Incidence of Long Covid Symptoms in Patients Previously Hospitalized for Covid-19

Background: Long COVID, also known as post-acute sequelae of COVID (PASC), affects more than 144 million people globally. While there is no broadly accepted consensus on a definition for the term "long COVID," studies have found symptoms persist or begin weeks or months after the end of SARS-CoV-2 infection. This study assessed the incidence of codes found in medical claims and hospital chargemasters that were consistent with long COVID symptoms commonly found in the literature. Method(s): Using the HealthVerity database, which provides closed claims and linked hospital chargemaster data on more than 25 million US patients, we examined patients aged 12 and above hospitalized between May 1, 2020 and September 30, 2021 with a diagnosis of COVID-19 who had at least 365 days of closed medical claims enrollment prior to index hospitalization admission and 90 days after admission, and did not have a long COVID diagnosis (ICD-10- CM U09.9) prior to the index hospitalization. Patients were allowed to have symptoms prior to hospitalization. The assessment period for the outcomes, which included 10 symptoms, was 90 days to 270 days after the date of hospitalization. Incidence rate per 100 person-years was calculated as the number of patients with the outcome divided by total person-time contributed (90 days after admission to the minimum of the following: outcome, inpatient death, disenrollment, end of data (April 30, 2022), or 270 days after admission). Result(s): The dataset included 3,661,303 patients with an inpatient hospitalization during the study period. The final study cohort included 44,922 patients hospitalized with COVID-19, 20,627 of whom experienced at least one of the long COVID symptoms. Anosmia and dysgeusia were the rarest events captured in medical claims. More commonly found symptoms were joint pain, fatigue and breathlessness (see table). Conclusion(s): This study examined diagnosed symptoms commonly found posthospitalization among COVID-19 patients and reported the incidence of these symptoms in a representative population. The start period of long COVID used in this study (90 days post hospitalization) is consistent with the WHO definition of long COVID. In the absence of an understanding of the pathophysiology of long COVID, the use of diagnosed symptoms to define long COVID has the advantage of ease of use and availability of data. Further studies of additional symptoms and predictors of long COVID are needed. (Figure Presented).

Discrimination and financial, occupational, and emotional well-being in strip club dancers during the COVID-19 pandemic: A call for policy reform

Due to the sexual nature of their work, strip club dancers have long been subject to marginalization and occupational stigma. During the coronavirus disease (COVID-19) pandemic, dancers faced unique stressors due to their status as contract workers within the stigmatized commercial sex/adult entertainment industry, and these stressors have likely impacted their financial, occupational, and emotional well-being. We surveyed 102 strip club dancers across 35 U.S. states and Puerto Rico to examine how their well-being has been impacted by the COVID-19 pandemic and to guide recommendations for policy reform. Findings revealed that during the pandemic, dancers experienced occupational stigmatization, structural and systematic exclusion from financial support during the pandemic, and numerous obstacles in obtaining employment outside of their industry, all of which contributed to reported financial and occupational stress. Furthermore, results demonstrated that strip club dancers experienced significant financial loss, and associated financial concern was associated with poorer mental health outcomes. Structural changes to financial relief packages are necessary for inclusion of strip club dancers, and there is also a clear need for more efforts to decrease discrimination and violence toward strip club dancers generally, including legal recognition of sex workers as laborers. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Implementing a Home-Based Cardiac Rehabilitation Programme for People with Heart Failure and Their Caregivers: Findings from the Scot: Reach-Hf Study

