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Risk and predisposing factors for viral zoonoses abound in the sub-Saharan Africa (SSA) region with significant public health implications. For several decades, there have been several reports on the emergence and re-emergence of arbovirus infections. The lifetime burden of arboviral diseases in developing countries is still poorly understood. Studies indicate significant healthcare disruptions and economic losses attributed to the viruses in resource-poor communities marked by impairment in the performance of daily activities. Arboviruses have reportedly evolved survival strategies to aid their proliferation in favorable niches, further magnifying their public health relevance. However, there is poor knowledge about the viruses in the region. Thus, this review presents a survey of zoonotic arboviruses in SSA, the burden associated with their diseases, management of diseases as well as their prevention and control, mobility and determinants of infections, their vectors, and co-infection with various microorganisms. Lessons learned from the ongoing coronavirus disease 2019 (COVID-19) pandemic coupled with routine surveillance of zoonotic hosts for these viruses will improve our understanding of their evolution, their potential to cause a pandemic, control and prevention measures, and vaccine development.Copyright © GERMS 2022.
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Air pollution, climate and population health are closely related in terms of their impacts on respiratory health and lung cancer. Air pollutants contribute to the exacerbation of chronic respiratory problems such as COPD and asthma. Air pollutants are also toxic and carcinogenic, initiating and promoting lung cancer development. Climate change in relation to environmental pollution affects the geographical distribution of food supply and diseases such as pneumonia in adults and children. The threat of air pollution, and hence global warming and climate changes, and their effects on population and respiratory health, is an imminent threat to the world and deserves immediate and sustainable combating strategies and efforts. The goals are to increase public awareness and engagement in action, with alignment of international collaboration and policy, and with steering towards further research. Now is the prime time for international collaborative efforts on planning and actions to fight air pollution and climate change before it is too late.Copyright © ERS 2021.
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We retrospectively analyzed spatial factors for coronavirus disease 2019 (COVID-19)-associated community deaths i.e., brought-in-dead (BID) in Lusaka, Zambia, between March and July 2020. A total of 127 cases of BID with geocoordinate data of their houses were identified during the study period. Median interquartile range (IQR) of the age of these cases was 49 (34-70) years old, and 47 cases (37.0%) were elderly individuals over 60 years old. Seventy-five cases (75%) of BID were identified in July 2020, when the total number of cases and deaths was largest in Zambia. Among those whose information regarding their underlying medical condition was available, hypertension was most common (22.9%, 8/35). Among Lusaka's 94 townships, the numbers (median, IQR) of cases were significantly larger in those characterized as unplanned residential areas compared to planned areas (1.0, 0.0-4.0 vs 0.0, 0.0-1.0;p=0.030). The proportion of individuals who require more than 30 minutes to obtain water was correlated with a larger number of BID cases per 105 population in each township (rho=0.28, p=0.006). The number of BID cases was larger in unplanned residential areas, which highlighted the importance of targeted public health interventions specifically to those areas to reduce the total number of COVID-19 associated community deaths in Lusaka. Brought-in-dead surveillance might be beneficial in monitoring epidemic conditions of COVID-19 in such high-risk areas. Furthermore, inadequate access to water, sanitation, and hygiene (WASH) might be associated with such distinct geographical distributions of COVID-19 associated community deaths in Lusaka, Zambia.Copyright © Amos Hamukale et al.
