A DIGITAL TWIN BASED APPROACH FOR ENSURING BUSINESS CONTINUITY PLAN AND SAFE RETURN TO WORKPLACE

Organizations are struggling to ensure business continuity without compromising on delivery excellence in the face of Covid19 pandemic related uncertainties. The uncertainty exists along multiple dimensions such as virus mutations, infectivity and severity of new mutants, efficacy of vaccines against new mutants, waning of vaccine induced immunity over time, and lockdown/opening-up policies effected by city authorities. Moreover, this uncertainty plays out in a non-uniform manner across nations, states, cities, and even within the cities thus leading to highly heterogeneous evolution of pandemic. While Work From Home (WFH) strategy has served well to meet ever-increasing business demands without compromising on individual health safety, there has been an undeniable reduction in social capital. With Covid19 pandemic showing definite waning trends, organizations are considering the possibility of safe transition from WFH to Work From Office (WFO) or a hybrid mode of operation. An effective strategy needs to score equally well on possibly interfering dimensions such as risk of infection, project delivery, and employee wellness. As large organizations will typically have a large number of offices spread across a geography, the problem of arriving at office-specific strategies becomes non-trivial. Moreover, the strategies need to adapt over time to changes that cannot be deduced upfront. This calls for an approach that is amenable to quick and easy adaptation. Our contribution in this regard is constructing a Digital Twin by leveraging various modelling techniques to realistically represent the above mentioned aspects of interest that can be subjected to what-if scenario analysis. We further demonstrate its efficacy using a case study from a large organization. © 2022 Society for Modeling & Simulation International (SCS)

Disparities in COVID-19 Mortality in Hispanic and Non-Hispanic Patients with Metabolic Syndrome in a Community-Based Hospital

In Hispanic populations, rates of metabolic comorbidities such as obesity are higher than that of non-Hispanic White in the United States. Despite having higher comorbidity rates, Hispanic populations have a lower total risk of mortality compared to non-Hispanic counterparts. In this study, we explore whether this paradox exists for COVID-19 related deaths in Hispanic patients with Metabolic Syndrome (MetS). MetS is defined by the WHO as having at least 3 of the following 5 criteria: obesity, hypertension, diabetes, hypertriglyceridemia, and low levels of HDL. A retrospective study was conducted of patients hospitalized for COVID-19 between January 1, 2020 and May 1, 2021 at a regional county hospital in Southern California. In this cohort of 269 patients, 55.4% were male, mean age was 58.4 (IQR, 48-68) years, 63.9% had obesity, 42.4% had hypertension, 40.1% had diabetes, 18.2% had hypertriglyceridemia, and 32.3% had low HDL levels, and 30.9% fit the criteria for MetS. The racial demographic of this cohort was 78.8% Hispanic, 6.32% African American, 4.46% White and 3.72% Asian. Odds ratios and confidence intervals for the relationship between MetS and mortality were calculated separately among patients who were either Hispanic or non-Hispanic. Multivariable logistic regressions accounting for interactions between MetS and Hispanic patients were assessed. In our cohort, 49 (18.2%) patients died of COVID-19. Hispanic patients had a lower probability of mortality (16.0%;95% CI 11.1-21.0) than non-Hispanic patients (26.3%;95% Cl 14.9-37.7). Hispanic patients with MetS had a higher risk of mortality from COVID-19 ([OR] 1.57;95% Cl 0.74-3.33) compared to Hispanic patients without MetS. Non-Hispanic patients with MetS also had a higher risk of mortality from COVID-19 ([OR] 4.38;95% Cl 1.19-16.03) compared to non-Hispanic patients without MetS. The MetS effect on mortality in Hispanic was 64% lower than that in non-Hispanic patients, although this result did not reach statistical significance (p value=0.18.) Our data suggests that MetS is a risk factor for COVID-19 mortality and MetS may have a lower impact on COVID-19 related death in the Hispanic population than non-Hispanic counterparts. Studies with larger sample sizes will be required to confirm these relationships.Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

A Digital Twin Based Approach For Ensuring Business Continuity Plan And Safe Return To Workplace

Organizations are struggling to ensure business continuity without compromising on delivery excellence in the face of Covid19 pandemic related uncertainties. The uncertainty exists along multiple dimensions such as virus mutations, infectivity and severity of new mutants, efficacy of vaccines against new mutants, waning of vaccine induced immunity over time, and lockdown / opening-up policies effected by city authorities. Moreover, this uncertainty plays out in a non-uniform manner across nations, states, cities, and even within the cities thus leading to highly heterogeneous evolution of pandemic. While Work From Home (WFH) strategy has served well to meet ever-increasing business demands without compromising on individual health safety, there has been an undeniable reduction in social capital. With Covid19 pandemic showing definite waning trends, organizations are considering the possibility of safe transition from WFH to Work From Office (WFO) or a hybrid mode of operation. An effective strategy needs to score equally well on possibly interfering dimensions such as risk of infection, project delivery, and employee wellness. As large organizations will typically have a large number of offices spread across a geography, the problem of arriving at office-specific strategies becomes non-trivial. Moreover, the strategies need to adapt over time to changes that cannot be deduced upfront. This calls for an approach that is amenable to quick and easy adaptation. Our contribution in this regard is constructing a Digital Twin by leveraging various modelling techniques to realistically represent the above mentioned aspects of interest that can be subjected to what-if scenario analysis. We further demonstrate its efficacy using a case study from a large organization. © 2022 SCS.

