Trust in sources of information on COVID-19 at the beginning of the pandemic first wave and incident persistent symptoms: A prospective population-based cohort study

Background: Many patients affected by COVID-19 suffer from persistent symptoms after infection. Compared to biomedical mechanisms, psychosocial mechanisms have been less investigated. This study examined the association between trust in sources of information on COVID-19 and the burden of incident persistent symptoms. Method(s): A prospective study using data from the SAPRIS and SAPRIS-Serologie surveys nested in the French CONSTANCES cohort. Trust in medical doctors, government, scientists, journalists, and social media was measured between April 2020 and May 2020. The number of incident persistent symptoms lasting for at least two months was recorded. Psychological burden was measured with the somatic symptom disorder B criteria scale. Associations between trust in information sources and outcomes were examined with zero-inflated negative binomial regression and general linear models, adjusting for gender, age, education, income, self-rated health, SARS-CoV-2 serology tests, and self-reported COVID-19 Results: Among 20,985 participants, those with higher trust in government/journalists at baseline had fewer incident persistent symptoms at follow-up (estimate (SE): -0.21 (0.03), p < 0.001). Among 3372 participants (16.07%) who reported at least one symptom, those with higher trust in government/journalists and medical doctors/scientists had lower SSD-12 scores (-0.39 (0.17), p = 0.0219 and - 0.85 (0.24), p < 0.001, respectively), whereas higher trust in social media sources predicted higher SSD-12 scores in those with lower trust in government/journalists (0.90 (0.34), p = 0.008). These associations did not depend upon surrogate markers of past infection with SARS-CoV-2 Conclusion(s): Trust in information sources on COVID-19 should be tested as a target in the prevention of incident persistent symptoms.Copyright © 2023

Plasma P-selectin is an early marker of thromboembolism in COVID-19

Objectives: The aim of this study was to explore the association of the plasma levels of coagulation proteins with venous thromboembolic events (VTE) in COVID-19 and identify candidate early markers of VTE. Background(s): Coagulopathy and thromboembolism are known complications of SARS-CoV-2 infection. The mechanisms of COVID-19-associated hematologic complications involve endothelial cell and platelet dysfunction and immunothrombosis and have been intensively studied. Yet, a full understanding of the pathogenesis and factors that lead to COVID-19 associated coagulopathy is lacking. Previous studies investigated only small numbers of coagulation proteins together, and they were limited in their ability to adjust for confounders. Method(s): This study was a post-hoc analysis of a previously published dataset (Filbin et al., 2021). We included in our analysis 305 subjects with confirmed SARS-CoV-2 infection who presented to an urban Emergency Department with acute respiratory distress during the first COVID-19 surge in 2020;13 (4.2%) were subsequently diagnosed with venous thromboembolism during hospitalization. Serial samples were obtained on days 0, 3, and 7 and assays were performed on two highly-multiplexed proteomic platforms, that in combination cover 1472 + 4776 proteins. We included 31 coagulation proteins in our analysis. Result(s): Nine coagulation proteins were differentially expressed in patients with thromboembolic events. In multivariable models, day 0 levels of P-selectin, a cell adhesion molecule on the surface of activated endothelial cells, displayed the strongest association with the diagnosis of VTE, independent of disease severity and other confounders (p=0.0025). P-selectin together with D-dimer upon hospital presentation provided better discriminative ability for VTE diagnosis than D-dimer alone (AUROC = 0.834 vs. 0.783). Conclusion(s): Our results suggest that plasma P-selectin is a potential early biomarker for the risk stratification of VTE in COVID-19 disease. Our findings support the importance of endothelial activation in the mechanistic pathway of venous thromboembolism in COVID-19.Copyright © 2023

Obesity increased the risk of SARS-CoV-2 positivity in children.

