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We present some recent activity in Ontario on the mathematical modeling of COVID-19 and the development of optimal strategies for vaccine distribution that take into account equity issues.
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This white paper will summarize the key topics, outcomes, and recommendations from the Canada-India Healthcare Summit 2021 COVID-19 Pandemic Response and Initiatives sessions held on May 20-21, 2021. In particular, the authors have focused their attention on topics on the effect of COVID-19 on noncommunicable diseases, depression, research on substance abuse, and post COVID-19 pain management. The authors have developed a better understanding of these conditions' interplay with COVID-19 infection. The paper also deals with important topics around the effects of NCD on COVID-19 and vice versa, as well as key considerations around research and development, innovation, policy, and finally, summarizes the ways forward in which Canada and India could collaborate strategically. We also include key points raised during the summit.
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Artificial intelligence (AI) has a great impact on our daily living and makes our lives more efficient and productive. Especially during the coronavirus disease (COVID-19) pandemic, AI has played a key role in response to the global health crisis. There has been a boom in AI innovation and its use since the pandemic. However, despite its widespread adoption and great potential, most people have little knowledge of AI concepts and realization of its potential. The objective of this white paper is to communicate the importance of AI and its benefits to society. The report covers AI applications in six different topics from medicine (AI deployment in clinical settings, imaging and diagnostics, and acceleration of drug discovery) to more social aspects (support older adults in long-term care homes, and AI in supporting small and medium enterprises. The report ends with nine steps to consider for moving forward with AI implementation during and post pandemic period. These include legal and ethical data collection and storage, greater data access, multidisciplinary collaboration, and policy reform.
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Objective: To characterize management and outcomes of seizures, status epilepticus, and cortical myoclonus in COVID-19, with individual patient data analysis of published literature. Background: Seizure disorders in COVID-19 have been sparingly reported. Lack of large-scale studies create challenges in identifying clinically relevant associated factors. Design/Methods: Systematic literature review was conducted in accordance with PRISMA guidelines. Criteria included new-onset seizures, status epilepticus, and/or cortical myoclonus developing prior to or during hospitalization, with concomitant COVID-19. COVID-19 severity was dichotomized into mild and severe cases, based on severity of respiratory symptoms. Good outcome was defined as discharge without severe deficits, and/or return to near baseline. Results: A total of 105 studies reporting 175 patients (male 56.6%;mean age 47.9, SD 25.7) were included. Status epilepticus occurred in 44 patients (25.1%) and myoclonus in 38 (21.7%). Any seizure-like activity on electroencephalography (EEG) was noted in 53/102 patients (52.0%). Abnormal cerebrospinal fluid analysis was reported in 32/83 patients (38.6%). Most common underlying diagnosis was encephalitis (autoimmune or infectious) in 42/175 patients (24.0%), followed by infarct (15/175;8.6%) and intracerebral hemorrhage (ICH) (13/175;7.4%). The most common treatment was levetiracetam (92/130;70.8%). Overall, 106/160 patients (66.3%) had good outcomes while 24/156 died (15.4%). Encephalitis was associated with good outcomes (p=0.005). Severe COVID-19 was associated with more myoclonus, poor outcome, and mortality (all p<0.001), with a trend towards more EEG abnormalities (p=0.066). In multivariate regression, only severe COVID-19 was associated with reduced odds of good outcome (OR=0.095;p=0.006), and higher odds of mortality (OR=4.60, p=0.040). Conclusions: Encephalitis, infarct, and ICH are common underlying etiologies in COVID-19 patients with seizure disorders. Overall, most patients achieved good outcome, thus highlighting the necessity of aggressively treating seizures, and identifying any treatable underlying etiology. Future research should investigate long-term neurocognitive outcomes in COVID-19 patients with seizure disorders.
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Background: Acute peritoneal dialysis (AKI-PD) used to manage about 20% of our COVID-19 AKI patients requiring renal replacement therapy (RRT) of whom 45% had renal recovery. Methods: Retrospective chart review of 11 consecutive patients undegoing bedside PD catheter placement from 4/1/2020 to 4/30/2020 Results: Median time from admission to the development of AKI was 1 day (IQR 0-3) (Table 1). In 73% of the patients, CRRT or intermittent HD was used as the initial RRT modality;CRRT circuit clotting was the primary reason for switching to PD in 2 patients. Median time from diagnosis of AKI to PD catheter insertion was 5 days (IQR 2-14). At one week, 10 catheters (91%) were functional with no leaks or bleeding detected. Only one patient was switched to CRRT due to primary PD catheter non-function;thispatient had BMI greater than 35 kg/m2 and a history of appendectomy. Median duration of follow up from time of PD catheter placement was 37 days (IQR 32-37.5), death-censored median follow up was 35 days (IQR 30-37.5). The median time from AKI to death was 17 days (IQR 14-22). Median time from AKI to renal recovery was 34 days (IQR 21- 40). Conclusions: In our AKI-PD cohort, the mortality rate was noted to be 36% and 45% had renal recovery during the follow up period. We hypothesize that preservation of residual renal function utilizing PD may have contributed to the high rate of renal recovery observed. Two of our patients converted from CRRT to PD due to repeated filter clotting. We did not observe any bleeding complications in our cohort. We hypothesize that hypercoagulable COVID-19 patients may be excellent candidates for PD potentially due to lower risk of bleeding complications.