The Evolution of the Covid-19 Pandemic in Pediatric Patients with Sickle Cell Disease: From Alpha to Omicron

Background: Approximately two years ago, COVID-19 was declared a global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and through genomic surveillance, we have seen the emergence of variants of SARS-CoV-2. In the United States, over 78 million cases and >900,000 deaths attributable to COVID-19 have been reported. SCD was identified as a risk factor for severe COVID-19 disease in adults and pediatric patients. The emergence of novel SARs- CoV-2 variants has led to challenges in diagnosis, treatment, and prediction of long-term sequelae in individuals with SCD and COVID-19. Aim(s): We compare the overall seasonal variation of COVID-19 variants and patterns of healthcare utilization and clinical presentation over time in pediatric patients with SCD and COVID-19 at Children's National Hospital (CNH). Method(s): Our single-center, observational cohort study included 193 pediatric patients with SCD (0-21 years) with PCR-confirmed SARSCoV- 2 infection between March 31, 2020, and January 31, 2022. Per the SECURE SCD Registry definitions, clinical severity was classified as asymptomatic, mild, moderate, and severe. Result(s): A total of 193 unique patients with SCD and positive SARS-CoV-2 PCRs between March 2020-January 2022 were included in our registry. Most patients were female (51.8%), and the mean age was 11.2 years (SD 6.5 years). Most of the cohort resides in Maryland (N=135), and HbSS was the dominant genotype (69.4%). During the alpha dominant variant of the COVID-19 pandemic (March 2020- June 2021) there were 70 cases, followed by 40 cases during the Delta variant (July 2021- December 19, 2021), and 83 cases during the Omicron variant dominance (from December 20, 2021-January 31,2022). There were 149 patients (77%) that presented to the emergency department (ED) or were hospitalized. There were a total of 80 hospitalizations (41.5%), and a relative comparison showed that the percentage of hospitalizations was highest during the delta wave (47.5%) and lowest during the omicron wave (36.1%) (p= 0.407). ED-only utilization was highest in the era of omicron (43.4%, N=36), followed by delta (32.5%, N=13), and then alpha (30%, N=21)(p=0.197). The most common SCD-related complication was vaso-occlusive (VOC) pain (33%, N=64) which accounted for half of all hospital admissions (51%, N=41 of 80). Acute chest syndrome (ACS) was reported in 40% (N=32) of admitted patients and was highest in the alpha era (54.8%, N=17). The use of blood transfusion therapy was highest in the alpha (N=17) and delta (N=14) variants, while Remdesivir use was highest in omicron (N=15). A total of 6 patients received monoclonal antibodies (Delta, N=4;omicron, N=2). Throughout all the variants, there was a significant difference in COVID-19 clinical severity (p>0.005). Of the patients classified as asymptomatic (13%, N=25), seventy-two percent (n=18) were diagnosed during the alpha variant. Mild severity was the most prevalent (69%, N=134), with the omicron variant having the highest cases (51.5%, N=69). Severe cases were observed in all variants (6.7%, N=13) but were most prevalent during the alpha variant (46.2%, N=6). Summary - Conclusion(s): Interestingly, while the relative percentage of hospitalizations was lowest during the omicron wave, it saw the highest percentages of ER utilization. Overall, COVID-19 remains mild in pediatric patients with SCD, and notably, there was higher health care utilization in the omicron era.

Social Determinants of Health and Their Impact on Families of Children with Sickle Cell Disease during Covid-19 Pandemic