AIM: To determine the effects of obesity in childhood on SARS-CoV-2 infection. METHODS: A population-based, cross-sectional study combining the Israeli Growth Survey and COVID-19 data for children with at least one SARS-CoV-2 test from 16 February 2020 to 20 December 2021. Overweight and obesity status were based on body mass index and the Center for Disease Control criteria. Multivariate logistics regression was performed to validate reliability for weight categories at the age of approximately 6 years compared with weights at approximately 12 years. RESULTS: A total of 444 868 records for children with an overall positivity rate of 22% were studied. The mean age was 9.5 years. The odds ratios of children with obesity or overweight after controlling for sex at 6 years to test positive were 1.07-1.12 and 1.06-1.08 (depending on the model), respectively, compared to those with healthy range body mass index. CONCLUSION: Excess weight appears to increase the risk of SARS-CoV-2 infection. This finding should be considered for public health planning. For example, children with overweight and obesity should be prioritised for vaccination. Excess weight in childhood can be harmful at a young age and not only for long-term health.

We wanted to rock the house

In this four- person interview, Martine Bungener, Janine Pierret, -Sebastien Darbon and Marcel Goldberg, founders of Sciences Sociales et Sante, look back at the scientific, administrative and social conditions that led to the creation of this journal. They recall the major steps that marked its development and the difficulties encountered over the years;they also take stock of the multidisciplinary project that was at the heart of this creation. Prospects for the journal are outlined, in the wake of the coronavirus crisis and in a context where interest in the field of health seems to be renewing itself and extending into the social sciences, an interest that has been partly aroused by opportunities for funding research-contracts.

IMMUNE EXHAUSTION IS ASSOCIATED with PERSISTENT SARS-CoV-2 VIREMIA and SEVERE DISEASE

Background: SARS-CoV-2 viremia is associated with adverse outcomes in COVID-19. The immunologic mediators of this relationship remain under-explored. In this study, we aimed to evaluate the correlation between immune exhaustion markers, SARS-CoV-2 viremia clearance and clinical outcomes. Methods: We included 126 participants with confirmed SARS-CoV-2 infection who were hospitalized at an urban hospital in Boston, Massachusetts, during the first surge of the COVID-19 pandemic in early 2020. Plasma samples from days 0, 3, and 7 of hospitalization were available for analyses. The plasma SARS-CoV-2 viral load was determined by reverse transcription quantitative PCR (RT-qPCR). Proteomics data were generated using the Olink platform and neutralization level was assessed using a pseudovirus neutralization assay. Viremia persistence was defined as >40 copies/ml (detection limit) if the baseline detectable viremia was <1000 copies/ml, or >100 copies/ml (quantification limit) if the baseline viremia was ≥1000 copies/ml at day 7 of admission. Partial least-squares discriminant analysis (PLS-DA) was used to select exhaustion markers that could distinguish viremia persistence and clearance. An exhaustion score was generated based on features selected by PLS-DA and was divided into four quartiles. Differentially expressed proteins between 1st and 4th quartiles were determined by linear model adjusting for baseline characteristics. R (4.1.0) was used for statistics. Results: Viremia persistence was associated with a higher level of baseline viremia, a higher rate of severe diseases and mortality within 28 days of follow-up. Viremia persistence was associated with elevation of certain exhaustion protein markers including TIM3, PDL1, LGALS9, LAG3 and IL2RA. With PLS-DA, we selected TIM3, PDL1, and LGALS9 into the exhaustion score modeling. A higher exhaustion score was associated with higher baseline viremia, persistent viremia, severe disease, and death (Figure). When compared to the lowest exhaustion score (1st quartile), the highest exhaustion score (4th quartile) was associated with elevation in proteins belonging to IL-18 signaling pathway, lung fibrosis, and immune evasion in COVID-19. The immune exhaustion level was not associated with the neutralization level. Conclusion: In participants with COVID-19, soluble exhaustion markers are associated with delayed viremia clearance, immune evasion independent of humoral immunity development, and adverse outcomes.

