Caribbean Tourism Development, Sustainability, and Impacts

The Caribbean economy is highly dependent on the tourism industry and the protection of the natural and cultural attractions on which it depends is critical. To address this concern, this chapter provides a snapshot of the progress that has been made on sustainable tourism development in the Caribbean region. There is now more demand from the traveling public for industries to be environmentally friendly and in order to continue to use tourism as a means of economic advancement, sustainable practices must be adopted. The evidence suggests that there are great economic, sociocultural, and environmental impacts of tourism in the Caribbean region that are both positive and negative. The actions of the accommodations sector are commendable but there is the need for all major stakeholders to better manage the negative impacts of tourism development. The Caribbean Tourism Organization has developed a policy framework which consists of guiding principles and integrated policies regarding sustainable tourism development, The Caribbean Sustainable Tourism Policy and Development Framework. A shock, such as COVID-19, can lead to economic collapse as communities heavily dependent on tourism have no capacity to respond to the loss of their primary revenue source. However, in order to strengthen the resilience of small island tourism development, the Caribbean region is transitioning toward community-driven solutions through innovation, employee training, upgrades, greater digitalization, and environmental sustainability. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

COVID-19 and the Precarity of Elite Women Athletes

In this chapter the authors examine the precariousness of being an elite female athlete during the COVID-19 pandemic. Drawing on data collected from an Australian professional sporting club, they explore the gendered nature of professional sport and associated challenges for female athletes. The authors utilise the theoretical work of Judith Butler to appraise the disproportionate impact of the global pandemic on the precarious work of female professional athletes. © 2023 selection and editorial matter, Stephen Frawley and Nico Schulenkorf;individual chapters, the contributors.

Qualitative benchmarking in context: environment and outlook

This chapter focuses on the environment in which qualitative benchmarking might operate in the future. It makes special reference to David Baker and Lucy Ellis's two most recent books, Future Directions in Digital Information: Predictions, Practice, Participation, and Libraries, Digital Information, and COVID: Practical Approaches to Challenge and Change. It highlights the main themes discussed in later chapters: physical and digital space;the third place;preparedness;disruptive change;hybrid working;digital divide;sustainability. © 2023 Elsevier Ltd. All rights reserved.

Sharing Automated Vehicles: Policies and Ideas to Improve the Sharing Experience to Reduce Congestion and Energy Use in a Post-COVID World

Research suggests widespread proliferation of automated vehicles (AV) can potentially greatly increase transportation energy use and congestion [ 1 ]. One of the ways to mitigate such increases is to increase sharing in order to provide more environmentally and financially sustainable and cost effective services that match consumer demands for reliability and convenience. This chapter explores how sharing can be encouraged through economic, technological, procedural/legal, and cultural levers in order for AV transportation systems to reduce energy use and congestion.

COVID-19 humoral and T-cell mediated vaccination responses in people with multiple sclerosis

Background: For people living with MS (pwMS) the impact of disease modifying treatments (DMT) on vaccine efficacy has been a growing concern. Method(s): We used remote sampling to assess humoral response using dried blood spot (DBS) and ELISA for anti-SARS-CoV-2 IgG and performed T-cell analysis on a selection of participants. Compliance rates were maintained at ~70% post each vaccination time-point and DBS quality rates improved across the time frame of the study. Result(s): The cohort consisted of 184 participants who could be grouped by DMT into;anti-CD20 (40%), fingolimod (8%) and all other DMT/no DMT (52%).The primary vaccination course was Oxford/AstraZeneca for 61% and Pfizer-BioNTech for the remainder. Post-v2 76/110 (69%) of participants had seroconverted, increasing to 131/173 (76%) post v3. Vaccine response was influenced by DMT. After v2 13/38 (34%) of participants on anti-CD20 and 1/9 (11%) on fingolimod seroconverted compared to 63/63 (100%) of those on other/no DMT. Lower vaccine responses were seen post-v2 in those on anti- CD20;6.6 BAU/ml (IQR 63) and fingolimod;9.9 BAU/ml (IQR 9) compared to all other/no DMT;326.7 BAU/ml (IQR 535), p<0.001. In v2 responders successive vaccinations further increased response. A median of 313 BAU/ml (IQR 440) was found post v2, increasing to 936 BAU/ml (IQR 1362) at v3 and 1559 BAU/ml (IQR 1374) at v4, p<0.001. Amongst v2 non-responders third vaccinations increased seroconversion. 9/32 (28%) of v2 non-responders seroconverted after v3;3/23 (13%) of these were on anti-CD20 and 5/9 (56%) were on fingolimod. T-cell responses were found in the majority of individuals regardless of seroconversion status. All 14 anti-CD20 participants tested had a positive T-cell response at v3. Preliminary evidence suggests that T-cell response is sustained for at least 6 months post vaccination. Conclusion(s): DMT influences both seroconversion and antibody titre in response to vaccination. Additional vaccination courses post-v2 result in increased titre, and even in those who failed to seroconvert after v2, increase chance of seroconversion. Amongst those who fail to show a humoral response, a T-cell response is evident in the majority.

