A Qualitative Investigation of Professionals' Perceptions of Working in Senior Care Organizations During the First Year of the COVID-19 Pandemic

Senior care organizations were some of the hardest hit by COVID-19 infections and deaths early in the pandemic, both for those receiving care as well as staff;22% of COVID-19-related deaths through March, April, and May of 2020 occurred in the senior care facility population. Professionals in senior care are an important population to understand as they have had to navigate a constantly changing work environment, increasing workloads, less support to safely and effectively conduct their work, and an ever-evolving communication environment. Semi-structured interviews were conducted with seven professionals employed by a variety of senior care organizations across the United States. Inductive thematic analysis revealed four themes related to perceptions of organizational functioning in response to the COVID-19 pandemic. The themes indicate that similar issues were encountered by professionals working in senior care, however, job type impacted the perceptions of those issues. Structuration theory is applied to the findings to explain how structure and agency are created and reinforced in the social systems of senior care organizations.

COVID-19 associated retinopathy

Purpose : Coronavirus disease (COVID-19) has escalated to a global pandemic with increasing reports of ophthalmic disease. We report ophthalmic observations of hospitalized COVID-19 patients and correlate retinal disease findings with clinical and laboratory data. Methods : Retrospective review of COVID-19 patients who underwent ophthalmic exam during hospitalization within Emory Healthcare between April-July 2020. Results : Thirty-seven patients were examined with 23 (62%) females and a mean age of 54 years. 35 patients were admitted to the ICU. Ophthalmic manifestations included conjunctival injection in 12 eyes (17%), chemosis in 8 (11%) and retinopathy in 20 eyes (27%) with bilateral retinopathy in 6 patients (16%). No difference in baseline comorbidities or COVID-19 complication development was observed between patients with and without retinopathy. However, patients with retinopathy required ICU care for 1 week longer than those without retinopathy (27.6 vs 19.9 days p=0.19). The mean sequential organ failure assessment score at ICU admission was 6.18. All patients with retinopathy required both mechanical ventilation and vasopressors, while in patients without retinopathy, 15 (65%) and 12 (52%) required mechanical ventilation and vasopressors respectively (p=0.015, p=0.002). 6 patients with retinopathy required extracorporal membrane oxygenation compared to 1 without retinopathy (p=0.0070). While the mean peak D-Dimer was elevated at 18477, in the entire cohort, the peak D-Dimer was higher in patients with retinopathy (28,971 vs 12,575, p=0.0298). The fibrinogen nadir during hospitalization was on average 338 for the entire cohort, and reduced in patients with retinopathy (262 vs 381, p=0.029). Peak D-dimer analyses with a threshold of 16,508 showed an odds ratio of 16.7 (95% CI 3.11-89.3) for retinopathy. Fibrinogen nadir with a threshold of 367 showed odds ratio of 0.06 (95% CI 0.01-0.53) with 0.75 concordance. Conclusions : Retinopathy was the most common ophthalmic manifestation in a critically ill COVID-19 population, exceeding 25% of patients. Elevated D-dimers and a lower fibrinogen nadir in patients with retinopathy suggest a pathogenic relationship between coagulation pathways and retinal microangiopathy.

Effect of Bamlanivimab vs Placebo on Incidence of COVID-19 Among Residents and Staff of Skilled Nursing and Assisted Living Facilities A Randomized Clinical Trial

Importance Preventive interventions are needed to protect residents and staff of skilled nursing and assisted living facilities from COVID-19 during outbreaks in their facilities. Bamlanivimab, a neutralizing monoclonal antibody against SARS-CoV-2, may confer rapid protection from SARS-CoV-2 infection and COVID-19. Objective To determine the effect of bamlanivimab on the incidence of COVID-19 among residents and staff of skilled nursing and assisted living facilities. Design, Setting, and Participants Randomized, double-blind, single-dose, phase 3 trial that enrolled residents and staff of 74 skilled nursing and assisted living facilities in the United States with at least 1 confirmed SARS-CoV-2 index case. A total of 1175 participants enrolled in the study from August 2 to November 20, 2020. Database lock was triggered on January 13, 2021, when all participants reached study day 57. Interventions Participants were randomized to receive a single intravenous infusion of bamlanivimab, 4200 mg (n = 588), or placebo (n = 587). Main Outcomes and Measures The primary outcome was incidence of COVID-19, defined as the detection of SARS-CoV-2 by reverse transcriptase-polymerase chain reaction and mild or worse disease severity within 21 days of detection, within 8 weeks of randomization. Key secondary outcomes included incidence of moderate or worse COVID-19 severity and incidence of SARS-CoV-2 infection. Results The prevention population comprised a total of 966 participants (666 staff and 300 residents) who were negative at baseline for SARS-CoV-2 infection and serology (mean age, 53.0 [range, 18-104] years;722 [74.7%] women). Bamlanivimab significantly reduced the incidence of COVID-19 in the prevention population compared with placebo (8.5% vs 15.2%;odds ratio, 0.43 [95% CI, 0.28-0.68];P < .001;absolute risk difference, -6.6 [95% CI, -10.7 to -2.6] percentage points). Five deaths attributed to COVID-19 were reported by day 57;all occurred in the placebo group. Among 1175 participants who received study product (safety population), the rate of participants with adverse events was 20.1% in the bamlanivimab group and 18.9% in the placebo group. The most common adverse events were urinary tract infection (reported by 12 participants [2%] who received bamlanivimab and 14 [2.4%] who received placebo) and hypertension (reported by 7 participants [1.2%] who received bamlanivimab and 10 [1.7%] who received placebo). Conclusions and Relevance Among residents and staff in skilled nursing and assisted living facilities, treatment during August-November 2020 with bamlanivimab monotherapy reduced the incidence of COVID-19 infection. Further research is needed to assess preventive efficacy with current patterns of viral strains with combination monoclonal antibody therapy. This randomized clinical trial assesses the effect of a single intravenous infusion of bamlanivimab vs placebo on incidence of COVID-19 among residents and staff of skilled nursing and assisted living facilities. Question Among residents and staff of skilled nursing and assisted living facilities with high risk of SARS-CoV-2 exposure, what is the effect of bamlanivimab on the incidence of COVID-19? Findings This randomized phase 3 clinical trial included 966 participants who were residents and staff at US skilled nursing and assisted living facilities with at least 1 confirmed SARS-CoV-2 index case and who were negative at baseline for SARS-CoV-2 infection and serology, enrolled from August to November 2020. The incidence of COVID-19 infection among those treated with bamlanivimab vs placebo was 8.5% vs 15.2%, respectively, a difference that was statistically significant. Meaning Bamlanivimab monotherapy compared with placebo reduced the risk of COVID-19 in residents and staff of skilled nursing and assisted living facilities.