Drive By Flu-FIT: A novel way to mitigate the decrease in colorectal cancer screening during the COVID-19 pandemic

Background: During the height of the COVID-19 pandemic, screening colonoscopy rates decreased by 90%. The decreased screening rates will increase the burden of colorectal cancer (CRC) in communities. The pandemic has created a need for novel models for safely engaging and screening community members for CRC. Methods: We implemented NCI's Screen to Save CRC screening campaign using a socially-distanced, Drive By Flu-FIT protocol and report the results of the FIT component of the program. In partnership with the leadership of Enon Tabernacle Church, the largest Baptist church in the Philadelphia region, we invited community members at average risk for CRC and between the ages of 45-75 to register for one of three Drive by Flu-FIT events held between Oct-Nov, 2020. Interested participants also completed eligibility, registration, and demographic questionnaires administered electronically via REDCap. Upon completion of these questionnaires, participants watched a 8-minute CRC screening educational video and pre- and post- CRC knowledge and intentions questionnaires. Participants who attended one of the three events received a Flu vaccine and/or FIT test and instructions to return the completed FIT to a medical collection box at Enon Tabernacle Church. This research was approved by the University of Pennsylvania's Institutional Review Board. Results: Of the 335 participants that registered for the event, 80 (23.9%) did not show, 63 (18.8%) were ineligible and 192 attended the event and received a FIT (57.3%). Reasons for ineligibility were: age outside of the recommended age for screening (n=40);having had a recent colonoscopy (n=13);symptoms/signs of CRC including change in your bowel habits, rectal bleeding, abdominal pain, iron deficiency anemia, unexplained weight loss (n=10);a possible family history or possible Lynch syndrome (n=1). Patients with symptoms/signs and family history of CRC were referred to colonoscopy. The 192 participants that comprised this analytic had a mean (s.d.) age of 58.9 (9.5) years, 60.4% were female, 93.8% self-identified as Black, and 1.6% as Hispanic. The pre-and post-knowledge scores showed an increase after the video intervention (p=0.0006) as did the intention to screen scores (p=0.007). To date, of the 192 participants who received a FIT, 38 (19.7%) did not return the FIT, 141 (73.4%) had a negative FIT result and 13 (6.7%) had a positive FIT result and were referred to colonoscopy. The results of colonoscopy are pending. Conclusions This research shows that a socially-distanced Drive By Flu-FIT program is feasible, acceptable and effective in engaging the community in CRC education and screening during the COVID-19 pandemic. Novel programs such as this can help mitigate the significant decline in screening for CRC that has occurred as a result of the COVID-19 pandemic and, thus, can help reduce the burden of CRC in our diverse communities.

KNOWLEDGE AND PRACTICES REGARDING COVID19 IN INNER-CITY PATIENTS WITH CHRONIC KIDNEY DISEASE (CKD) OR KIDNEY TRANSPLANT (KTX)

Studies have shown that COVID19 is associated with worse outcomes in older pts (OPs) with underlying conditions. We studied an inner-city population to look for differences in attitudes and behaviors in older vs younger pts in a high-risk population with CKD or KTx. A random sample of pts from Kidney Transplant (40) and CKD clinics (20) were interviewed by phone, concerning views of, knowledge of, and practices relating to COVID19. There were no differences noted in between clinics so all data were analyzed together. Pts were grouped as older (OP, age>65, n=40) and younger, (YP, age<65, n=20). Analysis was by Chi-square or t-test as appropriate. Mean age overall was 58.7±12.0 yrs. There were 28 (47%) men and 32 (53%) women with 42 (70%) Black, 6 (10%) Hispanic, 3 (5%) White, and 9 (15%) others. 31 (52%) had a current history of diabetes, 53 (88%) had a current history of HTN, 10 (17%) had not completed high school and 30 (50%) not attended college. OP were more likely to have DM (p<0.01) with no difference for HTN or hypercholesterolemia. There was no difference in gender or educational level between the two populations, but OP were more likely to be retired, unemployed, or on disability (p=0.01). Regarding beliefs about COVID19, OP were less afraid (p=0.015), with no difference regarding the importance of social distancing, knowing how to protect oneself or fear of getting the infection from family or friends. Regarding knowledge of COVID, OP were more likely to believe that white people are less likely to get it (p=0.049) and that vitamins can help prevent it (p=0.03). There were no significant differences between the populations regarding knowledge of asymptomatic presentation, droplet-based spread, or on whether the virus is preventable. Both populations were adequately knowledgeable on these topics based on their abilities to identify the correct answer to the yes/no questions we provided. Regarding patient health and social distancing practices, we found that OP were more likely to avoid leaving their home (p=0.043), equally likely to cover their face/nose while sneezing/coughing, wash their hands, and use face masks in crowds, and more likely to take a vitamin supplement (p=0.039) compared to YP. In our CKD and KTx population: 1. Pts at an increased risk for contracting and dying from COVID19 due to older age are more likely to have DM when compared to YP, placing them further at risk for COVID19 related complications. 2. Older pts feel less threatened by COVID than younger pts, despite their increased risks. 3. Older pts avoid leaving their home more than younger pts, which may allow them to feel less threatened by COVID19. In part this may be due to older pts being retired or unemployed with younger pts having to leave home for work. 4. Older pts are more likely to believe that vitamins can prevent COVID19 and are more likely to take a vitamin supplement than younger pts. This misinformation may also lead them to feel less threatened by COVID19, although their acceptance of public health recommendations seems equal to that of younger pts. 5. Further examination of the beliefs, knowledge, and practices relating to COVID19 in this high-risk population is warranted to create educational programs for them in order to best protect them during the current and future pandemics.

