ETHICAL, LEGAL, AND SOCIAL IMPLICATIONS OF USING HOST GENOMICS FOR INFECTIOUS DISEASE MANAGEMENT

Advances in host (or human) genomics can play an important role in enabling precision medicine and precision public health approaches for the clinical management and public health control of an infectious disease outbreak, such as COVID-19. This study examines the ethical, legal, and social implications (ELSI) raised by the potential utilization of host genomic information and the implementation of predictive infectious disease-related host genetic testing and/or genomic screening in clinical and public health decision-making during an infectious disease outbreak. Manuscripts 1 and 2 focus on understanding the perspectives of health professionals on the use of these host genomic technologies. A cross-sectional online survey was fielded to US health professionals. The survey explored how they view the value and ethical acceptability of using COVID-19 host genomic information in three main decision-making settings: (1) clinical, (2) public health, and (3) workforce. The survey also assessed participants’ personal and professional experience with genomics and infectious diseases and collected key demographic data. Manuscript 1 characterizes the views of health professionals on the potential use of COVID-19 host genomics across the three main decision-making settings. A majority of survey participants agreed that it is ethically acceptable to use host genomics to make decisions about clinical care and that genetic screening has an important role to play in the public health control of COVID-19. However, more than 90% disagreed that it is ethically acceptable to use host genomics to deny resources or admission to patients when hospital resources are scarce. Manuscript 2 explores the degree to which health professionals’ acceptance of using COVID-19 host genomics information is influenced by their perspectives on genetic determinism and biologization of race. Nearly 60% of the participants believed race to be a biological or genetic ancestral group. Only 5% believed that genomic risk factors should be prioritized over conventional risk factors. While a majority supported the overall use of host genomics in managing COVID-19, those who held highly deterministic views and/or believed that race was biological were more likely to support its use than those who did not. Manuscript 3 analyzes the ethical implications of implementing population-wide host genomic screening programs in the infectious disease context for public health decision-making and whether it is ethically acceptable to use host genomic information to target restrictive measures and/or to prioritize access to scarce resources. This intervention is analyzed using existing public health ethics frameworks. The manuscript argues that while population host genomic screening is ethically acceptable to use in the public health control of infectious disease outbreaks, it is more ethically acceptable to use host genomics to decide prioritization of resources rather than imposing restrictive measures based on host genomics. The findings from this study can inform the policies for hospitals and public health departments to evaluate and adopt host genomic technologies in an ethically and socially responsible manner during future infectious disease outbreaks

Profile of teleconsultation in dermatology at a tertiary care hospital in South India during the first wave of COVID-19 pandemic

Background: There was a rapid expansion of teledermatology around the world with the onset of COVID-19 pandemic. This helped to reduce hospital visits with better adherence to medication and overall costs, especially in chronic dermatoses. Methodology: A retrospective study of teleconsultations during the first wave of COVID-19 pandemic at the dermatology department of a tertiary care hospital in South India was done from May to October 2020. Real-time video teleconsultations were done using the hospital's teleconsultation portal. Demography, clinical profile of patients, and outcome of teleconsultation were studied. Results: During the study period, 476 teleconsultation sessions in 265 patients were carried out. The mean age of patients was 40.65 ± 16.79 years; geriatric population constituted 38 (14.3%) patients. Urban to rural population ratio was 1:1.3. Median disease duration was 2.5 years (interquartile range 4.75 years). Papulosquamous disorders and infectious diseases were the most common disorders constituting 52 (19.6%) and 51 (19.2%) cases, respectively. Patients with chronic dermatoses on systemic therapy constituted 268 (56.42%) teleconsultation sessions in 119 (44.9%) patients; common diseases being autoimmune blistering disorders (38; 31.9%), psoriasis (23; 19.3%), and leprosy (17; 14.3%). Optimization of therapy was done in 117 (44.2%) patients, initiation of new medication in 89 (33.6%), and continuation of therapy in 75 (28.3%) patients. An in-person review was advised in 46 (9.7%) sessions in 36 (13.6%) patients. Six (2.3%) patients were advised to have an urgent review. Conclusion: Teledermatology was an effective tool during the pandemic to extend hospital services. Optimization of therapy was the outcome in nearly half the sessions. This service can benefit patients from remote areas and geriatric population, especially with chronic dermatoses

SARS-CoV-2 seroprevalence among the general population and healthcare workers in India, December 2020–January 2021

Background: Earlier serosurveys in India revealed seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) of 0.73% in May–June 2020 and 7.1% in August–September 2020. A third serosurvey was conducted between December 2020 and January 2021 to estimate the seroprevalence of SARS-CoV-2 infection among the general population and healthcare workers (HCWs) in India. Methods: The third serosurvey was conducted in the same 70 districts as the first and second serosurveys. For each district, at least 400 individuals aged ≥10 years from the general population and 100 HCWs from subdistrict-level health facilities were enrolled. Serum samples from the general population were tested for the presence of immunoglobulin G (IgG) antibodies against the nucleocapsid (N) and spike (S1-RBD) proteins of SARS-CoV-2, whereas serum samples from HCWs were tested for anti-S1-RBD. Weighted seroprevalence adjusted for assay characteristics was estimated. Results: Of the 28,598 serum samples from the general population, 4585 (16%) had IgG antibodies against the N protein, 6647 (23.2%) had IgG antibodies against the S1-RBD protein, and 7436 (26%) had IgG antibodies against either the N protein or the S1-RBD protein. Weighted and assay-characteristic-adjusted seroprevalence against either of the antibodies was 24.1% [95% confidence interval (CI) 23.0–25.3%]. Among 7385 HCWs, the seroprevalence of anti-S1-RBD IgG antibodies was 25.6% (95% CI 23.5–27.8%). Conclusions: Nearly one in four individuals aged ≥10 years from the general population as well as HCWs in India had been exposed to SARS-CoV-2 by December 2020

Lessons learned from the eMERGE Network: balancing genomics in discovery and practice

The Electronic Medical Records and Genomics (eMERGE) Network, established in 2007, is a consortium of academic and integrated health systems conducting discovery and implementation research in translational genomics. Here, we outline the history of the network, highlight major impacts and lessons learned, and present the tools and resources developed for large-scale genomic analyses and translation into a clinical setting. The network developed methods to extract phenotypes from the electronic medical record to perform genome-wide and phenome-wide association studies. Recruited cohorts were clinically sequenced off a custom panel for targeted sequencing of variants and monogenic disease risks and returned to participants to investigate the impact of return of genomic results. After generating a 105,000 participant-imputed genome-wide association study (GWAS) dataset for discovery, the network enrolled and sequenced 24,998 participants. Integration of these results into the medical record and the effects of results on participants provided key lessons to the field. These learned lessons inform genetic research in diverse populations and provide insights into the clinical impact of return and implementation of genomic medicine using the electronic medical record. The lessons produced by the eMERGE Network can be utilized by other consortia as translational genomic medicine research evolves