Evaluation and Management of Dysphagia During the COVID-19 Pandemic

Dysphagia is a common symptom which requires a multidisciplinary approach to its assessment and management. Currently, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the novel coronavirus disease 2019 (COVID-19) pandemic. Reports of SARS-CoV-2 dissemination via droplet and aerosol production imply risks of virus transmission by both. The risk of transmission of SARS-CoV-2 during nasal endoscopic procedures has elicited concern from clinicians and other healthcare workers regarding the level of personal protective equipment required during any transnasal procedure. SARS-CoV-2 infection has a variety of clinical manifestations of which pneumonia is the most devastating and which may potentially be fatal. Complications after prolonged endotracheal intubation or tracheostomy are common and include dysphagia. Poor lung function following recovery from pneumonia is an underrated precipitating factor for dysphagia. Multiple cranial nerve neuropathies are a more common direct cause of dysphagia that require urgent evaluation and treatment to avoid the complications of aspiration pneumonia that may compound the existing pneumonia caused by SARS-CoV-2. A videofluoroscopic study of a patient with dysphagia after recovering from COVID-19 will likely demonstrate significant impairment of their oral and pharyngeal phase of swallowing. A practical workflow for assessing and managing dysphagia during the COVID-19 pandemic is crucial to ensure the safety of both patients and healthcare workers. Critical considerations include the reservation of instrumental assessments for urgent cases only, the optimization of the non-instrumental swallowing evaluation, the appropriate use of personal protective equipment (PPE), and the use of telemedicine when appropriate. Despite significant limitations in the clinical service provision during the current COVID-19 pandemic, a safe and reasonable dysphagia care pathway can still be implemented with an understanding of safety precautions, modifications of the investigation setup and with the application of newer technologies. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Virtual-Reality Simulation Can Teach VATS Lobectomy to Lobectomy-Naive Trainees Within 4 Weeks: A Cross-Over Study

Objective: The aim of the cross-over study was to evaluate skill acquisition in lobectomy-naive surgical trainees completing a 4-week program to learn VATS lobectomy on a virtual reality surgical simulator (LapSim). Method(s): Lobectomynaive surgical trainees (year 1 and 2 postgraduation) were enrolled during the COVID pandemic from March to June 2021 for a 4-week course on basic VATS skills and right upper lobectomy. They were divided into 2 groups. Both groups completed an initial assessment, Group 1 completed the course first, then both groups completed a second assessment. Then Group 2 completed the course, and both groups completed a final assessment. Skill acquisition was assessed using instrument movement, procedure time, and blood loss for both the trained operation and an untrained operation (left lower lobectomy). Result(s): 16 trainees were enrolled, 10 completed the training program. There was no difference in baseline assessment. After Group 1 completed the training, they outperformed Group 2 in all metrics but this did not reach statistical significance. After training Group 2 at week 8, there was no longer difference in performance from Group 1. After completing the training program, the entire cohort showed a significant improvement in basic VATS tasks as well as lobectomies. There was statistically significant improvement in both right upper lobectomy instrument movement (P=0.002) and time (P=0.009) and left lower lobectomy time (P=0.047). Conclusion(s): This study showed that VATS simulation training on LapSim allowed junior trainees to learn advanced VATS resection during a pandemic and within 4 weeks. The acquired skills is transferrable to untrained operations. (Table Presented).

Diminished Neutralization Capacity of SARS-CoV-2 Omicron BA.1 in Donor Plasma Collected from January to March 2021.

