Producing Official Statistics During the COVID-19 Pandemic

This chapter provides some international case studies of responding to COVID-19 to mitigate risks to business surveys and economic statistics. The case studies include impacts on the statistical business register, maintaining response rates, the classification and statistical implementation of COVID-19 Government policies, seasonal adjustment, and trend estimation. © 2023 John Wiley and Sons, Inc. All rights reserved.

Prognostic peripheral blood biomarkers at ICU admission predict COVID-19 clinical outcomes.

The COVID-19 pandemic continues to challenge the capacities of hospital ICUs which currently lack the ability to identify prospectively those patients who may require extended management. In this study of 90 ICU COVID-19 patients, we evaluated serum levels of four cytokines (IL-1ß, IL-6, IL-10 and TNFα) as well as standard clinical and laboratory measurements. On 42 of these patients (binned into Initial and Replication Cohorts), we further performed CyTOF-based deep immunophenotyping of peripheral blood mononuclear cells with a panel of 38 antibodies. All measurements and patient samples were taken at time of ICU admission and retrospectively linked to patient clinical outcomes through statistical approaches. These analyses resulted in the definition of a new measure of patient clinical outcome: patients who will recover after short ICU stays (< 6 days) and those who will subsequently die or recover after long ICU stays (≥6 days). Based on these clinical outcome categories, we identified blood prognostic biomarkers that, at time of ICU admission, prospectively distinguish, with 91% sensitivity and 91% specificity (positive likelihood ratio 10.1), patients in the two clinical outcome groups. This is achieved through a tiered evaluation of serum IL-10 and targeted immunophenotyping of monocyte subsets, specifically, CD11clow classical monocytes. Both immune biomarkers were consistently elevated ( ≥15 pg/ml and ≥2.7 x107/L for serum IL-10 and CD11clow classical monocytes, respectively) in those patients who will subsequently die or recover after long ICU stays. This highly sensitive and specific prognostic test could prove useful in guiding clinical resource allocation.

A Traumatic Pandemic: High Acuity Pediatric Trauma in the Covid-19 Era

Purpose of study COVID-19 has shifted the utilization of health care resources. Gaps remain in our understanding on how COVID-19 affects trends in pediatric trauma, the leading cause of mortality and morbidity during childhood and adolescence. We identified trends in the numbers and types of traumas presenting to a Level 1 Pediatric Trauma Center during the COVID-19 pandemic compared to prior years. Methods used We compared high acuity trauma visits (defined as traumas requiring admission, emergent surgical intervention or resulting in a fatality) presenting between January 1st and August 31st, 2020 to corresponding months in 2017-2019. We also evaluated the changes in mechanisms of injury during this time period. Data were analyzed using longitudinal time series analyses and t-tests. Summary of results Of 480 traumas presenting from January to August 2020, 227 (47.3%, 95%CI 42.7%-51.9%) were high acuity traumas. High acuity traumas declined significantly, as a state of emergency was declared, to a nadir of 16 in April 2020 (compared to the 2017-2019 mean of 38.3, p<0.001). As restrictions were lifted, high acuity traumas increased and surpassed previous years to a peak of 40 visits in August 2020 (2017-2019 mean 35.7, p<0.001). High acuity traumas as a proportion of total Emergency Department visits were higher from March to August 2020 compared to prior years (figure 1). There were more visits for high acuity assaults and child abuse but fewer for falls, drownings, and motor vehicle accidents from March to August 2020 compared to prior years, while visits for animal attacks remained stable Conclusions This analysis provides insight into how the COVID-19 pandemic has affected high acuity trauma in an inner-city pediatric population. Findings may be used to guide public health measures on safety and injury prevention as the pandemic continues and further restrictions are debated. (Figure Presented).

