Employability and ‘Marginal Efficiency’ of Labour in Post-COVID Economy

COVID-19-induced lockdown resulted into a differential impact and the most vulnerable among them are the labour. State is ineffective in preventing income and livelihood loss of the workers. Higher supply and lower wages resulted in a huge reserve labour force in developed and developing countries. The employer in a post-COVID economy is going to be highly selective and labour market also would be selective to labour. The labour is going to be free to move, however, the freedom of labour to move does not ensure better employability. This article explains about employability in the post-COVID economy.

Immunogenicity of Covid-19 vaccination in patients with myelodysplastic syndromes

Many patients with haematological cancers remain incompletely protected from SARS-CoV-2 following two doses of vaccine with Pfizer-BioNTech BNT162b2 nCoV-19 or ChAdOx1. Myelodysplastic syndrome (MDS) represents a spectrum of clonal bone marrow neoplasms. The response of patients with MDS to the COVID-19 vaccines remains unknown. Here, we report the humoral and T-cell responses of patients with low-and high-risk myelodysplastic syndrome (MDS), 2 weeks following completion of the second-dose schedules of ChAdOx1 or BNT162b2 nCoV-19 vaccines. Patients with MDS ( n = 38) followed up at Kings College Hospital, London were vaccinated with either BNT162b2 mRNA or ChAdOx1 nCoV-19 vaccine. Written informed consent was provided. Eligibility criteria included the diagnosis of MDS as per the WHO classification and age ≥18 years. Healthy volunteers (HV;n = 30) served as a reference group. Blood samples were collected 2 weeks after the second vaccine dose. Plasma samples were tested for SARS-CoV-2-specific antibody aimed at the SARS-CoV-2 spike (S) protein receptor-binding domain and neutralisation assays against pseudotypes with SARS-CoV-2 Wuhan strain (WT), VOC.B.1.1.7 (alpha) or VOC.B.1.617.2 (delta) Spike. Cellular responses were assessed using IFNγ ELISPOT and flow cytometry (CD25 and CD69 expression) after 24 h peptide stimulation. IFNγ ELISpot analysis was performed ex vivo for assessment of T-cell response. 32% of the MDS patients received BNT162b2 and 58% received ChAdOx1 nCoV-19 vaccines. All HV received BNT162b2. Overall serological responses were as follows: HV BNT162b2 100% (26/26);MDS BNT162b2 100% (15/15) and MDS ChAdOx1 76.2% (16/21). Notably, the MDS ChAdOx1 cohort demonstrated significantly decreased serological titres to the MDS BNT162b2 cohort. The functional implications of seroconversion were assessed by neutralisation assays for SARS-CoV-2 WT and VOC alpha and delta. All but four MDS patients could neutralise all variant strains, but MDS cohorts showed significantly reduced median neutralisations for all three variant strains compared to HV. Five MDS ChAdOx1 patients who did not have a serological response were able to mount T-cell responses. Additionally, treatment with either azacytidine or calcineurin inhibitor cyclosporin did not impair appropriate T-cell responses. The numbers of individuals who were both serological and T-cell responders were as follows: HV 95% (20/21), MDS BNT162b2 71.4% (10/14) and MDS ChAdOx1 52.9% (9/17). Overall serological responses in the MDS cohorts were 100% for those who had completed the two-dose BNT162b2 vaccine schedule compared to 76.2% of patients vaccinated with the ChAdOx1 vaccine. It may be advisable that MDS patients are boosted with an mRNA-based vaccine to promote enhanced immunity in this specific population. We observed that neutralisation in seroconverted patients was significantly weaker for both the ChAdOx-1 and BNT162b2 MDS cohorts compared to HV. This highlights the continued need for a third primary dose for this clinically vulnerable patient group and our further work will analyse the cohort's response to this.

