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Objectives: The COVID pandemic has imposed significant direct medical cost and resource use burden on healthcare systems. This study described the patient demographic and clinical characteristics, healthcare resource utilization and costs associated with acute COVID in adults in England. Method(s): This population-based retrospective study used linked primary care (Clinical Practice Research Datalink, CPRD, Aurum) and secondary care (Hospital Episode Statistics) data to identify: 1) hospitalized (admitted within 12 weeks of a positive COVID-19 PCR test between August 2020 and March 2021) and 2) non-hospitalized patients (positive test between August 2020 and January 2022 and managed in the community). Hospitalization and primary care costs, 12 weeks after COVID diagnosis, were calculated using 2021 UK healthcare reference costs. Result(s): We identified 1,706,368 adult COVID cases. For hospitalized (n=13,105) and non-hospitalized (n=1,693,263) cohorts, 84% and 41% considered high risk for severe COVID using PANORAMIC criteria and 41% and 13% using the UKHSA's Green Book for prioritized immunization groups, respectively. Among hospitalized cases, median (IQR) length of stay was 5 (2-7), 6 (4-10), 8 (5-14) days for 18-49 years, 50-64 years and >= 65 years, respectively;6% required mechanical ventilation support, and median (IQR) healthcare costs (critical care cost excluded) per-finished consultant episode due to COVID increased with age (18-49 years: 4364 (1362-4471), 50-64 years: 4379 (4364-5800), 65-74 years: 4395 (4364-5800), 75-84 years: 4473 (4364-5800) and 85+ years: 5800 (4370-5807). Among non-hospitalized cases, older adults were more likely to seek GP consultations (13% of persons age 85+, 9% age 75-84, 7% age 65-74, 5% age 50-64, 3% age 18-49). Of those with at least 1 GP visit, the median primary care consultation total cost in the non-hospitalized cohort was 16 (IQR 16-31). Conclusion(s): Our results quantify the substantial economic burden required to manage adult patients in the acute phase of COVID in England.Copyright © 2023
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Objectives: To estimate the public health impact of COVID-19 booster vaccination in the UK during Omicron predominance, and to explore the impact in counterfactual scenarios with different booster eligibility or uptake. Method(s): A dynamic transmission model was developed to compare public health outcomes for actual and hypothetical UK Spring and Autumn 2022 booster programs. Outcomes were projected over an extended time horizon from April 2022-April 2023, assuming continued Omicron predominance as in Jan-Mar 2022. Health outcomes included averted cases, hospitalizations, long COVID cases, and deaths. NHS resource use outcomes were averted general ward and intensive care unit bed days and general practitioner visits. Patient productivity loss outcomes considered productive days lost for those in and outside the paid work force. Analyses used publicly available data. Result(s): Model output suggested that actual Spring and Autumn 2022 programs, which offered boosters to older adults and vulnerable populations, would avert approximately 716,000 hospitalizations, 1.9M long COVID cases and 125,000 deaths compared to not offering boosters in Spring and Autumn 2022. In a scenario that broadened eligibility to individuals aged >=5 years, an estimated 1.6M hospitalizations, 8.3M long COVID cases, and 222,000 deaths were averted. A scenario assuming broadened eligibility and increased uptake produced the greatest benefit among scenarios analyzed: 1.6M hospitalizations, 9.2M long COVID cases, and 228,000 deaths averted;and 953M productive days saved. Scenarios offering boosters only to high-risk individuals (aged >=5 years) were also estimated to improve benefit relative to actual programs. High-risk-only programs assuming increased uptake provided about half to two-thirds of the benefit estimated for programs assuming broadened eligibility and increased uptake. Conclusion(s): UK booster vaccination programs were estimated to provide substantial benefit to public health during Omicron predominance. Public health benefits could be maximized by broadening booster eligibility to younger age groups and increasing uptake.Copyright © 2023
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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.
