STRUCTURAL RACISM AND INCOME-RELATED HEALTH INEQUITIES IN THE ONTARIO GOvERNMENT AND ITS PUBLIC HEALTH UNITS' RESPONSE TO THE COvID-19 PANDEMIC

Early reports in Canada indicated that the health impacts of COVID-19 would be disproportionately worse for marginalized groups due to existing health inequities. While the federal, provincial, and territor-ial governments had extensive emergency powers at their disposal, the bulk of the pan-demic response came from the provinces and territories. Despite warnings about the anticipated disparate impact of the pandem-ic, data from Ontario indicates that racial-ized populations and individuals in lower-income households were the worst hit by the pandemic. This paper explores four aspects of the Ontario government and its 34 public health units' emergency response: (1) data collection on COVID-19 and health inequi-ties, (2) administration of COVID-19 test-ing, (3) the provision of medical services to those with COVID-19, and (4) distribution of COVID-19 vaccines. For each of these four aspects of the Ontario government and its 34 public health units' response, we highlight central areas where structural ra-cism and income-related health inequities were apparent. We acknowledge the sig-nificant practical barriers, such as lack of information and severe resource constraints, involved in pursuing health equity goals during the COVID-19 pandemic. However, for each of these areas, we recommend steps that could have been taken by the Ontario government and the public health units, in part through the province's emergency pow-ers, to redress the disparate impact of the pandemic. We suggest that the Ontario gov-ernment had a moral duty to combat these inequities, as well as a possible legal duty to do so in light of the Canadian Charter of Rights and Freedoms and certain inter-national human rights obligations.

The real-world impact of the COVID-19 pandemic on patients with cancer: a multidisciplinary cross-sectional survey.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented disruptions to cancer care worldwide. We conducted a multidisciplinary survey of the real-world impact of the pandemic, as perceived by patients with cancer. METHODS: A total of 424 patients with cancer were surveyed using a 64-item questionnaire constructed by a multidisciplinary panel. The questionnaire examined patient perspectives regarding COVID-19-related effects (eg, social distancing measures) on cancer care delivery, resources, and healthcare-seeking behaviour, along with the physical and psychosocial aspects of patient well-being and pandemic-related psychological repercussions. RESULTS: Overall, 82.8% of respondents believed that patients with cancer are more susceptible to COVID-19; 65.6% expected that COVID-19 would delay anti-cancer drug development. Although only 30.9% of respondents felt that hospital attendance was safe, 73.1% expressed unaltered willingness to attend scheduled appointments; 70.3% of respondents preferred to receive chemotherapy as planned, and 46.5% were willing to accept changes in efficacy or side-effect profile to allow an outpatient regimen. A survey of oncologists revealed significant underestimation of patient motivation to avoid treatment interruptions. Most surveyed patients felt that there was an insufficient amount of information available concerning the impact of COVID-19 on cancer care, and most patients reported social distancing-related declines in physical, psychological, and dietary wellness. Sex, age, education level, socio-economic status, and psychological risk were significantly associated with patient perceptions and preferences. CONCLUSION: This multidisciplinary survey concerning the effects of the COVID-19 pandemic revealed key patient care priorities and unmet needs. These findings should be considered when delivering cancer care during and after the pandemic.

