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2.
J Am Acad Dermatol ; 87(3):AB43, 2022.
Article in English | PMC | ID: covidwho-2041852
3.
Journal of the American Academy of Dermatology ; 87(3):AB115, 2022.
Article in English | EMBASE | ID: covidwho-2031384

ABSTRACT

Background: The COVID-19 pandemic sparked increased utilization of telemedicine services, as telemedicine offers care at a safe distance. Dermatology is well-suited for telemedicine due to its visual nature;however, concerns regarding diagnostic accuracy limit its widespread use. Visits for certain types of concerns may be more conducive to virtual visits than others. Further study of teledermatology may reveal trends in visit types and influence future integration into practice. Methods: Thomas Jefferson University analyzed aggregated, de-identified data from FAIR Health’s FH NPIC repository of privately insured medical claims, for telehealth services performed by dermatologists between 2019 and 2020 at urban and rural levels. Calculations were performed to determine the percentage of teledermatology visits that used specific diagnosis codes relative to all teledermatology visits. Visits were also assessed for the following parameters: demographics, diagnosis codes, and procedure codes. Results: Diagnosis codes L70.0 and L71.0, which primarily pertain to acne and rosacea, comprised 61% and 75% of Disorders of Skin Appendages teledermatology claims in 2019 and 2020 respectively. In 2019, teledermatology visits most often used diagnosis codes L60-75 in both urban and rural locations (33.7% and 31.9%, respectively). Moreover, from 2019 to 2020, the percentage of teledermatology visits that used codes L60-75 was 1.35 times greater in urban locations and 1.48 times greater in rural locations. Conclusions: Teledermatology visits favored specific diagnoses, specifically pertaining to acne and rosacea. This suggests that these diagnoses may be more conducive to virtual visits relative to other diagnoses such as skin neoplasms or papulosquamous disorders, including psoriasis.

4.
Facets ; 7:1051-1120, 2022.
Article in English | Web of Science | ID: covidwho-1997243

ABSTRACT

Nurses represent the highest proportion of healthcare workers globally and have played a vital role during the COVID-19 pandemic. The pandemic has shed light on multiple vulnerabilities that have impacted the nursing workforce including critical levels of staffing shortages in Canada. A review sponsored by the Royal Society of Canada investigated the impact of the pandemic on the nursing workforce in Canada to inform planning and implementation of sustainable nursing workforce strat-egies. The review methods included a trend analysis of peer-reviewed articles, a jurisdictional scan of policies and strategies, analyses of published surveys and interviews of nurses in Canada, and a targeted case study from Nova Scotia and Saskatchewan. Findings from the review have identified longstanding and COVID-specific impacts, gaps, and opportunities to strengthen the nursing workforce. These findings were integrated with expert perspectives from national nursing leaders involved in guiding the review to arrive at recommendations and actions that are presented in this policy brief. The findings and recommendations from this policy brief are meant to inform a national and sustained focus on retention and recruitment efforts in Canada.