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Objectives: Clinical Practice Research Datalink (CPRD) Aurum contains primary care electronic health records, including vaccinations and nearly complete capture of SARS-CoV-2 PCR test results between August 2020-March 2022. Our objective was to build code lists to define a cohort of persons diagnosed with COVID in England using routinely collected health data. Method(s): Persons aged 1 year or older were indexed on first COVID diagnosis from August 1, 2020 - January 31, 2022. We developed SNOMED code lists to define high risk of severe disease: 1) National Health Service's (NHS) list of highest risk conditions;2) PANORAMIC trial inclusion criteria;3) UK Health Security Agency (UKHSA) clinical risk groups. COVID vaccinations were defined as of December 1, 2021 using medical and product codes. Code lists were developed using wildcard search terms which were reviewed by multiple independent reviewers, and inclusion/exclusion was determined by consensus. All lists for diagnoses were reviewed by a UK physician. Result(s): We identified 2,257,907 people diagnosed in primary care with COVID;46% were male and mean age was 34 years, comparable to governmental data for the same period reporting 47% of cases in England were male and mean age was 34 years. We identified 12% at high risk of severe disease using the NHS definition, 31% using the PANORAMIC trial criteria, and 10% using the UKHSA clinical risk groups. Among adults, 86.1% had >=1 and 80.2% had >=2 COVID vaccine doses (2% and 0.2% lower than official reports, respectively). Conclusion(s): This cohort represented the age and sex distribution of COVID cases, and the COVID vaccination coverage, in England through January 2022. Definitions were built using reproducible methods that can be leveraged for future work. The high capture of COVID vaccinations supports the use of this cohort to examine clinical and societal benefits of COVID vaccination in England.Copyright © 2023
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Objectives: Clinical Practice Research Datalink (CPRD) Aurum captures primary care electronic healthcare records for ~28% of the population in England. From August 2020-;March 2022, all SARS-CoV-2 polymerase chain reaction (PCR) tests performed were reported back to the patient's general practitioner (GP), making the CPRD a closed system uniquely positioned to answer COVID research questions. Method(s): We defined persons with COVID as those recorded in primary care with a positive PCR test from August 1, 2020-March 31, 2021. We required continuous registration with their GP practice for >=365 days prior to diagnosis to establish comorbid conditions, and eligibility for linkage to Hospital Episode Statistics (HES) Admitted Patient Care data. Hospitalizations for COVID were defined as persons admitted with a primary diagnosis of COVID (ICD-10-CM U07.1) within 12 weeks of the initial primary care diagnosis record. Result(s): Our cohort included 535,453 persons diagnosed in primary care with COVID, with 2% later hospitalized. The hospitalized group was 57% male, 42% current/former smokers, 35% obese46% with a Charlson Comorbidity Index >1 and 98% had never received any COVID vaccine. Hospitalizations increased with age;<0.1% of patients aged 1-17, 1% aged 18-49, 4% aged 50-64, 9% aged 65-74, 13% aged 74-84, and 11% of COVID cases aged >=85 were hospitalized. Persons living in socially disadvantaged areas were overrepresented in the hospitalized cohort (25% in the Index of Multiple Deprivation's most deprived quintile). Conclusion(s): Consistent with other studies, hospitalized COVID patients were disproportionately those with male sex, smoking history, high body mass index, comorbidity and unvaccinated status. Hospitalizations were more common with age, and for individuals living in socially and economically deprived communities. Understanding the demographic and clinical characteristics of this cohort can help contextualize future work describing healthcare resource utilization and costs, as well as the impact of vaccines, associated with COVID in England.Copyright © 2023
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IDWeek is the joint annual meeting of the Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA), the Pediatric Infectious Diseases Society (PIDS) and the Society of Infectious Diseases Pharmacists (SIDP). For the first time since the COVID-19 public health emergency began, IDWeek 2022 returned to in-person attendance. It was held in Washington, D.C., and the meeting comprised 5 days of live sessions and on-demand content that included posters and oral presentations.Copyright © 2023 Clarivate.
