Delays in Stroke Onset to Hospital Arrival Time during COVID-19

Background and Purpose: The current coronavirus disease 2019 (COVID-19) pandemic represents a global public health crisis, disrupting emergency healthcare services. We determined whether COVID-19 has resulted in delays in stroke presentation and affected the delivery of acute stroke services in a comprehensive stroke center in Hong Kong. Method(s): We retrospectively reviewed all patients with transient ischemic attack and stroke admitted via the acute stroke pathway of Queen Mary Hospital, Hong Kong, during the first 60 days since the first diagnosed COVID-19 case in Hong Kong (COVID-19: January 23, 2020-March 24, 2020). We compared the stroke onset to hospital arrival (onset-to-door) time and timings of inpatient stroke pathways with patients admitted during the same period in 2019 (pre-COVID-19: January 23, 2019-March 24, 2019). Result(s): Seventy-three patients in COVID-19 were compared with 89 patients in pre-COVID-19. There were no significant differences in age, sex, vascular risk factors, nor stroke severity between the 2 groups (P>0.05). The median stroke onset-to-door time was =1-hour longer in COVID-19 compared with pre-COVID-19 (154 versus 95 minutes, P=0.12), and the proportion of individuals with onset-to-door time within 4.5 hours was significantly lower (55% versus 72%, P=0.024). Significantly fewer cases of transient ischemic attack presented to the hospital during COVID-19 (4% versus 16%, P=0.016), despite no increase in referrals to the transient ischemic attack clinic. Inpatient stroke pathways and treatment time metrics nevertheless did not differ between the 2 groups (P>0.05 for all comparisons). Conclusion(s): During the early containment phase of COVID-19, we noted a prolongation in stroke onset to hospital arrival time and a significant reduction in individuals arriving at the hospital within 4.5 hours and presenting with transient ischemic attack. Public education about stroke should continue to be reinforced during the COVID-19 pandemic.Copyright © 2020 Lippincott Williams and Wilkins. All rights reserved.

Association between Recent Antibiotic Use and Early Immunogenicity of Covid-19 Bnt162b2 Vaccine

Introduction: Gut microbiota have been shown to be associated with COVID- 19 and influenza vaccine immunogenicity. While antibiotic-induced gut microbiota perturbation leads to suboptimal antibody production among influenza vaccine recipients, little is known about the effect of preexposure antibiotics on COVID-19 vaccine immunogenicity. Aims & Methods: We aimed to determine whether recent antibiotics use impaired COVID-19 immunogenicity. This was a prospective cohort study recruiting adult BNT162b2 recipients from five vaccination centers in Hong Kong. Exclusion criteria included prior COVID-19 infection, history of gastrointestinal surgery, inflammatory bowel disease, immunocompromised status (post-organ transplantation, immunosuppressants, chemotherapy), cancer, hematological, rheumatological and autoimmune diseases. Subjects received two doses of BNT162b2 at three weeks apart. Blood samples were collected at three time-points (before vaccination, day 21 and 56after first dose), and were tested for neutralising antibody (NAb) against receptor-binding domain (RBD) of wild type SARS-CoV-2 virus using a one-step competitive chemiluminescence immunoassay. NAb seroconversion was defined as 15 AU/mL. Primary outcomes were seroconversion rates of NAb at day 21 and 56 after first dose of vaccine. Exposure was pre-vaccination antibiotic use, defined as ever use of any antibiotics (including 11 different classes) within 6 months before vaccination. The adjusted odds ratio (aOR) of seroconversion with antibiotic use was derived by multivariable logistic regression model by adjusting for age, sex, diabetes mellitus (DM), overweight (BMI >23 kg/m2for Asians), hypertension, raised LDL (>=3.4 mmol/L), moderate-to-severe hepatic steatosis (defined as controlled attenuated parameter >= 268 dB/M on transient elastography), smoking and alcohol. Result(s): Of 316 BNT162b2 recipients (100 [31.6%] male;median age 50.1 [IQR:40.0-57.0] years), all and 284 (89.9%) had NAb level measured at day 21 and 56, respectively. There were 29 (9.2%) antibiotic users (median duration of use: 7 [IQR:7-13] days). There was no significant difference in baseline characteristics between antibiotic users and non-users. At day 21, there was a trend towards lower seroconversion rate among antibiotic users compared with non-users (82.8% vs 91.3%;p=0.135). Independent factors negatively associated with seroconversion after one dose of BNT162b2 were antibiotics use (aOR:0.26, 95% CI:0.08-0.96), age >60 years (aOR:0.34, 95% CI:0.13-0.95) and male sex (aOR:0.14, 95% CI:0.05-0.34). At day 56, there was no more significant difference in seroconversion rate between antibiotic users and non-users (96.6% vs 99.3%;p=0.149). Conclusion(s): Recent antibiotic use before BNT162b2 vaccination was associated with lower early seroconversion rate after a single dose of vaccine but not two doses of vaccine. Further research on the association between antibiotics, gut microbiota and COVID-19 early vaccine immunogenicity is warranted.

