A moth to a flame? Fulfilling connectedness needs through romantic relationships protects conspiracy theorists against COVID-19 misinformation

Conspiracy theorists' unpopular opinions likely make them more apprehensive about interactions with others, frustrating their need to belong. Therefore, they may be susceptible to believing misinformation because evidence that others share their beliefs provides "social proof” that they can expect interactions with others to be positive and rewarding. The present research examined whether alternatively fulfilling the need for social connection through romantic relationships could protect conspiracy theorists against COVID-19 misinformation. In a 3-week daily diary study (N = 555), experimental participants implicitly learned to associate their romantic partners with positive experiences (by repeatedly pairing their partner with highly positive and approachable stimuli, McNulty et al., 2017). We then assessed how much participants trusted individuals they might normally distrust, as a manipulation check, and how much participants tuned their daily personal beliefs and behavior to match the U.S. public's daily susceptibility to COVID-19 misinformation. Participants high on conspiratorial thinking trusted fellow community members more in the experimental than control condition. Participants high on conspiratorial thinking in the experimental condition were also less likely to treat the U.S. public's greater daily susceptibility to COVID-19 misinformation as proof that they could discount the virus. The present findings suggest that rewarding romantic connections might be leveraged to limit conspiracy theorists' susceptibility to believing public skepticism about COVID-19. © 2023 The Authors

Sensitizing the Behavioral-Immune System: The Power of Social Pain

People who believe they are invulnerable to infectious diseases often fail to protect themselves against the disease threats that others pose to them. The current paper hypothesizes that social pain-the experience of feeling interpersonally hurt or rejected-can sensitize the behavioral-immune system by giving people added reason to see others as worthy of protecting themselves against. We obtained four daily diary samples involving 2,794 participants who reported how hurt/rejected they felt by those they knew, how personally concerned they were about the spread of illness/COVID-19, and how vigilantly they engaged in self-protective behaviors to safeguard their health each day. An integrative data analysis revealed robust evidence that people who believed they were invulnerable to infectious disease engaged in more concerted efforts to protect themselves against the greater daily risk of contracting COVID-19 when being in acute social pain gave them added reason to see others as harmful to them.

Trust as a daily defense against collective disease threats

Although the isolated threat of disease often motivates people to avoid others, people need the help and cooperation of others to protect themselves against pandemic disease threats. Therefore, the fear of contracting a highly contagious virus like COVID-19 should motivate people to believe that they can in fact count on the help and cooperation of others for protection. Trusting in others provides the basis to anticipate their cooperation. Therefore, we expected a greater daily threat of contracting COVID-19 to motivate people to trust more in others, providing needed assurance that others would keep them safe from harm. We obtained 4 daily diary samples involving 2794 participants who provided in excess of 18,000 daily observations within the first three months of the COVID-19 pandemic. Each day, we tracked (1) disease threat, captured daily by personal concerns about COVID-19 and infection totals in the nearest most populous city, and (2) trust in others, captured daily by expressions of trust in intimates, collective caregivers (e.g., President, Congress), and strangers. Participants in two samples completed 2-month follow-ups. Integrative analyses of the daily diaries revealed that people trusted more in intimates and collective caregivers on days they had greater (vs. less) reason to be concerned about COVID-19. Further integrative analyses of the follow-up data revealed that participants who were initially more likely to trust in others on days when COVID-19 cases in nearby communities spread more rapidly later reported greater confidence that others would keep them safe from harm. That is, they evidenced greater physical, interpersonal, and collective security in social connection than participants who were initially less likely to defensively trust in others on such occasions. The present findings suggest that ecological threats may dynamically motivate people to trust others more than they otherwise would, providing optimism that collectively-faced crises may motivate social cooperation when it is most needed. © 2022

Management of Pediatric Pulmonary Hypertension Using Remote Pulmonary Artery Pressure Sensor Monitoring

