While Covid-19 has upended many industries around the globe, faculty, staff, and students at The George Washington University have persisted in doing what they do best--researching, learning about, and compiling publications about some of the most pressing healthcare issues of our time. Since the start of the pandemic, researchers and students associated with the George Washington University School of Medicine and Health Sciences, the Milken Institute School of Public Health, and the School of Nursing have published over fifty peer-reviewed articles related to Covid-19. The Himmelfarb Library has compiled a collection of these publications within our institutional repository, Health Sciences Research Commons. The Covid-19 Publications by GWU Authors collection highlights research by students, faculty, and staff and will be updated on a regular basis. Have a publication that needs to be added? Simply email hsrc@gwu.edu with a link to your publication and we will be happy to include your research.
Tag: COVID-19
Keeping Up with COVID in the DMV: Sources for Stats
As COVID-19 cases and hospitalizations are on the rise in many US states, here are some trusted sources for tracking the situation in the DMV.
Departments of Public Health:
DC Coronavirus Data - Includes daily numbers tested, positives, and lives lost. Scroll down for the DC Re-Opening Tracker and data by ward, neighborhood, and demographic break outs. Tables include data for cases, quarantine and deaths of public safety personnel. Check the Press Releases area on the home page for a detailed daily summary of Coronavirus Data including trends graphs for transmission and positivity rates, and contact tracing data. 
DC Hospital Status Data - Includes daily ICU, ventilator, and bed capacity, COVID hospitalization counts and total patient counts.
Maryland Coronavirus Disease 2019 Outbreak and Data Dashboard - Cases and testing by county, ICU and Acute bed capacities, percentage positive rates and testing volume 7 day averages since March 2020. Cases and deaths by age, gender, race and ethnicity.
Maryland COVID-19 in Congregate Facility Settings (Nursing Homes) - Staff and resident cases and deaths reported by county and facilities.
Virginia Department of Health COVID-19 Dashboard - Includes total counts and graphic representations of cases, hospitalizations and deaths. Demographics tab provides breakouts by age, sex, race and ethnicity. Interactive localities tab provides options for counts or rates, and bar chart generation by health district and locality. Outbreaks tab shows outbreak data by setting/facility type, including long term care and correctional facilities. MIS-C tab tracks cases of Multisymptom Inflammatory Syndrome in Children by health district.
Virginia Department of Health Data Insights - Includes case and testing data by zip code, COVID-like illness visits to EDs by health regions, and modeling data from the UVA COVID-19 Model.
Other Sources:
COVID-19 Watcher (Cincinnati Children's & University of Cincinnati) - Tool merges county-level COVID-19 data from The New York Times with sources from the U.S. Census Bureau, mapping the data by metropolitan area.
COVID Community Vulnerability Map - Drill down into communities by zipcode or manipulate the map to view populations most vulnerable for severe outcomes if infected with a COVID-like virus and the socioeconomic factors driving that risk.
Virginia Hospital COVID-19 Dashboard - Virginia Hospital & Healthcare Association provides counts of confirmed cases and pui currently hospitalized, ICU beds and ventilators in use, and hospitals with supply shortages.
State Health Workforce Estimator - From the Mullan Institute for Health Workforce Equity at GW, it provides state-level data for considering different strategic approaches to ensure sufficient heath workforce for COVID-19. A Contact Tracing Workforce Estimator is also available.
Washington Post Known Coronavirus Deaths and Cases in DC, Maryland and Virginia - Deaths, cases, daily and cumulative counts for each state, daily deaths per 100,000 residents, deaths by county and city, and hospitalizations by state.
Additional monitoring sites, data dashboards and calculators are available on the COVID-19 Research Guide Epidemiology page. The Health Care Resources page includes capacity calculators and models for hospital utilization. Check the Literature, Database, and Data Resources page for open data sets.
Revisiting MedRxiv in the Age of COVID-19
Earlier this year we published a post on the new preprint server, medRxiv (pronounced ‘Med Archive’). We touched on the benefits of archiving research via this service, as well as pointing out the potential downsides. But with the COVID-19 pandemic forcing many to work from home and observe social distancing guidelines, preprint services like medRxiv help researchers share their preliminary findings as they seek to better understand this new disease and discover potential treatment options.
With new information on COVID-19 released on a near daily basis, medRxiv is an excellent place to archive research and disseminate it within the medical community.The archival server has a specialized collection dedicated to research pertaining to the study of COVID-19. At the time of the publication of this post, the preprint server holds approximately 4204 articles. With Altmetrics, researchers are able to track the level of engagement their article receives.
