Correlates of attitudes toward COVID-19-related public health policies and prevention practices in six states

Objectives: The COVID-19 pandemic rapidly impacted communities, however there is limited information about the beliefs, behaviors, and trust in government responses of populations across the country. It may be especially useful to understand state-based and regional differences that people reported early in the pandemic, to inform national and regional public health policies and communication strategies. This paper reports on correlates of perceptions of state and federal policies and prevention practices in six states with varying trajectories of COVID-19 cases and deaths, during the first major wave of the pandemic. Methods: A cross-sectional survey of COVID-19 policies, perceptions, and behaviors in six states (three in the northeast/mid-Atlantic and three in the southeastern United States), was conducted in April 2020 using an online platform of research volunteers. The survey asked about demographics;use of and belief about the effectiveness of preventive behaviors;experience with COVID-19 testing, diagnosis, quarantine, and hospitalization;risk behaviors and perception;opinion of local, state, and federal government guidelines and information;sources of information;and scales measuring time perspective and collectivism/individualism. Results: Responses from 1476 adults in six states showed that the most often-practiced prevention practices involved social distancing, and that reactions to federal government policies differed regionally and by political party affiliation. Conclusions: These findings improve understanding of how Americans view government responses to the pandemic, and their prevention practices, early in the pandemic. These data will help to create more effective public health policies to control the pandemic and achieve public support for control measures.

HEALTH RELATED SOCIAL NEEDS IN THE TIME OF COVID-19 AMONG ADULT MEN - NEEDS ASSESSMENT AND RESPONSE

BACKGROUND: Health care systems are screening patients for unmet social risk factors and needs though there is variation in patients' interest in receiving assistance from health care systems in response to identified social risk. Understanding this variation would allow health systems to respond to patients' social and health needs more effectively. Our objective is to report findings from a large community outreach effort spurred by the COVID-19 epidemic. This effort sought to identify and meet the needs of men in our community and close the loop by documenting connections with resources. METHODS: We surveyed adult men who had previously participated in at least one community-focused annual health fair in Cleveland, Ohio. In this descriptive cohort study, we spoke with men up to three times (i.e. phases) from May - October 2020 by email and phone. Phase 1 was a needs assessment survey. Phase 2 was to outreach to those who identified a need to provide a resource. Phase 3 was to determine whether the resource met the individuals' needs. We described the demographic characteristics of the survey respondents, the percentage of men reporting a need and wanting a resource. Finally, we report whether that resource resolved their need. RESULTS: Of the 768 individuals contacted for the needs assessment, 275 men who lived in the state of Ohio completed the survey (36% response rate). The majority of respondents were 50-69 years old, African American, had at least a bachelor's degree, were employed, had a health care provider and health insurance, and reported good or higher health status. Eighty-five percent identified food, employment, financial, or health needs. Wellness, financial, and health care access were among the top reported needs. Among those that identified a need, 35%(n=82) respondents were interested in a referral. The remaining respondents were not interested in a referral (n=51) or were not able to be reached (n=100). Among those referred for an employment need (n=17), 70% connected with a resource, but none reported the resource meeting their need. Similarly, men with behavioral health, oral health, vision, substance use disorder, or wellness needs also felt the referred resources did not meet their need. A handful of respondents reported having their personal hygiene/food, financial, health care access, annual health screening, and medication needs resolved. CONCLUSIONS: Our needs assessment found that the vast majority of respondents identified food, employment, financial, or health needs. However, only a fraction of men were interested in a referral to a resource, and far fewer connected with a resource that resolved his need. A greater understanding of the effectiveness of social need screening and referrals for social needs by healthcare systems is warranted.

