Faculty Bibliography

The virus SARS-CoV2, which causes coronavirus disease (COVID-19) has become a pandemic and has spread to every inhabited continent. Given the increasing caseload, there is an urgent need to augment clinical skills in order to identify from among the many mild cases the few that will progress to critical illness. We present a first step towards building an artificial intelligence (AI) framework, with predictive analytics (PA) capabilities applied to real patient data, to provide rapid clinical decision-making support. COVID-19 has presented a pressing need as a) clinicians are still developing clinical acumen to this novel disease and b) resource limitations in a surging pandemic require difficult resource allocation decisions. The objectives of this research are: (1) to algorithmically identify the combinations of clinical characteristics of COVID-19 that predict outcomes, and (2) to develop a tool with AI capabilities that will predict patients at risk for more severe illness on initial presentation. The predictive models learn from historical data to help predict who will develop acute respiratory distress syndrome (ARDS), a severe outcome in COVID-19. Our results, based on data from two hospitals in Wenzhou, Zhejiang, China, identified features on initial presentation with COVID-19 that were most predictive of later development of ARDS. A mildly elevated alanine aminotransferase (ALT) (a liver enzyme), the presence of myalgias (body aches), and an elevated hemoglobin (red blood cells), in this order, are the clinical features, on presentation, that are the most predictive. The predictive models that learned from historical data of patients from these two hospitals achieved 70% to 80% accuracy in predicting severe cases

The adverse effects of climate change on human health are unfolding in real time. Environmental fragmentation is amplifying spillover of viruses from wildlife to humans. Increasing temperatures are expanding mosquito and tick habitats, introducing vector-borne viruses into immunologically susceptible populations. More frequent flooding is spreading water-borne viral pathogens, while prolonged droughts reduce regional capacity to prevent and respond to disease outbreaks with adequate water, sanitation, and hygiene resources. Worsening air quality and altered transmission seasons due to an increasingly volatile climate may exacerbate the impacts of respiratory viruses. Furthermore, both extreme weather events and long-term climate variation are causing the destruction of health systems and large-scale migrations, reshaping health care delivery in the face of an evolving global burden of viral disease. Because of their immunological immaturity, differences in physiology (e.g., size), dependence on caregivers, and behavioral traits, children are particularly vulnerable to climate change. This investigation into the unique pediatric viral threats posed by an increasingly inhospitable world elucidates potential avenues of targeted programming and uncovers future research questions to effect equitable, actionable change. IMPACT: A review of the effects of climate change on viral threats to pediatric health, including zoonotic, vector-borne, water-borne, and respiratory viruses, as well as distal threats related to climate-induced migration and health systems. A unique focus on viruses offers a more in-depth look at the effect of climate change on vector competence, viral particle survival, co-morbidities, and host behavior. An examination of children as a particularly vulnerable population provokes programming tailored to their unique set of vulnerabilities and encourages reflection on equitable climate adaptation frameworks.

Infection prevention and control (IPC) measures safeguard primary healthcare systems, especially as the infectious disease landscape evolves due to climate and environmental change, increased global mobility, and vaccine hesitancy and inequity, which can introduce unexpected pathogens. This study explores the importance of an "always-on," low-cost IPC approach, focusing on the role of natural ventilation in health facilities, particularly in low-resource settings. Ambient carbon dioxide (CO2) levels are increasingly used as a measure of ventilation effectiveness allowing for spot checks and targeted ventilation improvements. Data were collected through purposive sampling in Northern Ghana over a three-month period. Levels of CO2 ppm (parts per million) were measured by a handheld device in various healthcare settings, including Community-Based Health Planning and Services (CHPS) facilities, municipal and teaching hospitals, and community settings to assess ventilation effectiveness. Analyses compared CO2 readings in community and hospital settings as well as in those settings with and without natural ventilation. A total of 40 facilities were evaluated in this study; 90% were healthcare facilities and 75% had natural ventilation (with an open window, door or wall). Facilities that relied on natural ventilation were mostly community health centers (60% vs 0%) and more commonly had patients present (83% vs 40%) compared with facilities without natural ventilation. Facilities with natural ventilation had significantly lower CO2 concentrations (CO2 ppm: 663 vs 1378, p = 0.0043) and were more likely to meet international thresholds of CO2 < 800 ppm (87% vs 10%, p = <0.0001) and CO2 < 1000 ppm (97% vs 20%, p = <0.0001). The adjusted odds ratio of low CO2 in the natural facilities compared with non-natural were: odds ratios, OR (95% CI): 21.7 (1.89, 247) for CO2 < 800 ppm, and 16.8 (1.55, 183) for CO2 < 1000 ppm. Natural ventilation in these facilities was consistently significantly associated with higher likelihood of low CO2 concentrations. Improved ventilation represents one cost-effective layer of IPC. This study highlights the continuing role natural ventilation can play in health facility design in community health care clinics. Most health facilities met standard CO2 thresholds, particularly in community health facilities. Further research is needed to optimize the use of natural ventilation. The use of a handheld devices to track a simple metric, CO2 levels, could improve appreciation of ventilation among healthcare workers and public health professionals and allow for them to target improvements. This study highlights potential lessons in the built environment of community primary health facilities as a blueprint for low-cost, integrated multi-layer IPC measures to mitigate respiratory illness and anticipate future outbreaks.

