PROJECT ECHO FOR NURSING HOMES: A PATIENT-CENTERED, RCT TO IMPLEMENT INFECTION CONTROL BEST PRACTICES IN NHS

Nursing homes (NHs) have been devastated by COVID-19. Only 3% of designated infection preventionists in NHs have taken a basic infection control course. Little is known about the implementation of effective infection control practices in NHs. This study utilizes Project ECHO (Extension for Community Health Outcomes), an evidence-based tele-mentoring model, to connect subject matter experts with NH staff to proactively support evidence-based infection control guideline implementation. This study will determine how guidelines can be implemented effectively in NHs, including reducing COVID-19 diagnoses and improving other key patient-centered outcomes (e.g., quality of life) NHs (N=136) were recruited and assigned to ECHO or ECHO Plus using a randomized design. A multi-pronged approach to improving infection control and emergency preparedness in NHs is important. The ECHO model has significant strengths allowing for remote learning delivered by a multi-disciplinary team and utilizes case discussions that match the context and capacity of NHs.

FXR INHIBITION AS A NEW STRATEGY AGAINST COVID19 T Brevini1, M Maes2, GJ Webb3, CD Fuchs4, G Buescher5

Introduction: Vaccines revolutionised the management of COVID19. Nevertheless, they lack efficacy in high-risk or vulnerable groups (e.g., immunosuppressed patients), who may not mount an appropriate immune response. Monoclonal antibodies represent the gold-standard agents for such cases;but they are limited by availability, need for parenteral administration and the risk for viral escape because of spike protein mutations. Therefore, there is a pressing need for new prophylactic agents less prone to resistance.The viral receptor ACE2 represents an ideal target as it is essential for viral entry and transmission and because being a host protein it is not affected by viral mutations. However, the regulation of ACE2 remains elusive, due to the lack of appropriatein vitromodels. Cholangiocytes show one of the highest ACE2 expression levels in the body, representing an ideal platform for these studies. Here, we use cholangiocyte organoids as proof-of-principleto identify that the bile acid receptor FXR regulates ACE2 expression and SARS-CoV-2 infectionin vitro. We validate these findings in lung and gut organoids, animal models, human organs perfusedex situand patient cohorts. Aims & Methods: 1. Identify pathways controlling the transcriptional regulation of ACE2 2. Identify drugs modulating these pathways as novel prophylactic and therapeutic agents for COVID19. Organoids were propagated using established protocols. Marker expression was assessed using single-cell RNA sequencing, QPCR, and immunofluorescence. FXR binding on DNA was assessed with chromatin immunoprecipitation. SARS-CoV-2 was isolated from bronchoalveolar lavage of a COVID19 patient. Syrian golden hamsters were infected via direct inoculation and QPCR on oral swab, nasal turbinate and lung samples was used to measure SARS-CoV-2 infection. Human livers and lungs not used for transplantation were perfusedex-situusing normothermic perfusion. Nasopharyngeal swabs were used to measure ACE2 expression in nasal epithelial cells of healthy individuals taking UDCA at the standard therapeutic dose of 15 mg/kg/day. Patient registry data were compared using propensity score matching for sex, age, diabetes, NAFLD and Child- Turcotte-Pugh score. Result(s): We identified that FXR directly regulates ACE2 transcription in cholangiocyte organoids, while FXR inhibition with the approved drug ursodeoxycholic acid (UDCA), reduced ACE2 expression and SARS-CoV-2 infectionin vitro. We confirmed this mechanism in organoids from other COVID19-affected tissues, including the respiratory and intestinal systems. We validated our findingsin vivoin Syrian golden hamsters, showing that treatment with UDCA downregulates ACE2 and prevents SARS-CoV-2 infection. We confirmed that UDCA reduces ACE2 and SARS-CoV-2 infection in human lungs and livers perfusedex-situ. We performed a clinical study demonstrating that UDCA lowers ACE2 levels in the nasal epithelium of 6 healthy volunteers. Finally, we identified a correlation between UDCA and better clinical outcomes (hospitalisation, ICU admission and death) in COVID19 patients receiving UDCA for cholestatic diseases using the COVID-Hep and SECURELiver registry data. Conclusion(s): We identified FXR as a novel regulator of ACE2 expression. Using a bench-to-bedside approach combining in vitroand in vivomodels, exsituperfused human organs and clinical data we showed that FXR inhibition prevents or reduces SARS-CoV-2 infection and identified UDCA as an approved, cost-effective drug which could be repurposed for COVID19, paving the road for future clinical trials.

