Veno-Arterial Extracorporeal Membrane Oxygenation for Circulatory Failure in COVID-19 Patients: Insights from the ECMOSARS Registry.

OBJECTIVES: The clinical profile and outcomes of patients with Covid-19 who require veno-arterial or veno-venous-arterial extracorporeal membrane oxygenation (VA-ECMO - VAV-ECMO) are poorly understood. We aimed to describe the characteristics and outcomes of these patients and to identify predictors of both favorable and unfavorable outcomes. METHODS: ECMOSARS is a multicenter, prospective, nationwide French registry enrolling patients who require VV/VA-ECMO in the context of Covid-19 infection (652 patients at 41 centers). We focused on 47 patients supported with VA- or VAV-ECMO for refractory cardiogenic shock. RESULTS: Median age was 49. 14% of patients had a prior diagnosis of heart failure. The most common etiologies of cardiogenic shock were acute pulmonary embolism (30%), myocarditis (28%), and acute coronary syndrome (4%). E-CPR (Extracorporeal Cardiopulmonary Resuscitation) occurred in 38%. In-hospital survival was 28% in the whole cohort, and 43% when E-CPR patients were excluded. ECMO cannulation was associated with significant improvements in pH and FiO2 on day one, but non-survivors showed significantly more severe acidosis and higher FiO2 than survivors at this point (p = 0.030 and p = 0.006). Other factors associated with death were greater age (p = 0.02), higher BMI (p = 0.03), E-CPR (p = 0.001), non-myocarditis etiology (p = 0.02), higher serum lactates (p = 0.004), epinephrine (but not noradrenaline) use before initiation of ECMO (p = 0.003), hemorrhagic complications (p = 0.001), greater transfusion requirements (p = 0.001), and more severe SAVE and SAFE scores (p = 0.01 and p = 0.03). CONCLUSIONS: We report the largest focused analysis of VA- and VAV-ECMO recipients in Covid-19. Although relatively rare, the need for temporary mechanical circulatory support in these patients is associated with poor prognosis. However, VA-ECMO remains a viable solution to rescue carefully selected patients. We identified factors associated with poor prognosis and suggest that E-CPR is not a reasonable indication for VA-ECMO in this population.

Impact of VA's video telehealth tablets on substance use disorder care during the COVID-19 pandemic.

BACKGROUND: Telehealth has the potential to improve health care access for patients but it has been underused and understudied for examining patients with substance use disorders (SUD). VA began distributing video-enabled tablets to veterans with access barriers in 2016 to facilitate participation in home-based telehealth and expanded this program in 2020 due to the coronavirus COVID-19 pandemic. OBJECTIVE: Examine the impact of VA's video-enabled telehealth tablets on mental health services for patients diagnosed with SUD. METHODS: This study included VA patients who had ≥1 mental health visit in the calendar year 2019 and a documented diagnosis of SUD. Using difference-in-differences and event study designs, we compared outcomes for SUD-diagnosed patients who received a video-enabled tablet from VA between March 15th, 2020 and December 31st, 2021 and SUD-diagnosed patients who never received VA tablets, 10 months before and after tablet-issuance. Outcomes included monthly frequency of SUD psychotherapy visits, SUD specialty group therapy visits and SUD specialty individual outpatient visits. We examined changes in video visits and changes in visits across all modalities of care (video, phone, and in-person). Regression models adjusted for several covariates such as age, sex, rurality, race, ethnicity, physical and mental health chronic conditions, and broadband coverage in patients' residential zip-code. RESULTS: The cohort included 21,684 SUD-diagnosed tablet-recipients and 267,873 SUD-diagnosed non-recipients. VA's video-enabled tablets were associated with increases in video visits for SUD psychotherapy (+3.5 visits/year), SUD group therapy (+2.1 visits/year) and SUD individual outpatient visits (+1 visit/year), translating to increases in visits across all modalities (in-person, phone and video): increase of 18 % for SUD psychotherapy (+1.9 visits/year), 10 % for SUD specialty group therapy (+0.5 visit/year), and 4 % for SUD specialty individual outpatient treatment (+0.5 visit/year). CONCLUSIONS: VA's distribution of video-enabled tablets during the COVID-19 pandemic were associated with higher engagement with video-based services for SUD care among patients diagnosed with SUD, translating to modest increases in total visits across in-person, phone and video modalities. Distribution of video-enabled devices can offer patients critical continuity of SUD therapy, particularly in scenarios where they have heightened barriers to in-person care.

