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Background: During the COVID-19 pandemic, skiing venues were labeled high-risk, and in Colorado, ski resorts were considered the epicenter of the COVID-19 outbreak. The aim of this study is to examine trends in COVID-19 outbreaks at ski resorts and restaurants near ski resorts in Colorado during the 2020 to 2021 ski season to explore the potential multidirectional influence of COVID-19 within local communities. Furthermore, this study identifies potential high-risk settings associated with ski resorts and details infection control and risk mitigation strategies to inform future response planning. Methods: COVID-19 ski resort and restaurant outbreak data reported by the Colorado Department of Public Health and Environment during the 2020 to 2021 ski season was evaluated. The number of outbreaks and cases were described by county and month. Means described the number of cases and duration of outbreaks by setting type and differences were assessed using Welch's Two Sample T-tests. Results: A total of 57 COVID-19 outbreaks and 429 COVID-19 cases from seven counties with ski resorts were reported. Of the ski resort-related outbreaks, the majority of outbreaks occurred in maintenance and operation settings accounting for 39.0% (n=22) of the total outbreaks reported. However, 62.0% (n=266) of the total number of cases were reported from lodging settings. Of the total 429 cases, 425 (99.1%) were reported in resort workers, including one death. Additionally, 66 restaurant-related outbreaks were detected, yielding 266 COVID-19 cases in restaurant-related settings potentially associated with ski resort tourism. Conclusions: The results of this study suggest that COVID-19 ski-resort related outbreaks were highest in settings that typically involved close and frequent contact between individuals. There is little evidence to support increased transmission of SARS-CoV-2 and the activity of skiing outdoors. Nearly all the reported outbreak-related cases occurred among workers, suggesting the potential for multidirectional disease transmission between guests and workers within the community. This study highlights the importance of implementing improved disease monitoring and surveillance measures, as well as establishing multilayered infection control and risk mitigation strategies to prepare for future public health challenges. © 2022 Journal of Innovation Management. All rights reserved.
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Background: Coronavirus disease 2019 (COVID-19), had two pandemic waves in 2020, respectively in April and November. In the general population, the first wave has been characterized by a higher prevalence in Northern Italy and a higher mortality rate compared to the second one. The aim of this study was to compare the characteristics of IBD patients and negative outcomes of COVID-19 (pneumonia, hospitalization, ventilatory support, death) between the two pandemic waves in Italy. Methods: Prospective observational cohort study. Patients with diagnosis of IBD and confirmed SARS-CoV-2 infection were enrolled. Differences between first and second wave were tested for significance using the Student's t test and Fisher's test, as appropriate. A two-tailed p value <0.05 was indicative of statistical significance. Results: We enrolled 937 IBD patients from 47 participating IBD centres across Italy (219 in the first wave, 718 in the second wave). There were no significant differences between the first and the second wave in terms of age (46.3 ± 16.0 vs. 44.1 ± 15.5 years, p=0.06) and gender (female 45.7% vs. 48.2%, p= 0.54). In the first wave, a lower percentage of patients was affected by Crohn's disease (CD): 92 (42.0%) vs. 399 (55.6%) (p<0.001) while no differences were observed for disease clinical activity: 97/219 (44.3%) vs. 280/718 (38.9%) in the first and second wave, respectively (p=0.18). Regarding biologic therapy, the percentage of patients on biologics in the two waves was similar: 119/219 (54.3%) vs. 393/718 (54.7%) (p=0.94), without differences in anti-TNFalpha, anti-integrins and anti-IL12/23 distribution. During the first wave, a significantly higher percentage of patients were from Northern Italy compared to Central-Southern Italy: 171/219 (78.1%) vs. 387/718 (53.9%), respectively (p<0.001). Overall, COVID-19 negative outcomes were significantly higher in the first wave compared to the second one: 110 (50.2%) vs. 95 (13.2%), respectively (p<0.001). Also the single negative outcomes were significantly higher in the first wave: 61/219 (27.8%) vs. 84/718 (11.7%) had pneumonia, 62/219 (28.3%) vs. 76/718 (10.6%) required hospitalization, 26/219 (11.9%) vs. 39/718 (5.4%) required ventilatory support, and 12/219 (5.5%) vs. 13/718 (1.8%) died (Figure 1). Conclusion: IBD patients had higher number of COVID-19 negative outcomes in the first wave than in second wave. In the first wave, a significantly higher percentage of patients were from Northern Italy, but no significant differences in negative outcomes were observed in comparison with those from Central- Southern Italy. Overall, findings in IBD population are coherent with those observed in the general population. (Table Presented).