Physician burnout during the COVID-19 pandemic

Background: Physician burnout is associated with reduced quality of care and patient satisfaction and increased costs. We sought to quantify professional fulfillment levels and burnout rates and identify drivers of burnout among physicians within Vancouver Coastal Health during the COVID-19 pandemic. Methods: Members of the Vancouver Physician Staff Association were surveyed in the fall of 2020. The Stanford Professional Fulfillment Index was used to assess physician professional fulfillment and burnout. Physicians were also asked to assess the effect of the COVID-19 pandemic on their physical and mental health, determine psychological safety within their department, and identify interventions to improve their well-being. Results: Of the 1949 physicians contacted, 566 (29%) responded to the survey. Results were analyzed for 84% of the responses (475/566);the completion rate was 24% (475/1949). The overall professional fulfillment level was 25.3%, and the overall burnout rate was 51.4%. Interventions that physicians felt would improve their well-being included providing higher financial remuneration, improving patient access to resources, enhancing staff support, and providing coaching sessions and better support for work-life balance. Conclusions: Further work is needed at every level—individual, departmental, and system-ic—to address physician burnout. It is our hope that these survey results will help drive systemic, cultural, and organizational changes to improve physician well-being. Results: Of the 1949 physicians contacted, 566 (29%) responded to the survey. Results were analyzed for 84% of the responses (475/566);the completion rate was 24% (475/1949). The overall professional fulfillment level was 25.3%, and the overall burnout rate was 51.4%. Interventions that physicians felt would improve their well-being included providing higher financial remuneration, improving patient access to resources, enhancing staff support, and providing coaching sessions and better support for work-life balance. © 2023, British Columbia Medical Association. All rights reserved.

Fracture incidence and fracture-related mortality decreased with decreases in population mobility during the early days of the COVID-19 pandemic: an epidemiological study.

INTRODUCTION: We investigated the impact of coronavirus disease 2019 (COVID-19) social distancing measures on fracture incidence and fracture-related mortality, as well as associations with population mobility. METHODS: In total, 47 186 fractures were analysed across 43 public hospitals from 22 November 2016 to 26 March 2020. Considering the smartphone penetration of 91.5% in the study population, population mobility was quantified using Apple Inc's Mobility Trends Report, an index of internet location services usage volume. Fracture incidences were compared between the first 62 days of social distancing measures and corresponding preceding epochs. Primary outcomes were associations between fracture incidence and population mobility, quantified by incidence rate ratios (IRRs). Secondary outcomes included fracture-related mortality rate (death within 30 days of fracture) and associations between emergency orthopaedic healthcare demand and population mobility. RESULTS: Overall, 1748 fewer fractures than projected were observed during the first 62 days of COVID-19 social distancing (fracture incidence: 321.9 vs 459.1 per 100 000 person-years, P<0.001); the relative risk was 0.690, compared with mean incidences during the same period in the previous 3 years. Population mobility exhibited significant associations with fracture incidence (IRR=1.0055, P<0.001), fracture-related emergency department attendances (IRR=1.0076, P<0.001), hospital admissions (IRR=1.0054, P<0.001), and subsequent surgery (IRR=1.0041, P<0.001). Fracture-related mortality decreased from 4.70 (in prior years) to 3.22 deaths per 100 000 person-years during the COVID-19 social distancing period (P<0.001). CONCLUSION: Fracture incidence and fracture-related mortality decreased during the early days of the COVID-19 pandemic; they demonstrated significant temporal associations with daily population mobility, presumably as a collateral effect of social distancing measures.

Science communication in the media and human mobility during the COVID-19 pandemic: a time series and content analysis.

OBJECTIVES: The relationship between human mobility and nature of science (NOS) salience in the UK news media was examined. STUDY DESIGN: This is a mixed-method study. METHODS: A time series NOS salience data set was established from the content analysis of 1520 news articles related to non-pharmaceutical interventions of COVID-19. Data were taken from articles published between November 2021 and February 2022, which correlates with period of the change from pandemic to endemic status. Vector autoregressive model fitting with human mobility took place. RESULTS: The findings suggest that it was not the number of COVID-19 news articles nor the actual number of cases/deaths, but the specific NOS content that was associated with mobility change during the pandemic. Data indicate a Granger causal negative direction (P < 0.1) for the effect of the NOS salience represented in the news media on mobility in parks, as well as the effect of scientific practice, scientific knowledge and professional activities communicated in news media on recreational activities and grocery shopping. NOS salience was not associated with the mobility for transit, work or residential locations (P > 0.1). CONCLUSIONS: The findings of the study suggest that the ways in which the news media discuss epidemics can influence changes in human mobility. It is therefore essential that public health communicators emphasise the basis of scientific evidence to eliminate potential media bias in health and science communication for the promotion of public health policy. The present study approach, which combines time series and content analysis and uses an interdisciplinary lens from science communication, could also be adopted to other interdisciplinary health-related topics.

