3rd Wave Research Articles

COVID-19 infections in day care centres in Germany: social and organisational determinants of infections in children and staff in the second and third wave of the pandemic

BackgroundDuring the SARS-CoV-2 pandemic, German early childhood education and care (ECEC) centres organised children’s attendance in different ways, they reduced opening hours, provided emergency support for a few children, or closed completely. Further, protection and hygiene measures like fixed children-staff groups, ventilation and surface disinfection were introduced in ECEC centres. To inform or modify public health measures in ECEC, we investigate the occurrence of SARS-CoV-2 infections among children and staff in ECEC centres in light of social determinants (i.e. the socioeconomic status of the children) and recommended structural and hygiene measures. We focus on the question if the relevant factors differ between the 2nd (when no variant of concern (VOC) circulated) and the 3rd wave (when VOC B.1.1.7 (Alpha) predominated).MethodsBased on panel data from a weekly online survey of ECEC centre managers (calendar week 36/2020 to 22/2021, ongoing) including approx. 8500 centres, we estimate the number of SARS-CoV-2 infections in children and staff using random-effect-within-between (REWB) panel models for count data in the 2nd and 3rd wave.ResultsECEC centres with a high proportion of children with low socioeconomic status (SES) have a higher risk of infections in staff and children. Strict contact restrictions between groups like fixed group assignments for children and fixed staff assignments to groups prevent infections. Both effects tend to be stronger in the 3rd wave.ConclusionECEC centres with a large proportion of children with a low SES background and lack of using fixed child/staff cohorts experience higher COVID-19 rates. Over the long run, centres should be supported in maintaining recommended measures. Preventive measures such as the vaccination of staff should be prioritised in centres with large proportions of low SES children.

Latitude impact on pandemic Sars-Cov-2 2020 outbreaks and possible utility of UV indexes in predictions of regional daily infections and deaths

The importance of two related factors _ latitude and solar ultraviolet radiation _ has been insufficiently recognized as determining the spread of pandemic Sars-CoV-2 outbreaks across the globe. In this study we provide evidence of the impact of latitude and investigate how daily RT-PCR diagnosed infections and deaths are quantitively correlated with the UV component of solar light. Here, we present regression analyses using daily national numbers from Austria and from Portugal with daily ultraviolet indexes of two selected locations in these territories, obtained from a satellite source. These countries, have similar surfaces areas and population size but Austria's mean latitude is 9° up-north. The equations derived from regression analyses of those two variables are comparable for both countries, fit best the fall (2nd) pandemic wave and can be a useful non-R(t) (ratio of transmission at a particular time) dependent predictive tool. Similar equations were derived for deaths that follow infections within a few weeks delay. Strong correlations depend on the size of the region/country from which infections are collected, the robustness of screening practices, ideally kept through weekends and holidays. Besides the forecasting usefulness of such correlations, these findings also suggest that covid-19 transmission co-exists with a Sars-Cov-2 specific UV-induced immunosuppression response. While in 2020, intensity of pandemic spring and fall waves reflect a solar UV-light modulation, we relate exceptional low temperature and humidity with additional waves, as the winter 2020/2021 3rd wave, felt in the western European countries. This work may help understanding this Pandemic phenomenon and dealing with similar catastrophes in the future.