Diet and supplement use changes among male cancer survivors during the COVID-19 pandemic

Introduction: The COVID-19 pandemic has disrupted the lives of cancer survivors who may be at higher risk than people without cancer of other adverse health outcomes. For many individuals, a cancer diagnosis leads to lower physical activity and change in mental health status. Modifiable health behaviors, such as consumption of a healthy diet, can positively affect cancer survivorship outcomes. Aim: To investigate the individual-level changes in diet and supplement use among male cancer survivors during the COVID-19 pandemic and compared to men without cancer. Methods: Participants of the Health Professionals Follow-up Study, enrolled since 1986, were asked to self-report health behaviors during the pandemic on three web-based questionnaires administered during the COVID-19 pandemic (baseline COVID: October 2020, first follow-up: January 2021, second follow-up: April 2021). Diet and supplement use were analyzed descriptively between cancer survivors and individuals without a history of cancer. Further, outcomes were dichotomized to reflect whether a change was healthful or unchanged/unhealthful;for example, lower fast food consumption was classified as a healthful change. To assess the associations between cancer survivors and other men, logistic regression was used, adjusting for age, race, pre-pandemic body mass index, pre-pandemic physical activity, and other health information. Results: Of 4,416 men who completed the baseline COVID-19 questionnaire, 962 were cancer survivors (after excluding those with non-melanoma skin cancer). Across all eligible men (median age: 78 years), there were considerable proportions of men engaging in healthful changes following the start of the pandemic in intake of fast food (19% decreased), sugary drinks (14% decreased), fresh fruit (26% increased), fresh vegetables (19% increased), fish (13% increased), and red meat (12% decreased) consumption. Similar changes in diet were reported on the second follow-up questionnaire. For most foods, a similar percentage of cancer survivors and individuals without a history of cancer increased healthy eating. Findings from multivariable logistic regression models were reflective of higher odds of cancer survivors to engage in a healthful diet change for unhealthy food categories (i.e., less fast food, less frozen food), though none of which were statistically significant. There was little change in supplement use during the pandemic, except for 6% who started use of vitamin D supplements between the baseline and first follow-up questionnaire. Conclusion: Our findings suggest that older men engaged in healthful diet changes during the COVID-19 pandemic, without noticeable differences among cancer survivors.