Articles located on the preprint server have not undergone the rigorous peer review process.It is imperative that the research located on medrRxiv is not used in a clinical setting nor shared with the media or public. As we learn more about this disease, how best to fight it and how to prevent its spread, members of the medical community must observe best practices and avoid sharing potentially harmful misinformation to the public or media.
The research and news on COVID-19 is constantly evolving. There is still much to learn about this novel coronavirus and medical professionals are working tirelessly to add to the expanding literature on this disease. MedRxiv, the preprint server, has a collection dedicated exclusively to preliminary research on COVID-19. As such, it is an excellent and free resource that puts researchers in contact with each other.
If you would like to learn more about medRxiv or if you’re interested in submitting research to the server, be sure to visit https://www.medrxiv.org/.
Mental Well-Being During a Pandemic
In 2020 we faced the challenge of a worldwide Pandemic that has changed many of our lives. From relocating ourselves and our belongings to other states to limiting our errands and taking extra sanitary precautions, being on lock-down has taken its toll on many not only physically, but mentally as well.
That being said, there are many ways that you can take care of your mental health while still abiding by social distancing guidelines. Unsure of what you can do? Here are some ideas:
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Make a new daily outdoor resolution.
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Does being indoors so frequently get you down? You are not alone, being inside for so long can make anyone restless! Make it a daily goal to get outside just once, even if it’s a short stroll to the mailbox or spending an afternoon out on your balcony or patio. Even a short time spent outdoors can help you reap the benefits of some fresh air and vitamin D. Want to avoid any crowds? Get outside early. Not sure where to go? You can always take a few laps around some of the city’s athletic fields which are open as of May 29th.
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Start a garden.
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Never tried gardening before? What better time to start than now? There are a variety of flowers, herbs, and vegetables that can be grown both outdoors and indoors. Find seeds, plants and tools online or at your local grocer or hardware store. The internet has countless resources for gardening basics and tips, depending on what you would like to grow.
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Stop by your local Public library.
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While operating on a limited basis, there are several locations of the DC Public Library that are open for curbside pickup. Further information on which locations are open can be found on the Mayor’s Website.
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Try a new recipe.
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Never had the time to bake or cook due to a busy schedule? Why not use this time to bust out those pots, pans and baking sheets and put them to good use! No recipe is too simple or complex. Treat yourself to some french toast, or homemade pizza. Impress your roommate and your pets with this simple two ingredient pizza dough recipe which will not only cost a fraction of standard delivery, but will taste delicious too!
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These are challenging times for all. We cannot stress how important it is not only to be mindful of social distancing guidelines, but to take care of yourself too. Stay safe, and study hard. We are excited to be back and to see you at Himmelfarb!
COVID-19 and Librarian Reserve Corps
Stacy Brody is a Master of Information. Literally. That’s what it says on her degree from Rutgers University School of Communication and Information, at least. And she is using her skills to contribute to the fight against the COVID-19 infodemic.
Stacy was warmly welcomed to the Himmelfarb Library team three months ago. Like many of you, she isn’t sure whether those are short or long months - her perception of time seems to have been affected by the pandemic.
As a member of the Himmelfarb team, she supports the work of clinicians and researchers by conducting literature searches, compiling resources for the weekly Intelligence Reports, and maintaining the COVID-19 Research Guide.
Keeping up-to-date with, and searching for, COVID-19 literature requires some creativity. The research is coming out in torrents. New publications are posted on preprint servers and publisher websites, then picked up on Twitter and by the news media before the research community has had the opportunity to evaluate them. The quality of research described in scholarly articles is variable. Original research is showing up in Commentaries and Editorials for rapid dissemination. The delay between publication and appearance on PubMed and other databases is becoming more apparent and more critical. The norms of scholarly communication and publishing are being challenged in a big way.
Finding and evaluating the evidence to support evidence-based medicine is more difficult when it comes to COVID.
Which is why, when Stacy saw the call on the Medical Library Association’s listserv to support the global response by indexing COVID-19 research publications, she signed up. She hoped that, by applying topic tags to articles, she, in her small way, could make the evidence more findable and usable to the global audience of responders, clinicians, and researchers.