Nanofiber Filter Technologies for Filtration of Submicron Aerosols and Nanoaerosols

Nanofiber Filter Technologies for Filtration of Submicron Aerosols and Nanoaerosols covers the nanoaerosols (less than 100 nanometers) to larger submicron aerosols due mostly to pollution, which are present in high number concentration in our surroundings. People are breathing these nanoaerosols daily without being aware of it. Airborne viruses from flu to coronaviruses are also nanoaerosols. During the COVID-19 pandemic, it took a long time for health authorities and the General Public to recognize the airborne transmission mode of the virus. This leads to inadequate protection and ineffective virus control strategies resulting in high infection and death rates. The book cites evidence and observations pointing to the airborne transmission mode of the coronavirus. It also discusses different filtration technologies using nanofibers to capture these aerosols for short-term filtration, where aerosols are trapped in the filter (depth filtration), and long-term filtration, where aerosols are trapped in the growing filter cake (cake filtration). This book provides a good understanding on how nanofibers, which is of size 1/1000 times that of a normal human hair, can effectively filter these tiny aerosols. NFT, organized in four sections – fundamentals, deep understanding, technologies, and application, covering comprehensively on the subject, is a valuable resource for undergraduates and graduates, engineers, researchers and practitioners in related industries. © 2022 Elsevier Inc. All rights reserved.

UNPLANNED HOPSITAL ADMISSION AND EMERGENCY ATTENDANCE FOLLOWING TWO-DOSE OF BNT162B2 AMONG PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED COHORT STUDY

Background: Real-world population-based safety data about the COVID-19 mRNA vaccine is lacking in patients with various immunocompromised conditions, including inflammatory bowel disease (IBD). Aim: To determine the incidence rates of unplanned IBD-related hospital admission and all-cause emergency attendance following BNT162B2 vaccination in IBD patients. Methods: Through the Government commissioned, territory-wide active COVID19 safety surveillance, we linked population-level vaccination records and health outcome data, between March 10 (1st day of vaccination program) and September 30, 2021, to assess the association between two-dose of BNT162b2 and unplanned IBD-related hospitalization and all-cause emergency attendance. We used inverse probability treatment weightingbased cohort study design to balance the baseline characteristics between vaccinated and unvaccinated IBD patients. Poisson regression model was fitted to estimate the adjusted incidence rate ratio (IRR) of unplanned IBD hospital admission and 28-day emergency room attendance following the vaccination, using the unvaccinated group as the reference. Results: Among more than 4.1 million citizens with successful vaccine and health record-linkage, we identified 941 IBD patients (age: 46.0 ± 15.0 years, male: 64.2%) who completed twodose of BNT162b2 and 1196 age-sex matched unvaccinated IBD patients as control (age: 49.3 ± 18.3 years, male: 58.9%). After inverse propensity weighting, all baseline demographic and clinical characteristics were well balanced (standard mean difference < 0.1;Table 1). During a median follow-up of 59-60 days (181.2 person-years for BNT162b2 group;253.6 person-years for the unvaccinated group), there was no significant difference in the risk of unplanned IBD-related hospital admission [3.31 versus 5.13 per 100 person-years, IRR: 0.75 (0.38, 1.47)] and 28-day all-cause emergency room attendance [39.1 vs 47.5 per 100 person-years, IRR: 1.08 (0.76-1.53)] between BNT162b2 recipients and unvaccinated individuals. Series of stratified analyses, including patients with Crohn’s disease (N= 378) or ulcerative colitis (N=553), who received immunosuppressants (N=454) or biologics (N= 192), all showed that receiving two-dose of BNT162b2 vaccine was not associated with a higher risk of unplanned IBD-admission and 28-day emergency attendance when compared to their counterparts without vaccination (Figure 1). Conclusion: Results from this populationbased study showed no increase in risk of unplanned IBD-related hospitalization and allcause emergency attendance following two-dose of BNT162b2 Covid-19 vaccination in patients with IBD. This observation potentially reassures the medium-term safety of mRNA vaccine in patients with IBD, although there is still possible self-selection bias in receiving the vaccine. (Table Presented) (Figure Presented)

