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Aims/Hypothesis: Covid-19 has been associated with poorer outcomes in individuals with type 1 diabetes. Most existing data relate to hospitalised patients with few data available on seroprevalence and the effects of Covid-19 on people with diabetes in the general population. We examined antibody responses to SARS Cov-2 infection and vaccination in people with and without diabetes. Method(s): From June 2020, capillary blood samples collected remotely from 1828 individuals (type 1 diabetes n = 267) were analysed for SARS-CoV- 2 antibodies to RBD (infection pre-Jan 2021/vaccination post -Jan 21) and N (infection post Jan 21) antigens using low serum volume luciferase-based assays developed "in house". Questionnaire data recording experiences of Covid-19 and vaccinations dates were collected simultaneously with the samples. Median antibody levels were compared using Kruskal-Wallis tests. Result(s): There was evidence of SARS CoV-2 infection in 317/1828 (17%) of individuals screened with no evidence of more severe self-reported Covid-19 symptoms in those with diabetes (no participants were hospitalised) and almost a quarter of those with type 1 diabetes were asymptomatic. Although samples were collected at variable time points from vaccination, robust antibody responses to vaccination were observed (Pfizer, AstraZeneca, and Moderna) after the second vaccination with no differences in antibody levels between those with and without diabetes (p = 0.3). Conclusion(s): Hospitalised individuals with Covid-19 and type 1 diabetes were at greater risk of complications but this study shows that among the non-hospitalised population, clinical symptoms, antibody responses to infection, and vaccination in those with type 1 diabetes was similar to control subjects.
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Background: BHIVA Standards of Care for people living with HIV (PLWH) include quality statements and auditable outcomes for peer-support pathways to improve selfmanagement and engagement in care. FTCI London convened 3-year 'improvement collaborative' projects between HIV charities and NHS clinics. Chelsea and Westminster Hospital (CWHFT) supported the implementation of this initiative to 4 London HIV clinics with a cohort of >10,000 PLWH. We here illustrate the results of this initiative to date. Method(s): Positively UK, NAZ Project, Plus Health and CWHFT trialled approaches to integrating in-clinic peersupport pathways, with the aim of having >90% of those accessing peer-support retained in care, with a VL<50. 3 peer-supporters (2 FTE posts) received NHS honorary contracts, emails and the ability to log interventions within the Trust's EPR. Data on peer-support attendance and outcomes were collected from the EPR into an encrypted NHS database. Result(s): Although planned as an in-person initiative, the COVID-19 pandemic led to a shift to fully remote support and delayed project initiation to 7/2020, when email referrals commenced for newly diagnosed and those identified as being at risk of lost to follow up (LTFU). Referrals reached 4.4/month within the first 3 months. Initiatives such as MDT, focus group participation, staff teaching, and physical presence in clinics increased referrals to 7/month by 4/2021 and 12/month by 11/2021. Median patient age was 45 years (range 16-74), 13% were female, and 47% from BAME background (vs 34.5% in the CWHFT HIV cohort). Median diagnosis length was 2 years (<1-31). Moving from opt-in to opt-out support for newly diagnosed increased uptake of support from 33% in 4/2021 to 67% by 12/2021. Overall, 287 people (66% of referrals) engaged with peersupport between 7/2020 and 11/2022, with 164 (57%) receiving ongoing support. Virtual appointments moved from 100% to 54% over time. Rates of having a VL<50 increased from 71% at referral to 90% following peer-support, including new diagnoses. Conclusion(s): Implementing in-clinic peer-support pathways significantly increased referrals and uptake of support for new HIV diagnosis and those at risk of LTFU, showing the potential of improving clinical outcomes and quality of life of PLWH.
