Differential impacts of perceived social support on alcohol and cannabis use in young adults: lessons from the COVID-19 pandemic

Coronavirus (COVID-19) lockdowns provided a unique opportunity to examine how changes in the social environment impact mental health and wellbeing. We addressed this issue by assessing how perceived social support across COVID-19 restrictions alters alcohol and cannabis use in emerging adults, a population vulnerable to adverse outcomes of substance use. Four hundred sixty-three young adults in Canada and the United States completed online questionnaires for three retrospective time points: Pre-Covid, Lockdown and Eased Restrictions. Sociodemographic factors, perceived social support, and substance use were assessed. Overall, alcohol use decreased while cannabis use increased during Lockdown. Interestingly, social support negatively predicted alcohol use and positively predicted cannabis use during Lockdown. These findings suggest a difference in motives underlying alcohol and cannabis use in emerging adults. Importantly, these changes were not sustained when restrictions eased, suggesting that emerging adults exhibit resiliency to the impacts of COVID-19 restrictions on substance use. © 2023, University of Toronto. All rights reserved.

HOW FEARS and HOPES HAVE EVOLVED in PATIENTS with RMDS THROUGHOUT the COVID-19 PANDEMIC? RESULTS from the REUMAVID STUDY (PHASE 1 and 2)

Background: The COVID-19 pandemic has generated uncertainties and concerns along with expectations and hopes that may be of relevance to patients with rheumatic diseases. Objectives: The aim of this study is to assess changes in the fears and hopes of patients with rheumatic diseases throughout the two phases of REUMAVID. Methods: REUMAVID is an international cross-sectional study collecting data through an online survey in seven European countries led by the Health & Territory Research group of the University of Seville, together with a multidisciplinary team including patient representatives, rheumatologists, and health researchers. Data were collected in two phases: Phase 1 (P1) between April-July 2020 and Phase 2 (P2) between February-April 2021. Demographics, health behaviours, employment status, access to healthcare services, disease characteristics, WHO-5 Well-Being Index and Hospital Anxiety and Depression Scale (HADS). Participants rated a series of fears (infection, medication consequences, lack of medication, impact on healthcare, lost job, civil disorder) on a scale from zero ('no concern at all') to five ('extremely concerned') and hopes (treatment/vaccine availability, going outside, travel, economic situation, treatment continuation, health status) on a scale from zero ('no hopeful at all') to five ('extremely hopeful'). Descriptive analysis and Mann-Whitney test were used to explore fears and hopes in both phases of REUMAVID. Results: A total of 3,802 participants were recruited across both phases in REU-MAVID with comparable demographic characteristics: mean age 52.6 (P1) vs. 55.0 years (P2), 80.2% female (P1) vs. 83.7% (P2), 69.6% married (P1) vs. 68.3% (P2), and 48.6% university educated (P1) vs. 47.8% (P2). Most prevalent RMD was axial spondyloarthritis in P1 (37.2%), and rheumatoid arthritis in P2 (53.1%). In P1 and P2 the major concern was the impact on healthcare in the future (3.1 and 3.2 out of 5, p=0.051). Compared to P1, patients in P2 had less fears about RMD medications not reaching the country (2.4 vs. 1.9, p<0.001), civil disorders (2.0 vs. 1.8, p=0.001), or losing their jobs (1.4 vs. 1.5, p=0.003). Comparing hopes with P1, patients in P2 had greater hopes about availability of treatments or vaccines suitable for COVID-19 (3.2 vs. 3.9, p<0.001), to be able to go out as before the pandemic (3.1 vs. 3.5, p<0.001), to be able to travel as before the pandemic (2.8 vs. 3.3, p<0.001), maintain and even improve the current economic situation after the pandemic (2.6 vs. 3.0, p<0.001), and to be able to continue their treatment as usual (3.8 vs. 3.8, p=0.049;Table 1) Conclusion: During the frst phase of REUMAVID at the beginning of the pandemic, patients with RMDs were more fearful and less hopeful compared to the second phase. These fears were notable in terms of lack of medication for their RMD, while during the second phase, patients were hopeful of a treatment or vaccine against COVID-19, and of being able to go out and travel as before.