5.
Journal of General Internal Medicine ; 37:S490-S491, 2022.
Article in English | EMBASE | ID: covidwho-1995632

ABSTRACT

CASE: A 75-year-old incarcerated man presented to the ED with one week of chills, body aches, dry cough, and dyspnea. His past medical history was significant for hypertension, type II diabetes, and obesity. He had been incarcerated for 18 years and was looking forward to his release in five months. He was identified as African-American in his chart. On initial evaluation, his oxygen saturation was 87% on room air with otherwise normal vitals. His breathing was labored with crackles in the lung bases. His chest x-ray showed multifocal opacities. He tested positive for SARS-CoV- 19 and was admitted on high-flow nasal cannula. In the following week, his oxygen needs escalated and he was transferred to the Medical ICU. Multiple requests for medical clearance to contact family were declined by the correctional facility. On day 8, he was intubated, paralyzed, and proned. He remained shackled to his bed with two correctional officers posted outside his door. On day 14, he suffered a PEA arrest with return of spontaneous circulation following ACLS. Attempts to contact family are approved and his care plan is changed to comfort measures only. He was terminally extubated and passed away soon after. Throughout the hospitalization, including during his cardiac arrest, the patient remained shackled to his hospital bed by the left ankle. Two correctional officers were stationed outside his hospital room 24 hours per day. The medical team had been unable to contact the patient's next of kin until the day he arrested, at which time they opted to pursue comfort measures. Months later, a medical resident who had cared for him shared the following words during a reflective writing session: “Nobody should die in handcuffs.” IMPACT/DISCUSSION: End-of-life care for incarcerated people is a pressing issue in the United States, where approximately 2.4 million individuals are held within the prison system. Due to an aging prison population, more incarcerated patients are dying than ever before. It is predicted that by 2030, the number of elderly prisoners is expected to reach 400,000 - an increase of 4,400% since 1981, according to a 2012 report from the ACLU. Most jurisdictions in the United States require shackling of the hands or feet when inmates are transported outside the prison setting. For patients with debilitating illness, shackling in the medical setting violates the principles of beneficence, non-maleficence, and autonomy essential to the practice of medicine. The COVID-19 pandemic has further underscored the ethical, legal, and moral dilemmas which clinicians face in preserving the dignity of the dying patient. CONCLUSION: Given the expected changes in demographics within the US correctional system, clinicians must advocate for compassionate policies such as the removal of shackles at the end of life. Potential avenues for change in practice can involve increased medical-legal dialogue and partnerships with correctional officers and other stakeholders within medical and correctional institutions.

6.
Nat Commun ; 13(1): 3748, 2022 Jun 29.
Article in English | MEDLINE | ID: covidwho-1908182

ABSTRACT

Given high SARS-CoV-2 incidence, coupled with slow and inequitable vaccine roll-out in many settings, there is a need for evidence to underpin optimum vaccine deployment, aiming to maximise global population immunity. We evaluate whether a single vaccination in individuals who have already been infected with SARS-CoV-2 generates similar initial and subsequent antibody responses to two vaccinations in those without prior infection. We compared anti-spike IgG antibody responses after a single vaccination with ChAdOx1, BNT162b2, or mRNA-1273 SARS-CoV-2 vaccines in the COVID-19 Infection Survey in the UK general population. In 100,849 adults median (50 (IQR: 37-63) years) receiving at least one vaccination, 13,404 (13.3%) had serological/PCR evidence of prior infection. Prior infection significantly boosted antibody responses, producing higher peak levels and/or longer half-lives after one dose of all three vaccines than those without prior infection receiving one or two vaccinations. In those with prior infection, the median time above the positivity threshold was >1 year after the first vaccination. Single-dose vaccination targeted to those previously infected may provide at least as good protection to two-dose vaccination among those without previous infection.


Subject(s)
COVID-19 , Viral Vaccines , Adult , Antibodies, Viral , Antibody Formation , BNT162 Vaccine , COVID-19/prevention & control , COVID-19 Vaccines , Humans , SARS-CoV-2 , Vaccination
7.
Journal of Higher Education Policy and Leadership Studies ; 3(1):142-152, 2022.
Article in English | Scopus | ID: covidwho-1904270

ABSTRACT

Internationalization as a concept and strategy for, and in, higher education has evolved over the past four decades. Currently, discussion is increasing over whether internationalization is yet taking more distinctive forms in different parts of the world which better reflect local needs and priorities. We first consider several important moments in the development of international dimensions of higher education over the past hundred years which reflect the multidimensional and progressive development of internationalization: from an isolated to a process approach. Then we address the call for rethinking internationalization around the turn of the century, with initiatives such as internationalization of the curriculum in Australia and the UK and, across Europe, ‘Internationalization at Home’. The Covid-19 pandemic brought to the forefront a further rethinking: ‘internationalization of higher education for society’ and virtualization. But, internationalization continues to both reflect and exacerbate the inequalities in global societies. Moving our understanding of internationalization from a western, competitive paradigm to a global cooperative strategy is now an imperative for the coming years. © 2022 Journal of Higher Education Policy and Leadership Studies. All rights reserved.

