Vaccine Uptake in a Predominantly Black and Latinx Cohort Hospitalized for Covid-19

Background: Vaccine uptake has been notably lower in minoritized populations in the United States. The impact of previous infection with SARSCoV- 2, disease severity, and persistent symptoms on the uptake of COVID-19 vaccines and boosters in predominantly Black and Latinx communities has not been examined. We aimed to describe correlates of vaccine uptake in a minoritized cohort hospitalized for COVID-19 during the first pandemic wave in New York City, and investigate whether those with more severe initial COVID-19 and persistent symptoms would be less likely to get vaccinated. Method(s): This retrospective cohort study included the electronic medical records of the first 894 consecutive adult patients who survived hospitalization for COVID-19 at a large quaternary care medical center in Northern Manhattan between 1 March and 8 April 2020. We ed data regarding demographics, comorbidities, oxygen requirements during hospitalization, persistence of symptoms at 3- and 6-months after admission, COVID-19 vaccinations through November 2022, and influenza vaccination during the 2018-2019 through 2021-2022 seasons. Unadjusted and adjusted logistic regression analyses were conducted to describe the predictors of COVID-19 vaccination, delayed vaccination (first dose after 6 May 2021), and receipt of a booster vaccine. Statistical analyses were performed using R V.4.2.1. Result(s): The cohort of 894 patients was predominantly Latinx (54%) and Non- Hispanic Black (15%). 41% received at least one influenza vaccine pre-COVID, and 67% had at least one comorbidity. 22% (199/894) remained COVID-19 unvaccinated. Of the individuals who received at least one dose of COVID-19 vaccine, 57% (397/695) received at least one booster. Exactly 31% (212/695) delayed vaccination. 25% (27/106) of unvaccinated individuals reported persistent generalized symptoms compared to 18% (78/436) of vaccinated individuals. Multiple logistic regression showed that Hispanic/Latinx ethnicity, age 35-64, and concurrent influenza vaccination were associated with increased COVID-19 vaccine uptake. No association was found between vaccine uptake and disease severity or persistence of symptoms. Conclusion(s): Achieving a deeper understanding of the factors driving vaccine hesitancy is critical to increasing and sustaining acceptance of COVID-19 vaccination especially in communities with historically low uptake of annual vaccines.

A retrospective review of the role of platelet aggregometry in the diagnosis of platelet disorders in a single Comprehensive care centre

Basingstoke and North Hampshire hospital is part of the Southern Haemophilia Network (SHN) and is the Comprehensive Care Centre for the network. It spans a wide area and also receives regional referrals for further investigations of suspected platelet disorders. Platelet aggregation is a second-line test to investigate patients with possible bleeding disorders. It is usually performed after clotting factors are established to be normal and there is still concern about an underlying bleeding disorder. The aim of this study was to assess whether platelet aggregation studies led to a formal diagnosis of a platelet disorder. Further outcomes were to assess how many bleeding assessment tool (BAT) scores were documented and whether these corresponded with diagnostic rates. Patient records were retrospectively analysed over 13 months (from 20 June to 21 July). Seventy-two patients were identified who underwent platelet aggregation studies. These included regional and local referrals. Patients identified had their electronic records analysed for the appropriate information. Of note, platelet aggregation studies were stopped at the beginning of the COVID pandemic and only restarted in summer 2020. Therefore, these numbers may not be fully representative of a normal year due to a waiting list which developed during the suspension of this test. The 72 patients were made up of 78% females ( n = 56) and 22% males ( n = 16). Out of the 72 patients reviewed, 63% ( n = 45) were regional referrals and 37% were local referrals ( n = 27). The average age of this group was 31.89 years. Median age was 31 years (range 74). The youngest patient was 2 years old and the oldest was 76. BSH guidelines recommend using the BAT as a standardised tool for assessing bleeding history. However, it is not sensitive in determining which patients require further testing including platelet aggregometry. Only one patient had a documented BAT score out of the 72 referrals (1.39%). Platelet aggregometry did not go on and lead to a diagnosis in this patient. All the samples for platelet aggregometry were taken on site in keeping with national guidance. Three of the four cases of thrombocytopenia, (75%) had a blood film reviewed locally. Platelet aggregometry led to a diagnosis in 17% of patients ( n = 12) with a higher number of diagnoses in males than females. Forty-four per cent ( n = 7) of males seen were diagnosed with a platelet disorder compared to 9% ( n = 5) of females. Other diagnoses included connective tissue disease at 8% ( n = 6), drug induced/acquired defect 5% ( n = 4), thrombocytopenia 5% ( n = 4) and other bleeding disorders (such as VWF or Factor XI deficiency) at 4% ( n = 3). Out of the 12 diagnoses of bleeding disorders, 100% ( n = 12) were registered with the national database. In total 67% ( n = 48) of patients were discharged followed their platelet aggregations studies. In this study, platelet aggregometry had a low rate of diagnostic yield. There was a higher rate of diagnosis in the male population which likely reflects the that women are more heavily investigated due to menorrhagia . Despite the low diagnostic rates, platelet aggregation studies lead to a high number of discharges and reassurance to a number of patients that there is no underlying bleeding disorder. Therefore, they continue to have important role in the diagnosis and exclusion of underlying bleeding disorders.

