The study is part of a larger, ongoing collaboration involving the Centers for Disease Control and Prevention (CDC), Washington University School of Medicine in St. Louis, the Missouri Department of Health and Senior Services, the Missouri Department of Elementary and Secondary Education, Saint Louis University, the Springfield-Greene and St. Louis County health departments, and school districts in the St. Louis and Springfield, Mo., areas.

The findings are published March 19 in the CDC’s journal, Morbidity and Mortality Weekly Report. The Missouri school findings mirror those of schools in other states, demonstrating that COVID-19 prevention efforts can significantly curb the spread of SARS-CoV-2 among students, teachers and staff.

“This work is imperative because keeping kids in school provides not only educational enrichment but also social, psychological and emotional health benefits, particularly for students who rely on school-based services for nutritional, physical and mental health support,” said senior author Johanna S. Salzer, DVM, PhD, a veterinary medical officer with the CDC’s National Center for Emerging and Zoonotic Infectious Diseases.

The pilot study involved 57 schools in the Pattonville School District in St. Louis County and the Springfield Public School District in Greene County in southwest Missouri, as well as two private schools in St. Louis County. All schools in the pilot study required students, teachers, staff and visitors to wear masks while on campus or buses.

Other safety measures included a focus on hand hygiene, deep cleaning of facilities, physical distancing in classrooms, daily symptom screenings for COVID-19, installing physical barriers between teachers and students, offering virtual learning options, and increasing ventilation.

For two weeks in December, the schools involved in the pilot project notified the research team of students, teachers and staff who were either infected with COVID-19 or quarantined due to being considered a close contact of someone who had tested positive. In St. Louis, close contacts of students or teachers who had tested positive were placed in quarantine, meaning they were not to leave their homes for 14 days from when last exposed to a positive case. In Springfield, however, some of the close contacts of those who had tested positive were placed in modified quarantine — meaning they could stay in school if they and the infected person were wearing masks when in close contact; in this scenario, the infected person still isolated at home.

Participants in the pilot study included 193 persons across 22 of the 57 schools — 37 who tested positive for COVID-19 and 156 of their close contacts. Among participants who were COVID-19 positive, 24 (65%) were students, and 13 (35%) were teachers or staff members. Of the close contacts, 137 (88%) were students, and 19 (12%) were teachers or staff members.

Among the 102 close contacts who agreed to testing for COVID-19 using saliva tests, only two people received positive test results indicating probable school-based SARS-CoV-2 secondary transmission. Further, no outbreaks were identified in participating schools despite the high rates of community spread in December, even among the Springfield schools that followed modified quarantine protocols allowing some close contacts of positive individuals to remain in school.

“Schools can operate safely during a pandemic when prevention strategies are followed,” said one of the study’s leading researchers, Jason Newland, MD, a Washington University professor of pediatrics, who treats patients at St. Louis Children’s Hospital. Newland led the pilot program with the CDC and has advised multiple school districts in Missouri on plans for reopening schools. “The pilot study demonstrates low transmission in schools and no student-to-teacher transmission — and this was during the height of the pandemic in December, with high rates of community spread.”

Added Randall Williams, MD, director of the Missouri Department of Health and Senior Services: “Schools with proper prevention strategies remain a safe environment for students and teachers during the pandemic.”

Since mid-January, the CDC, Washington University and Saint Louis University researchers, and the St. Louis County and Springfield-Greene County health departments, along with three school districts from St. Louis County, and three school districts in Greene County have been participating in a larger study to further examine the COVID-19 prevention strategies and quarantine policies. The St. Louis County school districts involved are Rockwood, Pattonville and University City; the Greene County school districts involved are Springfield, Republic and Logan-Rogersville.

In addition, the researchers are going into classrooms to measure the distances between desks to evaluate whether the 6-foot social distancing rule can be relaxed in school settings. They’re also sending surveys to parents, teachers and staff to assess the stress and mental health challenges surrounding quarantine. In Springfield, the researchers are continuing to study modified quarantine policies.

“We are pleased to continue to work on this joint project with the CDC, Washington University, and the Springfield-Greene County Health Department,” said Jean Grabeel, director of health services for Springfield Public Schools. “The initial results helped verify that our mitigation strategies have been successful in the school setting. This continued work will help to further guide the full-time return of students to in-person learning, five days a week, in a safe manner. We deeply appreciate this unique opportunity to collaborate on such a meaningful, impactful project.”

