ON THE GREEN: CONSUMER PERCEPTIONS OF RETURNING TO GOLF SPECTATORSHIP AMID THE COVID-19 PANDEMIC

Throughout the COVID-19 pandemic, the sport industry has contended with stoppages of play and interrupted revenue streams. With sport beginning to "return to normal,” there is uncertainty about the safe return of spectatorship and how live-event attendees perceive safety and precautionary measures amid a serious health emergency. The purpose of this study was to assess golf consumers' perceptions of following COVID-19 preventative measures at a small-scale professional golf event in Canada, and how these perceptions may influence their future event attendance. The results from a multiple linear regression analysis indicated that perceived benefits of COVID-19 vaccination and self-efficacy of following preventative measures significantly and positively influenced golf spectator's consideration of attending an event where these measures are enforced, while the perceived barriers of mask wearing significantly and negatively influenced attendance consideration. This has several practical implications for event management practitioners planning and hosting an event amid the COVID-19 pandemic. © Copyright 2023 Cognizant, LLC.

Effects of COVID-19 on heart failure admissions.

Despite significant investigation into the effects of COVID-19 on cardiovascular disease, there is a paucity of national data specifically examining its effects on heart failure (HF) hospitalizations. Previous cohort study data demonstrate worsened outcomes in HF patients with recent COVID-19 infection. To better understand this association, this study aimed to utilize a nationally representative database to examine demographics, outcomes, and health care utilization in hospitalizations for HF with a codiagnosis of COVID-19.

Paradox of precaution: Infection and precautionary action during the COVID-19 pandemic

Objective: We consider the primary sources of COVID-19 infection, the main precautionary actions taken, and common understandings of their difficulty and necessity in order to understand why it has been difficult to control the pandemic. Methods: Online data collected in all 50 states during the Delta wave of the pandemic (n = 10,022) are used to examine how infection occurs and evaluate 32 precautionary actions. Results: The most common source of respondent infection was at home, from someone they lived with. While most precautions were widely practiced, avoiding close contact with cohabitants was uncommon. This precaution was considered to be the most difficult and least necessary by a wide margin. Conclusion: During the first 2 years of the pandemic, there was a mismatch between actions taken to avoid infection and the main way that people became infected. Many precautions caused people to stay at home, which may have increased their likelihood of infection. The identification of this "paradox of precaution” contributes to an understanding of why the pandemic could not be controlled in spite of the extensive and well-intended precautions that were taken. © 2023 by the Southwestern Social Science Association.

The Mask of War and the War of Masks: The Fabricated Culture War Gets Deadly

In the US, mask wearing, while opposed and evaded by people all over the political spectrum (albeit not equally), was disproportionately associated with reactionary political affiliation, especially in its most demagogic and violent forms. Anti-mask demagoguery associated mask wearing and mask mandates with communism, Nazism, satanism, genocide, suicide and a war on America. This article argues that this demagoguery was not unique to masks or COVID-19, but the rhetorical consequence of the pro-GOP strategic repurposing of twentieth-century anti-communist demagoguery. This demagoguery (which arose after World War I) framed all policy disagreements, not as issues with multiple legitimate perspectives that could be argued qua policies, but as battles in an apocalyptic war between good and evil, and therefore beyond normal political disagreement. © 2023 EURICOM.

Trends in outcomes and resource utilization for acute myocardial infarction admissions during the COVID-19 pandemic.

During the early COVID-19 pandemic, resources were at times rationed, and as a result, cardiovascular outcomes may have suffered, however despite this, there is a paucity of national data specifically examining the relationship between COVID-19 and acute myocardial infarction (AMI). Some of the most robust previous cohort studies suggest the risk of AMI is increased in patients with COVID-19 infection, and disproportionately so in certain patient populations. To better define national trends in the associations between COVID-19 and AMI, this study aimed to examine demographics, outcomes, and health care utilization in hospitalizations for AMI with a codiagnosis of COVID-19 using a nationally representative database.