Background Management of pediatric pulmonary hypertension (PH) may require manipulation of multiple receptor sites to maximize response to medical therapy. Assessment of response typically occurs through imaging, labs, physical exam and recurrent cardiac catheterization, with anesthetic exposure to assess pulmonary artery pressures (PAP) and vascular resistance (PVR). We aimed to assess feasibility, safety and utility of remote PAP monitoring in pediatric PH patients. Methods We reviewed 4 pediatric patients with significant PH, each of whom underwent cardiac catheterization with pulmonary vasoreactivity testing and placement of a CardioMEMS remote PAP monitoring device. Results Four patients (P1-4: ages 5, 6, 8 and 10 years old) underwent CardioMEMS insertion without procedural complication. P1, P2 and P3 presented with unrepaired VSD;ASD with partial anomalous pulmonary venous return;and ASD and PDA, respectively, while P4 had prior repair of atrioventricular canal. Three patients had Down syndrome. All had elevated PAP and PVR. Mean left lower PA branch size was 7 mm. Mean PAP prior to therapy was 70 mm Hg for P1, 82 for P2, 93 for P3 and 30 for P4. All 4 patients required initiation of triple therapy for treatment of PH, with improvement or normalization of PAP by CardioMEMS, which also included surgical or catheter based intervention for 3 patients. Post-repair of P2, he was unable to be separated from cardiopulmonary bypass and was placed on ECMO. Right ventricular cardiac output improved over 2 weeks, with improvement of PAP determined through serial CardioMEMS. He was successfully decannulated, utilizing CardioMEMS in the OR. Two patients also developed COVID respiratory infections at home with CardioMEMS assessments allowing for oxygen and medication titration. Conclusion Remote PAP monitoring is feasible and appears safe in pediatric patients with adequate PA size. It allows for manipulation of medical therapy with real time knowledge of impact on PAP and can augment management during weaning of mechanical cardiac support. It may also augment decision-making in management of PH patients with developmental disabilities in whom traditional assessments may be more challenging.Copyright © 2023 American College of Cardiology Foundation

Acute Massive Thrombus Following Fontan Procedure

Background Patients with hypoplastic left heart syndrome (HLHS) undergo a Fontan procedure as part of single ventricle surgical palliation. Post-Fontan, sluggish blood flow and an imbalance in coagulant factor proteins may predispose to thrombus formation. Other risk factors may include chylothorax as well as acute and chronic inflammation. Currently, there is no standardized surveillance strategy to detect thrombus in Fontan patients. Case A 34-month old male with HLHS underwent an extracardiac non-fenestrated Fontan complicated by chylothorax treated with 5 days of IV steroids and diuretics. He was on therapeutic aspirin. After progressive worsening of right pleural effusion, a chest tube was placed three weeks post-Fontan with continued chylous output. Stool alpha 1 antitrypsin was negative. Decision-making Given persistent chylothorax, a repeat echocardiogram was performed revealing a large mass in the Fontan circuit less than one month post-op. Cardiac CT showed occlusive thrombus filling the entirety of the Fontan conduit extending into hepatic veins and bilateral pulmonary arteries. He underwent extensive surgical thrombectomy and Fontan conduit revision. Hypercoagulable work-up revealed elevated factor 8 and von Willebrand factor activity which persisted more than one month post-op. Patient's history was also significant for COVID-19 infection 6 months prior. He was initially anticoagulated with bivalirudin with tirofiban initiated for antiplatelet therapy. He was ultimately transitioned to rivaroxaban, pentoxifylline and aspirin with chylothorax resolution over one month without thrombus recurrence. Conclusion Development of risk stratification tools to identify patients at higher risk for thrombi formation post-Fontan may facilitate patient selection for more aggressive anticoagulation. Consideration of elevated factor 8 as well as persistent or recurrent chylothorax may be beneficial, as increased thrombosis risk has been reported for both conditions in Fontan patients.Copyright © 2023 American College of Cardiology Foundation

