The COVID-19 pandemic, caused by the SARS-CoV-2 coronavirus, is responsible for over 400 million cases and over 5. 5 million deaths worldwide. In response to widespread SARS-CoV-2 infection, immunization of the global population has approached 60% one dose and 54% full dose vaccination status. Emerging data indicates decreasing circulating antibody levels as well as decreases in other immune correlates in vaccinated individuals. Complicating the determination of vaccine effectiveness is the concomitant emergence of novel SARS-CoV-2 variants with substantial antigenic differences from the ancestral D614G strain. The Omicron variant (B.1.1.529) spike protein has over 30 mutations compared with the D614G spike protein, which was used to design most SARS-CoV-2 vaccines in use today. Therefore, breakthrough cases of SARS-CoV-2 infections or severe disease in fully vaccinated individuals must be interpreted with caution taking into consideration vaccine waning and the degree of vaccine variant-mismatch resulting in adaptive immune evasion by novel emerging SARS-CoV-2 variants.

No abstract

IntroductionAfter the initial onset of the SARS-CoV-2 pandemic, the government of Canada and provincial health authorities imposed restrictive policies to limit virus transmission and mitigate disease burden. In this study, the pandemic implications in the Canadian province of Nova Scotia (NS) were evaluated as a function of the movement of people and governmental restrictions during successive SARS-CoV-2 variant waves (i.e., Alpha through Omicron).MethodsPublicly available data obtained from community mobility reports (Google), the Bank of Canada Stringency Index, the “COVID-19 Tracker” service, including cases, hospitalizations, deaths, and vaccines, population mobility trends, and governmental response data were used to relate the effectiveness of policies in controlling movement and containing multiple waves of SARS-CoV-2.ResultsOur results indicate that the SARS-CoV-2 pandemic inflicted low burden in NS in the initial 2 years of the pandemic. In this period, we identified reduced mobility patterns in the population. We also observed a negative correlation between public transport (−0.78), workplace (−0.69), retail and recreation (−0.68) and governmental restrictions, indicating a tight governmental control of these movement patterns. During the initial 2 years, governmental restrictions were high and the movement of people low, characterizing a ‘seek-and-destroy’ approach. Following this phase, the highly transmissible Omicron (B.1.1.529) variant began circulating in NS at the end of the second year, leading to increased cases, hospitalizations, and deaths. During this Omicron period, unsustainable governmental restrictions and waning public adherence led to increased population mobility, despite increased transmissibility (26.41-fold increase) and lethality (9.62-fold increase) of the novel variant.DiscussionThese findings suggest that the low initial burden caused by the SARS-CoV-2 pandemic was likely a result of enhanced restrictions to contain the movement of people and consequently, the spread of the disease. Easing public health restrictions (as measured by a decline in the BOC index) during periods of high transmissibility of circulating COVID-19 variants contributed to community spread, despite high levels of immunization in NS.

Mutations in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genome continue to threaten the global landscape of the coronavirus disease 2019 (COVID-19) pandemic. The Omicron variant (B.1.1.529) rapidly displaced previous ‘variants of concern’ (VoC) in 2021 due to its high rate of transmissibility and multitude of mutations. This global influx of infections saturated healthcare systems, overwhelmed testing capacity and case reporting, and increased the COVID-19 death toll. Global health leaders are now being faced with the most transmissible COVID-19 variants yet, the Omicron sublineages BA.4 and BA.5, which contain additional spike protein (S) mutations from previous Omicron and VoC serotypes. With universally observed antibody waning, increasing vaccine-variant mismatch, and resuming international travel, the stage is set for unprecedented levels of breakthrough infections and superspreading events. In this paper, we raise awareness to these novel variants and provide context for the high likelihood of an upcoming wave of infection capable of inflicting significant disease burden on a global scale.

Various methods have been described for the treatment of anterior shoulder instability with glenoid bone loss. The incidence of recurrent dislocations following surgical intervention is high and, therefore, necessitates a reliable and replicable revision procedure. The purpose of this Technical Note is to describe a method of arthroscopic anatomic glenoid reconstruction using a distal tibial allograft and screw fixation in the setting of a failed Latarjet procedure with significant glenoid bone loss. Methods: We describe in detail patient positioning, portal placement, steps of the diagnostic arthroscopy, and graft preparation using imaging and a detailed intraoperative arthroscopic technique.

