Grieving during Covid-19: Exploring the Lived Experiences of People Bereaved during the First Two Waves of the Pandemic

Introduction The COVID-19 pandemic has had a huge impact on all aspects of life. The high number of deaths and bereavements increased demand on already stretched services, whilst the unique circumstances caused by enforced social distancing meant that people bereaved at this time faced many additional challenges and potentially problematic grief trajectories. Aims To explore in depth people's lived experiences of bereavement during the Covid-19 pandemic, their adaptation and coping during this time, and the effect of informal and formal sources of bereavement support . Methods Semi-structured longitudinal telephone interviews were conducted with people bereaved during the first 10 months of the pandemic (March to December 2020), purposively sampled from a cohort of survey participants. Interview transcripts were analysed thematically. Results 24 participants (19 female;5 men) took part in a first interview and 15 in a follow up interview, approximately four months later. Five major themes were identified: End of life experiences;Funerals and memorialisation;Grieving and psychological impacts;Coping and adaptation and Sources of support. Many challenges relating to the pandemic context were identified, including restrictions to end of life and memorialisation arrangements, dealing with personal affairs, and lack of support. Such experiences negatively impacted individual grieving and wellbeing, in particular feelings of isolation and guilt surrounding lack of contact with the deceased. Participants experienced difficulties accessing services, and sometimes received support that was not appropriate for their particular situations and needs. Despite these difficulties, some people demonstrated remarkable resilience, and ability to cope and find meaning. Conclusions People bereaved in the COVID-19 pandemic have navigated grief and bereavement through exceptionally challenging circumstances, often lacking the informal and formal support needed to help them cope. Impact These insights can be used to help improve the care and support provided to bereaved people throughout their bereavement journeys.

What should good bereavement service support look like? Findings from pre-pandemic workshop discussions interpreted in the context of the Covid-19 pandemic

introduction: There has been a lack of consistency in approaches to bereavement support provision and evaluation. As part of a study which identified outcomes for adult bereavement support services in palliative care, we conducted stakeholder workshops with people from professional and lived experience backgrounds, providing a view on what support interventions should look like. aims: The aims of this first workshop were to gather stakeholder views on the purpose, impacts and outcomes of bereavement service support. In this paper we summarise these findings and consider their relevance to bereavement support during and following the Covid-19 pandemic. Methods: Stakeholders were divided into three groups and asked to consider how support services should help bereaved service users and what good bereavement service support looks like. Key themes were identified from the written and verbal content of the workshop.Findings: Three main themes emerged from the data;informal support and self¬management;the aims and purpose of bereavement service support and the timing, accessibility and quality of support. conclusion: Workshop findings align with public health models of bereavement care and recent service standards, identifying core support functions and aspirations for bereavement services. Finding the best mechanisms and modalities for meeting these, in the context of the late/post-pandemic period, presents both challenges and opportunities. © 2022, Cruse Bereavement Care. All rights reserved.

European Safety Analysis of mRNA and Viral Vector COVID-19 Vaccines on Glucose Metabolism Events

