Implementation of Modified Shutdown Protocol during COVID 19 Pandemic for Risk Mitigation at Manufacturing Sites

A well-planned pandemic protocol and define emerging risk preparedness checklist during pandemic help to ensure the shutdown is conducted safely and well efficiently so that manufacturing sites can be returned to normal operation as per defined timeline. As such we have implemented shutdown protocol to mitigate Occupational Health Hazards risk. The major challenge to manage the large workforce and additionally prevention of COVID 19 spread among workforces. COVID 19 risk management is a proactive preparedness which was included in revised shutdown protocol and implanted across all sites. This strategy would be great help to mitigate the risk and successfully completion of shutdown at respective manufacturing location. Methods & Guidelines: Methods: To managed shutdown risk management during a pandemic, the following methodology was considered during planning. * The first step was virtual meeting with the plant team to understand the shutdown job, list of hazardous activities, the number of the workforce, days of shutdown, etc. * The second step was to plan a Sustainable COVID 19 management program including testing and create a Bio bubble for all the employees and business partners involved in the shutdown. * The third step was to determine potential exposure to chemical, physical and biological agents, including medical OH requirements, the review of existing control measures. * The fourth step was to verification, planning, and execution of all requirements in the prescribed checklist and plant round to identify any gaps followed by a plant shutdown meeting. Result(s): Pandemic Management protocol and defined OH-IH emerging risk preparedness checklist during the pandemic had helped to ensured that Shutdown activities were well managed with proactive control program and robust system. Emerging risk details of one of the manufacturing sites are mentioned below. * Total no of workforce health screening: 25000 Nos Approx. * 24x7 ACLS ambulance with medical officer and nursing staff a defined job location * RT PCR testing before entry and periodic testing * Availability of antidotes & Safety Data Sheet * Basic first-aider training and shift wise availability * Arrangement of accommodation (Bio Bubble) till completion of shutdown Conclusion(s): Modified shutdown protocol with inclusion of COVID 19 management is great tool/approach to mitigate OH hazard including COVID 19 in shutdown and comprehensive monitoring of hazardous activities. The recommended control measures would help to ensure the next turnaround project will be completed with a well-defined checklist having all controls in place.

Occupational Health Hazard Identification and Risk Assessment with Introduction of Biomass in Coal Based Captive Power Plant

Introduction: Occupational Health should aim at the Promotion and Maintenance of the highest degree of physical, mental, and social well-being of all the employees. A pilot project was taken up due to acute shortages of coal during the COVID Pandemic, on industrial level, mixing of biomass with coal at a ratio of 20:80 respectively was considered as a good raw material. With introduction of biomass, workers were exposed to different organic substances either directly through dermal route or respirable dust with risk of becoming victims to Occupational diseases. Objective(s): The objective of the study is to identify and mitigate occupational health hazard of various nature prevailing at workplace after introduction of new raw materials;to safeguard the workforce from discomfort and occupational illness and to provide healthy working environment at RIL-Hazira. Method(s): Walk through survey was initiated by team of industrial hygienist and medical officer along with the process engineer. Subsequent workplace evaluation was done according to ACGIH screening criteria for respirable dust & VOC monitoring. To measure airborne respirable contaminants, we have considered housekeeping staff, operator, field executive, Boiler operation engineer which were found more likely to be at the risk of airborne contaminant exposure. To identify the concentration of contaminants, personal air sampler (SKC Make) was used for collection of respirable dust samples for different job category of workers. NIOSH 600 method was used for exposure assessment and samples were collected by using PVC filter used at the flow rate of 2.5 lpm. The composition of biomass pellets was received from biomass team & chemical analysis of biomass was done at our laboratory. Occupational Diseases known to be caused by organic agricultural compounds used as fuel were taken into account such as Bagasossis, farmer's lung & other hypersensitivity pneumonias, non-tubercular mycobacterial infections, infections caused by various fungi & bacteria. Prevention & Control measures were taken during the project such as modification of process, local exhaust ventilation, worker education on different diseases, personal hygiene, use of PPE, good housekeeping. Result(s): Through effective Risk assessment, Hazard Identification and measures taken to mitigate Occupational health hazards, no occupational health disease was reported after implementation of the change in process in a total of 55 identified workers. Moving forward these workers will be periodically monitored. The amount of total respirable dust was reduced by approx. 10- 25% at different location of the plant after control measures taken. This project also brought huge monetary benefits to the plant. Leading forward as the pilot project for introduction of biomass was a great success it has been planned to be scaled up to 40% mixture of biomass.