Measurement push and pull forces on automatic liquid dispensers

Since the COVID-19 pandemic, automated liquid dispensers have been increasingly developed to assist transmission prevention. However, data availability of automatic liquid dispenser mechanism's technical characteristics is not yet widely available. This causes frequent over or under design in its development. Therefore, we specifically measure push and pull forces engineering characteristics generated by the automatic liquid dispenser mechanism. A wire mechanism-based automatic liquid dispenser apparatus was used to experiment. A load-cell sensor was used to detect the force that occurs from a servo motor controlled by a microcontroller. The force data (push and pull) will be sent directly to the database server cloud with a recording frequency of every second. Three types of fluid treatment levels are used i.e. water, liquid soap, and hand sanitizer gel. Three types of fluid volume treatment levels used were 50 ml, 150 ml, and 250 ml. Each treatment level combination is carried out at the servo motors rotation steps 180°, 150°, 120°, 90°, 60°, and 30°. The results show that no significant differences were found in maximal forces required to release the water, liquid soap, and hand-sanitizer gel. It is also known that the volume of the fluid has a very significant effect on the amount of push and pull forces generated.

Continuity of cancer care: The surgical experience of two large Cancer Hubs in London and Milan

Introduction: A better understanding of the reality for cancer patients during COVID-19 will help us readapt current predication models. To further inform future clinical guidelines, we need a deep dive into rich data sources from apex Cancer Centres. We report on the outcomes of cancer patients receiving radical surgery between March-September 2020 (as well as 2019) in the European Institute of Oncology (EIO) in Milan and the South East London Cancer Alliance (SELCA). Methods: IEO is one of the largest cancer hospitals in Italy. SELCA includes 3 major hospital trust, treating about 8,000 new cancer patients per annum. Both institutions implemented a COVID-19 minimal pathway, whereby patients were required to shield for 14 days prior to admission and were swabbed for COVID-19 within 3 days of surgery. Positive patients had surgery deferred until a negative swab. Surgical outcomes assessed were: ASA grade, surgery time, theatre time, ICU stay>24h, pneumonia, length of stay (LOS), and admissions. For COVID-19, we focused on infection rate and mortality. Results: At IEO the number of radical surgeries (270 for gynaecological, 339 for head and neck, 377 for thoracic, and 491 for urological cancers) declined by 6% as compared to the same period in 2019 (n=1477 vs 1560). The main decline was observed for thoracic surgery (377 vs 460, i.e. -18%). Age, sex, SES, ethnicity, comorbidities, and performance status were all comparable between both periods (e.g. 58% male, 38% aged 70+, 48% high SES, 15% with existing cardiovascular diseases). Readmissions were required for 39%, and <1% (n=9) developed COVID-19, of which only 1 had severe disease and died. 11 died of other causes during follow-up (1%). At SELCA, the number of radical surgeries (321 for breast, 129 for colorectal, 114 for gynaecological, 152 for head and neck, 92 for liver, 56 for plastics/skin, 305 for thoracic, 72 for upper gastrointestinal, and 312 for urology) declined by 29% (n=1553 vs 2182). Even though a different geographical setting, characteristics were fairly comparable with the IEO: 58% males, 30% aged 70+, 34% high SES, 16% with existing cardiovascular diseases. Readmissions were required for 22%, <1% (n=7) developed COVID-19, and none died from it. 19 died of other causes within 30 days (1%). Conclusion: Milan and London were both at the epicentre of the first COVID-19 wave. Whilst a decline in number of surgeries was observed, the implemented COVID-19 minimal pathways have shown to be safe for cancer patients requiring radical treatment, with limited complications and almost no COVID-19 infections.

Evaluating the effect of a mobile audio companion to reduce feelings of distress and loneliness in cancer patients during COVID-19 (companion trial)