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Hematopoietic cell transplant (HCT) recipients are at increased risk of morbidity and mortality from COVID-19. They may have lower SARS-CoV-2-directed antibody levels due to protein loss from the gastrointestinal (GI) tract as a result of preparative regimen-related toxicity and graft-vs.-host disease (GVHD). In fact, previous studies suggested that GI GVHD or diarrhea from other etiologies were associated with a reduction in the half-life of monoclonal antibodies (mAbs). Hence, understanding the pharmacokinetic (PK) profile of mAbs targeting SARS-CoV-2 in this vulnerable population is critical for dose-selection and predicting the duration of protection against COVID-19. This analysis aims to use a population pharmacokinetics (popPK) approach to evaluate the PK of sotrovimab and the effect of covariates in HCT recipients. In a Phase I trial (COVIDMAB), all participants received 500 mg sotrovimab IV prophylactically within one week prior to starting transplant conditioning. Sotrovimab serum concentrations were determined weekly for up to 12 weeks in autologous (n=5) and allogeneic (n=15) HCT recipients (129 observations). Sotrovimb PK and the effect of covariates were analyzed using popPK modeling in NONMEM (version 7.4). GVHD and diarrhea severity data were collected weekly via survey and included as time-dependent covariates during the covariate screening process. The final PK model with covariates was validated using simulation-based validation and goodness of fit plots. PK data were compared to non-transplant patients from 1891 patients with COVID-19 in COMET-ICE, COMET-PEAK, BLAZE-4, and COMET-TAIL and 38 healthy individuals enrolled in GlaxoSmithKline Pharma Study 217653. A two-compartment model best described sotrovimab PK in HCT recipients. In comparison to non-transplant patients, sotrovimab clearance (CL) was 14.0% higher in HCT recipients. Weight was a significant covariate on sotrovimab CL and (Figure Presented) volume of distribution in the central compartment (V2). With every 10 kg increase in body weight, sotrovimab CL and V2 were estimated to increase by 9.5% and 5.5%, respectively. Diarrhea severity was also a significant covariate on sotrovimab CL. HCT recipients with grade 3 diarrhea showed an increase in CL by 1.5-fold compared to those without diarrhea. Based on popPK analyses, sotrovimab CL was higher in HCT recipients compared to non-transplant patients. Higher bodyweight as well as diarrhea resulted in increased sotrovimab CL. There were only 3 patients with GI GVHD, and larger studies are needed to determine whether diarrhea due to GI GVHD or conditioning toxicity was responsible for the observed increase in sotrovimab CL. Further validation of these findings in a larger number of HCT recipients is also warranted to help optimize mAb dosing for COVID-19 prophylaxis and determine whether presence of large-volume diarrhea may require intensified dosing strategiesCopyright © 2023 American Society for Transplantation and Cellular Therapy
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Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are common and associated with respiratory function decline, increased morbidity and mortality. It is unclear how COVID19 has impacted AECOPD phenotype and if it is associated with worse outcomes compared to other infections in COPD patients. Aim(s): To explore changes in AECOPD clinical characteristics and outcomes during the COVID-19 pandemic. Method(s): A prospective cohort study of all adults >=18y admitted to either acute care hospital in Bristol UK, Aug 20- Jul 21. Patients presenting with signs/symptoms or a clinical/radiological diagnosis of acute respiratory disease were included. Result(s): 2557 hospitalisations with AECOPD were recorded (incidence 361 per 100000);13% had SARS-CoV-2 identified, 69% had another pathogen and 18% had no infectious aetiology identified. Patient characteristics and clinical features were similar for patients with and without COVID19. ICU admissions were more common with SARS-CoV-2 than other infections (4% v 1%, P<0.001). SARS-CoV-2 associated AECOPD had greater inpatient (25% v 9%, P<0.001) and 30-day mortality (25% v 12%, P<0.001) than AECOPD associated with other infections. Among all AECOPD patients who had received >=1 dose of any COVID vaccination, ICU admission rates were lower than for unvaccinated persons (4% v 0%, P<0.01). Discussion(s): SARS-CoV-2 infection was associated with worse outcomes among persons hospitalized with AECOPD. SARS-CoV-2 vaccination was effective in reducing disease severity and ICU admission. More data are needed about the effectiveness of COVID19 vaccines for modifying disease severity in COPD patients.