Formalized Mentorship in Radiation Oncology: Bridging Existing Gaps in Mentorship

Purpose/Objective(s): The American College of Radiation Oncology (ACRO) Resident Committee offers a mentorship program to medical students, residents, and new practitioners. This program provides a unique opportunity to develop formal mentorship on a national level to bridge existing mentorship gaps. This abstract examined the perceived benefits of a formal mentorship program. Materials/Methods: All applicants provided demographic information and specific mentorship need requests. Pairings occurred periodically based on a personalized pairing process. This year, due to COVID-19, all sessions were held virtually. A questionnaire was designed in Google Forms based on the Society for Women in Radiation Oncology (SWRO) annual survey to evaluate the mentorship program. Data were collected and analysis was conducted using JMP version 15(SAS Institute Inc, Cary, NC). Results: Since June 2020, 78 individuals enrolled: 28 to become a mentor, 38 to become a mentee;12 were interested in both. The mentor group consisted of radiation oncology residents (47.5%), academic faculty (40%) and private practice physicians (12.5%). 57.5% of the mentors were males and 4% associated with the LGBTQI+ community. Geographic distribution of mentors: 40% Midwest, 27.5% South/Southeast, 15% Northeast, 12.5% West Coast and 5% international. Among resident mentors, 58% were Junior (PGY1-3) and 42% were senior (PGY4-5) residents. Among mentees, 50% were residents, followed by medical students (46%) and new practitioners (4%). There were equal number of males and females. The geographic distribution was: 32% Midwest, 22% South/Southeast, 36% Northeast, 2% West Coast, and 8% international. The distribution across residency training years was: 57% Junior (PGY1-3) and 43% Senior (PGY4-5). The survey was sent out in January 2021 and we currently have 29/78, 37% response rate. This survey showed the most common method of communication was email (59%), followed by video call (52%) and phone (48%). 62% had at least 2 interactions since being paired. Both parties set up the interactions in 59% of pairs, followed by mentees being responsible in 24%. Mentors reported experiencing mutual respect (94%), a personal connection (67%), clear expectations (44%), and shared values (44%). Mentees similarly reported mutual respect (94%), shared values (76%), a personal connection (59%) and clear expectations (47%). 96% had mentor/mentee relationship outside ACRO program;however, 62% felt that a formal program is more beneficial than informal opportunities. Conclusion: The results of our mentorship program highlight the continued interest and need for formal radiation oncology mentorship programs. The major strength of the program has been the high rates of interaction which is based on mutual respect, shared values and personal connection. Areas of future focus includes recruiting more new practitioners and private practice radiation oncologists to help enrich and diversify the mentorship program.

A machine learning platform to estimate anti-SARS-CoV-2 activities

Strategies for drug discovery and repositioning are urgently need with respect to COVID-19. Here we present REDIAL-2020, a suite of computational models for estimating small molecule activities in a range of SARS-CoV-2-related assays. Models were trained using publicly available, high-throughput screening data and by employing different descriptor types and various machine learning strategies. Here we describe the development and use of eleven models that span across the areas of viral entry, viral replication, live virus infectivity, in vitro infectivity and human cell toxicity. REDIAL-2020 is available as a web application through the DrugCentral web portal (http://drugcentral.org/Redial). The web application also provides similarity search results that display the most similar molecules to the query, as well as associated experimental data. REDIAL-2020 can serve as a rapid online tool for identifying active molecules for COVID-19 treatment. © 2021, The Author(s), under exclusive licence to Springer Nature Limited.

