PROLONGED SARS-CoV-2 VIRAL BURDEN IN SIV-SARS-CoV-2 COINFECTED MACAQUES

Background: Individuals living with HIV are at increased risk of morbidity and mortality from COVID-19. Furthermore, SARS-CoV-2 infection in immunocompromised HIV infected individuals poses a risk to prolonged infection and viral shedding and the emergence of new variants of concern (VOCs). Using the SIV macaque model for AIDS, we are investigating the hypothesis that immune dysfunction during HIV infection will prolong SARSCoV- 2 viral infection, promote enhanced COVID-19 disease, and accelerate viral evolution. Here, we report the impact of SIV-CoV-2 co-infection on immune responses and pathogenesis. Method(s): Eight female rhesus macaques (aged 7-15 years, 5.5-9.9kg) were infected with SIVmac251 via low dose intravaginal challenge and then inoculated with 6.5x105 TCID50/mL SARS-CoV-2 (WA-1) at 17-34 weeks post-SIV infection via combined intranasal and intratracheal routes. Blood, bronchoalveolar lavage (BAL), stool, and nasal, oral, and rectal swabs were collected pre-infection through 14 days post-infection (DPI) to measure immune responses and viremia. ELISAs, ELISPOT, qRT-PCR, lung pathology, cytokine multiplex, and virus neutralization assays were performed to measure viral loads, pathogenesis, and immune responses. Result(s): Three days post-SARS-CoV-2 infection, we observed a transient decrease in CD4 counts, but there were no changes in clinical symptoms or plasma SIV viral loads. However, SARS-CoV-2 replication persisted in the upper respiratory tract, but not the lower respiratory tract. In addition, SARS-CoV-2 IgG seroconversion was delayed and antigen-specific T-cell responses were dampened. Notably, viral RNA levels in nasal swabs were significantly higher 7-14 DPI in SIV+ compared to previously published results using the same SARS-CoV-2 challenge virus in SIV- rhesus (PMCID: PMC8462335, PMC8829873). In addition, SIV/CoV-2 co-infected animals exhibited elevated levels of myeloperoxidase (MPO), a marker of neutrophil activation and increased lung inflammation. Conclusion(s): Here we provide evidence for the utility of the rhesus macaque in modeling human HIV-SARS-CoV-2 co-infection. Our results suggest that immunosuppression during SIV infection impairs de novo generation of anti-SARS-CoV-2 immunity, that may contribute to prolonged SARS-CoV-2 viral shedding, increased transmission windows, altered disease pathogenesis, and lower protection against subsequent SARS-CoV-2 exposures. Studies in progress will determine if SARS-CoV-2 viral evolution is accelerated in SIV-infected macaques.

Recruitment of patients to the AVERT DOSE international trial - the Irish experience

Introduction: Mobility training is a complex intervention and recovery post-stroke is multidimensional. AVERT DOSE is the first trial to use an adaptive trial design in stroke rehabilitation and aims to define optimal early intervention regimens for people with mild to moderate ischaemic stroke. Seven Irish sites are participating. Method(s): AVERT DOSE (ACTRN:12619000557134) is a randomised trial that will recruit >2,500 patients internationally. Randomisation is to two groups according to stroke severity. Patients are then randomised to one of four mobility training regimens in each strata and the intervention is delivered for up to 14-days. Primary Outcome: Identification of the intervention regimen that results in higher proportion of favourable outcome at 3-months post-stroke. Seven Irish sites are participating. Result(s): In Ireland, 3 sites are recruiting (SJH, OLOLH, and MMUH) with 4 finalising contracts. Thirteen patients have been recruited to date in Ireland and 265 internationally. Trial set-up has proven complex and variable across Irish sites, with time to ethics approval ranging from 10-37-months. Given the COVID-19 pandemic and international nature of the trial, online training and meetings were necessitated for all Irish sites. Close communication, teamwork and shared responsibilities have supported this process. Flexibility was required with some blinded followup assessments using telehealth. Conclusion(s): Undertaking rehabilitation research requires a dynamic, problem-solving approach, particularly during a pandemic. Irish sites have embraced this opportunity to answer an important stroke research question. In Ireland, shared learning in trial governance should improve future rehabilitation trial readiness. Trial recruitment is expected to gain pace as more Irish and international sites are approved.

