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Background: Studies have shown that lymphopenia and a decreased CD4/ CD8 ratio are correlated with the severity of COVID-19 infections. As people with HIV (PWH) can have altered CD4/CD8 ratios at baseline, this study examined the relationship between lymphocyte and T-cell subsets with COVID-19 disease outcomes among PWH. Method(s): This retrospective study included adult PWH (identified by HIV ICD codes, HIV RNA or antibody results, or antiretroviral therapy use excluding preexposure prophylaxis) in the Optum COVID-19 EHR database with positive SARSCoV- 2 PCR or antigen tests from February 2020 to December 2021. Outcomes included 30-day hospitalization, ICU stay, mechanical ventilation, and death from COVID-19. Absolute lymphocyte counts and percent and CD4:CD8 ratios were collected prior to SARS-CoV-2 positivity (baseline) and then weekly for four weeks post-SARS-CoV-2 positivity. We examined lymphocyte trajectories in PWH who had available data at all time points, and we compared changes in counts and percentages at each week post-SARS-CoV-2 to baseline values, using Wilcoxon rank sum test. Result(s): Of a total of 4,525 PWH who tested positive for SARS-CoV-2, 102 PWH had available lymphocyte counts at all study time points. Compared to non-hospitalized PWH (n=38), hospitalized PWH (n=64) and PWH who were in the ICU (n=32) or ventilator dependent (n=27) experienced a larger drop in lymphocyte percentage in the first two weeks post-SARS-CoV-2 diagnosis with only a partial recovery in subsequent weeks. In patients who died (n=19), lymphocyte percentage recovered even more slowly. Hospitalized PWH, as compared to non-hospitalized PWH, had a significant decrease in lymphocyte percentage post-SARS-CoV-2 infection in the first week (-0.19 vs -0.05;< 0.001), second week (-0.23 vs -0.02;< 0.001), third week (-0.20 vs 0.00;< 0.001), and fourth week (-0.10 vs 0.00;0.001), a trend seen in the ICU, mechanically ventilated, and deceased groups as well (Table 1). By the first week, CD4/CD8 ratio in COVID-19 positive patients was lower in the deceased (-0.18 vs 0.00;p=0.4), ventilator dependent (-0.15 vs 0.00;p=0.2), and ICU (-0.15 vs 0.00;p=0.4) groups. Conclusion(s): Our study showed that not only is lymphopenia a marker of COVID-19 disease severity in PWH but also a failure of lymphocyte percentage recovery is associated with worse outcomes. There was also a trend towards worse outcomes associated with a lower CD4/CD8 ratio in the first week after COVID-19 infection. (Figure Presented).
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Satellites allow spatially precise monitoring of the Earth, but provide only limited information on events of societal impact. Subjective societal impact, however, may be quantified at a high frequency by monitoring social media data. In this work, we propose a multi-modal data fusion framework to accurately identify periods of COVID-19-related lockdown in the United Kingdom using satellite observations (NO2 measurements from Sentinel-5P) and social media (textual content of tweets from Twitter) data. We show that the data fusion of the two modalities improves the event detection accuracy on a national level and for large cities such as London.