9.
Diabetic Medicine ; 39(SUPPL 1):96, 2022.
Article in English | EMBASE | ID: covidwho-1868603

ABSTRACT

Aims: Gestational diabetes group education was delivered face to face prior to the covid-19 pandemic. An online workshop was set up in September 2020 to deliver remote group training on diet and lifestyle for blood glucose management in pregnancy. This created a safe, supportive environment to deliver education to patients and allowed efficient use of staffing during the pandemic response. Methods: An Eventbrite page for gestational diabetes workshop was set up and a presentation with additional resources created. A midwife referral system was created from two hospital sites and participants recruited weekly. Sessions were delivered online via Microsoft Teams and emails with resources sent to patients after the workshop. Data was collected on Excel regarding attendance and a follow up questionnaire via Survey Monkey. Results: Twenty six online workshops over eight months (November 2020-June 2021) had a total of 166 patient bookings. There was equal distribution across the two sites and an attendance rate of 59%. Forty patients completed the Survey Monkey questionnaire where it was found that 100% enjoyed and would recommend the session;47.5% strongly agree and 52.5% agree that they have a good understanding of Gestational Diabetes and how to manage it and 40% strongly agree, 57.5% agree and 2.5% neither agree/disagree with being confident to manage Gestational diabetes with diet and exercise. Conclusion: Virtual group workshops are an effective way to educate gestational diabetes patients on their diet and lifestyle to manage their blood glucose.

