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Spatial Variation of Fine Particulate Matter Levels in Nairobi Before and During the COVID-19 Curfew: Implications for Environmental Justice

The temporary decrease of fine particulate matter (PM(sub 2.5)) concentrations in many parts of the world due to the COVID-19 lockdown spurred discussions on urban air pollution and health. However there has been little focus on sub-Saharan Africa, as few African cities have air quality monitors and if they do, these data are often not publicly available. Spatial differentials of changes in PM(sub 2.5) concentrations as a result of COVID also remain largely unstudied. To address this gap, we use a serendipitous mobile air quality monitoring deployment of eight Sensirion SPS 30 sensors on motorbikes in the city of Nairobi starting on 16 March 2020, before a COVID-19 curfew was imposed on 25 March and continuing until 5 May 2020. We developed a random-forest model to estimate PM(sub 2.5) surfaces for the entire city of Nairobi before and during the COVID-19 curfew. The highest PM(sub 2.5) concentrations during both periods were observed in the poor neighborhoods of Kariobangi, Mathare, Umoja, and Dandora, located to the east of the city center. Changes in PM(sub 2.5) were heterogeneous over space. PM(sub 2.5) concentrations increased during the curfew in rapidly urbanizing, the lower-middle-class neighborhoods of Kahawa, Kasarani, and Ruaraka, likely because residents switched from LPG to biomass fuels due to loss of income. Our results indicate that COVID-19 and policies to address it may have exacerbated existing air pollution inequalities in the city of Nairobi. The quantitative results are preliminary, due to sampling limitations and measurement uncertainties, as the available data came exclusively from low-cost sensors. This research serves to highlight that spatial data that is essential for understanding structural inequalities reflected in uneven air pollution burdens and differential impacts of events like the COVID pandemic. With the help of carefully deployed low cost sensors with improved spatial sampling and at least one reference-quality monitor for calibration, we can collect data that is critical for developing targeted interventions that address environmental injustice in the African context.

Environmental justice↗

COVID-19 Lockdowns Drive Decline in Active Fires in Southeastern United States

Fire is a common ecosystem process in forests and grasslands worldwide. Increasingly, ignitions are controlled by human activities either through suppression of wildfires or intentional ignition of prescribed fires. The Southeastern United States leads the nation in prescribed fire, burning ca. 80% of the countries extent annually. The COVID-19 pandemic radically changed human behavior as workplaces implemented social-distancing guidelines and provided an opportunity to evaluate relationships between humans and fire as fire management plans were postponed or cancelled. Using active fire data from satellite-based observations, we found that in the Southeastern United States, COVID-19 led to a 21% reduction in fire activity compared to the 2003-2019 average. The reduction was more pronounced for federally managed lands, up to 41% below average compared to the past 20-years (38% below average compared to the past decade). Declines in fire activity were partly affected by an unusually wet February before the COVID-19 shutdown began in mid-March 2020. Despite the wet spring, the predicted number of active fire detections was still lower than expected, confirming a COVID-19 signal on ignitions. In addition, prescribed fire management statistics, reported by US federal agencies, confirmed the satellite observations, and showed that following the wet February and before the mid-March COVID-19 shutdown, cumulative burned area was approaching record highs across the region. With fire return intervals in the Southeastern United States as frequent as 1-2 years, COVID-19 fire impacts will contribute to an increasing backlog in necessary fire management activities, affecting biodiversity and future fire danger.

Biological Sciences↗

Hypothesis-Agnostic Network-Based Analysis of Real-World Data Suggests Ondansetron is Associated with Lower COVID-19 Any Cause Mortality