Racial and ethnic disparities in excess mortality among U.S. veterans during the COVID-19 pandemic.

OBJECTIVE: The COVID-19 pandemic disproportionately affected racial and ethnic minorities among the general population in the United States; however, little is known regarding its impact on U.S. military Veterans. In this study, our objectives were to identify the extent to which Veterans experienced increased all-cause mortality during the COVID-19 pandemic, stratified by race and ethnicity. DATA SOURCES: Administrative data from the Veterans Health Administration's Corporate Data Warehouse. STUDY DESIGN: We use pre-pandemic data to estimate mortality risk models using five-fold cross-validation and quasi-Poisson regression. Models were stratified by a combined race-ethnicity variable and included controls for major comorbidities, demographic characteristics, and county fixed effects. DATA COLLECTION: We queried data for all Veterans residing in the 50 states plus Washington D.C. during 2016-2020. Veterans were excluded from analyses if they were missing county of residence or race-ethnicity data. Data were then aggregated to the county-year level and stratified by race-ethnicity. PRINCIPAL FINDINGS: Overall, Veterans' mortality rates were 16% above normal during March-December 2020 which equates to 42,348 excess deaths. However, there was substantial variation by racial and ethnic group. Non-Hispanic White Veterans experienced the smallest relative increase in mortality (17%, 95% CI 11%-24%), while Native American Veterans had the highest increase (40%, 95% CI 17%-73%). Black Veterans (32%, 95% CI 27%-39%) and Hispanic Veterans (26%, 95% CI 17%-36%) had somewhat lower excess mortality, although these changes were significantly higher compared to White Veterans. Disparities were smaller than in the general population. CONCLUSIONS: Minoritized Veterans experienced higher rates excess of mortality during the COVID-19 pandemic compared to White Veterans, though with smaller differences than the general population. This is likely due in part to the long-standing history of structural racism in the United States that has negatively affected the health of minoritized communities via several pathways including health care access, economic, and occupational inequities.

Opportunities to Enhance the Implementation of Veterans Affairs Video-Based Care: Qualitative Perspectives of Providers from Diverse Specialties.

BACKGROUND: Increasing the adoption of digital care tools, including video visits, is a long-term goal for the US Department of Veterans Affairs (VA). While previous work has highlighted patient-specific barriers to the use of video visits, few have examined how clinicians view such barriers and how they have overcome them during the rapid uptake of web-based care. OBJECTIVE: This study sought input from providers, given their role as critical participants in video visit implementation, to qualitatively describe successful strategies providers used to adapt their practices to a web-based care setting. METHODS: We conducted interviews with 28 VA providers (physicians and nurse practitioners) from 4 specialties that represent diverse clinical services: primary care (n=11), cardiology (n=7), palliative care (n=5), and spinal cord injury (n=5). All interviews were audio recorded and transcribed, and transcripts were reviewed and coded according to an iteratively created codebook. To identify themes, codes were grouped together into categories, and participant comments were reviewed for repetition and emphasis on specific points. Finally, themes were mapped to Expert Recommendations for Implementing Change (ERIC) strategies to identify evidence-based opportunities to support video visit uptake in the VA. RESULTS: Interviewees were mostly female (57%, 16/28), with an average age of 49 years and with 2-20 years of experience working in the VA across 16 unique VA facilities. Most providers (82%, 23/28) worked in urban facilities. Many interviewees (78%, 22/28) had some experience with video visits prior to the COVID-19 pandemic, though a majority (61%, 17/28) had conducted fewer than 50 video visits in the quarter prior to recruitment. We identified four primary themes related to how providers adapt their practices to a web-based care setting: (1) peer-based learning and support improved providers' perceived value of and confidence in video visits, (2) providers developed new and refined existing communication and clinical skills to optimize video visits, (3) providers saw opportunities to revisit and refine team roles to optimize the value of video visits for their care teams, and (4) implementing and sustaining web-based care requires institutional and organizational support. We identified several ERIC implementation strategies to support the use of video visits across the individual-, clinic-, and system-levels that correspond to these themes: (1) individual-level strategies include the development of educational materials and conducting education meetings, (2) clinic-level strategies include identifying champions and revising workflows and professional roles, and (3) system-level strategies include altering incentive structures, preparing implementation blueprints, developing and implementing tools for quality monitoring, and involving executive leadership to encourage adoption. CONCLUSIONS: This work highlights strategies to support video visits that align with established ERIC implementation constructs, which can be used by health care systems to improve video visit implementation.

