Incidence of congenital complications related to COVID-19 infection during pregnancy.

PURPOSE: Infection with COVID-19 during pregnancy has been associated with a hypercoagulable state. It is unknown if maternal COVID-19 infection results in congenital anomalies secondary to intrauterine vascular accidents. This study sought to determine if the rate of in-utero vascular complications (intestinal atresia and limb abnormalities) that may be attributable to the hypercoagulable states associated with COVID-19 and pregnancy increased after the onset of the pandemic. METHODS: Pregnancy, neonatal, and congenital defect data from a single academic medical center and the partner's children's hospital were collected and compared to the period prior to onset of the pandemic. A subanalysis including pregnant woman 18 years or greater with documented COVID-19 infection during gestation between March 2020-2021 was performed. RESULTS: Rates of intestinal atresia did not differ prior to or after the onset of the pandemic (3.78% vs 7.23%, p = 0.21) nor did rates of limb deficiency disorders (4.41% vs 9.65%, p = 0.09). On subanalysis, there were 194 women with COVID-19 infection included in analysis: 135 (69.6%) were positive during delivery admission and 59 (30.4%) were positive earlier in their pregnancy. There was one infant born with intestinal atresia. CONCLUSION: We report a low incidence of congenital anomalies in infants born to mothers with COVID-19 infection. It remains unclear if the impact of COVID-19 on the coagulative state augments the normal pro-thrombotic state of pregnancy; ongoing surveillance is warranted.

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.

Distributing a billion vaccines: COVAX successes, challenges, and opportunities

By January 2022, the COVAX international vaccine collaboration had allocated over a billion vaccines to over 140 countries. We describe and review the allocation process chosen, which reflected both an objective of equitably distributing vaccines across the world and the need to fund that mission. We show how vaccine supply limitations and constraints on some countries' absorptive capacity have affected overall allocative outcomes. We also discuss market design approaches that were considered but not implemented, including the use of an exchange mechanism to better match countries' vaccine allocations to their preferences, as well as a vaccine brokerage under which countries could sell excess vaccines to countries with ongoing need. Our analysis addresses some criticisms of COVAX, and offers suggestions for agencies organizing global vaccine cooperation for future pandemics.

EXPLORING PATIENTS AND FAMILIES EXPERIENCES OF SERVICE ADAPTATIONS IN THE CONTEXT OF COVID-19

Background In March 2020, care within hospices had to be dramatically altered to comply with COVID-19 government guidance. Some services at Dorothy House Hospice were rapidly suspended, others adapted due to safety restrictions. Frequently, the human touch, typically enshrined in hospice care, was replaced with virtual/remote connections including video (Zoom) and telephone calls. Aim To identify and understand the impact of communication changes on patients', clients' and families' experiences of Dorothy House Hospice in the context of COVID-19 and explore their future communication preferences. Method In July 2020 a postal survey was sent to all who had used Dorothy House Hospice services since March 2020. Using closed questions plus free text comments, the survey asked about people's experiences of services since March 2020 including levels of satisfaction with communication, difficulties encountered and preferences for future communication types. Data were analysed using frequency counts, with exemplar quotations extracted. Results Responses were received from 218 participants comprising: patients (62%), family/carers/friends (28%) and bereaved people (10%). 189 (87%) of respondents reported receiving the right amount of information despite service changes, and 185 (85%) were happy with the format of contact received. 172 (62%) respondents did not want to receive video calls in future, however, 71% (n=10) of respondents aged 18-44 were happy with this method, compared with 12% (n=18) aged 65+. Respondents reported minor technical difficulties with Zoom and regret at restrictions on face-toface interactions. Concerns surrounding privacy during remote consultations at home, and hearing difficulties, were occasionally raised. Conclusion The majority of responses were overwhelmingly positive;patients, clients and families were reassured and appreciative that they were still able to access Dorothy House Hospice services, albeit sometimes in alternative formats. Steps to improve online access and technical support/education are needed to support older service users to access services with confidence.