Zoonosis at the Huanan Seafood Market: A Critique

Since the Hunan Seafood Market (HSM) in Wuhan, China was first suggested as the source of the COVID-19 pandemic in late January 2020, debate has continued over the evidence supporting this claim. Here, we assess the evidence provided in support of zoonotic spillover at the HSM as the origin of human infection of SARS-CoV-2. We find that the datasets and analyses put forward in support of zoonosis are biased, and lack sufficient verifiable data to support this hypothesis. The earliest COVID-19 case at the HSM was not at or near a wildlife stall, the distribution of cases at the HSM is consistent with a Poisson point process model (randomly distributed) and the distribution of wildlife stalls and COVID-19 cases are consistent with independent Poisson point processes. No statistical correlation is found between cases and wildlife stall locations. The random distribution of cases and several isolated clusters is consistent with human-to-human transmission in shared areas such as eating areas, toilets and social gathering areas. Sampling bias is evident in specimen collection at the market, with over-sampling evident in the SW corner of the market relative to the rest of the market. Notwithstanding this bias, environmental positive PCR samples are more consistent with contamination by infected COVID-19 cases and aerosol spread from the HSM toilets, as compared with from wildlife stalls. Although proposed as the intermediate spillover host, raccoon dogs were unlikely to be linked with the outbreak, as they were sold in Wuhan in small numbers, and there is no epidemiological evidence indicating any infection of a raccoon dog, or any other wild or domestic animal, before or during the early pandemic, at any market elsewhere in Wuhan, or even in the rest of China. These considerations indicate that HSM was instead likely a superspreader location, with only tenuous evidence to support a zoonotic spillover there. Consequently, we conclude there is sufficient evidence to indicate the HSM as the source of the pandemic

Extended Reality Head-Mounted Displays Are Likely to Pose a Significant Risk in Medical Settings While Current Classification Remains as Non-Critical

Extended reality (XR) devices, including virtual and augmented reality head-mounted displays (HMDs), are increasingly utilised within healthcare to provide clinical interventions and education. Currently, XR devices are utilised to assist in reducing pain and improving psychological outcomes for immunocompromised patients in intensive care units, palliative care environments and surgical theatres. However, there is a paucity of research on the risks of infection from such devices in healthcare settings. Identify existing literature providing insights into the infection control risk XR HMDs pose within healthcare facilities and the efficacy of current infection control and cleaning procedures. Three databases (PubMed, Embase and CINAHL) in addition to Google Scholar were systematically searched. A total of seven studies were identified for this review. Microorganisms, including pathogenic bacteria (e.g., Staphylococcus aureus and Pseudomonas aeruginosa), were found to be present on XR HMDs. Published cleaning and infection control protocols designed to disinfect XR HMDs and protect users were heterogeneous in nature. Current cleaning protocols displayed varying levels of efficacy with microbial load affected by multiple factors, including time in use, number of users and XR HMD design features. In healthcare settings, fitting XR HMDs harbouring microorganisms near biological and mucosal entry points presents an infection control risk. An urgent revision of the Spaulding classification is required to ensure flexibility that allows for these devices to be reclassified from ‘Non-critical’ to ‘Semi-Critical’ depending on the healthcare setting and patient population (surgery, immunocompromised, burns, etc.). This review identified evidence supporting the presence of microorganisms on XR HMDs. Due to the potential for HMDs to contact mucosal entry points, devices must be re-considered within the Spaulding classification as ‘Semi-critical’. The existence of microbial contaminated XR HMDs in high-risk medical settings such as operating wards, intensive care units, emergency departments, labour and delivery wards and clinical areas with immunosuppressed patients requires urgent attention. Public health authorities have a duty of care to develop revised guidelines or new recommendations to ensure efficient sanitation of such devices

Do mobile phone surfaces carry SARS-CoV-2 virus? A systematic review warranting the inclusion of a “6th” moment of hand hygiene in healthcare

