Transplacental transfer of SARS-CoV-2 variant antibodies following COVID-19 vaccination during pregnancy

Problem: Despite being over 3 years into the pandemic, infants remain highly undervaccinated and at a high risk for hospitalization due to COVID-19. Further investigation as to how maternal health decisions for immunization can reduce morbidity from infant COVID-19 by providing passive immunity is necessary. The objective of this study was to describe the rates of SARS-CoV-2 variant antibody transfer from mother to infant cord blood by trimester ofmaternal vaccination. Methods of study: This is an observational cohort study including mother-infant dyads receiving primary or subsequent booster COVID- 19 vaccines during pregnancy.Unvaccinated, but SARS-CoV-2 infected dyads with were included as a comparison group. We quantified median titer and interquartile range (IQR) for SARS-CoV-2 receptor binding domain (RBD) IgG in infant cord blood samples at delivery using the mesoscale discovery platform (electrochemiluminescence). Primary outcome was infant cord IgG titer by trimester of vaccination for the WA1/2022 RBD IgG and current circulating, immune evasive XBB RBD IgG. Secondary outcome is the percent detectable IgG for each variant. Sensitivity analysis was performed based on known SARS-CoV-2 infection. Result(s): Eighty-three mother-infant dyads were included in this analysis. Seven were vaccinated in the first trimester, 37 in the second trimester, 33 in the third trimester, and 6 were unvaccinated and infected. Twenty-three (30%) of the vaccinated group had known SARS-CoV-2 infection. Most received monovalent mRNA COVID-19 vaccines during pregnancy, aside from two who received the viralvectored Ad26.COV2.S, and two received the bivalent mRNA vaccine during pregnancy. The median cord blood WA1/2020 RBD IgG titer was 5370 (412-7296) for first, 1225 (589-3289) for second, 2623 (664-5809) for third trimester in individuals who received aCOVID-19 vaccine dose during pregnancy, and 45 (10-187) in those unvaccinated and infected. After excluding thosewith infection, the cord blood IgG was 514 (106-4182), 1070 (518-2317), and 2477 (664-4470) for first, second, and third trimester, respectively. The rate of detectable WA1/2020 RBD IgG was 100% for all three trimesters, even when excluding infected individuals. For theXBBvariant, cord bloodRBDIgG titer was 284 (43-1296) for first, 66 (32-227) for second, 173 (45-389) for third trimester, and 10 (10-11) in the unvaccinated/infected group. Excluding infections, the cord blood XBB RBD IgG was 54 (10-128), 44 (25-181), and 152 (45-360) for first, second, and third trimester vaccination, respectively. The rate of detectable XBB IgG in those who received a vaccine during pregnancy were 83%, 91%, and 90% for first, second, and third trimester respectively, compared to 17% in the unvaccinated/infected group. Excluding infections, the rate of XBB RBD IgG detection was 66%, 89%, and 95% for first, second, and third trimester vaccination, respectively. Conclusion(s): Vaccination during pregnancy leads to high rates of detectable cord blood IgG specific to SARS-CoV-2 WA1/2020 variant and current circulating variants (XBB), regardless of trimester of vaccination. Infection history leads to higher cord blood IgG in vaccinated;however, infection alone without vaccination leads to lower titer and greater rates of undetectable cord IgG at delivery.

Ordinary care in extraordinary times.

The Coronavirus Disease 2019 (COVID-19) has accounted for more than 25 000 cases in Ireland with approximately 28% of the clusters in nursing homes as of June 2020. The older population is the most vulnerable to serious complications from this illness and over 90% of deaths due to COVID-19 to date have been in patients over the age of 65. Continuing to provide routine care within nursing homes in these challenging times is an essential part of ensuring that presentations to hospitals for non-essential reasons are minimized. In this article, we describe a project being undertaken by a rural Psychiatry of Old Age Service in the northwest of Ireland. We aim to provide ordinary care in extraordinary times by using mobile tablets within the nursing homes and long-stay facilities in our region for remote video consultations during the COVID-19 crisis.