Introduction: COVID-19 is a complex disease with several clinical phases of progression, affecting many organs apart from the respiratory tract that has shown a worst prognosis in both patients with type 1 and type 2 diabetes mellitus [1]. Based on these considerations, the vaccination for COVID-19 is a priority for this subpopulation [2]. However, few data have been published on the effects of impaired glucose metabolism induced by COVID-19 vaccines. Objective(s): We decided to perform a study to describe Individual Case Safety Reports (ICSRs) of impaired glucose metabolism events reported in the European database (Eudravigilance, EV). Method(s): ICSRs were retrieved for the period from January 1st, 2021 to December 11th, 2021. An ICSR related to events of impaired glucose metabolism was identified by using selected preferred terms (PTs) from Standardized MedDRA Queries ''Hyperglycaemia/new onset diabetes mellitus'' and ''Hypoglycaemia''. Impaired glucose metabolism events were described and analyzed based on the Diabetologists' classification into nine groups: ''diabetes in pregnancy'', ''acute complications of diabetes'', ''pre-diabetes'', ''type 1 diabetes mellitus'', ''type 2 diabetes mellitus'', ''high glucose levels'', ''diabetes mellitus inadequate control'', ''diabetes melli-tus not specified'', and ''hypoglycaemia''. The reporting odds ratios were computed to assess the reporting frequency for COVID-19 mRNA vaccines compared to COVID-19 viral vector-based vaccines. Result(s): During the study period, 3,917 ICSRs with a COVID-19 vaccine as suspected and at least an event of impaired glucose metabolism were retrieved from the EV, of which 2,027 (51.75%) referred to Pfizer-BioNTech vaccine, 586 (14.96%) to Moderna vaccine, 1,163 (29.70%) to Oxford-AstraZeneca vaccine, and 141 (3.59%) to Janssen vaccine. From 3,917 ICSRs, we observed 4,275 impaired glucose metabolism events (1.09 adverse events per ICSR). Most adverse events were classified as serious (2,694;63.02%), and the most reported events were related to ''high glucose levels'' (2,012;47.06%). The mRNA vaccines were associated with an increased reporting frequency of ''type 1 diabetes mellitus'' (ROR 1.86;95% CI 1.33-2.60), ''type 2 diabetes mellitus'' (ROR 1.58;95% CI 1.03-2.42), ''high glucose levels'' (ROR 1.16;95% CI 1.06-1.27), ''diabetes mellitus inadequate control'' (ROR 1.63;95% CI 1.25-2.11), and ''hypoglycemia'' (ROR 1.62;95% CI 1.41-1.86) compared to viral vector-based vaccines. The highest reporting rate per 100,000 was observed for Oxford-AstraZeneca vaccine (1.87;95% CI 1.77-1.97). Conclusion(s): In conclusion, mRNA COVID-19 vaccines were associated with an increased reporting frequency of alterations of glucose homeostasis compared to viral-vector COVID-19 vaccines. Clinicians should be aware of these events to better manage glycaemic perturbations. Larger nationwide studies are warranted to verify these findings.

GBS antenatal screening and recto-vaginal colonization rates before and during the COVID-19 pandemic

Background: The SARS-CoV-2 pandemic has resulted in the implementation of recommendations to reduce interpersonal contact. From March 2020, rules were applied also in Italian Obstetrics units. Recent data report reduced rates of nosocomial and surgical site infections during the pandemic period. We wonder whether measures for containment of SARS-CoV-2 transmission would affect Group B streptococcus (GBS) maternal recto-vaginal colonization rates, usually screened at 36-37 weeks' gestation. The primary endpoint of this study was to evaluate the rate of maternal GBS colonization at antenatal screening. Method(s): This is a retrospective observational study (carried out in district of Modena), comparing maternal GBS colonization rates in the pre-COVID-19 (2018-2019) and during the pandemic period (2020-2021). Rates of rectovaginal colonization were retrieved from the laboratory database. The total number of deliveries was collected. Data were analyzed by using the Chi-Squared test, also evaluating the adherence to the GBS screening. A p-value < 0.05 was considered significant. Result(s): A total of 10968 and 10802 deliveries occurred in the pre-COVID-19 and the Pandemic period respectively (overall reduction in deliveries of 1.5%). The adherence to the antenatal GBS screening declined from 96.6% (pre-COVID-19 era) to 91.6% (pandemic era, p<0.001). Notably, the proportion of positive GBS screening remained stable (18.3% in 2018-2019 and 18.2% in 2020-2021, p=0.80). Conclusion(s): During the SARS-CoV-2 pandemic, we reported a reduced adherence to antenatal GBS screening. SARS-CoV-2 containment measures adopted by both the population and hospital professionals did not affect GBS colonization rates.

European Safety Analysis of mRNA and Viral Vector COVID-19 Vaccines on Glucose Metabolism Events: An International Journal of Medical Toxicology and Drug Experience