The impact of covid-19 on the UK severe asthma Population

Introduction Severe asthma patients were assumed to be at greater risk of morbidity from infection with the novel severe acute respiratory syndrome coronavirus (COVID-19), hence, in the UK, were advised to shield. Community data on COVID-19 infection in severe asthmatics is lacking. We assessed the burden of shielding, the impact of COVID-19 and the effect of asthma medication on the UK severe asthma population. Methods Adults previously consented to inclusion in the UK Severe Asthma Registry (UKSAR) across 14 centres were contacted in June 2020 to collect data on potential COVID-19 infection, asthma control and shielding. Electronic records, where available, were reviewed for confirmation. Data was combined with clinical data from the UKSAR. Univariate and multivariate logistic regression analyses were performed to identify risk factors for COVID-19 infection. Results 1365 patients were included. 1268 (93%) were advised to shield, 1131 (89%) patients who received shielding advice followed it. Men (OR 0.4, p=0.045) and those in non-shielding households (OR 0.27, p=0.001) were less likely to follow shielding advice. 544 (47%) of patients advised to shield reported worsening of mental health;females (OR 1.59, p=0.001) and those with history of anxiety or depression (OR 2.12 p=0.001) were at greater risk. 97 (7.1%) patients had suspected/confirmed COVID-19 infection, 19 (1.39%) PCR/serology confirmed infection, 13(0.95%) were hospitalised and 2 patients (0.15%) died (table 1). 918 (67%) were on biologic therapy, 515 (37%) maintenance oral corticosteroid (mOCS). Multivariate analysis showed neither biologic therapy (OR 0.73, p=0.165) nor mOCS (OR 1.18, p=0.427) increased the risk of COVID-19 infection. Patients on biologics were less likely to require an acute course of corticosteroids for asthma symptoms (OR 0.6, p=0.002) while patients on mOCS were more likely (OR 1.96 p£0.001). Inhaled corticosteroids (ICS) were not associated with COVID-19 infection, including high dose (2000 mcg BDP equivalent) (OR 0.64, p=0.234). Hospitalised patients were on lower median doses of ICS vs non-hospitalised patients (1000 vs 2000 mcg BDP equivalent, p=0.002). Conclusion Hospitalisation and death occurred in small numbers in our severe asthma population. From this observational data, biologic agents for asthma were not associated with increased risk of COVID-19 infection or hospitalisation.

Addressing COVID-19 health disparities through a regional community health response.

To combat racial/ethnic and socioeconomic health disparities associated with COVID-19 in our surrounding communities, the Cleveland Clinic Community Health & Partnership team developed a comprehensive program focused on connecting and communicating with local officials, faith-based organizations, and individual community members. Since March of 2020, our team has donated resources (e.g., personal protective equipment) to local organizations, referred thousands of community members to community or clinical resources, and partnered with federally-qualified health centers to support community COVID-19 testing. Future work will include the use of these networks to deploy the COVID-19 vaccine.

No change in patient outcomes for individuals admitted with upper gastrointestinal bleeding during the COVID-19 pandemic

Background and Aim: The aerosol-generating nature of gastroscopy has prompted a revision of endoscopic standard operating procedures during the coronavirus disease 2019 (COVID-19) pandemic, the health impacts of which are yet to be determined. Patient outcomes may be affected by restricted endoscopic services (50% reduction in activity in Melbourne, Victoria, performing elective category 1 and 2p procedures only), patient COVID-19 health questionnaires and screening, staffing availability, personal protective equipment changes, and health care worker-perceived exposure risk. Additionally, public fear of transmission has led to a reduction in non-COVID-19-related hospital presentations.1 Furthermore, a recent study found that patients presenting with upper gastrointestinal bleeding (UGIB) during COVID-19 had higher rates of hypotension and anemia, higher transfusion requirements, longer hospital lengths of stay, and lower rates of gastroscopy.2 We aimed to evaluate the impact of COVID-19 on presentation and outcomes in patients with UGIB at a single tertiary center in Melbourne. Methods: We conducted a retrospective cohort study of adult patients who presented to our tertiary center with hematemesis and/or melena over the 11-week period from 1 April to 17 June 2020, during the first lockdown period in Melbourne, when there were significant restrictions to endoscopic services (COVID-19 group). Presenting symptoms, comorbidities, laboratory results, hemodynamics, severity scores (Rockall, AIMS65, and Glasgow-Blatchford scores), and patient outcomes were evaluated and compared with those for patients presenting with UGIB during the same period in 2019 (2019 group). Patient outcomes included time to endoscopy, endoscopy procedure duration, endoscopic findings, rebleeding rate, inpatient and 30-day mortality, intensive care unit (ICU) admission, hemodynamic nadir, and transfusion requirements. Results: A total of 27 patients were admitted with UGIB during the COVID-19 period, compared with 25 in the preceding year. Patients in the COVID-19 group were younger (P = 0.05), but baseline demographics, comorbidities, and anticoagulation use were otherwise similar between the two groups. Patients in the COVID-19 group were more likely to present with hematemesis (P < 0.01) and less likely to present with melena (P = 0.02). Platelet count and albumin levels were significantly lower in the COVID-19 group compared with the 2019 group (P = 0.05);laboratory results and hemodynamics were otherwise similar between the two groups at presentation. Rockall, AIMS65, and Glasgow-Blatchford scores were also similar. Both groups were equally likely to receive gastroscopy. Etiology of UGIB at endoscopy was similar. Transfusion requirement, nadir hemoglobin level, and rebleed rates were similar between the two groups, although a subgroup analysis of those swabbed for COVID-19 showed a greater reduction in hemoglobin level compared with the 2019 group (P = 0.03). There were no differences in ICU admissions, inpatient and 30-day mortality, or length of stay. There was a non-significant trend towards longer anesthetic preparation time for the COVID-19 group, but endoscopic procedure length was similar in the two groups. This was also similar in the subgroup analysis of the six patients who were swabbed for COVID-19 during their UGIB admission. Conclusion: Our study showed that patients were more likely to present with hematemesis than melena and that hemoglobin reduction was significantly greater during COVID-19 than in the preceding year. However, measures of severity at presentation, ICU admission, endoscopic findings, and patient outcomes, including timing to endoscopy, length of hospital stay, and mortality, were similar. Our data suggest that the imposed restrictions to endoscopic services and general public concerns about COVID-19 did not adversely affect patient outcomes during the first COVID-19 wave. This is in direct contrast to the findings of a study in New York City, an epicenter of the global COVID-19 pandemic, which reported signi icantly worse patient outcomes during COVID-19,2 and suggests that COVID-19 inpatient burden may be the primary driver accounting for these findings. At the time of writing, Melbourne is amid a second and far more serious wave of COVID-19, with more than six times the daily confirmed case rate necessitating a more stringent lockdown period. Data will be updated to include and contrast this second lockdown period and will be presented at Australian Gastroenterology Week.