EDINBURGH DYSPHAGIA SCORE SAFELY PRIORITISES ENDOSCOPY IN A NURSE LED TELEPHONE TRIAGE CLINIC

Introduction As part of the COVID recovery strategy, the GI unit in North Sector of GGC set up a telephone clinic manned by experienced endoscopy nurse specialists to triage urgency of dysphagia investigation by undertaking symptom assessment and utilising the Edinburgh Dysphagia Score (EDS). Patients with high EDS were vetted to (the highest) Category 1 (of 4) priority, and patients with low EDS were investigated at Category 2. The outcomes for all patients referred with dysphagia over a 6 month period commencing January 2021 were audited to determine the safety and clinical value of maintaining this approach in the longer term. Methods Information on all patients referred to the service was prospectively collected using a shared MS Teams Excel spreadsheet. We collected information on the EDS at interview, the decision to investigate and the designated priority of the investigation. Electronic cases records were then interrogated to ascertain the outcome of investigations. Statistical comparison of the frequency of diagnoses made at endoscopy was undertaken using the CHI square test. Results 296 patients were assessed via 40 nurse dysphagia triage clinics during this period, with 266 undergoing endoscopy. Only 14/296 (6.4%) patients avoided endoscopy solely on account nurse assessment and reassurance. Relative diagnostic frequency is detailed in table 1. 144 (48.6%) were triaged to Category 1 endoscopy and 122 (41.2%) to category 2 endoscopy. Oesophageal cancer was diagnosed in 9/128 (7%) patients with EDS ≥ 3.5 and only 1/106 with EDS < 3.5 (p<0.05). For all other diagnoses there was no significant difference in frequency between those with high or low EDS. 59% of all patients had no new gastroesophageal diagnosis made. New diagnosis of Barrett's oesophagus was uncommon, being found in 2.6%. Conclusions Routine use of the Edinburgh Dysphagia score can safely and effectively prioritise dysphagia investigation. While this can be delivered via a telephone triage clinic run by experienced nurse endoscopists, such an approach rarely avoids endoscopy and with the return of capacity the nurses may be better utilised delivering endoscopy sessions rather than triage clinics. Alternative means of utilising the EDS need urgently considered, such as embedding the calculation of the EDS directly into the GP referral process to allow prioritisation at time of vetting. This will be the next focus of our service.

The Efficacy of a Mental Skills Training Course for Collegiate Athletes

Background: Psychological skills training has been shown to improve performance in athletes. However, few studies have looked at the efficacy of mental skills training programs in young athletes. Hypothesis/Purpose: The purpose of this study was to evaluate satisfaction of collegiate athletes with a 6-session mental skills course, and to assess changes in mental toughness and coping skills before and after the course. Methods: We conducted a 6-session mental skills training program with Division I female collegiate athletes during the fall of 2020. Athletes completed pre-course, post-course, and 4-month questionnaires to assess efficacy of the course, as well as their satisfaction. Due to the COVID-19 pandemic, none of the athletes were actively competing at the time of the course or during follow-up surveys. Demographic information was collected and the Athletic Coping Skills Inventory (ACSI, range=0-84) and Mental Toughness Inventory (MTI, range=8-56) were used to assess coping skills and mental toughness at all time points. Satisfaction was assessed on a ten-point scale, with 10 being most satisfied. Results: Fifty-four Division I female athletes participated in the program. Mean age was 19.8 years, 61% reported training in their sport for 8 or more months a year, 26% reported history of mental health conditions, and 22% reported being injured or recovering from injury at the time of participation. For participants with paired pre- and post-course data (n=37, 68.5%), MTI scores improved by a mean 2.6 points (95% CI=1.1-4.1;p=0.001) and ASCI scores improved by a mean 4.0 points (95% CI=0.6-7.4;p=0.02) from pre- to postcourse. For participants with paired data for pre-course and four-month follow-up (n=25, 46.2%), no change was detected in mean MTI score (p=0.72). There was, however, a mean increase of 3.4 points in mean ASCI from pre-course to four-month follow-up (95% CI=0.4-6.4;p=0.03). Overall satisfaction had a median score of 9/10 at the post-course assessment, and eighteen participants (18/37, 48.6%) shared positive free-text comments regarding course delivery, content, and impact. No negative feedback was reported. Conclusion: Following a 6-session mental skills course in collegiate female athletes, mental toughness and coping skills scores significantly improved at post-course assessment. Athletes reported being highly satisfied with the content of the course and reported overall positive experiences.