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Background: Although mRNA SARS-CoV-2 vaccines have received emergencyuse- authorization for infants age 6 months and older, vaccine uptake is slow, stressing that questions of safety and durability of vaccine efficacy remain prominent. Method(s): Infant rhesus macaques (RMs) (n=8/group) at 2 months of age, comparable to human toddler age, were immunized intramuscularly at weeks 0 and 4 with 30mug stabilized prefusion SARS-CoV-2 S-2P spike (S) protein (Washington strain) encoded by mRNA encapsulated in lipid nanoparticles (mRNA-LNP) or 15mug S protein mixed with 3M-052 in stable emulsion (Protein). At 1 year, vaccinated and age-matched unvaccinated RM (n=8) were challenged intranasally (106pfu) and intratracheally (2x106pfu) with B.1.617.2. Lung radiographs and pathology were blindly assessed, viral N gene RNA (vRNA) copies were measured by qPCR in pharyngeal swabs and lung, and neutralizing antibody and peripheral blood T cell responses were measured. Result(s): At 1 year, D614G-specific neutralizing antibody (nAb) titers were still detectable in the Protein (ID50=755;range: 359-1,949) and mRNA-LNP groups (ID50=73;range: 41-240). Both vaccines also induced cross-neutralizing antibodies to B.1.617.2. Peripheral blood CD4+ T cell responses to the ancestral spike protein at week 52 did not differ between the groups. However, median CD8+ T cell responses were higher (p=0.002, Mann Whitney) in the mRNA-LNP group (2.8%;range: 0.9%-7.1%) compared to the Protein group (0.8%;range: 0.1%-1.6%). Control RMs had significantly higher median vRNA copies/ml (1.4+/-2.7x108) in day 4 pharyngeal swabs compared to Protein (3.8+/-6.8x103) or mRNA-LNP (4.4+/-9.7x105) vaccinated RMs. Severe lung pathology was observed in 7 of 8 controls compared to 1 of 8 or 0 of 8 RMs in the mRNA-LNP or Protein group respectively. Protection against lung inflammation was associated with nAb titers (r=-0.592, p=0.003) (Figure 1). Conclusion(s): These results demonstrate that despite lower vaccine doses compared to adults, both protein and mRNA vaccines were safe, induced durable immune responses and provided comparable protective efficacy against infection with a heterologous SARS-CoV-2 variant in infants, implying that early life vaccination of human infants may lead to durable immunity. Neutralizing ID50 antibody titers are a correlate of protection in infant RMs challenged with SARS-CoV-2.
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The University of Queensland (UQ) Library was a participant in the international benchmarking exercise reported in Part Two of this book. This paper is inspired by a question raised during the workshop "will our COVID-19 responses and experience remain relevant in the future?” This paper presents a case study of the UQ Library experience 2020–21. We position qualitative benchmarking as a social and immediate practice and share our new ways of working born in response to the pandemic. We believe that these new ways of working can persist. We share our reflections so that others can consider leveraging benefits from the pandemic experience. © 2023 Elsevier Ltd. All rights reserved.
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The COVID-19 Research Database is a public data platform. This platform is a result of private and public partnerships across industries to facilitate data sharing and promote public health research. We analyzed its linked database and examined claims of 2,850,831 unique persons to investigate the influence of demographic, socio-economic, and behavioral factors on telehealth utilization in the low-income population. Our results suggest that patients who had higher education, income, and full-time employment were more likely to use telehealth. Patients who had unhealthy behaviors such as smoking were less likely to use telehealth. Our findings suggest that interventions to bolster education, employment, and healthy behaviors should be considered to promote the use of telehealth services. © 2023 IEEE Computer Society. All rights reserved.
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In the published article, there was an error in affiliation 1. Instead of "Department of Global Health, Washington, DC, United States,” it should be "Save the Children USA, Department of Global Health, Washington, DC, United States.” The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.In the published article, there was an error in affiliation 2. Instead of "Save the ChildrenInternational, Democratic Republic of Congo Country Office, Goma, Democratic Republic ofCongo,” it should be "Save the Children International, Rwanda-Burundi Country Office, Kigali,Rwanda.” The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated. © 2022 Meyer, Abimpaye, Harerimana, Williams and Gallagher.