Supporting emergency health services during a pandemic: Lessons from the canadian red cross

The COVID-19 pandemic has tested Canada's readiness capacity as emergency health needs continue to exceed some communities' capacity to respond. To address this gap, the Canadian Red Cross (in collaboration with local, provincial, territorial, national, and Indigenous partners) have leveraged international experience in humanitarian response and preparedness, developing innovative new response services, delivery modalities, and protocol through which to mitigate and manage risk. This approach breaks down emergency management into two main streams - health interventions and disaster management - to innovatively and effectively cope with increasingly complex and frequent requests for support. Using internal data from within the Canadian Red Cross, this paper presents and discusses the services, roles and expectations of this two-stream approach which has been designed to (i.) support COVID-19 testing and vaccination, (ii.) support outbreak crisis management, especially through epidemic, prevention, and control interventions, and (iii.) support traditional emergency management responses in the midst of a pandemic. It concludes by reporting on the successes of the two-stream approach to date while scoping further the potential evolutionary track of some of these services, their underpinning methodology, and appetite for recovery operations in the near future. This approach may therefore be of value to other organizations or practitioners coping with emergency management challenges during a pandemic. © 2021 Information Systems for Crisis Response and Management, ISCRAM. All rights reserved.

Forensic Assessment in the Time of COVID-19: The Colorado Experience in Developing Videoconferencing for Evaluating Adjudicative Competency

In this article, we briefly discuss how competency to proceed evaluations are conducted within the state of Colorado, the impact that COVID-19 had on forensic evaluations within the Colorado forensic services system, and the acquisition and adoption of videoconferencing (VC) capabilities. We then shift to an in-depth consideration of how VC forensic evaluations are facilitated in four different contexts: for adult defendants in custody, on bond, and in hospitals, and for juvenile defendants. Challenges and limitations are also addressed.

Ethics and equity in the time of coronavirus

Government responses and lockdowns, even done well, have also caused increased morbidity and mortality by a reduction in patients seeking treatment for non-COVID-19 conditions, and the postponement of therapy such as surgery and preventive screening. This opportunity cost of the lockdown also includes the morbidity and mortality induced by unemployment and mental health issues. Whether these risks of lockdown are outweighed by the projected lives saved from dying of COVID-19 has still to be adequately analysed both here and overseas, but such analyses are essential in understanding the circumstances under which such measures are ethically justified. Equity of information-provision has been problematic. There have been issues of access to digital information and telehealth, especially for people who are poor or homeless.29 Understanding the risks, benefits and ethics of virtual healthcare is evolving concurrently with its widescale implementation.

Operational K9s in the COVID-19 World

Severe acute respiratory syndrome coronavirus 2 (SARSCov- 2) is hypothesized to have originated from a spillover event from an animal reservoir. This has raised many questions, with an important one being whether the widely disseminated coronavirus disease 2019 (COVID-19) is transmissible to other animal species. SARS-CoV-2 is primarily transmitted person to person. K9-to-human transmission, although theoretically possible via fomites, is considered minimal, if at all, and there have been no reported cases of K9-to-human transmission. Human-to-K9 transmission, although rare, seems more likely;however, in only one case has a K9 been suspected to have displayed symptoms of COVID-19. Preparation, decontamination, hand hygiene, and distancing remain the key factors in reducing transmission of the virus. The information presented is applicable to personnel operating within the military conventional and Special Operation Forces as well as civilian Tactical Emergency Medical Services communities who may have the responsibility of supporting an operational K9.