Corticosteroid treatment in influenza virus and SARS-CoV-2 co-infected patients

Background. Co-infections with SARS-CoV-2 and influenza virus may become more prevalent now that many countries are easing restrictions to reduce the spread of SARS-CoV-2. Co-infected patients are more likely to receive invasive mechanical ventilation (IMV) and have higher odds of in-hospital mortality. In the RECOVERY trial, dexamethasone was found to reduce the risk of 28-day mortality in hospitalised COVID-19 patients. On June 16, 2020, corticosteroids were included in clinical guidelines for the treatment of COVID-19 patients requiring supplemental oxygen. However, corticosteroid treatment in severe influenza virus infection may increase mortality. The effect of steroids in influenza and COVID-19 co-infected patients is unknown. Methods. Adult patients with RT-PCR confirmed SARS-CoV-2 and influenza virus co-infection were evaluated. Patients without supplemental oxygen during admission were excluded. Patients who were hospitalised prior to June 16, 2020 were included in the 'early' group and patients who were hospitalised on or after June 16, 2020 were included in the 'late' group. Results. 171 co-infected patients were included, 123 patients in the early group (table 1) and 48 in the late group (table 2). In the early group, 25 patients received steroids. In the late group, 40 patients received steroids. In the early group, the proportion of patients who were admitted to critical care was slightly lower in the group that received steroids. IMV was similar in both groups. In-hospital mortality was slightly higher in the group treated with steroids. In the late group, critical care admission and receipt of IMV were higher in the group not treated with corticosteroids than the group with corticosteroid treatment. In-hospital mortality was slightly lower in the group not treated with steroids. Conclusion. There are differences between co-infected patients who were treated and not treated with corticosteroids and differences between the early and late groups. A limitation is that no dates were collected for the start of steroid treatment, making it impossible to draw conclusions on the causality of the need for IMV and treatment with steroids in this analysis. Future research should focus on the effect of steroids in COVID-19 and influenza co-infected patients.

Adapting application of multimodal prehabilitation across 3 tumour sites in the covid-19 era: Striving for equitable and improved cancer care

Aim: To adapt the theory of the Manchester model in a novel cancer service pilot across 3 tumour groups, colorectal, head and neck and lung cancer. Method(s): An adaptive methodology Multimodal adaption by combining evidence from literature, in context of practice within COVID-19 and across 3 tumour sites to create a valid and reproducible methodology, a prehabilitation working group of clinicians and cancer leads as well health development team. A pilot was developed and content adapted given the mixed tumour group and multimodal delivery. The multimodal prehabilitation pilot live March 2021, with a 12 month cycle with monthly working group meetings and in real time modifications as well as data collation and interrogation as part of service delivery and evaluation. Result(s): Many identified challenges common across tumour groups, some relating specifically to the delivering and capture of outcome data, in the context and restrictions of covid-19 and within pilot testing phase difficulties identified and resolved. During the pilot phase, delivery and capture difficulties were identified and resolved. Key stakeholder engagement was variable and limited by knowledge and application of prescriptive measures for patient outcome. With additional support and 'booster' sessions engagement and data capture improved with more appropriate patient screening and counselling and engagement within the programme. Conclusion(s): A adaptive methodology delivery prehabilitation in cancer care, designing an equitable service was developed. A pragmatic and and tangible approach has generated important insights to overcome challenges, enhance outcome content and usability to deliver success with an iterative and organised framework . The adaptation of the Greater Manchester Model has developed an novel resource in Northern Irelands cancer care to deliver equitable cancer service and improved patient outcomes across several health outcome domains.

Expression of the SARS-CoV-2 receptors ACE2 and TMPRSS2 in the respiratory tract of children and adults

S57 Figure 1Bar chart with error bars displaying mean% positive cells for each age group for alveolar and bronchial ACE2 and TMPRSS2[Figure omitted. See PDF]ConclusionACE2 and TMPRSS2 expression is similar in upper airways of children and adults, likely indicating that both groups are equally susceptible to SARS-CoV2 infection. In contrast, expression of both these receptors/co-factors is greater in adult lower airways of adults, and particularly for ACE2 receptor in alveolar tissue. In some adults, ACE2 receptor was detected in up to a quarter of alveolar cells, potentially explaining why some adults are so susceptible to lower respiratory tract disease.