Demo Abstract: Implementing a COVID-19 Risk Assessment System for User-Informed Travel Planning in Harris County

The COVID-19 pandemic has forced people worldwide to modify their daily activities, including travel plans. To help individuals make informed decisions about visiting public places, Cheng [2] first proposed a real-time COVID-19 risk assessment system called RT-CIRAM and implemented prototypes for two U.S. metropolitan locations. The system calculates a COVID-19 risk score and categorizes the risk levels into high, medium, and low, recommends the safe travel destination using the users' location and the specified distance the user is willing to travel, thereby helping users make informed decisions about their travel plans. © 2023 ACM.

Disrupting the disruption: Using digital tools to support psychiatry residency training in Singapore during the COVID-19 pandemic

This letter discusses the use of digital tools to support psychiatry residency training in Singapore during the COVID-19 pandemic. The National Psychiatry Residency Program is a five-year program accredited by the US Accreditation Council for Graduate Medical Education-International (ACGME-I) and Joint Committee on Specialty Training (JCST), Singapore. The pandemic infection control measures, including social distancing and cross hospital movement restrictions, have created unprecedented challenges to training. Psychiatry residents cannot meet in groups, go outside of their current sites to do clinical work or attend educational activities, and ambulatory teams have halted home visits and day treatment programs. However, in the process, other clinical learning opportunities have unexpectedly arisen. To help with shifting demands, some psychiatry residents have been assigned to different services than the ones belonging to their rotations. Several residents have volunteered for deployment to medical facilities which are set up in the community, and are assisting medical teams in managing clinically ill patients. There are ongoing discussions between the residency program committee, central educational office and health authorities to ensure that requisite training rotations are being fulfilled as best as possible at the respective training sites. Although the disruption to psychiatry residency training in the midst of the pandemic is severe, the innovative use of digital platforms is coming of age. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Long COVID: Rapid Evidence Review

Postacute sequelae of COVID-19, also known as long COVID, affects approximately 10% to 30% of the hundreds of millions of people who have had acute COVID-19. The Centers for Disease Control and Prevention defines long COVID as the presence of new, returning, or ongoing symptoms associated with acute COVID-19 that persist beyond 28 days. The diagnosis of long COVID can be based on a previous clinical diagnosis of COVID-19 and does not require a prior positive polymerase chain reaction or antigen test result to confirm infection. Patients with long COVID report a broad range of symptoms, including abdominal pain, anosmia, chest pain, cognitive impairment (brain fog), dizziness, dyspnea, fatigue, headache, insomnia, mood changes, palpitations, paresthesias, and postexertional malaise. The presentation is variable, and symptoms can fluctuate or persist and relapse and remit. The diagnostic approach is to differentiate long COVID from acute sequelae of COVID-19, previous comorbidities, unmasking of preexisting health conditions, reinfections, new acute concerns, and complications of prolonged illness, hospitalization, or isolation. Many presenting symptoms of long COVID are commonly seen in a primary care practice, and management can be improved by using established treatment paradigms and supportive care. Although several medications have been suggested for the treatment of fatigue related to long COVID, the evidence for their use is currently lacking. Holistic treatment strategies for long COVID include discussion of pacing and energy conservation;individualized, symptom-guided, phased return to activity programs;maintaining adequate hydration and a healthy diet;and treatment of underlying medical conditions.Copyright © 2022 American Academy of Family Physicians.

Treating mild COVID-19 What therapeutic options are available?

With the rapid introduction of new treatments for mild COVID-19, GPs need to be aware of the latest information to help them recognise which patients are candidates for available therapies. Treatment options for suitable patients with mild COVID-19 include antivirals and monoclonal antibodies, with the oral antivirals being most relevant for GPs. GPs should always refer to COVID-19 living guidelines to ensure they provide accurate advice to their patients. Copyright © MedicineToday 2022.

