Masking up and the role of the police

Purpose: The COVID-19 pandemic placed many challenges on policing, from limiting officers' ability to interact with citizens to enforcing regulations to prevent the spread of the virus. One of those regulations, and the focus of the current study, is mask mandates. Design/methodology/approach: Using a sample of over 550 US adults recruited on Amazon MTurk, the current study examines factors that may influence citizen attitudes toward the police's role in mask enforcement, with a specific focus on perceptions of the police, political leanings, and views about COVID-19 and mask-wearing. Findings: The authors find that when respondents believed COVID-19 was serious and a major public health threat, they were more likely to believe the police should enforce masks, regardless of attitudes about the police, political party affiliation or other demographics. Originality/value: The enforcement of public health mandates, such as mask wearing, often result in arguments related to the infringement of rights and questions about the overall legality of enforcement. This often puts law enforcement in a difficult position regarding how such mandates should be enforced and whether it is the responsibility of the police. Additional policy implications are discussed. © 2023, Emerald Publishing Limited.

Liquid Biopsy: Clinically Integrated Research in the Modern Pandemic Era

The COVID-19 pandemic forced a redesign of clinical research to adapt to an ever-changing situation while minimizing patient and provider risks and preserving scientific discovery. During the initial surge of COVID-19, elective healthcare services and non-critical research operations were halted. These changes inspired dispersed health care operations and streamlined clinical research. The first wave of COVID-19 hit Detroit, Michigan, in March 2020, consuming Henry Ford Health (HFH), in COVID-19 emergency care. HFH has a clinically integrated liquid biopsy (LB) program where enrolled patients provide an LB sample via venipuncture within 7 days of each MRI, typically in the clinic at the point-of-care. Prior to COVID-19, 183 neurooncology patients were actively providing LB samples in clinic with a mean of 29.9 specimens monthly. Institutional COVID-19 restrictions on noncritical interactions resulted in months were nearly all outpatient encounters utilized telemedicine and decentralized testing off-site from research operations. This halted LB procurement to 4.55 specimens monthly during early pandemic months. To reduce patient-provider exposure, LB specimens were then procured with the venipuncture for MRI which streamlined LB operations and improved the patient experience. After this change, LB specimen procurement returned to near pre-pandemic levels with a mean of 28.1 monthly specimens, despite a significant population utilizing video visits and imaging at satellite or non-HFH centers. The pandemic forced adaptations to patient encounters that have changed how healthcare is delivered, resulting in parallel changes in research that must be considered in the design of future studies.

Exacerbation of Racial Disparities in Living Donor Kidney Transplant During the Covid-19 Pandemic

Purpose: The SARS-CoV-2 or coronavirus disease 2019 (COVID-19) pandemic has disproportionately impacted racial and ethnic minority groups in the United States. Although, kidney transplant procedures decreased following onset of the pandemic, the differential impact of the pandemic on racial and ethnic minority groups remains unknown. Method(s): We examined kidney-alone procedures captured in the national Scientific Registry of Transplant Recipients (SRTR) analytic files and compared the change in deceased donor kidney transplant (DDKT) and living donor kidney transplant (LDKT) pre- and post- pandemic and the associated factors. Result(s): We found that the counts of LDKT declined more for Black patients in the 12 months following onset of the pandemic, March 2020 to Feb 2021, compared with counts in the same period in the preceding 12 months. LDKT counts among Black patients fell by 42.6% compared with 33.3% in White patients (P=0.02). This pattern of decrease in LDKT counts among Black patients occurred in all geographic areas of the country (based on current UNOS COVID-19 reporting) except for the Northeast and South Midwest (Figure 1). Along with recipient race, other factors associated with a significant decline in LDKT counts included public insurance, Black living donor race, and location of residence. In contrast, DDKT counts for both Black and White candidates declined initially (10% vs. 5.9% lower respectively, P=0.11) during the pandemic and then recovered closer to pre-pandemic levels. Conclusion(s): The COVID-19 pandemic disproportionately impacted Black patients' access to LDKT. While the current rate of DDKT procedures has recovered in 2021, it is unclear whether LDKT rates will recover to parity. As locoregional surge conditions can have differential effects, ongoing attention to transplant disparities resulting from the pandemic, with appropriately targeted interventions, is warranted.