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Background And Aim: Data From The First Wave Of Covid-19 Pan-Demic Suggested That Patients With Inflammatory Bowel Disease (Ibd) Are Not At Higher Risk Of Being Infected By Sars-Cov-2 Than The General Population And That, In Case Of Covid-19, Treatment With Immunomodulatory Drugs Is Not Associated With Worse Prognosis, With The Possible Exception Of Systemic Steroids. Evidence From The Second Wave Of Covid-19 Pandemic Is Required To Confirm These Findings. Materials And Methods: This Retrospective Observational Study Included Consecutive Ibd Patients Of The Cohort Of The Sicilian Network For Inflammatory Bowel Disease (Sn-Ibd) With Covid-19 Diagnosed By Pcr-Confirmed Presence Of Sars-Cov-2 Genome In A Nasopharyngeal Swab During The Second Covid-19 Pandemic Wave (15th September 2020–15th January 2020). Data Regarding Demo-Graphics, Ibd Features And Treatments, Comorbidities, And Symptoms Of Covid-19 Were Related To Covid-19 Clinical Outcomes. Results: One Hundred Twenty-Two Patients (Mean Age 43.9±16.7 Years;Males 50.0%;Crohn’S Disease 62.3%;Ulcerative Colitis: 37.7%) Were Included (Estimated Cumulative Incidence: 122/10,000 Ibd Patients=0.0122%). Twelve Patients Developed Covid-19-Related Pneumonia (9.8%), 4 (3.3%) Required Respiratory Assistance (Non-Mechanical Ventilation Or Orotracheal Intubation), And 4 Died (Case Fatality Rate: 3.3%). At Multivariate Analysis, Age (Or 1.034, 95% Ci 1.006-1.147, P=0.03) And Severe Ibd Activity (Or 13.465, 95% Ci 1.104-164.182, P=0.04) Were Independent Predictors Of Covid-19-Related Pneumonia, While Severe Ibd Activity (Or 15.359, 95% Ci 1.320-178.677, P=0.03) Was The Only Independent Predictor Of Severe Covid-19, A Composite End-Point Defined As Need For Respira-Tory Assistance And/Or Death. Concomitant Ibd Treatments Were Not Associated With Covid-19 Clinical Outcomes, Even If A Trend Toward A Protective Role Of Tnf-Inhibitors On Pneumonia Development Was Reported (P=0.08). Conclusions: In This Large Cohort Of Patients With Ibd And Covid-19, Severe Ibd Activity Was The Only Risk Factor For Severe Covid-19, While Ibd Treatments Were Not Associated With Worse Outcomes
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Background and aim: COVID-19 pandemics has led many IBD clinics to adopt a remote monitoring approach in order to ensure an adequate follow-up of patients with inflammatory bowel disease (IBD) while complying with the rules of social distancing while access to hospital had to be restricted. Materials and methods: The Aim of the study was to perform aremote monitoring survey in our tertiary referral center in order to assess patient adherence, perceptions and satisfaction, as well as their views for future monitoring. We also assessed changes in disease activity and quality of life. Consecutive patients scheduled for follow-up visits switched to remote monitoring via email from March 2020 to February 2021.They were asked to fill out a questionnairefocusing on 3 elements of the intervention: self-assessment, action plans and educational messages.For the self-assessment questions,we used the SIBDQ (to assess quality of life) and IBDSI (to rate symptoms as patient-reported outcomes). serum iron HBI and Mayo UC score were calculated by treating physicians.Results: 424 subjects,100% Caucasians,completed the survey. 233(55,1%) were male, 220 (52.0%) had Crohn’s Disease (CD).Median baseline Mayo Score and Harvey Bradshaw Index were 3 and 4, respectively. 9 (2,1%) patients were referred to emergency department because of disease flares. 2(1%) UC patients needed to add topical therapy, 9 (4%) CD patients started therapy with systemic steroids and 3 (1,3%) with biologics. 410 (96,9%) patients were satisfied about telemedicine, and 320 (76,5%) patients reported that would maintain this approach also after COVID-19 outbreak. On univariate logistic regression analysis, a high ferritin value was the only variable related to patients’ satisfaction (p=0.001). Lower calprotectin (p=0.012) and need for treatment change (p<0001) were found to be related to QoL, while CD (p=0.052), age (p=0.027), disease duration (p=0.046) and higher calprotectin (p=0.021) were associated to the need for treatment change. None of the variables were significant on multivariate analysis. Conclusions: Our results confirm, that a telemedicine approach can replace face-to-face consultations, at least for patients in remission or with mild clinical activity. Referral to emergency services or steroid use for disease flare were not significantly affected.Telemedicine could be the Covid19 legacy in the management of IBD in order to reduce the cost of patients’care and rationalize the use of health resources.
