Road crashes in Adelaide metropolitan region, the consequences of COVID-19.

Background: Many countries instituted lockdown rules as the COVID-19 pandemic progressed, however, the effects of COVID-19 on transportation safety vary widely across countries and regions. In several situations, it has been shown that although the COVID-19 closure has decreased average traffic flow, it has also led to an increase in speeding, which will indeed increase the severity of crashes and the number of fatalities and serious injuries. Methods: At the local level, Generalized linear Mixed (GLM) modelling is used to look at how often road crashes changed in the Adelaide metropolitan area before and after the COVID-19 pandemic. The Geographically Weighted Generalized Linear Model (GWGLM) is also used to explore how the association between the number of crashes and the factors that explain them varies across census blocks. Using both no-spatial and spatial models, the effects of urban structure elements like land use mix, road network design, distance to CBD, and proximity to public transit on the frequency of crashes at the local level were studied. Results: This research showed that lockdown orders led to a mild reduction (approximately 7%) in crash frequency. However, this decrease, which has occurred mostly during the first three months of the lockdown, has not systematically alleviated traffic safety risks in the Greater Adelaide Metropolitan Area. Crash hotspots shifted from areas adjacent to workplaces and education centres to green spaces and city fringes, while crash incidence periods switched from weekdays to weekends and winter to summer. Implications: The outcomes of this research provided insights into the impact of shifting driving behaviour on safety during disorderly catastrophes such as COVID-19.

COMPARISON OF PATIENT SATISFACTION SURVEYS OF IN PERSON VERSUS TELEHEALTH OUTPATIENT CLINIC VISITS DURING THE COVID PANDEMIC

Background: The COVID pandemic has markedly increased the adoption of telehealth. Patient satisfaction with telehealth may vary with the age and locale of the patient including the distance from the medical center and the setting the patient resides in (rural vs. urban). University of Utah Health is uniquely positioned to assess patient satisfaction in this transition due its very large geographic referral area from the continuum of the rural-urban settings. Aims: Compare pre-pandemic in-person visits to post-pandemic telehealth and in-person visits. Explore the temporal and spatial effect of a post-pandemic telehealth visits. Methods: Exceptional patient experience (EPE) surveys were sent to all patients after ambulatory care visits and consists of 8 questions. Possible responses ranged from Very Poor to Very Good on 5point scale. Survey responses were stratified by type of visit (in-person or telehealth), distance from medical center, rural vs. urban, age and time before and after start of COVID pandemic. Summary statistics of the response variables by pre pandemic in-person visit and post pandemic telehealth were done. We fitted a linear regression model adjusting for age and gender using the Covariate Balancing Propensity Score Estimation. Scores for entire institutional cohort and department of Gastroenterology were compared. Percentages reported are patients responding “Very Good.” Results: EPE scores were compared from in person pre-pandemic (11/01/18-2/28/20) to telehealth post-pandemic (04/1/20-12/31/20) with a transitional month of March (3/20) excluded. This included 235,227 returned surveys (14.0% response rate) of which 140,438 (GI 1852) were in person pre-pandemic and 87,135 (GI 1114) were telehealth post-pandemic. The entire cohort including GI patients reported greater satisfaction with in-person compared to telehealth visits with greatest % differences in “Overall assessment” and “Likelihood to recommend”. The other 6 questions showed similar scores between in-person and telehealth visits, but also favored in-person (Table 1, p<0.01 for all comparisons). Younger (£40) GI patients had higher scores for telehealth compared in person visits (p<0.03). The temporal effect of post-pandemic GI telehealth visits over time showed significantly higher scores of “ease of scheduling an appointment” “Likelihood to recommend” and “staff work together” in December compared to April (p<0.001) The spatial effect of a post-pandemic GI telehealth visits showed significantly lower scores for all questions for rural areas over micro/metropolitan for telehealth (p<0.001). Conclusion: All patients including GI patients preferred in person to telehealth visits though satisfaction was high with both. Younger GI patients preferred telehealth visits. Satisfaction with telehealth increased over time from the start of the pandemic.(Table Presented)

The Use of Bruton Tyrosine Kinase Inhibitors in Severe Covid-19 Patients

RATIONALE: SARS-CoV-2, a novel coronavirus, is the third coronavirus with an associated severe acute respiratory syndrome since SARS-CoV [1]. Patients with severe COVID-19 suffer from immune hyperactivity, also referred to as a cytokine storm, which causes increased vascular permeability and multiorgan dysfunction and is a significant source of morbidity and mortality.1 Because Bruton's Tyrosine Kinase (BTK) activity is thought to play a role in the cytokine storm, with elevated activity found in monocytes, it has been explored as a target for intervention for COVID- 19.2 METHODS : This observational, case-control study included 49 hospitalized patients with severe COVID-19. Of the 49 patients, 11 patients received off-label Acalabrutinib between May 2020 through June 2020. The purpose of the study is the assess the use of Acalabrutinib as a potential strategy for management of COVID-19 patients. Bivariate and Multivariate logistic regression models were used to analyze the data. The response variable was patient outcome (remission discharge or death). The main predictor of interest was the administration of Acalabrutinib on patients (Yes/No). For the multivariate analysis the covariates included were age, gender, change in CRP levels (Discharge CRP - Admission CRP), hypertension, COPD, and comorbidities status (Yes/No). Stata Version 17.0 (Stata Corp, College Station, Texas USA) was used in all analyses. RESULTS : The median age of patients was 58 with a majority being male (51%). The average length of hospitalization was 17 days with 23 (46.9%) patients receiving mechanical ventilation. Bivariate analysis revealed that acalabrutinib was protective against death from COVID-19. However, these results were nonsignificant (OR 0.36, 95 CI [0.04, 2.87], P=0.31). The multivariate analysis supported the results of the bivariate analysis. However, we did not observe a significant association between outcome and acalabrutinib when adjusted for the study covariates (OR 0.32, 95% CI [0.03, 3.79], P=0.37). CONCLUSION: Acalabrutinib did not significantly reduce morbidity or mortality on severe COVID-19 patients. Further studies are warranted to assess the efficacy of BTK inhibitors for COVID-19 in a larger clinical trial. (Table Presented).

Impact of COVID-19 infection on a physically active population: evaluation functional using the Cardiopulmonar Exercise Test (CPET)

Introduction: An increase it is being seen in patients who are referred for consultation due to dyspnea persistent after having overcome COVID19. The cause for this sequel is still not entirely clear, but our group has observed -in another study- that the consumption of oxygen (VO2) determined by cardiopulmonar exercise test (CPET) in these patients is low with respect to its predicted (p50). The objective of the present work was to demonstrate this hypothesis against to a control group with similar characteristics, who have not suffered from COVID19. Methods: We conducted a prospective study with military personnel who are part of a corps of army elite. All subjects have performed the same training daily during the last 2 years. They were divided into 3 groups: the first (G1) made up of those who had not suffered from the COVID19 disease;a second group (G2) that had suffered from it, but did not report impairment of functional class (CF);and a third group (G3) who maintained dyspnea persistent 3 months after suffering from the disease. Analytical with NT-proBNP, echocardiogram, basal spirometry, and CPET were performed. None required hospital admission. Results: 36 subjects were included, distributed as follows: G1 (n = 14), G2 (n = 15), G3 (n = 7). The 3 groups had a similar age and BMI. None of the subjects presented alterations in baseline spirometry, neither structural heart disease in the echo, and nor relevant analytical alterations, being NT-proBNP less than 125 pg/ml in all of them. In relation to the response variables cardiovascular, statistical differences (p = 0.03) were observed in peak oxygen consumption predicted among the three groups (% predicted peak VO2), being significantly lower in the G3 subjects. In addition, a trend was observed -in absolute values- of peak VO2 to be lower in G3 -not significant probably due to the small sample size-. They were not objectified significant differences in PulseO2, nor in OUES. No patient presented alterations in the ventilatory efficiency parameters, or in final BR. Conclusions: In our sample, patients who remained with persistent dyspnea after COVID-19, have a lower functional capacity compared to healthy subjects of the same characteristics, and with respect to subjects who after COVID19 do not present any symptoms. This subjective deterioration of the FC can be objectively quantified using CPET, thus reaffirming its value in this context. (Figure Presented).

Effects of the COVID-19 Pandemic on Caregivers of Young Children with Sickle Cell Disease Enrolled in the Engage-HU Trial

