effectiveness of tracing in preventing onward transmission by infected contacts. We are working with community-based organizations to scale up access to testing and culturally competent tracing and wraparound services. Currently, we have now decreased the time difference to 5 days. Moreover, given that the majority of contacts resided in the same household, transmission could have occurred presymptomatically such that by the time infected contacts were identified, they might have already transmitted the virus. Hence, why SFDPH, on May 5, 2020, implemented the recommendation of universal testing for COVID-19 contacts, regardless of symptoms.
We recommend that testing should be offered to all contacts regardless of symptoms and encourage local health departments to adopt novel ways of increasing testing access for contacts.
Dr. Adnan[/caption]
Darbaz Adnan, MBChB
Lab Research Assistant
Department of Internal Medicine - Section of Gastroenterology
Rush University Medical Center
Chicago, Illinois 60612
MedicalResearch.com: What is the background for this study?
Response: - We have conducted a large study of over 1000 patients at a major COVID-19 response center in Chicago at Rush University Medical Center, to assess for the frequency of initial GI symptoms (diarrhea, vomiting, abdominal pain) and evaluate whether these symptoms in adult COVID-19 positive could predict the disease course. Overall, 22.4% of our patients reported at least one GI symptom at the onset of their infection, with nausea/vomiting being the most common complaint. GI symptoms in COVID-19 patients were associated with worse outcomes.
Dr. Batool-Anwar[/caption]
Salma Batool-Anwar, MBBS, MPH
Instructor, Harvard Medical School
Pulmonary and Critical Care, Sleep Medicine
Brigham and Women's Faulkner Hospital
MedicalResearch.com: What is the background for this study?
Response: A well functioning sleep-wake cycle is vital to our health and prevention of chronic diseases.
During previous disaters sleep disturbances have been reported.
When Massachusetts governor declared a state of emergency in March’20, we hypothesized that sleep duration would be adversely affected by covid-19 related lockdown and stress.
The study was approved by the institutional review board and information was collected retrospectively using the electronic medical records. 
Mr. Olin[/caption]
Steve Olin
Chief Product Officer
Rally Health, Inc., part of the Optum business of UnitedHealth Grou
MedicalResearch.com: Can you please elaborate on Rally Health’s mission?
Mr. Olin: Our founding mission 10 years ago and still to this day is to put health in the hands of the individual. As a digital health company, we live this mission through our focus in three key areas:
1) Providing digital-first access to care by giving individuals easy-to-use digital tools and support to navigate their health care and take full advantage of their health benefits;
2) Engaging people in their daily health by creating experiences that people enjoy and that inspire them to perform healthy actions, and by giving them access to resources that help them achieve their health goals;
3) Saving people time and money by providing digital tools that help them understand health care costs and guide them to lower-cost, high-quality care options.
Dr. Mazzeffi[/caption]
Michael Mazzeffi MD MPH MSc
Associate Professor of Anesthesiology
Division Chief Anesthesiology Critical Care Medicine
Medical Director Rapid Response Team
MedicalResearch.com: What is the background for this study?
Response: We have known for some time that COVID19 is characterized by hypercoagulability or excess blood clotting. In fact, the incidence of blood clots in the lungs (pulmonary emboli) is as high 20% and is two to three times more common in COVID19 than in severe influenza. Further, autopsies of patients who died from COVID19 have shown that endothelial cells (cells that line the blood vessels) are damaged and that "micro clots" form in multiple organs. Together, these findings strongly suggest that excess blood clotting and endothelial cell dysfunction are defining features of severe COVID19.
For several months, my colleagues and I have been interested in whether aspirin might improve outcomes in patients with severe COVID19. In prior observational research studies, aspirin was found to be protective in patients with severe lung injury. The general idea is that aspirin reduces platelet aggregates in the lung and this improves outcome. Unfortunately, in a prior randomized controlled study (LIPS-A) aspirin was not shown to reduce the incidence of acute respiratory distress syndrome. Nevertheless, COVID19 has unique features that make aspirin more likely to be effective. Mainly COVID19 is associated with hypercoagulability to a greater degree than in other viral illnesses. 
Dr. Leaf[/caption]
David E. Leaf, MD, MMSc, FASN
Assistant Professor of Medicine, Harvard Medical School
Director of Clinical and Translational Research in Acute Kidney Injury
Division of Renal Medicine, Brigham and Women's Hospital
MedicalResearch.com: What is the background for this study?
Response: The data for this study were derived from a multicenter cohort study of over 4,000 critically ill patients with COVID-19 admitted to ICUs at 68 sites across the US, as part of the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID). STOP-COVID was initiated by David E. Leaf, MD, MMSc and Shruti Gupta, MD, MPH, from the Division of Renal Medicine at Brigham and Women’s Hospital and Harvard Medical School. It was initiated in March, 2020 as an unfunded, grassroots network, and now includes over 400 collaborators from 68 sites across the US.
