Acceptability of an Adapted Resiliency Program for Adolescent and Young Adult Cancer Survivors (AYA)

Background/Purpose: Receiving a cancer diagnosis during adolescence and young adulthood (AYA;15-39) coincides with a period of pivotal developmental milestones. Coping with the stress of cancer diagnosis exacerbates risk for distress and feelings of isolation among AYAs. Mind-body resiliency programs may offer a compassionate approach for tackling these negative post-treatment psychosocial experiences. The present mixed methods study explores the acceptability of an 8-week, synchronous, virtual group Relaxation Response Resiliency Program (3RP) adapted to address the unique challenges facing AYAs (3RP-AYA). Method(s): Recruitment occurred at an academic hospital in Boston, MA from 03/2019 to 09/2020. Participants (N = 72, Mage = 23.8, female = 73.6%, non-Hispanic White = 59.7%, Hispanic/Latino = 20.8%, 1.6 years post-treatment) were randomized to receive 3RP-AYA immediately (intervention group;n = 35) or after 3 months (waitlist control;n = 37) via Zoom. Electronic surveys were collected before and after participants completed treatment;we report post-treatment survey data measuring acceptability across five domains (enjoyability, helpfulness, convenience, future use, and satisfaction) using 4-point Likert scales (1 = not at all to 4 = very). Qualitative post-treatment interviews further queried program acceptability. Result(s): Program acceptability responses indicated program satisfaction: enjoyability (M = 3.62, SD = 0.69), helpfulness (M = 3.45, SD = 0.75), and convenience (M = 3.67, SD = 0.71). More specifically, 76.7% of participants found the virtual delivery to be very convenient, and 71.7% rated the sessions as very enjoyable. 91.7% of participants reported they were likely/very likely to use learned skills in the future and 91.7% reported the intervention as helpful/very helpful. Additionally, 96.6% reported satisfaction with the overall content. Exit interviews highlighted session intergroup connectivity as a particular strength. Conclusions and Implications: Across multiple domains, the 3RPAYA was deemed acceptable by AYAs. Participants valued the opportunity to learn mind-body skills and connect with other young survivors. The synchronous virtual study platform showed promise for being a convenient and helpful tool to deliver mind-body programs to AYA survivors during the Covid-19 pandemic.

A global snapshot of the impact of the COVID-19 pandemic on cancer research: Report from a Global Cancer and COVID-19 Task Force

Introduction: The COVID-19 pandemic has had profound effects on healthcare systems worldwide. It has also had global economic impacts that will continue to be felt for years. The effects have implications for how cancer research is conducted and funded. The REPRISE project aims to learn from the COVID-19 pandemic to provide opportunities to redefine cancer research priorities in low- to middle-income countries (LMICs). We aim to characterize the nature of these practical and economic impacts and use this information to redefine research priorities in a changed world moving forward. Methods: As a first step, we conducted a snapshot survey of members of the 'Cancer and COVID-19 Global Task Force', which consists of experienced cancer researchers across the world. We asked about the extent to which the COVID-19 outbreak and resulting public health measures had affected cancer research in their centers. Results: We received 57 responses to our questionnaire. The respondents worked in 22 countries, representing all Word Health Organization (WHO) regions. 67% of respondents worked in either an academic/university setting, or in a public teaching hospital. The specialities of medical oncology, radiation oncology, surgery, and epidemiology were each represented by >25% of all respondents, which also included those with backgrounds in nursing, palliative care, survivorship, psychology, pathology, and prevention. Respondents in 17/22 countries reported that some (n=10) or all (n=7) cancer research studies were suspended at their center following the outbreak of COVID-19. Respondents in 5 countries reported that suspension of these studies had lasted >6 months. Respondents in 8/22 countries reported that staff redeployment, furlough, or restriction from clinical areas had had a 'large impact' on the conduct of research they were involved with. Respondents in 4 further countries reported that these factors had had a 'moderate impact'. Respondents also reported local impacts on cancer research from in-center outbreaks of COVID-19 (14 countries);government-imposed 'lockdowns' (20 countries);compliance with COVID-19 safety (18 countries);decreases in participant accrual (11 countries);and decreased patient access to diagnostics or treatment (19 countries). Nine countries yielded reports of funding cuts in their center. Twenty countries yielded reports of concerns about future funding cuts. Fifteen countries yielded reports of issues from delays to postgraduate education. Additionally, respondents were concerned about future impacts on cancer research from COVID-19 safety measures, funding cuts, and decreased patient access to diagnostics or treatments. Conclusion: The COVID-19 pandemic has profoundly impacted on the conduct of cancer research in many different countries and in several different ways. The process of redefining cancer research priorities throughout the REPRISE project will ensure that the impacts we have documented here are mitigated as far as possible and that moving forward, we can begin to address global disparities in cancer research.