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Introduction: Vaccination against severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) offers hope in the fight against the current pandemic. However, the rapid development of SARS-CoV-2 vaccines has led to uncertainties among the Italian population, as well as among patients with inflammatory bowel disease (IBD) despite the international recommendations.1,2 Therefore, identification of valuable strategies to increase vaccine uptake in this population is needed. Aims & Methods: The aim of this study was to measure the acceptance of anti-SARS-CoV-2 vaccination in IBD patients, in order to develop measures against vaccine hesitancy. An anonymous web-based questionnaire was sent from Apr 05 to Apr 15, 2021 to patients of our IBD tertiary referral center addressing socio-demographic and therapeutic features as well as willingness and potential concerns regarding anti-SARS-CoV-2 vaccination. Results: Among the 450 questionnaires, 276 (61.3%) forms were returned. The population included 149 (54.0%) males, 109 (39.4%) patients with a mean age range of 35-54 years and 148 (56.8%) patients with Crohn's disease. 127 (46.0%) were on biologics, 28 (10.0%) were on steroids > 20 mg, 18 (6.0%) were on immunomodulators and only 10 (3.6%) were treated with combination therapy. Almost half of the cohort (47.1%) had received an influenza vaccine in 2020. A very small proportion (7.2%) of respondents declared they had contracted COVID-19. The proportion of patients willing to get vaccinated against SARS-CoV-2 was 148 (53.6%);among them, 110 (74.3%) had already received the first dose of vaccine. 103 (37.3%) patients reported they were uncertain but likely to change their mind after more safety information, whereas 25 (9.0%) declared to definitely refuse vaccination. For patients in favour of vaccination, the main reasons were duty for collective responsibility (65.4%), the wish to return to a normal life (53.0%), fear about their health (51.4%) and the desire to protect their relatives (42.7%). For patients against vaccination, the main reasons were the fear of side-effects (52.0%) and the possible negative effects on IBD course (52.0%). The predictors for vaccination acceptance in a multivariate analysis were influenza vaccination during the last year [odds ratio (OR) 3.78;95% confidence interval (CI) 2.22-6.44, P<0.0001], presence of an household member aged over 65 years (OR 2.22;95% CI 1.20-4.10, P=0.01) and gastroenterologist advice before booking vaccination (OR 3.30;95% CI 1.77-6.17, P=0.001). In particular, age, educational status and associated comorbidities were not significantly associated with vaccination willingness. Conclusion: This survey indicates that the majority of IBD patients wish to be vaccinated against SARS-CoV-2. Vaccine acceptance was associated with prior seasonal influenza vaccination, presence of an household member aged over 65 years and notably, gastroenterologist advice. Indeed, gastroenterology counselling plays a crucial role in combat hesitancy among uncertain patients.
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Introduction: COVID-19 pandemics has led IBD clinics to adopt a remote monitoring approach in order to ensure an adequate follow-up of patients with inflammatory bowel disease (IBD) while adhering to the rules of social distancing. However, physicians were concerned if a telemedicine approach could negatively affect the doctor-patient relationship and disease outcomes. Aims & Methods: The aim of the study was to perform a survey on IBD patients submitted to remote monitoring in our tertiary referral center in order to assess adherence, patients' perceptions and satisfaction as well as their opinions for future monitoring. We also evaluated changes in disease activity and Quality of Life using validated questionnaires. Consecutive patients with IBD scheduled for follow-up visits were switched to remote monitoring via e-mail from March 2020 to February 2021. Patients were asked to complete a questionnaire focusing on 3 elements of the intervention: (1) self-assessment questions, (2) action plans, and (3) educational messages. With regards to self-assessment questions, we used the SIBDQ (to evaluate the QoL) and the IBDSI (to evaluate symptoms as patients' reported outcomes). All patients sent by email results of blood texts: ESR, CRP, CBC, faecal calprotectin, ferritin, serum iron. HBI Index and Mayo UC score were calculated by the treating physicians. Results: 424 subjects, 100% Caucasians, completed the survey. 233 (55,1%) were male, 220 (52.0%) had Crohn's Disease (CD). Median baseline Mayo Score and Harvey Bradshaw Index were 3 and 4, respectively. 9 (2,1%) patients were referred to emergency department because of disease flares. 2 (1%) UC patients needed to add topical therapy, 9 (4%) CD patients started therapy with systemic steroids and 3 (1,3%) with biologics. 410 (96,9%) patients were satisfied about telemedicine, and 320 (76,5%) patients reported that would maintain this approach also after COVID-19 outbreak. On univariate logistic regression analysis, a high ferritin value was the only variable related to patients' satisfaction (p=0.001). Lower calprotectin (p=0.012) and need for treatment change (p<0001) were found to be related to QoL, while CD (p=0.052), age (p=0.027), disease duration (p=0.046) and higher calprotectin (p=0.021) were associated to the need for treatment change. None of the variables were significant on multivariate analysis. Conclusion: Our results confirm, in a homogeneous cohort of patients, that a telemedicine approach can replace face-to-face consultations, at least for patients in remission or with mild clinical activity. Referral to emergency services or steroid use for disease flare were not significantly affected. A high proportion of patients were satisfied and would maintain this management strategy. Telemedicine could be the Covid19 legacy in the management of IBD in order to reduce the cost of patients'care and rationalize the use of health resources.