Moments of Connection As Means of Survival: A Study of Queer Identity, Freedom and Community in UK Raves During the Covid-19 Pandemic

From the start of the pandemic in the UK, reports emerged of illegal raves being held by young people in violation of social distancing regulation. Media discourse was laden with condemnation levelled at the public health risk and the perceived immorality and unfairness associated with the behaviour. Drawing on 11 semi-structured interviews with attendees, this study explores the motivations for going to and experiences of raves during Covid-19. Raves are unique social safe spaces for LGBTQ+ individuals to create community, emotional connections and express their sexual identity. Additionally, the pursuit of escapism via raves was no longer only symbolic, as individuals chose to escape the confines of lockdown. These findings illuminate the function of raves as social spaces outside normal society where participants can experience identity expression, connection, and freedom. They offer a more nuanced understanding of raves beyond stereotypes of hedonist youth and immorality. © 2022 Dancecult.

Donor Temperature Screening with a Non-Contact Infrared Thermometer

Background/Case Studies: COVID-19 resulted in many changes to hospital patient care. In April 2020, the Food and Drug Administration (FDA) issued a guidance, Enforcement Policy for Clinical Electronic Thermometers During the Coronavirus Disease 2019 (COVID-19) Public Health Emergency to allow for the expanded clinical use of electronic thermometers. These clinical electronic, non-contact thermometers measure body temperature to screen for fever as a possible sign of infection with COVID-19 without the requisite of removing protective masks for an oral measurement. The aim is to validate and implement this safer practice for donor temperature screening. Study Design/Methods: Our hospital-based donor center (HBDC) implemented non-contact infrared thermometers (NCITs) as a screening tool for anyone entering fixed sites and mobile blood drives. A second temperature check was performed using an oral thermometer (OT) for donors following an approved donor qualification process. Initially, informal data comparing the temperature recordings for each donor was used to determine possible equivalence of the two methods and to use as a guide to proceed with formal validation. Validation of the NCIT included an Installation Qualification by the hospital Engineering Biomed Team, assignment of a Clinical Engineering Number, implementation of an Equipment Summary Sheet for preventative maintenance, and addition to the Master Equipment List. Operational Qualification included performance of the display and controller check, simulation of the alarm at maximum and minimum temperature ranges, verification of the infrared thermometer accuracy, ice water testing, and the development and revision of Standard Operating Procedures. Performance Qualification compared a minimum of 100 temperature readings of the OT and NCIT temperature measurements with different sources of variations to thermometers used, days taken, operators performing the measurement, and worksites. Successful completion of the OT and NCIT method comparison would be accomplished by attainment of 95% of the temperature comparisons being within +/-2% of the OT standard. Information generated from a known error or anomaly unrelated to the NCIT accuracy testing were excluded. Results/Findings: 258 comparisons readings were made. Four readings were excluded from the data: 2 readings were taken while the donor was wearing a cap;1 reading was taken while the NCIT was in the wrong reading mode;1 reading of the OT measured was not recorded. Of the remaining 254 paired readings, 96.5% of the NCIT data points were within 2% of the OT. Conclusion(s): Our HBDC validated and implemented the NCIT as a suitable and safe replacement of the OT to complete donor temperature measurements.

Introduction of a physical activity assessment and exercise prescription to the cardiac risk in the young clinic