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Background. The increase in SARS-CoV-2 cases due to the omicron wave led to significant utilization of healthcare resources and reduced acute care hospital beds at the Veterans Administration Hospital, North Texas Health Care System (VANTHCS). As a result, veterans with non-severe disease were managed at a VANTHCS community living center (CLC) during a COVID-19 outbreak. Methods. Veterans residing at the CLC with laboratory-confirmed cases of SARS-CoV-2 (the virus that causes COVID-19) by polymerase chain reaction diagnosed from January 1 to February 15, 2022, were included in the descriptive analysis. We described resident characteristics and outcomes and infection control practices (IPC) implemented to control the outbreak. Resident data was ascertained from the COVID-19 facility dashboard and medical record system. Results. From January 1-February 15, 2022, 33 adults residing at the CLC were diagnosed COVID-19. Most infections (93.9%) occurred between January 12-24 (figure 1). The median age was 76 years [interquartile range, 71-80 years] and 30 (90.9%) were men and 25 (75.8%) were white and 5 (15.2%) African American (table 1). Among the total cases, 9 (27.3%) resided in the dementia unit. Nineteen of 33 (57.6%) were asymptomatic. Overall, 28 (84.8%) were documented to be fully vaccinated against SARS-CoV-2 and 24 (72.7%) were boosted. Obesity, ischemic heart disease, chronic obstructive pulmonary disease, and stroke were the most common comorbidities. Residents were cohorted based on COVID-19 results. A multidisciplinary team was convened, and staff were fit tested for appropriate personal protective equipment (PPE) and received refresher training on hand hygiene, donning and doffing of PPE. Most residents were determined to have mild or moderate COVID-19 and managed at the CLC while 7 (21.2%) were hospitalized in the acute care hospital. For management of COVID-19, 11 (33.3%) received dexamethasone and 25 (75.8%) received remdesivir. Overall, 32 (97%) residents survived while one hospice resident was transferred to acute care and died;only 1 resident required ICU admission. Epidemic curve of laboratory-confirmed coronavirus disease 2019 (COVID-19) disease at a Community Living Center, Veterans Administration Hospital, North Texas Health Care System, January-February 2022. Table 1 Epidemiological Characteristics, and Outcomes of Laboratory-confirmed COVID-19 cases (N=33) Abbreviation: BMI, body mass index;COPD, Chronic Obstructive Pulmonary Disease;ESRD, end stage renal disease 1Other comorbidity (asthma n=1 and chronic liver disease n=2) Conclusion. It is feasible to administer COVID-19therapies to high-risk residents with mild-moderate disease in a CLC with a multidisciplinary team and IPC strategies.
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Background. Murine Typhus remains endemic in southern California and in southern Texas where it is transmitted by fleas, with opossums serving as the amplifying host. In Texas, the disease is increasingly recognized in municipalities outside its historic rural range and is spreading in a northward distribution. Since its expansion, we have observed increased cases in the Dallas-Fort Worth (DFW) area and aim to describe murine typhus in North Texas from 2011-2021. Methods. Leveraging the electronic health record, we retrospectively identified 482 individuals tested for murine typhus by Rickettsia typhi (R. typhi) serology in 2 Dallas hospitals. We subsequently collected epidemiologic characteristics, clinical features, and outcomes of 58 patients with positive R. typhi serologies ( >1:64). Results. Of the 58 patients with positive R. typhi serology, 39 (67%) were male, 45 (78%) were White, and 23 (40%) were Hispanic. Seventy-nine percent had symptom onset between May and November, and 36/58 (62%) were diagnosed in 2020 and 2021. Twenty-six (45%) had exposure to dogs, 18 (31%) to cats, and 13 (22%) to opossums. Twelve (21%) patients were immunocompromised. Fifty-two (90%) had fever, 35 (60%) headache, 26 (45%) nausea and vomiting, 26 (45%) rash, 25 (43%) myalgia, 20 (34%) cough, and 17 (29%) abdominal pain. In 2020 and 2021, 35/36 (97%) patients were additionally tested for COVID-19, and 29/35 (83%) patients had more than one negative SARS-CoV-2 test prior to R. typhi serologies being sent. Twenty-one out of fifty (42%) had an abnormal chest x-ray (CXR) and 28/30 (93%) had an abnormal chest computed tomography (CT). Nine (16%) had hypoxia, 9 (16%) required an intensive care unit, and 3 (5%) required mechanical ventilation. No patients died within 30 days of diagnosis. Conclusion. Our study highlights the expansion of murine typhus in North Texas (Figure 1) and demonstrates the heightened need for clinicians to be aware of this disease in the appropriate epidemiologic and clinical settings. We also describe increasing rates of respiratory findings, demonstrated through over half of patients having at least one respiratory symptom, and 93% having an abnormal chest CT (findings traditionally associated with severe disease).