COVID-19 Outcomes and Mortality in Patients with Metabolic Syndrome in a County-Based Hospital Setting in a Primarily Hispanic Population

Objective: Since the onset of the COVID-19 pandemic, it has been reported that those who are overweight, have diabetes mellitus (DM), or underlying vascular diseases were more likely to get severely ill from COVID-19. The goal of our study is to examine the association of these effects with COVID-19 severity in patients with metabolic syndrome (MetS), which is defined by the WHO as having at least 3 of the following 5 criteria: obesity, hypertension, DM, hypertriglyceridemia, and low levels of HDL. Methods: A retrospective study was conducted of patients hospitalized for COVID-19 between January 1, 2020 and May 1, 2021 at a regional county hospital in Southern California. In this cohort of 269 patients hospitalized for COVID-19, 44.6% were Female, mean age was 58.4 (IQR, 48-68) years, 63.9% had obesity, 42.4% had hypertension, 40.1% had diabetes, 18.2% had hypertriglyceridemia, and 32.3% had low HDL levels, and 30.9% fit the criteria for MetS. The racial demographic of this population was 78.8% Hispanic, 6.32% African American, 4.46% White and 3.72% Asian. 40 (14.9%) were intubated, 51 (18.9%) required admittance to the intensive care unit (ICU), 140 (52.0%) had acute respiratory failure (ARF), and 49 (18.2%) patients died. Unadjusted significance was assessed with chi-squared statistics. Multivariate logistic regression was used to adjust for race, age, and sex, and to examine the relationship between MetS and the outcome variables: intubation, ICU admittance, ARF, and mortality. Results: Unadjusted analysis of this cohort showed that MetS patients, when compared with non-MetS patients, had a higher risk of mortality (25.3% vs. 15.1%;p-value < 0.05), admittance rate to the ICU (27.7% vs. 15.1%;p-value < 0.05), intubation rates (18.1% vs. 13.4%;p-value = 0.3), but a lower incidence of ARF (47.0% vs. 54.3%;p-value =0.3). In multivariate analysis with covariates of age, sex and race, MetS patients were statistically significantly associated with mortality ([OR] 2.38;95% CI, 1.13-5.01;p-value < 0.05) and requiring ICU care ([OR] 1.99, 95% CI, 1.03-3.84;p-value < 0.05). However, MetS was not significantly associated with intubation ([OR] 1.27;95% CI, 0.60-2.68;p-value = 0.53) or with ARF ([OR] 0.69;95% CI, 0.40- 1.19;p-value = 0.18). Discussion/Conclusion: Our data suggests that MetS is strongly associated with worse COVID-19 outcomes, in a predominantly hispanic population. Further analysis of individual components of metabolic syndrome may yield a more detailed understanding of the drivers of COVID-19 outcomes. This work contributes to an understanding of the effects of MetS on COVID-19 outcomes in a broader population and community setting.

The spectrum of cerebrovascular events in COVID-19 patients in a racially and socioeconomically diverse patient population

Objective: To examine the breadth of cerebrovascular presentations in patients hospitalized with coronavirus disease 2019 (COVID-19) in a racially and socioeconomically diverse population. Background: COVID-19 has been associated with a significant risk for thrombotic events. Although reports suggest an increased number of cerebrovascular events in COVID-19 patients, most still had conventional vascular risk factors. Design/Methods: We conducted a retrospective, observational study of the incidence of cerebrovascular events and their mechanisms in all patients hospitalized with COVID-19 from April 15 to July 11 2020 at the largest academic safety net hospital in Boston, Massachusetts. Results: We identified 921 patients diagnosed with COVID-19;2.1% were found to have a cerebrovascular complication. 14 patients (1.5%) had confirmed ischemic stroke, 3 (0.3%) had hemorrhagic stroke, 2 (0.2%) had cerebral venous sinus thrombosis, and 2 (0.2%) had posterior reversible encephalopathy syndrome. Of all patients with cerebrovascular complications, the mean age was 64 years, 47% female, 53% male, with 16% identifying as White, 58% as African American and 26% as other. In regards to socioeconomic factors, 5% of patients were homeless, and 37% had Medicaid or low cost state funded insurance. Conventional stroke risk factors including hypertension were present in 53%, diabetes in 37%, tobacco use in 26%, hyperlipidemia in 16%, atrial fibrillation in 11% and 16% with history of a prior stroke. No identifiable risk factors were found in 21%. Of the ischemic stroke patients, the stroke mechanism was cardioembolic in 43%, small vessel disease in 7%, cryptogenic in 21.5%, stroke of other determined etiology in 21.5% and transient ischemic attack in 7%. Conclusions: We found that amongst the racially and socioeconomically diverse population at one large safety-net hospital, the rates of acute cerebrovascular events were low however varied in their presentations. Our patient population had fewer associated conventional vascular risk factors than typically observed in stroke patients.