The moderating role of industry clockspeed on the relation between supply chain integration practices and new product flexibility.

This study assessed the firm's new product flexibility in the recovery phase of COVID-19. Using the theoretical lens of organizational information processing theory, it established the relationship between supply chain integration practices (supply chain planning, internal integration, and supplier involvement) and new product flexibility. It also explained the moderating effect of industry clockspeed on supply chain integration practices and new product flexibility with the help of contingency theory. This study used an online survey method to collect data from plant managers, and we received 256 useable responses. We conducted a confirmatory factor analysis to test the validity and reliability of the scales, and we tested hypotheses using moderated multiple regression technique. The results showed significant positive relationships between supply chain integration practices and new product flexibility. The moderating effects hypotheses showed that industry clockspeed significantly and positively moderated on supply chain planning-new product flexibility and internal integration-new product flexibility links. But it negatively moderated on supplier involvement and new product flexibility. Our study departs from earlier studies in the field that were conducted under normal circumstances. We conducted our study in the recovery phase of COVID-19 in Pakistan, when firms, after fourteen days of complete lockdown, resumed their operations and experienced a new business landscape.

Religious coping, care burden and psychological distress among informal caregivers of COVID-19 patients: Results of a cross-sectional survey in Pakistan.

BACKGROUND: There is a complex relationship between health and religiosity. People may use religion to cope with difficulties and uncertainties in their life - such as induced by the COVID-19 pandemic. AIMS: The purpose of this study is to investigate the relationship between religious coping, care burden and psychological distress among caregivers during COVID-19 in Pakistan. METHOD: We conducted a cross-sectional survey in Pakistan. We used the Religious Coping Scale (RCOPE), Care Burden Scale (CB), and Depression, Anxiety and Stress Scale (DASS-21) to measure psychological stress from 303 caregivers. Data were analyzed using a hierarchical linear regression model for each of the three outcome variables, which are depression, anxiety, and stress. This analysis allows to investigate whether adding variables significantly improves a model's ability to predict the criterion variable. RESULTS: The findings reveal that emotional care burden, physical care burden, negative religious coping, and social care burden explain a significant amount of the variance of three components of psychological distress among caregivers. CONCLUSIONS: Health experts, psychologists, and policymakers can make better strategies to combat pandemics like COVID-19 by incorporating religious coping methods.

Genetic analysis of ACE2 peptidase domain in SARS-CoV-2-positive and SARS-CoV-2-negative individuals from Pakistan.

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19) has emerged as a serious public health emergency of global concern. Angiotensin converting enzyme 2 (ACE2) peptidase domain is important for the cellular entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Germline variants in ACE2 peptidase domain may influence the susceptibility for SARS-CoV-2 infection and disease severity in the host population. ACE2 genetic analysis among Caucasians showed inconclusive results. This is the first Asian study investigating the contribution of ACE2 germline variants to SARS-CoV-2 infection in Pakistani population. METHODS: In total, 442 individuals, including SARS-CoV-2-positive (n = 225) and SARS-CoV-2-negative (n = 217) were screened for germline variants in ACE2 peptidase domain (exons 2, 3, 9, and 10) using high resolution melting and denaturing high-performance liquid chromatography analyses followed by DNA sequencing of variant fragments. The identified variant was analyzed by in silico tools for potential effect on ACE2 protein. RESULTS: A missense variant, p.Lys26Arg, was identified in one SARS-CoV-2-positive (1/225; 0.4%) and three SARS-CoV-2-negative (3/217; 1.4%) individuals. No significant difference in the minor allele frequency of this variant was found among SARS-CoV-2-positive and SARS-CoV-2-negative individuals (1/313; 0.3% versus 3/328; 0.9%; P = 0.624), respectively. The SARS-CoV-2-positive patient carrying p.Lys26Arg showed mild COVID-19 disease symptoms. It was predicted as benign variant by in silico tool. No variant was detected in ACE2 residues important for binding of SARS-CoV-2 spike protein. CONCLUSION: The p.Lys26Arg variant may have no association with SARS-CoV-2 susceptibility in Pakistani population. Whole ACE2 gene screening is warranted to clarify its role in SARS-CoV-2 infection.

Beyond heroism: a qualitative study on the lived experiences of nurses caring for patients with COVID-19 in Pakistan.