Effect of Covid-19 Diagnosis on Organ Donation and Transplantation

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has challenged many aspects of healthcare, including organ donation and transplantation. The purpose of this study is to demonstrate that utilization of COVID-positive organs can be carried out safely. Method(s): De-identified data from 569 organ donors processed through an organ procurement organization (OPO) from March 24, 2020, through September 30, 2021, was collected from the OPO's database and retrospectively analyzed. Demographics, clinical measures, transplant numbers, and outcomes were recorded. Result(s): 25 COVID-positive (study) and 544 COVID-negative (control) organ donors were analyzed. There was no significant difference between the mean ages of the study group (43.12+/-11.08, p = 0.665) and the control group (44.15+/-17.94, p = 0.665). The COVID-positive group achieved donor management goals at a significantly lower rate than the COVID-negative group (4.0% vs 48.7%, p = 0.000012). The COVID-positive group required significantly more continuous renal replacement therapy (16.0% vs 1.8%, p < 0.00001), and extracorporeal membrane oxygenation (24.0% vs 0.7%, p < 0.00001). Significantly fewer organs were transplanted from the COVID-positive donors (1.12+/-1.013, p < 0.00001) than from the COVIDnegative donors (2.56+/-1.671, p < 0.00001). The mean observed to expected ratio for the study group (0.5372+/-0.47434, p < 0.00001) was significantly lower than that of the control group (0.9489+/-0.55041, p < 0.00001). The study group donors were significantly more likely to be categorized as donation after circulatory death (DCD) donors (96.0% vs 27.8%, p < 0.00001). There was no significant difference between the groups regarding delayed graft function in the recipient (18.2% vs 26.8%, p = 0.522561) nor regarding the need for dialysis post-transplant (9.1% vs 11.6%, p = 0.795292). Conclusion(s): Fewer organs from COVID-positive donors were utilized for transplantation than organs from COVID-negative donors over the study period. COVID-positive organs have been of no detriment to recipients, as there is no evidence of increased delayed graft function nor the need for dialysis. Though no short-term COVID-19 transmission has been identified, we will continue to monitor for this and to track non-renal transplant outcomes. A larger multi-center study is warranted to further delineate the safety and efficacy of implementing protocols to utilize these organs.

WAS COVID A “BLESSING IN DISGUISE?” MAY-THURNER SYNDROME COMPLICATES COVID

CASE: A 30-year-old previously healthy male presented with three weeks of progressively worsening pain, erythema, swelling in his left thigh, inability to bear weight and associated fatigue, fever, and dyspnea on exertion. Four weeks prior, he experienced 1 week of anosmia, fatigue, and “even worse” dyspnea on exertion with a resting heart rate in excess of 110 bpm and felt he most likely had had COVID. He self-treated for symptoms, rested, isolated and felt he had improved from COVID. The pain and swelling in the left leg increased over the prior three weeks and he sought care. On exam the left thigh was warm to touch, erythematous, and painful. Ultrasound imaging revealed left lower extremity deep venous thrombosis (DVT) extending from his upper thigh to lower leg. Abdominal/thoracic CT w/ contrast noted diffuse pulmonary emboli and May-Thurner Syndrome (MTS). Treatment was started with IV heparin followed by thrombolytic therapy with higher dose heparin and alteplase for 3 days. Shortly after this therapy was initiated, he developed significant hypoxia and was transferred to the ICU. He was stabilized and on the final day of thrombolytic therapy, a left common iliac vein stent was placed and he was discharged two days later on Apixaban and aspirin. IMPACT/DISCUSSION: May-Thurner syndrome (MTS), is an anatomical variant that may lead to venous outflow obstruction due to extrinsic compression by the iliac arterial system against bony structures in the iliocaval venous territory. Most common in the left leg, MTS is present in about 20% of the population and is more commonly found in women. It can result in venous hypertension and venous thromboembolisms (VTE). In serious and untreated cases, these VTEs can progress to pulmonary embolisms with resultant serious injury, hospitalization, and death. In this case, a recent COVID infection unearthed an MTS anomaly. The activated proinflammatory state induced by COVID is known to result in blood clots in hospitalized patients and appears to be related to a cytokine storm. This inflammatory state induces endothelial damage, microvascular thrombosis, and possibly pro-thrombotic antiphospholipid antibodies. In hospitalized patients with more severe disease VTE is commonly diagnosed, however the risk of COVID related coagulopathy in the outpatient setting is unknown. It appears that when blood clots do develop in outpatients, 1/5 have had a recent COVID infection which indicates an association between inflammation from infection contributes to VTE. In this case, the COVID complication helped to uncover a May-Thurner anomaly. CONCLUSION: - Delayed presentation can exacerbate COVID-related complications, even after acute symptoms have diminished - more should be done to educate patients on the dangers of post COVID thromboembolic disease. - Despite its prevalence in females, May-Thurners Syndrome should be in the differential for males with DVT.