An audit of questions asked by participants during the informed consent process for a phase 2/3 COVID-19 vaccine regulatory study at a tertiary referral centre.

Objective: To evaluate questions asked during the informed consent process by adult participants in a COVID-19 vaccine regulatory study conducted at our center in 2020. Methods: After approval by the IEC, informed consent documents and consent narratives were evaluated. We collated the total number and nature of questions. We then looked at the association between education, gender, socio-economic status, employment status, the language of consent, and number of questions. Between-group comparison (female vs male, unemployed vs employed, primary school vs secondary school vs graduate vs post-graduates, upper vs upper-middle vs middle vs lower middle vs lower) for the number of questions asked was done using univariate analysis followed by multivariate regression analysis with post hoc Tukey's test. Independent variables were gender, employment status, education and socioeconomic status and the dependent variable was the number of questions asked by the participant. All analyses were done at 5% significance. Content analysis was done in addition by creating categories after evaluation and coding them. Results: A total of N = 129 consents from the same number of participants were evaluated. A total of N = 127/129 participants asked at least one question. Sixty-seven percent of participants asked questions related to the study procedure, followed by 44.9% of participants who asked questions related to the safety of vaccine or placebo. A total of N = 295 questions were asked by the 127 participants. In content analysis, 149/295 (50.5%) questions were on study-related procedures followed by one quarter 76/295 (25.8%) based on safety associated with Investigational Product. Very few participants [2.4%] asked about post-trial access as the regulatory trial was a placebo-controlled trial. None of the independent variables were found to be associated with the number of questions. Conclusion: The majority of the questions asked by the participants were about study-related procedures and vaccine safety. No association was found between any of the independent variables and the number of questions asked. However, there were differences in the demographics of the trial participants between the pandemic and pre-pandemic era.

Successful Kidney Transplantation from a Deceased Donor with Severe COVID-19: Undetectable SARS-CoV-2 in Donor Kidney and Aorta by Sensitive Molecular Testing

Purpose: Kidney transplantation (KT) from coronavirus disease 2019 (COVID-19) positive donors has been avoided due to concerns for donor-derived transmission and possibility of the kidney being a viral reservoir. There is no long-term safety data, and sensitive molecular testing for SARS-CoV-2 in donor kidney is not routinely performed. We report a case of successful KT from a deceased donor who died from severe COVID-19 respiratory illness whose donor kidney and aorta were probed for virus using in situ hybridization (ISH) and quantitative reverse transcriptionpolymerase chain reaction (qRT-PCR). Method(s): A 30-year-old female was admitted to the hospital with severe COVID-19 pneumonia with a positive RT-PCR test for SARS-CoV-2 on nasopharyngeal swab. With clinical worsening, she was placed on extracorporeal membrane oxygenation, but developed hypoxic brain injury and progressed to brain death. Renal function was stable during her hospital course with serum creatinine concentration of 0.7 mg/dL. SARS-CoV-2 RT-PCR on bronchoalveolar lavage and nasopharyngeal samples tested again three days prior to donation was negative. A 55-year-old male recipient with an end-stage renal disease secondary to hypertension was transplanted with the left kidney from the above donor. The donor kidney was studied using pre-implantation surgical biopsy tissues to investigate the presence of SARS-CoV-2 RNA. Aorta tissue with the kidney was also studied given high expression of angiotensin-converting enzyme 2 receptors in vasculature. Result(s): ISH analyses did not show any positive signal for SARS-CoV-2 RNA in the donor kidney sample compared to a SARS-CoV-2 positive lung control. All samples tested by qRT-PCR were also negative for SARS-CoV-2. We found no evidence of SARS-CoV-2 mRNA in the donor kidney and aorta. The recipient has been free of COVID-19 related signs or symptoms and tested negative for SARSCoV- 2 by nasopharyngeal swab RT-PCR on days 20, 30, and 90 following KT. After an initial period of delayed graft function requiring hemodialysis, the recipient now has excellent renal recovery over 6 months following the transplant, and the most recent creatinine is 1.3 mg/dL. Conclusion(s): Taken together with recent observations of successful KT outcomes from mild or asymptomatic COVID-19 donors, we believe that the transmission risk of SARS-CoV-2 through KT is likely to be very low. Use of deceased donors who died after severe COVID-19 can be considered for KT. Larger scale studies are needed to confirm our findings.

