ABSTRACT
Introduction The Rockwood clinical frailty score (CFS) has been recommended for use in assessing patients during the COVID-19 pandemic. However, a recent cohort study has suggested it has little impact on the hazard of dying due to COVID-19,1 while use to inform escalation decisions has proven contentious. Method We identified patients hospitalised with COVID-19 from 11 March 2020 to 28 April 2020. Age, gender, key co-morbidities, inpatient mortality, length of stay, CFS, respiratory support, chest X-ray (CXR) appearance and C-reactive protein (CRP) were collected retrospectively from electronic records and medical notes. Multiple imputation used for missing values (CFS n= 1;CRP n= 5;CXR n= 9). Univariate relationships with in-hospital mortality were examined (Fisher's exact, T test and Mann-Whitney U as appropriate) and independent predictors of mortality were identified via backward stepwise logistic regression. CFS was verified in patients referred for CPAP/NIV on the Respiratory Support Unit (RSU;maximum level of care);mortality outcomes are separately shown. Results Among 414 patients;mean age was 73 (SD 14.297) years, 241 males (58%), 135 died (33%) and median CFS 4 (IQR 2.75-5.00). Older age (mean 69.90 [SD 15.122] vs. 79.40 [SD 9.616];p< 0.0001) and CFS (median 3 [IQR 2-4] vs. 5 [IQR 3-6];p< 0.0001) were significantly associated with mortality. Mortality was higher in those invasively (10/13, 76.9%, p= 0.001) and non-invasively (16/32, 50.0%, p= 0.027) ventilated. Independent predictors associated with mortality are shown in table 1. Among patients receiving CPAP/NIV on the RSU, mortality increased with each CFS category (1-3 n=6/17, 35.3%;4-5 n=9/14, 64.3%;6-7 n=5/6, 83.3%). Conclusion We report a large, single centre series of COVID-19 patients. Consecutive patients were identified, and missing data were few. CFS is a strong independent predictor of mortality in patients with COVID-19. This data would suggest that, in our population, the continuing use of CFS is important in our management and decision making in patients with COVID-19.
ABSTRACT
S6 Table 1Independent predictors of mortality in COVID-19 patientsConclusionWe report a large, single centre series of COVID-19 patients. Consecutive patients were identified, and missing data were few. CFS is a strong independent predictor of mortality in patients with COVID-19. This data would suggest that, in our population, the continuing use of CFS is important in our management and decision making in patients with COVID-19.ReferenceRK Owen, SP Conroy, N Taub, et al. Comparing associations between frailty and mortality in hospitalised older adults with or without COVID-19 infection: a retrospective observational study using electronic health records. Age and Ageing. 2020. doi.org/10.1093/ageing/afaa167
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Britain lags behind many other countries in its provision of high-speed rail. This paper looks in depth at the challenges of providing high-speed rail links, east-west, across Northern England, identified as a key issue by former Chancellor of the Exchequer George Osborne in his Northern Powerhouse speech in 2014. We ask what can be learned from the politics of Britain's successful motorway programme in the 1960s and 1970s, and from the plan advanced for High Speed North by the late Professor Sir Peter Hall and colleagues, published some weeks before Osborne's speech. Introducing the concept of centripetal urban dynamics, we doubt whether the suppression of public transport demand by the Covid 19 virus will be long lasting. Thus the Hall Plan still has remarkable relevance, especially in its tactics for sequencing investment, which we term modular incrementalism. Some updating is needed, so that the investment strategy focuses on super critical problems for rail investment. We conclude with recommendations for the High Speed North project itself and reflect on wider implications for decision-making processes. © (2020). All rights reserved.
ABSTRACT
BACKGROUND: In the wake of the SARS-CoV-2 pandemic and unprecedented global demand, clinicians are struggling to source adequate access to personal protective equipment. Respirators can be in short supply, though are necessary to protect workers from SARS-CoV-2 exposure. Rapid decontamination and reuse of respirators may provide relief for the strained procurement situation. METHOD: In this study, we investigated the suitability of 70°C dry heat and microwave-generated steam (MGS) for reprocessing of FFP2/N95-type respirators, and Type-II surgical face masks. Staphylococcus aureus was used as a surrogate as it is less susceptible than enveloped viruses to chemical and physical processes. RESULTS: We observed >4 log10 reductions in the viability of dry S. aureus treated by dry heat for 90 min at 70°C and >6 log10 reductions by MGS for 90 s. After 3 reprocessing cycles, neither process was found to negatively impact the bacterial or NaCl filtration efficiency of the respirators that were tested. However, MGS was incompatible with Type-II surgical masks tested, as we confirmed that bacterial filtration capacity was completely lost following reprocessing. MGS was observed to be incompatible with some respirator types due to arcing observed around some types of metal nose clips and by loss of adhesion of clips to the mask. CONCLUSION: Considering the advantages and disadvantages of each approach, we propose a reprocessing personal protective equipment/face mask workflow for use in medical areas.