"My Biggest Fear Is She'll Die Alone": Care Partner Perspectives of Institutional COVID-19 Visitor Restrictions in Ontario, Canada.

In March 2020, the Government of Ontario, Canada implemented public health measures, including visitor restrictions in institutional care settings, to protect vulnerable populations, including older adults (> 65 years), against COVID-19 infection. Prior research has shown that visitor restrictions can negatively influence older adults' physical and mental health and can cause increased stress and anxiety for care partners. This study explores the experiences of care partners separated from the person they care for because of institutional visitor restrictions during the COVID-19 pandemic. We interviewed 14 care partners between the ages of 50 and 89; 11 were female. The main themes that emerged were changing public health and infection prevention and control policies, shifting care partner roles as a result of visitor restrictions, resident isolation and deterioration from the care partner perspective, communication challenges, and reflections on the impacts of visitor restrictions. Findings may be used to inform future health policy and system reforms.

The effects of alcohol and marijuana co-use patterns on intimate partner aggression perpetration.

Alcohol and marijuana are two of the most widely used substances in the U.S, with rates of alcohol and marijuana co-use increasing in recent years. Despite this increase, little is known about the effects of alcohol and marijuana co-use patterns (e.g., simultaneous, concurrent) on intimate partner aggression (IPA) perpetration. The purpose of the current study was to examine differences in IPA among simultaneous and concurrent alcohol and marijuana use groups and an alcohol-only group. Participants were 496 individuals (57% identifying as a woman) recruited nationally in April 2020 via Qualtrics Research Services who reported being in a current relationship and recently consuming alcohol. Individuals completed an online survey that included demographics, measures of COVID-19 stress, alcohol and marijuana use, and physical and psychological IPA perpetration. Based on survey responses, individuals were categorized as belonging to the alcohol use only group (n = 300), the concurrent alcohol and marijuana use group (n = 129), or the regular simultaneous alcohol and marijuana use group (n = 67). Due to inclusion criteria, there was no marijuana use only group. Individuals with regular simultaneous or concurrent alcohol and marijuana co-use reported more frequent physical and psychological IPA perpetration compared to those who only used alcohol. Neither physical nor psychological IPA perpetration frequency differed between individuals who reported regular simultaneous versus concurrent alcohol and marijuana co-use. Results suggest that alcohol and marijuana co-use in general, and not the specific pattern of use, is associated with an increased likelihood of IPA perpetration.

Inhibition of IL-6 signaling prevents serum-induced umbilical cord artery dysfunction from patients with severe COVID-19.

Coronavirus disease 2019 (COVID-19) infection has a negative impact on the cytokine profile of pregnant women. Increased levels of proinflammatory cytokines seem to be correlated with the severity of the disease, in addition to predisposing to miscarriage or premature birth. Proinflammatory cytokines increase the generation of reactive oxygen species (ROS). It is unclear how interleukin-6 (IL-6) found in the circulation of patients with severe COVID-19 might affect gestational health, particularly concerning umbilical cord function. This study tested the hypothesis that IL-6 present in the circulation of women with severe COVID-19 causes umbilical cord artery dysfunction by increasing ROS generation and activating redox-sensitive proteins. Umbilical cord arteries were incubated with serum from healthy women and women with severe COVID-19. Vascular function was assessed using concentration-effect curves to serotonin in the presence or absence of pharmacological agents, such as tocilizumab (antibody against the IL-6 receptor), tiron (ROS scavenger), ML171 (Nox1 inhibitor), and Y27632 (Rho kinase inhibitor). ROS generation was assessed by the dihydroethidine probe and Rho kinase activity by an enzymatic assay. Umbilical arteries exposed to serum from women with severe COVID-19 were hyperreactive to serotonin. This effect was abolished in the presence of tocilizumab, tiron, ML171, and Y27632. In addition, serum from women with severe COVID-19 increased Nox1-dependent ROS generation and Rho kinase activity. Increased Rho kinase activity was abolished by tocilizumab and tiron. Serum cytokines in women with severe COVID-19 promote umbilical artery dysfunction. IL-6 is key to Nox-linked vascular oxidative stress and activation of the Rho kinase pathway.