Basic Demographics and Outcome of COVID-19 Patient Admitted in Tertiary Care Center, Surat

Introduction: COVID-19 pandemic started from Wuhan, China, and has spread across the world and whole humanity passed through this havoc of this pandemic. Healthcare system became overburdened due to scarcity of manpower and resources. Large number of cases treated in our hospital, here we are publishing our retrospective data of basic demographics and outcome of COVID-19 patients admitted in a tertiary care center in Surat. Materials and methods: This is a retrospective single-center study of demographics and outcomes of COVID-19 patients admitted to Sunshine Global Hospital between June 2020 and July 2021. Data were collected from the hospital information system and analysed. These all patients are diagnosed on basis of rapid antigen and, or RTPCR reports along with HRCT of the chest. Results: A total of 1525 COVID-19 patients were admitted between June 2020 and July 2021. Out of those patients, complete data of 1514 is available, among them, 1036 [68%] were males with a mean age of 54 years and 478 [32%] were females with a mean age of 55 years. The average length of stay in the hospital was 7 days. 1412 [93.2%] survived and 98 [6.4%] died. Among 297 [19%] patients admitted to ICU admission, 120 [7.9%] patients required intubation. Mean age was 55 years. Average length of stay [LOS] in ICU was 7 days and LOS in the hospital was 11 days. In the intubated patient, the average duration of ventilator support was 7 days. Tracheostomy was done in 43 [2.8%] patients. Out of 120 intubated patients, 44 survived and were discharged after an average in-hospital stay of 15 days, while 76 patients could not survive. Survival rate in ICU patients was 69.4% and among those requiring invasive mechanical ventilation 36.7%. Conclusion: Protocolised system of care helped limiting the mortality in the COVID-19 pandemic. Large majority of those who are intubated and survived required tracheostomy, prolonged mechanical ventilation, ICU, and hospital LOS.

Changes in Adiposity as Measured by Modified BMI Z-scores Associated with the COVID-19 Pandemic Among Well Children and Adolescents Within a Large Urban Health System

Background: To control the spread of COVID-19 in NYC, a stay-at-home order was issued for March 22, 2020-June 13, 2020 followed by ongoing restrictions and only partial school reopening. The health impacts of these unprecedented restrictions on children are not yet known. Our objective was to examine whether BMI change during the COVID-19 period differed from the prior year among healthy children. Methods: This is a multicenter retrospective observational study of children aged five to eighteen years who received care within the NYC public hospital system between 2018 and 2020 encompassing all the five boroughs of the city. Using the system's electronic medical records, we identified patients who had a well-child visit between June 13, 2020 and December 31, 2020. Patients were included if they had annual well-child visits in the two previous years with anthropometric data recorded at all three visits. Patients with diagnoses that may affect adiposity (e.g. hypothyroidism) were excluded. We collected sociodemographic and anthropometric data for each year and calculated a modified body mass index z-score (mBMIz), which is a measure of relative BMI adjusted for age and sex. We compared change in mBMIz/month between the 2019 and 2020 visits (which included the pandemic) with the change in mBMIz/month between the 2018 and 2019 visits using generalized estimating equations (GEE). We examined whether the mBMIz/month change differed between the two periods and whether 2018 BMI category (underweight (5%), normal (5-85%), overweight (85-95%), obese (95-99%), extremely obese(>99%))modified this effect. Analyses were conducted using STATA software. Results: Of 23,458 patients seen between June 13, 2020 and December 31, 2020, 7,575 (32.3%) met our inclusion and exclusion criteria. The mean mBMIz was 0.68 in 2018, 0.69 in 2019 and 0.90 in 2020. (Table 1). In GEE analysis, the change in mBMIz/month was statistically significantly higher in 2019-2020 than in 2018-2019 (mean difference in mBMIz/month change=0.0152, p < 0.0001). While the change in mBMIz/month in 2019-2020 was lowest in patients in the extremely obese category, the difference in mBMIz/month between the two periods was greatest in this group (interaction effect of period and 2018 baseline category p < 0.0001). (Table 2). Conclusion: Our study suggests that the activity restrictions due to the COVID-19 outbreak are associated with greater excess weight gain in a diverse NYC population of healthy children as measured by mBMIz relative to the year prior to the outbreak. These findings correspond to the mean BMI percentile of our population changing from approximately 75th to the 82nd. These findings require further monitoring to better understand the specific reasons for the observed patterns across children in different BMI categories, assessment of longer-term health impact on this population and interventions to modify or reverse these worrisome trends. (Table Presented).