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Background. As the risk for concomitant COVID-19 infection in people living with HIV (PLHIV) remains largely unknown, we explored a large national database to identify risk factors for COVID-19 infection among PLHIV. Methods. Using the COVID-19 OPTUM de-identified national multicenter database, we identified 29,393 PLHIV with either a positive HIV test or documented HIV ICD9/10 codes. Using a multiple logistic regression model, we compared risk factors among PLHIV, who tested positive for COVID-19 (5,134) and those who tested negative (24,259) from January 20, 2020, to January 20, 2022. We then compared secondary outcomes including hospitalization, Intensive Care Unit (ICU) stay, and death within 30 days of test among the 2 cohorts, adjusting for COVID-19 positivity and covariates. We adjusted all models for the following covariates: age, gender, race, ethnicity, U.S. region, insurance type, adjusted Charlson Comorbidity Index (CCI), Body Mass Index (BMI), and smoking status. Results. Among PLHIV, factors associated with higher odds for acquiring COVID-19 (Figure 1) included lower age (compared to age group 18-49, age groups 50-64 and >65 were associated with odds ratios (OR) of 0.8 and 0.75, P= 0.001), female gender (compared to males, OR 1.06, P= 0.07), Hispanic White ethnicity/race (OR 2.75, P=0.001),Asian (OR 1.35, P=0.04), and AfricanAmerican (OR1.23, P=0.001) [compared to non-Hispanic White], living in the U.S. South (compared to the Northeast, OR 2.18, P= 0.001), being uninsured (compared to commercial insurance, OR 1.46, P= 0.001), higher CCI (OR 1.025, P= 0.001), higher BMI category (compared to having BMI< 30, Obesity category 1 or 2,OR 1.2 and obesity category 3,OR1.34, P=0.001), and noncurrent smoking status (compared to current smoker, OR 1.46, P= 0.001). Compared to PLHIV who tested negative for COVID-19, PLHIV who tested positive, had an OR 1.01 for hospitalization (P = 0.79), 1.03 for ICU stay (P=0.73), and 1.47 for death (P=0.001). Conclusion. Our study found that among PLHIV, being Hispanic, living in the South, lacking insurance, having higher BMI, and higher CCI scores were associated with increased odds of testing positive for COVID-19. PLHIV who tested positive for COVID-19 had higher odds of death. (Figure Presented).
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BACKGROUND: In-home direct antigen rapid testing (DART) plays a major role in COVID-19 mitigation and policy. However, perceptions of DART within high-risk, intellectually impaired child populations are unknown. This lack of research could negatively influence DART uptake and utility among those who stand to benefit most from DART. The purpose of this study was to describe caregivers' perceptions of an in-home COVID-19 DART regimen in children with medical complexity, including the benefits and limitations of DART use. METHODS: This qualitative study was a subproject of the NIH Rapid Acceleration of Diagnostics Underserved Populations research program at the University of Wisconsin. We combined survey data and the thematic analysis of semi-structured interview data to understand caregivers' perceptions of in-home COVID-19 testing and motivators to perform testing. Caregivers of children with medical complexity were recruited from the Pediatric Complex Care Program at the University of Wisconsin (PCCP). Data were collected between May and August 2021. RESULTS: Among n = 20 caregivers, 16/20 (80%) of their children had neurologic conditions and 12/20 (60%) used home oxygen. Survey data revealed that the largest caregiver motivators to test their child were to get early treatment if positive (18/20 [90%] of respondents agreed) and to let the child's school know if the child was safe to attend (17/20 [85%] agreed). Demotivators to testing included that the child could still get COVID-19 later (7/20 [35%] agreed), and the need for officials to reach out to close contacts (6/20 [30%] agreed). From interview data, four overarching themes described perceptions of in-home COVID-19 testing: Caregivers perceived DART on a spectrum of 1) benign to traumatic and 2) simple to complex. Caregivers varied in the 3) extent to which DART contributed to their peace of mind and 4) implications of test results for their child. CONCLUSIONS: Although participants often described DART as easy to administer and contributing to peace of mind, they also faced critical challenges and limitations using DART. Future research should investigate how to minimize the complexity of DART within high-risk populations, while leveraging DART to facilitate safe school attendance for children with medical complexity and reduce caregiver burden.