Managed Wildfire: A Strategy Facilitated by Civil Society Partnerships and Interagency Cooperation

Federal land managers in the United States are permitted to manage wildfires with strategies other than full suppression under appropriate conditions to achieve natural resource objectives. However, policy and scientific support for “managed wildfire” appear insufficient to support its broad use. We conducted case studies in northern New Mexico and southwestern Utah to examine how managers and stakeholders navigated shifting barriers and opportunities to use managed wildfire from 2018 to 2021. The use of managed wildfire was fostered through an active network of civil society partnerships in one case, and strong interagency cooperation and existing policies and plans in the other. In both, the COVID-19 pandemic, drought, and agency direction curtailed recent use. Local context shapes wildfire response strategies, yet centralized decision-making and policy also can enable or constrain them. Future research could refine the understanding of social factors in incident decision-making, and evaluation of risks and tradeoffs in wildfire response. Implications Managers and stakeholders seeking to restore fire’s ecological roles in their own landscapes through the use of managed wildfires could use these findings to cultivate supportive local environments for their objectives. Both case studies offer examples of how managed wildfires may be facilitated through civil society partnerships and interagency cooperation. Networks of civil society and agency partners can encourage policy change at multiple levels through concerted efforts over time, particularly by building a larger case through localized examples of collaborative projects and a body of regionally relevant scientific evidence. Strong interagency cooperation on both mitigation and response can also foster an environment of mutual understanding, even given differing missions and mandates for managed wildfire. Management implications Federal wildfire response must consider multiple objectives that may compete across scales, social-ecological contexts, and timeframes. These include minimizing negative impacts on human values, responding to immediate risks of fire exposure, managing land sustainably under longer timeframes;and meeting accomplishment targets, such as acres of hazardous fuels reduction, ecological restoration, and other resource objectives. Federal wildfires and land managers are permitted to manage wildfires for natural resource objectives but face challenges of ambiguous terminology, conflicting policies, drought, increasing numbers of homes in wildlands, and unanticipated events, such as the COVID-19 pandemic. Conditions, opportunities, and barriers to manage wildfire vary substantially by locality and are dependent on local actors, yet also subject to higher-level changes in policy direction. Beyond improved risk analytics and decision support tools, enabling social and internal institutional conditions may also facilitate opportunities for use of managed wildfire. Social science can provide evidence and frameworks including concrete lessons learned, expanded use of after-action reviews, process monitoring, briefings with leadership, and science application through boundary-spanning organizations. © 2022 Taylor & Francis Group, LLC.

Racial/Ethnic Differences in Social Health of Older Adults in a Northern California Healthcare System

Background: The COVID-19 pandemic heightened concerns about the social health of older adults and potential exacerbation of racial disparities in health, well-being, and healthcare access. Methods: We used weighted data for 4282 Kaiser Permanente Northern California (KPNC) members aged 65-85 who responded to the 2020 KPNC Member Health Survey to estimate prevalence of frequent loneliness, lack of social support, financial strains, and other stressors during the prior 12 months. Results: Overall, 5% often felt lonely or socially isolated, and 37% often did not get sufficient social/emotional support (Figure). While approximately 4% had problems “making ends meet”, 10% worried about financial security. Cost led to 2-3% being food insecure, eating less healthy foods, and delaying/foregoing medical care, and 11% delaying/foregoing dental care. Black adults were most likely to report these financial strains, as well as experience harassment/ discrimination and worry about neighborhood violence. Asian/Pacific Islander adults (API) were most likely (57%) and White adults least likely (32%) to report lack of social/emotional support. Conclusions: While many older adults experienced adverse financial and social circumstances during the pandemic, Black adults were more likely than White adults to indicate financial and healthcare access strains. More research is needed on effective screening for financial and other social risks in diverse older adult populations to deliver socially and culturally appropriate care to vulnerable populations.