Impact of Telehealth on the Current and Future Practice of Lipidology: A Scoping Review

Lead Author's Financial Disclosures: Nothing to disclose. Study Funding: None. Background/Synopsis: Telehealth services have been implemented in many chronic conditions with the expectation to improve care for patients and has expanded greatly due to the COVID pandemic. Little is known about the impact that telehealth on the practice of lipidology. Objective/Purpose: To determine the current utilization of telehealth for lipid management and explore barriers and enablers to telehealth's future impact on the practice of lipidology. Methods: The PubMed database was searched from inception to June 25, 2021, to identify all relevant articles published utilizing telehealth for lipid management. This search returned 376 articles when using the following key words: "lipids or cholesterol" and "telehealth". Articles were included at screening if they mentioned telehealth and lipids. The definition of telehealth was refined during full-text screening as a synchronous visit between a patient and a clinician that replaced an in-office appointment. All other types of telehealth were excluded including those that only implemented mobile health technologies, remote monitoring, or call backs for return of laboratory results. Additionally, articles had to measure lipid levels. Article findings were synthesized into one of the following categories: 1) barriers to implementing and delivery of telemedicine visits, 2) facilitators to implementing and delivery of telemedicine visits, 3) clinician perspectives on telemedicine, or 4) mention future utility of telemedicine. Results: Of the 376 articles found, 128 s were included, and 79 articles were included after full text screening. The main reason for exclusion were not meeting the definition for telemedicine. Of the 81 articles, 18 were reviews, 31 were randomized clinical trials, 15 were pre-post evaluations, and 15 were categorized as other study designs. About half of the articles reported telehealth services for individuals with diabetes. Barriers reported include lack of evidence that supports telemedicine's impact or sustainability, technology cost, high appointment cancelation rates, and lack of reimbursement for clinicians. Enablers reported positive to no-negative impact on health outcomes, cost savings for health systems, and easier implementation of multidisciplinary approaches to care. Clinicians had mixed feelings on their ability to deliver clinical care, but report improved patient satisfaction. Future use of telemedicine included mentions of the need for new reimbursement structures, technology literacy programs, and revisions to current clinician licensing laws. Conclusions: Telemedicine use to provide care for individuals with lipid conditions has expanded during the COVID pandemic, but more research is needed to determine whether it is a sustainable model for lipid management.

