Hiv Viral Load Suppression and Racial Disparities during the Covid-19 Pandemic in Nyc

Background: Antiretroviral therapy is highly effective in achieving HIV viral load suppression (VLS) but requires sustained engagement in care. The COVID-19 pandemic disrupted medical care, and its impact on engagement in HIV care and VLS remains unclear. Health information exchanges (HIEs) enable examination of patient care across multiple health systems. We sought to leverage HIE data to examine the effect of pandemic-related disruptions in HIV care on VLS and to explore racial/ethnic disparities in VLS. Method(s): We performed a retrospective observational study of people living with HIV (PLWH) using de-identified data from Healthix, an HIE encompassing >20 million patients and 8,000 healthcare facilities in the greater New York City (NYC) region, between 1/1/2018 and 7/14/2022. We identified PLWH based on HIV viral load (VL) tests and HIV diagnosis codes (ICD and SNOMED). We established two cohorts: PLWH engaged in care in 2020 with >=1 VL test in 2019, 2020, and 2021(Group A) and PLWH not engaged in care in 2020 with >=1 VL test in 2019 and 2021 but 0 VL tests in 2020 (Group B). HIV VLS outcomes were categorized as suppressed (< 200 copies/mL) or not suppressed ( >200 copies/mL) using the last VL in 2019, first VL in 2021, and last recorded VL. We compared proportions using X2-tests and fit a group-stratified logistic regression to examine the effect of race/ethnicity on VLS. Result(s): We identified 711,358 VL tests representing 81,122 patients at 249 facilities. Of these patients, 36,199 met our definition of PLWH. Of those, 12,448 met the inclusion criteria for Group A, and 3,377 met the inclusion criteria for Group B. In 2019, Group B had a lower VLS proportion than Group A (85.9% vs 88.1%, X2 = 12.3, p< 0.0001). In 2021, this gap increased;the proportion of VLS was 80.7% in Group B and 88.0% in Group A (X2 = 121.8, p< 0.00001). Most recently, VLS in Group B had increased to 85.6%, but the inter-group gap in VLS had grown from 2.2% to 4.4%. Within both groups, Black and Hispanic patients had lower odds of VLS than white patients. This disparity was greatest in Group B when they reengaged in care in 2021, with 72.0% of Black patients (OR 0.30, 95% CI 0.22-0.42), and 79.1% of Hispanic patients (OR 0.45, 95% CI 0.31-0.63), compared to 89.5% of white patients achieving VLS. Conclusion(s): VLS remained high among PLWH who stayed engaged in care in 2020, dropped among PLWH who disengaged in care, and was lower in minoritized groups even after controlling for engagement in care.

A feasibility randomised trial comparing therapeutic thoracentesis to chest tube insertion for the management of pleural infection: results from the ACTion trial

Background: Pleural infection has a considerable healthcare burden with an average hospital stay of 14 days. There have been no randomised trials on the use of therapeutic thoracentesis (TT) for initial pleural fluid drainage. Aim(s): To assess the feasibility of a full-scale trial of chest tube vs TT for pleural infection. The primary outcome was defined as the acceptability of randomisation (ad priori defined as successful if >=50% of eligible patients were randomised). Method(s): Adult patients admitted with a pleural effusion related to infection and meeting recognised criteria for drainage were eligible. Participants were randomised (unblinded) to chest tube insertion or TT. Patients were followed up at 90 days. Result(s): From September 2019 and June 2021, 51 patients were diagnosed with complex parapneumonic effusion/empyema. Eleven patients met the inclusion criteria for trial and 10 patients were randomised (91%). The COVID-19 pandemic had a significant impact on recruitment. Patients randomised to TT had a shorter overall mean hospital stay (5.4 days, SD 5.1) compared to the chest tube control group (13 days, SD 6.0), p=0.04. Total number of pleural procedures required per patient were similar, 1.2 in chest tube group and 1.4 in TT group. No patients required surgical referral. Adverse events were similar between the groups with no readmissions related to pleural infection. Data completeness was high with no protocol deviations. Conclusion(s): The ACTion trial met its prespecified feasibility criteria for patient acceptability. The suggestion that TT can reduce hospital length of stay requires further investigation.