Background: The COVID-19 pandemic generated a massive amount of clinical data, which potentially hold yet undiscovered answers related to COVID-19 morbidity, mortality, long-term effects, and therapeutic solutions.Objectives: The objectives of this study were (1) to identify novel predictors of COVID-19 any cause mortality by employing artificial intelligence analytics on real-world data through a hypothesis-agnostic approach and (2) to determine if these effects are maintained after adjusting for potential confounders and to what degree they are moderated by other variables.Methods: A Bayesian statistics-based artificial intelligence data analytics tool (bAIcis®) within the Interrogative Biology® platform was used for Bayesian network learning and hypothesis generation to analyze 16,277 PCR+ patients from a database of 279,281 inpatients and outpatients tested for SARS-CoV-2 infection by antigen, antibody, or PCR methods during the first pandemic year in Central Florida. This approach generated Bayesian networks that enabled unbiased identification of significant predictors of any cause mortality for specific COVID-19 patient populations. These findings were further analyzed by logistic regression, regression by least absolute shrinkage and selection operator, and bootstrapping.Results: We found that in the COVID-19 PCR+ patient cohort, early use of the antiemetic agent ondansetron was associated with decreased any cause mortality 30 days post-PCR+ testing in mechanically ventilated patients.Conclusions: The results demonstrate how a real-world COVID-19-focused data analysis using artificial intelligence can generate unexpected yet valid insights that could possibly support clinical decision making and minimize the future loss of lives and resources.

60 APPLIED LIFE SCIENCES↗

Association of post-COVID phenotypic manifestations with new-onset psychiatric disease

Acute COVID-19 infection can be followed by diverse clinical manifestations referred to as Post Acute Sequelae of SARS-CoV2 Infection (PASC). Studies have shown an increased risk of being diagnosed with new-onset psychiatric disease following a diagnosis of acute COVID-19. However, it was unclear whether non-psychiatric PASC-associated manifestations (PASC-AMs) are associated with an increased risk of new-onset psychiatric disease following COVID-19. A retrospective electronic health record (EHR) cohort study of 2,391,006 individuals with acute COVID-19 was performed to evaluate whether non-psychiatric PASC-AMs are associated with new-onset psychiatric disease. Data were obtained from the National COVID Cohort Collaborative (N3C), which has EHR data from 76 clinical organizations. EHR codes were mapped to 151 non-psychiatric PASC-AMs recorded 28–120 days following SARS-CoV-2 diagnosis and before diagnosis of new-onset psychiatric disease. Association of newly diagnosed psychiatric disease with age, sex, race, pre-existing comorbidities, and PASC-AMs in seven categories was assessed by logistic regression. There were significant associations between a diagnosis of any psychiatric disease and five categories of PASC-AMs with odds ratios highest for neurological, cardiovascular, and constitutional PASC-AMs with odds ratios of 1.31, 1.29, and 1.23 respectively. Secondary analysis revealed that the proportions of 50 individual clinical features significantly differed between patients diagnosed with different psychiatric diseases. Our study provides evidence for association between non-psychiatric PASC-AMs and the incidence of newly diagnosed psychiatric disease. Significant associations were found for features related to multiple organ systems. This information could prove useful in understanding risk stratification for new-onset psychiatric disease following COVID-19. Prospective studies are needed to corroborate these findings.

60 APPLIED LIFE SCIENCES↗

Informing selection of drugs for COVID-19 treatment through adverse events analysis

Coronavirus disease 2019 (COVID-19) is an ongoing pandemic and there is an urgent need for safe and effective drugs for COVID-19 treatment. Since developing a new drug is time consuming, many approved or investigational drugs have been repurposed for COVID-19 treatment in clinical trials. Therefore, selection of safe drugs for COVID-19 patients is vital for combating this pandemic. Our goal was to evaluate the safety concerns of drugs by analyzing adverse events reported in post-market surveillance. We collected 296 drugs that have been evaluated in clinical trials for COVID-19 and identified 28,597,464 associated adverse events at the system organ classes (SOCs) level in the FDA adverse events report systems (FAERS). We calculated Z-scores of SOCs that statistically quantify the relative frequency of adverse events of drugs in FAERS to quantitatively measure safety concerns for the drugs. Analyzing the Z-scores revealed that these drugs are associated with different significantly frequent adverse events. Our results suggest that this safety concern metric may serve as a tool to inform selection of drugs with favorable safety profiles for COVID-19 patients in clinical practices. Caution is advised when administering drugs with high Z-scores to patients who are vulnerable to associated adverse events.

