Zoonotic diseases in animal agriculture and beyond: a one health perspective

This publication focuses on a group of vignettes to help understand zoonotic diseases, the anthropogenic factors accelerating their emergence, and the consequences of these events. While human activities and behavior are mostly responsible for creating this new era, the world struggles to prepare, change behavior, and rethink strategies to effectively address the inevitability of more frequent occurrences and severity of disease outbreaks and pandemics. Although we know and have experienced the cost of failure, past disease outbreaks seem to be quickly lost from our collective memories and new innovative interventions have not been imagined or adopted. This publication highlights examples that challenge our traditional actions and thinking and emphasize the need to adopt new approaches to prevent or ameliorate zoonotic diseases. The consensus of the experts contributing to this publication is that One Health should be embraced to achieve these results. The growing costs and societal disruptions of outbreaks and pandemics demand that zoonoses be part of our national security planning and deserve commensurate investments in preparedness, prevention, research, and resilience. This publication also highlights the necessity to fundamentally rethink and reestablish new relationships among institutions, organizations, and countries and especially between humanity and our natural systems worldwide.

Effect of Baseline Albumin on Diuretic Response in Patients with Ards Receiving Adjunctive Albumin

INTRODUCTION: Fluid stewardship is a pillar in the management of ARDS. Previous studies evaluating conservative fluid management had difficulty achieving daily fluid targets and evaluations of adjunctive albumin have found conflicting results. METHOD(S): This was a retrospective study conducted at a large community hospital. Patients were included if >17 years old, admitted to an ICU from January 2016 to September 2021, had a diagnosis of ARDS, and received loop diuretic and albumin within one hour of each other. Exclusion criteria included liver failure, ESRD, and positive test for SARSCOV- 2. Patients were divided into two groups by baseline serum albumin, where low albumin was defined as <= 3.5g/ dL. The primary outcome was the percentage of patients with a positive response to combination therapy, defined as UOP >= 600mL within 6 hours of administration. Secondary outcomes included UOP at 6 hours, and change in PF ratio and serum albumin at 24 hours. Nominal data are presented as percentage, whereas continuous variables are presented as median and were analyzed using Chi-square and Mann Whitney U tests, respectively. Alpha of < 0.05 was deemed statistically significant. RESULT(S): 108 patients were in the low-albumin (LA) group and 67 in the normal-albumin (NA) group. The NA group were statistically heavier (99 vs. 88kg), had higher total protein (7.2 vs. 5.1 g/dL), had diagnosis of sepsis (59 vs. 6%) and had less prior diuretic use (48 vs. 74%). Key baseline similarities included PF ratio (158 vs. 160, p=0.7), creatinine (1.22 vs. 1.20 mg/dL), and presence of shock (27 vs. 33%). Statistically, more patients in the NA group received 5% albumin, (63 vs. 34%), received less albumin (12.5 vs. 25 grams), and similar loop diuretic dose expressed as furosemide equivalents (40 vs. 40 mg). 43 (64%) were positive responders in the NA group compared to 61 (57%) in the LA group (p=0.48). UOP at 6 hours (670 vs. 653mL) and change in PF ratio at 24 hours (+23 vs. +13) were statistically similar. The change in albumin was different between the Normal and Low groups (-0.6 vs. +0.2 g/dL, p< 0.05). CONCLUSION(S): Low albumin did not affect the urinary response in patients with ARDS receiving albumin and loop diuretics. These findings are limited by heterogeneity in baseline characteristics and components of the intervention.

Impact of Covid-19 Wave 3 Paediatric Inpatient Unit Closures on Transfers to Tertiary Care Paediatric Hospital