Worker Participation in a Time of COVID: A Case Study of Occupational Health and Safety Regulation in Ontario

This study examines worker voice in the development and implementation of safety plans or protocols for COVID-19 prevention among hospital workers, long-term care workers, and education workers in the Canadian province of Ontario. Although Ontario occupational health and safety law and official public health policy appear to recognize the need for active consultation with workers and labour unions, there were limited - and in some cases no - efforts by employers to meaningfully involve workers, worker representatives (reps), or union officials in assessing COVID-19 risks and planning protection and prevention measures. The political and legal efforts of workers and unions to assert their right to participate and the outcomes of those efforts are also documented through archival evidence and interviews with worker reps and union officials. The article concludes with an assessment of weaknesses in the government promotion and protection of worker health and safety rights and calls for greater labour attention to the critical importance of worker health and safety representation.

Stool donor screening eligibility and retention with a Therapeutic Goods Order 105-compliant stool donor screening program for fecal microbiota transplantation

Background and Aim: The Australian Therapeutic Goods Administration (TGA) released Therapeutic Goods (Standard for Faecal Microbiota Transplant Products) (TGO 105) Order 2020 as a regulatory framework for fecal microbiota transplantation in Australia in September 2020. BiomeBank established a stool donor screening program and quality management system to produce fecal microbiota transplants as a Class 2 Biological;however, the feasibility of such a screening program was unknown. The aim of this study was to assess the eligibility and retention rates of potential stool donors over a 12-month period. Method(s): Stool donors were recruited in Adelaide through local flyers, targeted online advertising, and word of mouth. Data on the donor screening program were prospectively collected, including donor demographic details, screening and stool donation results at each stage of the screening, and donation process from 1 January to 31 December 2021. Result(s): Of 135 enquiries to the stool donor program during 2021, 55 people were excluded based on age and distance from the collection center. The remaining 80 potential donors were sent a donor screening questionnaire, and 65/80 (81.3%) were deemed ineligible based on established donor screening criteria. The remaining 15 potential donors (11%) underwent physician assessment, 11 (73.3%) of whom passed and progressed to blood, swab, and stool testing. Two of the remaining potential donors failed screening tests (with positive stool screening tests for an extended-spectrum beta lactamase-producing organism, one of whom also tested positive for hepatitis B core antibody on blood), and a third did not complete testing. The final outcome was eight new stool donors (5.9% of initial enquiries) being enrolled in the donor program in 2021. This was in addition to two donors who carried over from 2020. The median age of donors was 36.9 years (range, 27.6-47.1), and 50% of donors were female. The mean weight of accepted donations was higher for male than female donors (212 vs 120 g;P < 0.001). The median number of donations processed per donor was 7.0 (IQR, 1.8-28.8), the median number of 8-week donation periods per donor was 2.5 (IQR, 1-6), and the median number of donations processed per 60-day donation period was 3.2 (IQR, 1-5.1). There were 21 donated samples that were rejected due to issues detected on the day of donation (n = 14) or being too small to process (n = 7). In terms of donor retention in the program, half the donors (5/10) were retained at the end of 2021, with discontinuation being the result of personal choice, poor engagement, or ineligible occupation. In addition, 60% of the donors (6/10) incurred a total of seven temporary suspensions during the year due to various factors: antibiotic exposure (n = 2), ineligible medication (n = 1), gastroenteritis (n = 1), upper respiratory tract infection (n = 1), COVID-19 exposure risk (n = 1), and raw oyster ingestion (n = 1). Conclusion(s): A minority of potential stool donors are eligible to become stool donors. In addition, retention of donors in the program and maximizing the yield from a donation period were difficult due to strict donor screening criteria, frequent exposures to common pathogens, and the ongoing commitment required from donors. Despite this, BiomeBank was able to produce fecal microbiota transplants under the TGA-regulated Class 2 Biologicals framework and meet increasing demand for this product in Australia using a rigorous donor screening program.