SCOPING REVIEW OF THE IMPACT OF COVID-19 ON ASSESSMENT FORMAT IN MEDICAL AND DENTAL INSTITUTES

Objective: Technology enhanced assessment or e-assessment is an emerging approach across the globe and is adapted by almost all medical and dental institutes. The objective of this study is to report on effects of COVID-19 on assessment format of medical institutes. This review seeks to find which methods are being used for a changed assessment format and who is being affected by sudden change in assessment format and what facilitators and/or barriers have been reported related to the success and/or failure of changed assessment format. Material qnd Methods: This scoping review followed the methodology outlined by Arksey and O’Malley framework (2005). Data sources including PubMed, Eric, Medline, Semantic scholar and Google scholar were searched for the last 5 years of articles (from 2016 to 2021) related to e-assessment in medical education. Results: In total, 9 articles met our inclusion criteria. Open book examination was considered to be a new normal keeping in mind its strengths and advantages in an online format. Digital literacy plays an important role in the acceptance of technology enhanced assessment. Faculty needs training to opt for this sudden change in teaching and assessment format. Connectivity issues need to be taken care of, as the whole format depends upon it. Conclusion: e-assessment was well accepted by most of the students. Future studies should target students inconvenience for online assessment. Also lack of e-learning experience of some staff need attention. Insufficiency of IT technicians should be overcome. High speed internet is the requirement of the day. New software can be developed for a more reliable and valid assessment method.

Clinical and demographic characteristics associated with shorter time to COVID-19 death

Introduction: Cancer patients have been considered a high-risk population in the COVID-19 pandemic. We previously investigated risk of COVID-19 death in COVID-19 positive cancer patients during a median follow-up of 134 days, and identified the following risk factors: male sex, age >60 years, Asian ethnicity, hematological cancer type, cancer diagnosis for >2.5 years, patients presenting with fever or dyspnea, and high levels of ferritin and C-reactive protein (CRP). Here, we further investigate which factors are associated with a COVID-19 related death within 7 days of diagnosis. Methods: Using data from Guy's Cancer Centre and one of its partner trusts (King's College Hospital), we included 306 cancer patients with a confirmed COVID-19 diagnosis (February 29th-July 31st 2020). 72 patients had a COVID-19 related death (24%) of whom 35 died within 7 days (50%). Cox proportional hazards regression was used to identify which factors were associated with a COVID-19 related death <7 days of diagnosis. Results: Of the 72 cancer patients who had a COVID-19 related death, the mean age was 72 years (Standard Deviation (SD) 14). A total of 53 (74%) patients were men. 37 (52%) had a hematological cancer type, 47 (65%) had stage IV cancer, and 42 (58%) had been diagnosed with cancer more than 24 months before COVID-19 related death. In the group of patients who died within 7 days of diagnosis (n= 35), mean age was 73 years (SD 13.96), 24 (68%) were men, 20 (57%) had a hematological cancer type, 26 (74%) had stage IV cancer, and 24 (68%) had been diagnosed with cancer >24 months before COVID-19 diagnosis. Factors associated with COVID-19 related death <7 days of diagnosis were: hematological cancer (Hazard Ratio (HR): 2.74 (95% Confidence Interval (CI): 1.21-6.22)), 2-5 yrs since cancer diagnosis (HR: 4.81 (95%CI: 1.47-15.69)), and >5 yrs since cancer diagnosis (HR: 4.41 (95%CI: 1.38-14.06)). Additionally, patients who presented with dyspnea had increased risk of COVID-19 related death <7 days compared to asymptomatic patients (HR: 5.25 (95%CI 2.14-12.89)). CRP levels in the third tercile (146-528 mg/L) as compared to the first were also associated with increased risk of an early death due to COVID-19. Conclusion: From all the factors identified in our previous COVID-19 related death analysis, only hematological cancer type, a longer-established cancer diagnosis (2-5 years and more than 5 years), dyspnea at time of diagnosis and high levels of CRP were indicative of an early COVID-19 related death (within 7 days of diagnosis) in cancer patients.