Enhanced recovery after radical cystectomy: Outcomes of implementation after 80 cases

Objectives: To evaluate the effect of implementing Enhanced Recovery After Surgery (ERAS) and compliance to protocol in patients undergoing radical cystectomy (RC) and urinary diversion during the COVID-19 pandemic. Method(s): Since February 2020, a 14-point multimodal ERAS protocol has been implemented for patients undergoing elective CR and urinary diversion at our institution. We retrospectively evaluated 80 patients who underwent CR between February 2020 and February 2022. The effects of ERAS implantation for CR during the COVID-19 pandemic were validated. Result(s): With a mean age of 68.5 years [CI: 66.4-70.7], 80 patients who underwent RC were included in the analysis, 69 men (86%) and 11 women (14%). Main indication for surgery was muscle-invasive bladder cancer and laparoscopic or robot-assisted RC was performed in most cases (86%). Regarding urinary diversion, in 66 patients (82.5%) an ileal conduit was done and an orthotopic neobladder in 14 cases (17.5%). The attached table shows the percentage of compliance with each parameter of the 14-point ERAS protocol. Most of the compliance rates are above 80%, except for early mobilization. Efficiency item assesses whether the expected days of hospital admission are met. In this way, the median length of hospital stay (LOS) was 5 days [IQR 2.5]. In terms of follow-up, the hospital readmission rate one month after surgery was 6%. Before the application of the ERAS program this rate was 9.1%, thus it represents a significant reduction (p<0.05). [Formula presented] Conclusion(s): Our initial experience with the implementation of a 14-point enhanced recovery protocol after RC has been satisfactory achieving a 85% compliance rate and promising results regarding reduction of LOS and hospital readmission. Further cases and analysis are required to draw definitive conclusions. Disclosure of Interest: None declared Copyright © 2022

White Paper: Open Digital Health - accelerating transparent and scalable health promotion and treatment.

In this White Paper, we outline recommendations from the perspective of health psychology and behavioural science, addressing three research gaps: (1) What methods in the health psychology research toolkit can be best used for developing and evaluating digital health tools? (2) What are the most feasible strategies to reuse digital health tools across populations and settings? (3) What are the main advantages and challenges of sharing (openly publishing) data, code, intervention content and design features of digital health tools? We provide actionable suggestions for researchers joining the continuously growing Open Digital Health movement, poised to revolutionise health psychology research and practice in the coming years. This White Paper is positioned in the current context of the COVID-19 pandemic, exploring how digital health tools have rapidly gained popularity in 2020-2022, when world-wide health promotion and treatment efforts rapidly shifted from face-to-face to remote delivery. This statement is written by the Directors of the not-for-profit Open Digital Health initiative (n = 6), Experts attending the European Health Psychology Society Synergy Expert Meeting (n = 17), and the initiative consultant, following a two-day meeting (19-20th August 2021).

Prolonged COVID-19 symptom duration in people with systemic autoimmune rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey.

OBJECTIVE: We investigated prolonged COVID-19 symptom duration, defined as lasting 28 days or longer, among people with systemic autoimmune rheumatic diseases (SARDs). METHODS: We analysed data from the COVID-19 Global Rheumatology Alliance Vaccine Survey (2 April 2021-15 October 2021) to identify people with SARDs reporting test-confirmed COVID-19. Participants reported COVID-19 severity and symptom duration, sociodemographics and clinical characteristics. We reported the proportion experiencing prolonged symptom duration and investigated associations with baseline characteristics using logistic regression. RESULTS: We identified 441 respondents with SARDs and COVID-19 (mean age 48.2 years, 83.7% female, 39.5% rheumatoid arthritis). The median COVID-19 symptom duration was 15 days (IQR 7, 25). Overall, 107 (24.2%) respondents had prolonged symptom duration (≥28 days); 42/429 (9.8%) reported symptoms lasting ≥90 days. Factors associated with higher odds of prolonged symptom duration included: hospitalisation for COVID-19 vs not hospitalised and mild acute symptoms (age-adjusted OR (aOR) 6.49, 95% CI 3.03 to 14.1), comorbidity count (aOR 1.11 per comorbidity, 95% CI 1.02 to 1.21) and osteoarthritis (aOR 2.11, 95% CI 1.01 to 4.27). COVID-19 onset in 2021 vs June 2020 or earlier was associated with lower odds of prolonged symptom duration (aOR 0.42, 95% CI 0.21 to 0.81). CONCLUSION: Most people with SARDs had complete symptom resolution by day 15 after COVID-19 onset. However, about 1 in 4 experienced COVID-19 symptom duration 28 days or longer; 1 in 10 experienced symptoms 90 days or longer. Future studies are needed to investigate the possible relationships between immunomodulating medications, SARD type/flare, vaccine doses and novel viral variants with prolonged COVID-19 symptoms and other postacute sequelae of COVID-19 among people with SARDs.