Added Mark T. Miles, PhD, superintendent of the Rockwood School District, the largest school system in St. Louis County and one of the largest in the state, with 22,268 students: “I am grateful for Rockwood’s opportunity to participate in this collaboration. We all share the same priority: keeping schools safe for students, teachers and staff as well as the community at large.”

Dawson P, Worrell MC, Orscheln RC, Williams RW, Newland JG, Salzer JS et al and the COVID-19 Surge Laboratory Group. Pilot investigation of SARS-CoV-2 secondary transmission in Kindergarten through Grade 12 schools implementing mitigation strategies — St. Louis County and City of Springfield, Missouri, December 2020. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. March 19, 2021.

For this analysis, researchers accessed the American Heart Association’s COVID-19 Cardiovascular Disease Registry to investigate stroke risk among patients hospitalized for COVID-19, their demographic characteristics, medical histories and in-hospital survival. The COVID-19 Registry data pulled for this study included more than 20,000 patients hospitalized with COVID-19 across the U.S. between January and November 2020.

“These findings suggest that COVID-19 may increase the risk for stroke, though the exact mechanism for this is still unknown,” said lead study author Saate S. Shakil, M.D., a cardiology fellow at the University of Washington in Seattle. “As the pandemic continues, we are finding that coronavirus is not just a respiratory illness, but a vascular disease that can affect many organ systems.”

Two hundred eighty-one people (1.4%) in the COVID-19 CVD Registry had a stroke confirmed by diagnostic imaging during hospitalization. Of these, 148 patients (52.7%) experienced ischemic stroke; 7 patients (2.5%) had transient ischemic attack (TIA); and 127 patients (45.2%) experienced a bleeding stroke or unspecified type of stroke.

The analysis of COVID-19 patients also found:

• Those with any type of stroke were more likely to be male (64%) and older (average age 65) than patients without stroke (average age 61);
• 44% of patients who had an ischemic stroke also had Type 2 diabetes vs. about one-third of patients without stroke, and most of the ischemic stroke patients had high blood pressure (80%) compared to patients without stroke (58%);
• 18% of ischemic stroke patients had atrial fibrillation, while 9% of those without stroke also had atrial fibrillation;
• Patients who had a stroke spent an average of 22 days in the hospital, compared to 10 days of hospitalization for patients without stroke; and
• In-hospital deaths were more than twice as high among stroke patients (37%) compared to patients without stroke (16%).

In addition, stroke risk varied by race. Black patients accounted for 27% of the patients in the COVID-19 CVD Registry pool for this analysis; however, 31% of ischemic stroke cases were among Black patients.

“We know the COVID-19 pandemic has disproportionately affected communities of color, but our research suggests Black Americans may have higher risk of ischemic stroke after contracting the virus, as well,” Shakil said. “Stroke on its own can have devastating consequences and recovering from COVID-19 is often a difficult path for those who survive. Together, they can exact a significant toll on patients who have had both conditions.”

Shakil added, “It is more important than ever that we curb the spread of COVID-19 via public health interventions and widespread vaccine distribution.”

In April 2020, the American Heart Association created the COVID-19 CVD Registry within weeks of the declaration of the global pandemic to rapidly collect and provide insights into patients hospitalized with the novel coronavirus. The Association’s robust Get With the Guidelines registry infrastructure has allowed for rapid data collection, including over 37,000 patient records and more than 135,000 lab reports, with more than 160 registry sites enrolled (data as of 2/23/21).

Co-authors are Sophia Emmons-Bell, B.A.; Christine Rutan, B.A.; Jason Walchok, B.A., N.R.P.; James A. de Lemos, M.D.; Babak Navi, M.D., M.S.; Alexander E. Merkler, M.D., M.S.; Gregory A. Roth, M.D., M.P.H.; and Mitchell S.V. Elkind, M.D., M.S., FAHA, FAAN. Disclosures are available in the abstract.

This study was funded by the American Heart Association.

Story Source:

Materials provided by American Heart Association. Note: Content may be edited for style and length.

The research group consisted of Assistant Professor Takashi Iwata of Kobe University’s Graduate School of Maritime Sciences, Researcher Martin Biuw of the Norwegian Institute of Marine Research, Assistant Professor Kagari Aoki and Professor Katsufumi Sato of the Atmosphere and Ocean Research Institute, the University of Tokyo, and Professor Patrick Miller of the University of St. Andrews.

