ABSTRACT
Analyzing COVID-19-related stress in children with affective dysregulation (AD) seems especially interesting, as these children typically show heightened reactivity to potential stressors and an increased use of maladaptive emotion regulation strategies. Children in out-of-home care often show similar characteristics to those with AD. Since COVID-19 has led to interruptions in psychotherapy for children with mental health problems and to potentially reduced resources to implement treatment strategies in daily life in families or in out-of-home care, these children might show a particularly strong increase in stress levels. In this study, 512 families of children without AD and 269 families of children with AD reported on COVID-19-related stress. The sample comprised screened community, clinical, and out-of-home care samples. Sociodemographic factors, characteristics of child and caregiver before the pandemic, and perceived change in external conditions due to the pandemic were examined as potential risk or protective factors. Interestingly, only small differences emerged between families of children with and without AD or between subsamples: families of children with AD and families in out-of-home care were affected slightly more, but in few domains. Improvements and deteriorations in treatment-related effects balanced each other out. Overall, the most stable and strongest risk factor for COVID-19-related stress was perceived negative change in external conditions-particularly family conditions and leisure options. Additionally, caregiver characteristics emerged as risk factors across most models. Actions to support families during the pandemic should, therefore, facilitate external conditions and focus on caregiver characteristic to reduce familial COVID-19-related stress. Trial registration: German Clinical Trials Register (DRKS), ADOPT Online: DRKS00014963 registered 27 June 2018, ADOPT Treatment: DRKS00013317 registered 27 September 2018, ADOPT Institution: DRKS00014581 registered 04 July 2018.
ABSTRACT
Purpose: In December of 2020, our program was identifying up to twenty COVID-19 positive abdominal transplant recipients per week. After seeing our high hospitalization and mortality rate, we implemented a programmatic response, that included Bamlanivimab administration to all eligible patients. The purpose of this abstract is to review the outcomes of COVID-19 infection in our patients, evaluate the efficacy of our program's response, and determine if outpatient monoclonal antibody therapy impacted hospitalization and death rates. Methods: A database was created to track the outcomes of all liver and kidney transplant recipients who had a confirmed COVID-19 infection via PCR testing. On December 21, 2020, we implemented the following protocol for all symptomatic patients who did not meet hospital admission criteria (WHO Class 2 or 3): 1) Staff and patient education for communications regarding patient's symptom progression;2) home monitoring using Pulse Oximetry;and 3) outpatient Bamlanivimab administration to all patients who were identified within 10 days of a positive test. Results: As of February 2021, we have identified 105 liver transplant recipients and 116 kidney transplant recipients who have tested positive for COVID-19. These patients were between 27 days and 18.8 years after transplant (Median 1007 days). The case counts and disease severity before and after the protocol was implemented are shown in Figure 1. Concerningly, hospitalized recipients had a 31% and 46% mortality for liver and kidney respectively. To study outpatient Balanivimab therapy, we excluded all patients who presented as inpatient admissions. 86 liver and 91 kidney patients were initially identified as WHO Class 2 or 3. Of these patients, 15 Liver and 16 Kidney patients were treated with Bamlivamab. When comparing those patients who could have potentially been treated to those who received Bamlivamab, we reduced our rates of hospitalization from 29% to 10% and death from 13% to zero. Chi-squared analysis comparing the association between disease progression and antibody administration was significant (p=.04). Conclusions: Our findings show the severity of morbidity and mortality of COVID-19 in abdominal transplant patients. Our early experience suggests that outpatient bamlanivimab therapy can reduce disease progression and prevent hospitalization. All eligible patients should be offered this therapy and we will continue to accumulate data in this regard.