Basic principles of ultrasound and the use of lung ultrasound in the COVID-19 pandemic

Given that ultrasound use is increasing in healthcare, operators must be familiar with its physics in order to optimise the image and interpret potential artifacts. Ultrasound are sound waves at frequencies above the range of human hearing, that are transmitted from and received by an ultrasound transducer with piezoelectric properties. As it propagates through tissues, some of the ultrasound waves are reflected at tissue boundaries, leading to its detection by the ultrasound transducer. These are processed by the ultrasound machine and result in the generation of an image. Various settings can be adjusted to optimise the image, such as the frequency of the transmitted ultrasound wave, depth of the focal zone and the gain. Artifacts are presentations on the monitor of the ultrasound machine which are added, omitted, or are of improper brightness, location, shape, and size compared with true anatomical features. It can result in falsely perceived objects, missing structures or degraded images. The presence or absence of such artifacts in lung ultrasound can be valuable in the interpretation of the resulting image. In the setting of COVID-19, lung ultrasound has become increasingly useful in evaluating disease progression and providing a point-of-care radiological adjunct in clinical decision making. © World Federation of Societies of Anaesthesiologists 2022.

Machine Learning-Based Emerging Technologies in the Post Pandemic Scenario

The entire world is now fighting to overcome the after-effects of the COVID-19 pandemic. The most challenging factor is handling the post-pandemic scenario in various sectors such as medical, educational, civil services, business, etc. Every sector put its efforts in the best possible way to cope up with these unprecedented times. The majority of the sectors came up with the idea of work from home, robotics, online payment system, entertainment, meetings, webinars, etc., to continue with the smooth working environment. To manage this crisis, it is essential to be equipped with appropriate tools and technologies. These technologies may differ from sector to sector to satisfy their essential requirements. Among these, the educational sector is the only domain in which the entire transition happened from the classroom model to a fully virtual model of service. The digitalization of the educational system ensured the continuous delivery of education without any requirement of physical presence. The proposed idea uses data science techniques to understand the crisis in a better way and improvise the quality of education. In the medical sector, there are various techniques like online consultation with doctors, telemedicine and chatbots. Augmented Reality solutions provide a better platform for convenient, smooth and safe doctor-patient interaction. Data science techniques are implied to build an efficient novel approach for early diagnosis in medical sectors and reduce the mortality rate. Similarly, in other sectors such as business and civil services, there are betterments going to be brought about in a virtual environment. The segment which is facing the repercussions of this deadly virus is the common man, especially farmers, small businessmen, daily wagers, elders, children, and patients. Considering the current situation of the common public, one should try to make a brave new world, which is more adaptable, sustainable and stronger to mitigate the risks. This system includes a CNN model that classifies if a pair of lungs is normal or has pneumonia. The CNN model provides 87.71% accuracy, 12.29% miscalculation rate, 80.45% precision, 80.94% sensitivity, 91.20% specificity, 80.03% F-1 value against the testing dataset having a loss value of 0.5096. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

THE PREDICTIVE VALUE OF THE NATIONAL EARLY WARNING SCORE 2 IS IMPROVED BY THE ADDITION OF INSPIRED OXYGEN FRACTION AS A WEIGHTED CATEGORICAL VARIABLE

TYPE: Late Breaking TOPIC: Critical Care PURPOSE: The National Early Warning Score (NEWS2) is validated for the prediction of acute deterioration, however, the binary grading of inspired oxygen (FiO2) may be a limitation. We tested whether incorporation of FiO2 as a weighted categorical variable improves the predictive validity of NEWS2. METHODS: A retrospective cohort study of 3704 adult ward admissions between 01/01/17 and 30/03/21, with a viral respiratory infection (SARS-CoV-2/Influenza). 143,157 longitudinal physiological observations were extracted. FiO2 was transformed into a weighted categorical variable and assigned 0-3 points, substituting the original 0/2 points. The primary outcome was a composite of cardiac arrest, unplanned critical care admission or death within 24 hours of the observation. Ethics approval was granted. RESULTS: Baseline characteristics: age (mean±SD) 60.4±19.4 years, male gender n(%) 1949(52.6%), Charlson co-morbidity count (mean±SD) 1.6±2.3. The primary outcome occurred in 493(13.3%) patients and was strongly associated with the weighted FiO2 score (χ2, p=<0.001). In patients receiving supplemental oxygen, the area under the receiver operating characteristic curve was greater for NEWS-FiO2 (0.810 (95%CI 0.807-0.814)) versus NEWS2 (0.771 (95%CI 0.767-0.774)). This improvement persisted in the whole cohort. At the 5-point threshold, the positive predictive value (PPV) increased by 22.0% (number needed to evaluate 6.7) for only a 3.9% decrease in sensitivity. CONCLUSIONS: Incorporation of weighted FiO2 into NEWS2 improves the predictive validity for adverse events, particularly by improving the PPV. Confirmation with prospective analysis is required. CLINICAL IMPLICATIONS: Weighted FiO2 ought to be considered in the next iteration of NEWS2. This can be operationalised automatically within electronic health records or manually with a reference table. DISCLOSURE: No significant relationships. KEYWORD: Early Warning Systems

