It has been a productive year for Institute faculty, nearly 300 publications, many of those as first- or senior-author. Our clinician-researchers on the front lines of the COVID-19 pandemic kept pace, producing high-impact work on the evolving novel coronavirus and its effect on hospitals and healthcare workers. All investigators faced year two of the pandemic head-on.

Here, we recognize ten publications that received the most attention on social media, in the press, and in page views and downloads. Measured by Altmetric, we present to you a 2021 year in review: our most engaging research.

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Current Insights Into Respiratory Virus Transmission and Potential Implications for Infection Control Programs: A Narrative Review
From the front lines of the COVID-19 pandemic, Meghan Baker, Chanu Rhee, and Michael Klompas and collaborators have gleaned one of the few silver linings: an increased understanding of respiratory viral transmission. They further discuss the droplet versus aerosol debate with a new narrative review published in Annals of Internal Medicine, suggesting that current models of hospital-based respiratory virus transmission are outdated, rendering current infection control policies and protocols ineffective. The team suggests that transmission risk exists along a continuum; this new understanding of disease transmission and infection control allows for hospitals to implement a graded, risk-based approach to respiratory protection. To date, the publication has been mentioned in 42 news stories, including by outlets UPI, US News & World Report, and Medscape. On social media, it was mentioned in 3,032 tweets, reaching up to 7.5 million users.

Institute Investigator(s): Meghan Baker, Chanu Rhee, Michael Klompas

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A SARS-CoV-2 Cluster in an Acute Care Hospital
A descriptive study published in Annals of Internal Medicine by Michael Klompas, Meghan Baker, Chanu Rhee and colleagues described the detection, mitigation, and analysis of a large cluster of SARS-CoV-2 infections at Brigham and Women’s Hospital. The team examined the response to a large cluster of SARS-COV-2 infections among staff and patients that emerged despite a mature infection control program. They found that the introduction, spread, and containment of the cluster provided several insights into disease transmission and potential strategies to augment infection control programs should another similar cluster occur. The study has been referenced in 71 news stories from 61 media outlets, including Kaiser Health News (x2), Medscape, The Guardian, Scientific American, CNN, and Becker’s Hospital Review. To date, 783 Twitter users have sent 957 tweets about the study, reaching approximately 3.4 million users.

Institute Investigator(s): Meghan Baker, Chanu Rhee, Michael Klompas, Rui Wang
 

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The Risk of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Transmission from Patients With Undiagnosed Coronavirus Disease 2019 (COVID-19) to Roommates in a Large Academic Medical Center
Michael Klompas, Meghan Baker, Chanu Rhee, and colleagues examined an ongoing vulnerability for in-hospital SARS-CoV-2 transmission: shared hospital rooms. The report, published in Clinical Infectious Diseases, assessed transmission rates of patients admitted between September 2020-April 2021. Twenty-five tested positive, exposing 31 roommates, 12 of whom tested positive within 14 days. The paper recommends potential mitigation strategies, and also received much attention on Twitter, reaching nearly 7.8 million users. In the media, the paper was discussed in 35 news stories, including by Medpage Today, Healio, and Kaiser Health News.

Institute Investigators: Michael Klompas, Meghan Baker, Chanu Rhee

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Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From Asymptomatic and Presymptomatic Individuals in Healthcare Settings Despite Medical Masks and Eye Protection
In a new study in Clinical Infectious Diseases, a study team led by Michael Klompas and including Meghan Baker and Chanu Rhee describe 3 instances of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission despite medical masks and eye protection, including transmission despite the source person being masked, transmission despite the exposed person being masked, and transmission despite both parties being masked. Whole genome sequencing confirmed perfect homology between source and exposed persons' viruses in all cases. HealthLeaders, MedScape, and Modern Healthcare were among the 40 news outlets covering the findings, while up to 4.7 million users read about them on Twitter.

Institute Investigators: Michael Klompas, Meghan Baker, Chanu Rhee

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Understanding Breakthrough Infections Following mRNA SARS-CoV-2 Vaccination
In a new JAMA editorial, Michael Klompas discusses breakthrough infections in individuals fully vaccinated against COVID-19. As the pandemic has endured, the data and understanding of coronavirus has evolved greatly, including that surrounding breakthrough infections. Though breakthrough infections exist, new evidence shows that fully vaccinated individuals are less prone to carry COVID-19, shed less virus when they are infected (despite having viral loads as high as unvaccinated individuals), and that disease severity among those vaccinated individuals who do become infected is less severe. The publication was tweeted 937 times, reaching up to 2.2 million users. Media outlets including Vox, Forbes, and Cancer Therapy Advisor covered the story.