Background: Given the current physical isolation and distancing measures in place as a result of the COVID- 19 pandemic, and the health risks associated with leaving one's home, cancer patients face new and unprecedented challenges in connecting with their communities and conducting activities of daily living. They are also experiencing changes in their treatment and medical follow-up plans. Consequently, they are at even greater risk of experiencing loneliness, anxiety, depression, and reduced quality of life compared to the general population. There is emerging evidence for the use of mobile health applications to improve social connections, engage patients in their own health, and provide psychosocial support among cancer survivors. Thus, we are conducting the COMPANION study to examine the use of a mobile health application, Elly, to reduce levels of anxiety, stress, and feelings of social isolation and loneliness as a result of isolation during the COVID-19 pandemic among cancer patients and survivors (NCT04604158). Methods: This is a prospective, interventional study of patients who self-identify as currently receiving cancer-targeted treatment. All study recruitment and consent procedures, assessments, and follow-up are completed remotely using REDCap. Participants are given access to the Elly phone application developed by Elly Health Inc. and followed for 6 months. Elly is a multi-platform mobile solution that enables cancer patients to receive support and assistance in the management of their illness. Elly delivers audio content through a mobile app to comfort, inspire and motivate its users including tools to manage their diagnosis and symptoms including interactive sessions on motivation, unspoken (taboo topics), exercise, mindfulness, sleep, nutrition, self-care, and symptom as well as COVID-19 specific topics. Results: The COMPANION trial is currently open to accrual. Approximately 100 patients will be enrolled between November 2020 and December 2021. Trial design and protocol development, regulatory activities including submission to the local ethics review board, and communication was completed remotely and included an interdisciplinary team of clinical trialists, behavioral scientists, oncologists, and psychiatrists. This study provides an example of how clinical trials may be developed and managed in a decentralized manner and under budget and time constraints. Surveys will be administered through REDCap at baseline and monthly thereafter to assess the patient's social status, medical history (including history of COVID-19), and National Institutes of Health PROMIS anxiety, depression, perceived stress, pain, loneliness, social support, and global health scales. Participants may opt to wear and link activity trackers in order to obtain objective measures of daily activity. Patients will also have the option to consent to the optional qualitative interview sub-study. Conclusion: Using COMPANION as a case example, we demonstrate the feasibility of designing and conducting a trial to monitor patient outcomes and deliver a mobile health intervention in a remote setting. Findings from this work will provide fundamental knowledge of the additional impact COVID-19 has had on cancer patients' anxiety, depression, and stress levels. This study will also improve our understanding of the short- and long-term effects of COVID-19 and how it's trajectory over the course of the next 6 months and beyond will impact these outcomes.

Gender differences on the impact of the COVID-19 pandemic and lockdown in patients with rheumatic diseases. results from the reumavid study (phase 1)

Background: The COVID-19 pandemic has impacted health, lifestyle, treatment and healthcare of European patients with rheumatic and musculoskeletal diseases (RMDs). Objectives: The aim is to evaluate gender differences on the impact of the first wave of the COVID-19 pandemic in the wellbeing, life habits, treatment, and healthcare access of European patients with RMDs. Methods: REUMAVID is an international collaboration led by the Health & Territory Research at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from 1,800 patients with a diagnosis of 15 RMDs, recruited by patient organisations in Cyprus, France, Greece, Italy, Portugal, Spain, and the United Kingdom during the first phase of the pandemic (April-July 2020). Mann-Whitney and χ2 tests were used to analyse differences between gender regarding sociodemographic characteristics, life style, treatment, healthcare, and patient-reported outcomes. Results: 1,797 patients were included in this analysis. 80.2% were female and a mean age of 52.6 years. The most common diagnosis was inflammatory arthritis (81.7% male vs 73.8% female). There was a higher prevalence of fibromyalgia among females (20% vs 7.0% male). Overall, females reported worse self-perceived health (67.0% vs 51.4%, p<0.001), higher risk of anxiety (59.5% vs 48.1%, p<0.001), and depression (48.0% vs 37.2%, p<0.001). Females reported a greater increase in smoking (26.5% vs 17.5%, p=0.001), although they were less likely to drink alcohol (34.5% vs 25.4%, p=0.013), and also engaged less in physical activity (53.0% vs 60.3%, p=0.045). Overall, females were more likely to keep their scheduled rheumatology appointment (43.3% vs 34.1% of males (p=0.049;Table 1) with a higher proportion of females having their rheumatic treatment changed (17.0% vs 10.7%, p=0.005). Conclusion: The first wave of the COVID-19 pandemic and the containment measures have worsened self-perceived health status of patients with RMDs, affecting genders differently. Females reported worse psychological health and life habits such as increased smoking and reduced physical activity, while males increased their alcohol consumption and were less likely to attend their rheumatology appointments.

