EXERCISE CAPACITY IS REDUCED IN HIV INDEPENDENT OF SARS-CoV-2 INFECTION

Background: Reduced exercise capacity occurs as a post-acute sequela of COVID-19 ("PASC" or "Long COVID"). Cardiopulmonary exercise testing (CPET) is the gold standard for measuring exercise capacity and identifying reasons for exercise limitations. Only one prior study used CPET to examine exercise limitations among people living with HIV (PLWH). Extending our prior findings in PASC, we hypothesized that PLWH would have a greater reduction in exercise capacity after SARS-CoV-2 co-infection due to chronotropic incompetence (inability to increase heart rate). Method(s): We performed CPET within a COVID recovery cohort that included PLWH (NCT04362150). We evaluated associations of HIV and prior SARS-CoV- 2 infection with or without PASC with: (1) exercise capacity (peak oxygen consumption, VO2) and (2) adjusted heart rate reserve (AHRR, marker of chronotropic incompetence) using linear regression with adjustment for age, sex, and body mass index. Result(s): We included 83 participants (median age 54, 35% female, 10% hospitalized, 37 (45%) PLWH) who underwent CPET at 16 months (IQR 14-17) after SARS-CoV-2 infection. Among PLWH (median duration living with diagnosed HIV 21 years (IQR 15-28), all virally suppressed on antiretroviral therapy), 14 (39%) had not had SARS-CoV-2 infection, 12 (32%) had prior SARSCoV- 2 infection without PASC, and 11 (30%) had PASC (Long COVID symptoms at CPET). Median CD4 count was 608 (370-736) and CD4/CD8 ratio 0.92 (0.56-1.27). Peak VO2 was reduced among PLWH compared to individuals without HIV with an achieved exercise capacity only 80% vs 99% (p=0.005, Fig.), a difference in peak VO2 of 5.5 ml/kg/min (95%CI 2.7-8.2, p< 0.001). Exercise capacity did not vary by SARS-CoV-2 infection among PLWH (p=0.48 for uninfected vs infected;p=0.25 for uninfected vs no PASC;p=0.32 no PASC vs PASC). Chronotropic incompetence was present in 38% of PLWH vs 11% without HIV (p=0.002), and AHRR (normal >80%) was significantly reduced among PLWH vs individuals without HIV (60% vs 83%, p< 0.0001, Fig.). Heart rate response varied by SARSCoV- 2 status among those with HIV: namely, 3/14 (21%) without SARS-CoV-2, 4/12 (25%) with SARS-CoV-2 without PASC, and 7/11 (64%) with PASC (p=0.04 PASC vs no PASC). Among PLWH, CD4 count, CD4/CD8 ratio, and hsCRP were not associated with peak VO2 or AHRR. Conclusion(s): Exercise capacity is reduced among PLWH, with no differences by SARS-CoV-2 infection or PASC. Chronotropic incompetence may be a mechanism of reduced exercise capacity among PLWH. (Figure Presented).

Securitising infectious disease outbreaks: The WHO and the visualisation of molecular life

Following its exceptional response to the 2003 severe acute respiratory syndrome (SARS) outbreak, the World Health Organization (WHO) gained new powers to securitise infectious disease outbreaks via the revised 2005 International Health Regulations (IHRs) and the ability to declare a Public Health Emergency of International Concern (PHEIC). This article investigates the declaration of a PHEIC in relation to the 2009 H1N1 flu pandemic, the 2014-16 Ebola outbreak, and the ongoing COVID-19 pandemic. It argues that the securitisation of these outbreaks was dependent upon global surveillance networks that utilised genetic technologies to visualise the molecular characteristics and spread of the pathogen in question. Genetic evidence in these cases facilitated the creation of a securitised object by revealing the unique and 'untypable' nature of the H1N1 and SARS-CoV-2 viruses and made visible the widespread prevalence of Ebola across the population of West Africa. The power of this evidence draws from a societal perception of science as producing objective 'facts' about the world that objectivise their objects of concern and empower political actors in the implementation of their security agendas. As a result, scientific evidence provided by genetic technologies now plays a necessary and indispensable role in the securitisation of infectious disease outbreaks.

