Impact of the COVID-19 pandemic on Canadian Armed Forces Veterans who live with chronic pain

Introduction: Chronic pain is more prevalent in military Veterans than in the general population. The extent to which the COVID-19 pandemic has affected Canadian Armed Forces (CAF) Veterans living with chronic pain is unknown. This study compared the impact of the pandemic and public health measures on Canadian Veterans and non-Veterans. Methods: An online cross-sectional study was conducted across Canada. Participants (n = 3,159) were adults with chronic pain recruited from April to May 2020. Seventy-six participants reported having formerly served in the CAF and were pair-matched with non-Veterans. Results: CAF Veteran participants' mean age was 55.1 (standard deviation = 9.6) years;50.0% were female. Over 60% lived with chronic pain for > 10 years. Two thirds of Veterans (67.1%) reported worsened pain since pandemic onset, and 44.7% experienced moderate to severe psychological distress. This was comparable to the non-Veteran group (63.2%, p = 0.61;35.5%, p = 0.25), and no differences were found between female and male Veterans (p = 0.22, p = 0.36). Percentages of participants reporting changes in pharmacological pain treatments because of the pandemic were similar in CAF Veterans (14.9%) and non-Veterans (13.3%) (p = 0.68). Over 50% of Veterans modified their physical/psychological pain treatments due to the pandemic, compared with 45.3% of non-Veterans (p = 0.24). Discussion: Pain deterioration, psychological distress, and pain treatment changes were observed in CAF Veterans living with chronic pain during the COVID-19 pandemic, as was the case in non-Veterans. These results will help develop interventions to adequately face pandemic waves to come and future health crises. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (French) Introduction : La prevalence de la douleur chronique est plus elevee chez les veterans que dans la population en general. La mesure dans laquelle la pandemie de COVID-19 a touche les veterans des Forces armees canadiennes (FAC) souffrant de douleur chronique n'est pas connue. La presente etude compare l'impact de la pandemie et des mesures de sante publique chez des veterans et des non-veterans canadiens. Methodologie : Une etude transversale en ligne a ete effectuee partout au Canada. Les participants (n = 3 159) etaient des adultes vivant avec de la douleur chronique, recrutes en avril et en mai 2020. Soizante-seize participants ont indique avoir servi dans les FAC et ont ete apparies avec des non-veterans. Resultats : L'age moyen des participants veterans FAC etait de 55,1 ans (ecart-type = 9,6);50 % etaient des femmes. Plus de 60 % d'entre eux vivaient avec de la douleur chronique depuis plus de 10 ans. Deux tiers des veterans (67,1 %) ont indique que leur douleur s'etait aggravee depuis le debut de la pandemie et 44,7 % ont ressenti de la detresse psychologique moderee a grave. Ces pourcentages sont comparables a ceux observes chez le groupe de non-veterans (63,2 %, p =0,61 ;35,5 %, p = 0,25) et aucune difference n'a ete notee entre les veterans masculins et feminins (p = 0,22, p = 0,36). Les pourcentages de participants rapportant des changements dans leurs traitements pharmacologiques pour la douleur, en raison de la pandemie, etaient semblables chez les veterans des FAC (14,9 %) et les non-veterans (13,3 %) (p = 0,68). Plus de 50 % des veterans ont modifie leurs traitements physiques/psychologiques pour la douleur en raison de la pandemie, comparativement a 45,3 % des non-veterans (p = 0,24). Discussion : Une intensification de la douleur, de la detresse psychologique et des modifications apportees aux traitements de la douleur ont ete observees pendant la pandemie de COVID-19 chez les veterans des FAC qui vivent avec la douleur chronique comme c'etait le cas chez les non-veterans. Ces resultats aideront a mettre au point des interventions qui permettront de faire face de facon adequate aux prochaines vagues de la pandemie et a de futures crises sanitaires. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement Chronic pain is more frequent in military Veterans than in the general population. The objective of this study was to assess whether the COVID-19 pandemic has had a greater impact on Canadian Armed Forces (CAF) Veterans who live with chronic pain compared to non-Veterans. An online survey of Canadian adults with chronic pain was conducted between April and May 2020;76 respondents reported having formerly served in the CAF and were compared with 76 similar non-Veterans. About two thirds of the Veterans had been living with chronic pain for longer than 10 years. Two thirds reported worsened pain since the pandemic began. Nearly half experienced moderate to severe psychological distress. These changes were similar to those in non-Veterans with chronic pain. A significant number of Veterans and non-Veterans changed their pain treatments due to the pandemic. In summary, the COVID-19 pandemic and associated restriction measures did not have a greater impact in CAF Veterans with chronic pain compared with non-Veterans. However, changes in chronic pain supports are needed to be better prepared for COVID-19 waves to come and future health crises. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The Impact of Administration Formats on SIS-A Scores.