Physical activity among male cancer survivors during the COVID-19 pandemic

Introduction: The COVID-19 pandemic has greatly disrupted the lives of cancer survivors. Beyond being at increased risk for COVID-19 infection and severe complications, cancer survivors may be at higher risk of other consequential health outcomes compared to those without a history of cancer. Engagement in physical activity has been shown to positively affect cancer survivorship outcomes, and as such, it is important to assess physical activity habits during the pandemic of cancer survivors. Aim: To investigate the individual-level physical activity among male cancer survivors during the COVID-19 pandemic and compare to men without cancer. Methods: Participants of the Health Professionals Follow-up Study, enrolled since 1986, were asked to self-report health behaviors during the pandemic on three web-based questionnaires administered during the COVID-19 pandemic (baseline COVID: October 2020, first follow-up: January 2021, second follow-up: April 2021). Physical activity measures were analyzed descriptively between cancer survivors and individuals without a history of cancer. Outcomes were recoded dichotomously to reflect either: healthful (i.e., higher engagement since pandemic) vs unchanged/unhealthful behavior or high vs low engagement in an activity. Logistic regression models were employed to assess association with cancer survivor status and were adjusted for covariates such as age, race, pre-pandemic BMI, pre-pandemic physical activity, and other health information, as appropriate. Results: Of 4,416 men who completed the baseline COVID-19 questionnaire, 962 were cancer survivors (after excluding those with non-melanoma skin cancer). Of all eligible men (median age: 78 years) reporting on physical activity, over 50% walked for at least 2-3 hours per week, over 10% used a stationary bike for at least 1 hour per week, 14% engaged in yoga for at least 1 hour per week, and nearly 20% engaged in vigorous activity for at least 1 hour per week. Further, 42% engaged in high (1+ times per day) levels of mindfulness and 24% engaged in high (1+ times per day) levels of yoga. Engagement in vigorous physical activity was significantly lower among cancer survivors compared to individuals without a history of cancer (Chi-square p = 0.01). Conclusion: Our findings suggest older men had high engagement in physical activity during the COVID-19 pandemic, with vigorous physical activity engagement significantly lower in cancer survivors.

Psychosocial outcomes, sleep, and substance use among male cancer survivors during the COVID-19 pandemic

Introduction: Cancer survivors may experience impacts on their psychosocial health and sleep quality due to the cancer diagnosis and severity as well as treatments. The COVID-19 pandemic has greatly disrupted the lives of cancer survivors, including those who are in treatment and those who are living cancer-free. A better understanding of psychosocial behaviors, sleep, and substance use is of timely importance. Aim: To better understand the individual-level psychosocial outcomes, sleep patterns, and substance use of cancer survivors during the COVID-19 pandemic, and compared to individuals without a history of cancer. Methods: Participants of the Health Professionals Follow-up Study, enrolled since 1986, were asked to self-report health behaviors during the pandemic on three web-based questionnaires administered during the COVID-19 pandemic (baseline COVID: October 2020, first follow-up: January 2021, second follow-up: April 2021). Psychosocial presentations, sleep patterns, and substance use were analyzed descriptively between cancer survivors and individuals without a history of cancer. Substance use and non-continuous sleep outcomes (e.g., trouble falling asleep) were recoded dichotomously and assessed via logistic regression to calculate odds ratios (OR) and 95% confidence Intervals (CI). Continuous psychosocial outcomes and sleep outcomes (e.g., hours slept last night) were analyzed via linear regression. Models were adjusted for covariates such as age, race, marital status, living arrangement, employment status, and other health information, as appropriate. Results: Of 4,416 men who completed the baseline COVID-19 questionnaire, 962 were cancer survivors (after excluding those with non-melanoma skin cancer). Poor sleep quality was prevalent for all eligible men (median age: 78 years);34% reported trouble falling asleep, 74% woke during the night, 50% woke too early without getting back to sleep, 59% needed a nap most or some of the time. Cancer survivors were significantly more likely to wake early and not get back to sleep (OR = 1.19, (1.00, 1.41)) and sleep a greater amount in the past week (+0.14 (0.03, 0.25) hours per day) compared to those without a history of cancer. Compared to those without a history of cancer, survivors were more likely to present with lower psychological wellbeing, higher post-traumatic stress, and higher stress and lower gratitude. Across all men, healthful changes in alcohol (decreased) use were observed at baseline (10% of men) and second follow-up (15% of men). At the first follow-up, cancer survivors were at significantly higher odds to regularly use CBD products compared to individuals without a history of cancer (OR: 1.63 (1.03, 2.55)). Conclusion: Among male cancer survivors, there were significant impacts in sleep patterns and substance use, and further understanding of the effects of such differences is needed.

