COVID-19 Serosurvey of Frontline Healthcare Workers in Western Australia.

We aimed to study COVID-19 infection in healthcare workers (HCWs) during the first wave in a setting of low community incidence prior to HCW vaccination. We performed a cross-sectional study of frontline HCWs in two tertiary hospitals in Western Australia with questionnaire and testing for SARS-CoV-2 IgG antibodies, using a screening assay followed by confirmatory assays for initial reactive results. 799 Frontline HCWs were enrolled in the study, working in the emergency department (n = 194, 24.2%), ICU (n = 176, 22.0%), respiratory ward (n = 20, 2.5%), COVID clinic (n = 37, 4.6%), and theatre (n = 222, 28%). 189 (23.6%) were doctors, 327 (41.0%) nurses, and 283 (35.4%) other. Contact with a known COVID-19-positive patient occurred at work for 337 (42.1%), and outside work for 10 (1.2%). Four were diagnosed with COVID-19 by PCR, acquired overseas in two cases and related to healthcare work in two cases (one acquired from a colleague and one possibly acquired from patient contact in the healthcare setting). Nine HCWs had reactive screening serology, and three had confirmed positive IgG (these three were PCR-positive cases). Infection control procedures in the setting of low community incidence were effective at preventing HCW acquisition of COVID-19 infection.

Use of a simplified local guideline to optimise front door management of diabetes and hyperglycaemia in patients with COVID-19

Introduction: The National Diabetes Inpatient COVID response team have published guidance regarding initial and ongoing management of patients admitted with suspected COVID-19 with diabetes, or any patients experiencing elevated blood glucose levels as a consequence of COVID-19 or sequelae of dexamethasone administered as treatment. However, there was limited awareness and implementation of this guidance within our Trust. To improve patient care, we devised a local simplified guideline, highlighting key points from national guidance. Method: Audits were carried out prior to and following implementation of the local guideline. Results: Frequency of blood glucose recording on admission improved from 72% to 79% and review of metformin prescribing improved from 6 % to 67% post-guideline, while HbA1c measurement in patients with diabetes and COVID-19 improved significantly (from 36.1. % to 76.5%, p=0.006). Discussion: This is the most comprehensive audit conducted to our knowledge to gauge compliance with the ABCD Covid: Diabetes Front Door Guidance, involving 97 patients across both cycles. This project also brought about greater accessibility to ketone meters and heightened awareness regarding euglycaemic/sodium-glucose co-transporter 2 (SGLT-2) inhibitor-related diabetic ketoacidosis, which we feel will also improve clinical care for patients with diabetes within our service.

Airway pressure release ventilation in mechanically ventilated patients with COVID-19: a multicenter observational study.

BACKGROUND: Evidence prior to the coronavirus disease 2019 (COVID-19) pandemic suggested that, compared with conventional ventilation strategies, airway pressure release ventilation (APRV) can improve oxygenation and reduce mortality in patients with acute respiratory distress syndrome. We aimed to assess the association between APRV use and clinical outcomes among adult patients receiving mechanical ventilation for COVID-19 and hypothesized that APRV use would be associated with improved survival compared with conventional ventilation. METHODS: A total of 25 patients with COVID-19 pneumonitis was admitted to intensive care units (ICUs) for invasive ventilation in Perth, Western Australia, between February and May 2020. Eleven of these patients received APRV. The primary outcome was survival to day 90. Secondary outcomes were ventilation-free survival days to day 90, mechanical complications from ventilation, and number of days ventilated. RESULTS: Patients who received APRV had a lower probability of survival than did those on other forms of ventilation (hazard ratio, 0.17; 95% confidence interval, 0.03-0.89; P=0.036). This finding was independent of indices of severity of illness to predict the use of APRV. Patients who received APRV also had fewer ventilator-free survival days up to 90 days after initiation of ventilation compared to patients who did not receive APRV, and survivors who received APRV had fewer ventilator-free days than survivors who received other forms of ventilation. There were no differences in mechanical complications according to mode of ventilation. CONCLUSIONS: Based on the findings of this study, we urge caution with the use of APRV in COVID-19.

Cancer patients' perspectives on the real-world impact of COVID-19 pandemic: A multidisciplinary survey

Background: The outbreak of the COVID-19 pandemic has led to unprecedented disruptions to global cancer care delivery. We conducted this multidisciplinary survey to gain insights into the real-life impact of the pandemic as perceived by cancer patients. Methods: Cancer patients at various stages of their cancer journeys were surveyed with a questionnaire constructed by a multidisciplinary panel of oncologists, clinical psychologists, occupational therapists, physiotherapists and dieticians. The 64-question survey covered patient's concerns on cancer care resources, treatment provision and quality, changes in health-seeking behaviour;the impact of social isolation on physical wellbeing and psychological repercussions. Results: 600 cancer patients in Hong Kong were surveyed in May 2020. Preliminary results showed that 70% of respondents related a COVID-19 diagnosis to compromised cancer treatment and outcome. Although only 45% considered hospital attendance as safe, 80% indicated their willingness to attend oncology appointments remained unaffected. 91% of patients stated their decision to receive chemotherapy was not changed;however, 40% would be willing to trade off the efficacy/side-effect profile for an outpatient regimen. Patients also reported compromised physical wellbeing due to social isolation, in particular, deterioration in exercise tolerance & limb power (44%), reduced appetite (29%), worse sleep quality (35%). Interestingly, 59% of pts reported better care support as a result of family spending more time together. Anxiety and depression were reported in 70% and 54% of patients, respectively. In addition, 20 oncologists provided their predictions on changes in pt's health-seeking behaviours under the pandemic. Results showed that they significantly underestimated patients' willingness and preference to keep their scheduled oncology appointments and treatments despite the risk involved. Conclusions: This original survey revealed the breadth and profoundness of the impact of the COVID-19 pandemic as perceived by cancer patients, headlining patients’ care priorities and showing their unmet needs. It should be taken into consideration as we modify the way cancer care is provided during this unsettling period and beyond. Legal entity responsible for the study: The authors. Funding: The Kowloon Central Cluster Research Committee KCC Research Grant 2020/21, Hong Kong (KCC/RC/G/2021-B01). Disclosure: All authors have declared no conflicts of interest.