COVID-associated pernio: Mechanistic insights to an abortive, seronegative SARS-CoV-2 infection

Introduction: SARS-CoV-2 replicates primarily in the airways but generates a systemic immune response mediated by Type I interferons (IFN-I). Pernio is a rare skin manifestation of disorders characterized by excessive IFN-I signalling. Although pernio increased in incidence during the pandemic, the relationship to SARS-CoV-2 remains controversial. Because of the pivotal nature of interferons in COVID-19 outcomes, pernio offers a window to investigate the biology underlying host resiliency to SARS-CoV-2 infection. Method(s): To further assess COVID-associated pernio, we characterized clinical samples from affected patients across 4 waves of the pandemic and investigated mechanistic feasibility in a rodent model. Patients were followed longitudinally with banking of blood and tissue. Golden hamsters were mock-treated or intra-nasally infected with SARS-CoV-2 and harvested at 3-and 30-days post-infection. Result(s): In affected tissue, immunophenotyping utilizing multiplex immunohistochemistry profiled a robust IFN-1 signature characterized by plasmacytoid dendritic cell activation. Viral RNA was detectable in a subset of cases using in situ hybridization for the SARS-CoV-2 S gene transcript. Profiling of the systemic immune response did not reveal a durable type 1 interferon signature. Consistent with previous literature, antibody and T-cell specific responses to SARS-CoV-2 were not detected. Nasopharyngeal SARS-CoV-2 inoculation in hamsters resulted in rapid dissemination of viral RNA and the generation of an IFN-I response that were both detectable in the paws of infected animals. Conclusion(s): Our data support a durable local IFN signature, with direct evidence of viral SARS-CoV-2 RNA in acral skin and suggest that COVID-associated pernio results from an abortive, seronegative SARS-CoV-2 infection.

Pandemic Nationalism: Use of Government Social Media for Political Information and Belief in COVID-19 Conspiracy Theories in China

The COVID-19 pandemic unleashed a torrent of conspiracy theories across different social media platforms. Parallel to this conspiracy wave was a heightened sense of nationalism, which manifested through both in-group solidarity and perceived out-group threats. In this study, we examine how individuals' use of government social media to gather political information correlated with nation-related conspiracy beliefs during the pandemic. Data were collected from 745 subjects in China and analyzed through path analyses, which allowed us to examine the direct association with political information consumption from government social media and the indirect association with nationalism on conspiracy beliefs. The results indicated that the use of government social media to gather political information was associated with greater beliefs in nation-variant COVID-19 conspiracies, both directly and through different mediations of nationalism. Our findings highlight the importance of examining government social media use and how nationalism can have differentiated mediation effects on beliefs in conspiracy theories. © The Author(s) 2023.

Outcomes of Acute Inpatient Rehabilitation for Debility and COVID-19 Infection

Objective: The COVID-19 pandemic has presented a unique challenge for inpatient rehabilitation facilities to deliver safe and effective rehabilitation for patients recovering from COVID-19 and other rehabilitation diagnoses. There is a paucity of research assessing the effectiveness of inpatient rehabilitation on patients with COVID-19. The objective of this study was to compare post-acute rehabilitation outcomes of patients with debility and COVID-19 to outcomes of patients with debility only. Design(s): Retrospective Cohort Study Setting: Single inpatient rehabilitation facility Participants: Patients admitted for debility from April 1, 2020 to July 30, 2020. COVID-19 status was determined by a positive PCR test during the acute care or inpatient rehabilitation hospitalization period. Intervention(s): None Main Outcome Measure(s): Differences in admission and discharge functional performance scores (GG scores) and length of stay were compared. Rehabilitation efficiency, the average increase per day in functional performance score, was calculated. Result(s): 560 patients admitted for debility were reviewed. There were 83 (14.8%) patients admitted with COVID-19, who were on average 61 years old, male (55.4%), and African American (72.3%). Patients admitted with COVID-19 had a mean GG score gain of 26 points and median length of stay of 15 days. Patients admitted without COVID-19 had a mean GG score gain of 18 and median length of stay of 15 days. Compared to patients without COVID-19, patients with COVID-19 had a comparable length of stay but a significantly increased change in GG score at discharge (p < 0.001) and higher rehabilitation efficiency (p=0.001). Conclusion(s): There was a significantly greater improvement in GG scores and rehabilitation efficiency for patients with debility and COVID-19 compared to patients with debility without COVID-19. Our findings suggest that patients with debility and COVID- 19 benefit from acute inpatient rehabilitation and may be even more amenable to intensive therapeutic rehabilitation compared to patients with debility without COVID-19.