Primary results of the cTRAK TN trial: A clinical trial utilising ctDNA mutation tracking to detect minimal residual disease and trigger intervention in patients with moderate and high risk early stage triple negative breast cancer

Background Detection of circulating tumour DNA (ctDNA) in patients (pts) who have completed treatment for early-stage triple negative breast cancer (TNBC) is associated with a very high risk of future relapse. Identifiying those at high risk of subsequent relapse may allow tailoring of further therapy to delay or prevent recurrence. The c-TRAK TN trial assessed the utility of prospective ctDNA surveillance in pts treated for TNBC and the activity of pembrolizumab (P) in pts with ctDNA detected. Methods c-TRAK TN, a multi-centre phase II trial with integrated prospective screening component, enrolled pts with early-stage TNBC and either residual disease following neoadjuvant chemotherapy, or tumour size >20mm and/or axillary lymph node involvement if adjuvant chemotherapy was given. Tumour tissue was sequenced to identify somatic mutations suitable for tracking using personalised digital PCR ctDNA assays (BioRad QX200). Pts had "active" ctDNA surveillance via blood sample testing every 3 months to 12 months (potential up to 18 months if S samples missed due to COVID) during which time if ctDNA was detected (ctDNA+) pts could be randomised 2:1 to P (200mg i.v. q 3 weeks for 1 year) or observation (Obs). Pts and clinicians were blinded to ctDNA+ results unless they were allocated P, when staging scans were done and those free of clinical recurrence started treatment. Following advice from the Independent Data Monitoring Committee, the Obs arm closed on 16/06/2020 with all subsequent ctDNA+ pts allocated P. Following the completion of active ctDNA surveillance, 3-monthly visits continued to 24 months to be analysed retrospectively. The aim was to recruit 150 pts to ctDNA surveillance, assuming 30% would be ctDNA+ within 12 months, allowing ctDNA+ rate to be estimated with a 2-sided 95%CI of +/-7.3%. Co-primary endpoints are i) rates of ctDNA detection by 12 and 24 months from start of ctDNA surveillance;ii) rates of sustained ctDNA clearance on P defined as absence of detectable ctDNA, or disease recurrence 6 months after starting P. Results 208 pts were registered between 30/01/18 and 06/12/19, 185 had tumour sequenced, 171 (92.4%) had trackable mutations, and 161 entered ctDNA surveillance. The rate of ctDNA detection by 12 months after start of surveillance was 27.3% (44/161, 95% CI 20.6-34.9). ctDNA+ rates from baseline, 3, 6, 9 and 12 month ctDNA samples were 23/161 (14.3%), 6/115 (5.2%), 6/99 (5.1%), 7/84 (8.3%), and 2/84 (2.4%) respectively. An additional 2 pts were ctDNA+ on COVID extended active surveillance at 15 (1/51, 2%) or 18 months (1/11, 9%). 7 pts relapsed without prior ctDNA detection. 45 pts entered the therapeutic component of the trial (initially 31 to P and 14 to Obs). 1 Obs pt was re-allocated to P. Of pts allocated to P, 72% (23/32) had metastatic disease at time of ctDNA detection on staging scans (75% (12/16) who were ctDNA+ at baseline and 69% (11/16) at other timepoints). 4 pts declined to start P, largely due to COVID concerns. Of the 5 pts who commenced P, at the time of analysis none achieved sustained ctDNA clearance and 4 had recurred. In pts allocated to Obs, median time to recurrence was 4.1 months (95% CI: 3.2-not-defined). Conclusion The c-TRAK TN trial is to our knowledge the first study to assess the proof-of-principle of whether ctDNA assays have clinical utility in guiding further therapy in TNBC. Relatively few pts commenced P treatment precluding assessment of potential activity. At enrollment, patients had a relatively high of rate of undiagnosed metastatic disease when imaged. Our findings have implications for future trial design, emphasizing the importance of early start of ctDNA testing, and more sensitive and/or more frequent ctDNA testing regimes.