BACKGROUND: During Wave 3 of the COVID-19 pandemic, 15 community hospital paediatric inpatient units (comprising 167 beds) in Toronto were directed to close by the Greater Toronto Area (GTA) Hospital Incident Management System (IMS) Command Centre to increase adult inpatient bed capacity. All paediatric patients from closed inpatient units were redirected to a single tertiary care paediatric hospital, which increased capacity to accommodate these additional patients through activation of surge plans, while community hospitals redeployed resources to fill much needed gaps in adult care. OBJECTIVE(S): The objective was to describe patient characteristics of all transfers during the closure to explore the impact of community paediatric inpatient unit closures on transfers to the tertiary hospital. DESIGN/METHODS: A chart review of all transferred patients was conducted during the mandated closure and subsequent reopening. Transfers excluded ICU-level transfers as these were not impacted by IMS mandated closures. All transfers were categorized as requiring tertiary care (i.e. would typically be transferred) or not requiring tertiary care (i.e. only transferred due to the closure). Variables collected included sending hospital, admitting diagnosis, patient age, hospital disposition, and length of stay. Data was collected until the last paediatric unit reopened. Quality improvement project approval was granted by the institution. RESULT(S): A total of 858 patients were transferred to the tertiary hospital during the 67 day closure;of those, 530 were transferred solely to increase adult bed capacity (i.e. were categorized as patients requiring non-tertiary care). The majority of patients were admitted to general paediatrics (52%), and 39% went to a surgical inpatient unit. Most patients (68%) admitted had a length of stay between 24 and 72 hours. A third of patients admitted were under 2 years old, and a third were over 12 years old. The top three diagnoses for admission were infections, gastrointestinal issues, and general surgery. Two-thirds (60%) of transfers from closed sites came from three sites. CONCLUSION(S): More than half of the transfers occurred solely due to the mandated closures, and transfers returned to a stable volume once all sites re-opened. The GTA hospital system was able to respond to the mandated closure effectively through clear high-level communication, escalation processes and structures as well as responsive, real-time problem solving. Closures increased potential adult inpatient capacity by 6740 bed days and demonstrated an unprecedented system-wide approach to the provision of integrated paediatric care across the region.

Investigating sialic acid usage in species D human adenoviruses

Human adenoviruses are phylogenetically divided across seven species, A-G, causing transient mild illnesses, except in immunocompromised individuals. Their double stranded DNA genome is amenable to genetic manipulations, enabling development of highly engineered virotherapies. Species D adenoviruses have naturally low seroprevalence rates, an important trait in avoiding neutralising anti-vector immunity. We previously demonstrated that HAdV-D26, the platform of the Janssen SARS-CoV2 vaccine, uses sialic acid as a primary cell entry receptor. Here, we structurally and biologically investigated sialic acid usage across species D. We solved multiple structures of species D adenovirus fiber knob proteins alone and in complex with sialic acid, identifying a conserved binding pocket common with known sialic acid binders HAdV-D26 and 37. Using fiber-knob pseudotyped viruses, we demonstrate significantly reduced transduction in cells treated with neuraminidase to remove sialic acid residues in HAdV-D26 and 53, with HAdV-D15, 24 and 29 also demonstrating non-significant reductions. IC50 data also showed highlighted binding to CAR, although at a significantly lower affinity compared to the CAR-binding HAdV-C5. Improved understanding of the usage of sialic acid as a receptor will enable better exploitation of the species D adenoviruses as therapeutic vectors. Our findings raise the possibility of a conserved sialic acid binding pocket within species D adenoviruses resulting in varying affinity levels. Further evaluation of specific glycan binding patterns used by these viruses, as observed between HAdV-D37 and GD1a glycan, will better inform the design of appropriate antivirals to contain adenovirus outbreaks as well as the engineering of targeted vectors for translational applications.

Virus-cell interactions of the ChAdOx1 viral vector give insights into vaccine-induced immune thrombotic thrombocytopenia

The ChAdOx1 nCoV-19 vaccine (AZD1222/Vaxzervia) adapted from the chimpanzee adenovirus Y25 (ChAd-Y25) has been critical in combatting the severe acute respiratory coronavirus 2 (SARS-CoV-2) pandemic. However, as part of the largest vaccination campaign in history, a potentially lifethreatening clotting disorder, thrombosis with thrombocytopenia, resembling heparin-induced thrombocytopenia (HIT), has been observed in a minority of AZD1222 patients following the first but not the second dose. Vaccine-induced immune thrombotic thrombocytopenia (VITT) is characterised by development of thromboses at uncommon sites such as the cerebral venous sinuses and the splanchnic veins, with concomitant thrombocytopaenia. Therefore, to determine how ChAdOx1 may contribute to this novel disorder, it is critical to investigate the vector-host interactions of ChAdOx1. Structural and in vitro analysis of the fiber knob responsible for the primary virus-cell interaction suggests that coxsackie and adenovirus receptor (CAR) is the primary ChAdOx1 receptor. However, ChAdOx1 infection of CAR(-) human vascular endothelial cells has been demonstrated in vitro, suggesting ChAdOx1 may be using additional receptors. Dual tropism has been demonstrated in other human adenoviruses, with HAdV-D26 and HAdV-D37 both using sialic acid and CAR for transduction. Furthermore, coagulation factor X (FX), a factor demonstrated to bind to the hexon and facilitate human adenovirus type 5 (HAdV-C5) transduction via a CARindependent pathway does not increase ChAdOx1 infection, with amino acid alignment between the hexon proteins suggesting ChAdOx1 is unable to bind FX. Taken together, these findings suggest ChAdOx1 uses additional as yet unknown mechanisms for transduction, which may further contribute to the pathogenesis of VITT.

