The impact of COVID-19 on disease epidemiology, family dynamics, and social justice in Minnesota: All that you cannot see.

Objective: The COVID-19 pandemic presented a challenge to established seed grant funding mechanisms aimed at fostering collaboration in child health research between investigators at the University of Minnesota (UMN) and Children's Hospitals and Clinics of Minnesota (Children's MN). We created a "rapid response," small grant program to catalyze collaborations in child health COVID-19 research. In this paper, we describe the projects funded by this mechanism and metrics of their success. Methods: Using seed funds from the UMN Clinical and Translational Science Institute, the UMN Medical School Department of Pediatrics, and the Children's Minnesota Research Institute, a rapid response request for applications (RFAs) was issued based on the stipulations that the proposal had to: 1) consist of a clear, synergistic partnership between co-PIs from the academic and community settings; and 2) that the proposal addressed an area of knowledge deficit relevant to child health engendered by the COVID-19 pandemic. Results: Grant applications submitted in response to this RFA segregated into three categories: family fragility and disruption exacerbated by COVID-19; knowledge gaps about COVID-19 disease in children; and optimizing pediatric care in the setting of COVID-19 pandemic restrictions. A series of virtual workshops presented research results to the pediatric community. Several manuscripts and extramural funding awards underscored the success of the program. Conclusions: A "rapid response" seed funding mechanism enabled nascent academic-community research partnerships during the COVID-19 pandemic. In the context of the rapidly evolving landscape of COVID-19, flexible seed grant programs can be useful in addressing unmet needs in pediatric health.

Persistence of procoagulable thromboelastography results in hospitalized COVID-19 patients despite clinical improvement.

OBJECTIVE: COVID-19 patients have been shown to be hypercoagulable, increasing the risk for thromboembolic events. The kinetics of the blood coagulation process were monitored daily throughout hospitalization in COVID-19 positive patients. PATIENTS AND METHODS: Thromboelastography (TEG) was used to assess blood coagulation in 48 adult patients hospitalized for COVID-19 in this prospective cohort study. Clinical risk was assessed via National Early Warning Scores (NEWS) for each day of hospitalization. RESULTS: During hospitalization, 98% of patients had one or more procoagulable TEG result. Thromboelastography results remained prothrombotic upon discharge in 80% of patients. NEWS significantly decreased by discharge compared to the peak scores. CONCLUSIONS: Overall, patients were discharged from the hospital with significant clinical improvement, but without abnormal TEG results returning to a normal range. All patients in our study survived and few had thromboembolic events, so if and for how long these patients remain at risk for future complications warrants further investigation.

Fetal Effects of COVID-19 Infection: Targeted Metabolomic profiling of cord blood

Objective: The impact of maternal COVID-19 infection on fetal health remains to be determined. Using targeted metabolomic analysis of newborn umbilical cord blood, we aimed to evaluate the biological consequences of maternal infection on the fetus and develop metabolite biomarkers for the identification of newborn intrauterine exposure. Study Design: Cord blood serum samples from 23 COVID-19 cases (mother infected/ newborn negative) and 23 gestational age-matched controls were analyzed using nuclear magnetic spectroscopy and direct injection liquid chromatography mass spectrometry-mass spectrometry. Logistic regression models were developed using metabolites to predict intrauterine exposure with Area under the Receiver Operating Characteristics curve [AUC (95% CI)], sensitivity, and specificity. Metabolite set enrichment analysis was used to evaluate altered biochemical pathways to highlight biological mechanisms of COVID-19 intrauterine exposure. Results: There were no significant differences in gestational age at delivery between groups (p >0.05). All neonates tested negative for COVID-19 infection. Significant concentration differences (p-value < 0.05 or -log10=1.301) were observed in 19 metabolites between groups. The top metabolite model [cortisol and Ceramide (d18:1/20:0)] achieved an AUC (95% CI) = 0.839 (0.722 - 0.956) with a sensitivity of 91% and specificity of 69% (Table 1). Enrichment analysis revealed significantly (p< 0.05) altered metabolic pathway of steroidogenesis and gluconeogenesis (Figure 1). Cortisol is the stress hormone that increases glucose production through gluconeogenesis resulting in higher oxidative metabolism and energy generation. Ceramides are known to have anti-inflammatory properties. Elevated hypoxanthine has also been correlated with tissue hypoxia and inflammation. Conclusion: We found evidence of intrauterine stress, altered energy metabolism and inflammation in fetal life in cases of maternal COVID-19 infection but ultimately negative newborn culture. Elucidation of long-term consequences is imperative considering the large number of exposures in the population. [Formula presented] [Formula presented]