Second versus first wave of covid-19 in patients with mpn

Introduction. MPN-COVID is a European LeukemiaNet cohort study, launched in March 2020 in patients with myeloproliferative neoplasms (MPN) with COVID-19. The first cohort of 175 cases was analyzed at the end of first wave (July 2020) and results provided estimates and risk factors of overall mortality (Barbui T. Leukemia, 2021), thrombosis incidence (Barbui T. Blood Cancer J, 2021), and post-COVID outcomes (Barbui T. Blood Cancer J, 2021). In the second wave of pandemic (June 2020 to June 2021), case-fatality risk in the general population has been found variable across different countries, and no information is available in MPN patients with COVID-19 diagnosed during the second wave in comparison with those of the first wave. Methods. In an electronic case report form, we registered a total of 479 cases of ET (n=161, 34%), PV (n=135, 28%), pre-PMF (n=49, 10%) and overt MF (n=134, 28%), from 39 European hematology units (Italy, Spain, Germany, France, UK, Poland, Croatia). Of these, 304 were diagnosed COVID-19 during the second wave. Results. Patients in the second wave were significantly different from those in the first wave, including parameters such as age (median: 63 vs. 71 years, p<.001), sex (females: 52% vs. 42%, p=0.037), MPN category (MF 24% vs. 34%, p=0.020), comorbidity (at least one comorbidity 63% vs. 74%, p=0.012), disposition (home: 68% vs. 23%, regular ward: 29% vs. 66%, ICU: 3% vs. 11%, p<.001), need of respiratory support (28% vs. 59%, p<.001) and degree of systemic inflammation (C-Reactive Protein: 51% vs. 74%, p=0.008;Neutrophil to Lymphocyte Ratio: 4.1 vs. 5.4, p=0.038). In regard to COVID-19-directed therapy, in the second wave steroids were more frequently prescribed (28% vs. 40%, p=0.007), while the use of antibiotics, antivirals, hydroxychloroquine and experimental therapies was significantly less frequent (p<.001 for all the differences). Interestingly, only 4 out of 46 patients (8.7%) discontinued Ruxolitinib during second-wave acute COVID (all MF admitted to regular ward). In the two waves, distribution probability of COVID-19 incidence by Kernel method showed a substantially similar shape, whereas the two incidence peaks were associated with very different mortality, as reported in Fig. 1A. The difference between the probability of death was highly significant during the first (n=175) vs. second (n=304): 31% vs. 9% at 60 days from COVID-19 diagnosis, respectively (p<.001) (Fig. 1B). Of note, among 26 deaths, 4 (15%) occurred at home, 19 (73%) on regular wards and 3 (12%) in the ICU, and death more frequently afflicted patients with (n=17, 65%) than ET (n=5, 19%) and PV (n=4. 15%) (p<.001). Independent risk factors for death in a multivariate Cox regression model fitted on the whole cohort and adjusted for the wave to which patients belonged, were age over 70 years (HR=5.2, 95% CI 1.8-15.1, p=0.002), male sex (HR=1.9, 95% CI 1.1-3.1, p=0.016), COVID-19 severity revealed by the need for respiratory support (HR=4.5, 95% CI 1.9-10.7, p=0.001), and Ruxolitinib discontinuation (HR=3.0, 95% CI 1.3-6.9, p=0.011). Conversely, in patients who continued this drug, no risk was documented (HR=1.21, p=0.566). Taking into account death as competing event, the second outcome of interest was the incidence of thrombosis, wich occurred in a significantly lower proportion of patients in the second wave compared to the first one (n=5 [1.6%] vs. n=14 [8.0%] at +60 days, respectively, SHR=0.20, p=0.002) (Fig. 1C). All the events, but one (n=4/5) were venous and were reported in patients with ET (SHR=4.4, 95% CI 1.8-10.7, p=0.001). Conclusions. This is the largest series of MPN patients who incurred COVID-19 from June 2020 onward, namely during the 'second COVID-19 wave'. Compared to the first wave, the second one recorded a lower overall COVID-19 severity, but Ruxolitinib discontinuation still remained a risk factor for a dismal outcome. Greater vulnerability of ET than PV in developing venous thrombosis was confirmed also during the second wave. This finding suggests that ET warrants a specific antithrombo ic prophylaxis in addition to heparin.