Artificial intelligence in preventive and managed healthcare

Increasing application on account of the rapid progress made by artificial intelligence (AI) in healthcare has brought upon a progressive paradigm shift. By combining relevant AI architectures with digitized data acquisition and sophisticated data validation techniques, AI-based technologies are expanding to unchartered areas. This chapter focuses on understanding recent novel innovations and practical clinical applications of AI in aiding the conventional healthcare industry. Breakthrough AI-based platforms that aid in critical sectors of the healthcare industry like disease diagnosis, robot-assisted surgery, patient rehabilitation, and use of smartphones/smart wearables for health monitoring and AI’s role in controlling and tackling COVID-19 like pandemics are summarized. © 2021 Elsevier Inc. All rights reserved.

Comparison of outcomes in sot recipients during two eras of covid-19 therapeutics

Purpose: COVID-19 therapies have evolved over time, but little is known regarding outcomes in SOT recipients treated with newer therapeutic agents such as remdesivir, dexamethasone, and convalescent plasma. We sought to compare outcomes including mortality, rejection, and renal function in a retrospective cohort of SOT recipients with COVID-19 treated during two different eras of therapy. Methods: 40 SOT recipients hospitalized for COVID-19 at our center comprised Era 1 (Mar-May 2020, 20 patients) and Era 2 (Jun-Aug 2020, 20 patients). Data were collected on demographics, comorbidities, renal function, and mortality at time points out to 90 days after COVID-19 infection. Results: Patients in Era 1 received hydroxychloroquine (11/20, 55%), tocilizumab (5/20, 25%) and/or convalescent plasma (3/20, 15%) as targeted therapy;patients in Era 2 received primarily remdesivir (8/20, 40%), dexamethasone (6/20, 30%), and/or convalescent plasma (13/20, 65%). Mortality was 1/20 in Era 1 and 0/20 in Era 2. MMF was held in 33/35 (94%) of patients. Acute kidney injury was present on presentation in 14/40 (35%). The median (IQR) decrease in SCr (mg/dl) between admission and last followup was 0.5 (0.4-0.6) and 0.1 (0-0.4) in patients who had and had not received remdesivir, respectively (p=0.02), 0.5 (0.1-0.6) and 0.1 (0-0.3) in patients who had and had not received plasma, respectively (p=0.09). Antibodymediated rejection (AMR) occurred in 2 patients in Era 1 and 0 patients in Era 2. Acute cellular rejection (ACR) occurred in 1 patient in Era 1 and 0 patients in Era 2. Conclusions: SOT recipients treated in Era 2, when the major targeted therapies were remdesivir, dexamethasone, and convalescent plasma, were not at higher risk for renal dysfunction, ACR, or AMR in the aftermath of COVID-19;rejection was uncommon in both eras and mortality was low in both eras. While awaiting detailed safety studies, these results suggest against renal toxicity or triggering of alloimunity in those receiving newer therapies.