Introduction: COVID-19 is a complex disease with several clinical phases of progression, affecting many organs apart from the respiratory tract that has shown a worst prognosis in both patients with type 1 and type 2 diabetes mellitus [1]. Based on these considerations, the vaccination for COVID-19 is a priority for this subpopulation [2]. However, few data have been published on the effects of impaired glucose metabolism induced by COVID-19 vaccines. Objective: We decided to perform a study to describe Individual Case Safety Reports (ICSRs) of impaired glucose metabolism events reported in the European database (Eudravigilance, EV). Methods: ICSRs were retrieved for the period from January 1st, 2021 to December 11th, 2021. An ICSR related to events of impaired glucose metabolism was identified by using selected preferred terms (PTs) from Standardized MedDRA Queries "Hyperglycaemia/new onset diabetes mellitus" and "Hypoglycaemia". Impaired glucose metabolism events were described and analyzed based on the Diabetologists' classification into nine groups: "diabetes in pregnancy", "acute complications of diabetes", "pre-diabetes", "type 1 diabetes mellitus", "type 2 diabetes mellitus", "high glucose levels", "diabetes mellitus inadequate control", "diabetes melli-tus not specified", and "hypoglycaemia". The reporting odds ratios were computed to assess the reporting frequency for COVID-19 mRNA vaccines compared to COVID-19 viral vector-based vaccines. Results: During the study period, 3,917 ICSRs with a COVID-19 vaccine as suspected and at least an event of impaired glucose metabolism were retrieved from the EV, of which 2,027 (51.75%) referred to Pfizer-BioNTech vaccine, 586 (14.96%) to Moderna vaccine, 1,163 (29.70%) to Oxford-AstraZeneca vaccine, and 141 (3.59%) to Janssen vaccine. From 3,917 ICSRs, we observed 4,275 impaired glucose metabolism events (1.09 adverse events per ICSR). Most adverse events were classified as serious (2,694;63.02%), and the most reported events were related to "high glucose levels" (2,012;47.06%). The mRNA vaccines were associated with an increased reporting frequency of "type 1 diabetes mellitus" (ROR 1.86;95% CI 1.33-2.60), "type 2 diabetes mellitus" (ROR 1.58;95% CI 1.03-2.42), "high glucose levels" (ROR 1.16;95% CI 1.06-1.27), "diabetes mellitus inadequate control" (ROR 1.63;95% CI 1.25-2.11), and "hypoglycemia" (ROR 1.62;95% CI 1.41-1.86) compared to viral vector-based vaccines. The highest reporting rate per 100,000 was observed for Oxford-AstraZeneca vaccine (1.87;95% CI 1.77-1.97). Conclusion: In conclusion, mRNA COVID-19 vaccines were associated with an increased reporting frequency of alterations of glucose homeostasis compared to viral-vector COVID-19 vaccines. Clinicians should be aware of these events to better manage glycaemic perturbations. Larger nationwide studies are warranted to verify these findings.

LEVELS OF GRIEF, SUPPORT NEEDS AND RISK FACTORS AMONG PEOPLE BEREAVED DURING THE COVID-19 PANDEMIC: BASELINE RESULTS FROM A LONGITUDINAL UK ONLINE SURVEY

Background The COVID-19 pandemic has had a detrimental impact on millions of people's experiences of bereavement. Traumatic end-of-life experiences and disruptions to support networks increase chances of poor bereavement outcomes. Aim To examine grief and support needs, and identify associated risk factors. Methods Mixed-methods survey of people bereaved in the UK from March 2020-January 2021, disseminated via media, social media, national associations, community/charitable organisations. Practical and emotional support needs were assessed in 13 domains, and grief intensity using the Adult Attitude to Grief (AAG) scale, which calculates an overall index of vulnerability (IOV) (range 0-36). Results 711 participants, mean age 49.5 (SD 12.9);88.6% female;95.3% white. Mean age of deceased 72.2 (SD 16.1);58% died in hospital;44% from COVID-19. Mean IOV was 20.41 (95% CI = 20.06 to 20.77), i.e. high vulnerability in grief overall. 28.2% exhibited extreme levels of vulnerability (i.e., IOV ≥ 24). In six support domains, all relating to psycho- emotional support, 50% to 60% of respondents reported high/fairly high levels of need. Increased levels of perceived support from health professionals led to significantly (P < 0.001) lower levels of grief and support need (small/medium effect, P < 0.001). Bereaved participants who were socially isolated/lonely experienced higher levels of grief and support needs than those who were not (P < 0.001). Grief and support needs were much higher for close family members compared with other groups (P < 0.05). Levels of grief and support needs were slightly higher for COVID deaths compared with non-COVID (P < 0.01), although this was not significant in a mixed model. Conclusions People bereaved during the pandemic experience high levels of grief and emotional support needs, with social isolation/loneliness and death of a close family member particular risk factors. Healthcare professionals' support is associated with better bereavement experiences.