Many U.S. states use the Supports Intensity Scale-Adult Version (SIS-A; Thompson et al., 2015) to inform the distribution of public funds for long-term services and supports. Throughout the COVID-19 pandemic, many states began administering the SIS-A virtually instead of in person. Because administration format has the potential to influence SIS-A scores and, consequently, impact the funding people receive for long-term services and supports, this study examined the stability of support need scores, as measured by the SIS-A, over two time periods: (a) when assessments were conducted in person and (b) when assessments were conducted virtually using remote technology. Specifically, the influence of assessment administration formats on SIS-A scores and on the perceptions of SIS-A assessors were investigated. Results revealed that the virtual administration format impacted SIS-A scores, but the impact was of little to no practical importance.

Geographic variability of antibiotic prescribing for acute respiratory tract infections within a direct-to-consumer telemedicine practice.

In this retrospective cohort study of patients presenting to a national direct-to-consumer medical practice, we found that provider geographic location is a stronger driver of antibiotic prescribing than patient location. Physicians in the Northeast and South are significantly more likely than physicians in the West to prescribe antibiotics for upper respiratory infection and bronchitis.

Estimating the impact of interventions against COVID-19: From lockdown to vaccination.

Coronavirus disease 2019 (COVID-19) is an infectious disease of humans caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the first case was identified in China in December 2019 the disease has spread worldwide, leading to an ongoing pandemic. In this article, we present an agent-based model of COVID-19 in Luxembourg, and use it to estimate the impact, on cases and deaths, of interventions including testing, contact tracing, lockdown, curfew and vaccination. Our model is based on collation, with agents performing activities and moving between locations accordingly. The model is highly heterogeneous, featuring spatial clustering, over 2000 behavioural types and a 10 minute time resolution. The model is validated against COVID-19 clinical monitoring data collected in Luxembourg in 2020. Our model predicts far fewer cases and deaths than the equivalent equation-based SEIR model. In particular, with R0 = 2.45, the SEIR model infects 87% of the resident population while our agent-based model infects only around 23% of the resident population. Our simulations suggest that testing and contract tracing reduce cases substantially, but are less effective at reducing deaths. Lockdowns are very effective although costly, while the impact of an 11pm-6am curfew is relatively small. When vaccinating against a future outbreak, our results suggest that herd immunity can be achieved at relatively low coverage, with substantial levels of protection achieved with only 30% of the population fully immune. When vaccinating in the midst of an outbreak, the challenge is more difficult. In this context, we investigate the impact of vaccine efficacy, capacity, hesitancy and strategy. We conclude that, short of a permanent lockdown, vaccination is by far the most effective way to suppress and ultimately control the spread of COVID-19.

Effective Access to Care in a Crisis Period: Hypertension Control During the COVID-19 Pandemic by Telemedicine.