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12.
Meng, B.; Ferreira, I. A. T. M.; Abdullahi, A.; Goonawardane, N.; Saito, A.; Kimura, I.; Yamasoba, D.; Gerba, P. P.; Fatihi, S.; Rathore, S.; Zepeda, S. K.; Papa, G.; Kemp, S. A.; Ikeda, T.; Toyoda, M.; Tan, T. S.; Kuramochi, J.; Mitsunaga, S.; Ueno, T.; Shirakawa, K.; Takaori-Kondo, A.; Brevini, T.; Mallery, D. L.; Charles, O. J.; Bowen, J. E.; Joshi, A.; Walls, A. C.; Jackson, L.; Cele, S.; Martin, D.; Smith, K. G. C.; Bradley, J.; Briggs, J. A. G.; Choi, J.; Madissoon, E.; Meyer, K.; Mlcochova, P.; Ceron-Gutierrez, L.; Doffinger, R.; Teichmann, S.; Pizzuto, M.; de Marco, A.; Corti, D.; Sigal, A.; James, L.; Veesler, D.; Hosmillo, M.; Lee, J. H.; Sampaziotis, F.; Goodfellow, I. G.; Matheson, N. J.; Thukral, L.; Sato, K.; Gupta, R. K.; Kawabata, R.; Morizako, N.; Sadamasu, K.; Asakura, H.; Nagashima, M.; Yoshimura, K.; Ito, J.; Kimura, I.; Uriu, K.; Kosugi, Y.; Suganami, M.; Oide, A.; Yokoyama, M.; Chiba, M.; Saito, A.; Butlertanaka, E. P.; Tanaka, Y. L.; Ikeda, T.; Motozono, C.; Nasser, H.; Shimizu, R.; Yuan, Y.; Kitazato, K.; Hasebe, H.; Nakagawa, S.; Wu, J.; Takahashi, M.; Fukuhara, T.; Shimizu, K.; Tsushima, K.; Kubo, H.; Kazuma, Y.; Nomura, R.; Horisawa, Y.; Nagata, K.; Kawai, Y.; Yanagida, Y.; Tashiro, Y.; Tokunaga, K.; Ozono, S.; Baker, S.; Dougan, G.; Hess, C.; Kingston, N.; Lehner, P. J.; Lyons, P. A.; Matheson, N. J.; Owehand, W. H.; Saunders, C.; Summers, C.; Thaventhiran, J. E. D.; Toshner, M.; Weekes, M. P.; Maxwell, P.; Shaw, A.; Bucke, A.; Calder, J.; Canna, L.; Domingo, J.; Elmer, A.; Fuller, S.; Harris, J.; Hewitt, S.; Kennet, J.; Jose, S.; Kourampa, J.; Meadows, A.; O’Brien, C.; Price, J.; Publico, C.; Rastall, R.; Ribeiro, C.; Rowlands, J.; Ruffolo, V.; Tordesillas, H.; Bullman, B.; Dunmore, B. J.; Fawke, S.; Gräf, S.; Hodgson, J.; Huang, C.; Hunter, K.; Jones, E.; Legchenko, E.; Matara, C.; Martin, J.; Mescia, F.; O’Donnell, C.; Pointon, L.; Pond, N.; Shih, J.; Sutcliffe, R.; Tilly, T.; Treacy, C.; Tong, Z.; Wood, J.; Wylot, M.; Bergamaschi, L.; Betancourt, A.; Bower, G.; Cossetti, C.; de Sa, A.; Epping, M.; Fawke, S.; Gleadall, N.; Grenfell, R.; Hinch, A.; Huhn, O.; Jackson, S.; Jarvis, I.; Krishna, B.; Lewis, D.; Marsden, J.; Nice, F.; Okecha, G.; Omarjee, O.; Perera, M.; Potts, M.; Richoz, N.; Romashova, V.; Yarkoni, N. S.; Sharma, R.; Stefanucci, L.; Stephens, J.; Strezlecki, M.; Turner, L.; de Bie, E. M. D. D.; Bunclark, K.; Josipovic, M.; Mackay, M.; Mescia, F.; Michael, A.; Rossi, S.; Selvan, M.; Spencer, S.; Yong, C.; Allison, J.; Butcher, H.; Caputo, D.; Clapham-Riley, D.; Dewhurst, E.; Furlong, A.; Graves, B.; Gray, J.; Ivers, T.; Kasanicki, M.; Le Gresley, E.; Linger, R.; Meloy, S.; Muldoon, F.; Ovington, N.; Papadia, S.; Phelan, I.; Stark, H.; Stirrups, K. E.; Townsend, P.; Walker, N.; Webster, J.; Scholtes, I.; Hein, S.; King, R.; Márquez, S.; Prado-Vivar, B.; Becerra-Wong, M.; Caravajal, M.; Trueba, G.; Rojas-Silva, P.; Grunauer, M.; Gutierrez, B.; Guadalupe, J. J.; Fernández-Cadena, J. C.; Andrade-Molina, D.; Baldeon, M.; Pinos, A..
Web of Science; 2021.
Preprint in English | Web of Science | ID: ppcovidwho-331154

ABSTRACT

The SARS-CoV-2 Omicron BA.1 variant emerged in late 2021 and is characterised by multiple spike mutations across all spike domains. Here we show that Omicron BA.1 has higher affinity for ACE2 compared to Delta, and confers very significant evasion of therapeutic monoclonal and vaccine-elicited polyclonal neutralising antibodies after two doses. mRNA vaccination as a third vaccine dose rescues and broadens neutralisation. Importantly, antiviral drugs remdesevir and molnupiravir retain efficacy against Omicron BA.1. We found that in human nasal epithelial 3D cultures replication was similar for both Omicron and Delta. However, in lower airway organoids, Calu-3 lung cells and gut adenocarcinoma cell lines live Omicron virus demonstrated significantly lower replication in comparison to Delta. We noted that despite presence of mutations predicted to favour spike S1/S2 cleavage, the spike protein is less efficiently cleaved in live Omicron virions compared to Delta virions. We mapped the replication differences between the variants to entry efficiency using spike pseudotyped virus (PV) entry assays. The defect for Omicron PV in specific cell types correlated with higher cellular RNA expression of TMPRSS2, and accordingly knock down of TMPRSS2 impacted Delta entry to a greater extent as compared to Omicron. Furthermore, drug inhibitors targeting specific entry pathways demonstrated that the Omicron spike inefficiently utilises the cellular protease TMPRSS2 that mediates cell entry via plasma membrane fusion. Instead, we demonstrate that Omicron spike has greater dependency on cell entry via the endocytic pathway requiring the activity of endosomal cathepsins to cleave spike. Consistent with suboptimal S1/S2 cleavage and inability to utilise TMPRSS2, syncytium formation by the Omicron spike was dramatically impaired compared to the Delta spike. Overall, Omicron appears to have gained significant evasion from neutralising antibodies whilst maintaining sensitivity to antiviral drugs targeting the polymerase. Omicron has shifted cellular tropism away from TMPRSS2 expressing cells that are enriched in cells found in the lower respiratory and GI tracts, with implications for altered pathogenesis.