Supporting radiography clinical placements in Ireland during the COVID-19 pandemic: The practice educators perspective.

INTRODUCTION: The COVID-19 pandemic has significantly impacted healthcare services and the clinical learning environment. Several studies have investigated radiography students' experiences of clinical placement during the pandemic; however, few have investigated the Clinical Practice Educator's (CPEs) perspective. CPEs play a pivotal role in supporting clinical education. METHOD: A qualitative study was conducted using a purposeful sample of twenty-two CPEs, each working in a different Irish hospital. Four semi-structured focus groups were used to gather data. To maintain reasonable homogeneity, CPEs who were new to the role (n = 8) were assigned a separate focus group from experienced CPEs (n = 14). Inductive thematic analysis was applied. RESULTS: CPEs experienced role expansion, particularly in managerial and administrative aspects of the role. They described arranging COVID-19 vaccinations locally for radiography students and the complexities of student rostering during the pandemic. CPEs perceived the pandemic to have impacted students' emotional wellbeing with 'high anxiety levels' and 'loneliness' being reported. They also perceived issues with clinical readiness and the student transition to clinical practice. Many challenges were faced by CPEs including arranging clinical recovery time for numerous students when sites were already at full capacity, fewer learning opportunities due to decreased patient throughput and range of imaging examinations, social distancing constraints, resistance from staff to student placements, and a shortage of staff for student supervision. Flexibility, communication, and multi-level support helped CPEs to fulfil their role. CONCLUSION: The results provide insight into how CPEs supported radiography clinical placements during the pandemic and into the challenges faced by CPEs in their role. CPEs supported student placement through multi-level communication, teamwork, flexibility, and student advocacy. IMPLICATIONS FOR PRACTICE: This will aid understanding of the support mechanisms needed by CPEs to provide quality clinical placements.

A qualitative analysis of radiography students' reflective essays regarding their experience of clinical placement during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic significantly impacted healthcare services and clinical placement for healthcare students. There is a paucity of qualitative research into radiography students' experiences of clinical placement during the pandemic. METHOD: Students in stages three and four of a 4-year BSc Radiography degree in Ireland wrote reflective essays regarding their experience of clinical placement during the COVID-19 healthcare crisis. Permission was granted by 108 radiography students and recent graduates for their reflections to be analysed as part of this study. A thematic approach to data analysis was used, allowing themes to emerge from the reflective essays. Two researchers independently coded each reflective essay using the Braun and Clarke model. RESULTS: Four themes were highlighted; 1) Challenges associated with undertaking clinical placement during the pandemic, such as reduced patient throughput and PPE-related communication barriers; 2) Benefits of clinical placement during the pandemic, in terms of personal and professional development and completing degree requirements to graduate without delay; 3) Emotional impact and 4) Supporting students in clinical practice. Students recognised their resilience and felt proud of their contribution during this healthcare crisis but feared transmitting COVID-19 to family. Educational and emotional support provided by tutors, clinical staff and the university was deemed essential by students during this placement. CONCLUSIONS: Despite the pressure hospitals were under during the pandemic, students had positive clinical placement experiences and perceived these experiences to have contributed to their professional and personal growth. IMPLICATIONS FOR PRACTICE: This study supports the argument for clinical placements to continue throughout healthcare crisis periods, albeit with additional learning and emotional support in place. Clinical placement experiences during the pandemic prompted a deep sense of pride amongst radiography students in their profession and contributed to the development of professional identity.

High burnout among the South African orthopaedic community: a cross-sectional study