Silver lining of a very dark cloud: Telehealth virtually perfect in the COVID-19 era

Background and Aim: Public hospital outpatient departments are a critical interface between acute and specialist hospital services and primary care. Failure of patients to attend is an expensive and persistent issue worldwide, with reported did-not-attend (DNA) rates of up to 30% in some centers. Non-attendance is influenced by many factors, such as logistics in getting to the hospital, work commitments, financial hardship, transportation access, and competing health interests. Telehealth has been available for some years, but its implementation and uptake have been limited. Telehealth is defined as “information and communications technologies to deliver health and transmit health information over both long and short distances,”1 and it can be conducted via videoconferencing or telephone. It represents an attractive model to increase outpatient clinic appointments, which is important given the long waiting times for many clinics. Telehealth also provides avenues to continue critical outpatient management during the coronavirus disease 2019 (COVID-19) pandemic and for ongoing clinical management for furloughed or isolated staff who can still be engaged in outpatient care. At our institution, the COVID-19 pandemic stimulated the immediate and almost universal implementation of the telehealth model of care for outpatient appointments. We aimed to evaluate the experience of the telehealth model in the first 3 months of the COVID-19 pandemic in Victoria, focusing on the impact of telehealth on the number of scheduled appointments and clinic DNA rates. Methods: Over a 9-week period during the first COVID-19 lockdown in Melbourne, scheduled appointment numbers and patient attendance rates at 13 gastroenterology and hepatology outpatient clinics at a single tertiary hospital were evaluated through the hospital's online patient administration system, following rapid implementation of the telehealth model of outpatient care. Appointment numbers and attendance were compared with the average attendance rate over the same period in the preceding 5 years. Data collected included patient DNA rates for every scheduled clinic and appointment type (videoconferencing, telephone, or face-to-face consultation). Results: A total of 2626 outpatient clinic appointments were scheduled during the first 9-week COVID-19 lockdown, with 2237 appointments (85%) attended and 389 DNAs (15%), an improvement of 2.2% in attendance rate compared with the average attendance rate during the same 9-week period in the preceding 5 years (P = 0.035). Of the 2626 appointments, 1319 (50%) were video consultations, and 1307 (50%) were telephone consultations. In the preceding 5 years, an average of 2304 outpatient clinic appointments (322 fewer appointments) were scheduled during the same 9-week period, with 1912 appointments (83%) attended and 392 (17%) not attended. Of these 2304 appointments, 2271 (99%) were face-to-face consultations and only 33 (1%) were video consultations. Attendance rates differed according to clinic type. Compared with previous years, outpatient clinics with significantly lower DNA rates during COVID-19 included combined general gastroenterology (15% vs 20%, P = 0.014), satellite inflammatory bowel disease (2% vs 10%, P = 0.033), satellite liver clinic (20% vs 28%, P = 0.198), and privatized liver clinic (13% vs 18%, P = 0.051). Clinics with higher numerical DNA rates included hepatoma (18% vs 12%, P = 0.731) and weight management (20% vs 15%, P = 0.343). When evaluating the appointment type, we found that consultations carried out by telephone resulted in a significantly lower DNA rate, compared with video consultations (9% vs 21%;P < 0.001). Furthermore, an additional 37 clinic lists occurred during this 9-week period, equivalent to four additional lists per week, compared with the average number in the preceding 5 years. Conclusion: Despite the upheaval of clinical services during the COVID-19 pandemic, the major and rapid systems change to overhaul outpatient clinics to an almost exclusively telehealth model was highly succes ful. A total of 1319 video consultations occurred during the 9-week period, compared with just 43 in the preceding year, demonstrating the rapid and widespread implementation of telehealth. Importantly, there was a significant overall reduction in DNA rates, by 2.2%, using the telehealth model. Phone calls were particularly effective for clinic consultations, with DNA rates of only 9.0%. Telehealth has the potential to improve outpatient clinic attendance and efficiency, and our data strongly advocate for ongoing support for telehealth models, including both video and telephone consultation, beyond the COVID-19 era.