13.
Embase; 2021.
Preprint in English | EMBASE | ID: ppcovidwho-330530

ABSTRACT

We investigated anti-spike IgG antibody responses and correlates of protection following second doses of ChAdOx1 or BNT162b2 SARS-CoV-2 vaccines in the UK general population. In 222,493 individuals, we found significant boosting of anti-spike IgG by second doses of both vaccines in all ages and using different dosing intervals, including the 3-week interval for BNT162b2. After second vaccination, BNT162b2 generated higher peak levels than ChAdOX1. Older individuals and males had lower peak levels with BNT162b2 but not ChAdOx1, while declines were similar across ages and sexes with ChAdOX1 or BNT162b2. Prior infection significantly increased antibody peak level and half-life with both vaccines. Anti-spike IgG levels were associated with protection from infection after vaccination and, to an even greater degree, after prior infection. At least 67% protection against infection was estimated to last for 2-3 months after two ChAdOx1 doses and 5-8 months after two BNT162b2 doses in those without prior infection, and 1-2 years for those unvaccinated after natural infection. A third booster dose may be needed, prioritised to ChAdOx1 recipients and those more clinically vulnerable.

14.
Clin Infect Dis ; 74(7): 1208-1219, 2022 04 09.
Article in English | MEDLINE | ID: covidwho-1704072

ABSTRACT

BACKGROUND: Natural and vaccine-induced immunity will play a key role in controlling the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. SARS-CoV-2 variants have the potential to evade natural and vaccine-induced immunity. METHODS: In a longitudinal cohort study of healthcare workers (HCWs) in Oxfordshire, United Kingdom, we investigated the protection from symptomatic and asymptomatic polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection conferred by vaccination (Pfizer-BioNTech BNT162b2, Oxford-AstraZeneca ChAdOx1 nCOV-19) and prior infection (determined using anti-spike antibody status), using Poisson regression adjusted for age, sex, temporal changes in incidence and role. We estimated protection conferred after 1 versus 2 vaccinations and from infections with the B.1.1.7 variant identified using whole genome sequencing. RESULTS: In total, 13 109 HCWs participated; 8285 received the Pfizer-BioNTech vaccine (1407 two doses), and 2738 the Oxford-AstraZeneca vaccine (49 two doses). Compared to unvaccinated seronegative HCWs, natural immunity and 2 vaccination doses provided similar protection against symptomatic infection: no HCW vaccinated twice had symptomatic infection, and incidence was 98% lower in seropositive HCWs (adjusted incidence rate ratio 0.02 [95% confidence interval {CI} < .01-.18]). Two vaccine doses or seropositivity reduced the incidence of any PCR-positive result with or without symptoms by 90% (0.10 [95% CI .02-.38]) and 85% (0.15 [95% CI .08-.26]), respectively. Single-dose vaccination reduced the incidence of symptomatic infection by 67% (0.33 [95% CI .21-.52]) and any PCR-positive result by 64% (0.36 [95% CI .26-.50]). There was no evidence of differences in immunity induced by natural infection and vaccination for infections with S-gene target failure and B.1.1.7. CONCLUSIONS: Natural infection resulting in detectable anti-spike antibodies and 2 vaccine doses both provide robust protection against SARS-CoV-2 infection, including against the B.1.1.7 variant.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Cohort Studies , Health Personnel , Humans , Immunoglobulins , Incidence , Longitudinal Studies , Vaccination
15.
Nat Med ; 28(5): 1072-1082, 2022 05.
Article in English | MEDLINE | ID: covidwho-1684095

