Impact of COVID-19 pandemic on health workers sentiment towards influenza vaccination: A literature review

INTRODUCTION The COVID-19 era highlighted vaccine hesitancy (VH) among health workers (HWs) as a major hurdle to optimum immunization practices. Through the identification of relevant determinants, barriers, and interventions to counteract VH, this literature review examines the impact of the COVID-19 pandemic on HWs' influenza vaccination sentiment. METHODS Studies were identified by searching the PubMed database for articles published between August 2019 and July 2022. The search was restricted to articles in English that were original studies or meta-analyses or reviews. They were included in the review if they covered influenza VH among HWs during the COVID-19 pandemic. Inductive content analysis was used to identify themes that illustrate facilitators, barriers, and consideration. Risk of bias was not assessed. RESULTS Of 924 articles identified, 20 were selected. Of these, 15 were conducted in Europe and focused on healthcare staff, primarily in hospital settings. Within the COVID-19 context, physicians and residents were more willing than nurses to adhere to influenza vaccination. Young HWs, particularly males and those with chronic comorbidities, demonstrated the highest acceptance of the influenza vaccine. HWs' immunization history is associated with higher influenza vaccine adherence. Factors determining HW's acceptance of flu immunization were: healthcare staff's knowledge of the influenza vaccine, concerns about protecting themselves or others, and the rising perception of risk and fear from COVID-19 infection. Main barriers were negative perceptions about vaccine safety and effectiveness, insufficient time for vaccine uptake, and confidence in natural or acquired immunity. In the context of the pandemic, awareness campaigns and targeting vaccine affordability and accessibility were the most adopted interventions to increase vaccine acceptance amongst HWs. CONCLUSIONS In the context of COVID-19, confidence in influenza vaccines and the perception of risk from COVID-19 infection have increased among healthcare staff. To further explore the impact of the pandemic on HWs' sentiment toward influenza vaccination, conducting new empirical studies are strongly recommended © 2023 Meckawy R. et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial 4.0 International License. (http://creativecommons.org/licenses/by-nc/4.0)

Implementing older adult vaccination within the Immunization Agenda 2030: A discussion of potential challenges and solutions

As the World Health Organization moves forward into the Decade of Healthy Ageing in 2020, developing immunization programs with a life-course and integration approach for older people is one of the key strategic priority areas, and is highlighted in the Immunization Agenda 2030 roadmap. The World Federation of Public Health Associations (WFPHA) conducted a focus group discussion on 11 November 2021. Nine national experts specializing in vaccination policy from Canada, the United States, Taiwan, Brazil, and El Salvador were recruited through the World Federation Public Health Associations network to participate in an online focus group discussion to discuss the operational challenges and potential strategies for the implementation of older adult vaccination programs. Experts' recommendations were presented using the Immunization Agenda 2030 roadmap after consensus was reached. Key recommendations were that it is important to ensure equitable vaccine access using a people-centered approach;that optimizing health communication channels and strategies can combat hesitancy and promote knowledge of vaccination among older people;that there is a need for data-driven strategies to guide the surveillance and monitoring of disease burden and vaccination status;and that the success of such programs will depend on sustained government funding and support. As countries start to look beyond the immediate impact of the COVID-19 pandemic, there is a window of opportunity to re-prioritize vaccination programs within existing health systems to protect older adults. Moving forward, creative solutions and buy-in from a wide range of stakeholders are required, and further research is needed to fill in knowledge gaps. © 2023 Whang S.D. et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial 4.0 International License.

