Background In response to reported COVID-19 outbreaks among people experiencing homelessness (PEH) in other U.S. cities, we conducted multiple, proactive, facility-wide testing events for PEH living sheltered and unsheltered and homelessness service staff in Atlanta, Georgia. We describe SARS-CoV-2 prevalence and associated symptoms and review shelter infection prevention and control (IPC) policies Methods PEH and staff were tested for SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR) during April 7–May 6, 2020. A subset of PEH and staff was screened for symptoms. Shelter assessments were conducted concurrently at a convenience sample of shelters using a standardized questionnaire Results Overall, 2,875 individuals at 24 shelters and nine unsheltered outreach events underwent SARS-CoV-2 testing and 2,860 (99.5%) had conclusive test results. SARS-CoV-2 prevalence was 2.1% (36/1,684) among PEH living sheltered, 0.5% (3/628) among PEH living unsheltered, and 1.3% (7/548) among staff. Reporting fever, cough, or shortness of breath in the last week during symptom screening was 14% sensitive and 89% specific for identifying COVID-19 cases compared with RT-PCR. Prevalence by shelter ranged 0%–27.6%. Repeat testing 3–4 weeks later at four shelters documented decreased SARS-CoV-2 prevalence (0%–3.9%). Nine of 24 shelters completed shelter assessments and implemented IPC measures as part of the COVID-19 response Conclusions PEH living in shelters experienced higher SARS-CoV-2 prevalence compared with PEH living unsheltered. Facility-wide testing in congregate settings allowed for identification and isolation of COVID-19 cases and is an important strategy to interrupt SARS-CoV-2 transmission

The COVID-19 pandemic has sparked unprecedented public health and social measures (PHSM) by national and local governments, including border restrictions, school closures, mandatory facemask use and stay at home orders. Quantifying the effectiveness of these interventions in reducing disease transmission is key to rational policy making in response to the current and future pandemics. In order to estimate the effectiveness of these interventions, detailed descriptions of their timelines, scale and scope are needed. The Health Intervention Tracking for COVID-19 (HIT-COVID) is a curated and standardized global database that catalogues the implementation and relaxation of COVID-19 related PHSM. With a team of over 200 volunteer contributors, we assembled policy timelines for a range of key PHSM aimed at reducing COVID-19 risk for the national and first administrative levels (e.g. provinces and states) globally, including details such as the degree of implementation and targeted populations. We continue to maintain and adapt this database to the changing COVID-19 landscape so it can serve as a resource for researchers and policymakers alike.

Climate change is a well-recognized threat to human health with impacts on every organ system and with implications for disease processes across subspecialties. Climate-driven environmental exposures influence the pathophysiologic underpinnings of disease emphasized in the pre-clinical years of medical school. While medical schools are beginning to offer climate change and health electives, medical education is lagging in providing fundamental climate-and-health content to adequately prepare the next generation of physicians for the challenges that they will face in the provision of healthcare and the prevention and treatment of disease. This perspective piece highlights the unique role of medical students in catalyzing the incorporation of climate content into the pre-clinical medical school curriculum and provides topics for disseminated curricular integration with the concepts emphasized in the pre-clinical years of medical education.

Antibiotic-resistant strains of Staphylococcus aureus pose a major threat to human health and there is an ongoing need for new antibiotics to treat resistant infections. In a high throughput screen (HTS) of 230,000 small molecules designed to identify bioactive wall teichoic acid (WTA) inhibitors, we identified one hit, which was expanded through chemical synthesis into a small panel of potent compounds. We showed that these compounds target TarG, the transmembrane component of the two-component ATP-binding cassette (ABC) transporter TarGH, which exports WTA precursors to the cell surface for attachment to peptidoglycan. We purified, for the first time, a WTA transporter and have reconstituted ATPase activity in proteoliposomes. We showed that this new compound series inhibits TarH-catalyzed ATP hydrolysis even though the binding site maps to TarG near the opposite side of the membrane. These are the first ABC transporter inhibitors shown to block ATPase activity by binding to the transmembrane domain. The compounds have potential as therapeutic agents to treat S. aureus infections, and purification of the transmembrane transporter will enable further development.

IntroductionMedical trainees are front-line workers in our worsening climate and health crisis. A movement is underway to teach medical students essential climate change and health content. Few evaluations of climate and health curricula exist to support ongoing curricular development, innovation, and improvement. This study explores student perspectives on climate change and health content and delivery post-implementation of a climate change and health curriculum that was co-created by students and faculty and integrated across 16 months of pre-clinical coursework at Emory University School of Medicine.MethodsThe authors conducted focus groups with the inaugural cohort of students to receive the climate and health education content at the conclusion of their preclinical curriculum. The focus groups elicited student perspectives across four domains: (i) prior perceptions of climate change and health, (ii) current attitudes about climate change and health, (iii) reflections on the existing curriculum, and (iv) opportunities for the curriculum. In this qualitative evaluation, the authors coded focus group transcripts using an inductive content analysis approach.ResultsOut of 137 eligible students in the cohort, 13 (9.5%) participated in the focus groups. Implementation strategies that students valued included contextualization and integration of climate content within existing topics and student representation through the co-creation process. Students recommended bolstering small group sessions and case-based learning to build relevant history and physical examination skills as well as creating interprofessional and community-based opportunities.DiscussionThis evaluation offers in-depth student perspectives of our climate and health curriculum. Opportunities exist to synergize climate and health education with broader transformations in medicine toward health promotion and sustainable, climate-ready healthcare. From the input of focus groups, the authors derive a framework for strengthening and extending curricular content.