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S38 Figure 1ConclusionsOmicron infection was associated with less severe illness compared to Delta infection across three separate measures of severity. COVID-19 vaccination was independently associated with lower in-hospital disease severity, regardless of variant. Lower severity of Omicron combined with the ability of vaccine to further reduce severity may result in reduced pressure on healthcare services;however, the increased transmissibility of Omicron and potential for higher numbers of infections, particularly in elderly patients, may mitigate these benefits.Please refer to page A208 for declarations of interest related to this .
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IDWeek is the joint annual meeting of the Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA), the Pediatric Infectious Diseases Society (PIDS) and the Society of Infectious Diseases Pharmacists (SIDP). For the first time since the COVID-19 public health emergency began, IDWeek 2022 returned to in-person attendance. It was held in Washington, D.C., and the meeting comprised 5 days of live sessions and on-demand content that included posters and oral presentations.
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Introduction: The SARS-CoV-2 virus has potential to cause acute and long-term cardiac effects. The vaccines were developed to prevent severe illness, but there are concerns about vaccine related side effects. Specific to the heart there have been case reports of mRNA vaccine related cardiomyopathies, particularly myocarditis. We present a case of a patient with presumptive stress induced cardiomyopathy in the setting of recent Covid-19 mRNA vaccination. Case Presentation: A 93-year-old female with a past medical history of hypertension presented with worsening shortness of breath and bilateral lower extremity edema. She received her second dose of the Covid-19 mRNA vaccine five days prior to presentation. She had no history of heart disease, was a nonsmoker, and denied alcohol or drug use. In the ED she was noted to be fluid-overloaded, and her CT chest showed minimal coronary calcification and bilateral pleural effusions. She was admitted for heart failure exacerbation and started on IV furosemide. Her transthoracic echocardiogram showed an ejection fraction of 40-45%. The pattern of left ventricular dysfunction was consistent with stress induced cardiomyopathy with apical akinesis and basal sparing of the left ventricular wall segments. Cardiology was consulted and recommended management with diuretics and beta blocker. She had a diuresis of 5 liters during her hospitalization. At clinic follow-up, dyspnea had improved, and her peripheral edema had resolved. Repeat echocardiogram showed recovery of left ventricular ejection fraction to 61% by Simpsons biplane technique with no regional wall motion abnormalities. Further cardiac assessment to evaluate for obstructive coronary artery disease and myocarditis was discussed and offered to the patient but was declined due to her positive response to conservative management. Discussion(s): The precise etiology of stress induced cardiomyopathy is unknown, but it is thought to be secondary to the sudden release of stress hormones. There are isolated reports of stress induced cardiomyopathy associated with Covid-19 vaccination, but the potential mechanism is unclear. An improved understanding of the potential effects of mRNA vaccines may help guide decisions regarding future booster vaccinations.