“Empty and Lost”: The Challenges of Being Bereaved During the COVID-19 Pandemic

Background/aims: The COVID-19 pandemic has resulted in millions of deaths worldwide, whilst also causing severe disruption to end-of-life, grieving and coping processes. We examine bereavement experiences during the pandemic and relate our findings to the constructs of lossoriented and restoration- oriented coping, described in Stroebe and Schut's Dual Process Model (DPM). Methods: Two independent UK-wide surveys were disseminated online, including via social media and community/charitable organizations. They captured adult experiences of bereavement (to all causes of death) from March 2020 to January 2021. Free-text data were analyzed thematically. Results: Free-text comments were provided by 881 participants. Six main themes were identified: troubled and traumatic deaths;disrupted mourning, memorialization and death administration;mass bereavement, media/societal responses and the ongoing threat of the virus;grieving and coping (alone and with others);workplace and employment difficulties;and accessing support via health and social care. Examples of loss-oriented stressors included being unable to visit or say goodbye, the sudden and traumatic nature of many deaths, and restricted funeral and memorialization practices. Reactions included feelings of guilt and anger, and problems accepting the death and starting to grieve. Examples of restoration-oriented stressors and reactions comprised stressful deathrelated administration and severely curtailed social networks, support systems and social/recreational activities, which impacted peoples' ability to cope. Conclusions: These results demonstrate the exceptionally difficult sets of experiences associated with pandemic bereavement, defined by significant disruption to end of life, death and mourning practices, as well as usual coping mechanisms and formal or informal bereavement support. The DPM provides a useful framework for conceptualizing the additional challenges associated with pandemic bereavement and their impact on grieving and mental health.

Inequalities in Access to Bereavement Support Before and During COVID-19: Findings from Voluntary and Community Sector Bereavement Services in the UK

Background/aims: The COVID-19 pandemic has resulted in global mass bereavement;in the UK alone there have been 140,000 deaths to date, with a disproportionate impact on Black, Asian or minoritized ethnic (BME) communities. Voluntary and community sector (VCS) bereavement services including hospices play an important role in bereavement support. We aimed to determine services' perspectives on access to their support. Methods: Cross-sectional online survey of VCS bereavement services in the UK, open March-May 2021, disseminated via national organisations, associations and networks and social media. Results: 147 organisations participated;53% served specific counties or smaller regions;16% were UK-wide. 36% were hospice or palliative care services, 15% national bereavement charities or NGOs;12% local bereavement charities. 67.3% reported there were groups with unmet needs not accessing their services before the pandemic;most frequently reported were people from BME communities (49%), sexual minority groups (26.5%), deprived communities (24.5%) and men (23.8%). 50% of services reported that, in the year before COVID-19, <5% of clients were from BME communities;25% did not collect this data and 25% reported >5% BME clients. Compared with before the pandemic, 3.4% of services were seeing more people from BME groups, 52% were seeing the same proportion, 6.1% were seeing fewer and 38% didn't know/didn't collect this data. Conclusions: For over two thirds of VCS bereavement services in the UK, there are known inequities in who accesses support, with people from BME groups most likely to be recognised as needing support but not Paediatric Palliative Care Commissioners (n=2) Gender Female:Male 2:0 accessing services. During the pandemic, the proportion of BME clients did not increase, despite these communities being disproportionately affected by COVID-19. More attention needs to be paid to assessing and meeting unmet needs for formal bereavement support among disadvantaged groups and routinely collecting client data to help determine and ensure equity. (Table Presented).

The Impact of COVID-19 on the Provision of Voluntary and Community Sector Bereavement Services: A Cross-Sectional Survey from the UK

Background/aims: During the COVID-19 pandemic, voluntary and community sector (VCS) bereavement services including hospices have played a central role in supporting the bereaved. We aimed to describe the impact of the pandemic on these services to inform service development and policy. Methods: Cross-sectional online survey of VCS bereavement services in the UK, open March-May 2021, disseminated via national organisations, associations and networks, and social media. Results: 147 organisations participated;53% were regional, 16% UK-wide. 36% were hospice or palliative care services, 15% national bereavement charities or NGOs;12% local bereavement charities. During the pandemic referrals increased for 46% of organisations and decreased for 35%. 40.3% reported a current waiting list >3 weeks. 78.2% had changed services due to Covid;51.7% introduced new services. There had been a significant reduction in provision of all face-toface support including peer group meetings (50% to 4.1%, OR 0.04), facilitated group meetings (78% to 11%, OR 0.04), 1:1 support (87% to 27%, OR 0.06) and specialist intervention (44% to 16%, OR 0.25). Online and telephone provision saw major increases, particularly online 1:1 support (8.8% to 83%, OR 50.3), facilitated group meetings (4.1% to 56%, OR 30.48) and specialist intervention (3.4% to 36%, OR 16.01). Challenges included staff/volunteers providing support from home (69/64%), emotional impact on staff/volunteers (67/41%), increased pressure on staff due to client volume (41%) and complexity of needs (44%), implementing staff training (60%) and financial challenges (53%). 93% reported positive changes/opportunities during the pandemic, e.g., new coordination initiatives (47%). Conclusions: UK bereavement services rapidly transformed during the pandemic, despite significant challenges. To ensure positive changes and innovations are retained, the experiences and acceptability of new and adapted services among clients and staff require further investigation.

