Inflammatory Profiles Are Associated with Long Covid 6 Months after Illness Onset

Background: Systemic hyperinflammation is key to the pathogenesis of severe, acute COVID-19. However, few studies have analysed inflammatory profiles in adults with mild/moderate COVID-19, or in those with post-acute sequelae of COVID-19 (PASC). We aimed to i) describe trajectories of cytokines in a prospective cohort of adults with mild to severe COVID-19, compared to uninfected, healthy controls and ii) identify early (< 4 weeks after illness onset onset) predictors of ongoing PASC and inflammation at 6 months after illness onset. Method(s): RECoVERED is a prospective cohort of adults with laboratoryconfirmed SARS-CoV-2 infection between May 2020 and June 2021 in Amsterdam, the Netherlands. Serum was collected at weeks 4, 12 and 24. Participants completed monthly symptom questionnaires. PASC was defined as having at least one ongoing symptom that originated < 1 month of illness onset. Cytokine concentrations were analysed by human magnetic Luminex screening assay. We performed random forest regression to identify early predictors of PASC and raised CRP/IL-6 at 24 weeks, using Shapley additive explanation values as measures of importance for the different predictors. Result(s): Of 349 RECoVERED participants, 186 (53%) had >=2 serum samples and were included in current analyses. Of these, 101 (54%: 45/101 [45%] female, median age 55 years [IQR=45-64]) reported PASC at 12 weeks after illness onset, of whom none recovered by 24 weeks. We included 37 uninfected controls (17/37 [46%] female, median age 49 years [IQR=40-56]). At 4 weeks after illness onset, levels of IP10, IL10, IL17, IL1beta, IL6 and TNFalpha were significantly elevated among participants infected with SARS-CoV-2 compared to controls. Ongoing PASC was independently associated with raised CRP at 24 weeks. Early raised IL1beta and sCD14 levels and greater BMI at illness onset were the strongest predictors of PASC at 24 weeks. Those with higher early sCD14 or IL1beta and TNFalpha levels were also more likely to have persistently raised CRP and IL6, respectively, at 24 weeks (Fig.1). Conclusion(s): Differences in cytokine concentrations between individuals with COVID-19 and uninfected controls largely were greatest < 4 weeks after illness onset. In our study, ongoing PASC was associated with persistently elevated CRP at 24 weeks. Early immune dysregulation was, alongside BMI, an important determinant for persistent PASC. Further investigation of individuals with PASC and long-term aberrant cytokine levels may help improve our understanding of the condition. (Figure Presented).

High Uptake and Series Completion of COVID-19 Vaccine at Community-Based Vaccination for Latinos With Limited English Proficiency.

BACKGROUND: Despite the disproportionate impact of COVID-19 on Latinos, there were disparities in vaccination, especially during the early phase of COVID-19 immunization rollout. METHODS: Leveraging a community-academic partnership established to expand access to SARS-CoV2 testing, we implemented community vaccination clinics with multifaceted outreach strategies and flexible appointments for limited English proficiency Latinos. RESULTS: Between February 26 and May 7 2021, 2250 individuals received the first dose of COVID-19 vaccination during 18 free community events. Among them, 92.4% (95% confidence interval [CI], 91.2%-93.4%) self-identified as Hispanic, 88.7% (95% CI, 87.2%-89.9%) were limited English proficiency Spanish speakers, 23.1% (95% CI, 20.9%-25.2%) reported prior COVID-19 infection, 19.4% (95% CI, 16.9%-22.25%) had a body mass index of more than 35, 35.0% (95% CI, 32.2%-37.8%) had cardiovascular disease, and 21.6% (95% CI, 19.2%-24.0%) had diabetes. The timely second-dose completion rate was high (98.7%; 95% CI, 97.6%-99.2%) and did not vary by outreach method. CONCLUSION: A free community-based vaccination initiative expanded access for Latinos with limited English proficiency at high risk for COVID-19 during the early phase of the immunization program in the US.