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Objectives: The COVID-19 global pandemic has caused children and adolescents to face substantial challenges in their daily lives, but as the pandemic restrictions are lifted, children and adolescents have varying opinions about returning to a prepandemic lifestyle. This study investigates the impact of the transition out of a virtual lifestyle to an in-person lifestyle on the mental health of children and adolescents with psychiatric conditions. Method(s): A retrospective review of medical records was conducted on individuals who were treated in an inpatient or outpatient setting at the UCLA Department of Child and Adolescent Psychiatry following the pandemic. Subjects completed a questionnaire that collected both subjective and objective data on mental health, social and family functioning, academics, daily time spent, and more. The Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), and UCLA Loneliness Scale scores were used to measure depression, anxiety, and loneliness, respectively. Result(s): A total of 93 subjects under the age of 21 years were enrolled in the study (Mage= 14.2;49 females, 24 males;20 transgender/nonbinary). Using the subject's subjective response regarding the transition from a virtual to in-person lifestyle, subjects were categorized by having positive, negative, and ambivalent feedback. Each feedback group was then compared using a single-factor ANOVA, which found that mental health scores for all 3 groups in all 3 measures had significant differences. There was a significant decline in depression scores (PHQ-9) with a decline in positivity toward the transition (p <.05). Subjects in the feedback groups experienced the same trend in symptoms of anxiety (GAD-7) (p <.05) and Loneliness Scale scores (p <.05). Conclusion(s): Online learning and returning to an in-person lifestyle has made significant impacts on the overall mental health of pediatric psychiatric patients. These results show that there are many different experiences within this transition, and that subjective data is a good indicator of mental health scores. Further research can be done to investigate the specific trends or implications of various diagnoses on the transition from a virtual to in-person lifestyle. ADOL, AD, DDD Copyright © 2022
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Introduction: Underserved populations are 40% more likely to have hypertension and three times more likely to die from heart diseases due to uncontrolled blood pressure (BP). Disrupted access to care from the COVID-19 pandemic further puts these populations at higher risks of complications. A C-RPM for hypertension was established in response to this threat. Research Question or Hypothesis: Will C-RPM promote timely BP control among underserved patients during the COVID19 pandemic? Study Design: A retrospective, single-arm observational study conducted in two federally qualified health center sites. Method(s): All adult patients with uncontrolled BP (>=140/90) who received physician or nurse practitioner referral to participate in CRPM were included. Patients who failed to use BP device independently were excluded. All participants received a BP device that transmitted their BP measurements to the institution electronic health records. Clinical pharmacists, under a collaborative practice agreement, followed the readings and provided dose adjustments via telemedicine. Patient demographics were collected at baseline and BP readings were tracked daily for the first three months. Descriptive analysis, ASCVD risk calculator and paired t-test were used accordingly. Result(s): Between August and December 2021, 89 patients were referred, of which 70 (78.7%) monitored BP daily while 19 (21.3%) were lost to follow up. The average age of the patients was 60.8 years with majority being Hispanic (76.4%), female (63%), and diagnosed with type 2 diabetes (52.8%). The average BP improved from 163/82 at baseline to 132/71 at three months (p<0.001) with an average ASCVD risk score reduction of 25%. Approximately 76% achieved BP target (<140/90) within three months. BP of those lost to follow up maintained uncontrolled over the three months. Conclusion(s): C-RPM achieved clinically meaningful and timely improvement in BP control and cardiovascular risks among underserved patients, bypassing the threat of care access disruption due to the COVID19 pandemic.
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Drawing on an equitable collaboration framework (Ishimaru, 2019), this study examines how teachers and families collaborated virtually to support children's' learning during the Covid-19 pandemic. The study was part of a research practice partnership with 31 teachers and their students across 14 schools in a large urban school district in California. Case study analyses of teacher and caregiver interviews reveal four dimensions of effective family-school partnerships: 1) having the "classroom in the living room,” 2) open strengths-based communication, 3) social and emotional support, and 4) active partnership. Furthermore, family-school partnerships led to positive outcomes including greater windows into children's learning and empathy between families and teachers. This work has significant implications for how families and schools can move forward to leverage these practices to have more equitable, collaborative, and authentic family-school partnerships in distance learning and beyond. © 2022 International Society of the Learning Sciences (ISLS). All rights reserved.
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This paper introduces a sociocultural framework called the zone of proximal self to reimagine how higher education institutions can support students from first-generation, low-income, and marginalized backgrounds. Employing mixed-method approaches, we analyze diary entries, surveys, and interviews of 50 students who met with a counselor/advisor during the Covid-19 pandemic. Thematic qualitative analyses reveal a model of effective practices characterized by creating a brave space, validation, and strengthening students' social-emotional competencies in culturally mindful ways. Case examples highlight features of this model including building working partnerships, understanding students' cultural backgrounds, validating students' experiences, and organizational brokering. Results from multiple linear regression models suggest that students, on average, have higher growth towards their professional and personal goals when exposed to more of these model practices. Taken together, the findings call for future research directions and designs of learning environments to consider cultural, relational, and social-emotional interactions in improving equity in higher education. © ISLS.