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BACKGROUND: Hospital transmission of SARS-CoV-2 has proved difficult to control, with healthcare-associated infections troublesome throughout. AIM: To understand factors contributing to hospital transmission of infections, which is necessary for containing spread. METHODS: An outbreak of 56 staff and patient cases of COVID-19 over a 31-day period in a tertiary referral unit is presented, with at least a further 29 cases identified outside of the unit and the hospital by whole genome sequencing (WGS). FINDINGS: Transmission is documented from staff to staff, staff to patients, and patients to staff, showing disruption of a tertiary referral service, despite implementation of nationally recommended control measures, superior ventilation, and use of personal protective equipment. There was extensive spread from the index case, despite this patient spending only 10 h bed bound on the ward in strict cubicle isolation and with an initial single target low level (CT = 32) polymerase chain reaction test. CONCLUSION: This investigation highlights how effectively and rapidly SARS-CoV-2 can spread in certain circumstances. It raises questions about infection control measures in place at the time and calls into question the premise that transmissibility can be reliably detected by using lower sensitivity rapid antigen lateral flow tests. We also highlight the value of early intervention in reducing impact as well as the value of WGS in understanding outbreaks.
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BACKGROUND: Barriers to rapid return of sequencing results can affect the utility of sequence data for infection prevention and control decisions. AIM: To undertake a mixed-methods analysis to identify challenges that sites faced in achieving a rapid turnaround time (TAT) in the COVID-19 Genomics UK Hospital-Onset COVID-19 Infection (COG-UK HOCI) study. METHODS: For the quantitative analysis, timepoints relating to different stages of the sequencing process were extracted from both the COG-UK HOCI study dataset and surveys of study sites. Qualitative data relating to the barriers and facilitators to achieving rapid TATs were included from thematic analysis. FINDINGS: The overall TAT, from sample collection to receipt of sequence report by infection control teams, varied between sites (median 5.1 days, range 3.0-29.0 days). Most variation was seen between reporting of a positive COVID-19 polymerase chain reaction (PCR) result to sequence report generation (median 4.0 days, range 2.3-27.0 days). On deeper analysis, most of this variability was accounted for by differences in the delay between the COVID-19 PCR result and arrival of the sample at the sequencing laboratory (median 20.8 h, range 16.0-88.7 h). Qualitative analyses suggest that closer proximity of sequencing laboratories to diagnostic laboratories, increased staff flexibility and regular transport times facilitated a shorter TAT. CONCLUSION: Integration of pathogen sequencing into diagnostic laboratories may help to improve sequencing TAT to allow sequence data to be of tangible value to infection control practice. Adding a quality control step upstream to increase capacity further down the workflow may also optimize TAT if lower quality samples are removed at an earlier stage.
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Madagascar is well known as a source of aquamarine and other pegmatite-related gem materials (e.g. Pezzotta 2001), but in recent years most gem exploration and mining activities there have been curtailed by circumstances related to the COVID-19 pandemic and government regulations. Nevertheless, according to Dr Federico Pezzotta (pers. comm. 2022), in early 2021 there was a new find of aquamarine (Figures 1 and 2) that entered the market in the capital city of Antananarivo. The material was represented as coming from an area called Manakana, which is the name historically used for the region encompassing the pegmatitic districts on the west side of Lake Alaotra in central Madagascar. In this case, the specific aquamarine locality is Andilana, which is situated near the north-western shore of Lake Alaotra. Hundreds of kilograms of good-quality aquamarine were mined from near-surface deposits by thousands of miners from all over Madagascar who rushed there despite COVID-19 restrictions. In early May, the Malagasy government sent the military to gain control over the situation, and subsequently the export of aquamarine from Madagascar was made illegal. © 2022, Journal of Gemmology. All Rights Reserved.