Fully autonomous domino capillaric circuit for instrument-free, quantitative detection of SARS-CoV-2 in saliva

Rapid, sensitive, quantitative and patient-friendly diagnostic tools have yet to be developed for COVID-19 continued monitoring at the point-of-care. Here, we present an instrument-free capillary microfluidic chip coupled to a lateral flow module that is compatible with a smartphone application for quantitative detection of SARS-CoV-2 from saliva samples. The microfluidic chip is fully autonomous, and performs aliquoting, sample metering, and sequential delivery of reagents. The limit of detection is 0.07 ng/mL for recombinant nucleocapsid protein in saliva. This rapid antigen test provides results in less than 1 hour, without sacrificing analytical sensitivity. © 2021 MicroTAS 2021 - 25th International Conference on Miniaturized Systems for Chemistry and Life Sciences. All rights reserved.

CHANGES IN PATTERNS OF REFERRAL FOR INPATIENT REHABILITATION CANCER PATIENTS DUE TO COVID-19

Introduction There is a paucity of literature reflecting how the initial phases of COVID-19 and the changes to hospital processes affected referrals to cancer physiatry and inpatient cancer rehabilitation admissions. Methods A retrospective cross-sectional descriptive study was performed to evaluate inpatient hospital admissions, referrals to physiatry, and the number of patients admitted to inpatient rehabilitation and subsequent discharge disposition. There were no active interventions. Results In 2019 vs 2020, there were 10,274 vs 7,051 inpatient hospital admissions, 387 vs 337 referrals to physiatry, and 108 vs 102 rehabilitation admissions. There was an increase in referrals in 2020 (3.8% vs 4.8%, p=0.001) with no significant change to rehabilitation admissions (27.9% vs 30.3%: p= 0.485). There was an increase in hematological services referrals and a decrease in neurosurgical services in 2020 (20.4% vs 31.4%;48.2% vs 26.5%;p = 0.01). There was an increased frequency of transfer back to primary acute care service in 2020 (7.4% vs 21.8%;p = 0.01). Conclusions During the COVID-19 pandemic, there was an increase in referrals to physiatry despite a decrease in hospital admissions, suggesting the importance of rehabilitation. There was an increase in the percentage of referrals by hematological services accompanied by a decrease in neurological services, likely due to decreased elective procedures. Finally, return to primary increased, which may be reflective of increased acuity of patients.

A Case of Acute Shortness of Breath and Acute Refractory Hypoxemia

We present a case with significant diagnostic and therapeutic challenges;a 57 year old female with history of bi-ventricular failure status post Left Ventricular Assisted Device (LVAD) in 2020 and Rheumatoid Arthritis (RA) who presented with Shortness of breath and refractory hypoxemia, Computerized tomography(CT) showed dense ground glass opacity and superimposed traction bronchiectasis which was not present in a prior CT. The management included high FiO2 therapy High flow nasal cannula (HFNC), initial heart failure measures with diuresis and antibiotics treatment were attempted, the clinical and radiological diagnosis of acute exacerbation (AE) of connective tissue disease associated interstitial lung disease (CTD-ILD) with progressive fibrosing phenotype was made, The decision of therapeutic pulse corticosteroids with Rituximab was based on the degree of severity of acute exacerbation, following treatment, the course of the disease was reversed with complete oxygen weaning with impressive clinical and radiological response. The case is considered puzzling from multiple aspects, first the complex comorbidities, LVAD placement made heart failure the main differential diagnosis (DD), the absence of interstitial infiltrate in the old CT made the initial diagnosis of AE of ILD less likely, other DD as Covid-19 pneumonia, pulmonary embolism, bacterial pneumonia were worked up. Another major dilemma was the optimal management of the life threatening hypoxemia in the setting of new CT findings. Connective tissue disease associated ILD is a diffuse parenchymal lung disease characterized by both inflammation and fibrosis. The progressive fibrosing phenotype carries poor prognosis, even worse is the prognosis of AE that characterized by marked deterioration and alveolar abnormalities with high mortality. There is extremely limited data of optimal treatment of AE and lack of blinded randomized controlled trials. Management is mainly supportive care, oxygen therapy is considered the cornerstone, otherwise no formal therapeutic strategy. The potential reported therapies included corticosteroids, immunosuppressant, anticoagulants, antibodies targeted therapy with no conclusive evidence. Although corticosteroids were described based on anecdotal evidence but recently published case series described novel combination of treating AE with combination of pulse steroid, Rituximab and plasma exchange resulting in promising outcome. In our case we followed the regimen of pulse steroids in combination with Rituximab which lead to satisfactory results in short interval. The rational of steroids use for its potent anti-inflammatory properties and since AE is linked to autoimmune antibody-driven inflammation, treatment with Rituximab causes Bcell depletion, the impressive clinical outcome of our patient signals a promising therapeutic potentials in treating fatal AE. (Figure Presented).