BACKGROUND:Vaccination can help control the coronavirus disease 2019 (COVID-19) pandemic but is undermined by vaccine hesitancy. Social media disseminates information and misinformation regarding vaccination. Tracking and analyzing social media vaccine sentiment could better prepare health professionals for vaccination conversations and campaigns. METHODS:A real-time big data analytics framework was developed using natural language processing sentiment analysis, a form of artificial intelligence. The framework ingests, processes, and analyzes tweets for sentiment and content themes, such as natural health or personal freedom, in real time. A later dataset evaluated the relationship between Twitter sentiment scores and vaccination rates in the United States. RESULTS:The real-time analytics framework showed a widening gap in sentiment with more negative sentiment after vaccine rollout. After rollout, using a static dataset, an increase in positive sentiment was followed by an increase in vaccination. Lag cross-correlation analysis across US regions showed evidence that once all adults were eligible for vaccination, the sentiment score consistently correlated with vaccination rate with a lag of around 1 week. The Granger causality test further demonstrated that tweet sentiment scores may help predict vaccination rates. CONCLUSIONS:Social media has influenced the COVID-19 response through valuable information and misinformation and distrust. This tool was used to collect and analyze tweets at scale in real time to study sentiment and key terms of interest. Separate tweet analysis showed that vaccination rates tracked regionally with Twitter vaccine sentiment and might forecast changes in vaccine uptake and/or guide targeted social media and vaccination strategies. Further work is needed to analyze the interplay between specific populations, vaccine sentiment, and vaccination rates.

Google searches create a window into population-wide thoughts and plans not just of individuals, but populations at large. Since the outbreak of COVID-19 and the non-pharmaceutical interventions introduced to contain it, searches for socially distanced activities have trended. We hypothesize that trends in the volume of search queries related to activities associated with COVID-19 transmission correlate with subsequent COVID-19 caseloads. We present a preliminary analytics framework that examines the relationship between Google search queries and the number of newly confirmed COVID-19 cases in the United States. We designed an experimental tool with search volume indices to track interest in queries related to two themes: isolation and mobility. Our goal was to capture the underlying social dynamics of an unprecedented pandemic using alternative data sources that are new to epidemiology. Our results indicate that the net movement index we defined correlates with COVID-19 weekly new case growth rate with a lag of between 10 and 14 days for the United States at-large, as well as at the state level for 42 out of 50 states with the exception of 8 states (DE, IA, KS, NE, ND, SD, WV, WY) from March to June 2020. In addition, an increasing caseload was seen over the summer in some southern US states. A sharp rise in mobility indices was followed by a sharp increase, respectively, in the case growth data, as seen in our case study of Arizona, California, Florida, and Texas. A sharp decline in mobility indices is often followed by a sharp decline, respectively, in the case growth data, as seen in our case study of Arizona, California, Florida, Texas, and New York. The digital epidemiology framework presented here aims to discover predictors of the pandemic's curve, which could supplement traditional predictive models and inform early warning systems and public health policies.