Effect of the SRTR COVID-19 3-Month Carve-Out on Program- Specific Transplant Outcome Evaluations

Purpose: The SRTR January 2022 program evaluations (Jan 2022 program-specific reports [PSRs]) applied a COVID-19 carve-out where follow-up for transplants performed before March 13, 2020, ends on March 12, 2020;transplants performed from March 13, 2020, through June 12, 2020, are excluded;and transplants performed after June 12, 2020, are followed as usual. This study quantified the impact of the carve-out and investigated the effect of censoring COVID-19 deaths (in addition to the carve-out) on first-year posttransplant outcomes metrics in the Jan 2022 PSRs, with particular attention to investigating variation among OPTN regions. Method(s): The program-specific hazard ratios (HRs) for graft failure and patient death were estimated under 2 alternative scenarios and compared with the published HRs. In the first scenario, the COVID-19 carve-out was removed. In the second scenario, the COVID-19 carve-out was retained, but deaths due to COVID-19 infection that were not already carved out were censored. Result(s): Compared to the HRs from the Jan 22 PSRs as published with the COVID- 19 carve-out, adding censoring for the COVID-19 deaths that are not already removed by the carve-out results in very little change on average in the HRs (beta=1.0, r2=0.96). Removing the COVID-19 carve-out has a relatively larger impact on the estimated HRs (beta=0.89, r2=0.82) By geography, there were 2 slight yet statistically significant differences. When removing the carve-out, the average HR in the Northwest (OPTN Region 6) was 0.049 lower (95% CI: -0.087 to -0.011) than under the program evaluations with the carve-out. When censoring COVID-19 deaths in addition to the carve-out, the average HR in the Midwest (OPTN Regions 7, 8, and 10) was 0.009 lower (95% CI: -0.015 to -0.003) than under the program evaluations as published with only the COVID-19 carve-out. Conclusion(s): The HRs estimated by censoring COVID-19 deaths are highly correlated with those estimated with the carve-out alone. Removal of the carve-out resulted in greater variation in estimated HRs than the censoring scenario. Little variation by OPTN Region was observed, with the carve-out resulting in slightly higher HRs on average in OPTN Region 6. Censoring COVID-19 deaths imparted little regional variation, with HRs in the Midwest reduced on average by 0.009. The impact of the carve-out on program-specific evaluations will continue to be evaluated.

Multidisciplinary Care of Pediatric Disroders of Gut-Brain Interaction in the Era of Telemedicine: Equal Patient Satisfaction and Outcomems of in-Person Vs Telemedicine Encounters

Background: Patients with Disorders of Gut-Brain Interaction (DGBI) respond best to multidisciplinary treatment. With the emergence of the Coronavirus disease 2019 (COVID-19) pandemic in 2020 and the implemented lockdown in large areas of the United States, the multidisciplinary functional abdominal pain program (FAPP) at Boston Children's Hospital for the first time switched to providing care via telemedicine. We aimed to evaluate patient satisfaction and outcomes of patients seen in a multidisciplinary telemedicine visit compared to in-person care at the time of initial evaluation and follow-up. Method(s): Prospective study in which families were given a questionnaire to evaluate the visit and treatment (satisfaction, improvement overall, of abdominal pain (Abdominal Pain Index, API) and of daily functioning (Functional Disability Index, FDI) since initial visit in the FAPP. Patients <= 18 years seen for an initial visit in the FAPP between 4/1/20 and 6/20/21 were recruited. Multidisciplinary evaluation was performed in-person or via zoom (Gastroenterology, Pain medicine, Psychology, Social services, Dietician). Initially all visits were done via telemedicine (4/1/20-7/1/2020) due to the temporary closure of outpatient clinics. Thereafter, in-person visits restarted but telemedicine visits were continued to be offered. Result(s): Patient population: 41 patients completed the study. Two groups were defined based on initial visit type: Group A (Gr-A = Telemedicine, n=26) and group B (Gr-B = in-person, n=15). For Gr-A, follow-up visits were via telemedicine (n=17), in-person (n=2) and 7 patients had no follow-up. For Gr-B, the follow-up visits were via telemedicine (n=9), in-person (n=4) and 2 patients had no follow up visit. Mean age of participants was 14.5+/-2.8 years with female predominance (73.2%). No significant difference was found in age, gender, race, DGBI diagnosis, presence of extra-intestinal symptoms, number of follow-up visits, baseline API or FDI between groups. Patient satisfaction with multidisciplinary care at initial visit (Figure 1): No significant differences were detected between Gr-A and Gr-B (p>0.05). Patient visit type preference: Families preferred in-person visits (73%) for the first visit, but telemedicine (46%) or no preference (47%) for follow-up visits. When asked if patients were equally satisfied with telemedicine and in-person visits, 81.9% agreed, 9.1% were undecided and 9.1% disagreed. 81.9% were not worried about somethinig being missed during the telemedicine visit, while18.2% were undecided about this. When asked if patients felt telemedicine was more efficient than in-person visits, 54.6% agreed, 27.3% were undecided and 45.5% disagreed. 90.9% of patients agreed that telemedicine visits were more convenient, where 9.1% were undecided. Patient outcomes: There was no clinically significant improvement of the API score in either group (Gr-A: 2.7+/-0.8 to 2.4+/-1.1, p=0.04;Gr-B: 2.6+/-0.9 to 2.4+/-1.0, p=0.5) or FDI (Gr-A: 13.4+/-11.2 to 13.9+/-10.5,p=0.8, Gr-B: 15.4+/-10.7 to 14.3+/-8.0, p=0.8) between the initial and follow-up visit. When asked how patients felt subjectively at the time of study, there was improvement but no difference between groups: Much better (Gr-A: 52.6% vs Gr-B: 84.6%), Better (Gr-A: 47.4% vs Gr-B: 15.4% ), no patients in either group reported feeling worse (p=0.07). Subjective improvement of functioning was reported in Gr-A: 58.5% fair to excellent, 29.4% poor and 11.8% none, whereas in Gr-B 58.3% felt fair to excellent improvement of functioning and 41.7% continued to function poorly (p=0.4). Conclusion(s): Patients are equally satisfied with delivery of multidisciplinary care for pediatric DGBI via telemedicine and in-person, suggesting this may be a promising route for expanding delivery of care even in the post-pandemic era. Limitations of this study are the small sample size. Further the lock-down promoted lack of functioning and measures of disability such as the FDI may not be representative.

The Impact of COVID-19 on Neuro-Oncology Clinical Trials DuringWave 1 andWave 2 at a Frontline Detroit Healthcare System

Objective: 1. N/A 2. Background: In the wake of the Coronavirus disease outbreak (COVID-19), clinical trial operations were significantly impacted following the shutdown of elective healthcare services and, in some cases, emergency operations. When the pandemic hit Detroit, Michigan in March 2020, the Hermelin Brain Tumor Center (HBTC) at Henry Ford Health System was consumed in COVID-19 emergency care which affected patient enrollment, conduct of trial activities, therapeutic treatment, deviation from protocol requirements, and sponsor-study site contact. The first Metro-Detroit COVID-19 case was confirmed March 10th 2020. At that time there were 18 active brain tumor clinical trials (phase 1 - 3) providing anti-cancer therapies. Design/Methods: Modifications included decentralized operations to buildings with clinic and radiology access away from inpatient COVID-19 care, utilization of telemedicine for nonessential visits, shipping of investigational products to patient home, and in some cases utilization of local results in place of central histopathological confirmation. By April 2020, trials were ranked based on availability of alternate therapies and subject safety in 4 tiers that correlated with subject benefit and impact on care. Trials were given a prioritization level to commence enrollment with priority given to trials where no standard of care exists. Of the HBTC trials, one was graded Tier 1 and most were graded Tier 2. All patients already enrolled, continued study participation. As restrictions eased, trials were opened in a sequential manner. Results: N/A Conclusions: Changes that were made during the first wave of the pandemic helped to minimize its effect on clinical trial operation and enrollment during the second wave in Fall 2020. Thus, leading toward a decrease in trial deviations and increased enrollment during the 2 wave. Changes made during the first wave helped to safely continue enrollment and treatment during the second wave and will have a longstanding impact on how clinical trials are conducted in the future.

Neuro-Oncologic Care During the COVID-19 Pandemic

The COVID-19 pandemic has shocked health-care systems around the world necessitating profound shifts in resources and alterations to standard therapies. The pandemic’s impact on delivering care to people with cancer is regionally specific and the resultant changes in disease outcomes are not yet known. Neuro-oncologic conditions are often rare diseases with few effective therapies that require coordinated care by a team of specialists organized through a multidisciplinary cancer conference. During this pandemic, additional factors need to be considered such as COVID-19 exposure and therapy-related risks in the setting of a COVID-19 infection. The COVID-19 pandemic has resulted in dramatic changes to therapeutic clinical trials which are a preferred path of care in neuro-oncology due to dismal outcomes and few effective standard therapies. Herein, we discuss plans of care for neuro-oncologic conditions in a pandemic environment where every health-care exposure is considered a risk and standard approaches may not be possible due to limited access to resources such as intensive care units and surgical suites. © 2021 Elsevier Inc. All rights reserved.

OPTN/SRTR 2020 Annual Data Report: Lung.

For the first time in a decade, both the number of candidates added to the waiting list and the number of lung transplants performed decreased from the year prior; the number of lung donors also declined. This slowing of transplant activities in 2020 was associated with a modest increase in waitlist mortality. The year 2020 was notable for the global outbreak of the COVID-19 pandemic, which undoubtedly influenced all trends noted in lung transplantation. Time to transplant continued to decrease, with a median time to transplant of 1.4 months across all waitlist candidates. Posttransplant survival remained stable, with 89.4% of transplant recipients surviving to 1 year, 74.8% to 3 years, and 61.2% to 5 years.

OPTN/SRTR 2020 Annual Data Report: Kidney.

The year 2020 presented significant challenges to the field of kidney transplantation. After increasing each year since 2015 and reaching the highest annual count to date in 2019, the total number of kidney trans- plants decreased slightly, to 23642, in 2020. The decrease in total kidney transplants was due to a decrease in living donor transplants; the number of deceased donor transplants rose in 2020. The number of patients waiting for a kidney transplant in the United States declined slightly in 2020, driven by a slight drop in the number of new candidates added in 2020 and an increase in patients removed from the waiting list owing to death-important patterns that correlated with the COVID-19 pandemic. The complexities of the pandemic were accompanied by other ongoing challenges. Nationwide, only about a quarter of waitlisted patients receive a deceased donor kidney transplant within 5 years, a proportion that varies dramatically by donation service area, from 14.8% to 73.0%. The nonutilization (discard) rate of recovered organs rose to its highest value, at 21.3%, despite a dramatic decline in the discard of organs from hepatitis C-positive donors. Nonutilization rates remain particularly high for Kidney Donor Profile Index ≥85% kidneys and kidneys from which a biopsy specimen was obtained. Due to pandemic-related disruption of living donation in spring 2020, the number of living donor transplants in 2020 declined below annual counts over the last decade. In this context, only a small proportion of the waiting list receives living donor transplants each year, and racial disparities in living donor transplant access persist. As both graft and patient survival continue to improve incrementally, the total number of living kidney transplant recipients with a functioning graft exceeded 250,000 in 2020. Pediatric transplant numbers seem to have been impacted by the COVID-19 pandemic. The total number of pediatric kidney transplants performed decreased to 715 in 2020, from a peak of 872 in 2009. Despite numerous efforts, living donor kidney transplant remains low among pediatric recipients, with continued racial disparities among recipients. Of concern, the rate of deceased donor transplant among pediatric waitlisted candidates continued to decrease, reaching its lowest point in 2020. While this may be partly explained by the COVID-19 pandemic, close attention to this trend is critically important. Congenital anomalies of the kidney and urinary tract remain the leading cause of kidney disease in the pediatric population. While most pediatric de- ceased donor recipients receive a kidney from a donor with KDPI less than 35%, most pediatric deceased donor recipients had four or more HLA mis- matches. Graft survival continues to improve, with superior survival for living donor recipients versus deceased donor recipients.

OPTN/SRTR 2020 Annual Data Report: Liver.

This year was marked by the COVID-19 pandemic, which altered transplant program activity and affected waitlist and transplant outcomes. Still, 8906 liver transplants were performed, an all-time high, across 142 centers in the United States, and pretransplant as well as graft and patient survival metrics, continued to improve. Living donation activity decreased after several years of growth. As of June 30, 2020, 98989 liver transplant recipients were alive with a functioning graft, and in the context of increasing liver transplant volume, the size of both the adult and pediatric liver transplant waitlists have decreased. On February 4, 2020, shortly before the pandemic began, a new liver distribution policy based on acuity circles was implemented, replacing donor service area- and region-based boundaries. A policy change to direct pediatric livers to pediatric recipients led to an increase in deceased donor transplant rates and a decrease in pretransplant mortality rate among children, although the absolute number of pediatric transplants did not increase in 2020. Among adults, alcohol-associated liver disease became the predominant indication for liver transplant in 2020. After implementation of the National Liver Review Board and lower waitlist priority for most exception cases in 2019, fewer liver transplants were being performed via exception points, and the transplant rate between those with and without hepatocellular carcinoma has equalized. Women continue to experience higher pretransplant mortality and lower rates of liver transplant than men.

OPTN/SRTR 2020 Annual Data Report: Heart.

As we enter the third year of the new adult heart allocation policy, we are faced with the new challenges of the COVID-19 pandemic. In 2020, new listings (adult and pediatric) decreased slightly, with 4000 new listings in 2020, compared with 4087 in 2019; however, the number of adult heart transplants performed continued to increase, to 3715 in 2020. The number of pediatric heart transplants declined from 509 in 2019 to 465 in 2020. One-year and six-month posttransplant mortality rates in adult recipients have increased slightly since 2015 but have not significantly changed over the past decade. Overall, posttransplant mortality rates for adult recipients were 7.4% at six months and 9.4% at one year for transplants in 2019, 14.0% at three years for transplants in 2017, and 19.1% at five years for transplants in 2015. Although shorter-term posttransplant mortality rates have slightly increased, there has been a steady downward trend in longer-term mortality. Mortality rates for pediatric recipients were 5.7% at six months and 8.1% at one year for transplants in 2019, 11.6% at three years for transplants in 2017, and 15.2% at five years for transplants in 2015.

OPTN/SRTR 2020 Annual Data Report: DOD.

SRTR uses data collected by OPTN to calculate metrics such as donation rate, organ yield, and rate of organs recovered for transplant but not transplanted. In 2020, there were 12,588 deceased donors, an increase from 11,870 in 2019; this number has been increasing since 2010. The number of deceased donor transplants increased to 33,303 in 2020, from 32,313 in 2019; this number has been increasing since 2012. The increase may be due in part to the rising number of deaths of young people amid the ongoing opioid epidemic. The number of organs transplanted included 18,410 kidneys, 962 pancreata, 8350 livers, 91 intestines, 3722 hearts, and 2463 lungs. Compared with 2019, transplants of all organs except pancreata and lung transplants increased in 2020, which is remarkable despite the pandemic caused by the SARS-CoV2 virus. In 2020, 4870 kidneys, 294 pancreata, 861 livers, 3 intestines, 39 hearts, and 115 lungs were discarded. The number of discards was similar to that of the previous year. In 2019, 4,324 kidneys, 346 pancreata, 867 livers, 5 intestines, 31 hearts, and 148 lungs were discarded. These numbers suggest an opportunity to increase numbers of transplants by reducing discards. Despite the pandemic, there was no dramatic increase in number of discards and an increase in total number of donors and transplants.

An innovative virtual multi-institutional, multidisciplinary neuro-oncology tumor board: The Nih-Nob experience during the COVID-19 pandemic

BACKGROUND: The American Academy of Neurology Institute and Society for Neuro-Oncology recommend multidisciplinary tumor board (MTB) meetings as a quality metric in neuro-oncology. With the COVID-19 pandemic resulting in travel restrictions, we expanded our existing MTB by transitioning to a virtual format that maintained our commitment to providing consultation for primary CNS tumor cases. This transition permitted participation by neuro-oncology teams from over 30 Brain Tumor Trials Collaborative (BTTC)/National Cancer Institute-Comprehensive Oncology Network Evaluating Rare CNS Tumors (NCI-CONNECT) centers across the United States. Here, we describe results from opening our MTB remotely to these teams. METHODS: We retrospectively reviewed records from remote MTB meetings held between April 2020 and March 2021. To gauge the impact of our MTB on clinical management, we administered a brief survey querying BTTC members. RESULTS: Twenty-eight providers presented 41 cases during 24 virtual MTB meetings (range: 1-4 cases per meeting). Two cases (5%) were presented only for educational value. Approximately half (54%) of the cases discussed dealt with diagnosis/management of an NCI-CONNECT rare CNS tumor. During MTB discussions of the 39 cases seeking diagnosis/management recommendations, 32% received clinical trial recommendations, 10% were suggested to enroll in the NCI Neuro-Oncology Branch (NOB) Natural History Study (NCT02851706), 17% received a recommendation to obtain central neuropathology review, and 100% received recommendations for further disease management. Most BTTC survey respondents (83%) found these recommendations impactful in the management/treatment of their presented case or generally useful/ informative for their clinical practice. CONCLUSION: We describe the feasibility and utility of an innovative virtual multi-institutional MTB. These novel remote meetings allowed for discussion of complex neuro-oncology cases and recommendations from experts, particularly important for those with rare CNS tumors. Our study's findings during the COVID-19 pandemic of the value of providing remote access to MTBs should apply postpandemic.

Increased Risk of Thrombosis in Patients with Myeloproliferative Neoplasms Compared with the General Population Hospitalized with COVID-19

[Formula presented] Background: Coronavirus disease-2019 (COVID-19) is an inflammatory, multisystem infectious disease caused by severe acute respiratory syndrome-coronavirus-2 (SARS-COV-2) and is associated with increased risk of thrombosis, particularly among critically ill patients. The myeloproliferative neoplasms (MPNs) include Philadelphia chromosome-negative (Ph-negative) MPNs polycythemia vera (PV), essential thrombocytosis (ET), and primary myelofibrosis (PMF), and Philadelphia-chromosome positive chronic myeloid leukemia (CML). Patients with MPNs, especially PH-negative, have increased risk of thrombotic complications. Given the increased propensity of thrombosis and prognostic significance of thrombosis in both COVID and MPNs, defining the risk of thrombotic complications in this patient population compared to the general population is important. Methods: Using an institutional database within the Mass General Brigham integrated health network, we retrospectively analyzed 63 consecutive patients with MPN who were ≥ 18 years old and tested positive for SARS-COV-2 infection based on polymerase chain reaction (PCR) testing from March 1, 2020 to January 1, 2021. We compared patients admitted to the hospital in our “MPN cohort” with patients admitted to the hospital from a separate COVID-19 (non-MPN cohort) Mass General Brigham registry of 1114 consecutive patients who tested positive for SARS-COV-2 infection based on PCR testing from March 13, 2020 to April 3, 2020. Care was taken to ensure the cohorts were mutually exclusive. The 90-day primary outcome for MPN cohort was a composite of all-cause death, any thrombosis (composite of arterial and venous thromboembolism [VTE]), International Society on Thrombosis and Haemostasis (ISTH) defined major and clinically relevant non-major bleeding. To identify risk factors for primary outcome in MPN cohort we used a multivariable logistic regression using age, sex, hospital admission status, MPN type, cytoreduction for MPN, hypertension, smoking status, baseline anticoagulation (AC), prior thrombosis (stroke, myocardial infarction or VTE) as co-variables. The 90-day outcomes of interest in our MPN vs non-MPN cohort analysis were any thrombosis, death, ISTH major and clinically relevant non-major bleeding and readmission for any reason. To assess impact of MPN status in hospitalized patients in our MPN vs non-MPN comparison, we used a multivariable logistic regression using age, sex, race, Hispanic ethnicity, ICU admission, treatment with steroids and/or Remdesivir, baseline AC and aspirin use, prior thrombosis (stroke, myocardial infarction or VTE), diabetes, heart failure, admission hematocrit, platelet count and D-dimer as co-variables. Continuous variables were compared using student t-test and categorical variables were compared using Fischer's Exact Test with a p value of < 0.05 considered significant. Results: Of the 63 patients with MPN (23 with PV, 17 ET, 4 PMF, 15 CML, 4 other), 27 (43%) were admitted to the hospital for COVID-19 and 5 (8%) required ICU admission. The mean age of all MPN patients was 66, 84% were White, 8% Black and 10% Hispanic. Primary 90-day outcome occurred in 12 (19%) of MPN patients. In multivariable analysis, only admission to hospital was associated with increased odds of composite (aOR 21.11, 95% CI 2.38 - 546.40), Figure 1A. In patients with (n = 27) and without MPN (n = 399) who were admitted to the hospital, patients with MPN were older (mean age 70 vs 61, p = 0.0076), more likely to be White (89% vs 54%, p = 0.0004) and less likely to be Hispanic (7% vs 29%, p = 0.0158), less likely to be admitted to the ICU (19% vs 43%, p = 0.0138), and more likely to be treated with corticosteroids (30% vs 14%, p = 0.025) or remdesivir (41% vs 13%, p < 0.0001). After multivariable logistic regression, diagnosis of MPN was significantly associated with increased odds of thrombosis (aOR 5.38, 95% CI 1.15-25.38) and readmission (aOR 6.28, 95% CI 1.60-24.88), but not bleeding (aOR 3.51, 95% CI 0.62-18.87) or death (aOR 4.29, 95% CI 0.95-18.9 ), Figure 1B. Conclusions: Thrombotic complications are common in patients with MPN and COVID-19, particularly if hospitalized for COVID-19. After multivariable analysis, MPN patients admitted for COVID-19 had a significantly increased risk of thrombotic complications compared with non-MPN patients. [Formula presented] Disclosures: Al-Samkari: Dova/Sobi: Consultancy, Research Funding;Novartis: Consultancy;Argenx: Consultancy;Rigel: Consultancy;Amgen: Research Funding;Agios: Consultancy, Research Funding;Moderna: Consultancy. Rosovsky: Janssen: Consultancy, Research Funding;BMS: Consultancy, Research Funding;Inari: Consultancy, Membership on an entity's Board of Directors or advisory committees;Dova: Consultancy, Membership on an entity's Board of Directors or advisory committees. Fathi: Agios/Servier: Consultancy, Other: Clinical Trial Support;BMS: Consultancy, Other: Clinical Trial Support;AbbVie: Consultancy, Other: Clinical Trial Support;Pfizer: Consultancy;Trillium: Consultancy;Kura: Consultancy;Blueprint Medicines Corporation: Consultancy;Genentech: Consultancy;Novartis: Consultancy;Trovagene: Consultancy;Daiichi Sankyo: Consultancy;Novartis: Consultancy;Morphosys: Consultancy;Kite: Consultancy;Foghorn: Consultancy;Takeda: Consultancy;Amgen: Consultancy;Seattle Genetics: Consultancy;NewLink Genetics: Consultancy;Forty Seven: Consultancy;Ipsen: Consultancy. Goldhaber: Bayer: Consultancy, Research Funding;Boehringer-Ingelheim: Consultancy, Research Funding;BMS: Research Funding;Boston Scientific BTG EKOS: Research Funding;Daiichi: Research Funding;Janssen: Research Funding;Pfizer: Consultancy, Research Funding;Agile: Consultancy. Piazza: Portola: Research Funding;Bayer: Research Funding;Amgen: Research Funding;BMS: Research Funding;Janssen: Research Funding;BSC: Research Funding. Hobbs: Celgene/Bristol Myers Squibb: Consultancy;Novartis: Consultancy;Merck: Research Funding;Constellation Pharmaceuticals: Consultancy, Research Funding;Bayer: Research Funding;Incyte Corporation: Research Funding;AbbVie.: Consultancy.