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Background: SARS-CoV- 2 infection causing COVID-19 is associated with a high incidence of thrombotic complications, a phenomenon in which platelets play an important contributory role. COVID-19 is associated with alterations in platelet function, including increased platelet-neutrophil aggregates and impaired integrin alphaIIbbeta3 activation. The mechanisms underlying such effects remain unclear. Aim(s): In this study, we aimed to identify changes in the platelet proteome in patients with COVID-19 and explore implicated biological pathways. Method(s): Patients hospitalized with COVID-19 (N = 7) and healthy controls (N = 6) were recruited between October 2020 and February 2021. Proteomics analysis was performed on washed platelets using Tandem Mass Tag Mass Spectrometry (TMT-MS). Alterations in platelet proteins were analyzed using Gene Ontology (GO) pathways. Result(s): A total of 5773 proteins were quantified in COVID-19 patients and controls. There was differential expression of 858 (15%) proteins between patients with severe COVID-19 infection and controls (false discovery rate p < 0.05). Pathway analysis revealed expression changes in gene products associated with regulation of platelet activation (GO:0010543), with reduced expression of platelet kinases (PRKCA, PRKCD, PRKCQ, LYN, SYK and JAK2), glycoproteins (GP5 and GP9) and PLEK, known positive regulators of integrin activation. There was increased expression of alpha-and dense-granule lumen gene products (GO:0031093 and GO:0031089), including protease inhibitors SERPINA3, SERPING1 and SERPINF2 Conclusion(s): Our results demonstrate diverse changes in signaling and secretion pathways important to platelet activity in patients hospitalized with COVID-19. Increased abundance of platelet granule proteins is in keeping with published plasma proteome descriptions, suggesting platelet uptake of plasma proteins. Platelet granule proteins involved in the regulation of hemostasis may contribute to the increased risk of thrombosis seen in this patient cohort and point towards potential therapeutic targets for COVID-19 related thrombotic complications.
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Purpose Many interventional radiology procedures are suitable as day case procedures. Other, historically inpatient procedures, may be suitable as day case procedures with appropriate safeguards and evaluation. With increasing inpatient bed pressures, and the risks to patients from the COVID pandemic, we evaluated the recent introduction of a day case pathway for patients undergoing TACE for hepatocellular carcinoma (HCC). Materials and methods Patients undergoing TACE at our centre between 01/01/2020 and 09/11/2021 were identified using radiology archive systems (PACS). A day case procedure was defined as a patient who was admitted, and discharged on, the day of the procedure. All patients received a maximum of 50mg of Doxorubicin instilled embospheres. Electronic patient data systems were scrutinised to identify any post-procedural adverse events, defined as either an unplanned admission to hospital, in-hospital complications, or post-procedural mortality within 30 days. Results During the study period, 55 patients underwent TACE procedures, of which 40 were day case procedures. 3/40 (7.5%) day case patients experienced adverse events. One patient was admitted overnight due to abdominal pain, one re-admission to hospital with cholecystitis and one postprocedural mortality. 2/15 (13.3%) of non-day case TACE patients experienced adverse events, with one post-procedural mortality and one hospital readmission with cholecystitis. Conclusion A day case strategy was feasible in the majority of patients undergoing TACE (40/55, 73%). In our initial experience, adverse events were not increased in patients undergoing day case TACE procedures, and this remains a safe option for patients.
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SESSION TITLE: Novel Education and Assessments of Trainees SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: The COVID-19 pandemic led to increased psychological burdens in all ages. As the crisis continues with few signs of abatement, the impact in a university setting is unclear. Very limited literature examines the relationship between religiosity, burnout and mental health. We examined the relationship of religiosity to the prevalence of burnout, depression and anxiety in a university setting. METHODS: We emailed a survey questionnaire to all faculty, staff and students at a single, faith based university in February–March, 2022. The survey contained three validated scales: including the 16-item Oldenburg Burnout Inventory (OLBI) with sub-domains of eight exhaustion and eight disengagement ratings, the 14-item Hospital Anxiety and Depression Scale (HADS) to measure psychological distress, and the 5-item Duke University Religion Index (DUREL). The survey obtained institutional review board approval. RESULTS: One hundred twenty five respondents completed the survey, from 17 faculty, 18 staff and 90 students. The mean (SD) age of respondents was 30 (12) years, with 70% female. Burnout thresholds determined with a mean score of ≥ 2.25 for exhaustion and ≥ 2.10 for disengagement revealed a prevalence of 32% and 73%, respectively. HAD-depression and HAD-anxiety scores ≥ 8 