Blood Supply Management Amidst COVID -19 Pandemic (preprint)

AIMS AND OBJECTIVES: The mandatory lockdown restrictions and curtailment strategies towards mass gatherings imposed by the government amid the COVID-19 outbreak, the organization of the voluntary blood donation camps were suspended and in house donations were limited leading to scarcity of blood With this we intend to assess the effect of this mass lockdown on our blood supply management in four phases [phase-I prior to the outbreak] ,phase-II[during the outbreak], Phase-III: The declining phase [Oct20-Feb21] and Phase IV: The second wave [March21-may21] MATERIALS AND METHOD : This is a retrospective study of twenty months of a blood bank supplying to a 1200 bedded multi-specialty Tertiary Care Academic Hospital in Lucknow. The study was divided into four phases namely: • Phase-I: Pre-pandemic phase [Oct’19 to Feb’20] • Phase-II: The full-blown pandemic phase [Mar 20-Sep 20] • Phase-III: The declining phase [Oct20-Feb21] • Phase IV: The second wave [March21-may21] Details of the blood units collected both in-house as well as in the VBDC’s were used for the study. The date of collection, expiry and date of issue for each packed red blood cell [PRBC] units were noted. The components prepared from the whole blood was also noted. The average In-house donations were tabulated. The various components issued month wise was also noted. The supply of Convalescent plasma in all the three phases was tabulate RESULT: The average whole blood collection pre pandemic was 1103 units (55%), 768units (51%) in pandemic phase, 1219units (61%) in declining phase and only 692units (21%) in second wave of the pandemic. In Phase I 27 VBDC collected 1153 units (58%) and in Phase III 8 VBDC collected 236units(12%) Due to restrictions in mass gatherings and lockdown enforced, the whole blood collections from Phase II and Phase IV was 93units (6.5%) and 76units (2.2%) only. In Phase I, the average In House Donation was 33.6%, In Phase II it was12%, In Phase III was 5.75% and lastly in Phase IV was 5.4% The PRBC issued on an average in the four phases was 59%, 48%, 55% and 26% respectively. Similarly the FFP issued in Phase I , II, III and IV was 62%,34%,58% and 20%. Lastly the RDP issued was 15%, 13%, 19% and 4.5% in all the various phases. CONCLUSION: Our study concluded that COVID 19 pandemic had a negative impact on total number of In-house donations, voluntary blood donation camps, blood stock inventory and transfusion recipients along with taking a major toll on health and safety of our blood bank staff as well. With little insight of the disease and everyday learning, by motivating more voluntary donors and health care workers the efficient chain of blood supply and demand can be maintained as the virus is to stay with us for a long time.

SARS-CoV-2 Antibody Response in Patients Undergoing Kidney Transplantation (preprint)

Abstract The response of the immune system to COVID-19 in end stage kidney disease patients who undergo kidney transplantation has yet to be described. We report data on 72 patients who underwent SARS-CoV-2 antibody testing both before and after kidney transplantation and were followed for a median of 186 days (range 83, 277). Of the 25 patients with a positive antibody test at the time of transplant, 17 (68%) remained positive after transplantation. Patients were significantly more likely to have a persistently positive test if they reported a symptomatic COVID-19 infection prior to transplant (p=0.01). SARS-CoV-2 IgG index values were measured in a subset of kidney transplant recipients and compared to wait -listed dialysis patients. These assays demonstrated a more significant decline in IgG (58% versus 14% p = 0.008) in transplant recipients when compared to dialysis patients tested during the same time period. Additional analysis of the quality of the immune response measuring the binding of SARS-CoV-2 antibodies to the receptor-binding domain (RBD binding), the antibody neutralizing capability, and the antibody avidity demonstrated a more pronounced effect when comparing pre-transplant values to post-induction therapy/post transplant values. The attenuated IgG response seen in transplant patients compared to dialysis patients after induction therapy requires further study. These data have important implications for post-transplant management of vaccinated dialysis patients.