The 50% plaque reduction neutralization assay (PRNT50) has been previously used to assess the neutralization capacity of donor plasma against wild-type and variant of concern (VOC) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Emerging data suggest that plasma with an anti-SARS-CoV-2 level of ≥2 × 104 binding antibody units/mL (BAU/mL) protects against SARS-CoV-2 Omicron BA.1 infection. Specimens were collected using a cross-sectional random sampling approach. For PRNT50 studies, 63 previously analyzed specimens by PRNT50 versus SARS-CoV-2 wild-type, Alpha, Beta, Gamma, and Delta were analyzed by PRNT50 versus Omicron BA.1. The 63 specimens plus 4,390 specimens (randomly sampled regardless of serological evidence of infection) were also tested using the Abbott SARS-CoV-2 IgG II Quant assay (anti-spike [S]; Abbott, Chicago, IL, USA; Abbott Quant assay). In the vaccinated group, the percentages of specimens with any measurable PRNT50 versus wild-type or VOC were wild type (21/25 [84%]), Alpha (19/25 [76%]), Beta (18/25 [72%]), Gamma (13/25 [52%]), Delta (19/25 [76%]), and Omicron BA.1 (9/25 [36%]). In the unvaccinated group, the percentages of specimens with any measurable PRNT50 versus wild type or VOC were wild-type SARS-CoV-2 (16/39 [41%]), Alpha (16/39 [41%]), Beta (10/39 [26%]), Gamma (9/39 [23%]), Delta (16/39 [41%]), and Omicron BA.1 (0/39) (Fisher's exact tests, vaccinated versus unvaccinated for each variant, P < 0.05). None of the 4,453 specimens tested by the Abbott Quant assay had a binding capacity of ≥2 × 104 BAU/mL. Vaccinated donors were more likely than unvaccinated donors to neutralize Omicron when assessed by a PRNT50 assay. IMPORTANCE SARS-CoV-2 Omicron emergence occurred in Canada during the period from November 2021 to January 2022. This study assessed the ability of donor plasma collected earlier (January to March 2021) to generate any neutralizing capacity against Omicron BA.1 SARS-CoV-2. Vaccinated individuals, regardless of infection status, were more likely to neutralize Omicron BA.1 than unvaccinated individuals. This study then used a semiquantitative binding antibody assay to screen a larger number of specimens (4,453) for individual specimens that might have high-titer neutralizing capacity against Omicron BA.1. None of the 4,453 specimens tested by the semiquantitative SARS-CoV-2 assay had a binding capacity suggestive of a high-titer neutralizing capacity against Omicron BA.1. These data do not imply that Canadians lacked immunity to Omicron BA.1 during the study period. Immunity to SARS-CoV-2 is complex, and there is still no wide consensus on correlation of protection to SARS-CoV-2.

The Bitcoin Halving Cycle Volatility Dynamics and Safe Haven-Hedge Properties: A MSGARCH Approach

This paper introduces a unique perspective towards Bitcoin safe haven and hedge properties through the Bitcoin halving cycle. The Bitcoin halving cycle suggests that Bitcoin price movement follows specific sequences, and Bitcoin price movement is independent of other assets. This has significant implications for Bitcoin properties, encompassing its risk profile, volatility dynamics, safe haven properties, and hedge properties. Bitcoin's institutional and industrial adoption gained traction in 2021, while recent studies suggest that gold lost its safe haven properties against the S&P500 in 2021 amid signs of funds flowing out of gold into Bitcoin. Amid multiple forces at play (COVID-19, halving cycle, institutional adoption), the potential existence of regime changes should be considered when examining volatility dynamics. Therefore, the objective of this study is twofold. The first objective is to examine gold and Bitcoin safe haven and hedge properties against three US stock indices before and after the stock market selloff in March 2020. The second objective is to examine the potential regime changes and the symmetric properties of the Bitcoin volatility profile during the halving cycle. The Markov Switching GARCH model was used in this study to elucidate regime changes in the GARCH volatility dynamics of Bitcoin and its halving cycle. Results show that gold did not exhibit safe haven and hedge properties against three US stock indices after the COVID-19 outbreak, while Bitcoin did not exhibit safe haven or hedge properties against the US stock market indices before or after the COVID-19 pandemic market crash. Furthermore, this study also found that the regime changes are associated with low and high volatility periods rather than specific stages of a Bitcoin halving cycle and are asymmetric. Bitcoin may yet exhibit safe haven and hedge properties as, at the time of writing, these properties may manifest through sustained adoption growth. © 2023 by the authors.

Keep DRAGging ON: Is solving more problems in DragonBox 12+ associated with higher mathematical performance during the COVID-19 pandemic?