Babesiosis and Red Blood Cell Exchange Transfusion: Consider It Early

INTRODUCTION: Babesiosis, or Babesia microti in the blood, is a rare tickborne parasitic illness. It is endemic to the Northeast and upper Midwest regions of the United States, in warmer summer months, and is a reportable disease. Babesia is transmitted by the bite of an infected Ixodes scapularis nymph tick (black-legged or deer tick). Many people remain asymptomatic, while others experience life-threatening illness. even with low parasite index, such as the case described. Cases are rising in Pennsylvania overall since 2010, but since the start of COVID-19 pandemic, our small community hospital in rural Northeastern Pennsylvania (NEPA) has seen 12 cases. DESCRIPTION: A 63-year-old male presented with severe illness due to persistent Babesiosis parasitemia in a NEPA community hospital, with history of recent COVID-19 infection. He presented with fever, rigors, myalgias, diarrhea, and weakness. He reported history of tick bite two weeks prior to presentation. Initial exam was unremarkable. He was admitted to the hospital with hyponatremia, acute liver and kidney injury, anemia, thrombocytopenia, and elevated bilirubin. Babesia microti red blood cell (RBC) parasite index initially was 2%. He then became lethargic and hypotensive and parasite index escalated to 5% with worsening febrile illness, confusion, rapid atrial fibrillation, worsening acute kidney injury, and evidence of hemolysis and consumptive coagulopathy, despite standard-of-care antimicrobial regimen. He was fluid resuscitated and transferred to a higher level of care for urgent RBC exchange, which he obtained, and recovered after prolonged intensive care unit stay. DISCUSSION: Babesiosis can present indolently or acutely with flu-like and hemolytic illness. Those at higher risk of illness are elderly, and those with asplenia, baseline liver or kidney dysfunction, or immunocompromised status. Babesia cases are rising all over the country. Our single small hospital has seen 12 cases in the past 3 years. It is a possibility that the recent COVID-19 infection created a relative immunocompromised and pro-inflammatory state leading to susceptibility to the parasite. Illness can be life-threatening. Even with low parasitemia index, early RBC exchange should be considered if end organ dysfunction is present and clinical course is not improving.

SARS-CoV-2 Diverges from Other Betacoronaviruses in Only Partially Activating the IRE1α/XBP1 Endoplasmic Reticulum Stress Pathway in Human Lung-Derived Cells.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has killed over 6 million individuals worldwide and continues to spread in countries where vaccines are not yet widely available or its citizens are hesitant to become vaccinated. Therefore, it is critical to unravel the molecular mechanisms that allow SARS-CoV-2 and other coronaviruses to infect and overtake the host machinery of human cells. Coronavirus replication triggers endoplasmic reticulum (ER) stress and activation of the unfolded protein response (UPR), a key host cell pathway widely believed to be essential for viral replication. We examined the master UPR sensor IRE1α kinase/RNase and its downstream transcription factor effector XBP1s, which is processed through an IRE1α-mediated mRNA splicing event, in human lung-derived cells infected with betacoronaviruses. We found that human respiratory coronavirus OC43 (HCoV-OC43), Middle East respiratory syndrome coronavirus (MERS-CoV), and murine coronavirus (MHV) all induce ER stress and strongly trigger the kinase and RNase activities of IRE1α as well as XBP1 splicing. In contrast, SARS-CoV-2 only partially activates IRE1α through autophosphorylation, but its RNase activity fails to splice XBP1. Moreover, while IRE1α was dispensable for replication in human cells for all coronaviruses tested, it was required for maximal expression of genes associated with several key cellular functions, including the interferon signaling pathway, during SARS-CoV-2 infection. Our data suggest that SARS-CoV-2 actively inhibits the RNase of autophosphorylated IRE1α, perhaps as a strategy to eliminate detection by the host immune system. IMPORTANCE SARS-CoV-2 is the third lethal respiratory coronavirus, after MERS-CoV and SARS-CoV, to emerge this century, causing millions of deaths worldwide. Other common coronaviruses such as HCoV-OC43 cause less severe respiratory disease. Thus, it is imperative to understand the similarities and differences among these viruses in how each interacts with host cells. We focused here on the inositol-requiring enzyme 1α (IRE1α) pathway, part of the host unfolded protein response to virus-induced stress. We found that while MERS-CoV and HCoV-OC43 fully activate the IRE1α kinase and RNase activities, SARS-CoV-2 only partially activates IRE1α, promoting its kinase activity but not RNase activity. Based on IRE1α-dependent gene expression changes during infection, we propose that SARS-CoV-2 prevents IRE1α RNase activation as a strategy to limit detection by the host immune system.