Background Burnout is epidemic among physicians, with the orthopaedic speciality displaying one of the highest rates of burnout in international studies. The burnout rate of the South African orthopaedic community is unknown. This study aimed to determine the prevalence and causes of burnout, as well as the coping mechanisms and associations with burnout, in South African orthopaedic surgeons and trainees. Methods We conducted a cross-sectional, secure, online survey of members of the South African Orthopaedic Association. The survey assessed demographic characteristics, workload, professional fulfilment and burnout (utilising the Stanford Professional Fulfilment Index), associated workplace distress conditions, causes of and coping strategies for burnout. A response was not compulsory for any question. Statistical analysis was performed to assess for independent associations with burnout. Results One hundred and fifty-six respondents, with a median age of 46.5 years (interquartile range [IQR] 37–58) participated. Ninety per cent (139 of 155) of respondents were male. Registrars accounted for 17% (27 of 155), while 83% (128 of 155) were qualified specialists. Respondents were in orthopaedic practice for a median of 17 years (IQR 9–28). Sixty per cent (76 of 127) practise in private, 17% (22 of 127) in public and 23% (29 of 127) in both sectors. The overall burnout rate was 72% (113 of 156). Burnout was associated with being the parent of young children and having fewer hours of sleep on call. Registrars were more likely to have burnout than consultants (OR 5.68, 95% CI 1.3–25.2). Gender, practice setting and subspeciality were not associated with burnout. Self-reported causes of burnout that were found to be associated with actual burnout were: ‘hours at work’, ‘lack of free time’ and ‘work–life imbalance’. No self-reported coping mechanisms were found to be protective in this cohort, but the use of alcohol as a coping mechanism was associated with an increased likelihood of burnout (OR 3.9, 95% CI 1.4–10.7). Respondents felt that the concurrent experience of the COVID pandemic at the time of running the survey reduced their experience of burnout. Conclusion The burnout rate in the South African orthopaedic community is 72%. Trainees were found to be particularly vulnerable. There appears to be a need to develop, assess and implement effective system-related initiatives aimed at reducing the burnout rate among orthopaedic surgeons and trainees in South Africa. Level of evidence: Level 4. © 2022 O’Connor M.

BEREAVEMENT IN THE COVID-19 PANDEMIC: THE GRIEF EXPERIENCE OF AFRICAN AMERICAN & LATINO COMMUNITIES

Background: The COVID-19 pandemic death rate for African American and Latinx communities is twice as high as White Americans, leaving more loved ones to cope with the difficulties of bereavement. With already existing challenges, the COVID-19 pandemic has emphasized the need to understand the disproportionate struggles of people of color. Methods: To study the impact, we conducted the Survey of Bereavement After Covid-Related Death. In the current study, 267 participants answered online surveys, measuring loss characteristics, demographics, depression, grief, and an option for open-ended comments. Results: Grief and depression scores were predicted by kinship relationship, participant age, and time since loss, but were not predicted by gender, race, or ethnicity in regression analyses (grief: F = 6.38, p < .001;depression: F = 5.30, p < .001). However, the sample was not representative of the current population, with fewer African Americans and Hispanic/Latinx individuals than in the community. Conclusion: Pandemic grief severity and depression following bereavement is predicted by factors seen in pre-pandemic grief research. However, the study revealed that there are still significant challenges among recruiting underrepresented populations in academic research, indicating that further research is necessary.

GRIEF AND LOSS DURING THE COVID-19 PANDEMIC: EXPLORING PERCEIVED PHYSICAL HEALTH AS A PREDICTOR FOR RUMINATION

Background: Ruminative thought predicts complicated grief and hinders the adjustment to loss by acting as a cognitive avoidance strategy. Not only is the process linked to psychological issues, rumination is also associated with negative health consequences, such as poor sleep quality, impaired immune functioning, and cardiovascular disease. Understanding how bereaved people adjust to the death of a loved one, and the associated physical and psychological health outcomes, can offer meaningful direction for interventions. Self-reported physical health has been shown to be indicative of documented physical health. Very few studies have investigated the potential relationship between self-reported physical health and rumination, especially in the bereaved population. Methods: Arizonans who experienced the death of a partner, child, sibling, parent, grandparent, other family member, non-biological family, or close friend in the past year were recruited for a semi- structured phone interview, during which they reported their grief severity, depressive symptoms, grief-specific rumination, and perceived physical health. Results: In the present study (N = 51), we tested whether perceived physical health acts as a predictor for grief-specific rumination in bereaved individuals who experienced the death of a loved one during the COVID-19 pandemic. Participants (74.5% White, 80.4% non-Hispanic) had an average age of 51 (SD = 15.9) and were mostly female (76.5%). Linear regression analyses showed that self-reported physical health predicted grief rumination outcomes (F = 4.0, p = 0.005). Notably, self-reported physical health also predicted grief severity (F = 4.0, p < 0.005) and depression (F = 5.2, p < 0.001). Conclusion: These results are consistent with previous findings that engagement in ruminative thought is associated with poorer health. Using self-report measures to assess physical health may offer accessible insights related to psychological health outcomes-especially in a time of social distancing.

