BRAIN AND BEHAVIOR PREDICTORS OF SARS-CoV-2 INFECTION AMONG PEOPLE WITH HIV

Background: Recent findings from the UK Biobank revealed that healthy adults who later became infected with SARS-CoV-2 had lower brain volumes in regions involved in risk-taking behavior and olfaction compared to individuals who did not become infected. We examined if similar pre-existing differences in brain regions correspond to SARS-CoV-2 infection among people with HIV (PWH) receiving suppressive ART. Method(s): Participants included adult Thai MSM enrolled in the acute HIV (AHI) cohort (RV254/SEARCH010) in Bangkok, Thailand. Participants underwent 3T MRI and clinical assessments (i.e., HIV disease metrics, cognitive testing, and self-reported mood and substance use). ART initiation occurred within 5 days of the MRI (median=same day). Regional brain volumes were summed across hemispheres and corrected for head size. Brain volumes and clinical indices were compared between participants with laboratory confirmed SARS-CoV-2 and those without a diagnosis of SARS-CoV-2 following ART initiation. Machine learning was utilized to identify variables at the time of enrollment into the cohort that predicted subsequent SARS-CoV-2 infection status. Result(s): 112 participants were included in the analysis. All study participants achieved viral suppression after ART and received SARS-CoV-2 vaccinations. Fifty-four participants became infected with SARS-CoV-2 during the observation period (median=79 weeks from ART initiation). Study participants who became infected with SARS-CoV-2 after ART had lower volumes at the time of enrollment in several subcortical brain regions with the most pronounced effect in the pallidum (p=.025). There were no associations between brain volumes and ratings of mood, demographics, or HIV disease indices. SARS-CoV-2 infection was two-fold higher among individuals who reported use of amyl nitrites (i.e., poppers) during chemsex. Machine learning with repeated cross validation revealed that lower orbital and medial frontal lobe, anterior cingulate, pallidum, vermis, and olfactory volumes, worse motor function, and higher education collectively predicted co-infection status (average AUC of 85%). Conclusion(s): Study findings point toward a risk phenotype for SARS-CoV-2 infection among PWH defined by pre-existing differences in brain volumes relevant to risk-taking behavior, emotion, and neuroHIV as well as behavioral factors such as inhalant use and lack of social distancing during chemsex. (Table Presented).

Characteristics and Outcomes of Covid-19 in an Early-Treated Hiv Cohort in Thailand

Background: Emerging data indicate that people with HIV (PWH) are at risk of more severe outcomes from COVID-19. We described the clinical course and laboratory parameters pre-and post-COVID-19 in an early-treated HIV cohort in Thailand. Method(s): RV254 cohort participants were enrolled during Fiebig I-V acute HIV and initiated antiretroviral therapy (ART) within days. They underwent regular blood tests (CD4+ & CD8+ T-cell counts, HIV RNA), neuropsychiatric (NP) assessment (Color Trails 1 & 2, non-dominant hand Grooved Pegboard, Trails Making A), and mood questionnaires (Patient Health Questionnaire-9, Distress Thermometer) post-enrollment longitudinally. Their assessment outcomes pre-and post-COVID-19 were compared using Generalized Estimating Equations (GEE) with a normal distribution and identity link (CD4+, CD8+ T-cell counts, NP parameters) or binomial distribution with log link (HIV RNA), and autoregressive correlation structure. Result(s): Between 4/2021 and 9/2022, 295 participants on ART (98% male, median age 32 [IQR 28-37] were diagnosed with COVID-19. Of these, 16(5%), 38(13%) and 241(82%) were infected with alpha, delta and o variants, determined by the predominant strain circulating in Thailand at the time of infection;238(81%) received >=2 doses of COVID-19 vaccines prior to diagnosis;121(41%) received favipiravir. While 106 (36%) were managed in hospital or 'hospitel', including one intensive care unit admission, only 4(1.4%) received supplemental oxygen and none required mechanical ventilation (mean length of stay: 12 days). The participants were followed a median of 8 [IQR 5-15] weeks post-COVID. Comparing the outcomes pre-and post-COVID, plasma HIV suppression rate remained stable (98% vs. 96%, p=0.212). CD4+ (782 [IQR 708-856] vs. 823 [IQR 748-899], p=0.018) and CD8+ (622 [IQR 563-681] vs. 667 [IQR 605-728], p=0.023) T-cell counts were higher at follow-up after adjusting for age, sex, and duration between COVID-19 diagnosis and follow-up. The increasing trends of CD4+ and CD8+ T-cell were sustained on subsequent visits. Mood scores and NP performance (n=217) were stable at follow-up. Conclusion(s): In this cohort of young PWH on stable ART, we did not observe major clinical adverse events after COVID-19. Increases of CD4+ and CD8+ T-cell counts were observed while mood and NP parameters remained stable. More extensive NP assessment with incorporation of multimodal imaging outcomes and longer follow-up are needed to determine the long-term sequelae of COVID-19 in PWH.