49 Table 1Exercise Prescription template using the FITT-VP (frequency, intensity, type, time, volume and progress) principle of exercise prescription.Exercise type Frequency (per week) Intensity Time (mins/session) Volume (weekly mins) Progression As always if you develop any concerning symptoms during exercise please stop and seek medical advice 49 Table 2‘How do I estimate exercise intensity?’ patient guide as part of the exercise prescription template and patient information leafletIntensity RPE (Rating of perceived exertion) % of HR max** Talk test 0 Resting 1 2 Very light No noticeable change in breathing or sweating Low 3 Somewhat light <55% Can talk and sing 4 Light Moderate 5 Somewhat moderate 55–74% Can talk, can’t sing Increased breathing and sweating 6 Moderate 7 Somewhat hard Feeling ‘out of breath’ and increased sweating High 8 Very hard 75–90% Can’t talk or sing 9 Extremely hard 10 Maximal exertion **%HR max will not be an accurate measure of exercise intensity if your heart rate is effected by certain medications or conditions 49 Figure 1Levels of self reported physical activity based on the NAPQ-short questionnaire and WHO 2020 physical activity guidelines[Figure omitted. See PDF] 49 Figure 2Variety of patients with a diagnosis of a cardiac condition or a family history of a cardiac condition receiving an exercise prescription. HCM;hypertrophic cardiomyopathy, DCM;dilated cardiomyopathy, ARVC;arrhythmogenic right ventricular cardiomyopathy, LQTS;long QT syndrome, Brugada;brugada Syndrome, CPVT;catecholaminergic polymorphic ventricular tachycardia, SADS;sudden adult death syndrome, Other;Friedreich’s ataxia, ischemic heart disease, supraventricular tachycardia)[Figure omitted. See PDF]ConclusionsCompared to the general adult Irish population, self reported adherence to the WHO PA Guidelines was 6% lower among the CRY Clinic patient cohort (33% vs. 27%). Additionally, reported resistance exercise levels was lower (30%) than aerobic exercise (72%). This is despite resistance exercise being additionally beneficial for many cardiac conditions. During the period of data collection, access to gyms and group exercise was limited due to pandemic government restrictions that likely effected resistance exercise more than aerobic exercise. In fact, a significant increase in recreational walking during covid restrictions was previously reported. Exercise is often discussed during medical consultation but rarely prescribed. In our cohort only 0.5% of patients received an Ex Rx. The reported barriers to Ex Rx are lack of time, perceived lack of patient engagement, complex co-morbidities and clinician education. Attempts were made in the form of education and resource provision to clinicians to challenge perceived barriers. Ex Rx are important in the CRY Clinic not only for the known benefits of PA but as inappropriate exercise can be harmful for some cardiac conditions. The Ex Rx enabled the benefit of PA to be gained by the safe promotion of appropriate exercise to such patients (figure 2). The introduction of this PA assessment and Ex Rx was a successful call to action to incorporate exercise as medicine to the CRY Clinic. ‘Walking is a (wo)mans best medicine’ (Hippocrates 460BC).

Sensitizing the Behavioral-Immune System: The Power of Social Pain

People who believe they are invulnerable to infectious diseases often fail to protect themselves against the disease threats that others pose to them. The current paper hypothesizes that social pain—the experience of feeling interpersonally hurt or rejected—can sensitize the behavioral-immune system by giving people added reason to see others as worthy of protecting themselves against. We obtained four daily diary samples involving 2,794 participants who reported how hurt/rejected they felt by those they knew, how personally concerned they were about the spread of illness/COVID-19, and how vigilantly they engaged in self-protective behaviors to safeguard their health each day. An integrative data analysis revealed robust evidence that people who believed they were invulnerable to infectious disease engaged in more concerted efforts to protect themselves against the greater daily risk of contracting COVID-19 when being in acute social pain gave them added reason to see others as harmful to them. © The Author(s) 2022.

The Oropharyngeal Microbiome Predicts Need for Respiratory Support Among COVID-19 Patients