Background: According to national prevalence data, SCD has an estimated economic burden of $2.98 billion per year in the United States and caring for a child with sickle cell disease (SCD) carries its own financial burden, resulting in higher healthcare costs and unintended days lost from employment. Social experiences are known to impact health outcomes in the general pediatric population. These experiences can be examined through the construct of social determinants of health (SDOH), the "condition in which people are born, grow, work, live and age" that impact their health. Since the WHO has designated COVID-19 a pandemic in January 2020, many families in the US have suffered financially, and during the shutdowns, there was a record number of jobs lost. The objective of this study was to determine the impact of the COVID-19 pandemic on financial and employment status of SCD Families Methods: This study was part of the larger CNH Sickle Cell Disease Social Determinants of Health study that was IRB approved. Caregivers of children with SCD completed a 30-question survey reporting their experiences with SDOH that included Demographics, USDA Food Security Scale, the We Care housing screening tool, and the validated COVID-19 Employment Status/COVID-19 related household finances survey in RedCap during clinic visits and hospitalizations Results: 99 caregivers of SCD patients responded to our survey (82.5% Female, 17.5% Male) (N=97). 93.9% identified as African-American, 3% identified as Hispanic or Latinx, 1% identified as "other". Of respondents, 66% were insured through on Medicaid and 33% had private insurance. Twenty-six percent endorsed food insecurity and 2724% relied on low-cost food. Thirty-one percent lived in an apartment, 67.768% lived in a home, 1% lived in shelter or transitional housing. Sixteen percent lived in subsidized or public housing. Thirty-seven (36.8%) percent reported at least once they were being unable to pay the mortgage or rent on time at least once, 9% (8.5%) reported living with other people because of financial difficulties, 55.2% reported their home not being heated, 7.2% reported being evicted from their home and 3.1% lived in an emergency shelter or transitional housing. 6.1% had an educational level of high school graduation or less, 42.2% were college graduates or completed additional post-graduate education (N=98). Two weeks prior to the pandemic, 61.5% worked full time, 13.5% worked part time, 6.3% were unemployed with only 2.1% working from home of the 96 caregivers who responded to this question. 15.5% (N=12 of 77) reported losing their job or were furloughed during the pandemic;34.4% (N=33 of 96) reporting at least one household member losing a job or a significant amount of income. Twenty-five percent (N=21 of 83) reported it was difficult to get work/school done because of the home environment. 36.4 % (N=35 of 96) reported household income was significantly less since February 2020. 53% (N=52 of 97) worried their household income has been or will be negatively impacted by the COVID-19 pandemic. Additionally, 48.9% (N=47 of 96) worried the value of their assets (housing, savings, other financial assets) has been or will be negatively impacted by COVID-19 and its effects. Since February 2020, 9.8% (N= 9 of 97) received unemployment insurance, 30.9% (N=29 of 94) received SNAP or food stamps, 16.5% (N= 15 of 91) received from the food pantry, 6.6% (N=6 of 90) applied for temp ass.

COVID-19 TravelCover: Post-Lockdown Smart Transportation Management System

Public transportation is not safe during the COVID-19 pandemic even after post lockdown, because it will be very hard to maintain social distancing in public transport. The COVID-19 pandemic is a worldwide pandemic because of which it became risky to allow public transportation without the proper mechanism to maintain social distancing. So to resolve this problem we came up with an idea of making an intelligent application to schedule the timings of transportation, avoiding over occupancy of public transport, providing them the shortest route to reach their desired destination, providing them proper guidelines, also providing them the information of the nearest hospitals for any emergency. In the proposed work, we have tested the result on 100 random users from various locations, determined the shortest distance of the vehicles, booked online tickets based on mask detection, and maintained the social distancing based on government guidelines. We have applied only 50% ticket booking for maintaining the social distancing and the ticket validation system has been checked with the user's images and it was successfully able to distinguish between masked and unmasked images. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

The Effect of the Different Waves of COVID-19 Pandemic on the Outcome of Diabetic Foot Ulcers