PANDEMIC GRIEF STUDY (PANGS): ACUTE GRIEF OF BEREAVED RELATIVES FOLLOWING DEATHS DURING COVID-19

Background: The COVID-19 pandemic has led to the death of over 700,000 Americans, with each death leaving 9 surviving Americans (i.e., over 6 million bereaved). One harsh reality of the pandemic has been that survivors have often not been able to care for their dying loved ones, and grieve for them in traditional ways (e.g., wakes, funerals), due to social distancing. The present study used semi-structured clinical interviews to investigate acute grief during the pandemic. Methods: Participants were interviewed by phone, including the Center for Epidemiological Studies-Depression scale, a 20-item measure of depression;the Prolonged Grief Disorder scale, a 13-item measure of prolonged grief disorder;the Work and Social Adjustment Scale (WSAS), a 5-item measure assessing for adjustment after major life events;the Post-Traumatic Growth (PTG) scale, a 10-item measure of growth following a traumatic event such as the death of a loved one;the Utrecht Grief Rumination Scale (UGRS), a 15-item scale measuring various aspects of grief-related rumination;the Interpersonal Support Evaluation List (ISEL), a 12-item measure assessing for social support following a major life event. Results: Participants (N = 51, 74.5% White, 80.4% non-Hispanic) had an average age of 51 (SD = 15.9) and were mostly female (76.5%). 53.0% said they were unable to provide support for their dying loved one, 45.1% said they were not able to say good-bye, 47.1% said they were not prepared, 45.1% said they should have been present for the death. The sample experienced sub-clinical depressive symptoms (M = 10.04, SD = 7.03), and moderate prolonged grief symptoms (M = 23.0, SD = 9.15). Participants had a mean of 7.61 (SD = 10.02) on the WSAS, 23.24 (SD = 13.50) on the PTG, 17.31 (SD = 14.50) on the UGRS, and 30.25 (SD = 4.63) on the ISEL. Conclusion: Despite feeling unprepared for the death of their loved ones during the pandemic, depression and grief scores suggest that many individuals are resilient, given their moderate prolonged grief and sub-clinical depression scores on average. The scores for the WSAS suggest that people are adjusting to work and social life following the death of their loved ones. Clinical intervention should focus on the small proportion who are not adjusting during pandemic bereavement.

CPD: ADAPTING TO COVID-19

Background: During 2020, continuing professional development (CPD) was not mandatory for doctors in Australia and New Zealand. However, a substantial number of psychiatrists continued to participate in CPD activities, particularly their peer review groups (PRGs). PRGs have been a cornerstone of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) CPD programme since the 1980s. Objectives: To illustrate how psychiatrists participated in CPD when completion was not compulsory, and how PRGs adapted to the COVID-19 environment during 2020. Methods: The annual survey of PRGs, conducted to meet the reporting requirements for qualified privilege, was adjusted to include questions relating to the conduct of PRGs during 2020. Qualitative and quantitative questions were included, and the results analysed. The activity data from My CPD were analysed to determine the proportion of members who participated in CPD activities during 2020, including the proportion of members meeting the usual minimum requirement of 10°hours per year of formal peer review. Findings: More than 70% of all participants enrolled in the CPD programme registered participation in the Formal Peer Review section of their CPD records. The hours recorded ranged from 1 hour to 20.25°hours. Qualitative analysis revealed that the importance of the PRG during COVID-19 was enhanced for members. Conclusion: This study reinforces the importance of PRGs to psychiatrists, and the flexibility demonstrated to continue with this activity during the restrictions of 2020.