ATTITUDES TOWARDS RECEIPT OF A COVID-19 VACCINE IN A POPULATION OF INNER-CITY KIDNEY TRANSPLANT RECIPIENTS (KTX)

Kidney transplant recipients, given their multiple associated diseases, constitute a high-risk group for COVID-19 infection. Assessing their attitudes toward receiving a COVID-19 vaccine is important for developing education that can be targeted to this specific population. A telephone survey was conducted in a random sample of 33 kidney transplant recipients. Patients were asked whether they would receive a COVID-19 vaccine if it were available and about their attitudes toward vaccines in general. The Multidimensional Health Locus of Control (MHLC) questionnaire was also administered. Pearson r was used for analysis unless otherwise noted. Mean age was 57.9 ± 10.4 years. Mean time since transplant was 8.1 ± 6.5 yrs. There were 18 (54.5%) men, 15 (45.5%) women, 20 (64%) black, 5 (16%) Hispanic, 3 (10%) white, and 3 (10%) mixed race or other. 3 (9%) did not finish high school, 14 (44%) completed high school, 6 (19%) finished some college, 7 (22%) completed college, and 2 (6%) completed graduate school. In response to the question, “Would you receive a COVID-19 vaccine if one were currently available?”, 64% (21) replied “no.” 80% (12) of pts who replied “no” cited safety as their main reason for declining compared to efficacy (2, 13%) or cost (1, 7%). Replying “no” correlated with higher education level (r=0.449, p=0.010). Replying “yes” correlated with higher MHLC subscores of Doctors (r=0.589, p<0.001), Powerful Others (r=0.652, p<0.001), and Other People (r=0.488, p=0.005). Replying “yes” also correlated with greater trust in information received about vaccines (r=0.389, p=0.025). There were no statistically significant differences with respect to age, gender, or race. In our population: 1. The majority of KTx pts would not agree to take a COVID-19 vaccine citing safety as their main concern. 2. Pts who had completed higher education were less likely to agree to the vaccine. 3. Pts who had an external locus of control, including relying on doctors and other authority figures, and trusting information one receives about vaccines were more likely to agree to the vaccine. 4. Successful implementation of a COVID-19 vaccine program for our inner-city KTx pts should take into account educational background and individual locus of control. 5. Understanding how to increase trust in vaccine information and alleviate patient concerns related to vaccine safety would be valuable next steps in terms of planning a COVID-19 vaccine program for this high risk population.