Harnessing Virtual Reality for Disaster Mental Health: A Systematic Review

Widespread disasters, such as hurricanes, terrorist attacks, and viral outbreaks, represent a unique class of stressors that increase the demand for mental health care but also limit access to services. During the course of COVID-19, an unprecedented global pandemic, the detrimental effects of fear, uncertainty, and social isolation have particularly strained existing structures for psychological care. Virtual reality (VR) represents a promising means to address this still-growing need. Although VR has been applied in medical settings for decades, no existing literature has synthesized the strength of empirical support for VR's acceptability, feasibility, and efficacy in the context of disaster mental health. In an attempt to fill this urgent need, the present systematic review summarizes the findings of 21 diverse studies of VR as a tool for disaster-related psychological resilience training, psychological first aid, or counseling. With an eye toward VR's potential utility to address the incredible need for services created by the COVID-19 pandemic, we offer recommendations for key future directions and methodological considerations in the context of disaster mental health.

A pathway transformation to transition from a ‘routine’ to a ‘responsive’ severe asthma service in the post COVID era

P154 Figure 1A pathway transformation to transition from a ‘routine’ to a ‘responsive’ severe asthma service in the post COVID era[Figure omitted. See PDF]ConclusionsThe COVID-19 pandemic has necessitated a comprehensive re-evaluation of services and care pathways across the NHS. Transitioning from a ‘routine’ to ‘responsive’ patient-triggered service has facilitated flexible but personalised care empowering patients in the self-management of their asthma and significantly reducing the burden of ‘routine’ follow-up for patients and the MDT. This has reduced waiting times and increased capacity for new patient assessments whilst ensuring patients are offered timely reviews when their asthma control deteriorates, delivering equitable access across the system with the potential to improve patient outcomes.

Measures of inflammation, complement activation and coagulation in patients with COVID-19