LONGITUDINAL PATTERNS OF POPULATION AND INDIVIDUAL-LEVEL HEALTH-RELATED SOCIAL NEEDS

BACKGROUND: While almost half of US adults report a health-related social need (HRSN), little is known about how an individual's HRSNs change over time. Existing research on HRSNs has mostly focused on cross-sectional studies and has been geographically localized. To overcome these limitations, we examined longitudinal patterns of HRSNs among a large nationwide cohort of Medicare beneficiaries. METHODS: We used data from a longitudinal nationwide cohort of individuals ≥65 years of age enrolled in Humana Medicare Advantage plans. Four surveys were administered approximately quarterly between Q4 2019 to Q4 2020 and asked validated questions about financial strain, food insecurity, loneliness or social isolation, housing insecurity, poor housing quality, utility insecurity, and unreliable transportation. We restricted our analyses to those who responded at least in part to all 4 surveys. We used Sankey plots to visualize transitions in individual patients' total number of reported HRSNs over time. We also used baseline patient characteristics drawn from medical and pharmacy claims data to characterize 3 distinct groups: 1) no HRSN across all quarters, 2) any fluctuation between 0 and ≥1 HRSN, and 3) ≥1 HRSN across all quarters. RESULTS: Of 18,881 individuals, the overall number reporting HRSNs was relatively consistent over time. Specifically, financial (29.6-31.3%), food (18.7-19.8%), and housing quality (15.9-17.3%) were the most frequent needs across each quarter. However, when characterized at the individual level, patients reported substantial fluctuations in need: 27.7% reported no HRSNs in all four quarters;45.5% fluctuated between having 0 and ≥1 HRSN across the four quarters;26.8% reported ≥1 HRSN in all 4 quarters. For example, of those who reported one HRSN in Q1, 44.8% transitioned to no need in Q2. Demographic and clinical characteristics differed across the three groups. For example, female gender, Black race/ethnicity, residence in the South, and higher comorbidity burden were disproportionately represented in those reporting ≥1 HRSN in each quarter, followed by those with fluctuating needs. CONCLUSIONS: In this nationwide survey of health-related social needs among Medicare beneficiaries, while the overall prevalence of HRSNs was consistent over time, we observed marked fluctuation in individuals' needs during the year observed. This fluctuation occurred over all quarters and did not change after the COVID-19 pandemic began. Our findings have important ramifications for health systems or communities that wish to offer support for these patients. In some populations, screening for needs may have to happen more frequently than typically done at present. Support may need to be offered rapidly as patients experience a change in need. Key demographic and clinical characteristics also appear to differ for patients experiencing consistent or fluctuating needs, which could be used as potential identifiers for those at greatest need.

A Secure and Efficient Blockchain-Based Data Sharing Scheme for Location Data

Location data containing trajectory information is of great value, but its unrestricted sharing also brings problems such as data abuse, privacy threat and lack of audit evidence. Especially when it comes to researchers or governments to collect location data to stem the spread of COVID-19, the authorization of the data owner is often missing. In this paper, we propose a data sharing scheme for location data based on a high-performance consortium blockchain combined with proxy re-encryption, which can guarantee location data sharing under user authorization while ensure the efficiency and security in the process of data sharing. The performance analysis and simulation results illustrate that the proposed scheme can meet the performance requirements in practical scenarios, guarantee the privacy of personal location data while making the data useful for stemming the spread of COVID-19. © 2022 ACM.