Grief, Support Needs and Associated Factors Among People Bereaved During the COVID-19 Pandemic: Baseline Results from a Longitudinal UK Online Survey

Background/aims: The COVID-19 pandemic has had a detrimental impact on millions of people's experiences of bereavement. Traumatic end-of-life experiences and disruptions to support networks increase chances of poor bereavement outcomes. We aimed to examine grief and support needs, and identify associated risk factors. Methods: Mixed-methods survey of people bereaved in the UK from Mar 2020-Jan 2021, disseminated via media, social media, national associations, community/charitable organisations. Practical and emotional support needs were assessed in 13 domains, and grief intensity using the Adult Attitude to Grief (AAG) scale, which calculates an overall index of vulnerability (IOV) (range 0-36). Results: 711 participants, mean age 49.5 (SD 12.9);88.6% female;95.3% white. Mean age of deceased 72.2 (SD 16.1);58% died in hospital;44% from COVID-19. Mean IOV was 20.41 (95% CI = 20.06 to 20.77), i.e., high vulnerability in grief overall. 28.2% exhibited extreme levels of vulnerability (i.e., IOV ≥ 24). In six support domains, all relating to psycho-emotional support, 50% to 60% of respondents reported high/fairly high levels of need. Increased levels of perceived support from health professionals led to significantly (P < 0.001) lower levels of grief and support need (small/medium effect, P < 0.001). Bereaved participants who were socially isolated/lonely experienced higher levels of grief and support needs than those who were not (P < 0.001). Grief and support needs were much higher for close family members compared with other groups (P < 0.05). Levels of grief and support needs were slightly higher for COVID-19 deaths compared with non- COVID-19 (P < 0.01), although this was not significant in a mixed model. Conclusions: People bereaved during the pandemic experience high levels of grief and emotional support needs, with social isolation/loneliness and death of a close family member particular risk factors. Healthcare professionals' support is associated with better bereavement experiences.

The Grief and Support Needs of Children and Young People Bereaved During the COVID-19 Pandemic: Parental Views From a UK National Survey

Background/aims: During the COVID-19 pandemic, many children and young people have experienced the death of close family members, whilst also facing unprecedented disruption to their lives. This study aimed to investigate the bereavement experiences and support needs from the perspective of their parents or guardians. Methods: We analysed cross-sectional free-text data from a survey of adults bereaved in the UK during the pandemic. Participants were recruited via media, social media, national associations and community/ charitable organisations. Thematic analysis was conducted on parent/ guardian responses to a question on the bereavement experiences and support needs of their children. Results: Free-text responses from 106 participants were included. Three main themes were identified: the pandemic-related challenges and struggles experienced by children and young people;family support and coping;and support from schools and services. Pandemic specific challenges include the impacts of being separated from the relative prior to their death, isolation from peers and other family members and disruption to daily routines and wider support networks. Examples were given of effective family coping and communication, but also difficulties relating to parental grief and children's existing mental health problems. The important role of schools and bereavement organisations in providing specialist support was demonstrated, but there was evidence of unmet need and lack of access to specialist grief or mental health support. Conclusions: Children and young people have faced additional strains and challenges associated with pandemic bereavement. We recommend initiatives that facilitate open and supportive communication within family and school settings, adequate resourcing of school and community- based specialist services and increased information and signposting to the support that is available.

Risk factors associated with poorer experiences of end-of-life care and challenges in early bereavement: Results of a national online survey of people bereaved during the COVID-19 pandemic.

BACKGROUND: Experiences of end-of-life care and early bereavement during the COVID-19 pandemic are poorly understood. AIM: To identify clinical and demographic risk factors for sub-optimal end-of-life care and pandemic-related challenges prior to death and in early bereavement, to inform clinical practice, policy and bereavement support. DESIGN: Online national survey of adults bereaved in the UK (deaths between 16 March 2020 and 2 January 2021), recruited via media, social media, national associations and organisations. SETTING/PARTICIPANTS: 711 participants, mean age 49.5 (SD 12.9, range 18-90). 628 (88.6%) were female. Mean age of the deceased was 72.2 (SD 16.1, range miscarriage to 102 years). 311 (43.8%) deaths were from confirmed/suspected COVID-19. RESULTS: Deaths in hospital/care home increased the likelihood of poorer experiences at the end of life; for example, being unable to visit or say goodbye as wanted (p < 0.001). COVID-19 was also associated with worse experiences before and after death; for example, feeling unsupported by healthcare professionals (p < 0.001), social isolation/loneliness (OR = 0.439; 95% CI: 0.261-0.739), and limited contact with relatives/friends (OR = 0.465; 95% CI: 0.254-0.852). Expected deaths were associated with a higher likelihood of positive end-of-life care experiences. The deceased being a partner or child also increased the likelihood of positive experiences, however being a bereaved partner strongly increased odds of social isolation/loneliness, for example, OR = 0.092 (95% CI: 0.028-0.297) partner versus distant family member. CONCLUSIONS: Four clear risk factors were found for poorer end-of-life care and pandemic-related challenges in bereavement: place, cause and expectedness of death, and relationship to the deceased.

What is good bereavement support and how can it help? Findings from an expert workshop with bereaved and professional stakeholders

IntroductionBereavement support comes in different forms and degrees of formality, reflecting the varying needs of bereaved people. Following the Covid-19 pandemic there is renewed interest in improving the support available for bereaved people, seen in the UK Commission on Bereavement. This (pre-pandemic) Marie Curie funded study identified core outcomes for the evaluation of adult bereavement support interventions. The first part of this study involved a stakeholder-workshop with people from professional and lived experience backgrounds.AimsThe workshop aimed to gather stakeholder views on what good bereavement support looks like and the impacts that it should have for bereaved service users.Method21 bereaved and professional stakeholders were divided into three groups and asked to discuss how support services should benefit their service users. Key themes were identified from these sessions.ResultsThree main themes emerged from the discussions;informal support and self-management;the purpose and impacts of bereavement service support and the timing, accessibility and quality of support. It was agreed that support services should work to promote resilience, enable coping and improve social functioning and relationships, offering practical as well as emotional support. Support should be tailored to individual needs, be accessible to people from diverse socio-cultural backgrounds and be available at different stages of the bereavement process. Identifying and responding to those with more complex grief or mental health problems is vital.ConclusionThis stakeholder workshop identified key support functions, impacts and goals for adult bereavement services, which align with resilience and public health approaches to bereavement support.ImpactWorkshop themes featured centrally in the two core outcomes identified in the wider study (‘ability to cope’ and ‘quality of life and wellbeing’).Identifying the best mechanisms and modalities for achieving these outcomes presents a challenge and opportunity, as we respond to the adaptations and renewed interest in bereavement support brought by the pandemic.

SARS-CoV-2 mRNA vaccine BNT162b2 triggers a consistent cross-variant humoral and cellular response.

As the SARS-CoV-2 pandemic continues to rage worldwide, the emergence of numerous variants of concern (VOC) represents a challenge for the vaccinal protective efficacy and the reliability of commercially available high-throughput immunoassays. Our study demonstrates the administration of two doses of the BNT162b2 vaccine that elicited a robust SARS-CoV-2-specific immune response which was assessed up to 3 months after full vaccination in a cohort of 37 health care workers (HCWs). SARS-CoV-2-specific antibody response, evaluated by four commercially available chemiluminescence immunoassays (CLIA), was qualitatively consistent with the results provided by the gold-standard in vitro neutralization assay (NTA). However, we could not observe a correlation between the quantity of the antibody detected by CLIA assays and their neutralizing activity tested by NTA. Almost all subjects developed a SARS-CoV-2-specific T-cell response. Moreover, vaccinated HCWs developed a similar protective neutralizing antibodies response against the EU (B.1), Alpha (B.1.1.7), Gamma (P.1), and Eta (B.1.525) SARS-CoV-2 variants, while Beta (B.1.351) and Delta (B.1.617.2) strains displayed a consistent partial immune evasion. These results underline the importance of a solid vaccine-elicited immune response and a robust antibody titre. We believe that these relevant results should be taken into consideration in the definition of future vaccinal strategies.