were reported by 41% and 62% of respondents, respectively. Higher disengagement and exhaustion scores correlated with symptoms of depression and anxiety (all p < 0.001). Sixty-one participants (49%) attended a church service at least once or more per week and 46 (37%) spent time in religious activities (e.g. reading the bible and prayer) each day. However, intrinsic religious activities and attending organized religious meetings were not associated with burnout, depression or anxiety (each p > 0.05). There was no significant difference in the mean total OLBI score (burnout) between faculty, staff and students (all p > 0.05). However, faculty had lower anxiety and depression scores compared to staff and students (all p < 0.05). CONCLUSIONS: • A high level of burnout prevails in this academic institution during this pandemic. One-third of respondents had symptoms of exhaustion, and over 70% reported a disengaged attitude. • Over 40% of respondents potentially experience clinically relevant depression, and 60% experience clinically relevant anxiety. • Religious activities were not associated with burnout, depression or anxiety. CLINICAL IMPLICATIONS: • Academic institutions should focus on providing coping strategies (promote awareness, offer education, and maintain robust referral systems) to alleviate the symptom burdens of burnout, depression and anxiety among faculty, staff and students alike. • The role of religiosity in this faith based setting is unclear. Religiosity may impart a more protective benefit in non-ecumenical universities. DISCLOSURES: No relevant relationships by Candice Williams No relevant relationships by Abebaw Yohannes
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We present an outbreak of 56 staff and patient cases of COVID-19 over a 31 day period in a tertiary referral unit, with at least a further 29 cases identified outside of the unit and the hospital by whole genome sequencing (WGS). We document transmission from staff-to-staff, staff-to-patients and patients-to-staff and show disruption of a tertiary referral service, despite implementation of nationally recommended control measures, superior ventilation and use of PPE. We demonstrate extensive spread from the index case, despite them spending only 10 hours bed bound on the ward in strict cubicle isolation and with an initial single target low level (CT=32) PCR test. This investigation highlights critical issues including how effectively and explosively SARS-CoV-2 can spread in certain circumstances. It raises questions about infection control measures in place at the time and calls into question the premise that transmissibility can be reliably detected using lower sensitivity rapid antigen lateral flow tests. We also highlight the value of early intervention in reducing impact as well as the value of WGS in understanding outbreaks.
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Purpose : To report the longterm safety and stability of two suprachoroidal retinal prosthesis trials (NCT01603576, NCT03406416), comprising of seven patients, with followup ranging from two to nine years. Methods : Three patients with retinitis pigmentosa were implanted with our prototype 24 channel suprachoroidal retinal prosthesis in May-August 2012. One patient had the entire device removed following the trial in 2014 for a medical reason unrelated to the device. The other two patients had the intraocular array left in situ and the percutaneous connector removed, as planned. Ocular followup has continued since that time, albeit interrupted due to the Covid 19 pandemic. Four patients with retinitis pigmentosa were implanted with our second generation 44 channel fully implantable device in February to August 2018. They continue to use the device in the home enviroment. Ocular assessments including clinical examination, colour fundus photographs and optical coherence tomography (OCT) have been used to assess stability of the devices and retinal health longitudinally in patients (P) 1-7. Results : Electrode to retina distance OCT measurements over two to nine years, calculated by comparing group means, showed an increase over time. (Wilcoxon, p=0.03) In the prototype trial, the increase appeared linked to fibrosis and stimulation, with no progression once devices were inactivated, in the second generation trial, it seemed primarily due to passive fibrosis. Retinal thickness OCT measurements showed a slow reduction in central retinal thickness, as expected, due to progression of dystrophic disease. (Wilcoxon, p=0.11) Device position compared to the optic nerve head (ONH) was calculated and three patients demonstrated some temporal movement. P1 position returned to baseline over seven years, P2 stabilised over three months and P6 had a temporary choroidal effusion event which settled spontaneously. Function of the four Generation two fully implantable devices remains stable. Conclusions : Using fundus photography and OCT measurements we demonstrate that retinal prostheses implanted in the suprachoroidal space for up to nine years are overall stable in position and cause mild progressive fibrosis in the suprachoroidal space. Longterm assessment of the changes in the retina are all consistent with the underlying retinal dystrophy. This provides further evidence of the safety of the suprachoroidal surgical approach for retinal prostheses.