OBJECTIVE: To assess the effectiveness of telemedicine video visits in the management of hypertensive patients at home during the first year of the COVID-19 pandemic. METHODS: A quantitative analysis was performed of all home video visits coded with a diagnosis of essential hypertension during the first 12 months of the COVID-19 pandemic (March 2020 through February 2021). A total of 10,634 patients with 16,194 hypertension visits were present in our national telemedicine practice database during this time. Among this population, a total of 569 patients who had 1785 hypertension visits met the criteria of having 2 or more blood pressure (BP) readings, with the last BP reading occurring in the report period. We analyzed baseline characteristics and BP trends of these 569 patients during the study period. Voluntarily submitted patient satisfaction ratings, which were systematically requested at the end of each visit, were also analyzed. RESULTS: The mean age of the patients in this study cohort of 569 patients was 43.9 years, and 48.3% (275) were women. More than 62% (355) of the patients had an initial systolic BP (SBP) above 140 mm Hg, and 25.3% (144) had an initial SBP of greater than 160 mm Hg. The average number of visits during the study period was 3.1 visits per patient; an average of 6.4 BP measurements per patient were available. During the study period, 77% (438) of the patients experienced an improvement in either SBP or diastolic BP (DBP), with mean reductions of -9.7 mm Hg and -6.8 mm Hg in SBP and DBP, respectively. A total of 416 patients in the cohort started with a BP above 140/90 mm Hg. For this subset of patients, 55.7% (232) achieved a BP of 140/90 mm Hg or lower by the end of the study period, and the average reductions in SBP and DBP were -17.9 mm Hg and -12.8 mm Hg, respectively, which corresponded to improvements of 11.2% and 12.4%. These improvements did not vary significantly when patients were stratified by age, sex, or geographic region of residence (rural vs urban/suburban). Voluntarily submitted patient surveys indicated a high degree of patient satisfaction, with a mean satisfaction score of 4.94 (5-point scale). CONCLUSION: Clinician-patient relationships established in a video-first telemedicine model were broadly effective for addressing suboptimally controlled hypertension. Patient satisfaction with these visits was high.

Effective Access to Care in a Crisis Period: Hypertension Control during the COVID-19 Pandemic via Telemedicine

Objectives To assess the effectiveness of telemedicine video visits in the management of hypertensive patients at home during the first year of the COVID-19 pandemic. We also evaluated associated measures of patient satisfaction with these holistic visits. Patients and Methods A quantitative analysis was performed of all home video visits coded with a diagnosis of Essential Hypertension during the first 12 months of the COVID-19 pandemic (March, 2020 through February, 2021). A total of 10,634 patients with 16,194 hypertension visits were present in our national telemedicine practice database during this time period. Among this population, a total of 569 patients who had 1,785 hypertension visits met the criteria of having two or more blood pressure readings, with the last blood pressure reading occurring in the report period. We analyzed baseline characteristics and blood pressure trends of these 569 patients over the study period. Voluntarily submitted patient satisfaction ratings, which were systematically requested at the end of each visit, were also analyzed. Results The mean age of the patients in this study cohort of 569 patients was 43.9 years, and 48.3% were women. Over 62% of the patients had an initial systolic BP over140 mm Hg, and 25% had an initial SBP of greater than 160 mm Hg. The average number of visits over the study period was 3.1 visits per patient. An average of 6.4 BP measurements per patient were available over the study period. Over the study period, 77% of the patients experienced an improvement in either systolic or diastolic blood pressure, with mean reductions of -9.7 mm Hg and -6.8 mm Hg in systolic and diastolic blood pressures, respectively. A total of 416 patients in the cohort started with a blood pressure above 140/90 mm Hg. For this subset of patients, 55.7% achieved a BP of <=140/90 by the end of the study period, and the average reductions in systolic and diastolic blood pressures were -17.9 mm Hg and -12.8 mm Hg respectively, which corresponded to improvements of 11.2% and 12.4% respectively. These improvements did not vary significantly when patients were stratified by age, sex, or geographic region of residence (rural versus urban/suburban). Voluntarily submitted patient surveys indicated a high degree of patient satisfaction, with a mean satisfaction score of 4.94 (5 point scale). Conclusion Clinician-patient relationships established in a video-first telemedicine model were broadly effective for addressing sub-optimally controlled hypertension. Patient satisfaction with these visits was very high.

Impact of the COVID-19 pandemic on the pharmacological, physical, and psychological treatments of pain: findings from the Chronic Pain & COVID-19 Pan-Canadian Study.