The Challenge Of Covid19 In The Management Of Vascular Access For Hemodialysis In An Universitary Hospital.

INTRODUCTION: Chronic kidney disease prevalence has been increasing worldwide, with an increasing need to deliver an effective treatment. During the first months of the coronavirus disease 2019 (COVID-19) pandemic healthcare systems around the world were under stress. Therefore, the aim of this study is to report a single center experience with arteriovenous fistula (AVF) creation while also evaluating the impact of COVID-19. METHODS: Procedures for AVF creation in a tertiary hospital between March 2017 and December 2020 were included in this study and their case records were retrospectively analyzed and data retrieved. RESULTS: A total of 582 procedures were performed and a total of 568 accesses were created (506 being made pre-COVID onset and 62 post-COVID onset). The period between the referral to the vascular surgery consultation was significantly longer for the COVID group [18 (23) days vs 28 (44) days; p<0,001] while the period between the consultation to the surgery was significantly shorter [76 (77) days vs 40 (57) days; p<0,001]. This resulted in significantly less time between referral to surgery in the COVID group [103 (77) days vs 88 (55) days; p=0,008]. CONCLUSION: The ability of hospitals to adapt their resources was paramount to mitigate COVID impact. In the institution where the study took place, the time from referral to consultation was increased significantly during the first months of COVID but the time from consultation to surgery was significantly reduced. Overall, these results show that there was a successful effort to expedite the creation of a vascular access.

Digital Vā: Pacific Perspectives on the Shift from ‘Ordinary Practices' to ‘Extraordinary Spaces' During the COVID-19 Pandemic in Aotearoa/New Zealand

The emergence of the COVID-19 virus has significantly shifted the lives of Pacific families and communities from face-to-face communal settings to digital spaces. While there has been a multitude of opportunities for Pacific people to express themselves in digital spaces, little is known about the impacts of this on social life, including on quality time within families, exposure to misinformation, and the adoption of online addictive behaviours. This article sets out to critically review and explore the impacts and influences of digital experiences and behaviours on Pacific peoples in Aotearoa/New Zealand, shifting from ordinary practices such as church, kava-drinking and educational learning, to online platforms. Vā (space) and tauhi vā (nurturing relationships) are also discussed as theoretical concepts in navigating the shift from ordinary practices to extraordinary spaces. Findings include the exposure to COVID-19-related misinformation and online addictive behaviours, which will better inform community leaders, services providers, and policy makers in addressing the digital impacts and influences that Pacific people may be facing in Aotearoa/NZ. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Telemedicine at the VA: Examining smartphone connectivity rates to VA video connect and doximity dialer video.

Background: Telemedicine usage has accelerated as a result of the COVID-19 pandemic, raising concerns those without the necessary technology and digital literacy to participate may face increasing health disparities. In this study, we examined the rates at which veterans are able to connect to two common telemedicine applications: VA Video Connect (VVC) and Doximity Dialer Video (DV). Methods: Participants were selected from a pool of vascular surgery patients seen from August 2020 to October 2021 at a single Veterans Affairs medical center. Participants had to be >50 years old and not previously participated in a video visit. Eligible veterans were asked their interest participating in video visits and if they owned a smartphone. Those who met the eligibility requirements were tested on their ability to connect to both VVC and DV with minimal assistance. The connectivity rate for both platforms was recorded, and basic demographic and medical history information was collected. Results: One-hundred-four veterans participated in the study, with an average age of 70 ± 7 years. Seventy-four participants (71%) expressed interest in video visits, and 52 (70%) owned a smartphone. Forty-five smartphone owners (87%) successfully connected to DV, whereas 19 (37%) successfully connected to VVC (p < 0.001). VVC connectivity decreased with increasing age-group: 50-59 = 80%, 60-69 = 44%, ≥70 = 18% (p = 0.02). Conclusions: Older veterans demonstrate difficulty connecting to VVC. The VHA is taking important steps to streamline usability of VVC, however continued expansion of support programs is necessary to improve access and reduce healthcare disparities in this population.