S56 Table 1Table to show measures of complement activation, inflammation and coagulation in patients with COVID-19 stratified by disease severityMildModerateSevereOverall P-ValueMild vs Mod*Mild vs Sev*Mod vs Sev*Number (%)30289----CRP (mg/L)75.5 [28.5,117.25]93.5 [72,143.5]60 [34,157.5]NSNSNSNSFerritin (ug/L)426 [290.5,847.5]728 [381.25,1071.5]857 [443,1607.5]NSNSNSNSPCT (ug/L)0.08 [0.06,0.19]0.16 [0.09,0.49]0.19 [0.12,0.8]0.019NS0.046NSLDH (U/L)708.5 [523.5,903]830 [569,1122]1037 [927.5,1086]0.008NS0.006NSPlatelets (10*9/L)220 [174.75,328.75]255 [203.5, 335]292 [209.5, 329.5]NSNSNSNSINR1.1 [1.08,1.23]1.1 [1.1, 1.2]1.1 [1.1, 1.15]NSNSNSNSAPTR0.9 [0.9,1.0]0.9 [0.9, 1.0]1.0 [0.95, 1.10]NSNSNS0.038D-dimer (ugFEU/ml)0.56 [0.38,0.95]0.74 [0.55, 1.52]0.85 [0.54, 19.2]NSNSNSNSFibrinogen (g/L)4.45 [4.05,5.22]4.7 [4.3, 6.38]4.3 [3.9, 6.0]NSNSNSNSThrombin-AT III Complex ug/L)4.75 [2.65,12.13]8.8 [5.3, 12]14.3 [6.9, 40.7]0.045NSNSNSProthrombin Fragment 1&2 (pMol/L)275 [164.5,380.5]311 [163, 492]301 [258, 709]NSNSNSNSCH50 (U Eq/ml)123.4 [101.75,174.7]113.4[88.68, 153.43]114.7 [74.6,158.9]NSNSNSNSComplement C5a (ng/ml)29 [21.5, 36]36.5[25.5, 48.75]68 [39.5,122.5]<0.0010.0380.001NSComplement C5 (mg/L)270 [235.25,290.5]263[235.25, 279]276 [220,299.5]NSNSNSNSComplement C3 (g/L)1.5 [1.25,1.77]1.48[1.33, 1.71]1.56 [1.16,1.73]NSNSNSNSSC5b-9 complex (ng/ml)1070.46 [836.41,1632.17]1725.48[1092.62, 2403.3]2392.66 [1245.68,5145.88]0.006NS0.019NSComplement Fragment Bb (µg/ml)0.2[0.15,0.27]0.25[0.17, 0.3]0.29 [0.2,0.43]NSNSNSNSComplement C3a ng/ml)296.88[244.33,345.22]325.88[248.33, 484.03]460.23 [282.49,652.1]NSNSNSNS*P-values given a Bonferroni adjustment to allow for multiple testing between subgroupsDiscussionOur findings demonstrated increased levels of complement activity in patients with COVID-19, particularly in those patients requiring non-invasive and mechanical ventilation and those patients that deteriorate requiring increasing ventilatory support. The complement cascade is a key player in protective immunity against pathogens, with its activation orchestrating key immunoprotective and anti-inflammatory effects Increased activation of the complement cascade may contribute to the dysregulated and destructive inflammatory response that leads to multi-organ failure and our findings suggest a potentially important treatment target for COVID-19.

Delivering physiotherapy outpatient assessment and treatment in a severe asthma clinic in the era of COVID-19

Introduction and ObjectivesThe global SARS-CoV-2 pandemic has forced clinicians to consider alternative methods of service provision to patients with respiratory conditions who were clinically vulnerable and/or advised to shield.Breathing pattern disorders (BPD) are a common comorbidity affecting approximately one third of patients with asthma. The respiratory physiotherapy team within the Portsmouth Severe Asthma Service (PSAS) recognised the need to continue to assess and deliver treatment for patients with BPD particularly at a time of heightened anxiety.Breathing retraining requires precise and highly specific assessment and treatment to ensure optimal outcomes and the decision to use a video conferencing platform was made to utilise the visual medium. To ensure quality service was being delivered, patients using the video conferencing platform to receive respiratory physiotherapy in the PSAS were asked for feedback.MethodsAt the end of every video consultation, written feedback was requested. Sixty-nine responses were received from July 2020-May 2021. Patients were asked to rate their physiotherapy consultation from very good to very poor;how they would prefer to receive treatment;if they would use this method of consultation again and the ease of use of the video consultation.ResultsOf the 69 responses:68/69 (98%) would use the service again58/69 (84%) rated the service as very good35/69 (51%) would choose video over face to face appointments23/69 (33%) would prefer to be seen face to face63/69 (91%) felt that accessibility of the video platform could be improvedQualitative feedback was also gathered from patients and included statements suchExcellent quality and a very thorough appointment.It was helpful to actually see a clinician face to face via video instead of a phone callConclusionsVideo consultations have proven to be a feasible and successful way of assessing BPD in asthma patients. Despite feedback regarding the ease of accessing the online platform being suboptimal, overarching positive responses to video consultations was received. With 51% favouring being seen via video consultation rather than face to face, this has wider implications for patients and the NHS including reduced travel time to appointments and reduced waiting room pressures.