ABSTRACT

Antibody responses are an important part of immunity after Coronavirus Disease 2019 (COVID-19) vaccination. However, antibody trajectories and the associated duration of protection after a second vaccine dose remain unclear. In this study, we investigated anti-spike IgG antibody responses and correlates of protection after second doses of ChAdOx1 or BNT162b2 vaccines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the United Kingdom general population. In 222,493 individuals, we found significant boosting of anti-spike IgG by the second doses of both vaccines in all ages and using different dosing intervals, including the 3-week interval for BNT162b2. After second vaccination, BNT162b2 generated higher peak levels than ChAdOX1. Older individuals and males had lower peak levels with BNT162b2 but not ChAdOx1, whereas declines were similar across ages and sexes with ChAdOX1 or BNT162b2. Prior infection significantly increased antibody peak level and half-life with both vaccines. Anti-spike IgG levels were associated with protection from infection after vaccination and, to an even greater degree, after prior infection. At least 67% protection against infection was estimated to last for 2-3 months after two ChAdOx1 doses, for 5-8 months after two BNT162b2 doses in those without prior infection and for 1-2 years for those unvaccinated after natural infection. A third booster dose might be needed, prioritized to ChAdOx1 recipients and those more clinically vulnerable.


Subject(s)
COVID-19 , SARS-CoV-2 , Antibody Formation , BNT162 Vaccine , COVID-19/prevention & control , ChAdOx1 nCoV-19 , Humans , Immunoglobulin G , Male
16.
Gastroenterology ; 160(6):S-173, 2021.
Article in English | EMBASE | ID: covidwho-1592283

ABSTRACT

Background During the first wave of the coronavirus (COVID-19) pandemic, restrictive public health measures including prolonged shielding, were recommended by the United Kingdom government for many patients with immune-mediated inflammatory disorders treated with immunosuppressive and biologic drugs. Low-volume intracapillary blood sampling can be undertaken by patients at home and returned by post and may ensure access to therapeutic drug monitoring (TDM) for all patients irrespective of shielding status. Methods We undertook a cross-sectional blood sampling methods comparison study to assess the clinical validity and acceptability to patients of low volume intracapillary testing for serum TDM enzyme-linked immunosorbent assays (ELISA) compared to conventional venepuncture. Sample types were compared using linear regression and fit-for-purpose equivalence was defined using total allowable error (TEa) rates derived using interassay coefficient of variations from routine clinical practice. Acceptability was assessed using a purpose-designed questionnaire. Results The median (IQR) volume of serum obtained using intracapillary sampling was 195μL (130 - 210). We showed drug level equivalence (slope [95% CI]: TEa vs observed mean % difference) between intracapillary sampling and conventional venepuncture for adalimumab (1.02 [0.90 - 1.14]: 11.7% vs 2.1%) (Figure 1), infliximab (1.08 [0.98 - 1.18]: 18.3% vs 1.2%), vedolizumab (0.91 [0.85 - 0.96]: 17.6% vs 4.1%), and ustekinumab (0.92 [0.90 - 0.94]: 19.4% vs 3.3%). Anti-drug antibody equivalence was observed for antiadalimumab (0.96 [0.95 - 0.98]: 24.5% vs 2.1%) and anti-infliximab (0.89 [0.81 - 0.97]: 17.3% vs 1.3%) antibody levels. Most patients reported that intracapillary testing was easy, convenient, and that they preferred it to conventional venepuncture (Figure 2). Conclusions Low-volume intracapillary blood sampling was equivalent to conventional venepuncture for the measurement of biologic drug and anti-drug antibodies. Patients preferred intra-capillary testing to conventional venepuncture. Irrespective of future COVID-19 surges, patient-led intracapillary blood sampling is likely to become a key adjunct to telemedicine in patients with immune-mediated inflammatory diseases.(Figure Presented) Adalimumab drug Linear regression and Bland Altman plot Left: Linear regression analysis of venous vs capillary adalimumab drug level results (mg/L), Slope 1.02 [0.90 - 1.14]. Right: Bland Altman plot of mean of venous and capillary adalimumab drug measurement against percentage difference between TEa vs observed mean % difference.(Figure Presented) Figure 2: Questionnaire acceptability response data Patient acceptability questionnaire response results by 5-point Likert scale. (A) Itemised proportional responses, grouped by domain. (B) Cumulative agreement per respondent;+1/+2 points for agree/strongly agree, 0 for neither agree nor disagree, -1/-2 for disagree/strongly disagree. Lowest decile reflecting participants with lowest acceptability scores indicated.