These research results were published online in Behavioural Processes on February 25, 2021.

Main Points

• The researchers attached an omnidirectional (360°) camera to a humpback whale and discovered that these animals rest while drifting underwater. Whales can rest either on the surface or underwater, and it is believed that they choose which of these different environments to rest in depending on the situation.
• The omnidirectional camera recorded a wide range of information on the environment surrounding the tagged whale, revealing that humpback whales rest in groups rather than on their own.
• These results have demonstrated that animal-borne omnidirectional cameras are useful for learning more about animals that are difficult to observe.

Research Background

It is difficult to observe the ecology of marine animals directly as they spend the majority of their lives underwater. However, studies on the ecology of difficult-to-observe marine animals have been recently conducted using a method called bio-logging. This method involves attaching a camera to an animal and recording environmental information related to their behavior and surroundings. Various kinds of data can be recorded and measured, and this information can be used to understand aspects such as animal behavior and diving physiology. Such data includes depth, swimming speed, acceleration (which can be used to understand the animal’s posture and detailed movements), vocalizations, heart rate and GPS (Global Positioning System) location data.

Cameras in particular are a powerful tool as they enable researchers to view the individual animal’s surroundings, which in turn helps them to understand the animal’s behavior. However, the camera’s limited field of view has been an issue with animal-borne cameras up until now. For example, research using a camera attached to a humpback whale (Megaptera novaeangliae) revealed that the whale would quickly move away from foraging sites if a competitor was present. However, the competitor was not visible due to the limited scope of the camera, therefore its presence was merely assumed. A camera with a wide-angle lens is therefore necessary to film the animal’s entire surroundings.

This research focused on the humpback whale, a species of baleen whale that is found in oceans around the globe. Using bio-logging, researchers have learned more about humpback whales’ foraging habits, however little is known about their resting behaviors. Foraging events can be identified from the recorded depth, swimming speed and acceleration (movement) of the whale that are characteristic signs that it is chasing prey. However, researchers have not identified the characteristic signs of resting, and it is not understood what the differences are between resting and swimming slowly. Information about an animal’s resting behavior is necessary in order to understand their ecology. For example, if we consider animal behaviors in terms of their time budget, the percentage of time for other activities such as foraging decreases if their resting periods increase. Even though information about resting behaviors is essential for understanding animal ecology, hardly anything is known about baleen whales’ resting habits.

This research group used an omnidirectional camera (with a 360° field-of-view on land and a 270° field-of-view underwater) and a behavioral data logger in order to illuminate the resting behavior of humpback whales.

Research Methodology and Findings

RICOH supplied the basic THETA camera module for this research, which was made pressure-resistant and waterproofed using epoxy glue by Little Leonardo Corp., leading to the development of a new type of animal-borne omnidirectional camera. A suction cup tag was made out of buoyant materials that could be attached to the whale. The tag contained an omnidirectional camera, a behavioral data logger and a radio transmitter.

The field study was conducted in January 2016, off the Tromsø coast in Norway. To tag the whale, the researchers approached it in a small vessel (5-6m) and used a 6m pole to attach the tag to the animal. The tag was designed so that it would fall off naturally after several hours and float up to the surface. The tag was then recovered by determining its location via the signal from the transmitter.

The research team were able to tag one individual, obtaining around one hour of video data and approximately eleven hours of behavioral data. From the behavioral data, the researchers discovered that the whale was inactive during the first half of the recorded period and demonstrated active behavior in the latter half.

Based on past research, it was assumed that this active movement in the latter half was foraging activity. The video data was captured during the first half of the behavioral data recording period when the whale did not move much. In this videoed period, the tagged whale’s deepest dive was 11m on average and its average swimming speed (cruising speed) was 0.75m/s-1. It has been reported that humpback whales’ regular swimming speed is 1.45m/s-1, however the tagged whale was moving much more slowly during this period. Whales usually move their flukes (tails) when they swim but there were no signs that the individual whale moved its fluke in the behavioral data recorded during the videoed period. In the footage, two other whales that are drifting underwater without moving their flukes are visible. It was determined that the tagged individual was also drifting underwater from its slow swimming speed, lack of fluke movement and the continued presence in the video footage of other individuals that were drifting. Seal species, sperm whales and loggerhead turtles are known to drift underwater while they are resting. Therefore, it is believed that the tagged humpback whale in this study was also resting. Previous research has reported that baleen whale species rest on the surface but this study has revealed that they also rest while drifting underwater. It is thought that whales consider factors such as marine conditions and their own physical condition when choosing from the two different resting environments: on the surface or underwater. In addition, the footage from the omnidirectional camera shows that whales rest underwater in a group rather than on their own.