Quantifying Population Immunity to Covid-19 in Washington State and Oregon

Background: Since early 2020, the novel SARS-CoV-2 virus has spread rapidly throughout the globe. Subsequently many individuals have developed some form of immunity due to either a prior infection, one or more vaccinations, or a combination of the two. Using local epidemic data and mathematical modeling, we enumerate the various immune populations in Washington State and Oregon and quantify the level of protection against infection and hospitalization. Method(s): We developed a compartmental model of ordinary differential equations, which stratifies the population by age (0-17 years, 18-49 years, 50-64 years, and 65+ years), region, type of immunity (naive, infectionderived, vaccine-derived, booster-derived, hybrid immunity, etc), and recency of immune conferring event (recent and waned). To track the number of individuals in each category we combine 1) literature-based estimates of susceptibility to infection and severe disease by age, immune status, and variant, 2) calibration to the number of severe infections (hospitalizations and deaths) and number of vaccinations and 3) validation with serological surveys of the population. Result(s): We estimate that by mid-April 2022 more than 95% of the populations of both Washington and Oregon had some immunity against COVID-19 infection and hospitalization. Younger age groups tended to have much higher rates of natural or hybrid immunity with 96% of 0-17-year-olds and 83% of 18-49-year-olds protected due to past infections. Overall, the population-level immunity against the Omicron variant reduced risk of infection by 59% (95% Credible Interval 54% - 62%) and risk of hospitalization by 79% (95% CI 77% - 81%) in Washington and 62% (95% CI 57% -66%) and 83% (95% CI 82% - 85%), respectively, in Oregon. There was similar population-level protection against Delta at the start of the Omicron wave in early December 2021, which reduced risk of infection by 60% (95% CI 56% - 63%) and risk of hospitalization 79% (95% CI 78% - 80%) in Washington and 66% (95%CI 63% - 70%) and 82% (81% - 83%), respectively, in Oregon. Conclusion(s): Very large waves of new infections throughout 2021 and early 2022, in addition to high levels of vaccination and boosting among the older age groups in Washington and Oregon have greatly reduced population susceptibility to currently circulating strains. However even very high population immunity has allowed for emergence of novel variants that escape existing immunity, highlighting the need for continued develop of new variantspecific boosters.

The dual pandemic: COVID-19, systemic racism, and college student-athletic mental health

The dual pandemic of 2020–COVID-19 and systemic racism–continues to reshape society. The current study examines how this dual pandemic contributes to the psychological distress of college student-athletes, with attention to college student-athletes who identify as Black, Indigenous, or people of colour (BIPOC). A total of 222 student-athletes from nine universities completed the online survey. Student-athletes reported COVID-19 had a moderate impact on daily life. The direct effect of COVID-19 on psychological distress was found to be positive and significant but did not differ for BIPOC and White participants. Additionally, nearly all BIPOC student-athletes reported experiencing systemic racism;yet the level of systemic racism did not predict psychological distress. Findings provide insight related to the importance of mental health among college student-athletes. © 2022 International Society of Sport Psychology.

Acute Hemorrhagic Leukoencephalitis in a Pediatric Patient with COVID-19 Infection: A Case Report

Case Diagnosis: This is a pediatric case of acute hemorrhagic leukoencephalitis (AHLE). Case Description or Program Description: A 6-yearold female with history of Hemoglobin SC disease presented to the hospital with a two-day history of fever, cough, congestion, and positive COVID PCR test. She became apneic with oxygen saturations in the 70s, hypotensive, and incontinent of urine, ultimately requiring intubation and an intensive care unit stay. MRI brain revealed innumerable microhemorrhages within the superior greater than infratentorial periventricular and subcortical white matter. Blood and urine cultures and extensive workup including cerebrospinal fluid studies were negative, other than elevated myelin basic protein. The patient underwent treatment with intravenous steroids and IVIG with subsequent clinical improvement. Setting(s): Acute care hospital and acute inpatient rehabilitation hospital. Assessment/Results: Neurology concluded that the brain MRI findings were likely due to AHLE in the setting of acute COVID infection. The patient was ultimately extubated and transitioned from tube feeds to a regular diet with thin liquids. She discharged from acute rehabilitation ambulating 150 feet and walking up stairs. She displayed deficits in cognition and communication that improved throughout her rehabilitation stay. Discussion (relevance): AHLE is typically seen in adults and mortality is reported as high as 70%. Here we present a case in a pediatric patient with favorable neurological outcomes. Conclusion(s): Although AHLE is more common in the adult population, it may present in the pediatric patient in the setting of COVID infection. Increased awareness can lead to early diagnosis and may contribute to positive functional outcomes.

The influence of COVID-19 upon perceptions of parent identity and role among youth sport spectators

Parent experiences in youth sport settings during the COVID-19 pandemic are a notable and understudied phenomenon. Parents had varied experiences as a result of safety mandates and protocols that limited physical presence and engagement in their child's sports activities. These limitations proved to be an emotional challenge for parents - balancing the responsibilities of protecting the safety of their families and providing sports experiences to promote both normalcy and acquire the life skills gained from sports participation in a fluid environment. In some instances, parents engaged in virtual spectating experiences which sought to minimize physical risks associated with COVID-19, but also did not require their physical presence to participate. Research on the virtual experience of parents is novel and from a sample of 112 parents across youth sport sectors in 18 states how the spectating modality influenced parental roles and identities was examined. Virtual spectating experiences reflected many challenges for parents, but also prompted much gratitude for allowing continued engagement in their child's sports activities. This exploratory research prompts larger questions urging sport-based professionals to examine the influences of spectating modalities on experiences of parents. The authors captured retrospective parent reactions to their personal spectating experience and generated a grounded theory diagram to demonstrate relationships between factors shaping the parent identity and role in this context. Implications for sport-based professionals are discussed.