INFLAMMATION, EXERCISE CAPACITY, CHRONOTROPY, and SYMPTOMS in POST-ACUTE COVID-19

Background: Cardiopulmonary symptoms and reduced exercise capacity can persist after SARS-CoV-2 infection. Mechanisms of post-acute sequelae of COVID-19 ("PASC" or "Long COVID") remain poorly understood. We hypothesized that systemic inflammation would be associated with reduced exercise capacity and pericardial/myocardial inflammation. Methods: As part of a COVID recovery cohort (NCT04362150) we assessed symptoms, biomarkers, and echocardiograms in adults >2 months after PCR-confirmed SARS-CoV-2 infection. In a subset, we performed cardiac magnetic resonance imaging (CMR), ambulatory rhythm monitoring (RM), and cardiopulmonary exercise testing (CPET) >12 months after acute infection. Associations between symptoms and oxygen consumption (VO2), cardiopulmonary parameters and biomarkers were evaluated using linear and logistic regression with adjustment for age, sex, BMI, and time since infection. Results: We studied 120 participants (median age 51, 42% female, and 47% had cardiopulmonary symptoms at median 7 months after acute infection). Elevated hsCRP was associated with symptoms (OR 1.32 per doubling, 95%CI 1.01-1.73, p=0.04). No differences in echocardiographic indices were found except for presence of pericardial effusions among those with symptoms (p=0.04). Of the subset (n=33) who underwent CMR at a median 17 months, all had normal cardiac function (LVEF 53-76%), 9 (27%) had pericardial effusions and none had findings suggestive of prior myocarditis. There were no differences on RM by symptoms. On CPET, 33% had reduced exercise capacity (peak VO2 <85% predicted). Individuals with symptoms had lower peak VO2 compared to those reporting recovery (28.4 vs 21.4 ml/kg/min, p=0.04, Figure). Elevated hsCRP was independently associated with lower peak VO2 after adjustment (-9.8 ml/kg/min per doubling, 95%CI-17.0 to-2.5;p=0.01, Figure). The predominant mechanism of reduced peak VO2 was chronotropic incompetence (HR 19% lower than predicted, 95%CI 11-26%;p<0.0001, Figure). Chronotropic incompetence on CPET correlated with lower peak HR during ambulatory RM (p<0.001). Conclusion: Persistent systemic inflammation (hsCRP) is associated with pericardial effusions and reduced exercise capacity > 1 year after acute SARS-CoV-2 infection. This finding appears to be driven mainly by chronotropic incompetence rather than respiratory compromise, cardiac pump dysfunction, or deconditioning. Evaluation of therapeutic strategies to target inflammation and/or chronotropy to alleviate PASC is urgently needed.

Prospects of Antiviral Drugs Derived from Natural Products: Targeting SARS-CoV Entry and Replication

The recent coronavirus disease (COVID-19) pandemic outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its rapid spread from continent to continent pose a global health emergency. Researchers are making headway to combat the ongoing COVID-19 to prevent further losses. Many natural antiviral compounds have been explored for their potential application in treating viral infections, including those caused by SARS-and MERS-CoV. This review focuses on natural compounds that have been showing promising results against SARS-CoV, SARS-CoV-2 and MERS-CoV, along with their mechanism of action. The entry and replication of CoV are among the major mechanism for the spread of COVID-19. In this context, natural compounds inhibiting the proteins essential for SARS-CoV-2 entry and replication in the nanomolar (nicotianamine) and micromolar (baicalin, baicalein, scutellarein, dihydromyricetin, quercetagetin, myricetin, amentoflavone, herbacetin, isobavachalcone, quercetin 3-beta d-glucoside, helichrysetin, hirsutenone, hirsutanonol, oregonin, rubranol, rubranoside B, rubranoside A, tanshinones, emodin, and griffithsin) concentration could be potential sources of new anti-SARS-CoV-2 drugs.

SARS-CoV-2 diverges from other betacoronaviruses in only partially activating the IRE1α/XBP1 ER stress pathway in human lung-derived cells (preprint)