Does work from home reshape the urban rental structure? Early evidence from a rental gradient analysis in Auckland

Purpose: This study aims to identify the pandemic's impact on house rents by applying a rental gradient analysis to compare the pre-and post-COVID-19 periods in Auckland. The micro-level household census data from the Integrated Data Infrastructure of Statistics New Zealand is also applied to scrutinise this WFH trend as a robustness check. Design/methodology/approach: Since the outbreak of COVID-19, work-from-home (WFH) and e-commerce have become much more common in many cities. Many news reports have contended that households are leaving city centres and moving into bigger and better houses in the suburbs or rural areas. This emerging trend has been redefining the traditional theory of residential location choices. Proximity to central business district (CBD) is no longer the most critical consideration in choosing one's residence. WFH and e-commerce flatten the traditional bid rent curve from the city centre. Findings: The authors examined micro-level housing rental listings in 242 suburbs of the Auckland Region from January 2013 to December 2021 (108 months) and found that the hedonic price gradient models suggest that there has been a trend of rental gradient flattening and that its extent was almost doubled in 2021. Rents are also found to be increasing more in lower-density suburbs. Research limitations/implications: The results imply that the pandemic has accelerated the trend of WFH and e-commerce. The authors further discuss whether the trend will be a transient phenomenon or a long-term shift. Practical implications: Suppose an organisation is concerned about productivity and performance issues due to a companywide ability to WFH. In that case, some standard key performance indicators for management and employees could be implemented. Forward-thinking cities need to focus on attracting skilful workers by making WFH a possible solution, not by insisting on the primacy of antiquated nine-to-five office cultures. Social implications: WFH has traditionally encountered resistance, but more and more companies are adopting WFH policies in this post-COVID era. The early rental gradient and the micro-level household data analysis all confirm that the WFH trend is emerging and will likely be a long-term shift. Instead of resisting the change, organisations should improve their remote work policies and capabilities for this WFH trend. Originality/value: So far, empirical studies of post-COVID urban restructuring have been limited. This study aims to empirically test such an urban metamorphosis by identifying the spatial and temporal impacts of COVID on house rental gradients in the Auckland Region, New Zealand. The authors apply rental gradient analysis to test this urban restructuring hypothesis because the method considers the spatial-temporal differences, i.e. a difference-in-differences between pre-and post-pandemic period against the distance measured from the city centre. The method can control for the spatial difference and the endogeneity involved. © 2023, Emerald Publishing Limited.

Association of Molnupiravir and Nirmatrelvir-Ritonavir with preventable mortality, hospital admissions and related avoidable healthcare system cost among high-risk patients with mild to moderate COVID-19