Objective: Diabetic foot ulcers (DFUs) are complications of diabetes mellitus. COVID-19 pandemic has massively impacted human health. We studied effect of COVID-19 on outcome of DFUs. Method(s): We recruited 483 people with DFU from June 2020-April 2022 (pandemic group) together with a matched group of 227 people with DFU from March 2019-March 2020 (pre-pandemic group). Matching was done with respect to glycemic control (Average HbA1c in pandemic group 9.15%;pre-pandemic group 8.92%), and renal status. Primary endpoint was outcome of ulcers- healed or undergone amputation. Primary outcome was further sub analyzed in the 3 waves of COVID-19 Secondary endpoint was healing of individual types of DFUs. Basic anthropometric data with site, nature and Wegner's grading of DFUs were collected. Diagnosis of peripheral neuropathy was done by monofilament testing and peripheral arterial disease by handheld Doppler and ABI. Standardized treatment protocol including glycemic control, infection control, debridement, dressing, offloading was provided. All patients were monitored for >6 months. Result(s): In pandemic cohort of 483 patients 323(66.9%) patients had healed ulcers, 70(14.5%) had minor amputation, 11(2,2%) had major amputation, 29(6%) lost to follow up, 22(4.6%) had not healed and 28 are in follow up (5.8%). Rate of healing of DFU in pandemic group was higher (66.9%) than control group (53.5%). Similarly, rate of amputation in pandemic group was less (16.7%) than pre-pandemic group (23.4%). Among healed ulcers in pandemic group, non-infected neuropathic ulcers healed better (77.8%;199/256) than other types (54.6%;124/227) [p< 0.00001]. Similarly, rate of amputation (major/minor) in ischemic and neuroischemic ulcers in pandemic group was more (32.3%;11/34) than other types (15.6%;70/449) [p= 0.011]. Rate of healing of foot ulcers in 1st wave was 65.4% (53/81), 2nd wave 75.2% (158/210), 3rd wave 58.3% (112/192). Neuropathic ulcers though less prevalent in first two waves (49.8%;145/291) than 3rd wave (57.8%;111/192) healing rate was more in first two (79.3%;115/145 vs 75.6%;84/111). [p=0.488 (statistically not significant]. Ischemic and neuroischemic ulcers were more in 3rd wave (7.8%;15/192) than first two waves (6.5%;19/291) and undergone more amputation (46.7%;7/15 vs 15.7%;3/19). [p=0.58 (statistically not significant;due to small sample size]. Discussion/Conclusion: COVID-19 pandemic (mainly first two waves) accounted for travel restrictions contributing to better healing of neuropathic ulcers whereas ischemic and neuroischemic ulcers worsened and underwent more amputation as patients could not seek intervention. Conversely, in third wave withdrawal of COVID restrictions lead to worsening of DFUs leading to less healing and more amputation.Copyright © 2023

Impact of BCG Vaccine Against the Pandemic of Corona (COVID-19): A Review

The explanations behind the wide spreadability of coronavirus sickness (COVID-19) are not known properly in this world. Several clinical investigations have indicated that the BCG antibody impacts on the immune system and human sicknesses which take part in the host system to such an extent that numerous types of viral diseases are extensively diminished or reduced. Subsequently, it was also observed in different studies that the recurrence and seriousness of numerous microbial or viral diseases, including COVID-19, will be lower in few countries where BCG Immunization programs are carried out. Few clinical investigations proposed by the epidemiological data have shown that the BCG antibody has a valuable impact in the treatment of COVID-19. So the BCG immunization may be found valuable in the coming months, particularly in the countries, where mass BCG immunization is done. Further thorough BCG immunization clinical trial is required to establish the above findings and its clinical significance. In future, this investigation will concentrate on the BCG vaccine and it may forestall the event of SARS-CoV-2 contamination and its succession in the large population.Copyright © 2021 Bentham Science Publishers.

A feasibility study on adoption of autonomous vans for relief distribution in rural India

In the wake of the COVID-19 global health emergency, governments in different countries of the world have restricted the movement of people and goods intra-country or even intrastate to reduce the spread of infections. Developing countries like India face an acute shortage of distribution centers for disaster management and recovery. Residents in semi-urban and rural areas in India continue to face tremendous scarcity of daily basic supplies and food grains. The safety concern stemming from the delivery options for essential goods from one point to another has been under serious concern considering the widespread of the coronavirus in India. The purpose of this study is to understand the shortcomings, needs and requirements of existing food and logistics supply in disaster scenarios by NGOs and local government and then perform a gap analysis to propose Connected Refrigerated Driverless Vans (CRDVs). The adoption of driverless car technology (DCT) is still a long-term effort, and this research aims to delve into the ways in which the proposed CRDV framework can be adopted in relief and supply distribution in rural India. © 2022 IEEE.

