Resurgence of Shoshin beriberi during the COVID-19 pandemic.

This report describes two patients who presented with severe type B lactic acidosis and shock, initially thought to be due to bowel ischaemia/myocardial infarction and pulmonary sepsis, respectively. This led to a delay in the diagnosis of thiamine deficiency. In both cases there was a dramatic response to intravenous thiamine, confirming the diagnosis of Shoshin beriberi. Both patients admitted to drinking home-brewed alcohol during the time of COVID-19 restrictions on alcohol consumption. These cases highlight the need for early diagnosis and immediate empirical treatment with intravenous thiamine in patients presenting with unexplained severe metabolic acidosis and circulatory shock.

Current Practice in Occupational Therapy for COVID-19 and Post-COVID-19 Conditions.

The onset of the pandemic highlighted the need for a review of rehabilitation practices to ensure coordinated, effective, and efficient services for people affected by COVID-19. This paper reports on a global survey highlighting the delivery of occupational therapy services to people with COVID-19/post-COVID-19 condition (PCC) and makes recommendations to facilitate quality service delivery for this population. An online cross-sectional descriptive survey was developed and distributed to the global occupational therapy community via member organisations and communication channels of the World Federation of Occupational Therapists to collect information for this study. The survey obtained qualitative and quantitative data from respondents who were occupational therapists or occupational therapy assistants regarding (i) demographic characteristics, (ii) work experience with persons with COVID-19 and PCC, (iii) modes of working, (iv) education and training, (iv) occupational therapy intervention provided to persons with COVID-19 and PCC, and (v) the perceived quality of the occupational therapy services provided. Findings indicate that respondents provided a range of occupational therapy interventions for people affected by COVID-19/PCC aligned with evidence-based practice guidelines. While respondents identified a strong role for occupational therapy and generally rated their services as effective, issues related to the accessibility of their services impacted quality and user satisfaction. The study highlighted the need to advocate for access to occupational therapy to facilitate engagement in desired and needed occupations for COVID-19 survivors. Other recommendations emerging from the findings include the need to develop, disseminate, and use research evidence for guiding services for people with COVID-19/PCC, create quality service standards, and ensure the availability of necessary resources and supports such as referral pathways and screening criteria, availability of staff, training, personal protective equipment, and assistive devices and technology.

UTILISATION OF THE CYTOSPONGE DEVICE AS A TOOL FOR RISK STRATIFICATION IN PATIENTS WITH BARRETT'S OESOPHAGUS WHO ARE OVERDUE ENDOSCOPIC SURVEILLANCE DUE TO THE COVID-19 PANDEMIC

Introduction: At the onset of the COVID-19 pandemic, all patients undergoing endoscopic surveillance for Barrett's Oesophagus (BE) in the UK were indefinitely postponed. As well as the potential for missed progression to dysplasia, the negative impact on patients' quality of life is immeasurable. The Cytosponge® is a minimally invasive cell sampling device which has been researched in screening for BE. We describe the first worldwide use of the Cytosponge® outside of a clinical trial to support the triage of BE patients unable to undergo endoscopic surveillance due to COVID-19. Aims and Methods: Consecutive patients with non-dysplastic BE (NDBE) or those deemed to be low risk after previous treatment for BErelated dysplasia, DBE (more than 18 months after completion of therapy with no visible BE and no intestinal metaplasia/dysplasia at last endoscopy) with no prior history of stenosis who were overdue endoscopy (OGD) were invited to have the Cytosponge®. The sample was analysed for TFF3 (a marker of intestinal metaplasia), cellular atypia and p53. Fisher's test was used to examine the association between the overall cytosponge result and its individual components with follow-up OGD outcomes. Results: To date, 153 patients (mean age 66 years, 126 male) have undergone the Cytosponge® procedure. The median maximal length of BE was 3cm (1-15cm). Three patients were unable to swallow the device and 19 (12%) needed a repeat procedure as no columnar cells were present suggesting that the sponge had not entered the stomach. 87 patients (80%) with NDBE had a either a low-risk result (TFF3 positive only – 62) or required a repeat Cytosponge® routinely (TFF3/atypia/ p53 negative – 25). The remaining 21 patients (20%) needed an OGD within 3 months, 17 of which have since had an OGD. Of these 17 patients, 4 had a new diagnosis of dysplasia (indefinite - 2, low grade dysplasia – 1, intramucosal cancer - 1) and 2 a new diagnosis of cancer. 18/87 patients in the low-risk NDBE cohort have undergone follow-up OGD (NDBE 17/18, high grade dysplasia 1/18). Of the 23 patients in the post-treatment BE cohort, 1 patient had a high-risk result and subsequent OGD confirmed HGD (Table 1). A high-risk cytosponge result and the presence of both p53 and typia were all associated with a positive OGD result. Over-expression of p53 appeared to be the most sensitive marker (Table 2). In treatment naive patients, a low-risk cytosponge result was closely associated with no dysplasia detected at follow-up OGD with a negative predictive value of 94%. Conclusions: Cytosponge® has proved to be a useful non-endoscopic tool for patients with BE under surveillance where OGD is not possible. Preliminary data are promising to help triage patients and may in turn offer a less invasive approach to monitoring patients compared to endoscopy, particuarly for low risk patients. (Table Presented) (Table Presented)