Background Mobile phones, used in billions throughout the world, are high-touch devices subject to a dynamic contamination of microorganisms and rarely considered as a dynamic fomite to sanitise systematically. The emergence of SARS-CoV-2 resulted in the COVID-19 pandemic, arguably the most impactful pandemic of the 21st century with millions of deaths and disruption of all facets of modern life globally. Aim To perform a systematic review of the literature exploring SARS-CoV-2 presence as a contaminant on mobile phones. Methods A systematic search (PubMed and Google Scholar) of literature was undertaken from December 2019 to February 2023 identifying English language studies. Studies included in this review specifically identified or tested for the contamination of the SARS-CoV-2 virus or genome on mobile phones while studies SARS-CoV-2 testing for SARS-COV-2 in environments and/or other fomites samples than but not mobile phones were excluded. Results A total of 15 studies with reports of SARS-CoV-2 contamination on mobile phones between 2020-2023 were included. Amongst all studies, which encompassed ten countries, 511 mobile phones were evaluated for the presence of SARS-CoV-2 contamination and 45% (231/511) were positive for SARS-CoV-2. All studies were conducted in the hospital setting and two studies performed additional testing in residential isolation rooms and a patient’s house. Four studies (3 in 2020 and one in 2021) reported 0% contamination while two other studies (in 2020 and 2022) reported 100% of mobile phone contamination with SARS-COV-2. All other studies report mobile phones positive for the virus within a range of 4% to 77%. Conclusion A total of 45% of mobile phones are contaminated with SARS-CoV-2 virus. These devices might be an important fomite vector for viral dissemination worldwide. Competent health authorities are advised/recommended to start a global implementation of mobile phone decontamination by introducing regulations and protocols in public health and health care settings such as the 6th moment of hand washing

Effect of Exercise Interventions on Anxiety in People with Multiple Sclerosis: A Systematic Review and Meta-analysis.

Background: Evidence suggests that exercise can alleviate symptoms associated with multiple sclerosis (MS). However, it is unclear whether exercise alleviates symptoms of anxiety, present in one-third of people with MS. This systematic review and meta-analysis investigates whether exercise interventions are effective in reducing anxiety in people with MS. Methods: CINAHL, Embase, MEDLINE, PsycINFO, and the Cochrane Controlled Clinical Trials Register were searched to identify relevant randomized controlled trials (RCTs) published up to March 30, 2018. The primary outcome was postintervention difference in anxiety scores between intervention and control groups. Using a restricted maximum likelihood random-effects model, standardized mean differences were pooled and heterogeneity was estimated. Risk of bias was assessed using an a priori modified Cochrane Risk of Bias 2.0 tool. Results: Four RCTs with 133 participants were included. Exercise type included walking, aerobic activities, and cycling. Intervention duration ranged from 8 to 26 weeks. The pooled standardized mean difference in anxiety score was -0.16 (95% CI, -0.50 to 0.19), without heterogeneity. Two studies had high risk of bias, and two had some risk of bias. Conclusions: Based on available RCT data, exercise does not seem to have an effect on anxiety in people with MS. These results should be interpreted with caution because studies had concerns of bias and small sample sizes, and anxiety was not the primary outcome measure. Future studies should exhibit sufficient reporting standards, alongside publishing protocols. There is opportunity to investigate the effect of exercise in people with MS experiencing clinically relevant levels of anxiety rather than in the general MS population

Supplementary Materials for: Detailed documentation of a COVID-19 case with onset date in November 2019, and no exposure to the Huanan Seafood Market

<p><em>Supplementary Materials for</em></p> <p><strong>Detailed documentation of a COVID-19 case with onset date in November 2019, and no exposure to the Huanan Seafood Market</strong></p> <p>Kory Swain, Gilles Demaneuf, Steven E Massey, Adrian Jones, António Duarte, Steven Quay</p> <p> </p> <p><strong>PDF file includes:</strong></p> <p>Figures S1 to S33</p> <p>Table S1</p> <p>References</p&gt

Evaluating the strategies to control SARS-CoV-2 Delta variant spread in New Caledonia, a Zero COVID country until September 2021