As she hit the Reply button, she didn’t know that she would become co-lead of the Librarian Reserve Corps. She hadn’t yet met her Librarian Reserve Corps co-lead Sara Loree, a medical librarian at St. Luke’s Health System in Idaho, or the visionary Librarian Reserve Corps founder Elaine Hicks, Research, Education and Public Health Librarian at Tulane University. Hicks, reflecting on her own professional experience in public health and emergency preparedness, recognized that the need of Tulane University epidemiologist and GOARN (Global Outbreak Alert and Response Network)-Research lead Dr. Lina Moses, was one no librarian could meet alone. Members of GOARN, a WHO network of 250-plus agencies, institutes, and universities organized to respond to outbreaks, need the literature to support evidence-based public health response efforts. As described above, that evidence is hard to find in an infodemic. For evidence-finding at a global scale, you need an international army of librarians. Hicks, seeing this and dreaming of just such an army, put out a call to the Medical Library Association listserv. The newly formed Librarian Reserve Corps, modeled after the Medical Reserve Corps, supports evidence-based response efforts by providing resources for evidence-based public health.
The initial efforts to tag articles quickly grew - not only because the number of COVID-19 research articles has grown but also because we have learned more about the skills and expertise of our volunteers and the needs of GOARN-Research! Librarian Reserve Corps volunteers continue to index articles on a daily basis and have since expanded their services. Volunteers now conduct literature searches and monitor the media. They work to connect groups working on systematic reviews and meta-analyses.
Librarians have the skills needed to fight the infodemic and help our public health and medical professionals fight the pandemic.
Stacy recognizes that many of the Librarian Reserve Corps’s volunteers contribute to the infodemic-pandemic response at this global level and at the local level. They provide search support for clinicians and researchers. They help students and faculty access the library resources they need to continue their work virtually. They help professors transition to online instruction. As librarians, Stacy acknowledges, we are often in behind-the-scenes roles. She is honored to be part of this amazing, talented, dedicated team of volunteers making librarians famous.
Himmelfarb Staff Member 3D Prints Face Shields for Health Care Workers
John Lopez, Himmelfarb Library’s Data Technician, has joined an initiative to 3D print face shields for healthcare workers. John shares how he became involved in the project, and what the process entails.
How did you learn about the face shield printing initiative?
I initially read an article about a hospital in Brescia, Italy which was hit hard by the pandemic. They were running out of valves used for their respirators which the manufacturer couldn't provide quickly enough, so a small startup company reversed engineered the valve and began 3D printing them, which the hospital then used. The article quickly became viral just as COVID-19 reached the states.
I began noticing online 3D printing communities around the world organizing similar efforts once Josef Prusa - the founder of Prusa Lab in Prague, Czech Republic - released an open-source face shield design, made available for anyone with a 3D printer to produce. Various iterations were soon released, but the Prusa face shield design proved to be the most effective among health care workers.
Are you partnering with a particular organization or initiative?
I joined the volunteer effort started by Open Works, a makerspace workshop based in Baltimore who were among the first to mobilize volunteer makers with an organized and efficient plan to provide face shields to local healthcare systems and hospitals. A chain of custody is established via email registration, as each 3D print file is assigned a unique parts number which helps keep track of how many face shields were printed by a volunteer.
What part of the shield is 3D-printed? What other materials do you need for assembly, and where can you get them? Is there a standard for what material the face shield should be made of (e.g., thickness)?
The face shield is actually a printable headband, as well as a printable chin strap which serves as a mount for the visor; both are included in the 3D print file. An elastic cord, along with the actual clear acrylic visor, are required to complete assembly, both of which are done at Open Works once they receive completed face shields.
PETG is the type of filament material primarily used to print the face shields, which can be purchased on Amazon for example. It's preferred due to its rigidity and because it can be sterilized more efficiently than other types of printing material such as PLA. There is indeed a printing guideline for makers to follow which sets the parameters to prevent the face shield from breaking.
How long does it take to print the shield frames?
The average print time when following the recommended print settings can take up to 6 hours for a single face shield. There are certainly a variety of ways to print faster by tinkering with hardware, such as changing the nozzle size, but it's not encouraged as strength and quality of the model are prioritized over speed.
Are you using the library’s 3D printer?
I'm grateful for my two 3D printers at home since the library's 3D printer service hasn’t been accessible.
Roughly how many have you assembled so far?
Volunteers had been asked to print at least three face shields each during the early weeks of the pandemic. The incredible response from volunteers reached a saturation point in mid-April as thousands of face shields had been made. Since then my focus has been printing ear straps for face masks.
