Muscle volume, functionality and metabolic resilience during recovery following severe COVID-19

Introduction: Following hospitalisation with SARS-Cov2 infection a large proportion of individuals report fatigue as a persisting symptom. Here, we performed a detailed study of the muscle for insight into underlying mechanisms. Method(s): Adults were recruited at 5-7 months following hospital discharge for severe SARS-Cov2 infection (n=21), along with control volunteers (n=10) of a similar age, gender, ethnicity and body mass. Perceived fatigue was estimated using the fatigue severity scale. The short physical performance battery test determined habitual functionality, alongside isometric quadriceps strength normalised for appendicular mass and isokinetic force loss during 20 knee extensions (Cybex Norm dynamometer). Leg muscle volume, and phosphocreatine (PCr) resynthesis during recovery from ischemic plantar flexion exercise (an index of muscle metabolic resilience) were quantified using MRI and 31P MRS. Student t-test was used to detect differences between groups and all data are mean (SD). Result(s): Patients (P) reported greater perception of fatigue and demonstrated worse habitual functionality compared to controls (C). However, leg volume [P: 2,578 (303) cm3/m2 vs C: 2,384 (289) cm3/m2, p=0.1], strength [P: 21.8 (4.1) Nm/kg vs C: 21.1 (4.5) Nm/kg, p=0.7], force loss [P: 25% (6) vs C: 21% (10), p=0.1] and PCr recovery kinetics (Qmax) [P: 25.8 (11.3) vs C: 22.8 (8.7), p=0.5] were not different. Conclusion(s): Despite greater perception of fatigue and lower habitual functionality, patients recovering from severe COVID-19 infection did not have altered muscle volume, strength, fatiguability or metabolic resilience compared to controls.

THE IMPACT OF SOCIAL DEPRIVATION ON COVID-19 INFECTIONS IN NURSING HOMES

Health inequities vary along social and economic gradients. The COVID-19 pandemic and nursing home infections have highlighted this fact. Using the Centers for Medicare and Medicaid Services' Nursing Home COVID-19 Public File, Brown University's LTCFocus, Robert Graham Center's Social Deprivation Index, and CMS Nursing Home Payroll Based Journal Staffing Data. We examined the relationship between community resource scarcity, as conceptualized by the Social Deprivation Index (SD) and COVID-19 incidence rates in nursing homes. After controlling for interstate differences, organizational enabling factors, as well as, facility-level resident and community-level characteristics, nursing homes located in communities with medium levels of social deprivation had 4.4% more COVID-19 infection rates (Incidence Rate Ratio [IRR] = 1.04;p < 0.05) and communities with high levels of social deprivation had 7.5% higher COVID-19 infection rates (Incidence Rate Ratio [IRR] = 1.07;p < 0.01) as compared to nursing facilities located in areas of low social deprivation. From a policy perspective, nursing homes, that are located in socially deprived communities, may need additional resources, such as, funding for staffing and personal protective equipment in the face of the pandemic. The COVID-19 pandemic has sharpened the focus on healthcare disparities and societal inequalities in the delivery of long-term care.

DYNAMO Covid-19 Dynamic assessment of multi organ level dysfunction in patients recovering from Covid-19: insulin resistance and metabolic flexibility

P226 Figure 1ConclusionPatients recovering from severe Covid-19 have worse insulin sensitivity compared to controls, but similar metabolic flexibility. Physical inactivity and liver adiposity may play a role in these observations.FundingNIHR Nottingham BRC (NoRCoRP), PHOSP UKRI, Nottingham Hospitals Charity, University of Nottingham alumni donation.

Nursing Homes Located in Socially Deprived Communities Have Been Disproportionately Affected by COVID-19

Health inequities vary along social and economic gradients. The COVID-19 pandemic and nursing home infections have highlighted this fact. Using the Centers for Medicare and Medicaid Services Nursing Home COVID-19 Public File, Brown University's LTCFocus, Robert Graham Center's Social Deprivation Index, and CMS Nursing Home Payroll-Based Journal Staffing Data. We examined the relationship between community resource scarcity, as conceptualized by the Social Deprivation Index (SD), and COVID-19 incidence rates in nursing homes. After controlling for interstate differences, organizational enabling factors, as well as, facility-level resident and community-level characteristics, nursing homes located in communities with medium levels of social deprivation had 4.4% more COVID-19 infection rates (Incidence Rate Ratio [IRR] = 1.04;p < 0.05) and communities with high levels of social deprivation had 7.5% higher COVID-19 infection rates (Incidence Rate Ratio [IRR] = 1.07;p < 0.01) as compared to nursing facilities located in areas of low social deprivation. From a policy perspective, nursing homes, that are located in socially deprived communities, may need additional resources, such as funding for staffing and personal protective equipment in the face of the pandemic. The COVID-19 pandemic has sharpened the focus on healthcare disparities and societal inequalities in the delivery of long-term care. © 2021 Aspen Publishers Inc.. All rights reserved.

