Burden of respiratory coinfections in haematology patients with COVID-19

Introduction: Following the lifting of generalised restrictions and universal masking, severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2)- infected patients, especially the clinically extremely vulnerable (CEV) haematology patients, are at an increased risk for other respiratory viral coinfections;therefore, physicians need to be cognizant about excluding other treatable respiratory pathogens. Here, we report coinfection with SARS-CoV- 2 and other respiratory pathogens in patients with haematological cancers presenting to a large tertiary care hospital. Method(s): From July 2022-December 2022, patients with haematological disorders were screened for SARS-CoV- 2 and other 10 common respiratory pathogens by PCR. We performed a retrospective analysis of patients with concurrent respiratory viruses and will prospectively evaluate the same from Jan 2023 to March 2023. Result(s): During this period a total of 322 inpatients had routine screening and additional 6213 swabs were done in the outpatient/ambulatory setting, of which 294 were positive in 221 patients. We excluded all patients who had a single positive PCR swab result and specifically analysed only patients with coinfections. We identified 30 patients (14%) who had respiratory coinfections with 73 viral infections/reactivations over 6 months period, which represented 25% of all positive swabs: 25 inpatients (19 symptomatic/6 asymptomatic) and 48 in outpatients (32 symptomatic/16 asymptomatic). The median age of the cohort was 47.3 years (21-77). Patients were post allograft (n = 15), autograft (n = 7), post CART (n = 5) and postchemotherapy (n = 4). Of the 30 cases, 13 patients had concurrent infections: 5 SARS-CoV2, 10 Respiratory syncytial virus (RSV), 7 Rhino and 4 Influenza A, with all patients having dual viral infection. The remaining 17 patients had multiple viral infections but separated by a median of 54 days (range 27-137 days): 16 SARS-CoV2, 5 RSV, 6 Rhino, 2 Parainfluenza, 2 Adeno and one each of Influenza A, Influenza B, and metapneumovirus. Of the treatable infections (n = 46), 22% were detected on routine asymptomatic swabbing, with 50% of SARS-CoV2 detected on routine swabs. All 8 patients with Influenza were treated with oseltamivir, of 16 RSV cases one was treated with oral ribavirin and of the 22 SARS-CoV2 patients, 5 were treated (4 Paxlovid and 1 Remdesivir). No patients needed intensive care support and no deaths were reported. Conclusion(s): The burden of respiratory coinfections in CEV cohort has a significant impact on respiratory isolation and management, including appropriate & timely initiation of therapy for treatable viral infections. Although mortality was not increased secondary to respiratory coinfections and none needed intensive care, larger prospective cohorts are needed to assess the exact impact.

Surveillance of RNase P, PMMoV, and CrAssphage in wastewater as indicators of human fecal concentration across urban sewer neighborhoods, Kentucky.

Wastewater surveillance has been widely used as a supplemental method to track the community infection levels of severe acute respiratory syndrome coronavirus 2. A gap exists in standardized reporting for fecal indicator concentrations, which can be used to calibrate the primary outcome concentrations from wastewater monitoring for use in epidemiological models. To address this, measurements of fecal indicator concentration among wastewater samples collected from sewers and treatment centers in four counties of Kentucky (N = 650) were examined. Results from the untransformed wastewater data over 4 months of sampling indicated that the fecal indicator concentration of human ribonuclease P (RNase P) ranged from 5.1 × 101 to 1.15 × 106 copies/ml, pepper mild mottle virus (PMMoV) ranged from 7.23 × 103 to 3.53 × 107 copies/ml, and cross-assembly phage (CrAssphage) ranged from 9.69 × 103 to 1.85 × 108 copies/ml. The results showed both regional and temporal variability. If fecal indicators are used as normalization factors, knowing the daily sewer system flow of the sample location may matter more than rainfall. RNase P, while it may be suitable as an internal amplification and sample adequacy control, has less utility than PMMoV and CrAssphage as a fecal indicator in wastewater samples when working at different sizes of catchment area. The choice of fecal indicator will impact the results of surveillance studies using this indicator to represent fecal load. Our results contribute broadly to an applicable standard normalization factor and assist in interpreting wastewater data in epidemiological modeling and monitoring.

