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Higher education institutions worldwide were compelled to deliver their courses online due to mobility restrictions and lockdowns during the COVID-19 pandemic. This sudden shift has disrupted the educational system leaving millions unprepared for the new mode of instruction. One critical area that received little attention during this transition is student assessment. Many assessment methods designed for face-to-face classes have been adapted for online learning without much consideration. The conversion to emergency remote education has likewise exacerbated existing and uncovered new socioeconomic issues that demand immediate action. A scoping review has been carried out to map the concepts and develop a socioeconomic inclusive assessment framework for online learning in higher education. This framework will serve as a guide in designing assessment tasks that are more socioeconomically inclusive, making online learning more equitable. This chapter offers practical implications for developing a more inclusive assessment design that is beneficial to a broader group of students. © 2022, IGI Global. All rights reserved.
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OBJECTIVE The prevalence of coronavirus disease 2019 (COVID-19) can cause inconvenience and affect lifestyle because human movements can spread virus transmission. This study aims to investigate the impact of the government's public health intervention policies and reported COVID-19 cases on locals' mobility patterns. DESIGN Secondary data on various mobility patterns of Hong Kong people against public health intervention policies and reported COVID-19 cases were collected and analyzed from publicly available sources, including government, commercial, and news sites. Data were collected from January to July 2020. Multiple regression was applied for hypothesis testing. RESULTS Results showed positive and negative impacts of public health intervention policies and reported COVID-19 cases on locals' mobility patterns. The policy of wearing facial masks negatively influenced locals' mobility patterns. Then, the policy of closure of leisure and cultural service venues increases locals' mobility for retail, groceries, and transit. Moreover, the policy limiting social gatherings to 50 people enhanced locals' mobilities for retail and transit. From another aspect, the reported COVID-19 cases had a negative impact on locals' mobility for retail, parks, and transit. CONCLUSION This study presents considerable effects of public health intervention policies. With the restrictions on certain activities or behaviors, locals will transfer to another behavior, which consequently enhances travel mobilities. The reported COVID-19 cases significantly reduced local mobility patterns.
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Google and Apple jointly introduced a digital contact tracing technology and an API called "exposure notification,'' to help health organizations and governments with contact tracing. The technology and its interplay with security and privacy constraints require investigation. In this study, we examine and analyze the security, privacy, and reliability of the technology with actual and typical scenarios (and expected typical adversary in mind), and quite realistic use cases. We do it in the context of Virginia's COVIDWISE app. This experimental analysis validates the properties of the system under the above conditions, a result that seems crucial for the peace of mind of the exposure notification technology adopting authorities, and may also help with the system's transparency and overall user trust. © 2022 Owner/Author.
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Study Objectives: At the peak of the initial COVID-19 outbreak in Italy, providers were required to make decisions related to resource rationing due to a shortage of medical equipment. Identifying COVID-19 positive patients who were high-risk for severe illness early in their course could have assisted in determining the most appropriate medical management in many cases. Currently, few models exist to predict the outcome of COVID-19 positive patients. Among those that do, none to our knowledge utilize Bayesian logistic regression. The goal of this study was to generate a model that would dynamically estimate the probability of severe disease in patients who test positive for COVID-19 during their initial emergency department (ED) visit. Methods: This model initially utilized a Bayesian approach with prior data based on the literature at the time, and after one week employed logistical regression using retrospective data from our own patient set. In total, data from 428 RT-PCR-confirmed COVID-19 patients who presented between March 4th and May 7th of 2020 was incorporated. Priors included: female sex, O2 