Background Real-world data is currently limited on the association between oral antiviral therapy and healthcare system burden in patients with mild-to-moderate COVID-19. This study aims to evaluate the clinical and cost effec-tiveness of Molnupiravir and Nirmatrelvir-ritonavir use in reducing mortality in this population. Methods This is a retrospective cohort study involving 54,355 COVID-19 patients during February 22-March 31,2022 in Hong Kong. Inverse probability of treatment weighting (IPTW) was used to adjust patient characteristics. Our exposure of interest was Molnupiravir/Nirmatrelvir-Ritonavir prescription, with all-cause mortality as the pri-mary outcome. IPTW-adjusted multivariate regressions were used to estimate treatment impact on clinic re -atten-dance and unplanned admissions. Finally, attributed cost and incremental cost-effectiveness ratios (ICER) were estimated. Findings In the outpatient cohort (N = 33,217, 61.1%), 16.1% used Molnupiravir and 13.4% used Nirmatrelvir-Ritona-vir, while in the inpatient cohort (N = 21,138, 38.9%), 3.8% used Molnupiravir and 1.3% used Nirmatrelvir-Ritonavir. IPTW-adjusted Cox model estimated that Molnupiravir (hazard ratio (HR)(95%CI)=0.31 (0.24-0.40), P< 0.0001) and Nirmatrelvir-Ritonavir (HR=0.10 (95%CI 0.05-0.21), P< 0.0001) were significantly associated with a reduced mortality hazard. In the outpatient cohort, both antiviral prescriptions were associated with reduced odds for unplanned hospital admissions (Molnupiravir: odds ratio (OR) =0.72 (0.52-0.98), P=0.039;Nirmatrelvir-Ritonavir: OR=0.37 (0.23-0.60), P<0.0001). Among hospitalised patients, both antiviral prescriptions were associated with sig-nificant reductions in the odds ratios for 28-days readmission (Molnupiravir: OR=0.71 (0.52-0.97), P=0.031;Nirma-trelvir-Ritonavir: OR=0.47 (0.24-0.93), P=0.030). ICERs for death averted for Molnupiravir stood at USD493,345.09 in outpatient settings and USD2,629.08 in inpatient settings. In outpatient settings, Nirmatrelvir-ritonavir cost USD331,105.27 to avert one death, but saved USD5,502.53 to avert one death in comparison with standard care. Interpretation In high-risk patients in Hong Kong with mild-to-moderate COVID-19, Molnupiravir and Nirmatrel-vir-Ritonavir prescriptions were associated with reduced all-cause mortality and significant cost savings.

The updated SIOG COVID-19 working group recommendations on COVID-19 vaccination among older adults with cancer

Background: Older patients with cancer remain at high risk for negative outcomes from COVID-19 infection, particularly those who have multimorbidities and on immunosuppressive therapy. These patients have been excluded or underrepresented in pivotal COVID-19 vaccine clinical trials and there are ongoing concerns that they may not acquire the same level of protection from the available vaccines as the immunocompetent adults. Moreover, the level of protection wanes over time making them more susceptible to emerging COVID-19 novel variants of concern. Despite the implementation of global vaccination campaigns which have successfully reduced COVID-related hospitalisations and deaths in many parts of the world, there remains many unresolved issues and challenges to address as the pandemic ensues. With aging, concerns for age-related dysregulation and immune dysfunctions called immunosenescence may lead to potentially lower immunogenicity to vaccines. Despite receiving the primary vaccination, real-world evidence showed that both patients aged > 65 years and those with cancer have a higher risk of developing breakthrough COVID-19 infections and related complications. Subsequent booster doses are found to be effective at improving immune response, particularly against the novel variants, and the vulnerable population should be given the priority in booster campaigns. Method(s): Since the beginning of the pandemic in 2020, The International Society of Geriatric Oncology set up a COVID-19 Working Group comprised of multidisciplinary specialists by developing recommendations, advocacy, and action plans based on expert opinion and evidence related to older adults with cancer. Result(s): The table below summarises the updated recommendations from the SIOG COVID-19 Working Group. Conclusion(s): The SIOG COVID-19 Working Group supports ongoing public health interventions, continued mass immunisations, and booster campaigns targeting the most vulnerable members of the society, including older adults with cancer (Table Presented).

SURVIVAL OF THE FITTEST OR FRAILEST? COMPARING THE HEALTH OF CENTENARIANS OVER A 10-YEAR PERIOD

The first centenarian study in Hong Kong was conducted in 2011 and examined the multidimensional health of adults aged 95 or older. The 2011 study found that, among a population of about 3,000 centenarians, a significant proportion enjoyed a high degree of autonomy in their daily functions in relatively good health. The study has been repeated in 2021/22 (i.e., born in 1926 or before) when the city had more than 11,000 centenarians. Comparison of the two samples (2011: Nf77;2021/22: Nf120) who lived with their family shows a significant difference in functional health, but not as much for physical health, favouring the 2011 cohort. More than 75% of the 2011 cohort demonstrated autonomy in activities of daily living (Bathing: 77.9%, dressing: 85.7%, toileting: 90.9%, indoor transfer: 89.6%;continence:75.3% and feeding: 94.8%). Only about half of the 2021/22 cohort were autonomous in these areas (40.0%, 44.3%, 54.7%, 42.5%, 63.2%, 46.7%, respectively). The number of chronic illnesses between the two cohorts were comparable (Mean(SD): 2011: 2.7 (1.6);2021: 3.26 (1.60), yet dementia and frailty were more prevalent in the 2021 cohort (dementia: 44%;frailty: 9.1%) then the 2011 cohort (41.0%;23.4%). Our findings alert metropolitans worldwide to the fast-increasing population of adults of advanced age with significant personal care and health needs in the community. Existing care for older adults has to be reframed and overhauled to provide comprehensive home- and personal-care support which will be essential for realizing ageing-in-place for adults in advanced age, especially after social distancing policies in COVID-19.