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COVID-19 , Caregivers , COVID-19/diagnosis , COVID-19 Testing , Child , Family , Humans , Qualitative ResearchABSTRACT
This chapter provides an overview of how digital technologies are transforming the financial services landscape. We highlight the latest in digital financial product and service offerings related to payments and transfers, savings and investments, borrowing, and risk management. We then consider how digitalization is impacting the delivery of financial advice - including virtual advisors, robo- and hybrid advisors, and personal finance communities. While many of these digital innovations were underway prior to Covid-19, the pandemic accelerated the transition raising concerns that some individuals and families may be at risk of being excluded from financial services due to growing socioeconomic and digital divides. We look at barriers to access and usage and emphasize the need for digital financial literacy. Legal and regulatory challenges are also examined. Particular attention is given to recent efforts by regulatory and supervisory authorities to balance innovation and competition with consumer protection. The insights from this chapter provide a useful starting place for scholars and practitioners who are interested in exploring in greater detail how digital technologies are impacting the financial services industry. © 2022 Walter de Gruyter GmbH, Berlin/Boston.
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Objective: Assess the relationship of seasonal temperature and COVID-19 infection with the occurrence of cerebral venous thrombosis (CVT). Background: Increased thrombogenicity is associated with COVID-19. Warm environments cause intravascular constriction, promoting CVT. After COVID-19 began, CVT increased during South Carolina's (SC) warmer months. However, the interaction of seasonal temperature and COVID-19 with CVT has not been elucidated. Design/Methods: The Vizient database provided frequency of non-pyogenic CVT, with and without infarction, between 10/2017 and 7/2021. SC's monthly temperatures were obtained from the National Weather Service, and SC DHEC provided COVID-19 cases. This study initially explored the relationship between COVID-19, CVT, and temperature and the effect of COVID-19 on the occurrence of CVT in Greenville, SC. It then expanded to include all SC and nationwide Vizient hospitals. Results: A Pearson correlation assessed the relationship between CVT, temperature, and COVID-19 in Greenville. A significant positive relationship between CVT and both average daily and maximum temperature (r(46) = 0.343, p<0.05;r(46) 0.339, p<0.05, respectively) was identified. There was not a significant relationship between COVID-19 and CVT, even when controlling for temperature. Greenville's independent t-test compared CVT incidence and showed an increase in CVT cases after the COVID-19 pandemic began (t(20)= 2.71, p<0.01). This significance was also demonstrated from the total data from SC and nationwide (t(36) = 2.538, p < .01, t(44) = 4.050, p <.001, respectively). Conclusions: Increased maximum and average daily temperature is significantly correlated to increased CVT hospitalizations. Although COVID-19 cases were insignificantly correlated with CVT, CVT hospitalizations significantly increased from an unknown variable after the COVID19 pandemic. When relating statistics to observed patterns, it is still possible that the conditions surrounding the COVID-19 pandemic complete the increased risk of CVT hospitalizations during warmer months. Future study is needed to elucidate variables' effects and patterns on COVID-19, temperature, and CVT.
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Purpose of Study Vaccine hesitancy is a complex and controversial issue that undermines current efforts at ending the COVID-19 pandemic. Vaccine hesitancy in healthcare workers further complicates these issues as healthcare workers interact, educate and influence their peers and community members at large.We sought to understand vaccine hesitancy among HCW in four large healthcare systems in the metro- Atlanta region. Methods Used We conducted a cross-sectional multicenter 12 question anonymous survey sent via email to HCWs in four healthcare systems in metropolitan Atlanta over a seven week period from May to June 2021 using Qualtrics XM. We defined vaccine hesitancy as those who had not received the vaccine or planned to get it later. Demographics, employment information, history of COVID-19 diagnosis, vaccination status, and reasons for vaccine hesitancy were assessed. Descriptive variables including HCW demographics, clinical role, and self/family member with previous diagnosis of COVID were compared using chi-square and t-tests. A multivariate logistic regression model controlling for age, sex, race, ethnicity, and education was used to estimate adjusted measures of association analyzed with SAS 9.4. COVID vaccine perceptions were further explored using a five point Likert scale. Summary of Results Of the 5,329 completed responses from HCW, the largest group of respondents comprised of nurses (35%), followed by physicians (18%). Of the 551 (10%) vaccine hesitant HCW, 43% of them were black and 39% were white. 16% of the vaccine hesitant identified as working in the Emergency Department and 14% in the Intensive Care Unit. In the multivariate analysis, HCW aged 18-35 were more likely to be vaccine hesitant then other age groups with vaccine hesitancy decreasing as age increased. Non-Hispanics were more likely to be vaccine hesitant than Hispanics. Those with education levels of less than a Bachelor's degree were more likely to be vaccine hesitant than those with bachelor's degree or higher. There were no differences observed between the black and white races for vaccine hesitancy. Having a family member with COVID or caring for COVID patients did not have a significant impact on vaccine hesitancy. The main reasons for vaccine hesitancy were fear of side effects followed by concerns about safety and inadequate research Conclusions Ten percent of HCW in the four health systems studied were found to be vaccine hesitant. Increased vaccine hesitancy was associated with the younger age group of 18- 35, Non-Hispanic ethnicity, and education less than a bachelor's degree. The main reasons for vaccine hesitancy were fear of side effects followed by safety and inadequate research concerns. As vaccine mandates begin, the threat of workforce losses is imminent creating a strain on healthcare systems. Booster/third dose vaccine hesitancy also remains a significant concern. It is critical to identify and develop strategic interventions to reduce vaccine hesitancy among HCW.