Quantifying caregiver workload during the COVID-19 pandemic using ambient intelligence

Introduction: The COVID-19 pandemic has increased caregiver workload [1]. It is unclear how this workload is distributed across patients with varying presentations. Ambient intelligence (AmI) utilizes neural networks to monitor multiple data points in video feeds, and automatically tracks various aspects of human movement [2]. AmI was used to examine the workload of healthcare staff in relation to temporal and patient characteristics on a COVID ward at a major metropolitan hospital. Method(s): Sensors were deployed in patient rooms on a COVID ward to detect caregiver visits at 5-min intervals. Electronic medical records were used to identify variables hypothesized to contribute to visits. Result(s): 5514 h across 55 patients (mean age 72, range 17-98) were analyzed. The primary reason for admission was medical in 45 cases (81.8%), psychiatric in 8 cases (14.5%) and surgical in 2 cases (3.6%). Medical emergency (MET) calls occurred in 21 (38.2%) cases. As summarized in Fig. 1, visitation was lowest between 0000 and 0400 (27.3 +/- 1.1 min/hour (min/hr)) and highest between 1200 and 1600 (65.5 +/- 1.3 min/hr). The mean +/- SE visitation spent with medical, psychiatric, and surgical patients was 51.7 +/- 0.6, 38.8 +/- 1.3, and 33.7 +/- 3.9 min/hr respectively (p < 0.005). Overall lowest visitation was in surgical patients between 0400 and 0800 (4.5 +/- 4.5 min/hr). Mean +/- SE visitation were 66.7 +/- 4.6 min/hr in the three hours preceding and following MET calls compared to 50.2 +/- 0.5 min/hr in periods without MET calls (p < 0.005). There was no difference in visitation time between patients with respiratory symptoms and those without (50.7 +/- 0.9 vs 48.8 +/- 0.7 min/hr, p = 0.1). Conclusion(s): AmI can help quantify patient workload, potentially improving staff planning. Further studies comparing healthcare attendance between patients on COVID wards and non-COVID wards may provide insight into the impact of unique factors associated with the pandemic.

The monopoly of minor group rhinovirus in respiratory virus infection in children during the SARS-CoV-2 pandemic

Rhinovirus (RV) is one of the pathogens causing acute and chronic respiratory illnesses worldwide in paediatric patients. Compulsory mask-wearing and high stringency of social distancing were executed in Hong Kong since the SARSCoV-2 outbreak. While other common respiratory viruses vanished in routine surveillance programme, two sudden upsurges of RV associated upper respiratory tract infections were observed from Oct. to Nov. 2020 after schools reopening, and Apr. to Aug. 2021. We aimed to investigate if these RVs have a prominent role in transmission by analysing the RV genotype composition, assessing their replication competence, and the clinical features of paediatric patients. RV specimens collected from the hospitalised patients were genotyped, with clinical features of the patient documented and compared to those obtained in the pre-COVID-19 period. The replication competence of the RVs was examined in the well-differentiated human nasopharyngeal epithelial cells (HNPEC), and the stability of the RVs on different materials was tested. We identified the monopoly of minor group RV in each of the study duration, namely RV-A47 (80%) and RV-A49 (51%), respectively. In contrast to a diversified RV genotype composition in 2018-19. Without prior in vitro adaptation, the two minor-group RVs replicated in the HNPECs effectively to a comparable level as in the laboratory strain RVA16. The rise of minor-group RVs and dominance of single RV genotype under strict social distancing and hand hygiene is remarkable. Further investigation of the viral determinant, with an assessment of transmissibility in an animal model, will be needed to validate the specific role of these RVs.