Simultaneous Primary Sinonasal Adenocarcinoma and Breast Adenocarcinoma: A Case Report

Sinonasal cancer accounts for roughly only 3% of upper respiratory tract malignancies and generally presents as a primary malignancy. Although extremely rare, the sinonasal cavity is also a known location for metastasis, with 8% of these cases originating from primary breast cancer. When attempting to differentiate primary disease from metastasis, immunohistochemical analyses play a crucial role in reaching the correct diagnosis. To date, there are a handful of reports describing metastasis involving the paranasal sinuses but even fewer reporting primary sinonasal cancer with coexisting primary malignancy. Here we present a case of primary sinonasal adenocarcinoma in the setting of a long-standing history of breast cancer. The patient, a 73-year-old female, was diagnosed with T1cN1aM0, progesterone receptor positive and estrogen receptor negative ductal carcinoma in situ of the left breast in November 2019. She subsequently underwent bilateral mastectomy and treated with 3 cycles of chemotherapy and anastrozole, which were both discontinued due to intolerance. Of note, in March 2019, MRI of the head incidentally found a 3 x 2 cm mass in right nasal cavity extending into ethmoid sinus. One year later, she presented with mild right sided nasal obstruction and drainage, and biopsy revealed squamous and respiratory mucosa with chronic inflammation. The patient elected to cancel initial surgical resection of the mass due to the COVID-19 pandemic. The patient returned in March 2022 with complaints of eye pressure, double vision, headaches, and worsening nasal obstruction. PET/CT scan was negative for distant metastasis but demonstrated increased uptake in sinus cavity. MRI showed a larger 5 x 3.7 cm mass impressing on medial inferior margins of orbit. Imaging also suggested evidence of dehiscence of lamina and irregular neo-osteogenesis of the skull base. She underwent approach and resection of the mass with histology demonstrating a well differentiated, low grade non-intestinal mucinous adenocarcinoma. Immunohistochemistry was positive for pankeratin and CK7, favoring a primary sinonasal origin. It was estrogen receptor negative and negative for GATA3, a sensitive and fairly specific stain in mammary carcinoma. Adjuvant radiation was recommended postoperatively, however the patient declined this therapy. This case highlights the role of immunohistochemistry to discriminate a new primary cancer from metastasis in patients with a history of breast cancer. Clinically, patients with sinonasal metastasis can present with symptoms ranging from unilateral nasal obstruction, facial pain, diplopia, and decreased vision. On imaging, suspicion of malignancy is raised when there is evidence of destruction of bony boundaries and invasion of surrounding tissues such as the orbit and anterior skull base, as found in our patient. Notably, metastasis to the paranasal sinuses can mimic a primary cancer of the nasal cavity, with both tumors showing epithelial differentiation. However, primary tumors often show neoplastic changes in the overlying respiratory epithelium and do not express estrogen receptor, progesterone receptor, or HER2 positivity, which are known to be correlated with breast cancer. In this setting, GATA3 and estrogen receptor negativity allowed us to diagnose primary nasal cancer more confidently. Therefore, clinicians should be aware of metastatic disease and expand immunohistochemistry panels when appropriate.

Bilateral Lung Transplantation With Donor Positive for COVID-19 Infection on Bronchoalveolar Lavage: A Case Report.

Initial experience with lung transplant of COVID-19-positive donors was marked by disappointing results, including a reported case of mortality through donor to recipient transmission of infection. However, since that time a number of improvements in preventative and therapeutic measures against COVID-19 have been developed. We present the case of a 51-year-old woman with scleroderma-associated interstitial lung disease who was awaiting lung transplant. A potential donor with excellent lung physiology was located; however, initial testing on bronchoalveolar lavage (BAL) was positive for COVID-19. The donor had tested positive 2 weeks prior and had symptomatically recovered. Our patient had been fully vaccinated but not seroconverted. Given the history of a donor with recovering COVID infection and a fully immunized recipient, our multidisciplinary team elected to proceed with the transplant. The patient successfully underwent bilateral lung transplant with standard induction immunosuppression. Bebtelovimab was given post-transplant day 1 because the recipient remained seronegative to COVID-19. Serial bronchoalveolar lavages post transplant have been negative for COVID-19. The patient has done well after transplant. She was seen in the clinic 2 months post transplant and is ambulatory without supplemental oxygen requirements. To our knowledge, this represents the first reported successful case of lung transplant with a donor positive for COVID-19 on lower respiratory tract sampling.