Tele-Neuro-Ophthalmology: An Update One YearInto The COVID-19 Pandemic

Objective: This study evaluates the usage of tele-neuro-ophthalmology one year into the pandemic. Background: Tele-neuro-ophthalmology emerged as a resource early in the COVID-19 pandemic. Since then, telehealth utilization has evolved. Design/Methods: Telehealth utilization pre-COVID-19, early pandemic (March, 2020), and 1 year later (March, 2021) was surveyed among practicing neuro-ophthalmologists in and outside the United States using an online platform. Demographics, utilization, perceived benefits, barriers, and data utility opinions were collected over a two-week period in May 2021, prior to the emergence of the Delta and Omicron variants. Results: 135 practicing neuro-ophthalmologists (81.5% United States, 47.4% females) participated in the survey. One year into the pandemic, the proportion of respondents utilizing video telemedicine (50%) decreased from early-pandemic rates (65%) (p<0.0005, McNemar), but was sustained above pre-pandemic percentages (6%, p<0.0005, McNemar). 82% of current video users plan to continue video visits. Proportion of respondents using remote testing (42.2% vs 46.2%, p=0.45), virtual second opinions (14.5% vs 11.9%, p=0.38), eConsults (13.5% vs 16.2%, p=0.25), online portal communications, and remote interpretation of patient-submitted testing remained similar between March 2020 and 2021. The majority selected increased access to care, better continuity of care, and enhanced patient appointment efficiency as benefits, while reimbursement, liability, disruption of in-person clinic flow, limitations of video exams, and patient technology use were barriers. Many neuro-ophthalmic exam elements were deemed more suitable collected in a separate in-person visit rather than during a live video session, although respondents felt some exam components could be evaluated adequately via a virtual platform. Conclusions: One year into the COVID-19 pandemic yet prior to the emergence of the Delta and Omicron variants, neuro-ophthalmologists have maintained telemedicine utilization at rates higher than pre-pandemic levels. Tele-neuro-ophthalmology remains a valuable tool in augmenting patient care.

RFID Based Identity Authentication System in COVID-19 Era

To control the COVID-19 outbreak, the Malaysia government has to tighten the rules and add on some standard operating procedures (SOP) for all premises. There will be an entrance registration for people that enter any shops, malls, schools, or offices. This entrance registration will take their identities, such as name, contact number, and current temperature. Thus, the government can easily track down and notify the person if the virus transmission occurs. This paper is mainly about improving the daily registration system to monitor the movement of Malaysians during the Covid-19 outbreak. With that needs in mind, a Radio-frequency Identification (RFID) based identity authentication system is developed and presented in this paper. Users do not need to fill in the manual form or scan the Quick Response (QR) code repeatedly, and instead, they are required to just key in the personal data once at the entrance. The RFID tag is applicable to be used as a self-registration at all premises. It can also keep track of the user identity, and the data will be recorded automatically through a monitoring application every time the users enter or leave the premises. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Design of an IoT Safety Distance Monitoring Device for COVID-19