Improving the accessibility of peak expiratory flow during the COVID-19 pandemic using a patient-friendly system

P78 Figure 1ConclusionThis electronic system re-vitalised the use of PEF in our asthma clinic;it is paper-light, patient-friendly and has increased our PEF diary responses, without additional cost or the requirement of a smart-phone. An average daily diurnal PEF variability >10% is valuable for the diagnosis of asthma and to assess asthma control. We continue to utilise PEF and have shared this resource across our local asthma networks. This is also likely to be beneficial in primary care to support annual asthma reviews and the requirement for at least two confirmatory diagnostic tests in the 2020/2021 NHS Quality and Outcomes Framework.

Perspectives of Interstitial Lung Disease Patients and Carers During COVID-19

Aim To gain an understanding of the impact of COVID-19 on the daily life, healthcare needs, mental wellbeing and outlook of patients with Interstitial Lung Disease (ILD) and their caregivers. Methods ILD patients and caregivers were invited to participate in a quantitative survey. Respondents could self-select to then participate in in-depth structured telephone interviews. Survey data was compared to Department of Health COVID-19 public opinion tracker findings for the comparable time period. Results There were 170 survey respones (111 patients and 59 caregivers) and 14 in-depth interview participants. 32% (n=36) of patients and 42% (n=25) of caregivers expressed extreme worry regarding COVID-19 on a 1-10 scale. 83% (n=92) of patients expressed concern about safe hospital access, 33% (n=37) had received a telephone consultation with their clinician, 43% (n=48) reported test delays, 47% (n=52) were exercising less, 23% (n=26) reported worse sleep and 15% (n=17) reported being financially worse off. Carers reported that sleep was worse for 58% (n=34), 42% (n=25) reported being worse off financially, and 40% (n=24) reported a worse diet. Worry (66%, n=39), stress (51%, n=30), anxiety (49%, n=29) were commonly reported by carers. Discussion ILD patients and caregivers reported higher levels of worry regarding COVID-19 compared to the general public. Alternative pathways for quality ILD patient care and interventions to reduce the burden of care on ILD caregivers are required.

Perspectives of interstitial lung disease healthcare professionals during covid-19

We examined the impact of COVID-19 on the daily lives, mental wellbeing, training and support needs of healthcare professionals (HCPs) working in interstitial lung disease (ILD), and implications for ILD patient care. We invited ILD HCPs to participate in a quantitative survey, following which respondents (n=49) self-selected to participate in structured telephone interviews (n=9). Worry (43%, n=21) and frustration (43%, n=21) were the most commonly reported emotions by survey respondents. Interviewees reported significant impacts on their daily lives and mental wellbeing. Few of the interviewees had received self-care (n=1, 11%) or mental healthcare training (n=2, 22%). Wellbeing supports were available, but interviewees reported deprioritising self-care. Interviewees reported concern about the impact of appointment cancellations on ILD patients. Virtual clinics were considered useful, but interviewees reported some limitations. COVID-19 profoundly impacted the daily lives and mental wellbeing of ILD HCPs and affected ILD care delivery, with implications for occupational health, HCP training and ILD patient services.