Circumventing anti-vector immunity towards adenoviral vectored vaccines

Replication deficient (RD) adenoviruses (Ad) are the most widely administered viral vectors, with licensed SARS-CoV-2 vaccines using vectors derived from human Ad type 5 (Ad5) and 26 (Ad26), and chimpanzee Ad ''ChAdOx1''. Ad vectored vaccines generate robust cellular and humoral immunity, against both the transgene-encoded protein and the Ad vector itself. It's unclear how many times a single Ad vector can be readministered before this anti-vector immunity impairs generation of the desired transgene-specific adaptive responses. Antivector immunity also arises from naturally acquired Ad infections. In the absence of anti-Ad5 immunity, Ad5 is a goldstandard vector with robust vaccine immunogenicity, however widespread Ad5 seroprevalence hampers its use as a vector for the global population. We developed novel pseudotyped Ads as RD vectored vaccines encoding SARS-CoV-2 spike protein. These vectors exhibit fiber knob swaps from low seroprevalence Ads grafted onto an Ad5 backbone. We characterised innate immune responses following administration of these vectors in mice, and spikespecific adaptive responses three weeks later. Furthermore, we quantified the effects of anti-vector humoral immunity against these vectors in an in vitro transduction assay using human plasma. The pseudotyped vectors exhibit many desirable vaccine characteristics as the equivalent Ad5 vector, including CD4+ and CD8+ T cell responses against multiple spike epitopes. Importantly, fiber knob pseudotyping can substantially circumvent the direct, humoral, anti-vector immunity induced through Ad exposure in humans. These data indicate the fiber knob plays an important role in anti-vector immunity, and can be manipulated for evasion of such responses without hampering vaccine immunogenicity.

Implications of novel Adenovirus-Host interactions in Thrombosis with Thrombocytopenia Syndrome

In this study we investigated a link between adenovirus-based vaccines, deployed to fight the SARS-CoV-2 pandemic, and lifethreatening thromboembolisms after vaccination. Post-marketing surveillance showed that, following vaccination, Vaxzevria (ChAdOx1 based, AstraZeneca) and Jcovden (Adenovirus type 26 based, Johnson & Johnson) are associated with reduced platelet counts (thrombocytopenia) and blood clots (thrombosis) in some individuals. This extremely rare condition, with a rate between 1:50,000 - 1:350,000 cases per vaccinated individual, is above background rates of thrombosis in the population and can lead to fatal ischemic events including cerebral venous thrombosis, intracranial haemorrhage, and pulmonary embolism. It has been termed vaccine induced thrombotic thrombocytopenia (VITT) or thrombosis with thrombocytopenia syndrome (TTS). Heparin induced thrombocytopenia (HIT) is another condition with a similar clinical presentation to TTS. In HIT, immunoaggregates are formed due to the presence of strong anti-selfantibodies directed against Platelet Factor 4 (PF4). When similar anti-PF4 antibodies were detected in TTS patients, we investigated whether there could be a link between the adenovirus vectors used in the vaccines and PF4. This study demonstrates a direct interaction between adenovirus capsids and PF4 using surface plasmon resonance. We then utilized an integrative structural biology workflow including cryo-electron microscopy and molecular dynamics to characterize and demonstrate the mechanism of this interaction. These results demonstrate a previously unknown adenovirushost interaction and provide critical clues as to the underlying mechanism which causes TTS, including how these pathogenic anti-PF4 antibodies may be induced. We are therefore able to present a hypothesis as to the route of pathogenesis in TTS.