Despite the efficacy of vaccines, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has killed over 5 million individuals worldwide and continues to spread in countries where the vaccines are not yet widely available or its citizens are hesitant to become vaccinated. Therefore, it is critical to unravel the molecular mechanisms that allow SARS-CoV-2 and other coronaviruses to infect and overtake the host machinery of human cells. Coronavirus replication triggers endoplasmic reticulum (ER) stress and activation of the unfolded protein response (UPR), a key host cell pathway widely believed essential for viral replication. We examined the activation status and requirement of the master UPR sensor IRE1 kinase/RNase and its downstream transcription factor effector XBP1s, which is processed through an IRE1-mediated mRNA splicing event, in human lung-derived cells infected with betacoronaviruses. We found human respiratory coronavirus OC43 (HCoV-OC43), Middle East respiratory syndrome coronavirus (MERS-CoV), and the murine coronavirus (MHV) all induce ER stress and strongly trigger the kinase and RNase activities of IRE1 as well as XBP1 splicing. In contrast, SARS-CoV-2 only partially activates IRE1 whereby it autophosphorylates, but its RNase fails to splice XBP1. Moreover, IRE1 was dispensable for optimal replication in human cells for all coronaviruses tested. Our findings demonstrate that IRE1 activation status differs upon infection with distinct betacoronaviruses and is not essential for efficient replication of any of them. Our data suggest that SARS-CoV-2 actively inhibits the RNase of autophosphorylated IRE1 through an unknown mechanism, perhaps as a strategy to eliminate detection by the host immune system.

A femin horizontal ellipsis manifesto: Academic ecologies of care and cure during a global health pandemic

This article is a femin horizontal ellipsis manifesto for supporting and encouraging academic ecologies of care and cure: it is a collaborative assemblage created by six academics-laborers, white, native American, European, Caucasian, cisgender, neurodivergent, bisexual, gay, and horizontal ellipsis and horizontal ellipsis and horizontal ellipsis -who wrote these reflections during the pandemic events that affected their lives. The cultural artifact, the femin horizontal ellipsis manifesto, is organized around nine theses, each of which tries to highlight the multiplicity of cares and genders, the challenges, the productive vitality, and the enforced slowness experienced both during lockdown and after it. The paper uses different forms/styles-academic writing, pictures, poems, first-person narratives-which nurture the flow of the presentation of the nine theses. Each thesis ends with a call for action. The femin horizontal ellipsis manifesto is a performative text which, while opposing the constraints of the COVID-19 emergency, also sees the potential the event offers for caring and curing - both life and our academic lives. Femin horizontal ellipsis manifesto renders explicit the undecidability of cares and cures and is a call to unite with the aim of resisting the inequalities and vulnerabilities which COVID-19 has exacerbated.

The impact of technician-led virtual spirometry sessions on the availability and quality of home spirometry results in a virtual Cystic Fibrosis clinic

IntroductionSpirometry is an essential component of monitoring the health of people with Cystic Fibrosis (CF). Since the Covid-19 pandemic, most consultations have been conducted via video conferencing. All appropriate patients were given MIR Spirobank® portable spirometers (MIR Medical International Research Srl) and asked to send in readings before each clinic. We noticed a fall in the number and quality of spirometry reports available to clinicians in virtual clinics compared to face-to-face reviews. We set out to improve this through a Respiratory Physiologist-led virtual spirometry clinic.MethodsSpirobank® spirometry reports (including grading of quality using ATS/ERS criteria1) provided by patients attending virtual CF clinics in our CF centre in January 2021 were reviewed. Following this review, a virtual spirometry clinic was established (running before the main clinic) in which the patient performs spirometry via the ‘Live Video Exam’ app on their mobile device, coached by a Physiologist who is able to see the patient via their mobile phone camera and view spirometry flow loops in real time, downloading results ready for the subsequent clinic. Review of spirometry available for clinics in May 2021 was then performed and the number and quality of reports available compared.ResultsSpirometry reports were available for 35 out of 70 appointments for patients with Spirobank® devices in January 2021, of which 26/70 (37%) were ATS grade A or B. In May 2021, 50 patients with devices had clinic appointments: 9 provided reports independently (7 grade A or B), 37 were coached by a physiologist (31 A or B), and 4 did not attend or declined a coaching session.ConclusionWithout coaching, only 37% patients with a Spirobank® device provided ATS grade A or B spirometry for virtual CF clinics;this increased to 76% with the introduction of pre-clinic online Respiratory Physiologist coaching sessions.We plan to review how the number and quality of reports provided with and without coaching changes as patient experience in the use of home spirometers increases.ReferenceStandardization of Spirometry 2019 Update. American Journal of Respiratory & Critical Care Medicine 2019;200(8):e70–e88.