Understanding the Health care Needs of Migrant Children in Government Custody

Background: There are increasing numbers of immigrant children held in government custody at the US-Mexico border and across the US. Further, anti-immigrant policies and the US COVID-19 pandemic response exacerbated detention conditions under the Trump administration. Thus, there is a greater need to identify the health concerns and challenges clinicians face when caring for these children. Methods: A national cross-sectional 66- question online survey was distributed from October 2020 to January 2021 through national pediatric and migrant health listservs including the Academy of Pediatrics (AAP). The reported total number of listserv members was 6200, but the degree of redundancy among these groups was not able to be assessed. Clinicians were asked about care delays, health problems encountered, and resources needed while caring for children under government custody. “Children in government custody” was defined as children (0-17 years) who currently or previously (in the past 5 years) were under the custody of the US Immigration Customs Enforcement, Customs Border Protection and/or the Office of Refugee and Resettlement. Results: Eightytwo clinicians responded and cared for children clinically. Thirty four cared for children who were in government custody. About 1/3 of this subset of respondents noted care delays while in custody and delays in establishing primary care after custody release. The two main health issues seen were a lack of routine health maintenance and traumatic exposures. Most commonly, children were behind on vaccinations and needed mental health screening. Exposure to violence was the most common traumatic exposure. Furthermore, 47% of clinicians felt that their current resources were inadequate and requested legal assistance and mental health support. Importantly, 58% of respondents were not aware of or were unsure of the Centers for Disease Control and Prevention domestic refugee health guidelines for the care of migrant children and adults. Conclusion: Children who experience detention have significant healthcare needs, many of which clinicians do not feel equipped to address. The reported health complications emphasize the need for policy measures, such as those recommended by the AAP, namely, the provision of evidence-based medical evaluations, trauma-informed care, and family-centered medical homes with comprehensive primary care and embedded mental health and legal support systems. Child detention should end. If present, children should be released to ORR shelters with pediatric clinicians providing healthcare and oversite until children can be safely released to vetted legal guardians and established in medical homes. This process should be swift with improved integration of detainment and post-detainment healthcare. Clinicians can be supported with training on immigrant screening guidelines. Of note, the low response rate and inability to distinguish between ICE, CBP, and ORR on the survey limits these results. Nonetheless, these findings support further research and recommendations for policy changes to improve the health and well-being of newly-arrived immigrant children.

COVID Response: A Blended Approach to Studying Sanitizer Station Deployment at a Large Public University

We present a blended approach to integrate qualitative human factors and quantitative operations research modeling to understand how Clemson University adapted to the challenges of the COVID-19 pandemic. We focus primarily on the strategic deployment of hand sanitizer stations to reduce transmission of the virus. We identify key adaptations and effective coordination amongst various departments during the crisis. We describe how the qualitative data influenced our development of a discrete facility location covering model and use the model to select optimal locations for dispenser stations. Future plans include further model development, providing model-informed redeployment recommendations in preparation for the Fall 2021 semester, and tactical planning. The blended approach can be broadly applied to understand and improve resiliency decisions in other contexts.

Risks for Hospitalization and Death Among Patients with Blood Disorders from the ASH RC COVID-19 Registry for Hematology

