Understanding and promoting racial diversity in healthcare settings to address disparities in pandemic crisis management

Background: Health disparities have become apparent since the beginning of the COVID-19 pandemic. When observing racial discrimination in healthcare, self-reported incidences, and perceptions among minority groups in the United States suggest that, the most socioeconomically underrepresented groups will suffer disproportionately in COVID-19 due to synergistic mechanisms. This study reports racially-stratified data regarding the experiences and impacts of different groups availing the healthcare system to identify disparities in outcomes of minority and majority groups in the United States.Methods: Studies were identified utilizing PubMed, Embase, CINAHL Plus, and PsycINFO search engines without date and language restrictions. The following keywords were used: Healthcare, raci*, ethnic*, discriminant, hosti*, harass*, insur*, education, income, psychiat*, COVID-19, incidence, mortality, mechanical ventilation. Statistical analysis was conducted in Review Manager (RevMan V.5.4). Unadjusted Odds Ratios, P-values, and 95% confidence intervals were presented.Results: Discrimination in the United States is evident among racial groups regarding medical care portraying mental risk behaviors as having serious outcomes in the health of minority groups. The perceived health inequity had a low association to the majority group as compared to the minority group (OR = 0.41; 95% CI = 0.22 to 0.78; P = .007), and the association of mental health problems to the Caucasian-American majority group was low (OR = 0.51; 95% CI = 0.45 to 0.58; P \u3c .001).Conclusion: As the pandemic continues into its next stage, efforts should be taken to address the gaps in clinical training and education, and medical practice to avoid the recurring patterns of racial health disparities that become especially prominent in community health emergencies. A standardized tool to assess racial discrimination and inequity will potentially improve pandemic healthcare delivery

Industry 4.0 technologies for the manufacturing and distribution of COVID-19 vaccines

Background: The evolutionary stages of manufacturing have led us to conceptualize the use of Industry 4.0 for COVID-19 (coronavirus disease 2019), powered by Industry 4.0 technologies. Using applications of integrated process optimizations reliant on digitized data, we propose novel intelligent networks along the vaccine value chain. Vaccine 4.0 may enable maintenance processes, streamline logistics, and enable optimal production of COVID-19 vaccines.Vaccine 4.0 framework: The challenge in applying Vaccine 4.0 includes the requirement of large-scale technologies for digitally transforming manufacturing, producing, rolling-out, and distributing vaccines. With our framework, Vaccine 4.0 analytics will target process performance, process development, process stability, compliance, quality assessment, and optimized maintenance. The benefits of digitization during and post the COVID-19 pandemic include first, the continual assurance of process control, and second, the efficacy of big-data analytics in streamlining set parameter limits. Digitization including big data-analytics may potentially improve the quality of large-scale vaccine production, profitability, and manufacturing processes. The path to Vaccine 4.0 will enhance vaccine quality, improve efficacy, and compliance with data-regulated requirements.Discussion: Fiscal and logistical barriers are prevalent across resource-limited countries worldwide. The Vaccine 4.0 framework accounts for expected barriers of manufacturing and equitably distributing COVID-19 vaccines. With amalgamating big data analytics and biometrics, we enable the identification of vulnerable populations who are at higher risk of disease transmission. Artificial intelligence powered sensors and robotics support thermostable vaccine distribution in limited capacity regions, globally. Biosensors isolate COVID-19 vaccinations with low or limited efficacy. Finally, Vaccine 4.0 blockchain systems address low- and middle-income countries with limited distribution capacities.Conclusion: Vaccine 4.0 is a viable framework to optimize manufacturing of vaccines during and post the COVID-19 pandemic

THE INCIDENCE OF ALCOHOL USE DISORDERS DURING THE COVID-19 PANDEMIC

Background: The COVID-19 pandemic has introduced a myriad of challenges to healthcare systems and public health policies across the globe. Individuals with alcohol use disorders are at peaked risk due to mental, socio-demographic, and economic factors leading to hindered mental health service access, misinformation and adherence. Methods: Keywords including “alcohol use”, “death”, “hand sanitizer", "overdose" and "COVID-19" were used to obtain 8 media reports for case analysis. A review of 34 manually extracted records were also conducted using PubMed, MEDLINE, Scopus, and the Embase database with no time and language restrictions. Results: A total of 2,517 individuals with alcohol overdose across the United States, India, Canada, and Iran were presented. The majority of cases were male, ages 21-65. Common contributors were linked to socio-economic changes, disruption to mental health services, and physical isolation. Conclusion: While original studies are essential to evaluate the etiologies of alcohol use and misuse during pandemics, the dissemination of misinformation must be curbed by directing vulnerable individuals towards accurate information and access to mental health services