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Objective: In this paper, we wanted to review the annual British Association of Urological Surgeons (BAUS) programme to analyse the female and ethnic minority (EM) representation and find out whether there is ethnic and gender disparity, and if it does reflect the reality of the workforce. Method(s): To investigate gender and EM representation, we requested data for BAUS annual meetings over a 13-year period (2009-2021). All speakers and chairpersons for all four sub-sections including Endourology, Oncology, Andrology and Female, Neurological and Urodynamic urology (FNUU) were collated. We also looked at the geographic distribution of the speakers (London area, rest of England, Scotland, Northern Ireland and Wales). Data were analysed separately before and after the COVID-19 pandemic (cut-off March 2020), as in the latter 2 years, the meeting was held virtually. Result(s): A total of 2569 speakers (range: 135-323 speakers/year) were included in our analysis and 2187 (85%) speakers were from the United Kingdom. Of the UK speakers, more than three-quarters (76.6%, n = 1676) were males and females of White ethnicity and (23.4%, n = 511) were EM. The vast majority of speakers throughout the years were males (86%, n = 1891) with only 14% (n = 296) females regardless of their origin and ethnicity. The presence of EM females was only 1.9% (n = 43). The percentage of female representation rose consistently over time from 6.7% (n = 8) in 2009 to 21.1% (n = 44) in 2020, suggesting an upward trend. Regional distribution showed 31%, 63%, 3.6%, 1.6% and 0.2% from London, Rest of England, Scotland, Wales and Northern Ireland, respectively. Both gender and EM representation doubled in the last 2 years during the pandemic (p < 0.001). Conclusion(s): Annual BAUS meetings have seen a higher proportion of ethnic and gender representation in recent years. However, considering the workforce within urology, more needs to be done to address this historical disparity. Hopefully, the BAUS 10-point programme will provide a framework for addressing Equality, Diversity and Inclusion issues related to this bias. Level of Evidence: Not applicable.Copyright © British Association of Urological Surgeons 2022.
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Background: In many countries, non-pharmaceutical interventions to limit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission resulted in significant reductions in other respiratory viruses. However, similar data from Africa are limited. We explored the extent to which viruses such as influenza and rhinovirus co-circulated with SARS-CoV-2 in The Gambia during the COVID-19 pandemic. Methods: Between April 2020 and March 2022, respiratory viruses were detected using RT-PCR in nasopharyngeal swabs from 1397 participants with influenza-like illness. An assay to detect SARS-CoV-2 and a viral multiplex RT-PCR assay was used as previously described to detect influenza A and B, respiratory syncytial virus (RSV) A and B, parainfluenza viruses 1-4, human metapneumovirus (HMPV), adenovirus, seasonal coronaviruses (229E, OC43, NL63) and human rhinovirus. Result(s): Overall virus positivity was 44.2%, with prevalence higher in children <5 years (80%) compared to children aged 5-17 years (53.1%), adults aged 18-50 (39.5%) and >50 years (39.9%), p<0.0001. After SARS-CoV-2 (18.3%), rhinoviruses (10.5%) and influenza viruses (5.5%) were the most prevalent. SARS-CoV-2 positivity was lower in children <5 (4.3%) and 5-17 years (12.7%) than in adults aged 18-50 (19.3%) and >50 years (24.3%), p<0.0001. In contrast, rhinoviruses were most prevalent in children <5 years (28.7%), followed by children aged 5-17 (15.8%), adults aged 18-50 (8.3%) and >50 years (6.3%), p<0.0001. Four SARS-CoV-2 waves occurred, with 36.1%-52.4% SARS-CoV-2 positivity during peak months. Influenza infections were observed in both 2020 and 2021 during the rainy season as expected (peak positivity 16.4%-23.5%). Peaks of rhinovirus were asynchronous to the months when SARS-CoV-2 and influenza peaked. Conclusion(s): Our data show that many respiratory viruses continued to circulate during the COVID-19 pandemic in The Gambia, including human rhinoviruses, despite the presence of NPIs during the early stages of the pandemic, and influenza peaks during expected months.Copyright: © 2023 Jarju S et al.