Immunogenicity of Covid-19 Vaccination in Subjects with Myelodysplastic Syndromes

Myelodysplastic syndromes (MDS) represent a spectrum of clonal bone marrow neoplasms from low risk disease through to those transforming into acute myeloid leukaemia. The COVID-19 pandemic has presented a great risk to those with hematological malignancies who are at higher risk of severe disease and death than the general population. Previous studies looking at the immune response to influenza vaccination in those with MDS had shown promising results, with immune responses not differing from those of healthy family members. Whilst some data exist to reassure the MDS community that majority of patients show seroconversion following Covid-19 vaccination, little data exists on their neutralizing capacity or post vaccination T-cell responses in this cohort. In addition, the majority of patients in these studies received BNT162b2 and there is little published data on vaccine response to the ChAdOx1 nCoV-19 vaccine. We have investigated the humoral and T-cell response of 39 patients with MDS two to four weeks following Covid-19 booster vaccination with BNT162b2 or ChAdOx1 nCoV-19 through the SOAP study (Sars-cov-2 fOr cAncer Patients, IRAS project ID:282337). Plasma and PBMCs from MDS cases and healthy controls have been collected, and are being assessed for both humoral and cellular responses to SARS_CoV_2, the alpha (B.1.1.7) and delta (B.1.617.2) variants. Humoral responses will be assessed using ELISA (peptide binding) and functional viral neutralization assays. Cellular responses will be assessed using IFNy ELISPOT and flow cytometry (CD25 and CD69 expression) after 24h peptide stimulation. All data at time point 1 (2 - 4 weeks following booster vaccination) have been collected and will subsequently be collected at 6 months and 12 months post-vaccination. We also report on the safety data for these vaccines within this patient population. Of this cohort 64% were male with a median age of 65 years (range 21-84). 54% received vaccination with ChAdOx1 nCoV-19 and 44% received BNT162b2 (2% unrecorded). The vaccines were well tolerated with no serious adverse events to date. The mean interval between doses was 70.7 days (range 50 - 90 days). 71% of the cohort were receiving no disease modifying therapy at the time of vaccination, half of whom were receiving supportive therapy and the other half no intervention for their MDS. Of those receiving disease modifying therapy;5 were receiving azacitidine, (1 in conjunction with low-dose cytarabine) and 3 ciclosporin. We will report the largest study of the humoral and T-cell mediated response to the Covid-19 vaccine in MDS patients to date. This will include cellular response to the delta variant and immunogenicity of both the BNT162b2 and ChAdOx1 nCoV-19 vaccines. Given the vulnerability of these patients to severe disease, investigating the immune response to the vaccines begins to build an evidence base for advising MDS patients on their ongoing risk of infection during the pandemic and going forward. The SOAP study will reassess the immune response at 6 and 12 months post-vaccination to continue to investigate post-vaccine immunity in this cohort. Disclosures: Kulasekararaj: F. Hoffmann-La Roche Ltd.: Consultancy, Honoraria, Speakers Bureau;Apellis: Consultancy;Akari: Consultancy, Honoraria, Speakers Bureau;Biocryst: Consultancy, Honoraria, Speakers Bureau;Achilleon: Consultancy, Honoraria, Speakers Bureau;Alexion: Consultancy, Honoraria, Speakers Bureau;Ra Pharma: Consultancy, Honoraria, Speakers Bureau;Amgen: Consultancy, Honoraria, Speakers Bureau;Novartis: Consultancy, Honoraria, Speakers Bureau;Celgene: Consultancy, Honoraria, Research Funding, Speakers Bureau;Alexion, AstraZeneca Rare Disease Inc.: Consultancy, Honoraria, Other: Travel support. Patten: JANSSEN: Honoraria;NOVARTIS: Honoraria;GILEAD SCIENCES: Honoraria, Research Funding;ROCHE: Research Funding;ASTRA ZENECA: Honoraria;ABBVIE: Honoraria.

Factors influencing outcome in COVID-19 patients requiring respiratory support – A single centre experience from West Midlands

P213 Table 1 CPAP survived CPAP Deceased P value Age 62 77 0.000004* BMI 33 28.7 0.001* CFS 4.3 4.7 1.98 CRP 89 136 0.004* D Dimer 1.7 3.6 0.18 Troponin 325 125 0.19 Time to start RS (days) 2 2.9 0.10 Length of stay(days) 13.4 12.1 0.42 Days on RS (days) 8.4 7.2 1.98 *p < 0.05 = statistically significantDiscussionAge, high CFS, and poor compliance with CPAP is associated with higher mortality in COVID 19 related ARDS. Further studies are needed to assess impact of troponin and D Dimer on COVID related ARDS outcomes.

