Beliefs about vaccination and relation to COVID-19 vaccination side-effects in asthma patients

Background: Clinical trials of COVID-19 vaccination provide evidence of side effects in the placebo group, consistent with some side effects reporting being a nocebo effect (Amanzio M, et al. Lancet Reg Health Eur 2022;12:100253) Aim: To investigate whether side effects of COVID-19 vaccination are associated with negative beliefs about vaccination. Method(s): European patients with severe asthma (SHARP network) completed a questionnaire (May-June 2021) about their vaccination status, the Vaccination Attitudes EXamination (VAX) Scale, a measure of vaccination hesitancy related to four different types of belief, and if vaccinated whether they experienced side effects (none, mild, severe). Result(s): 660 patients from 12 European countries participated, of whom 497 had at least a first vaccination and also completed the VAX questions and side effects. Of these patients, those reporting severe side effects (5.7%) compared to those with mild (48.2%) or no side effects (43.8%) had significantly (p = 0.001, ANOVA) more mistrust of vaccine efficacy, more concerns about future effects and more concerns about profiteering but not significantly more preference for natural immunity (Fig 1). Conclusion(s): People with severe asthma who have negative beliefs about vaccination are more likely to report severe side effects to COVID-19 vaccination. Consistent with the nocebo effect, negative beliefs create negative expectations and side effects. (Figure Presented).

Augmented Reality as a Digital Tool to Support All Learners in Inquiry-Based Learning Lessons

This article presents a conceptual understanding of how the powerful digital tool of augmented reality (AR) can be used for enhancing inquiry-based learning lessons (IBLLs). With an increased reliance on technology following the COVID-19 pan-demic, reduced teacher preparation time, and a need to provide students with alternative student-centered lessons, we provide a simplified understanding of the often-complex nature of IBLLs using experiential learning theory (ELT). Further, we highlight the immersive qualities within AR, pair AR with the simplified foundation, provide examples within the research, and offer further applications available to current practitioners. © Holder: Adam Carreon & Sean Smith.

Adherence to the NICE traumatic brain injury management guidelines in a trauma centre during the covid pandemic

Objectives: The National Institute of Health and Care Excellence (NICE) has set standards for TBI patients' initial assessment and management. This study assessed respect for NICE TBI guidelines in patients referred to an English trauma centre during the Covid-19 pandemic. Design: A cross-sectional study. Subjects: TBI patients who presented to a District General Hospital between 1st December 2020 and 12th August 2021 and were referred to the tertiary neurosurgical centre. Methods: Data were collected from the electronic medical records of our subjects. Descriptive statistical analysis of the time between patients presenting to the emergency department, being reviewed by a trained member of staff, request for cranial CT imaging, and response to neurosurgical referral was done with SPSS version 27.0. Results: We collected data on 115 patients, and the TBI frequency peaked in the 60-99 age range. Most patients were men (55.9%, n = 65), and 77% had a frailty score of 5 or less, with 90% presenting with a GCS range of 13-15. At the referring hospital, twenty-eight percent (n = 32) of the patients were evaluated by a trained member of staff within 15 min of admission, and only 30% (n = 35) had cranial CT imaging within an hour of the assessment. Only half of the referrals (n = 58) were reviewed by Neurosurgeons within an hour. The most common lesion on cranial CT imaging was a subdural haemorrhage (34%, n = 40).

Large-scale sequencing of SARS-CoV-2 genomes from one region allows detailed epidemiology and enables local outbreak management.

