Occupational dermatoses during the second COVID-19 pandemic wave: an audit of 401 healthcare workers

Healthcare workers (HCWs) assessed by dermatologists during the first wave of the COVID-19 pandemic had high rates of irritant hand dermatitis, facial dermatitis and acne triggered by wearing personal protective equipment (PPE) (Ferguson FJ, Street G, Cunningham L et al. Occupational dermatology in the time of the COVID-19 pandemic: a report of experience from London and Manchester, UK. Br J Dermatol 2021;184: 180-2). We report data from a tertiary National Health Service trust during the second COVID-19 wave in winter 2020-21. At its peak, the Trust had 835 COVID-positive inpatients and 263 intensive care unit (ICU) beds - one of the largest ICUs in Europe. Building on the published experience of dermatology units, we ran 30 dermatology pop-up clinics over 3 weeks in allocated rest areas across the Trust: 08.00-09.00 h and 13.00-14.00 h on weekdays, from 18 January 2021. HCWs requiring formal dermatology referral were provided with letters to their line managers. In 3 weeks, 401 HCWs were assessed: 327 females and 74 males (mean age 35 2 years). The most frequently seen occupation was nurses (n = 130;32 4%) followed by doctors (n = 74;18 4%). On average, staff spent 9 5 h in PPE per shift. Consistent with the existing literature, the most common diagnosis was irritant hand dermatitis (n = 186;46 4%). There was an increased incidence of acne (n = 171;42 6%) vs. the first wave, where the reported incidence was 17% in a multicentre study (O'Neill H, Narang I, Buckley DA et al. Occupational dermatoses during the COVID-19 pandemic: a multicentre audit in the UK and Ireland. Br J Dermatol 2021;184: 575-7). Less common in the second wave was facial eczema (n = 50, 12 5%) and pressure injury (n = 30;7 5%). Thirty-one (16 7%) of the HCWs with hand dermatitis required the prescription of potent topical corticosteroids, suggesting at least moderate symptoms. The majority received emollient samples. It was rare for HCWs to require formal referral (n = 11;2 7%). In our cohort, at least four (1 0%) HCWs required time off work owing to their skin problems. Our data support previous reports of increased occupational dermatoses in HCWs during the COVID-19 pandemic. We highlight the sheer scale of the issue, with 401 HCWs presenting for dermatological assessment in only 3 weeks in one trust. Compared with our experience during the first wave, acne exacerbated or precipitated by masks is increasingly common, which may be due to emollient use to prevent facial eczema or injury when wearing masks.

Personalized electronic record supported optimisation when alone for patients with hypertension-pilot study for remote medical management of hypertension during the Covid-19 pandemic (personal covidBP)

Introduction: Hypertension remains a leading cause of disability and preventable death globally. This study tested patient use of a drug-device combination of a smartphone application (App) to record blood pressure (BP), drug (amlodipine) dose and side effects each day at home during the COVID-19 pandemic. Method(s): In this community-based trial with remote monitoring and remote medical management from the investigational site, hypertensive participants aged 18 years + with poor BP control (prior 7 day mean of 135 mmHg systolic BP or above and/ or 85 mmHg diastolic BP and above) were enrolled to intervention with open label dose titration over 14 weeks, allowing personalized dosing of liquid amlodipine (1-2mg steps from 1-10 mg daily). Those with adequate BP control after 7 day baseline recorded BP over the same period. Result(s): 205 patients were enrolled into the intervention group between October 2020 and July 2021. Dose-related wanted (BP reduction) and emergence of unwanted effect plots were produced for individual participants. Average BP in intervention fell from 141/87 to 131/81 (difference -10/6 p < 0.001) and observation from 125/77 to 124/76 (difference -2/1 p < 0.001). Even low doses of 1 or 2 mg amlodipine reduced BP, as did small increments e.g. from 5mg to 6 mg or from 6mg to 8mg. Mean amlodipine dose at study end averaged 5.5mg on those without amlodipine at baseline, and 7.9mg in those starting at 5mg at baseline. Adherence with participant completion of the daily App routines was high and unrelated to age (median >90%). Conclusion(s): Remote clinician assessment of twice daily home BP measurements and side effects recorded in the App may inform more precise amlodipine titration and BP control. Personalised dose-response curves for both wanted and unwanted effects may change the relationship of participant and clinician to dose selection, convincement and help optimize long term care.

The reorganisation of emergency general surgery services during the COVID-19 pandemic in the UK: outcomes of delayed presentation, socio-economic deprivation and Black, Asian and Minority Ethnic patients.

INTRODUCTION: The COVID-19 pandemic is a global public health emergency. Lockdown restrictions and the reconfiguration of healthcare systems to accommodate an increase in critical care capacity have had an impact on 'non-COVID' specialties. This study characterises the utilisation of emergency general surgery (EGS) services during the UK lockdown period at a university teaching hospital with a catchment population that represents one of the most deprived and ethnically diverse areas in the UK. METHODS: EGS admissions during the UK lockdown period (March to May 2020) were compared with the same period in 2019. Patient demographics were recorded together with clinical presentation, hospital stay and treatment outcomes, and readmission data. RESULTS: The study included 645 patients, comprising 223 in the COVID-19 period and 422 in the non-COVID-19 period. There was no difference in age, sex, comorbidity or socio-economic status. A lower proportion of patients of Black, Asian and Minority Ethnicity (BAME) were admitted during the pandemic (20.6% vs 35.4%, p < 0.05). The duration of symptoms prior to presentation was longer, and admission clinical parameters and serum inflammatory markers. More patients presented with an acute kidney injury (9.9% vs 4.7%, p = 0.012). There was no difference in perioperative outcomes or 30-day mortality, but more patients were readmitted following conservative management (10.6% vs 4.7%, p = 0.023). CONCLUSIONS: The reorganisation of EGS to a senior-led model has been successful in terms of outcomes and access to treatment despite a more unwell population. There was a significantly lower proportion of BAME admissions suggesting additional barriers to healthcare access under pandemic lockdown conditions.

Farmers' response to COVID-19 disruptions in the food systems in Ghana: the case of cropland allocation decision

The COVID-19 pandemic is a global health issue with disruption effects in the agricultural food systems especially in Sub-Saharan Africa (SSA) where most of the population is engaged in the agricultural sector. While prices of food commodities continue to increase, farmers are likely to be food insecure or market-oriented by allocating land resources between commercial and staple crops. This study provides new evidence on the determining factors of cropland allocation decisions within the context of the COVID-19 pandemic. The study employs the probit and seemingly unrelated regression (SUR) models on 309 farm households. The results reveal that socio-economic, production, institutional, and political factors significantly influence the choice of cropland allocation decisions and the size of cropland allocated to legumes and cereals. Beyond these factors, we find that COVID-19 education increases land area allocated to staples while farmers' perception that COVID-19 will impact negatively on agricultural production leads to an increase in the area under commercial crop (soybean) production. The result suggests that promoting farmer education on the disruptive effects of the COVID-19 pandemic and understanding farmer perceptions of the disruptive effects of the COVID-19 will guide future adaptation and mitigation strategies as well as determining the "best" possible cropland allocation decision.