Fears and hopes during the COVID-19 pandemic in patients with rheumatic diseases Results from the reumavid study (PHASE 1)

Background: The first wave of the COVID-19 pandemic led to a rapidly evolving global crisis characterized by major uncertainty. Objectives: The objective is to assess COVID-19-related fears and hopes in patients with rheumatic and musculoskeletal diseases (RMDs) during the first wave of the pandemic. Methods: REUMAVID is an international collaboration led by the Health & Territory Research group at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from 1,800 patients with a diagnosis of 15 RMDs recruited by patient organisations in Cyprus, France, Greece, Italy, Portugal, Spain and, the United Kingdom. Data are collected in two phases, the first phase between April and July 2020, the second in 2021. Participants rated a series of fears (infection, medication consequences, lack of medication, impact on healthcare, job loss, civil disorder) on a Likert scale from zero (no concern at all) to five (extremely concerned) and their hopes (treatment/vaccine availability, going outside, travel, economic situation, treatment continuation, health status) on a Likert scale from zero (not hopeful at all) to five (extremely hopeful). The Mann-Whitney and Kruskal-Wallis tests were used to analyse the different fears and hopes according to socio-demographics characteristics, disease and health status. Results: 1,800 patients participated in the first phase of REUMAVID. The most frequent RMDs group was inflammatory arthritis (75.4%), the mean age was 52.6 years and 80.1% were female. The most important fear for patients was the impact of the COVID-19 pandemic on healthcare (3.1 out of 5), particularly for those younger in age (3.0 vs 3.2, p=0.004), female gender (3.2 vs 2. 9 of men, p=0.003), experiencing greater pain (3.1 vs 2.8, p=0.007), with higher risk of anxiety (3.3 vs 2.9 of without anxiety, p<0.001) and depression (3.3 vs 2.9 without depression, p<0.001). The possible impact of anti-rheumatic medication and the development of severe disease if they became infected with COVID-19,was mostly feared (2.8 out of 5), by those receiving biological therapy (3.1 vs 2.5 not biological therapy, p<0.001) or those with underlying anxiety (2.9 vs 2.6 without anxiety, p=0.007). The risk of contracting COVID-19 due to their condition (2.8 out of 5), was especially feared by those with vasculitis (3.2 out of 5), who were female (2.9 vs 2.5, p<0.001), using biologics (2. 9 vs 2.7 of no use, p=0.003), in greater pain (2.8 vs 2.4, p<0.001), with a risk of anxiety (3.0 vs 2.6 without anxiety, p=0.004), and risk of depression (3.0 vs 2.6 without depression, p<0.001). The major hopes were to be able to continue with their treatment as usual (3.7 out of 5), particularly for those taking biologics (3.8 vs 3.6 not taking, p=0.026), those with a better well-being (3.8 vs 3.6 with worse well-being, p=0.021), without anxiety (3.8 vs 3.6 at risk, p=0.004) and without depression (3.8 vs 3.6 at risk, p=0.007). Hoping not to become infected with COVID-19 and to maintain the same health status, were especially those who were older (3.6 vs 3.4 p=0.018) without anxiety (3.4 vs 3.6 at risk, p=0.005), and without depression (3.6 vs 3.4 at risk, p=0.006). Another important hope was the availability of a treatment or vaccine for COVID-19, which was important for patients experiencing better well-being (3.3 vs 3.0 with worse well-being, p<0.001;Figure 1). Conclusion: The outstanding COVID-19-related fear expressed by European patients with RMDs was its impact on healthcare, while the greatest hope was to be able to continue treatment. Younger patients reported more fears while older patients were more hopeful. Those receiving biologics had greater fears and hopes associated with their treatment. In addition, patients at risk of mental disorders presented greater fears and less hopes.

Impact of the COVID-19 pandemic and lockdown on wellbeing on patients with rheumatic diseases. results from the reumavid study (phase 1)