Patient Perceptions of Drive Through Medical Treatment Facilities During the COVID-19 Pandemic

Study Objectives: The cumulative burden of the COVID-19 virus on the US healthcare system is substantial. To help mitigate this burden, novel solutions including tele-health and dedicated screening facilities have been utilized. However, there is limited data on the efficacy of such models and none assessing patient comfort levels with these changes in health care delivery. The aim of our study was to evaluate patients’ perceptions of a drive through medical treatment system in the setting of the COVID-19 pandemic. Methods: In response to the COVID-19 pandemic, NMCP’s emergency department established a drive-through medical evaluation facility (DMEF) in proximity to the emergency department. The DMEF was designed to allow full evaluation of patients to include: vital signs, complete medical history, clinician physical examination, limited point-of-care testing and medication distribution. All patients presenting to the emergency department with symptoms of potential COVID etiology and deemed non-critical were directed to the DMEF for initial evaluation. Patients were surveyed about their experience following their visit. An anonymous questionnaire consisting of 5 questions, utilizing a 5-point Likert scale was distributed via electronic tablet. Results: A total of 827 responses were obtained over two months. Three quarters of respondents believed care received was similar to that in a traditional emergency department. Overall positive impression of the drive-thru was 86.6%, and 95% believed that it was more convenient. Conclusion: Overall the drive-thru medical system was perceived as more convenient than the emergency department, and is viewed as a positive experience. While a dramatic change in the delivery model of medical care, if such systems are able to provide comparable levels of care, they may represent a viable option for sustained and surge health care delivery.

Thromboelastic Profiles of Patients With Coronavirus (COVID-19) Pneumonia

Study Objectives: The primary objective of the study was to use thromboelastography (TEG) to evaluate coagulation dynamics in patients hospitalized with COVID-19 and to investigate TEG as a predictive tool for clinical course of infection. Methods: Adult patients admitted to Naval Medical Center Portsmouth with the diagnosis of SARS-CoV-2 were eligible for enrollment. TEG was performed on admission and trended daily with other laboratory tests through the hospitalization. Charts were reviewed for demographic, medical history, daily progress notes, clinical status, lab values, and anticoagulation medication use for each patient. Treatment teams were blinded to TEG values. Results: A total of 53 patients were enrolled, with three patients having two separate admissions. There were 31 males and 22 females with a mean age of 48. The preponderance of individual TEG components showed progression towards hypercoagulation as days of illness progressed, with 92% of subjects having at least one TEG value outside the reference range, even with the vast majority of patients receiving either therapeutic or prophylactic anticoagulants. The maximum amplitude (MA) and TEG coagulation indexes (CI) best correlated with day of illness (r = 0.45 and r = 0.32, respectively). Peak CI also correlated with length of hospital stay (r = 0.38). The majority (91%) remained hypercoagulable on discharge. Conclusions: The use of TEG measurements in those hospitalized at NMCP with COVID-19 infection confirms the hypercoagulable state previously reported in COVID-19 patients. It may have a role as a tool to predict clinical courses or to direct anticoagulation or antiplatelet therapy to reduce morbidity and mortality.

JUE Insight: Are City Centers Losing Their Appeal? Commercial Real Estate, Urban Spatial Structure, and COVID-19

This paper estimates the value firms place on access to city centers and how this has changed with COVID-19. Pre-COVID, across 89 U.S. urban areas, commercial rent on newly executed long-term leases declines 2.3 percent per mile from the city center and increases 8.4 percent with a doubling of zipcode employment density. These relationships are stronger for large, dense “transit cities” that rely heavily on subway and light rail. Post-COVID, the commercial rent gradient falls by roughly 15% in transit cities, and the premium for proximity to transit stops also falls. We do not see a corresponding decline in the commercial rent gradient in more car-oriented cities, but for all cities the rent premium associated with employment density declines sharply following the COVID-19 shock.