Real-Time Measurement of Alcohol Vapours Released from Alcohol-based Hand Disinfectants and User Habits Study of Hong Kong Residents in the Pandemic of COVID-19

Based on the information suggested by World Health Organization (WHO) and Hong Kong Special Administrative Region (HKSAR) government, wearing a mask and sterilizing hands with alcohol-based hand disinfectants are effective ways to maintain good personal hygiene to prevent viral infections. This study focused on the real-time concentrations of alcohol vapor in the air associated with five alcohol-based hand disinfectants. The results indicated that the alcohol concentrations increased dramatically (max. ~46,000 ppb/g sample) in the hand-rubbing process. Hong Kong residents' survey on habits of using such disinfectants showed that 65% of people use them daily and 34% of people use them ≥ 5 times per day, indicating a high frequency of usage. About 79% of respondents claimed to have skin problems, and 18% got eyes discomfort when using these disinfectants. Despite the potential health risks of using alcohol disinfectants remaining unclear, such a large amount and frequent usage should be aware of potential health problems in the long term. © 2022 by the authors.

OUT-OF-HOSPITAL SUPPORT FOR PREPARATION OF RADIOTHERAPY IN PEDIATRIC PATIENTS DURING COVID-19

Introduction Child Life Specialists (CLS) cannot support pediatric cancer patients (PCPs) in hospitals during COVID-19 to minimize infection risk. We have recently developed an out-of-hospital radiotherapy (RT) preparatory workshop for PCPs and their carers, providing multidisciplinary support before the actual radiation treatment. Methods 6 PCPs were referred by the Hong Kong Children's Cancer Foundation (Table 1). RT undergraduates and practising radiotherapists hosted individualized, 2-hour simulation workshop for PCPs with a theme featuring PCP's favorite game or cartoon character. The Virtual Environment for Radiotherapy Training system realistically mimics the RT environment. The workshop included treatment preparation and delivery simulation to improve PCP's compliance with daily RT. Carer's queries were addressed by our professional workers. Evaluative questionnaires were given to participating families and CLS, with 6 questions to assess if the workshop addressed the needs of relevant stakeholders. Results The carers opined that the workshops eased their concerns and helped PCPs comply with daily RT (Figure 1). The CLS found the workshop was as effective as hospital visits, and should be continued after COVID19 (Table 2). The workshop allowed more time and multidisciplinary resources than hospital visits. Conclusions The proposed workshop provides better support for PCPs and their carers compared to conventional in-hospital counseling and should be recommended as a standard service provision beyond COVID-19.

The role of virtual reality interactivity in building tourists' memorable experiences and post-adoption intentions in the COVID-19 era. (Special Issue: Challenges and prospects of AIoT application in hospitality and tourism marketing.)

Purpose: This study aims to examine the impact of virtual reality (VR) interactivity elements, including synchronicity, two-way communication and active control, on tourists' VR memorable experiences, and the subsequent effect on tourists' word-of-mouth (WOM) and VR continuance intention. Design/methodology/approach: The research model was tested using self-administrated survey data from 285 Chinese tourists who were experienced in travel and VR tourism activities. Partial least squares-structural equation modelling was adopted to perform latent variable analysis. Findings: VR interactivity elements, including synchronicity, two-way communication and active control, play a considerable role in driving tourists' VR memorable experiences, which in turn drive tourists' WOM and VR continuance intention. Research limitations/implications: Cross-sectional, single country data was used and thus the generalisability of the findings may be limited. Future research is recommended adopting a longitudinal approach to compare the relationship between constructs in countries with diverse cultures. Practical implications: The findings provide guidance for tourism marketers to use the interactive features of VR, including synchronicity, two-way communication and active control, to drive tourists' memorable experiences and thereby strengthen tourists' referral and continuance intention. Originality/value: Scholarly attention on the importance of VR interactivity in driving tourists' memorable experiences and behavioural intention is limited. This study contributes to the tourism marketing literature by empirically testing the research model to reveal the importance of VR interactivity elements, including synchronicity, two-way communication and active control, to drive tourists' VR memorable experiences and behavioural intentions.