Study Objective: The clinical course and severity of infection with respiratory viruses such as SARS-CoV-2, the causative agent of COVID-19, are hypothesized to be affected by the microbes colonizing the upper airway, also known as the oropharyngeal microbiome, where they first establish infection. To determine how the oropharyngeal microbiome interacts SARS-CoV-2 and if it affects the clinical course of COVID-19, we carried out a study of the oropharyngeal microbiome of patients presenting to the emergency department or on the admission wards with symptoms of COVID-19. Methods: We collected oral swabs and clinical data regarding COVID-19 severity including need for respiratory support and mortality. Nucleic acids were extracted from oral swabs and high- throughput metagenomic sequencing was performed on extracted DNA. Out of a total of 115 enrolled patients with complete data, 51 had a laboratory confirmed diagnosis of acute COVID-19 and 40 went on to require some respiratory support. We analyzed the relative abundance of detected organisms in individuals who were COVID-19+ versus COVID-19- and used mixed-effect random forest modeling to identify microbiota and clinical covariates that associated with the need for respiratory support among COVID-19+ subjects. Results: We found 19 species that were significantly different among COVID-19+/ COVID-19– patients, most notably, several Actinomyces species showed significant increases among COVID-19+ patients. We found that among COVID- 19+ patients, microbiome features were highly correlated with need for respiratory support (F1 score 0.876). Conclusions: The contributions of microbiome features such as relative abundances of Prevotella salivae, Campylobacter concisus, and Veillonella infantium as well as the Shannon Diversity Index this model approximated the importance of clinical factors known to contribute to risk for severe COVID-19 such as body mass index (BMI) and age. The composition of the oropharyngeal microbiome may represent a target for diagnostics in the ED to aid in the determination of who is likely to suffer respiratory failure and require oxygen support. [Formula presented]

Reducing routine bloodwork in home dialysis patients: A quality improvement initiative

Background: There is a paucity of evidence for routine bloodwork frequency in maintenance dialysis patients to assess and manage complications such as anemia and mineral bone disease (MBD). Recent studies showed that decreasing the frequency in conventional in-center hemodialysis (ICHD) patients had no negative impacts. Given the strain on lab services from the COVID-19 pandemic, Alberta Kidney Care-South (AKC-S) decreased the frequency of routine labs from monthly to every 2 months in home hemodialysis (HHD) and peritoneal dialysis (PD) patients. We studied the effect of this change on patient outcomes. Methods: We retrospectively compared prevalent home dialysis patients (>3 months) in AKC-S over two 6-month periods: a) Pre-pandemic May-Oct 2019 and b) Pandemic May-Oct 2020. Primary outcomes were number of routine bloodwork days and percentage of patients within target for anemia (hemoglobin, iron saturation) and MBD (calcium, phosphorus, parathyroid hormone). We also compared hospitalizations, mortality, technique failure (defined as transition to ICHD for >60days), and cost. Results: There were 366 home dialysis patients in 2019 (270 PD, 96 HHD) and 400 in 2020 (296 PD, 104 HHD). The number of routine bloodwork days decreased in 2020 compared to 2019 (p<0.01) (Fig 1). The proportion of patients who achieved anemia (33% vs 35%, p=0.44) and MBD (34% vs 28%, p=0.1) targets was similar. There was no difference in the number of hospitalizations (155 vs 141, p=0.34), deaths (13 vs 17, p=0.71) or technique failure (8% vs 5%, p=0.06). Projected cost savings were $102 per patient year from reduced labs. Conclusions: AKC-S reduced the frequency of routine labs during the pandemic in home dialysis without negative consequences on patient biomarkers or outcomes. Our study suggests that bloodwork frequency in home dialysis patients may be safely reduced. (Figure Presented).

Inflammation-Type Dysbiosis of the Oral Microbiome Associates With the Duration of Coronavirus Disease 2019 (COVID-19) and Long COVID Disease States