STANDARDIZED THROMBOPROPHYLAXIS PROTOCOL IN MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN

Background: Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) exhibit laboratory evidence of hypercoagulability and are at risk of experiencing thrombotic complications. We developed and implemented a standardized multidisciplinary treatment approach which encompassed a thromboprophylaxis protocol and a computerized clinical decision support system including a provider order set to guide and unify practice. In high-risk patients defined as critically ill and/or having additional risk factors for thromboembolism, prophylactic-dose enoxaparin (target anti-Factor Xa of 0.1-0.3 U/mL) was added. Objectives: To evaluate impact of implementation of a standardized thromboprophylaxis protocol in hospitalized patients with MIS-C. Design/Method: We conducted a retrospective study of patients who were admitted to our center between March 2020 and December 2021 with confirmed MIS-C based on Centers for Disease Control and Prevention case definition. Relevant data were extracted from prospectively maintained institutional databases and the electronic medical records and were summarized using descriptive statistics. Key outcome measures included frequency of objectively confirmed venous and/or arterial TE during hospitalization and within 30 days after discharge and frequency of major bleeding and/or clinically relevant nonmajor bleeding (CRNMB) defined according to the International Society on Thrombosis and Haemostasis criteria. Results: A total of 136 patients (59 females, median age 8 years) with confirmed MIS-C were included in this study. Forty-five patients (33%) were ≥12 years of age. Of 136 patients, 124 patients (91%) required intensive care unit (ICU) stay and 64 patients (47%) required a central venous catheter for a median duration of 5 days [Interquartile range (IQR) 4-7]. The median total hospital and ICU length of stays were 11 days [IQR 6-14] and 3 days [IQR 2-6], respectively. Prophylactic-dose enoxaparin was initiated in 119 patients (88%) who were deemed high-risk per our protocol at a median of 1 day after admission [IQR 0-3] achieving target levels at a median of 1 day [IQR 1-2]. The median first anti-Factor Xa level was 0.13 u/mL [IQR 0.05-0.19]. Only 1 patient (0.7%) developed symptomatic non-catheter related superficial vein thrombosis requiring therapeutic anticoagulation. There were no other TEs encountered in our cohort. Bleeding events occurred in 5 patients (4.2%). All bleeding events were considered CRNMB (gastrointestinal bleeding in 4 patients and epistaxis in 1 patient). There were no mortalities. Conclusion: Implementation of an institutional standardized thromboprophylaxis protocol in patients with MIS-C was feasible and led to timely initiation of prophylactic anticoagulation and low rates of TEs and bleeding complications.

Worry, Perceived Discrimination, Lifestyle Changes, and Protective Factors During COVID-19: A Study With Recovering Patients in Delhi, India

COVID-19 has affected people all over the world. For those who were infected by the virus, the repercussions go beyond immediate medical conditions to include social stigma, fear, uncertainty, and lifestyle changes. This study presents data collected as part of a mental health intervention (COVID Response) with individuals who had been diagnosed with coronavirus and had completed the minimum 14 days isolation period, in the city of Delhi, India. Through a survey conducted telephonically, participants self reported on six major mental health indicators: levels of worry, mood, lifestyle changes made through the phase of diagnosis and recovery, perceived discrimination faced due to the diagnosis, and the willingness to donate blood plasma. Descriptive findings show lower levels of worry than at the time of testing and diagnosis, positive mood states, and availability of social support. One Way Anova results further indicate that worry differed significantly across groups with differences in lifestyle changes, reported mood, availability of medical care, and the willingness to donate plasma. These findings contribute toward an informed understanding about recovery from coronavirus and sustainable coping with the pandemic, which can aid related health initiatives and evolving policy.

Towards an Open Global Air Quality Monitoring Platform to Assess Children's Exposure to Air Pollutants in the Light of COVID-19 Lockdowns

This ongoing work attempts to understand and address the requirements of UNICEF, a leading organization working in children's welfare, where they aim to tackle the problem of air quality for children at a global level. We are motivated by the lack of a proper model to account for heavily fluctuating air quality levels across the world in the wake of the COVID-19 pandemic, leading to uncertainty among public health professionals on the exact levels of children's exposure to air pollutants. We create an initial model as per the agency's requirement to generate insights through a combination of virtual meetups and online presentations. Our research team comprised of UNICEF's researchers and a group of volunteer data scientists. The presentations were delivered to a number of scientists and domain experts from UNICEF and community champions working with open data. We highlight their feedback and possible avenues to develop this research further.