The ethics of exploring social cognition in HD using ethnography during a pandemic

Aim Using ethnography to study social cognition through social functioning in HD will begin to address the empirical gap in our knowledge of everyday life with HD from the perspective of both people with HD and their companions. As ethnography moves into the messiness of real life in that the researcher is an observer of the participants in their own space and this now needs to include Covid safe strategies (i.e. online observation) risks to all parties may be seen as greater due to the nature of HD alongside exploring the intimacies of interaction remotely. Primacy needs to be given to the principle of 'do no harm'. Method Whilst our fears often do not come to fruition, researchers using this methodology with people with HD and their companions need to consider:. Involving a patient participant group. Building trust and rapport amongst the community through the life of the project and beyond. Family dynamics. Tensions which may have been worsened by the pandemic. A distress strategy. Adjusting the way we as researchers do things and not the other way round. Giving more structure, planning and prompting to optimise HD engagement. Fluid revisiting of consent. Access to technology. The limitations of technology in this population Outcome Thoughtful preparation although time consuming may enable equitable access to all interested participants but also reduce risks. As Markham notes methods = ethics.

The impact of the COVID-19 pandemic on mental health and well-being of people living with a long-term physical health condition: a qualitative study.

BACKGROUND: The COVID-19 pandemic and associated restrictions caused major global disruption. Individuals with long-term physical health conditions (LTCs) are at higher risk of severe illness and often subject to the strictest pandemic guidance, so may be disproportionally affected. The aim of this study was to qualitatively explore how living with a LTC during the COVID-19 pandemic affected people's mental health and wellbeing. METHODS: Participants were people living with LTCs who participated in telephone/video call interviews based on a semi-structured topic guide. Key themes and subthemes were determined using deductive and inductive thematic analysis. RESULTS: The sample included 32 participants with LTCs (most commonly cancer, respiratory conditions or cardiovascular diseases), mean age 57 (SD 13) years, 66% female and 72% white British. There were four overarching themes specific to living with a LTC. These were 1) high levels of fear and anxiety related to perceived consequences of catching COVID-19, 2) impact of shielding/isolation on mental health and wellbeing, 3) experience of healthcare during the pandemic and 4) anxiety created by uncertainty about the future. Fourteen subthemes were identified, including concerns about accessing essential supplies and the importance of social support. Individuals who lived alone and were advised to shield could be profoundly negatively affected. CONCLUSIONS: This study found that there were a number of aspects of living with a LTC during the pandemic that had a significant impact on mental health and well-being. There should be focus on how best to provide practical and social support to people with LTCs during a pandemic, particularly if they have to shield or isolate.

Impact of covid-19 on autologous stem cell transplantation (asct) in multiple myeloma (mm) patients: A single-centre, qualitative evaluation study