Saturation, lymphocytes, LDH, and CRP. Data acquired during the patients’ encounter included co-morbidities, temperature, MAP, HR, ferritin, d-dimer, hs-troponin, platelets, total bilirubin, hgb, lactate, albumin, and SOFA score. Single imputation was utilized to address patients with missing data points. Our primary outcomes were vasopressor requirement, intubation, and death. Results: Utilizing these data points, a risk calculator for vasopressor requirement, intubation, and/or death was developed with a C-statistic of 0.85. See the supplementary materials for a comprehensive list of the regression coefficients, their betas, and standardized betas (Table 1) and a graph of our predicted primary outcomes compared to actual primary outcomes (Figure 1). Conclusion: A model predictive of vasopressor use, intubation, and death in COVID-19 positive patients was derived. By initially incorporating Bayesian logistic regression and prior data, this model could have theoretically been utilized in medical decision-making early in US outbreak the event that resource rationing had to be pursued at our institution. [Formula presented] [Formula presented]
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Background: Influenza or acute myocardial infarction (AMI) is seasonal with usual upsurge in winter months. Influenza might be a trigger of AMI. The outbreak of COVID-19 in China led to population wide masking, practice of hand hygiene and social distancing in Hong Kong starting from late January 2020. Methods: Our study aimed to look at the relationship between influenza activity and ST-segment elevation myocardial infarction (STEMI) incidence as well as the epidemiological impact of universal infection control measures. Patients with a diagnosis of acute STEMI from January 2014 to March 2020 were retrieved from the Hospital Authority Clinical Data Analysis and Reporting System. We also downloaded data of influenza activity and air pollution from Centre for Health Protection and Environmental Protection Department respectively. Results: With few exceptions, the STEMI incidence per standardized month basically mirrored the influenza activity from 2014 to 2020. During the winter of 2014-15, 2015-16, 2017-18 and 2018-19, the number of STEMI cases went up with the influenza activity. The rise in the number of STEMI cases in December 2016 and January 2017 was not obvious mirroring the inconspicuous rise in influenza activity of the same period. The surge of influenza during the summer of 2015 and 2017 was not accompanied by an increase in the number of STEMI cases. Influenza activity is a predictor of STEMI incidence after adjusting for air pollution and time factors. We observed an abbreviated peak and narrow base of the influenza activity curve for the winter of 2019-20. The number of STEMI cases rose to 220 in December 2019 but then dropped significantly from January to March 2020 mimicking the influenza activity curve. Conclusion: Our observation agrees with the hypothesis of AMI triggered by influenza infection and cold weather. Furthermore, population wide infection control measures during the COVID-19 pandemic might have contained influenza activity and possibly reduced the population risk of STEMI.
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This study examined jaystaycationer behaviors to complement the overly optimistic discussions of staycations in the literature. Guided by constructivist grounded theory, 10 frontline hotel workers in Hong Kong were interviewed to identify jaystaycationer behaviors during the pandemic that deviate from generally accepted social norms. A theoretical framework comprising six causes, four jaystaycationer types (i.e. attention seeker, benefit seeker, rule breaker, and property abuser), and seven hotel worker emotional and practical responses, is proposed. These findings critically investigate whether staycation is a better form of vacation from the perspective of hotel workers, laying a theoretical foundation for more comprehensive discussions of staycations. It also discusses the managerial implications for developing staycations in a better way.
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Study Objectives: Early evidence has suggested a high prevalence of acute pulmonary embolism (PE) in Coronavirus 19 (COVID). However, the bulk of existing data evaluates the population of COVID patients admitted to an intensive care unit (ICU). There has been limited evidence in the emergency department (ED) population and as a result, there is variability in diagnostic evaluation for patients presenting with COVID. The objective of this study was to describe the diagnostic evaluation of both COVID positive and negative patients in the ED. Methods: Over a period of 13 months beginning March 2020, all patients presenting to the emergency department (ED) of a single, tertiary academic medical center in