Confronting a post-pandemic new-normal-threats and opportunities to trust-based relationships in natural resource science and management.

Natural resource governance is inherently complex owing to the socio-ecological systems in which it is embedded. Working arrangements have been fundamentally transformed throughout the COVID-19 pandemic with potential negative impacts on trust-based social networks foundational to resource management and transboundary governance. To inform development of a post-pandemic new-normal in resource management, we examined trust relationships using the Laurentian Great Lakes of North America as a case study. 82.9% (n = 97/117) of Great Lakes fishery managers and scientists surveyed indicated that virtual engagement was effective for maintaining well-established relationships during the pandemic; however, 76.7% (n = 89/116) of respondents indicated in-person engagement to be more effective than virtual engagement for building and maintaining trust. Despite some shortcomings, virtual or remote engagement presents opportunities, such as: (1) care and nurturing of well-established long-term relationships; (2) short-term (1-3 years) trust maintenance; (3) peer-peer or mentor-mentee coordination; (4) supplemental communications; (5) producer-push knowledge dissemination; and, if done thoughtfully, (6) enhancing diversity, equity, and inclusion. Without change, pre-pandemic trust-based relationships foundational to cooperative, multinational, resource management are under threat.

Chest CT in COVID-19 patients: a clinical need

Purpose: The COVID-19 pandemic caused by the coronavirus SARS-CoV-2 has resulted in a global health care crisis. The provision of CT imaging services by radiology departments for COVID-19 patients poses multiple challenges. Thus, the clinical indications and utility of thoracic CT, determined by whether it subsequently alters patient management, in COVID-19 patients is important to establish. Current literature is not well established specifically for the 'Delta' SARS-CoV-2 variant. Methods and Materials: This is a single tertiary hospital centre retrospective review of all consecutive confirmed COVID-19 cases admitted during the peak of the 'Delta' variant wave in Australia who underwent a chest CT. Clinical indication for chest CT and patient management plan pre and post CT were ascertained. Result(s): During this period, 1403 patients were admitted with COVID-19 and 92 patients underwent CT of the thorax, with 18 patients scanned urgently. There were 73 CTPA, 14 CT Chest and 5 HRCT studies. 20 patients were in ICU at the time of scan. Regarding the clinical indications for thoracic CT, 72.8% of studies were to evaluate for pulmonary emboli, 16.2% for assessment of COVID-19 pneumonia complications, 5.4% for tuberculosis and 6.5% for other indications. 21 (23%) of these studies resulted in a change in management with 2 patients having a major change in management (thrombolysis, CT guided aspiration) whilst 19 had minor changes. Of 73 CTPA studies, 11 (15%) patients had evidence of pulmonary embolism. 6 patients underwent a second chest CT for diverse reasons. Conclusion(s): In conclusion, 6% of patients in the cohort of COVID- 19 patients admitted to our centre during the Delta variant wave of COVID-19 in NSW, Australia underwent a CT of the thorax. In 23% of these patients, chest CT resulted in a change in management. 72.8% of chest CT scans were for the evaluation of possible pulmonary emboli. CT was not used for diagnosis or follow-up of COVID-19 in any of our patients.

Real-time surveillance of severe acute respiratory infections in Scottish hospitals: an electronic register-based approach, 2017-2022.

OBJECTIVES: The COVID-19 pandemic highlighted the importance of routine syndromic surveillance of respiratory infections, specifically new cases of severe acute respiratory infection (SARI). This surveillance often relies on questionnaires carried out by research nurses or transcriptions of doctor's notes, but existing, routinely collected electronic healthcare data sets are increasingly being used for such surveillance. We investigated how patient diagnosis codes, recorded within such data sets, could be used to capture SARI trends in Scotland. STUDY DESIGN: We conducted a retrospective observational study using electronic healthcare data sets between 2017 and 2022. METHODS: Sensitive, specific and timely case definition (CDs) based on patient diagnosis codes contained within national registers in Scotland were proposed to identify SARI cases. Representativeness and sensitivity analyses were performed to assess how well SARI cases captured by each definition matched trends in historic influenza and SARS-CoV-2 data. RESULTS: All CDs accurately captured the peaks seen in laboratory-confirmed positive influenza and SARS-CoV-2 data, although the completeness of patient diagnosis records was discovered to vary widely. The timely CD provided the earliest detection of changes in SARI activity, whilst the sensitive CD provided insight into the burden and severity of SARI infections. CONCLUSIONS: A universal SARI surveillance system has been developed and demonstrated to accurately capture seasonal SARI trends. It can be used as an indicator of emerging secondary care burden of emerging SARI outbreaks. The system further strengthens Scotland's existing strategies for respiratory surveillance, and the methods described here can be applied within any country with suitable electronic patient records.