Background: The overall goal of this survey was to understand the Ebola Virus Disease (EVD) -related knowledge, attitudes, and practices at individual, inter-personal, institutional, and societal levels in Rwanda. Methodology: This cross-sectional mixed-methods survey was conducted in five selected districts: Rusizi, Karongi, Rubavu, Burera and Gasabo. Quantitative data was collected from 1,010 participants using a structured questionnaire and Kobo Collect. Qualitative data was collected from 98 participants through Key Informant Interviews and Focus Group Discussion using a semi structured interview guide. Key Findings: Among the 1,010 surveyed respondents, 56% were male, 70.3% were married, and 50% had primary education. An important finding was the high level of Ebola awareness and knowledge in all the five districts, with 99.6% reporting having previously heard of Ebola, which indicates previous awareness-raising efforts were successful. More than 54% of respondents indicated that Ebola is caused by a virus which originates from wild animal animals (42.1%). Furthermore, fever (85%), bleeding (87.7), and vomiting (40.2%) were cited as the primary signs and symptoms for Ebola. Most of the respondents were knowledgeable regarding prevention measures for Ebola. Despite this, 80% of the survey respondents had not received formal training or health education on Ebola. Most respondents (78.2%) reported having a positive attitude towards EVD survivors. Many respondents (90%) believe that the country is at risk of an EVD outbreak and about 87.8% think that they are personally at risk of contracting Ebola. Most respondents reported adopting habits that included avoiding physical contact with the patients and reducing unnecessary movements/travel throughout the Ebola-affected regions. At the community level, participants state that they participate in the sharing of Ebola-related information and reporting suspected cases to relevant authorities. Additionally, many participants know the necessary emergency contact number (114) for assistance and reporting of EVD-related information. Most respondents (97.2%) believed that it is important to be vaccinated to prevent Ebola, and around 93.3% are ready/willing to be vaccinated once the EVD vaccine is available. While the radio is the preferred source for Ebola-related information, the most trusted sources are the ministry of health and governmental institutions, such as the Rwanda Biomedical Centre. Conclusion: Our results show that there was high EVD-related knowledge and awareness among the general population in Rwanda. However, for strong public health awareness, preparedness, and protection, there is a need to implement public sensitization programmes that address EVD-related misconceptions and discriminatory attitudes toward EVD patients.

Background: The overall goal of this survey was to understand the Ebola Virus Disease (EVD) - related knowledge, attitudes, and practices in Rwanda. Methods: This cross-sectional mixed-methods survey was conducted in five selected districts: Rusizi, Karongi, Rubavu, Burera and Gasabo. Quantitative data was collected from 1,010 participants using a structured questionnaire and Kobo Collect. Qualitative data was collected from 98 participants through Key Informant Interviews and Focus Group Discussion using a semi structured interview guide. Results: Among the 1,010 surveyed respondents, 56% were male, 70.3% were married, and 50% had primary education. An important finding was the high level of Ebola awareness and knowledge in all the five districts, with 99.6% reporting having previously heard of Ebola, which indicates previous awareness-raising efforts were successful. More than 54% of respondents indicated that Ebola is caused by a virus which originates from wild animal animals (42.1%). Furthermore, fever (85%), bleeding (87.7), and vomiting (40.2%) were cited as the primary signs and symptoms for Ebola. Most of the respondents were knowledgeable regarding prevention measures for Ebola. Despite this, 80% of the survey respondents had not received formal training or health education on Ebola. Many respondents (90%) believe that the country is at risk of an EVD outbreak and about 87.8% think that they are personally at risk of contracting Ebola. Most respondents reported adopting habits that included avoiding physical contact with the patients and reducing unnecessary movements/travel throughout the Ebola-affected regions. Additionally, most respondents (97.2%) believed that it is important to be vaccinated to prevent Ebola, and around 93.3% were ready and willing to get vaccinated once the EVD vaccine is available. While the radio is the preferred source for Ebola-related information, the most trusted sources are the ministry of health and governmental institutions, such as the Rwanda Biomedical Centre. Conclusion: Our results show that there was high EVD-related knowledge and awareness among the general population in Rwanda. However, for strong public health awareness, preparedness, and protection, there is a need to implement public sensitization programmes that address EVD-related misconceptions and discriminatory attitudes toward EVD patients.

The rapid development of multiple SARS-CoV-2 vaccines within one year of the virus’s emergence is unprecedented and redefines the timeline for vaccine approval and rollout. Consequently, over 13 billion COVID-19 vaccine doses have been administered worldwide, accounting for ∼70% of the global population. Despite this steadfast scientific achievement, many inequalities exist in vaccine distribution and procurement, particularly in low- and middle-income countries such as those in Africa. This stems from the cost of COVID-19 vaccines, storage and cold-chain challenges, distribution to remote areas, proper personnel training, and so on. In addition to logistical challenges, many developed nations rapidly procured available vaccines, administering second and third doses and leaving many developing nations without the first dose. In this paper, we explore the level of reception to COVID-19 vaccines prior to their availability in Rwanda using a survey-based approach. While several countries reported spikes in vaccine hesitancy generally coinciding with new information, new policies, or newly reported vaccine risks, Rwanda functions as an exemplar for controlling disease burden and educating locals regarding the benefits of vaccination. We show that, even before COVID-19 vaccines were available, many Rwandans (97%) recognized the importance of COVID-19 vaccination and (93%) were willing to receive a COVID-19 vaccine following vaccine availability. Our results underscore the level of preparedness in Rwanda, which rivals and outcompetes many developed nations in terms of vaccination rate (nearing 80% in Rwanda), vaccine acceptance, and local knowledge relating to vaccination. Furthermore, in addition to the whole-of-government coordination as well as tailored delivery approach, previously developed practices relating to vaccination and communication surrounding the Ebola Virus Disease may have compounded the COVID-19 vaccine program in Rwanda, prior to its implementation.