RELATIONSHIP OF CO-MORBIDITIES AND COVID19 TO MALE SEXUAL PERFORMANCE IN PATIENTS WITH CHRONIC KIDNEY DISEASE (CKD)

Erectile dysfunction (ED) in CKD pts is a multifactorial process involving both biological and psychosocial factors. We examined the prevalence of ED and association with co-morbidities in a population of inner-city CKD pts. A random sample of pts from CKD (3), dialysis (1), and transplant (5) clinics were interviewed by telephone. Pts were asked to complete the validated International Index of Erectile Function (IIEF)-5, the Self-Esteem and Relationship (SEAR) questionnaires, the Perceived Stress Scale (PSS) and rate changes in sexual activity during the COVID pandemic. Associations are by Pearson r. Mean age was 55.3 ± 12.9 yrs, 77% were Black, 11% Hispanic, and 11% other. Mean erectile function (EF) was 25±3.9 out of 30 points. No men met the score to start treatment for ED (score below 14). History of hypertension (HTN) was negatively correlated with erectile function (-0.759, p=0.007) but there was no association with length of time since diagnosis (p=NS). Diabetes (DM) and high cholesterol (HC) were not associated with EF (p=NS). Orgasmic function (OF) was correlated with length of time since diagnosis with HTN, DM and HC (-0.706, p=0.015;-0.789, p=0.004;-0.689, p=0.019 respectively). There was no correlation between perceived social stress, EF and OF (p=NS). Since the start of the COVID19 pandemic 8.3% reported a large decrease in sexual activity, 33.3% reported a slight decrease, 50% reported no change and 8.3% reported a large increase. Pts reported that decline was due to social factors (fear of spreading the virus, unable to travel) and not due to sexual performance. In our population: 1. Pts with CKD had slightly decreased erectile function and not true ED. 2. Hypertension was associated with poorer erectile function and the length of time with HTN, diabetes, and high cholesterol was associated with poorer orgasmic function. 3. During the COVID pandemic, more than half of men reported a decrease in sexual activity due to changes in social circumstances and not a change in erectile function. 4. The relationship between orgasmic function and the co-morbidities associated with CKD should be further evaluated rather than simply focusing on erectile function.

GROCERY SHOPPING PATTERNS AND FOOD SCARCITY DURING THE COVID19 PANDEMIC IN INNER-CITY PATIENTS WITH CHRONIC KIDNEY DISEASE (CKD)

Inner-city CKD pts have been affected by both the COVID19 pandemic and economic hardship. We studied grocery store shopping habits in pts with CKD compared to pts from family medicine clinic (FM). A random sample of pts from kidney transplant (29), CKD (14), dialysis (5), and family medicine clinic (24) were surveyed by telephone regarding frequency of food shopping, types of food purchased and concerns regarding COVID19. Pts were grouped as High Frequency (HF-once a week or less), and Low Frequency (LF-once every two weeks or greater) shoppers. There were no differences between kidney disease clinics so they were analyzed together. Mean age for CKD (combined) was 60.8±11.2. There were 22 (45%) male and 27 (55%) female respondents, with 6 (13%) hispanic, 56 (73%) black, 3 (6%) white, 4 others (8%). FM pts were older than CKD (p=0.02, 65.3±8.5) with no difference for race or gender. There was no difference in frequency of grocery shopping for CKD pts and FM pts (p=NS) before COVID19. CKD pts shopped less than FM during COVID19 (p=0.01). CKD pts also decreased shopping frequency compared to pre COVID19 (p=0.05). Within CKD, 15 pts were grouped into HF and 19 to LF. There were no differences in these groups for age, race or gender. HF reported buying more frozen food (p=0.01) and eating more fast food (p=0.01) while eating more food overall (p=0.03). LF were more likely to cut portion sizes or skip meals due to lack of money (p=0.02) and agree with the statements “I am afraid of the coronavirus” (p=0.04) and “I am afraid of going to public spaces” (p=0.01). In our population: 1. Prior to COVID-19 grocery store habits did not differ between CKD and FM pts. 2. After COVID-19 CKD pts shopped less than FM patients and less than they did before. 3. CKD patients who shopped less frequently bought less frozen food, ate less fast food and less food total and were more likely to cut portion sizes or skip meals due to finances. 4. CKD pts who shopped less were more fearful of COVID and felt less comfortable in public spaces. 5. These data suggest that multiple factors are affecting food choices in CKD pts and may contribute to food scarcity in this population.