A multivariable triage model to support direct access of symptomatic breast patients to specialist breast units?

Background: Patients with breast symptoms access specialist care when referred by their General Practitioner (GP). The One-Stop Clinics (OSCs) remain the standard of specialist breast care but are resource-dependent, and OSCs are inundated with low specificity referrals, more so, since the Covid-19 crisis. Direct Patient Access (DPA) is theoretically more efficient and avoids delayed diagnoses. However, DPA can potentially further overwhelm breast units with self-referrals unless a reliable triage model that enables risk-based resource allocation is adopted. We aim to examine the accuracy of such model. Methods: In our OSC, patient-reported symptoms and demographics were prospectively collected and stratified: 1) TOP-Tumour;lump, thickening, firmness, etc. 2) TOP-Observation;nipple change, discharge, dimpling, rash, etc. 3) TOP-Perception;pain, itch, discomfort, etc. A multivariable model (mpMODEL) was constructed using logistic regression and was tested at semi-arbitrary BC risk cut-offs: A) <0.5% (advice & discharge), B) ≥0.5 to <2.0% (remote consultation via phone or video), C) ≥2.0% to <3.0% (non-OSC) and D) ≥3.0% (OSC). Research Ethics Committee reference: 19/LO/1737. Results: Of 7474 eligible patients 6.8% (n=510) had breast cancer. Multivariable Odds Ratios were significant for: age (1.08, p=<0.001), gravidity (0.66, p=0.004), TOP-T (7.89, p=<0.001), TOP-O (1.74, p=<0.001) and TOP-P (0.45, p=<0.001). Self-referral triage outcomes according to the mpMODEL: advice & discharge;8.2% (n=632), remote consultation;28.6% (n=2135), non-OSC;13.1% (n=980), and OSC;only 49.9% (n=3727). Breast cancer would be diagnosed in 0.2%(n=1), 0.9%(n=19), 3.3% (n=32), and 12.3% (n=458), respectively. Conclusion: This proposed model halves the OSC demand and can safely facilitate DPA to specialist breast clinics.

Mapping the student experience of UK-wide virtual placement initiative in physiotherapy