BACKGROUND: Healthcare professionals around the globe suffered severely during the COVID-19 pandemic. The present study aims to explore the lived experiences of nurses caring for COVID-19 patients in Pakistan. METHODS: The study is a qualitative exploration of the lived experiences caring for patients with COVID-19 in Pakistan. This research was conducted in two government hospitals there. Face-to-face in-depth interviews were conducted amongst 30 nurses who had been selected using purposive sampling technique. Thematic analysis was applied to extract the themes from respondents' answers. RESULTS: By using thematic analysis, social response, impacts on physical and mental health, and experience of handling COVID-19 patients were extracted as major themes. CONCLUSIONS: The findings of this research are of immense importance in showing the impact of COVID-19 on mental and physical health, along with the social and personal consequences for nurses providing care to COVID-19 patients.

Interventions and outcomes of COVID-19 patients in a community hospital-A single center study comparing the first and second waves.

BACKGROUND: We have had 3 coronavirus-related pandemics in the last two decades. Each has brought significant toll and with each case there was no cure. Even as vaccines have been developed for the current strain of the virus thereby increasing the prospects of bringing transmissions in communities to a minimum, lessons from this pandemic should be explored in preparation for future pandemics. Other studies have looked at differences in characteristics of patients and mortality rates between the first two waves. In our study we not only identify the differences in outcomes but also explore differences in hospital specific interventions that were implemented at Jersey City Medical Center, NJ, a community-based hospital. AIM: The aim of this study is to assess the differences between the first two waves of the COVID -19 pandemic in terms of management and outcomes to help identify any key lessons in the handling of future pandemics. We compared the population demographics, interventions and outcomes used during the first two waves of COVID-19 in a community-based hospital. METHODS: This is a retrospective single-center cross-sectional study including Laboratory confirmed COVID-19 patients requiring oxygen supplementation admitted at Jersey City Medical Center during the first wave (April 1 to June 30, 2020) and the second wave between (October 1, 2020, and January 1, 2021). The Chi-squared test was used to assess the relationship between categorical variables and the T- test for continuous variables. A Logistic regression model was built comparing the second to the first wave while accounting for important covariates. RESULTS: There was a combined total of 473 patients from both waves. Patients in the first wave were older (66.17 years vs 60.38 years, p <0.01), had more comorbidities (2.75 vs 2.29, p 0.003), had more severe disease (50% vs 38.78% p of 0.002), had a longer length of stay (14.18 days vs 8.77 days, p <0.001) and were more likely to be intubated (32.49% vs 21.9 4%, p 0.01). In the univariate model, the odds of mortality in the second wave compared to the first wave was 0.63 (CI, 0.41-0.96) and 1.73 (CI, 0.65-4.66) in the fully adjusted model. CONCLUSION: Overall, there was no statistically significant difference in mortality between the two waves. Interventions that were noted to be significantly different between the two waves were, increased likelihood of mechanical intubation in the first wave and increased use of steroids in the second wave compared to the first.

Optimal urban planning through the best–worst method: bicycle lanes in Palermo, Sicily

Since 2020, due to the Covid-19 pandemic, planners and designers have proposed numerous changes for urban spaces and mobility concepts to comply with governments' anti-contamination restrictions. Several European cities have implemented strategies for developing cycling, favouring the design of temporary (pop-up) or permanent cycle lanes and state incentives to purchase bicycles and electric micro-mobility vehicles. However, existing research suggests that design optimisation must pursue specific geometric, functional and safety standards for cyclists and space sharers (pedestrians/cars). It is thus necessary to analyse the perceptions of citizens and commuters for optimisation of the planning and design of these infrastructures. A multi-criteria evaluation was used to determine optimal infrastructure schemes (temporary and permanent) for the metropolis of Palermo in Sicily, Italy. First, three groups of cyclists (citizens, technicians and commuters) were selected. Then, applying the best-worst method, a series of design alternatives were evaluated by the target groups. The results showed a correlation between different types of users in terms of those who live in the city compared with commuters in the city for the first time. The results of this work lay the foundation for improved planning and design strategies in sustainable urban mobility plans and the Italian Biciplan guidelines.

Profiling of phthalates, brominated, and organophosphate flame retardants in COVID-19 lockdown house dust; implication on the human health.