Electronic smart-hub based intervention during COVID-19 in a rural Psychiatry of Old Age service in North-West Ireland

Introduction: The COVID-19 pandemic caused significant disruptions in services and necessitated innovation to continue care provision to the vulnerable population of older adults with psychiatric needs. Objective(s): The objective of this study was to examine the experiences of staff and patients using a hands-free electronic smart-hub (eSMART hub) intervention to keep patients connected with psychiatry of old age following COVID-19 restrictions. Method(s): A risk stratification register was created of all patients known to the Psychiatry of Old Age service in the North-West of Ireland to identify those at highest risk of relapse. These patients were offered a smart-hub with remote communication and personal assistant technology to be installed into their homes. Smarthubs were also installed in the team base to facilitate direct device to device communication. Semi-structured qualitative interviews were conducted with 10 staff members and 15 patients at 6-12 months following the installation of the smart-hubs. Result(s): The smart-hubs were utilized by the POA team to offer remote interventions over video including clinician reviews, regular contact with key workers and day-hospital based therapeutic interventions such as anxiety management groups and OT led physical exercises. Patients also used the personal assistant aspect of the hub to attend to personal hobbies such as accessing music and radio. Positive feedback related to companionship during isolation and connectivity to services. Negative feedback was mainly related to technology, particularly internet access and narrow scope of communication abilities. Conclusion(s): Electronic smart-hub devices may offer an acceptable avenue for remote intervention and communication for isolated high-risk older persons.

The impact of Covid-19 restrictions in Ireland on symptom severity in mild to moderate Parkinson’s disease

Introduction:: The COVID pandemic and public health restrictions significantly impacted those living with neurological conditions such as Parkinson’s Disease due to the curtailment of therapies. Patients attending a single centre movement disorders clinic reported reduced physical activity and quality of life during the pandemic. This study aimed to assess the impact of pandemic restrictions on Parkinson’s Disease symptom severity in people with mild to moderate Parkinson’s Disease. Method:: A cross-sectional study design with a convenience sample of 20 people living with mild to moderate Parkinson’s Disease was adopted. A telephone survey questionnaire was completed to measure changes in symptom severity on the 14 most common Parkinson’s Disease symptoms. Data were analysed using descriptive statistics. Results:: Nineteen participants completed the survey. Participants frequently reported a decline in nine symptoms of Parkinson’s Disease;bradykinesia, rigidity, walking, sleep, mood, memory, quality of life and fatigue. Nil changes in freezing were reported. No change was reported in the nonmotor symptoms of constipation, speech and pain in 75, 65 and 95% of participants, respectively. Conclusion:: Findings of this study acknowledge the negative impact of restrictions on the motor and nonmotor symptoms of Parkinson’s Disease. Flexibility to access and delivery of service should be considered to mitigate any future potential restrictions.

An audit of Lithium Prescribing Practices in an Old Age Psychiatry Service high lighting renal impairment in this cohort

Aims:To compare Lithium prescribing practices in a Psychiatry of Old Age (POA) Service in the North-WestofIreland among adults aged 65 years and over with best practice guidelines.Methods:Review of the literature informed development of audit standards for Lithium prescribing. Theseincluded National Institute for Clinical Excellent (NICE) 2014 guidelines, The British NationalFormulary(2019) and Maudsley Prescribing Guidelines (2018). Data was collected retrospectively,using an audit-specific data collection tool, from clinical files of POA team caseload, aged 65 years ormore and prescribed Lithium over the past year.Results:At the time of audit in February 2020, 18 patients were prescribed lithium, 67% female, average age74.6 years. Of those prescribed Lithium;50% (n=9) had depression, 44% (n=8) had bipolar affectivedisorder (BPAD) and 6% (n=1) schizoaffective disorder.78% (n= 14) of patients met the NICE standard of 3-monthly lithium level. Lithium levels werecheckedon average 4.5 times in past year, average lithium level was 0.61mmol/L across the groupand 39% (n=7) had lithium level within recommended therapeutic range (0.6-0.8mmol/L).83% of patients (n=15) met the NICE standards of 3 monthly renal tests. Taking into considerationmostrecent blood test results, 100% (n=18) had abnormal renal function.Half (n=9) were initiated on lithium by POA service and of these, 56% (n=5) had documented renalimpairment prior to initiation. Of patients on long term lithium at time of referral (n=9), almost half(n=4) had a documented history of lithium toxicity. Conclusions:The results of this audit highlight room for improvement in lithium monitoring of older adults attendingPOA service. Furthermore, all patients prescribed lithium had impaired renal function. This is animportant finding given the associations between those admitted to hospital with COVID-19 and comorbid kidney disease and increased risk of inpatient death.Our findings highlight the need for three monthly renal function monitoring in elderly prescribedlithiumgiven the additive adverse effects of increasing age and lithium on the kidney. Close workingwith specialised renal services to provide timely advice on renal management for those with renalimpairment prescribed lithium is important to minimise adverse patient outcomes.