Humoral and T- cell response to multiple COVID-19 booster vaccinations in people with MS

Introduction: People with multiple sclerosis (PwMS) treated with anti-CD20 therapies and fingolimod are less likely to successfully produce a humoral response to COVID-19 vaccines 1 and 2. Objective(s): To measure the humoral and/or cellular response to COVID-19 booster vaccinations in a cohort of PwMS who were previously seronegative after their initial COVID vaccine course. Aim(s): To determine whether there is a benefit of COVID-19 booster vaccinations for people with MS who are known to have had an attenuated response to initial vaccines. Method(s): We studied a cohort of PwMS all of whom were seronegative for anti-SARS-CoV-2 spike protein IgG after the 1st and 2nd COVID-19 vaccines, including PwMS treated with ocrelizumab (n=53), fingolimod (n=15), other DMTs (n=9) and no DMT (n=2). Dried blood spot +/- whole blood samples were obtained from participants at 2-8 weeks after their 3rd (n=79) and 4th (n=40) COVID-19 vaccines. Samples were used to measure anti-SARS-CoV-2 spike protein IgG (ELISA) and T-cell response (IFN-g release assay measured on whole blood). Result(s): Overall 27/79 (34%) who were seronegative after COVID vaccine 2 seroconverted after vaccine 3. Seroconversion rates were 17% for PwMS treated with ocrelizumab, 47% for fingolimod and 100% for other DMTs. A further 2/30 (7%) of those who remained seronegative after vaccine 3 seroconverted after vaccine 4. Anti-SARS-CoV-2 T-cell responses were measurable in 26/40 (65%) after vaccine 3 and 13/19 (68%) after vaccine 4 but were conspicuously absent in people treated with fingolimod. Overall, 75% of participants showed either humoral or cellular response after receiving 4 COVID vaccinations. PwMS with laboratory evidence of prior COVID-19 infection had higher measurable T-cell responses. Conclusion(s): Booster vaccinations for COVID-19 are associated with incremental benefits in measurable immunity in those with attenuated responses to the initial vaccine course. Overall, three quarters of those who were seronegative after COVID vaccines 1 & 2 had a measurable immune response after COVID vaccine 4. This data supports the use of booster vaccinations in pwMS at risk of attenuated vaccine response.

CLADRIPLAS: Does cladribine Target CNS plasma cells and reduce neuro-axonal damage in people with MS?

Introduction: Cladribine is a CNS penetrant disease-modifying treatment, which - in an oral preparation (Mavenclad) - was licensed for people with highly active relapsing MS in August 2017. Our experience with cladribine dates back to 2014 when we started using subcutaneously injected cladribine as a compassionate immunotherapy in people with MS (pwMS) off-label. This programme enabled us to embed CLADRIPLAS, a mechanistic study of the effect on intrathecal B cell and plasma cell function and axonal damage focussing on progressive MS (PMS) (IRAS # 240360). Objective(s): To study the effect of cladribine on peripheral and intrathecal B and plasma cells. Aim(s): To study the effect of cladribine on oligo-clonal bands (OCB) and the level of neurofilament light (NfL) chain. Method(s): Observational study involving two lumbar punctures and phlebotomies, 6-12 months apart, to collect B cell subsets, and intrathecal plasma cell as well as neurofilament light chain (NfL) level in pwMS eligible and not eligible for cladribine treatment based on cerebro-spinal fluid (CSF) NfL, clinical and/or MRI evidence of inflammatory disease activity. Here, we report baseline cohort characteristics. Result(s): Thirty-eight pwMS were recruited (19 women, 19 men) and had their first sample collections. Eight pwMS were eligible for cladribine treatment (7 based on elevated NfL, 1 due to MRI activity). Follow-up samples have been collected in 21. Mean age at baseline was 55 years (40-76). Fourteen had primary, 24 secondary PMS. Median EDSS=6.5 (3.5-8). Twenty-one pwMS had been treated with DMT before consideration of cladribine, 17 were immunotherapy-naive. Mean CSF-NfL level was 552 (176- 2072) pg/ml. Conclusion(s): Despite restrictions due to COVID-19, 38 of 40 planned pwMS were enrolled. 7/8 were eligible based on CSFNfL level indicating the importance of using biomarkers other than MRI to establish disease activity in PMS. We expect our cohort to enable meaningful comparison between groups. CLADRIPLAS will finish in early 2023.