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Archives of Disease in Childhood ; 106(SUPPL 1):A304-A305, 2021.
Article in English | EMBASE | ID: covidwho-1495084

ABSTRACT

Background During the Covid-19 pandemic, remote 'working from home' (WFH) practices were developed on a tertiary neonatal unit to ensure compliance with Covid-19 recommendations around shielding, self-isolating and social distancing, and mitigate anticipated junior doctor staff shortages. Objectives . Establish a remote working service for junior doctors unable to attend in person due to Covid-19 restrictions then develop a remote working rota and guideline. . Enable remote staff to contribute to clinical and non-clinical tasks securely. . Conduct a mixed-methods evaluation of remote working by practices and identify facilitators and barriers. Methods A remote working rota allocated shielded and selfisolating staff to contribute to intensive care, postnatal duties, outpatients clinic or community calls. Staff used an electronic patient notes system that was securely accessible from home and communicated using digital technology. A guideline formalised practice. Quantitative and qualitative data was collected as part of a mixed methods evaluation. Quantitative data was collective retrospectively from remote working rotas between March- August 2020 to analyse time worked by staff role. Data was collected prospectively via online questionnaires sent to remote working staff between 28th July -15th August 2020 to record activities undertaken on shift. Qualitative evaluation was conducted using focus group discussions (FGDs) with staff according to whether they were working remotely intermittently or permanently. Thematic analysis of focus groups was undertaken. Results Between 23rd March-15th August 506 hours were WFH over 274 shifts equating to a mean of 119 hrs/week (equivalent to 12 shifts). (66% ST6-8, 25% ST1-3, 8% Advanced Neonatal Nurse Practitioners (ANNPs)). 20 questionnaires were sent with 14 responses (70% response rate) covering 126 hours of WFH activities. The largest proportion of time was spent on audit/management roles, followed by ward-based work. The table reports on thematic analysis of FGDs. Conclusions The remote workforce contributed substantially to the neonatal unit service and was broadly valued with positive impacts on junior doctors' experience. Hierarchy and communication were recognized barriers posing a risk to effective teamwork. Promoting an inclusive handover and utilising digital technology further may mitigate this. Remote working has positive and negative impacts on training and wellbeing. It is important to recognize this and ensure staff and training remains supported.

19.
Nat Commun ; 12(1): 6250, 2021 10 29.
Article in English | MEDLINE | ID: covidwho-1493099

ABSTRACT

Understanding the trajectory, duration, and determinants of antibody responses after SARS-CoV-2 infection can inform subsequent protection and risk of reinfection, however large-scale representative studies are limited. Here we estimated antibody response after SARS-CoV-2 infection in the general population using representative data from 7,256 United Kingdom COVID-19 infection survey participants who had positive swab SARS-CoV-2 PCR tests from 26-April-2020 to 14-June-2021. A latent class model classified 24% of participants as 'non-responders' not developing anti-spike antibodies, who were older, had higher SARS-CoV-2 cycle threshold values during infection (i.e. lower viral burden), and less frequently reported any symptoms. Among those who seroconverted, using Bayesian linear mixed models, the estimated anti-spike IgG peak level was 7.3-fold higher than the level previously associated with 50% protection against reinfection, with higher peak levels in older participants and those of non-white ethnicity. The estimated anti-spike IgG half-life was 184 days, being longer in females and those of white ethnicity. We estimated antibody levels associated with protection against reinfection likely last 1.5-2 years on average, with levels associated with protection from severe infection present for several years. These estimates could inform planning for vaccination booster strategies.