Public Awareness of and Support for the Use of Wastewater for SARS-CoV-2 Monitoring: A Community Survey in Louisville, Kentucky

The majority of sewer systems in the United States and other countries are operated by public utilities. In the absence of any regulation, the public perception of wastewater monitoring for population health biomarkers is an important consideration for a public utility commission when allocating resources for this purpose. We conducted a survey in August 2021 as part of an ongoing COVID-19 community prevalence study in Louisville/Jefferson County, KY, US. The survey comprised seven questions about wastewater awareness and privacy concerns and was sent to approximately 35 000 households randomly distributed within the county. A total of 1220 adults were involved in the probability sample, and data from 981 respondents were used in the analysis. A total of 2444 adults additionally responded to the convenience sample, and data from 1751 respondents were used in the analysis. The samples were weighted to obtain estimates representative of all adults in the county. Public awareness of tracking the virus that causes COVID-19 in sewers was low. Opinions strongly support the public disclosure of monitoring results. Responses showed that people more strongly supported measurements in the largest areas (>50 000 households), typically representing population levels found in a large community wastewater treatment plant. Those with a history of COVID-19 infection were more likely to support highly localized monitoring. Understanding wastewater surveillance strategies and privacy concern thresholds requires an in-depth and comprehensive analysis of public opinion for continued success and effective public health monitoring.

Carbon Dioxide Concentration Levels and Thermal Comfort in Primary School Classrooms: What Pupils and Teachers Do

The current climate emergency concerns and the COVID-19 pandemic demand urgent action to maintain healthy indoor environments in energy efficient ways. Promoting good indoor environments, in particular, increasing ventilation levels, has been a prominent strategy to mitigate the risk of COVID-19 transmission indoors. However, this strategy could be detrimental to thermal comfort, particularly during the heating season in buildings located in temperate climate zones. This paper presents research conducted in two primary schools in South Wales (UK) where the temperature, relative humidity and the carbon dioxide (CO2) concentration levels were monitored. The study monitored six classrooms and two communal spaces in the two schools during the academic year 2021/2022, the first academic year back to teaching and learning in school buildings after home-schooling and educational disruptions due to COVID-19 lockdowns. The study investigated the actions taken by teachers and pupils to balance the thermal comfort needs while minimising CO2 concentration levels. We conducted user studies to explore the comfort perceptions by pupils and teachers in relation to the thermal conditions and the freshness of air in the monitored classrooms. The paper identifies opportunities where end-users, teachers and pupils engaged with the management of the indoor environmental conditions and adopted actions to balance the requirement of reducing CO2 concentration levels while promoting thermal comfort. This research offers lessons and insights related to end-users' agency and their understanding of indoor environments and thermal experience in schools.

SARS-CoV-2 RNA abundance in wastewater as a function of distinct urban sewershed size

During the COVID-19 pandemic, wastewater-based epidemiology has emerged as a promising approach for monitoring SARS-CoV-2 prevalence on a community-level. Despite much being known about the utility of making these measurements in large wastewater treatment plants, little is known about the correlation with finer geographic resolution, such as those obtained through sewershed sub-area catchments. This study aims to identify community wastewater surveillance characteristics between sewershed areas that affect the strength of the association of SARS-CoV-2 RNA detection in a metropolitan area. For this, wastewater from 17 sewershed areas were sampled in Louisville/Jefferson County, Kentucky (USA), from August 2020 to April 2021 (N = 727), which covered approximately 97% of the county's households. Solids were collected from the treatment plants from November 2020 to December 2020 (N = 42). Our results indicate that the sewersheds differ in SARS-CoV-2 trends;however, high pairwise correlation spatial trends were not observed, and the mean SARS-CoV-2 RNA concentrations of smaller upstream community sewershed areas did not differ from their respective treatment centers. Solid samples could only be collected at treatment plants, therefore not allowing us to evaluate SARS-CoV-2 abundance as a function of the sewershed scale. The population size sensitivity of SARS-CoV-2 concentration detection is non-linear: at low population levels the measures are either too sensitive and generate a high level of variability, or at high population levels the estimates are dampened making small changes in community infection levels more difficult to discern. Our results suggest selecting sampling sites that include a wide population range. This study and its findings may inform other system-wide strategies for sampling wastewater for estimating non-SARS-CoV-2 targets.