Pre-operative checklist to improve pathway for carotid endarterectomy (CEA) patients: A single centre audit

Introduction: The SARS-COV-2 pandemic has led to The redistribution of NHS services. In our sector, CEA surgery moved to an NHS hospital where it had not previously been undertaken. To ensure safety a new standard operating procedure (SOp) was proposed. An audit was undertaken to evaluate The SOp, construct a pre-operative checklist, subsequently measure its effectiveness and identify improvements. Method(s): To ascertain key pre-operative steps to include in The checklist a questionnaire was completed by 9 SpR/Consultants. The form consisted of a ranking score from 0 (never done) to 10 (always done). Once The checklist was established The questionnaire was re-sent additionally asking for feedback On its impact On The service and suggestions for improvement. Using these results, The checklist was incorporated as a smart text to EpIC (electronic patient notes). Result(s): The following key steps were identified: MDT decision, vascular review, imaging, anaesthetic review, relevant results (bloods, COVID swab and echo), theatre/bed booking, on-admission steps and post-op care. All 9 doctors felt The checklist improved The service in all domains, except bed availability and subsequent surgical delay, likely because this depended On HDU bed availability and need for on-the-day prioritisation. Conclusion(s): The CEA surgery checklist is now an established part of The electronic patient record in The form of a simplified flowsheet with tick-boxes and space to insert results. This has ensured a standardised contemporary record of each patient's progress. All members of The team including new/temporary staff can follow this, ensuring a safe care pathway. Take-home message: With The move of CEA surgery to an alternative London site it is important to establish a safe standard operating procedure. This has been facilitated by The use of a new pre-operative checklist ensuring a standardised contemporary record of each patient's progress.

Policy responses of the COVID-19 pandemic in the Philippines: Impacts on the profitability of the agri-food supply chain

The Philippines experienced many challenges brought about by the COVID-19 pandemic. In 2020, the country experienced a decline in economic growth. The agri-food sector's micro, small and medium enterprises (MSME) are amongst the country's most vulnerable. This study analyses the various policy constraints and enablers related to food manufacturing as well as the distribution in the agri-food supply chain. This study applied a mixed methods approach. Interviews with 30 agri-food enterprise owners and key officers were conducted and concept mapping was applied using Leximancer software. Key themes emerged including introduction of new products, increased online selling activity, limited supply of inputs and packaging materials, increased cost of production and delivery, and availability of government assistance. A subsequent survey (n=125) for the food manufacturers, logistics operators, traders, wholesalers, and retailers was also implemented. The effect of policy measures on enterprises' profitability was assessed using ordered probit regression. The results suggest that the likelihood of reporting profitability after the pandemic increases when the owner or key officer is male, the business is operating under a partnership, enterprises suspended their operations at some point during the pandemic, enterprises implemented health and safety protocols for their employees, there is no oversupply of employees during the lockdown period, and enterprises increased operation work hours during lockdown. The study also highlighted that manufacturing and distribution of food during the pandemic should be unhampered. However, MSMEs in the agri-food chain experienced delays and increases in prices of raw materials despite clear policy guidelines. Interregional trade was affected due to varying localised policies on health protocols and lockdowns. These policy constraints generally affected the profitability of the enterprises.

Increasing Computational Protein Design Literacy through Cohort-Based Learning for Undergraduate Students

Undergraduate research experiences can improve student success in graduate education and STEM careers. During the COVID-19 pandemic, undergraduate researchers at our institution and many others lost their work- study research positions due to interruption of in-person research activities. This imposed a financial burden on the students and eliminated an important learning opportunity. To address these challenges, we created a paid, fully remote, cohort based research curriculum in computational protein design. Our curriculum used existing protein design methods as a platform to first educate and train undergraduate students and then to test research hypotheses. In the first phase, students learned computational methods to assess the stability of designed protein assemblies. In the second phase, students used a larger data set to identify factors that could improve the accuracy of current protein design algorithms. This cohort based program created valuable new research opportunities for undergraduates at our institute and enhanced the undergraduates' feeling of connection with the lab. Students learned transferable and useful skills such as literature review, programming basics, data analysis, hypothesis testing, and scientific communication. Our program provides a model of structured computational research training opportunities for undergraduate researchers in any field for organizations looking to expand educational access.