Navigating digital inclusion and the digital vā among Niue mamatua through the provision of mobile phones during COVID-19

Technology and digital platforms have become essential for people and communities to interact because of COVID-19. Despite its benefits, digital exclusion disproportionately affects Pacific communities living in New Zealand. This article provides insights into how Niue mamatua (older adults) used their gifted mobile phones and mobile data as part of a COVID-19 digital inclusion initiative. It begins with an overview of the digital inclusion needs of older adults, followed by a description of the digital vā (relational space) and negotiating a new way of maintaining connection in an online world. The tutala (a Niue method of conversation anchored on respect) with 12 mamatua highlighted the benefits, support factors, and challenges of how they were able to use their mobile phone. Importantly, mobile phones provided the necessary access and connectivity to interact in a digitally connected world, namely the digital vā, when in-person connections were disrupted because of COVID-19. © The Author(s) 2023.

A Different Kind of Vā: Spiraling through Time and Space

This dialogue is a structured account of an experiment that we, as researchers in the Vā Moana–Pacific Spaces cluster at Auckland University of Technology, carried out during and between lockdowns in Tāmaki Makaurau Auckland during the COVID-19 pandemic in 2020–2021. The previous year, Vā Moana had begun to investigate how—without shared physical presence—virtual participation in events can uphold central Māori and Moana (Pacific) traditional values of tikanga (te reo Māori: correct procedure, custom) and teu le vā (gagana Sāmoa: nurturing relational space). Aspects of our research concern practices that continue to emphasize vā—as the attachment and feeling for place and relatedness—outside the Pacific homelands. These nascent practices contribute to an emerging understanding of place as an imaginary space of belonging, in which online environments (the digital vā) play a role. The outbreak of COVID-19 gave this general interest unexpected but sharp focus. In this essay, we present, contextualize, and analyze excerpts from three conversations between Vā Moana team members in Aotearoa. Held during, between, and after lockdown periods between March and November 2020, these conversations were conducted either fully online or in a blended format. In the latter case, some members met face-to-face in a "hub,” and others used online platforms to participate in reviewing and reorganizing our research relationships under the new conditions, using the challenge thrown before us as an opportunity for experimentation and change. © 2022, University of Hawaii Press. All rights reserved.

The effect of having COVID-19 on insomnia, fatigue, and quality of life: A comparative study with vaccinated and unvaccinated COVID-19–negative patients

Aim:To compare insomnia, fatigue, and activities of daily living of patients who were infected during the coronavirus disease-2019 (COVID-19) pandemic with those who did not have the infection, according to their vaccination status.Methods: A total of 176 volunteers (104 women and 72 men) participated in the study. The study group was divided into three groups: patients who had COVID-19, individuals who did not have COVID-19 and were vaccinated, and those who did not have COVID-19 and were not vaccinated. The data collection tools were a personal information form;insomnia, fatigue and activities of daily living short questionnaire;and anxiety and depression inventories, which evaluated psychological status.Results:There was no difference in terms of depression, insomnia, fatigue, and quality of life scale scores between the groups. Work and education status did not affect scores. The fatigue rate was higher in those who had COVID-19 (10.7%, p=0.007). Women's fatigue scores were higher (p<0.001), and their physical and psychological health scores in the quality of life scale were lower than men's (p=0.025 and p=0.007, respectively). The anxiety score of married participants was higher (p=0.021). The rate of insomnia was high in the entire study group (41.7%). Depression and anxiety were positively correlated with insomnia and fatigue. Depression was negatively correlated with all sub-parameters of quality of life, and anxiety was negatively correlated with physical, psychological health, and environment. There was no difference between insomnia, fatigue, depression, and quality of life scale scores between the groups, irrespective of COVID-19 infection.Conclusion:The high rates of insomnia and depression suggested that the progression of the pandemic also brought about chronic health problems. Therefore, it is important to conduct extensive preventive health programs for the population.

Characterization of SARS-CoV-2 Isolate (MZ558159) for in Silico Drug Designing, Reported from India

Introduction: Inadequate information available about the genomics and proteomics characterization of SARS-CoV-2 isolates reported from India and other part of the globe. This characterization is important for the in silico drug designing as there are no approved medications available to treat SARS-CoV-2 infection. Aim(s): The aim of the present study is characterization of SARS-CoV-2 (MZ558159) isolate reported from India using homology modelling, validation and in silico drug designing methods. Material(s) and Method(s): Genome sequence of SARS-CoV-2 (MZ558159) was retrieved from NCBI, and four protein sequences selected for the homology modeling, validation and in silico drug designing e.g., QXN18496, QXN18498, QXN18504, and QXN18497. SWISS-MODEL and UCLA-DOE server used for homology modeling. Validation for structure model performed using PROCHECK and molecular docking using MCULE-1-Click server. Result(s): The surface glycoprotein (QXN18496) model corresponding to probability conformation with 93.6%, envelope protein (QXN18498) with 88.9%, nucleocapsid phosphoprotein (QXN18504) with 93.6%, and ORF3a protein (QXN18497) with 91.8% residues in core section of o-o plot that specifies accuracy of prediction model. The corresponding ProSA Z-score score -12.67, -0.01, -4.4, and -2.87 indicates the good quality of the models. Molecular dynamic simulation and docking studies revealed the inhibitor binds effectively at the SARS-CoV-2 (MZ558159) proteins. Predicted inhibitor 2-acetamido-2-deoxy-beta-D-glucopyranose exhibited effective binding affinity against surface glycoprotein (QXN18496). Conclusion(s):The results of study establish inhibitor 2-Acetamido-2-deoxy-beta-D-glucopyranose as valuable lead molecule with great potential for surface glycoprotein (QXN18496).

Wayfinding waves and winds of change: The currency of the post– covid gaze into Pasifika/Pacific education's trajectory

The thematic currency of this paper is a post–covid concern. My talatalanoa sits alongside Pacific educators' voices in this volume of the Waikato Journal of Education, colleagues from Aotearoa New Zealand's Realm Nations of the Cook Islands, Niue and Tokelau. While adopting a place-based and Indigeno-centric Pasifika/Pacific gaze through talanoa–vā, an analytical lens centred on unpacking stories and insights, I share my motivations and concerns wayfinding the wave-like changes facing Pasifika/Pacific education's level of criticality and trajectory within Aotearoa New Zealand. © 2022, Wilf Malcolm Institute of Educational Research. All rights reserved.

Literature Review for Office-Based Anesthesia

The authors observed a decreased heart rate in the dexmedetomidine groups, but none of the patients required treatment for bradycardia. Ann Surg. 2022;276(5):e265–e272 doi:10.1097/SLA.0000000000005597 This study aimed to determine whether COVID-19 vaccination status or mode of anesthesia modified the temporal harms associated with surgery following coronavirus disease-2019 (COVID-19) infection. The authors recommend a thorough consideration of risks and benefits as requests for family presence in the operating environment continue to grow.

Perceptions of the COVID-19 Vaccine within the Sudanese-American Community

Background. One of the primary issues affecting COVID-19 vaccine uptake in high-income countries is vaccine hesitancy, which is prevalent in people from different countries of origin. Characterizing vaccine uptake in immigrant and refugee populations in the US could provide a unique window into both local and global health behaviors. The goal of this project is to characterize Sudanese American perspectives on the COVID-19 vaccine. Methods. We conducted an anonymous, online, anonymous, cross-sectional survey directed toward Sudanese Americans, with survey development guided by principles from the Vaccine Examination Scale. The survey was distributed in both English and Arabic and included questions about vaccination history, motives for getting the vaccination, reasons for vaccine hesitancy, and barriers to vaccination. Fisher's exact tests were used to analyze evaluate possible associations between vaccine uptake and sources of information on the vaccine and social media use, respectively. Data analysis was conducted using STATA SE v17.0 (StataCorp, College Station, TX). Results. A total of 108 survey responses were received;4 were excluded for failing to meet inclusion criteria. A total of 92% received at least one dose of COVID-19 vaccine, with the primary motivation being to protect oneself (62%). Only 8 had not been vaccinated and, of those, 2 were willing to take the vaccine. Of the 6 unwilling to take the vaccine, the most cited reason was a belief that it had not been studied enough. Of the 14 possible hesitancy responses, 9 were selected at least once. When asked about their primary source of information on COVID-19, 44% used government websites, followed by mass media (22%), social media (12%) and health personnel (11%). Using Fisher's exact tests, no statistically significant conclusions were drawn between vaccine uptake and primary source of information (P = .097) or specific types of social media. Conclusion. Vaccine uptake among our survey population (92%) was much higher than that of the US (77%) or Sudanese population (11%). Overall motivators for vaccine hesitancy and vaccine uptake varied and no specific correlations were found to be associated to vaccine uptake. Future research should evaluate high levels of vaccine uptake in this community.

Association between Self-reported Masking Behavior and SARS-CoV-2 Infection Wanes from Pre-Delta to Omicron-Predominant Periods - North Carolina COVID-19 Community Research Partnership (NC-CCRP)

Background. Wearing a face mask is a primary public health method to reduce SARS-CoV-2 transmission. We assessed the association between self-reported mask use and risk of COVID-19 infection during three periods of the pandemic. Methods. We performed a nested case-control analysis within the NC-CCRP of adults >=18 years who completed daily syndromic surveillance surveys from April 2020 through February 2022, comparing self-reported cases to controls who never selfreported a positive test. We matched up to 10 controls to each case on calendar time of self-reported positive test and corresponding daily survey entry. Not wearing a mask was defined as responding "no" at least once in the ten days preceding the match date to "In the last 24 hours, have you worn a face mask or face covering every time you interacted with others (not in your household) within a distance of less than 6 feet?" Conditional logistic regression models of risk of COVID-19 infection were adjusted for demographics, vaccination status, and recent known exposure to COVID-19. We tested any days not wearing a mask during the Pre-Delta (July 1 2020-June 30, 2021), Delta (July 1- November 30, 2021), and Omicron (December 1, 2021 - February 28, 2022) periods. Results. Among 3,901 cases and 27,813 date-matched controls, there was a significant interaction between mask use and time period (p< 0.001). Prior to July 2021, the odds of a reported SARS-CoV-2 infection was 66% higher (aOR=1.66, 95% CI=1.43 - 1.91) among participants reporting at least one day not wearing a mask compared to those who reported no days (1592 cases, 11717 controls). During the Delta-predominant period, the results were similar (aOR=1.53, 95% CI=1.23 - 1.89;659 cases, 4649 controls). This association was attenuated during the Omicron-predominant period, where the odds of a reported SARS-CoV-2 infection was 16% higher (aOR=1.16, 95% CI=1.03 - 1.32;1563 cases, 10960 controls). Conclusion. While the effect of not wearing a mask remains significant, during the Omicron-predominant period we observed a decrease in the association between self-reported mask wearing and risk of SARS-CoV-2 infection. The increased transmissibility of Omicron, pandemic fatigue, and increasing population immunity are possible contributing factors.

Disparities in virtual cardiology visits among Veterans Health Administration patients during the COVID-19 pandemic.

Objective: In response to the coronavirus disease 2019 (COVID-19) pandemic, the Veterans Health Administration (VA) rapidly expanded virtual care (defined as care delivered by video and phone), raising concerns about technology access disparities (ie, the digital divide). Virtual care was somewhat established in primary care and mental health care prepandemic, but video telehealth implementation was new for most subspecialties, including cardiology. We sought to identify patient characteristics of virtual and video-based care users in VA cardiology clinics nationally during the first year of the COVID-19 pandemic. Materials and Methods: Cohort study of Veteran patients across all VA facilities with a cardiology visit January 1, 2019-March 10, 2020, with follow-up January 1, 2019-March 10, 2021. Main measures included cardiology visits by visit type and likelihood of receiving cardiology-related virtual care, calculated with a repeated event survival model. Results: 416 587 Veterans with 1 689 595 total cardiology visits were analyzed; average patient age was 69.6 years and 4.3% were female. Virtual cardiology care expanded dramatically early in the COVID-19 pandemic from 5% to 70% of encounters. Older, lower-income, and rural-dwelling Veterans and those experiencing homelessness were less likely to use video care (adjusted hazard ratio for ages 75 and older 0.80, 95% confidence interval (CI) 0.75-0.86; for highly rural residents 0.77, 95% CI 0.68-0.87; for low-income status 0.94, 95% CI 0.89-0.98; for homeless Veterans 0.85, 95% CI 0.80-0.92). Conclusion: The pandemic worsened the digital divide for cardiology care for many vulnerable patients to the extent that video visits represent added value over phone visits. Targeted interventions may be necessary for equity in COVID-19-era access to virtual cardiology care.

A Successful Case of Cardiac Arrest due to Acute Myocarditis with COVID-19: 120 Minutes on Manual Cardiopulmonary Resuscitation then Veno-Arterial Extracorporeal Membrane Oxygenation.

Acute myocarditis is one of the common complications of coronavirus disease 2019 (COVID-19) with a relatively high case fatality. Here reported is a fulminant case of a 42-year-old previously healthy woman with cardiogenic shock and refractory cardiac arrest due to COVID-19-induced myocarditis who received veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) after 120 minutes of cardiopulmonary resuscitation (CPR). This is the first adult case of cardiac arrest due to COVID-19-induced myocarditis supported by ECMO that fully recovered with normal neurological functions. The success of the treatment course with full recovery emphasized the potential role of ECMO in treating these patients.