Institute Investigator(s): Michael Klompas
 

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Universal Use of N95 Respirators in Healthcare Settings When Community Coronavirus Disease 2019 Rates Are High
Institute investigators Michael Klompas, Chanu Rhee, and Meghan Baker have spent the pandemic both on the front lines and conducting research on the transmission and prevention of COVID-19 in health care settings. In a new commentary in Clinical Infectious Diseases, they suggest that new CDC guidance – that all providers seeing patients with possible or confirmed COVID-19 wear N95 respirators – be adjusted to consider communities where incidence of the disease is elevated. They reason that because SARS-COV-2 is most contagious before the onset of symptoms, universal use of N95s when community incidence rates are high may help decrease nosocomial transmission. Read more in McKnight’s Long-term Care News and CIDRAP. The publication reached up to 2.6 million Twitter users.

Institute Investigators: Michael Klompas, Chanu Rhee, Meghan Baker
 

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Impact of COVID-19 Pandemic on Breast Cancer Mortality in the US: Estimates From Collaborative Simulation Modeling
Pandemic-associated disruptions in cancer screenings may have long-lasting impacts without intervention. Using established Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer models, a new study in Journal of the National Cancer Institute senior-authored by Natasha Stout projected the impact of COVID-19 on future breast cancer mortality between 2020 and 2030. The team found that early pandemic-related disruptions in breast cancer care (mammography, symptomatic cancer diagnosis, reduced chemotherapy for early-stage disease) will have a small long-term cumulative impact on breast cancer mortality. Though small, efforts to minimize further delays can help reduce the impact. The study received media coverage by Healio, The Kansas City Star, MedPage Today, Physician’s Weekly, and WHECTV and reached approximately 280,000 Twitter users.

Institute Investigator(s): Natasha Stout

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The Case for Mandating COVID-19 Vaccines for Health Care Workers
Michael Klompas has spent much of his time during the pandemic on the front lines treating patients but also evaluating how to best keep healthcare workers safe as the body of knowledge of COVID evolved. In a new Ideas and Opinions piece in Annals of Internal Medicine, he and colleagues support the notion of making SARS-COV-2 vaccines mandatory for healthcare workers, comparing against the mandating of influenza vaccines 15 years ago. Though a hotly debated topic, the team discusses eight reasons in favor of a mandate, arguing their belief that the case is significantly stronger than was the case for mandating influenza vaccines. Reasons include the mortality rate and post-COVID-19 symptoms, threat to essential workers’ lives, common transmission by asymptomatic and presymptomatic individuals, the need to protect patients, the safety and efficacy of the vaccines, and COVID’s disruption of the hospital operations community and workforce overall. Media outlets covering the study included McKnight’s, McKnight’s Senior Living, and the Toronto Star (as well as an editorial). On Twitter, the story reached approximately 3.3 million users via 589 tweets. In addition to the study, the authors participated in the Annals podcast, Annals on Call to discuss the article.

Institute Investigators: Michael Klompas
 

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Long-term Risk of Parkinson Disease Following Influenza and Other Infections
A case-controlled study led by Noelle Cocoros, published in JAMA Neurology, takes a closer look at whether prior influenza and other infections are associated with a long-term risk of developing Parkinson disease (PD). The team looked at all Danish citizens with Parkinson disease between 2000 and 2016 and found that the odds of Parkinson disease increased by more than 70% for PD occurring more than 10 years post-influenza infection. The odds were approximately 90% for PD occurring 15 years after influenza. The study received attention from outlets including The New York Times (twice), The Scientist, Healio, and ABC Radio National’s Health Report. Via Twitter, the study reached up to 897,000 followers.

Institute Investigator(s): Noelle Cocoros

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Real-world Use of and Spending on New Oral Targeted Cancer Drugs in the US, 2011-2018
Despite growing concerns about the evidence supporting new cancer drug approvals, launch prices in the U.S. have substantially increased in recent years. A new study led by former research fellow Cathy Fu with Darren Toh, Dennis Ross-Degnan, and senior author Anita Wagner focuses on the use of and spending on oral targeted cancer drugs among U.S. residents with employer-sponsored health insurance between 2011 and 2018. The team used deidentified claims data from insurers to examine the uptake and cost implications of 44 new oral targeted cancer drugs among a sample of 37,348 U.S. residents with private, employer-sponsored insurance. Results, published in JAMA Internal Medicine, showed that although most individuals received drugs for which evidence from randomized clinical trials existed, a growing share of patients received drugs without documented overall survival benefit. The proportion of patients receiving drugs without documented overall survival benefit increased from 13% in 2011 to 59% in 2018, accounting for 52% of the $3.5 billion estimated cumulative spending on 44 new oral targeted cancer drugs by the end of 2018. Nine news outlets, including UPI and MedPage Today, covered the findings, while they reached up to 375,000 Twitter users.

Institute Investigator(s): Dennis Ross-Degnan, Darren Toh, Anita Wagner