Virtually perfect? High patient satisfaction and reduced work absenteeism using a telehealth model of inflammatory bowel disease care during the coronavirus pandemic

Background and Aims: With an emphasis now on treat to target care in inflammatory bowel disease (IBD) and a focus on strict control of inflammation, IBD management has become more dynamic, and regular monitoring is required to optimize care. This can be burdensome for patients;faceto- face clinic appointments often require absenteeism from work, which can create barriers to accessing care. In the setting of the coronavirus 2019 (COVID-19) pandemic, much of outpatient IBD care has rapidly transitioned to a telehealth model. Our aims were to (i) assess patient satisfaction with the telehealth platform for IBD appointments in the COVID-19 period;(ii) review the failure to attend clinic rates for telehealth appointments during COVID-19, compared with a similar period before COVID-19;(iii) review rates of work absenteeism among patients attending telehealth appointments during COVID-19, compared with a similar period before COVID-19;and (iv) explore patients' beliefs with respect to the safety of their immunomodulatory (IM) therapy in the COVID-19 era, whether they could be reassured by nursing or medical staff with respect to the risks of IM treatment during the COVID-19 pandemic, and their adherence to IM therapy. Methods: At a large tertiary IBD center in Melbourne, Australia, patients with IBD who had attended a scheduled IBD telehealth clinic via video link or phone call from April to June 2020 were invited, via text message, to participate in a web-based survey (ethics approval: QA 20056). The 15-question survey assessed patient satisfaction, concerns, and behavior regarding their treatment and the impact of telehealth clinic appointments on patients' working schedules. The questions regarding patient satisfaction were modeled on the validated Short Assessment of Patient Satisfaction questionnaire. Results: A total of 483 patients were invited to participate in this survey, and 86 have so far completed the survey. Of these, 76 patients (92%) were either satisfied or very satisfied with the treatment they have received, 74 (88%) were satisfied or very satisfied with the health counseling they received, and 74 (88%) agreed or strongly agreed that they had a thorough assessment. There were 69 patients (84%) who were either satisfied or very satisfied with the overall care they received during their telehealth appointment. Failure-to-attend rates were similar for telehealth appointments during the COVID-19 pandemic and for standard appointments during the same period before COVID-19 (10.5% vs 11.4%). Seventeen patients (20%) needed to take time off work to attend a telehealth appointment, compared with 55 (64%) who would previously have taken time off work for a traditional face-to-face clinic appointment. We found that 47 patients (55%) were concerned that their IM therapy put them at increased risk of COVID-19 infection, but most (98%) did not make any alterations to their therapy without the advice of our IBD unit, despite their concerns. After advice received from our IBD unit, most patients (42, 69%) who were concerned about their IM use could be reassured. Conclusion: In this study, patients report high levels of satisfaction with telehealth for their IBD care during the COVID-19 pandemic. This model of care was not associated with a higher rate of clinic non-attendance. Telemedicine reduced work absenteeism when compared with traditional face-to-face clinic appointments. A significant proportion of patients with IBD had concerns about their IM use during the COVID-19 pandemic, but most could be reassured after specialist nursing or medical consultation. We would encourage health providers and payors to consider the expansion of telemedicine beyond the COVID-19 pandemic as an acceptable way of delivering clinic care, and one that is associated with reduced work absenteeism compared with traditional face-to-face outpatient models of care.