First-surge COVID-19 experience at a comprehensive cancer center

INTRODUCTION: Several reports have associated COVID-19 and cancer patients with poor outcomes. We describe outcomes of COVID-19 cancer patients who required ICU level care. METHODS: A retrospective cohort of cancer patients with COVID-19 admitted to a comprehensive cancer center,between March and May 2020.All patients had positive RT-PCR for SARS-CoV-2.Demographics, clinical, and outcome data were recorded.All patients were admitted to a designated COVID unit.Patients who required >6L O2, HFNC or invasive mechanical ventilation were considered ICU level.Continuous data is presented as median. RESULTS: A total of 37 patients were included.The median age was 62 (54-72) years,65% of them were female, 41% African American, and the median BMI was 30.The majority (54%) had solid tumors;with 55% had metastatic disease. Hematological malignancy were 17 (46%);of them, 47% had active disease, 41% had relapsed malignancy, and 12% were in remission;stem cell transplants receipents 7, (71% were autologous). The most common comorbidities were hypertension (63%), Diabetes mellitus (37%), hyperlipidemia (31%), obstructive sleep apnea (23%), and chronic kidney disease (20%). Majority (81%) had a performance status score of 0-1. The most common symptoms were fever (74%), dyspnea (51%), and cough (48%). 48% patients were neutropenic, and 73% had undergone cancer treatment within 90 days of admission.Total of 54% of patients were mild-moderate,14% severe,and 32% critical.Interventions received:57% hydroxychloroquine,51% azithromycin,8% remdesivir,16% convalescent plasma,22% statins,38% vitamin C,30% zinc,43% tocilizumab,11% anakinra,43% aspirin,78% heparin, 40% steroids, and 16 awake patients did self-proning.From this cohort,15 patients required ICU level care;with 3 of them transitioning to palliative care.Of the remaining 12 were ICU patients;67% required HFNC, and 33% IMV with a median 10 ventilator days.Complication wise,83% of them developed shock and required 3 days on vasopressor therapy.All ventilated patients survived, one patient on HFNC developed a sudden fatal pulmonary embolism. Overall hospital and 28-day mortality was 8%. CONCLUSIONS: In our cohort, the mortality rate of critically ill cancer patients with COVID-19 was lower than reported. This early finding should be interpreted with caution.

Rates of asymptomatic carriage and antibody positivity for SARSCOV-2 in a large haemodialysis cohort

Background: Haemodialysis patients represent a unique challenge in the COVID-19 pandemic, balancing infection risk while safely providing life-sustaining haemodialysis. Asymptomatic infection rates in haemodialysis patients are unknown. Aims: 1 - To define rates of asymptomatic swab positivity in a cohort of prevalent haemodialysis patients 2 - To define rates of antibody positivity in patients known to have been historically swab positive 3 - To define rates of antibody positivity in patients without prior symptoms or clinical suspicion of COVID-19 Methods: A programme of COVID-19 screening using a validated nasopharyngeal PCR analysis was carried out across a prevalent cohort of 1253 haemodialysis patients. Concurrently all patients were offered antibody testing for Anti-SARS-CoV-2 IgG/IgM (Roche) and a total of 848 tests were completed. Results: 1 - Routine screening over a 4 week period from 4/5/20 to 1/6/20 confirmed 7 cases of asymptomatic swab positivity (0.6%). 2 - In our cohort there were 197 confirmed swab positive cases of COVID, and of the 153 survivors 124 were antibody positive (81%). 10 patients were highly clinically suspicious of COVID and managed as such;of those 3 were antibody positive (30%). 3 - Of the remaining swab negative patients who had antibody testing (n=710) 82 were antibody positive (11.5%). Conclusions: In a large inner-city London haemodialysis where the population prevalence of COVID has been high, we demonstrate 1 - low asymptomatic rates of virus carriage at this later stage in the pandemic 2 - significant proportions of swab positive patients seroconverting to be antibody positive 2 - suggestion that 11.5% of patients had previous been asymptomatic carriers and had seroconverted to be antibody positive.

The application of the whirlpool of grief to support experiences of loss in light of the covid-19 pandemic

This paper discusses the use of the ‘Whirlpool of Grief’ which provides a visual method for conceptualising, discussing and understanding loss that may be beneficial as practitioners navigating the impact of the Covid-19 crisis. © 2020, British Psychological Society. All rights reserved.