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INTRODUCTION AND OBJECTIVE: Infertility is a global health concern that affects couples worldwide. Economic, racial, and geographic disparities in reproductive medicine have long affected access to fertility care. These inequalities further worsened during the COVID-19 pandemic as fertility care services were systematically paused and treatments were delayed. At-home fertility tests emerged as a seemingly convenient, affordable and accessible option for all men seeking initial semen analysis testing and screening. We aim to study the racial and socioeconomic characteristics of a cohort of men utilizing at-home sperm testing kits in the United States over 3 years. METHOD(S): We retrospectively reviewed the records of 5,822 men who requested semen analysis at Give Legacy, Inc. (Legacy) facilities from 2019 to 2021. The demographic characteristics of these men were collected including their age, race/ethnicity, and place of residence. Further, the weighted median household income of Legacy customers was calculated using their personal ZIP codes and corresponding median income data from the U.S. census bureau. RESULT(S): The mean age (SD) of this cohort was 34.9+/-7.3 years. Among these 5,822 men, there were 3,936 (67.6%) normozoospermic men and 1,886 (32.3%) oligozoospermic men. The group consisted of predominantly white men (64.9%) with only 5.2% Black, 5.4% Latino, 8.9% Asian, 3.1% Arab, 2% Native Hawaiian, 2.4% Indian American, and 8.2% other groups. The geographic distribution of participants showed a majority of men from the Northeast (31.6%) and Pacific (23.4%) regions. The median household income of a Legacy customer is $108,858;significantly higher than the U.S. median household income of $70,784 (P<.01). CONCLUSION(S): Despite the fact that at-home, mail-in kits provide a better and more affordable access to initial fertility care, ethnic minorities and lower socioeconomic classes are still underrepresented in the population of men seeking fertility testing in this cohort. Further research is needed to understand the racial and socioeconomic drivers of the existing disparities in fertility care.
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This research developed a multinomial classification model that predicts the prevalent mode of transmission of the coronavirus from person to person within a geographic area, using data from the World Health Organization (WHO). The WHO defines four transmission modes of the coronavirus disease 2019 (COVID-19);namely, community transmission, pending (unknown), sporadic cases, and clusters of cases. The logistic regression was deployed on the COVID-19 dataset to construct a multinomial model that can predict the prevalent transmission mode of coronavirus within a geographic area. The k-fold cross validation was employed to test predictive accuracy of the model, which yielded 73% accuracy. This model can be adopted by local authorities such as regional, state, local government, and cities, to predict the prevalent transmission mode of the virus within their territories. The outcome of the prediction will determine the appropriate strategies to put in place or re-enforced to curtail further transmission.Copyright © 2023 Inderscience Enterprises Ltd.
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Background: On March 2020, the federal government of Kosovo declared a nationwide lockdown due to the COVID-19 pandemic until May 2020. Since the lockdown, examinations and routine checkups have been restricted. This resulted in a severe decline in patient referrals to the hospitals. We want to assess the impact of the COVID-19 pandemic on the rate of newly diagnosed gynecological cancers. Method(s): The data are taken from our patient database. Data from 752 patients from the only cancer centre in Kosovo with newly diagnosed gynaecological cancer between 2019, 2020 and 2021 were collected. Incidence, age group, stages of diagnosis and geographical distribution were compared between the time before and after the COVID-19 outbreak. Result(s): Our results showed a slight decline in newly diagnosed cancers in 2020 as compared with 2019 and 2021: -17 % in 2020 versus an increase of 18% in 2019. We expected to have a major increase in 2021 but data shows that it was a slight increase of 17%. As we not expected after the COVID-19 pandemic we have a strong decline of metastatic new cases of 39% in 2021 compared to 2020 and a 60% decline in 2020 compared to 2019. The results show a slight increase of 13 % in the early stages from 2020 to 2021 and the same rates come up from 2019 to 2020. In all three years in a row the dominant type of cancer according to localization is corpus uteri then cervix uteri and ovarian cancer with