Variation in US states' responses to COVID-19

US states continue to display significant variation in responses to COVID-19. This working paper updates the assessments of policy stringency by region, political leadership, and COVID-19 spread amid a critical policy moment in the US. We use OxCGRT indicators and aggregate stringency indices to describe variation in government responses, explore the relationship between government response and the rate of infection, and identify correlates of more or less intense responses. We find that Midwestern states, as well as Republican-voting states have less stringent policy measures overall, while Northeastern states have more stringent and longer lasting policies. We also apply the OxCGRT 'Risk of Openness Index' to the US context, showing high risk levels across all regions. In combination, this paper provides an overview of US states' COVID-19 policy action as well as unique applications of OxCGRT indicators and risk of openness index scores to inform policy making and research at this key moment in the US COVID-19 response.

A Demographic Study on the Purchase Pattern of Consumers with respect to Social Learning Theory during COVID-19 times

Shopping is a necessity in everyone's life. Mostly shopping is need based and sometimes it is a leisure activity in the form of entertainment. However when the condition leads to extreme buying situation resulting into destructive and harmful activity, then this is the result of Compulsive Buying Behaviour (CBB). While studying the consumer buying behaviour and process, the external stimuli is not the sufficient reason, to generate a response, rather the consumers' characteristics significantly influence the way they perceive the stimuli, utilize their internal processes and result in a specific buying behaviour. Hull (1951) developed a model as a behavioural model to explain the social learning theory: Stimulus — Response Model (S — R Model). Few of psychologist and marketing researchers tried to find out the characteristics of consumers within “black box” and analyze the impact of both factors to determine specific buying behaviour. In this research project we have tried to analyse Social Learning Theory with respect to the purchase pattern of the consumer in Kolkataduring the COVID-19 Pandemic. The respondents are mostly the parents who are influenced by their children to exert Compulsive Buying Behaviour. The collected responses will be analysed using one way ANOVA to find out which of the factors significantly influence purchase behaviour. The findings of the study will help the organisation to decide their marketing strategies. © 2021. Transnational Press London. All Rights Reserved.

Detection of face mask in real-time using convolutional neural networks and open-CV

The world has witnessed a major uproar in the year 2020 with the widespread transmission of COVID-19. The propensity for wearing a face mask has become essential as a countermeasure against the transmission of the infection particularly in open settings where keeping up with social distancing is not functional more often than not. As a result, wearing a face mask is crucial to curb the spread of the pandemic. This paper is concerned with a simplified approach for the detection of face mask in real-time using convolutional neural networks (CNN) and Open-CV. The proposed CNN model trains on a dataset of 12000 images of faces with and without mask using two convolutional layers and predicts on real-time video streams using the Haar cascade classifier of Open-CV. The model reported an accuracy score of 98.8% on the training set and 99.37% on the validation set using the CNN architecture without undergoing any problems of overfitting. © 2021 IEEE.

Adapting active case-finding for TB during the COVID-19 pandemic in Yogyakarta, Indonesia.

The COVID-19 pandemic and response measures, including lockdowns and the reorientation of health services, have disrupted essential health services for other diseases, including TB, HIV and malaria. For TB, reductions in case detection due to the COVID-19 pandemic are projected to result in increased TB transmission, morbidity and mortality. Active case-finding (ACF) for TB using community-based approaches is a potential strategy to offset reductions in TB detection by obviating the need for patients to seek care at a health facility. A number of approaches can be used to conduct TB ACF safely and screen designated target populations while managing the risks of SARS-CoV-2 transmission for staff, individuals and the community. We present a framework of options for and experience of adapting TB ACF services in response to the challenges of COVID-19 in our programme in Yogyakarta, Indonesia. Key changes have included revised prioritisation of target populations focusing on household contacts, reducing case-finding throughput, implementation of additional infection control measures and precautions, and integration of COVID-19 screening among those being screened for TB. Our approach could inform other programmes seeking to adapt TB ACF services to mitigate the negative impact of COVID-19 on TB case detection.