Background Despite robust evidence and national guidance recommending cardiac rehabilitation (CR) for heart failure (HF), access remains poor, a situation magnified by COVID- 19. The Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) randomised controlled trial demonstrated the clinical and cost-effectiveness of a novel home-based CR selfmanagement programme. The SCOT:REACH-HF study was designed to provide the understanding of real-world implementation needed for NHS-wide roll-out in a Scottish context. Aim To 1) compare outcome improvements and delivery costs with those identified in the RCT;and 2) identify facilitators of and barriers to real-world implementation. Methods A mixed-method implementation study of REACHHF delivery across six NHS Scotland areas in 2021-22. Health professionals were trained to facilitate delivery of the 12-week programme. We assessed patient- and caregiverreported outcomes (including health-related quality of life, psychological wellbeing) pre-and post-REACH-HF participation. Primary Outcome: Minnesota Living with Heart Failure Questionnaire (MLHF). 136 adults with reduced ejection fraction HF (HFrEF) were recruited, and 101 completed follow-up. 54 participants nominated caregivers, 26 of whom completed follow- up. Qualitative interviews with 20 key health professionals (primarily REACH-HF facilitators) were subject to thematic analysis to explore barriers to and facilitators of implementation. Fidelity, contextual, and economic data were also collected. Results REACH-HF participation resulted in significant gains in health-related quality of life, as assessed by the MLHF, PROM-CR+, and EQ-5D-5L, and Self-Care of Heart Failure Index (SCHFI). MLHF improvements were both statistically significant and met the minimum clinically important difference in 63% of participants (see figure 1). Interviewees were largely positive about REACH-HF - considering it to have 'filled a gap' when no other CR was available - and key issues to support future roll-out were identified. Conclusion Our findings support the scaled roll-out of REACH-HF. This would offer people with HFrEF, and their families and friends, an accessible alternative to centre-based CR. (Figure Presented).

The lasting impact of coronavirus disease 2019 on head and neck cancer services: a UK tertiary centre study.

BACKGROUND: The coronavirus disease 2019 pandemic led to increased pressure on health services, which, combined with variable social restrictions, led to decreased referrals for head and neck cancer. This study assessed whether there were lasting changes to head and neck cancer referrals during different stages of the pandemic response in 2020 and 2021. METHODS: A retrospective review was conducted of all cases referred for suspected head and neck cancer to our institution in January 2020, April 2020, April 2021 and June 2021. RESULTS: There was a rebound 91 per cent increase in referrals between April 2020 and April 2021 following the 59 per cent decrease in referrals between January 2020 and April 2020. Males made up 47.1 per cent of referrals in January 2020, 40 per cent in April 2020 and 37.82 per cent in April 2021. CONCLUSION: Further research is recommended to investigate the reasons why there is a continued decline in male referrals and the effect this has on their outcomes.

A wound care and immunization needs assessment for participants of a mobile syringe services program in Austin, TX.

BACKGROUND: People who inject drugs (PWID) are subject to injection-related harm, including skin and soft tissue infections. Syringe services programs (SSPs) provide sterile syringes, disposal of used syringes, and other supportive services. Given their contact and credibility with PWID, SSPs could facilitate triage and treatment of wounds and access to immunizations for communicable diseases. OBJECTIVE: This work aimed to assess wound care and immunization needs among participants accessing mobile SSP services in Austin, TX. METHODS: A 21-item mixed-methods survey was created to assess frequency and severity of wounds, wound care approaches, and vaccination status. Participants were included if they reported injection drug use and experienced a related wound in the previous 6 months. Interview sections included screening, demographics, wound care, and immunization status. RESULTS: A total of 21 participants completed the semistructured interview. A majority identified as male (n = 13, 61.9%), white (n = 12, 57.1%), and were unhoused (n = 12, 57.1%). The primary drug of injection was heroin alone (n = 14, 66.7%). Many avoided seeking wound care from health care providers (n = 16, 76.2%) owing to stigmatization (n = 13, 61.9%) and previous negative experiences (n = 7, 33.3%). Self-treatment of wounds included over-the-counter medications (n = 10, 47.6%), over-the-counter supplies (n = 10, 47.6%), and antibiotics (n = 9, 42.8%). In the past 5 years, few had received vaccination for hepatitis A and B (n = 3, 14.3%) or tetanus (n = 7, 33.3%), and many expressed interest in receiving vaccinations through the SSP. Interest for other expanded services included access to antibiotics, an on-site provider, wound care supplies, and education. CONCLUSIONS: PWID may avoid professional health care for wound care or immunizations owing to perceived stigma. Expanding availability of wound care services and immunizations directly through mobile SSPs is desired by participants and could positively affect public health.