Once they’re assembled, how do you get them to their destination?
Once a face shield is done printing, I wear nitrile gloves to remove the part from the print bed and follow the sanitation checklist provided by Open Works. A liability waiver is also signed then sent along with the face shields through USPS.
Is there a website (or several websites) you would recommend people visit for more information?
A good starting point for anyone with a 3D printer looking to join local volunteer efforts in their area
COVID-19 Supply Chain Response: Essential Information
https://3dprint.nih.gov/collections/covid-19-response/essential-info
Article re: 3D printed valve parts used in hospitals throughout Italy
https://www.bbc.com/news/technology-51911070
Blog post from Josef Prusa about face shield design
https://blog.prusaprinters.org/from-design-to-mass-3d-printing-of-medical-shields-in-three-days/
Open Works/Makers Unite/We the Builders - the volunteer org I had joined for printing the face shields
https://www.wethebuilders.com/projects/11
The group was mentioned in a recent article from The Economist:
NIH’s 3D Print Exchange now has downloadable designs for PPE and devices, including the Prusa face shield and face mask ear savers:
Prusa Protective Face Shield
https://3dprint.nih.gov/discover/3dpx-013409
Surgical Mask Tension Release Band for Ear Comfort & Extended Use
Graphic Medicine & COVID-19 Comics
As Dr. James Griffiths noted in his recent Grand Rounds presentation, trauma shifts how the brain processes information, and we lose our capacities to reflect and to relate and to maintain our sense of identity. When faced with the fear and uncertainty of a medical illness - or a global pandemic - we lose our ability to concentrate. We cannot sit still to read the books we once loved. We pick up our pens and put them down again. Each time we try to explain what we are going through, it seems like we aren’t being clear enough, like there is no language adequate to encapsulate our experiences. Patients, family members, health care providers, we are, each of us and in our own ways, experiencing these strange times. Providers on the front lines - to whom we extend our sincere gratitude - may not be able to separate themselves from their work. Others of us, working from home for over a month now, may have established a schedule, but we still cannot bring ourselves to concentrate on the novel on our bedside table.
In our virtual meetings and phone calls, there is a tacit understanding that these are not normal times. Where do we start the conversations we need, and do not necessarily want, to have? How can we express ourselves and find the connections necessary to cope?
Graphic medicine comic creators often grapple with these and other questions. How does one illustrate both the events and the emotions of coping with the pain, fear, and hope that accompany medical crises?
The New England Graphic Medicine conference was among the many that moved online this spring. The organizers added a COVID-19 comics panel discussion to the agenda. In this discussion, presenter Alice Jaggers described how the comics appearing - online, on social media channels, and via other platforms - provide a sampling of how graphic medicine is used [see: https://www.graphicmedicine.
I am not surprised that I find myself turning to COVID-19 comics. Comics “provide companionship through shared experience” (Williams, 2012). When we are socially distancing, physically isolated, reading a comic strip that encapsulates the quarantine experience can make us laugh, make us cry, and remind us that we are not alone (Myers & Goldenberg, 2018).
Even when we cannot focus, especially when we cannot or do not want to focus, this rich medium, with all its layers, accomplishes through the synergy of drawing, words, and dialogue, that feat of connecting us. The space between the comic panes allows us to pause and process as we encounter traumatic events and difficult emotions on the page or screen (Williams, 2012).
Graphic medicine has been accepted and embraced by long-standing institutions and publishers. The Annals Graphic Medicine Channel includes comic strips that bring to the surface struggles healthcare professionals face. In comic format, these stories are human, relatable, and non-threatening. Since 2016, JAMA has issued an annual “Best Of” list for graphic medicine. (remember to access JAMA via the Himmelfarb Library’s website; check out their medical humanities section for articles about graphic medicine and more).
A search for “Graphic medicine” in PubMed returns 155 results, with most appearing within the last 5 years. Recognizing the growth in this area, two MeSH terms were added: in 2016, Graphic Novel as a publication type was introduced and, in 2018, “Graphic Novels as Topic” with the entry term “Graphic Medicine as Topic” was added. This is defined as “Works about book-length narratives told using a combination of words and sequential art, often presented in comic book style.” Graphic medicine is a diverse and growing field, with, as described, a broadly inclusive definition. Graphic medicine is at the intersection of the already blurry spheres of health and medicine and comic style. Graphic medicine can come in the form of an Instagram post or a strip on the Annals Graphic Medicine channel or a 200-page graphic novel. The topics range from anxiety to spanish flu (both pertinent to these times). The perspective may be that of the patient or provider or the family members and friends of those affected.