Anticoagulation and Antiplatelet Therapy for Prevention of Venous and Arterial Thrombotic Events in Critically Ill Patients With COVID-19: COVID-PACT.

BACKGROUND: The efficacy and safety of prophylactic full-dose anticoagulation and antiplatelet therapy in critically ill COVID-19 patients remain uncertain. METHODS: COVID-PACT (Prevention of Arteriovenous Thrombotic Events in Critically-ill COVID-19 Patients Trial) was a multicenter, 2×2 factorial, open-label, randomized-controlled trial with blinded end point adjudication in intensive care unit-level patients with COVID-19. Patients were randomly assigned to a strategy of full-dose anticoagulation or standard-dose prophylactic anticoagulation. Absent an indication for antiplatelet therapy, patients were additionally randomly assigned to either clopidogrel or no antiplatelet therapy. The primary efficacy outcome was the hierarchical composite of death attributable to venous or arterial thrombosis, pulmonary embolism, clinically evident deep venous thrombosis, type 1 myocardial infarction, ischemic stroke, systemic embolic event or acute limb ischemia, or clinically silent deep venous thrombosis, through hospital discharge or 28 days. The primary efficacy analyses included an unmatched win ratio and time-to-first event analysis while patients were on treatment. The primary safety outcome was fatal or life-threatening bleeding. The secondary safety outcome was moderate to severe bleeding. Recruitment was stopped early in March 2022 (≈50% planned recruitment) because of waning intensive care unit-level COVID-19 rates. RESULTS: At 34 centers in the United States, 390 patients were randomly assigned between anticoagulation strategies and 292 between antiplatelet strategies (382 and 290 in the on-treatment analyses). At randomization, 99% of patients required advanced respiratory therapy, including 15% requiring invasive mechanical ventilation; 40% required invasive ventilation during hospitalization. Comparing anticoagulation strategies, a greater proportion of wins occurred with full-dose anticoagulation (12.3%) versus standard-dose prophylactic anticoagulation (6.4%; win ratio, 1.95 [95% CI, 1.08-3.55]; P=0.028). Results were consistent in time-to-event analysis for the primary efficacy end point (full-dose versus standard-dose incidence 19/191 [9.9%] versus 29/191 [15.2%]; hazard ratio, 0.56 [95% CI, 0.32-0.99]; P=0.046). The primary safety end point occurred in 4 (2.1%) on full dose and in 1 (0.5%) on standard dose (P=0.19); the secondary safety end point occurred in 15 (7.9%) versus 1 (0.5%; P=0.002). There was no difference in all-cause mortality (hazard ratio, 0.91 [95% CI, 0.56-1.48]; P=0.70). There were no differences in the primary efficacy or safety end points with clopidogrel versus no antiplatelet therapy. CONCLUSIONS: In critically ill patients with COVID-19, full-dose anticoagulation, but not clopidogrel, reduced thrombotic complications with an increase in bleeding, driven primarily by transfusions in hemodynamically stable patients, and no apparent excess in mortality. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT04409834.

COVID Stress, socioeconomic deprivation, and intimate partner aggression during the COVID-19 pandemic.

