Profiling Inconsistent/Non-Adopters of Infection Prevention Behaviours during the Covid-19 Pandemic for Targeted Public Health Education: A Population Study

Intro: With the relentless waves of coronavirus disease 2019(COVID-19), there is a need for widespread community adoption of infection prevention(IP) measures including hand hygiene, use of face masks, and staying at home when unwell. Understanding the profile of individuals who do not consistently practice IP can help target public health education. Method(s): We conducted a nationally-representative population survey from November 2020 to January 2021. Households were randomly selected from a proportionately stratified national census. The household member with the most recent birthday was invited to complete the survey. Three questions on a 5-point Likert-scale(never-rarely-occasionally-often-always) assessed IP behaviours(hand hygiene, face mask use when having a cough/cold, staying at home when having a cold/flu) before and during the pandemic. A multivariable logistic regression model was constructed to assess factors associated with the non- or inconsistent("never-rarely-occasionally") adoption of any of the three IP behaviours during the pandemic. Finding(s): Mean age of 2004 respondents was 44.5(SD 15.0) years, with 52% females and 65% being highly educated (diploma/degree holders). Although 12% reported consistently("often-always") adopting all 3 IP behaviours pre-pandemic, the majority(n=1752, 87%) reported doing so during the pandemic. After adjusting for age, educational level, and presence of chronic illness, males(AOR 1.71 [95%CI 1.30, 2.25], Chinese(AOR 1.48 [1.07, 2.05]), low-adopters of healthy lifestyle(AOR 1.59 [1.03, 2.45]) and those who did not or inconsistently adopted IP behaviours pre-pandemic(AOR 8.92 [3.28, 24.27]) were more likely not to or inconsistently adopt the 3 IP behaviours during the pandemic. Discussion(s): During the ongoing pandemic, educational messages and information channels on IP measures could be more targeted at males and Chinese. Additionally, the promotion of healthy lifestyle and consistent adoption of IP behaviours during non-pandemic times is critical for consistent adoption of IP behaviours during pandemics. Conclusion(s): Males, Chinese, and low-adopters of healthy lifestyle and IP behaviours pre-pandemic do not consistently practice IP during the pandemic.Copyright © 2023

Using Extracorporeal Membrane Oxygenation for COVID-Positive Urgent Tracheostomy

Introduction: Extracorporeal membrane oxygenation (ECMO) can be used during difficult airway surgery because it provides an unobstructed operative field while ensuring adequate oxygenation without need for ventilation. We present a case of utilizing ECMO to perform urgent tracheostomy on a COVIDpositive patient with a large oropharyngeal mass causing critical airway narrowing. Method(s): A 62-year-old man presented with 6 months of worsening dyspnea. Computed tomography imaging and flexible laryngoscopy showed a large oropharyngeal mass extending into the nasopharynx and larynx causing critical airway narrowing and severely distorted upper airway anatomy. Traditional methods to secure the airway including transnasal vs transoral intubation vs awake tracheostomy were considered inadequate due to tumor location/friability, trismus, inability to lie flat, and unclear tracheal landmarks on palpation. In addition, on the day of surgery, the patient tested positive for COVID. We decided ECMO was the safest method to safely perform tracheostomy while minimizing COVID aerosolization. Result(s): The thoracic surgery team proceeded with bifemoral cannulation, and ECMO was initiated in less than 30 minutes. Standard tracheostomy was performed, and biopsies of the oropharyngeal mass were obtained. The patient was weaned off ECMO after <1 hour and awakened without any issues. There were no complications from bi-femoral venous access. Conclusion(s): Multiple methods to secure this patient's difficult airway were considered. Fiber-optic nasal intubation would require navigating the bronchoscope around the large tumor partially obstructing the nasopharynx and larynx. Awake tracheostomy was considered risky due to his large neck circumference, significant coughing episodes, and inability to lay supine. Both of these options would also be associated with high levels of COVID aerosolization. The use of ECMO allowed for apneic tracheostomy while minimizing the risk of COVID infection to all operating room personnel. In the era of COVID, ECMO is an unconventional but powerful tool that should be added to the armamentarium of highrisk airway surgery.

The subspecialty of adult infectious diseases in British Columbia: A personal perspective

The current COVID-19 pandemic has intensified the public's and medical community's interest in the discipline of infectious diseases. The evolution of this relatively new subspecialty in BC over the past 40 years is highlighted. Major milestones include the establishment of an infectious diseases clinical pharmacy program, an infectious diseases fellowship program, an inpatient HIV/AIDS unit, a transplant infectious diseases service, a fellowship in reproductive infectious diseases program, and an Immunity and Infection Research Centre, as well as outpatient parenteral antimicrobial therapy and home intravenous antimicrobial treatment programs, outpatient clinics for tropical medicine and travel-acquired diseases, and cross-appointments with the BC Centre for Disease Control.

Safety and feasibility of bariatric surgery without inpatient hospital admission-prospective study

Background: Delays from the COVID-19 pandemic led to increased surgical wait times. With ongoing bed pressures, we must safely maximize surgical volumes. We prospectively evaluated the feasibility and safety of bariatric surgery without inpatient hospital admission. Methods: We identified patients whose elective bariatric surgery we felt could be safely scheduled without inpatient admission to a surgical ward. Patients recovered in an 'overnight stay' perioperative area. Selection criteria excluded patients with revisional surgery, BMI≥55, insulin-dependent diabetes, or therapeutic anticoagulation. Data were collected on consecutive patients scheduled without admission between April and June 2021. Seven-day emergency department (ED) visits and readmissions were used to establish the safety of this intervention. Results: Of 47 patients scheduled for surgery without admission, 42 (89.4%) underwent Roux-en- Y gastric bypasses and 5 (10.6%) sleeve gastrectomies. Patients stayed between 16 and 23 hours, with a mean and median of just over 20 hours. Only 2 (4.3%) patients required admission to the surgical ward, but both were discharged on postoperative day 1 (POD1). Only 2(4.3%) patients had ED visits within 7 days postoperatively, and neither required admission. There were no complications, reoperations, or deaths. A control group of bariatric surgery patients with planned hospital admission per usual care is being analyzed for comparison. Conclusions: We demonstrated that bariatric surgery can be performed without inpatient hospital admission in select patients. We anticipate our controls will further confirm the safety of this endeavor. Optimizing resource utilization is crucial now, as hospitals recover from the pandemic and prepare for potential future waves.