EARLY INTESTINAL ULTRASOUND PREDICTS ENDOSCOPIC RESPONSE ON ANTI-INFLAMMATORY TREATMENT AND SHOWS DRUG-SPECIFIC RESPONSE TO BIOLOGICALS AND TOFACITINIB IN ULCERATIVE COLITIS

Introduction Objective evaluation of treatment response is the gold standard in ulcerative colitis (UC). In this setting, intestinal ultrasound (IUS) is a non-invasive alternative to endoscopy. Recent studies showed change in IUS parameters after treatment initiation but studies with an endoscopic reference standard are scarce. The aim of this study was to evaluate early change of IUS parameters and determine cut-off values for endoscopic endpoints in UC patients starting anti-inflammatory treatment. Methods In this longitudinal prospective study consecutive patients with moderate-severe UC (baseline endoscopic Mayo score (EMS)≥2) starting an anti-inflammatory treatment were included. Clinical scores, biochemical parameters and IUS parameters were collected at baseline, after 2 (T1), 6 (T2) and 8-26 weeks (T3) around time of the second sigmoidoscopy/colonoscopy. Bowel wall thickness (BWT), Colour Doppler signal (CDS), haustrations, inflammatory fat and wall layer stratification were measured as previously established1. Endoscopic remission (ER) and mucosal healing (MH) were evaluated in the sigmoid and defined as EMS=0 and EMS≤1, respectively. The ultrasonographist and endoscopist were blinded for the outcomes of endoscopy and IUS, respectively. Results 51 consecutive patients were included (Table 1) of whom 31 underwent a second endoscopy. Two additional patients underwent colectomy and were considered non-responders. 18 patients did not undergo second endoscopy due to the COVID-19 pandemic (n=2), refusal (n=5), loss to follow-up (n=1) or treatment escalation because of clinical deterioration confirmed by IUS and biomarkers before second endoscopy was performed (n=10). BWT was significantly lower from T2 onwards in patients reaching MH (p=0.026) and ER (p=0.002) at T3 (Fig 1). A significant decrease in BWT was already visible at T1 in patients receiving infliximab (median DBWT T0-T1: -26% [-43% - -6%], p=0.001) or tofacitinib (median ∆BWT T0-T1: -33% [-46% - -5%], p=0.001) but not in patients treated with vedolizumab (median ∆BWT T0-T1: -14% [-43% - 5%], p=0.11). Most accurate BWT cut-off values at T3 to determine MH and ER were 3.52 mm (AUROC: 0.95, 95% CI: 0.86-1.00, p<0.0001, sens:91%, spec:91%) and 2.98 mm (AUROC: 0.94, 95% CI: 0.85-1.00, p=0.001, sens:87%, spec:100%), respectively. At T2, BWT per 1 mm increase and CDS were inversely associated with MH (BWT: OR: 0.48 (0.24-0.96, p=0.038);CDS: OR 0.16 (0.03-0.83), p=0.028) and ER (BWT: OR: 0.30 (0.11-0.76), p=0.01). Conclusion BWT and CDS 6 weeks after start of treatment could predict MH and ER. In addition, treatment response at IUS is drug-specific. Furthermore, we have provided accurate BWT cut-off values for endoscopic outcomes. In a point-of-care setting, (early) treatment evaluation with IUS could guide treatment decision in UC in order to optimize treatment response. 1. Bots et al. JCC 2021

