The Psychological Implications of COVID-19: A Mental Health Perspective

This planet has witnessed several pandemics earlier in its history. The last pandemic, Spanish flu which was far more deadly, happened about a century ago and apart from a few centenarians, nobody who is alive today has any experience of living during the time of pandemic. COVID-19 discovered about 9 months back has reached almost every continent and country. With around 29 million known COVID-19 infected people, about a million deaths and with billions are affected due to quarantines, lockdowns, and restrictions on movement of person and goods, and social distancing measures. This has resulted in adversities and hardships in the areas such as financial, employment, school, family, and health. All these directly affect the mental health and well-being of an affected individual as well as their family members. Some of the common mental health conditions observed are anxiety about coronavirus infection, and worries about stigma, well-being, and future of the family members. In addition, the prevailing situation has further worsened people with already existing mental health conditions, such as inability to consult the mental health professionals due to COVID safety measures and fear of contamination in the mental health institutions. To mitigate mental health issues and to improve psychosocial well-being, NIMHANS, with the help of the government and other institutions, adopted several measures, such as creating IEC materials for the general public, counseling people who are quarantined, and starting a national telephone free helpline. This chapter will discuss the efficacy of online counseling, related issues, experiences, lessons learned and offer suggestions for the future. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Taylor and Francis Pte Ltd. 2022.

Increased diagnosis of diabetes in secondary care: Is Covid-19 the only reason?

Aim: To evaluate the prevalence of new diabetes in secondary care during the second wave of the Covid-19 pandemic. Method(s): Data were collected prospectively for patients presenting to the hospital with new diagnosis of diabetes from December 2020 to May 2021. It included demographics, risk factors, presenting glucose, other investigations and treatment. Result(s): In the six-month study period, 31 patients were diagnosed with new diabetes. Thus far, approximately 13 patients have been identified to have type 1 diabetes and the average age was 37 years. Everyone was discharged with insulin except one patient. Prior to the pandemic in the year 2019, only 17 patients were diagnosed with diabetes in the hospital. Conclusion(s): The lockdown led to a reduction in physical activity and varied diet which may have contributed to weight gain;worsening insulin resistance. It is plausible that severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) could trigger autoimmune type 1 diabetes or accelerate its presentation. Together with a hesitancy for patients to seek medical attention and reduced access to face-to- face primary care consultations, this may have contributed to the increased presentation of diabetes-related emergencies and reduction in symptomatic hyperglycaemia. Various studies found patients with pre-existing diabetes have a worse outcome if they develop Covid-19. Overall, during the pandemic, physical and mental health worsened, pre-disposing to medical conditions and impacting self-management of health and disease. We predict the increase in new diagnoses of diabetes in secondary care is multifactorial due to the effects of the pandemic rather than Covid-19 infection solely.

Is a hybrid skin cancer surveillance service for organ transplant recipients feasible? Lessons from the pandemic

Organ transplant recipients (OTRs) are highly vulnerable to SARS-CoV-2 infection and routine transplant consultations were converted primarily to virtual (VC) rather than face to face (F2F) from the outset of the pandemic. A similar strategy was adopted in our tertiary OTR dermatology clinic, but the implications of this on safe and effective skin cancer surveillance are uncertain. We audited clinical and patient experiences of our hybrid service with the aim of identifying the benefits and limitations of this approach, and improvements required to optimize a future hybrid VC-F2F model for skin cancer surveillance. All OTRs consultations held between 1 April 2020 to 31 March 2021 were identified through electronic patient records. Data collected included proportions and reasons for VC and F2F consultations, teledermatology requests, VC to F2F conversion rate, rates of skin cancer diagnoses and adherence to established follow-up protocols. All patients were invited to complete an online service evaluation. In total, 554 encounters (80.3% VC, 19.7% F2F) were recorded in 247 OTRs (42% with previous skin cancer). Of routine F2F consultations, this was patient preference in 17 of 109 (16%) and clinician-based risk assessment for the remainder. In 108 (25%) VCs, photographs were requested and received for 63%, of which 82% were adequate for diagnosis. Overall, 12% of VCs were converted to F2F and in 19 of 45 (42%) OTRs this was due to suspected skin cancer, which was confirmed in nine of 19 (47%). All other skin cancers were diagnosed in routine F2F consultations. Surveillance in 167 of 192 (87%) assessable OTRs adhered to established follow-up protocols. Of patients who responded to the online survey, 74% felt that there were benefits to VCs, but 41% expressed concern about the lack of skin examination and 57% reported little/no confidence in self-monitoring. Despite this, 59% expressed a preference to continue hybrid VC-F2F surveillance, with VC as routine and F2F consultation when required. Our audit provides preliminary evidence supporting the effectiveness, safety and patient acceptability of a VC-F2F hybrid model for the delivery of OTR skin cancer surveillance. We did not identify major delays in skin cancer diagnosis, although not all patients have yet been seen F2F. Certain aspects of service delivery will require optimization. In particular, despite routine skin cancer education, many patients expressed concerns about self-monitoring. Programmes specifically tailored to address this need will be required, as will information technology support for some OTRs. With this information we are redesigning our service to incorporate a VC-F2F model for routine skin cancer surveillance and are evaluating the incorporation of a patient-initiated follow-up pathway.