COMPARING SUCCESSFUL AGING OF NEAR-CENTENARIANS AND CENTENARIANS: FINDINGS FROM 2011 AND 2021/22

Successful aging (SA) was proposed by Robert J Havighurst in 1961 to capture how older adults add "lives onto (their) years.” While there is a consensus regarding the multidimensionality of the concept, the set of criteria that should be applied to older adults of advanced age remain controversial. Notwithstanding their inevitable decline in physical health, adults of advanced age may still enjoy good psychosocial well-being. In this light, we compared the proportion of "successful agers” in two cohorts of adults aged 95 or above who lived with their families in 2011 (Nf77) and 2021/22 (Nf120) in Hong Kong using two models – Model A: i: Good subjective health, ii: more well-off than average, iii: as happy as young (Cho et al., 2012) and Model B: i: Weekly social activities, ii: absence of dementia, iii: intact sight and hearing ability, iv: intact mobility (Nosraty et al, 2012). Both models have been applied in adults aged 90 or above. In the 2011 cohort, 13.0% and 16.9% of our sample fulfilled the SA criteria of Model A & B respectively. The percentages fell to 1.7% and 13.7% respectively in the 2021/22 cohort. The decrease is due to less participants fulfilling the financial criterion of Model A, as well as the criteria on intact sight and hearing ability and the absence of dementia of Model B. COVID presents multidimensional challenges for adults of advanced age. Examining the dimensions that are most impacted will help orient recovery works along the direction of SA.

LOVE OR OBLIGATION TO "SEE THEM THROUGH:” BURDENS AND GAINS IN CAREGIVING FOR CENTENARIANS

In Hong Kong, the population of centenarians increased from about 3,000 in 2011 to over 10,000 in 2021. The growth of this population has led to challenges concerning how far family caregivers, who are usually older adults themselves, could care for their spouse or parents. In 2021, we launched the 2nd Hong Kong Centenarian Study and included the voices of family caregivers. Notwithstanding the increased difficulties of caregiving during COVID outbreaks, our interviews with 120 caregivers revealed low to moderate scores of caregiving burden and gains (measured by 4-items from the Zarit Burden Scale and 5-items from the Positive Aspects of Caregiving Scale). Female and older (aged 70 or above) caregivers reported more emotional distress, burden, and poorer self-rated health, while younger caregivers (less than 70 years old) sustained a wider social network. Financial stress was related to smaller social network size and more emotional distress. When being asked what sustained their motivation to care for their spouse or for their parents, "filial obligation to see them through” and "repaying for love” were answered as key motivators. Caregivers also derived pride and satisfaction from contributing to the remarkable longevity of their loved ones or from witnessing their loved ones recovering from life-threatening traumas (e.g., falls, hospitalization), but felt helpless when faced with escalating care needs due to their own deteriorating physical health and capacities. "Double-old caregiving” will become more common, and society will need to overhaul the care system to support these motivated families who have escalated care needs.

Elective versus Emergency management of gallstone disease at a tertiary referral centre amidst the COVID-19 pandemic-should the protocol be altered?