Strengthening a One Health approach to emerging zoonoses

Given the enormous global impact of the COVID-19 pandemic, outbreaks of highly pathogenic avian influenza in Canada, and manifold other zoonotic pathogen activity, there is a pressing need for a deeper understanding of the human-animal-environment interface and the intersecting biological, ecological, and societal factors contributing to the emergence, spread, and impact of zoonotic diseases. We aim to apply a One Health approach to pressing issues related to emerging zoonoses, and propose a functional framework of interconnected but distinct groups of recommendations around strategy and governance, technical leadership (operations), equity, education and research for a One Health approach and Action Plan for Canada. Change is desperately needed, beginning by reorienting our approach to health and recalibrating our perspectives to restore balance with the natural world in a rapid and sustainable fashion. In Canada, a major paradigm shift in how we think about health is required. All of society must recognize the intrinsic value of all living species and the importance of the health of humans, other animals, and ecosystems to health for all. © 2022 Authors: Mubareka, Amuasi, Banerjee, Carabin, Jack, Jardine, Jaroszewicz, Keefe, Kotwa, Kutz, McGregor, Mease, Nicholson, Nowak, Reed, Saint-Charles, Simonienko, Weese, Parmley, and The Crown.

Ctla4 Variant of Uncertain Significance in a Patient with a History of Cytopenias

Introduction: CTLA-4 haploinsufficiency is caused by heterozygous mutations in CTLA4, a negative regulator of immune responses. Hypogammaglobulinemia, infections, and autoimmune cytopenias can be seen. Here, we describe a patient with history of ITP who presented with neutropenic fever, lymphopenia, and hypogammaglobulinemia in the setting of COVID-19 with a VUS in CTLA4. Case Description: The patient is a 24-year-old female diagnosed with ITP at 10-years-old, initially treated with IVIG/steroids, then on mycophenolate for 6-years. 5-years later, she had a relapse of ITP in the setting of viral illness, requiring steroids/IVIG/rituximab. She developed neutropenic fever, unresponsive to GCSF, but responsive to cyclosporine and was noted to have a LGL clone. At 24-years-old, she was admitted with neutropenic fever (ANC 0);adenovirus, parainfluenza-virus, and SARS-CoV-2 were positive. Immunology was consulted due to hypogammaglobulinemia (IgG 140, IgA 7, IgM <5 mg/dL). Prior genetic testing identified a missense VUS in CTLA4 c.370A>C (P.Thr124Pro), shown to affect CTLA4 function and observed in individuals with clinical features of CTLA-4 haploinsufficiency. Lymphopenia, absent lymphocyte antigen responses, and impaired vaccine immunity were noted. ANC improved with GCSF. The patient was discharged with immunology follow-up for consideration of abatacept. Discussion(s): This case highlights the importance of considering VUS in the diagnosis and treatment of primary immunodeficiency. Our patient had a history of recurrent ITP, neutropenia, and LGL clone, all likely manifestations of CTLA-4 haploinsufficiency. Subsequent recognition of hypogammaglobulinemia and lymphopenia in the setting of neutropenia supported the diagnosis. Abatacept replaces the missing CTLA4-protein and should be considered in patients with CTLA-4 haploinsufficiency presenting with cytopenias. Copyright © 2022

The Impact of Traveler-Based Genomic Surveillance on SARS-CoV-2 Variant Detection in Arriving International Air Travelers- United States, November 29, 2021-April 24, 2022

