COVID-19 and Sport Stadia: Managing Large Sport Facilities during a Crisis Like No Other

This chapter considers the impact of COVID-19 on sport stadia. The cancellation and/or pausing of sport leagues and events around the world had a large impact on the sport stadium sector. Thousands of stadia and sporting facilities were closed, with very little warning, as nations and cities were placed in lockdown and social distancing measures were established. These events had significant financial consequences and placed pressure on the managers of sport stadia to explore creative ways for staying financially afloat. The chapter features a case study of the famous New Zealand sporting venue Eden Park, and how management planned to recover from their period of closure. © 2023 selection and editorial matter, Stephen Frawley and Nico Schulenkorf;individual chapters, the contributors.

Convalescent plasma and COVID-19: Time for a second-second look?

In this short narrative, we highlight some of our experiences leading the US Convalescent Plasma Program at the beginning of the pandemic in the spring and summer of 2020. This includes a brief summary of how the program emerged and high-level lessons we learned. We also share our impressions about why convalescent plasma was used at scale in the United States, early in the pandemic and share ideas that might inform the use of convalescent plasma in future outbreaks of novel infectious diseases.

Automate to Resuscitate: Outcomes of Mechanical Cpr Two Years after Acute Care Implementation

INTRODUCTION: Expert Guidelines endorsed Mechanical Cardiopulmonary Resuscitation (mCPR) devices in response to the COVID-19 pandemic. In April, 2020, a regional hospital received grant-funding for mCPR devices to reduce team exposure during CPR events. METHOD(S): We aimed to evaluate patient outcomes and teammate perceptions associated with mCPR. The primary clinical outcome measured was 1 hour survival post CPR event among inpatients experiencing a cardiopulmonary arrest before & after mCPR implementation, including subset analysis of CPR events where mCPR was specifically noted as being used. Teammate perceptions comparing resuscitation events with and without the mCPR device, barriers to use, and impact on communication and teamwork were assessed using an electronic survey approximately one year post-implementation. RESULT(S): Respondents to the team survey (n=22) were primarily nurses (81%) in the critical care unit or the critical care code team, Respiratory Therapists (9.5%) & physicians or APPs (9.5%). One third of participants self-reported using the mCPR device 60% or more of the time. Most (72%) indicated a reduction in teammates required in the room for CPR events in the ICU. Participants rated improvement in communication and ability to focus on their role during a Code Blue. Most (76%) "Agreed" or "Strongly Agreed" that the quality of resuscitation is improved when the mCPR is in use. We defined event survival as return of spontaneous circulation (ROSC) plus survival >1 hour after the CPR event to align with historic institutional data. Baseline survival (2019) at 1 hour across all inpatient areas was 53.1%. During the 2 years post-implementation, inpatient event survival was similar at 52.9% with confirmed mCPR. In critical care, post implementation non-mCPR codes had 54.2% survival compared with 57.14% confirmed mCPR ICU Codes. mCPR was documented only in about 8% of ICU and non- ICU codes. Data are limited by onconsistent documentation of mCPR Utilization. Measures were implemented May 1 2022 and following to better capture utilization. CONCLUSION(S): Staff report benefits with mCPR. mCPR outcomes should be monitored as a variable in ongoing quality improvement. Further study of quantitative outcomes with subgroup analysis & staff perception of mCPR devices in inpatient CPR events is needed.

Comparison of Video-Coached Remote Spirometry with In-Person Spirometry in Patients with Severe Asthma Participating in the NHLBI PrecISE Network