Subject(s)
Antibodies, Viral/immunology , Antibody Formation/immunology , COVID-19/immunology , SARS-CoV-2/pathogenicity , Adult , Aged , Antibody Formation/physiology , Bayes Theorem , Female , Humans , Immunoglobulin G/metabolism , Male , Middle Aged , SARS-CoV-2/immunology
20.
Annals of Oncology ; 32:S1130, 2021.
Article in English | EMBASE | ID: covidwho-1432854

ABSTRACT

Background: The long-term impact of COVID-19 in cancer patients (pts) is undefined. Methods: Among 2795 consecutive pts with COVID-19 and cancer registered to OnCovid between 01/2020 and 02/2021, we examined clinical outcomes of pts reassessed post COVID-19 recovery. Results: Among 1557 COVID-19 survivors, 234 (15%) reported sequelae including respiratory symptoms (49.6%), fatigue (41%) and cognitive/psychological dysfunction (4.3%). Persisting COVID-19 sequelae were more likely found in males (p=0.0407) aged ≥65 years (p=0.0489) with ≥2 comorbidities (p=0.0006) and positive smoking history (p=0.0004). Sequelae were associated with history of prior hospitalisation (p<0.0001), complicated disease (p<0.0001) and COVID-19 therapy (p=0.0002). With a median post-COVID-19 follow up of 128 days (95%CI 113-148), multivariable analysis of survival revealed COVID-19 sequelae to be associated with an increased risk of death (HR 1.76, 95%CI 1.16-2.66) after adjusting for sex, age, comorbidities, tumour characteristics, anticancer therapy and COVID-19 severity. Out of 473 patients who were on systemic anticancer therapy (SACT) at COVID-19 diagnosis;62 (13.1%) permanently discontinued therapy and 75 (15.8%) received SACT adjustments, respectively. Discontinuations were due to worsening performance status (45.1%), disease progression (16.1%) and residual organ disfunction (6.3%). SACT adjustments were pursued to avoid hospital attendance (40%), prevent immunosuppression (57.3%) or adverse events (20.3%). Multivariable analyses showed permanent discontinuation to be associated with an increased risk of death (HR 4.2, 95%CI: 1.62-10.7), whereas SACT adjustments did not adversely affect survival. Conclusions: Sequelae post-COVID-19 affect up to 15% of patients with cancer and adversely influence survival and oncological outcomes after recovery. SACT adjustments can be safely pursued to preserve oncological outcomes in patients who remain eligible to treatment. Clinical trial identification: NCT04393974. Legal entity responsible for the study: Imperial College London. Funding: Has not received any funding. Disclosure: A. Cortellini: Financial Interests, Personal, Advisory Board: MSD;Financial Interests, Personal, Advisory Board: BMS;Financial Interests, Personal, Advisory Board: Roche;Financial Interests, Personal, Invited Speaker: Novartis;Financial Interests, Personal, Invited Speaker: AstraZeneca;Financial Interests, Personal, Invited Speaker: Astellas;Financial Interests, Personal, Advisory Board: Sun Pharma. D.J. Pinato: Financial Interests, Personal, Advisory Board: ViiV Healthcare;Financial Interests, Personal, Invited Speaker: Bayer;Financial Interests, Personal, Advisory Board: Eisai;Financial Interests, Personal, Invited Speaker: Roche;Financial Interests, Personal, Invited Speaker: AstraZeneca. All other authors have declared no conflicts of interest.

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