Background. International travel facilitates SARS-CoV-2 spread globally. Early detection of variants among arriving international travelers could provide viral information about introduction of variants with differing infectivity, virulence, and vaccine effectiveness, enabling adjustments to treatment and prevention strategies. We initiated a genomic surveillance program at 4 US airports to detect SARS-CoV-2 variants among arriving international travelers. Methods. Between November 29, 2021-April 24, 2022, we enrolled arriving air travelers (>=18 years) from flights originating in 16 countries on 5 continents. At four airports, participants self-collected nasal swab samples that were pooled with 5-25 other samples by country of flight. Participants were also given a take-home saliva collection kit;saliva was collected 3-5 days after arrival and mailed back to the laboratory. SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) was performed on all samples at the laboratory. Positives underwent whole genome sequencing. Demographic, clinical, and travel information was collected. Results. We enrolled 28,656 travelers;median age was 42 years (interquartile range 31-55), 48% were female, and 99.4% self-reported COVID-19 vaccination. Overall, 19%(504/2,666) of pooled and 7.5%(285/3804) of individual samples were positive for SARS-CoV-2. Highest pool positivity of 46% occurred during January 3-10, 2022 (Figure 1).Omicron variant accounted for 97%of sequences (Figure 2).We detected the earliest reporting of Omicron sub-lineages BA.2 and BA.3 (7 and 43 days earlier than reported elsewhere) in the United States and North America, respectively. During April 4-18, we detected an increasing trend of pool positivity among travelers on South African flights, detecting one of the first US-reported BA.4 sub-lineages consistent with early surge of cases in South Africa. Weekly pooled positivity for travelers on South African flights aligned with World Health Organization (WHO)-reported 7-day COVID-19 incidence rates over the same period (Figure 3). ] Conclusion. This genomic sequencing surveillance platform is a model for traveler-based SARS-CoV-2 genomic surveillance that can be used as an early warning system to detect future outbreaks and pandemics. (Figure Presented).

Anti- CD20 agents are associated with higher incidence and severity of breakthrough COVID-19 infections in vaccinated people with multiple sclerosis - an observational study by the New York Covid-19 Neuro- Immunology Consortium (NYCNIC)

Background: SARS-CoV-2 influenced all aspects of healthcare and will do so in the future. Early pre-vaccination studies, including our first NYCNIC cohort, demonstrated favorable COVID-19 outcomes in people with MS, though anti-CD20 therapies were associated with increased hospitalization. While SARS-CoV-2 vaccines reduce incidence and severity of infections in the general population, anti-CD20 and S1P modulating agents blunt humoral vaccination response. T cell responses are preserved in anti- CD20-treated-patients, suggesting at least partially intact vaccinemediated protection. Therefore, data on COVID-19 incidence and severity in vaccinated MS patients is necessary. Objective(s): To identify risk factors of severity of breakthrough COVID-19 infection in vaccinated MS patients before and during the Omicron wave. Aim(s): To characterize COVID -19 infection in vaccinated MS patients. Method(s): Demographics, MS, clinical variables (time from last vaccination to infection, vaccine type, booster receipt, antibody presence, ambulatory status, comorbidities) and COVID-19 outcomes were collected on vaccinated MS patients followed at 5 MS Centers through January 31st, 2022. Infections were labeled as 'pre-Omicron (prior to Dec 1st 2021) and "During Omicron". Infection severity was measured by a 4-point ordinal scale (home care, hospitalization, ICU, death). Univariate and multivariate regression models were used to assess risk factors for hospitalization. Result(s): Our cohort included 209 patients with 211 breakthrough infections (45 pre and 166 during Omicron) with median age 42 (range 19-78), 71% female, 65% Caucasian. Anti-CD20 agents were used by 67% of patients pre- and 62% during Omicron, substantially higher than in first (pre-vaccination) NYCNIC cohort (35%). In a multivariate model including the entire cohort, adjusting for age, use of anti-CD20 or S1P agents during infection increased risk of hospitalization or worse (p= 0.0454, OR 3.815, 95% CI: 1.028-14.161). In a multivariate model including only patients during the Omicron wave, adjusting for comorbidity, use of anti-CD20 therapies during vaccination increased risk of hospitalization or worse (p=0.0462, OR 3.565, 95% CI: 1.022-12.436). Conclusion(s): Anti-CD20 and S1P modulating agents were associated with higher severity of COVID-19 infections in vaccinated MS patients. Compared to the first NYCNIC cohort, use of anti- CD20 was more prevalent, suggesting potential negative impact on vaccine efficacy.