Evaluation of covid-19 studies registered with the clinical trials registry of india [ctri] - a database analysis

Objective: To evaluate nature of COVID-19 studies registered with Clinical Trials Registry of India [CTRI]. Methods: An audit of all studies registered between March 2020 and January 2021 was done. We mined www.ctri.nic.in with keywords- 'COVID-19, SARS CoV2 and corona virus'. The variables considered for analysis were total number of studies, nature of study (interventional/observational), type (Allopathy/AYUSH/ Miscellaneous), source of funding (Pharmaceutical Industry/Government/ Institute/Self-funded), site (national/multinational and states in India), health category (patient/healthy human volunteer) and duration of the study. The comparison between the medicinal systems was done using the ANOVA. All analysis were done at 5% significance. Results: A total of N=1071 COVID-19 studies were registered. More than half were from the Miscellaneous category [for example behavioral, questionnaire-based studies]. A fourth of registered studies were from AYUSH followed by Allopathy which accounted for a fifth. Observational and interventional studies accounted for approximately 50% each of the total studies with the bulk belonging to the miscellaneous category. Amongst interventional studies, half were from AYUSH. Approximately 41% of these were funded by Ministry of AYUSH. A statistically significant difference was seen between the three medicinal systems [p <0.01]. Maximum studies were registered from Maharashtra (16%). Conclusion: Majority studies were registered from May to August 2020 and from Maharashtra. The AYUSH studies were maximally registered and their findings need to be urgently disseminated to guide policy for the country. © 2021 Journal of Association of Physicians of India. All rights reserved.

Indian Academy of Pediatrics Revised Guidelines on School Reopening: First Revision, September 2021

JUSTIFICATION: The COVID-19 pandemic has affected schooling for more than 24 crores students, since March 2020. Students need a respite from the long standing social isolation so that they regain their chance to develop holistically, but after the devastating effects of the second wave, the administrators as well as parents are skeptical about the decision of school reopening. PROCESS: The Indian Academy of Pediatrics constituted a task force comprising of national and international experts in the field who deliberated on the issue. OBJECTIVES: To bring out scientifically supported guidelines on the prerequisites of opening and attending the schools, in the current context of the COVID-19 pandemic. RECOMMENDATIONS: The task force recommends i) Decentralization of the school reopening decision;ii)Three epidemiological parameters, case positivity rate (<5 or steadily declining number of cases for past two weeks), number of new cases(<20 per lakh population per day for past two weeks) and vaccination coverage (>60% of the vaccine-eligible population) to be met at the local level, before the schools reopen;and iii) Criteria regarding health and vaccination to be met by the schoolattendees.

Fit and filter integrity of a respirator mask after multiple cycles of autoclave

Background: The COVID-19 pandemic has led to profound shortages in personal protective equipment worldwide. The availability of filtering facepiece class 3 (FFP3) respirators could be greatly increased if they could be reused after sterilisation. Aims: To determine the effects of repeated autoclave cycles on the fit and filter function of the 3M 1863 FFP3 disposable respirator. Methods: Participants underwent fit tests with 3M 1863 FFP3 respirators. Respirators were subjected to autoclave cycles and a repeat fit test was conducted after each cycle until failure. The filter function of both unused and autoclaved respirators was determined by quantitatively assessing the differential pressures and filter penetration of aerosolised sodium chloride particles. Mask structural inspection was also carried out by light microscopy. Results: A total of 38 participants were recruited. Repeat fit testing with a new respirator was passed by 30 of 38 (79%) participants in comparison with 31 of 38 (82%) of participants after the respirator had undergone one autoclave cycle. There was fit test failure with further rounds of autoclave. There was no evidence of structural changes after one autoclave cycle, but the nose foam began to separate from the mask following further cycles. Filter efficiency of all 15 autoclaved respirators that underwent filter testing was 97.40% or more. Differential pressure (breathability) of respirators was unaffected by autoclaving. Conclusions: 3M 1863 FFP3 respirator retains good fit and filter function after a single autoclave cycle. Addressing nose foam separation and further testing to EN149 standards would be required before respirators could be considered for reuse.