VR tourism experiences and tourist behavior intention in COVID-19: an experience economy and mood management perspective

Purpose Virtual reality (VR) technology is a potential tool for tourism marketers to maintain the attractiveness of their destinations and recover from the COVID-19 pandemic. However, the effectiveness of VR technology in motivating potential tourists' visit intention under lockdown conditions remains unknown. An integrated model based on the experience economy framework and mood management theory was, therefore, used to explain how tourists' VR experiences affect their mood management processes and subsequent behaviors. This research also examined how perceived travel risk influenced the relationship between mood management processes and future decisions. Design/methodology/approach This study used a cross-sectional design based on a sample collected from a Chinese survey company, Sojump. The author surveyed 285 respondents who had experienced VR tourism activities during the COVID-19 pandemic. The research model was tested using partial least squares-structural equation modeling. Findings The results demonstrated that the four dimensions of VR experiences differently affected mood management processes, while perceived travel risk differently moderated the influence of mood management processes on visit intention and VR stickiness. This provides insights for tourism marketers to adapt to the current tourism environment and develop recovery strategies. Originality/value In response to gaps in the literature, this research examined the effectiveness of VR technology in driving tourists' visit intention during the COVID-19 pandemic, providing insights for tourism marketers to successfully implement VR tourism and plan timely recovery strategies.

Assessment of SARS-CoV-2 Immunity in Convalescent Children and Adolescents.

Persistence of protective immunity for SARS-CoV-2 is important against reinfection. Knowledge on SARS-CoV-2 immunity in pediatric patients is currently lacking. We opted to assess the SARS-CoV-2 adaptive immunity in recovered children and adolescents, addressing the pediatrics specific immunity towards COVID-19. Two independent assays were performed to investigate humoral and cellular immunological memory in pediatric convalescent COVID-19 patients. Specifically, RBD IgG, CD4+, and CD8+ T cell responses were identified and quantified in recovered children and adolescents. SARS-CoV-2-specific RBD IgG detected in recovered patients had a half-life of 121.6 days and estimated duration of 7.9 months compared with baseline levels in controls. The specific T cell response was shown to be independent of days after diagnosis. Both CD4+ and CD8+ T cells showed robust responses not only to spike (S) peptides (a main target of vaccine platforms) but were also similarly activated when stimulated by membrane (M) and nuclear (N) peptides. Importantly, we found the differences in the adaptive responses were correlated with the age of the recovered patients. The CD4+ T cell response to SARS-CoV-2 S peptide in children aged <12 years correlated with higher SARS-CoV-2 RBD IgG levels, suggesting the importance of a T cell-dependent humoral response in younger children under 12 years. Both cellular and humoral immunity against SARS-CoV-2 infections can be induced in pediatric patients. Our important findings provide fundamental knowledge on the immune memory responses to SARS-CoV-2 in recovered pediatric patients.

How are family doctors serving the Hong Kong community during the COVID-19 outbreak? A survey of HKCFP members.

INTRODUCTION: This study evaluated the preparedness of family doctors during the early phase of the coronavirus disease 2019 (COVID-19) outbreak in Hong Kong. METHODS: All members of the Hong Kong College of Family Physicians were invited to participate in a cross-sectional online survey using a 20-item questionnaire to collect information on practice preparedness for the COVID-19 outbreak through an email followed by a reminder SMS message between 31 January 2020 and 3 February 2020. RESULTS: Of 1589 family doctors invited, 491 (31%) participated in the survey, including 242 (49%) from private sector. In all, 98% surveyed doctors continued to provide clinical services during the survey period, but reduced clinic service demands were observed in 45% private practices and 24% public clinics. Almost all wore masks during consultation and washed hands between or before patient contact. Significantly more private than public doctors (80% vs 26%, P<0.001) experienced difficulties in stocking personal protective equipment (PPE); more public doctors used guidelines to manage suspected patients. The main concern of the respondents was PPE shortage. Respondents appealed for effective public health interventions including border control, quarantine measures, designated clinic setup, and public education. CONCLUSION: Family doctors from public and private sectors demonstrated preparedness to serve the community from the early phase of the COVID-19 outbreak with heightened infection control measures and use of guidelines. However, there is a need for support from local health authorities to secure PPE supply and institute public health interventions.