INTRODUCTION: Patients (pts) with blood disorders are at particular risk for severe infection and death from COVID-19. Factors that contribute to this risk, including cancer treatment, have not been clearly delineated. The ASH RC COVID-19 Registry for Hematology is a public-facing, volunteer registry reporting outcomes of COVID-19 infection in pts with underlying blood disorders. We report a multivariable analysis of the impact of cancer treatment and other key variables on COVID-19 mortality and hospitalization among pts with blood cancer. METHODS: Data were collected between April 1, 2020, and July 2, 2021. All analyses were performed using R version 4.0.2. Multivariable logistic regression explored associations between mortality and seven patient/disease factors previously reported as important to COVID-19 outcome. Independent variables included: age (>60);sex;presence of a major comorbidity (defined as any of heart disease, hypertension, pulmonary disease and/or diabetes);type of hematologic malignancy;estimated prognosis of < 6 months prior to COVID-19;deferral of ICU care;and administration of cancer treatment in the previous year (excluding single agent hydroxyurea). A secondary multivariable logistic regression explored associations between the same variables and hospitalization with COVID-19. RESULTS: We included all pts in the registry with a malignant diagnosis except for 3 patients excluded based on a data sharing agreement (N=1029). Median age category was 50-59y (range <5y to > 90y). The sample was 42% female and 28% had major comorbidities. Types of hematologic malignancies were 354 (34%) acute leukemia/MDS, 255 (25%) lymphoma, 206 (20%) plasma cell dyscrasia (myeloma/amyloid/POEMS), 116 (11%) CLL, 98 (10%) myeloproliferative neoplasm (MPN). Most pts (73%) received cancer treatment during the previous year, 9% had a pre-COVID-19 prognosis of <6months, and 10% deferred ICU care. COVID-19 mortality in the entire cohort was 17%. In multivariable analyses, age > 60 (OR 2.03, 1.31-3.18), male sex (OR 1.69, 1.11 - 2.61), estimated pre-COVID-19 prognosis of less than 6 months (OR 6.16, 3.26 - 11.70) and ICU deferral (OR 10.87, 6.36 - 18.96) were all independently associated with an increased risk of death. Receiving cancer treatment in the year prior to COVID-19 diagnosis and type of hematologic malignancy were not significantly associated with death. In multivariable analyses, age > 60 (OR 2.46, 1.83 - 3.31), male sex (OR 1.34, 1.02 - 1.76), estimated pre-COVID-19 prognosis of < 6 months (OR 4.81, 2.45 - 10.50), presence of a major comorbidity (OR 1.57, 1.15 - 2.16), and cancer treatment in the previous year (OR 1.50, 1.10 - 2.06) were all independently associated with an increased risk of a severe COVID-19 requiring hospitalization. Pts with a MPN or plasma cell dyscrasia and COVID-19 were less likely to require hospitalization for COVID-19 compared to patients with CLL, leukemia/MDS, or lymphoma. CONCLUSIONS: These analyses confirm the negative impact of age > 60, male sex, pre-COVID-19 prognosis of < 6 months, and deferral of ICU care on mortality among patients with hematologic malignancy and COVID-19. We did not observe an increased risk of COVID-19 mortality among pts with COVID-19 who received blood cancer treatment in the previous year, although rate of hospitalization was higher. Pts with some hematologic malignancies (MPN, plasma cell dyscrasias), may experience less severe COVID-19 infections than others. Disclosures: Anderson: Celgene: Membership on an entity's Board of Directors or advisory committees;Millenium-Takeda: Membership on an entity's Board of Directors or advisory committees;Gilead: Membership on an entity's Board