Introduction of Implicit Bias Training to oncology faculty as a means to improve minority participation in cancer clinical trials

Background: Following George Floyd's murder in May 2020, conversations about equity and bias became part of our daily national conversation. Simultaneously the COVID-19 outbreak disproportionately affected people of color which further illuminated existing disparities in outcomes. Bias training was introduced in many sectors as a strategy to address inequity. Inclusivity in healthcare is essential to develop evidence-based therapies and treatment plans. Previous studies have demonstrated the consequences when racial and ethnic minorities are excluded from research. (Hamel et al, 2016). Racial and ethnic minorities disproportionately bear adverse outcomes from cancer. Cancer clinical trials would benefit from solutions to promote inclusivity. (Khan et al. 2021) Research Purpose: The purpose of our study was to assess whether Implicit Bias Training can increase minority participation in cancer clinical trials. Methodology: The Office of Diversity, Equity, and Inclusion offered Implicit Bias Training to all clinical oncologists at the Yale Cancer Center (YCC) between May and July 2021. While 109 physicians were eligible to participate, 57 physicians were required by the department to complete this training, and 84% of these physicians completed this opportunity. We analyzed YCC clinical trial enrollment data between two time periods defined as pre-intervention and post-intervention. We selected these periods to investigate not only the efficacy of bias training but specifically bias training as an adjunct to the national conversation during the time of our study. We selected the preintervention period as January 1, 2021, to June 30, 2021. The intervention was designed to be completed by July 1, 2021 therefore the post-intervention period is defined as July 1, 2021 to December 31, 2021. Results/Summary: Our analysis showed an increase of 2.5% in the participation of Black/African American patients. There was a slight (1.5%) decrease in Hispanic patient enrollment during this time. Conclusion(s): Our analysis suggested that implicit bias training delivered once had only a very modest, if any, improvement in racial minority participation in cancer clinical trials. Our project focused on participation by Black/African American patients. The impediment to Hispanic participation is quite nuanced. Hispanic patients, many of whom are non-English speaking with immigration/insurance issues face additional structural barriers. We think that a different strategy is needed to better serve this patient population. While we had hoped for metrics to demonstrate greater impact from bias training, our next investigation will look at if the intervention is best delivered repeatedly. Future Work: We have not abandoned the strategy of bias training to build trust and increase Black/AA participation. After the intervention, we are interested in whether greater impact is seen over time. We have designed a survey to look at the effects of the intervention after a year. Our next step is to examine whether repeated delivery of this intervention will amplify our results.

The Uk Paediatric Liver Transplant Programme during the Covid-19 Pandemic

Introduction The UK has been severely affected by the COVID-19 pandemic. The impact on the adult population has been disproportionately higher when compared to children with consequent challenges to organ donation and liver transplantation (LT). Across the three UK paediatric liver centres there has only been a very small number of patients who tested positive for COVID-19 and all made a speedy and full recovery. We report here the response during the pandemic across the 3 paediatric LT centres. Methods A series of nationally agreed policy changes affecting the liver procurement, listing and transplant process were agreed during regular meetings with LT centre directors and NHSE. Actions at a local and national level were agreed to protect and maintain the paediatric LT programmes. Data were collected from 27/03/20 until 26/11/20 and compared with same time period for the years 2016-19. Results During the study period, there was a significant reduction in the adult population in the mean number of weekly liver offers, donors and LTs compared to before the pandemic with signs of recovery between the 1st and 2nd UK lockdown periods (figure 1). More specifically the number of livers offered nationally was reduced from an average 30-40/week to only <10/week during the 1st wave in the March-April period. The number of children on the LT list during the study period across all 3 centres was 74 in total with 17 (23%) super-urgent and 57(77%) electives, which was comparable to previous years. Overall, 65-80 paediatric LTs are performed annually across the UK's 3 paediatric centres. From March-November 2020 there were 58(82%) elective and 13(18%) super urgent (acute liver failure & hepatoblastoma) paediatric LTs performed. Donor Brain Dead (DBD) and Donor Cardiac Dead (DCDC) LTs were 54(76%) and 3(4%), respectively. Living related LT (LRLT) programme was sustained comprising 20% of LTs performed. The number of paediatric LTs performed during the pandemic was comparable to those performed yearly since 2016. The number of LT per paediatric centre for King's College Hospital (KCH), Birmingham Children's Hospital (BCH) and Leeds Liver Unit were 40 (56%), 15(21%) and 16(23%), respectively with excellent outcome. A 15-year-old girl from KCH diagnosed with Wilson disease presented with liver failure and became COVID-19 positive whilst listed. She underwent LT soon after becoming COVID-19 negative. No perioperative mortality was reported with excellent outcome so far in all. Conclusion The current COVID-19 pandemic had a significant impact on the UK adult LT programme. The paediatric programme LT was preserved despite a decrease in organ offering and retrieval nationally plus limitations on adult intensive care resources at a regional level. Overall, paediatric LT outcome remained very good.