La pandémie de COVID-19 et les mesures de riposte incluant des confinements et une réorientation des services de santé ont perturbé les services de santé essentiels destinés aux autres maladies comme la TB, le VIH et le paludisme. En ce qui concerne la TB, les réductions de la détection des cas dues à la pandémie de COVID-19 devrait entraîner une augmentation de la transmission, morbidité et mortalité de la TB. La recherche active des cas (ACF) de TB grâce à des approches communautaires est une stratégie potentielle visant à compenser pour les réductions de détection de la TB en écartant le besoin pour les patients de solliciter des soins dans un structure de santé. Plusieurs approches peuvent être utilisées pour réaliser l'ACF TB de façon sûre et de dépister des populations cibles désignées tout en gérant les risques de transmission du SARS-CoV-2 pour le personnel, les individus et la communauté. Nous présentons un cadre d'options et d'expériences d'adaptation des services TB ACF en réponse aux défis du COVID-19 dans notre programme à Yogyakarta, Indonésie. Les changements majeurs ont inclus une révision des priorités des populations cibles focalisée sur les contacts domiciliaires ; une réduction de la cadence de la recherche de cas ; la mise en œuvre de mesures supplémentaires de lutte contre l'infection et de précautions ; et l'intégration du dépistage de COVID-19 parmi ceux dépistés pour la TB. Notre approche pourrait informer d'autres programmes voulant adapter les services TB ACF afin d'atténuer l'impact négatif du COVID-19 sur la détection des cas de TB.

SARS CoV-2-associated multisystem inflammatory syndrome of children (MIS-C) in the Washington DC metropolitan region

Background: Background: Multi-system Inflammatory Syndrome of Children (MIS-C) has recently emerged internationally as a serious inflammatory complication of SARS-CoV-2 infection with significant morbidity for the pediatric population. Methods: This observational retrospective cohort study includes 33 children meeting CDC criteria for MIS-C treated between March 15 and June 17, 2020 at Children's National Hospital in Washington DC. Clinical and demographic data were extracted from medical records and are summarized. Results: Of 33 hospitalized MIS-C patients, 42% were critically ill, and 58% were non-critically ill. The median age was 8.9 years (0.7-18.7 years). More males (58 %) than females (43 %) were represented in the MIS-C cohort. The majority (75%) of children had no underlying medical condition. Criteria for incomplete or complete Kawasaki Disease (KD) were present in 39% of patients, while an additional 9% had some features of KD. However the remaining 52% of MIS-C patients presented with other sub-phenotypes including prominent severe abdominal pain and/or nonspecific multiorgan dysfunction. 30% presented with shock requiring volume and/or inotropic support. SARS-CoV-2 antibodies were present in 61% of patients. Virus was detectable by PCR in 36% of patients. At the time of initial evaluation, 39% (13/33) of children had identified cardiac abnormalities including myocardial dysfunction (5/33;15%), coronary ectasia (4/33;12%), coronary aneurysm (3/33;9%), or pericardial effusion 5/33;15%) either alone or in combination. Cytokine profiling identified elevation of several cytokines in this cohort, including IL-6. Treatment has included intravenous immunoglobulin, aspirin, anakinra and other immunomodulatory therapies, with overall rapid response to therapy. No deaths have occurred. Conclusion: The emergence of MIS-C late in the surge of SARS-CoV-2 circulation in the Washington DC metropolitan region has added to the already significant burden of hospitalized and critically ill children in our region. A significant percentage of these children present with cardiac dysfunction and abnormalities, whether or not with KD features at presentation. Detailed characterization of immune responses and long term outcome of these patients is a priority.

P09.48 Experience and Outcome of COVID-19-Positive Lung Cancer Patients from a Eastern Indian Hospital