Implementing Adult Covid-19 Electronic Order Sets in a Children's Hospital

BACKGROUND AND AIM: An eight-bed adult COVID-19 critical care (CC) unit was established within our pediatric intensive care unit (PICU) when SARS-CoV-2 variants increased CC bed demand. Our objective was to rapidly roll out electronic order sets (OS) to facilitate computerized provider order entry (CPOE) for adult patients admitted within a children's hospital. METHOD(S): OS development began from the assessment of OS from seven adult CC units. Using a pre-existing PICU Admission template, we created two OS: adult COVID-19 admission and on-going care. We tested the prototypes in a multidisciplinary onsite-virtual hybrid tabletop simulation to evaluate usability within established workflows. Participants utilized role-specific profiles within the electronic medical record (EMR) training environment which paralleled their computer interface, permitting charting and documentation. EMR analysts were present to gather change requests. Following implementation, we performed twice daily hot debriefs with end-users to further identify issues. RESULT(S): 16 multidisciplinary bedside providers participated in simulation testing of the prototypes. Two safety issues were addressed before implementation. The electronic OS were developed, tested, and implemented within 8 days. The post-implementation hot debriefs identified one medication addition, and no deletions were necessary. CONCLUSION(S): Caring for adult COVID-19 patients within a freestanding children's hospital presents challenges and has the potential to introduce latent safety threats. Rapid development and implementation of electronic OS within 8 days to facilitate CPOE and reduce healthcare provider cognitive burden relied on leveraging functionality within the EMR system, performing iterative testing with a tabletop simulation, integration into previously established workflows, and gathering post-implementation feedback for continuous improvement.

Impact of Covid-19 Wave 3 Paediatric Inpatient Unit Closures on Transfers to Tertiary Care Paediatric Hospital

BACKGROUND: During Wave 3 of the COVID-19 pandemic, 15 community hospital paediatric inpatient units (comprising 167 beds) in Toronto were directed to close by the Greater Toronto Area (GTA) Hospital Incident Management System (IMS) Command Centre to increase adult inpatient bed capacity. All paediatric patients from closed inpatient units were redirected to a single tertiary care paediatric hospital, which increased capacity to accommodate these additional patients through activation of surge plans, while community hospitals redeployed resources to fill much needed gaps in adult care. OBJECTIVE(S): The objective was to describe patient characteristics of all transfers during the closure to explore the impact of community paediatric inpatient unit closures on transfers to the tertiary hospital. DESIGN/METHODS: A chart review of all transferred patients was conducted during the mandated closure and subsequent reopening. Transfers excluded ICU-level transfers as these were not impacted by IMS mandated closures. All transfers were categorized as requiring tertiary care (i.e. would typically be transferred) or not requiring tertiary care (i.e. only transferred due to the closure). Variables collected included sending hospital, admitting diagnosis, patient age, hospital disposition, and length of stay. Data was collected until the last paediatric unit reopened. Quality improvement project approval was granted by the institution. RESULT(S): A total of 858 patients were transferred to the tertiary hospital during the 67 day closure;of those, 530 were transferred solely to increase adult bed capacity (i.e. were categorized as patients requiring non-tertiary care). The majority of patients were admitted to general paediatrics (52%), and 39% went to a surgical inpatient unit. Most patients (68%) admitted had a length of stay between 24 and 72 hours. A third of patients admitted were under 2 years old, and a third were over 12 years old. The top three diagnoses for admission were infections, gastrointestinal issues, and general surgery. Two-thirds (60%) of transfers from closed sites came from three sites. CONCLUSION(S): More than half of the transfers occurred solely due to the mandated closures, and transfers returned to a stable volume once all sites re-opened. The GTA hospital system was able to respond to the mandated closure effectively through clear high-level communication, escalation processes and structures as well as responsive, real-time problem solving. Closures increased potential adult inpatient capacity by 6740 bed days and demonstrated an unprecedented system-wide approach to the provision of integrated paediatric care across the region.