End of life experiences during the COVID-19 pandemic: Results of a national survey of bereaved people

Background: From March 2020-March 2021 530,000+ people have died from COVID-19 in the EU, and 120,000+ in the UK. In addition, c.4.85 million in the region have died of other causes, leaving c.43.6 million people bereaved at a time of unprecedented social and clinical restrictions. We aimed to inform practice and policy by describing end of life experiences among people bereaved during the pandemic. Methods: National survey of people bereaved in the UK since March 2020, disseminated via media, social media, national associations, community/ charitable organisations. Results: Interim findings from the first 532 participants are reported (full results available by time of conference). 55% of deaths were in hospital;46% were caused by confirmed/suspected COVID-19. Respondents reported high levels of problems specific to the pandemic bereavement context: 56% were unable to visit their loved one prior to death, 59% had limited contact in last days of life, 67% were unable to say goodbye, 67% experienced social isolation and loneliness, 81% had limited contact with other relatives/friends. COVID-19 deaths were associated with higher levels of all these problems compared with other causes of death (all p < 0.05). Experiences of end of life care were variable: 23% were 'never' involved in decisions about their loved one's care, 17% were not at all informed about the approaching death, 36% felt not at all supported by healthcare professionals after the death, 51% were not provided with information about bereavement support. Conclusions: There is evidence of poor end of life care and challenging experiences among people bereaved during the pandemic. To reduce the trauma of negative death experiences, we recommend improved communication by healthcare professionals, with a known point and method of contact, family involvement in decision-making, enabling family visiting as far as possible, and better support after a death, including information about bereavement services.

The support needs and experiences of people bereaved in the uk during the COVID-19 pandemic: Baseline results from a mixed-methods longitudinal survey

Background: COVID-19 presents a mass bereavement event, causing over 120,000 deaths in the UK. Unprecedented infection control restrictions also mean that all people bereaved at this time experience high level disruption to end of life, mourning, grief and coping experiences. This study aims to investigate the grief experiences, support needs and use of bereavement support by people bereaved during the pandemic. Methods: A mixed method online survey of adults bereaved in UK since March 2020, disseminated via media, social media, national associations and community and charitable organisations. Grief was measured using the Adult Attitude to Grief Scale. Results: Interim findings from the first 532 participants are reported (full baseline results available by time of conference).46% of deaths were confirmed/suspected COVID-19 and 55% of deaths were in hospital. Over half of participants demonstrated 'severe' (28%) or 'high' (24%) levels of vulnerability in grief, as well as high/fairly high needs for support in six psycho-emotional domains (51- 62%). 21% of those with 'severe' vulnerability were accessing individual counselling support, compared with 23% overall. 59% of respondents had not tried to access support from bereavement services;of those who tried, 56% experienced difficulties. Barriers included long waiting lists, feeling uncomfortable asking for help, and lack of appropriate support/knowledge of how to access help. 41% also experienced difficulties getting support from family and friends, reporting issues such as a lack of understanding and struggling without in-person contact. Conclusions: Results suggest unmet needs for support and problems getting support from friends/family and bereavement services. We recommend increased public information about bereavement support options, increased provision of and investment in bereavement services and flexible 'support bubble' arrangements for those bereaved during 'lockdown' conditions.

A realist synthesis of mobile application-enabled communication for patients in end-of-life care and in light of the COVID-19 pandemic

Background: The COVID-19 pandemic restrictions have led to extended usage of virtual communication technology in healthcare, especially via mobile applications. Understanding the adoption of mobile applicationenabled communication in end-of-life care in particular is important to improve its usage for patients and carers. This is a pertinent topic in light of the pandemic and the higher health risks of this population group. Aims: To explore the use of mobile application-enabled communication for end-of-life care patients and their carers. Methods (design, data collection, analysis): A realist synthesis approach is being adopted, using six databases and other information sources from 2005 to present. Data screening and quality assessment will be carried out by two reviewers independently. Discrepancies and disagreements will be discussed and resolved by a third reviewer. Data abstraction will use the context, mechanism, and outcome approach to capture specific information about the theories around the development, adoption, and use of mobile application-enabled technologies in end-of-life care. (https:// www.crd.york.ac.uk/prospero/display-record.php?RecordID=231535) Results: A total of 666 abstracts were screened and 218 full texts are being analysed. The project is ongoing, and the results will be presented at the meeting. A summary table of the theories around the development, adoption, and use of mobile application-enabled technologies in end-of-life care will be used to create a logic model of the link between empirical data and theories. Conclusion / Discussion: The study will highlight the theories which explain the adoption of technology use in end-of-life care. The realist synthesis uses the available theories as a starting point and the empirical findings to build on these. The results will help to inform the applicability of a blended model of face-to-face and virtual communication after the end of the pandemic.