Introduction: The COVID-19 pandemic has caused unprecedented crisis in the care of non-Covid patients all across the globe and care for lung cancer patients is no exception. Lung Cancer patients are at increased risks of COVID due to increased mortality from dual aggressive pathology in the lungs. Our aim was to examine the impact of COVID-19 on lung cancer therapy and factors responsible delay in optimal care during the pandemic. Methods: This study included all patients with a diagnosis of lung cancer being treated at our Institute, a tertiary level referral hospital in eastern part of India during on going pandemic. Seven developed COVID-19, confirmed by RT-PCR method (Table 1). Results: The mean age of the patients was 49 years. All the patients had metastatic lung cancer. All males had history of smoking. Hypertension was present in only one patient. Four patients (57%) died from concomitant COVID-19 at our institution.Three patients who recovered from COVID were stable. One of them (positive for ROS1) was switched over to Crizotinib and other patient resumed chemotherapy only after he had recovered from COVID-19. Most of the patients acquired COVID-19 infection during the process of evaluatio/chemotherapy and that further delayed the treatment. [Formula presented] Conclusion: The results were disappointing because more than half of lung cancer patients died due to COVID-19. The disease course of COVID-19 has been more severe in patients with lung cancers with Chemotherapy. There have been delay in resuming treatment among survivors by few weeks. Fear of aggressiveness of disease was the key factor for interruption or delay in chemotherapy. Other variable factors like stage of cancer, palliative intent of chemotherapy, ECOG status were key determinants for interruption of treatment. The decision to temporarily suspend chemotherapy while waiting for recovery from SARS-CoV-2 and then restart, was not easy due to the risk of cancer progression. The findings amplify the importance of optimizing of lung cancer care in the context of the COVID-19 prevalence. The decisions need to be taken on the basis of individual cases rather than rely on a generalized approach. In resource limited country like India diverting the existing resources to an emergency leads to compromise of routine outpatient care, especially patients with chronic illness. We need to be flexible in restarting of services guided by local COVID prevalence, while awaiting a definite management plan for COVID-19. Keywords: lung cancer, India, COVID-19, SARS-CoV-2

DNA aptamers in COVID-19 research

Novel coronavirus (SARS-CoV-2), a variant of the severe acute respiratory syndrome (SARS) family has claimed around 1 million lives and more than 33 million people worldwide have been infected. It has been declared a pandemic by the World Health Organization. COVID-19 is transmitted mainly through aerosol droplets from patients (both asymptomatic and symptomatic) to healthy people. Its high rate of transmission demands a quick and early diagnosis of patients followed by urgent quarantine of those affected. Since the SARS-CoV-2 virus is mutating, it is of utmost importance to develop a quick diagnosis against it. The current techniques use either PCR-based methods or antibody-based ELISA methods for diagnosis, which are both time-consuming and expensive. This is the biggest impediment in large-scale diagnosis of COVID-19. Multiple biosensors based on antibodies and aptamers have been reported and tested. Aptamers seem much more lucrative due to ease of synthesis, cost-effectiveness and extremely high degree of sensitivity in terms of detection, less immunogenicity and robustness to modifications. We present the history and characterization of aptamers, their selection strategies and applications to multiple viruses such as HIV, HCV and SARS-CoV. However, to date, no aptamers have been designed against any of the protein components or the genomic RNA of SARS-CoV-2. Based on the success of aptamers against many viruses, we argue for the future exploration of aptamers in the context of SARS-CoV-2 diagnostic testing. © 2020. All Rights Reserved.

CAN DEVELOPING COUNTRIES HANDLE the MENTAL BURDEN DUE to the LOCKDOWN SITUATION? UNDERSTANDING the UNCERTAINTY and MANAGEMENT of COVID-19 PANDEMIC

BACKGROUND Coronavirus (Covid-19) pandemic can be referred to as a life-threatening war where every country is fighting with an invisible untold enemy. Realizing the disease severity and managing the prevention is crucial in current situations. Hence, it is time to follow the lockdown protocol until the situation improves worldwide. METHOD We have searched all the possible validated resources such as WHO, governmental data-sharing portal, news media, blogs, and existing empirical studies. We identified the significant inputs from social media platforms provided by healthcare entrepreneurs, clinicians, and interrelated different domain experts. Here we qualitatively narrated an in-depth understanding of the phenomena and proposed a few steps to deal with the mental burden in developing country context. RESULT There must be some effective strategy to reduce the mental burden and availability of the health consultancy services continuously to deal with such vulnerable situations. Telehealth is one such solution in a developed country where the healthcare system is well equipped to offer such services. CONCLUSIONS Here, we have presented a few proposed steps that can be adapted/practiced dealing with a similar situation in developing and densely populated nation like India. This approach may help to deal with such emergencies and challenges for healthcare management in lockdown conditions. © 2020 Australasian College of Health Service Management. All rights reserved.