The effect of lockdown and media coverage following vaccine rollout on Deep Vein Thrombosis ( DVT ) clinic activity during the first year of the COVID -19 pandemic-a single-centre experience

An explosion of research has occurred since the advent of the COVID-19 pandemic relating to its effect on the NHS, health consciousness and vaccine side effects, such as vaccine-induced thrombocytopenia and thrombosis (VITT). This project sought to establish the effects of the UK's national lockdowns and media coverage of VITT on the rate of referrals and outcomes of DVT clinic appointments at our hospital. There was a suspicion among nurses running the DVT clinic that referrals were lower, but rates of positive scans higher, during the first national lockdown and that the reverse was true following media reporting of the first cases of VITT, with large numbers of patients testing negative for DVT. We report the findings of a retrospective, observational case-control study of 3550 patients presenting to Norfolk and Norwich University Hospital outpatient DVT clinic from any referral source (usually GP or A + E) between 2/3/2020 and 10/5/2021. Data from 2015 to 2019 were also obtained, providing 5-year averages for comparison. Outcomes were classified as positive (for DVT), negative (including those where Doppler ultrasound scan was not indicated due to low Wells score and negative D-dimer) and DNA (did not attend). Chi-squared (χ2 ) analyses were undertaken to determine heterogeneity of weekly referrals during specific periods of the pandemic. With 2 degrees of freedom (2df), a χ2 result above 5.9 suggests heterogeneity. T -tests were run to compare the outcomes driving the χ2 results with the data from the preceding 5 years. Compared to the non-lockdown period, there was a significant reduction in the number of referrals seen during the dates of the 1st national lockdown (χ2 = 20.01, 2df, p = <0.01). This was primarily due to a reduction in the number of patients subsequently found to be negative for DVT (31.0 vs. 45.4, p = <0.01). The difference was less marked and did not reach statistical significance during the 2nd and 3rd lockdowns. A significant increase in total weekly referrals was observed during the period immediately following media reporting of the first cases of VITT related to the AstraZenaca COVID-19 vaccine (55.1 vs. 73.1, p = <0.01). This was driven by an increase in patients subsequently found to be negative for DVT (39.2 vs. 57.2 p = <0.01). The weekly number of positive patients during this time was not significantly higher than the preceding 5-year average for the same dates (9.7 vs. 10.2, p = 0.30). Comparison with 5-year averages confirmed that the pattern seen in different parts of the pandemic year described above did not follow the usual pattern of referrals across the year. Finally, throughout the observed period, there was a below average rate of DNA outcomes when compared to the preceding 5-year average. These findings suggest several phenomena unique to the COVID-19 pandemic. First, measures to prevent the spread of COVID-19 were associated with fewer patients without DVT being referred to the DVT clinic. Second, media reporting of VITT was associated with a higher rate of referral of patients without a DVT to the DVT clinic without any change in the number of positive patients compared to the preceding 5 years. Third, during the COVD-19 pandemic, there were fewer patients failing to attend their clinic appointment, which we hypothesise is as a result of increased awareness of the need not to waste NHS resources..

#COVIDTIMES: Social experiments, liminality and the COVID-19 pandemic

On the 22nd of March 2020, the Australian government announced Stage 1 restrictions in response to the global coronavirus pandemic (Johnson and Smale, 2020). Since then, numerous nation-wide measures have been implemented in an effort to control the rate of transmission and minimise the pandemic's negative impact on the Australian people and the economy, ranging from lockdowns and stay-at-home orders to border closures and extensive contact tracing systems. As a growing body of research emerges exploring the efficacy and consequences of these strategies, there is an opportunity to reflect on their social and cultural impacts. In this paper I propose two analytical lenses through which to understand these impacts, framing the pandemic firstly as an (unplanned) social experiment which has transformed and illuminated our relationships with digital technologies, and secondly as a liminal moment and a shared set of social experiences. © 2021. All Rights Reserved.

Rapid rise in insulin requirements of inpatients with covid-19 given dexamethasone: Adaptations of the national guidelines to local needs

Background: Hyperglycaemia during admission with covid- 19 is associated with worse outcomes. Dexamethasone is used in severe covid-19. The national guidance suggests using prn quick acting insulin followed by twice daily intermediate acting insulin (0.3 units/kg) if blood glucose continues >12 mmol/L. Aim: To evaluate insulin requirements in inpatients with covid-19 and treated with steroids. Methods: Four rapid iterative quality improvement cycles evaluated the strategy for initiating insulin for patients with persistent hyperglycaemia (>11 mmol/L) and given steroids in an inner city teaching hospital trust. We identified consecutive referrals to the inpatient diabetes team. Exclusions include <7 days of steroids course, admission to intensive care or intravenous insulin. Electronic records were reviewed. Results are mean±SD. Results: Thirty-two referrals identified (63% male), type 2 diabetes 78%/22% no history of diabetes, 66 ± 11 years old, weight 90 ± 24 kg, HbA1c 75 ± 2.8 mmol/mol. covid-4C score 11/21 indicating high-risk patients. Seven days cumulative dexamethasone (or equivalent) dose was 48±23 mg. Admission glucose was 11.5 ± 5.7 mmol/L peaking on day 2 of steroids course (15.2 ± 4.4 mmol/L) and declining to nadir of 11.7 ± 4.2 mmol/L on day 6. Total daily insulin requirements rose rapidly from 0.07 ± 0.18 units/kg (day 1) to a peak of 0.72 ± 0.8 units/kg (day 4) and nadir of 0.64±0.7 units/kg (day 7). Conclusions: We found insulin requirements suggested in the national guidance to be a conservative estimate. In our cohort it is more than doubled in a short period of time requiring rapid titration. Learnings from this work informed the rapid adaptation of the local guidance by advocating early introduction of scheduled intermediate acting insulin when pre-steroids blood glucose is ≥11 mmol/L.

Pandemic Passages An Anthropological Account of Life and Liminality during COVID-19

The World Health Organization declared the COVID-19 pandemic on 11 March 2020, and the world has been different ever since. Recalling the work of Victor Turner and Arnold van Gennep, this article explores how their ideas about rituals and rites of passage can be used to make sense of the pandemic. In particular, it seeks to show how using the structure of rituals of separation and incorporation and liminality can unpack and highlight changing ideas about temporality, embodiment and relationships.

Olfactory acuity test while pre-symptomatic for COVID-19

An easily-constructed and self-administered olfactory acuity test for pre-symptomatic indication of infection by COVID-19 is described. This paper offers a simple test of smell threshold, which can be made and conducted at home and re-tested on oneself or others sharing isolation, and producing numerical data to indicate whether smell ability has decreased. During the COVID-19 pandemic, and until a vaccine is developed and available, becoming aware immediately of a loss of the important chemical sense, olfaction, can signal sufficient concern in individuals to self-isolate for the requisite period. The risk of COVID-19 spreading through communities can be reduced by promoting smell awareness by everyone, using simple, inexpensive measures, suggested in this paper. © 2020, Royal Society of New South Wales.