Naval Medical Center Portsmouth (NMCP) COVID-19 Literature Reports 

Prepared by: Tracy C. Shields, MSIS, AHIP (Ms.; she/her) 
Naval Medical Center Portsmouth; Library Services, Reference Medical Librarian

Purpose: These reports, published every other week on Fridays, are curated collections of current research, evidence reviews, special reports, grey literature, and news regarding the COVID-19 pandemic that may be of interest to medical providers, leadership, and decision makers.

Disclaimer: I am not a medical professional. This information is current as of the date noted. While I make every effort to find and summarize available data, I cannot cover everything in the literature on COVID-19. Please feel free to reach out with questions, suggestions for future topics, or any other feedback.

The Big Picture

News in Brief

A new report recommends that the WHO's Access to COVID-19 Tools Accelerator (ACT-A) program, which focuses on diagnostics, therapeutics, and vaccines, should likely continue through 2022 (CIDRAP; see also: strategic review of WHO's ACT-A program).

"'I hope you die': how the COVID pandemic unleashed attacks on scientists — Dozens of researchers tell Nature they have received death threats, or threats of physical or sexual violence" (Nature).

"Who really has the authority to write about the pandemic? (LitHub)

"Addressing biocrises after COVID-19: Is deterrence an option?" (War on the Rocks).

Webinars and Events

WHAT:             The Next Season of Pandemic Response: What Leaders Need to Know this Fall and Winter — Center for Homeland Defense and Security (CHDS)

WHEN:             Wednesday, 27 October 2021; 1400–1530 ET

DETAILS:          "In this webinar, national experts will discuss what local and state leaders might expect next in the U.S. response to COVID-19. Panelists will address the latest developments in vaccine expansion for youth populations, challenges in maintaining a resilient healthcare workforce, and endgame strategies for the pandemic. Please join us as we explore collaboration opportunities for homeland security, emergency management, public health and public safety officials in the months to come."

Special Reports and Other Resources

DHS OIG: Lessons Learned from FEMA's Initial Response to COVID-19[pdf] (21 September 2021)

"In response to the COVID-19 pandemic, FEMA worked closely with the U.S. Department of Health and Human Services and other Federal agencies to facilitate the shipment of PPE and ventilators. However, the magnitude of the global event exposed weaknesses in FEMA's resource request system and allocation processes. Specifically, WebEOC — the system FEMA used to process resource requests including those for PPE and ventilators — contained unreliable data to inform allocation decisions and ensure requests were accurately adjudicated. This occurred because FEMA did not develop controls to validate requests and prevent incomplete, inaccurate, or duplicate data entries; nor did FEMA ensure WebEOC users received training on proper use of the system. In addition, although FEMA developed a process to allocate the limited supply of ventilators, it did not have a similarly documented process for PPE.

Finally, FEMA did not have strategic guidance clearly outlining the roles and responsibilities used to lead the Federal response. FEMA’s decision to prioritize ongoing pandemic response efforts without updating its written guidance and strategic plans hindered FEMA's coordination efforts.

To its credit, FEMA evaluated its COVID-19 response operations, identifying similar key findings and recommendations aimed at improving current and future responses, including making updates to its WebEOC system."

Journal Articles

PLoS One: The impact of the COVID-19 response on the provision of other public health services in the U.S.: A cross sectional study (14 October 2021)

"Introduction: Funding and staff formerly dedicated to routine public health tasks (e.g., responding to communicable and non-communicable diseases, investigating foodborne outbreaks, conducting routine surveillance) and services (e.g., environmental health, substance abuse, maternal-child health) may no longer be available in many public health departments due to the COVID-19 response. The objective of this study was to assess the extent to which staffing for essential public health services has been redirected to the COVID-19 response.

Materials and methods: This is a cross-sectional study using a survey distributed through the Qualtrics platform. Individuals (N = 298) working in public health across governmental and academic public health departments in the U.S. during the ongoing COVID-19 pandemic response were surveyed. Survey items measured multiple domains including professional experience (i.e., training, years of experience, content expertise, job functions, hours worked), mental and physical health status (i.e., generalized anxiety, depression, burnout), and career plans (i.e., pre-pandemic vs. current career plans).

Results: The total number of content expertise areas and programmatic functions covered by individual public health workers increased between January and September of 2020, with 26% (73 of 282) of respondents reporting an increase in both. The total number of respondents working in infectious disease and preparedness remained constant, while declines were reported in program evaluation (-36%) and health education (-27%) and increases were reported in disease investigation (+35%).

Conclusions: The provision of many essential public health functions and tasks have been limited or eliminated while the U.S. public health workforce responds to the COVID-19 pandemic. These findings highlight opportunities for funding and professional development of public health systems, both during and after the COVID-19 response, to help ensure the continuity of essential public health services, staffing sustainability, and preparedness for future public health emergencies in the U.S."