COVID-19 and endoscopy services

Die Pandemie durch die Coronaviruserkrankung 2019 (COVID-19) hat im Jahr 2020 initial zu einem erheblichen Rückgang elektiver Endoskopien in Deutschland geführt. Maßgeblich hierfür waren besonders der harte Lockdown sowie der Mangel an Schutzausrüstung (PSA) und Testverfahren. Seither erschienen internationale Empfehlungen der Fachgesellschaften zum Infektionsschutz in der Endoskopie. Inwieweit diese in Deutschland umgesetzt wurden, ist unklar: Während der 2. und 3. Welle 2020/2021 blieben die meisten Endoskopieeinheiten geöffnet und wenden seither zahlreiche Schutzmaßnahmen an. Ein einheitliches „Standardvorgehen“ ist bisher nicht publiziert. Die genaue Rolle und Effektivität von Testverfahren zum Schutz von Patienten und Personal während der Endoskopie war bisher nicht bekannt, verlässliche Zahlen über in Endoskopieeinrichtungen in Deutschland erworbene/weitergegebene Infektionen bei Personal und Patienten fehlten bisher. Wichtigstes Ergebnis der Arbeit ist nun die ermittelte COVID-19-Rate in endoskopierenden Einrichtungen. Die Daten zeigen, dass die Infektionsrate bei Mitarbeitern in deutschen Kliniken und Praxen Anfang 2021 im Mittel bis 5 % betrug; die meisten dieser Infektionen wurden im privaten Umfeld erworben. Kliniken mit gastroenterologischer Endoskopie hatten signifikant mehr Infektionsübertragungen (10 %) als z. B. Zahnarzt- und Hals-Nasen-Ohren-Praxen. Daher sind besonders hier zukünftig weiterhin Schutzmaßnahmen nötig. Die wichtigsten Faktoren für die Infektionssicherheit sind vollständig geimpfte (oder genesene) Mitarbeiter und Patienten („2-G“), eine abnehmende Prävalenz von Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) sowie die Anwendung von PSA und – allerdings kontrovers diskutiert – die Durchführung konsequenter Screeningtests.

PPE pollution in the terrestrial and aquatic environment of the Chittagong city area associated with the COVID-19 pandemic and concomitant health implications.

The present study focuses on the indiscriminate disposal of personal protective equipment (PPEs) and resulting environmental contamination during the 3rd wave of COVID-19-driven global pandemic in the Chittagong metropolitan area, Bangladesh. Because of the very high rate of infection by the delta variant of this virus, the use of PPEs by the public is increased significantly to protect the ingestion/inhalation of respiratory droplets in the air. However, it is a matter of solicitude that general people throw away the PPEs to the dwelling environment unconsciously. With the increase of inappropriate disposal of PPEs (i.e., mostly the disposable face masks made from plastic microfibers), the possibility of transmission of the virus to the general public cannot be neglected completely. This is because this virus can survive for several days on the inanimate matter like plastics and fibers. At the same time, the result of environmental contamination by microplastic/microfiber has been widespread which eventually creates the worst impact on ecosystems and organisms. The present results may help to increase public perception of the use and subsequent disposal of PPEs, especially the face masks.

Treatment outcomes in Polish COVID-19 patients requiring hospitalisation in the intensive care unit: asingle-centre retrospective study.

COVID-19 has disturbed the functioning of Polish healthcare for the past two years. Due to the high proportion of patients requiring admission to the intensive care unit (ICU), these wards are particularly overwhelmed and are considered the bottleneck of the healthcare system. The aim of this study was to describe clinical outcomes of critically ill patients treated in a single tertiary ICU in Poland, assess factors associated with mortality and compare outcomes of patients treated during the 2nd and 3rd waves of the pandemic. This is a retrospective single-centre study including patients admitted to the ICU between October 2020 and May 2021 (the 3rd wave) with confirmed SARS-CoV-2 infection. Patients were followed up until death or 90 days after ICU admission. The co-primary endpoints of this study included ICU, 30-day and 90-day mortality. We enrolled 108 patients at a mean age of 64.3 (SD = 12) years, the majority of whom were male (63.9%). Mortality in the ICU, after 30 days and 90 days was 44.4% (48/108), 50.0% (54/108), and 57.9% (62/108), respectively. Mortality at 90 days was associated with increasing age (OR = 3.97, 95% CI: 1.87-8.41) and was significantly higher during the 2nd wave (65.6 vs. 46.5%, log-rank P = 0.043) compared to the 3rd wave of the pandemic. This retrospective single-centre study confirms the high mortality rate among critically ill patients with COVID-19. Moreover, it suggests a significant association between 90-day mortality and increasing age as well as differences in mortality between the 2nd and 3rd waves of the pandemic in Poland.