The COVID-19 pandemic arises in the year 2020 that leads to almost more than 100,000,000 confirmed cases happened in worldwide and yet, the cases are continuing to rise now. One of the common methods that used to prevent the COVID-19 is through keeping the social distancing between each other. However, people do not aware of the importance of applying social distancing rules. A low-cost solution is urgently needed for contact tracing and remind the users to keep the social distancing with the others. An IoT-based safety distance monitoring (ISDM) device is proposed to monitor safety distance, remind people to always stay alert and keep the data of the users that violated the social distancing rules for contact tracing. ISDM is a lightweight wearable wristwatch. Bluetooth Low Energy technique is used to send and receive information such as body temperature and contact tracing information. Fever is the most common symptom of COVID-19 patients. ISDM can operate either online or offline. The health and contact tracing information are stored in a local Micro-SD card storage when offline and data will be uploaded to the cloud server for further analysis once ISDM is connected. The detailed contact tracing information can be used to trace the potential COVID-19 patients with close contact with the COVID-19 patient. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Mentoring in palliative medicine in the time of COVID-19

Background and aim: The COVID-19 pandemic has had significant ramifications upon clinical medical education. Restrictions on in-person face-to-face meetings and the limited mentoring support from redeployed physicians have compromised mentoring relationships and jeopardised mentoring programs in palliative medicine. The evidenced success of combined novice, peer-, near-peer and electronic-mentoring (CNEP) and interprofessional mentoring (IPM), together with palliative medicine's emphasis on interprofessional teamwork for holistic patient care, suggest that the concurrent application of CNEP and IPM (CNEPIPM) may be effective in addressing the continued geographical and manpower constraints in palliative medicine training amidst the COVID- 19 pandemic. This study thus aims to assess the viability and suitability of a CNEP-IPM mentoring approach in palliative medicine. Methods: With little known about this form of mentoring, a systematic scoping review (SSR) was carried out studying published accounts of CNEP and IPM. The Systematic Evidence Based Approach (SEBA) was adopted to enhance the trustworthiness, transparency and reproducibility of SSRs. Results: A total of 15,121 abstracts were reviewed, 557 full text articles were evaluated, and 92 articles were included. Concurrent content and thematic analysis revealed 4 themes/categories: characteristics of CNEP and IPM, stages of CNEP and IPM, the roles of host organizations and assessment methods and criteria. Conclusions: This SSR evidences the viability of a CNEP-IPM approach and forwards an evidence-based framework for the design, implementation and evaluation of a CNEP-IPM mentoring program in palliative medicine. Further prospective studies and research into the program design, mentoring process, complex CNEP-IPM mentoring relationships, and the validation of robust evaluation tools are still required.

Phase II Multi-Institutional Study of Low-Dose (2 Gy x 2) Palliative Radiotherapy for Symptomatic Bone Metastases From Multiple Myeloma

Purpose/Objective(s): Painful osteolytic bone lesions are common in patients with multiple myeloma (MM). Radiotherapy (RT) is effective in providing pain relief from MM bone lesions in over 80% of patients. There is no consensus as to the most effective dose or fractionation for palliation. Shorter courses of RT are not only more convenient for patients and their families, but they also have less impact on timing of systemic therapies. There is precedent for using 2 Gy x 2 for palliation of lymphomas, which have similar radiosensitivity to myeloma. The primary objective is to determine whether treatment with 2 Gy x 2 to painful myeloma bone lesions achieves patient-reported pain reduction comparable to historical controls at 4 weeks. Secondary objectives will assess QOL endpoints, use of analgesia and time to pain relief, and duration of pain relief. Materials/Methods: Patients who consent to participation will complete quality of life and pain questionnaires (Brief Pain Index, EORTC QLQ-BM22, and EORTC QLQ-C30) prior to treatment and at 2,4,8 weeks and 6 months following treatment. Pain response, as defined by the international consensus on palliative RT for bone metastases, will be measured based on BPI and daily oral morphine equivalent. Reirradiation at standard dose can be considered at ≥4 weeks following initial treatment for indeterminate pain response or pain progression. Cytogenetics and International Myeloma Working Group risk stratification and response criteria are recorded, when available, but are not required for patient participation. Results: This trial, supported by ILROG, has opened at 7 institutions with one more in process of opening. Prior to COVID, accrual was 1.5 patients per month. Since COVID, enrollment has been at 0.7 patients per month. A total of 18 patients have been accrued. The median age of patients accrued is 65.5 years with 7/18 female patients. Fourteen patients are Caucasian. Twelve patients have an ECOG performance score of 1-2. Thirteen patients had pain response captured at 4 weeks following RT. Of the 5 patients that did not complete questionnaires at 4 weeks post-RT, 2 expired, 1 was lost to follow-up, 1 had a missed evaluation and 1 had pain progression). The most common site of treatment was the shoulder (4/18). Conclusion: This ongoing prospective trial in palliation of multiple myeloma bone lesions is feasible and able to accrue at multiple institutions and will provide valuable information as to the role of low-dose RT in this population.