Further Research

Researchers have been using animal-borne cameras as a tool to investigate the ecology of marine animals. For example, a backwards-facing camera attached to a mother seal recorded images of a pup swimming behind her. However, to ascertain the significance of these images (for example, whether or not the mother was teaching the pup how to hunt) it is necessary to use a camera with a wide field of view so that we can obtain knowledge about the surrounding environment. Still camera images of touching behaviors between whales have also been recorded; however, a wide-lens camera would aid researchers in determining the frequency at which this behavior occurs. These examples show how necessary wide-lens cameras, such as omnidirectional cameras, are for investigating the ecology of marine animals. Such cameras enable researchers to record the environment surrounding the tagged animal, enabling them to determine whether other individuals (such as competitors, collaborators, or predators) are present or not, and understand the frequency and distribution of food sources.

This research group inferred that the tagged whale was resting based on the captured footage of nearby individuals at rest, demonstrating the usefulness of omnidirectional cameras. It is hoped that these cameras can be utilized to illuminate the ecology of marine animals that are difficult to observe.

Video of whale tagging: https://www.youtube.com/watch?v=oCESDySblqM

COVID-19 and influenza are both contagious respiratory viral diseases that can lead to pneumonia and acute respiratory failure in severe cases. However, detailed comparison of the epidemiology and clinical characteristics of COVID-19 and those of influenza are lacking.

“COVID-19 has been compared to influenza both by health care professionals and the lay public, but there’s really limited detailed objective data available for comparing and contrasting the impact of these two diseases on patients and hospitals,” said corresponding author Michael Donnino, MD, Critical Care and Emergency Medicine physician at BIDMC. “We compared patients admitted to BIDMC with COVID-19 in spring 2020 to patients admitted to BIDMC with influenza during the last five flu seasons. We found that COVID-19 causes more severe disease and is more lethal than influenza.”

Donnino and colleagues included a total of 1,634 hospitalized patients in their study, 582 of whom had laboratory-confirmed COVID-19 and 1,052 of whom had confirmed influenza. The team found that, on average, 210 patients were admitted to BIDMC during each eight-month flu season, compared to the 582 patients with COVID-19 admitted in March and April 2020. While 174 patients with COVID-19 (or 30 percent) received mechanical ventilation during the two-month period, just 84 patients with influenza (or 8 percent) were placed on ventilation over all five seasons of influenza. Likewise, the proportion of patients who died was much higher for COVID-19 than for influenza; 20 percent of admitted patients with COVID-19 died in the two-month period, compared to three percent of patients with influenza over five seasons.

Further analysis revealed that hospitalized patients with COVID-19 tended to be younger than those hospitalized with influenza. Among patients requiring mechanical ventilation, patients with COVID-19 were on ventilation much longer — a median duration of two weeks — compared to just over three days for patients with influenza. Moreover, among patients requiring mechanical ventilation, patients with COVID-19 were far less likely to have had pre-existing medical conditions.

“Our data illustrate that 98 percent of deaths of patients hospitalized with COVID-19 were directly or indirectly related to their COVID-19 illness, illustrating that patients did not die with COVID but rather from COVID pneumonia or a complication,” said Donnino.

The authors note that the stringent social distancing guidance in effect last spring may have impacted these findings by limiting the incidence and lethality of COVID-19 toward the end of April 2020. Conversely, some treatment practices have evolved over the course of the pandemic, potentially improving outcomes for patients with COVID-19.

Co-authors included Ari Moskowitz, MD, Garrett S. Thompson, MPH, Stanley J. Heydrick, PhD, Rahul D. Pawar, MD, Katherine M. Berg, MD, Shivani Mehta, Parth V. Patel, BSN, RN, and Anne V. Grossestreuer, PhD, all of Beth Israel Deaconess Medical Center.

This work was supported by internal funding. Donnino, Moskowitz and Berg are supported in part by grants from the National Institutes of Health (K24HL127101, R01HL136705 and 1R01DK112886; K23GM128005; and K23HL128881404).