How the COVID-19 pandemic has affected the presentation of testicular cancer in the West Midlands Deanery

Introduction: There are approximately 2,400 new cases of testicular cancer in the UK annually. NICE guidelines recommend all suspected patients to be referred on the 2 week-wait pathway, with a 31 day target to commence treatment following decision to treat. The COVID-19 pandemic has decimated routine hospital service provision and led to the cancellation of 36,000 cancer operations in the UK during the first wave. Our aim was to assess the impact of the pandemic on our testicular cancer patients. Patients and Methods: Eleven trusts in the West Midlands deanery performed a retrospective analysis of all testicular cancer patients between January 2015 to December 2020. The pre-COVID cohort (January 2015-February 2020) were compared to the COVID cohort (March 2020-December 2020). Parameters assessed included date of referral, first clinic appointment, operation, and post-operative tumour markers. Sperm banking and pathological stage was also compared. Results: A total of 830 patients were included. Pre- COVID n=753, COVID n=77. Conclusions: There was statistically no significant difference in time from initial referral to first clinic appointment, duration from clinic to theatre, timeliness of post-operative tumour markers and pathological stage of tumour. Sperm banking was performed significantly more in the COVID era (25.7 vs 10.3%). This reflects consistency in the management of testicular cancer patients during the COVID period. Of note less patients were assessed on average during the COVID era (92 v 146/year) implying that we may experience an increase in patients with later presentations and advanced disease;further analysis will be required to confirm this.

The dangers of reused personal protective equipment: healthcare workers and workstation contamination.

BACKGROUND: Personal protective equipment (PPE) is essential to protect healthcare workers (HCWs). The practice of reusing PPE poses high levels of risk for accidental contamination by HCWs. Scarce medical literature compares practical means or methods for safe reuse of PPE while actively caring for patients. METHODS: In this study, observations were made of 28 experienced clinical participants performing five donning and doffing encounters while performing simulated full evaluations of patients with coronavirus disease 2019. Participants' N95 respirators were coated with a fluorescent dye to evaluate any accidental fomite transfer that occurred during PPE donning and doffing. Participants were evaluated using blacklight after each doffing encounter to evaluate new contamination sites, and were assessed for the cumulative surface area that occurred due to PPE doffing. Additionally, participants' workstations were evaluated for contamination. RESULTS: All participants experienced some contamination on their upper extremities, neck and face. The highest cumulative area of fomite transfer risk was associated with the hook and paper bag storage methods, and the least contamination occurred with the tabletop storage method. Storing a reused N95 respirator on a tabletop was found to be a safer alternative than the current recommendation of the US Centers for Disease Control and Prevention to use a paper bag for storage. All participants donning and doffing PPE were contaminated. CONCLUSION: PPE reusage practices pose an unacceptably high level of risk of accidental cross-infection contamination to healthcare workers. The current design of PPE requires complete redesign with improved engineering and usability to protect healthcare workers.

NeuroLytes: Developing Clinical Reasoning for Medical Students on the Neurology Clerkship

Objective: Evaluate the role of virtual case-based discussions lead by neurology residents at supplementing the standard didactic series in the neurology clerkship. Background: COVID-19 created a new barrier to medical education by reducing trainee participation in patient care. Neurophobia is still present in up to 50% of medical students. To encourage critical thinking, we developed a series of virtual case-based resident-led discussions ('NeuroLytes'), simulating neurological cases. Design/Methods: Second and third year medical students were enrolled in NeuroLytes during their neurology clerkship. Each rotation was divided into two groups (one group participating earlier). Each group received a virtual case discussion weekly (migraine and multiple sclerosis (MS)). Both groups completed surveys regarding perception of the experience and a quiz of 10 questions regarding case knowledge, followed by 7 questions regarding confidence on clinical reasoning. Results: 108 students participated in NeuroLytes. Over 96% of students that discussed both cases had a score ≥7/10 in knowledge questions compared with 72.9% of students that did not attend any cases (p=0.005). Over 80% of students that participated in NeuroLytes felt confident in identifying clinical findings of neurological diseases compared to 52.2% of students who had not (p=0.026). Students who participated in NeuroLytes also felt more comfortable building a preliminary differential diagnosis after receiving an initial patient history (90.3% compared to 69.6%, p=0.052). Conclusions: Medical students participating in NeuroLytes reported perceived improvement in formulating differentials and identifying common neurological diseases. Virtual case-based discussions could be an effective supplemental learning tool for developing clinical reasoning.