Introduction: PrecISE is an ongoing Phase II clinical trial sponsored by the National Heart, Lung, and Blood Institute to investigate the efficacy of several treatments for severe asthma. The threat of COVID-19 has raised interest in obtaining reliable spirometry data for asthma research and clinical care in a remote, “no-touch” fashion. Prior studies of the accuracy of remote spirometry have not included real-time coaching. The PrecISE investigators hypothesized that remote spirometry with real-time video coaching could provide an accurate FEV1 for use as a study endpoint in a clinical trial setting. Methods: PrecISE network participants had remote spirometry post-bronchodilator (4 puffs of albuterol) measured with video coaching from trained research coordinators using the ZEPHYRx platform connected to MIR Spirobank Smart handheld spirometers. Remote spirometry measurements occurred within a +/- 3-day window from scheduled in-person PrecISE visits during which in-person spirometry with bronchodilator challenge was measured with standard equipment (Vyaire Medical). All measurements occurred during the screening/run-in period of the PrecISE protocol. Both remote and in-person spirometry was overread by the PrecISE Spirometry Core and only included in analysis if sessions met ATS acceptability and reproducibility criteria. Correlations between remote and in-person FEV1 and FVC were analyzed, and Bland-Altman plots generated. As a comparison, within subject biological variability was measured using data from separate in-person visits during the screening/run-in period. Results: A total of 128 pairs of remote/in-person spirometry data were obtained. The mean FEV1 for remote spirometry was 2.50 L (SD 0.81) and for inperson spirometry was 2.42 L (SD 0.80), with an estimated correlation of 0.95 (95% CI: 0.93, 0.97). The mean difference in FEV1 (in-person - remote) was -0.07 L (95% CI: -0.11, -0.03, SD 0.25). The mean FVC for remote spirometry was 3.72 L (SD 1.01) and for in-person spirometry was 3.53 L (SD 0.93), with an estimated correlation of 0.91 (95% CI: 0.87, 0.93). The mean difference in FVC (in-person - remote) was -0.19 L (95% CI: -0.27, -0.12, SD 0.42). A total of 142 pairs of repeated in-person spirometry measurements were performed (median time between measurements: 43 days), with mean difference in FEV1 of -0.01 L (95% CI: -0.06, 0.03) and FVC of -0.02 L (95% CI: -0.07, 0.03). Bland-Altman plots for FEV1 differences are shown in Figure 1. Conclusions: Remote spirometry with real-time video coaching provides a reliable FEV1 measurement which correlates closely with in-person spirometry and is suitable for use in clinical trials. (Figure Presented).

The 'Sparks of Kuwai': Baniwa Cosmovision, Covid-19, and the 'Nos Cuidamos' 'We Care' Campaign

The spread of Covid-19 among the vulnerable indigenous populations of Amazonia has produced complex moral and spiritual issues that have demanded creative and cooperative solutions. The Baniwa indigenous peoples of the Northwest Amazon pin the spread of the pandemic on the failure of humans to observe respectful relations with the spirit-people of the environment. Ritual specialists typically believe that the pandemic is due to humans having violated the original instructions, remembered in initiation ceremonies and reinforced throughout a lifetime. Consequently, they further believe, the spirit-people of the environment retaliate by inflicting sicknesses, including the Covid-19 pandemic. To reverse the damage, a strong movement of healthcare led by indigenous women has promoted a revitalization of the use of herbal medicines together with healing practices and the traditional teachings of the initiation rites for men and women.

An audit of inpatient diabetic footcare at a Lothian district general hospital: Has progress been made since the 2013 Scottish Inpatient Diabetic Foot Audit?

Aims: The National Institute for Health and Care Excellence recommend that all adult patients with diabetes should have a foot examination 'on any admission to hospital'. However, a 2013 Scotland-wide audit highlighted that this was not being done for over half of patients, with growing concern about hospital-acquired foot ulceration. A similar audit was conducted at a district general hospital in 2021, to assess for any improvement. Method: A 'snap shot' study was performed, identifying all inpatients with diabetes in the general medicine department at St John's Hospital, Livingston, on the 11th February 2021. Data were collected from patient notes including age, HbA1c, last documented foot risk, and any recorded inpatient diabetic foot examination up until the study date. 14 of these patients then underwent a diabetic foot examination. Results: 51 patients with diabetes were identified, 90% of whom had type 2 diabetes. The average age was 73.7 years (SD ± 13.9 years), and the average HbA1c was 65mmol/ mol (SD ± 18.7mmol/mol). 66% had low foot risk on last examination. Only 8% had a diabetic foot examination documented this admission. Of the 14 patients examined during this study, half had evidence of neuropathy, and two had active foot ulcers. Conclusions: This audit demonstrates that there is still much progress to be made in inpatient diabetic footcare. Furthermore, the covid-19 pandemic has likely had an impact both on foot screening and access to podiatry services, making it even more vital to be diligent with foot examinations.

