Increased proportion of alcohol-related trauma in a South London major trauma centre during lockdown, a cohort study

Background: Alcohol has been associated with 10-35% trauma admissions and 40% trauma-related deaths globally. In response to the Covid-19 pandemic, the United Kingdom (UK) entered a state of 'lockdown' on 23rd March 2020. Restrictions were most significantly eased on 1st June 2020, when shops and schools re-opened. The purpose of this study was to quantify the effect of lockdown on alcohol-related trauma admissions. Method: All adult patients admitted as 'trauma calls' to a London Major Trauma Centre (MTC) during April 2018 and April 2019 (pre-lockdown;N=316), and 1st April - 31st May 2020 (lockdown;N=191) had electronic patient records analysed. Patients' blood alcohol level and records of intoxication were used to identify alcohol-related trauma. Trauma admissions from pre- and post-lockdown cohorts were compared using multiple regression analyses. Results: Alcohol-related trauma was present in a significantly higher proportion of adult trauma calls during lockdown (lockdown 60/191 (31.4%), versus pre-lockdown 62/316 (19.6%);(Odds Ratio (OR) 0.83, 95% CI 0.38 to 1.28, p<0.001). Lockdown was also associated with increased weekend admissions of trauma (lockdown 125/191 weekend (65.5%) vs pre-lockdown 179/316 (56.7%);OR -0.40, 95% CI -0.79 to -0.02, p=0.041). No significant difference existed in the age, gender, or mechanism between pre-lockdown and lockdown cohorts (p>0.05). Conclusions: UK lockdown was independently associated with an increased proportion of alcohol-related trauma. Trauma admissions were increased during the weekend when staffing levels are reduced. With the possibility of subsequent global 'waves' of Covid-19, the risk of long-term repercussions of dangerous alcohol-related behaviour to public health must be addressed.

Comparing outcomes and characteristics of COVID-19 patients treated with CPAP inside and outside of the intensive care unit

P211 Table 1Displaying baseline characteristics, physiological observations, laboratory tests, and outcomes of all patients treated with CPAP and comparing these observations between those treated inside and outside of the ICU All Patients (n=187) ICU (n=90) Non-ICU (n=97) p-value Age - Mean (SD) 66.1 (12.7) 61.2 (13.9) 70.9 (11.8) <0.001 Male – n (%) 120 (64) 57 (63) 63 (65) 0.530 CPAP duration in days – Median (range) 4 (1–48) 4 (1–20) 4 (1–48) 0.356 Inpatient Death – n (%) 84 (45) 26 (29) 58 (60) <0.001 Comorbidities - n (%) HTN 94 (50) 37 (41) 57 (59) 0.005 Diabetes Mellitus 53 (28) 16 (18) 37 (38) <0.001 COPD 39 (21) 12 (13) 27 (28) 0.008 Asthma 24 (13) 7 (8) 17 (18) 0.031 IHD 36 (19) 10 (11) 26 (27) 0.003 Smoking History 87 (47) 30 (33) 57 (59) <0.001 Obesity 69 (37) 36 (40) 33 (34) 0.108 Laboratory Results - Mean (SD) Admission WCC - x109/L 9.8 (4.4) 11.0 (6.3) 8.8 (4.2) 0.016 Admission lymphocyte count - x109/L 1.25 (0.64) 1.94 (0.81) 1.18 (0.95) 0.190 Admission Urea - mmol/L 9.3 (6.7) 7.8 (4.2) 10.6 (7.8) 0.006 Admission C-reactive Protein - mg/L 135.8 (101.5) 135.2 (102.0) 130.1 (90.8) 0.750 Observations pre-CPAP – Mean (SD) Respiratory Rate 25.8 (6.4) 26.4 (6.9) 25.7 (6.0) 0.345 Heart Rate 92.4 (20.4) 96.9 (21.7) 89.8 (19.7) 0.044 Oxygen Saturations 88.8 (7.1) 88.7 (7.3) 88.4 (6.7) 0.280 FiO2 -% 59.9 (22.9) 58.9 (32.3) 66.1 (17.5) 0.074 Arterial Blood Gas Results pre-CPAP – Mean (SD) Arterial pH 7.44 (0.08) 7.45 (0.07) 7.44 (0.07) 0.484 Arterial pO2 - kPa 7.4 (1.4) 7.4 (1.3) 7.4 (1.5) 0.796 Arterial Base Excess – mmol/L 0.6 (4.9) 0.7 (3.6) 0.5 (5.0) 0.813 ConclusionsIn our report we found that inpatient mortality of those treated inside of the ICU was significantly lower than that of those treated outside of this setting, however, those treated in the ICU were also significantly younger and had fewer comorbidities. Despite the higher mortality outside of the ICU, 40% of patients treated in this setting survived to discharge, this may suggest that those who may be deemed unsuitable for treatment with CPAP on the ICU can be managed safely outside of this setting.