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In its preamble, the Department of Higher Education and Training's (DHET) strategic plan for 2015 to 2020 identified ways to expand access to education and training. However, in South Africa, Technical and Vocational Education and Training (TVET) colleges' enrolment growth is inhibited by inadequate physical infrastructure and a shortage of additional and relevant human resources (DHET, 2018). The draft Open Learning Policy Framework for the Post-School Education and Training (2017) recommends that the principle of flexibility be applied to increase student access and support their success. This exploratory case study focuses on possibilities and limitations of flexible learning provision at a selected TVET college in the Free State province. It adopts Nancy Fraser's (1995, 2005) theory of social justice, which emphasizes parity of participation with respect to economic, cultural and political dimensions, to discuss ways in which flexible learning is socially just. COVID-19 lockdowns severely curtailed this study to virtual interviews with two institutional managers only, as students were not readily available. The transcripts were subsequently coded along Fraser's three dimensions of social justice. The study demonstrates that flexible learning provision responded to the economic dimensions of transport poverty by providing access to curriculum content via online platforms, radio broadcasts and hardcopy materials deposited for collection at selected physical destinations. In relation to cultural parity, it reveals that the college provides a pedagogically responsive intervention programme as a second opportunity for students to succeed. Politically, the study indicates that assessment practices at the college are exclusionary due to national assessment policies that constrain flexibility. This chapter contributes towards understanding the practices and policies that influence flexible learning provision as an aspirational form of open learning as well as the complex ways in which social injustices are entangled in the South African PSET sector.
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Background: Stress Management and Resiliency Training (SMART) is a validated resilience training program designed to reduce stress, improve emotional resilience, and decrease burnout. The prevalence of burnout among practicing oncologists is as high as 40%, but unknown among oncology trainees. We implemented a virtual format of the SMART program to the Hematology/Oncology fellowship at Mayo Clinic to assess the feasibility of such a delivery, measure baseline rates of burnout in this group, and to investigate if a virtual method of delivery is as effective as in-person delivery as described in the literature. Methods: The SMART project was a mixed-methods, prospective, single arm clinical trial. Hematology/Oncology Fellows at Mayo Clinic were invited to participate. Four one-hour training sessions were conducted virtually. Fellows were given access to SMART online video modules and a book which supported the content covered during virtual training, a companion resilience mobile app, and a paperback mindfulness journal. Stress, burnout, and emotional resilience were measured at baseline and three months post-intervention using the Perceived Stress Scale (PSS), Maslach Burnout Inventory (MBI), and Connor-Davidson Resilience Scale (CD-RISC2). Changes in mean scores on the PSS, MBI, and CD-RISC2 were assessed using the Wilcoxon signed-rank test. Program feedback and feasibility data were obtained during a virtual focus group. Audio transcripts from the focus group were codified for thematic analysis and verified by intercoder triangulation. A 6-month assessment will be due in March 2022. Results: 26 of 50 fellows invited participated in our study. At baseline, 24% of participants had measurable burnout and 92% had moderate to high stress. At 3-months, the number of participants with moderate to high stress decreased to 71%, while rates of burnout remained unchanged. The PSS demonstrated a decrease in mean stress (-10.9%, p = 0.005), while the MBI demonstrated decreased emotional exhaustion (MBI-EE -6.01%, p = 0.04), an improved sense of personal achievement (MBI-PA 28.1%, p < 0.001), but slightly worse feelings of depersonalization (MBI-DP 16.46%, p = 0.05). The CD-RISC2 suggested no change in global emotional resilience (-0.71%, p = 0.82). Thematic analysis of the focus group data revealed that participants overwhelmingly found the program beneficial (83% of all responses), 20% indicated improved stress, and 15% indicated improved work performance. Conclusions: Oncology fellows in this study had lower rates of burnout compared to practicing oncologists. Virtual implementation of the SMART program is feasible and resulted in improvements in stress and prevented worsened burnout. Outcomes were comparable to previously published studies conducted in-person. Focus group participants found the training beneficial, reported lower stress, and improved work performance.