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OBJECTIVES: To establish statewide consensus priorities for safer in-person school for children with medical complexity (CMC) during the coronavirus disease 2019 (COVID-19) pandemic using a rapid, replicable, and transparent priority-setting method. METHODS: We adapted the Child Health and Nutrition Research Initiative Method, which allows for crowdsourcing ideas from diverse stakeholders and engages technical experts in prioritizing these ideas using predefined scoring criteria. Crowdsourcing surveys solicited ideas from CMC families, school staff, clinicians and administrators through statewide distribution groups/listservs using the prompt: "It is safe for children with complex health issues and those around them (families, teachers, classmates, etc.) to go to school in-person during the COVID-19 pandemic if/when " Ideas were aggregated and synthesized into a unique list of candidate priorities. Thirty-four experts then scored each candidate priority against 5 criteria (equity, impact on COVID-19, practicality, sustainability, and cost) using a 5-point Likert scale. Scores were weighted and predefined thresholds applied to identify consensus priorities. RESULTS: From May to June 2021, 460 stakeholders contributed 1166 ideas resulting in 87 candidate priorities. After applying weighted expert scores, 10 consensus CMC-specific priorities exceeded predetermined thresholds. These priorities centered on integrating COVID-19 safety and respiratory action planning into individualized education plans, educating school communities about CMC's unique COVID-19 risks, using medical equipment safely, maintaining curricular flexibility, ensuring masking and vaccination, assigning seats during transportation, and availability of testing and medical staff at school. CONCLUSIONS: Priorities for CMC, identified by statewide stakeholders, complement and extend existing recommendations. These priorities can guide implementation efforts to support safer in-person education for CMC.
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COVID-19/prevention & control , Infection Control/methods , Multiple Chronic Conditions , Safety , Schools , Adolescent , Adult , Child , Child Health , Consensus , Crowdsourcing , Female , Health Policy , Humans , Male , Middle Aged , Stakeholder Participation , Wisconsin , Young AdultABSTRACT
Purpose of Study Team science provides an opportunity to leverage a collaborative, cross-disciplinary approach to increasing diversity in academic faculty conducting clinical research. Black, Indigenous, People of Color (BIPOC) and women are underrepresented as academic medicine faculty and clinical researchers. We aimed to increase the participation of BIPOC and women in clinical research through intentional recruitment and determination of invidual team member's planned participation within an integrated research team. Methods Used A team investigating COVID-19 characteristics, readmissions, outcomes, and social determinants of health led by BIPOC women researchers was established in June 2020. BIPOC and women from specialties involved in the direct care of COVID-19 patients at eight metropolitan Atlanta hospitals and clinic practices were recruited. Specialties included infectious diseases, emergency medicine, hospital medicine, family medicine, and general internal medicine. Team members were of all medical school ranks and levels of research experience. A survey was conducted to collect team demographics and team members' desired level of participation. Respondents were asked to select their intended level of participation in each of the 5 following categories: data analytics, data collection, manuscript development, development/ poster presentation, and serving as a consultant. Each category had options of: none, 1-25%, 26-50%, 51-75%, and 76-100%. Summary of Results All 37 team members responded to the survey. 78.4% identified as BIPOC, 78.4% identified as women, and 62.2% identified as BIPOC women. In addition to English, 18 languages were spoken by team members. Academic affiliations included 81.1% Emory Healthcare/University School of Medicine, 10.8% Morehouse School of Medicine, 5.4% Kaiser Permanente of Georgia, and 2.7% Atlanta VA Medical Center. Medical school ranks represented among the team were 2.7% Professor, 16.2% Associate Professor, 32.4% Assistant Professor, 13.5% Learners (medical student or internal medicine residents), and 35.2% Other Roles (e.g. data analyst, advanced practice provider). The desired level of participation of respondents in the two categories that included >50% of time were in the following categories: 32.4% data collection, 29.7% manuscript development, 27.0% development/poster presentation, 16.2% data analytics, and 16.2% serving as a consultant. Conclusions Team science utilizing intentional recruitment and determination of invidual team members' planned participation in an integrated research team is an effective strategy to increase the pipeline of BIPOC and women clinical researchers. Our team created a unique mentorship (and peer mentorship) opportunity that resulted in multiple institutional, regional, and national poster and oral presentations, a successful intramural grant submission, development of three additional ancillary clinical research studies, and submission of three peer-reviewed manuscripts.