Isolated Anti-GBM Disease and COVID-19 Vaccination

Introduction: IgA nephropathy is the most reported glomerulonephritis post-COVID vaccination. Other reported cases include atypical anti-GBM nephritis, among others. Treatment consists of immunosuppressants and plasmapheresis with renal replacement therapy. Renal outcomes have varied. A case is presented of isolated anti-GBM nephritis in a patient whose renal injury occurred weeks after receiving a booster dose of COVID vaccine. Case Description: A 59-year-old male with recent history of ureteral stones with stent placement, travel history in the last 6 months and use of doxycycline for suspected Lyme's disease in the last 3 months presented to the emergency department for decreased urine output, fevers, and arthralgias. He also received a Pfizer COVID vaccine booster 6 weeks ago. His symptoms had worsened in the last 2 weeks. On initial evaluation, he was noted to have stage 3 acute kidney injury (AKI) with creatinine 5.3 mg/dL. Although he had findings of nephrolithiasis, no ureteral obstruction or hydronephrosis were noted on imaging. He received extensive infectious work up which was all negative. Hemodialysis was initiated on day 7 for metabolic derangements and volume overload. After infectious work up was negative, renal biopsy was perfromed revealing linear IgG deposits. Serum anti-GBM antibodies were positive. Despite receiving plasmapheresis, cyclophosphamide and prednisone, the patient continued to require dialysis and was discharged on home hemodialysis. Discussion(s): The development of AKI with systemic symptoms occurred about 6 weeks following his COVID vaccine, longer than previously reported cases. The patient also has a history of nephrolithiasis. At this time, direct association of this patient's anti-GBM disease with the COVID vaccine is unclear however remains a clinical consideration. The presentation of anti-GBM disease is unique as disease is limited to renal involvement. (Figure Presented).

Psychedelic science in post-COVID-19 psychiatry.

The medium- to long-term consequences of COVID-19 are not yet known, though an increase in mental health problems are predicted. Multidisciplinary strategies across socio-economic and psychological levels may be needed to mitigate the mental health burden of COVID-19. Preliminary evidence from the rapidly progressing field of psychedelic science shows that psilocybin therapy offers a promising transdiagnostic treatment strategy for a range of disorders with restricted and maladaptive habitual patterns of cognition and behaviour, notably depression, addiction and obsessive compulsive disorder. The COMPASS Pathways (COMPASS) phase 2b double-blind trial of psilocybin therapy in antidepressant-free, treatment-resistant depression (TRD) is underway to determine the safety, efficacy and optimal dose of psilocybin. Results from the Imperial College London Psilodep-RCT comparing the efficacy and mechanisms of action of psilocybin therapy to the selective serotonin reuptake inhibitor (SSRI) escitalopram will soon be published. However, the efficacy and safety of psilocybin therapy in conjunction with SSRIs in TRD is not yet known. An additional COMPASS study, with a centre in Dublin, will begin to address this question, with potential implications for the future delivery of psilocybin therapy. While at a relatively early stage of clinical development, and notwithstanding the immense challenges of COVID-19, psilocybin therapy has the potential to play an important therapeutic role for various psychiatric disorders in post-COVID-19 clinical psychiatry.

Effect of Hypoalbuminemia on Response to Loop Diuretics and Albumin in Patients with Acute Respiratory Distress Syndrome

Introduction: Conservative fluid management is a cornerstone of therapy for Acute Respiratory Distress Syndrome (ARDS). Existing studies of loop diuretics have had difficulty achieving goal urine output (UOP) and evaluations of adjunctive albumin have been limited by heterogeneous cohorts. Research Question or Hypothesis: Hypoalbuminemic patients with ARDS are more likely to exhibit a positive response to loop diuretics with adjunctive albumin than patients with normal serum albumin. Study Design: Single-center, retrospective observational study Methods: Adult patients were included if admitted to an intensive care unit (ICU) from January 2016 to September 2021 and received loop diuretic and albumin within one hour of each other. Exclusion criteria included liver failure, dialysis, pregnancy, trauma or positive test for SARS-COV-2. Patients were divided into two groups (low and normal) by baseline serum albumin, where low albumin was defined as ≤ 3.5g/dL. The primary outcome was the percentage of patients with a positive response to combination therapy, defined as UOP ≥ 600mL within six hours of the last agent being administered. Secondary outcomes included UOP at six hours and change in body weight, oxygenation, and serum albumin at 24 hours. Chi-squared and Mann- Whitney U tests were used for nominal and continuous variables, respectively with alpha <0.05 used to determine significance. Results: 102 patients were in the low-albumin group and 73 in the normal-albumin group. 61 (56%) were positive responders in the lowalbumin group, compared to 43 (64%) in the normal-albumin group (p=0.313). Patients in low-albumin group had a greater change in serum albumin (p<0.001) at 24 hours. No other secondary outcomes were statistically significant. Conclusion: Patients with low albumin were no more likely to have a positive response to adjunctive albumin therapy with loop diuretics than patients with normal albumin. Heterogeneity of administration exist and should be further explored.