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Background: Telemedicine use during the COVID-19 pandemic among financially distressed patients with cancer, with respect to the determinants of adoption and patterns of utilization, has yet to be delineated. We sought to systematically characterize telemedicine utilization in financially distressed patients with cancer during the COVID-19 pandemic. Methods: We conducted an analysis of survey data assessing the use of telemedicine in patients with cancer during the COVID-19 pandemic collected by Patient Advocate Foundation (PAF) from May 2020 to December 2020. Primary study outcome was telemedicine utilization rate. Secondary outcomes were independent predictors of telemedicine utilization patterns, volume, and utilization preferences. Multivariate and poisson regression analyses were used to identify predictive factors. Results: Of the 1,390 respondents, 627 completed two survey waves and were included in this study. Telemedicine adoption during the pandemic was reported by 67% of patients, with most (63%) preferring video visits. Younger age (odds ratio, 6.07;95% CI, 1.47-25.1), and higher comorbidities (odds ratio, 1.79;95% CI, 1.13-2.65) were independent predictors associated with telemedicine adoption. Younger age (19-35 yrs.) (incidence rate ratios [IRR], 1.78;95%CI, 24-115%) and higher comorbidities (≥3) (IRR;1.36;95%CI, 20-55%) were independent predictors associated with higher utilization volume. As area deprivation index increased by 10 units, the number of visits decreased by 3% (IRR 1.03, 95%CI, 1.03-1.05). Conclusions: The rapid adoption of telemedicine may exacerbate existing inequities, particularly among vulnerable financially under-resourced patients with cancer. Policy-level interventions are needed for the equitable and efficient provision of this service.
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Background: During the COVID-19 pandemic the US experienced a dramatic decline in in-person visits due to stay at home orders and social distancing. In May 2020 our health system established a regional pediatric telehealth consortium (RPTC) in response to the pandemic. The program, supported in part by the Federal Communications Commission's COVID-19 Telehealth Program enabled;expansion of an established telehealth platform to support 15 urban, suburban and rural healthcare sites in the DCMaryland-Virginia region;continuity of care for patients while limiting community spread of COVID 19;and remote care to expand region-wide surge capacity. Our objectives were first to establish a virtual telemedicine command center to coordinate and provide care via network technology and broaden regional access to pediatric specialty services. Second to provide connected care services-including remote monitoring, video consults, imaging diagnostics, remote treatment and family presence, maintaining social distancing and protecting healthcare workers and patients from exposure to the coronavirus. Thirdly, to prepare and assist health care providers at regional partner sites to conduct connected care services. Methods: RPTC infrastructure was established with the purchase of hardware, software and other connected devices including telehealth carts, robots, peripherals, digital BP cuffs, pulse ox, thermometers, tablets, telehealth platforms, and innovative AI software. Data plans to provide care for underserved patients, virtual interpreter service platforms and tablets to maintain family presence for inpatients were provided. A dashboard was developed to track program assets, roll out, utilization, patient and provider characteristics and geographic distribution of visits. A project management team coordinated roll out of the program. Results: Between March 1 to August, 31, 2020, the RPTC provided 62,864 DTC telemedicine visits, with 558 providers. Telemedicine patients were 51.7% female, insurance was 45.7% public, 34% private, 8.7% federal and the top 10 diagnoses were behavioral health related. In response to the COVID-19 pandemic, telemedicine patient volume increased 284% across all specialties and subspecialties over the course of March and April 2020. Additionally, the number of providers of direct to consumer telemedicine increased by 38% between February (400 providers pre-COVID) and March, 2020 (554 providers post-COVID). The expanded telehealth infrastructure supported provider-to-patient pediatric care and provider-toprovider consultations through a connected “virtual hospital” model. It is used for ED, ICU and inpatient care to provide access to specialized expertise and DTC care across the 15 regional partner sites. Conclusion: Establishment of the RPTC allowed our health system to shift to a telemedicine first model, treat seriously ill COVID-19 pediatric patients and to continue to provide the highest quality care to patients with acute or chronic health needs via telehealth across a tri-state region.