PRACTICE PEER REVIEW: A NOVEL CPD ACTIVITY

Background: Regular practice review - commonly practice visits - is encouraged as a continuing professional development (CPD) activity by the Medical Council of New Zealand (MCNZ) and the Medical Board of Australia (MBA). Traditional practice visits are better suited to interventional medical practitioners rather than psychiatrists and have presented significant logistical challenges to implement in the Royal Australian and New Zealand College of Psychiatrists (RANZCP) programme. The COVID-19 pandemic presented an opportunity to redesign regular practice review by psychiatrists for psychiatrists, resulting in a pilot of a programme known as Practice Peer Review (PPR). Objectives: To explore a novel approach to regular practice review for psychiatrists. Methods: Psychiatrists were invited to participate in a pilot of the PPR. Following an application process, psychiatrists were matched using two methods: (1) self-pairing and (2) pairing by RANZCP staff using criteria including career stage, area of practice and individual's preferences. Each pair was assigned a facilitator, a Fellow with training in the principles of coaching. Pairs undertook a series of structured discussions, with the facilitator assisting the pair in the final session to reflect on the activity and applications to their practice. Data collected included quantitative measures (e.g. the period over which the meetings occurred) and qualitative measures (e.g. satisfaction with the matching process and learning outcomes). Findings: Evaluation is underway and will be concluded by the end of March 2022. Initial analysis indicates that the activity has been considered valuable by participants, but there have been some challenges particularly with scheduling. Conclusion: PPR shows promise as an alternative to the 'traditional' practice visit.

Successful Treatment of Fulminant Myocarditis with Intracardiac Thrombus in COVID-19

Introduction The treatment of pediatric patients with COVID-19 associated myocardial injury and prothrombotic coagulation derangements remains to be established. We cared for an adolescent with COVID-19 and fulminant myocarditis who required veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Her course was complicated by a large intracardiac thrombus, which was successfully treated with systemic tissue plasminogen activator (tPA). Case Report A 17 year old unvaccinated female presented with fever and chest pain 7 days after testing positive for COVID-19. She had a peak troponin of 21.48 ng/ml, elevated brain natriuretic peptide (629 pg/ml), and severely diminished left ventricular systolic function. She progressed to cardiogenic shock and was cannulated to VA-ECMO via the neck. On ECMO day 2 while therapeutic on unfractionated heparin (UFH), a large thrombus was noted in the left ventricular apex, extending toward the aortic valve (Figure 1). Prior to this, she had no evidence of a deep vein thrombosis. Given the concern for an impending stroke upon restoration of ventricular function, a continuous systemic high-dose tPA infusion (0.1mg/kg/hr) was initiated, while she was continued on UFH. A twenty-fold increase in D-dimer levels and serial echocardiograms indicated a thrombolytic effect. After 22 hours of thrombolysis, the patient developed bleeding complications and tPA was discontinued. By ECMO day 4, the thrombus completely resolved. Once her bleeding was controlled, she was transitioned to bivalirudin. Cardiac function recovered by day 11 allowing for separation from ECMO. 25 days later, she was discharged without any neurologic deficits. Summary The coagulopathic derangements associated with COVID -19 pose significant challenges to the management of fulminant myocarditis. There are no guidelines regarding management of an intracardiac thrombus on ECMO. However, with careful monitoring, systemic tPA can be used to provide life-saving therapies with excellent neurological outcomes.

The impact of COVID-19 on oncology professionals-one year on: lessons learned from the ESMO Resilience Task Force survey series.

BACKGROUND: COVID-19 has had a significant impact on the well-being and job performance of oncology professionals globally. The European Society for Medical Oncology (ESMO) Resilience Task Force collaboration set out to investigate and monitor well-being since COVID-19 in relation to work, lifestyle and support factors in oncology professionals 1 year on since the start of the pandemic. METHODS: An online, anonymous survey was conducted in February/March 2021 (Survey III). Key outcome variables included risk of poor well-being or distress (expanded Well-Being Index), feeling burnout (single item from expanded Well-Being Index), and job performance since COVID-19. Longitudinal analysis of responses to the series of three surveys since COVID-19 was carried out, and responses to job demands and resources questions were interrogated. SPSS V.26.0/V.27.0 and GraphPad Prism V9.0 were used for statistical analyses. RESULTS: Responses from 1269 participants from 104 countries were analysed in Survey III: 55% (n = 699/1269) female, 54% (n = 686/1269) >40 years, and 69% (n = 852/1230) of white ethnicity. There continues to be an increased risk of poor well-being or distress (n = 464/1169, 40%) and feeling burnout (n = 660/1169, 57%) compared with Survey I (25% and 38% respectively, P < 0.0001), despite improved job performance. Compared with the initial period of the pandemic, more participants report feeling overwhelmed with workload (45% versus 29%, P < 0.0001). There remain concerns about the negative impact of the pandemic on career development/training (43%), job security (37%). and international fellowship opportunities (76%). Alarmingly, 25% (n = 266/1086) are considering changing their future career with 38% (n = 100/266) contemplating leaving the profession. CONCLUSION: Oncology professionals continue to face increased job demands. There is now significant concern regarding potential attrition in the oncology workforce. National and international stakeholders must act immediately and work closely with oncology professionals to draw up future-proof recovery plans.