Background: Gallstones are a common pathology affecting approximately 15% of The population in UK, 20% of which are symptomatic. It is suggested symptomatic patients undergo cholecystectomies. Guidelines recommend this is performed within one week of initial Emergency presentation or 52 weeks for elective case. Surgical capacity to manage Emergency cholecystectomies was limited due to The COVID pandemic. We assessed wait time discrepancy between elective and Emergency cholecystectomies. Method(s): A retrospective review of all patients undergoing cholecystectomies between January and November 2021 in a major tertiary referral centre in London was undertaken. Initial pathology at The time of presentation, elective vs Emergency presentation, pre-surgical Biliary complications along and wait times were reviewed. Result(s): 219 (74 elective, 145 emergency) patients underwent surgery, mean age 48 years (23% Male and 77% Female). Average wait times for elective cholecystectomies were 69.7 days (min 0, max 246) in Comparison to 68.9 days (min 1, max 253) for Emergency surgery. 22 (15%) of The patients of initial Emergency presentation re-attended hospital and 6 (4%) had adverse events such as gallbladder perforation or pancreatitis due to delayed treatment. Comparatively, 9 (12%) elective patients attended A&E due to pain, with no adverse outcomes. Conclusion(s): Overall wait time of Emergency vs elective cholecystectomies were similar. This review indicates Emergency cases require prioritisation over elective cholecystectomies due to The higher number of re-attendance and adverse events. Emergency cases need to be prioritised to meet guidelines, which could also reduce complication rates whilst awaiting Surgery and lead to fewer adverse outcomes.

Difficulties in managing acute gallstone disease at a Tertiary Referral Centre admist COVID-19

Background: Acute Biliary disease, a surgical emergency, is predominantly treated conservatively initially. Specialist units aim to follow guidelines set by The Royal College of Surgeons and NICE to provide a cholecystectomy within a set time. Clinical practice at St Thomas' Hospital was reviewed along with The difficulties during The COVID-19 pandemic. Aim(s): Reassess practice at a specialist unit failing to meet guidelines during The start of COVID-19. Prospective data collection, on patients booked for a laparoscopic cholecystectomy (LC) after Emergency attendances. Method(s): Initial retrospective data analysis, reviewing pre-COVID (PC19) practice (03/19-02/20), initial COVID-19 (IC19) management (03/20-12/20). Prospective data (01/21-11/21) after implementing changes (AC19). Identifying demographics, pathology, length of stay during acute admission, average wait for Surgery and readmission rate prior to surgery. Patients receiving Surgery within 6 weeks, which has been set by our Trust as an acceptable standard. Result(s): Patients with acute presentation (acute cholecystitis, gallstone pancreatitis, cholangitis) 162 (PC19), 80 (IC19), 145 (AC19). Gender Ratio M:F 1:2 for all groups. Average wait to Surgery 93 (PC19), 44 (IC19), 69 (AC19) days. Patients receiving Surgery within 6 weeks 24.7% (PC19), 32.5% (IC19), 51.7% (AC19). Patients who were still awaiting Surgery at The end of each time frame 49% (PC19), 51% (IC19), 48% (AC19). Mean length of surgical stay 1.75 (AC19) days. Conclusion(s): Further changes are required, as guidelines are still not being met, with average wait times significantly above The recommended wait to undergo laparoscopic cholecystectomy.

Three Cases of Autoimmune Thyrotoxicosis after the BNT162b2 mRNA Covid-19 Vaccine