Background: ASCT is standard of care in biologically fit, newly diagnosed MM (NDMM) patients (pts), offering deeper responses with prolonged progression free/overall survival and improved quality of life (QOL). However, with the UK's 1st national lockdown on 23/03/2020, several guidelines recommended deferring ASCT for MM due to risks of infection, with resource limitations forcing some units to suspend ASCT entirely. Such changes to pts' treatment plans inevitably altered their lived experience during these uncertain times with expected impact on QOL. Aims: To provide a snapshot of how COVID-19 affected the MM ASCT service in a single UK institution, including changes to chemotherapy treatment plans, timing, and prioritisation of ASCT. To gain insight into MM pts' understanding of their disease, initial therapy and ASCT, and their response to therapy changes. Methods: We collected data on 115 NDMM pts who had a stem cell harvest (PBSCH) for upfront ASCT from December 2019-January 2021. During this time, 3 national lockdowns led to the ASCT service being suspended twice (March-June 2020 and January-February 2021). 25 pts within this cohort underwent a semi-structured interview via telephone. Inductive and deductive framework analysis was utilised to determine key themes and subthemes. Results: Pts were discussed in multidisciplinary meetings and decisions taken to delay or defer ASCT based on pt fitness, disease risk and depth of response. 73 (63%) proceeded to ASCT and 42 (37%) were deferred indefinitely (ASCTdef). The 2 groups were similar in terms of gender, age and ISS, but there were more pts with adverse risk cytogenetics in the ASCT group (26% vs 12%). Both groups were predominantly treated with bortezomib-based induction;in 11/73 (15%) ASCT and 7/42 (16.7%) ASCTdef pts treatment was changed to an oral, lenalidomide- based regimen to reduce hospital attendances for parenteral therapy. Overall response to induction in the 2 groups was similar;97.3% and 95.2% and 3VGPR 59% and 52.4% in ASCT and ASCTdef pts respectively. 28/73 ASCT pts had no delay to ASCT and none received bridging chemotherapy;45/73 had delayed ASCT (median 11 months [5-17] from start of induction) of whom 31 were put on bridging chemotherapy. In the 42 ASCTdef pts, 5 relapsed within ≤6 weeks of PBSCH and received 2nd line therapy, 30 were put on holding chemotherapy (previously not offered in the UK) as per NHS England COVID-19 interim guidance and 7 remained treatment-free post-induction. Thematic analysis identified 6 overarching themes: a) psychological response to diagnosis and initial therapy, b) beliefs and opinions about the benefits of ASCT, c) perceptions of information provided about MM and ASCT, d) high levels of fear and anxiety around COVID-19 and e) feelings about ASCT disruption or delay due to COVID-19 f) perceptions of care. Example subthemes were beliefs that ASCT would provide a long-remission/best chance of normality including freedom from chemotherapy and associated side-effects, disappointment and devastation at COVID-related treatment delays (in spite of high anxiety about infection) and exceptionally high levels of trust in the transplant team.

The promoting individualised self-management and survivorship (PrISMS) clinic - A multidisciplinary remote monitoring clinic for a patient-centred approach in multiple myeloma

Content: Introduction: Myeloma patients who have completed chemotherapy moved from an intensive period of interaction with healthcare professionals, to less frequent visits. At this time, they often struggle with disease burden, treatment side effects and age-related co-morbidities. Improved patient survival with novel therapies has resulted in increasing patient numbers in outpatient haematology clinics. Centralisation of services means that many patients travel long distances to maintain contact with their transplant centres because they value the access to new drugs and clinical trials, and expertise in management of transplant-related complications and relapse. Faced with growing numbers of patients in follow up with survivorship needs, a new patient-centred model of care is needed. Method: The Promoting Individualised Self-Management and Survivorship (PrISMS) clinic was designed for myeloma patients who are off treatment and in plateau phase. This remote clinic is staffed by a doctor, a nurse specialist and a physiotherapist, a multidisciplinary team (MDT) approach to holistic management centred on patient needs and providing consistent individualised physical activity and lifestyle advice. Two weeks before the consultation, patients complete a questionnaire about their concerns, symptoms and ways in which they would like to improve their health. This allows the MDT to prepare appropriate advice for each patient, ensuring efficient use of consultations. Patients are also required to have a blood test either locally or at University College London Hospital before the clinic. Results: From March 2019 to October 2020, 54 patients were enrolled into the pilot PrISMS clinic and 197 telephone or video consultations were held. The median call duration was 12 minutes. Most patients had their blood tests (89%) and questionnaires (84%) completed before the appointment. Patients needing closer monitoring or active treatment due to disease relapse (9/54) were referred immediately back to face-to-face clinics. 78% and 89% of patients received nurse specialist's and physiotherapist's advice respectively at any point in time, with 11 patients (20%) referred to local exercise programmes. Patients were signposted to survivorship tools such as online exercise videos and lifestyle mobile applications when appropriate. Patient feedback was positive, with 31 of the 36 surveyed patients (86%) agreed or strongly agreed that they felt more confident in self-managing myeloma after PrISMS consultations. 94% (34/36) agreed or strongly agreed that their concerns and symptoms were addressed, and 77% (28/36) gave an overall service rating of good or excellent. Thematic analysis of telephone feedback interviews with 22 participants revealed additional benefits of reduction in travel costs and time, substantially shorter clinic waiting times and reduction in associated psychological stress (Table 1). Conclusion: This new patient-centred model of care has been demonstrated to be safe and feasible, with good patient satisfaction. We hope that this MDT approach will empower patients, improve their clinical experience, and build trust in their clinical teams, as well as reducing patients' sense of isolation and vulnerability particularly in this time of COVID-19 crisis. Future work is needed to formally confirm its effects on patient reported outcome measures, safety and healthcare resource usage.