STRAIN-SPECIFIC SEROLOGICAL RESPONSE FOLLOWING SARS-CoV-2 VOC INFECTION

Background: The emergence of new SARS-CoV-2 variants raises concerns whether preexisting artificial (vaccine-induced) and natural immunity from prior COVID-19 prevents re-infections. Here, we investigated the differences in primary humoral immune response following SARS-CoV-2 variants of concern (VOCs) infection and aimed to identify the key mutations involved in these differences. Methods: Patients with primary PCR-proven SARS-CoV-2 infection with no history of previous COVID-19 vaccination were included between October 2020 and May 2021 at Amsterdam UMC and via the Dutch SARS-CoV-2 sequence surveillance program. Serum was collected 4-8 weeks after symptom onset and tested for IgG binding and pseudovirus neutralization of the wild-type (WT, Wuhan/D614G), Alpha, Beta and Delta variants. Results: We included 51 COVID-19 patients, who were infected with the WT (n=20), Alpha (n=10), Beta (n=9) or Delta variant (n=12). Generally, the highest neutralization titers were against the autologous virus. After stratifying for hospitalization status, non-hospitalized patients infected with the WT (ID50 817) or Alpha (ID50 2524) variant showed the strongest geometric mean autologous neutralization, followed by the Delta variant (ID50 704) infected participants. By contrast, only one participant infected with the Beta variant showed strong autologous neutralization (median ID50 171). The VOCs also differed in their ability to induce cross-neutralizing responses, with WT-infected patients showing the broadest immune response, followed by Alpha, Delta and Beta infected participants. Additionally, participants infected with the WT, Alpha or Delta variant showed the lowest cross-neutralization against the Beta variant, with a median 5.0-fold (2 to 16-fold), 7.7-fold (2 to 32-fold), and 5.3-fold (1 to 19-fold) reduction compared to the autologous neutralization, respectively. We identified the E484K mutation as the key mutation responsible for this low cross-neutralization. Conclusion: We demonstrated that even small differences in the S protein influences the polyclonal antibody response following infection. The low level of (cross-)neutralization induced by the Beta variant may implicate a higher re-infection risk, but further research of the memory B cell compartment and clinical studies are needed. The broadest cross-neutralizing response observed for WT-infected patients suggests that artificial immunity induced by the current approved COVID-19 vaccines already protects against many re-infections.

Motivating Ethnic Minority Students in Hong Kong to Learn Chinese Culture with EduVenture VR

This paper presents our initiative for leveraging SV-IVR (spherical video-based immersive virtual reality) to give Hong Kong ethnic minority students exposure to local Chinese culture via EduVenture VR-an interactive learner-immersed virtual interactive learning application. The work was conducted in the COVID-19 pandemic context;outdoor fieldwork-based learning was not recommended in the circumstance. The research participants were 63 ethnic minority students (from Grade 7 to Grade 9) from a Hong Kong secondary school. The ARCS model of instructional motivation was employed to evaluate the motivational effectiveness of the Chinese culture learning activity supported by EduVenture VR. In the study, we obtained positive results in terms of the 4 motivational dimensions: "Attention," "Relevance," "Confidence' and "Satisfaction."

Risk of SARS-CoV-2 transmission upon return to work in RNA-positive healthcare workers.

BACKGROUND: Healthcare workers (HCWs) are at risk for coronavirus disease 2019 (COVID-19), and for spreading severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) amongst colleagues and patients. AIM: To study the presence of SARS-CoV-2 RNA and possible onward transmission by HCWs upon return to work after COVID-19, and association with disease severity and development of antibodies over time. METHODS: Unvaccinated HCWs with positive SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) were recruited prospectively. Data on symptoms were collected via telephone questionnaires on days 2, 7, 14 and 21 after a positive test. Upon return to work, repeat SARS-CoV-2 RT-PCR was performed and serum was collected. Repeat serum samples were collected at weeks 4, 8, 12 and 16 to determine antibody dynamics over time. Phylogenetic analysis was conducted to investigate possible transmission events originating from HCWs with a positive repeat RT-PCR. FINDINGS: Sixty-one (84.7%) participants with mild/moderate COVID-19 had a repeat SARS-CoV-2 RT-PCR performed upon return to work (median 13 days after symptom onset), of which 30 (49.1%) were positive with a median cycle threshold (Ct) value of 29.2 (IQR 26.9-29.9). All HCWs developed antibodies against SARS-CoV-2. No significant differences in symptomatology and presence of antibodies were found between repeat RT-PCR-positive and -negative HCWs. Eleven direct colleagues of six participants with a repeat RT-PCR Ct value <30 tested positive after the HCW returned to work. Phylogenetic and epidemiologic analysis did not indicate onward transmission through HCWs who were SARS-CoV-2 RNA positive upon return to work. CONCLUSIONS: HCWs regularly return to work with substantial SARS-CoV-2 RNA loads. However, this study found no evidence for subsequent in-hospital transmission.