SARS-CoV-2 and Stroke Characteristics: A Report from the Multinational COVID-19 Stroke Study Group (preprint)

Background: Stroke is reported as a consequence of SARS-CoV-2 infection. However, there is a lack of regarding comprehensive stroke phenotype and characteristics Methods: We conducted a multinational observational study on features of consecutive acute ischemic stroke (AIS), intracranial hemorrhage (ICH), and cerebral venous or sinus thrombosis (CVST) among SARS-CoV-2 infected patients. We further investigated the association of demographics, clinical data, geographical regions, and countrie's health expenditure among AIS patients with the risk of large vessel occlusion (LVO), stroke severity as measured by National Institute of Health stroke scale (NIHSS), and stroke subtype as measured by the TOAST criteria. Additionally, we applied unsupervised machine learning algorithms to uncover possible similarities among stroke patients. Results: Among the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least one eligible stroke patient. Out of 432 patients included, 323(74.8%) had AIS, 91(21.1%) ICH, and 18(4.2%) CVST. Among 23 patients with subarachnoid hemorrhage, 16(69.5%) had no evidence of aneurysm. A total of 183(42.4%) patients were women, 104(24.1%) patients were younger than 55 years, and 105(24.4%) patients had no identifiable vascular risk factors. Among 380 patients who had known interval onset of the SARS-CoV-2 and stroke, 144(37.8%) presented to the hospital with chief complaints of stroke-related symptoms, with asymptomatic or undiagnosed SARS-CoV-2 infection. Among AIS patients 44.5% had LVO; 10% had small artery occlusion according to the TOAST criteria. We observed a lower median NIHSS (8[3-17], versus 11[5-17]; p=0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; p<0.001) in countries with middle to high-health expenditure when compared to countries with lower health expenditure. The unsupervised machine learning identified 4 subgroups, with a relatively large group with no or limited comorbidities. Conclusions: We observed a relatively high number of young, and asymptomatic SARS-CoV-2 infections among stroke patients. Traditional vascular risk factors were absent among a relatively large cohort of patients. Among hospitalized patients, the stroke severity was lower and rate of mechanical thrombectomy was higher among countries with middle to high-health expenditure.

DETERMINANTS OF BURNOUT AND OTHER ASPECTS OF PSYCHOLOGICAL WELL-BEING IN HEALTHCARE WORKERS DURING THE COVID-19 PANDEMIC: A MULTINATIONAL CROSS-SECTIONAL STUDY (preprint)

BackgroundThe Covid-19 pandemic has placed unprecedented pressure on healthcare systems and workers around the world. Such pressures may impact on working conditions, psychological wellbeing and perception of safety. In spite of this, no study has assessed the relationship between safety attitudes and psychological outcomes. Moreover, only limited studies have examined the relationship between personal characteristics and psychological outcomes during Covid-19. MethodsFrom 22nd March 2020 to 18th June 2020, healthcare workers from the United Kingdom, Poland, and Singapore were invited to participate using a self-administered questionnaire comprising the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory (OLBI) and Hospital Anxiety and Depression Scale (HADS) to evaluate safety culture, burnout and anxiety/depression. Multivariate logistic regression was used to determine predictors of burnout, anxiety and depression. ResultsOf 3,537 healthcare workers who participated in the study, 2,364 (67%) screened positive for burnout, 701 (20%) for anxiety, and 389 (11%) for depression. Significant predictors of burnout included patient-facing roles: doctor (OR 2.10; 95% CI 1.49-2.95), nurse (OR 1.38; 95% CI 1.04-1.84), and other clinical (OR 2.02; 95% CI 1.45-2.82); being redeployed (OR 1.27; 95% CI 1.02-1.58), bottom quartile SAQ score (OR 2.43; 95% CI 1.98-2.99), anxiety (OR 4.87; 95% CI 3.92-6.06) and depression (OR 4.06; 95% CI 3.04-5.42). Factors significantly protective for burnout included being tested for SARS-CoV-2 (OR 0.64; 95% CI 0.51-0.82) and top quartile SAQ score (OR 0.30; 95% CI 0.22-0.40). Significant factors associated with anxiety and depression, included burnout, gender, safety attitudes and job role. ConclusionOur findings demonstrate a significant burden of burnout, anxiety, and depression amongst healthcare workers. A strong association was seen between SARS-CoV-2 testing, safety attitudes, gender, job role, redeployment and psychological state. These findings highlight the importance of targeted support services for at risk groups and proactive SARS-CoV-2 testing of healthcare workers.