Prior research has shown that game-based learning tools, such as DragonBox 12+, support algebraic understanding and that students' in-game progress positively predicts their later performance. Using data from 253 seventh-graders (12–13 years old) who played DragonBox as a part of technology intervention, we examined (a) the relations between students' progress within DragonBox and their algebraic knowledge and general mathematics achievement, (b) the moderating effects of students' prior performance on these relations and (c) the potential factors associated with students' in-game progress. Among students with higher prior algebraic knowledge, higher in-game progress was related to higher algebraic knowledge after the intervention. Higher in-game progress was also associated with higher end-of-year mathematics achievement, and this association was stronger among students with lower prior mathematics achievement. Students' demographic characteristics, prior knowledge and prior achievement did not significantly predict in-game progress beyond the number of intervention sessions students completed. These findings advance research on how, for whom and in what contexts game-based interventions, such as DragonBox, support mathematical learning and have implications for practice using game-based technologies to supplement instruction. Practitioner notes What is already known about this topic DragonBox 12+ may support students' understanding of algebra but the findings are mixed. Students who solve more problems within math games tend to show higher performance after gameplay. Students' engagement with mathematics is often related to their prior math performance. What this paper adds For students with higher prior algebraic knowledge, solving more problems in DragonBox 12+ is related to higher algebraic performance after gameplay. Students who make more in-game progress also have higher mathematics achievement, especially for students with lower prior achievement. Students who spend more time playing DragonBox 12+ make more in-game progress;their demographic, prior knowledge and prior achievement are not related to in-game progress. Implications for practice and/or policy DragonBox 12+ can be beneficial as a supplement to algebra instruction for students with some understanding of algebra. DragonBox 12+ can engage students with mathematics across achievement levels. Dedicating time and encouraging students to play DragonBox 12+ may help them make more in-game progress, and in turn, support math learning. © 2023 The Authors. British Journal of Educational Technology published by John Wiley & Sons Ltd on behalf of British Educational Research Association.

Traveling with pets: designing hospitality services for pet owners/parents and hotel guests

Purpose: Pet-friendly hotels are growing rapidly. The prevalence of pet adoption has largely resulted from the loneliness due to social distancing that happened during the Coronavirus disease 2019 pandemic. Many hotels around the world aim to become pet-friendly to satisfy the growing demand. Hoteliers believe that the popularity of pet-friendly hotels will continue, as pet owners often treat pets as their kids. This study aims to investigate how pet-friendly hotels need to design and manage pet-friendly services and policies. Design/methodology/approach: Using grounded theory methodology, this research conducts interviews with 25 pet-friendly hotel managers from Hong Kong (HK). The study includes hotels from different hotel categories and classifications. It examines the conceptualization of pet-friendly service design, drawing on a service blueprint. Findings: Building on the service marketing and service blueprint literature, this research provides a synthesis that reflects how pet-friendly hotels can serve both guests with and without pets. The findings reveal that pet-owner's service expectations are formed on anthropomorphism, that is, an inclination of attributing human features to nonhuman entity. Hotel managers, and particular those who have pets personally understand better how pet-friendly service can be adapted to meet the expectations and requirements of pet owners while accommodating guests without pets. The market of pet-friendly hospitality is growing, with high profit potential from pet owners who are willing to spend generously. Research limitations/implications: Data were collected from selected pet-friendly hotels in HK through interviews with pet-friendly service providers. The research is qualitative and exploratory in nature. It aims to explore and examine the multilevel pet-friendly hospitality service design from a managerial perspective. This research enriches the literature on anthropomorphism theory, the design of pet-friendly services and the application of service blueprint. Practical implications: The research offers explicit suggestions for the design of pet-friendly hospitality services. A pet-friendly hotel service blueprint is developed. This can help managers to develop essential pet-friendly policies and service collaborations between internal departments and with external specialist organizations, maximizing the value for all stakeholders. Originality/value: The study explores a rapidly emerging market and scrutinizes its specific design requirements. It extends theoretical insights by enriching the anthropomorphism theory and broadening the conceptualizations of service blueprint based on anthropomorphism theory. © 2023, Emerald Publishing Limited.

COVID-19 Pandemic and the Malaysian Tourism

This chapter analyses the impacts of the coronavirus pandemic on the Malaysian tourism industry. The discussion starts with general development of global tourism, followed by the drastic changes in Malaysian tourism and the economic conditions before and during the pandemic. With support of updated statistics, this chapter further presents the disastrous strikes on domestic tourism value chain, hotel lines, and the aviation industry. The relevant policy responses and post-pandemic tourism recovery are also discussed for better understanding of the vulnerable ecosystem. This chapter concludes that the recovery is progressive along UNWTO's Scenario 1 (before or by 2023) but subjected to domestic policy efficacy and global responses, especially the availability and affordability of vaccines. This chapter recommends proactive short-term policy initiatives in preparing the sector and its value chain to be COVID secure, and then launching marketing campaigns. For long-term strategic planning, the government should look into initiating and building capacity of digitalisation in the sector. © 2022 by World Scientific Publishing Co. Pte. Ltd.