Background: Various vaccines have been produced around the world in the battle against coronavirus disease 2019 (COVID-19) in the past year. Clinical trials and approvals of these vaccines were expedited at an unprecedented speed, with some of them approved under emergency use. Since March 2021, government coordinated vaccination program using two types of vaccines against COVID-19 were being undertaken in Hong Kong. BNT162b2 mRNA COVID-19 vaccine under the name of BioNTech was one. While it is a promising measure to control COVID-19, the new mRNA vaccine technology does cast some doubts, particularly its safety. In addition to the commonly reported injection site reactions and systemic upsets, less reported reactions after this new vaccine requires more clarifications. Here, we report 3 cases of autoimmune thyrotoxicosis all happened soon after the vaccination. Clinical Cases: Case1: A 40-year-old man with family history of thyroid cancer (mother had thyroid cancer with operation done) developed palpitations 17 days after receiving the first dose of BioNtech vaccine. Investigations confirms Graves’ thyrotoxicosis as evidenced by elevated fT4 and suppressed sTSH with positive thyroid stimulating immunoglobulin (TSI) and a diffuse vascular goiter on ultrasound (USG) thyroid. He was started on a course of anti-thyroid drug and had been advised to defer the second dose of vaccine until clinically stable. Case2: A 44-year old lady without personal/family history of thyroid disease developed progress neck swelling and palpitation with tremor 3 days after receiving the first dose of BioNtech vaccine. Investigations confirmed Graves’ thyrotoxicosis with elevated fT4 and suppressed sTSH with positive TSI, anti-TPO, and anti-ATG. USG thyroid showed diffuse vascular goiter. She was treated with a course of anti-thyroid drug and had been advised to defer the second dose of vaccine until stabilization of thyroid function. Case3: A 56-year-old man with positive family history of thyrotoxicosis (elder brother with history of thyrotoxicosis treated with radioactive iodine) developed progressive weight loss, increased appetite, insomnia, palpitation, and tremor around 7 days after the first dose of BioNtech vaccine. Patient only presented to an Endocrinologist for further workup 63 days after the first dose (42 days after second dose of BioNtech). Biochemically he had high fT4, suppressed sTSH, with positive anti-ATG, anti-TPO and TSI. USG thyroid revealed a small diffuse goiter. He was treated with a course of anti-thyroid drug with regular follow-up and monitoring. Conclusion: This is the first case-series in Hong Kong demonstrating the possible triggering of Graves’ thyrotoxicosis after BioNTech vaccination. TSI and USG thyroid are invaluable tools to confirm the autoimmunity nature of the disease. Further studies are needed to clarify the prevalence, mechanisms, preventions, and treatments of this vaccine complication.Presentation: No date and time listed

Association between Recent Antibiotic Use and Early Immunogenicity of Covid-19 Bnt162b2 Vaccine

Introduction: Gut microbiota have been shown to be associated with COVID- 19 and influenza vaccine immunogenicity. While antibiotic-induced gut microbiota perturbation leads to suboptimal antibody production among influenza vaccine recipients, little is known about the effect of preexposure antibiotics on COVID-19 vaccine immunogenicity. Aims & Methods: We aimed to determine whether recent antibiotics use impaired COVID-19 immunogenicity. This was a prospective cohort study recruiting adult BNT162b2 recipients from five vaccination centers in Hong Kong. Exclusion criteria included prior COVID-19 infection, history of gastrointestinal surgery, inflammatory bowel disease, immunocompromised status (post-organ transplantation, immunosuppressants, chemotherapy), cancer, hematological, rheumatological and autoimmune diseases. Subjects received two doses of BNT162b2 at three weeks apart. Blood samples were collected at three time-points (before vaccination, day 21 and 56after first dose), and were tested for neutralising antibody (NAb) against receptor-binding domain (RBD) of wild type SARS-CoV-2 virus using a one-step competitive chemiluminescence immunoassay. NAb seroconversion was defined as 15 AU/mL. Primary outcomes were seroconversion rates of NAb at day 21 and 56 after first dose of vaccine. Exposure was pre-vaccination antibiotic use, defined as ever use of any antibiotics (including 11 different classes) within 6 months before vaccination. The adjusted odds ratio (aOR) of seroconversion with antibiotic use was derived by multivariable logistic regression model by adjusting for age, sex, diabetes mellitus (DM), overweight (BMI >23 kg/m2for Asians), hypertension, raised LDL (>=3.4 mmol/L), moderate-to-severe hepatic steatosis (defined as controlled attenuated parameter >= 268 dB/M on transient elastography), smoking and alcohol. Result(s): Of 316 BNT162b2 recipients (100 [31.6%] male;median age 50.1 [IQR:40.0-57.0] years), all and 284 (89.9%) had NAb level measured at day 21 and 56, respectively. There were 29 (9.2%) antibiotic users (median duration of use: 7 [IQR:7-13] days). There was no significant difference in baseline characteristics between antibiotic users and non-users. At day 21, there was a trend towards lower seroconversion rate among antibiotic users compared with non-users (82.8% vs 91.3%;p=0.135). Independent factors negatively associated with seroconversion after one dose of BNT162b2 were antibiotics use (aOR:0.26, 95% CI:0.08-0.96), age >60 years (aOR:0.34, 95% CI:0.13-0.95) and male sex (aOR:0.14, 95% CI:0.05-0.34). At day 56, there was no more significant difference in seroconversion rate between antibiotic users and non-users (96.6% vs 99.3%;p=0.149). Conclusion(s): Recent antibiotic use before BNT162b2 vaccination was associated with lower early seroconversion rate after a single dose of vaccine but not two doses of vaccine. Further research on the association between antibiotics, gut microbiota and COVID-19 early vaccine immunogenicity is warranted.