Empowering patients in the face of a pandemic-a multidisciplinary remote monitoring clinic for a patient-centred approach in myeloma

Myeloma patients who have completed chemotherapy move from an intensive period of interaction with healthcare professionals, to less frequent visits. At this time, they often struggle with disease burden, as well as treatment related toxicities and age-related co-morbidities. We previously reported from focus group interviews that patients need lifestyle support and advice to return to their pre-morbid social, psychological and economic functionality. Improved patient survival with novel therapies has resulted in increasing patient numbers in outpatient clinics. Centralisation of services means that many patients travel long distances to maintain contact with their transplant centre because they value the access to optimal treatment and clinical trials. Faced with growing numbers of patients in follow up with survivorship needs, we designed the Promoting Individualised Self- Management and Survivorship (PrISMS) clinic for myeloma patients who are off treatment and in plateau phase in early 2019. This remote clinic is staffed by a doctor, a nurse specialist and a physiotherapist, a multidisciplinary team approach to holistic management centred on patient needs and providing consistent individualised physical activity and lifestyle advice. Two weeks before the consultation, patients are required to have a blood test locally or at our hospital, and to complete a questionnaire about their concerns, symptoms and ways in which they would like to improve their health. We did not know at the time that such model of care would become especially pertinent as a result of the COVID-19 pandemic. From March 2019 to October 2020, we enrolled 54 patients into the pilot PrISMS clinic and held 197 telephone or video consultations. The median call duration was 12 minutes, with most patients having had their blood tests (89%) and questionnaires (84%) completed before the appointment. Patients needing closer monitoring or active treatment due to disease relapse (9/54) were referred immediately back to face-to-face clinics. 78% and 89% of patients received nurse specialist's and physiotherapist's advice at any point in time, with 11 patients (20%) referred to local exercise programmes. Regarding patients' feedback, 31 of the 36 surveyed patients (86%) agreed or strongly agreed that they felt more confident in self-managing myeloma after the consultations. 94% (34/36) of the survey patients agreed or strongly agreed that their concerns and symptoms were addressed, and 77% (28/36) gave an overall service rating of good or excellent. Thematic analysis of telephone interviews with 22 participants revealed additional benefits of reduction in travel costs and time, shorter waiting times and reduction in associated psychological stress (Table 1). PrISMS clinic aims to empower patients through patient-centred care by providing tailored advice, through enhancing patients' competences by signposting them to various survivorship tools (Table 2), and through active patient participation by setting achievable goals. We hope that this new care model will improve patients' clinical experience and build trust in their clinical teams particularly at this time of crisis, and to reduce their sense of isolation. We continue to evaluate this service based on patients' feedback to optimise individualised care and resource allocation. Future work is needed to formally confirm its effects on patient reported outcome measures, safety and healthcare resource usage. (Table Presented).

Exploring the Relationships Between Resilience and News Monitoring with COVID Distress in Health Profession Students