the United States and tested for COVID, who had contrast-enhanced computed tomography (CT) imaging of the chest performed were included in this retrospective cohort study. The primary outcome was CT positivity rate for PE and radiologist impressions were used to determine positivity rate for all patients. A subset of patients received D-dimer testing or received supplemental oxygen in the ED and CT positivity was evaluated in these strata. Results: After exclusion of CT chest studies without contrast, 5576 patient encounters were included in the final cohort with 367 patients considered to be COVID positive at the time of ED presentation. The positivity rate for PE in COVID positive patients was 9.8% compared to 7.1% for non-COVID patients. The rate of D-dimer testing prior to CT was higher (76% vs 25%) in COVID positive compared to negative patients. CT test positivity rate was close when comparing COVID positive and negative patients who did not receive oxygen (5.0% vs 6.3%) but in those that received supplemental oxygen in the ED, 12.7% of COVID positive patients were positive for PE compared to 8.3% for COVID negative. The d-dimer institutional cut-off of 0.5 mcg/mL was sensitive for PE on CT without false negative results. There was a significant age difference between hypoxic patients (median age of 63) and not-hypoxic patients (median age of 50). A Sankey diagram of COVID positive patients who had both contrast-enhanced CTs performed and D-dimers drawn is presented as a figure. Conclusion: Non-hypoxic COVID positive patients had a largely comparable positivity rate of PE on contrast enhanced CT imaging compared to non-hypoxic non-COVID patients, but in the subset of patients who received supplemental oxygen, COVID patients were at considerably increased risk of PE. Using the conventional cut-off value of D-dimers yielded no false negative results, however D-dimer values frequently were obtained as part of a routine COVID workup for risk stratification. Our study was limited by its single center design. Further research is needed to determine if COVID positive patients have an increased risk of pulmonary embolism. [Formula presented]
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RATIONALE Multiple case reports and case series have described pneumothorax and pneumomediastinum as a complication of patients hospitalized with COVID-19, particularly among those receiving invasive mechanical ventilation. However, it is not known whether patients with COVID-19 have a uniquely higher incidence of these events compared to historical ARDS (non-COVID-19 ARDS) patients. METHODS We compared barotrauma rates in patients hospitalized with COVID-19 who received invasive mechanical ventilation between March-July 2020 to patients with non-COVID-19 ARDS who received mechanical ventilation in 2016-2018. We defined barotrauma as pneumothorax or pneumomediastinum during mechanical ventilation. RESULTS We analyzed 222 patients with COVID-19 who received invasive mechanical ventilation and 421 patients with ARDS. Barotrauma events occurred in 13.1% of patients with COVID-19 and 9.3% of historical ARDS patients (p = 0.136). Mean tidal volumes were 5.7 and 6.4 mL/kg of predicted body weight, plateau pressures were 25.6 and 23.6, PEEP was 11.2 and 8.8, and driving pressures were 14.4 and 14.8 cmH2O, respectively, in COVID-19 and non-COVID-19 ARDS. There were 42 pneumothoraces among COVID-19 patients and 50 among historical ARDS patients (p = 0.144). Incidence rates were 1.7 and 2.7 per 100 ventilator days in COVID-19 and historical ARDS respectively (p=0.808). There were 14 cases of pneumomediastinum among patients with COVID-19 compared to 16 among patients with ARDS (p = 0.152). Overall, pneumothoraces were identified within 24 hours of ipsilateral internal jugular or subclavian line placement in 5.4% (5/92) of events. In both groups, barotrauma was associated with fewer vent-free days at 28 days (3.0 vs 9.2 in COVID-19, p < 0.001 and 7.6 vs 11.5 in historical ARDS, p = 0.0214). Barotrauma was not associated with an increased mortality at discharge for either cohort. For COVID-19 patients only, mean plateau pressure and driving pressure were associated with barotrauma events (28 vs 25 cmH2O, p = 0.0015;16.7 vs 14.0 cmH2O, p ≤ 0.01). Administered tidal volume, PEEP, age, sex, tobacco use, obesity, number of comorbidities, and the presence of lung comorbidities were not associated with barotrauma in either cohort. CONCLUSIONS Both COVID-19 and non-COVID-19 ARDS patients who are mechanically ventilated are at high risk of barotrauma;this was not unique to patients with COVID-19. Barotrauma is associated with prolonged ventilation and fewer ventilator-free days. Despite advances in lung-protective ventilation, barotrauma continues to be a significant source of morbidity in patients mechanically ventilated for respiratory failure.