Identification of Early Features to Differentiate Hospitalized Children Admitted for Suspected MIS-C from Alternative Diagnoses

Background. Multi-system inflammatory syndrome in children (MIS-C) is a rare consequence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). MIS-C shares features with common infectious and inflammatory syndromes and differentiation early in the course is difficult. Identification of early features specific to MIS-C may lead to faster diagnosis and treatment. We aimed to determine clinical, laboratory, and cardiac features distinguishing MIS-C patients within the first 24 hours of admission to the hospital from those who present with similar features but ultimately diagnosed with an alternative etiology. Methods. We performed retrospective chart reviews of children (0-20 years) who were admitted to Vanderbilt Children's Hospital and evaluated under our institutional MIS-C algorithm between June 10, 2020-April 8, 2021. Subjects were identified by review of infectious disease (ID) consults during the study period as all children with possible MIS-C require an ID consult per our institutional algorithm. Clinical, lab, and cardiac characteristics were compared between children with and without MIS-C. The diagnosis of MIS-C was determined by the treating team and available consultants. P-values were calculated using two-sample t-tests allowing unequal variances for continuous and Pearson's chi-squared test for categorical variables, alpha set at < 0.05. Results. There were 128 children admitted with concern for MIS-C. Of these, 45 (35.2%) were diagnosed with MIS-C and 83 (64.8%) were not. Patients with MIS-C had significantly higher rates of SARS-CoV-2 exposure, hypotension, conjunctival injection, abdominal pain, and abnormal cardiac exam (Table 1). Laboratory evaluation showed that patients with MIS-C had lower platelet count, lymphocyte count and sodium level, with higher c-reactive protein, fibrinogen, B-type natriuretic peptide, and neutrophil percentage (Table 2). Patients with MIS-C also had lower ejection fraction and were more likely to have abnormal electrocardiogram. Conclusion. We identified early features that differed between patients with MIS-C from those without. Development of a diagnostic prediction model based on these early distinguishing features is currently in progress.

Covid-19 in older adults: Inpatient outcomes in a level 3 irish hospital

Background: COVID-19 has proved devastating in older persons. Previous studies reveal a mortality rate of 31% for hospitalised patients over 70.1 We examine outcomes for older COVID patients in our hospital. Methods: We conducted a Hospital In Patient Enquiry Scheme review for patients coded as COVID-19 between 19/03/2020-19/02/2021 (n=674). Older adults were defined as those aged over 65 years at time of admission. Age, sex, length of stay and survival were collected. Data was collated by 'wave': (Wave 1 n=294, 2 n=105, 3 n=275). We reviewed whether patients had a CT pulmonary angiogram (CTPA) on the National Integrated Medical Imaging System. Results: 42.3% of COVID patients in our hospital were older persons (n=285). This remained stable throughout the pandemic (Wave 1 44.2%,Wave 2 44.7%,Wave 3 39.3%). Mean length of stay was 19.7 days for older adults vs 7.4 for those under 65. Older persons had a higher mortality rate at 30.9% vs 3.6%. Overall incidence of PE was low at 1.9% (1.1% in older persons). However, the likelihood of a CTPA being positive for those over 65 was much higher at 42.9% vs 17.9%. While there was improvement in mortality rates in older persons from Wave 1 (31.5%) to 2 (19.1%), our data showed a significant rise in mortality inWave 3 (35.2%). This compares to a different pattern in younger people, with mortality rates by wave at 6.7%, 0% and 1.7%. Conclusion: In a large Irish cohort of patients hospitalised with COVID-19, 42.3% were older adults. Length of hospital stay was 3 times longer and mortality was 10 times higher than patients under 65.Older adults were alsomore likely to have a positive CTPA. Further study is needed to evaluate the long term effects of COVID-19 in our older population.

The dual pandemic: COVID-19, systemic racism, and college student-athletic mental health

The dual pandemic of 2020 - COVID-19 and systemic racism - continues to reshape society. The current study examines how this dual pandemic contributes to the psychological distress of college student-athletes, with attention to college student-athletes who identify as Black, Indigenous, or people of colour (BIPOC). A total of 222 student-athletes from nine universities completed the online survey. Student-athletes reported COVID-19 had a moderate impact on daily life. The direct effect of COVID-19 on psychological distress was found to be positive and significant but did riot differ for BIPOC and White participants. Additionally, nearly all BIPOC student-athletes reported experiencing systemic racism;yet the level of systemic racism did not predict psychological distress. Findings provide insight related to the importance of mental health among college student-athletes.