Post-9/11 veterans perceptions of the pandemic: Areas of greatest impact on health and well-being.

Objective: Assess potential impacts of the COVID-19 pandemic on a subset of Post-9/11 U.S. Veterans included in a study of post-traumatic epilepsy (PTE). Methods: Two measures were added to a structured health interview for Veterans during temporary pandemic research shutdown: a validated health questionnaire [1] previously completed by survey, and a semi-structured instrument developed to assess whether pandemic conditions affected responses to the health questionnaire and identify unique impacts. Interviews were conducted between August 2020 - February 2021. Scaled items were calculated and t-tests used to compare results. Open-ended items were coded using thematic analyses. Results: Veterans identified eight major areas of impact with negative and positive impacts: mental health, family, social, work/employment, access to resources, physical health, finances, and education. Innovation: The temporary shut-down of a large health study for Post-9/11 Veterans provided an opportunity to devise an instrument to assess COVID-19's impact on health and well-being. The instrument was accepted as of the first Veteran instrument in a pandemic SDOH research repository [2], and is being used in other studies. Conclusion: This study highlights the need to assess and understand interrelated relationships of factors impacting health and well-being, especially as COVID-19 moves from pandemic to endemic with reverberating effects across multiple social determinants of health (SDOH).

[Reverse Takotsubo ou myocardite fulminante ? Succès de VA ECMO chez une patiente ayant une atteinte cardiaque liée COVID 19]. / Reverse TakoTsubo or Fulminant myocarditis ? Life saving VA ECMO in a COVID 19 patient.

A 45 years old female patient was admitted to our facility for COVID -19 infection complicated by fulminant cardiac injury and refractory cardiogemic shock. She had echographic findings of reverse takotsubo cardiomyopathy. She was successfully treated by VA-ECMO allowing complete revocery of the left ventricule function and weaning from support.

Maximizing VA remote patient monitoring during the COVID-19 response

Objective: The Veterans Health Administration (VHA) has one of the largest remote patient monitoring programs in the United States and is supported by an enterprise-wide infrastructure for providers, clinicians, staff, Veterans, and caregivers. The coronavirus disease 2019 (COVID-19) pandemic, however, presented new challenges: a sudden need to provide large-scale remote monitoring for a new disease that did not yet have a disease management protocol (DMP). Veterans Health Administration (VHA) needed to be ready within weeks to provide this daily monitoring for hundreds – even thousands – of Veterans. Methods: The US Department of Veterans Affairs Office of Connected Care already had a comprehensive infrastructure in place for its remote patient monitoring – Home Telehealth (RPM – HT) program. Connected Care activated and built on this infrastructure to support providers, clinicians, and staff in their efforts to rapidly bring RPM – HT to Veterans across the nation when they had COVID-19 symptoms or exposure. To do this, Connected Care activated an emergency management plan, rapidly developed a new COVID-19-specific DMP, added weekend monitoring, and procured critically needed monitoring supplies, such as thermometers and pulse oximeters. The strong foundation for Connected Care allowed for innovation and flexibility, such as the training of non-RPM – HT staff in RPM – HT processes, RPM – HT enrollment within acute care settings, and new strategic partnerships. Outcomes: More than 23,500 Veterans were enrolled for COVID-19-related monitoring from March 2020 to May 2021. During December 2020 and January 2021, the number of Veterans being monitored in a single day topped 2,000. Even with this rapid buildup, patient satisfaction levels remained at about 90% in numerous categories. In addition, the percentage of Veterans admitted to Veterans Administration (VA) facilities while on COVID-19-related home monitoring has been extremely low, at 4%, the monitoring system has been a potential indicator in enabling Veterans who did have the virus to convalesce at home. Further study is needed to determine the impact RPM – HT enrollment for COVID-19 care had on the need for inpatient care. Conclusion: The Office of Connected Care’s established, enterprise-wide RPM – HT business, clinical, and technical infrastructure enabled VHA to enter the COVID-19 public health emergency well-positioned for the rapid deployment and growth of at-home and mobile monitoring. As the COVID-19 emergency made at-home management of Veterans increasingly important, the national RPM – HT program successfully adapted its practices to meet the needs of Veterans, caregivers, and staff.