WELL-BEING DURING THE COVID-19 PANDEMIC: A FUNCTION OF PERSONALITY, AGE, AND URBANICITY

The COVID-19 pandemic has differentially impacted population sub-groups over the last two years. For example, engagement in social isolation may have been particularly difficult for extroverted adults. The virus spread widely in densely populated regions and is more risky to health with increasing age. This paper explores the ways in which personality, age, and urbanicity are associated with subjective well-being during the pandemic. Longitudinal data from the Health and Retirement Study (N = 4316;M age = 69.0, Range 31 - 99) investigates Big Five personality characteristics from 2016 and interactions with age on life satisfaction and loneliness during the pandemic. Models are then stratified by Beale Rural-Urban Continuum codes denoting urban, suburban, and ex-urban residence. Results indicate the benefit of high conscientiousness on life satisfaction is weaker among older adults (p<.05) and associations of extroversion and age on loneliness are driven by individuals living in urban areas (p<.05).

WELL-BEING DURING THE COVID-19 PANDEMIC: THE ROLES OF DEMOGRAPHICS, PERSONALITY, AND SOCIAL TIES

The COVID-19 pandemic continues to exert widespread impacts on individuals, particularly older adults (Tyrrell & Williams, 2020). This symposium capitalizes on a variety of data sources to advance our understandings of the psychosocial impact of the pandemic on older adults. The first two papers consider the importance of personality characteristics in understanding the effects of social distancing. Fiori et al. highlight the potential for sociability to act as a liability during times of social distancing, finding that sociability exacerbated the effects of social distancing on mental health outcomes in a sample of community-dwelling older adults. Ryan's paper focuses on the Big Five Personality traits, age, and population density as key characteristics explaining differences in subjective well-being during the pandemic. Next, Van Vleet et al. apply a mixed-methods approach to investigate when older adults expect life to go back to normal, finding that expectations about the future became more positive with the passage of time. The final two papers consider the importance of adults' home social context during the pandemic. Newton examines relationships between living alone and well-being outcomes among older Canadian women, finding that perceived COVID-19 impact was significant only at T1 and living alone was linked to poorer well-being by T2. Birditt et al. examine how individuals' and partner's COVID-19 stress and couples' racial composition are related to affective experiences measured via ecological momentary assessments, finding that husbands' stress impacted both partners' well-being, and that associations differed by race. Sherman will lead a discussion to synthesize these new findings.

Nirmatrelvir Resistance in SARS-CoV-2 Omicron_BA.1 and WA1 Replicons and Escape Strategies (preprint)

The antiviral component of Paxlovid, nirmatrelvir (NIR), forms a covalent bond with Cys145 of SARS-CoV-2 nsp5. To explore NIR resistance we designed mutations to impair binding of NIR over substrate. Using 12 Omicron (BA.1) and WA.1 SARS-CoV-2 replicons, cell-based complementation and enzymatic assays, we showed that in both strains, E166V imparted high NIR resistance (~55-fold), with major decrease in WA1 replicon fitness (~20-fold), but not BA.1 (~2-fold). WA1 replicon fitness was restored by L50F. These differences may contribute to a potentially lower barrier to resistance in Omicron than WA1. E166V is rare in untreated patients, albeit more prevalent in paxlovid-treated EPIC-HR clinical trial patients. Importantly, NIR-resistant replicons with E166V or E166V/L50F remained susceptible to a) the flexible GC376, and b) PF-00835231, which forms additional interactions. Molecular dynamics simulations show steric clashes between the rigid and bulky NIR t-butyl and {beta}-branched V166 distancing the NIR warhead from its Cys145 target. In contrast, GC376, through-wiggling and jiggling- accommodates V166 and still covalently binds Cys145. PF-00835231 uses its strategically positioned methoxy-indole to form a beta-sheet and overcome E166V. Drug design based on strategic flexibility and main chain-targeting may help develop second-generation nsp5-targeting antivirals efficient against NIR-resistant viruses.