INTRODUCTION: Multimodal treatment is recognized as the optimal paradigm for the management of chronic pain (CP). Careful balance between pharmacological and physical/psychological approaches is thus desirable but can be easily disrupted. OBJECTIVES: This study aimed at exploring the impact of the COVID-19 pandemic on pharmacological and physical/psychological treatments of CP. METHODS: A Pan-Canadian cross-sectional web-based study was conducted between April 16th and May 31st 2020 among adults living with CP when the country was in the ascending slope of the first COVID-19 pandemic wave. RESULTS: A total of 2864 participants shared their treatment experience (mean age: 49.7 years and women: 83.5%). Among medication users (n = 2533), 38.3% reported changes in their pharmacological pain treatment. The main reasons were as follows: (1) changes in pain symptoms, (2) lack of access to prescribers/cancellation of medical appointments, and (3) increased medication intake in compensation for stopping physical/psychological treatments because of the pandemic. Among participants who used physical/psychological pain management approaches before the pandemic (n = 2467), 68.3% had to modify their treatments or self-management strategies. Common reasons were lack of access to clinics/exercise facilities and the need to compensate for having to stop another type of physical/psychological treatment because of the pandemic-related public health safety measures. CONCLUSIONS: Our study underlines the negative impact of the COVID-19 pandemic on access to pain relief, which is considered a fundamental human right. Results will help to justify resource allocation and inform the development of interventions to be better prepared for waves to come and future health crises.

Une étude transversale sur l’évolution de la douleur et la détresse psychologique chez les personnes atteintes de douleur chronique : l’étude pancanadienne « Douleur chronique et COVID-19 »

Introduction. La pandémie de COVID-19 a eu un impact disproportionné sur les populations vulnérables, notamment les personnes atteintes de douleur chronique. Nous avons examiné les associations entre les variations géographiques des taux d’infection par le coronavirus, le stress et l’intensité de la douleur et nous avons étudié les facteurs associés à l’évolution de la douleur et à la détresse psychologique chez les personnes atteintes de douleur chronique pendant la pandémie. Méthodologie. Cette analyse s’inscrit dans le cadre d’une initiative plus vaste, l’étude pancanadienne « Douleur chronique et COVID-19 », qui emploie une méthode de recherche transversale observationnelle. Au total, 3 159 personnes atteintes de douleur chronique ont répondu à une enquête quantitative entre le 16 avril et le 31 mai 2020. Résultats. Les deux tiers (68,1 %) des participants avaient entre 40 et 69 ans, et 83,5 % étaient des femmes. Les deux tiers (68,9 %) des répondants ont signalé une aggravation de leur douleur depuis le début de la pandémie. Un niveau élevé de risques perçus liés à la pandémie (rapport de cotes ajusté : 1,27 %;intervalle de confiance [IC] à 95 % : 1,03 à 1,56), un niveau élevé de stress (1,21;IC à 95 % : 1,05 à 1,41), la modification des traitements de la douleur pharmacologiques (3,17;IC à 95 % : 2,49 à 4,05) et physiques/psychologiques (2,04;IC à 95 % : 1,62 à 2,58) et enfin le fait d’occuper un emploi au début de la pandémie (1,42;IC à 95 % : 1,09 à 1,86) étaient associés à une probabilité accrue de déclarer une aggravation de la douleur. La perte d’emploi (34,9 % des personnes travaillaient avant la pandémie) a été associée à une probabilité inférieure (0,67;IC à 95 % : 0,48 à 0,94) de déclarer une aggravation de la douleur. Près de la moitié (43,2 %) des personnes ont indiqué une détresse psychologique d’intensité modérée ou grave. Les émotions négatives à l’égard de la pandémie (2,14;IC à 95 % : 1,78 à 2,57) et le stress global (1,43;IC à 95 % : 1,36 à 1,50) ont été associés à une détresse psychologique modérée ou grave. Conclusion. Les résultats de l’étude ont permis de cerner, outre les facteurs biomédicaux, plusieurs facteurs psychosociaux à prendre en compte pour surveiller l’état des patients atteints de douleur chronique et faciliter leur accès aux traitements pendant une pandémie.

A cross-sectional study of pain status and psychological distress among individuals living with chronic pain: the Chronic Pain & COVID-19 Pan-Canadian Study. / Une étude transversale sur l'évolution de la douleur et la détresse psychologique chez les personnes atteintes de douleur chronique : l'étude pancanadienne « Douleur chronique et COVID-19.