Keywords: Virtuality;Placement;Qualitative Purpose: During the COVID-19 pandemic it has become increasingly necessary for healthcare teams to diversify their approaches to frontline delivery. One key change in outpatient services has been the introduction and/or proliferation of virtual platforms to safely conduct assessments and ensure sustained patient contact, even within the traditionally tactile domain of physiotherapy. Consonant with these developments is the need for physiotherapy students to gain experience of working through such platforms, as they are highly likely to remain an integral element of service delivery in the post-COVID environment. The research reported herein explores student experiences of a UK-wide physiotherapy Virtual Placement (VP) scheme, run by ConnectHealth in 2020 and 2021, with a view to better understanding the nuanced impacts of their working in a virtual healthcare space over a six-week period. Methods: The research team contacted all students who had (a) completed a ConnectHealth VP, while also (b) having prior experience of conventional placement(s). These students, registered at a wide array of UK universities, were informed that participation would involve taking part in a semi-structured interview, during which they could critically discuss their experiences of the VP itself. Given pragmatic concerns around time and funding, the first N=10 students to register interest in participating were invited to take part in an online interview. All invited students provided interviews, with a mean duration of 30 minutes. Interviews were transcribed verbatim, though redactions were made where issues of participant identity protection were at stake. Coordinative investigation of the transcripts, using Reflexive Thematic Analysis, was undertaken by the full research team. Results: Thematic analysis revealed three core themes in the data. 1. Workload and Flexibility;all participants had anticipated that the VP would involve less direct work than a conventional placement, but most actually found the inverse to be true, with technological problems adding significant additional time. However, the VP was widely considered to be more flexible, helping with independent time-management skills, while also providing greater opportunities to exercise and ‘take a break’, and the absence of travel time was often reported to shorten the overall working day. 2. Variety of Experience;all participants lauded the rich variety of working contexts afforded by their geographically decentred VP, and the opportunity to work with other students from UK-wide universities. 3. Contact and Isolation;variety of contacts was universally taken to enrich multi-disciplinary working skills, but at the expense of depth. Most participants reported a sense of active isolation at times, particularly where their clinical supervisor(s) took a light-touch approach. While some viewed this as having enhanced their independent problem-solving skills, all explicitly missed more direct and consistent contact with clients and colleagues. Conclusion(s): Findings indicate that the VP had many strengths for participants, particularly around variety of experiences. Future research should not, however, overlook the role of workplace social contact in student wellbeing. Impact: These findings ideally give some provisional direction on how prospective physiotherapy VPs might be shaped to best mitigate issues of isolation, while preserving richness of diverse experience. Funding acknowledgements: The work was supported by a small grant from the University of Cumbria's Internal Research Fund.

Implementing a virtual placement scheme for physiotherapy students in the UK: The experiences of clinical educators

Keywords: Education, Technology, Qualitative Purpose: At the level of frontline service delivery, a key healthcare impact of the COVID-19 pandemic in the UK has been the increasingly widespread usage of virtual platforms. Even physiotherapy, which is traditionally strongly associated with face-to-face delivery, has embraced online working to ensure safe and sustained patient contact during viable assessments and treatments. Allied to such change has been the development of Virtual Placement (VP) schemes for physiotherapy students, designed to provide experience of such remote working, given that it will very likely remain a feature of physiotherapeutic work in the longer term. Given this, the research reported herein explores the experiences of Clinical Educators (CEs) working on a nationwide ConnectHealth physiotherapy VP scheme that ran during 2020 and 2021. This is done with a view to (a) highlighting how future VPs might be refined for greatest efficacy, while (b) providing needs-sensitive assistance to CEs in their practical roles. Methods: The research team contacted all ConnectHealth CEs who had worked with at least two full six-week VP student cohort, inviting them to take part in an online semi-structured interview addressing their experiences of the VP scheme itself. The first N = 10 to register interest in participating were formally recruited. Interviews (with a mean duration of 33 min) were provided by all invited CEs and were transcribed verbatim, though necessary redactions were made to protect participants’ identities. Investigation of the transcripts, using Reflexive Thematic Analysis, was undertaken by the full research team. Results: Analysis revealed four global data themes. 1. Supervision and Oversight;while reduced direct contact time with students lessened some of the background working pressures on the participants themselves, they all expressed concerns that it might have increased those pressures on their students. This was, however, widely taken to be counterbalanced by the students’ access to a much broader range of clinicians. 2. Technology and Independence;all participants saw design and delivery of Facebook Live sessions as powerful independent learning experiences for the students, although they were patient engagement with them was sometimes inconsistent. These sessions also contributed a bank of online resources that would help ‘lighten the load’ for both students and CEs in the future. 3. Patient Contact;it was widely held that the VP environment had improved students’ subjective assessment capacities. The students’ ability to work directly with patients was limited by GDPR concerns regarding sharing those patients’ contact details, however, and meetings including a CE were harder to arrange with increased chances of technical glitches. 4. Assessment;it was much more difficult for participants to effectively observe students’ clinical work in a virtual environment, with existing assessment schemes being particularly awkward to apply remotely. Conclusion(s): Findings indicate that the present VP scheme, although deemed highly effective in some areas, involved some legacy structures that made its delivery difficult for CEs, not least around practical assessment. Impact: These findings ideally give some provisional direction on how prospective physiotherapy VPs might be shaped to help CEs more effectively help themselves and students. Funding acknowledgements: The work was supported by a small grant from the University of Cumbria's Internal Research Fund.