The COVID-19 pandemic has spread rapidly throughout the world. In the UK, the initial peak was in April 2020; in the county of Norfolk (UK) and surrounding areas, which has a stable, low-density population, over 3200 cases were reported between March and August 2020. As part of the activities of the national COVID-19 Genomics Consortium (COG-UK) we undertook whole genome sequencing of the SARS-CoV-2 genomes present in positive clinical samples from the Norfolk region. These samples were collected by four major hospitals, multiple minor hospitals, care facilities and community organizations within Norfolk and surrounding areas. We combined clinical metadata with the sequencing data from regional SARS-CoV-2 genomes to understand the origins, genetic variation, transmission and expansion (spread) of the virus within the region and provide context nationally. Data were fed back into the national effort for pandemic management, whilst simultaneously being used to assist local outbreak analyses. Overall, 1565 positive samples (172 per 100 000 population) from 1376 cases were evaluated; for 140 cases between two and six samples were available providing longitudinal data. This represented 42.6 % of all positive samples identified by hospital testing in the region and encompassed those with clinical need, and health and care workers and their families. In total, 1035 cases had genome sequences of sufficient quality to provide phylogenetic lineages. These genomes belonged to 26 distinct global lineages, indicating that there were multiple separate introductions into the region. Furthermore, 100 genetically distinct UK lineages were detected demonstrating local evolution, at a rate of ~2 SNPs per month, and multiple co-occurring lineages as the pandemic progressed. Our analysis: identified a discrete sublineage associated with six care facilities; found no evidence of reinfection in longitudinal samples; ruled out a nosocomial outbreak; identified 16 lineages in key workers which were not in patients, indicating infection control measures were effective; and found the D614G spike protein mutation which is linked to increased transmissibility dominates the samples and rapidly confirmed relatedness of cases in an outbreak at a food processing facility. The large-scale genome sequencing of SARS-CoV-2-positive samples has provided valuable additional data for public health epidemiology in the Norfolk region, and will continue to help identify and untangle hidden transmission chains as the pandemic evolves.

Asthma deaths in Scotland during the first peak of covid-19: Did reduced hospital admission result in excess asthma mortality?

Introduction During the first wave of the COVID-19 pandemic in the UK there was a reduction in A&E attendances and hospital admissions. Monthly excess deaths peaked in April 2020;driven by COVID-19.1 We investigated whether hospital admissions due to asthma were reduced in April 2020 compared to the previous five years and if this was accompanied by an increase in asthma deaths. Methods Five-year data were obtained from Public Health Scotland from the time period January 2015 to June 2020. Hospital admission data was sourced from Public Health Scotland's Scottish Morbidity Records, death certificate data from National Records of Scotland and A&E attendance data from Public Health Scotland. Data were analysed using statistical process control charts. Results A&E presentations in April 2020 reduced to 44% of April 2019. Hospital admissions for all conditions reduced, as did asthma admissions (figure 1a) [218 in April 2020 versus previous 5 year mean of 418]. 7958 deaths occurred in April 2020;an excess of 2731 from previous 5-year mean. In 130 deaths asthma was recorded on the death certificate as either the underlying or the contributory cause, giving rise to around 100 apparent excess deaths versus the previous 5-year mean of 27.5 (figure 1b). Asthma was recorded as the underlying cause of death in 7 cases, comparable with the previous 5 year mean of 9.2 deaths (figure 1c). The age distribution of those with asthma on the death certificate was: 97-65, 27 aged 45-65, 6 aged 18-44 and 0 <18 years. Of the 123 patients with asthma recorded as a contributory cause, 81 had COVID-19 recorded as the underlying cause of death. All 7 patients with asthma recorded as underlying cause of death were elderly and the location of death was: 3 at home, 2 in residential care, 1 in hospital and 1 in a hospice. Conclusions Reduced acute healthcare utilisation by people with asthma during the first peak of COVID-19 did not appear to result in increased mortality where asthma was the primary underlying cause of death.