BACKGROUND: The COVID-19 pandemic has had a disproportionate impact on vulnerable populations, including individuals with chronic pain. We examined associations between geographical variations in COVID-19 infection rates, stress and pain severity, and investigated factors associated with changes in pain status and psychological distress among individuals living with chronic pain during the pandemic. METHODS: This investigation is part of a larger initiative, the Chronic Pain & COVID-19 Pan-Canadian Study, which adopted a cross-sectional observational design. A total of 3159 individuals living with chronic pain completed a quantitative survey between 16 April and 31 May 2020. RESULTS: Two-thirds (68.1%) of participants were between 40 and 69 years old, and 83.5% were women. Two-thirds (68.9%) of individuals reported worsened pain since pandemic onset. Higher levels of perceived pandemic-related risks (adjusted odds ratio: 1.27; 95% confidence interval: 1.03-1.56) and stress (1.21; 1.05-1.41), changes in pharmacological (3.17; 2.49-4.05) and physical/psychological (2.04; 1.62-2.58) pain treatments and being employed at the beginning of the pandemic (1.42; 1.09-1.86) were associated with increased likelihood of reporting worsened pain. Job loss (34.9% of individuals were employed pre-pandemic) was associated with lower likelihood (0.67; 0.48-0.94) of reporting worsened pain. Almost half (43.2%) of individuals reported moderate/severe levels of psychological distress. Negative emotions toward the pandemic (2.14; 1.78-2.57) and overall stress (1.43; 1.36-1.50) were associated with moderate/severe psychological distress. CONCLUSIONS: Study results identified psychosocial factors to consider in addition to biomedical factors in monitoring patients' status and facilitating treatment access for chronic pain patients during a pandemic.

Chronic pain experience and health inequities during the COVID-19 pandemic in Canada: qualitative findings from the chronic pain & COVID-19 pan-Canadian study.

BACKGROUND: Chronic pain affects about 20 % of the Canadian population and can lead to physical, psychological and social vulnerabilities. However, this condition remains poorly recognized and undertreated. During 2020, as the COVID-19 pandemic disrupted daily living and health care systems, the situation of people with chronic pain has drawn little public attention. METHODS: This qualitative study was part of a pan-Canadian mixed-methods project and aimed to understand the experiences and challenges of people living with chronic pain during the COVID-19 pandemic in Canada. Between May and August 2020, we conducted in-depth semi-structured interviews with 22 individuals living with chronic pain across the country. We used reflexive thematic analysis to interpret data. RESULTS: Our findings underscored four dimensions of the chronic pain experience during the pandemic: (1) Reinforced vulnerability due to uncertainties regarding pain and its management; (2) Social network as a determinant of pain and psychological condition; (3) Increasing systemic inequities intermingling with the chronic pain experience; (4) More viable living conditions due to confinement measures. Though several participants reported improvements in their quality of life and reduced social pressure in the context of stay-at-home orders, participants from socio-economically deprived groups and minorities reported more challenges in accessing pain relief, health care services, and psychosocial support. CONCLUSIONS: The COVID-19 pandemic has revealed and intensified pre-existing disparities and challenges among people living with chronic pain in terms of material resources, psychosocial condition, social support, and access to care. In post-pandemic times, it will be essential to address flaws in health and welfare policies to foster equity and social inclusiveness of people with chronic pain.

A novel ACE2 isoform is expressed in human respiratory epithelia and is upregulated in response to interferons and RNA respiratory virus infection.

Angiotensin-converting enzyme 2 (ACE2) is the main entry point in airway epithelial cells for SARS-CoV-2. ACE2 binding to the SARS-CoV-2 protein spike triggers viral fusion with the cell plasma membrane, resulting in viral RNA genome delivery into the host. Despite ACE2's critical role in SARS-CoV-2 infection, full understanding of ACE2 expression, including in response to viral infection, remains unclear. ACE2 was thought to encode five transcripts and one protein of 805 amino acids. In the present study, we identify a novel short isoform of ACE2 expressed in the airway epithelium, the main site of SARS-CoV-2 infection. Short ACE2 is substantially upregulated in response to interferon stimulation and rhinovirus infection, but not SARS-CoV-2 infection. This short isoform lacks SARS-CoV-2 spike high-affinity binding sites and, altogether, our data are consistent with a model where short ACE2 is unlikely to directly contribute to host susceptibility to SARS-CoV-2 infection.

