Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

A Comparison of Private Recreational Fishing Harvest and Effort for Gulf of Mexico Red Snapper during Derby and Extended Federal Seasons and Implications for Future Management

Fisheries managers often use regulations such as bag, size, and season limits to manage recreational anglers and prevent overharvest, and this has been the case for the Gulf of Mexico Red Snapper Lutjanus campechanus fishery, which has been highly regulated for over 20 years. During this period, the federal season for private recreational anglers has decreased from year-round in 1996 to only 3 d in 2017. However, in 2017 the private recreational season was reopened for an additional 39 d. This scenario allowed us to examine a very short, derby-style initial season with an unexpected extended season and make comparisons with longer-term data sets from the Texas Parks and Wildlife Department's angler-intercept program, where we hypothesized that harvest and effort may not be directly related to season length. Our data indicated that there were higher harvest and effort rates during the initial season than during the extended season, and these differences were a function of extended season length (i.e., future access) and weather. The harvest and effort rates of the extended season were not proportional to the initial season, suggesting that recreational anglers compensated for reductions in season length by compressing their effort into the shortened season. While our results suggest that an extended season results in a reduction of daily harvest and effort rates, it is important to have programs in place to closely monitor the total harvest in a timely manner to prevent overharvest

New Insights Into the Seasonal Movement Patterns of Shortfin Mako Sharks in the Gulf of Mexico

Highly mobile apex predators such as the shortfin mako shark (mako shark; Isurus oxyrinchus) serve an important role in the marine ecosystem, and despite their declining populations and vulnerability to overexploitation, this species is frequently harvested in high abundance in both commercial and recreational fisheries. In 2017, the North Atlantic stock was deemed overfished and to be undergoing overfishing and was recently listed in CITES Appendix II. Effective management of this species can benefit from detailed information on their movements and habitat use, which is lacking, especially in the Gulf of Mexico, a potential mating and parturition ground. In this study, we used satellite telemetry to track the movements of mako sharks in the western Gulf of Mexico between 2016 and 2020. In contrast to previous studies that have primarily tagged juvenile mako sharks (>80% juveniles), ∼80% of sharks tagged in this study (7 of 9) were presumed to be mature based on published size-at-maturity data. Sharks were tracked for durations ranging from 10 to 887 days (mean = 359 days; median = 239 days) with three mature individuals tracked for >2 years. Mako sharks tagged in this study used more of the northwestern Gulf of Mexico than reported in previous movement studies on juveniles, suggesting potential evidence of size segregation. While one mature female remained in the Gulf of Mexico over a >2-year period, predominantly on the continental shelf, two mature males demonstrated seasonal migrations ∼2,500 km from the tagging location off the Texas coast to the Caribbean Sea and northeastern United States Atlantic coast, respectively. During these migrations, mako sharks traversed at least 12 jurisdictional boundaries, which also exposed individuals to varying levels of fishing pressure and harvest regulations. Movement ecology of this species, especially for mature individuals in the western North Atlantic, has been largely unknown until recently. These data included here supplement existing information on mako shark movement ecology and potential stock structure that could help improve management of the species

Utility of citizen science data: A case study in land-based shark fishing.

Involving citizen scientists in research has become increasingly popular in natural resource management and allows for an increased research effort at low cost, distribution of scientific information to relevant audiences, and meaningful public engagement. Scientists engaging fishing tournament participants as citizen scientists represent ideal scenarios for testing citizen science initiatives. For example, the Texas Shark Rodeo has begun shifting to conservation-oriented catch-and-release practices, which provides a unique opportunity to collect data on a large scale for extended periods of time, particularly through tagging large numbers of sharks for very little cost compared to a directed scientific study. However, critics are somewhat skeptical of citizen science due to the potential for lack of rigor in data collection and validation. A major management concern for shark fisheries is the ability of anglers to identify species. We tested some of the assumptions and value of citizen-collected data by cross-verifying species identification. Specifically, the purpose of this study was to evaluate the accuracy of shark species identifications made by anglers fishing in the Texas Shark Rodeo using photographs that were submitted as a requirement for tournament participation. Using a confusion matrix, we determined that anglers correctly identified 97.2% of all shark catches submitted during the Texas Shark Rodeo from 2014-2018; however, smaller sharks and certain species, including blacknose and spinner sharks, were more difficult to identify than others. Most commonly confused with blacktip sharks, spinner sharks were most commonly identified incorrectly (76.1% true positive rate [TPR]) followed by blacknose (86.8% TPR), finetooth (88.0% TPR), and Atlantic sharpnose sharks (93.8% TPR). This study demonstrated that citizen scientists have the ability to identify sharks with relatively low error. This is important for science and management, as these long-term datasets with relatively wide geographic scope could potentially be incorporated into future assessments of sharks in the Gulf of Mexico

Genomic reconstruction of the SARS-CoV-2 epidemic in England

AbstractThe evolution of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus leads to new variants that warrant timely epidemiological characterization. Here we use the dense genomic surveillance data generated by the COVID-19 Genomics UK Consortium to reconstruct the dynamics of 71 different lineages in each of 315 English local authorities between September 2020 and June 2021. This analysis reveals a series of subepidemics that peaked in early autumn 2020, followed by a jump in transmissibility of the B.1.1.7/Alpha lineage. The Alpha variant grew when other lineages declined during the second national lockdown and regionally tiered restrictions between November and December 2020. A third more stringent national lockdown suppressed the Alpha variant and eliminated nearly all other lineages in early 2021. Yet a series of variants (most of which contained the spike E484K mutation) defied these trends and persisted at moderately increasing proportions. However, by accounting for sustained introductions, we found that the transmissibility of these variants is unlikely to have exceeded the transmissibility of the Alpha variant. Finally, B.1.617.2/Delta was repeatedly introduced in England and grew rapidly in early summer 2021, constituting approximately 98% of sampled SARS-CoV-2 genomes on 26 June 2021.</jats:p

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted