Improving the treatment pathway in small cell lung cancer

Introduction: Extensive stage small cell lung cancer (ES-SCLC) is the most aggressive form of lung cancer, and delays in treatment result in worse outcomes. The National Lung Cancer Audit1 guidelines advise 70% of patients should receive systemic treatment and 80% within 14 days of pathological diagnosis. We aimed to assess compliance with these recommendations and improve the treatment pathway for patients with ES-SCLC in East London. Method(s): To establish baseline metrics, we reviewed compliance with these guidelines in all patients diagnosed with ES-SCLC in 2019 (pre-COVID pandemic). Two interventions were made: i) admission of all newly diagnosed patients for urgent chemotherapy to improve time to treatment and ii) all newly diagnosed ES-SCLC patients across our network of five hospitals were requested to be reviewed by or transferred under a lung oncologist to improve treatment rates. We re-evaluated data from all ES-SCLC patients diagnosed in 2022 using the same pre-intervention criteria. Result(s): 31 patients in 2019 and 17 patients in 2022 were included. There was no significant difference in baseline characteristics including (median) age (68 vs 70, p=0.64), co-morbidities (1 vs 1, p=0.12), and performance status (1 vs 1, p=0.86) between cohorts. There was a significant decrease in the median [range] time to treatment (13 [4-80] days vs 4 [1-31] days, p=0.03] and an increase in the proportion of patients reviewed by a lung oncologist (74% to 100%, p=0.04). There was also an increase in the proportion of patients receiving treatment (61% vs 77%). [Figure presented] Conclusion(s): Our data suggest that these interventions may improve the proportion of patients receiving treatment and the time to treatment. Larger local audits and correlation with national data is required to evaluate the impact these interventions have on outcomes. Reference: [1] RCP National Lung Cancer Audit Annual Report. 2022. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.

A COST ANALYSIS of TELEHEALTH-INTEGRATED ANTENATAL CARE

Background: Monash Health implemented a new telehealth-integrated antenatal care schedule in March 2020, in response to the COVID-19 pandemic. Given ever-increasing healthcare costs, new interventions must be evaluated to ensure value for money. Method(s): We conducted a retrospective comparative cost analysis from the health service and patient perspective. Women with a singleton pregnancy who received antenatal care and gave birth at Monash Health from 1 January 2018 to 22 March 2020 (pre-telehealth) and 20 April 2020 to 31 December 2021 (post-telehealth) were included. We generated propensity score matched pre- and post-telehealth cohorts, balancing baseline characteristics and comorbidities. We assigned costs for all episodes of care at Monash Health and calculated the average cost per birth in each cohort. Travel costs were estimated using the average travel distance and time. Result(s): Matched pre- and post-telehealth cohorts (both n = 13 534) were generated from the pre-telehealth ( n = 18 628) and post-telehealth ( n = 14 137) populations. We found an AU$122 increase per birth, for a total cost of AU$12 069 per birth post-telehealth. This was mainly driven by an AU$188 per birth increase in outpatient costs, associated with an extra half an appointment per birth, but offset by an AU$99 per birth decrease in patient travel costs. Differences in clinical outcomes are described in Table 1. Conclusion(s): Telehealth-integrated antenatal care enabled the health service to provide safe, ongoing care for more complex pregnancies during the pandemic for only a minimal cost increase. The results highlight the need for more research into obstetric telehealth, including more comprehensive valuations of benefits and costs to all stakeholders.

PHASE 1 CLINICAL TRIALS OF A Q-GRIFFITHSIN NASAL SPRAY FOR SARS-CoV-2 PROPHYLAXIS

Background: The currently approved vaccines do not induce sterilizing immunity against SAR-CoV-2 infection, and immunity wanes over time. A robust broad spectrum topical prophylaxis strategy could protect vulnerable populations in the face of continuous evolution of SARS-CoV-2. The algal antiviral lectin Griffithsin (GRFT), and an engineered oxidation-resistant variant Q-GRFT have robust entry inhibitory activity against SARS-CoV variants of concern, in addition to other respiratory viruses with pandemic potential. We designed a nasal spray to deliver Q-GRFT to the upper respiratory tract mucosa for on-demand use as a broad-spectrum prophylactic. Two clinical trials (Phase 1a and 1b) were conducted to assess safety, tolerability, and pharmacokinetics of Q-GRFT nasal spray in healthy adults. Method(s): Healthy adult volunteers were enrolled in a Phase 1a double blinded, randomized study to receive a single dose of either intranasal Q-GRFT (3.0 mg, 2 sprays per nostril) or placebo at 2:1 ratio. Following a safety review, the Phase 1b study was initiated. Eleven volunteers in Group 1 received 3.0 mg dose once daily, for 7 days. After a safety review, 11 volunteers in Group 2 received a total of 6.0 mg Q-GRFT (3.0 mg twice daily for 7 days). Topical Q-GRFT concentrations were measured by ELISA in collected nasal and nasopharyngeal fluids. Drug levels in plasma were assayed to determine systemic exposure. Viral microneutralization cytopathic effect (CPE) assays were performed against SARS-CoV-2 Omicron BA-5 and MERS-CoV. Result(s): Eighteen adults (24-54 years;Males 58.3%, Females 41.7%;12 Q-GRFT, 6 Placebo), and 22 adults (aged 23-59 years;Males 52.4%, Females 47.6%) were enrolled in Phase 1a and 1b, respectively. In Phase 1a, a single dose of Q-GRFT maintained quantifiable levels in nasal passages and nasopharynx for up to 24 hours. Similarly, Q-GRFT was quantifiable in nasal and nasopharyngeal regions in the Phase 1b study. No dose accumulation effect or systemic exposure was observed. Nasal and nasopharyngeal swab eluates inhibited SARS-CoV-2 Omicron BA.5 and MERS-CoV in CPE assays. Q-GRFT did not modify olfactory sensation. No severe adverse events were reported. Thus, the nasal spray was deemed safe. Conclusion(s): Intranasal Q-GRFT was safe and enhanced mucosal SARSCoV-2 inhibitory activity in human volunteers. The results support further development of Q-GRFT as a broad-spectrum prophylactic against coronaviruses to curb ongoing infections, and for future pandemic preparedness.

IMPACT of COVID-19 LOCKDOWN on STILLBIRTHS and PRETERM BIRTHS among WOMEN with TWIN PREGNANCIES in MELBOURNE

Background: Melbourne's 2020 pandemic lockdown was associated with an increase in stillbirths and a reduction in preterm births (PTB) among singleton pregnancies. Twin pregnancies may be particularly susceptible due to higher background risk. We aimed to compare the rates of adverse pregnancy outcomes in twin pregnancies exposed and unexposed to Melbourne's lockdown. Method(s): Multicentre retrospective cohort study of all twin pregnancies > 20 weeks birthing in all 12 public maternity hospitals in Melbourne. Multivariable log-binominal regressions were used to compare outcomes between a pre-pandemic control group ('unexposed') independently with two lockdown-exposed groups: exposure 1 from 22 March 2020 to 21 March 2021 (pre-vaccination era) and exposure 2 from 22 March 2021 to 27 March 2022 (vaccination era). Result(s): We included 2259 pregnancies. There were fewer PTBs < 37 weeks during exposure 1 compared with the pre-pandemic era (63.1% vs. 68.3%;adjusted risk-ratio (aRR) 0.95;95% confidence interval (CI) 0.88-0.98, P = 0.01). This lower rate was most prominent in iatrogenic PTB for suspected fetal compromise (13.4% vs. 20.3%;aRR 0.94 95% CI 0.90-0.99, P = 0.01). There were correspondingly fewer special care nursery admissions during exposure 1 (38.5% vs. 43.5%;aRR 0.91 95% CI 0.87-0.95, P < 0.001), but no changes in stillbirth (1.5% vs. 1.4%;aRR 1.00, 95% CI 0.99-1.01, P = 0.85). Compared with the pre-pandemic period, exposure 2 was associated with a trend to more PTB < 28 weeks and significantly higher neonatal intensive care unit admissions (25.0% vs. 19.6%;aRR 1.06 95% CI 1.03-1.10, P < 0.001). Conclusion(s): Melbourne's first lockdown-exposure period was associated with fewer preterm twin births for suspected fetal compromise, without any increase in stillbirth.

CO-SPROUT: A PILOT DOUBLE-BLINDED RANDOMISED CONTROL TRIAL of BROCCOLI SPROUT for PREGNANT WOMEN with COVID-19: STUDY PROTOCOL

Background: COVID-19 is caused by SARS-CoV-2 and has is responsible for over 619 million infections and over 6.5 million deaths globally since identification in 2019. Infection during pregnancy is associated with increased adversity including increased risks of admission to intensive care, increased ventilatory support, preeclampsia, preterm birth and maternal death. Vaccination remains the best protection against severe disease. The majority of trials for novel or repurposed COVID-19 therapies including mRNA vaccinations have excluded pregnant or lactating women despite being an at-risk population. Broccoli sprout extract contains a naturally occurring phytonutrient sulforaphane which upregulates the Nrf2 transcription factor resulting in expression of antioxidant proteins, anti-inflammatory effects and has demonstrated anti-viral effects in-vitro . Severe COVID-19 results in excessive cytokine production resulting in a proinflammatory state with significant oxidative stress and multi-organ dysfunction with evidence of placental abnormalities in almost half of infected mothers. Method(s): CO-Sprout is a pilot, double blinded, placebo controlled randomised trial that is recruiting pregnant women ( n = 60) between 20 and 36 weeks completed gestation with COVID-19 diagnosed within 5 days. Participants are randomised to either broccoli sprout capsules (containing 21 mg sulforaphane) or identical placebo (microcrystalline cellulose) twice daily for 14 days. The primary outcome will be duration (days) of COVID-19 related symptoms and other exploratory outcomes including unplanned hospital admissions, birth outcomes, inflammatory markers, microbiome and placental changes. Patients are recruited through maternity departments at Monash Health and Jessie McPherson Private Hospital. Result(s): Trial in progress. Conclusion(s): Trial results to be published after trial completion.

Public Awareness of and Support for the Use of Wastewater for SARS-CoV-2 Monitoring: A Community Survey in Louisville, Kentucky

The majority of sewer systems in the United States and other countries are operated by public utilities. In the absence of any regulation, the public perception of wastewater monitoring for population health biomarkers is an important consideration for a public utility commission when allocating resources for this purpose. We conducted a survey in August 2021 as part of an ongoing COVID-19 community prevalence study in Louisville/Jefferson County, KY, US. The survey comprised seven questions about wastewater awareness and privacy concerns and was sent to approximately 35 000 households randomly distributed within the county. A total of 1220 adults were involved in the probability sample, and data from 981 respondents were used in the analysis. A total of 2444 adults additionally responded to the convenience sample, and data from 1751 respondents were used in the analysis. The samples were weighted to obtain estimates representative of all adults in the county. Public awareness of tracking the virus that causes COVID-19 in sewers was low. Opinions strongly support the public disclosure of monitoring results. Responses showed that people more strongly supported measurements in the largest areas (>50 000 households), typically representing population levels found in a large community wastewater treatment plant. Those with a history of COVID-19 infection were more likely to support highly localized monitoring. Understanding wastewater surveillance strategies and privacy concern thresholds requires an in-depth and comprehensive analysis of public opinion for continued success and effective public health monitoring.

Maternal and Infant Outcomes Following Maternal Exposure to SARS-CoV-2 During Pregnancy in an Australian Cohort

Background: Infections during pregnancy can increase the risk for neurodevelopmental disorders in offspring. This study aimed to prospectively monitor children exposed in utero to SARS-CoV-2 from birth to 15 years of age with a secondary aim to identify biomarkers of neurodevelopmental impairments. Method(s): Women infected with SARS-CoV-2 during pregnancy and sociodemographic and age matched non-exposed women were recruited from Monash Health, Australia (N=112 mother-infant dyads). Demographics, biospecimens and clinical data are collected at multiple time points from birth-15 years using standardised sample collection and neurological and behavioural scales. We present here the birth data. Result(s): Mother-infant dyads are classified as;non-exposed, mild SARS-CoV-2 (limitation of activities) and severe SARS-CoV-2 (hospitalised). Edinburgh postnatal depression scale scores were significantly higher in severe SARS-CoV-2 vs. non-exposed mothers (p<0.05). Maternal attachment scores were unchanged. Hammersmith neonatal neurological assessment scores were unchanged across groups, as were anthropometric measures. Severe SARS-CoV-2 exposed infants had lower scores on the sensory profile 2 questionnaire auditory domain than non-exposed infants (p<0.05). Analysis of infant buccal DNA (Illumina MethylationEPIC BeadChip >850,000 CpGs, N=8) showed hypomethylation of the gene AFAP-1 (q value<0.0008), and hypermethylation of neurodevelopmental pathways;'dendrite morphology' and 'axogenesis' in SARS-CoV-2 infants vs. non-exposed. Conclusion(s): While most assessments show no group differences thus far, the severe SARS-CoV-2 exposed group are faring worse in terms of maternal mental health, infant auditory domains and infant hypermethylation of genes belonging to neurodevelopmental pathways. Follow up assessments at 1-15 years will inform as to whether these initial group differences are early signs of more severe neurodevelopmental outcomes. Funding Source: Other - One in Five Philanthropic organisation Keywords: SARS-CoV-2, Pregnancy, DNA methylation, in utero, Neurodevelopmental trajectoriesCopyright © 2023

Adapting a Picu for Adult Patients during a Pandemic: Impacts and Learning from Interprofessional Care of Critically Ill Adults with Covid-19

BACKGROUND AND AIM: Worldwide health systems have been strained by the COVID-19 pandemic. Surging numbers of critically ill adult patients demanded urgent system-wide responses. Our Paediatric Intensive Care Unit (PICU) underwent a care delivery model redesign and rapid shift in processes and resources to care for critically ill adults at the peak of the pandemic. We describe novel adaptions made to accommodate adult patients for the first time in this paediatric setting. Personal insights of clinical staff, leaders and adult care partners about the experience of caring for critically ill adult patients are shared. METHOD(S): Program components included;preparation, education, collaboration (both interprofessional and interorganizational), continuous process improvement, and staff well-being initiatives. Interprofessional team impacts gathered during the implementation phase of the program and 10 months following were analysed using Havelock's Theory of Change framework1. RESULT(S): The Adult COVID-19 program facilitated rapid team capacity building and supported responsive care for adult patients. Over 12 weeks, 35 adults (426 patient days) received care in the PICU. Staff acknowledged;1] the burden of providing high quality care for adults, 2] the opportunity for individual and team growth and 3] guiding paediatric principals of strength-based, family-centered care enhanced the quality of care provided and provider perceptions of accomplishment. CONCLUSION(S): This program facilitated a rapid transformation and expansion in models of care and processes, successfully enhanced the team's capacity to deliver quality evidence-based service to adults with COVID-19 and was a source of personal growth and meaning for the health care team.

Music Programs for Young Children During the COVID-19 Pandemic: Stories from Across the World

The disruptions caused by the COVID-19 pandemic affected education and services geared toward young children and families, including early childhood music programs. While some programs were shut down, others were able to migrate to online formats and outdoor offerings (where allowed). Early childhood music programs are usually collective, with babies and young children often sharing and exploring common spaces, instruments, and props. These programs are also heavily based on singing, a behavior that is celebrated by early childhood specialists for its emotional expressiveness, communicative potential, and relevance for child development. Because the coronavirus can be transmitted via aerosol particles, singing became highly unsafe during the pandemic. Other challenges arose as early childhood music education programs were transferred into new formats, ranging from issues of logistics and access to technology to adherence to everchanging local and national policies, as well as cultural beliefs and behaviors. In this chapter, teachers, researchers, and program directors offer stories of adaptation and resilience in varied early childhood music programs in Kenya, Hong Kong, New Zealand, Brazil, South Korea, and the United States. Accounts are presented first, followed by their juxtaposition, to reveal common themes and implications for early childhood music education in the post-COVID era. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Effects of COVID-19 on Cervical Cancer Screening

INTRODUCTION: In the United States, cancer screening rates declined in spring 2020 due to the COVID-19 pandemic. Stay-athome orders and social distancing mandates created a new barrier to health care while further exposing the pre-pandemic health care disparities. METHODS: Using fully de-identified electronic health record data from the University of Mississippi Medical Center's (UMMC) Patient Cohort Explorer, we assessed changes in cervical cancer screening before and during the COVID-19 pandemic. The number of women screened with cervical cytology and human papillomavirus (HPV) testing in the pre-COVID months of September 2019 and January 2020 were compared with the same months of the following year during the pandemic (September 2020;January 2021). RESULTS: Data showed a pre-pandemic baseline of 319 and 340 women screened via cervical cytology during September 2019 and January 2020, respectively. Compared to pre-pandemic baseline, cervical cytology screening remained consistent throughout the pandemic with 302 and 311 women screened in September 2020 and January 2021, respectively. Similarly, HPV testing in the pre- COVID months resulted in 229 and 226 women screened as compared to 211 and 170 women screened during the pandemic. CONCLUSION: Cervical cancer screening did not significantly decline during the COVID-19 pandemic in Mississippi as compared to the 80% decline in cervical screening noted in California. The lack of change could be attributed to the low number of women screened both before and during the pandemic. Low cancer screening in women demonstrates various health care disparities affecting the UMMC patient population and the need to increase patient awareness and education regarding the importance of routine cancer screening.

CARDIOTOCOGRAPHIC AND PLACENTAL EVIDENCE OF FETAL HYPOXIA IN MATERNAL COVID-19 DISEASE

Background: COVID-19 can cause placental histopathological changes through associated inflammatory responses, maternal hypoxia and hypoperfusion, with subsequent placental microvasculopathy and fetal hypoxia. We hypothesise that these placental changes will cause placental insufficiency, as reflected by histopathological abnormalities and fetal distress on a cardiotocography (CTG), that correlates with disease severity. Methods: During the Delta wave, Monash Medical Centre was the only referral centre for pregnant women with COVID-19 in Victoria, Australia. Three groups undergoing caesarean section prior to the onset of labour were identified: 13 women with severe COVID-19 requiring hospitalisation, 53 with asymptomatic/ mild illness and 10 with placental insufficiency without COVID-19. CTGs and placental histology were analysed for evidence of maternal and fetal hypoxia. Results: Placental histology was obtained in 12/13 of severe, 40/53 asymptomatic/mild and 8/8 cases of placental insufficiency without COVID-19. Histopathological abnormalities were associated with COVID-19 disease severity;severe (8/12, 67%) and asymptomatic/mild (24/40, 60%) compared with 100% (8/8) in the placental insufficiency group. Maternal vascular malperfusion was seen in 58%, 15% and 75% and inflammatory changes in 17%, 30% and 0%, respectively (Table 1). Abnormal CTGs reflecting fetal hypoxia were seen in 77% of severe COVID-19 cases and in 49% with asymptomatic/mild illness (Table 2). Conclusions: Both mild/asymptomatic and severe COVID-19 illness are associated with high rates of CTG and placental abnormalities. These changes are similar to those seen with other causes of placental insufficiency. Therefore, increased surveillance and delivery from >37 weeks should be considered in women with COVID-19 in pregnancy, regardless of disease severity. (Table Presented).

Clinical and demographic characteristics associated with shorter time to COVID-19 death

Introduction: Cancer patients have been considered a high-risk population in the COVID-19 pandemic. We previously investigated risk of COVID-19 death in COVID-19 positive cancer patients during a median follow-up of 134 days, and identified the following risk factors: male sex, age >60 years, Asian ethnicity, hematological cancer type, cancer diagnosis for >2.5 years, patients presenting with fever or dyspnea, and high levels of ferritin and C-reactive protein (CRP). Here, we further investigate which factors are associated with a COVID-19 related death within 7 days of diagnosis. Methods: Using data from Guy's Cancer Centre and one of its partner trusts (King's College Hospital), we included 306 cancer patients with a confirmed COVID-19 diagnosis (February 29th-July 31st 2020). 72 patients had a COVID-19 related death (24%) of whom 35 died within 7 days (50%). Cox proportional hazards regression was used to identify which factors were associated with a COVID-19 related death <7 days of diagnosis. Results: Of the 72 cancer patients who had a COVID-19 related death, the mean age was 72 years (Standard Deviation (SD) 14). A total of 53 (74%) patients were men. 37 (52%) had a hematological cancer type, 47 (65%) had stage IV cancer, and 42 (58%) had been diagnosed with cancer more than 24 months before COVID-19 related death. In the group of patients who died within 7 days of diagnosis (n= 35), mean age was 73 years (SD 13.96), 24 (68%) were men, 20 (57%) had a hematological cancer type, 26 (74%) had stage IV cancer, and 24 (68%) had been diagnosed with cancer >24 months before COVID-19 diagnosis. Factors associated with COVID-19 related death <7 days of diagnosis were: hematological cancer (Hazard Ratio (HR): 2.74 (95% Confidence Interval (CI): 1.21-6.22)), 2-5 yrs since cancer diagnosis (HR: 4.81 (95%CI: 1.47-15.69)), and >5 yrs since cancer diagnosis (HR: 4.41 (95%CI: 1.38-14.06)). Additionally, patients who presented with dyspnea had increased risk of COVID-19 related death <7 days compared to asymptomatic patients (HR: 5.25 (95%CI 2.14-12.89)). CRP levels in the third tercile (146-528 mg/L) as compared to the first were also associated with increased risk of an early death due to COVID-19. Conclusion: From all the factors identified in our previous COVID-19 related death analysis, only hematological cancer type, a longer-established cancer diagnosis (2-5 years and more than 5 years), dyspnea at time of diagnosis and high levels of CRP were indicative of an early COVID-19 related death (within 7 days of diagnosis) in cancer patients.

The impact of COVID-19 in the cancer population stratified by age: A real-world data study from Guy's Cancer Center

Background It is widely accepted that advancing age is associated with worse COVID-19 outcomes. However, there is insufficient data analyzing the impact of COVID-19 in the older cancer population. The aim of the study is to establish if age has an influence on severity and mortality of COVID-19 in cancer patients. Methods We reviewed 306 oncology patients with PCR-confirmed COVID-19 from Guy's Cancer Centre and its partner Trust King's College Hospital, between 29 February - 31 July 2020. Demographic and tumor characteristics in relation to COVID-19 severity and death were assessed with logistic and Cox proportional hazards regression models, stratified by age (≤65 and >65 years). Severity of COVID-19 was classified by World Health Organization (WHO) grading. Results A total of 135 patients were aged ≤65 years (44%) and 171 aged >65 (56%). Severe COVID-19 presentation was seen in 27% of those aged ≤65 and 30% of those aged >65. The COVID-19 mortality rate was 19% in those aged ≤65 and 27% in those aged >65. In the older cohort, there was an increased incidence of severe disease in Caucasian ethnicity compared to the younger cohort (55% vs 43%) and compared to severe disease in Black and Asian ethnicities. There were increased co-morbidities in the older cohort including hypertension (54% vs 32%), diabetes (30% vs 12%) with increased rate of poly-pharmacy (62% vs 40%) compared to the younger cohort. In terms of cancer characteristics in the older cohort, there was a higher rate of patients with cancer for more than 2 years (53% vs 32%) and performance status of 3 (22% vs 6%). In terms of severity, Asian ethnicity [OR: 3.1 (95% CI: 0.88-10.96) p=0.64] had greater association with increasing COVID-19 severity in those aged >65. Interestingly, there were no positive associations between number of co-morbidities, treatment paradigm or performance status with severity of disease in the older group. The risk of mortality was greater in the elderly cohort with hematological cancer types [HR: 2.69 (1.31-5.53) p=0.85] and having cancer for more than 2 years [2.20 (1.09-4.42) p=0.28] compared to the younger cohort. Conclusions In our study we demonstrate that severity and mortality of COVID-19 did not significantly differ between the two age cohorts except in regards to Asian ethnicity, hematological malignancies and having cancer for more than 2 years. As expected, the older population had more co-morbidities and polypharmacy. Despite this, the incidence of severe COVID-19 was similar regardless of age. Further analyses for other geriatric presentations are ongoing to understand their interaction with COVID-19 in the cancer population.

Real world data analysis of patients with genitourinary cancers receiving systemic anticancer treatment during the COVID-19 pandemic at Guy's Cancer Centre: A single centre retrospective study in the UK

Background: To understand the impact of the COVID-19 pandemic on National Health Services (NHS) cancer service delivery, care and patients, we examined the impact of changes in cancer service delivery, treatment intensity and delay by evaluating oncological outcomes of genitourinary (GU) cancer patients receiving systemic anticancer treatment (SACT) during 1st March and 8th July 2020. Methods: We used data from patients with GU cancers (i.e. prostate, urothelial, kidney and testicular) treated with SACT at Guy's Cancer Centre during the first wave of the COVID-19 pandemic in the UK: demographics (sex, age, ethnicity, ECOG performance status (PS), comorbidities, smoking history, socio-economic status (SES)) and disease characteristics (stage, treatment type and setting, lines of treatment), as well as results from SARS-CoV-2 PCR testing. Classification of COVID-19 severity was based on the World Health Organisation (WHO) guidelines. Results: A total of 457 GU cancer patients received SACT during the study period: 68% prostate cancer, 23% renal cancer, 7% urothelial cancer, 2% testicular cancer. Mean age was 69 years (SD: 11.2). 91% were males, 82% were classified as low SES and out of the 291 patients we had ethnicity data on 199 (68%) were White British. The majority of patients had a PS of 1 and 95% of all patients had stage IV disease and hence received palliative SACT, with 58% being in the second line setting. Half of the patients received hormone therapy, 17% received chemotherapy, 20% received targeted therapy, 13% received immunotherapy (IO) and 1% received combination IO and targeted treatment. Only 5 (1%) patients tested SARS-CoV-2 positive: 2 had prostate cancer, 2 renal and 1 bladder cancer. Mean age was 66 years (SD: 5.6). They were all male, 2 White British, 1 Black African and 2 of unknown ethnicity and were all classified as low SES. Average PS was 2. Of these 5 patients 3 had at least two comorbidities (i.ehypertension, diabetes mellitus, renal impairment, frailty) and were receiving multiple medications. All had stage IV disease and received palliative SACT. 3 were on hormone therapy alone and 2 on chemotherapy. 2 of the patients presented symptoms within less than 7 days from PCR diagnosis, 1 within 7 to 14 days and 1 after 14 days. All 5 COVID-19 positive patients required hospitalization, 4 suffered severe pneumonia, 1 died from COVID-19 and 2 died from cancer related causes. In comparison, the mortality rate for the COVID-19 negative patients was 3.3%. Conclusion: Despite the impact of COVID-19 in health provision, a large number of our GU patients at Guy's Cancer Centre safely received SACT. Our results suggest that the continuation of SACT during the COVID-19 pandemic did not increase the risk of COVID-19 in our patient cohort (SARS-CoV-2 infection rate: 1%). Of note, the infection rate was lower than observed in a similar study in our centre for gastrointestinal cancer patients (SARS-CoV-2 infection rate: 3.4%). In light of the above, decisions against SACT or SACT intensity should carefully be evaluated.

Factors affecting COVID-19 outcomes in cancer patients from Guy's Cancer Center and King's College Hospital