Background: The COVID-19 pandemic has impacted the wellbeing of patients with Rheumatic and Musculoskeletal Diseases (RMDs). Objectives: The aim is to assess emotional well-being and its associated factors in patients with RMDs during the first wave of the COVID-19 pandemic. Methods: REUMAVID is an international collaboration led by the Health & Territory Research group at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from patients with a diagnosis of 15 RMDs in Cyprus, France, Greece, Italy, Portugal, Spain, and the United Kingdom. 1,800 participants were recruited by patient organisations. Data was collected between April and July 2020. Participants were divided into two groups: 1) Participants with poor wellbeing (World Health Organization-Five Wellbeing Index (WHO-5) ≤ 50), 2) Participants with good wellbeing (WHO-5 ≥50). The Mann-Whitney and χ2 tests were used to analyse possible relations between sociodemographic characteristics, lifestyle, and outdoor contact with wellbeing during the first wave of the COVID-19 pandemic. Univariate and multivariate binary logistic regression was used to determine the impact of the independent variables associated with poor wellbeing. Results: 1,777 patients with 15 different RMDs were included. The mean age was 52.7, 80.2% female, 48.7% had a university degree, and 69.7% were married or in a relationship. The most frequent diagnoses were inflammatory arthritis (75.4%). 49.0% reported poor wellbeing. 57.7% of patients who belonged to a patient organisation reported good wellbeing (vs 46.3% who did not, p<0.001). Those who reported poor wellbeing had higher disease activity (51.4% vs 41.3%, p<0.001), a higher risk of anxiety (54.3% vs 41.7%, p<0.001) and depression (57.0% vs 42.1%, p<0.001), and poorer self-perceived health (53.0% vs 41.8%, p<0.001), compared to those who did not. A higher proportion of those who engaged in physical activity presented good wellbeing (54.0% vs 46.5%, p=0.012). 57.4% of the patients who were unable to attend their appointment with their rheumatologist reported poor wellbeing, compared to 48.2% who did attend (p=0.027). Patients who did not walk outside (56.2%) or who lacked elements in their home to facilitate outside contact (63.3%) experienced poor wellbeing (p<0.001). The factors associated with poor wellbeing were lack of elements in the home enabling contact with the outside world (OR=2.10), not belonging to a patient organisation (OR=1.51), risk of depression (OR=1.49), and not walking outside (OR=1.36) during the COVID-19 pandemic (Table 1). Conclusion: Almost half of the patients with RMDs reported poor emotional wellbeing during the first wave of the COVID-19 pandemic. The lack of elements in the home that facilitate outdoor contact, not belonging to a patient organisation, the presence of anxiety, and not walking outside during the pandemic increase the probability of poor emotional well-being. These results highlight the importance of environmental factors and the role of patient organisations in addressing the effects of the pandemic and its containment measures.

Country comparison on the impact of the COVID-19 pandemic on patients with rheumatic diseases. results from the reumavid study (phase 1)

Background: The COVID-19 pandemic has impacted every aspect of life of European patients with rheumatic and musculoskeletal diseases (RMDs). Objectives: The aim is to evaluate country differences on the impact of the first wave of the COVID-19 pandemic on life habits, healthcare access, health status, mental health and wellbeing in European patients with RMDs. Methods: REUMAVID is an international collaboration led by the Health & Territory Research group at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from patients with a diagnosis of 15 RMDs in Cyprus, France, Greece, Italy, Portugal, Spain, and the United Kingdom. Participants were recruited by patient organisations (April-July 2020). The Kruskal-Wallis and χ2 tests were used to analyse differences between countries and independent variables. Results: 1,800 patients participated in the first wave of the COVID-19 pandemic (REUMAVID). 37.8% of Spanish patients increased their smoking consumption during the pandemic followed by Cyprus (32.1%) and Portugal (31.0%), while alcohol consumption was higher in the UK (36.3%) and France (27.0%). 82.3% of patients in Spain unable to attend their appointment with their rheumatologist, either due to cancellations or other personal reasons. Access to primary care was most limited in Portugal and Italy, where only 45.0% and 51.6% got access. 61.9% in Italy and 53.3% in Spain experienced a worsening of their health during the pandemic. 68.5% in Spain and 67.8% in Portugal were at risk of anxiety. The highest proportion at risk of depression was found in Greece (55.4%), Cyprus (55.1%), and Italy (54.8%). 66.9% of patients in Spain reported poor wellbeing, compared to 23.8% in Italy and 30.1% in Portugal (Table 1). Conclusion: The first wave of the pandemic and the related containment measures heterogeneously affected patients with RMDs across European countries, who overall increased harmful habits, experienced more difficulties in accessing healthcare and, reported poor mental health and well-being.