Contemporary Issues in Mediation

Contemporary Issues in Mediation (CIIM) Volume 6 builds on the success of the past five volumes as testament to a growing interest of authors and readers in the wide variety of issues that arise with mediation. Readers stand to benefit from a diverse range of topics especially selected for their high quality of research and novelty that cannot be replicated elsewhere. With the recent ratification of the Singapore Convention on Mediation in 2020, there is no doubt that mediation is and will continue to be extremely pertinent in the world of dispute resolution. The COVID-19 situation and evolution of technology has also heralded a new era of cross-border and domestic online dispute resolution. Edited by Singapore’s leading expert on mediation and negotiation, Professor Joel Lee, and former Chief Executive Officer of the Singapore International Mediation Institute (SIMI), Marcus Lim, CIIM is a unique and valuable addition to the growing body of mediation and dispute resolution literature. © 2022 by World Scientific Publishing Co. Pte. Ltd.

Burden of Respiratory Syncytial Virus (RSV) Infection among Hospitalized Older Adults and Those with Underlying Chronic Obstructive Pulmonary Disease (COPD) or Congestive Heart Failure (CHF)

Background. The burden of Respiratory Syncytial Virus (RSV)-associated hospitalization in adults is incompletely understood. The COVID-19 pandemic has resulted in multiple public health measures (e.g., social distancing, handwashing, masking) to decrease SARS-CoV-2 transmission, which could impact RSV-associated hospitalizations. We sought to compare RSV-associated hospitalizations from 2 pre- and one mid-COVID-19 winter viral respiratory seasons. Methods. We conducted an IRB-approved prospective surveillance at two Atlanta-area hospitals during the winter respiratory viral seasons from Oct 2018-Apr 2021 for adults ≥ 50 years of age admitted with acute respiratory infections (ARI) and adults of any age with COPD or CHF-related admissions. Adults were eligible if they were residents of an 8 county region surrounding Atlanta, Georgia. Those with symptoms > 14 days were excluded. Standard of care test results were included. Asymptomatic adults ≥ 50 years of age were enrolled as controls in Seasons 1 and 2. Nasopharyngeal swabs from cases and controls were tested for RSV using BioFireR FilmArrayR Respiratory Viral Panel (RVP). We compared the demographic features and outcomes of RSV+ cases and controls. Results. RSV was detected in 71/2,728 (2.6%) hospitalized adults with ARI, CHF, or COPD and 4/466 (0.9%) controls. In Season 1, RSV occurred in 5.9% (35/596 patients), in Season 2 3.6% (35/970 patients), but in only 0.09% (1/1,162 patients) in Season 3 (P < 0.001 for both seasons). RSV detection in Season 3 was similar to RSV detection among controls during Seasons 1 and 2 (P=0.6). Median age of cases and controls was 67 years (Table 1). Of cases with RSV 11% were admitted to the ICU and two required mechanical ventilation. The majority of hospitalized patients were discharged home (95.8%) with a median length of hospitalization of three days (IQR 2-7). Conclusion. Over 3 seasons, RSV was detected in 2.6% of adults admitted to the hospital with ARI, CHF or COPD. The rate of RSV dramatically declined during the 2020-21 winter respiratory viral season, likely due to public health measures implemented in response to COVID-19.

Outcomes among Influenza and SARS-CoV-2 Infection in Hospitalized Adults Age ≥ 50 Years and with Underlying Chronic Obstructive Pulmonary Disease (COPD) or Congestive Heart Failure (CHF)

