PERSPECTIVES ON THE FUTURE CROSS-BORDER PANDEMIC MANAGEMENT

Within this paper requirements and related gaps associated with cross-border pandemic management are analyzed. In order to systematically investigate the potential of solutions to close such gaps, trials can be executed and evaluated. Core elements of such trials are specific scenarios that frame the validation of the applicability of solutions. Stakeholders involved in pandemic management specified a framing for such scenarios such as cross-border common operational picture and resource management, pandemic management during a refugee crisis and sharing of mobile infrastructure to detect pathogens. An insight in these scenarios is given and, finally, solutions having the potential to close at least partially gaps arising in the mentioned scenarios provided from projects such as STAMINA are presented. © 2022 IDIMT. All rights reserved.

REQUIREMENT FOCUSED INTERVENTION-MATCHING FOR PANDEMIC MANAGEMENT: NATIONAL PERSPECTIVES FOR INVOLVEMENT OF EVIDENCE BASED LESSONS LEARNED

COVID-19 still represents one of the greatest global challenges of the last decades in terms of medical, coordination and management aspects, but also on the societal and economic level. Even after more than two years, the rapidly changing requirements that the emerging variations of the virus call for, show that Austria – as the majority of countries and organizations – is still struggling with a stringent and pertinent management approach. The call for a comprehensive, applicable and interoperable solution portfolio including evidence-based analysis of current processes/structures, tools and infrastructures as well as lessons learned from the current pandemic response, is evident. The enhanced “ROADS to Health”-approach, currently evaluated by national funding agencies, reflects this aim: a holistic solution set aiming at a technologically supported, lessons learned based system for the pandemic management for the future. ROADS focuses on a basis for optimized crisis management for future pandemics/epidemics from a holistic, user-centric perspective. The concrete goal is to create a basis for a technologically supported measure matching to current requirements for decision-makers and critical infrastructures. Thus, interventions or future mitigation measures for the management of a pandemic are matched with concrete and current requirements. This measure matching will build upon the existing "Portfolio of Solutions" (POS) platform developed by AIT. Relevant medical/epidemiological, social, economic and legal fundamentals and different types and characteristics of pandemics/epidemics will also be considered (infection routes, morbidity and mortality risks, affectedness: age, gender ...) as well as various needs, given resources and processes. International lessons learned from the COVID-19 crisis, knowledge and results from merging practical experiences from crisis management feed into a concept design to facilitate and initiate technological support for enhanced future pandemics/epidemics tackling and potentially for other crisis situations. This keynote paper will draft the frame of this model by presenting the underlying background and basis of the ROADS to Health-solution set and open the floor for a wider range of perspectives of optimization in pandemic and crisis management. © 2022 IDIMT. All rights reserved.

Tocilizumab is associated with increased risk of fungal infections among critically ill patients with COVID-19

IntroductionDozens of medications have been re-evaluated as possible treatments for coronavirus 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Tocilizumab is a humanized monoclonal antibody directed against the interleukin-6 (IL-6) receptor that has been proposed as a therapy for patients with severe COVID-19 pneumonia. It is possible that the immunomodulatory effects of tocilizumab may also have the unintended consequence of predisposing to secondary infections. We sought to assess the risk of invasive fungal disease and therapeutic impact of tocilizumab on hospital and intensive care unit (ICU) outcomes in critically ill patients with severe COVID-19. MethodsRecords of critically-ill patients with COVID-19 over a 6 month period at our institution were reviewed, and medical histories, treatments, and clinical outcomes were extracted. The incidence of fungal infections in those that received tocilizumab in addition to standard COVID-19 treatments was assessed. ICU length of stay (LOS), duration of mechanical ventilation, and hospital LOS were compared between treatment groups. ResultsOne-hundred and thirty patients were identified, of which 56 met inclusion criteria. 16 patients received tocilizumab, and 40 did not. Invasive fungal infections occurred in 10.7% of all patients. Infection rates were significantly higher in the tocilizumab group than in the control group (31.2% v 2.5%, RR 12.5, p<0.01). There was a strong dose-response relation for tocilizumab, with 2.5% of events occurring with 0 doses, 20% with a single dose, and 50% with 2 doses (M-H OR 39, p<0.01). There were also statistically significant increased ICU LOS (3.73 v 1.91, p <0.01), duration of mechanical ventilation (3.58 v. 1.95, p<0.01), and hospital LOS (3.83 v. 2.58, p <0.01) in those that received tocilizumab and developed a fungal infection (Figure 1). ConclusionsRepurposed therapies like tocilizumab may have a potential role in the treatment of severe COVID-19, but these data suggest there is a significant risk of developing secondary fungal infection and highlight the impact this can have on important ICU outcomes. (Table Presented).