Evaluation of the impact of the COVID-19pandemic on patients with rheumatic diseases in theUK: Results from the REUMAVID study

Background/AimsThis study presents the impact of the COVID-19 pandemic on healthcare, access to treatment, daily activities, well-being and mental health and the role of patient organisations from the perspective of the patientwith rheumatic disease in the UK.MethodsREUMAVID is an international collaboration led by HTR of the University ofSeville, together with a multidisciplinary team of rheumatologists andpatient organisations from 7 European countries (in the UK: NASS, NRASand Arthritis Action). The study consists of an online survey, including thefollowing instruments: Self-Perceived Health, WHO-5 Well-Being Indexand Hospital Anxiety and Depression Scale (HADS). Data are collected intwo phases: the first wave of the pandemic (from May 14th to July 18th2020) and the second wave (to be conducted in winter 2020).Results558 patients with rheumatic diseases participated in REUMAVID UK.The most frequently reported diagnoses were axial spondyloarthritis(44.6%), rheumatoid arthritis (44.1%) and osteoarthritis (25.6%). Themean age was 58.513.4 years, 78.7% women, 70.8% married or in arelationship and 54.1% having university studies. 45.8% perceivedtheir health status being "fair to very poor" with 38.4% reporting aworsening during lockdown. 48.8% had their rheumatology appointment cancelled. Of these, 46.9% were offered either online ortelephone follow-up, while the remaining 50.6% were not given anyalternative. 15.6% changed their medication, of which 66.3% wereindicated to do so by the medical team and 21.7% did so out ofconcern with COVID-19 with the major fear being that their treatmentwould lead to serious illness if they contracted SARS-CoV-2, while thegreater hope was to be able to continue with their treatment as usual.10.3% smoked more than before, 59.4% quit smoking and 36.3%drank more alcohol than before. 20.7% were unable to physicallyexercise at home and 39.2% reported weight gain. According to theWHO-5 scale, 52.5% declared poor well-being (-50). A total of 43.6%were at risk of anxiety and 33.6% at risk of depression according tothe HADS scale. During the lockdown, 54.3% were able to continuetheir psychological therapy. The main source of COVID-19 informationwas the patient organisations (reaching 63.6% of members), compared to 45.3% of non-members who did not receive any information.ConclusionThe REUMAVID study has allowed us to measure and quantify theexperience of British patients with rheumatic disease during anunprecedented public health crisis. A reduction in healthcare access, concern about treatment, changes in daily life habits and worsening ofwell-being and mental health were reported during the first wave.Patient organisations were the main source of COVID-19-relatedinformation. Further data will be gathered during the second wave.

30-Day postoperative COVID-19 outcomes in 398 patients from regional hospitals utilising a designated COVID-19 minimal surgical site pathway.

INTRODUCTION: Postoperative pulmonary complications and mortality rates during the COVID-19 pandemic have been higher than expected, leading to mass cancellation of elective operating in the UK. To minimise this, the Guy's and St Thomas' Hospital NHS Foundation Trust elective surgery hub and the executive team at London Bridge Hospital (LBH) created an elective operating framework at LBH, a COVID-19 minimal site, in which patients self-isolated for two weeks and proceeded with surgery only following a negative preoperative SARS-CoV-2 polymerase chain reaction swab. The aim was to determine the rates of rates of postoperative COVID-19 infection. METHODS: The collaboration involved three large hospital trusts, covering the geographic area of south-east London. All patients were referred to LBH for elective surgery. Patients were followed up by telephone interview at four weeks postoperatively. RESULTS: Three hundred and ninety-eight patients from 13 surgical specialties were included in the analysis. The median age was 60 (IQR 29-71) years. Sixty-three per cent (252/398) were female. In total, 78.4% of patients had an American Society of Anesthesiologists grade of 1-2 and the average BMI was 27.2 (IQR 23.7-31.8) kg/m2. Some 83.6% (336/402) were 'major' operations. The rate of COVID-19-related death in our cohort was 0.25% (1/398). Overall, there was a 1.26% (5/398) 30-day postoperative all-cause mortality rate. Seven patients (1.76%) reported COVID-19 symptoms, but none attended the emergency department or were readmitted to hospital as a result. CONCLUSION: The risk of contracting COVID-19 in our elective operating framework was very low. We demonstrate that high-volume major surgery is safe, even at the peak of the pandemic, if patients are screened appropriately preoperatively.