Advanced liver disease and Coronavirus Disease-2019 (COVID-19) vaccination rates among prisoners with Hepatitis C Virus (HCV)

Introduction: Incarcerated populations with HCV are at high risk of contracting COVID-19 disease and COVID-19-induced liver injury, causing significant morbidity and mortality. Despite the availability of vaccines, vaccine hesitancy among these populations remains a problem. Unfortunately, few studies discussed COVID-19 vaccination rates among HCV-positive prisoners. To identify subgroups that will require more interventions to prevent COVID-19, this study will assess the association between COVID-19 vaccination rates and the degree of hepatic impairment among HCV-positive prisoners. Research Question or Hypothesis: HCV-positive prisoners are more likely to receive COVID-19 vaccine if they have advanced liver disease compared to HCV-positive prisoners without hepatic impairment. Study Design: Retrospective chart review at the Illinois Department of Corrections (IDOC) HCV Clinic. Method(s): Patients seen between 12/11/2020 to 1/10/2022 were evaluated. Eligible IDOC patients included if >18 years old, had a documented COVID-19 vaccination status, and were eligible for HCV treatment. Vaccination status, FibroScan scores, abdominal ultrasound, and APRI were collected to determine if there is an association between COVID-19 vaccination rates and degree of hepatic impairment. Estimates and odds ratios were assessed using continuous and categorical variables, respectively. P-values determined statistical significance. Result(s): This IRB approved study including 336 patients showed no significant associations between the degree of hepatic impairment and COVID-19 vaccination rates using the regression model for analysis. The odds of one receiving the COVID-19 vaccine are 1.24 times more likely for someone with ultrasound evidence of cirrhosis compared to one without a documented ultrasound, and 1.01 times more likely for someone with advanced fibrosis compared to one with mild fibrosis. Conclusion(s): There was a trend showing that HCV-positive prisoners with advanced liver disease were more likely to be vaccinated against COVID-19. While an association cannot be made given statistically non-significant results, education about the importance of COVID-19 vaccination among all HCV-positive prisoners, including those with minor hepatic impairment, is imperative.

Automatic Text Summarization of COVID-19 Scientific Research Topics Using Pre-trained Models from Hugging Face

Automated text summarizing helps the scientific and medical sectors by identifying and extracting relevant information from articles. Automatic text summarization is a way of compressing text documents so that users may find important and useful information in the original text in reduced time. We will first review some new works in the field of summarization that uses deep learning approaches, and then we will explain the application to COVID-19 related research papers. The ease with which a reader can grasp written text is referred to as the readability test. The substance of text determines its readability in natural language processing. We constructed word clouds using the s' most commonly used text. By looking at those three measurements, we can determine the performance measures of ROUGE-1, ROUGE-2, ROUGE-L, ROUGE-L-SUM. Our findings indicated that Distilbart-mnli-12-6 and GPT2-large outperform than others considered. © 2022 IEEE.

A "missed" nasal button battery in a child during the COVID-19 pandemic

A 5-year-old boy was referred acutelytoThe on-call ENT doctor following multiple remote consultations with his General practitioner with 2 months history of worsening left-sided foul-smelling nasal discharge and bleeding. He underwent examination under anaesthesia and removal of nasal foreign body which was subsequently identified as a button battery (intra-operative as well as imaging pictures included). This case highlights The challenges posed to clinicians during The COVID-19 pandemic but also serves as a reminder to keep a high index of suspicion and low threshold for clinical examination in suspected cases of nasal foreign body. It also highlights that since COVID19 omicron variant has emerged it is more than significant to evaluate cases that are assessed remotely with increased care to avoid any further misses or mistakes.

COVID-19 vaccination-related exacerbation of seizures in persons with epilepsy.