Implementation of a Novel Virtual Testing Approach for HIV and Sexually Transmitted Infections

"BACKGROUND: Rates of HIV and sexually transmitted infections (STIs) continue to increase across the United States. The COVID-19 pandemic has created additional challenges in accessing STI care. Novel approaches to increasing access to HIV/STI testing are needed. METHOD(S): The Rhode Island Department of Health (RIDOH) and The Miriam Hospital implemented a novel, virtual testing program, ""Testing 1-2-3,"" that allows asymptomatic people to request STI (syphilis, gonorrhea, and chlamydia) and HIV testing online via a secure form. The platform is bilingual and generates a physician-signed laboratory order under standing orders at local walk-in lab locations (N=72). Symptomatic patients or those with clinical concerns are referred to communitybased clinics which offer sexual healthcare services. We evaluate program uptake. RESULT(S): A total of 106 people requested STI/HIV testing from November 2021-March 2022: 38 (36%) completed testing, and one (3%) positive case was identified, referred to clinical care, and completed treatment. Participants' median age was 32.7 years. Fifty-seven percent of participants identified as male, 39% as female, and 2% as another gender. Fourteen percent of participants identified as a man who has sex with men. Of people who requested STI/HIV testing, 51% had >=2 sexual partners, 23% reported prior STI diagnosis, 14% reported 5+ sexual partners, 6% reported using inhalants (poppers), 12% reported condomless receptive anal sex, 25% reported sexual intercourse while intoxicated, and 16% reported sex with an anonymous partner. Although 30% of participants reported difficulties accessing STI/HIV testing and treatment during COVID-19, program feedback has been positive, with participants reporting no significant difficulties in requesting and completing testing, receiving RESULTS, and being referred to care. CONCLUSION(S): A novel virtual STI/HIV testing platform offers improved access for STI/HIV testing. The approach has been able to successfully overcomes some of the barriers to accessing STI/HIV testing and treatment services which have resulted from COVID-19."

Establishment of the first inflammatory bowel disease in pregnancy multidisciplinary service in New South Wales

Background and Aim: Inflammatory bowel disease (IBD) commonly affects men and women during their reproductive years. Misconceptions surrounding the impact of IBD and associated therapies on the peripartum period contributes to increased rates of voluntary childlessness. Navigating IBD and obstetric-related decisions during pregnancy can be challenging. We established a monthly multidisciplinary clinic comprising a gastroenterologist, IBD nurse, and obstetric fellow, in addition to dietetic and psychological referral pathways, to optimize care for women with IBD in the peripartum period.We aim to describe the patient cohort and associated pregnancy-related outcomes. Method(s): Between January 2021 and May 2022, 43 women were referred to the multidisciplinary pregnancy in IBD clinic for the indications of preconception counseling or IBD care during pregnancy and postpartum. The consultations were conducted face-to-face or via telehealth due to the impact of the COVID-19 pandemic. Nutritional and psychological screening occurred before clinic review, while intestinal ultrasound (IUS) was done as needed;however, the latter was limited due to COVID-19-related clinical restrictions. A review of prospectively collected patient records, including the use of Crohn's Colitis Care (CCCare), was performed to obtain demographic data, medical and surgical history, and obstetric outcomes. Patients referred for preconception counseling were prospectively assessed using the decisional conflict scale (DCS) and Crohn's and Colitis Pregnancy Knowledge Score (CCPKnow). Result(s): Of the 43 women (mean age, 30.9 years) who received care in our clinic, 14 were at preconception stage, and 29 were pregnant. Twenty-one patients had a diagnosis of ulcerative colitis, 19 had Crohn's disease, and one had IBD-unclassified. Two additional patients with pregnancy-onset IBD did not yet have a confirmed diagnosis, as their endoscopic assessment was deferred until after delivery. The mean DCS score for women referred for preconception counseling was 39.1 (>37.5 being associated with decision delay and difficulty with implementation). The median CCPKnow score at baseline was 7/18 (range, 3-11), suggesting poor IBD and pregnancy-related knowledge. The median score improved to 9/18 (range, 4-11) at 1 month follow-up and to 11/18 (range, 4-13) at 3 months. Nineteen patients (44.2%) were prescribed 5-aminosalicylates alone, eight (18.6%) thiopurines, and 21 (48.8%) biologic therapy (antitumor necrosis factor agents, 12;ustekinumab, 6;vedolizumab, 3). Eleven of 29 patients (37.9%) had active disease at conception, as assessed through symptomatic, biochemical, and radiological assessment. Two patients (4.7%) were prescribed oral budesonide during pregnancy. Five of 29 patients (17.2%) were assessed using IUS, while none required endoscopic assessment during pregnancy. Fifteen of 29 patients (51.7%) have given birth to date, with 12 (80%) having an uncomplicated vaginal delivery and three (20%) having a caesarean section, temporally compared with a caesarean section rate of 32.5% in the general South West Sydney Local Health district population. None were indicated for known perianal Crohn's disease. There have been no cases of preterm birth or pregnancy. The mean birth weight was 3.53 kg (range, 2.67-4.29). Two of 15 women (13.3%) experienced a postpartum flare. Nine of 15 women (60%) breastfed, while three (20%) formula-fed, and the remaining three (20%) mixed-fed their infants. Conclusion(s): Establishment of a multidisciplinary clinic has enabled provision of IBD care in the reproductive stage of life, with the ongoing aim to minimize the impact of voluntary childlessness through the delivery of dedicated clinic sessions for preconception counseling and the negative impact of active disease on obstetric and maternal outcomes.