Where Virtual Care Was Already a Reality: Experiences of a Nationwide Telehealth Service Provider During the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has led to an increase in the use of and demand for telehealth services. OBJECTIVE: Here, we describe the utilization of telehealth services provided by Doctor On Demand, Inc., a well-known telehealth company in the United States, before and during the COVID-19 pandemic. We also explore how the number of virtual visits, reasons for visits, and patients served changed over time. METHODS: We reported data as a percentage change from the baseline week during 2 distinct time periods: February-June 2019 and February-June 2020 based on 4 categories of visits: respiratory illness, unscheduled behavioral health, scheduled behavioral health, and chronic illness. RESULTS: In 2020, the total visit volume increased considerably from March through April 7, 2020 (59% above the baseline) and then declined through the week of June 2 (15% above the baseline). Visits for respiratory illnesses increased through the week of March 24 (30% above the baseline) and then steadily declined through the week of June 2 (65% below the baseline). Higher relative increases were observed for unscheduled behavioral health and chronic illness visits through April (109% and 131% above the baseline, respectively) before a decline through the week of June 2 (69% and 37% above the baseline, respectively). Increases in visit volume among rural residents were slightly higher than those among urban residents (peak at 64% vs 58% above the baseline, respectively). CONCLUSIONS: Although this telehealth service provider observed a substantial increase in the volume of visits during the COVID-19 pandemic, it is interesting to note that this growth was not fueled by COVID-19 concerns but by visits for behavioral health and chronic illness. Telehealth services may play a role as a "safety valve" for patients who have difficulty accessing care during a public health emergency.

A Revised Protocol for Culture of Airway Epithelial Cells as a Diagnostic Tool for Primary Ciliary Dyskinesia.

Air-liquid interface (ALI) culture of nasal epithelial cells is a valuable tool in the diagnosis and research of primary ciliary dyskinesia (PCD). Ex vivo samples often display secondary dyskinesia from cell damage during sampling, infection or inflammation confounding PCD diagnostic results. ALI culture enables regeneration of healthy cilia facilitating differentiation of primary from secondary ciliary dyskinesia. We describe a revised ALI culture method adopted from April 2018 across three collaborating PCD diagnostic sites, including current University Hospital Southampton COVID-19 risk mitigation measures, and present results. Two hundred and forty nasal epithelial cell samples were seeded for ALI culture and 199 (82.9%) were ciliated. Fifty-four of 83 (63.9%) ex vivo samples which were originally equivocal or insufficient provided diagnostic information following in vitro culture. Surplus basal epithelial cells from 181 nasal brushing samples were frozen in liquid nitrogen; 39 samples were ALI-cultured after cryostorage and all ciliated. The ciliary beat patterns of ex vivo samples (by high-speed video microscopy) were recapitulated, scanning electron microscopy demonstrated excellent ciliation, and cilia could be immuno-fluorescently labelled (anti-alpha-tubulin and anti-RSPH4a) in representative cases that were ALI-cultured after cryostorage. In summary, our ALI culture protocol provides high ciliation rates across three centres, minimising patient recall for repeat brushing biopsies and improving diagnostic certainty. Cryostorage of surplus diagnostic samples was successful, facilitating PCD research.

COVID-19 and the Field of Intellectual and Developmental Disabilities: Where Have We Been? Where Are We? Where Do We Go?

The coronavirus (COVID-19) pandemic has affected, and will continue to affect, every aspect of the intellectual and developmental disabilities (IDD) community. We provide recommendations to (a) support people with IDD and the broader of field of IDD during the course of the pandemic, and (b) place the IDD community in a strong position when the health threats associated with the pandemic abate and post-pandemic social and policy structures are formed.