Background: The Coronavirus disease 2019 (COVID-19) pandemic continues to have a significant impact on the treatment of cancer patients. Understanding the clinical course, potential risk factors for severe infection and excess mortality, is essential to improve patient outcomes. We previously presented preliminary results from 156 SARS-CoV-2 positive cancer patients from Guy's Cancer Center, which suggested that increased COVID-19 mortality was associated with a diagnosis of cancer for over 2 years, Asian ethnicity and being on palliative treatment. Herein, we present an updated analysis using data from Guy's Cancer Centre and a partner Hospital Trust (King's College Hospital), with an increased number of patients and an extended follow up. Methods: We performed an analysis of all cancer patients who had a positive RT-PCR nasal/throat swab for SARS-CoV-2 infection at our Centers between 29th February and 31st July 2020. Associations between patients' demographics, clinical characteristics, and laboratory investigations with COVID-19 severity and mortality, were assessed using Logistic regression and Cox proportional hazards models. Results: 306 SARS-CoV-2 positive cancer patients were included in the analysis with a median follow up of 134 days (IQR 32-156). 184 (60%) were male and 217 (71%) were aged over 60 (mean age: 66). The most common malignancies were haematological (38%) and urological-gynaecological (20%). 218 (71%) had mild/moderate COVID-19 and 88 (29%) had severe disease. The overall COVID-related mortality rate was 24%;19% in solid and 32% in haematological cancers. Male sex [OR: 1.84 (95%CI:1.08-3.13)], Asian ethnicity [3.86 (1.20-12.36)], haematological cancer type [2.16 (1.18-3.95)], being diagnosed with cancer for 2-5 years [3.74 (1.80-7.78)] or ≥5 years [3.06 (1.50-6.26)] and a ferritin > 1964 mcg/l [54.92 (5.90-511.33)] were all associated with a risk of developing severe COVID-19 disease. Similarly, male sex [HR:1.97 (95%CI:1.15-3.38)], Asian ethnicity [3.42 (1. 59-7.35)], haematological cancer type [2.03 (1.16-3.56)] as well as a cancer diagnosis for >2-5 years [2.81 (1.41-5.59)] or ≥5 years [2.13 (1.06-4.27)] and a ferritin > 1964 mcg/l [16.11 (3.81-68.17)] were associated with an increased risk of death from COVID-19. Age >60 [2.14 (1.15-3.98)] and a raised CRP [4.10 (1.66-10.10)] were also associated with COVID-19 death. An inverse relationship was observed between a raised albumin and COVID-19 related death [0.12 (0.03- 0.51)]. Performance status and treatment paradigm were not associated with COVID-19 severity or mortality. Conclusions: This study further substantiates the evidence for an increased risk of severe COVID-19 infection and mortality for male and Asian patients with cancer, and those with haematological malignancies or with a diagnosis of cancer for over 2 years. These risk factors should be taken into account when making clinical decisions for cancer patients during the pandemic.

COVID-19 infection and mortality in patients with skin malignancies receiving systemic anti-cancer therapy (SACT): The Guy's Cancer Centre experience

Background: The COVID-19 pandemic has influenced treatment decisions in cancer patients. There is increasing evidence that not all oncology patients are at increased risk of COVID-19 infection or death. This study aimed to look at rate of SARS-CoV-2 infection and mortality in patients with skin malignancies receiving systemic anti-cancer therapy (SACT) during the pandemic in Guy's Cancer Centre. Methods: All patients with skin cancer receiving SACT at Guy's Cancer Centre between March 1st and May 31st 2020 were included. Demographic data: sex, age, socio-economic status (SES), ethnicity, comorbidities, medications and smoking history were collected along with cancer characteristics: cancer type, stage, treatment paradigm, modality and line. COVID-19 infection was confirmed by PCR and severity defined by the World Health Organisation classification. Patients with radiological or clinical diagnoses alone were excluded. Results: Of 116 skin cancer patients on SACT over the 3-month period, 89% had Melanoma, 5% Kaposi's Sarcoma (KS), 3% Squamous Cell, 2% Merkel Cell, 1% Basal Cell Carcinoma and 1% Angiosarcoma. 53% were male and 78% were of low SES. 62% were being treated with palliative intent and 70% of these were on first line palliative treatment. The median age was 57.6 years in COVID-19 positive patients (n=3) compared to 60.3 years in the negative group (n=113). 58.6% received immunotherapy, 28.4% targeted therapy, 7.8% chemotherapy and 4.3% combined treatment. Of the 3 patients (2.6%) with confirmed COVID-19 infection, the two patients with KS were receiving liposomal doxorubicin hydrochloride and the other paclitaxel chemotherapy and the patient with Melanoma was receiving encorafenib and binimetinib. All COVID-19 positive patients were of low SES, 2 females and 1 male. There was a low rate of co-morbidities with hypertension in 1 COVID-19 positive patient and none in the negative group. All 3 confirmed COVID-19 patients developed severe pneumonia and were diagnosed within 7 days of the onset of symptoms. There were no COVID related deaths and one disease-related death in the negative cohort. Conclusion: There was a low rate of COVID-19 infection in the 116 skin cancer patients on SACT (2.6%) with 60% of patients on immunotherapy. All 3 confirmed cases had severe pneumonia with no COVID-19 related deaths (0%);2 were receiving chemotherapy and 1 on targeted therapy. Patients on treatment were encouraged to shield between hospital attendances during this period which may account for the reduced rate of SARS-CoV-2 infection. This data supports the emerging observations that immunotherapy does not confer an increased risk of severe COVID-19 infection in cancer patients. This observation is confounded by the relatively young age and low co-morbidity rates in the cohort which may have contributed to the low infection and mortality rate.

Impact of COVID-19 pandemic restrictions on pregnancy duration and outcome in Melbourne, Australia.