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In the current scenario, there is critical global demand for the protection of daily handling surfaces from the viral contamination to limit the spread of COVID-19 infection. The nanotechnologists and material scientists offer sustainable solutions to develop antiviral surface coatings for various substrates including fabrics, plastics, metal, wood, food stuffs etc. to face current pandemic period. They create or propose antiviral surfaces by coating them with nanomaterials which interact with the spike protein of SARS-CoV-2 to inhibit the viral entry to the host cell. Such nanomaterials involve metal/metal oxide nanoparticles, hierarchical metal/metal oxide nanostructures, electrospun polymer nanofibers, graphene nanosheets, chitosan nanoparticles, curcumin nanoparticles, etched nanostructures etc. The antiviral mechanism involves the repletion (depletion) of the spike glycoprotein that anchors to surfaces by the nanocoating and makes the spike glycoprotein and viral nucleotides inactive. The nature of interaction between the nanomaterial and virus depends on the type nanostructure coating over the surface. It was found that functional coating materials can be developed using nanomaterials as their polymer nanocomposites. The various aspects of antiviral nanocoatings including the mechanism of interaction with the Corona Virus, the different type of nanocoatings developed for various substrates, future research areas, new opportunities and challenges are reviewed in this article.
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Background: The availability of accurate, reliable, and timely clinical data is crucial for clinicians, researchers, and policymakers so that they can respond effectively to emerging public health threats. This was typified by the recent SARS-CoV-2 pandemic and the critical knowledge and data gaps associated with novel Coronavirus 2019 disease (COVID-19). We sought to create an adaptive, living data mart containing detailed clinical, epidemiologic, and outcome data from COVID-19 patients in our healthcare system. If successful, the approach could then be used for any future outbreak or disease. Methods: From 3/13/2020 onward, demographics, comorbidities, outpatient medications, along with 75 laboratory, 2 imaging, 19 therapeutic, and 4 outcome-related parameters, were manually extracted from the electronic medical record (EMR) of SARS-CoV-2 positive patients. These parameters were entered on a registry featuring calculation, graphing tools, pivot tables, and a macro programming language. Initially, two internal medicine residents populated the database, then professional data ors populated the registry. Clinical parameters were developed with input from infectious diseases and critical care physicians and using a modified COVID-19 worksheet from the U.S. Centers for Disease Control and Prevention (CDC). Registry contents were migrated to a browser-based, metadata-driven electronic data capture software platform. Eventually, we developed queries and used various business intelligence (BI) tools which enabled us to semi-automate data ingestion of 147 clinical and outcome parameters from the EMR, via a large U.S. hospital-based, service-level, all-payer database. Statistics were performed in R and Minitab. Results: From March 13, 2020 to May 17, 2021, 549,691 SARS-CoV-2 test results on 236,144 distinct patients, along with location, admission status, and other epidemiologic details are stored on the cloud-based BI platform. From March 2020 until May 2021, extraction of clinical-epidemiologic parameter had to be performed manually. Of those, 543 have had >/=75 parameters fully entered in the registry. Ten clinical characteristics were significantly associated with the need for hospital admission. Only one characteristic was associated with a need for ICU admission. Use of supplemental oxygen, vasopressors and outpatient statin were associated with increased mortality. Initially, 0.5hrs -1.5 hours per patient chart (approximately 450-575 person hours) were required to manually extract the parameters and populate the registry. As of May 17, 2021, semi-automated data ingestion from the U.S. hospital all-payer database, employing user-defined queries, was implemented. That process can ingest and populate the registry with 147 clinical, epidemiologic, and outcome parameters at a rate of 2 hours per 100 patient charts. Conclusion: A living COVID-19 registry represents a mechanism to facilitate optimal sharing of data between providers, consumers, health information networks, and health plans through technology-enabled, secure-access electronic health information. Our approach also involves a diversity of new roles in the field, such as using residents, staff, and the quality department, in addition to professional data extractors and the health informatics team. Initially, due to the overwhelming number of infections that continues to accelerate, and the labor/time intense nature of the project, only a small fraction of all patients with COVID-19 had all parameters entered in the registry. Therefore, this report also offers lessons learned and discusses sustainability issues, should others wish to establish a registry. It also highlights the registry's local and broader public health significance. Beginning in June 2021, whole-genome sequencing results such as lineages harboring important viral mutations, or variants of concern will be linked to the clinical meta-data.