PROSTATE SBRT BOOST RADIOTHERAPY (PBS TRIAL): A RANDOMIZED PHASE II TRIAL OF SBRT VERSUS CONVENTIONALLY-FRACTIONATED RADIOTHERAPY BOOST FOLLOWING PELVIC RADIOTHERAPY IN HIGH-RISK PROSTATE CANCER

Purpose: Curative therapy for high-risk prostate cancer (HR-PrCa) includes androgen deprivation therapy (ADT) and a long course of pelvic and prostate boost radiotherapy (RT), which adds a significant burden on patients. Several non-randomized studies in the past 10 years suggested that 3-fraction Stereotactic body radiotherapy (SBRT) regimens provide promising rates of disease control and may be able to replace the conventionally fractionated (CF) External Beam RT (EBRT) boost, improving significantly the convenience of RT treatment. To address the deficit in randomized data, we opened a regional Prostate Boost irradiation with SBRT (PBS) randomized controlled trial at Juravinski and Walker Family Cancer Centres, in 2019. Materials and Methods: Men with localized HR-PrCa receive ADT for a total duration of three years, pelvic CF-EBRT (45-46Gy in 23-25 fractions) and are randomized to either CF-EBRT boost (32-33Gy in 15-16 fractions) or SBRT boost (19.5-21Gy in 3 fractions) to prostate and seminal vesicles. All patients receive fiducial (gold seed) implants and planning margins compatible with SBRT, regardless of treatment arm. SBRT boost is delivered with a Cyberknife unit at the Juravinski Cancer Centre or with LINACbased VoluMetric Arc Therapy (VMAT) at the Walker Family Cancer Centre) and, therefore, cases are stratified per treatment centre. Primary endpoint is quality of life (based on EPIC), and secondary endpoints include treatment-related toxicity and biochemical control. Biospecimens are collected for future analysis. Salient methodological differences between our study and a 2-fraction randomized phase II trial reported very recently (HYPO-PROST, Nov.2020) include fiducial-guided SBRT-based boost treatment and higher dose weekly fractions of boost RT. Results: We have completed nearly 50% of our target accrual of 100 patients. The mean age at enrollment was 73 (IQR 71-78) with a mean PSA of 12.7, IPSS score of 8.4 (IQR 4-13). 62.5% of the accrued patients had Gleason scores of 8 or higher, 23% had a PSA of 20 or higher, and 10% had findings consistent with cT3a or higher on DRE. Interim safety analysis of this trial will be completed in August 2021 and presented. To date, no Grade 3 or higher toxicity has been reported in either treatment arm. No biochemical failure has been noted. Conclusions: Despite interruption due to the COVID-19 pandemic, accrual on this study is progressing well with no unexpected toxicity or treatment failures detected. This study provides a formal evaluation of SBRT as a boost RT technique in HR-PrCa in a randomized setting. It is an important endeavour given the potential to develop a safe and convenient treatment for HR-PrCa.

Early cross-coronavirus reactive signatures of humoral immunity against COVID-19

The introduction of vaccines has inspired hope in the battle against SARS-CoV-2. However, the emergence of viral variants, in the absence of potent antivirals, has left the world struggling with the uncertain nature of this disease. Antibodies currently represent the strongest correlate of immunity against SARS-CoV-2, thus we profiled the earliest humoral signatures in a large cohort of acutely ill (survivors and nonsurvivors) and mild or asymptomatic individuals with COVID-19. Although a SARS-CoV-2-specific immune response evolved rapidly in survivors of COVID-19, nonsurvivors exhibited blunted and delayed humoral immune evolution, particularly with respect to S2-specific antibodies. Given the conservation of S2 across 0-coronaviruses, we found that the early development of SARS-CoV-2-specific immunity occurred in tandem with preexisting common I3-coronavirus OC43 humoral immunity in survivors, which was also selectively expanded in individuals that develop a paucisymptomatic infection. These data point to the importance of cross-coronavirus immunity as a correlate of protection against COVID-19.