Pediatric gastroenterology tool kit for telemedicine during the COVID-19 pandemic

Background/Significance: Telehealth (TH) services rapidly expanded during the COVID-19 pandemic. This rapid deployment precluded the opportunity for initial planning of implementation strategies. Purpose and Goals: To understand the needs of nurse practitioners and examine TH procedures and interventions designed to promote high quality, equitable health care for pediatric patients with gastrointestinal concerns. Methods: The Plan, Do, Study, Act model was used. Survey data from providers and families were collected and analyzed. They were further illuminated through iterative dialog across the research team to determine the quality and efficiency of TH. Findings: A toolkit of strategies for promoting the quality and efficiency of TH was created according to the three domains of health equity: availability, accessibility, and acceptability. We reached the following conclusions: No specific telehealth training and competencies have been established for NPs. Interpreters are needed for patients who have language barriers and hearing impairment. Scheduling flexibility and revenue needs should account for increased time needed for complex patients. Technology needs to be current for NPs and patients to prevent audiovisual failures. Reading level of introductory TH emails need to be at a 5th grade literacy level and should be available in different languages. Ideally families should have access to a scale at home since accurate weights are an integral part of the GI visit. Patient's location should be matched with location of clinic when scheduling appointments so that follow up care can be provided easily when visits are in person. Physical examination is limited and laboratory orders and stool/urine collections require a prescheduled appointment. Implications/Next Steps: Development and implementation of comprehensive education to address the above findings. Ongoing collaboration with virtual visit team and AAs to find systems to proactively arrange for interpreters and flexibility with allotted time for visits. Provide alternate methods to support families with audio/visual difficulties;IT/help desk telephone number and option of in-person visits. Introductory email that meets literacy standards now includes specific expectations, including: all patient visits need to be done in a private setting, presence of patient for the entire visit, and weight to be obtained before visit. Development and provision of alternative communication when audio connectivity fails, ie: flashcards to alert family and suggest solutions (signing in/out of appointment) to preserve full audio/visual visit capabilities. Develop algorithm to prioritize in person visits, based on acuity of presenting illness and complexity of patient.

Patient and staff satisfaction with remote psychiatry assessments using mobile tablets in long-stay facilities in rural north-west Ireland

IntroductionThe COVID-19 pandemic has required services to evolve quickly to continue routine care and telemedicine has been rapidly implemented to facilitate this. Older persons are at high risk of serious complications of COVID-19 and it is essential that their exposure to COVID-19 is minimized.ObjectivesOur aim was to assess staff and patient satisfaction with remote psychiatric assessments using mobile tablets in long-stay facilities.MethodsRemote clinics using Skype video on mobile tablets were conducted with patients in long-stay facilities attending psychiatry in rural North-West Ireland between April and July 2020. At each review, a satisfaction survey was administered to the patient, their keyworker and the clinician. The patient/keyworker survey instrument had four yes/no statements and the clinician survey had four statements with 5-point likert scale responses (1=very low to 5=very high). Open feedback was also obtained for thematic analysis. Descriptive analyses were completed using SPSS software.Results23 patients (mean age 80.9yrs) were assessed in 10 long-stay facilities. All patients were agreeable to participating in video consultation although only 13 patients were able to respond to survey due to cognitive impairment. There was a 92.3% positive patient response (12/13) and 95.7% positive keyworker response (N=22/23) for all statements. The mean score on the assessor response ranged from 3.43 to 4.04 with the lowest rate for quality of transmission. The main themes identified were related to the quality of connection and sensory difficulties.ConclusionsVideo consultations using mobile tablets offer an acceptable form of remote psychiatry assessment for older persons in long-stay facilities.