S25 The impact of COVID-19 on the UK severe asthma population

S25 Table 1Characteristics of severe asthma patients with suspected or confirmed mild (ambulatory) or severe (hospitalised) COVID-19 infection Mild COVID-19 (n=84)Hospitalised with COVID-19 (n=13)p-valueAge (Years) (mean [SD])50.5 (13.8)55.6 (13.7)0.215Male Gender (n [%])39 (46.4%)4 (30.8%)0.290BMI (kg-m2) (mean [SD])31.3 (6.3)31.3 (4.9)0.967Non-Caucasian Ethnicity (n [%])15 (17.9%)3 (25.0%)0.553Atopic Disease (n [%])48 (62.3%)10 (76.9%)0.310FEV1% Predicted (mean [SD])67.9 (59.9,82.8)73.7 (60.1,84.8)0.555ICS Dose (BDP equivalent-ug) (median [IQR])2000 (1600,2000)1000 (800,1600)0.002On Maintenance OCS (n [%])35 (47.9%)3 (23.1%)0.872Evidence of Poor Adherence (n [%])18 (24.7%)7 (53.8%)0.033Maintenance Macrolides (n [%])7 (9.9%)2 (16.7%)0.428On Asthma Biologic (n [%])57 (67.9%)8 (61.5%)0.652Shielding against COVID-19Followed Shielding Advice (n [%])64 (84.2%)9 (90.0%)0.631Shielding affected mental health (n [%])33 (46.5%)5 (50.0%)0.835Contracted COVID-19 Before Shielding (n [%])40 (60.6%)4 (40.0%)0.219ConclusionHospitalisation and death occurred in small numbers in our severe asthma population. From this observational data, biologic agents for asthma were not associated with increased risk of COVID-19 infection or hospitalisation.

COVID-19 induced liver function abnormality

Background: Coronavirus disease 2019 (COVID-19) is a novel infectious disease that may cause fever, dry cough, fatigue and shortness of breath The impact of COVID-19 on liver function is not well described Methods: The Second People's Hospital of Fuyang City in China has admitted a total of 159 patients with confirmed COVID-19 since the outbreak from January 2020 to March 2020 We analyzed the incidence of liver function test (LFT) abnormality in these patients with confirmed COVID-19 infection. Results: We found that the overall frequency of LFT abnormality was 17.6%. Frequency of LFT abnormality was significantly greater in patients with severe/critical (SC) COVID-19 compared to those with mild/moderate (MM) COVID-19 (32 4% vs 11 6%, p=0 011) Among patients with LFT abnormality, the median age was significantly higher in the SC group compared to the MM group (52 vs 39 years, p=0 021) Conclusion: COVID-19 is frequently associated with mild liver function abnormality, particularly in individuals with severe/critical COVID-19 who were older Liver function should be monitored carefully during infection, with judicious use of hepatotoxic agents where possible and avoidance of prolonged hypotension to minimize liver injury in older patients.