MORAL INJURY: A CONTEMPORARY PERSPECTIVE

Background: This symposium provides a timely contemporary perspective on moral injury (MI) in the context of current events, namely the COVID-19 pandemic and the fall of Afghanistan, with the likelihood of these events exposing individuals to potentially morally injurious events (PMIEs). Objectives: To highlight the need for a greater understanding of the concept of MI and the associated mental health (MH) consequences in the context of recent significant global events. MI is primarily concerned with the transgression of deeply held moral beliefs and the negative MH sequelae. Methods: This presentation will discuss some of the key controversies about the construct of MI (e.g. whether MI adds to our understanding of post-traumatic MH, and whether MI should be considered a psychiatric disorder). We also discuss the Moral Injury Outcome Scale (MIOS) developed by Phoenix Australia and the importance of MI in a treatment setting. Findings: The MIOS was shown to be a reliable and valid measure of MI for international use. This research is an important step in further understanding the impacts of MI, and in improving the support that is provided to those exposed to PMIEs. Conclusion: We argue that the yawning gap between the diverse moral frameworks that define personal identity, on one side, and the thin and narrow military ethics of the state, on the other, is potentially a significant cause of MI among military personnel.

Did it hurt? COVID-19 vaccination experience in people with multiple sclerosis.

BACKGROUND: Current guidelines recommend vaccination against SARS-CoV2 for people with multiple sclerosis (pwMS). The long-term review of the safety and effectiveness of COVID-19 vaccines in pwMS is limited. METHODS: Service re-evaluation. PwMS using the MS service at Barts Health National Health Service Trust were sent questionnaires via email to report symptoms following first and second COVID-19 vaccinations (n = 570). A retrospective review of electronic health records was conducted for clinical and safety data post-vaccination(s); cut-off was end of September 2021. Separate logistic regressions were carried out for symptoms experienced at each vaccination. Two sets of regressions were fitted with covariates: (i) Disease-modifying therapy type and (ii) patient characteristics for symptoms experienced. RESULTS: 193/570 pwMS responded. 184 pwMS had both vaccinations. 144 received the AZD1222 and 49 the BNT162b2 vaccine. 87% and 75% of pwMS experienced any symptoms at first and second vaccinations, respectively. The majority of symptoms resolved within a short timeframe. No severe adverse effects were reported. Two pwMS subsequently died; one due to COVID-19 and one due to aspiration pneumonia. Males were at a reduced risk of reporting symptoms at first vaccination. There was evidence that pwMS in certain treatment groups were at reduced risk of reporting symptoms at second vaccination only. CONCLUSIONS: Findings are consistent with our preliminary data. Symptoms post-vaccination were similar to the non-MS population and were mostly temporary. It is important to inform the MS community of vaccine safety data.

State Higher Education Funding During COVID-19: Lessons From Prior Recessions and Implications for Equity

States provide substantial support for higher education through appropriations to public colleges and universities that can be used to maintain relatively low tuition levels and funds for financial aid. Higher education often receives disproportionate cuts during recessionary periods, and it faces potentially unprecedented reductions in coming years amid a pandemic that has left some states with revenue shortfalls. How states approach higher education cuts has the potential to exacerbate existing inequities among racially minoritized and low-income students and historically underfunded institution types. In this study, we document trends in higher education funding over time and use latent profile analysis to identify distinct approaches states have taken to higher education funding. We then examine the trajectories of higher education funding within each approach over time, particularly during prior recessions. We conclude by discussing the implications of each approach for equity, particularly in light of states' early responses to the current economic downturn.

Libraries, Digital Information, and COVID: Practical Applications and Approaches to Challenge and Change