The public's attitude to and acceptance of periodic doses of the COVID-19 vaccine: A survey from Jordan.

AIMS: This study surveyed people regarding their acceptance of periodic doses (i.e., annual boosters) of the COVID-19 vaccine. Moreover, factors that correlate with attitudes toward periodic COVID-19 vaccines were assessed and identified. METHOD: The study employed a cross-sectional methodology. The study questionnaire was distributed using Google Forms. Data were collected during the last quarter of 2021, and 1,416 adults (18 years old and over) from Jordan responded. Acceptance of COVID-19 periodic vaccine doses was calculated as a percentage of the total number of study participants, and their attitudes were scored. A multiple regression model was used to determine the predictors of public attitudes toward the annual dose of COVID-19 vaccines. RESULTS: The acceptance rate for receiving periodic doses of the COVID-19 vaccine was low (19.3%). Additionally, 26% of participants were unsure about receiving additional doses of the vaccine. However, 54.7% had a negative attitude toward getting periodic doses. The mean score for attitudes toward periodic doses was 47.9 (range: 29-66). Among the identified factors leading to decisions not to receive periodic doses were side effects (49.1%), waiting for further clinical studies (38.8%), and perceived no risk of contracting COVID-19 (17.7%). Regression analysis showed that income, educational attainment, and following the news about COVID-19 were predictors of participants' attitudes toward the periodic COVID-19 vaccine. CONCLUSION: Acceptance of periodic doses of the COVID-19 vaccine in Jordan is low, and the public's attitude is generally negative. Health programs and educational interventions are needed to promote vaccine acceptance and positive attitudes.

RURAL HEALTH CHALLENGES IN OPTIMAL FOLLOW-UP CARE AMONG CHILDHOOD CANCER SURVIVORS

Background: Children with cancer and their families from rural and non-urban areas face unique challenges across the continuum of care, from active treatment to survivorship. Oklahoma is a highly rural state with thirty-four percent of residents living in non-urban areas. Therefore, given the known burden of late effects, health equity for this population requires attention to potential geographic disparities in optimal follow-up care in order to mitigate adverse health outcomes. Objectives: The primary purpose of this study was to construct a childhood cancer survivorship cohort in Oklahoma, through the integration of cancer registry, electronic health record, and geospatial data, and identify potential disparities in optimal follow-up care among survivors from non-urban areas. Design/Method: The Oklahoma Childhood Cancer Survivor Cohort was based on all patients <18-years-old at diagnosis captured by the cancer registry between January 1, 2005 and September 24, 2014 (to allow for at least seven years of follow-up data for all survivors). Patients with documented death or relapse, non-analytic cases, and those not seen in the pediatric oncology clinic were excluded. The primary outcome was whether survivors were seen in the pediatric oncology clinic between 2020-2021. To assess the potential impact of the COVID-19 pandemic, clinic attendance from 2018-2019 was also analyzed. The primary predictor of interest was rurality, defined by Rural-Urban Commuting Area coding based on zip code. Other explanatory variables included age, gender, race/ethnicity, late effects risk strata, and primary diagnosis. Results: A total of three-hundred and twenty-one survivors met eligibility criteria, of whom 41.1% (n = 132) were not seen in the pediatric oncology clinic between 2020-2021. There were significant differences (p = 0.036) in optimal follow-up care with 53% of survivors from large towns (n = 64) and 45% of survivors from small town/isolated rural areas (n = 49) without a documented clinic visit compared with 36% of survivors from urban areas (n = 205). There were no significant differences in follow-up by race/ethnicity, gender, age at diagnosis, or late effects risk strata. In the two years preceding the COVID-19 pandemic, 31% of survivors were not seen in the clinic with observed differences among survivors from urban, large town, and small town/isolated rural areas at 25%, 47%, and 26% with suboptimal follow-up, respectively (p = 0.011). Conclusion: Survivors from non-urban areas were less likely to receive optimal follow-up care compared to survivors from urban areas. The COVID-19 pandemic worsened optimal follow-up care and disproportionately affected survivors from large town and small town/isolated rural areas.