59 BASIC BIOLOGICAL SCIENCES↗

Developing a SARS-CoV-2 main protease binding prediction random forest model for drug repurposing for COVID-19 treatment

The coronavirus disease 2019 (COVID-19) global pandemic resulted in millions of people becoming infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and close to seven million deaths worldwide. It is essential to further explore and design effective COVID-19 treatment drugs that target the main protease of SARS-CoV-2, a major target for COVID-19 drugs. In this study, machine learning was applied for predicting the SARS-CoV-2 main protease binding of Food and Drug Administration (FDA)-approved drugs to assist in the identification of potential repurposing candidates for COVID-19 treatment. Ligands bound to the SARS-CoV-2 main protease in the Protein Data Bank and compounds experimentally tested in SARS-CoV-2 main protease binding assays in the literature were curated. These chemicals were divided into training (516 chemicals) and testing (360 chemicals) data sets. To identify SARS-CoV-2 main protease binders as potential candidates for repurposing to treat COVID-19, 1188 FDA-approved drugs from the Liver Toxicity Knowledge Base were obtained. A random forest algorithm was used for constructing predictive models based on molecular descriptors calculated using Mold2 software. Model performance was evaluated using 100 iterations of fivefold cross-validations which resulted in 78.8% balanced accuracy. The random forest model that was constructed from the whole training dataset was used to predict SARS-CoV-2 main protease binding on the testing set and the FDA-approved drugs. Model applicability domain and prediction confidence on drugs predicted as the main protease binders discovered 10 FDA-approved drugs as potential candidates for repurposing to treat COVID-19. Our results demonstrate that machine learning is an efficient method for drug repurposing and, thus, may accelerate drug development targeting SARS-CoV-2.

Research & Experimental Medicine↗

Circulating SARS-CoV-2 + megakaryocytes are associated with severe viral infection in COVID-19

Several independent lines of evidence suggest that megakaryocytes are dysfunctional in severe COVID-19. Herein, we characterized peripheral circulating megakaryocytes in a large cohort of inpatients with COVID-19 and correlated the subpopulation frequencies with clinical outcomes. Using peripheral blood, we show that megakaryocytes are increased in the systemic circulation in COVID-19, and we identify and validate S100A8/A9 as a defining marker of megakaryocyte dysfunction. We further reveal a subpopulation of S100A8/A9 + megakaryocytes that contain severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) protein and RNA. Using flow cytometry of peripheral blood and in vitro studies on SARS-CoV-2–infected primary human megakaryocytes, we demonstrate that megakaryocytes can transfer viral antigens to emerging platelets. Mechanistically, we show that SARS-CoV-2–containing megakaryocytes are nuclear factor κB (NF-κB)-activated, via p65 and p52; express the NF-κB–mediated cytokines interleukin-6 (IL-6) and IL-1β; and display high surface expression of Toll-like receptor 2 (TLR2) and TLR4, canonical drivers of NF-κB. In a cohort of 218 inpatients with COVID-19, we correlate frequencies of megakaryocyte subpopulations with clinical outcomes and show that SARS-CoV-2–containing megakaryocytes are a strong risk factor for mortality and multiorgan injury, including respiratory failure, mechanical ventilation, acute kidney injury, thrombotic events, and intensive care unit admission. Furthermore, we show that SARS-CoV-2 + megakaryocytes are present in lung and brain autopsy tissues from deceased donors who had COVID-19. To our knowledge, this study offers the first evidence implicating SARS-CoV-2 + peripheral megakaryocytes in severe disease and suggests that circulating megakaryocytes warrant investigation in inflammatory disorders beyond COVID-19.