Outcome of Children on the Uk National Prioritised Paediatric Registration Tier

Introduction In April 2020 weekly teleconferences were established involving adult and paediatric representation from all 7 UK liver transplant (LT) centres and NHS England to discuss and maintain a national LT service during the COVID19 pandemic. Objective criteria to prioritise adult patients of high clinical urgency for prioritised access to LT were established. In lieu of such criteria for paediatric patients all three paediatric centres agreed to prioritise individual paediatric patients with chronic liver disease who were clinically deteriorating by consensus. A process to formally nationally prioritise clinically deteriorating paediatric patients was successfully introduced in October 2020. We report on the utilisation of the tier and outcome of these patients at a national level. Methods Patients from all 3 paediatric LT centres registered on the newly established national prioritised paediatric registration tier from October 2020-October 2021 were included. Demographic, clinical and laboratory data were collected and analysed. Results Since the introduction of the prioritization tier for children there were eight UK elective applications and all approved registrations. Mean age of patients registered was 5 years (range, 0-15). All patients were listed for LT prior to (Table Presented) prioritisation except patient 5 who was listed for liver-small bowel transplant before being prioritised for isolated LT. Indications for prioritization were hepatocellular carcinoma (1), acute decompensation due to portal hypertension (2), encephalopathy (3), sepsis (1), acute kidney injury (1). At time of prioritisation median values and range of alanine aminotransferase, albumin, total bilirubin, INR and platelets were 95 IU/ L (23-453), 25 g/L (16-39), 196 micromol/L (10-553), 1.6 (0.97-2.27) and 75 x109 (41-188), respectively. Median waiting time to transplant after prioritisation was 10 days (range, 3-37). All patients received a graft from a DBD donor and are all well at home. Median length of post-transplant ICU stay was 9 days (3-62) and total length of hospital stay was 56 days (27-85). Data on demographics and LT are listed on table 1. Conclusion The national paediatric prioritisation tier, introduced during the COVID19 pandemic, has been a pivotal initiative for the UK paediatric LT program, showcasing national collaboration. All patients underwent a LT successfully within a short time from prioritisation with 100% patient and graft survival. The intention is to maintain this prioritised paediatric tier following the pandemic.

Prevention and early treatment of the long-term physical effects of COVID-19 in adults: design of a randomised controlled trial of resistance exercise-CISCO-21.

BACKGROUND: Coronavirus disease-19 (COVID-19) infection causes persistent health problems such as breathlessness, chest pain and fatigue, and therapies for the prevention and early treatment of post-COVID-19 syndromes are needed. Accordingly, we are investigating the effect of a resistance exercise intervention on exercise capacity and health status following COVID-19 infection. METHODS: A two-arm randomised, controlled clinical trial including 220 adults with a diagnosis of COVID-19 in the preceding 6 months. Participants will be classified according to clinical presentation: Group A, not hospitalised due to COVID but persisting symptoms for at least 4 weeks leading to medical review; Group B, discharged after an admission for COVID and with persistent symptoms for at least 4 weeks; or Group C, convalescing in hospital after an admission for COVID. Participants will be randomised to usual care or usual care plus a personalised and pragmatic resistance exercise intervention for 12 weeks. The primary outcome is the incremental shuttle walks test (ISWT) 3 months after randomisation with secondary outcomes including spirometry, grip strength, short performance physical battery (SPPB), frailty status, contacts with healthcare professionals, hospitalisation and questionnaires assessing health-related quality of life, physical activity, fatigue and dyspnoea. DISCUSSION: Ethical approval has been granted by the National Health Service (NHS) West of Scotland Research Ethics Committee (REC) (reference: GN20CA537) and recruitment is ongoing. Trial findings will be disseminated through patient and public forums, scientific conferences and journals. TRIAL REGISTRATION: ClinicialTrials.gov NCT04900961 . Prospectively registered on 25 May 2021.