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INTRODUCTION: Clinical phenotypes of acute hypoxic respiratory failure (AHRF) in COVID-19 have been proposed- Gattinoni type ?L? with less interstitial edema/ lung weight and greater compliance vs type ?H? with a more classic acute respiratory distress syndrome (ARDS) pattern of interstitial edema, higher lung weight and lower compliance. Lung ultrasound (LUS) is a sensitive tool for the detection of interstitial pulmonary edema. Our objective was to describe lung US profiles in COVID-19 induced AHRF, in association with markers of severity and outcomes. METHODS: Retrospective observational study. Consecutive critically-ill adult COVID-19 patients with AHRF and P/F ratio <300mmHg who underwent LUS performed by a single provider in March-April 2020 were included. Patients with an established alternate etiology of AHRF, or chronic lung parenchymal pathology, were excluded. LUS was performed in the anterior and lateral zones. LUS phenotypes were: A (<3 B-lines per intercostal space (ICS) permitted), B (at least 3 B-lines in any ICS) and C (consolidation >1cm thickness). B and C profiles could overlap. The A-profile was compared to all others in the analyses of statistical significance. Outcomes included the need for and duration of mechanical ventilation, need for tracheostomy and mortality. RESULTS: Ten patients met eligibility criteria. 3 demonstrated A-profile, 6 B-profile and 1 C-profile. Median days (interquartile range) from symptom onset to LUS was: A- 6 (6-14, p=0.20), B- 18 (8-30), C- 6. Median P/F ratio at the time of LUS was: A- 152 (103-269, p=0.31), B- 131 (112- 146), C-98. Median C-reactive protein (mg/dL): A- 8 (5-10, p=0.3), B- 18 (6-31), C- 12. Median Lactate Dehydrogenase (IU/L) was: A- 528 (287-594, p=0.36), B- 622 (528-787), C- 258. Median D-Dimer (mg/L FEU) was: A- 0.88 (0.64- 3.12, p=0.57), B- 2.50 (1.74-35.00), C- 0.35. Mechanical ventilation was required in: A- 1 (33%, p=0.067), 6 (100%), C- 1 (100%). Median days of mechanical ventilation was: A- 0 (0-20, p=0.03), B- 36 (32-52), C- 88. Median static compliance (mL/cmH2O) was: A- 18, B- 27 (25-28), C- 37. Tracheostomy was performed in: A- 0 (0%, p=0.008), B- 6 (100%), C- 1 (100%). Mortality was: A- 0, B- 1 (17%), C- 0. CONCLUSIONS: An A-profile on LUS appeared to be associated with less severe respiratory illness in COVID-19 AHRF with P/F< 300mmHg.
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Background: Due to the limited availability of rapid testing for SARS-CoV-2 infection, these tests are often reserved for those requiring urgent procedures or hospital admission and are often not available to emergency department (ED) patients. Complete blood count (CBC), C-reactive protein (CRP) and Ferritin levels can be easily obtained in the ED. Lymphopenia and high C-reactive protein and Ferritin levels are associated with poor outcome in COVID-19 illness. However, it is not known whether these biomarkers are useful for identifying persons with SARS-CoV-2 infection. Methods: We performed a cross-sectional study of patients 18 years or older who were evaluated at an academic ED for suspected SARS-CoV-2 infection from March to May 2020. CBC, CRP and Ferritin levels were ordered at clinician’s discretion in patients who were suspected to have SARS-CoV-2 infection. SARS-CoV-2 infection was diagnosed using a number of PCR-based tests including the Cepheid Xpert Xpress and the Diasorin Simplexa. The discriminative values of the candidate biomarkers were estimated using the area under the receiver operating characteristic curve (AUC). Results: We studied a total of 1082 patients who had a median age of 59.5 (IQR: 46.0 – 71.0) years. A total of 431 (39.8%) of the subjects had PCR confirmed SARS-CoV-2 infection. The median absolute lymphocyte count was 0.9 (IQR: 0.7 – 1.3) and 1.0 (0.7 – 1.6) in those with and those without SARS-CoV-2 infection respectively (p=0.0004). The median CRP level in mg/L was 8.9 (IQR: 4.6 – 17.3) and 6.1 (IQR: 1.6 – 14.0) in those with and those without SARS-CoV-2 infection respectively (p=0.0001). The median ferritin level in ng/mL was 782 (IQR: 299 – 1479) and 312 (IQR: 106 – 1015) in those with and those without SARS-CoV-2 infection respectively (p=0.0001). Lymphocyte count, CRP and Ferritin levels distinguished between those with and those without SARS-CoV-2 infection with AUCs of 0.56 (IQR: 0.53 – 0.60), 0.61 (IQR: 0.58 – 0.64) and 0.66 (IQR: 0.62 – 0.68). Conclusion: Although patients with SARS-CoV-2 infection have lymphopenia and elevated CRP and ferritin levels, the levels of these biomarkers are not useful for identifying persons under investigation who have SARS-CoV-2 infection.