The concerns of oncology professionals during the COVID-19 pandemic: results from the ESMO Resilience Task Force survey II.

BACKGROUND: The COVID-19 pandemic has resulted in significant changes to professional and personal lives of oncology professionals globally. The European Society for Medical Oncology (ESMO) Resilience Task Force collaboration aimed to provide contemporaneous reports on the impact of COVID-19 on the lived experiences and well-being in oncology. METHODS: This online anonymous survey (July-August 2020) is the second of a series of global surveys launched during the course of the pandemic. Longitudinal key outcome measures including well-being/distress (expanded Well-being Index-9 items), burnout (1 item from expanded Well-being Index), and job performance since COVID-19 were tracked. RESULTS: A total of 942 participants from 99 countries were included for final analysis: 58% (n = 544) from Europe, 52% (n = 485) female, 43% (n = 409) ≤40 years old, and 36% (n = 343) of non-white ethnicity. In July/August 2020, 60% (n = 525) continued to report a change in professional duties compared with the pre-COVID-19 era. The proportion of participants at risk of poor well-being (33%, n = 310) and who reported feeling burnout (49%, n = 460) had increased significantly compared with April/May 2020 (25% and 38%, respectively; P < 0.001), despite improved job performance since COVID-19 (34% versus 51%; P < 0.001). Of those who had been tested for COVID-19, 8% (n = 39/484) tested positive; 18% (n = 7/39) felt they had not been given adequate time to recover before return to work. Since the pandemic, 39% (n = 353/908) had expressed concerns that COVID-19 would have a negative impact on their career development or training and 40% (n = 366/917) felt that their job security had been compromised. More than two-thirds (n = 608/879) revealed that COVID-19 has changed their outlook on their work-personal life balance. CONCLUSION: The COVID-19 pandemic continues to impact the well-being of oncology professionals globally, with significantly more in distress and feeling burnout compared with the first wave. Collective efforts from both national and international communities addressing support and coping strategies will be crucial as we recover from the COVID-19 crisis. In particular, an action plan should also be devised to tackle concerns raised regarding the negative impact of COVID-19 on career development, training, and job security.

Transition to a virtual cancer multidisciplinary team meeting during the COVID-19 pandemic: Experience from a regional Irish Cancer Centre

Background: The COVID-19 pandemic has dramatically changed how healthcare services are provided. In order to comply with public health recommendations, the multidisciplinary team (MDT) network of the South East Cancer Centre at University Hospital Waterford made a transition to a virtual meeting format. The centre coordinates a network of eight individual cancer MDTs with three satellite hospitals. Following adaptation to virtual format, remote participants now join by videoconference, telephone call, or by phone application. Methods: A 30-part questionnaire was developed in electronic format and distributed to consultants who comprise the senior membership of the cancer MDTs. The objectives were to investigate experience of the virtual meetings post-implementation, and assess preference regarding the future of the meetings. Results: Among 36 respondents, surgeons accounted for 38.9%, medical oncologists (22.2%), pathologists (13.9%), radiologists (11.1%), haematologists (5.6%) and radiation oncology, palliative care and physicians for 2.8% each. The most common means of joining the meeting included videoconference (61.1%), physical attendance at MDT room (19.4%), telephone (11.4%) and by phone application (8.3%). 67% experienced difficulties using the technology including issues connecting (67%) and screen-sharing (50%). 78% reported that the virtual format did not affect their attendance at MDT, with 11% reporting increased attendance. 56% thought the case discussion at the virtual MDT was not as in-depth as the conventional MDTs, but a majority (81%) believe that decisions made are not impacted by the virtual format. 71% believe it has negatively impacted on education. Most respondents (40%) preferred the traditional face-to-face format, with 37% preferring a combination of virtual and face-to-face. The majority of consultants determine that virtual MDTs should continue past social distancing guidelines. Conclusions: The results of this study suggest that virtual MDT meetings can be implemented into routine MDT practice. Although challenges are encountered, transition to a virtual format enables continuation of MDT meetings in uncertain times and may become a lasting legacy of COVID-19. Legal entity responsible for the study: C.M. Goggin. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.