Background. A significant burden of disease exists for adults infected with influenza (flu) and SARS-CoV-2, which causes COVID-19. However, data are limited comparing outcomes between hospitalized adults infected with these viruses. Methods. Over the course of 3 consecutive winter respiratory viral seasons, adults ≥ 50 years of age admitted with acute respiratory tract infections (ARI) and adults of any age with COPD or CHF-related admissions were enrolled from 2 Atlanta area hospitals. For the 2018-19 and 2019-20 seasons, participants were approached in the hospital. If the participant enrolled, nasopharyngeal (NP) and oropharyngeal (OP) swabs were collected and tested using BioFire® FilmArray® respiratory panel. Due to the COVID-19 pandemic in 2020-21 and limitations involving participant contact, only NP standard of care (SOC) swabs were collected. A comprehensive medical chart review was completed for each subject which encompassed data on their hospitalization, past medical history, and vaccination history. Co-infected patients were excluded from the analyses. Results. Of the eligible participants, 118 were flu positive (three RSV-influenza co-infections were excluded) and 527 were COVID-19 positive. Median age was lower for the flu cohort at 62 (IQR 56-71) than those with COVID-19 (67, IQR 59-77) (p < 0.0001). Length of stay (LOS) was shorter in flu-infected patients (median 3 d, IQR 2-6), but was longer for COVID-19 patients (median 5 d, IQR 3-10). ICU admission occurred in 20% of those with flu, and among those admitted to the ICU mechanical ventilation (MV) occurred in 12.5%. ICU admission and MV was significantly higher for those with COVID-19, with 28% of patients admitted to the ICU and 47% of those requiring MV. Among patients with COVID-19, 8.9% died. This was significantly higher than that of flu (3.4%) (p=0.008). Hospital discharge occurred more frequently to a nursing home or LTCF with COVID-19 (10.3%) than with flu (0%) (p< 0.0001). Table 1. Breakdown of age, hospitalization course, and discharge disposition for participants diagnosed with influenza or COVID-19 during hospitalization. Conclusion. COVID-19 resulted in a longer hospital admission, a greater chance of ICU admission and MV as compared to flu. Additionally, COVID-19 participants had a high rate of discharge to a nursing home/LTCF and a significantly higher risk of death. While the clinical course was not as severe as COVID-19, influenza contributed a significant burden.

The Burden of Influenza and Rhinovirus among Hospitalized Adults Post the COVID-19 Pandemic

Background. Acute respiratory tract infections (ARIs) are a significant cause of morbidity in adults. Influenza is associated with about 490,600 hospitalizations and 34,200 deaths in the US in the 2018-2019 season. The burden of rhinovirus among adults hospitalized with ARI is less well known. We compared the burden of influenza and rhinovirus from 2 consecutive winter respiratory viral seasons in hospitalized adults and healthy controls pre-COVID-19 and one season mid-COVID-19 to determine the impact of rhinovirus as a pathogen. Methods. From Oct 2018 to Apr 2021, prospective surveillance of adults ≥50 years old admitted with ARI or COPD/CHF exacerbations at any age was conducted at two Atlanta hospitals. Adults were eligible if they lived within an eightcounty region around Atlanta and if their symptom duration was < 14 days. In the seasons from Oct 2018 to Mar 2020, asymptomatic adults ≥50 years old were enrolled as controls. Standard of care test results were included and those enrolled contributed nasopharyngeal swabs that were tested for respiratory pathogens using BioFire® FilmArray® Respiratory Viral Panel (RVP). Results. During the first two seasons, 1566 hospitalized adults were enrolled. Rhinovirus was detected in 7.5% (118) and influenza was detected in 7.7% (121). Rhinovirus was also detected in 2.2% of 466 healthy adult controls while influenza was detected in 0%. During Season 3, the peak of the COVID-19 pandemic, influenza declined to 0% of ARI hospitalizations. Rhinovirus also declined (p=0.01) but still accounted for 5.1% of all ARIs screened (Figure 1). Rhinovirus was detected at a greater rate in Season 3 than in asymptomatic controls in the first 2 seasons (p=0.008). In the first two seasons, Influenza was detected in 8.6% (24/276) of those admitted to the ICU. Rhinovirus was detected in 6.1% (17/276) of those admitted to the ICU but declined to 3.1% (8/258) in Season 3. Conclusion. Dramatic declines occurred in influenza in adults hospitalized with ARI, CHF, or COPD in Atlanta during the COVID-19 pandemic and with enhanced public health measures. Although rhinovirus declined during the COVID-19 pandemic, it continued to be identified at a rate higher than in historical controls. Additional data are needed to understand the role of rhinovirus in adult ARI, CHF, and COPD exacerbations.