Characterizing Surgical Management of Laryngotracheal Stenosis in COVID-19 Patients

Introduction: Early literature describes an array of laryngotracheal complications in patients who were hospitalized with COVID-19. Laryngotracheal stenosis (LTS), in particular, is difficult to manage, requiring multiple procedures, frequent follow-up, and long-term reliance on tracheostomy. We aim to characterize the timeline and challenges associated with surgical management of LTS in this patient population. Method(s): We conducted a retrospective review of patients who presented to laryngology clinic after hospitalization with COVID-19 at a tertiary academic medical center from June 2020 to September 2021. Those who were diagnosed with LTS, intubated during their hospitalization, and underwent surgical management were included. Data on patient demographics, duration of intubation and tracheostomy, access to specialty clinic, and timeline of surgical care were collected. Result(s): A total of 9 patients were identified. Six patients had posterior glottic stenosis (PGS) (67%), 1 had subglottic stenosis (SGS) (11%), and 2 had tracheal stenosis (22%). The median duration of intubation was 21 days (IQR: 15-30). Of the patients, 67% underwent tracheostomy during the study period. Median duration of time between tracheostomy placement and decannulation was 75 days (IQR: 59.5-117). The median duration between COVID-19 diagnosis and presentation to laryngology clinic was 150 days (IQR: 65-209). All 6 patients with PGS underwent at least 1 laser cordotomy procedure. Those with SGS and tracheal stenosis underwent endoscopic procedures, while the latter patients also underwent tracheal resection. The median duration between COVID-19 diagnosis and the first operating room (OR) procedure was 201 days (IQR: 83.5-308.5). The median number of OR procedures per patient was 2 (IQR: 1-3.5). Conclusion(s): LTS after hospitalization with COVID-19 represents a significant challenge for both patients and their providers, often requiring multiple surgeries and delays in tracheostomy decannulation. Studies characterizing surgical management and long-term outcomes in these patients are imperative.

A Validation Study on a Sputum Home Collection Method with Immediate Freezing and Delayed Processing: Impact on Proteomic, Mucin and RNA/DNA Endpoints

Introduction: Due to Covid-19 restrictions on collecting and processing sputum samples in real time in clinic, we designed a novel sputum home collection method with immediate freezing and delayed processing (“home”). A validation study was carried out to compare key sputum endpoints using the “home” vs “real time (RT)” collection and processing methods. Sputum soluble phase proteomics, mucins and RNA/DNA endpoints were measured and compared between the 2 methods to assess the validity of the “home” method. Methods: Spontaneous sputum samples were collected from N=10 healthy adult volunteers. Each sample was split evenly by weight and processed, half by the “home” method and half by the RT method. Home method samples were first aliquoted into 3 collection tubes (T) as follows: T1: 100-250mg for mucin analysis (refractive index, gel chromatography, and CsCl gradients);T2 and T3: equal weights each, T2 for proteomic analysis (MesoScale Discovery) and T3 for RNA/DNA analysis (Isohelix collection kit). Each was immediately frozen at -20 deg C (24-48hr), then at -80 deg C (2-4 weeks) without any processing. Thawed home T1 and T2 samples were processed by treating with 8M Urea (1:1) to deactivate SARS-CoV-2 if present. T1 was then stored at 2-4 deg C, and T2 was processed with 7x DPBS, centrifuged and recovered supernatants stored at -80 deg C. In contrast, the RT sputum was first treated with 8M Urea (1:1) soon after collection, and then processed for mucins and proteomics per the “home” method above. The remaining cell pellet from the RT processed sample was stored in Zymo research RNA/DNA shield (0.5ml) and, along with home T3 samples, extracted and analyzed for qualitative and quantitative yield, as well as for genes of interest. Paired T-Test analysis compared all sputum endpoints between the home and RT method. Results: There were no statistically significant differences (p<0.05) between the home and RT method for any mucin (MUC5B, MUC5AC, MUC5AC:MUC5B ratio, total mucin) or proteomic endpoint (IL-1a, IL-6, IL-8, TNFalpha, TIMP1, TIMP2, MMP-9, CRP, MPO). In addition, except for CRP and MUC5AC, correlation between sample pairings was strong (correlation coefficient R, range = 0.5-0.9) and statistically significant (p<0.05) for all sputum endpoints. RNA/DNA results are still pending. Conclusion: The sputum “home collection method with immediate freezing and delayed processing” does not result in significantly different proteomic and mucin measurements when compared to the same samples being processed in real time in an identical manner.