Recent advances in the knowledge of coronaviruses with special emphasis on severe acute respiratory syndrome coronavirus 2 (Sars-cov-2)

COVID-19 continues to pose a global public health emergency several months after the first cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (then referred to as novel coronavirus [2019-nCoV]) infection were reported in Wuhan, China. Starting off as local infection, it has now affected most countries devastatingly while taking its toll on millions of people. So far, clinicians and researchers have derived biological understanding and treatment designs to tackle COVID-19 from the recently learned lessons during similar epidemics caused by coronaviruses, namely, SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV). However, COVID-19 has transformed into a pandemic surpassing the previously reported epidemics and requires a targeted therapy approach in addition to synchronized preventive measures. With the advent of new knowledge and developments on the subject of SARSCoV-2 almost every day, an update to the biological understanding of coronaviruses is necessary as well. This article presents a comprehensive review of SARS-CoV-2 biology, COVID-19 epidemiology, and therapeutic approaches for patients along with the major issues of concern. We cover the structure and infection mechanism of SARS-CoV-2 known till date, along with the common pathological findings and immune responses in patients. We also review the patterns of disease epidemiology in India and worldwide, the current therapeutic modalities as well as the possible strategies of prophylaxis and treatment that may be used for COVID-19 patients in the near future. Finally, we discuss a few challenges put forth by this pandemic in a developing country like India which need to be addressed immediately. © 2021 Irshad, et al.

Factors affecting COVID-19 outcomes incancer patients: A first report from Guy's Cancer Centre inLondon

Background: Current precautionary management decisions being made for cancer patients are based onassumptions supported by limited evidence, based on small case series from China and Italy and larger series fromNew York and a recent consortium of 900 patients from over 85 hospitals in the USA, Canada, and Spain. Hence, there is insufficient evidence to support clinical decision-making for cancer patients diagnosed with COVID-19 dueto the lack of large studies. Methods: We used data from a single large UK Cancer Centre to assess demographic/clinical characteristics of 156cancer patients with a confirmed COVID-19 diagnosis between 29 February-12 May 2020. Logistic/Cox proportionalhazards models were used to identify which demographic and/or clinical characteristics were associated withCOVID-19 severity/death. Results: 128 (82%) presented with mild/moderate COVID-19 and 28 (18%) with severe disease. Initial diagnosis ofcancer >24m before COVID-19 (OR:1.74 (95%CI: 0.71-4.26)), presenting with fever (6.21 (1.76-21.99)), dyspnea(2.60 (1.00-6.76)), gastrointestinal symptoms (7.38 (2.71-20.16)), or higher levels of CRP (9.43 (0.73-121.12)) werelinked with greater COVID-19 severity. During median follow-up of 47d, 34 patients had died of COVID-19 (22%).Asian ethnicity (3.73 (1.28-10.91), palliative treatment (5.74 (1.15-28.79), initial diagnosis of cancer >24m before(2.14 (1.04-4.44), dyspnea (4.94 (1.99-12.25), and increased CRP levels (10.35 (1.05-52.21)) were positivelyassociated with COVID-19 death. An inverse association was observed with increased levels of albumin (0.04 (0.01-0.04). Conclusions: Our analysis of one of the largest single-center series of COVID-19-positive cancer patients to dateconfirms a similar distribution of age, sex, and comorbidities as reported for other populations. With respect tocancer-specific observations, patients who have lived longer with their cancer were found to be more susceptible toa greater infection severity, possibly reflecting the effect of more advanced malignant disease, as almost half of thesevere cohort were on third-line metastatic treatment, or the impact of this infection. The latter was also found to beassociated with COVID-19 death in cancer patients, as were Asian ethnicity and palliative treatment. Furthervalidation will be provided from other large case series, as well as from those including longer follow-up, to providemore definite guidance for oncologic care.