Comparison of baseline characteristics, treatment and clinical outcomes of critically ill COVID-19 patients admitted in the first and second waves in Australia

Objective: To report longitudinal differences in baseline characteristics, treatment, and outcomes in patients with coronavirus disease 2019 (COVID-19) admitted to intensive care units (ICUs) between the first and second waves of COVID-19 in Australia. Design, setting and participants: SPRINT-SARI Australia is a multicentre, inception cohort study enrolling adult patients with COVID-19 admitted to participating ICUs. The first wave of COVID-19 was from 27 February to 30 June 2020, and the second wave was from 1 July to 22 October 2020. Results: A total of 461 patients were recruited in 53 ICUs across Australia;a higher number were admitted to the ICU during the second wave compared with the first: 255 (55.3%) versus 206 (44.7%). Patients admitted to the ICU in the second wave were younger (58.0 v 64.0 years;P = 0.001) and less commonly male (68.9% v 60.0%;P = 0.045), although Acute Physiology and Chronic Health Evaluation (APACHE) II scores were similar (14 v 14;P = 0.998). High flow oxygen use (75.2% v 43.4%;P < 0.001) and non-invasive ventilation (16.5% v 7.1%;P = 0.002) were more common in the second wave, as was steroid use (95.0% v 30.3%;P < 0.001). ICU length of stay was shorter (6.0 v 8.4 days;P = 0.003). In-hospital mortality was similar (12.2% v 14.6%;P = 0.452), but observed mortality decreased over time and patients were more likely to be discharged alive earlier in their ICU admission (hazard ratio, 1.43;95% CI, 1.13–1.79;P = 0.002). Conclusion: During the second wave of COVID-19 in Australia, ICU length of stay and observed mortality decreased over time. Multiple factors were associated with this, including changes in clinical management, the adoption of new evidence-based treatments, and changes in patient demographic characteristics but not illness severity. © 2021, College of Intensive Care Medicine. All rights reserved.

Real-Time COVID-19 Infection Risk Assessment and Mitigation based on Public-Domain Data

A number of models have been developed to predict the spreads of the COVID-19 pandemic and how non-pharmaceutical interventions (NPIs) such as social distancing, facial coverings, and business and school closures can contain this pandemic. Evolutionary artificial intelligence (AI) approaches have recently been proposed to automatically determine the most effective interventions by generating a large number of candidate strategies customized for different countries and locales and evaluating them with predictive models. These epidemiological models and advanced AI techniques assist policy makers by providing them with strategies in balancing the need to contain the pandemic and the need to minimize their economic impact as well as educating the general public about ways to reduce the chance of infection. However, they do not advise an individual citizen at a specific moment and location on taking the best course of actions to accomplish a task such as grocery shopping while minimizing infection.Therefore, this paper describes a new project aiming to develop a mobile-phone-deployable, real-time COVID-19 infection risk assessment and mitigation (RT-CIRAM) system which analyzes up-to-date data from multiple open sources leveraging urgent HPC/cloud computing, coupled with time-critical scheduling and routing techniques. Implementation of a RT-CIRAM prototype is underway, and it will be made available to the public. Facing the increasing spread of the more contagious Delta (B.1.617.2) and Delta Plus (AY.4.2) variants, this personal system will be especially useful for individual citizen to reduce her/his infection risk despite increasing vaccination rates while contributing to containing the spread of the current and future pandemics. © 2021 IEEE.

Deep learning to estimate covid-19 mortality risk from chest radiographs

Introduction: Management of coronavirus disease 2019 (COVID-19) requires accurate assessment of risk of future cardiopulmonary complications. Deep learning can extract complex relationships between medical imaging and clinical outcomes. Hypothesis: A deep learning model can predict 30-day mortality from COVID-19 based on a chest radiograph image. Methods: A deep learning model (CXR-CovRisk) was developed to estimate 30-day mortality risk using a single chest radiograph image (chest x-ray or CXR). The model was developed using 1,738 patients with PCR-confirmed coronavirus disease 2019 (COVID-19) from four Boston-area hospitals between March 1, 2020 and April 24, 2020. CXR-CovRisk was tested on 903 consecutive patients with confirmed COVID-19 between April 25, 2020 and June 15, 2020. CXR-CovRisk was compared to two published deep learning models (PXS and COVID-GMIC) and a clinical risk factor-based severity score for discrimination of 30-day mortality. The continuous risk score was converted to three risk groups: Low, Medium, and High based on development dataset probability quantiles. Results are provided for the independent testing set onlyResults: CXR-CovRisk had high discrimination for 30-day mortality (AUC = 0.839, 95% CI [0.79,0.89]), which was higher than when using a deep learning lung disease severity score (PXS AUC 0.750 [0.70,0.80], p < 0.001) or the output of a model trained for 96-hour mortality prediction (COVID-GMIC 0.755 [0.70,0.81], p = 0.003). CXR-CovRisk had added value to the clinical riskfactor based severity score (Clinical Severity Score AUC 0.799 [0.76,0.84] vs. Combined AUC 0.872 [0.84,0.90], p < 0.001). Among outpatients not admitted to the hospital, the CXR-CovRisk High-risk group had a high rate of subsequent hospital admission and 30-day mortality (composite event rate 11/26, 42.3%), higher than the medium-risk (30/179, 16.8%, p=0.005) and low-risk groups (17/172, 9.9%, p < 0.001). Conclusion: A deep learning model, CXR-CovRisk, can estimate 30-day mortality risk from a chest radiograph image.