Although vaccines are generally safe in persons with epilepsy (PWE), seizures can be associated with vaccination, including COVID-19. This study assessed the occurrence of COVID-19 vaccination-related seizure exacerbations in PWE. Adult PWE who had received a COVID-19 vaccine were consecutively recruited at a tertiary epilepsy clinic between June 2021 and April 2022. Patient demographics, including epilepsy history, vaccination details, and reported adverse effects were recorded. Seizure exacerbation, defined as occurring within one week of vaccination, was assessed. Five hundred and thirty PWE received the COVID-19 vaccine. 75 % received the Comirnaty (Pfizer) vaccine as their initial dose. Most patients (72 %) were taking ≥ 2 antiseizure medications (ASM) and had focal epilepsy (73 %). One-third were 12 months seizure free at their first vaccination. 13 patients (2.5 %) reported a seizure exacerbation following their first vaccination, three of whom required admission. None were seizure-free at baseline. Six of these patients (46 %) had a further exacerbation of seizures with their second vaccine. An additional four patients reported increased seizures only with the second vaccine dose. Seizure exacerbations are infrequently associated with COVID-19 vaccination, mainly in patients with ongoing seizures. The likelihood of COVID-19 infection complications in PWE outweighs the risk of vaccination-related seizure exacerbations.

Slack Intern Curriculum Supports Intern Preparedness and Bridges Curriculum Gaps due to COVID-19 Slack Intern Curriculum

"Objectives: Assess the effectiveness of social media implementation of an Accreditation Council for Graduate Medical Education (ACGME) milestone-based curriculum during the spring 2020 U.S. COVID-19 surge. The hypothesis is that pre-interns will report improvements in PP regarding multiple ACGME milestone topics. Background(s): Transitioning to residency involves translation of academic knowledge into clinical acumen, and is complicated by variable medical school experiences. The COVID-19 pandemic presented a new challenge by displacing students from clinical rotations. Virtual educational modalities such as the Slack Intern Curriculum (SIC) have increased newly-matched ""pre-intern"" perceived preparedness (PP) for residency in prior years, but the SIC had never been implemented or evaluated in a pandemic with disrupted medical education. Method(s): The SIC was constructed using topics from 8 ACGME milestones in emergency medicine (EM), incorporated into 8 clinical scenarios. Residency recruitment occurred via national EM listservs;of 276 programs, 27 enrolled. Curricular implementation was on Slack workspaces. Cases included stimulus images and clinical questions. Ample discussion time, answers, and resources were provided. Trends in PP were calculated with descriptive statistics and the Wilcoxon Rank Sum test. Result(s): Of 311 total pre-interns contacted, 289 (92.9%) completed a presurvey in April/May 2020, and 240 (77.2%) completed a post-survey in June/July 2020, for an 83.9% follow-through rate. Pre-interns reported statistically significant increases in PP both overall and regarding 14 of 21 milestones. See Table 1. Conclusion(s): Amidst the educational disruption of the COVID-19 pandemic, pre-interns participating in the SIC reported statistically significant increases in PP. Limitations include absence of control or pre-pandemic data. Future directions include adapting the SIC to other specialties' ACGME milestones for generalizability across all fields. (Table Presented) ."

The prevalence and course of COVID-19 and the Cardiovascular Diseases

The SARS-CoV2 virus has infected over 545 million people and has claimed over 6 million lives globally by the end of June 2022. The global case fatality rate ranged from 5.5% in Mexico, 2.1-2.5% in South Africa, Brazil, Guatemala, Russia, 1.1-1.5% in the United States, Canada, India and Chile, 0.5-0.9% in Western European countries, 0.3% in Japan, 0.2% in Taiwan to 0.1% in Australia. Among hospitalized COVID-19 patients, the prevalence of pre-existing cardiovascular diseases was approximately 10%. The prevalence of cardiovascular diseases among COVID-19 non-survivors and COVID-19 patients requiring intensive care unit admission were approximately 20-30%. In a multicenter study of 8910 COVID-19 patients from 169 hospitals in Asia, Europe and North America, presence of pre-existing coronary artery disease, chronic heart failure and cardiac arrhythmia was associated with increased mortality of 10.2%, 15.3% and 11.5% respectively, compared with 5-6% mortality in those without the above co-morbidities. The systemic inflammation caused by SARS-CoV-2 could lead to a wide spectrum of cardiovascular complications including acute cardiac injury, acute coronary syndrome, coronary artery dissection, acute myocarditis, cardiomyopathy, chronic heart failure, cardiac arrhythmia, pulmonary embolism, cardiogenic shock, circulatory failure or even cardiac arrest. Copyright © 2022 Heart, Vessels and Transplantation. All right reserved.

Utilization of the Abbott SARS-CoV-2 IgG II Quant Assay To Identify High-Titer Anti-SARS-CoV-2 Neutralizing Plasma against Wild-Type and Variant SARS-CoV-2 Viruses.