Efficacy and Toxicity of Alternative Radiation Treatment Schemes for Patients With Hematologic Malignancies: A Collaborative ILROG COVID Era Report

Purpose/Objective(s): The COVID19 pandemic required radiation oncologists (ROs) to consider shorter treatment courses to minimize patient and staff exposure and conserve healthcare resources. Hematologic ROs adopted hypofractionated radiation therapy (hRT) regimens according to guidelines published by the International Lymphoma Radiation Oncology Group (ILROG). We report for the first time the preliminary efficacy and toxicity of these novel hypofractionated regimens in the treatment of hematologic malignancies. Materials/Methods: We conducted a multicenter, multinational retrospective study under the direction of the ILROG. All patients receiving hRT according to ILROG guidelines from 1/1/2020 to 8/31/2020 were included. Patient and treatment details were abstracted from separate institutional databases. Toxicity was graded using CTCAE v5.0. Results: Ninety-three patients from 4 institutions treated with 114 RT courses were included. Patient and treatment details are displayed in Table 1. Median follow up for the cohort was 179 days, and 77 patients (82%) were alive at last follow up. Maximal toxicity experienced by patients included Grade 1 (n = 16), Grade 2 (n = 1) and Grade 3 (n = 1) toxicities. Of 80 sites with response assessment within the RT field, 69% of patients achieved a complete response (n = 55), 20% partial response (n = 16), 9% stable disease (n = 7), and 2% progressive disease (n = 2). No COVID19 infections during or after RT have been documented in this patient cohort. Conclusion: HRT according to ILROG guidelines resulted in low rates of acute toxicity and reasonable short-term treatment efficacy. Longer follow up and comparison with control groups is needed to draw more definitive conclusions and will be presented at the Annual Meeting.

Classroom aerosol dispersion: desk spacing and divider impacts.

A study of aerosol dispersion was conducted in a university classroom using a CO2 tracer gas emitted from three source locations in a steady release, one source location per test. The tracer gas emitted from the single source location represented the potentially infectious aerosol droplets emitted from a single student and was thus a way to examine the influence of one sick student on the rest of the class. Two parameters were adjusted during the testing-the spacing of the desks, which included a spread and compressed configuration, and the inclusion of three-sided clear dividers attached to the student desk surfaces. Tracer dispersion was measured through the use of monitors in 13 locations within the classroom, with eight monitors representing seated student locations, four monitors representing a standing instructor along the classroom front, and one monitor at the return vent in the ceiling. As expected, spacing strongly influenced concentration levels at desks adjacent to the source location. The use of dividers reduced overall student and instructor location tracer concentrations when compared to desks without dividers in most cases. Finally, the influence of air change differences on the results was noted with consistent trends. The experimental construct provides a systematic means for classroom testing that may be broadly applicable to various configurations of classrooms beyond the one tested.