60 APPLIED LIFE SCIENCES↗

COVID-19: Spatiotemporal social data analytics and machine learning for pandemic exploration and forecasting

This task focused on developing a preliminary approach to use machine learning (ML) to explore the relationship between county-level societal variables and COVID-19 parameters, including COVID-19 cases rates and counts and COVID-19 death rates and counts. The objective was to develop and test a prototype approach for linking COVID-19 and county-level data. The task focused on enhancing and applying existing LANL ML techniques to COVID-19. Our novel ML methods have been a subject of a recently approved U.S. patent. The codes based on these methods are already open-source released. Our ML tools (NMFk/NTFk) are applied to extract hidden features (signals, waves) in the analyzed datasets and automatically identify their optimal number. The features are extracted by identifying counties that have similarities between the county-level societal variables and the COVID-19 parameters. These demonstration analyses will facilitate the ongoing pandemic simulations and predictions performed by Los Alamos other institutions, as well as lay the groundwork for future work.

60 APPLIED LIFE SCIENCES↗

COVID ‐19 outcomes in patients with cancer: Findings from the University of California health system database

Abstract Background The interaction between cancer diagnoses and COVID‐19 infection and outcomes is unclear. We leveraged a state‐wide, multi‐institutional database to assess cancer‐related risk factors for poor COVID‐19 outcomes. Methods We conducted a retrospective cohort study using the University of California Health COVID Research Dataset, which includes electronic health data of patients tested for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) at 17 California medical centers. We identified adults tested for SARS‐CoV‐2 from 2/1/2020–12/31/2020 and selected a cohort of patients with cancer. We obtained demographic, clinical, cancer type, and antineoplastic therapy data. The primary outcome was hospitalization within 30d after the first positive SARS‐CoV‐2 test. Secondary outcomes were SARS‐CoV‐2 positivity and severe COVID‐19 (intensive care, mechanical ventilation, or death within 30d after the first positive test). We used multivariable logistic regression to identify cancer‐related factors associated with outcomes. Results We identified 409,462 patients undergoing SARS‐CoV‐2 testing. Of 49,918 patients with cancer, 1781 (3.6%) tested positive. Patients with cancer were less likely to test positive (RR 0.70, 95% CI: 0.67–0.74, p < 0.001). Among the 1781 SARS‐CoV‐2‐positive patients with cancer, BCR/ABL‐negative myeloproliferative neoplasms (RR 2.15, 95% CI: 1.25–3.41, p = 0.007), venetoclax (RR 2.96, 95% CI: 1.14–5.66, p = 0.028), and methotrexate (RR 2.72, 95% CI: 1.10–5.19, p = 0.032) were associated with greater hospitalization risk. Cancer and therapy types were not associated with severe COVID‐19. Conclusions In this large, diverse cohort, cancer was associated with a decreased risk of SARS‐CoV‐2 positivity. Patients with BCR/ABL‐negative myeloproliferative neoplasm or receiving methotrexate or venetoclax may be at increased risk of hospitalization following SARS‐CoV‐2 infection. Mechanistic and comparative studies are needed to validate findings.

60 APPLIED LIFE SCIENCES↗

Associations between SARS-CoV-2 Infection or COVID-19 Vaccination and Human Milk Composition: A Multi-Omics Approach

Background: The risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via human milk-feeding is virtually nonexistent. Adverse effects of coronavirus disease 2019 (COVID-19) vaccination for lactating individuals are not different from the general population, and no evidence has been found that their infants exhibit adverse effects. Yet, there remains substantial hesitation among this population globally regarding the safety of these vaccines. Objectives: Herein, we aimed to determine if compositional changes in milk occur following SARS-CoV-2 infection or COVID-19 vaccination, including any evidence of vaccine components. Methods: An extensive multiomics approach was taken using a subset of milk samples obtained as part of our broad studies examining the effects on milk of SARS-CoV-2 infection and COVID-19 vaccination. Results: We found that compared with unvaccinated individuals, SARS-CoV-2 infection was associated with significant compositional differences in 67 proteins, 385 lipids, and 13 metabolites. In contrast, COVID-19 vaccination was not associated with any changes in lipids or metabolites, although it was associated with changes in 13 or fewer proteins. Compositional changes in milk differed by vaccine. Changes following vaccination were greatest after 1–6 h for the mRNA-based Moderna vaccine (8 changed proteins), 3 d for the mRNA-based Pfizer (4 changed proteins), and adenovirus-based Johnson and Johnson (13 changed proteins) vaccines. Proteins that changed after both natural infection and Johnson and Johnson vaccine were associated mainly with systemic inflammatory responses. In addition, no vaccine components were detected in any milk sample. Conclusions: Together, our data provide evidence of only minimal changes in milk composition because of COVID-19 vaccination, with much greater changes after natural SARS-CoV-2 infection.