Outcomes of convalescent plasma transfusion for SARS-CoV2 patients in the intensive care unit

Background: SARS-CoV2 is a grave illness and few therapeutic agents have yielded benefit or reduced mortality. Administration of convalescent plasma (CP) in viral illnesses in the past, including SARS, before day 14, has been associated with a shorter hospital course. In the present study, we are interested in determining the benefit of administering CP to critically ill patients in the intensive care unit, and the impact on mortality and other clinical markers. Methods: 5 critically ill patients with confirmed SARS-CoV2 infection were observed in the uncontrolled case series study. Mechanically ventilated patients with severe ARDS (PaO2/FiO2 < 100) were eligible to receive CP transfusion. We reviewed daily vital signs, inflammatory markers, PaO2/FiO2 ratio and SOFA scores before and after CP transfusions. SARS-CoV2 PCR viral load testing was completed on day 0 of transfusion and repeated on day 3 and 6. Complications during the hospitalization and 30-day mortality were assessed. Results: All 5 patients were mechanically ventilated at the time of transfusion and between day 7 to 31 of their illness. Following plasma transfusion, body temperature and inflammatory markers remained elevated in four patients (figure 1). SOFA score and PaO2/FiO2 ratios continued to worsen in three and four patients respectively (figure 2). SARS-CoV2 PCR remained positive in 4 patients. 4 of the 5 patients had died at the end of the follow up period. One patient was successfully extubated on day 29 (table 1) and discharged after a long hospital course. Conclusion: In our patient cohort, the administration of CP did not improve laboratory markers or clinical outcomes. Some notable limitations of this study are the small sample size, and that the patients received CP late in their disease course. Further investigation is necessary to draw definitive conclusions about the utility of CP in the treatment of SARS-CoV2. (Table Presented).

The placental protein expression pattern of the SARS-COV-2 receptor ACE2 and serine proteinase TMPRSS2 suggest a protective mechanism against infection

Background: The rarity of placental infection by SARSCoV- 2 suggests the presence of protective measures. SARS-CoV-2 requires coexporession of its receptor, ACE2, and the serine proteinase TMPRSS2 for cellular infection. Both are expressed in the placenta but their protein expression pattern has not been demonstrated to date. Methods: 19 placentas from women with PCR proven SARS-CoV-2 infection were examined for SARS-CoV-2 expression by RNAish and immunohistochemistry (IHC) and for ACE2 and TMPRSS2 by IHC. Gross and histopathology were also reviewed. Two sets of controls were used: 'normal controls' - 122 placentas examined solely for GBS exposure (no other indication for examination) delivered from 2000-2004;and 'abnormal controls' - 130 placentas from neonates with a clinical diagnosis of HIE delivered from 2000-2019. The control placentas were reviewed for gross and histopathology. Results: 2 cases showed placental infection with viral RNA the villous syncytiotrophoblast (ST) and cytotrophoblast (CT) in a patchy distribution in 1 and only focally in the other. The infant with the patchy infection was SARSCoV- 2 PCR positive at 24 hours, the infant with only focal infection was PCR negative. None of the other placentas showed viral infection. All placentas showed robust expression of ACE2 in the trophoblast. The ST and CTexpression was membranous and In most cases ST expression was polarized-strongest, and in many cases only present, on the villous stromal side of the ST. TMPRSS2 was weakly expressed in the placental endothelial cells. Hofbauer cells were negative for both. We did not find a an increase in maternal or fetal vascular malperfusion (MVM or FVM) over controls. We saw MVM at 25%, FVM at 20%, acute chorioamnionitis at 30%, inflammatory pathologies (1 case each of ungradable VUE, intervillositis, Hofbauer cell hyperplasia) at 15%, all within published prevalences and similar to our controls. Conclusion:We did not find increased prevalence of MFM, FVM, infectious, or inflammatory pathology above published our our sets of controls as other have, perhaps due to small sample size. SARS-CoV-2 infection of the placenta is rare and vertical transmission, if it occurs, is even rarer. One mechanism for this is the rare occurrence of maternal SARS-CoV-2 viremia. Another mechanisms might be the unfavorable expression ACE2 and TMPRSS2. We show that their expression is uniquely distinct: ACE2 in the tropohobast and TMPRSS2 in the endothelium. Although we did not detect coexpression we cannot rule out that the vascular-syncytial membranes might coexpress ACE2 and TMPRSS2. We also show that ACE2 expression is polarized in most cases away from the maternal vascular space thereby perhaps limiting SARS-CoV-2 access to ST infection.