COVID-19 in health care workers, Australia 2020

Background: Health care workers are at increased risk of SARS-CoV-2 infection due to potential exposure to patients or staff in health care settings. Australian health care services and health care workers experienced intense pressure to prepare for and respond to SARS-CoV-2 infections. We summarise national data on health care worker infections and associated outbreaks during 2020.

The Role of Disease Severity and Demographics in the Clinical Course of COVID-19 Patients Treated With Convalescent Plasma.

Treatment of patients with COVID-19 using convalescent plasma from recently recovered patients has been shown to be safe, but the time course of change in clinical status following plasma transfusion in relation to baseline disease severity has not yet been described. We analyzed short, descriptive daily reports of patient status in 7,180 hospitalized recipients of COVID-19 convalescent plasma in the Mayo Clinic Expanded Access Program. We assessed, from the day following transfusion, whether the patient was categorized by his or her physician as better, worse or unchanged compared to the day before, and whether, on the reporting day, the patient received mechanical ventilation, was in the ICU, had died or had been discharged. Most patients improved following transfusion, but clinical improvement was most notable in mild to moderately ill patients. Patients classified as severely ill upon enrollment improved, but not as rapidly, while patients classified as critically ill/end-stage and patients on ventilators showed worsening of disease status even after treatment with convalescent plasma. Patients age 80 and over showed little or no clinical improvement following transfusion. Clinical status at the time of convalescent plasma treatment and age appear to be the primary factors in determining the therapeutic effectiveness of COVID-19 convalescent plasma among hospitalized patients.

SARS-CoV-2 infects human corneal epithelium and elicits an antiviral immune response

Purpose : We recently reported the presence of SARS-CoV-2 RNA, Spike, and Envelope proteins in the corneas of COVID-19 donors. However, the presence of viral RNA and antigens does not necessarily equate to infection. In this study, using RNA-seq of COVID-19 corneal tissue, and SARS-CoV-2 infection of human corneal epithelial cultures, we now examined whether SARS-CoV-2 could replicate in the cornea and elicits an innate immune response. Methods : Eyes from healthy and COVID-19 donors were from the Eversight eye bank. The corneal tissue was used for IHC detection of SARS-CoV-2 by RNA-FISH. In another experiment, total RNA was extracted from corneas for RNA-seq analysis to identify genes/ pathways altered by infection. In vitro studies were performed by infecting primary human corneal epithelial cells (HCECs) from normal and diabetic donor corneas with SARS-CoV-2. Bioinformatics analysis was performed to determine the differential gene expression. qPCR was used to assess the expression of innate inflammatory and antiviral genes and to confirm RNA-seq data in corneal tissue and cells. Results : RNA-FISH analysis showed the presence of both positive and negative strands of SARS-CoV-2 viral RNA in the epithelium of COVID-19 donor corneas. This coincided with infiltration of CD45+ cells in the stroma and induced expression of inflammatory (IL-6, IL1β) and antiviral (ISG15, OAS2) genes. RNA-seq analysis revealed significant upregulation of genes involved in the viral response, inflammation, and injury along with induction of lncRNA XIST and TSIX involved in modulation of the immune response. The primary HCECs were found permissive to SARS-CoV-2 infection, as evidenced by increase viral replication which peaked at day 3 p.i. along with an induction of p-STAT1. Interestingly, HCECs from diabetic cornea had higher viral RNA on day 1 p.i. compared to non-diabetic cells. SARSCoV-2 infected HCECs also exhibited induced expression of antiviral innate response genes, which was elevated in diabetic donor cornea cells. Conclusions : Our study confirms the presence of replicating SARS-CoV-2 viral RNA and antigen in the cornea of COVID-19 affected donors resulting in the production of inflammatory mediators and recruitment of CD45+ immune cells to the cornea. Moreover, HCECs from diabetic corneas had increased SARS-CoV-2 replication and immune response, suggesting that diabetes is a potential risk for ocular transmission of COVID-19.

Early safety indicators of COVID-19 convalescent plasma in 5000 patients.