60 APPLIED LIFE SCIENCES↗

Air, surface, and wastewater surveillance of SARS-CoV-2; a multimodal evaluation of COVID-19 detection in a built environment

Environmental surveillance of infectious organisms holds tremendous promise to reduce human-to-human transmission in indoor spaces through early detection. In this study we determined the applicability and limitations of wastewater, indoor high-touch surfaces, in-room air, and rooftop exhaust air sampling methods for detecting SARS-CoV-2 in a real world building occupied by residents recently diagnosed with COVID-19. We concurrently examined the results of three 24-hour environmental surveillance techniques, indoor surface sampling, exhaust air sampling and wastewater surveillance, to the known daily census fluctuations in a COVID-19 isolation dormitory. Additionally, we assessed the ability of aerosol samplers placed in the large volume lobby to detect SARS-CoV-2 multiple times per day. Our research reveals an increase in the number of individuals confirmed positive with COVID-19 as well as their estimated human viral load to be associated with statistically significant increases in viral loads detected in rooftop exhaust aerosol samples (p = 0.0413), wastewater samples (p = 0.0323,), and indoor high-touch surfaces (p < 0.001)). We also report that the viral load detected in lobby aerosol samples was statistically higher in samples collected during presence of occupants whose COVID-19 diagnostic tests were confirmed positive via qPCR compared to periods when the lobby was occupied by either contact-traced (suspected positive) individuals or during unoccupied periods (p = 0.0314 and <2e–16). We conclude that each daily (24h) surveillance method, rooftop exhaust air, indoor high-touch surfaces, and wastewater, provide useful detection signals for building owner/operator(s). Furthermore, we demonstrate that exhaust air sampling can provide spatially resolved signals based upon ventilation exhaust zones. Additionally, we find that indoor lobby air sampling can provide temporally resolved signals useful during short duration sampling periods (e.g., 2-4 hours) even with intermittent occupancy by occupants diagnosed with COVID-19.

60 APPLIED LIFE SCIENCES↗

Excess deaths reveal the true spatial, temporal and demographic impact of COVID-19 on mortality in Ecuador

Accepted Background In early 2020, Ecuador reported one of the highest surges of per capita deaths across the globe. Methods We collected a comprehensive dataset containing individual death records between 2015 and 2020, from the Ecuadorian National Institute of Statistics and Census and the Ecuadorian Ministry of Government. We computed the number of excess deaths across time, geographical locations and demographic groups using Poisson regression methods. Results Between 1 January and 23 September 2020, the number of excess deaths in Ecuador was 36 402 [95% confidence interval (CI): 35 762–36 827] or 208 per 100 000 people, which is 171% of the expected deaths in that period in a typical year. Only 20% of the excess deaths are attributable to confirmed COVID-19 deaths. Strikingly, in provinces that were most affected by COVID-19 such as Guayas and Santa Elena, the all-cause deaths are more than double the expected number of deaths that would have occurred in a normal year. The extent of excess deaths in men is higher than in women, and the number of excess deaths increases with age. Indigenous populations had the highest level of excess deaths among all ethnic groups. Conclusions Overall, the exceptionally high level of excess deaths in Ecuador highlights the enormous burden and heterogeneous impact of COVID-19 on mortality, especially in older age groups and Indigenous populations in Ecuador, which was not fully revealed by COVID-19 death counts. Together with the limited testing in Ecuador, our results suggest that the majority of the excess deaths were likely to be undocumented COVID-19 deaths.