If double is the trouble, the triple is undoable: A fatal association of hypertrophic cardiomyopathy (MYH7 PARG719TRP), heterozygous familial hypercholesterolemia (LDLR pglu343lys) and sars cov-2 infection

Introduction: Hypertrophic Cardiomyopathy (HCM;MIM #192600) and Heterozygous Familial Hypercholesterolemia (HeFH;MIM #144010) are the most common genetic cardiovascular disorders. Although the phenotypical spectrum can be extremely different, both HCM and HeFH can lead to severe heart failure and sudden cardiac death. As the SARS-CoV-2 pandemic spread medical oriented pathologists felt the need to a closer cooperation with cardiologists and pneumologists. In this report, we describe a successful interdisciplinary workout between pathologists, cardiologists, clinical pathologists and geneticists in a case of a young man who suddenly died after a fatal arrythmia and resulted positive for SARS-CoV-2 virus with high titer in myocardium. Methods and Results: The proband is 32-year-old man who suddenly died during physical exercise. The emergency electrocardiogram (ECG) documented a fatal sustained ventricular arrythmia. Autopsy findings showed increased thickness of interventricular septum (IVS;18mm) and left posterior wall (LPW;20 mm). Non-obstructive diffuse coronary artery disease (CAD) was also observed. Furthermore, the presence of multifocal cardiac myocytes injury with lymphocytic myocarditis prompted the search of cardiotropic viruses. Real-Time PCR (RT-PCR) identified a high concentration of SARS-CoV-2 (Ct=13 for Orf1ab, Rdrp and N genes). Molecular autopsy identified two genetic variants classified as pathogenic in the MYH7 (p.Arg719Trp) and LDLR (p.Glu343Lys) genes. Co-segregation analysis within the family (N=22) showed that LDLR mutation was maternally inherited, while MYH7 genetic lesion was de novo. The LDLR mutation carriers (N=12) had LDL plasma concentrations above the 95th percentile (>130 mg/dL) and positive records of cardiac (N=5) and vascular (N=7) ischemic events at young age. Conclusion: Our findings support the idea that the electrical remodeling associated with a genetic substrate and a concomitant presence of diffuse CAD and SARS-CoV-2-induced myocarditis can trigger a fatal arrhythmia. Despite the outcome, the continued investigation throughout the use molecular autopsy led to the identification of the underlying arrhythmic mechanism. This finding is of paramount importance for the first-degree relatives in which the identification of the pathogenic substrate, that renders them vulnerable to an increased risk for life-threatening cardiac events, including sudden death, might prompt for clinical and tailored treatments.

Glucose control in home-isolated adults with type 1 diabetes affected by COVID-19 using continuous glucose monitoring.

PURPOSE: This study is aimed at evaluating changes in metrics of glucose control in home-isolated patients with type 1 diabetes and COVID-19 using a continuous glucose monitoring (CGM) system. METHODS: We included adults aged 18-45 years with type 1 diabetes, using CGM, followed by telemedicine at a Southern Italian University Hospital. Thirty-two home-quarantined subjects with SARS-CoV-2 positive swab constituted the COVID-19 group. Thirty age-matched diabetic individuals without COVID-19 formed the control group. The effects of COVID-19 on glycemic control in patients infected were assessed at different time points [2 weeks before-COVID-19 (Time 1), 2 weeks during-COVID-19 (Time 2) and 2 weeks after COVID-19 (Time 3)] and compared with those without infection. RESULTS: A significant reduction of TIR (Time 1 vs Time 2, %, 60.1 ± 16.6 vs 55.4 ± 19.2, P = 0.03), associated with a significant increase of TAR level 2 (10.1 ± 7.3 vs 16.7 ± 12.9, P < 0.001), GMI (7.1 ± 0.6 vs 7.5 ± 0.8, P < 0.001), CV (37.3 ± 7.1 vs 39.6 ± 7.0, P = 0.04), mean glucose values (mg/dL, 160.2 ± 26.5 vs 175.5 ± 32.6, P = 0.001) and standard deviation (59.2 ± 13.1 vs 68.6 ± 17.7, P = 0.001) was observed in patients with COVID-19. No significant change of glycemic metrics was found in the NO COVID-19 group across the time. CONCLUSION: Young home-isolated patients with type 1 diabetes and COVID-19 showed a worsening of glucose control during COVID-19, as compared with age-matched diabetic subjects without the infection.