The impact of covid-19 on patients presenting with lung cancer-the missing fifth

Background The Coronavirus Disease-19 (COVID-19) pandemic continues to cause significant disruption worldwide. Within the UK there were considerable adjustments in all healthcare settings to ensure appropriate management of patients affected by COVID-19, with consequent disruption to existing services. Lung cancer is associated with a high mortality rate, not least because there are often delays in diagnosis. We examined referrals before and during the COVID-19 pandemic to determine whether this affected the number of patients seen and the speed to diagnosis. Methods We compared referrals to our Lung Cancer Service during the four months prior to and immediately following the onset of the UK COVID-19 pandemic in March 2020. We collected data relating to the numbers and origins of referrals, as well as the time intervals at different stages of our diagnostic pathway. Results Our service received fewer referrals following the onset of the pandemic, with a mean of 97 patients per month from November 2019 to February 2020, compared to 79 patients per month between March and June 2020. Urgent cancer referrals from General Practitioners ('twoweek-wait') were reduced (50% to 44%) during the pandemic. A greater proportion of patients presented via alternative pathways, including A&E, suggesting a later presentation. The gender of patients referred remained similar between both timeframes, although during the COVID-19 pandemic, the mode average age was slightly younger at 73 years (79 years previously), with an age range 29-97 years (21-93 years pre-COVID-19). After receiving a referral, the time to first review remained stable (98% vs 99%). The mean time from referral to diagnosis remained 14 days. 91% of patients received a lung cancer diagnosis within 28 days of referral, despite the COVID-19 pandemic (94% previously). Conclusion Time to lung cancer diagnosis was not affected by changes to our clinical service during the COVID-19 pandemic. However, there was a significant reduction in the overall number of referrals (almost one fifth). We will monitor to review whether there is an increase in late presentations in the coming months due to delays in referral. The fear is that future increases in COVID-19 cases nationally will further delay these patients presenting.

The impact of covid-19 on the UK severe asthma Population

Introduction Severe asthma patients were assumed to be at greater risk of morbidity from infection with the novel severe acute respiratory syndrome coronavirus (COVID-19), hence, in the UK, were advised to shield. Community data on COVID-19 infection in severe asthmatics is lacking. We assessed the burden of shielding, the impact of COVID-19 and the effect of asthma medication on the UK severe asthma population. Methods Adults previously consented to inclusion in the UK Severe Asthma Registry (UKSAR) across 14 centres were contacted in June 2020 to collect data on potential COVID-19 infection, asthma control and shielding. Electronic records, where available, were reviewed for confirmation. Data was combined with clinical data from the UKSAR. Univariate and multivariate logistic regression analyses were performed to identify risk factors for COVID-19 infection. Results 1365 patients were included. 1268 (93%) were advised to shield, 1131 (89%) patients who received shielding advice followed it. Men (OR 0.4, p=0.045) and those in non-shielding households (OR 0.27, p=0.001) were less likely to follow shielding advice. 544 (47%) of patients advised to shield reported worsening of mental health;females (OR 1.59, p=0.001) and those with history of anxiety or depression (OR 2.12 p=0.001) were at greater risk. 97 (7.1%) patients had suspected/confirmed COVID-19 infection, 19 (1.39%) PCR/serology confirmed infection, 13(0.95%) were hospitalised and 2 patients (0.15%) died (table 1). 918 (67%) were on biologic therapy, 515 (37%) maintenance oral corticosteroid (mOCS). Multivariate analysis showed neither biologic therapy (OR 0.73, p=0.165) nor mOCS (OR 1.18, p=0.427) increased the risk of COVID-19 infection. Patients on biologics were less likely to require an acute course of corticosteroids for asthma symptoms (OR 0.6, p=0.002) while patients on mOCS were more likely (OR 1.96 p£0.001). Inhaled corticosteroids (ICS) were not associated with COVID-19 infection, including high dose (2000 mcg BDP equivalent) (OR 0.64, p=0.234). Hospitalised patients were on lower median doses of ICS vs non-hospitalised patients (1000 vs 2000 mcg BDP equivalent, p=0.002). Conclusion Hospitalisation and death occurred in small numbers in our severe asthma population. From this observational data, biologic agents for asthma were not associated with increased risk of COVID-19 infection or hospitalisation.