A mixed method approach to understanding the impact of COVID-19 on patients with or at risk for aortic dissection.

Aortic dissection (AD) is a life-threatening rare disease that occurs as a spontaneous tear in the wall of the aorta. Survivors of AD go on to have a chronic disease process that requires lifelong follow-up and management. Although the COVID-19 pandemic has strained health systems and impacted practice in the United States, the effects of these impacts on people living with or at risk for AD is not well understood. This mixed methods project examined the experiences of people in the AD community during the COVID-19 pandemic between March and October 2020. Results reveal that the AD community lacked clear guidance on the role aortic health status plays in COVID-19 risk and experienced significant disruptions in aortic healthcare. At the same time, the new expansion in access to medical care with telehealth conferred unforeseen benefits in the form of reduced barriers for access to specialized aortic health care.

Clinical outcomes of patients with and without HIV hospitalized with COVID-19 in England during the early stages of the pandemic: a matched retrospective multi-centre analysis (RECEDE-C19 study).

BACKGROUND: The contribution of HIV to COVID-19 outcomes in hospitalized inpatients remains unclear. We conducted a multi-centre, retrospective matched cohort study of SARS-CoV-2 PCR-positive hospital inpatients analysed by HIV status. METHODS: HIV-negative patients were matched to people living with HIV (PLWH) admitted from 1 February 2020 to 31 May 2020 up to a 3:1 ratio by the following: hospital site, SARS-CoV-2 test date ± 7 days, age ± 5 years, gender, and index of multiple deprivation decile ± 1. The primary objective was clinical improvement (two-point improvement or better on a seven-point ordinal scale) or hospital discharge by day 28, whichever was earlier. RESULTS: A total of 68 PLWH and 181 HIV-negative comparators were included. In unadjusted analyses, PLWH had a reduced hazard of achieving clinical improvement or discharge [adjusted hazard ratio (aHR) = 0.57, 95% confidence interval (CI): 0.39-0.85, p = 0.005], but this association was ameliorated (aHR = 0.70, 95% CI: 0.43-1.17, p = 0.18) after additional adjustment for ethnicity, frailty, baseline hypoxaemia, duration of symptoms prior to baseline, body mass index (BMI) categories and comorbidities. Baseline frailty (aHR = 0.79, 95% CI: 0.65-0.95, p = 0.011), malignancy (aHR = 0.37, 95% CI 0.17, 0.82, p = 0.014) remained associated with poorer outcomes. The PLWH were more likely to be of black, Asian and minority ethnic background (75.0% vs 48.6%, p = 0.0002), higher median clinical frailty score [3 × interquartile range (IQR): 2-5 vs, 2 × IQR: 1-4, p = 0.0069), and to have a non-significantly higher proportion of active malignancy (14.4% vs 9.9%, p = 0.29). CONCLUSIONS: Adjusting for confounding comorbidities and demographics in a matched cohort ameliorated differences in outcomes of PLWH hospitalized with COVID-19, highlighting the importance of an appropriate comparison group when assessing outcomes of PLWH hospitalized with COVID-19.

"This Is What You Signed Up for": Oral Histories of New York State Nurses During the COVID-19 Pandemic

One of the first healthcare providers in New York City to die from COVID-19 was a nurse. When the city was already seeing hundreds of cases a day at area hospitals, particularly in neighborhoods already marginalized by health and economic disparities, nurses at one hospital in the Bronx staged a demonstration to protest the lack of essential personal protective equipment. The astounding response by hospital administrators was to threaten nurses that they would be fired if they continued to speak out regarding their concerns. Like many activists, healthcare providers took to social media to warn the public about the realities of both the COVID-19 crisis and the threats to the health and safety of their own families. However, in at least one Facebook thread, the response to nurses was, "This is what you signed up for." As scholars of women's history, we have to wonder about the irony of nurses being lauded as heroes in one breath and criticized as hand-wringing turncoats in another. Did such a callous response have anything to do with the fact that nursing is still considered to be a "feminized" profession? As it turns out, nurses-who are always at the forefront of patient care-were right to raise the alarm. By mid-June, more than 140 nurses in the United States were estimated to have died from COVID-19. Countless others continue to put their lives on the line to do the jobs they have committed to do every day. This article does what some hospital administrators and health officials did not. We listen to nurses. Through oral history interviews, we highlight what nurses in the New York metropolitan area, one of the epicenters of the pandemic, experienced during this staggering healthcare crisis.