Study Objectives: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the pandemic, Coronavirus Disease 2019 (COVID-19), with many of those infected now facing the burden of prolonged symptoms after they have cleared the infection. The most debilitating of these, called post-acute sequelae of COVID-19 (PASC), known colloquially as long COVID, is thought to be linked to immune dysregulation due to harmful inflammation, with the exact causes being unknown. Given the oral-lung aspiration axis being a key factor to many respiratory infectious processes and the microbiome’s previous role in systemic inflammation, we aimed to examine the relationship between the oral microbiome and the duration of symptom, including development of long COIVD. Methods: Symptom duration was determined via follow-up among a cohort of emergency department patients admitted to the hospital for COVID-19 infection. Tongue swabs were collected from patients presenting with symptoms concerning for COVID-19 infection. Patients with confirmed COVID-19 infection were followed until resolution of all symptoms. Bacterial composition of oral samples was determined by metagenomic sequencing. We used random forest classification modeling to identify microbiota and clinical covariates that associate with longer duration of symptoms. Results: Of the 31 patients followed, 17 developed ongoing symptomatic COVID-19 (symptoms > 4 weeks) and 10 went on to long COVID (symptoms>8 weeks). Patients with prolonged symptoms had higher abundances of microbiota that induce inflammation, such as members of the genera Prevotella and Veillonella. Notable is the increased abundances of species that produce inflammation causing lipopolysaccharides and the similarity of long COVID patients’ oral microbiome to those of patients with chronic fatigue syndrome. Conclusion: This is the first study to describe the microbiome’s association with long COVID and explore the possibility that the oral microbiome may play a role in this disease.

A PNEUMATIC COMPRESSION VEST FOR TRANSTHORACIC MANIPULATION OF VENTILATION-PERFUSION IN CRITICAL CARE PATIENTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME CAUSED BY COVID-19

Critical Care patients who experience symptoms of Acute Respiratory Distress Syndrome (ARDS) are commonly placed on mechanical ventilators to increase the oxygen being supplied to their pulmonary system. If patients' pulmonary inflammation is severe, they can experience ventilation-perfusion mismatch (V/Q mismatch) where blood flow and gas exchange are mismatched such that oxygen uptake is greatly impaired. In these cases, patients are typically rotated into a prone position to facilitate improved blood flow to segments of the lung that were not previously participating in the gas exchange process. However, proning a patient has a significant risk of complications. The low-cost vest presented in this work is designed to be used as a surrogate to patient proning while also requiring less hospital staff to operate than the proning process. The vest was preliminarily tested on 6 patients with Coronavirus disease 2019 (COVID-19) who experienced ARDS and presumptive V/Q mismatch. The results from this preliminary testing show that 5 out of 6 patients showed a significant increase in ventilation-perfusion similar to the effects of proning.

Establishment, implementation and utilization of a Human COVID-19 biospecimen biorepository at UCLA

Background: We have developed a semiautomated infrastructure to identify remnant clinical fluid samples to support specimen collection for UCLA Institute of Precision Health from patients who have opted in through the UCLA institutional Universal Consent. This system has allowed us to collect unique remnant fluid biosamples for subsequent DNA extraction and genotyping on over 30,000 patients to date. Here we describe the modification of this system to efficiently capture specimens from patients with SARS-CoV-2 causing coronavirus disease (COVID-19). Methods: We utilized a COVID-19 patient registry to identify potential sources of remnant biospecimens. This dynamically linked registry to UCLA Healthcare's electronic health record system includes all patients who have had at least one resulted COVID-19 PCR or Antibody IgG test. A COVID-19 remnant specimen report is generated three times each week by cross-referencing the COVID-19 patient registry to a listing of all clinical biospecimens scheduled for disposal for the next three days. This report is refined by selecting patients who have had a positive PCR or IgG test result and compared to our current inventory to identify specimens from previously unsampled patients. Additional filtering is performed to track the interval between positive test date and sample collection date, allowing for the collection of longitudinal plasma/serum samples. Through our Biomaterial Tracking and Management System (BTM, Daedalus Software Inc.), reports are generated daily to detect sample collection from onsite and offsite labs, to pull and courier samples to our repository. Whole blood samples are retrieved for DNA, serum, plasma and PBMC isolation. We also initiated the generation of an automated, weekly report from the EHR that alerts us to any autopsies from COVID-19 positive patients for potential remnant tissue samples. Results: From March to November, over 11,700 biospecimens have been collected from 1,300 unique patients, consisting of whole blood, DNA, PaxGene, PBMC, plasma, serum, and various tissue samples. Over 2,370 biospecimens have been released to approved study teams. Conclusions: We have successfully established a semiautomated infrastructure and workflow to capture annotated specimens from patients infected with SARS-CoV-2 that significantly reduces the chance that specimens may be missed. This allows for the efficient generation of a large number of specimens that researchers can rapidly obtain for study.