QI in Pediatric Complex Care: Growing and Sustaining a Telehealth Practice During COVID-19

Purpose/Objectives: Our objective was to use the necessary changes in healthcare delivery during the COVID-19 pandemic to accelerate ongoing quality improvement initiatives in growing telemedicine services in our primary care practice that serves children with medical complexities. We believe that synchronous and asynchronous telehealth care greatly benefits the patients and families of our highly complex pediatric population. However, despite our efforts, participation of families and staff members was low. Our goal was to use this COVID-19 catalyst to create an enduring and sustainable telehealth presence and practice, and to do so, we invested in meeting both patient and staff needs. Design/Methods: We used the Model for Improvement to guide PDSA cycles with the aim of increasing and sustaining telehealth usage by patients and staff. This would be achieved by increasing asynchronous patient portal contacts and finding equilibrium in virtual visits and office visits (compared to pre-COVID utilization). Success of incremental improvements was measured in feedback from staff and patients (both anecdotally and with surveys) and in tracking IT service requests for virtual visit support as compared to the number of virtual visits completed. Results: Patients reported increased comfort in using the patient portal and confidence in participating in virtual visits. Percentage of patients completing office visits active to our patient portal increased from 72% preCOVID to essentially 100% during and ongoing. Patients reported high satisfaction with virtual care and planned to use whenever possible and appropriate. Staff demonstrated high levels of comfort with using the patient portal, confidence in conducting virtual visits, and working in remote environments. Completed patient appointments have maintained an even split between inclinic and virtual visits since August 2020. IT service requests compared to virtual visit appointments peaked in April 2020 and maintained high levels over the course of the spring. They have returned to pre-COVID levels while virtual visit appointments are at a 10% increase from their pre-COVID average across our organization. Conclusion/Discussion: We were able to maintain a level of patient and staff satisfaction, develop additional care coordination methods, and increase and sustain the percentage of virtual visits conducted. We had no clinic closures related to COVID-19 and little to no interruption of patient care. The user experience is important. To successfully implement broad practice change, we must remember both patients and staff are the target audience. If both groups feel supported and championed, it elevates everyone's experience.

Fieldwork for public health responses during pandemics: lessons from the New South Wales Health experience with COVID-19

Problem: Fieldwork is a vital component of public health emergency response, yet little has been published on undertaking fieldwork safely. Safety is of particular importance with emerging pandemic viruses, which can pose additional risks to public health fieldwork staff. Context: During a pandemic, surge health staff may be drawn from diverse professional backgrounds;they may have limited experience in fieldwork or be unfamiliar with the risks posed by a novel virus. Novel pathogens pose dangers to fieldwork staff, particularly when there are global or local shortages of personal protective equipment. Action: During the coronavirus disease 2019 (COVID-19) pandemic, New South Wales (NSW) Health's Public Health Emergency Operations Centre (PHEOC) deployed staff for fieldwork in a range of settings. The PHEOC developed a protocol to systematize planning, risk assessment and management for COVID-19 fieldwork. The protocol was accompanied by training, discussion exercises and debriefs to support PHEOC fieldwork staff. Lessons learned: Effective fieldwork is an essential component of outbreak investigation and management, including stakeholder management. Here, we share and discuss key elements of the NSW Health protocol to support fieldwork during outbreak responses for emerging communicable diseases across various resource contexts. Limited understanding of novel viruses, particularly in the early phases of a pandemic, must be considered in decisions to deploy fieldwork staff and implement precautionary risk mitigation approaches. Planning is essential to protect staff and ensure ethical allocation of resources. Through appropriate selection of teams and training, surge staff can be supported to effectively conduct fieldwork.