Probing remdesivir nucleotide analogue insertion to SARS-CoV-2 RNA dependent RNA polymerase in viral replication

Remdesivir (RDV) prodrug can be metabolized into a triphosphate form nucleotide analogue (RDV-TP) to bind and insert into the active site of viral RNA dependent RNA polymerase (RdRp) to further interfere with viral genome replication. In this work, we computationally studied how RDV-TP binds and inserts to the SARS-CoV-2 RdRp active site, in comparison with natural nucleotide substrate adenosine triphosphate (ATP). To do that, we first constructed atomic structural models of an initial binding complex (active site open) and a substrate insertion complex (active site closed), based on high-resolution cryo-EM structures determined recently for SARS-CoV-2 RdRp or non-structural protein (nsp) 12, in complex with accessory protein factors nsp7 and nsp8. By conducting all-atom molecular dynamics simulation with umbrella sampling strategies on the nucleotide insertion between the open and closed state RdRp complexes, our studies show that RDV-TP can initially bind in a comparatively stabilized state to the viral RdRp active site, as it primarily forms base stacking with the template uracil nucleotide (nt +1), which under freely fluctuations supports a low free energy barrier of the RDV-TP insertion (similar to 1.5 kcal mol(-1)). In comparison, the corresponding natural substrate ATP binds initially to the RdRp active site in Watson-Crick base pairing with the template nt, and inserts into the active site with a medium low free energy barrier (similar to 2.6 kcal mol(-1)), when the fluctuations of the template nt are well quenched. The simulations also show that the initial base stacking of RDV-TP with the template can be specifically stabilized by motif C-S759, S682 (near motif B) with the base, and motif G-K500 with the template backbone. Although the RDV-TP insertion can be hindered by motif F-R555/R553 interaction with the triphosphate, the ATP insertion seems to be facilitated by such interactions. The inserted RDV-TP and ATP can be further distinguished by specific sugar interaction with motif B-T687 and motif A-D623, respectively.

Home visit to renal dialysis patients by zoom

Background: Home visit service to dialysis patients has established in Queen Mary Hospital renal unit for long times. However, such service was suspended due to COVID-19 pandemic. Objectives: We decided to perform the home visit (HV) by zoom to evaluate patient's home performance to both peritoneal patients (PD) and home haemodialysis (HHD) patients. Methodology: 'Zoom' was chosen to perform HV and a pilot run was started in December 2020. For pre-zoom preparation, a workgroup was formed by dialysis nurses;HV checklists were modified from existing one;consent forms were revised;zoom apps were allowed to use after approved by the internet technology (IT) department;two instruction guides were prepared to nurses and patients / helpers and special cell phone / i-pad stabilizers were provided to patients. One trail run was conducted with nursing staff and two trail runs were conducted with PD patient volunteers. Results: 26 PD and 1 HHD zoom HV was done in December 2020. During zoom HV, patient's home environments;techniques;PD / HHD related knowledge were evaluated. Performance improvement advice were given to patients and caregivers before end of HV. 1 patient was found contamination of transfer set and need to return to hospital for treatment. Evaluation forms were prepared to patients and nurses. 24 patients were satisfied with the zoom HV arrangement and agreed that zoom was easy to manage. 17 patients disagreed that their performance would be affected by external factors and causing some distractions. All 6 nurses agreed that zoom HV were easy to manage and they were satisfied. 2 of them were distracted by external factors and 4 of them were neutral on this point. Conclusions: Zoom HV is a convenient way to assess patient's condition and performance at home when physical visit is restricted during COVID 19 pandemic.

An Effective Self-directed Personalized Learning Environment for Engineering Students During the COVID-19 Pandemic

This study has brought a new dimension in engineering education where the researchers investigated the motivation of engineering undergraduates in using a specifically developed self-directed personalized learning environment utilizing WhatsApp application to overcome the issues that hamper the teaching and learning process during the COVID-19 pandemic. The findings showed that the respondents responded positively towards the intrinsic motivation and self-determination while the respondents responded negatively on assessment anxiety and grade motivation. The findings revealed that the developed platform need to be improved in order to bring forward as an alternative teaching and learning platform in future. © 2020