respectively 39%, 26%, and 33% in 2019, 36%, 33%, and 29% in 2020 and the last, 40%, 26% and 32% in 2021. The groupages have a slight shift from 45-49 years old the peak of new cases in 2021. Conclusion(s): The lockdown led to a slight decrease in the number of newly diagnosed cases. The decreased accessibility of the medical services has not led to significant higher number of metastatic new diagnosed cases, on contrary lower metastatic cases and higher number of early cases and slight increase on advanced cases were presented in 2021. The impact on incidence were not significantly higher in 2021 despite the lockdown. Therefore, new strategies to manage early cancer detection are needed to optimize cancer care in a time of pandemic in the future. Effective, appropriate and affordable cancer prevention and control strategies are urgently needed in Kosovo for gynaecological cancer especially cervical cancer. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.Copyright © 2023 European Society for Medical Oncology
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Background: Pharmaceutical businesses had enormous difficulties in product distribution during COVID-19, and the solution to this perpetual issue is a resilient supply chain. Aim(s): The study aims to understand the vulnerabilities to which it subjected the pharmaceutical product distribution supply chains during the COVID-19 pandemic and further develop an adaptive model through which the pharmaceutical product supply chain can enhance its resilience capabilities. Material(s) and Method(s): The conceptual model is developed for the supply chain of pharmaceutical companies based on the literature survey, and then the conceptual model is explored through factor analysis. Researchers have developed a validated model after a statistical analysis using Cronbach's alpha. Subjective analysis has concluded that the pharmaceutical supply chain's resilience is driven by factors such as "trade cost," which comprises transport cost, business practices, and raw material sourcing cost;"shock propagation," which comprises country-specific shocks, production shocks, and policy changes;and "technological infrastructure bottleneck," which relates to the availability of cold chain storage warehouses and refrigerated transport vehicle facilities. Result(s): An empirical model pertaining to supply chain resilience may be further studied with different geographies, like Pune, Hyderabad, and Delhi NCR, for the purpose of generalizing the study. Conclusion(s): The identified major factors were trade cost, shock propagation, and technological infrastructure bottlenecks. The sensitivity of the issue under investigation required a personal touch to the survey, as the COVID-19 pandemic had left these respondents emotionally vulnerable. As COVID-19 is the recent catastrophe that has hit humanity, it has made the pharmaceutical product distribution channel vulnerable during the pandemic. This difficult time of pandemic has really tested the pharmaceutical products' supply chain capabilities as well.Copyright © 2023, Association of Pharmaceutical Teachers of India. All rights reserved.
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Background & Objective: The late-term neurological effects of COVID-19 are not fully understood yet. Herein, we aimed to determine if COVID-19-related acute and late-term neurological symptoms exist in the patient group that differs from the general population during the pandemic period. Methods: Two hundred fifty patients with a history of COVID-19, whose treatments were completed at least one month before enrollment, were examined together with a control group consisting of 150 individuals that lived in the same socio-cultural environment during the same period. A survey that included questions about possible neurological symptoms that might be related to the COVID-19 infection was completed in both groups. Results: The patient and control groups were mostly similar regarding the neurological symptoms in the pre-pandemic period. The control group did not report any new symptoms except ageusia during the pandemic period. Whereas a number of neurological symptoms such as headache, ageusia and anosmia, difficulty in thinking and planning, forgetfulness, clumsiness of one or both hands, dizziness, unsteadiness, numbness in both hands and feet, and neuropathic pain occurred during the infection. Neurological symptoms, except headache and unsteadiness, prolonged to the late-term with a decreased prevalence. Conclusion: The emergence of new neurological symptoms during the pandemic in those with COVID-19 disease, unlike the control group, suggested that these symptoms are related to the infection itself. © 2023, ASEAN Neurological Association. All rights reserved.