The Impact of COVID-19 on Psychiatric Services and Individuals with Serious Mental Illness in New York State during 2020

Background: New York State was the epicenter of the COVID-19 pandemic's initial US surge in March 2020. The pandemic precipitated dramatic and immediate changes throughout the State's psychiatric treatment system and presented serious threats to the wellbeing of individuals with serious mental illness in 23 State-operated psychiatric hospitals. Methods: We describe how the State mental health authority rapidly restructured the public mental health system and implemented infection control and vaccination programs targeting individuals with serious mental illness. Results: Changes in the supply of and demand for psychiatric services: When the pandemic struck, general hospitals in the NYC and its suburban region immediately closed about 20% of their inpatient psychiatric beds. The NYC public hospital system, which accounts for ∼40% of the city's inpatient psychiatric beds, converted ∼30% of its adult inpatient capacity and 40% of its child/adolescent capacity to COVID-19 medical services. State-operated psychiatric hospitals responded by significantly increasing admissions. These shifts were coordinated to create a single psychiatric inpatient system of care during the height of the pandemic. We will present data showing a dramatic shift to telehealth platforms for outpatient psychiatric outpatient services in the early stages of the pandemic. Risk of infection and mortality among individuals with serious mental illness: Within 3 months of the onset of the pandemic in NYS, five of the 23 State-operated psychiatric hospitals reported 50% or more of their residential/inpatient census exposed to COVID-19. Over an 18-month period from 2020-2021 spanning 3 distinct COVID-19 surges, ∼12% of the almost 11,000 patients treated in these programs were diagnosed with COVID-19 illness and 53 died from the virus. We will review infection control practices implemented in these State-operated psychiatric hospitals to mitigate the impact of the virus. Implementing a COVID-19 vaccination program: Within 8 months of onset of the pandemic, surveillance testing and vaccination programs were implemented in all 23 State-operated psychiatric hospitals. We will present data showing marked reductions in COVID- 19 transmission in this population following this implementation, which occurred while COVID-19 cases were peaking in NYS during the 2nd surge in January-February 2021. Population level management of the economic fallout related trauma, stress, anxiety, and depression: Finally, we will review results from 2 surveys of New Yorkers who used psychiatric services during the pandemic. We will report on their experiences with access to care, telehealth, and the impact of COVDI-19 on their health and wellbeing. Discussion and Implications: Mental health authorities can rapidly implement new policy and protocols to protect the health of individuals served in psychiatric hospital systems during urgent public health crises. Assertive cross-agency coordination is necessary to ensure the safety and wellbeing of these individuals.

Covid-19 accelerates refinery rationalisation

Oversupply of refining capacity worldwide is seen even before the Covid-19 pandemic, with projections of capacity growth exceeding increases in refined product demand by a factor of 2:1. Refinery throughput reductions have been significant globally in 2020 but have varied by region. In the US, refinery utilization rates dropped ≤ 68 pc in April before recovering to 80 pc in August and decreasing back to 76 pc in November. For OECD Europe, production for October stabilized at 10.6 million bpd. In China, refinery throughput averaged at 80 pc in November, in line with October levels, while the smaller independent refineries in the Shandong region maintained slighter lower run rates of 72 pc. Over 550,000 bpd of capacity shutdowns have already been announced to take effect between 2021 and 2023, with the potential for further closures on the horizon.