Changes in health-seeking behavior among adult and pediatric patients with seizures during the COVID-19 pandemic

Objective: To demonstrate any changes in seizure-related medical help-seeking behavior and admission outcomes during COVID-19. Background: The global outbreak of COVID-19 has imposed a huge challenge on healthcare systems globally. Infection control measures may have impacted patients' health-seeking behavior for non-respiratory conditions, particularly chronic diseases such as epilepsy. Design/Methods: All Accident & Emergency (A&E) attendances in Hong Kong for seizures in 2020 from January 23 to March 24 (adult) and April 22 (pediatric) were compared with parallel periods from 2015 to 2019. All data and admission outcomes were identified from a centralized territory-wide electronic database. Pre-existing time trend in control periods and changes during COVID-19 were analyzed by Poisson, negative and logistic regression models. Results: Among adults aged ≥ 18 years, seizure-related A&E attendances (adjusted relative risk, aRR 0.78, 95% CI=0.65 - 0.92, p=0.003) and admissions (aRR 0.70, 95% CI=0.60 - 0.80, p<0.001) decreased significantly during COVID-19. Ratio of ward admission per A&E attendance, intensive care utility and mortality rates remained stable. Among pediatric patients aged < 18 years, seizure-related attendances also decreased in 2020 (RR 0.38, 95% CI=0.25 - 0.59, p<0.001), with a disproportionate decrease in the 0-6 age group (RR 0.303, 95% CI=0.17 - 0.53, p<0.001). A drastic decline in upper respiratory infection-related A&E attendances (RR 0.208, 95% CI=0.14 - 0.31, p<0.001) was congruent to the time trends of seizure-related attendances in in the 0-6 age group. Conclusions: A significant reduction in emergency attendances for seizures during COVID-19 calls for appropriate measures to ensure healthcare services and education are provided to patients with epilepsy in a timely and effective manner during this global public health crisis. The congruent decrease in seizure- and URTI-related attendances among younger children suggests potential novel approaches focusing on infection control measures and immunization programs among younger children in prevention of febrile seizures and thus other related epileptic disorders in later life.

Relationship between viral load, infection-to-delivery interval and mother-to-child transfer of anti-SARS-CoV-2 antibodies.

OBJECTIVE: To investigate the association of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load and infection-to-delivery interval with maternal and cord serum concentrations of anti-SARS-CoV-2 immunoglobulin G (IgG) antibodies and transplacental transfer ratio in pregnant women with active or recovered SARS-CoV-2 infection. METHODS: This was a prospective case series of consecutive pregnant women with laboratory-confirmed SARS-CoV-2 infection between 27 March 2020 and 24 January 2021. We collected information regarding deep throat saliva or nasopharyngeal swab (NPS) reverse transcription polymerase chain reaction (RT-PCR) test results, serial cycle threshold (Ct) values at and after diagnosis, demographic, clinical and outcome data, and neonatal NPS RT-PCR results. Qualitative and quantitative analysis of IgG and immunoglobulin M (IgM) antibodies against SARS-CoV-2 was performed in maternal and cord blood serum samples obtained at delivery. Correlation of maternal Ct values, infection-to-delivery interval, infection duration and viral load area under the curve (AUC) with gestational age (GA) at diagnosis, maternal and cord serum IgG concentrations and transplacental transfer ratio of IgG were evaluated using Pearson's correlation. RESULTS: Twenty pregnant women who consented to participate and who had delivered their babies by 31 January 2021 were included in the study, comprising 14 who had recovered from coronavirus disease 2019 (COVID-19) and six with active infection at delivery. The median GA at clinical manifestation was 32.7 (range, 11.9-39.4) weeks. The median infection-to-delivery interval and infection duration were 41.5 (range, 2-187) days and 10.0 (range, 1-48) days, respectively. The median GA at delivery was 39.1 (range, 32.4-40.7) weeks and the median seroconversion interval was 14 (range, 1-19) days. Of 13 neonates born to seropositive mothers with recovered infection at delivery, 12 tested positive for anti-SARS-CoV-2 IgG. All neonatal NPS samples were negative for SARS-CoV-2 and all cord sera tested negative for IgM. The median transplacental transfer ratio of IgG was 1.3 (interquartile range, 0.9-1.6). There was a negative correlation between infection-to-delivery interval and anti-SARS-CoV-2 IgG concentrations in maternal (r = -0.6693, P = 0.0087) and cord (r = -0.6554, P = 0.0068) serum and a positive correlation between IgG concentration in maternal serum and viral load AUC (r = 0.5109, P = 0.0310). A negative correlation was observed between transfer ratio and viral load AUC (r = -0.4757, P = 0.0409). CONCLUSIONS: In pregnant women who have recovered from COVID-19, anti-SARS-CoV-2 IgG concentrations at delivery increased with increasing viral load during infection and decreased with increasing infection-to-delivery interval. The median transplacental transfer ratio of IgG was 1.3 and it decreased with increasing viral load during infection. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Findings from the first public COVID-19 temporary test centre in Hong Kong.