Fit-testing of respiratory protective equipment in the UK during the initial response to the COVID-19 pandemic.

BACKGROUND: Public Health England guidance stipulates the use of filtering facepiece (FFP3) masks for healthcare workers engaged in aerosol-generating procedures. Mask fit-testing of respiratory protective equipment is essential to protect healthcare workers from aerosolized particles. AIM: To analyse the outcome of mask fit-testing across National Health Service (NHS) hospitals in the UK during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Using the Freedom of Information Act, 137 NHS hospitals were approached on May 26th, 2020 by an independent researcher to provide data on the outcome of fit-testing at each site. FINDINGS: Ninety-six hospitals responded to the request between May 26th, 2020 to October 29th, 2020. There was a total of 86 mask types used across 56 hospitals, 13 of which were used in at least 10% of these hospitals; the most frequently used was the FFP3M1863, used by 92.86% of hospitals. Overall fit-testing pass rates were provided by 32 hospitals with mean pass rate of 80.74%. The most successful masks, in terms of fit-test failure rates, were the Alpha Solway 3030V and the Alpha Solway S-3V (both reporting mean fit-test failures of 2%). Male- and female-specific pass and failure rates were provided by seven hospitals. Across the seven hospitals, 20.1% of men tested failed the fit-test for all masks used, whereas 19.9% of women tested failed the fit-test for all masks used. Failure rates were significantly higher in staff from Black, Asian, and Minority Ethnic (BAME) backgrounds 644/2507 (25.69%) across four hospitals. CONCLUSION: Twenty percent of healthcare workers tested during the first response to the pandemic failed fit-testing for masks. A small sample revealed that this was most prominent in staff from BAME backgrounds.

D614G is located in a densely hydrophobic spike glycoprotein motif conserved in the Sarbecovirus group

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the pathogen responsible for the COVID-19 pandemic. The D614G substitution appeared in the spike glycoprotein (SGP) of SARS-CoV-2 at an early stage of the COVID-19 outbreak and the mutant carrying the substitution quickly became the most prevalent SARS-CoV-2 variant at several COVID-19 epicenters across the world. There has been a debate on the nature of the mutation, some even suggesting that the mutation is likely to be functionally neutral. One of the ways to understand the nature of this mutation is to study the evolutionary history of the 614th amino acid position of the spike glycoprotein in coronaviruses. In the present bioinformatics study we analyzed a few hundred SARS-CoV (of 2003 outbreak), SARS-CoV-2 and animal SARS-Like strains of the Sarbecovirus group to obtain insights into the conservation of aspartic acid at the 614th amino acid position in the SGP of these viruses, using our software tool Compare. After analyzing the conservation profiles of several Sarbecovirus sequences obtained from GenBank we show here that the 614 amino acid residue is located in an 11-amino acid densely hydrophobic motif, vavlyqdvnct (11-aa) that is almost perfectly conserved in the Sarbecovirus sub-genus and the D614G substitution increased the hydrophobicity of the motif by about 38%. We also identified one SARS-CoV genome in the pre-pandemic GenBank records (Accession: FJ882963) that has the D614G substitution. The fact that the original strain of SARS-CoV-2 with aspartic acid at the 614th position (D-variant) is now almost extinct emphasizes the importance of the D614G mutation for the survival of the virus. We propose that the D614G substitution altered the chemistry of the 11-aa and helped in the spread and continued survival of the virus by some yet to be identified biochemical mechanisms.