PEDIATRIC and ADOLESCENT RETENTION TRENDS ACROSS AGE BANDS during COVID-19 PANDEMIC

Background: Progress towards the 90-90-90 HIV goals is slower for children, adolescents and youth ≤19 years (CAY) living with HIV, with only 71% of those knowing their status linked to sustained ART in the BroadReach supported districts. From the start of COVID-19 pandemic and lockdown, facility headcounts declined. We reviewed trends in CAY ART initiation and retention to evaluate effects of COVID-19 and lockdown on the already struggling CAY ART programme. Methods: Retrospective data from October 2019 to June 2021 for CAY was analyzed. October 2019 to March 2020 data was categorised as pre-COVID and April 2020 to June 2021 as COVID-era. Indicators evaluated were ART initiations, remaining in care, lost to follow-up (LTFU) and returned to care. We analyzed trends disaggregated into age bands: <5, 5-9, 10-14 and 15-19 years. Results: The quarterly ART initiation average was 1302 pre-COVID and 826 in COVID-era, (37% drop) with ages 5-9 and 10-14 years most affected (57% and 55% drop respectively). Pre-COVID CAY on ART growth was 10% (2% quarterly average). COVID-19 restrictions resulted in 8% decline in CAY on ART from 27640 to 25550 from January 2020 to June 2021. Ages 5-9 and 10-14 years had the largest attrition of-698 (15%) and-1209 (14%) respectively, with <5 years dropping by 16% (-326). However, ages 15-19 showed a gain of 143 adolescents (1% growth). Majority (66%) of CAY not in care were LTFU after being on ART >3 months, mostly noted from July to December 2020 (78%) with ages 5-9 and 10-14 years most affected (82% and 86% respectively). During more restrictive lockdown levels (April to June 2020), 4.4% CAY on ART were lost in one quarter vs 3.4% lost in the next 12 months (July 2020 to June 2021) of less restrictive levels;an average reduction of 0.85% per quarter. Intense tracing from May 2020 resulted in >94% CAY resuming treatment after more than a month of interruption vs the 17% resumption to interruption ratio seen in the 2 quarters prior. Conclusion: COVID-19 pandemic and lockdown restrictions impacted negatively on an already poorly performing CAY ART program by reducing initiations and reversing gains made in retention. The worst affected age band was 5-14-year-olds which already had the largest performance gaps prior to the COVID-19 pandemic. As we continue to trace CAY back to care, we need to upscale interventions aimed at retention in care i.e., multi-month scripting and dispensing, HIV disclosure, community and differentiated ART delivery especially for the 5-14-year-olds.

Resilience and Sustainability of the Water Sector during the COVID-19 Pandemic

The COVID-19 pandemic brought unprecedented socio-economic changes, ushering in a “new (ab)normal” way of living and human interaction. The water sector was not spared from the effects of the pandemic, a period in which the sector had to adapt rapidly and continue providing innovative water and sanitation solutions. This study unpacks and interrogates approaches, products, and services adopted by the water sector in response to the unprecedented lockdowns, heralding novel terrains, and fundamental paradigm shifts, both at the community and the workplace. The study highlights the wider societal perspective regarding the water and sanitation challenges that grappled society before, during, after, and beyond the pandemic. The premise is to provide plausible transitional pathways towards a new (ab)normal in adopting new models, as evidenced by the dismantling of the normal way of conducting business at the workplace and human interaction in an era inundated with social media, virtual communication, and disruptive technologies, which have transitioned absolutely everything into a virtual way of life. As such, the novel approaches have fast-tracked a transition into the 4th Industrial Revolution (4IR), with significant trade-offs to traditional business models and human interactions. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