COVID-19 DISRUPTION TO PROSTATE CANCER MANAGEMENT IN A UK TERTIARY REFERRAL CENTRE

INTRODUCTION AND OBJECTIVE: Covid-19 caused major disruptions to cancer diagnosis and treatment. We aimed to evaluate the longitudinal disruption to prostate cancer management. METHODS: We completed a prospective service evaluation from 01/09/2019 to 31/08/2021 of all referrals, investigations, and treatments for prostate cancer at a single centre. The first UK Covid-19 lockdown occurred from 23/03/20 to 04/07/2020: monthly data for the time period before, during, and after the first UK lockdown were compared using ANOVA and Tukey HSD. RESULTS: We identified 4501 patients for inclusion. There was a profound decrease in all aspects of prostate cancer management during the first lockdown period. For pre-lockdown, lockdown, and postlockdown periods respectively, the mean monthly rates were: 256 v 125 v 363 PSA tests (p=0.0003);86 v 40 v 79 two-week-wait referrals (p=0.0005);62 v 18 v 54 MRI imaging for possible cancer (p<0.0001);32 v 15 v 36 diagnoses (p=0.002);17 v 9 v 14 prostatectomies (p=0.06). In the period after the first lockdown, despite the previous drop, we did not observe an increase in the number of referrals, MRI imaging, diagnoses, or treatment required (including active monitoring, chemotherapy, radiotherapy, prostatectomy, and palliative care) in comparison to pre-lockdown levels (all p>0.05). However, interestingly, we did see an increase in the number of PSA tests performed (p=0.04), which continued through the two subsequent UK lockdowns. CONCLUSIONS: To our knowledge, this is the first study to provide an overview of the impact of COVID-19 national lockdowns on the whole prostate cancer management pathway - from initial referral to final treatment. Despite the disruption to prostate cancer management during the first UK Covid-19 lockdown leading to a decrease in referrals, diagnoses and treatment in the context of reduced PSA testing, we have not seen a subsequent increase in these numbers after lockdown despite a rise in PSA testing. The rise in the number PSA tests performed post-lockdown may suggest a degree of compensatory PSA observation in the community. (Figure Presented).