3-weekly paclitaxel-carboplatin with radiation for stage III NSCLC – option during COVID-19 pandemic

Purpose or Objective: The optimal choice and schedule of chemotherapy (CT) given concurrently with radiation (RT) for primary treatment of stage III unresectable non-small cell lung cancer (NSCLC) remain debatable. 3-weekly paclitaxelcarboplatin (PC) is a convenient schedule but not well studied. This study aims to review the efficacy, toxicities and prognostic factors for treatment outcomes of this regime. Materials and Methods: Patients with unresectable stage III (AJCC TNM 7th edition) NSCLC treated with radical chemoradiotherapy using 3-weekly PC (P 175mg/m2, C AUC=5 on day 1 of 21-day cycle) from January 2007 to April 2017 were retrospectively reviewed. RT was given 5 days per week in 2 Gy daily fractions to the planning target volume using 3D-conformal technique. Total of 4 to 6 cycles of CT were allowed at clinicians’ discretion. Patients who had >2 CT cycles before RT, <1 cycle of CT concurrently with RT and total RT dose < 60 Gy were excluded. Results: A total of 65 patients with median age 63 years (range 45-74 years) were included. Stage distribution was similar between IIIA (53.8%) and IIIB (46.2%). Majority (41.5%) of patients had adenocarcinoma, followed by squamous histology (38.5%). Most patients received 60 Gy of RT (96.9%) and 4 cycles of CT (83.1%). At a median follow up of 29.5 months (mo) (Interquartile range 13.4-53.6 mo), the median overall survival (OS) was 35.0 mo (95% CI 17.5-52.4 mo) and the median progressive free survival (PFS) was 12.2 mo (95% CI 8.7-15.8 mo). The 1, 3 and 5-year OS rates were 76.9%, 48.3% and 29.7% respectively. Multivariate analyses showed that gross tumour volume (HR 1.005 [95% CI 1.002-1.008];p<0.01), mean heart dose ≥ 5 Gy (HR 2.507 [95% CI 1.293-5.108];p< 0.01) and more than 4 cycles of CT given (HR 3.830 [95% CI 1.479-9.921];p <0.01) were independent prognostic factors for worse OS, while ≥ grade 2 esophagitis was an independent prognostic factor for worse PFS (HR 2.563 [95% CI 1.031-6.370];p=0.04). The maximum grade toxicity was grade 2 in 20 patients (41.5%), grade 3 in 27 patients (20.0%) and grade 4 in 5 patients (7.7%). No grade 5 events were observed. The most common grade 3 or 4 toxicity was neutropenia, which occurred in 9 (13.8%) and 5 (7.7%) patients respectively. Neutropenic fever was seen in 3 patients (4.6%). Grade 2 or above pneumonitis and esophagitis occurred in 5 (7.7%) and 9 (13.8%) patients respectively. (Figure Presented) Conclusion: Radical chemoradiotherapy using 3-weekly PC for unresectable stage III NSCLC is well tolerated, with comparable outcomes to historical data and less hospital visits which is preferred during the COVID-19 pandemic. Prospective studies evaluating whether this regime in combination with more sophisticated RT techniques to lower the cardiac and esophageal doses could improve the survival outcomes and further enhance the therapeutic ratio in the era of consolidative durvalumab are warranted.