Biochemical and structural insights into SARS-CoV-2 polyprotein processing by Mpro.

SARS-CoV-2, a human coronavirus, is the causative agent of the COVID-19 pandemic. Its genome is translated into two large polyproteins subsequently cleaved by viral papain-like protease and main protease (Mpro). Polyprotein processing is essential yet incompletely understood. We studied Mpro-mediated processing of the nsp7-11 polyprotein, whose mature products include cofactors of the viral replicase, and identified the order of cleavages. Integrative modeling based on mass spectrometry (including hydrogen-deuterium exchange and cross-linking) and x-ray scattering yielded a nsp7-11 structural ensemble, demonstrating shared secondary structural elements with individual nsps. The pattern of cross-links and HDX footprint of the C145A Mpro and nsp7-11 complex demonstrate preferential binding of the enzyme active site to the polyprotein junction sites and additional transient contacts to help orient the enzyme on its substrate for cleavage. Last, proteolysis assays were used to characterize the effect of inhibitors/binders on Mpro processing/inhibition using the nsp7-11 polyprotein as substrate.

Prognostic peripheral blood biomarkers at ICU admission predict COVID-19 clinical outcomes

The COVID-19 pandemic continues to challenge the capacities of hospital ICUs which currently lack the ability to identify prospectively those patients who may require extended management. In this study of 90 ICU COVID-19 patients, we evaluated serum levels of four cytokines (IL-1β, IL-6, IL-10 and TNFα) as well as standard clinical and laboratory measurements. On 42 of these patients (binned into Initial and Replication Cohorts), we further performed CyTOF-based deep immunophenotyping of peripheral blood mononuclear cells with a panel of 38 antibodies. All measurements and patient samples were taken at time of ICU admission and retrospectively linked to patient clinical outcomes through statistical approaches. These analyses resulted in the definition of a new measure of patient clinical outcome: patients who will recover after short ICU stays (< 6 days) and those who will subsequently die or recover after long ICU stays (≥6 days). Based on these clinical outcome categories, we identified blood prognostic biomarkers that, at time of ICU admission, prospectively distinguish, with 91% sensitivity and 91% specificity (positive likelihood ratio 10.1), patients in the two clinical outcome groups. This is achieved through a tiered evaluation of serum IL-10 and targeted immunophenotyping of monocyte subsets, specifically, CD11clow classical monocytes. Both immune biomarkers were consistently elevated ( ≥15 pg/ml and ≥2.7 x107/L for serum IL-10 and CD11clow classical monocytes, respectively) in those patients who will subsequently die or recover after long ICU stays. This highly sensitive and specific prognostic test could prove useful in guiding clinical resource allocation.

Economic pressures of Covid-19 lockdowns result in increased timber extraction within a critically endangered region: A case study from the Pacific Forest of Ecuador.