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The COVID-19 pandemic has brought disruptions and constraints to K-12 STEM education, such as the shortened classroom time and the restrictions on classroom interactions. More empirical evidence is needed to inform educators and practitioners which strategies work and which do not in the pandemic context. In response to the call for more empirical evidence and the need for cultivating responsible and competent 21st century citizens, we designed and implemented a transdisciplinary STEM curriculum during the COVID-19 outbreak. In order to facilitate the smooth delivery of the learning contents and authentically engage learners in the learning process, multi-model video approaches were employed considering the characteristics of three disciplines, STEM, social service, and writing, as well as learner diversity. Pre- and post-test results indicated that students’ transdisciplinary STEM knowledge improved significantly after completing the curriculum. The integration of STEM, social service, and writing disciplines promoted the growth of students’ empathy, interest, and self-efficacy. Consistent with the quantitative results, students responded in the interview that their STEM knowledge and empathy were both enhanced. Some implementation strategies introduced in the current study are also applicable when the standard teaching order is restored in the post-COVID-19 era. © 2022, Educational Technology and Society. All rights reserved

Early intestinal ultrasound predicts endoscopic response to anti-inflammatory treatment and shows drug-specific response to biologicals and tofacitinib in Ulcerative Colitis

Background: Objective evaluation of treatment response is the gold standard in ulcerative colitis (UC). In this setting, intestinal ultrasound (IUS) is a non-invasive alternative to endoscopy. Recent studies showed change in IUS parameters after treatment initiation but studies with an endoscopic reference standard are scarce. The aim of this study was to evaluate early change of IUS parameters and determine cut-off values for endoscopic endpoints in UC patients starting anti-inflammatory treatment. Methods: In this longitudinal prospective study consecutive patients with moderate-severe UC (baseline endoscopic Mayo score (EMS)≥2) starting an anti-inflammatory treatment were included. Clinical scores, biochemical parameters and IUS parameters were collected at baseline, after 2 (T1), 6 (T2) and 8-26 weeks (T3) around time of the second sigmoidoscopy/colonoscopy. IUS parameters were measured as previously established1. Endoscopic remission (ER) and mucosal healing (MH) were evaluated in the sigmoid and defined as EMS=0 and EMS≤1, respectively. The ultrasonographist and endoscopist were blinded for the outcomes of endoscopy and IUS, respectively. Results: 51 consecutive patients were included (Table 1) of whom 31 underwent a second endoscopy (MH: n=15 (45%), ER: n=9 (27%)). Two additional patients underwent colectomy and were considered non-responders. 18 patients did not undergo second endoscopy due to the COVID-19 pandemic (n=2), refusal (n=5), loss to follow-up (n=1) or treatment escalation because of clinical deterioration confirmed by IUS and biomarkers before second endoscopy was performed (n=10). Bowel wall thickness (BWT) was significantly lower from T2 onwards in patients reaching MH (p=0.026) and ER (p=0.002) at T3 (Fig 1). A significant decrease in BWT was already visible at T1 in patients receiving infliximab (p=0.001) or tofacitinib (p=0.007), but not in patients treated with vedolizumab (p=0.11) (Fig 2). Most accurate BWT cut-off values at T3 to determine MH and ER were 3.52 mm (AUROC: 0.95, 95% CI: 0.86-1.00, p<0.0001, sens: 91%, spec: 91%) and 2.98 mm (AUROC: 0.94, 95% CI: 0.85-1.00, p=0.001, sens: 87%, spec: 100%), respectively. Other IUS parameters at T3 did not improve association with MH or ER. IUS parameters at T2 that predict MH and ER are demonstrated in Table 2. Conclusion: BWT and Colour Doppler Signal 6 weeks after start of treatment are associated with and could predict MH and ER. In addition, treatment response patterns at IUS are drug-specific. Furthermore, we have provided accurate BWT cut-off values for endoscopic outcomes. In a point-of-care setting, (early) treatment evaluation with IUS could guide treatment decision in UC in order to optimize treatment response.