First nosocomial cluster of COVID-19 due to the Delta variant in a major acute care hospital in Singapore: investigations and outbreak response.

OBJECTIVES: The first large nosocomial cluster of coronavirus disease 2019 (COVID-19) in Singapore in April 2021 led to partial closure of a major acute care hospital. This study examined factors associated with infection among patients, staff and visitors; investigated the possible role of aerosol-based transmission; evaluated the effectiveness of BNT162.b2 and mRNA1273 vaccines; and described the successful containment of the cluster. METHODS: Close contacts of patients with COVID-19 and the affected ward were identified and underwent surveillance for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Patient, staff and visitor cohorts were constructed and factors associated with infection were evaluated. Phylogenetic analysis of patient samples was performed. Ward air exhaust filters were tested for SARS-CoV-2. RESULTS: In total, there were 47 cases, comprising 29 patients, nine staff, six visitors and three household contacts. All infections were of the Delta variant. Ventilation studies showed turbulent air flow and swabs from air exhaust filters were positive for SARS-CoV-2. Vaccine breakthrough infections were seen in both patients and staff. Among patients, vaccination was associated with a 79% lower odds of infection with COVID-19 (adjusted odds ratio 0.21, 95% confidence interval 0.05-0.95). CONCLUSIONS: This cluster occurred despite enhancement of infection control measures that the hospital had undertaken at the onset of the COVID-19 pandemic. It was brought under control rapidly through case isolation, extensive contact tracing and quarantine measures, and led to enhanced use of hospital personal protective equipment, introduction of routine rostered testing of inpatients and staff, and changes in hospital infrastructure to improve ventilation within general wards.

What moves Hong Kong's train ridership?

Hong Kong is a densely populated international metropolis with ∼7.5 million residents living in a small geographic area of ∼1,100 km2. Like some major cities around the world, it has a vast public transportation system that moves ∼12.4 million passengers per day, ∼42% of which is attributable to the Mass Transit Railway's (MTR's) extensive network interconnecting widely dispersed stations across Hong Kong. MTR's ridership substantially declined in 2019 because of social unrest and related system service suspension (SSS). This decline was further exacerbated by Covid-19's outbreak in 2020. Using a hand-collected sample of monthly data for January 2000–June 2020, we estimate a log-linear demand regression to find that MTR's ridership is price and income inelastic, varies seasonally, and exhibits a trend of gradual growth. Further, Covid-19, social unrest and SSS significantly reduce MTR's ridership. Finally, the estimates for passenger welfare losses due to SSS and social unrest are large, revealing the potential gains from improving MTR's service reliability and resolving the root causes of social unrest.

Impact of COVID-19 on ventricular tachycardia and atrial tachycardia events in patients with transvenous devices

Background: Covid-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has resulted in a significant number of increased hospitalizations and excess deaths worldwide. Though reports regarding myocardial injury/inflammation relating to Covid-19 are known, little is known about larger scale effects of the virus on cardiac arrhythmias. Additionally, it is known that autonomics play a large role in the incidence of cardiac arrhythmias, and the temporal relationship of the national lockdown on cardiac arrhythmias has not well characterized. We aimed to assess the temporal trends of cardiac arrhythmias seen in the Barts device clinic and compare it to the previous year. Hypothesizing that there had been a decrease in the burden of Ventricular Tachycardia (VT). Methods: We exported all arrhythmia events that have been transmitted to the Latitude remote monitoring platform (Boston Scientific) retrospectively between January 2020 to May 2020 and January 2019 to May 2019. We will compare trends against the previous year to exclude any seasonal variation. Results: From the cohort of 2,110 patients on latitude remote monitoring, this produced 28,005 arrhythmia episodes in the study period. From January to 21 May 2019 there were 7,940 Ventricular events (Mean 56/day;SD ± 20) vs 7,017 events (Mean 49/day;SD ± 19) in the same time period in 2020. Figure 1A shows a lowess regression curve of ventricular events in 2019 vs 2020 with confidence intervals. It can be seen that events are largely similar until after lockdown when there are fewer ventricular events, Annova with Turkey post hoc correction (p=0.01, mean difference 19 events per day). From January to 21 May 2019 there were 6,380 atrial events (Mean 45/day;SD ± 13) compared with 6,690 events during the same time period in 2020 (Mean 49/day;SD ± 16). Figure 1B shows a lowess regression curve of atrial events in 2019 vs 2020 with confidence intervals. It can be seen that events are largely similar until lockdown there is an increase on atrial events, Anova with Tukey post hoc correction (p=0.02, mean difference 12 events per day). Conclusion: These data suggest that ventricular events were largely similar pre-lockdown but decreased during the lockdown, while atrial events increased during the period of the lockdown before normalizing. This suggests that autonomic and psychological impacts of lockdown had an important effect on the frequency of atrial and ventricular events that presented to our joint VT clinic, and underlines the important role of the autonomic nervous system in arrhythmia. [Image Omitted]