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The new emerging coronavirus SARS-CoV2 is an alerting pandemic worldwide. Understanding the epidemiology, viral behavior in the host, and the severity of the disease in an infected patient is a demanding approach for the healthcare system which lead to plan and contemplate the response for further waves of the same virus and even other related viruses. The evaluation of the protection measurements along with analyzing the recorded data of epidemiology and spread provides thorough insights toward the new Coronavirus modes of transmission, infection, and severity. Kurdistan Region of Iraq was hit by the SARS-CoV2 on March 2020 when first confirmed case recorded. The present paper analyzed a full month data of confirmed hospitalized and quarantined cases with regard to age, sex, geographical distribution. The highest risks were shown to be males of their young ages of 30-39 years old in Sulaimani province due to the social structure of the Kurdish population and the geographical position of Sulaimani. Social integration played a significant role in the spreading the virus in all cities of Kurdistan first onset of the virus in the community. Diagnosed hospitalized cases were mostly suffered from high fever, dry cough and breathing difficulties. The mortality rate was shown to be reasonable, and the majority of the cases were recovered after hospitalization and receive supportive treatment. Social distancing and total lockdown played a significant role in viral spread containment. The health authorities prevented devastating outbreak through tracing all the cases and their contacts, isolating the suspicious contacts, quarantining the neighborhoods were the virus found. Further investigation is needed in a larger scale of data in order to be armed with adequate knowledge for any other waves of COVID-19 in the region.Copyright © 2020 Ubiquity Press. All rights reserved.
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Background: The Omicron variant B.1.1.529 has led to a new dynamic in the COVID-19 pan-demic, with an increase in cases worldwide. Its rapid propagation favors the emergence of novel sub-lineages, including BA.4 and BA.5. The latter has shown increased transmissibility compared to other Omicron sub-lineages. In Senegal, the emergence of the Omicron variant in December 2021 characterized the triggering of a short and dense epidemiological wave that peaked at the end of February. This wave was followed by a period with a significant drop in the number of COVID-19 cases, but an upsurge in SARS-CoV-2 infection has been noted since mid-June. Objective(s): The purpose of this brief report is to give an update regarding the genomic situation of SARS-CoV-2 in Dakar during this phase of recrudescence of cases. Method(s): We performed amplicon-based SARS-CoV-2 sequencing on nasopharyngeal swab samples from declared COVID-19 patients and outbound travelers that tested positive. Result(s): Ongoing genomic surveillance activities showed that more than half of recent COVID-19 cases were due to the BA.4 and BA.5 sub-lineages that share two critical mutations associated with increased transmissibility and immune response escape. The circulation of recombinants between Omicron sub-lineages was also noted. Conclusion(s): Despite the lack of proven severity of BA.4 and BA.5 sub-lineages, their increased transmis-sibility causes a rapid spread of the virus, hence a surge in the number of cases. This rapid spread consti-tutes a greater risk of exposure for vulnerable patients. To tackle this issue, any increase in the number of cases must be monitored to support public health stakeholders. Therefore, genomic surveillance is an ever-essential element in managing this pandemic.Copyright © 2022 Bentham Science Publishers.
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Background: In many countries, non-pharmaceutical interventions to limit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission resulted in significant reductions in other respiratory viruses. However, similar data from Africa are limited. We explored the extent to which viruses such as influenza and rhinovirus co-circulated with SARS-CoV-2 in The Gambia during the COVID-19 pandemic. Method(s): Between April 2020 and March 2022, respiratory viruses were detected using RT-PCR in nasopharyngeal swabs from 1397 participants with influenza-like illness. An assay to detect SARS-CoV-2 and a viral multiplex RT-PCR assay was used as previously described to detect influenza A and B, respiratory syncytial virus (RSV) A and B, parainfluenza viruses 1-4, human metapneumovirus (HMPV), adenovirus, seasonal coronaviruses (229E, OC43, NL63) and human rhinovirus. Result(s): Overall virus positivity was 44.2%, with prevalence higher in children <5 years (80%) compared to children aged 5-17 years (53.1%), adults aged 18-50 (39.5%) and >50 years (39.9%), p<0.0001. After SARS-CoV-2 (18.3%), rhinoviruses (10.5%) and influenza viruses (5.5%) were the most prevalent. SARS-CoV-2 positivity was lower in children <5 (4.3%) and 5-17 years (12.7%) than in adults aged 18-50 (19.3%) and >50 years (24.3%), p<0.0001. In contrast, rhinoviruses were most prevalent in children <5 years (28.7%), followed by children aged 5-17 (15.8%), adults aged 18-50 (8.3%) and >50 years (6.3%), p<0.0001. Four SARS-CoV-2 waves occurred, with 36.1%-52.4% SARS-CoV-2 positivity during peak months. Influenza infections were observed in both 2020 and 2021 during the rainy season as expected (peak positivity 16.4%-23.5%). Peaks of rhinovirus were asynchronous to the months when SARS-CoV-2 and influenza peaked. Conclusion(s): Our data show that many respiratory viruses continued to circulate during the COVID-19 pandemic in The Gambia, including human rhinoviruses, despite the presence of NPIs during the early stages of the pandemic, and influenza peaks during expected months.Copyright © 2022 Jarju S et al.