Lifestyle changes during the first wave of the COVID-19 pandemic: a cross-sectional survey in the Netherlands

Introduction: During the Covid-19 pandemic the Dutch government implemented its so-called 'intelligent lockdown' in which people were urged to stay at home. This life changing event may have caused changes in lifestyle-behavior. Methods: Life-style related changes were studied among a random representative sample of adults in the Netherlands using an online survey (22-27 May 2020). Differences in COVID-19-related lifestyle changes between Complementary and Alternative Medicine (CAM) users and non-CAM users were determined. The survey included a modified version of the I-CAM-Q and 26 questions on lifestyle-related-measures and changes since the COVID-19-outbreak. Results: 1004 respondents were included in the study, aged between 18 and 88 years (50.7% females). Changes to a healthier lifestyle were observed in 19.3% of the population, mainly due to a change in diet habits, physical activity and relaxation, of whom 56.2% reported to be motivated to maintain this in a post-COVID-19 era. Fewer respondents (12.3%) changed into an unhealthier lifestyle. Multivariable logistic regression analyses revealed that changing into a healthier lifestyle was positively significantly associated with the variables 'Worried/Anxious getting COVID-19′ (OR:1.56, 95% C.I. 1.26-1.93), 'CAM use' (OR:2.04, 95% C.I. 1.38-3.02) and 'stress in relation to financial situation' (OR:1.89, 95% C.I. 1.30-2.74). 'Age' (OR18-25:1.00, OR25-40:0.55, 95% C.I. 0.31-0.96, OR40-55:0.50 95% C.I. 0.28-0.87 OR55+:0.1095% C.I. 0.10-0.33), 'stress in relation to health' (OR:2.52, 95% C.I. 1.64-3.86) and 'stress in relation to the balance work and home' (OR:1.69, 95% C.I. 1.11-2.57) were found predicting the change into a more unhealthy direction. Conclusion: These findings suggest that the coronavirus crisis results in a healthier-lifestyle in one part and, to a lesser extent, in an unhealthier-lifestyle in another part of the Dutch population. Further studies are warranted to see whether this behavioral change is maintained over time, and how different lifestyle factors can affect the susceptibility for and the course of COVID-19. Keywords: COVID-19, Life-style, CAM, Integrative Medicine

CAM use during the COVID-19 Pandemic: A Population Based International Cross-sectional Survey

Introduction: This study was initiated to determine consultations with health care providers and use of self-management strategies such as herbal remedies, dietary supplements and self-help techniques for prevention and treatment of COVID-19 related symptoms in countries with a full lockdown (Norway), a partial lockdown (the Netherlands) and no lockdown (Sweden) during the first three months of the COVID-19 pandemic. Methods: Data were collected in April-June 2020 during the first wave of the COVID-19 pandemic. An adapted version of the I-CAM-Q was used in which the categories 'for prevention of COVID-19′ and 'to treat COVID-19-related symptoms were added as reasons for use. Data were collected among a representative sample using data assisted telephone interviews (Norway, n=990 and Sweden, n=500), and an online survey (the Netherlands, n=1004). Total response rate was 30%. Results: Only a very small number of people in any of the three countries consulted a health care provider with the intention to treat or prevent COVID-19 (1.2% and 1.0% respectively) with medical doctors mostly visited (1.0% and 0.9%). Similarly, the use of self-management strategies to prevent or treat COVID-19 was low (3.4% and 0.2% respectively);most commonly used were vitamins and minerals (2.8%) for prevention of COVID-19, primarily vitamin C (1.7%), vitamin D (0.9%), and multivitamins (0.5%). Consultations with health care providers and use of self-management strategies for prevention of COVID-19 were positively associated with worries of being infected with COVID-19. No such associations were found for worries about loved ones or the perception that COVID-19 is more dangerous than ordinary influenza. Conclusion: The COVID-19 pandemic does not seem to have evoked a large-scale difference in behaviour related to consultations with health care providers or the use of self-management strategies such as dietary supplements and self-help techniques in any of the three countries, despite different containment and mitigation measures. Keywords: COVID-19;Consultations with health care providers;Self-management