COVID-19 is profoundly affecting the ways in which we live, learn, plan, and develop. What does COVID-19 mean for the future of digital information use and delivery, and for more traditional forms of library provision? Libraries, Digital Information, and COVID gives immediate and long-term solutions for librarians responding to the challenge of COVID-19. The book helps library leaders prepare for a post-COVID-19 world, giving guidance on developing sustainable solutions. The need for sustainable digital access has now become acute, and while offering a physical space will remain important, current events are likely to trigger a shift toward off-site working and study, making online access to information more crucial. Libraries have already been providing access to digital information as a premium service. New forms and use of materials all serve to eliminate the need for direct contact in a physical space. Such spaces will come to be predicated on evolving systems of digital information, as critical needs are met by remote delivery of goods and services. Intensified financial pressure will also shape the future, with a reassessment of information and its commercial value. In response, there will be a massification of provision through increased cooperation and collaboration. These significant transitions are driving professionals to rethink and question their identities, values, and purpose. This book responds to these issues by examining the practicalities of running a library during and after the pandemic, answering questions such as: What do we know so far? How are institutions coping? Where are providers placing themselves on the digital/print and the remote/face-to-face continuums? This edited volume gives analysis and examples from around the globe on how libraries are managing to deliver access and services during COVID-19. This practical and thoughtful book provides a framework within which library directors and their staff can plan sustainable services and collections for an uncertain future. © 2021 David Baker and Lucy Ellis Published by Elsevier Ltd.

Seroconversion following vaccination against SARS-CoV-2 in people with MS: Impact of disease modifying therapy

Introduction: People with multiple sclerosis (MS) have faced particular concerns around vaccine efficacy and timing with respect to disease modifying therapy (DMT). Clinical advice has varied around delaying or suspending DMT to optimise vaccine response. Aims: To provide an understanding of vaccine response across DMTs to inform risk-benefit discussions with people with MS, and guide therapy choice. Methods: People with MS were invited to provide dried blood spots for analysis. Where possible, samples were obtained prior to vaccination and at 6 weeks following each vaccination. Serum from 4mm punched dried blood spots was resuspended in triton- PBS, and antibodies against SARS-COV-2 spike receptor binding domain protein assayed using the GloBody technique. The assay was validated against Roche Elecsys. Results: 98 participants had samples available for analysis. No samples had detectable anti-spike RBD IgG detectable pre-vaccination (n=34). A significant increase in anti-spike RBD IgG titre was seen following second vaccination (v2;n=98) compared to first vaccination (v1;n=34) (p<0.001). 16% (8/50) of those on anti-CD20 monoclonal antibodies demonstrated an IgG response to v2;in a logistic regression model this was significantly different to natalizumab (73% seroconverted, n=11), oral cladribine (73% seroconverted, n=11) and dimethyl fumarate (89% seroconverted, n=9). Alemtuzumab (40% seroconverted;n=5) and fingolimod (0% seroconverted, n=3) were not significantly different, although limited by small numbers. IgG titre was significantly lower in people who had received ocrelizumab following second vaccination compared to other DMT (p<0.001). Total time on treatment had a borderline relationship with IgG titre following v2 in the anti- CD20 cohort in a linear regression model (p=0.06);no relationship was seen between time from infusion and IgG response. In a univariate model excluding DMT, vaccine type (p<0.001), gender (p=0.023), EDSS (p=0.042), and time between vaccination doses (p=0.03) influenced odds of seroconversion;in a multivariate model only gender (OR male 0.13, p=0.027) and vaccine type (OR Pfizer 15.2, p<0.001) contributed significantly. Conclusions: DMT, vaccine type and gender have differential impacts on IgG response to vaccination, both in terms of seroconversion and antibody titre. The impact of these factors on susceptibility to clinical infection and longer term protection remain to be determined.

Up to 6 years follow-up of people with MS (n=250) receiving cladribine

Introduction: Oral cladribine is a licensed disease-modifying treatment (DMT) for highly active relapsing multiple sclerosis (RMS). We report clinical and paraclinical data collected as part of ongoing follow-up of our cohort of people with MS (pwMS) treated with subcutaneous (s.c.) cladribine personalised dosing (CPD). Objectives and Aims: To report follow-up data in pwMS treated using CPD (adjusted for weight and total lymphocyte count, TLC). Methods: CPD was offered to pwMS with signs of disease activity irrespective of their disease course. Cladribine 10 mg s.c. was given on three consecutive days (four in pwMS & gt;90kg) during week 1. Based on TLC at week 4, patients were given another 0-3 doses at week 5. A second cycle of CPD was administered 11 months later. Follow-up included recording of adverse events, relapses, annual EDSS, 9-hole peg, timed 25-foot walking, and symbol digit modalities tests. MRI (gadolinium enhancing T1 and T2 lesions), cerebrospinal fluid (CSF) neurofilament light chain (NfL) measurements and full blood counts were obtained. Results: 250 pwMS (113 RMS, 137 PMS) received CPD. 211/250 completed a second cycle. Baseline age 45 (17-72) years and baseline EDSS 0-8.5. The safety and tolerability profile of CPD was generally very good. Six severely disabled pwMS died (one each from influenza, encephalitis, hypoxic brain injury due to choking, COVID19 pneumonia, haemopericardium and dissecting aortic aneurysm and unknown [prior EDSS 9.5]). One myocardial infarction, two breast cancers, one pulmonary embolism occurred, and three severe allergic skin reactions without long term sequelae. Severe lymphopenia (WHO grade 3-4) occurred in 7% despite personalised dosing. In 74/155 pwMS (47.7% of those with EDSS data available), EDSS remained stable or improved at follow up (median 2.9 years). In n=37, mean pre- and post-treatment CSF-NfL measurements at -4.4 and 11.3 months, respectively, were 1079pg/ml (CI 557, 1601) and 508pg/ml (CI 330, 686). Conclusions: Our ongoing observations of this uncontrolled real world cohort suggests CPD is a safe, well tolerated treatment for pwMS with disease activity. Efficacy of cladribine in preserving upper limb function in advanced MS (EDSS 6.5-8.5) will be tested in the ChariotMS trial.