Interventions to improve headcount during covid-19 lockdown in South Africa

Background: The world was overcome by the COVID-19 pandemic from late 2019. South Africa entered into a country wide lockdown level 5 from March 26 to April 16, 2020. Public health facilities were greatly affected as they experienced reduced facility headcounts, which resulted in reduced HIV testing services (HTS), reduced patients attending their follow-up visits, and this also impacted the viral load completions. Methods: This was a retrospective review that analyzed the trends and the impact COVID-19 had on the headcount of primary health care (PHC) facilities and the number of patients accessing HTS and the Total Remaining on ART (TROA). In order to view the facility headcount and HTS trends on the same scale, for graphical representation the monthly figures have been indexed to their values in July 2019 (Jul 2019 = 100), prior to the impact of COVID-19 and the typical seasonal decline in activity during the holiday period. Results: Facility headcount dropped during the COVID-19 period (Mar 20, 0.98 to Apr 20, 0.73);and it is clear that the HTS trends (Mar 20, 0.89 to Apr 20, 0.47) mirror the headcount trends (Figure 1). However, the total remaining on ART remained relatively stable during this period;demonstrating successful programme efforts towards retention. These activities included case management of clients, community ART delivery, SMS reminders, extension of CCMDD (Centralised Chronic Medication Dispensing and Distribution) scripts, multi-month scripting and dispensing, improved appointment systems in facilities where we had filing interns, data quality improvement activities during this period and daily tracking with the district teams. Historically we have seen that HTS habitually drops during the holiday periods of December and April but starts picking up and follows the headcount trends. This year Level-5 lockdown brought on a steep drop with a strong recovery once lockdown restrictions eased, albeit not totally to former levels. Conclusion: Therefore, despite drastic drops in headcount from April 2020 to September 2020 as compared to 2019, the stability of TROA shows that implemented retention strategies have had a positive impact on the retention of patients during a pandemic.

Comparison of community testing outcomes over south african covid-19 lockdown levels

Background: BroadReach Healthcare is a PEPFAR district support partner in four districts in two South African Provinces: Mpumalanga (MP) and Kwa-Zulu Natal (KZN). CareWorks and Hospice Palliative Care Association of South Africa (HPCA) are organizations implementing community-based HIV testing services (HTS) under BroadReach Healthcare. During the COVID-19 level-5 lockdown time period, community-based HTS was halted and confined to areas immediately outside of healthcare facilities, and in MP, community-based Lay Counsellors provided HTS in facilities. The aim of this evaluation is to compare HTS rates observed during three 5-week time intervals in 2020: pre-level-5 lockdown (19 February-25 March), during level-5 lockdown (26 March-30 April), and after level-5-lockdown (01 May-06 June). Methods: We conducted an operational evaluation of community and facility data from CareWorks and HPCA: HTS completed, HTS with positive results (HTS-TST-POS), and testing yield. Chi-square tests were used to determine statistical significance. Results: Testing decreased in all districts, averaging a 43.1% drop (4,809/11,166) from pre-level-5 lockdown to level-5 lockdown, then rebounded to 91.4% of baseline (10,208/11,166) afterwards (p<0.05). Over the same timescale, HTS-TST-POS decreased by only 6.3% (419 from 447) before reverting to 97.1% (407/447) of its pre-level-5 lockdown performance (p<0.05). This was inconsistent across provinces: case finding increased in MP by 64.6% (321 from 195), despite decreased testing, and decreased in KZN by 61.1% (98 from 252). Testing yield was highest during level-5 lockdown in both provinces;averaging 8.7% (419/4,809) compared to 4.0% before (447/11,166) and 4.0% after (407/10,208) level-5 lockdown (p<0.05). MP's testing yield increases far exceeded observed increases in KZN between pre-level-5 lockdown and level-5 lockdown time intervals: 9.2% from 3.0% in MP and 7.4% from 5.4% in KZN (p<0.05). Conclusion: The allocation of community-based Lay Counsellors inside and outside of healthcare facilities during the South African COVID-19 level-5 lockdown assisted with finding people who are HIV-positive, and who are presumably at higher risk of developing severe COVID-19 disease.

Descriptive epidemiology of coronavirus disease 2019 in Nigeria, 27 February-6 June 2020.

The objective of this study was to describe the epidemiology of COVID-19 in Nigeria with a view of generating evidence to enhance planning and response strategies. A national surveillance dataset between 27 February and 6 June 2020 was retrospectively analysed, with confirmatory testing for COVID-19 done by real-time polymerase chain reaction (RT-PCR). The primary outcomes were cumulative incidence (CI) and case fatality (CF). A total of 40 926 persons (67% of total 60 839) had complete records of RT-PCR test across 35 states and the Federal Capital Territory, 12 289 (30.0%) of whom were confirmed COVID-19 cases. Of those confirmed cases, 3467 (28.2%) had complete records of clinical outcome (alive or dead), 342 (9.9%) of which died. The overall CI and CF were 5.6 per 100 000 population and 2.8%, respectively. The highest proportion of COVID-19 cases and deaths were recorded in persons aged 31-40 years (25.5%) and 61-70 years (26.6%), respectively; and males accounted for a higher proportion of confirmed cases (65.8%) and deaths (79.0%). Sixty-six per cent of confirmed COVID-19 cases were asymptomatic at diagnosis. In conclusion, this paper has provided an insight into the early epidemiology of COVID-19 in Nigeria, which could be useful for contextualising public health planning.