There is evidence that COVID-19 convalescent plasma may improve outcomes of patients with impaired immune systems; however, more clinical trials are required. Although we have previously used a 50% plaque reduction/neutralization titer (PRNT50) assay to qualify convalescent plasma for clinical trials and virus-like particle (VLP) assays to validate PRNT50 methodologies, these approaches are time-consuming and expensive. Here, we characterized the ability of the Abbott severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG II Quant assay to identify high- and low-titer plasma for wild-type and variant (Alpha, Beta, Gamma, and Delta) SARS-CoV-2 characterized by both VLP assays and PRNT50. Plasma specimens previously tested in wild-type, Alpha, Beta, Gamma, and Delta VLP neutralization assays were selected based on availability. Selected specimens were evaluated by the Abbott SARS-CoV-2 IgG II Quant assay [Abbott anti-Spike (S); Abbott, Chicago, IL], and values in units per milliliter were converted to binding antibody units (BAU) per milliliter. Sixty-three specimens were available for analysis. Abbott SARS-CoV-2 IgG II Quant assay values in BAU per milliliter were significantly different between high- and low-titer specimens for wild-type (Mann-Whitney U = 42, P < 0.0001), Alpha (Mann-Whitney U = 38, P < 0.0001), Beta (Mann-Whitney U = 29, P < 0.0001), Gamma (Mann-Whitney U = 0, P < 0.0001), and Delta (Mann-Whitney U = 42, P < 0.0001). A conservative approach using the highest 95% confidence interval (CI) values from wild-type and variant of concern (VOC) SARS-CoV-2 experiments would identify a potential Abbott SARS-CoV-2 IgG II Quant assay cutoff of ≥7.1 × 103 BAU/mL. IMPORTANCE The United States Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for the use of COVID-19 convalescent plasma (CCP) to treat hospitalized patients with COVID-19 in August 2020. However, by 4 February 2021, the FDA had revised the convalescent plasma EUA. This revision limited the authorization for high-titer COVID-19 convalescent plasma and restricted patient groups to hospitalized patients with COVID-19 early in their disease course or hospitalized patients with impaired humoral immunity. Traditionally our group utilized 50% plaque reduction/neutralization titer (PRNT50) assays to qualify CCP in Canada. Since that time, the Abbott SARS-CoV-2 IgG II Quant assay (Abbott, Chicago IL) was developed for the qualitative and quantitative determination of IgG against the SARS-CoV-2. Here, we characterized the ability of the Abbott SARS-CoV-2 IgG II Quant assay to identify high- and low-titer plasma for wild-type and variant (Alpha, Beta, Gamma, and Delta) SARS-CoV-2.

Covid‐19 dermatoses: Acral vesicular pattern evolving into bullous pemphigoid

Bullous pemphigoid (BP) appears to be rising in incidence across the Western World, especially in the elderly. Some of the pathogenetic mechanisms involving antigen mimicry and antibody cross‐reactivity have been elucidated for cases associated with neurological disease and certain drugs. There have been reports of cutaneous manifestations of Covid‐19 (SARS‐Cov2 infection) as the pandemic has raged across the world. We report here a case of prolonged Covid‐19, symptomatic with dermatoses only, which was seen to evolve initially from a maculo‐papular exanthema with acral vesicular dermatitis, into classical BP disease. This was confirmed histologically by positive skin autoantibody serology, direct IMF on peri‐lesional skin and also salt‐split IMF. Although possible that the development of BP could be a purely co‐incidental finding during Covid‐19, we suggest that it is more likely that prolonged SARS‐Cov2 infection triggered an autoimmune response to the basement membrane antigens, BP 180 and 230. To our knowledge, this is the first case of BP developing during concurrent Covid‐19 disease. It will be necessary to continue dermatological surveillance as the pandemic continues, to collate data on BP incidence and to test these patients for Covid‐19 disease. As the pandemic continues, even potential and rare associations such as this will be clarified eventually. What's already known about this topic? Covid‐19 disease has been associated with a spectrum of dermatoses Common presentations in up to 20% of patients include exanthema, pseudo‐chilblain like acral lesions ‘Covid toes’, livedo‐/retiform purpuric/necrotic vascular lesions, acute urticarial lesions, and vesicular/varicella‐like lesions A multi‐system inflammatory syndrome in children akin to Kawasaki syndrome has been described What does this study add? To our knowledge, this is the first description of classic Bullous Pemphigoid evolving from vesicular lesions caused by prolonged SARS‐Cov2 induced skin inflammation