Employing a coaching model of supervision during physiotherapy placements: Charting the student experience

Keywords: Education;Coaching;Qualitative Purpose: Placement capacity during physiotherapy degree programmes is presently under unprecedented stress. In the wake of COVID-19, Health Education England has moved to increase university places across all Allied Health Professions (AHPs) by 50%, without any reduction in quality of education. In order to facilitate this increase in student numbers, Higher Education Institutions (HEIs) and healthcare teams are being asked to change their ways of working and consider alternative supervision models. One such model is the group-based ‘coaching’ approach which is commonly used in the education of medical students but seldom employed on AHP programmes, where one-to-one supervision remains the default. The research reported herein was tasked with qualitatively elucidating student experiences of such a coaching supervision initiative, introduced by the research team across a set of undergraduate and postgraduate physiotherapy placements in two NHS Trusts the north of England during 2020 and 2021. Methods: The research team contacted all students who had (a) completed a placement using the coaching supervision model, while also (b) having prior experience of placement(s) using the more conventional one-to-one approach. These students, registered at a number of UK HEIs, were informed that participation would involve sitting for a semi-structured interview in which they would be afforded the opportunity to critically discuss their experiences of the coaching placement. In accordance with time and budgetary constrictions, the first N = 20 students to register interest in participating were invited to take part in an online interview. All invited students provided interviews, with a mean duration of 25 min. Interviews were transcribed verbatim, with redactions made only for participant identity protection. Transcripts were investigated coordinatively by the full research team using Reflexive Thematic Analysis. Results: Analysis yielded four global themes. (1) Teamwork and Camaraderie;the collective experience engendered by the coaching model was widely lauded and cited as a source of confidence and support, though some participants were conscious that they were too often deferring to the more ‘experienced’ students in their group. (2) Leadership;all students cited opportunities to lead and delegate within their group as important to their professional development, though the experience of being led – and delegated to – by other students was more difficult for some than others. (3) Safety Nets;it was commonly asserted that the coaching model exposed both strengths and weaknesses in performance much more than one-to-one supervision, which was taken to simultaneously boost and undermine confidence. (4) Acceleration and Inertia;while all students argued that they initially learned more quickly in the group environment, a few contended that, as time passed, it began to hold them back. Conclusion(s): Findings indicated that although the coaching model was generally very popular with students, these successes did not come without caveats. Future research might specifically investigate links between these caveats and student profiles over a wider population. Impact: These findings have clear import for nuancing in design of future coaching placements, particularly regarding how to maintain the strengths while further improving the student experience. Funding acknowledgements: The work was supported by a small grant from the University of Cumbria's Internal Research Fund.