Sars-Cov-2 Infection Associated with Aplastic Anemia and Pure Red Cell Aplasia

Introduction: Aplastic anemia (AA) is a life-threatening disorder characterized by pancytopenia and a hypocellular bone marrow. Pure red cell aplasia (PRCA) is a similar disorder with primary reduction in the red blood cell population and virtual absence of erythroid precursors in the bone marrow. While the etiology of immune mediated marrow failure is multifactorial, preceding viral infections have been associated with the disease;these include parvovirus B19, cytomegalovirus, and Epstein-Barr virus. We present four cases of immune mediated marrow failure with either preceding or simultaneous SARS-CoV-2 infection. Methods: The medical records of patients treated for AA or PRCA at the University of Texas Southwestern Medical Center, Parkland Hospital, and the National Institutes of Health (NIH) were reviewed for SARS-CoV-2 infection. Four patients without prior hematological diseases were identified who had SARS-CoV-2 infection prior to or with simultaneous the diagnosis of AA or PRCA. Results: Patient #1 was a 22-year-old white female who was diagnosed with asymptomatic COVID-19 10 days prior to her pancytopenia and AA diagnosis was confirmed by bone marrow biopsy (5% cellularity;Table 1). Her extensive work-up including HIV, hepatitis panel, immunoglobulins, B12 and folate was negative, and she underwent HLA-matched family donor hematopoietic stem cell transplant. Patient #2 was a 69-year-old Asian female who presented to her primary care physician with symptoms of fatigue and was found to be pancytopenic. CBC from a few months prior was completely normal. Further work-up was positive for COVID-19 and negative for HIV, nutritional deficiency, or hemolysis. She did not have respiratory symptoms, was eventually diagnosed with pRBC and platelet transfusion-dependent severe AA (5-10% cellularity on bone marrow), and underwent treatment with cyclosporine, equine antithymocyte globulin, and eltrombopag. She has had a partial response to this therapy. Both patients had bone marrow specimens stained for SARS-CoV-2 by immunohistochemistry that were negative. Patient #3 was a 76-year-old white male who was diagnosed with COVID-19 4 months prior to presenting with a non-ST segment myocardial infarction and found to be profoundly anemic, requiring pRBC transfusion. He re-presented with chest pain one week later and was found to be anemic again, and required transfusion. A trial of darbepoetin alfa was unsuccessful. Extensive work-up for malignancy, infection, and autoimmune etiologies were negative. He was diagnosed with PRCA based on the bone marrow biopsy and initiated treatment with cyclosporine. Patient # 4 was diagnosed with severe AA (presenting as pancytopenia) and COVID-19 infection. He had fatigue for one month and fever, chills and sore throat one-week prior seeking medical care. Testing for hepatitis, HIV, EBV, and CMV was negative. He was treated on a clinical trial (NCT04304820) at NIH with cyclosporine and eltrombopag until SARS-CoV-2 PCR was negative then received equine anti-thymocyte globulin. He has achieved a complete hematologic response at 6 months and remains well at last follow-up. Conclusion: The four patients described had minimal respiratory COVID-19 symptoms, but they presented with cytopenia and were eventually diagnosed with bone marrow failure. It is possible that this is co-incidental due to the high prevalence of SARS-CoV-2. However, there is emerging evidence that COVID-19 pneumonia is a hyperinflammatory and immune dysregulated state improved by dexamethasone therapy. Other immune mediated hematologic conditions, such as autoimmune hemolytic anemia and immune thrombocytopenia, have been reported. The onset from infection to cytopenia appears rapid, although patients often presented with symptoms for many days prior to diagnosis and thus testing may have been delayed from the onset of infection. This case series does not provide a mechanistic link between SARS-CoV-2 infection and bone marrow failure, but it raises the possibility that SARS-CoV-2 may mediate an immunologic response that cont ibutes to marrow failure. Patients appear to respond well to standard immunosuppressive treatment. Further cases and studies are needed to determine if this is directly linked to SARS-CoV-2 and whether the natural history and response to standard therapy is different than idiopathic cases. [Formula presented] Disclosures: Young: Novartis: Research Funding.

Is the Anthropause a useful symbol and metaphor for raising environmental awareness and promoting reform?

Lockdowns associated with the COVID-19 pandemic temporarily restricted human activity and removed people from many places of work and recreation. The resulting 'Anthropause' generated much media and research interest and has become an important storyline in the public history of the pandemic. As an ecological event, the Anthropause is fleeting and unlikely to alter the long-term human impact on the planet. But the Anthropause is also a cultural symbol whose effects may be more enduring. Will the Anthropause inspire people and governments to mobilize for meaningful reform, or does it present a misleading and too-comforting portrayal of resilient nature and wildlife that could ultimately discourage action? While it is too early to gauge the impact of the Anthropause on human behaviour and politics, we use existing research on environmental symbols and metaphors to identify factors that may influence long-term behavioural and political responses to this globally significant period of time. © The Author(s), 2021. Published by Cambridge University Press on behalf of Foundation for Environmental Conservation.

COVID-19 restrictions and recreational fisheries in Ontario, Canada: Preliminary insights from an online angler survey.

The COVID-19 pandemic and corresponding public health mitigation strategies have altered many facets of human life. And yet, little is known about how public health measures have impacted complex socio-ecological systems such as recreational fisheries. Using an online snowball survey, we targeted resident anglers in Ontario, Canada, to obtain preliminary insights on how the pandemic has impacted recreational fishing and related activity. We also explored angler perspectives on pandemic-related restrictions and other aspects of fisheries management. Our results point to the value of recreational fisheries for the mental and physical well-being of participants, as well as the value and popularity of outdoor recreation during a pandemic. Although angling effort and fish consumption appeared to decline during the early phases of the pandemic, approximately 21 % of the anglers who responded to our survey self-identified as new entrants who had begun or resumed fishing in that time. Self-reported motivations to fish during the pandemic suggest that free time, importance to mental and physical health, and desires for self-sufficiency caused some anglers to fish more, whereas a lack of free time, poor or uncertain accessibility, and perceived risks caused some anglers to fish less. Respondents also expressed their desires for more clear and consistent communication about COVID-19 fishing restrictions from governments, and viewed angling as a safe pandemic activity. Information on recreational angler behaviours, motivations, and perspectives during the pandemic may prove valuable to fisheries managers and policy makers looking to optimize their strategies for confronting this and other similar crises.