The impact of covid-19 on the UK severe asthma Population

Introduction Severe asthma patients were assumed to be at greater risk of morbidity from infection with the novel severe acute respiratory syndrome coronavirus (COVID-19), hence, in the UK, were advised to shield. Community data on COVID-19 infection in severe asthmatics is lacking. We assessed the burden of shielding, the impact of COVID-19 and the effect of asthma medication on the UK severe asthma population. Methods Adults previously consented to inclusion in the UK Severe Asthma Registry (UKSAR) across 14 centres were contacted in June 2020 to collect data on potential COVID-19 infection, asthma control and shielding. Electronic records, where available, were reviewed for confirmation. Data was combined with clinical data from the UKSAR. Univariate and multivariate logistic regression analyses were performed to identify risk factors for COVID-19 infection. Results 1365 patients were included. 1268 (93%) were advised to shield, 1131 (89%) patients who received shielding advice followed it. Men (OR 0.4, p=0.045) and those in non-shielding households (OR 0.27, p=0.001) were less likely to follow shielding advice. 544 (47%) of patients advised to shield reported worsening of mental health;females (OR 1.59, p=0.001) and those with history of anxiety or depression (OR 2.12 p=0.001) were at greater risk. 97 (7.1%) patients had suspected/confirmed COVID-19 infection, 19 (1.39%) PCR/serology confirmed infection, 13(0.95%) were hospitalised and 2 patients (0.15%) died (table 1). 918 (67%) were on biologic therapy, 515 (37%) maintenance oral corticosteroid (mOCS). Multivariate analysis showed neither biologic therapy (OR 0.73, p=0.165) nor mOCS (OR 1.18, p=0.427) increased the risk of COVID-19 infection. Patients on biologics were less likely to require an acute course of corticosteroids for asthma symptoms (OR 0.6, p=0.002) while patients on mOCS were more likely (OR 1.96 p£0.001). Inhaled corticosteroids (ICS) were not associated with COVID-19 infection, including high dose (2000 mcg BDP equivalent) (OR 0.64, p=0.234). Hospitalised patients were on lower median doses of ICS vs non-hospitalised patients (1000 vs 2000 mcg BDP equivalent, p=0.002). Conclusion Hospitalisation and death occurred in small numbers in our severe asthma population. From this observational data, biologic agents for asthma were not associated with increased risk of COVID-19 infection or hospitalisation.

L8 Asthma deaths in Scotland during the first peak of COVID-19: Did reduced hospital admission result in excess asthma mortality?

L8 Figure 1Statistical Process charts of: 1a) Emergency Asthma Admissions from January 2015 to April 2020. 1b) Deaths with Asthma Recorded as underlying or Contrubutory Cause of Death on Death Certificate January 2015 to June 2020. 1c) Deaths with Asthma Recorded as underlying or contributory Cause of Death on Death Certificate January 15 to June 2020[Figure omitted. See PDF]ConclusionsReduced acute healthcare utilisation by people with asthma during the first peak of COVID-19 did not appear to result in increased mortality where asthma was the primary underlying cause of death.ReferenceScottish Government. COVID-19 in Scotland 2020 [04 November 2020]. Available from: https://data.gov.scot/coronavirus-covid-19/index.html.

S25 The impact of COVID-19 on the UK severe asthma population

S25 Table 1Characteristics of severe asthma patients with suspected or confirmed mild (ambulatory) or severe (hospitalised) COVID-19 infection Mild COVID-19 (n=84)Hospitalised with COVID-19 (n=13)p-valueAge (Years) (mean [SD])50.5 (13.8)55.6 (13.7)0.215Male Gender (n [%])39 (46.4%)4 (30.8%)0.290BMI (kg-m2) (mean [SD])31.3 (6.3)31.3 (4.9)0.967Non-Caucasian Ethnicity (n [%])15 (17.9%)3 (25.0%)0.553Atopic Disease (n [%])48 (62.3%)10 (76.9%)0.310FEV1% Predicted (mean [SD])67.9 (59.9,82.8)73.7 (60.1,84.8)0.555ICS Dose (BDP equivalent-ug) (median [IQR])2000 (1600,2000)1000 (800,1600)0.002On Maintenance OCS (n [%])35 (47.9%)3 (23.1%)0.872Evidence of Poor Adherence (n [%])18 (24.7%)7 (53.8%)0.033Maintenance Macrolides (n [%])7 (9.9%)2 (16.7%)0.428On Asthma Biologic (n [%])57 (67.9%)8 (61.5%)0.652Shielding against COVID-19Followed Shielding Advice (n [%])64 (84.2%)9 (90.0%)0.631Shielding affected mental health (n [%])33 (46.5%)5 (50.0%)0.835Contracted COVID-19 Before Shielding (n [%])40 (60.6%)4 (40.0%)0.219ConclusionHospitalisation and death occurred in small numbers in our severe asthma population. From this observational data, biologic agents for asthma were not associated with increased risk of COVID-19 infection or hospitalisation.