BACKGROUND: Intimate partner aggression (IPA) is a prevalent public health concern that is associated with multiple negative consequences. Rates of IPA in the U.S. have increased since the onset of the Coronavirus Disease 2019 (COVID-19) pandemic, likely due to stress associated with the pandemic. Socioeconomic deprivation is associated with COVID-19 outcomes as well as IPA. However, whether socioeconomic deprivation interacts with COVID-19 stress in predicting IPA remains unclear. METHODS: Using a sample of 510 individuals recruited via Qualtrics Research Services in April 2020, the present study tested whether socioeconomic deprivation moderates the association between COVID-19 stress and IPA perpetration and victimization. Participants completed a questionnaire battery that included measures of COVID-19 stressors and physical and psychological IPA perpetration and victimization. In addition, participants reported their residential zip codes, which were subsequently matched with scores on the Social Deprivation Index, a composite measure of seven demographic variables from the 5-year American Community Survey. RESULTS: Sequential generalized linear models in Mplus Version 8.7 showed that the effects of COVID-19 stress on physical IPA perpetration and psychological IPA victimization can be best understood through its interactive effects with socioeconomic deprivation. Higher COVID-19 stress was associated with higher levels of physical IPA perpetration and psychological IPA victimization when socioeconomic deprivation was low but not when socioeconomic deprivation was high. Importantly, however, overall rates of IPA were higher among individuals with higher socioeconomic deprivation than among individuals with lower socioeconomic deprivation, regardless of the amount of COVID-19 stress they experienced. CONCLUSIONS: The present analyses implicate COVID-19 stress as a critical correlate of IPA and show that the association between this stress and physical IPA perpetration and psychological IPA victimization may be particularly salient among individuals who live in areas of lower socioeconomic deprivation. Furthermore, our results clearly pinpoint the detrimental effects of socioeconomic deprivation more broadly, showing that individuals who live in more deprived areas tend to have high levels of IPA regardless of their level of COVID-19 stress. These findings call for public health policies at the community and societal level that target not only COVID-related stress but also the impacts of socioeconomic inequality.

Olfactory dysfunction in Long-COVID

Aim The project aims to examine chemosensory dysfunction in long-COVID with a focus on olfactory function about 9 months after SARS-CoV-II-infection. Material and Methods In this population-based cross sectional study, PCR-confirmed SARS-CoV-2 outpatients were examined between November and June 2020 at Kiel university hospital. Data on medical history and chemosensory function were collected via questionnaires and a Visual Analogue Scale (VAS), olfactory performance was psychophysically objectified using the Sniffin' Sticks test. Results A total of 376 female and 290 male patients were included with a mean age of 48.2 years ranging from 19 to 87 years. The mean follow-up was 9.09 months (range 1.64-15.18) after initial positive PCR-testing. The prevalence for olfactory dysfunction (OD) during infection was 66,1 %. 33,7 % of the subjects reported persistent OD subjectively at the time of examination (female 28,8 %, male 42,3 %). T-test analysis showed a significant decline of reported olfactory evaluation from before COVID-19 to the time of examination based on VAS (p < 0.001). 34,6 % of the subjects were tested hyposmic or anosmic by Sniffin' Sticks. A significant correlation was shown between a subjective estimation of OD by the patients and an objectively tested OD (p < 0.001). The TDI-score correlated positively with the amount of time (in months) that passed since PCR-testing (p < 0.001). Discussion OD in SARS-CoV-II-infection is frequent and can be persistent long beyond the acute phase of ilness. We demonstrated that anamnestic OD is significantly related to psychophysically tested OD. Therefore one can conclude that a subjective OD is a likely predictor of an actual objective OD. Furthermore, OD shows a tendency to improve over time.