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The analysis of the daily spatial patterns of near-surface Nitrogen dioxide (NO2) concentrations can assist decision makers mitigate this common air pollutant in urban areas. However, comparative analysis of NO2 estimates in different urban agglomerations of China is limited. In this study, a new linear mixed effect model (LME) with multi-source spatiotemporal data is proposed to estimate daily NO2 concentrations at high accuracy based on the land-use regression (LUR) model and Ozone Monitoring Instrument (OMI) and TROPOspheric Monitoring Instrument (TROPOMI) products. In addition, three models for NO2 concentration estimation were evaluated and compared in four Chinese urban agglomerations from 2018 to 2020, including the COVID-19 closed management period. Each model included a unique combination of methods and satellite NO2 products: ModelⅠ: LUR model with OMI products;Model Ⅱ: LUR model with TropOMI products;Model Ⅱ: LME model with TropOMI products. The results show that the LME model outperformed the LUR model in all four urban agglomerations as the average RMSE decreased by 16.09% due to the consideration of atmospheric dispersion random effects, and using TropOMI instead of OMI products can improve the accuracy. Based on our NO2 estimations, pollution hotspots were identified, and pollution anomalies during the COVID-19 period were explored for two periods;the lockdown and revenge pollution periods. The largest NO2 pollution difference between the hotspot and non-hotspot areas occurred in the second period, especially in the heavy industrial urban agglomerations. © 2022 Elsevier Ltd
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Introduction: The goal of cardiovascular training programs is to increase recruitment of women and underrepresented in medicine (UIM) trainees. Due to the COVID-19 pandemic, virtual interviewing replaced in-person interviewing for cardiology fellowship applications in the United States. However, there is little data on the influence of these changes on fellowship candidate diversity. Method(s): In a single-center retrospective study, we identified demographic changes in the profiles of trainees who interviewed for the Stanford University Cardiovascular Fellowship Program before and after the transition to virtual interviewing (2019 and 2020 vs 2021 and 2022 cycles). UIM applicants were defined as those who self-identified Black or Hispanic. Test of proportions and t-test were used for categorical and numeric variables respectively. Result(s): Over four years, 2250 trainees applied, 212 candidates interviewed, and 24 were accepted to the fellowship. Of those interviewed, 42.0% were women, 9.9% were Black, and 9.4% were Hispanic. The proportion of UIM trainees interviewed increased from 10.5% during the in-person years to 30.2% during the virtual years (p < 0.001;Figure 1A). The increase among women was not statistically significant (40% in-person vs. 44% virtual, p = 0.58). The geographic distribution shifted over time to include lower representation from closer Western programs (40% in-person to 29% virtual) and higher representation from Northeast programs (35% in-person to 44% virtual;Figure 1B). The weighted mean distance of represented residency programs nominally increased from 1730 miles to 2067 miles away (p = 0.06). Conclusion(s): Virtual interviews were associated with a three-fold increase in UIM interviewed applicants for cardiology fellowship positions at a single center. Further research is warranted to assess the full impact of virtual interviews, as well as to understand and mitigate potential bias in the evolving selection process.