The National Library of Medicine collects graphic medicine materials for several reasons, including to “record progress in [medical] research, especially from the perspective of the patient patient”, contribute to medical education, describe “policies that affect the delivery of health services” in a straightforward manner, and depict “the public’s perception of medical practice” (Tuohy & Eannarino, 2018) As they go on to state, the perspectives and stories found in graphic medicine are unique from those found in technical and research literature.
According to Dr. Griffiths, to be resilient, we must step into adversity. We can use graphic medicine to reflect, cope, and connect and to ultimately help us step into adversity.
References:
Myers, K. R., & Goldenberg, M. D. F. (2018). Graphic Pathographies and the Ethical Practice of Person-Centered Medicine. AMA Journal of Ethics, 20(2), 158–166. https://doi.org/10.1001/
Tuohy, P., & Eannarino, J. (2018). Reading graphic medicine at the National Library of Medicine. Journal of the Medical Library Association: JMLA, 106(3), 387–390. https://doi.org/10.5195/jmla.
Williams, I. C. M. (2012). Graphic medicine: comics as medical narrative. Medical Humanities, 38(1), 21–27. https://doi.org/10.1136/
Image source: https://www.
"All comics in the infocomic series about COVID19 are free to use for educational purposes with credit. If you would like to support me through donations, it would be greatly appreciated."
Maximizing Health IT, Modeling, Tracking, Tracing, and Other Public Health Tools during the COVID-19 Outbreak
The American Medical Informatics Association (AMIA) presents a free webinar today (4/20) at noon ET entitled: Maximizing Health IT, Modeling, Tracking, Tracing, and Other Public Health Tools during the COVID-19 Outbreak.
To register, go to: https://register.gotowebinar.com/register/6742608129043857933
"As part of AMIA's ongoing COVID-19 Webinar Series exploring the role informatics experts are playing in the fight against the global pandemic, this session will discuss the use of informatics by public health agencies to assist in determining where best to allocate resources to maximize health efficiency and efficacy.”
Academic Medicine seeks COVID-19 Related Letters to the Editor from Medical Trainees
The journal Academic Medicine is soliciting original submissions from medical students, residents, and fellows related to COVID-19 for their Letters to the Editor feature. Editors are looking for pieces that emphasize courage and connection in light of the global pandemic. More specifically, editors want to hear how COVID-19 might be contributing to health care and healthcare education in a positive manner.
More information related to the call for papers can be found here in a blog post from Academic Medicine. Letters of 400 words or less should come from students, residents, and fellows and should be submitted here by 5pm EST on Monday, June 1st, 2020.
If you need writing support, the Himmelfarb Library has tools to help. Make a distance appointment with the Writing Center or utilize RefWorks to manage citations.
Nursing skills to Support COVID-19 Care
Do you need nursing training to support COVID-19 care? Are you training new staff to support COVID-19 care? Lippincott’s Nursing Procedures and Skills recently added a section to support to 'Rapid Onboarding'!
This valuable tool was designed to help quickly train new and additional nursing staff who will be able to safely and efficiently care for COVID-19 patients. Made available March 27th, it can be used to better nurses for the front lines. Access Lippincott’s Nursing Procedures and Skills, then locate the box for 'Rapid Onboarding' where you can find diverse topics including patient admission, assessment, and code.
The Chief Nursing officer at Wolters Kluwerr, Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, wrote:
“Today we are in a crisis due to COVID-19. We are seeing a surge of patients that are overwhelming our healthcare system, and in many of the hardest hit areas, hospitals have been granted permission to increase their bed capacity. While that sounds wonderful to the public, it is a nightmare for hospital administrators and those of us on the frontline of care.
We need to ask ourselves the question, who is going to care for those patients?
Our healthcare systems need to find a different way to care for these patients and staff these beds. Many hospitals are looking at alternative staffing models, such as using nurses from different areas and implementing a team-based approach to help ease their staffing challenges. Nurses who are mobilized from different areas will need rapid onboarding and orientation to care for patients especially those with COVID-19.
Wolters Kluwer recognizes the challenges you face and we are here to support you and your team. We know what’s foremost in your mind is making sure your nurses are safe and have the information they need to provide safe and effective care for the patients in your institution.”
Himmelfarb Library proves 24/7 access to Lippincott’s Nursing Procedures and Skills.