Carotid surgery during the COVID-19 pandemic

Introduction: The aim of this prospective study was to evaluate the efficacy and safety of carotid endarterectomy for symptomatic carotid stenosis during the COVID-19 pandemic Method: Re-organisation of stroke services due to the COVID-19 pandemic resulted in carotid endarterectomy for symptomatic disease being performed in two hospitals;Covid-19 free and non-free sites Patients were referred from multiple online regional neurovascular multi-disciplinary team meetings, and managed according to the pre- Covid-19 guidance. All patients referred for carotid endarterectomy between 23 March 2020 and 31 July 2020 were included. Demographic medical history, imaging, peri-operative, complication and follow-up data were collected and analysed prospectively Result: 28 patients were referred for carotid endarterectomy, of whom 21 patients underwent surgery. The mean time to surgery was 11 days (3-35). The technical success rate was 100%. Peri-operatively and within 30-days post-operatively, no patient suffered death or stroke There were 2 minor complications;one non-ST elevation myocardial infarction, and another wound haematoma and infection requiring readmission for antibiotics. No patient developed new COVID-19 infection post-operatively. Of the 7 patients not operated on;2 were medically unfit for surgery, three declined surgery, and two had free floating thrombus that was managed successfully with anti-coagulation Conclusion: During the pandemic, the provision of carotid endarterectomy for symptomatic carotid diseases was carried out safely and within the current recommendations, with several pre-cautionary measures being undertaken. Therefore, symptomatic carotid intervention should still be considered to reduce the risk of stroke provided similar pre-cautionary measures are undertaken Take-home Message: Carotid surgery should continue during successive waves of the COVID-19 pandemic .

Safe delivery of surgical tracheostomies in COVID-19 patients during the pandemic

Introduction: During the corona virus disease (COVID-19) pandemic frontline units worldwide faced the challenging task of providing highrisk services (like surgical tracheostomy) while safe-guarding the very people performing the high risk procedures. The aim of our study was to assess the incidence of COVID-19 infection among staff involved in surgical tracheostomy on COVID-19 patients Method: A surgical tracheostomy protocol and operation theatre modifications were put in place at our centre, dictated by local resources staff availability and previous tracheostomy experience. Between 26/ 03/2020 and 27/05/2020, staff participating in 71 tracheostomy procedures were sent a questionnaire. The presence of COVID-19 symptoms (new onset continuous cough, fever, loss of taste and/or loss of smell) in tracheostomy staff and patient related data were analysed Result: Among the responders (72/122), compliance with personal prophylaxis equipment use was 100%. Eleven (15%,11/72) reported key COVID-19 symptoms and self-isolated. 10 had a COVID-19 swab test and three tested positive. One staff attended (1/72) hospital for symptomatic treatment, none required hospitalisation. 43/72 staff (60%) underwent a COVID-19 antibody test, 18.6% (8/43) were positive Among the tracheostomised patients, the mean age was 58 years(29- 78) and 65.5% were males. The median time from intubation to ST was 15 days (range 5-33, IQR=9). There were no tracheostomy related deaths and overall mortality was 11%(6/55) Conclusion: Safe delivery of tracheostomy during a pandemic like COVID-19 is possible with strict adherence to personnel protective equipment, surgical protocols and regulation of traffic flow in theatres to mitigate the potential transmission of COVID-19 among surgical staff Take-home Message: Compliance with PPE, adherence to tracheostomy protocol and local modifications can mitigate potential COVID-19 transmission among health care personnel .