Use of CAM during the first wave of the COVID-19 Pandemic: A Cross-sectional Survey

Introduction: The COVID-19 pandemic lockdown has a profound impact on physical and mental well-being throughout the world. Previous studies have revealed that complementary and alternative medicine (CAM) is frequently used for and can be potential beneficial for strengthening physical and mental resilience. The aim of this study was therefore to determine the prevalence and associations for use of CAM during the first wave of the COVID-19 pandemic among a representative sample of women and men in Norway. Methods: Computer assisted telephone interviews using an adapted questionnaire (I-CAM-QN) were conducted with 1000 randomly selected Norwegians aged 16 and above using multistage sampling in April and May 2020 applying age and gender quotas for each area. Descriptive statistics were carried out using Pearson's Chi-square test, Fisher exact test, and Independent samples T-tests to identify group differences. Results: The study revealed that two thirds of the respondents (67%) had used CAM within the first three months of the COVID-19 pandemic, in particular CAM modalities that did not involve a provider. Most used were CAM natural remedies and dietary supplement (57%), mainly vitamins and minerals (43%), but self-help practices like yoga and meditation were also widely used (24%). Women used these therapies significantly more than men (77% vs. 58%). Conclusions: In summary, it can be concluded that the first wave of the COVID-19 pandemic has not profoundly changed the overall need of Norwegian citizens to seek for care outside the conventional healthcare system, but rather has caused a shift in the type of CAM modalities used. It remains to be investigated whether this changed pattern is maintained during the whole period of the pandemic. Keywords: Survey, Norway, CAM, COVID-19

[Covid-19 vaccines in times of the Delta variant]

1,5 years into the pandemic, SARS-CoV-2 remains a dynamic and evolving disease. Growing proportions of the population have been vaccinated, but what degree of protection does vaccination actually offer, particularly in the face of an evolving virus and the emergence of viral variants? Here we explore the limits of vaccine protection -providing an overview of emerging data on how well vaccines protect against mild and asymptomatic disease, vaccine effectiveness against the backdrop of variants such as the Delta, and the implications for SARS-CoV-2 transmission. We assess the continued risks for our vulnerable elderly and immune-compromised patient populations, and whether emerging literature should impact our diagnostic strategies.

Value of SARS-COV-2 genomic characterization in elucidating within-hospital transmission

Introduction: Identifying probable transmission routes of SARS-CoV-2 in the hospital setting is needed to direct implementation of infection prevention measures to stop transmission. Objectives: We investigated probable transmission routes of clusters of SARS-CoV-2 using both epidemiological data and Next generation sequencing (NGS), and assessed congruence. Methods: All positive SARS-CoV-2 PCR test performed in our hospital from both patients and healthcare workers (HCW) between September and December 2020 were evaluated. When more than two HCW or patients from the same ward tested positive within 14 days (a potential cluster), the ward was contacted to identify transmission routes. Suspected transmission was categorized based on epidemiological data (e.g. attendance, contacts in and outside the hospital). All available samples within clusters with sufficient viral load (CT value < 30) were analysed using NGS. A team of molecular biologists, infection prevention specialists and virologists discussed the NGS results and called possible, probable or unlikely clusters based on phylogenetic reconstruction, background prevalence and the epidemiological data. Results: From 14 possible clusters NGS was performed on 98 samples (Table 1). Congruence between epidemiological data and expert conclusion was high for probable transmission (89%) and unlikely transmission (76%). In case of possible transmission NGS guided the definite conclusion in 85% towards probable. Four of the five cases in which no transmission was suspected based on epidemiological data, but were identical in NGS analysis, occurred in one cluster. Other disconcordances were dispersed in different clusters. Conclusion: In 33% NGS changed the conclusion on transmission events. NGS analysis enables confirmation that transmission has ended and thereby helps evaluate outbreak management(OM). Besides, concerns of HCW can be managed by definite results on specific transmission events. One of fourteen clusters was only detected by NGS. Epidemiological data alone can give direction to OM, however NGS analysis gives essential feedback on OM and specific transmission events. (Figure Presented). (Figure Presented).

