Public Health

Cravedi, P., Schold, J.D., Safa, K., Kates, O.S., Elfadawy, N., Mannon, R.B., Shah, M.B., Hammond, S.P., Avery, R., Guerrero Miranda, C., Riella, L.V., Jowsey-Gregoire, S., Akalin, E., Camirand, G., Alegre, M.L. and Azzi, J. (2020). “The COVID-19 Pandemic: A community approach.” Clin Transplant Aug 6;e14059. [Epub ahead of print.].

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An unprecedented global pandemic caused by a novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has quickly overwhelmed the health care systems worldwide. While there is an absence of consensus among the community in how to manage solid organ transplant recipients and donors, a platform provided by the American Society of Transplantation online community “Outstanding Questions in Transplantation”, hosted a collaborative multicenter, multinational discussions to share knowledge in a rapidly evolving global situation. Here, we present a summary of the discussion in addition to the latest published literature

McCullough, P.A., Kelly, R.J., Ruocco, G., Lerma, E., Tumlin, J., Wheelan, K.R., Katz, N., Lepor, N.E., Vijay, K., Carter, H., Singh, B., McCullough, S.P., Bhambi, B.K., Palazzuoli, A., De Ferrari, G.M., Milligan, G.P., Safder, T., Tecson, K.M., Wang, D.D., McKinnon, J.E., O’Neill, W.W., Zervos, M. and Risch, H.A. (2020). “Pathophysiological Basis and Rationale for Early Outpatient Treatment of SARS-CoV-2 (COVID-19) Infection.” Am J Med Aug 7;S0002-9343(20)30673-2. [Epub ahead of print.].

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Approximately 9 months of the severe acute respiratory syndrome coronavius-2 (SARS-CoV-2 [COVID-19]) spreading across the globe has led to widespread COVID-19 acute hospitalizations and death. The rapidity and highly communicable nature of the SARS-CoV-2 outbreak has hampered the design and execution of definitive randomized, controlled trials of therapy outside of the clinic or hospital. In the absence of clinical trial results, physicians must use what has been learned about the pathophysiology of SARS-CoV-2 infection in determining early outpatient treatment of the illness with the aim of preventing hospitalization or death. This article outlines key pathophysiological principles that relate to the patient with early infection treated at home. Therapeutic approaches based on these principles include 1) reduction of reinoculation, 2) combination antiviral therapy, 3) immunomodulation, 4) antiplatelet/antithrombotic therapy, and 5) administration of oxygen, monitoring, and telemedicine. Future randomized trials testing the principles and agents discussed will undoubtedly refine and clarify their individual roles; however, we emphasize the immediate need for management guidance in the setting of widespread hospital resource consumption, morbidity, and mortality.

Shrank, W.H., Caveney, B., Miller, S., Medows, R.M., Arroliga, A., Doga, B., Ban, K., Muldoon, S., Seiden, J.M., Tong, I., Chaguturu, S. and Wohlgemuth, J.G. (2020). “A Simple Algorithm for Return to Workplace Employer Antibody Testing.” Popul Health Manag Aug 26. [Epub ahead of print.].

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The role of serological antibody testing to aid in the management of the COVID-19 pandemic has garnered considerable enthusiasm in the lay media and policy spheres. There is intuitive appeal in using Immunoglobin G (IgG) testing to better understand levels of immunity in individuals and population as we develop plans for resuming economic activity. [No abstract available; excerpt from article.].

Johnson-Mann, C., M. Hassan and S. Johnson (2020). “COVID-19 pandemic highlights racial health inequities.” Lancet Diabetes Endocrinol 8(8): 663-664.

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The COVID-19 pandemic has substantially affected health care on a global scale, and has magnified the inequities in access to health care that existed before. This pandemic has highlighted the equity gap in outcomes for marginalised communities, specifically the Black community, as starkly shown by the disparate morbidity and mortality from COVID-19 in individuals from these communities compared with the majority white population.Furthermore, obesity and its associated comorbidities, which disproportionately affect racial or ethnic minorities, have played a central role in the severity of COVID-19 in marginalised communities. [No abstract; excerpt from article].

Mamun, A., H. Kitzman and L. Dodgen (2020). “Reducing metabolic syndrome through a community-based lifestyle intervention in African American women.” Nutr Metab Cardiovasc Dis Jun 12;S0939-4753(20)30232-5. [Epub ahead of print.].

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BACKGROUND AND AIMS: Metabolic syndrome (MetS) increases the risk of cardiovascular disease and type 2 diabetes. Despite a higher prevalence of MetS in African American (AA) women, little is known about the effectiveness of lifestyle interventions in improving metabolic markers in this high-risk group. This study investigated the effectiveness of a community-based lifestyle intervention delivered by lay health coaches in reducing MetS among AA women. METHODS AND RESULTS: A cluster-randomized diabetes prevention program (DPP) was implemented in 11 churches utilizing a community-based participatory research (CBPR) approach to develop and deliver the interventions. A total of 221 adults, AA women who were overweight or obese, and did not have diabetes were included in this study. The prevalence of MetS was 42.08% before receiving the DPP intervention and 31.22% after the intervention that represented a 10.86% absolute reduction and a 25.81% relative reduction from baseline. The adjusted odds ratio (OR) of being free from MetS at post-intervention in contrast to baseline was 2.14 (p = 0.02). Factors that increased the odds of being free from MetS were younger age, reduction in intake of total calories, total fat, saturated and trans-fat, and dietary sodium. CONCLUSION: A faith adapted lifestyle intervention held in church settings and delivered by minimally trained lay health coaches reduced the prevalence of MetS in AA women who were overweight or obese. Findings from this study can be used to translate evidence into public health programs at the community level for the prevention of type 2 diabetes and cardiovascular disease.