Delayed Surgery for localised prostate cancer: A systematic review for the COVID-19 Pandemic

Introduction: The risks of delaying cancer surgery and the best management for these patients during COVID-19 is unknown. This systematic review aims to compare outcomes of patients with localised prostate cancer (PCa) who experienced any delay of radical prostatectomy (RP) (including surgical waiting times and use of neoadjuvant hormone therapy [NHT]), compared to those who underwent immediate RP. Methods: MEDLINE and Cochrane CENTRAL were searched for studies pertaining to the review question. Outcomes included (Biochemical) Recurrence-free survival, cancer-specific survival, overall survival and positive surgical margin (PSM). Results: 4,120 studies were retrieved. 36 observational studies investigated the effects of delayed RP. A variety of PCa risks and delay periods contributed to considerable heterogeneity in the include studies. When stratifying by PCa risk groups, low risk PCa (Grade Group [GG] 1) can be delayed safely from at least 26 weeks to 2.6 years, without significant effects on all outcomes. Similarly, RP can be safely delayed for 6 to 9 months in intermediate risk patients (GG 2/3). In high-risk patients (GG 4/5), the delay of RP for 2 or more months tends to associate with worsen recurrences, hence NHT should be considered. Ten RCTs show 3-months of NHT is non-inferior for oncological outcomes and superior for PSM compared to immediate RP. The risk of biases of the included studies ranged from low to serious risk. Conclusion: RP is safe to be delayed in low-risk and intermediate-risk PCa patients. High-risk patients should be offered NHT;there is no sufficient evidence extending NHT over 3-months.

Adapting atrial fibrillation ablation to covid times: The feasibility of very high power short duration ablation under mild conscious sedation

Introduction Radiofrequency (RF) ablation for atrial fibrillation (AF) has traditionally been performed under general anaesthesia (GA) to improve procedure tolerance and efficacy, but this has been compromised during the COVID-19 pandemic due to a reduction in GA availability. A very high-power short duration (vHPSD) energy delivery protocol may reduce RF delivery times and hence overall procedure duration, potentially obviating the need for GA when using such an approach. However, the use of vHPSD under conscious sedation has not previously been reported. We sought to evaluate first-time AF ablation using a vHPSD approach during the COVID-19 pandemic by comparing the procedural metrics and same day discharge (SDD) rates of vHPSD against cryoballoon ablation. Methods Procedural data was collected from consecutive patients undergoing first-time AF ablation at two UK centres from September 2020 to February 2021 using either the QDot Micro catheter (Biosense Webster) or the Arctic Front Advance Pro cryoballoon (Medtronic). In the QDot group, vHPSD ablation (90W, 4 second lesions) was mandated for pulmonary vein isolation (PVI), while Ablation-Index guided 50W ablation was allowed for additional lesions. Procedures were performed under mild conscious sedation with opiates and benzodiazepines, with a default strategy of SDD in the absence of clinical concerns or adverse events. Results 78 patients were evaluated, with 39 patients undergoing vHPSD and 39 receiving cryoablation. The procedural metrics of both groups are shown in the table 1. 34 out of 39 (87%) vHPSD procedures were under conscious sedation, and the 5 GA cases were all from the initial 2 months of experience with the Qdot catheter. The duration of RF energy delivery to achieve PVI using vHPSD was significantly shorter than the equivalent duration of cryothermy. Overall fluoroscopy times were shorter using vHPSD, while procedure duration was longer. There was failure to achieve isolation of all pulmonary veins in 3 (7.7%) cryoablation patients versus none when using vHPSD ablation. In the vHPSD group. 3 patients received adjunctive ablation beyond PVI: 1 had roof and floor lines;1 cavotricuspid isthmus line, and 1 received a mitral isthmus line. No adjunctive ablation was performed in the cryoablation group. SDD rates were similar in in both groups. Conclusion A vHPSD approach can be used with conscious sedation to achieve same-day discharge rates for AF ablation that are comparable to cryoablation. There are advantages in fluoroscopy time and the required duration of ablation delivery, as well as the versatility to handle variations in pulmonary venous anatomy and additional ablation beyond PVI. Conflict of Interest GAN - Fellowship support from Biosense Webster and Abbott, consultancy fees from Biosense Webster and Catheter Precision. DG - institutional research grants and speaker fees from Biosense Webster, Medtronic and Boston Scientific. Others - Nil.