PREVALENCE OF BACTERIAL COINFECTION AND PATTERNS OF ANTIBIOTICS PRESCRIBING IN PATIENTS WITH COVID-19: A SYSTEMATIC REVIEW AND META-ANALYSIS

Introduction: Evidence on prevalence of bacterial coinfection in Coronavirus Disease 2019 (COVID-19) is controversial;previous global viral respiratory pandemics reported high prevalence of bacterial coinfection, which was associated with increased risk of morbidity and mortality (1). Data on Prevalence of antibiotic prescribing in COVID- 19 indicates high antibiotic prescribing, causing a potential setback in antimicrobial stewardship and potential increase in antimicrobial resistance (2). The study protocol was registered in the international register of systematic reviews, PROSPERO, under the following ID: CRD42021261734 Aim: to determine the prevalence of bacterial coinfection and antibiotic prescribing in COVID-19 patients Methods: Systematic review and meta-analysis was conducted using Covidence. Data were extracted by one reviewer. Proportion data was pooled using random effects meta-analysis approach using STATA 17;and stratified based on region and study design. Data Source: OVID MEDLINE, OVID EMBASE, Cochrane and MedRxiv between January 2020 and June 2021. Study Eligibility: English language studies of laboratory-confirmed COVID-19 patients which reported (a) prevalence of bacterial coinfection and/or (b) prevalence of antibiotic prescribing with no restrictions to study designs or healthcare setting. Participants: Adults with RT-PCR confirmed diagnosis of COVID-19 Results: a total of 1058 studies were screened, of which 22 studies were eligible. Retrospective cohort studies accounted for the majority of the studies involved (n = 18, 81%), whilst prospective cohort studies accounted for the remaining (n=4, 18%). Of the 22 studies included, 3 (13%) studies were preprints, whilst the remaining (n=19, 86%) were peer-reviewed. A total of 13 (59%) studies were conducted in multicentre settings, whilst the remaining (n=9, 40%) were conducted in single centre settings. All of the studies included were conducted in hospital setting, whether it be in a normal, isolation or an intensive care ward. Twenty-one out of 22 studies have been rated Good'' rating during the quality assessment process. Pooled estimates for the prevalence of bacterial co-infection and antibiotic use were 5.62% (95% CI 2.26 - 10.31) and 61.77% (CI 50.95 - 70.90), respectively. Conclusion: The prevalence of bacterial coinfection amongst COVID-19 patients is low (5.62%) when compared with previous pandemics, yet antibiotic prescribing in COVID-19 patients was high (61.77%) indicating the need for stronger antimicrobial stewardship to reduce the global threat of AMR. Prescribing of antibiotics in COVID-19 should be based on clinical and/or laboratory evidence of bacterial coinfection. Key strengths of this review, is that it included a comprehensive search strategy spanning over several databases, including both pre-prints and peer-reviewed studies. Limitations in this review was that during the screening process, a significant number of studies have been excluded due to not meeting the inclusion criteria, therefore, bacterial coinfection and antibiotic use may be under- or over-reported. In addition, disproportionate representation from North America and failure to include studies from regions other than Europe and Asia, can limit the generalizability of the results to other regions impacted by COVID-19.