Using this data, we used a ‘target trial emulation’ approach to examine whether early administration of the monoclonal antibody, tocilizumab, reduces mortality in critically ill patients with COVID-19. Target trial emulation, a novel method of analyzing observational data, is the idea of simulating a randomized control trial to reduce bias. 
Dr. Meyers[/caption]
Craig Meyers, PhD
Department of Microbiology and Immunology
Pennsylvania State College of Medicine
Hershey, PA
MedicalResearch.com: What is the background for this study?
Response: As nasal and oral cavities are major points of entry and transmission for human coronaviruses our team of physicians and scientists (Craig Meyers, Janice Milici, Samina Alam, David Quillen, David Goldenberg and Rena Kass of Penn State College of Medicine and Richard Robison of Brigham Young University) were interested in testing common over-the-counter oral antiseptics and mouthwashes for their efficacy to inactivate infectious human coronavirus, which is structurally similar to SARS-CoV-2, the virus that causes COVID-19. While we wait for a vaccine for COVID-19 to be developed, methods to reduce transmission are needed. We chose products that are readily available and often already part of people’s daily routines.
Dr. Kriner[/caption]
Douglas L. Kriner, PhD
The Clinton Rossiter Professor in American Institutions
Department of Government
Cornell University
MedicalResearch.com: What is the background for this study?
Response: When a safe and effective vaccine for COVID-19 reaches the market, the world will not change overnight. Rather, government and public health individuals will have to develop a comprehensive plan to distribute the vaccine and to convince potentially wary Americans to take it.
Our study examined the influence of both specific vaccine characteristics and the politics surrounding it on public willingness to vaccinate. Both matter in important ways. For example, efficacy is unsurprisingly a major driver of public opinion; Americans are more willing to take a vaccine that is more efficacious.
Dr. Profeta[/caption]
Paola Profeta, PhD
Professor of Public Economics, Department of Social and Political Sciences
Bocconi University
Director, Msc Politics and Policy Analysis, Bocconi University
Coordinator, Dondena Gender Initiative, Dondena Research Center
President, European Public Choice Society
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We interview more than 20000 men and women in 8 OECD countries in two periods during the lockdown.
Using two waves from 8 OECD countries, we find that women are more likely to perceive the pandemic as a very serious health problem, to agree with restraining measures and to comply with public health rules, such as using facemasks. This gender differences are less strong for married individuals and for individuals who have been directly exposed to COVID, for instance by knowing someone who was infected.
Shane Riddell[/caption]
Shane Riddell MSc
CSIRO—Australian Animal Health Laboratory
Geelong, Australia
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: While it is generally considered that SARS-CoV-2 is spread via aerosol and respiratory droplets, we still need to investigate how much of a role fomites play in transmission.
Understanding the risk first requires you to know how long the virus can survive on a surface. We therefore wanted to assess how long the virus would remain viable on various common surfaces such as stainless steel, glass and banknotes. We found that, under controlled conditions, we could recover infectious virus at 28 days for all non-porous surfaces at 20 degrees Celsius. When the temperature was raised to 40 degrees Celsius, SARS-CoV-2 only remained viable for 24hrs on most surfaces.
Dr. Nagata, MD[/caption]
Jason Nagata, MD, MSc
Assistant Professor of Pediatrics
University of California, San Francisco
San Francisco, California, USA
MedicalResearch.com: What is the background for this study?
Response: During the COVID-19 pandemic, food insecurity is expected to rise given economic uncertainty and job losses. Vulnerable and marginalized populations are disproportionately affected by both COVID-19 and food insecurity.
MedicalResearch.com: What are the main findings?
Response: In this perspective, we argue that food insecurity and COVID-19 can exacerbate one another via bidirectional links. Experiencing food insecurity can lead to nutritional deficiencies and weakened host defenses, increasing susceptibility to COVID-19 infection. Food insecurity is also associated with chronic medical conditions which may lead to a higher risk of severe COVID-19 illness.
Conversely, people with COVID-19 may not be able to work, generate income, or procure food while quarantined, which may worsen food insecurity.
Dr. Garg[/caption]
Dr. Madhur Garg, MD MBA
Clinical director, Radiation Oncology
Montefiore Health System and Professor
Departments of Otorhinolaryngology - Head & Neck Surgery - and Urology
Albert Einstein College of Medicine
MedicalResearch.com: What is the background for this study?
Response: The Bronx was hit particularly hard with Covid-19 - making up one of the highest per capita cases and deaths in the country. Montefiore Health System and Albert Einstein College of Medicine, care for a large population of ethnic minorities (non-Hispanic Black and Hispanic individuals make up 65% of our patient population).
