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Modern Pathology ; 35(SUPPL 2):1276-1278, 2022.
Article in English | EMBASE | ID: covidwho-1857284


Background: SARS-CoV-2 placentitis is defined by the triad of histiocytic or mixed inflammatory intervillositis, increased perivillous fibrin deposition, and villous trophoblastic necrosis. We have observed multiple cases of intrauterine fetal demise (IUFD) or perinatal morbidity with intraparenchymal thrombohematomas, a feature not previously linked to poor outcomes associated with SARS-CoV-2-placentitis. Here we present 17 cases with such findings and provide a possible point of intervention as these lesions can be identified by ultrasonography. Design: A retrospective study, approved by the Institutional Review Board, was performed by searching the terms SARS-CoV-2 placentitis or SARS-CoV-2 infection or COVID in our pathology database for all in-house deliveries and cases from the consult practice of the authors between 1/1/21 and 9/24/21. Clinical data was obtained via the electronic medical records or through contacting the consulting pathologists. Results: Twenty-three cases were retrieved and reviewed for the presence of thrombohematomas in the maternal space. Seventeen cases had thrombohematomas, intervillous thrombi, or intervillous hemorrhage in addition to classic SARS-CoV-2 placentitis, and 12 of those cases (71%) were associated with IUFD. The period between a positive maternal COVID test and loss was less than 14 days in all but three cases of IUFD (75%). The non-IUFD cases were all associated with other perinatal morbidity. In 8 of 17 cases (47%), thrombohematomas were noted grossly. The presence of multiple placental lakes were identified in three cases where placental imaging was available. Representative gross and histologic findings and an ultrasound displaying placental lakes are presented in Figures 1 and 2, respectively. Clinical data associated with each case is in Table 1. Conclusions: We identify a novel feature present in placentas with SARS-CoV-2 placentitis associated with poor outcomes. The often grossly identifiable thrombohematomas were present in 17 cases of SARS-CoV-2 placentitis, the majority of which were associated with IUFD, suggesting that their presence is a marker for increased perinatal morbidity and mortality. We also show that these thrombohematomas can be identified by ultrasound, demonstrating that imaging the placenta is critical in pregnancies affected by COVID-19 independent of maternal symptoms as it may identify markers of severe placental damage that can be associated with IUFD or significant perinatal morbidity.

Journal of Economic Issues ; 55(2):484-491, 2021.
Article in English | Scopus | ID: covidwho-1284771


Abstract: The COVID-19 induced recession are forcing central banks to adopt tools advocated by Modern Monetary Theory, financing their efforts to stabilize their economies with keystrokes. The keystrokes create claims, enabling governments to purchase assets and finance deficits in their attempts to stabilize their economies. COVID-19 reminds us that markets are not alert to threats: foreign, domestic, or microbial. Creating the rules and policies to provide people with needed goods and services falls to government, a role that government has only partly fulfilled. The tepid response also reflects a misapprehension of the possibilities of monetary and fiscal policies. There are two dimensions of the market economy, both related, both highlighted by the current pandemic. The first is the institutional basis of the market economy revealed in the promises we make to each other in the form of financial assets. The second is the dependence of people on employment for their livelihood. The inability to earn an income creates insecurity. It also impairs the ability of people to keep their promises. The move to fiat currency in 1971 ended the dollar’s link to gold, expanding the possibilities of both monetary and fiscal policy to mitigate the effects of the pandemic. © 2021, Journal of Economic Issues / Association for Evolutionary Economics.

J Public Health (Oxf) ; 2021 May 17.
Article in English | MEDLINE | ID: covidwho-1228534


BACKGROUND: This study describes the epidemiology of COVID-19 outbreaks in four care homes in terms of spread, severity, presentation and interventions. METHODS: Participants were 100 residents and 102 staff from four co-located care homes in Wales. Data were collected from the homes and Public Health Wales, including demographics, presentations, test status and results, hospital admissions and deaths. Genomic sequencing of confirmed case samples was completed, where possible. Epi-curves, crude attack rates, a Kaplan-Meier survival curve and adjusted hazard ratios were calculated using R. RESULTS: About 14 confirmed and 43 possible resident cases, 23 confirmed and 47 possible staff cases occurred. Crude attack rates of possible and confirmed cases were 57% (residents) and 69% (staff). Genomic sequencing for 10 confirmed case PCR samples identified at least 5 different UK lineages of COVID-19.42 (42%) residents died, 23 (55%) with COVID-19 or suspected COVID-19 recorded on the death certificate. The hazard ratio for death amongst resident possible and confirmed cases compared to null cases, adjusting for age and sex, was 13.26 (95% CI 5.61-31.34). CONCLUSIONS: There were extensive outbreaks of COVID-19 in these homes with high crude attack rates and deaths. Universal testing and early isolation of residents are recommended.

Public Health ; 191: 21-22, 2021 02.
Article in English | MEDLINE | ID: covidwho-342724