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Background. During the COVID-19 pandemic, evolving literature and emerging therapies have led to significant controversies on what constitutes optimal therapy for hospitalized patients with COVID-19. In addition, multiple guidelines emerged exhibiting variable recommendations in key areas of therapeutic management. Thus, interpreting emerging data and deploying novel therapeutics during the pandemic has been challenging. Antimicrobial stewardship programs (ASP) have been proven to help promote evidence-based practices and are now common the United States (US). We seek to further understand the role of ASP during the COVID-19 pandemic. Methods. A survey was developed and disseminated through Infectious Diseases Society of America (IDSA) IDea network, IDSA Antimicrobial Stewardship Centers for Excellence and the Society for Healthcare Epidemiology messaging boards. Data collected included city, hospital size, facility type, and existence of active ASP. COVID-19 therapeutic restrictions and type of provider who decides on treatment allocation was surveyed. Results. A total of 92 surveys were completed, representing wide geographic reach within the United States (Figure 1). Hospital size by beds were 14% less than 200 (13), 18.5% 201-300 beds (17), 15.2% 301-400 beds (14), and 52.2% over 400 beds (48). Community hospitals accounted for 31.5% (29), county/public hospital 3.3% (3, 3.3%), University-affiliated Community-Based Teaching Hospitals 10.9% (10), University-based Teaching Hospital 45.7% (42), and 8.7% selected other. ASP were present in 97.2% of hospitals. COVID-19 therapeutic restrictions were common (Figure 2). Infectious diseases (ID) approval was required in 87.9% of facilities (Figure 3). Figure 1 Geographic distribution of hospitals represented in the survey Figure 2. Restricted COVID-19 therapies by medication type (%) Figure 3 Specialties or providers that are able to order or approve restricted COVID-19 therapies (%) Conclusion. COVID-19 therapeutics were commonly restricted during the COVID-19 pandemic. Approval by ID clinicians was required almost universally (87.9%). The role of other specialties was significantly lower, representing less than 45% of hospitals. ID clinicians have played a vital role in guiding therapy and supporting ASP during the COVID-19 pandemic. This survey highlights the value of ID clinicians to healthcare systems in allocating resources and promoting evidence-based practices through ASP.
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Introduction: MS centers (MSc) activities related to OCR management were strongly and diffusely hit during the first wave of COVID-19 pandemic. Concerns were mainly related to its immunosuppressive effects and the need for in-hospital administration. Objective(s): To investigate changes in OCR schedule among Italian MS centers participating to the Italian MS Register during the first wave of COVID-19 pandemic and to identify factors determining such changes. Material(s) and Method(s): A quick online survey was sent to 65 Italian MSc in order to collect from them the following data: macro-region (North, Center, South) location, number of OCRtreated patients, modifications of OCR schedule and a list of factors potentially influencing the postponement of OCR infusions (i.e. age, co-morbidity, MS phenotype, number of previous OCR cycles, disease severity/activity, CD-20 lymphocytes count, distance to MS center, fear of infection, inclusion in a research trial, infections trend, shortage of medical/paramedical staff for reallocation/ infection). Result(s): Among 55 MSc who answered the survey, 50 (91%) declared to have suspended or extended OCR interval dosing for at least one patient. The MSc that didn't modify OCR schedule were all from the South of Italy (33% of all South MSc). Main factors influencing OCR schedule delay were advanced age/comorbidity (70%) and pandemic trend in the area (72%), while recent MS-disease activity hindered OCR schedule modifications (65%). Conclusion(s): This study shows that most Italian MSc decided either to delay or suspend OCR treatment during the first wave of COVID-19 pandemic. Advanced age and co-morbidity and no evidence of recent MS-disease activity were the most relevant patient-dependent predictors of OCR postponement. Among patient-independent factors the most relevant factor was the local trend of infections. Contrary to what expected, the shortage of medical and/or paramedical staff in MSc did not come out as relevant. The disruption of OCR schedule during the first COVID-19 pandemic wave in Italy mostly reflected the geographical distribution and the impact on the National Health System of COVID- 19 pandemic.