BACKGROUNDConvalescent plasma is the only antibody-based therapy currently available for patients with coronavirus disease 2019 (COVID-19). It has robust historical precedence and sound biological plausibility. Although promising, convalescent plasma has not yet been shown to be safe as a treatment for COVID-19.METHODSThus, we analyzed key safety metrics after transfusion of ABO-compatible human COVID-19 convalescent plasma in 5000 hospitalized adults with severe or life-threatening COVID-19, with 66% in the intensive care unit, as part of the US FDA expanded access program for COVID-19 convalescent plasma.RESULTSThe incidence of all serious adverse events (SAEs), including mortality rate (0.3%), in the first 4 hours after transfusion was <1%. Of the 36 reported SAEs, there were 25 reported incidences of related SAEs, including mortality (n = 4), transfusion-associated circulatory overload (n = 7), transfusion-related acute lung injury (n = 11), and severe allergic transfusion reactions (n = 3). However, only 2 of 36 SAEs were judged as definitely related to the convalescent plasma transfusion by the treating physician. The 7-day mortality rate was 14.9%.CONCLUSIONGiven the deadly nature of COVID-19 and the large population of critically ill patients included in these analyses, the mortality rate does not appear excessive. These early indicators suggest that transfusion of convalescent plasma is safe in hospitalized patients with COVID-19.TRIAL REGISTRATIONClinicalTrials.gov NCT04338360.FUNDINGMayo Clinic, Biomedical Advanced Research and Development Authority (75A50120C00096), National Center for Advancing Translational Sciences (UL1TR002377), National Heart, Lung, and Blood Institute (5R35HL139854 and R01 HL059842), National Institute of Diabetes and Digestive and Kidney Diseases (5T32DK07352), Natural Sciences and Engineering Research Council of Canada (PDF-532926-2019), National Institute of Allergy and Infectious Disease (R21 AI145356, R21 AI152318, and AI152078), Schwab Charitable Fund, United Health Group, National Basketball Association, Millennium Pharmaceuticals, and Octapharma USA Inc.

Mortality in individuals treated with COVID-19 convalescent plasma varies with the geographic provenance of donors.

Successful therapeutics and vaccines for coronavirus disease 2019 (COVID-19) have harnessed the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Evidence that SARS-CoV-2 exists as locally evolving variants suggests that immunological differences may impact the effectiveness of antibody-based treatments such as convalescent plasma and vaccines. Considering that near-sourced convalescent plasma likely reflects the antigenic composition of local viral strains, we hypothesize that convalescent plasma has a higher efficacy, as defined by death within 30 days of transfusion, when the convalescent plasma donor and treated patient were in close geographic proximity. Results of a series of modeling techniques applied to approximately 28,000 patients from the Expanded Access to Convalescent Plasma program (ClinicalTrials.gov number: NCT04338360) support this hypothesis. This work has implications for the interpretation of clinical studies, the ability to develop effective COVID-19 treatments, and, potentially, for the effectiveness of COVID-19 vaccines as additional locally-evolving variants continue to emerge.

Convalescent Plasma Therapy for COVID-19: A Graphical Mosaic of the Worldwide Evidence.

Convalescent plasma has been used worldwide to treat patients hospitalized with coronavirus disease 2019 (COVID-19) and prevent disease progression. Despite global usage, uncertainty remains regarding plasma efficacy, as randomized controlled trials (RCTs) have provided divergent evidence regarding the survival benefit of convalescent plasma. Here, we argue that during a global health emergency, the mosaic of evidence originating from multiple levels of the epistemic hierarchy should inform contemporary policy and healthcare decisions. Indeed, worldwide matched-control studies have generally found convalescent plasma to improve COVID-19 patient survival, and RCTs have demonstrated a survival benefit when transfused early in the disease course but limited or no benefit later in the disease course when patients required greater supportive therapies. RCTs have also revealed that convalescent plasma transfusion contributes to improved symptomatology and viral clearance. To further investigate the effect of convalescent plasma on patient mortality, we performed a meta-analytical approach to pool daily survival data from all controlled studies that reported Kaplan-Meier survival plots. Qualitative inspection of all available Kaplan-Meier survival data and an aggregate Kaplan-Meier survival plot revealed a directionally consistent pattern among studies arising from multiple levels of the epistemic hierarchy, whereby convalescent plasma transfusion was generally associated with greater patient survival. Given that convalescent plasma has a similar safety profile as standard plasma, convalescent plasma should be implemented within weeks of the onset of future infectious disease outbreaks.