60 APPLIED LIFE SCIENCES↗

COVID-19-associated school closures and related efforts to sustain education and subsidized meal programs, United States, February 18-June 30, 2020

Pre-emptive school closures are frontline community mitigation measures recommended by the US Centers for Disease Control and Prevention (CDC) for implementation during severe pandemics. This study describes the spatiotemporal patterns of publicly announced school closures implemented in response to the coronavirus disease 2019 (COVID-19) pandemic and assesses how public K-12 districts adjusted their methods of education delivery and provision of subsidized meals. During February 18–June 30, 2020, we used daily systematic media searches to identify publicly announced COVID-19–related school closures lasting ≥1 day in the United States (US). We also collected statewide school closure policies from state government websites. Data on distance learning and subsidized meal programs were collected from a stratified sample of 600 school districts. The first COVID-19–associated school closure occurred on February 27, 2020 in Washington state. By March 30, 2020, all but one US public school districts were closed, representing the first-ever nearly synchronous nationwide closure of public K-12 schools in the US. Approximately 100,000 public schools were closed for ≥8 weeks because of COVID-19, affecting >50 million K-12 students. Of 600 districts sampled, the vast majority offered distance learning (91.0%) and continued provision of subsidized meal programs (78.8%) during the closures. Despite the sudden and prolonged nature of COVID-19–associated school closures, schools demonstrated flexibility by implementing distance learning and alternate methods to continue subsidized meal programs.

60 APPLIED LIFE SCIENCES↗

Understanding the Drivers of Mobility during the COVID-19 Pandemic in Florida, USA Using a Machine Learning Approach

As of March 2021, the State of Florida, U.S.A. had accounted for approximately 6.67% of total COVID-19 (SARS-CoV-2 coronavirus disease) cases in the U.S. The main objective of this research is to analyze mobility patterns during a three month period in summer 2020, when COVID-19 case numbers were very high for three Florida counties, Miami-Dade, Broward, and Palm Beach counties. To investigate patterns, as well as drivers, related to changes in mobility across the tri-county region, a random forest regression model was built using sociodemographic, travel, and built environment factors, as well as COVID-19 positive case data. Mobility patterns declined in each county when new COVID-19 infections began to rise, beginning in mid-June 2020. While the mean number of bar and restaurant visits was lower overall due to closures, analysis showed that these visits remained a top factor that impacted mobility for all three counties, even with a rise in cases. Our modeling results suggest that there were mobility pattern differences between counties with respect to factors relating, for example, to race and ethnicity (different population groups factored differently in each county), as well as social distancing or travel-related factors (e.g., staying at home behaviors) over the two time periods prior to and after the spike of COVID-19 cases.

60 APPLIED LIFE SCIENCES↗

Impact of COVID-19 Restrictions on Atmospheric Concentrations of O3 and NO2 Across the Globe

We use a machine learning algorithm combining information from the NASA GEOS composition forecast (GEOS-CF) model and surface observations of nitrogen dioxide (NO2) and ozone (O3) at more than 5,000 observation sites to assess the impact of COVID-19 restrictions on surface air quality in 46 countries. Our methodology removes the compounding impacts of meteorology, seasonality and atmospheric chemistry on air pollution, thus allowing for a quantitative estimate of the change in surface air quality following COVID-19 containment measures. Compared to GEOS-CF model predictions that do not include emission reductions related to COVID-19 restrictions, surface observations show a drop in surface NO2 of up to 60% after the implementation of lockdowns. Average NO2 concentrations between February 2020 to June 2020 were 18% lower than business as usual. The earliest and strongest declines are observed over China, followed by Europe and the US. While NO2 concentrations over China recovered within 2 months, the recovery has been slower over Europe and the US. The impact of COVID-19 restrictions on O3 is complicated by non-linear atmospheric chemistry. Locally, O3 can show a short-term increase of up to 50% as a result of the decrease in NO2, which leads to a reduction in night time titration. However, this effect is offset by a decrease in photochemical production during the day. Our results indicate that these two competing processes resulted in a net zero change in average surface ozone during the first 5 months of the pandemic. The results also indicate that the reduced photochemical production becomes increasingly important over time. Our analysis is based on surface observations and model simulations available in near real-time, and we will present an up-to-date view of the short and medium-term impacts of COVID-19 restrictions on air quality around the world.