In this study, brominated flame retardants (BFRs), phthalates, and organophosphate flame retardants (PFRs) were analyzed in indoor household dust collected during the COVID-19 related strict lockdown (April-July 2020) period. Floor dust samples were collected from 40 households in Jeddah, Saudi Arabia. The levels of most of the analyzed chemicals were visibly high and for certain chemicals multifold high in analyzed samples compared to earlier studies on indoor dust from Jeddah. Bis (2-ethylhexyl) phthalate (DEHP) was the primary chemical in these dust samples, with a median concentration of 769,500 ng/g of dust. Tris (2-butoxy ethyl) phosphate (TBEP) and Decabromodiphenyl ether (BDE 209) contributed the highest among PFRs and BFRs with median levels of 5990 and 940 ng/g of dust, respectively. The estimated daily exposure in the worst case scenario (23,700 ng/kg bw/day) for Saudi children was above the reference dose (20,000 ng/kg bw/day) for DEHP, and the hazardous index (HI) was also >1. The long-term carcinogenic risk was above the 1 × 10-5, indicating a risk to the health of Saudi young children from getting exposed to DEHP from indoor dust. This study draws attention to the increased indoor pollution during the lockdown period when all of the daily activities by adults and children were performed indoors, which negatively impacted human health, as suggested by the calculated risk. However, the current study has limitations and warrants more monitoring studies from different parts of the world to understand the phenomenon. At the same time, this study also highlights another side of COVID-19 related to our lives.

Implementation of Omni-D Tele-Presence Robot Using Kalman Filter and Tricon Ultrasonic Sensors

The tele-presence robot is designed to set forth an economic solution to facilitate day-to-day normal activities in almost every field. There are several solutions to design tele-presence robots, e.g., Skype and team viewer, but it is pretty inappropriate to use Skype and extra hardware. Therefore, in this article, we have presented a robust implementation of the tele-presence robot. Our proposed omnidirectional tele-presence robot consists of (i) Tricon ultrasonic sensors, (ii) Kalman filter implementation and control, and (iii) integration of our developed WebRTC-based application with the omnidirectional tele-presence robot for video transmission. We present a new algorithm to encounter the sensor noise with the least number of sensors for the estimation of Kalman filter. We have simulated the complete model of robot in Simulink and Matlab for the tough paths and critical hurdles. The robot successfully prevents the collision and reaches the destination. The mean errors for the estimation of position and velocity are 5.77% and 2.04%. To achieve efficient and reliable video transmission, the quality factors such as resolution, encoding, average delay and throughput are resolved using the WebRTC along with the integration of the communication protocols. To protect the data transmission, we have implemented the SSL protocol and installed it on the server. We tested three different cases of video resolutions (i.e., 320×280, 820×460 and 900×590) for the performance evaluation of the video transmission. For the highest resolution, our TPR takes 3.5 ms for the encoding, and the average delay is 2.70 ms with 900 × 590 pixels.

A Modified Iterative Algorithm for Numerical Investigation of HIV Infection Dynamics

The human immunodeficiency virus (HIV) mainly attacks CD4+ T cells in the host. Chronic HIV infection gradually depletes the CD4+ T cell pool, compromising the host’s immunological reaction to invasive infections and ultimately leading to acquired immunodeficiency syndrome (AIDS). The goal of this study is not to provide a qualitative description of the rich dynamic characteristics of the HIV infection model of CD4+ T cells, but to produce accurate analytical solutions to the model using the modified iterative approach. In this research, a new efficient method using the new iterative method (NIM), the coupling of the standard NIM and Laplace transform, called the modified new iterative method (MNIM), has been introduced to resolve the HIV infection model as a class of system of ordinary differential equations (ODEs). A nonlinear HIV infection dynamics model is adopted as an instance to elucidate the identification process and the solution process of MNIM, only two iterations lead to ideal results. In addition, the model has also been solved using NIM and the fourth order Runge–Kutta (RK4) method. The results indicate that the solutions by MNIM match with those of RK4 method to a minimum of eight decimal places, whereas NIM solutions are not accurate enough. Numerical comparisons between the MNIM, NIM, the classical RK4 and other methods reveal that the modified technique has potential as a tool for the nonlinear systems of ODEs.

Diagnostic bias during the COVID-19. A rare case report of salmonella typhi.

