COVID-19 HYPERINFLAMMATION CAN BE PREDICTED USING ROUTINE CLINICAL LABORATORY MARKERS

Background/Aims Since early in the COVID-19 pandemic, there has been interest in the concept that some morbidity and mortality may be due to excessive inflammation. Several definitions of COVID-19 hyperinflammation COV-HI) have been proposed, including Manson criteria (C-reactive protein, CRP ≥150mg/L or doubling above 50mg/L in 24 hours and/or ferritin 1500ug/L);and Webb criteria (includes CRP ≥150mg/L or ferritin ≥750ug/L). A consistent finding has been worse outcomes. Little is known regarding the underlying pathologies separating these patients from others. Aim To investigate whether machine learning using standard laboratory features can identify a distinguishing 'COV-HI signature'. Methods A database of daily clinical and laboratory features was collected from 611 patients admitted to hospital with confirmed COVID-19 during the first wave of community-acquired infection at University College London Hospitals, Sheffield Teaching Hospitals, Newcastle upon Tyne Hospitals and Royal Wolverhampton. All data prior to mechanical ventilation were interrogated. Patients were categorised as COV-HI based on Webb thresholds (CRP >150 mg/L or ferritin ≥750ug/L). Laboratory features (peak or nadir depending on recognised predictors of illness severity) included: minimum lymphocyte count 10

Detectability of COVID-19 global emissions reductions in local CO2 concentration measurements

It is estimated that global anthropogenic carbon dioxide (CO2) emissions reduced by up to 12% at the start of 2020 compared to recent years due to the COVID-19 related downturn in economic activity. Despite the large decrease in CO2 emissions, no reduction in the trend in background atmospheric CO2 concentrations has been detected. So, how long would it take for sustained COVID-19 CO2 emission reductions to be detected in daily and monthly averaged local CO2 concentration measurements? CO2 concentration measurements for five measurement sites in the UK and Ireland are combined with meteorological numerical weather prediction data to build statistical models that can predict future CO2 concentrations. It is found that 75% of the observed daily variability can be explained by these simple models. Emission reduction scenario experiments using these simple models illustrate that large daily and seasonal variability in local CO2 concentrations precludes the rapid emergence of a detectable signal. COVID-19 magnitude emissions reductions would only be detectable in the daily CO2 concentrations after at least 38 months and in monthly CO2 concentrations after 11 months of sustained reductions. For monthly CO2 concentrations the time of emergence is similar for all sites since the seasonal variability is largely driven by non-local fluxes of CO2 between the terrestrial biosphere and the atmosphere. The COVID-19 CO2 anthropogenic emissions reductions are similar in magnitude to those that are required to meet the Paris Agreement target of keeping global temperatures below 2 degrees C. This study demonstrates that, using measurements alone, there will be a considerable lag between changes in global anthropogenic emissions and a detected signal in local CO2 concentration trends. Thus, there is likely to be a delay of several years between changes in policy designed to meet CO2 anthropogenic emissions targets and our ability to detect the impact of these policies on CO2 concentrations using atmospheric measurements alone.

“I Can’t Give Up When I Have Them to Care for”: People’s Experiences of Pets and Their Mental Health

Contact with animals has been increasingly recognized as being beneficial to mental health and wellbeing due to their therapeutic function, with “animal-assisted therapies” gaining in popularity. There is less research exploring how companion animals within the home impact upon mental health and wellbeing. This qualitative study explores people’s experiences of the role of their pets in reducing or exacerbating their mental health symptomology and general wellbeing. One hundred and nineteen adults, 41 with a diagnosed mental health condition, and 70 recently struggling with their mental health, completed an online survey with open and closed questions to explore their experiences of their pets and mental health. Through thematic analysis, seven key themes were identified. Six themes encompassed benefits of pets;increased hedonic tone;increased motivation and behavioral activation;reduced anxiety symptoms and panic attacks;increased social connections and reduced loneliness;reduced risk behaviors;and coping and aiding the recovery process. One theme encompassed negative impacts: increased negative feelings and emotional strain. Notably, pets reduced urges of self-harm, and prevented onsets of panic attacks and suicide attempts. Both direct mechanisms (e.g., lowering physiological anxiety through physical touch) and indirect mechanisms (e.g., elevating mood through humor, increased mindfulness and disrupting rumination) were identified. These findings encapsulate the complex roles that pets can play in people’s mental health and wellbeing, and highlights that even when the human–pet relationship is regarded positively, pets cannot “treat” mental health difficulties, and should not be viewed as such. Mental health practitioners should be aware and considerate of the importance of pets in people’s lives as well as individual differences in the potential capability of pets to both reduce or exacerbate mental health symptomology and overall wellbeing.

Insights into creating a virtual patient andpublic involvement initiative

Background/AimsPatient and public involvement (PPI) initiatives are important to ensurepatient-centered research. However, traditional focus groups canpresent challenges including the recruitment and retention of patientpartners. Additional challenges to patient involvement have also arisendue to the coronavirus pandemic (COVID-19). The University CollegeLondon (UCL) Patient Partners in Rheumatology Research initiativehas been developed to explore novel ways to boost patientinvolvement and foster an active collaboration between basicresearchers and patient partners.MethodsTwo online surveys were designed to obtain information with regardsto the expectations and practicalities of this initiative. One survey wassent to patients who had registered an interest in being patientpartners and the other survey to rheumatology researchers at UCL andUniversity College London Hospital (UCLH).ResultsWe received responses from 25 researchers and 21 patients. Themajority of patients who responded (71%) had not previously beeninvolved in PPI. Most of the researchers (84%) had previously utilisedPPI, however 20% of those had some difficulty accessing it.Most patients (86%) were interested in becoming a patient partner.Amongst those with reservations, one stated that ''I don't think I havethe qualifications to be involved with scientists and researchers''. Overhalf of patients (52%) were happy to participate in PPI more than fivetimes a year and most researchers (84%) expressed that five times ayear was acceptable. Patients favoured (52%) conducting PPI meetings after office hours (5-8pm) during the working week. Due to socialrestrictions because of COVID-19, we asked both patients andresearchers their preferred mode of meeting. Both groups favoureda mixed (virtual and face to face) meeting arrangement (81% forpatients and 68% for researchers). A third of patients (38%) expressedthat they would need technical assistance accessing a virtual meeting.Almost all patients (95%) were happy to contribute to lay summaryreviews remotely via email.ConclusionBased on the insights gained from the survey results, our PPI initiativemeetings will be hosted in a hybrid virtual/face to face format. Thesewill be held at a time and frequency that is convenient for the patientpartners to increase participation across wider demographics. Thissurvey has highlighted that we have to be mindful of certain patientperceptions of PPI which creates a barrier to patient involvement andthat some individuals may require further support in accessing virtualmeetings. By designing a PPI initiative that creatively addressed theneeds of both the researchers and patient partners we hope to createa platform for productive dialogue and collaboration to ensure patientcentred research, despite the changes brought about by the COVID-19 pandemic.