INTRODUCTION: The Hospital Authority of Hong Kong Special Administrative Region established a coronavirus disease 2019 (COVID-19) temporary test centre at the AsiaWorld-Expo from March 2020 to April 2020, which allowed high-risk individuals to undergo early assessment of potential severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study reviewed the characteristics and outcomes of individuals who attended the centre for COVID-19 testing. METHODS: This retrospective cross-sectional study collected epidemiological and clinical data. The primary outcome was a positive or negative SARS-CoV-2 test result, according to reverse transcription polymerase chain reaction analyses of pooled nasopharyngeal and throat swabs collected at the centre. The relationships of clinical characteristics with SARS-CoV-2 positive test results were assessed by multivariable binary logistic regression. RESULTS: Of 1258 attendees included in the analysis, 86 individuals tested positive for SARS-CoV-2 infection (positivity rate=6.84%; 95% confidence interval [CI]=5.57%-8.37%). Of these 86 individuals, 40 (46.5%) were aged 15 to 24 years and 81 (94.2%) had a history of recent travel. Symptoms were reported by 86.0% and 96.3% of individuals with positive and negative test results, respectively. The clinical characteristics most strongly associated with a positive test result were anosmia (adjusted odds ratio [ORadj]=8.30; 95% CI=1.12-127.09) and fever ORadj=1.32; 95% CI=1.02-3.28). CONCLUSION: The temporary test centre successfully helped identify individuals with COVID-19 who exhibited mild disease symptoms. Healthcare providers should carefully consider the epidemiological and clinical characteristics of COVID-19 to arrange early testing to reduce community spread.

Critically ill patients with COVID-19 in Hong Kong: a multicentre retrospective observational cohort study

Objective: To report the first eight cases of critically ill patients with coronavirus disease 2019 (COVID-19) in Hong Kong, describing the treatments and supportive care they received and their 28-day outcomes. Design: Multicentre retrospective observational cohort study. Setting: Three multidisciplinary intensive care units (ICUs) in Hong Kong. Participants: All adult critically ill patients with confirmed COVID-19 admitted to ICUs in Hong Kong between 22 January and 11 February 2020. Main outcome measure: 28-day mortality. Results: Eight out of 49 patients with COVID-19 (16%) were admitted to Hong Kong ICUs during the study period. The median age was 64.5 years (range, 42-70) with a median admission Sequential Organ Failure Assessment (SOFA) score of 6 (IQR, 4-7). Six patients (75%) required mechanical ventilation, six patients (75%) required vasopressors and two (25%) required renal replacement therapy. None of the patients required prone ventilation, nitric oxide or extracorporeal membrane oxygenation. The median times to shock reversal and extubation were 9 and 11 days respectively. At 28 days, one patient (12%) had died and the remaining seven (88%) all survived to ICU discharge. Only one of the survivors (14%) still required oxygen at 28 days. Conclusion: Critically ill patients with COVID-19 often require a moderate duration of mechanical ventilation and vasopressor support. Most of these patients recover and survive to ICU discharge with supportive care using lung protective ventilation strategies, avoiding excess fluids, screening and treating bacterial co-infection, and with timely intubation. Lower rather than upper respiratory tract viral burden correlates with clinical severity of illness.