INTRODUCTION: In poor countries, due to the limited resources, mostly they prescribe medications without proper diagnosis. The aim of this report is to show diagnostic bias of COVID-19 case. CASE PRESENTATION: A 17-year-old male patient was presented to the Hospital with a fever up to 39 °C associated with rigor, sweating, generalized body pain, myalgia, fatigue, loss of appetite, headache, and multiple joint pain with no swelling and redness. The vital signs were steady on physical examination, except temperature which was 39 °C. The chest was clear, and the pulse rate was 90 beats per minute. The heart rate relative bradycardia and lungs were normal. Both a PCR test for COVID-19, and a viral assay ELISA were negative. After further investigations, the culture findings revealed the strong development of Gram-negative coccobacilli (Salmonella serotype Typhi) bacteria under the microscope, which was confirmed by using VITEK 2 to identify it. and treated with ciprofloxacin tab, two times per day for five days and amikacin ampule 500 mg IV every 24 hours for 10 days. DISCUSSION: Fever is a well-known sign of COVID-19 infection which has been observed in 83%-98% of patients with COVID19. As a result, it may be difficult to tell the difference between COVID-19 and other febrile infections, causing delays in diagnosis and treatment and may blind the physician from considering other febrile illnesses. CONCLUSION: Physicians should construct more comprehensive differential diagnoses for people who experience fever, headache, or myalgia symptoms that are linked to a pandemic. COVID-19.

The COVID-19 pandemic in Indonesia: Problems identification and solutions for micro small and medium enterprises (MSMEs)

Strategic issues regarding the development of Micro Small and Medium Enterprises (MSMEs) need to get significant attention from the government to develop and be more competitive with other economic actors. Various MSME development policy agendas do not have a comprehensive and implementable program to build a solid MSME sector. This study aims to identify the obstacles and solutions faced by (MSMEs) during the COVID-19 Pandemic. This research method is a qualitative method with media analysis using steps coding content using NVivo software as the analytical tool. The research findings show that development capital marketing products and technology are the main problems faced by MSMEs to survive amid the COVID-19 pandemic. MSMEs solutions include creative economy accessing capital loan restructuring facility digital marketing digital marketing training human resource capacity online business and credit facilities. Keywords: SMEs, COVID-19 pandemic, NVivo software

Laboratory biosafety measures of SARS-CoV-2 at containment level 2 with particular reference to its more infective variants.

The novel betacoronavirus (Severe Acute Respiratory Syndrome Coronavirus 2, SARS-CoV-2) is a pathogen that causes deadly respiratory disease named coronavirus disease 2019 (COVID-19). The incidence of this disease has increased in the last few months affecting 257,832,881 people in 221 countries and 51,68,069 deaths worldwide according to Worldometer at 04:03 GMT on November 22, 2021. Thus, the emergence of this disease creates a challenge for health care providers in handling this pathogen and reducing its risk of transmission. In developing countries, this virus is treated in biosafety level 2 laboratories, where a high concentration of pathogen can easily affect the laboratory staff and cause the spread of this disease. Based on the epidemiology and characteristics of the SARS-CoV-2 virus already discussed in recent studies, we will provide biosafety guidelines and suggestions for safe handling and transportation of the SARS-CoV-2 virus in dealing with the current pandemic situation with a focus on increased infectivity of emerging new variants.

Pneumatocele formation following COVID-19 pneumonia. Is there a role for surgical intervention?

COVID-19 mainly causes a lower respiratory tract illness, meaning there has been great interest in the chest and lung radiological findings seen during the course of the disease. Most of this interest has centred around the computed tomographic findings. Most commonly, computed tomographic images report ground-glass opacities but a less common finding, and potential complication associated with COVID-19, is pneumatocele formation. In this case series, we describe the presentation and management of three patients with large pneumatoceles that developed during the recovery phase of COVID-19. A conservative approach is most recommended, with surgical intervention reserved for complicated cases that cause cardiorespiratory compromise.

Temperature, humidity and outdoor air quality indicators influence COVID-19 spread rate and mortality in major cities of Saudi Arabia.