Low SARS-CoV-2 seroprevalence and no active infections among dogs and cats in animal shelters with laboratory-confirmed COVID-19 human cases among employees

Human-to-animal and animal-to-animal transmission of SARS-CoV-2 has been documented;however, investigations into SARS-CoV-2 transmission in congregate animal settings are lacking. We investigated four animal shelters in the United States that had identified animals with exposure to shelter employees with laboratory-confirmed COVID-19. Of the 96 cats and dogs with specimens collected, only one dog had detectable SARS-CoV-2 neutralizing antibodies;no animal specimens had detectable viral RNA. These data indicate a low probability of human-to-animal transmission events in cats and dogs in shelter settings with early implementation of infection prevention interventions.

Reshaping the diagnostic pathways for investigation of haematuria during and after the COVID-19 pandemic: Diagnostic accuracy of strategies for the detection of bladder cancer from the IDENTIFY cohort study

Background: Haematuria often requires investigation with an imaging test and flexible cystoscopy to rule out urinary tract cancers. With a reduction in diagnostic services due to the COVID-19 pandemic there is a risk of compromise in the care of patients referred with haematuria. We aimed to provide a pragmatic strategy that optimises the use of scarce resources by reducing patient visits to hospital and allocating the appropriate diagnostic tests according to risk of bladder cancer. Methods: The IDENTIFY study was an international, prospective, multicentre cohort study of over 11,000 patients referred to secondary care for investigation of newly suspected urinary tract cancer. Patients underwent cystoscopy, imaging tests, urine cytology and transurethral resection of bladder tumour (TURBT), where indicated. We developed strategies using combinations of imaging and cytology as triage tests to flexible cystoscopy. These strategies aimed to maximise cancer detection within a pragmatic pathway in a resource-limited environment. Findings: 8112 patients (74 4%) received an ultrasound or a CT urogram, with or without cytology. 5737 (70 7%) patients had visible haematuria (VH) and 2375 (29 3%) had non-visible haematuria (NVH). Amongst all patients, 1474 (18 2%) had bladder cancer;1333 (23 2%) in VH group and 141 (5 94%) in NVH group. Diagnostic test performance was used to determine optimal age cut-offs for each proposed strategy. We recommended proceeding directly to TURBT for patients of any age with positive triage tests for cancer. Patients with negative triage tests under 35-years-old with VH, or under 50-years-old with NVH can safely be discharged without undergoing flexible cystoscopy. The remaining patients may undergo flexible cystoscopy, with a greater priority for older patients (threshold of 60-years-old with VH, or 70-years-old with NVH) to capture high risk bladder cancer. Interpretation: We suggest diagnostic strategies in patients with haematuria, which focus on detection of bladder cancer, whilst reducing the burden to healthcare services in a resource-limited setting.

Neuro Lytes as a novel, virtual,case-based didacticstargeted at medicalstudents undergoing Neurology clerkship

Objective: To demonstrate that interactive virtual case-based discussions contribute to the education and satisfaction of medical students as an adjunct to standard educational practices. Background: Due to the COVID-19 pandemic, medical students have had their time engaging with patients dramatically decreased. In an attempt to compensate for this deficit in education, many novel teaching methods have been utilized such as the use of interactive virtual case discussions. Design/Methods: We designed four interactive case discussions (NeuroLytes), each focusing on a particular neurologic disorder. These discussions were held weekly, led by neurology residents, and targeted at medical students during their neurology clerkship. Satisfaction surveys were distributed to medical students who participated in NeuroLytes in order to assess their subjective perception of these sessions as well as their overall perspective on how education was impacted by COVID-19. Results: Seventy-six medical students participated in NeuroLytes and responded to the perception survey. Students identified that their learning experience after the pandemic was most affected by decreased interaction with patients (85.5%), other students (73.6%), residents (46.1%), attendings (53.9%), as well as decreased motivation to study (52.6%). Students also felt their ability to learn the neurological exam, take a history, and reason clinically would be most affected (51.5%, 69.7%, and 42.4% respectively). Satisfaction with NeuroLytes has been reported as high-86% strongly agreed or agreed that NeuroLytes should continue. Additionally, there was a significant increase in student rating of teaching sessions prior (median of 4/5) and after (median of 4.3/5) NeuroLytes (p=0.01). Similarly, there was a significant increase in student rating of overall educational experience on the clerkship as a median of 3.5 before and 3.9 after (p=0.02). Conclusions: Interactive virtual case-based discussions (NeuroLytes) appear to be a successful educational method and may be implemented in neurology clerkships as an add-on to standard teaching, especially during the COVID-19 pandemic.