THE EFFECT OF COVID-19 PANDEMIC ON SPHINCTER PRESERVING SURGERY FOR RECTAL CANCER: AN INITIAL REPORT

Purpose/Background: The lack of screening and healthcare access during COVID-19 has delayed diagnosis of rectal cancer. Purpose: To determine whether the COVID-19 pandemic influenced sphincter preserving surgery rates. Hypothesis/Aim: The COVID-19 pandemic influenced sphincter preserving surgery rates in rectal cancer. Methods/Interventions: Methods: In this retrospective cross-sectional study patients undergoing surgery for rectal cancer between 2016 and 2021 were divided into two groups. Patients operated during the COVID-19 pandemic (2020 - 2021) and patients operated before the pandemic (2016-2020). Intervention(s): Sphincter preserving surgical interventions included transanal local excision and low anterior resection with restorative proctectomy or coloanal anastomosis. Radical surgery included abdominoperineal resection with a permanent colostomy. Results/Outcome(s): 234 patients were included, 180 patients (76.9 %) in the pre-COVID-19 group, and 54 patients (23.1%) in the COVID-19 era group. There were no differences between the groups in mean patient age (60.0 ± 12.7 vs 60.6 ± 12.7;p = 0.7648), gender (33.3% vs 40.7% females;p = 0.31) and BMI (26.6 ± 4.8 vs. 27.4 ± 4.6;p = 0.2580). The COVID-19 era group had a significantly lower rates of sphincter preserving surgery (73.1% vs. 86%;p=0.028). Patients in the COVID-19 era also presented with a significantly higher rate of locally advanced disease (stage T3/T4 78.8% vs 57.9%;p=0.02) and metastatic disease (9.4% vs. 2.8%;p = 0.05) compared to the pre COVID-19 group. Time from diagnosis to surgery in this group was also significantly longer (median 272 vs. 146 days, p<0.0001). Limitations: Retrospective single center study Conclusions/Discussion: Patients diagnosed with rectal cancer during the COVID-19 era presented at a more advanced oncological stage and underwent sphincter preserving surgery at lower rates.

UTILISING VIRTUAL REALITY FOR REMOTE JOINT INJECTION TRAINING FOR THE POST-PANDEMIC RHEUMATOLOGIST

Background/Aims The impact of dealing with COVID-19 for rheumatology higher specialist trainees has been profound. Sacrifices were made to their training to support the UK's pandemic response. Virtual Reality (VR) has long been used as a solution for specific surgical skills;providing a hands-on experience to enable specific delivery of outcomes. We utilised existing technology alongside a specialist VR and haptics team to review ways at delivering a valid and reliable training tool to administer joint injections, beginning with the review of this procedure specific to the knee. We aimed to describe this process. Methods A qualitative study using focus groups was undertaken, one medical student, four higher specialty trainees and two consultants were convened in a focus group to review existing mannequin-based training with the purpose of identifying a skill to develop in virtual reality. A story board was developed through collaboration with a graphic designer. The scenario was imbedded into a virtual reality environment in collaboration with a virtual reality partner. Results The focus group identified intra-articular knee injection as the most appropriate rheumatology skill to develop. Storyboarding built a series of scenarios around clinical situations which would require injection or aspiration. Working with the engineering team we successfully mapped knee joint anatomy and rendered an authentic clinical environment for the storyboards to run inside. Conclusion Virtual reality training scenarios are complex to develop but have enormous potential to create immersive training and assessment experiences which are not boundaried by the challenges of social distancing and COVID-19 risks.

Predicting COVID-19 Patient Shielding: A Comprehensive Study

There are many ways machine learning and big data analytics are used in the fight against the COVID-19 pandemic, including predictions, risk management, diagnostics, and prevention. This study focuses on predicting COVID-19 patient shielding—identifying and protecting patients who are clinically extremely vulnerable from coronavirus. This study focuses on techniques used for the multi-label classification of medical text. Using the information published by the United Kingdom NHS and the World Health Organisation, we present a novel approach to predicting COVID-19 patient shielding as a multi-label classification problem. We use publicly available, de-identified ICU medical text data for our experiments. The labels are derived from the published COVID-19 patient shielding data. We present an extensive comparison across 12 multi-label classifiers from the simple binary relevance to neural networks and the most recent transformers. To the best of our knowledge this is the first comprehensive study, where such a range of multi-label classifiers for medical text are considered. We highlight the benefits of various approaches, and argue that, for the task at hand, both predictive accuracy and processing time are essential. © 2022, Springer Nature Switzerland AG.