Dynamic knowledge management in response to the pandemic outbreak: an interinstitutional risk-based approach to sustainability

The coronavirus pandemic (COVID-19) represents an unprecedented challenge for the survival of various organisations around the world. The resilience of an organisation depends predominantly on its ability to respond in a timely manner by leveraging optimal decisions, as supported by dynamic knowledge management in assessing rapidly evolving external uncertainties while evaluating real options. Such a capability can be enhanced by a risk-based approach through collaboration among organisations under public health policy directives to implement concerted control measures in a responsive manner. An integrative framework is developed to illustrate an underlying system that embraces dynamic knowledge management to mitigate limitations in the conventional approach based on a single organisation’s perspective. The case of Hong Kong, a highly populated city in Asia, is illustrated to explore the interinstitutional dynamics of knowledge transfer to external stakeholders in protecting public health under an exposed system. Implications for postpandemic management system development for institutional sustainability are articulated. © Operational Research Society 2021.

Evaluation of an Automated High-Throughput Liquid-Based RNA Extraction Platform on Pooled Nasopharyngeal or Saliva Specimens for SARS-CoV-2 RT-PCR

SARS-CoV-2 RT-PCR with pooled specimens has been implemented during the COVID-19 pandemic as a cost- and manpower-saving strategy for large-scale testing. However, there is a paucity of data on the efficiency of different nucleic acid extraction platforms on pooled specimens. This study compared a novel automated high-throughput liquid-based RNA extraction (LRE) platform (PHASIFY TM) with a widely used magnetic bead-based total nucleic acid extraction (MBTE) platform (NucliSENS^R easyMAG^R). A total of 60 pools of nasopharyngeal swab and 60 pools of posterior oropharyngeal saliva specimens, each consisting of 1 SARS-CoV-2 positive and 9 SARS-CoV-2 negative specimens, were included for the comparison. Real-time RT-PCR targeting the SARS-CoV-2 RdRp/Hel gene was performed, and GAPDH RT-PCR was used to detect RT-PCR inhibitors. No significant differences were observed in the Ct values and overall RT-PCR positive rates between LRE and MBTE platforms (92.5% (111/120] vs. 90% (108/120]), but there was a slightly higher positive rate for LRE (88.3% (53/60]) than MBTE (81.7% (49/60]) among pooled saliva. The automated LRE method is comparable to a standard MBTE method for the detection of SAR-CoV-2 in pooled specimens, providing a suitable alternative automated extraction platform. Furthermore, LRE may be better suited for pooled saliva specimens due to more efficient removal of RT-PCR inhibitors.

Effect of SARS and COVID-19 outbreaks on urology practice and training.

INTRODUCTION: The objective was to investigate the changes in urology practice during coronavirus disease 2019 (COVID-19) pandemic with a perspective from our experience with severe acute respiratory syndrome (SARS) in 2003. METHODS: Institutional data from all urology centres in the Hong Kong public sector during the COVID-19 pandemic (1 Feb 2020-31 Mar 2020) and a non-COVID-19 control period (1 Feb 2019-31 Mar 2019) were acquired. An online anonymous questionnaire was used to gauge the impact of COVID-19 on resident training. The clinical output of tertiary centres was compared with data from the SARS period. RESULTS: The numbers of operating sessions, clinic attendance, cystoscopy sessions, prostate biopsy, and shockwave lithotripsy sessions were reduced by 40.5%, 28.5%, 49.6%, 44.8%, and 38.5%, respectively, across all the centres reviewed. The mean numbers of operating sessions before and during the COVID-19 pandemic were 85.1±30.3 and 50.6±25.7, respectively (P=0.005). All centres gave priority to cancer-related surgeries. Benign prostatic hyperplasia-related surgery (39.1%) and ureteric stone surgery (25.5%) were the most commonly delayed surgeries. The degree of reduction in urology services was less than that during SARS (47.2%, 55.3%, and 70.5% for operating sessions, cystoscopy, and biopsy, respectively). The mean numbers of operations performed by residents before and during the COVID-19 pandemic were 75.4±48.0 and 34.9±17.2, respectively (P=0.002). CONCLUSION: A comprehensive review of urology practice during the COVID-19 pandemic revealed changes in every aspect of practice.