Interface Focus: How did we get here: what are droplets and aerosols and how far do they go? A historical perspective on the transmission of respiratory infectious diseases (12 October 2021)

"The COVID-19 pandemic has exposed major gaps in our understanding of the transmission of viruses through the air. These gaps slowed recognition of airborne transmission of the disease, contributed to muddled public health policies and impeded clear messaging on how best to slow transmission of COVID-19. In particular, current recommendations have been based on four tenets: (i) respiratory disease transmission routes can be viewed mostly in a binary manner of ‘droplets’ versus ‘aerosols’; (ii) this dichotomy depends on droplet size alone; (iii) the cut-off size between these routes of transmission is 5 µm; and (iv) there is a dichotomy in the distance at which transmission by each route is relevant. Yet, a relationship between these assertions is not supported by current scientific knowledge. Here, we revisit the historical foundation of these notions, and how they became entangled from the 1800s to today, with a complex interplay among various fields of science and medicine. This journey into the past highlights potential solutions for better collaboration and integration of scientific results into practice for building a more resilient society with more sound, far-sighted and effective public health policies."

Modeling

PLoS One: Mechanistic modelling of COVID-19 and the impact of lockdowns on a short-time scale (18 October 2021)

"Background: To mitigate the spread of the COVID-19 coronavirus, some countries have adopted more stringent non-pharmaceutical interventions in contrast to those widely used. In addition to standard practices such as enforcing curfews, social distancing, and closure of non-essential service industries, other non-conventional policies also have been implemented, such as the total lockdown of fragmented regions, which are composed of sparsely and highly populated areas.

Methods: In this paper, we model the movement of a host population using a mechanistic approach based on random walks, which are either diffusive or super-diffusive. Infections are realised through a contact process, whereby a susceptible host is infected if in close spatial proximity of the infectious host with an assigned transmission probability. Our focus is on a short-time scale (∼ 3 days), which is the average time lag time before an infected individual becomes infectious.

Results: We find that the level of infection remains approximately constant with an increase in population diffusion, and also in the case of faster population dispersal (super-diffusion). Moreover, we demonstrate how the efficacy of imposing a lockdown depends heavily on how susceptible and infectious individuals are distributed over space.

Conclusion: Our results indicate that on a short-time scale, the type of movement behaviour does not play an important role in rising infection levels. Also, lock-down restrictions are ineffective if the population distribution is homogeneous. However, in the case of a heterogeneous population, lockdowns are effective if a large proportion of infectious carriers are distributed in sparsely populated sub-regions."

JAMA Netw Open: A Continuously Benchmarked and Crowdsourced Challenge for Rapid Development and Evaluation of Models to Predict COVID-19 Diagnosis and Hospitalization (11 October 2021)

"Question: What can be learned from a crowdsourced challenge for the prediction of COVID-19 diagnosis and hospitalization?

Findings: This diagnostic and prognostic study used a model-to-data approach to implement a continuous benchmarking challenge that has enabled 482 participants to join in the effort to use regularly updated COVID-19 patient data to build machine learning models for COVID-19 diagnosis and hospitalization prediction. Machine learning models showed high accuracy in COVID-19 outcome prediction, but analysis of subgroups and prospective data revealed limitations and bias in the models.

Meaning: This study suggests that crowdsourced clinical algorithms can predict COVID-19 diagnosis and hospitalization, but evaluation of the submitted models using reserved data sets is necessary to avoid self-assessment traps."

Hawaii J Health Soc Welf: COVID-19 Containment Ship Model: A Case Study for Pacific Island Response (September 2021)

"The Republic of the Marshall Islands, American Samoa, the Federated States of Micronesia, and the Republic of Palau have been without any COVID-19 community transmission since the beginning of the global pandemic. The Commonwealth of the Northern Mariana Islands has experienced modest community transmission, and Guam has had significant COVID-19 community transmission and morbidity. Although several of these United States Affiliated Pacific Island jurisdictions made difficult strategic choices to prevent the spread of COVID-19 which have been largely successful, the built environment and the population density in the urban areas of the Pacific remain inherently conducive to rapid COVID-19 transmission. Rapid transmission could result in devastating health and economic consequences in the absence of continued vigilance and long-term strategic measures. The unique COVID-19 vulnerability of islands in the Pacific can be modeled through examination of recent outbreaks onboard several United States Naval ships and other marine vessels. The environmental characteristics that pose challenges to infection control on an isolated naval ship are analogous to the environmental characteristics of these Pacific island communities. Considering a collection of case studies of COVID-19 transmission on ships and applying to Pacific Island environments, provides a heuristic, easily accessible epidemiologic framework to identify methods for interventions that are practical and reliable towards COVID-19 containment, prevention, and control. Using accessible evidence based public health policies, infection risk can be decreased with the objective of maintaining in-country health and social stability. These case studies have also been examined for their relevance to current discussions of health care infrastructure and policy in the Pacific Islands, especially that of vaccination and repatriation of citizens marooned in other countries. The need for aggressive preparation on the parts of territories and nations not yet heavily exposed to the virus is critical to avoid a rapid "burn-through" of disease across the islands, which would likely result in catastrophic consequences."

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