OBJECTIVE: To investigate the effect of restriction measures implemented to mitigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission during the coronavirus disease 2019 (COVID-19) pandemic on pregnancy duration and outcome. METHODS: A before-and-after study was conducted with cohort sampling in three maternity hospitals in Melbourne, Australia, including women who were pregnant when restriction measures were in place during the COVID-19 pandemic (estimated conception date between 1 November 2019 and 29 February 2020) and women who were pregnant before the restrictions (estimated conception date between 1 November 2018 and 28 February 2019). The primary outcome was delivery before 34 weeks' gestation or stillbirth. The main secondary outcome was a composite of adverse perinatal outcomes. Pregnancy outcomes were compared between women exposed to restriction measures and unexposed controls using the χ-square test and modified Poisson regression models, and duration of pregnancy was compared between the groups using survival analysis. RESULTS: In total, 3150 women who were exposed to restriction measures during pregnancy and 3175 unexposed controls were included. Preterm birth before 34 weeks or stillbirth occurred in 95 (3.0%) exposed pregnancies and in 130 (4.1%) controls (risk ratio (RR), 0.74 (95% CI, 0.57-0.96); P = 0.021). Preterm birth before 34 weeks occurred in 2.4% of women in the exposed group and in 3.4% of women in the control group (RR, 0.71 (95% CI, 0.53-0.95); P = 0.022), without evidence of an increase in the rate of stillbirth in the exposed group (0.7% vs 0.9%; RR, 0.83 (95% CI, 0.48-1.44); P = 0.515). Competing-risks regression analysis showed that the effect of the restriction measures on spontaneous preterm birth was stronger and started earlier (subdistribution hazard ratio (HR), 0.81 (95% CI, 0.64-1.03); P = 0.087) than the effect on medically indicated preterm birth (subdistribution HR, 0.89 (95% CI, 0.70-1.12); P = 0.305). The effect was stronger in women with a previous preterm birth (RR, 0.42 (95% CI, 0.21-0.82); P = 0.008) than in parous women without a previous preterm birth (RR, 0.93 (95% CI, 0.63-1.38); P = 0.714) (P for interaction = 0.044). Composite adverse perinatal outcome was less frequent in the exposed group than in controls (all women: 2.1% vs 2.9%; RR, 0.73 (95% CI, 0.54-0.99); P = 0.042); women with a previous preterm birth: 4.5% vs 8.4%; RR, 0.54 (95% CI, 0.25-1.18); P = 0.116). CONCLUSIONS: Restriction measures implemented to mitigate SARS-CoV-2 transmission during the COVID-19 pandemic were associated with a reduced rate of preterm birth before 34 weeks. This reduction was mainly due to a lower rate of spontaneous prematurity. The effect was more substantial in women with a previous preterm birth and was not associated with an increased stillbirth rate. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Changes in lifestyle, diet, and body weight during the first COVID 19 'lockdown' in a student sample.

Changes in lifestyle and body weight were examined retrospectively in students at a German university during the first COVID-19 lockdown period (March 12- May 3, 2020) using an online survey. Data from a total of 827 participants was used. Almost half of the students reported perceived body weight changes with about 27% gaining weight and around 22% losing weight. Regression analyses showed that consumption changes in the following food categories: fruits, sweets and cakes, bread and bakery products, pasta, savoury snacks, and meats and sausages were predictive of weight changes. Additionally, changes in the frequency of cooking with fresh ingredients, physical activity, exercise, smoking, and alcohol consumption as well as pre-lockdown BMI were all predictive of weight changes. Given the continuous global pandemic, increased and innovative public health efforts to support this population group are needed.

Jenga, Kafka, And The Triumph Of Academic Capitalism A Taxonomy of Scholars and their COVID Capital

As universities around Australia sever entire schools and faculties, others face collapse entirely. An overdependence on international revenue and an unhappy marriage with the federal government had many universities already feeling some discomfort before COVID-19 exacerbated the pain. Whether universities rapidly decline, or languish and recover, they will undoubtedly see more violent restructuring as they transition into the recovery and renewal phase. In the meantime, the absence of any tangible assistance from the government, combined with mostly short-sighted cost reduction strategies, mean that a sector-wide crisis has now been left to individual universities to manage alone. As Teresa Tija et al. explain, ‘The immediate response of Australian universities was to defer capital works spending, reduce non-salary expenditure, scale back the use of casual and fixed-term staff, and introduce other short-term measures’ (2020: 3). These emergency surgeries, which in many cases have been performed without anaesthesia, reveal that universities need a more innovative ethical strategy for triaging and treating the many systemic disorders that the virus has not only aggravated but also exposed. As several academics have already observed, Australian universities were sick before the pandemic (Kunkler 2020;Zaglas 2020). Indeed, the commodification and destruction of ‘all the collective institutions capable of counteracting the effects of the infernal machine’ (Bourdieu 1998: 4) ensures that those commodified most — that is, the precariat — can do liPle to save the university from its self-cannibalising tendencies. © 2020, Axon. All Rights Reserved.