COVID-19↗

Quantitative methods and modeling to assess COVID–19–interrupted in vivo pharmacokinetic bioequivalence studies with two reference batches

The coronavirus disease 2019 (COVID-19) has presented unprecedented challenges to the generic drug development, including interruptions in bioequivalence (BE) studies. Per guidance published by the US Food and Drug Administration (FDA) during the COVID-19 public health emergency, any protocol changes or alternative statistical analysis plan for COVID-19-interrupted BE study should be accompanied with adequate justifications and not lead to biased equivalence determination. In this study, we used a modeling and simulation approach to assess the potential impact of study outcomes when two different batches of a Reference Standard (RS) were to be used in an in vivo pharmacokinetic BE study due to the RS expiration during the COVID-19 pandemic. Simulations were performed with hypothetical drugs under two scenarios: (1) uninterrupted study using a single batch of an RS, and (2) interrupted study using two batches of an RS. The acceptability of BE outcomes was evaluated by comparing the results obtained from interrupted studies with those from uninterrupted studies. The simulation results demonstrated that using a conventional statistical approach to evaluate BE for COVID-19-interrupted studies may be acceptable based on the pooled data from two batches. An alternative statistical method which includes a “batch” effect to the mixed effects model may be used when a significant “batch” effect was found in interrupted four-way crossover studies. However, such alternative method is not applicable for interrupted two-way crossover studies. Overall, the simulated scenarios are only for demonstration purpose, the acceptability of BE outcomes for the COVID19-interrupted studies could be case-specific.

60 APPLIED LIFE SCIENCES↗

Evidence that Maackia amurensis seed lectin (MASL) exerts pleiotropic actions on oral squamous cells with potential to inhibit SARS-CoV-2 infection and COVID-19 disease progression

COVID-19 was declared an international public health emergency in January, and a pandemic in March of 2020. There are over 125 million confirmed COVID-19 cases that have caused over 2.7 million deaths worldwide as of March 2021. COVID-19 is caused by the SARS-CoV-2 virus. SARS-CoV-2 presents a surface “spike” protein that binds to the ACE2 receptor to infect host cells. In addition to the respiratory tract, SARS-Cov-2 can also infect cells of the oral mucosa, which also express the ACE2 receptor. The spike and ACE2 proteins are highly glycosylated with sialic acid modifications that direct viral-host interactions and infection. Maackia amurensis seed lectin (MASL) has a strong affinity for sialic acid modified proteins and can be used as an antiviral agent. Here, we report that MASL targets the ACE2 receptor, decreases ACE2 expression and glycosylation, suppresses binding of the SARS-CoV-2 spike protein, and decreases expression of inflammatory mediators by oral epithelial cells that cause ARDS in COVID-19 patients. In addition, we report that MASL also inhibits SARS-CoV-2 infection of kidney epithelial cells in culture. This work identifies MASL as an agent with potential to inhibit SARS-CoV-2 infection and COVID-19 related inflammatory syndromes.

60 APPLIED LIFE SCIENCES↗

Design of COVID-19 staged alert systems to ensure healthcare capacity with minimal closures

Community mitigation strategies to combat COVID-19, ranging from healthy hygiene to shelter-in-place orders, exact substantial socioeconomic costs. Judicious implementation and relaxation of restrictions amplify their public health benefits while reducing costs. We derive optimal strategies for toggling between mitigation stages using daily COVID-19 hospital admissions. With public compliance, the policy triggers ensure adequate intensive care unit capacity with high probability while minimizing the duration of strict mitigation measures. In comparison, we show that other sensible COVID-19 staging policies, including France’s ICU-based thresholds and a widely adopted indicator for reopening schools and businesses, require overly restrictive measures or trigger strict stages too late to avert catastrophic surges. As proof-of-concept, we describe the optimization and maintenance of the staged alert system that has guided COVID-19 policy in a large US city (Austin, Texas) since May 2020. As cities worldwide face future pandemic waves, our findings provide a robust strategy for tracking COVID-19 hospital admissions as an early indicator of hospital surges and enacting staged measures to ensure integrity of the health system, safety of the health workforce, and public confidence.

60 APPLIED LIFE SCIENCES↗