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Background: Solid organ transplant (SOT) recipients are considered to be 'vulnerable' to COVID-19 infection due to immunosuppression To date, there are no studies that compared the disease severity of COVID-19 in SOT recipients with non-SOT COVID-19 patients We characterized COVID-19 illness and clinical course among SOT recipients and compared the COVID-19 outcomes between SOT recipients and matched non-SOT patients Methods: In this case-control study, we compared the outcomes of COVID-19 between SOT recipients (cases: N=41) and their matched non-SOT (controls: N=121) patients from our center between 3/10/20 and 5/15/20 SOT recipients with COVID-19 were matched with up to three non-SOT COVID-19 controls on age (±5years), race, and admission status Patients were followed up until death or June 10, 2020 The primary outcome was death and secondary outcomes were severe diseasedefined as transfer to the intensive care unit and requiring at least humidified high flow oxygen), intubation and renal replacement therapy (RRT) use Results: The SOT recipients had the following transplants: 9 heart, 3 lung, 16 kidney, 8 liver and 5 dual organ (2 kidney-pancreas,1 heart-kidney, 1 liver-kidney, 1 kidney after liver) with a median age of 60 years (54-69), 80% male, 67% Black, 92% hypertension, 51% diabetes and 80% chronic kidney disease (CKD) Median time from transplant to COVID-19 was 9 years (5-16) Fortyfour percent of SOT COVID-19 had severe disease (61% renal replacement therapy [RRT], 61% intubation and 11% ECMO) The overall (14 6% vs 11 4%, P=NS) and severe disease (33% vs 29%;p=NS) case fatality rates were similar in SOT and non-SOT with COVID-19 Organ type did not predict the severe disease or death in SOT-recipients Risk of death was similar between SOT and non-SOT matched COVID-19 patients (HR=0 84[0 32, 2 20]) after adjusting for disease severity RRT use was higher in SOT recipients than matched non-SOT with COVID-19 (adjusted OR=5 32 [1 26, 22 42]) after adjusting for baseline CKD Tocilizumab use was higher in SOT than non-SOT COVID-19 patients (27% vs 9%, P=0 01) Hydroxychloroquine (HCQ) use for COVID-19 was similar (28% vs 29%;p=0 89) in both the groups Among SOT recipients, those treated with HCQ for COVID-19 had a ten-fold higher hazard of death compared to those who did not receive HCQ (HR=10 62[1 24, 91 09]) (Figure 1) This effect was not seen in non-SOT matched controls with COVID-19 Conclusion: Blacks and Males SOT recipients affected disproportionately with COVID-19 Black constitute one-tenth of all SOT in our center yet they represented two-thirds of COVID-19 cases Despite high RRT use in SOT recipients, the severe disease and short-term death were similar in both groups HCQ for the treatment of COVID-19 among SOT recipients was associated with high mortality and therefore, its role as a treatment modality requires further scrutiny(Figure Presented).
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Study Objectives: Emergency department (ED) revisits are associated with significant resource utilization. Accordingly, revisits serve as an important quality measure for emergency care. In recent times, EDs have been challenged by critical resource constraints in the setting of the COVID-19 pandemic. When appropriate, medically stable COVID-19 patients are discharged home rather than admitted for further care. However, the natural history of COVID-19 is not well understood and patients may quickly progress to requiring medical attention. To our knowledge, ED revisits have not been previously characterized in the setting of COVID-19. We aim to quantify the incidence of, as well as determine risk factors for, ED revisits for COVID-19 patients. Methods: We conducted retrospective study of 323 reverse-transcription polymerase chain reaction-confirmed COVID-19 patients who presented to a single academic tertiary-care institution from March 15 to April 15 of 2020. Demographic and clinical information was abstracted from the electronic medical record. Predictor variables (age, history of hypertension, diabetes, asthma, chronic obstructive pulmonary disease, current tobacco or marijuana use) were selected based on current knowledge of risk factors for severe COVID-19 illness. All return visits to the ED within 28 days of index ED presentation were classified as revisits. Multivariable logistic regression models were used to identify independent demographic and clinical risk factors for ED revisits. We also performed