A gendered therapeutic learning landscape: Responding creatively to a pandemic

Crafting has occupied the hands and minds of women over many centuries providing vital connections with cultural skills and with community. While the COVID-19 pandemic has isolated women in their homes, it has also provided opportunities for women to reconnect to crafting through virtual spaces. This paper draws on a thematic analysis of a focus group interview examining the experiences of regional women participating in a crafting group and identifies the ways in which they used craft to support their wellbeing. Drawing on the concept of therapeutic landscapes, the paper highlights that connection in a virtual craft group supports lifelong learning and wellbeing, brings women together in support through a community of women's practice and facilitates opportunities for producing meaningful and commemorative quilting projects This finding has implications for a society experiencing unprecedented levels of stress, mental illness and anxiety about the future.

Time-Dependent Increase in Susceptibility and Severity of Secondary Bacterial Infections During SARS-CoV-2.

Secondary bacterial infections can exacerbate SARS-CoV-2 infection, but their prevalence and impact remain poorly understood. Here, we established that a mild to moderate infection with the SARS-CoV-2 USA-WA1/2020 strain increased the risk of pneumococcal (type 2 strain D39) coinfection in a time-dependent, but sex-independent, manner in the transgenic K18-hACE2 mouse model of COVID-19. Bacterial coinfection increased lethality when the bacteria was initiated at 5 or 7 d post-virus infection (pvi) but not at 3 d pvi. Bacterial outgrowth was accompanied by neutrophilia in the groups coinfected at 7 d pvi and reductions in B cells, T cells, IL-6, IL-15, IL-18, and LIF were present in groups coinfected at 5 d pvi. However, viral burden, lung pathology, cytokines, chemokines, and immune cell activation were largely unchanged after bacterial coinfection. Examining surviving animals more than a week after infection resolution suggested that immune cell activation remained high and was exacerbated in the lungs of coinfected animals compared with SARS-CoV-2 infection alone. These data suggest that SARS-CoV-2 increases susceptibility and pathogenicity to bacterial coinfection, and further studies are needed to understand and combat disease associated with bacterial pneumonia in COVID-19 patients.

Staying isolated in order to stay safe: Exploring experiences of the MIT AgeLab 85+ lifestyle leaders during the COVID-19 pandemic

This reprinted chapter originally appeared in Journal of Gerontological Social Work, 2020, 63[6-7], 694-695. (The following of the original article appeared in record 2021-00510-028.) Comments on an article by N. Kusmaul et al. (see record 2018-49264-004). Kusmaul et al. explained that one role of gerontological social workers in disaster preparedness and response is to identify unique needs, risk factors, and strengths possessed by older adults during periods of disaster. We would like to describe how a developing study of ours strives to understand these characteristics as they pertain to the "oldest old"-that is, adults ages 85 and over-in the midst of the disaster spurred by the current global spread of COVID-19. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Introduction and Overview

This overview introduces the general context within which the topics of the following chapters may be viewed. Sustainable development is broadly defined, embracing natural capital and Environmental, Social and Governance (ESG) issues, especially in the light of the COVID 19 pandemic. Sino-American rivalry, manifested also in competitive infrastructure projects, is seen as impacting on sustainable development in Asia and the initiatives of the two countries are compared. The role of economic integration in ASEAN, particularly relating to digital transformation, is assessed. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Discrimination and financial, occupational, and emotional well-being in strip club dancers during the COVID-19 pandemic: A call for policy reform