Although the COVID-19 lockdowns in 2020 had some environmental benefits, the pandemic's impact on the global economy has also had conservation repercussions, especially in biodiverse nations. Ecuador, which is heavily reliant on petroleum, agricultural exports, and ecotourism, experienced a rise in poverty in response to pandemic shutdowns. In this study, we sought to quantify levels of illegal timber extraction and poaching before and after the start of COVID-19 lockdowns throughout two protected areas (Reserva Jama Coaque [JCR] and Bosque Seco Lalo Loor [BSLL]) in the endangered Pacific Forest of Ecuador. We analyzed chainsaw and gunshot acoustic data recorded from devices installed in the forest canopy from December 2019 to March 2020 and October 2020 to March 2021. Results from generalized linear mixed effects models indicated less chainsaw activity before lockdowns (ßpost.lockdown = 0.568 ± 0.266 SE, p-value = .030), although increased average rainfall also seemed to negatively affect chainsaw activity (ßavg.rainfall = -0.002 ± 0.0006 SE, p-value = .003). Gunshots were too infrequent to conduct statistical models; however, 87% of gunshots were detected during the 'lockdown' period. Observational data collected by rangers from these protected areas also noted an increase in poaching activities beginning mid to late 2020 and persisting into 2021. These results add to the steadily growing literature indicating an increase in environmental crime, particularly in biodiverse nations, catalyzed by COVID-19-related economic hardships. Identifying areas where environmental crime increased during pandemic lockdowns is vital to address both socioeconomic drivers and enforcement deficiencies to prevent further biodiversity loss and disease outbreaks and to promote ecosystem resilience. Our study also demonstrates the utility of passive acoustic monitoring to detect illegal resource extraction patterns, which can inform strategies such as game theory modeling for ranger patrol circuits and placement of real-time acoustic detection technologies to monitor and mitigate environmental crimes.

You Do Not Have to Get through This Alone: Interpersonal Emotion Regulation and Psychosocial Resources during the COVID-19 Pandemic across Four Countries.

While experiencing the unpredictable events of the COVID-19 pandemic, we are likely to turn to people in order to regulate our emotions. In this research, we investigate how this interpersonal emotion regulation is connected to affective symptoms, above and beyond intrapersonal emotion regulation. Furthermore, we explore whether perceived psychosocial resources moderate these associations, i.e., if individuals reporting healthier social connections benefit differently from interpersonal emotion regulation. N = 1401 participants from the USA, UK, Germany, and Switzerland completed an online survey that included text samples. Affective symptoms (depression, adjustment disorder, fear of COVID-19) were examined based on self-reported as well as language-based indicators. As psychosocial resources, we examined social support, loneliness, attachment style, and trust. We defined latent variables for adaptive and maladaptive interpersonal emotion regulation and analyzed how they were associated with affective symptoms controlling for intrapersonal emotion regulation. Further, we analyzed how they interacted with psychosocial resources. Maladaptive interpersonal emotion regulation strategies were associated with affective symptoms. With lower psychosocial resources, the associations between interpersonal emotion regulation and depressive symptoms were more pronounced. The results highlight that maladaptive interpersonal emotion regulation is associated with worse mental health. These effects are not buffered by more psychosocial resources and are stronger for people with low psychosocial resources.

Durable antibody and effector memory T cell responses in breastmilk from women with SARS-CoV-2.

Background: Given that only 25% of pregnant women elect to receive a COVID-19 vaccine, maternal SARS-CoV-2 infection remains an important route of conferring protective passive immunity to breastfed infants of mothers who are not vaccinated. Methods: We enrolled 30 lactating participants between December 2020 and March 2021 who had a positive PCR-test and their first COVID-19 symptoms within the previous 21 days. Participants were asked to provide serial bilateral milk samples at 12 timepoints (~ every 3 days) over a period of 35 days. A second set of samples was collected at least four months after the beginning of the first set. Participants also were asked to provide their dried blood spots and infant stool samples. All samples were tested for receptor-binding domain (RBD)-specific immunoglobulin (Ig)A, IgG, and IgM. Milk samples were assessed for neutralizing ability against the spike protein and four SARS-CoV-2 variants: D614G, Alpha (B.1.1.7), Beta (B.1.351), and Gamma (P.1). Permeability of the breast epithelium was assessed by measuring the sodium to potassium ions (Na:K) in milk. Using flow cytometry, memory CD4 and CD8 T cells (CD45RO+ and CCR7+/-) and mucosal-homing CD4 and CD8 T cells (CD103+) were determined in cells from milk expressed at 35 days and at least 4 months after their first milk donation. Results: Milk antibodies from SARS-CoV-2 positive participants neutralized the spike complex. Milk from 73, 90, and 53% of participants had binding reactivities to RBD-specific IgA, IgG, and IgM, respectively. In contrast to blood spots, which showed increased levels of IgG, but not IgA or IgM, the COVID-19 response in milk was associated with a robust IgA response. Twenty-seven percent of participants had increased breast-epithelium permeability, as indicated by Na:K ≥ 0.6. The percentage of CD45RO+CCR7- effector-memory T cells in the day ≥120 milk samples was significantly higher than day 35 samples (P< 0.05). Conclusions: Antibodies in milk from participants with recent SARS-CoV-2 infection and those who recovered can neutralize the spike complex. For the first time we show that breastmilk T cells are enriched for mucosal memory T cells, further emphasizing the passive protection against SARS-CoV-2 conferred to infants via breastmilk.