COVID-19, “lockdown” and achilles tendon ruptures

Introduction The COVID-19 pandemic has affected the types of trauma being operated on by Orthopaedic surgeons. Lifting of restrictions around sports saw a sudden return to play for people after a period of inactivity. Achilles tendon ruptures are associated with these episodic athletes. We hypothesised that easing of “Lockdown” restrictions led to increased presentations of Achilles tendon ruptures vs. the same period in 2019. We conducted a case-control study to investigate. Methods Data from electronic theatre logbooks of all operations performed from 27th March 2020 (Lockdown begins) to 31st July 2020 and 27th March 2019 to 31st July 2019 was collected. All operatively managed Achilles tendon ruptures were included. All other operations were excluded. Results 772 total cases were performed in 2019. There were 17 Achilles tendon ruptures in that period (2.2%). 14 occurred after easing of restrictions. 580 total cases were performed in 2020. There were 13 Achilles tendon ruptures in that period (2.2%). 11 occurred after easing of restrictions and the return of sport. There was a greater incidence of Achilles tendon ruptures in 2019 vs. the equivalent “Lockdown” period in 2020. Conclusion COVID-19 pandemic restrictions and return to play after inactivity does not increase the incidence or rate of Achilles tendon rupture.

The impact of COVID-19-delayed elective sports surgery on young patients

Objectives: The COVID-19 pandemic has stressed the US healthcare system in unprecedented ways. As a response to the spread of the virus, elective surgeries throughout the country have been canceled, in an effort to minimize further transmission. To our knowledge, the effects of delayed surgeries on patients have not been investigated. Thus, the purpose of this study was to evaluate the physical and psychological consequences of elective surgery delays on young sports medicine patients. Methods: We conducted a cross sectional study of patients, ages 10-25 years old, who had sports medicine surgery delayed between March and May 2020 due to the COVID crisis. All patients were still awaiting surgery at the time of the initial survey. Electronic surveys were sent to patients and included the 12-item Short Form Health Survey (SF-12), which yields a physical component score (SF12-PCS) as well as a mental component score (SF12-MCS), the PROMIS Psychological Stress Experience survey (PROMIS-PSE), and self-designed questions about patient concerns regarding the COVID crisis and delayed surgery. A higher score on SF-12 subscales signifies better health, whereas a higher score on the PSE indicates more psychological stress. Scores that deviate significantly from a mean of 50 indicate a difference from the general population norm. Results: Of the 146 eligible patients with delayed elective sports surgeries, 89 patients (61%) elected to participate (mean age 17.7±2.9 years, 30% male). The median length of surgical delay was 36 days (range 9-54), and 79% of patients were awaiting surgery on the lower extremity. Delayed surgery patients scored significantly lower than population norms on the SF12-PCS (mean 39.4, CI 36.8-42.1, p<0.001). Males scored significantly higher than females on the SF12-MCS (53 vs 45.1, p=0.003), but the overall mean was not significantly different from the general population (47.2, p=0.08). The mean PSE score was significantly higher than population norms (57.9, CI 56.3-59.6, p<0.001), but did not differ by age or sex. Those with a history of mental health conditions reported higher PROMIS-PSE scores compared to those without (61.2 vs 56.9 p=0.02). Patients who reported being extremely concerned about their surgical delay had lower scores on the SF-PCS and SF-MCS, and higher scores on the PROMIS-PSE (p=0.03, p=0.01, and p<0.001 respectively), suggesting more significant physical and emotional symptoms. The majority of patients indicated that their physical and emotional symptoms were attributed mostly to their injury awaiting surgery, with patients reporting a median 50% attribution (IQR, 32-75%), compared to attributions for COVID or other concerns. The biggest concern with COVID-related surgical delays was a concern about not being back in time for a sports season. Conclusions: Young sports medicine patients reported significant physical and emotional symptoms associated with COVIDrelated surgical delays. Patients were most concerned about delays resulting in missed sport seasons. Those who reported greater levels of concern with surgical delays demonstrated lower physical and mental health scores and higher levels of psychological stress. The physical and psychological impact of surgical delays should be considered when caring for young athletes.

Marginal warming associated with a COVID-19 quarantine and the implications for disease transmission.