There is an increasing evidence that meteorological (temperature, relative humidity, dew) and air quality indicators (PM2.5, PM10, NO2, SO2, CO) are affecting the COVID-19 transmission rate and the number of deaths in many countries around the globe. However, there are contradictory results due to limited observations of these parameters and absence of conclusive evidence on such relationships in cold or hot arid tropical and subtropical desert climate of Gulf region. This is the first study exploring the relationships of the meteorological (temperature, relative humidity, and dew) and air quality indicators (PM10,CO, and SO2) with daily COVID-19 infections and death cases for a period of six months (1st March to August 31, 2020) in six selected cities of the Kingdom of Saudi Arabia by using generalized additive model. The Akaike information criterion (AIC) was used to assess factors affecting the infections rate and deaths through the selection of best model whereas overfitting of multivariate model was avoided by using cross-validation. Spearman correlation indicated that exponentially weighted moving average (EWMA) temperature and relative humidity (R > 0.5, P < 0.0001) are the main variables affecting the daily COVID-19 infections and deaths. EWMA temperature and relative humidity showed non linear relationships with the number of COVID-19 infections and deaths (DF > 1, P < 0.0001). Daily COVID-19 infections showed a positive relationship at temperature between 23 and 34.5 °C and relative humidity ranging from 30 to 60%; a negative relationship was found below and/or above these ranges. Similarly, the number of deaths had a positive relationship at temperature ˃28.7 °C and with relative humidity ˂40%, showing higher number of deaths above this temperature and below this relative humidity rate. All air quality indicators had linear relationships with the number of COVID-19 infections and deaths (P < 0.0001). Hence, variation in temperature, relative humidity and air pollution indicators could be important factors influencing the COVID-19 spread and mortality. Under the current scenario with rising temperature and relative humidity, the number of cases is increasing, hence it justifies an active government policy to lessen COVID-19 infection rate.

Comparison of Colorectal Cancer Surgery Services During COVID-19 First Wave With Pre-COVID Time.

Introduction The first confirmed case of COVID-19 in the United Kingdom (UK) was reported on 29 January 2020. The country saw the peak of infection between March and May of 2020. The result was a change in the practice of how we treat most surgical conditions including cancer. We continued providing service to our colorectal cancer patients at a District General Hospital. The aim of this study was to compare our provision of colorectal cancer service during the peak of the pandemic to that of the pre-COVID time in our hospital.  Methods We collected data of all colorectal cancer patients who underwent surgery between 1 March 2020 and 30 April 2020 in our hospital. The comparative data were collected for similar patients during the same time frame in 2019. A detailed data set was compiled on Microsoft Excel (Microsoft Corp, Washington) and analysed using IBM SPSS Statistics for Windows, Version 21.0 (Released 2012. IBM Corp, Armonk, NY). Results The two groups were comparable in demographics including age, BMI, gender, and Charlson comorbidity index. Time from decision- to-treat to surgery, post-operative HDU/ITU stay, and overall length of stay was shorter in the COVID group than the Pre-COVID group without any significant statistical difference. There was no statistically significant difference between the two groups in Calvien-Dindo complications grade 1 and 2. No mortality was reported due to direct or indirect consequences of COVID-19 infection. More open procedures were performed in our department during the first wave of COVID-19 in the UK compared to Pre-COVID time. Conclusions Despite the challenges we faced during the peak of the COVID-19 pandemic, we managed to provide standard care to our colorectal cancer patients with comparable post-operative surgical and oncological outcomes.

Quality of acute myocardial infarction care in England and Wales during the COVID-19 pandemic: linked nationwide cohort study.

BACKGROUND AND OBJECTIVE: The impact of the COVID-19 pandemic on the quality of care for patients with acute myocardial infarction (AMI) is uncertain. We aimed to compare quality of AMI care in England and Wales during and before the COVID-19 pandemic using the 2020 European Society of Cardiology Association for Acute Cardiovascular Care quality indicators (QIs) for AMI. METHODS: Cohort study of linked data from the AMI and the percutaneous coronary intervention registries in England and Wales between 1 January 2017 and 27 May 2020 (representing 236 743 patients from 186 hospitals). At the patient level, the likelihood of attainment for each QI compared with pre COVID-19 was calculated using logistic regression. The date of the first national lockdown in England and Wales (23 March 2020) was chosen for time series comparisons. RESULTS: There were 10 749 admissions with AMI after 23 March 2020. Compared with before the lockdown, patients admitted with AMI during the first wave had similar age (mean 68.0 vs 69.0 years), with no major differences in baseline characteristics (history of diabetes (25% vs 26%), renal failure (6.4% vs 6.9%), heart failure (5.8% vs 6.4%) and previous myocardial infarction (22.9% vs 23.7%)), and less frequently had high Global Registry of Acute Coronary Events risk scores (43.6% vs 48.6%). There was an improvement in attainment for 10 (62.5%) of the 16 measured QIs including a composite QI (43.8% to 45.2%, OR 1.06, 95% CI 1.02 to 1.10) during, compared with before, the lockdown. CONCLUSION: During the first wave of the COVID-19 pandemic in England and Wales, quality of care for AMI as measured against international standards did not worsen, but improved modestly.