Attitudes towards COVID-19 vaccination in an inner-city population of kidney transplant patients (KTX)

Purpose: Kidney transplant recipients are at high risk for complications from COVID-19 infection and prevention is important. We studied attitudes toward vaccines including willingness to take a COVID-19 vaccine in a population of inner-city KTx. Methods: A telephone survey was conducted in summer 2020 in a random sample of 34 KTx patients regarding attitudes and knowledge about vaccines and compared with data that were collected from 28 pts in 2019. Statistics were by t-test or Pearson r as appropriate. Results: In 2020 mean age was 57.5 ± 10.8 yrs, 18 (55%) males and 15 (46%) females, 21 (66%) black, 5 (16%) Hispanic, 3 (9%) white, 3 (9%) other. 4 (12%) did not finish high school, 14 (43%) completed high school, 15 (35%) finished some college or more. Time since transplant was 8.3 ± 6.5 yrs. 14 (41%) had diabetes. There were no differences between 2019 and 2020 for age, gender, race, time since txp or education. Compared to 2019, KTx in 2020 were more likely to agree that vaccines prevent severe illness (p=0.001) but were more concerned that vaccines could have serious side effects (p=0.023) and reported feeling more comfortable discussing concerns with doctors (p=0.016). For 2020 education level inversely correlated with belief that vaccines prevent severe illness (r = -0.41, p = 0.019). Patients with diabetes expressed less concern about vaccines than those without (p = 0.013). There were no differences in vaccine attitudes with respect to age, gender, or race. When asked if they would take a COVID-19 vaccine 12 (36%) responded “yes” and 21 (64%) responded “no”. Education level inversely correlated with agreement (r = -0.45, p = 0.010). There were no differences with respect to age, gender, or race. When asked about primary sources of information on vaccines 21 (66%) said health professionals, 9 (28%) said their own research, 1 (3%) said news, and 1 (3%) said religion. Compared to patients who said health professionals, pts who reported own research had a higher level of education (p = 0.039), believed themselves to be more knowledgeable about vaccines (p = 0.031), and expressed more concern that vaccines can lead to serious side effects (p = 0.030). Conclusions: In our population: 1) Compared to 2019, KTx in 2020 were more likely to believe that vaccines prevent illness, were more concerned with vaccine safety but felt more comfortable expressing their concern to their doctor. 2) Pts with diabetes had fewer concerns about vaccines. 3) Pts with higher education were more likely to question and express concern about vaccines. 4) The majority of pts would not accept a COVID-19 vaccine at this time, especially those with higher education who report doing their own research to find information. 5) Once the vaccine becomes available, an intensive education program will have to be created so that vaccine acceptance rises in this vulnerable, inner-city population.

Beliefs about and impact of the COVID-19 pandemic on a population of inner city kidney transplant recipients (KTRS)

Background: The COVID-19 pandemic was especially stressful for indigent people with multiple health conditions. We examined beliefs and behaviors at the height of the pandemic in a population of inner-city KTRs. Methods: 40 KTRs followed at our Center were surveyed by telephone including questions about behaviors, knowlege and attitudes regarding COVID-19 using yes/ no or Likert scale answers as well as the Stress and Social Suppory and Health Beliefs Questionnaires. Results: Mean age was 57±1.8yrs, with 22 males and 18 females, 27 (77%) Black, (4) White 11% and 8 (23%) other. Time since transplant 7.75±1.07yrs. 35% (9/26) felt difficulties were piling up so high that they could not overcome them.13% (4/31) reported it was more difficult to pay for medications and were more likely to skip doses to make them last longer (r=0.473, p=0.008). 75% (23) were afraid of COVID-19. 51% (17/33) were afraid of catching it from a family member, 54% (18) from a friend, 84% (26) limited any in person interactions, 44% (19) avoided leaving home for any reason and 45% (15) avoided going to any public spaces. Pts who reported being more afraid of COVID-19 were more likely to report poor health (r=-0.39, p=0.032), to report being afraid to leave their home (r=0.48, p=0.006), were more likely to have contacted their provider more than 4-6 times in the past two months (p=0.034), to state that their health was poor (r=-0.39, p=0.032), and to say that their condition keeps them from working (r=0.52, p=0.027). They also believed that eating Chinese food could increase COVID-19 risk (r=0.37, p=0.039). Conclusions: In our population of inner-City KTRs: 1. Two thirds were afraid of COVID-19, including catching itfrom a friend or family member, and limited leaving their home. 3. They were also more likely to report poor health. contact their healthcare provider multiple times, as well as state their condition made it impossible to work and believe that one could catch COVID-19 from Chinese food. 4. Over 10% were financially stressed and skipped doses of medication to make them last longer and a third felt it difficult to cope overall. 5. Follow up will be necessary as the pandemic subsides to examine if there was a detrimental effect on graft survival due to multiple stressors that could affect adherence in this population.