Work-in-progress-motivation in virtual reality chinese language learning in the context of COVID-19

This work-in-progress paper discusses an interview-based study in a VR-assisted Chinese language learning program during the COVID-19 outbreak in Hong Kong. Due to the pandemic, an online instructional mode was adopted. We examined teacher and student motivation through the framework of self-determination theory. The results revealed autonomy was fostered in their teaching and learning process. Students perceived they acquired competence in writing with improved learning performance and motivation. Relatedness also existed among the teacher-student interactions. This work is among the first to evaluate how an online VR-assisted Chinese writing curriculum was implemented in a secondary school under the pandemic. © 2021 Immersive Learning Research Network.

COVID-19 in Adults With Congenital Heart Disease.

BACKGROUND: Adults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications. OBJECTIVES: This study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes. METHODS: Adults (age 18 years or older) with CHD and with confirmed or clinically suspected COVID-19 were included from CHD centers worldwide. Data collection included anatomic diagnosis and subsequent interventions, comorbidities, medications, echocardiographic findings, presenting symptoms, course of illness, and outcomes. Predictors of death or severe infection were determined. RESULTS: From 58 adult CHD centers, the study included 1,044 infected patients (age: 35.1 ± 13.0 years; range 18 to 86 years; 51% women), 87% of whom had laboratory-confirmed coronavirus infection. The cohort included 118 (11%) patients with single ventricle and/or Fontan physiology, 87 (8%) patients with cyanosis, and 73 (7%) patients with pulmonary hypertension. There were 24 COVID-related deaths (case/fatality: 2.3%; 95% confidence interval: 1.4% to 3.2%). Factors associated with death included male sex, diabetes, cyanosis, pulmonary hypertension, renal insufficiency, and previous hospital admission for heart failure. Worse physiological stage was associated with mortality (p = 0.001), whereas anatomic complexity or defect group were not. CONCLUSIONS: COVID-19 mortality in adults with CHD is commensurate with the general population. The most vulnerable patients are those with worse physiological stage, such as cyanosis and pulmonary hypertension, whereas anatomic complexity does not appear to predict infection severity.

Update for Anaesthetists on Clinical Features of COVID-19 Patients and Relevant Management. LID - 1495

When preparing for the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the coronavirus infection disease (COVID-19) questions arose regarding various aspects concerning the anaesthetist. When reviewing the literature it became obvious that keeping up-to-date with all relevant publications is almost impossible. We searched for and summarised clinically relevant topics that could help making clinical decisions. This is a subjective analysis of literature concerning specific topics raised in our daily practice (e.g., clinical features of COVID-19 patients;ventilation of the critically ill COVID-19 patient;diagnostic of infection with SARS-CoV-2;stability of the virus;Covid-19 in specific patient populations, e.g., paediatrics, immunosuppressed patients, patients with hypertension, diabetes mellitus, kidney or liver disease;co-medication with non-steroidal anti-inflammatory drugs (NSDOs);antiviral treatment) and we believe that these answers help colleagues in clinical decision-making. With ongoing treatment of severely ill COVID-19 patients other questions will come up. While respective guidelines on these topics will serve clinicians in clinical practice, regularly updating all guidelines concerning COVID-19 will be a necessary, although challenging task in the upcoming weeks and months. All recommendations during the current extremely rapid development of knowledge must be evaluated on a daily basis, as suggestions made today may be out-dated with the new evidence available tomorrow. FAU - Preckel, Benedikt