Effective real-time face mask detection on NVIDIA edge devices

During these difficult times of COVID-19, people are struggling to return to their normal routines, including going back to schools and workspaces. To prevent the spread of the disease, wearing face masks is essential for everyone to protect themselves and the ones around them. However, challenges arise in regard to enforcement of wearing masks in large crowds such as at educational centres and public transportation. This paper proposes a robust automatic system for face mask detection using transfer learning kits from NVIDIA. Based on the backbone of Resnet-18, the model results in high accuracy in the distinguishing of persons who do and do not wear masks. Leveraged by the NVIDIA edge accelerator, the system can run in real-time environments, making it applicable in various venues. Its feasibility was demonstrated by deploying the approach in an education centre in Hong Kong. © 2022, Hong Kong Institution of Engineers. All rights reserved.

A case of acute hepatitis and morbilliform eruption after mRNA COVID-19 vaccination

Objectives: A 36-year-old Caucasian woman developed acute hepatitis and morbilliform eruption arising ten days after the first dose of the mRNA BNT162b2 SARS-CoV-2 vaccine. Materials and Methods: The patient was asymptomatic apart from the skin rash. Liver function tests showed predmoninantly severe transaminitis (AST 523 U/L, ALT 1550 U/L, GGT 151 U/L, ALP 128 U/L, bilirubin 12 umol/L). Only the ANA 1:160 was abnormal. Other serology for autoimmune and infectious diseases were negative. Multiphase computed tomography of the abdomen was unremarkable. The SARS-CoV-2 anti-spike IgG titre was 67.5 AU/mL (cut-off[15 AU/mL). The skin histology revealed spongiotic reaction pattern with focal interface lymphocytic inflammation. Multiple eosinophils and a few plasma cells were present. The epidermal lymphocytes were composed of CD2, CD3, C4, CD5, CD7 and CD8-positive T cells, with a CD4:CD8 ratio of 1:5. A small number stained positive with TIA1, PD1 and granzyme B. CD56 staining was negative. A liver biopsy was performed after 2 days of steroids. Liver histology showed mild steatosis and mild inflammatory portal infiltrate comprising mainly of small lymphocytes that were CD3 positive with retained staining for CD7 and CD8. Lobular architecture was preserved with inconspicuous interface hepatitis or piecemeal necrosis. Results: The patient was treated with intravenous hydrocortisone (400 mg/day) followed by prednisone (50 mg/day). There was rapid improvement in her liver function tests and cutaneous manifestations (Fig. 1). Conclusion: mRNA COVID-19 vaccine induced hepatitis is a rare phenomenon that is steroid-responsive and has associations with cutaneous eruptions. Our patient's lack of hepatic histological abnormalties is most likely due to early immunosuppression. She had epidermal lymphocytosis with predominance of CD8-positive T cells that were not of cytotoxic phenotype and we are uncertain as to their significance. There is limited guidance on the safety of SARS-CoV-2 vaccination in those who have had developed significant hepatic and cutaenous reactions. Further work is needed.