Trajectories of pulmonary epithelial and endothelial injury markers in COVID-19 patients requiring respiratory support at presentation

RATIONALE:Acute respiratory distress syndrome (ARDS) phenotypes differ by pulmonary epithelial vs. endothelial injury marker predominance. Epithelial vs. endothelial injury patterns in severe SARS-CoV-2 infection have not been directly compared. METHODS:Adult patients presenting to a single ED in Boston from 3/24-4/30/20 were enrolled. Inclusion criteria: clinical concern for COVID-19 ARDS and 1) respirations ≥22/minute or 2) SpO2≤92% on room air or 3) respiratory support. For this study, we excluded patients without subsequently polymerase chain reaction-confirmed COVID-19 or without supplemental oxygen or invasive mechanical ventilation (IMV) at presentation (non-invasive mechanical ventilation for COVID-19 was against hospital policy during enrollment). On Day=0, 3, and 7, patients had dedicated research blood draws and detailed clinical data were recorded. Data included clinical/respiratory status using the World Health Organization (WHO)-scale, and non-pulmonary (renal, cardiovascular, and coagulation) dysfunctions. Clinical status on Day=28 was also recorded. Blood was analyzed using the Olink Proximity Extension Assay, an oligonucleotide-labelled antibody assay that provides high-specificity analysis of plasma proteins, including low abundance proteins. Targets included markers of epithelial injury (n=5), endothelial activation and injury (n=11), and inflammatory cytokines (interleukin-6, interleukin-8, soluble-Tumor Necrosis Factor Receptor-1 (sTNF-R1). We used multivariable mixed-effects generalized linear models to determine associations between biomarker and clinical status trajectories. Multivariable proportional-odds models measured associations between biomarker trajectories with 28-day outcome. Models were adjusted for age, sex, BMI, heart, lung, and renal comorbidities, and initial Sequential Organ-Failure Assessment score. RESULTS:Figure-A shows (n=225) patients' clinical status over time. At Day=0, epithelial injury markers were higher in patients requiring IMV vs. supplemental oxygen and decreased over time independent of respiratory status (Figure-B). They did not discriminate renal, cardiovascular, or coagulation dysfunctions. In contrast, endothelial markers were initially lower for IMV than supplemental oxygen patients;they fell over time in lower severity patients but rose sharply in IMV patients (Figure-C). Endothelial markers discriminated patients with non-pulmonary organ dysfunction from those without. More endothelial (8/11, 73%) than epithelial (1/5, 20%) markers were significantly associated with worse 28-day outcome (Figure-E). Change from Day=0 to Day=3 was significantly associated with 28-day WHO-scale for all 11 (100%) endothelial vs. 3/5 (60%) epithelial markers. Endothelial effect-sizes were substantially larger (median odds-ratio:3.60 vs. 1.58). CONCLUSIONS:In COVID-19 patients with respiratory distress, endothelial markers are more strongly associated with clinical progression, non-pulmonary organ dysfunction, and 28-day outcomes than pulmonary epithelial markers. Over the course of illness, endothelial dysfunction may play an important role in COVID-19 pathophysiology. (Table Presented).