of Directors or advisory committees;Janssen: Membership on an entity's Board of Directors or advisory committees;Sanofi-Aventis: Membership on an entity's Board of Directors or advisory committees;Bristol Myers Squibb: Membership on an entity's Board of Directors or advisory committees;Pfizer: Membership on an entity's Board of Directors or advisory committees;Scientific Founder of Oncopep and C4 Therapeutics: Current equity holder in publicly-traded company, Current holder of individual stocks in a privately-held company;AstraZeneca: Membership on an entity's Board of Directors or advisory committees;Mana Therapeutics: Membership on an entity's Board of Directors or advisory committees. Desai: Janssen R&D: Research Funding;Astex: Research Funding;Kura Oncology: Consultancy;Agios: Consultancy;Bristol Myers Squibb: Consultancy;Takeda: Consultancy. Goldberg: Celularity: Research Funding;Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees;Astellas: Consultancy, Membership on an entity's Board of Directors or advisory committees;Aptose: Consultancy, Research Funding;Prelude Therapeutics: Research Funding;DAVA Oncology: Honoraria;Pfizer: Research Funding;Arog: Research Funding;Aprea: Research Funding;AbbVie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding. Neuberg: Madrigal Pharmaceuticals: Other: Stock ownership;Pharmacyclics: Research Funding. Radhakrishnan: Janssen India: Honoraria;Dr Reddy's Laboratories: Honoraria, Membership on an entity's Board of Directors or advisory committees;Aurigene: Speakers Bureau;Novartis: Honoraria;Johnson and Johnson: Honoraria;Pfizer: Consultancy, Honoraria;Astrazeneca: Consultancy, Honoraria;Emcure Pharmaceuticals: Other: payment to institute;Cipla Pharmaceuticals: Honoraria, Other: payment to institute;Bristol Myers Squibb: Other: payment to institute;Roche: Honoraria, Other: payment to institute;Intas Pharmaceutical: Other: payment to institute;NATCO Pharmaceuticals: Research Funding. Sehn: Genmab: Consultancy;Debiopharm: Consultancy;Novartis: Consultancy. Sekeres: Novartis: Membership on an entity's Board of Directors or advisory committees;Takeda/Millenium: Membership on an entity's Board of Directors or advisory committees;BMS: Membership on an entity's Board of Directors or advisory committees. Tallman: Kura: Membership on an entity's Board of Directors or advisory committees;Syros: Membership on an entity's Board of Directors or advisory committees;Innate Pharma: Membership on an entity's Board of Directors or advisory committees;Novartis: Membership on an entity's Board of Directors or advisory committees;Biosight: Membership on an entity's Board of Directors or advisory committees;Roche: Membership on an entity's Board of Directors or advisory committees;Jazz Pharma: Membership on an entity's Board of Directors or advisory committees;Oncolyze: Membership on an entity's Board of Directors or advisory committees;KAHR: Membership on an entity's Board of Directors or advisory committees;Orsenix: Membership on an entity's Board of Directors or advisory committees;Daiichi-Sankyo: Membership on an entity's Board of Directors or advisory committees;Abbvie: Membership on an entity's Board of Directors or advisory committees;Amgen: Research Funding;Rafael Pharmaceuticals: Research Funding;Glycomimetics: Research Funding;Biosight: Research Funding;Orsenix: Research Funding;Abbvie: Research Funding;NYU Grand Rounds: Honoraria;Mayo Clinic: Honoraria;UC DAVIS: Honoraria;Northwell Grand Rounds: Honoraria;NYU Grand Rounds: Honoraria;Danbury Hospital Tumor Board: Honoraria;Acute Leukemia Forum: Honoraria;Miami Leukemia Symposium: Honoraria;New Orleans Cancer Symposium: Honoraria;ASH: Honoraria;NCCN: Honoraria.