Objectives New Caledonia, a former Zero-COVID country, was confronted with a SARS-CoV-2 Delta variant outbreak in September 2021. We evaluate the relative contribution of vaccination, lockdown and timing of interventions on healthcare burden. Methods We developed an age-stratified mathematical model of SARS-CoV-2 transmission and vaccination calibrated for New Caledonia and evaluated three alternative scenarios. Results High virus transmission early on was estimated, R0 equal to 6.6 (95% CI [6.4 – 6.7]). Lockdown reduced R0 by 73% (95% CI [70 - 76%]). Easing the lockdown increased transmission (39% reduction of the initial R0); but we did not observe an epidemic rebound. This contrasts with the rebound in hospital admissions (+116% total hospital admissions) that would have been expected in the absence of an intensified vaccination campaign (76,220 people or 34.12% of the eligible population were first-dose vaccinated during one month of lockdown). A 15-day earlier lockdown would have led to a significant reduction in the magnitude of the epidemic (-53% total hospital admissions). Conclusions The success of the response against the Delta variant epidemic in New Caledonia was due to an effective lockdown that provided additional time for people to vaccinate. Earlier lockdown would have greatly mitigated the magnitude of the epidemic

The Efficacy of Psychological Interventions for Managing Fatigue in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis

BackgroundMultiple sclerosis (MS) is a complex, demyelinating disease of the central nervous system. Fatigue is commonly reported by people with MS (PwMS). MS-related fatigue severely affects daily activities, employment, socioeconomic status, and quality of life.ObjectiveWe conducted this systematic review and meta-analysis to determine whether psychological interventions are effective in managing fatigue in PwMS.Data sourcesWe performed systematic searches of Medline, EMBASE, PsycINFO, and CINAHL to identify relevant articles published from database inception to April 5, 2017. Reference lists from relevant reviews were also searched.Study selection and designTwo independent reviewers screened the papers, extracted data, and appraised the included studies. A clinical psychologist verified whether interventions were psychological approaches. A narrative synthesis was conducted for all included studies. For relevant randomized controlled trials that reported sufficient information to determine standardized mean differences (SMDs) and 95% confidence intervals (CIs), meta-analyses were conducted using a random-effects model.ResultsOf the 353 identified articles, 20 studies with 1,249 PwMS were included in this systematic review. Narrative synthesis revealed that psychological interventions reduced fatigue in PwMS. Meta-analyses revealed that cognitive behavioral therapy decreased levels of fatigue compared with non-active controls (SMD = −0.32; 95% CI: −0.63 to −0.01) and compared with active controls (relaxation or psychotherapy) (SMD = −0.71; 95% CI: −1.05 to −0.37). Meta-analyses further showed that both relaxation (SMD = −0.90; 95% CI: −1.30 to −0.51), and mindfulness interventions (SMD = −0.62; 95% CI: −1.12 to −0.12), compared with non-active control, decreased fatigue levels. The estimates of heterogeneity for the four meta-analyses varied between none and moderate.ConclusionThis study found that the use of psychological interventions for MS-related fatigue management reduced fatigue in PwMS. While psychological interventions are generally considered first-line therapy for MS-related fatigue, further studies are needed to explore the long-term effect of this therapy

Cross-cultural adaptation, reliability, and validity of the Turkish version of the SymptoMScreen

Purpose: The study aimed to translate and cross-culturally adapt the SymptoMScreen into Turkish and evaluate its reliability and validity. Methods: One hundred nine MS patients were included in the study. SymptoMScreen was translated into Turkish according to the standardized guidelines and cross-culturally adapted. For construct validity, SymptoMScreen was compared with the Expanded Disability Status Scale (EDSS), Multiple Sclerosis-Related Symptom Checklist (MS-RS), and Beck Depression Scale (BDS) by Spearman?s correlation coefficient. Thirty patients refilled SymptoMScreen one week later, and the test-retest reliability was analyzed by the Intraclass Correlation Coefficient (ICC). Internal consistency was evaluated with Cronbach?s alpha coefficient. The standard error of measurement (SEM95) and the minimum detectable change (MDC95) were calculated. Results: Test-retest reliability and internal consistency of the SymptoMScreen were excellent (ICC = 0.925, ? = 0.914). SEM95 and MDC95 were 3.28 and 9.29, respectively. There was a strong correlation between the SymptoMScreen with the MS-RS and EDSS (r1= 0.908, p < 0.00; r2= 0.511, p < 0.001). Besides, the SymptoMScreen was moderately correlated with BDS (r = 0.584, p < 0.001). Conclusion: The Turkish version of the SymptoMScreen is a reliable and valid questionnaire for multiple sclerosis patients