Youth social innovation during the COVID-19 pandemic in the Philippines: a quantitative and qualitative descriptive analyses from a crowdsourcing open call and online hackathon

Introduction Young people have played a pivotal role as part of the COVID-19 response, including developing health messages and social innovations. Social innovation in health engages multiple stakeholders in linking social change and health improvement. The study examined the feasibility of youth ideas and innovations to address the impacts of the COVID-19 pandemic using quantitative and qualitative descriptive analyses. Methods In partnership with the WHO, academic institutions, youth organisations and civil society groups, we conducted a crowdsourcing open call among Filipino youth (15-30 years old) using a structured Special Programme for Research and Training in Tropical Diseases/Social Innovation in Health Initiative process. The open call had three categories: youth voices to cocreate the post-COVID-19 world (entries were texts, images, videos and music), youth-led COVID-19 social innovations, and youth-led social innovations not related to COVID-19. Each submission was evaluated by three independent judges. Finalists were selected in each of the categories alongside four grand winners. All finalists were invited to attend a 1 day online civic hackathon. Results We received a total of 113 entries (youth voices to cocreate the post-COVID world=76;youth-led COVID-19 social innovations=17;youth-led social innovations not related to COVID-19=20). Twelve entries focused on youth mental health during the pandemic. The online hackathon provided the participants mentorship for further development of their ideas. Finalists were able to produce draft health communication campaigns and improved social innovations. Conclusion Many Filipino youth created exceptional entries in response to the open call. This suggests the feasibility of including youth voices in strategic planning processes. A global youth social innovation call is recommended.

Impact of the Coronavirus 2019 Pandemic on Pediatric Out of Hospital Cardiac Arrest Outcomes During 2020

Purpose: The Coronavirus 2019 (COVID-19) pandemic impacted adult out-of-hospital arrest (OHCA) outcomes in the United States. The impact of the pandemic on pediatric OHCA is unknown. Materials and methods: An analysis of the Cardiac Arrest Registry to Enhance Survival for non-traumatic pediatric OHCAs (≤18 years) was conducted. Outcomes during 3 pandemic surge periods in 2020 (March 16 to May 15, July 1 to August 15, and October 16 to December 31) were compared to the same time periods pre-pandemic in 2019. The primary outcomes were overall survival and neurologically favorable survival, defined as a cerebral performance score of 1 or 2 at the time of hospital discharge. Age groups included infants (<1 year), children (1 to 11 years), and adolescents (≥12 years). Results: A total of 1381 pandemic surge period arrests were compared to 1274 pre-pandemic arrests. There was an increase in OHCAs in adolescents (pandemic 26.6% [368/1381], pre-pandemic 22.4% [286/1274], p = 0.01). Therewere no differences in OHCAs by sex, race/ethnicity, witness status, location, initial rhythm, bystander CPR rates or bystander AED use. There were no differences in overall survival during the pandemic surge periods in 2020 (10.6% [147/ 1381]), as compared to the same months in 2019 (9.7% [123/1274], p = 0.40) or in neurologically favorable survival (2020: 8.9% [123/1381] vs. 2019: 7.3% [93/1274], p = 0.13). Conclusions: During the COVID-19 pandemic surge periods in 2020, pediatric OHCA survival rates in the United Stateswere similar to the rates of pediatric OHCA pre-pandemic. Further study is warranted to determine if pediatric survival for OHCA was affected during the delta and omicron COVID-19 surges in 2021.

Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma presented as cystic lung disease - a case report in Tuen Mun Hospital Hong Kong.

We report a rare case of pulmonary mucosa-associated lymphoid tissue lymphoma (MALToma) in a 52-year-old woman presented as cystic lung disease together with ground-glass lesion on computed tomography (CT) of the thorax incidentally found as part of workup for organ donation.

Experiences of delivering virtual education workshops for children with type 1 diabetes during the Covid-19 pandemic

Background: Diabetes education is an essential element to achieve treatment objectives in children with type 1 diabetes mellitus (T1D) and it often involves group educations. Due to government group gathering restrictions during the Covid-19 pandemic, face-to-face group education were not possible. An alternative means of delivering group education is needed in this special time. With that, a series of virtual education workshops were designed. Aim: The study aimed to review the experience in conducting virtual education workshops for children and families with T1D during the Covid-19 pandemic. Method: The virtual workshops consisted of warm-up and ice-breaking games led by play therapists, followed by diabetes-related education workshops conducted by diabetes nurses, paediatric endocrinologists, and dietitians. Patients and families were invited to fill in a standard feedback questionnaire afterwards. Results: In the period of July 2020 to June 2021, a total of 10 virtual workshops were organised. A total of 33 children (13 boys and 20 girls) attended the workshops. The mean age of these patients was 9.5 +/- 3.8 years and the duration of T1D was 4.0 +/-3.3 years. Their mean HbA1c were 8.2 +/- 1.5%. A total of 22 responses on the feedback questionnaires were received. Among those who responded, 68% respondents had attended the virtual workshops for more than 2 times. The majority (86%) agreed that they had acquired new diabetes related knowledge from the workshops and 86% found the workshops interesting and enjoyable. Most (95%) reported that they could listen to instruction clearly and communicate causally in the virtual workshops. Only 32% strongly agreed that virtual workshops were the same as face-to-face workshops and 27% reported that they would prefer zoom to face-to-face workshop in the future. The commonest reasons for not joining virtual workshop in the future included unstable internet connection and feeling uneasy in virtual environment. Discussion: A safe, socially distanced method of delivering group education for children and families with T1D during the pandemic was possible and well-received. Virtual education workshops could be an alternative tool in delivering diabetes education. However, this could not totally replace face-to-face therapy.

Spread of SARS-CoV-2 aerosols via two connected drainage stacks in a high-rise housing outbreak of COVID-19.

Vertical transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) along a vertical column of flats has been documented in several outbreaks of coronavirus disease 2019 (COVID-19) in Guangdong and Hong Kong. We describe an outbreak in Luk Chuen House, involving two vertical columns of flats associated with an unusually connected two-stack drainage system, in which nine individuals from seven households were infected. The index case resided in Flat 812 (8th floor, Unit 12), two flats (813, 817) on its opposite side reported one case each (i.e., a horizontal sub-cluster). All other flats with infected residents were vertically associated, forming a vertical sub-cluster. We injected tracer gas (SF6) into drainage stacks via toilet or balcony of Flat 812, monitored gas concentrations in roof vent, toilet, façade, and living room in four of the seven flats with infected residents and four flats with no infected residents. The measured gas concentration distributions agreed with the observed distribution of affected flats. Aerosols leaking into drainage stacks may generate the vertical sub-cluster, whereas airflow across the corridor probably caused the horizontal sub-cluster. Sequencing and phylogenetic analyses also revealed a common point-source. The findings provided additional evidence of probable roles of drainage systems in SARS-CoV-2 transmission.