Cardiovascular outcomes in hospitalized patients with COVID-19 and history of cancer: A CORONA-VTE analysis

Background: In hospitalized patients with COVID-19, active cancer has been identified as a potential risk factor for adverse cardiovascular outcomes, including thrombosis. However, the impact of COVID-19 on outcomes in patients with a remote history of cancer is poorly understood. We evaluated hospitalized patients with a history of remote cancer and COVID-19 to examine whether a history of cancer contributes to 30-day major adverse cardiovascular outcomes among patients with COVID-19. Methods: Using a retrospective cohort of 1114 patients from CORONAVTE (Registry of Arterial and Venous Thromboembolic Complications in Patients With COVID-19), we looked at 399 hospitalized patients diagnosed with polymerase chain reaction (PCR)-confirmed COVID-19 within a large heath care network that consists of two large academic medical centers and several community hospitals. Twenty-six patients with active cancer or receiving cancer treatment within 1-year of COVID-19 diagnosis and five patients with unknown cancer history were excluded.We assessed 46 patients with a history of cancer and 322 patients without any history of cancer. The primary endpoint was the frequency of adjudicated major adverse cardiovascular outcomes, defined as myocardial infarction, stroke, pulmonary embolism, deep vein thrombosis, and mortality. Results: Among the 46 hospitalized patients with COVID-19 and a history of cancer, 23.9% were non-white and 43.48% women. Compared to patients without any history of cancer, patients with a history of cancer were older (median 59.0 vs. 75.5 years, p<0.001) and had higher BMI (median 26.4 vs. 29.6 kg/m2, p<0.05). Patients with a history of cancer had higher rates of underlying CVD than those without (42.4% vs. 23.2%). Rates of major adverse cardiovascular events were similar in patients with and without a history of cancer (28.3% vs. 23.6%, respectively). Those with a history of cancer had a higher mortality rate (28.9% vs. 11.2%, p<0.05). Acute Respiratory Distress Syndrome (ARDS) and preexisting CVD were independently associated with mortality in this patient cohort (OR 19.7, 95% CI 7.5-51.7 and OR 2.9, 95% CI 1.2-6.9). History of remote cancer was not independently associated with mortality (OR 2.39, 95% CI 0.93-6.15, p=0.07). Conclusion: Our findings indicate that a history of remote cancer is not independently associated with increased mortality in hospitalized COVID-19 patients. These data suggest that the cause of death among hospitalized patients with COVID-19 and history of cancer is most likely multifactorial, with a strong contribution from cardiovascular disease.