Due to the sexual nature of their work, strip club dancers have long been subject to marginalization and occupational stigma. During the coronavirus disease (COVID-19) pandemic, dancers faced unique stressors due to their status as contract workers within the stigmatized commercial sex/adult entertainment industry, and these stressors have likely impacted their financial, occupational, and emotional well-being. We surveyed 102 strip club dancers across 35 U.S. states and Puerto Rico to examine how their well-being has been impacted by the COVID-19 pandemic and to guide recommendations for policy reform. Findings revealed that during the pandemic, dancers experienced occupational stigmatization, structural and systematic exclusion from financial support during the pandemic, and numerous obstacles in obtaining employment outside of their industry, all of which contributed to reported financial and occupational stress. Furthermore, results demonstrated that strip club dancers experienced significant financial loss, and associated financial concern was associated with poorer mental health outcomes. Structural changes to financial relief packages are necessary for inclusion of strip club dancers, and there is also a clear need for more efforts to decrease discrimination and violence toward strip club dancers generally, including legal recognition of sex workers as laborers. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Conventional oxygen therapy versus CPAP as a ceiling of care in ward-based patients with COVID-19: a multi-centre cohort evaluation

S52 Figure 1Kaplan-Meier curve comparing overall survival in the two treatment groups (conventional oxygen therapy vs continuous positive airway pressure therapy). The null hypothesis of no survival difference is evaluated with a log-rank test (p = 0.92)[Figure omitted. See PDF]DiscussionThis is, as far as we are aware, the first study comparing conventional oxygen therapy with CPAP in cohorts unaffected by physician selection. No survival difference was found between using oxygen alone or CPAP to treat patients with severe COVID-19 who were nIMV. A high patient-initiated discontinuation rate for CPAP suggests a significant treatment burden. Further reflection is warranted on the continued widespread use of CPAP in this patient group.Please refer to page A189 for declarations of interest related to this abstract.

System-wide depression screening implementation in ambulatory oncology care: Key strategies and early implementation outcomes

Background: Oncology Care Model (OCM) requires cancer programs to provide depression screening during each care episode to meet the quality measure benchmark of 85% screening rate. This quality improvement (QI) project aims to assess 1) key strategies to integrate systemwide depression screening into routine cancer care, and 2) early outcomes of depression screening implementation. Methods: A mixed method study design was used to assess strategies to implement routine depression screening in a southeast comprehensive cancer center between July 2019 and December 2020. Two top high-volume hematological oncology clinics that covers sixty percent of ambulatory care participated in the depression screening implementation. Data were collected using 1) depression screening completion rate during OCM performance periods, 2) needs assessment to identify barriers and facilitators of implementation, and 3) semi-structured interviews to assess staff and provider feedback on sustainable implementation strategies. Data were analyzed using descriptive analysis for quantitative outcomes and thematic analysis for qualitative outcomes. Results: A total of 64 hematological oncology providers (n = 22) and staff (n = 42) participated in the depression screening implementation training during three OCM performance periods. Depression screening rate of total ambulatory oncology care increased from 12% (OCM-PR 5, Jul-Dec 19), to 51% (OCM-PR 6, Jan-Jun 20) to 77% (OCM-PR 7, Jul-Dec 20) after the two top-volume clinics integrated depression screening into clinic intake process. Themes emerged from needs assessment revealed multi-level implementation strategies including 1) patient education and psycho-oncological care, 2) staff training and practice modification, 3) provider education & interdisciplinary Care, 4) leadership, administration, and staffing support, and 5) clinical informatics collaboration to build the infrastructure for integrating depression screen with clinic intake in the electronic medical record (EMR). Feedback from staff and provider interviews indicated high receptiveness and buy-in, especially during the COVID-19 pandemic to improve timely identification and triage of patients with depressive symptoms across all oncology care services. Conclusions: Depression screening is a key component of quality comprehensive cancer care that aims to provide timely identification and triage of cancer patients needing follow-up psychosocial care. Early implementation outcomes revealed significant improvement in depression screening completion rate after two clinics adopted depression screening into intake process. Further investigation is needed to refine system-wide implementation strategies across all ambulatory oncology sites and to assess long-term implementation outcomes meet the psychosocial care needs of cancer patients.

Dispositional characteristics in firearm ownership and purchasing behavior during the 2020 purchasing surge.