CheetahKG: A Demonstration for Core-based Top-k Frequent Pattern Discovery on Knowledge Graphs

Knowledge graphs capture the complex relationships among various entities, which can be found in various real world applications, e.g., Amazon product graph, Freebase, and COVID-19. To facilitate the knowledge graph analytical tasks, a system that supports interactive and efficient query processing is always in demand. In this demonstration, we develop a prototype system, CheetahKG, that embeds with our state-of-the-art query processing engine for the top-k frequent pattern discovery. Such discovered patterns can be used for two purposes, (i) identifying related patterns and (ii) guiding knowledge exploration. In the demonstration sessions, the attendees will be invited to test the efficiency and effectiveness of the query engine and use the discovered patterns to analyze knowledge graphs on CheetahKG. © 2022 IEEE.

Poisoning-related Pediatric Emergency Department Visits During the COVID-19 Pandemic at Three Mid-atlantic Hospitals

Background: The COVID-19 pandemic restructured daily life for children and adolescents in the United States and may have altered injury risk patterns. Studies exploring a possible increase in pediatric poisoning events are equivocal, with some indicating increased calls to poison control centers but no increased pediatric emergency visits for poisoning. This study aimed to i) compare the proportion of Emergency Department (ED) visits related to poisoning for pediatric patients before and during the COVID-19 pandemic, and ii) describe the acuity and patient characteristics associated with these visits. Methods: This is a repeated cross-sectional study of ED health records for patients 0 to 18 years of age at three hospitals in the mid-Atlantic region from 2018 through 2020. Poisoning-related visits were identified through International Classification of Disease (ICD-10) code or chief complaint. Relevant ICD-10 codes included T36-50 “Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances,” T51-65 “Toxic effect of substances chiefly nonmedical as to source,” and F10-19 “Mental and behavioral disorders due to psychoactive substance use.” Poisoning-related keywords in the chief complaint included “Poison/Poisoning,” “Ingestion,” “Overdose” and “Toxin.” These identifiers do not distinguish between intentional and unintentional poisonings. Patient demographic characteristics (age, sex, race, ethnicity), illness acuity, and disposition were reported. Data were analyzed using descriptive statistics and logistic regression on the odds of poisoning-related ED visits compared to ED visits for other reasons. Results: Of 147,736 total ED visits over the three-year study period, 2,478 (1.68%) were related to poisoning. There was a higher proportion of poisoning-related ED visits in 2020 (2.07% [721/34,835], 95%CI 1.92%-2.22%) compared to 2019 (1.49% [845/56,814], 95%CI 1.39%-1.59%) or 2018 (1.63% [912/56,087], 95% CI 1.52%-1.73%). The most common substances referenced in poisoning-related codes included cannabis (12.2%), non-opioid analgesics (7.7%), and alcohol (6.9%). The odds of poisoning-related ED visits increased for each increase in acuity along a 5-point scale (adjusted OR 2.18, 95%CI 1.90 - 2.50). The odds of poisoningrelated ED visits increased in 2020 compared to 2018 (OR 1.28, 95%CI 1.16 - 1.41) and to 2019 (OR 1.40, 95%CI 2.53 - 2.79), but results did not persist when adjusted for acuity and demographic characteristics. Teenagers and females displayed higher odds of poisoning-related ED visits (Table 1). Median acuity differed by year according to the Kruskal-Wallis test (X2(2) = 35, p<0.001). Post-hoc Dunn testing revealed median acuity differed in 2020 compared to 2018 (p<0.0001) or 2019 (p<0.0001), which suggests increased acuity of poison-related visits over time (Figure 1). Conclusion: Poisoning-related ED visits represented a higher proportion of total ED visits in 2020 compared to prior years;this was likely driven by the higher acuity of poisoning-related visits. Public health interventions should be targeted to decrease the frequency and acuity of pediatric poisoning events. Proportion of ED visits with a Triage Acuity Score of 1-2 for poisoning-related ED visits compared to ED visits for other reasons from 2018-2020. The number of poisoning-related ED visits with an acuity score of 1 or 2 was 432, 422, and 450 in 2018, 2019, and 2020, respectively. The number of other ED visits with an acuity score of 1 or 2 was 8,882, 9,489, and 6,656 in 2018, 2019, and 2020, respectively.