Patient satisfaction with ophthalmic telemedicine visits during the COVID-19 pandemic

Purpose : To compare patient satisfaction for telemedicine visits to traditional in-person clinical visits during the COVID-19 pandemic in the Ophthalmology Department at Boston Medical Center (BMC), the largest academic safety-net hospital in New England. Methods : Patient satisfaction surveys using the NRC Health platform were sent to all patients in their preferred language following eye clinic visits at BMC from June to October 2020. Three visit types were studied: 1) virtual visits via telephone or video conferencing, 2) hybrid visits with protocol-driven set of undilated imaging (e.g. OCT, fundus photos, visual fields), visual acuity, and intraocular pressure obtained by a trained technician, followed by a virtual visit with the physician within 1-2 weeks, and 3) traditional in-person visits. Twotailed Student's t-test was used to compare survey responses of telemedicine to traditional visits in 4 questions: 1) trust in provider (4-point scale, trust), 2) felt provider listened (4- point scale, listened), 3) satisfied with amount of time spent with provider (4-point scale, time), and 4) recommend provider to other patients (10-point scale, recommend). Additionally, responses between English and non-English speakers, requiring trained interpreter services, were compared. Results : A total of 793 visits were included (44 virtual, 56 hybrid, 693 traditional). The majority of telemedicine visits were from the retina and optometry services (Figure 1). There was no statistically significant difference in trust, listened, time, or recommend when comparing virtual or hybrid visits to traditional visits (Table 1a). NonEnglish speakers had statistically significant lower scores in trust, listened, and time with no difference in recommend when compared to English speakers (Table 1b). When stratified by visit type, non-English speakers had a trend towards a lower score in trust for both virtual and hybrid groups. Conclusions : Telemedicine provides patients access to clinical care with decreased risk of infection during the COVID-19 pandemic. Non-English speakers tended to have less trust in the physician for all visit types, which should be considered when communicating with patients. Overall, we found that patients were equally satisfied with telemedicine visits as with traditional in-person visits in a hospital-based academic eye clinic.

E-008 Variation in subarachnoid hemorrhage presentation and demographics in California during the COVID-19 pandemic: A UC stroke consortium study

E-008 Figure 2Relative fraction of Hispanic patients with SAH by COVID19 status across the UC Health systems. Dashed line indicates equal portion of COVID(+) and COVID (-) patients;centers below the dashed line had lower fraction of COVID(+) SAH patients and those above the line had higher fraction of COVID19(+) (*p<0.1)[Figure omitted. See PDF]ConclusionsCOVID19(+) patients presenting with SAH were younger than COVID(-) controls, and there was a trend toward underrepresentation of Hispanic patients in the COVID(+) group. Recognizing COVID19 status as a factor in SAH presentation is important to mitigate healthcare disparities in California.DisclosuresA. Gautam: None. T. Caton: None. K. Narsinh: None. A. Baker: None. S. Hetts: None. D. Cooke: None.

Multi-modality imaging in survivors of COVID-19

Background Widespread abnormalities of the myocardium have been reported in patients with COVID-19. However, these patients often have substantial co-morbidities and it is essential to understand whether cardiac abnormalities represent preexisting disease or are the consequence of COVID-19. Objective To determine the contribution and cardiac impact of co-morbidities in patients who have recovered from COVID-19. Methods In a prospective observational study, adult patients hospitalized with confirmed COVID-19 were recruited from the Edinburgh Heart Centre between May and November 2020 and compared to healthy and co-morbidity-matched volunteers. Patients underwent gadolinium and manganeseenhanced magnetic resonance imaging and coronary computed tomography angiography. Results Twenty-three patients (54±11 years, 20 male) who recovered from COVID-19 were recruited. Half (n=11, 48%) required admission to the intensive care unit and a third (n=7, 31%) received non-invasive or invasive ventilation. Patients had a high prevalence of known cardiovascular disease (n=18, 78%), associated risk factors (n=11, 45%) and coronary artery disease (n=8, 35%). Compared with younger healthy volunteers (n=10), myocardial native T1 values (1202 ±25 versus 1162±27 ms, P=0.008, figure 1) and extracellular volume fraction (31.9±1.7 versus 29.8±0.5 %, P=0.001, figure 1) were higher with no differences in manganese uptake. Compared to co-morbidity-matched volunteers (n=20), there were no differences in native T1 values (1202±25 versus 1196±39 ms, P=0.61, figure 1), extracellular volume fraction (31.9±1.7 versus 31.0±0.5 %, P=0.11), presence of late gadolinium enhancement or manganese uptake. These findings remained irrespective of COVID-19 disease severity, presence of concomitant myocardial injury or coronary artery disease. Conclusions Patients who have recovered following hospitalization with COVID-19 have no evidence of a major excess in myocardial injury or dysfunction compared to co-morbiditymatched volunteers. The presence of co-morbidities likely explains many of the previously reported myocardial abnormalities.