The COVID-19 Army Rapid Assessment Tool (CARAT) for Management of COVID-19 in the Deployed Setting

The COVID-19 pandemic poses unique challenges within the austere clinical setting, and the time between patient presentation and deterioration is a critical opportunity for intervention. In some cases, this may be a life-saving transfer to a higher level of care. US Central Command (CENTCOM) has provided valuable guidance for COVID-19 management in the operational environment,1 and has proposed the National Early Warning System 2 (NEWS2) scoring tool as a useful adjunct to gauging illness severity. NEWS2, however, does not consider co-morbidities, such as diabetes or chronic cardiac disease, which could worsen the clinical course of SARS-CoV-2 patients. Thus, NEWS2 fails to address such factors during the risk stratification of patients to a higher level of care. To address this concern, June 2020, 3rd Medical Brigade, Operation Spartan Shield (OSS) developed the COVID-19 Army Rapid Assessment Tool (CARAT) with inputs from clinicians and researchers (The Team). The CARAT is a clinical scoring system, modified from the NEWS2, which combines the effects of co-morbid disease with the current physiological condition of a COVID-19 patient. The Team obtained clinical data for 105 patients from the CENTCOM area of responsibility (AOR), who presented to a military treatment facility (MTF) symptomatic for, and testing positive for SARS-CoV-2, during the time period of June to mid-August 2020. Each patient was retrospectively assigned a CARAT score based on his or her initial presentation. Preliminary review of data suggested a CARAT value of 4 or greater was an indicator for risk of further deterioration. Patients were then grouped into two categories: patients who received transfer to a higher level of care, versus "stay-in-place" supportive care. Results showed that 100% of patients with a score >=4 had been transferred to a higher echelon of care, compared to 2% of patients with scores less than 4. A Fisher's exact test demonstrated a statistically significant difference between these two groups (p is less than 0.001). Interestingly, when compared with the NEWS2 score, the CARAT identified 9 individuals for transfer to a higher level of care, of whom only one patient was identified by the NEWS2, clearly underscoring the significance of CARAT despite small sample size. We therefore recommend that CARAT be further validated in predicting disease severity and need for emergent evacuation in larger patient settings.

The hidden dangers of staying home: a London trauma unit experience of lockdown during the COVID-19 virus pandemic.

INTRODUCTION: The COVID-19 pandemic resulted in reconfiguration of the NHS. Elective services were stopped and trauma services focused on decreasing patient-clinician interactions and managing injuries nonoperatively wherever possible. The everyday life of the general public changed dramatically with the introduction of a national lockdown to prevent the spread of COVID-19. This paper looks at the experience of a South West London trauma unit. MATERIALS AND METHODS: All patients reviewed in fracture clinic and by the orthopaedic on-call team between 23 March to 23 April 2020 were included. Data on the mechanism of injury and whether this was a usual activity, the injury sustained and its management were collected. RESULTS: A total of 167 trauma injuries were seen, compared with 735 new patients with injuries in the previous month. The number of trauma operations completed decreased by 38%; 55% of injuries occurred inside the home and 44% outside the home during daily exercise. Some 31% of injuries were secondary to a new activity taken up during lockdown. Three open fractures and two polytrauma cases were seen that would have normally been managed at the local major trauma centre. CONCLUSION: Overall, both the number of injuries seen and trauma operations completed during the enforced lockdown decreased. This is probably due to a change in the way the general public are living their lives, and the reconfigurations within the NHS in response to the COVID-19 pandemic. This is an interesting time within trauma and orthopaedic departments, as they continue to adapt to the changing injuries and working environment.