RATIONALE: In 2020 the U.S. saw a firearm purchasing surge that was synchronous with the onset of the SARS-CoV-2 (COVID-19) pandemic and notable community unrest. Extant literature has highlighted a potential cohort effect among 2020 firearm purchasers and the importance of characterizing these individuals to inform policy and interventions. Dispositional traits have received minimal attention in the firearm literature overall, despite research that indicates dispositional traits impact intervention interest, access, and effectiveness. OBJECTIVE: The current study examined two dispositional traits indicated as important in firearm research - threat sensitivity (THT) and disinhibition (DIS). We hypothesized that 1) firearm owners overall would have lower THT and higher DIS relative to non-firearm owners, 2) mean levels of DIS (but not THT) would be higher among firearm owners who purchased during the 2020 purchasing surge relative to firearm owners who did not and non-firearm owners, and 3) DIS (but not THT) would be related to future plans for purchasing such that mean levels of DIS would be highest amongst those who have plans. METHODS: This study used an online-recruited sample (N = 3500) matched to 2010 US Census data. RESULTS: Firearm owners demonstrated lower THT and higher DIS than non-firearm owners. 2020 firearm purchasers had higher DIS compared to non-firearm owners and non-purchasing firearm owners, while firearm owners who did not purchase had lower THT compared to non-owners and 2020 purchasers. Plans to purchase in the next 12 months was associated with higher DIS relative to those undecided or without plans. CONCLUSIONS: In combination with prior research, findings suggest elevated DIS may drive purchasing as a danger and distress management strategy, while low THT may protect against emotion-based firearm purchasing. Further research is needed to clarify the directionality of these relationships and to identify other dispositional characteristics of those purchasing firearms in 2020.

Conventional oxygen therapy versus CPAP as a ceiling of care in ward-based patients with COVID-19: a multi-centre cohort evaluation.

BACKGROUND: Continuous positive airway pressure (CPAP) therapy is commonly used for respiratory failure due to severe COVID-19 pneumonitis, including in patients deemed not likely to benefit from invasive mechanical ventilation (nIMV). Little evidence exists demonstrating superiority over conventional oxygen therapy, whilst ward-level delivery of CPAP presents practical challenges. We sought to compare clinical outcomes of oxygen therapy versus CPAP therapy in patients with COVID-19 who were nIMV. METHODS: This retrospective multi-centre cohort evaluation included patients diagnosed with COVID-19 who were nIMV, had a treatment escalation plan of ward-level care and clinical frailty scale ≤ 6. Recruitment occurred during the first two waves of the UK COVID-19 pandemic in 2020; from 1st March to May 31st, and from 1st September to 31st December. Patients given CPAP were compared to patients receiving oxygen therapy that required FiO2 ≥0.4 for more than 12 hours at hospitals not providing ward-level CPAP. Logistic regression modelling was performed to compare 30-day mortality between treatment groups, accounting for important confounders and within-hospital clustering. FINDINGS: Seven hospitals provided data for 479 patients during the UK COVID-19 pandemic in 2020. Overall 30-day mortality was 75.6% in the oxygen group (186/246 patients) and 77.7% in the CPAP group (181/233 patients). A lack of evidence for a treatment effect persisted in the adjusted model (adjusted odds ratio 0.84 95% CI 0.57-1.23, p=0.37). 49.8% of patients receiving CPAP-therapy (118/237) chose to discontinue it. INTERPRETATION: No survival difference was found between using oxygen alone or CPAP to treat patients with severe COVID-19 who were nIMV. A high patient-initiated discontinuation rate for CPAP suggests a significant treatment burden. Further reflection is warranted on the current treatment guidance and widespread application of CPAP in this setting. FUNDING: L Pearmain is supported by the MRC (MR/R00191X/1). TW Felton is supported by the NIHR Manchester Biomedical Research Centre.

Modeling the Stability of SARS-CoV-2 on Personal Protective Equipment (PPE).

We modeled the stability of SARS-CoV-2 on personal protective equipment (PPE) commonly worn in hospitals when carrying out high-risk airway procedures. Evaluated PPE included the visors and hoods of two brands of commercially available powered air purifying respirators, a disposable face shield, and Tyvek coveralls. Following an exposure to 4.3 log10 plaque-forming units (PFUs) of SARS-CoV-2, all materials displayed a reduction in titer of > 4.2 log10 by 72 hours postexposure, with detectable titers at 72 hours varying by material (1.1-2.3 log10 PFU/mL). Our results highlight the need for proper doffing and disinfection of PPE, or disposal, to reduce the risk of SARS-CoV-2 contact or fomite transmission.