Clinical Predictors of Outcome in Adult Patients with Acute Leukemias and Myelodysplastic Syndrome and COVID-19 Infection: Report from the American Society of Hematology Research Collaborative (ASH RC) Data Hub

Background: Predictors of severe infection and outcomes with COVID-19 in patients (pts) with acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL) and myelodysplastic syndromes (MDS) are lacking. Pts with active disease may experience worse outcomes due to overall prognosis and cytopenias. Here we identify risk factors for severe COVID-19 infection and mortality in pts with AML, MDS, and ALL using the ASH RC COVID-19 Registry for Hematology. Methods: The ASH RC COVID-19 Registry for Hematology includes features and outcomes of a laboratory-confirmed or presumptive diagnosis of SARS-CoV-2 infection in adult pts with ongoing or a history of blood disorders. The Registry opened for data collection on April 1, 2020 and is a global effort housed on a secure data platform hosted by Prometheus Research, an IQVIA company. Data are made publicly available and regularly updated on the ASH RC website. Pt characteristics, outcomes, and predictors were analyzed and stratified by disease status (active initial diagnosis and relapsed/refractory vs. remission) and type of hematologic malignancy. Variables included age, comorbidities, type of hematologic malignancy (AML, MDS, ALL), neutrophil and lymphocyte count at time of COVID-19 diagnosis, and active treatment at the time of COVID-19 diagnosis. COVID-19 severity was defined as mild (no hospitalization required), moderate (hospitalization required), or severe (ICU admission required). Categorical pt characteristics for each response group and associations between response groups and characteristics (i.e., alive vs. dead, severity vs. non-severity) were summarized by frequency with differences between response groups evaluated by Fisher's exact test and odds ratios with 95% confidence intervals (CIs) estimated by logistic regression. Multivariable analyses identified independent predictors of outcomes. Results: Analyses were conducted on data from 257 pts with AML (n=135), MDS (n=40), and ALL (n=82);46% were in remission and 44% had active disease (10% unknown). Overall mortality from COVID-19 infection was 21%. Pts with active disease were significantly more likely to present with moderate and severe COVID-19 compared to those in remission (remission vs. active disease, severe 33% (n=20) vs. 67%(n=40), moderate 45% (n=35) vs.55% (n=42), and mild: 67% (n=56) vs. 33% (n=28), p value <0.001) (Figure 1). This was significant when categorized as severe vs. non severe as well (p=0.002). COVID-19 severity was also associated with AML diagnosis, major comorbidities, and neutropenia and lymphopenia at the time of COVID-19 diagnosis. Univariate analyses of increased mortality after COVID-19 diagnosis were significantly associated with advanced age, male sex, pre-diagnosis survival < 6 months, active disease status, neutropenia, lymphopenia and forgoing ICU care. Multivariable analyses in all pts (Figure 1), revealed that increased COVID-19 related mortality was significantly associated with neutropenia at diagnosis (OR 3.15, 95% C.I. 1.31-8.08, p=0.01), estimated pre-COVID-19 prognosis of < 6 months (OR 8.58, 95% C.I. 3.24-24.46, p<0.001) and forgoing ICU care (OR 6.66, 95% C.I. 2.56-18.23, p<0.001). Among hospitalized pts, increased COVID-19 mortality was associated with estimated pre-COVID-19 prognosis of < 6 months (OR 6.77, 95% C.I. 2.34-22.24, p<0.001) and forgoing ICU care (OR 3.98, 95% C.I. 1.45-11.66, p=0.007). Pts who were older, male, smokers, with active disease, or estimated to have pre-COVID-19 survival of < 6 months were more likely to forgo ICU care. Forgoing ICU care (n=37,16%) was associated with a higher COVID-19 mortality in all pts (n=234, OR 15.6, 95% C.I. 6.4-40.9, p<0.001), hospitalized pts (n=143, OR 9.2, 95% C.I., 3.5-26.5, p<0.001) and in pts where ICU admission was indicated and declined (n=61 OR 5.6, 95% C.I. 1.1-56.4, p=0.03)). Neither active disease status nor ongoing cancer treatment were associated with increased mortality among hospitalized patients. Conclusions: These data suggest that patients with active disease experience significantly higher COVID-19 severity but not increased mortality from COVID-19. Patients who had neutropenia and a pre-COVID-19 prognosis of < 6 months had higher mortality from COVID-19 infection and may be more likely to forgo ICU care. If desired by patients, aggressive support for hospitalized patients with COVID-19 is appropriate regardless of remission status. [Formula