Background: Hydroxyurea (HU) is the primary medication used to prevent the significant medical and neurologic morbidities of pediatric sickle cell disease (SCD;HbSS or HbSB0 thalassemia). Despite the benefits of HU, it remains under-utilized likely due to lack of clinician knowledge/training and negative caregiver perceptions. Thus, we developed the Engage-HU randomized controlled trial (NCT03442114) as a novel approach to address HU utilization barriers. Engage-HU is designed to assess how clinicians can engage caregivers in a shared discussion that considers their values, preferences, and scientific evidence about HU. The COVID-19 pandemic has resulted in significant changes to healthcare delivery for children with SCD, as they are at increased risk of severe illness from COVID-19 infection. Given their risk status, it was recommended that patients with SCD complete telehealth visits when possible. Some families also chose to delay care because they feared their child would get infected at hospitals/healthcare clinics that care for COVID-19 positive patients. Since the lives of all families enrolled in the Engage-HU trial have been affected to some extent, we incorporated measures to capture the impact of the COVID-19 pandemic and the usability of telemedicine implementation and services. Methods: Engage-HU is a randomized control trial comparing two dissemination methods for clinicians to facilitate shared decision-making with caregivers of young children with SCD. Study outcomes include caregiver confidence in decision-making and perceptions of experiencing shared decision-making as well as HU uptake and child health outcomes. Eligible children are 0 to 5 years, candidates for HU, and their caregiver has not decided about HU in the past 3 months. The trial is being conducted at 9 sites in the United States and uses a unidirectional crossover design. The primary endpoints are caregiver decisional uncertainty and caregiver perception of shared decision-making measured using validated tools. Data will be analyzed using the intent-to-treat principle, and all participants will remain in the arm to which they were randomized. A multiple group comparison analysis will be performed to assess significant response variable differences by group randomization. The Engage-HU study aims to recruit 174 caregivers who are considering initiating HU. The trial is being conducted at 9 sites in the United States. Data collection is ongoing, and 160 caregiver-participants have been enrolled to date. Since May 2020, caregiver-participants have completed the COVID-19 Exposure and Family Impact Scales (CEFIS), which contain 2 subscales (exposure to potentially traumatic aspects of the pandemic, impact on families), and the COVID-19 telemedicine use survey during a study visit. Results: Currently, 8 of the 9 sites have collected data from 48 caregivers (93.8% mothers), most of whom (93.8%) identify as African American/Black (see Figure 1). Correlations indicated that older caregivers experienced greater exposure (Mean = 7.0, SD = 4.1, range = 1-19) to potentially traumatic aspects of the pandemic (r =.31, p =.04). Distress related to COVID-19 varied widely across the sample, for both caregivers (Mean = 5.9, SD = 2.9, range = 1-10) and children (Mean = 4.1, SD = 3.4, range = 1-10). Scores on the telemedicine usability survey were generally high, indicating that caregivers are happy with the quality of care delivered via telehealth. However, caregivers (r =.30, p =.09) and children (r =.32, p =.07) experiencing more pandemic-related distress reported less satisfaction with telehealth. Conclusion: Although Engage-HU has resumed research operations, recruitment has not reached pre-pandemic targets, as fewer eligible patients are scheduled for routine care visits at SCD clinics. Our preliminary analyses suggest a significant continued impact of the pandemic on families and general satisfaction with the quality of healthcare delivered via telemedicine. These findings indicate that targeted screenings to identify and intervene for those who emonstrate more COVID-19 pandemic-related distress are needed. [Formula presented] Disclosures: Quinn: Forma Therapeutics: Consultancy;Aruvant: Research Funding;Novo Nordisk: Consultancy;Emmaus Medical: Research Funding. Yates: Agios Pharmaceuticals: Current Employment. Badawy: Sanofi Genzyme: Consultancy;Vertex Pharmaceuticals Inc: Consultancy;Bluebird Bio Inc: Consultancy. Thompson: bluebird bio, Inc.: Consultancy, Research Funding;Baxalta: Research Funding;Biomarin: Research Funding;Celgene/BMS: Consultancy, Research Funding;CRISPR Therapeutics: Research Funding;Vertex: Research Funding;Editas: Research Funding;Graphite Bio: Research Funding;Novartis: Research Funding;Agios: Consultancy;Beam: Consultancy;Global Blood Therapeutics: Current equity holder in publicly-traded company. Smith-Whitley: Global Blood Therapeutics: Current Employment. King: National Cancer Institute: Research Funding;National Heart, Lung, and Blood Institute: Research Funding;Health Resources and Services Administration: Research Funding;Global Blood Therapeutics: Research Funding. Meier: CVS Caremark: Consultancy;Forma Therapeutic: Membership on an entity's Board of Directors or advisory committees;NovoNordisk: Membership on an entity's Board of Directors or advisory committees;Novartis,: Other: Data Safety Monitoring Board membership;NHLBI: Other: Data Safety Monitoring Board membership;Global Blood Therapeutics: Other: Steering Committee membership, grant funding;CDC,: Other: grant funding;Indiana Department of Health: Other: grant funding. Tubman: Global Blood Therapeutics: Consultancy, Research Funding;Novartis Pharmaceuticals: Honoraria, Research Funding;Forma Pharmaceuticals: Consultancy;Perkin Elmer: Honoraria. Crosby: Forma Therapeutics: Honoraria;PCORI: Research Funding;HRSA: Research Funding;Global Blood Therapeutics Panel: Honoraria;Children's Hospital of Philadelphia: Honoraria;Professional Resource Exchange: Patents & Royalties: $30-$60 every other year;SCDAA: Honoraria;NHLBI: Other: Payment for review of LRP Proposals, Research Funding. OffLabel Disclosure: Hydroxyurea has been FDA approved for the treatment of sickle cell disease for patients ages 2 years and above but NHLBI and ASH Guidelines recommend it be offered to children as young as age 9 months.