exploratory univariable analyses of a subset of 179 patients who had measured serum biomarkers (absolute neutrophil count (ANC), alanine aminotransferase (ALT), ferritin, C-reactive protein, D-dimer, lactate dehydrogenase (LDH)) in order to identify potential biochemical risk factors for ED revisits. Results: Of the 323 patients studied, 98 were discharged from the ED during their index visit and 225 were admitted to the hospital. Among those discharged, 25/98 (25.5%) returned within 28 days of index ED presentation. Median time to revisit was 3 days (interquartile range (IQR): 2 to 7). Among those admitted during their index visit (median hospital length of stay: 6 days), 26/225 (11.6%) returned within 28 days of index ED presentation. Median time to revisit for this group was 14.5 days (IQR: 5 to 22). Cumulative incidence of ED revisits was 15.8% (95% CI: 12.2 to 20.2). Patients with and without ED revisits were similar across demographic and clinical variables examined, with the exceptions of tobacco or marijuana use and history of COPD. Both tobacco or marijuana use (odds ratio (OR): 2.9, 95% CI: 1.1 to 7.6) and history of COPD (OR: 3.1, 95% CI: 1.1 to 8.8) were found to be independent risk factors for ED revisits. In our exploratory analysis of patients with biomarker data, ANC (OR: 0.808, 95% CI: 0.689 to 0.948), ALT (OR: 0.973, 95% CI: 0.953 to 0.993), and LDH (OR: 0.996, 95% CI: 0.992 to 0.999) were found to be associated with ED revisits. Conclusion: The incidence of ED revisits in our COVID-19 cohort was 15.8% (95% CI: 12.2 to 20.2). Risk factors for revisits included current tobacco or marijuana use and history of COPD. Preliminary study suggests the utility of serum biomarker data in helping to stratify revisit risk. In future analysis we will determine the reasons for ED revisits as well as develop a model for identifying those at risk for ED revisits.
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Study Objectives: Concerns over the use of non-steroidal anti-inflammatory drugs (NSAIDs) for the management of fever and myalgia in COVID-19 patients were raised after four cases of critical illness in young, otherwise healthy patients who took NSAIDS were observed in France. France’s health minister subsequently made a recommendation to use acetaminophen in lieu of ibuprofen. However, the association between NSAID use and outcomes in COVID-19 illness has not been adequately studied. The objective of this study is to determine whether an association exists between prior NSAID use and COVID-19 illness severity. Methods: We performed a single-center retrospective cohort study of consecutive adult patients diagnosed in the emergency department (ED) with PCR confirmed SARS-Cov-2 infection. NSAID use was ascertained based on a review of the medication list found in patients’ electronic medical records. Our primary outcome was critical COVID-19 illness, defined as a composite of death, respiratory failure requiring intubation, and shock requiring vasopressors, occurring within 28 days of ED presentation. We modeled the association between NSAID use and our primary outcome using logistic regression, and adjusting for hypertension, diabetes, asthma, chronic obstructive pulmonary disease (COPD), other chronic lung disease, obstructive sleep apnea, immunocompromised status, angiotensin converting enzyme inhibitor (ACE-I) or aldosterone receptor blocker (ARB) use, anticoagulation use, and immunosuppressant use. Results: Among the 422 patients studied, 88 (21%) were on NSAIDS prior to acquiring COVID-19 and a total of 89 patients (21%) developed critical COVID-19 illness within 28 days of ED presentation. Among those using NSAIDs, 18 (20%) developed critical illness. Of the 11 predictor variables examined, hypertension (odds ratio = 1.04 (95% CI: 0.38 - 1.71)), diabetes (0.97 (95% CI: 0.42 - 1.52)), and chronic lung disease (1.20 (0.20 - 2.20)) were significantly associated with increased risk of critical COVID-19 illness (Table 1). NSAID use was not found to be an independent predictor of critical COVID-19 illness (odds ratio = 0.05 (95% CI;-0.57 - 0.73). Conclusion: To our knowledge, this is the first study of the association between NSAID use and critical COVID-19 illness. Our results demonstrate that NSAID use does not significantly increase the risk of critical COVID-19 illness. This study is limited by lack of prospective ascertainment of NSAID use. Prospective evaluation of evaluate outcomes among COVID-19 patients with NSAID use is warranted. [Formula presented]