A Descriptive Review of Epidemiology of COVID–19 in Smokers

Coronavirus disease 2019 caused by SARS Cov 2, gains entry to bronchial epithelial cells by binding of the viral spike protein to angiotensin-converting enzyme-2 (ACE-2) receptors. We conducted a non - systematic review of databases with (English articles only), PubMed, Google Scholar using keywords like “COVID-19,” “SARS-CoV-2,” “novel coronavirus,” smoking,” “smokers,” “nicotine.” A total of 33 articles were reviewed. Smokers were 1.4 times more likely to have severe COVID-19 (RR=1.4 95% CI: 0.98-2.00), and 2.4 times more likely to require an ICU admission (RR= 2.4 CI: 1.43-4.04) when compared to non-smokers (n=926). Current smokers were less likely to experience an adverse outcome (OR: 0.42, 95% CI: 0.24–0.74), compared to former smokers.  22% of current smokers and 46% of former smokers had more severe complications. Current smokers had a case fatality rate of 38.5% (n=1790) and higher odds of mortality (OR= 1.25) especially males >65 years (OR=2.51). Public education about smoking cessation should be implemented along with standard guidelines to prevent disease progression

Low left atrial appendage emptying velocity is a predictor of atrial fibrillation recurrence after catheter ablation

BACKGROUND: Recurrence of atrial fibrillation (AF) after catheter ablation (CA) remains common and studies have shown about 5%-9% annual recurrence rate after CA. We sought to assess the echocardiogram derived left atrial appendage (LAA) emptying velocity as a predictor of AF recurrence after CA. OBJECTIVE: To determine if LAA emptying is a marker of recurrence of AF post-CA METHODS: A total of 303 consecutive patients who underwent CA for AF between 2014 and 2020 were included. Baseline clinical characteristics and echocardiographic data of the patients were obtained by chart review. LAA emptying velocities were obtained from transesophageal echocardiogram (TEE). LA voltage was obtained during the mapping for CA. Chi-square test and nominal logistic regression were used for statistical analysis. An receiver operator characteristic curve was used to determine LAA velocity cut-off. RESULTS: Mean patient age was 61.7 ± 10.5; 32% were female. Mean LAA emptying velocity was 47.5 ± 20.2. A total of 103 (40%) patients had recurrence after CA. In the multivariable model, after adjusting for potential confounders, LAA emptying velocity of ≥52.3 was associated with decreased AF recurrence postablation (odds ratio [OR]: 0.55; 95% confidence interval [CI]: 0.31-0.97; p = .03*). There were 190 (73%) patients in normal sinus rhythm during TEE and CA, and sensitivity analysis of these patients showed that LAA velocity ≥52.3 remained associated with decreased AF recurrence (OR: 0.35; 95% CI: 0.15-0.82; p = .01*). CONCLUSION: LAA emptying velocity measured during preprocedural TEE can serve as a predictor of AF recurrence in patients undergoing CA

COVID-19 Pathophysiology and Clinical Effects on Multiple Organ Systems - A Narrative Review

Patients with comorbidities including Hypertension (HTN), Diabetes Mellitus (DM), Chronic Obstructive Pulmonary Disease (COPD), Asthma, Obesity, Cardiovascular Disease (CVD), Chronic Kidney Disease (CKD), and those who are immunocompromised are prone to more severe complications of COVID-19 and a higher rate of hospitalizations. In the United States, around 94% of COVID-19 deaths had an average of 2.6 additional conditions or causes per death. In a summary report published by the Chinese Centre for Disease Control and Prevention of 72,314 cases, case-fatality rate was elevated among those with preexisting comorbid conditions—10.5% for cardiovascular disease, 7.3% for diabetes, 6.3% for chronic respiratory disease, 6.0% for HTN, and 5.6% for cancer. The COVID-19 pandemic continues to threaten people and healthcare systems globally and therefore the global economy. Currently, there is no cure or vaccine for COVID-19 and there is an urgent need to develop target therapies as we continue to learn more about this novel virus. Without therapeutic interventions, much of how we contain the viral spread is prevention through mitigation strategies (social distancing, face masks, supportive care). Early suspicion of COVID-19 symptoms with radiological and laboratory assessments may play a major role in preventing severity of the COVID-19. With this literature review we aim to provide review of pathophysiology of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and its clinical effects on multiple organ systems

COVID-19 Pathophysiology and Clinical Effects on Multiple Organ Systems: A Review

Patients with comorbidities including Hypertension (HTN), Diabetes Mellitus (DM), Chronic Obstructive Pulmonary Disease (COPD), Asthma, Obesity, Cardiovascular Disease (CVD), Chronic Kidney Disease (CKD), and those who are immunocompromised are prone to more severe complications of COVID-19 and a higher rate of hospitalizations. In the United States, around 94% of COVID-19 deaths had an average of 2.6 additional conditions or causes per death. In a summary report published by the Chinese Centre for Disease Control and Prevention of 72,314 cases, case-fatality rate was elevated among those with preexisting comorbid conditions—10.5% for cardiovascular disease, 7.3% for diabetes, 6.3% for chronic respiratory disease, 6.0% for HTN, and 5.6% for cancer. The COVID-19 pandemic continues to threaten people and healthcare systems globally and therefore the global economy. Currently, there is no cure or vaccine for COVID-19 and there is an urgent need to develop target therapies as we continue to learn more about this novel virus. Without therapeutic interventions, much of how we contain the viral spread is prevention through mitigation strategies (social distancing, face masks, supportive care). Early suspicion of COVID-19 symptoms with radiological and laboratory assessments may play a major role in preventing severity of the COVID-19. With this literature review we aim to provide review of pathophysiology of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and its clinical effects on multiple organ systems