Gustatory dysfunction in long COVID

Background This study aims to investigate the prevalence and long-term development of gustatory dysfunction (GD) after COVID-19. Methods In the population-based cross-sectional COVIDOM-study, 667 patients above the age of 18 years (mean 48.2) who tested positive for SARSCoV- 2 via PCR-testing on average 9.09 months ago were examined between November 2020 and June 2021. Extensive medical history taking was conducted via questionnaires. Participants were asked to rate their ability to taste before, during and after COVID-19 on a Visual Analogue Scale (VAS) ranging from 0 to 10. Whole mouth gustatory testing with Taste Strips for the qualities sweet, sour, salty, and bitter was performed. Results 60.9 % (406 of 667) participants reported gustatory impairment during their infection. Out of those, 56.9 % perceived this symptom as severe and 13.3 % noticed it as the earliest symptom. At the time of our examination, 36.2 % had a persistent subjective GD, defined as a lower score on the VAS than before COVID-19 (mean difference -0.9 points). This difference was significant (p < 0.001). In the testing, 7.3 % (47 of 667) participants had a GD, defined as the correct identification of less than three out of four Taste Strips. No signifi- cant correlation was found between subjectively persistent and tested GD (p = 0.250). Conclusions SARS-CoV-2 seems to frequently affect the gustatory function in the long term as well, what might have an influence on patients' everyday-life. However, Patients' own perception does not always correspond with psychophysiological testing which might be caused by the common difficulty to differentiate between the chemosensory senses of taste and smell.

Baseline factors associated with self-reported disease flares following COVID-19 vaccination among adults with systemic rheumatic disease: results from the COVID-19 global rheumatology alliance vaccine survey.

OBJECTIVE: To examine the frequency of, and risk factors for, disease flare following COVID-19 vaccination in patients with systemic rheumatic disease (SRD). METHODS: An international study was conducted from 2 April to 16 August 2021, using an online survey of 5619 adults with SRD for adverse events following COVID-19 vaccination, including flares of disease requiring a change in treatment. We examined risk factors identified a priori based on published associations with SRD activity and SARS-CoV-2 severity, including demographics, SRD type, comorbidities, vaccine type, cessation of immunosuppressive medications around vaccination and history of reactions to non-COVID-19 vaccines, using multivariable logistic regression. RESULTS: Flares requiring a change in treatment following COVID-19 vaccination were reported by 4.9% of patients. Compared with rheumatoid arthritis, certain SRD, including systemic lupus erythematosus (OR 1.51, 95% CI 1.03, 2.20), psoriatic arthritis (OR 1.95, 95% CI 1.20, 3.18) and polymyalgia rheumatica (OR 1.94, 95% CI 1.08, 2.48) were associated with higher odds of flare, while idiopathic inflammatory myopathies were associated with lower odds for flare (OR 0.54, 95% CI 0.31-0.96). The Oxford-AstraZeneca vaccine was associated with higher odds of flare relative to the Pfizer-BioNTech vaccine (OR 1.44, 95% CI 1.07, 1.95), as were a prior reaction to a non-COVID-19 vaccine (OR 2.50, 95% CI 1.76, 3.54) and female sex (OR 2.71, 95% CI 1.55, 4.72). CONCLUSION: SRD flares requiring changes in treatment following COVID-19 vaccination were uncommon in this large international study. Several potential risk factors, as well as differences by disease type, warrant further examination in prospective cohorts.

Assessing Occupational Stressors in Restaurant Work Prior to and During the COVID-19 Pandemic: An Exploratory Analysis.

OBJECTIVE: This exploratory study investigated occupational stress in restaurant work prior to and during the COVID-19 pandemic. METHODS: The study was a mixed methods design conducted in two phases with biomarker data for stress, questionnaire data, and semi-structured interviews. RESULTS: Results indicated elevated stressors elevated stress during normal shift conditions (P < 0.05), low job satisfaction, an effort to reward imbalance (P < 0.05), and the majority (72%, n = 28) of participants reporting discrimination at least a "few times a year." Interview data revealed four interrelated occupational stressors including: (1) financial hardships; (2) increased exposure to occupational health risks during the reopening phases; (3) increased workloads due to inadequate staffing and fewer hours; and (4) social and psychological pressures and ill treatment. CONCLUSION: These elements were reported prior to the COVID-19 pandemic and have persisted throughout with heightened impacts.