Convalescent plasma use in the USA was inversely correlated with COVID-19 mortality.

Background: The US Food and Drug Administration authorized COVID-19 convalescent plasma (CCP) therapy for hospitalized COVID-19 patients via the Expanded Access Program (EAP) and the Emergency Use Authorization (EUA), leading to use in about 500,000 patients during the first year of the pandemic for the USA. Methods: We tracked the number of CCP units dispensed to hospitals by blood banking organizations and correlated that usage with hospital admission and mortality data. Results: CCP usage per admission peaked in Fall 2020, with more than 40% of inpatients estimated to have received CCP between late September and early November 2020. However, after randomized controlled trials failed to show a reduction in mortality, CCP usage per admission declined steadily to a nadir of less than 10% in March 2021. We found a strong inverse correlation (r = -0.52, p=0.002) between CCP usage per hospital admission and deaths occurring 2 weeks after admission, and this finding was robust to examination of deaths taking place 1, 2, or 3 weeks after admission. Changes in the number of hospital admissions, SARS-CoV-2 variants, and age of patients could not explain these findings. The retreat from CCP usage might have resulted in as many as 29,000 excess deaths from mid-November 2020 to February 2021. Conclusions: A strong inverse correlation between CCP use and mortality per admission in the USA provides population-level evidence consistent with the notion that CCP reduces mortality in COVID-19 and suggests that the recent decline in usage could have resulted in excess deaths. Funding: There was no specific funding for this study. AC was supported in part by RO1 HL059842 and R01 AI1520789; MJJ was supported in part by 5R35HL139854. This project has been funded in whole or in part with Federal funds from the Department of Health and Human Services; Office of the Assistant Secretary for Preparedness and Response; Biomedical Advanced Research and Development Authority under Contract No. 75A50120C00096.

Use of convalescent plasma in COVID-19 patients with immunosuppression.

In the absence of effective countermeasures, human convalescent plasma has been widely used to treat severe acute respiratory syndrome coronavirus 2, the causative agent of novel coronavirus disease 19 (COVID-19), including among patients with innate or acquired immunosuppression. However, the association between COVID-19-associated mortality in patients with immunosuppression and therapeutic use of convalescent plasma is unknown. We review 75 reports, including one large matched-control registry study of 143 COVID-19 patients with hematological malignancies, and 51 case reports and 23 case series representing 238 COVID-19 patients with immunosuppression. We review clinical features and treatment protocols of COVID-19 patients with immunosuppression after treatment with human convalescent plasma. We also discuss the time course and clinical features of recovery. The available data from case reports and case series provide evidence suggesting a mortality benefit and rapid clinical improvement in patients with several forms of immunosuppression following COVID-19 convalescent plasma transfusion. The utility of convalescent plasma or other forms of antibody therapy in immune-deficient and immune-suppressed patients with COVID-19 warrants further investigation.

Improving monitoring and treatment of dexamethasone induced hyperglycaemia in patients with covid-19

Aims: The use of dexamethasone has increased since its benefit in treating covid-19 was discovered. Hyperglycaemia has been shown to be associated in poorer outcomes in patient with covid-19. The aim of this audit was to improve monitoring and management of hyperglycaemia in covid-19 patients on dexamethasone. Methods: In October 2020 the notes of ten patients on dexamethasone for covid-19 were audited over a 1-week period to determine if they had a glucose chart present, if they were having glucose checked four times daily, and if raised glucose was appropriately actioned upon. Following this a covid-19 bundle was created to improve management of covid-19. This included guidance on monitoring and treatment of hyperglycaemia, with an aim for this to be placed in all patients notes with confirmed covid-19. The bundle was based on covid:Diabetes guidance from the national inpatient diabetes covid-19 response team. Re-audit was then performed in January 2021 for a total of seven patients. Results: In October 2020 80% of patients were having their glucose levels checked, improving to 100% by January. Appropriate frequency of checking glucose improved from 20% to 57%. Appropriate actioning of hyperglycaemia, if required, improved from 50% to 75%. Conclusion: Providing local education regarding the guidelines for dexamethasone associated hyperglycaemia in covid- 19 patients can improve both management and monitoring of hyperglycaemia. Ongoing education is required for both medical and nursing staff to ensure ongoing development in recognition and management of hyperglycaemia.