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Background: Measures put in place to modify the COVID-19 infection rate, may have jeopardised typical end-of-life care values, focused on individual needs and preferences, such as the wish not to die alone. Aim: To understand bereaved relatives' perceptions about the dying experience during the pandemic. Methods: A national online survey, informed by patient and public involvement, was developed and disseminated via social media, public and professional networks (June - September 2020). Validated instruments and purposively designed questions were used to assess experiences. Analysis used descriptive statistics, logistic regression and thematic analysis of free-text responses. Results: Respondents (n=278) had a mean age of 53.4 years;216 (78.0%) were female and 174 (62.6%) were the 'child' to the deceased. Almost 70% of the deceased (mean age 80.5 years;160 (57.6%) female) died in their 'usual place of care' (home n=30 (10.8%);nursing home n=162 (58.3%)). Quantitative survey data and qualitative free-text responses indicated: public health restrictions compounded the distress of 'not knowing' (156, 56.5% were unable to visit during the dying phase of illness);greater confidence and trust in nursing staff compared with medical staff (81.6% vs 57.4%);lack of preparedness (19.9% didn't receive a meaningful explanation about their family members condition);the positive impact of compassionate leadership (176 (75.2%) perceived their family member died in the 'right' place);and unmet emotional needs (30.1% rated emotional support as 'poor'). Being a male respondent (OR 2.9, p=0.03) and being able to visit during the last days of life (OR 2.2, p=0.04) were independently associated with good perceptions of support. Conclusion: Promoting individualised care within an environment of public health restrictions can be enabled by proactive, regular, informative communication;local autonomy and decision-making;and facilitating the ability to be present before death.
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Healthcare consultations with adults are rightly focused on the needs and priorities of the presenting patient. Children are rarely brought to appointments, exacerbating the invisibility of a patient's wider family network and particularly relationships with children. This has become acutely evident during the COVID-19 pandemic due to visiting restrictions. Parental illness can have serious implications for children's psychological wellbeing and bring additional caring responsibilities for young people. It is therefore critical for the children of adult patients to be identified by healthcare staff so that they can be offered appropriate support. Moreover, effective communication with children about an important adult's illness has long term benefits for their psychological wellbeing and family functioning. Conversely, an absence of developmentally appropriate information can increase the risk of emotional and behavioural problems, including depression and anxiety. Global research has shown that children want and need to know when someone they love is ill. This information enables children to make sense of their observed reality and advocate for their own needs as carers. Healthcare professionals may feel uncertain about their role in identifying children of adult patients and how to raise these sensitive conversations. Medical staff report wanting specific guidance and training resources about navigating this aspect of care;these are not one-off conversations and need to be regularly reviewed, particularly in the context of changing care needs of parents and children's evolving understanding of illness and death during childhood.