THE NATIONAL CENSUS OF UK ENDOSCOPY SERVICES 2021

Introduction The Joint Advisory Group (JAG) on Gastrointestinal (GI) Endoscopy biennial census provides an insight into the provision of UK endoscopy services. We report on the 2021 census which was conducted to understand the impact of COVID-19 and ongoing pressures on endoscopy services. Methods The census was disseminated to all JAG-registered services in April 2021 using an online survey platform. Prior to analysis, any missing data from services was sought as part of a second step verification process. Data were analysed across the domains of endoscopic activity, waiting time targets, workforce, COVID-19, safety, GI bleeding, anaesthetic support, equipment and decontamination. Outcome variables from each section of the census were analysed against independent variables derived from service-specific core demographic data (JAG accreditation status, sector and region) using a variety of statistical methods. Results Overall, 321 services completed the census, with information pertaining to 393 individual units (response rate 79.2%). In 2020, just over 1.5 million endoscopic procedures were performed across all services. In the first 3 months of 2021, 66% of services met urgent cancer waits, 38.7% met routine waits and 33.9% met surveillance waits (Figure 1). Workforce redeployment was the predominant reason cited for not meeting targets. There were significant regional differences in the proportion of patients waiting 6 or more weeks (p = 0.001). During the pandemic, 64.8% of NHS services had staff redeployed and there was a mean sickness rate of 8.5% with no clear variation across sectors or regionally. Endoscopic activity was outsourced to the private sector in 21.6% of services. Services were, on average, at 79.3% activity compared to 2 years ago. JAG accredited services are more likely to meet urgent cancer waits, with a lower proportion of patients waiting 6 weeks or more (p = 0.03). Clinical endoscopists, who make up 11% of the endoscopist workforce, have a significantly greater number of annual planned sessions per individual than consultant colleagues, who make up 75% of the workforce. Over 10% of services stated that equipment shortage interferes with service delivery. Conclusions Services are adapting to continued pressure and there are signs of a focussed response to demand during a time of ongoing uncertainty. These findings will inform ongoing guidance from JAG and relevant stakeholders.

A Performance Study on Emotion Models Detection Accuracy in a Pandemic Environment

This paper studies emotion detection using deep learning on the prevalent usage of face masks in the Covid-19 pandemic. Internet repository data Karolinska Directed Emotional Faces (KDEF) [1] was used as a base database, in which it was segmented into different portions of the face, such as forehead patch, eye patch, and skin patch to be representing segments of the face covered or exposed by the mask were transfer learned to an Inception v3 model. Results show that the full-face model had the highest accuracy 74.68% followed by the skin patch (area occluded by the mask) 65.09%. The models trained on full-face were then used to inference the different face segments/patches that showed poor inferencing results. However, certain emotions are more distinct around the eye region. Therefore, this paper concludes that upper segmented faces result in higher accuracy for training models over full faces, yet future research needs to be done on additional occlusion near the eye section. © 2021, Springer Nature Switzerland AG.

Opsoclonus-Myoclonus-Ataxia syndrome (OMAS) associated with SARS-CoV-2 infection: Post-infectious neurological complication with benign prognosis

Objective: Etiology of Opsoclonus-Myoclonus Syndrome (OMAS) is multifactorial. This is a case of OMAS secondary to SARS-CoV-2 infection, and the clinical presentation suggests a postinfectious mechanism, possibly antibody-mediated. This case was seen on March 2020, at the beginning of this pandemic, and becomes a novel condition of the COVID-19 infection. Background: SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) is the cause of the COVID-19 pandemic. Reports from China have described ataxia and tremor as neurological symptoms of SARS-CoV-2 infection, but no OMAS. Opsoclonus is a rare phenomenon of combined multidirectional, involuntary, arrhythmic and chaotic saccadic oscillations, without an intersaccadic interval;myoclonus refers to brief, involuntary, irregular muscle contractions. Design/Methods: We describe a novel case of post-infectious OMAS with benign prognosis. Results: A 32 year-old man presented with cough, fever, weakness, and loss of appetite. He denied changes in smell or taste. His father had similar symptoms 5 days earlier, and both tested positive for SARS-CoV-2. He developed increasing fatigue and dyspnea, but denied wheezing or chest tightness. He had watery, non-bloody diarrhea throughout the febrile period, until his cough improved and he became afebrile 11 days after diagnosis. On day 12 he developed "tremors" and ataxia;the former confirmed as myoclonus on exam 2 days later. While hospitalized on days 17 to 20, evaluation revealed a chest X-ray consistent with viral pneumonia, and normal brain MRI. IgG antibodies were positive. Opsoclonus, myoclonus and ataxia (Videos 1 and 2) caused inability to ambulate without assistance. Initial treatment was effective and he was able to walk short distances without assistance. Telehealth follow-up on day 24 demonstrated substantial improvement of gait and balance (Video 3). No opsoclonus was observed, and he demonstrated only very mild ataxia and occasional myoclonus. Conclusions: This is a novel relation with SARS-CoV-2 infection, and needs to be included in the differential diagnosis .