Risk and Assessment of COVID-19 in a Retina Ophthalmologic Setting

Purpose : To evaluate the risks and impact of COVID-19, SARS-CoV-2, on a private ophthalmology practice in Ohio and analyze the fluctuation in patient visits and surgeries before and during the COVID-19 pandemic. Methods : A retrospective analysis was performed using outpatient clinic logs for patients seen during the first 10 weeks of 2020 and compared to outpatient clinic logs for 10 weeks during the COVID-19 pandemic. During the twenty-week period, the number of appointments, intravitreal injections, and surgeries, most commonly retinal detachments, epiretinal membrane (ERM), and vitreous hemorrhages, were compared. Additionally, consideration was given to potential measures to reduce the spread and maintain prepandemic clinical care levels. The number of appointments, injections administered, and surgeries completed or postponed were analyzed before and during the COVID-19 pandemic. The practice implemented additional precautions for patients and staff. These included, but were not limited to, temperature checks, hand sanitizer availability, required use of face masks, and asking patients to come alone to appointments;with the exception of patients that were wheelchair bound, suffered from dementia, were under the age of 18, or required a translator. Results : During the first 10 weeks of 2020, the practice saw an average of 2,205 visits a week. In week one of the pandemic, the average was 1,147 patients per week, a 54% drop. An overall 40% drop was seen in surgical cases;vitreous hemorrhage surgeries decreased by 35%, retinal detachment surgeries decreased 25%, and ERM peels reduced by 60%. The drop in ERM's were mostly due to rescheduling. Intravitreal injections during the first 10 weeks averaged 1,025 (SD±112) per week. During the start of the 10 COVID-19 weeks, intravitreal injections averaged 852 (SD±122) per week and by the last weeks injections averaged 972 (SD±142) per week. Conclusions : In the early stages, the initial number of outpatient visits declined by 54%, the average number of intravitreal injections did not change in a similar pattern. This represents the importance of patients' triage and prioritizing urgent cases.

COVID-19 outbreak - New York City, February 29-June 1, 2020

This article used supplementary information sources and relied on direct data importation and matching of patient identifiers for data on hospitalisation status, the occurrence of death, race/ethnicity, and presence of underlying medical conditions. The highest rates of cases, hospitalisations, and deaths were concentrated in communities of color, high poverty areas, and among persons aged 75 years or with underlying conditions. The crude fatality rate was 9.2% overall and 32.1% among hospitalised patients. Using these data to prevent additional infections among NYC residents during subsequent waves of the pandemic, particularly among those at highest risk for hospitalisation and death, is critical. Mitigating COVID-19 transmission among vulnerable groups at high risk for hospitalisation and death is an urgent priority. Similar to NYC, other jurisdictions might find the use of supplementary information sources valuable in their efforts to prevent COVID-19 infections. This report describes cases of laboratory-confirmed COVID-19 among NYC residents diagnosed during 29 February 29 to 1 June, 2020, that were reported to DOHMH. DOHMH began COVID-19 surveillance in January 2020 when testing capacity for SARS-CoV-2 (the virus that causes COVID-19) using real time reverse transcription polymerase chain reaction (RT-PCR) was limited by strict testing criteria because of limited test availability only through CDC. The NYC and New York State public health laboratories began testing hospitalised patients at the end of February and early March. DOHMH encouraged patients with mild symptoms to remain at home rather than seek health care because of shortages of personal protective equipment and laboratory tests at hospitals and clinics. Commercial laboratories began testing for SARS-CoV-2 in mid to late March. During 29 February 29 to 15 March, patients with laboratory confirmed COVID-19 were interviewed by DOHMH, and close contacts were identified for monitoring. The rapid rise in laboratory-confirmed cases (cases) quickly made interviewing all patients, as well as contact tracing, unsustainable. Subsequent case investigations first included medical chart review for patients who were hospitalised or who had died, but then progressed to chart review only for patients who had died, and then finally only for deaths in patients aged <65 years. Mitigating COVID-19 transmission among vulnerable groups at high risk for hospitalisation and death is an urgent priority.