OBJECTIVE: Alarming rates of anxiety and burnout in pre-clinical health profession trainees are now challenged by additional COVID-19 stressors. This study explored COVID-related stressors among first-year medical, physician assistant, nurse practitioner, and veterinary medical students. The authors examined associations between resilience, news monitoring, and COVID stress. METHODS: Students completed an online questionnaire that included the Brief Resilience Scale at their matriculation in August 2019. Survey results were linked to demographic information collected by all schools. A follow-up survey in May 2020 included original questions on COVID-19 stressors and news monitoring. Statistical analyses included descriptive statistics and multivariable linear regression models. RESULTS: Across schools, 74% (266/360) provided consent for the 2019 survey, and 76% (201/264) responded to COVID-19 questions in the follow-up 2020 survey. Students were "extremely" or "very" concerned about family members getting infected (n = 71, 76% School of Medicine (SOM);n = 31, 76% School of Nursing (SON);n = 50, 75% School of Veterinary Medicine (SVM)) and curriculum schedule changes (n = 72, 78%, SOM;n = 28, 68% SON;n = 52, 79% SVM). Greater frequency of COVID news monitoring was associated with greater COVID-related stress (p = 0.02). Higher resilience at matriculation was associated with lower COVID-related stress ten months later (p < 0.001). CONCLUSIONS: Amid COVID-19 uncertainty, health science schools should address the immense student stress regarding curriculum disruptions. The results of this study underscore the powerful role of resilience in protecting against stress not only during the known academic rigor of health professions training but also during unprecedented crises.

Cardiothoracic Organ Utilisation during the SARS-CoV-2 Pandemic in the UK

Purpose The severe acute respiratory syndrome coronavirus (SARS-CoV-2) pandemic has caused widespread changes to healthcare practice. Demand on capacity, concerns for transplant recipients, including the risks of nosocomial infection, and the availability and safety of donors, lead to continuation of transplantation for only urgent and super-urgent, in-patient candidates, in the UK from March to May 2020. The aim of this study is to evaluate the impact of these practice changes on heart and lung donor utilisation during the pandemic period. Methods Data on all adult and paediatric heart and lung donors offered, and transplants performed, between 1 March and 30 September 2019 and 1 March and 30 September 2020 were obtained from the UK Transplant Registry. The early pandemic period is defined as 1 March to 31 May 2020. Ideal lung donors are defined as age <56 years and no smoking history. Results Lung transplant activity during the early pandemic period fell by 77% (13 transplants compared to 56 in 2019). Heart transplant activity fell by 10% (38 compared to 42 heart transplants in 2019). The number of donors, who donated at least 1 solid organ, fell by 51%. The lung donor utilisation rate during the early pandemic period was 11%, compared to 24% for the same period of 2019. The heart donor utilisation rate during the pandemic period was 35% compared to 26% during the same period of 2019. The proportion of ideal lung donors, from donors where lung(s) were offered, was 23% in 2020 compared to 24% in 2019. Following the early pandemic period (1 June to 30 September 2020), there has been an increase in the number of lung donors, lung transplant activity and utilisation, rising from 11% in March to May to 14% in June to September. This compares with a utilisation rate of 21% for the same period of 2019. Conclusion During the SARS-CoV-2 pandemic, changes to practice led to the continuation of heart transplantation, with minimal impact on activity, whilst lung transplant activity fell. The number of organ donors fell, while the ‘quality’ of potential lung donors remained unchanged. As the evidence base guiding clinical practice is evolving, along with improved donor testing, lung transplant activity is again increasing, however the utilisation of donors remains lower than in 2019. On-going analysis of activity is required to fully assess the impact of the SARS-CoV-2 pandemic on the UK lung transplant population.

Gender inequalities during COVID-19

The onset of the global COVID-19 pandemic put a halt to progress toward gender equality and, instead, exacerbated existing gender inequalities across domains—from gendered divisions of labour to economic stability. In this paper we document some of the most glaring gender inequalities that have arisen in the COVID-19 pandemic and discuss how social psychological theories and research—including work on gender stereotypes and roles, responses to threat, precarious masculinity, perceptions of risk, and backlash—can help to explain the roots of these inequalities. In doing so, we use a broad definition of gender and consider relevant intersections of identity. Finally, we present three key considerations for research on gender inequalities moving forward. Namely, the need for social psychologists to (a) challenge binary conceptualizations of gender, (b) broaden the focus of research on gender inequalities, and (c) adopt an intersectional lens to address systemic inequalities in the wake of COVID-19. © The Author(s) 2021.