The effect of acuity circles on deceased donor transplant and offer rates across meld and exception statuses

Purpose: Acuity circles (AC) allocation was implemented on February 4, 2020. AC significantly changed the relative priority of candidates with allocation PELD/ MELD scores of 29 to 34. We therefore performed a difference-in-differences analysis for the effect of AC on adjusted deceased donor transplant and offer rates across PELD/MELD categories. Methods: The before-AC period was February 4, 2019 to February 3, 2020, and the after-AC period was February 4 to March 12, 2020, the day before the national declaration of emergency due to COVID-19. Deceased donor transplant rates used active candidate time on the waiting list during the study period. The deceased donor offer rate was the number of offers in the first 10 spots of match run a candidate received per person-year. Only offers before the final acceptance were included. Transplant and offer rates were adjusted for other candidate characteristics. Results: Candidates with PELD/MELD 29-32 and PELD/MELD 33-36 had larger differences in transplant rates before and after AC than candidates with PELD/MELD 15-28, while other PELD/MELD categories also had larger but non-significant dif Admin ferences compared to candidates with PELD/MELD 15-28 (Figure 1). In contrast, all candidates with PELD/MELD 29 and higher had dramatically larger offers rates before and after AC than candidates with PELD/MELD 15-28 (Figure 2). Conclusions: Taken together, the implementation of AC increased the relative access to deceased donor transplant for candidates with PELD/MELD of 29-36 without reducing access for candidates with higher allocation priority.

COVID-19 incidence was initially associated with post-transplant kidney graft failure

Purpose: To better understand the effect of COVID-19 on kidney posttransplant outcomes, we estimated the association of county-level COVID-19 incidence with kidney posttransplant graft failure. Methods: The study used a period-prevalent cohort of kidney recipients from March 13, 2019 to July 31, 2020 who received a transplant on or after January 1, 2000. The county-level incidence of COVID-19 for each kidney transplant program was determined from the New York Times database and aggregated into cases per 1,000,000 for each week before and after the national emergency declaration for COVID-19. Results: For each week, recipients were given the county-level incidence of the transplant program during the previous week. A two-dimensional spline estimated the effect of COVID-19 across calendar time and incidence. Conclusions: The effect of COVID-19 incidence had a nonlinear relationship with kidney graft failure, and the effect changed over the course of the pandemic. At the time of the national emergency declaration (March 13 to 19, 2020), the incidence of COVID-19 had a nonlinear effect (Figure 1, left panel): relatively flat up to an incidence of about 16, then the effect rapidly increased to a hazard ratio of about 3, for an incidence of 1024. This nonlinear effect attenuated during the weeks after the declaration of a national emergency. Roughly 10 weeks after the emergency declaration (May 22 to 28, 2020), the incidence of COVID-19 had a less dramatic effect on posttransplant graft failure rates (Figure 1, right panel). Thus, the emergence of COVID-19 coincided with a significantly higher rate of kidney graft failure, potentially from COVID-19 infection or patients not seeking for-cause medical care. However, after the initial disruption, kidney graft failure rates were less strongly associated with COVID-19 incidence, suggesting that kidney recipients and/or transplant programs may have adapted to the new conditions imposed by COVID-19. (Table Presented).