Basic reproduction number projection for novel pandemics and variants. Ancestral SARS-CoV2 R0 projection (preprint)

The recently derived Hybrid-Incidence Susceptible-TransmissibleRemoved (HI-STR) prototype is a deterministic epidemic compartment model and an alternative to the Susceptible-Infected-Removed (SIR) model prototype. The HI-STR predicts that pathogen transmission depends on host population characteristics including population size, population density and some common host behavioural characteristics. The HI-STR prototype is applied to the ancestral Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) to show that the original estimates of the Coronavirus Disease 2019 (COVID-19) basic reproduction number ([R]0) for the United Kingdom (UK) could have been projected on the individual states of the United States of America (USA) prior to being detected in the USA. The Imperial College London (ICL) groups[R] 0 estimate for the UK is projected onto each USA state. The difference between these projections and ICLs estimates for USA states is either not statistically significant on the paired student t-test or epidemiologically insignificant. Projection provides a baseline for evaluating the real-time impact of an intervention. Sensitivity analysis was conducted because of considerable variance in parameter estimates across studies. Although the HI-STR predicts that in-creasing symptomatic ratio and inherently immune ratio reduce[R] 0, relative to the uncertainty in the estimates of[R] 0 for the ancestral SARS-CoV2, the projection is insensitive to the inherently immune ratio and the symptomatic ratio.

Development of a virtual glucagon-like peptide 1 analogue initiation service for people with type 2 diabetes within Forth Valley

Background: Prior to the covid-19 pandemic glucagon-like peptide (GLP-1) education was delivered face-to- face by diabetes specialist nurses. This service is now predominately virtual, with diabetes dietitians hosting online groups to deliver education. Aim: To evaluate the clinical outcomes of GLP-1 therapy education delivered online compared to face-to- face education sessions. Methods: Data were collated from 53 patients prior to the restrictions imposed by the covid-19 pandemic (Group A) and 53 patients who were educated virtually (Group B). The demographics of the patient group including duration of diabetes, gender, age, body mass index (BMI), Hba1c on referral and Hba1c change after four months of GLP-1 therapy were compared. Results: Group A was 45% male, with a mean age of 57 years, 10% had type 2 diabetes for over 10 years and 88% had a BMI between 30-39 kg/m2. The range of HbA1c at referral was 62-121mmol/ mol and mean improvement in HbA1c after 4 months of GLP-1 therapy in Group A was 24.3 ± 15.3mmol/mol. Group B was 55% male, with a mean age of 56 years, 43% had type 2 diabetes for over 10 years and 51% had a BMI of over 40 kg/m2. The range of HbA1c at referral was between 61-117mmol/ mol and the mean improvement in HbA1c after 4 months of GLP-1 therapy in Group B was 23.8 ± 17.5mmol/mol. Conclusions: The launch of virtual education for patients starting on GLP-1 therapy has been successful and maintained significant improvements in HbA1c after 4 months of treatment.