presented] Disclosures: Desai: Agios: Consultancy;Janssen R&D: Research Funding;Kura Oncology: Consultancy;Bristol Myers Squibb: Consultancy;Astex: Research Funding;Takeda: Consultancy. Goldberg: AbbVie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;Aprea: Research Funding;Prelude Therapeutics: Research Funding;Pfizer: Research Funding;Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees;DAVA Oncology: Honoraria;Astellas: Consultancy, Membership on an entity's Board of Directors or advisory committees;Arog: Research Funding;Celularity: Research Funding;Aptose: Consultancy, Research Funding. Anderson: Sanofi-Aventis: Membership on an entity's Board of Directors or advisory committees;Celgene: Membership on an entity's Board of Directors or advisory committees;Gilead: Membership on an entity's Board of Directors or advisory committees;Janssen: Membership on an entity's Board of Directors or advisory committees;Bristol Myers Squibb: Membership on an entity's Board of Directors or advisory committees;Pfizer: Membership on an entity's Board of Directors or advisory committees;Millenium-Takeda: Membership on an entity's Board of Directors or advisory committees;Scientific Founder of Oncopep and C4 Therapeutics: Current equity holder in publicly-traded company, Current holder of individual stocks in a privately-held company;AstraZeneca: Membership on an entity's Board of Directors or advisory committees;Mana Therapeutics: Membership on an entity's Board of Directors or advisory committees. Neuberg: Pharmacyclics: Research Funding;Madrigal Pharmaceuticals: Other: Stock ownership. Radhakrishnan: Emcure Pharmaceuticals: Other: payment to institute;Bristol Myers Squibb: Other: payment to institute;Astrazeneca: Consultancy, Honoraria;Cipla Pharmaceuticals: Honoraria, Other: payment to institute;Pfizer: Consultancy, Honoraria;Johnson and Johnson: Honoraria;Novartis: Honoraria;Aurigene: Speakers Bureau;Roche: Honoraria, Other: payment to institute;Intas Pharmaceutical: Other: payment to institute;Dr Reddy's Laboratories: Honoraria, Membership on an entity's Board of Directors or advisory committees;Janssen India: Honoraria;NATCO Pharmaceuticals: Research Funding. Roboz: Novartis: Consultancy;Mesoblast: Consultancy;Amgen: Consultancy;Actinium: Consultancy;AbbVie: Consultancy;Janssen: Consultancy;Blueprint Medicines: Consultancy;Astex: Consultancy;Janssen: Research Funding;Daiichi Sankyo: Consultancy;Jazz: Consultancy;Agios: Consultancy;Glaxo SmithKline: Consultancy;Celgene: Consultancy;Otsuka: Consultancy;Astellas: Consultancy;Helsinn: Consultancy;MEI Pharma - IDMC Chair: Consultancy;Jasper Therapeutics: Consultancy;Bristol Myers Squibb: Consultancy;AstraZeneca: Consultancy;Bayer: Consultancy;Pfizer: Consultancy;Roche/Genentech: Consultancy. Sehn: Novartis: Consultancy;Genmab: Consultancy;Debiopharm: Consultancy. Sekeres: Takeda/Millenium: Membership on an entity's Board of Directors or advisory committees;Novartis: Membership on an entity's Board of Directors or advisory committees;BMS: Membership on an entity's Board of Directors or advisory committees. Tallman: Syros: Membership on an entity's Board of Directors or advisory committees;Kura: Membership on an entity's Board of Directors or advisory committees;NYU Grand Rounds: Honoraria;Innate Pharma: Membership on an entity's Board of Directors or advisory committees;Novartis: Membership on an entity's Board of Directors or advisory committees;Biosight: Membership on an entity's Board of Directors or advisory committees;Roche: Membership on an entity's Board of Directors or advisory committees;Jazz Pharma: Membership on an entity's Board of Directors or advisory committees;Oncolyze: Membership on an entity's Board of Directors or advisory committees;KAHR: Membership on an entity's Board of Directors or advisory committees;Orsenix: Membership on an entity's Board of Directors or advisory committees;Daiichi-Sankyo: Membership on an entity's Board of Directors or advisory committees;Abbvie: Membership on an entity's Board of Directors or advisory committees;Amgen: Research Funding;Rafael Pharmaceuticals: Research Funding;Glycomimetics: Research Funding;Biosight: Research Funding;Orsenix: Research Funding;Abbvie: Research Funding;Mayo Clinic: Honoraria;UC DAVIS: Honoraria;Northwell Grand Rounds: Honoraria;NYU Grand Rounds: Honoraria;Danbury Hospital Tumor Board: Honoraria;Acute Leukemia Forum: Honoraria;Miami Leukemia Symposium: Honoraria;New Orleans Cancer Symposium: Honoraria;ASH: Honoraria;NCCN: Honoraria. Wood: Pfizer: Research Funding;Teladoc: Consultancy;Koneksa Health: Consultancy, Current equity holder in publicly-traded company.