Fake News in Health and Medicine

With the rise of social media, the world is faced with the challenge of increasing health-related fake news more than ever before. We are constantly flooded with health-related information through various online platforms, many of which turn out to be inaccurate and misleading. This chapter provides an overview of various health fake news and related studies which have been reported in various news articles and scientific journals. Some of the studies conducted on health misinformation identified a prominence of vaccine- and cancer-related fake news. The popularity of so-called unproven natural cures for cancer and other diseases is alarming. The chapter also highlights the importance of maintaining accurate and effective scientific communication in this COVID-19 pandemic-hit world to safeguard public health. The current pandemic has also proved fertile ground for spreading misinformation. The chapter brings the audience’s attention to the consequences of health misinformation, ranging from giving false hope to patients to the hurdles it poses to effective medical care. Finally, the chapter addresses some of the possible strategies to keep health misinformation in check. © 2021, Springer Nature Switzerland AG.

Remote delivery of care to people with cystic Fibrosis during covid-19 shielding is not Detrimental to patient outcomes

Introduction and Objectives Intensive surveillance of lung function (FEV1), body weight and airway microbiology is central to good cystic fibrosis (CF) care. National standards recommend people with CF (pwCF) are reviewed at least three monthly by specialist multidisciplinary teams. COVID-19 'shielding' precautions, set to protect clinically extremely vulnerable people, terminated all but essential face-to-face clinical contact for over four months. Many pwCF remain apprehensive as restrictions ease. The King's Adult CF Unit delivers care to 250 pwCF across south-east England. We discuss the immediate service changes in response to COVID-19, and the effect on patient outcomes of limited clinician review. Methods At the start of shielding the entire patient cohort was reviewed and grouped as stable or of concern. Telephone and/or video clinics were implemented, and patients identified as high risk were prioritised for remote self-monitoring (FEV1 with Bluetooth home spirometers, weight, postal sputum samples). Home visits or ward reviews, by specialist nurses or physiotherapists, were arranged if clinically essential. We undertook a cohort review of consecutive patients emerging from shielding to compare clinical parameters before and after lockdown. Results Since shielding ended, 24 consecutive patients (see table 1) have been reviewed, at a median (IQR) of 167 (155, 180) days after pre-COVID assessments. At review, 2 patients had a clinically significant fall in lung function (10%), however no statistical difference in FEV1, weight or BMI (n=21) was seen overall following shielding when compared to measurements immediately (29 (21, 46) days) before lockdown (ppFEV10.0 (-0.1, 0.1), BMI 0.5 (-1.0, 1.6)). 11 (45.8%) patients sent sputum samples, 1 identified a clinically insignificant new microorganism. 13 (54%) patients required treatment for pulmonary exacerbations, 8 (33.3%) with intravenous, 5 (20.8%) with oral antibiotics. Conclusions Unpredicted changes to CF care delivery at our centre was not detrimental to patient outcomes. In this cohort, key CF clinical indices remained stable over a short period of shielding, supporting safe remote delivery of care. Modulator therapies likely contributed to the stability in lung function seen.

P123 Remote delivery of care to people with cystic fibrosis during COVID-19 shielding is not detrimental to patient outcomes

P123 Table 1Baseline characteristics and lung function pre- and post- shielding. Data presented as mean ± SD, or median (IQR). *At start of shieldingAge, years* 28 (22, 30) Male, n (%) 10 (41.7) CFTR modulator therapy, n (%)* Ivacaftor 1 (4.2) Lumacaftor/ivacaftor 1 (4.2) Tezacaftor/ivacaftor 10 (41.7) Best measurements in last year FEV1 percent predicted,% 70.8 (23.4) Body mass index (kg/m2) 28.0 (3.6) Patients identified as ‘high risk’*, n (%) 5 (20.8) Pre- and post- shielding FEV1 percent predicted,% 67.2 (27.3) 66.9 (26.3) Weight, kg (n=21) 66.0 (15.1) 66.9 (12.9) Body mass index, kg/m2 (n=21) 23.3 (3.8) 24.0 (3.5) ConclusionsUnpredicted changes to CF care delivery at our centre was not detrimental to patient outcomes. In this cohort, key CF clinical indices remained stable over a short period of shielding, supporting safe remote delivery of care. Modulator therapies likely contributed to the stability in lung function seen.