Implications of the COVID-19 San Francisco Bay Area Shelter-in-Place Announcement: A Cross-Sectional Social Media Survey

BACKGROUND: The U.S. has experienced an unprecedented number of shelter-in-place orders throughout the COVID-19 pandemic. There is limited empirical research that examines the impact of these orders. We aimed to rapidly ascertain whether social distancing;difficulty with daily activities (obtaining food, essential medications and childcare);and levels of concern regarding COVID-19 changed after the March 16, 2020 announcement of shelter-in-place orders for seven counties in the San Francisco Bay Area. METHODS: We conducted an online, cross-sectional social media survey from March 14 - April 1, 2020. We measured changes in social distancing behavior;experienced difficulties with daily activities (i.e., access to healthcare, childcare, obtaining essential food and medications);and level of concern regarding COVID-19 after the March 16 shelter-in-place announcement in the San Francisco Bay Area and elsewhere in the U.S. RESULTS: The percentage of respondents social distancing all of the time increased following the shelter-in-place announcement in the Bay Area (9.2%, 95% CI: 6.6, 11.9) and elsewhere in the U.S. (3.4%, 95% CI: 2.0, 5.0). Respondents also reported increased difficulty with obtaining food, hand sanitizer, and medications, particularly with obtaining food for both respondents from the Bay Area (13.3%, 95% CI: 10.4, 16.3) and elsewhere (8.2%, 95% CI: 6.6, 9.7). We found limited evidence that level of concern regarding the COVID-19 crisis changed following the shelter-in-place announcement. CONCLUSION: These results capture early changes in attitudes, behaviors, and difficulties. Further research that specifically examines social, economic, and health impacts of COVID-19, especially among vulnerable populations, is urgently needed. =.

Immediate effect of the COVID-19 pandemic on patient health, health-care use, and behaviours: results from an international survey of people with rheumatic diseases.

BACKGROUND: The impact and consequences of the COVID-19 pandemic on people with rheumatic disease are unclear. We developed the COVID-19 Global Rheumatology Alliance Patient Experience Survey to assess the effects of the COVID-19 pandemic on people with rheumatic disease worldwide. METHODS: Survey questions were developed by key stakeholder groups and disseminated worldwide through social media, websites, and patient support organisations. Questions included demographics, rheumatic disease diagnosis, COVID-19 diagnosis, adoption of protective behaviours to mitigate COVID-19 exposure, medication access and changes, health-care access and communication with rheumatologists, and changes in employment or schooling. Adults age 18 years and older with inflammatory or autoimmune rheumatic diseases were eligible for inclusion. We included participants with and without a COVID-19 diagnosis. We excluded participants reporting only non-inflammatory rheumatic diseases such as fibromyalgia or osteoarthritis. FINDINGS: 12 117 responses to the survey were received between April 3 and May 8, 2020, and of these, 10 407 respondents had included appropriate age data. We included complete responses from 9300 adults with rheumatic disease (mean age 46·1 years; 8375 [90·1%] women, 893 [9·6%] men, and 32 [0·3%] participants who identified as non-binary). 6273 (67·5%) of respondents identified as White, 1565 (16·8%) as Latin American, 198 (2·1%) as Black, 190 (2·0%) as Asian, and 42 (0·5%) as Native American or Aboriginal or First Nation. The most common rheumatic disease diagnoses included rheumatoid arthritis (3636 [39·1%] of 9300), systemic lupus erythematosus (2882 [31·0%]), and Sjögren's syndrome (1290 [13·9%]). Most respondents (6921 [82·0%] of 8441) continued their antirheumatic medications as prescribed. Almost all (9266 [99·7%] of 9297) respondents adopted protective behaviours to limit SARS-CoV-2 exposure. A change in employment status occurred in 2524 (27·1%) of 9300) of respondents, with a 13·6% decrease in the number in full-time employment (from 4066 to 3514). INTERPRETATION: People with rheumatic disease maintained therapy and followed public health advice to mitigate the risks of COVID-19. Substantial employment status changes occurred, with potential implications for health-care access, medication affordability, mental health, and rheumatic disease activity. FUNDING: American College of Rheumatology.

Population Decline in COPD Admissions During the COVID-19 Pandemic Associated with Lower Burden of Community Respiratory Viral Infections.

BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic has led to widespread implementation of public health measures, such as stay-at-home orders, social distancing, and masking mandates. In addition to decreasing spread of severe acute respiratory syndrome coronavirus 2, these measures also impact the transmission of seasonal viral pathogens, which are common triggers of chronic obstructive pulmonary disease (COPD) exacerbations. Whether reduced viral prevalence mediates reduction in COPD exacerbation rates is unknown. METHODS: We performed retrospective analysis of data from a large, multicenter health care system to assess admission trends associated with community viral prevalence and with initiation of COVID-19 pandemic control measures. We applied difference-in-differences analysis to compare season-matched weekly frequency of hospital admissions for COPD prior to and after implementation of public health measures for COVID-19. Community viral prevalence was estimated using regional Centers for Disease Control and Prevention test positivity data and correlated to COPD admissions. RESULTS: Data involving 4422 COPD admissions demonstrated a season-matched 53% decline in COPD admissions during the COVID-19 pandemic, which correlated to community viral burden (r = 0.73; 95% confidence interval, 0.67-0.78) and represented a 36% greater decline over admission frequencies observed in other medical conditions less affected by respiratory viral infections (incidence rate ratio 0.64; 95% confidence interval, 0.57-0.71, P < .001). The post-COVID-19 decline in COPD admissions was most pronounced in patients with fewer comorbidities and without recurrent admissions. CONCLUSION: The implementation of public health measures during the COVID-19 pandemic was associated with decreased COPD admissions. These changes are plausibly explained by reduced prevalence of seasonal respiratory viruses.

The Impact of the COVID-19 Pandemic on Occupational Stress in Restaurant Work: A Qualitative Study.

The economic downturn due to the COVID-19 pandemic disproportionately impacted the food service industry-one of the largest workforce sectors in the United States. The purpose of this qualitative study was to explore the occupational stressors experienced by restaurant and food service workers during the COVID-19 pandemic through a detailed assessment of their lived experiences. Thematic analysis was used to identify patterns within data from sixteen semi-structured interviews with people employed or recently employed in the restaurant industry during July of 2020. Five themes were highlighted including fear of being exposed to the COVID-19 virus while working under inadequate safety policies, job insecurity, inconsistent pay and hours and a lack of health benefits and paid time off, all of which increased occupational stress and led to uncertainty if respondents would return to the restaurant industry. Hardships associated with the pandemic were mitigated by the support and connections fostered by the communities built within the restaurants. Results led to several recommendations to address the social and economic contributors to occupational stress at the structural and population levels which can be used in the current and post-pandemic workplace.

Early experience of COVID-19 vaccination in adults with systemic rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey.

BACKGROUND: We describe the early experiences of adults with systemic rheumatic disease who received the COVID-19 vaccine. METHODS: From 2 April to 30 April 2021, we conducted an online, international survey of adults with systemic rheumatic disease who received COVID-19 vaccination. We collected patient-reported data on clinician communication, beliefs and intent about discontinuing disease-modifying antirheumatic drugs (DMARDs) around the time of vaccination, and patient-reported adverse events after vaccination. RESULTS: We analysed 2860 adults with systemic rheumatic diseases who received COVID-19 vaccination (mean age 55.3 years, 86.7% female, 86.3% white). Types of COVID-19 vaccines were Pfizer-BioNTech (53.2%), Oxford/AstraZeneca (22.6%), Moderna (21.3%), Janssen/Johnson & Johnson (1.7%) and others (1.2%). The most common rheumatic disease was rheumatoid arthritis (42.3%), and 81.2% of respondents were on a DMARD. The majority (81.9%) reported communicating with clinicians about vaccination. Most (66.9%) were willing to temporarily discontinue DMARDs to improve vaccine efficacy, although many (44.3%) were concerned about rheumatic disease flares. After vaccination, the most reported patient-reported adverse events were fatigue/somnolence (33.4%), headache (27.7%), muscle/joint pains (22.8%) and fever/chills (19.9%). Rheumatic disease flares that required medication changes occurred in 4.6%. CONCLUSION: Among adults with systemic rheumatic disease who received COVID-19 vaccination, patient-reported adverse events were typical of those reported in the general population. Most patients were willing to temporarily discontinue DMARDs to improve vaccine efficacy. The relatively low frequency of rheumatic disease flare requiring medications was reassuring.