Management of Critically Ill Pregnant Patients with COVID-19 Infection in a Rural State.

OBJECTIVE: There is limited data on the treatment of coronavirus disease 2019 (COVID-19) in pregnancy. Arkansas saw an increase in COVID-19 cases in June 2020. The first critically ill pregnant patient was admitted to our institution on May 21st, 2020. The objective of this study was to evaluate outcomes in critically ill pregnant women with COVID-19 at a single tertiary care center who received remdesivir and convalescent plasma (CCP). STUDY DESIGN: This is a retrospective observational review of critically ill pregnant women with COVID-19 who received remdesivir and CCP. This study was approved by the institutional review board (#261354). RESULTS: Seven pregnant patients with COVID-19 were admitted to the intensive care unit (ICU). All received remdesivir and CCP. Six received dexamethasone. The median ICU length of stay (LOS) was 8 days (range 3-17). Patient 1 had multi-organ failure requiring vasopressors, renal dialysis, and had an intrauterine fetal demise. Patients 4 and 6 required mechanical ventilation, were delivered for respiratory distress and were extubated at 2 and 1 days postpartum, respectively. The only common risk factor was obesity. There were no adverse events noted with remdesivir or CCP. CONCLUSION: There is little data regarding the use of remdesivir or CCP for the treatment of COVID-19 in pregnant women. In our cohort, these were well tolerated with no adverse events. Previously reported median ICU LOS in critically ill pregnant women with COVID-19 was 8 days (range 4-15).1 Our study found a similar ICU LOS (8 days; range 3-17). Patient 1 did not receive remdesivir or CCP until transport to our facility on hospital day 3. Excluding patient 1, median ICU LOS was 6.5 days (range 3-9). Our institution's treatment of pregnant women with critical illness with remdesivir, CCP and dexamethasone combined with delivery in select cases has thus far had good outcomes. KEY POINTS: · Combined therapy: remdesivir, CCP, dexamethasone.. · Remdesivir, CCP and dexamethasone was effective in treating critically ill pregnant women with COVID-19.. · No adverse events were associated with combined therapy.. · Delivery improved respiratory status..

Two Epidemics and a Pandemic: The Collision of Prescription Drug Misuse and Racism during COVID-19.

The present study investigated the relationship between perceived racial discrimination and prescription drug misuse (PDM) among Asian, Black, and Latinx Americans during the COVID-19 crisis. U.S. racial/ethnic minorities may have been uniquely affected by two national and one global pandemic: the opioid crisis, racism, and COVID-19. Opioid death rates increased among many groups prior to the pandemic. This country witnessed an increase in racialized acts against people of color across the spectrum in the spring and summer months of the world's COVID-19 outbreak. While studies have shown a clear link between perceived racial discrimination and substance abuse outside of the global pandemic, no identified studies have done so against the backdrop of a global health pandemic. Separate hierarchical regressions revealed a significant association between perceived racial discrimination and PDM for Black Americans, Asian Americans, and Latinx individuals. Findings build on the scant literature on PDM in diverse samples and establish a relationship between perceived racial discrimination and PDM, as previously identified for other abused substances. Future post-pandemic substance misuse interventions should consider the influence of perceived racial discrimination as they help individuals recover from the aftermath of this stressful trifecta.