Effectiveness, safety and acceptability of no-test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study.

OBJECTIVE: To compare outcomes before and after implementation of medical abortion (termination of pregnancy) without ultrasound via telemedicine. DESIGN: Cohort analysis. SETTING: The three main abortion providers. POPULATION OR SAMPLE: Medical abortions at home at ≤69 days' gestation in two cohorts: traditional model (in-person with ultrasound, n = 22 158) from January to March 2020 versus telemedicine-hybrid model (either in person or via telemedicine without ultrasound, n = 29 984, of whom 18 435 had no-test telemedicine) between April and June 2020. Sample (n = 52 142) comprises 85% of all medical abortions provided nationally. METHODS: Data from electronic records and incident databases were used to compare outcomes between cohorts, adjusted for baseline differences. MAIN OUTCOME MEASURES: Treatment success, serious adverse events, waiting times, gestation at treatment, acceptability. RESULTS: Mean waiting time from referral to treatment was 4.2 days shorter in the telemedicine-hybrid model and more abortions were provided at ≤6 weeks' gestation (40% versus 25%, P < 0.001). Treatment success (98.8% versus 98.2%, P > 0.999), serious adverse events (0.02% versus 0.04%, P = 0.557) and incidence of ectopic pregnancy (0.2% versus 0.2%, P = 0.796) were not different between models. In the telemedicine-hybrid model, 0.04% were estimated to be over 10 weeks' gestation at the time of the abortion; all were completed safely at home. Within the telemedicine-hybrid model, effectiveness was higher with telemedicine than in-person care (99.2% versus 98.1%, P < 0.001). Acceptability of telemedicine was high (96% satisfied) and 80% reported a future preference for telemedicine. CONCLUSIONS: A telemedicine-hybrid model for medical abortion that includes no-test telemedicine and treatment without an ultrasound is effective, safe, acceptable and improves access to care. TWEETABLE ABSTRACT: Compelling evidence from 52 142 women shows no-test telemedicine abortion is safe, effective and improves care.

Heritability of temperature and theeffects of ageing on temperatureregulation: An observational multi-cohortstudy

Introduction Ageing affects homeostasis and immunosenescence, resulting inaberrant fever and immune responses to infection in older adults.This study assesses heritability of basal temperature and exploreseffects of ageing on basal temperature and temperature inresponse to SARS-CoV-2 infection. Methods Observational study using multiple cohorts. Participants: (a) Twinvolunteers: 1089 healthy adults enrolled in Twins-UK, mean age59 (17);tympanic temperature measurements;(b) Community-based: 3972 adults using the COVID Symptom Study mobileapplication, age 43 (13);self-reported test-positive for SARS-CoV-2 infection;self-reported temperature measurements;(c)Hospitalised: cohorts of 520 and 757 adult patients withemergency admission to two teaching hospitals between01/03/2020-04/05/2020, age 62 (17) and 68 (17) respectively;RT-PCR-confirmed SARS-CoV-2 infection. Analysis (a) heritability analysed using saturated and ACE univariatemodels;linear mixed-effect model for associations between basaltemperature and age, sex and BMI. (b&c) multivariable linearregression for associations between temperature and age, sex and BMI;multivariable logistic regression for associations betweenfever(>/= 37.8°C) and age, sex and BMI. Results Basal temperature in twins demonstrated 50% heritability(95%CI[42-57%]). In healthy twin, community-based and hospitalised cohorts, increasing age is associated with lowertemperatures, and increasing BMI with higher temperatures: (a)Twins (age:p < 0.001;BMI:p = 0.002);(b) Community-based (age:p < 0.001;BMI: p < 0.001);(c) Hospitalised (1st hospital: age: p = 0.106;BMI: p = 0.033;2nd hospital: age: p < 0.001;BMI: p = 0.010).Increasing age was negatively and BMI positively associated withfever (1st hospital: Age: OR = 0.99, p = 0.033;BMI: OR = 1.00, p = 0.045;2nd hospital: Age: OR = 0.99, p = 0.010;BMI: OR 1.02, p = 0.038). Conclusions Heritability of basal temperature suggests a genetic component tothermoregulation. Associations observed between increasing ageand lower temperatures and higher BMI and higher temperaturesare important in understanding effects of ageing and obesity onbasal temperature and the fever response. In older adults, findingshave important implications for defining fever thresholds and diagnosing infections, including SARS-CoV-2.