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Background: The global COVID-19 pandemic is having a major impact on experiences of dying and death. Family members perceptions about the quality of care for dying individuals and their preparedness for death may influence their psychological adjustment in grief. Aim: To explore relatives' experiences and needs when their family member was dying during the COVID-19 pandemic to help inform current/ future clinical practice and policy. Design: Participants, who had responded to a national on-line COVID- 19 survey, were invited to participate. Semi-structured interviews were conducted (via telephone or video-call) with relatives whose family member died during the pandemic. Data were analysed thematically. Results: 19 participants (12 female, 7 male) reflected experiences of deaths within hospital and care home settings, with and without COVIDrelated illness. Three themes were identified: (1) entering the final weeks and days of life during a pandemic, (2) navigating the final weeks of life during a pandemic, and (3) the importance of 'saying goodbye' in a pandemic. In the absence of direct physical contact, it was important for families to have a clear understanding of their family member's condition, declining health and detailed, holistic information about their wellbeing. Staying virtually connected with them in the final weeks/days of life and having the opportunity for a final contact before death were fundamentally important. Health and social care professionals were instrumental to providing these aspects of care but faced practical challenges in achieving these. Conclusions: Health and social care professionals have an important role in mitigating the absence of relatives' visits at end of life during a pandemic. Strategies include prioritising virtual connectedness, ensuring holistic, individualised care updates and creating alternative opportunities for relatives to 'say goodbye'.
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Introduction: Post-operative pulmonary complications in perioperative SARS-CoV- 2 infection are associated with significant morbidity and mortality. To maintain a safe cancer service, the Countess of Chester Hospital adopted “Cold-site” operating and maintained ERAS principles for patients undergoing elective colorectal cancer surgery during the pandemic. A comparative assessment of service was undertaken for benchmarking purposes. Methods: A comparative retrospective audit was undertaken of consecutive patients undergoing elective colorectal cancer surgery from May to December 2019 and compared to May to December 2020. The Somerset Cancer Registry and electronic medical case records were used to obtain the data set. Outcomes measured were;approach to surgery;stoma rate;length of stay;level of care required;post-operative complications (>Clavien-Dindo 2) and survival at 30 days. Mann-Whitney U test and Chi-squared were used for analysis. Results: There were 44 and 50 elective colorectal cancer operations in 2019 and 2020 respectively. There was a significant difference in the median age (66:70;P = 0.03) but not in ASA grade (P = 0.14). The median length of stay was 5 and 4 days respectively (P = 0.06). There was a 17% reduction in laparoscopic approach to surgery in 2020 (57% vs 40%;P = 0.10). There was no difference in the stoma rate (P = 0.7), post-operative complication rate (P = 0.6), ITU admission rate (P = 0.14), length of ITU stay (P = 0.2) and 30-day mortality rates. Conclusion: “Cold-site” operating allows robust ERAS care to be adopted to ensure comparative outcomes for patients undergoing colorectal cancer surgery and was associated with a non-significant trend to shorter hospital stay during the COVID-19 pandemic.
ABSTRACT
CONTEXT: Hyperglycemic emergencies such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) and new-onset diabetes mellitus (DM) have been reported in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Hyperglycemia is a predictor of poor prognosis in COVID-19 disease. OBJECTIVES: The objective of this work is to describe a case series of HHS and/or DKA likely triggered by the COVID-19 vaccine. The aim is to alert physicians of the potential hyperglycemic complications from the COVID-19 vaccination and to provide further insight into the underlying mechanism of the bidirectional relationship between SARS-CoV-2 and DM. CASE DESCRIPTIONS: All 3 patients developed HHS and/or DKA within 2 to 10 days of the COVID-19 vaccination. PCR testing for SARS-CoV-2 was negative and other clinical precipitating factors were excluded. Two patients had a history of type 2 DM (T2DM) with pre-admission HbA1c levels of 7.0% to 7.5% while 1 patient was newly diagnosed with T2DM during the hospitalization. They were each treated with insulin infusion and were discharged on subcutaneous insulin therapy. Due to the rapid resolution of the hyperglycemia, insulin was discontinued in all patients within 8 weeks and they remain well-controlled on oral DM medications. CONCLUSION: Severe hyperglycemia including HHS and DKA may be triggered by COVID-19 vaccination. Early evaluation and screening of patients with hyperglycemic symptoms after COVID-19 vaccination is recommended. The vaccine-induced hyperglycemia may provide further insight into the underlying pathogenesis caused by the SARS-CoV-2 infection itself. The underlying robust inflammatory response and "cytokine storm" may be the primary precipitant.