During January-February 2020, parts of China faced restricted mobility under COVID-19 quarantines, which have been associated with improved air quality. Because particulate pollutants scatter, diffuse, and absorb incoming solar radiation, a net negative radiative forcing, decreased air pollution can yield surface warming. As such, this study (1) documents the evolution of China's January-February 2020 air temperature and concurrent particulate changes; (2) determines the temperature response related to reduced particulates during the COVID-19 quarantine (C19Q); and (3) discusses the conceptual implications for temperature-dependent disease transmission. C19Q particulate evolution is monitored using satellite analyses, and concurrent temperature anomalies are diagnosed using surface stations and Aqua AIRS imagery. Meanwhile, two WRF-Chem simulations are forced by normal emissions and the satellite-based urban aerosol changes, respectively. Urban aerosols decreased from 27.1% of pre-C19Q aerosols to only 17.5% during C19Q. WRF-Chem resolved ~0.2 °C warming across east-central China, that represented a minor, though statistically significant contribution to C19Q temperature anomalies. The largest area of warming is concentrated south of Chengdu and Wuhan where temperatures increased between +0.2-0.3 °C. The results of this study are important for understanding the anthropogenic forcing on regional meteorology. Epidemiologically, the marginal, yet persistent, warming during C19Q may retard temperature-dependent disease transmission, possibly including SARS-CoV-2.

COVID-19 infections and outcomes in a live registry of heart failure patients across an integrated health care system.

BACKGROUND: Patients with comorbid conditions have a higher risk of mortality with SARS-CoV-2 (COVID-19) infection, but the impact on heart failure patients living near a disease hotspot is unknown. Therefore, we sought to characterize the prevalence and outcomes of COVID-19 in a live registry of heart failure patients across an integrated health care system in Connecticut. METHODS: In this retrospective analysis, the Yale Heart Failure Registry (NCT04237701) that includes 26,703 patients with heart failure across a 6-hospital integrated health care system in Connecticut was queried on April 16th, 2020 for all patients tested for COVID-19. Sociodemographic and geospatial data as well as, clinical management, respiratory failure, and patient mortality were obtained via the real-time registry. Data on COVID-19 specific care was extracted by retrospective chart review. RESULTS: COVID-19 testing was performed on 900 symptomatic patients, comprising 3.4% of the Yale Heart Failure Registry (N = 26,703). Overall, 206 (23%) were COVID- 19+. As compared to COVID-19-, these patients were more likely to be older, black, have hypertension, coronary artery disease, and were less likely to be on renin angiotensin blockers (P<0.05, all). COVID-19- patients tended to be more diffusely spread across the state whereas COVID-19+ were largely clustered around urban centers. 20% of COVID-19+ patients died, and age was associated with increased risk of death [OR 1.92 95% CI (1.33-2.78); P<0.001]. Among COVID-19+ patients who were ≥85 years of age rates of hospitalization were 87%, rates of death 36%, and continuing hospitalization 62% at time of manuscript preparation. CONCLUSIONS: In this real-world snapshot of COVID-19 infection among a large cohort of heart failure patients, we found that a small proportion had undergone testing. Patients found to be COVID-19+ tended to be black with multiple comorbidities and clustered around lower socioeconomic status communities. Elderly COVID-19+ patients were very likely to be admitted to the hospital and experience high rates of mortality.

COVID-19 and Disruptive Modifications to Cardiac Critical Care Delivery: JACC Review Topic of the Week.

The COVID-19 pandemic has presented a major unanticipated stress on the workforce, organizational structure, systems of care, and critical resource supplies. To ensure provider safety, to maximize efficiency, and to optimize patient outcomes, health systems need to be agile. Critical care cardiologists may be uniquely positioned to treat the numerous respiratory and cardiovascular complications of the SARS-CoV-2 and support clinicians without critical care training who may be suddenly asked to care for critically ill patients. This review draws upon the experiences of colleagues from heavily impacted regions of the United States and Europe, as well as lessons learned from military mass casualty medicine. This review offers pragmatic suggestions on how to implement scalable models for critical care delivery, cultivate educational tools for team training, and embrace technologies (e.g., telemedicine) to enable effective collaboration despite social distancing imperatives.