Clinical Characteristics of COVID-19-Infected Cancer Patients in Pakistan: Differences Between Survivors and Non-Survivors.

BACKGROUND: Cancer patients are considered as highly vulnerable individuals in the current COVID-19 pandemic. We studied the clinical characteristics of survivor and non-survivor COVID-19-infected cancer patients in Pakistan. PATIENTS AND METHODS: We did a retrospective study of 70 cancer patients with PCR-confirmed COVID-19 infection from Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore and Peshawar, Pakistan between April 13 and July 09, 2020. These patients were discharged from the hospital or had died by July 09, 2020. Clinical, pathological and radiological characteristics were compared between survivors and non-survivors by fisher's exact test and chi-square test. Univariable and multivariable logistic regression models were performed to explore the risk factors of mortality. RESULTS: Seventy cancer patients with SARS-CoV-2 infection were enrolled and the majority were males 38 (54.3%). 57 (81.4%) had solid tumors and 13 (18.6%) had hematological malignancies. Dyspnea (44 cases) was the most common symptom (62.9%). Complications were reported in 51 (72.9%) patients during the course of disease. 19 (27.1%) patients were admitted to an intensive care unit (ICU). A significant increase in the C-reactive protein level and neutrophil count was observed in the deceased patients as compared to the surviving patients. D-dimer values of ≥0.2 mg/L were significantly associated with mortality (P=0.01). We identified two independent risk factors associated with death, ICU admission (P=0.007) and D-dimer (P=0.003). CONCLUSION: Pakistani cancer patients with COVID-19 infection reported poor prognosis. Intensive surveillance of clinicopathological characteristics of cancer patients infected with COVID-19 especially D-dimer values may play a pivotal role in the outcome of the disease.

Substantial decline in hospital admissions for heart failure accompanied by increased community mortality during COVID-19 pandemic.

AIMS: We hypothesized that a decline in admissions with heart failure during COVID-19 pandemic would lead to a reciprocal rise in mortality for patients with heart failure in the community. METHODS AND RESULTS: We used National Heart Failure Audit data to identify 36 974 adults who had a hospital admission with a primary diagnosis of heart failure between February and May in either 2018, 2019, or 2020. Hospital admissions for heart failure in 2018/19 averaged 160/day but were much lower in 2020, reaching a nadir of 64/day on 27 March 2020 [incidence rate ratio (IRR): 0.40, 95% confidence interval (CI): 0.38-0.42]. The proportion discharged on guideline-recommended pharmacotherapies was similar in 2018/19 compared to the same period in 2020. Between 1 February-2020 and 31 May 2020, there was a 29% decrease in hospital deaths related to heart failure (IRR: 0.71, 95% CI: 0.67-0.75; estimated decline of 448 deaths), a 31% increase in heart failure deaths at home (IRR: 1.31, 95% CI: 1.24-1.39; estimated excess 539), and a 28% increase in heart failure deaths in care homes and hospices (IRR: 1.28, 95% CI: 1.18-1.40; estimated excess 189). All-cause, inpatient death was similar in the COVID-19 and pre-COVID-19 periods [odds ratio (OR): 1.02, 95% CI: 0.94-1.10]. After hospital discharge, 30-day mortality was higher in 2020 compared to 2018/19 (OR: 1.57, 95% CI: 1.38-1.78). CONCLUSION: Compared with the rolling daily average in 2018/19, there was a substantial decline in admissions for heart failure but an increase in deaths from heart failure in the community. Despite similar rates of prescription of guideline-recommended therapy, mortality 30 days from discharge was higher during the COVID-19 pandemic period.