A cross sectional survey on estimating the prevalence of post-COVID depression in 3rd wave among homoeopathic students of MNR homoeopathic medical college

Depression is the most burning issue in public and has a most substantial effect on the health and wellbeing. COVID-19 pandemic has caused disruptions to the livelihoods of people. It had shown its commendable influence in the psychological health of youth. Because of the impact of covid-19, the prevalence of stress and depression on young generation is been increasing day by day. In this scenario, this study was conducted to find the prevalence of depression among homoeopathic medical students of MNR Homoeopathic medical college of Sangareddy district Telangana.Using a purposive sampling method, an online survey using PHQ-9 questioner was send to covid positive students (turned positive in last 2 months) of MNR Homoeopathic medical college, Sangareddy were asked to fill the questioner via Google form. The statistical scores for the responses were calculated and analysis was performed.In this study overall 88% of the study participants are depressed where 20.5% students with minimal depression, 47% students with mild depression, 17.6% with moderately depression 11.7% with moderately severe depression and 2% are having severe depression.Early screening will help for early detection of depression so that interventions either supportive or medicinal can be provided in the very early stage according to the grades of depression so that we can prevent morbidity and suicide rate of young generation.

Pulmonary embolism at the emergency department during the COVID-19 pandemic. A comparative cohort study from a tertiary level hospital in southern Spain

Several studies have been published showing a significant increase in thrombotic complications in coronavirus disease 2019 (COVID-19) patients, including acute pulmonary embolism (PE). However, there is significant variability regarding published data on the number of computed tomography pulmonary angiography (CTPA) orders to rule out PE, frequency and characteristics of PE, and other factors that could have magnified the actual incidence of PE. The aim of this work is to analyze these factors during the first year of the pandemic. A longitudinal retrospective observational study was designed comparing two cohorts (preCOVID and COVID) of patients for whom an emergency CTPA was requested to rule out PE at the emergency department of our institution. Information was collected regarding the number of CTPAs requested, patient demographics, presence and extension of PE, and radiological signs of right ventricle strain/pulmonary hypertension (RVS/PH). Univariate and bivariate analyses were performed, with stratification by time intervals according to different pandemic waves in the COVID cohort. A total of 1905 patients (530 in the pre-COVID cohort and 1375 in the COVID cohort), with a mean age of 68.3 years (standard deviation, 16.5) and 981 (51.5%) women were included. No significant differences were observed regarding the incidence of PE between both cohorts. In patients with PE, no significant differences regarding age or sex were found, but a significantly higher frequency of peripheral PE was observed in the COVID cohort (42.0% vs. 6.5%, p < 0.001). Regarding signs of RVS/PH, a lower degree of septal deviation and contrast reflux to the inferior vena cava was observed in the COVID cohort, but no significant differences were observed in the right-to-left ventricular ratio. For the COVID cohort, the distribution of central vs. peripheral PE was similar in patients without laboratory-confirmed COVID-19 infection. Finally, the analysis of signs of RVS/PH stratifying by pandemic waves showed a lower frequency of RVS/PH signs in the 2nd and 3rd pandemic waves. In conclusion, despite a significantly higher number of CTPAs were performed during the pandemic, the incidence of PE was similar to that of the pre-pandemic period. A higher number of peripheral PE and less radiological signs of RVS/PH were observed during the pandemic. These findings could be explained by an increased incidental detection of PE during the pandemic. Our study has some limitations, mainly derived from its retrospective and single-center nature, which should be overcome in future research.

Distinct differences were noticed during the 3rd COVID wave in India

Distinct differences were noticed during the 3rd COVID wave in India

Value Chain Analysis and Attractiveness of the Telecommunications Industry in Mongolia

During the 4th Industrial Revolution and the 3rd Wave of Digitalization, the telecommunications sector developed rapidly and played a key role in accelerating economic development and competitiveness. Researchers and experts point out that the sector is an important tool to directly and indirectly support the implementation of the 17 goals of the 2030 Sustainable Development Goals. In this context, a demand it is important for the information and communications technologies (ICT) companies to make strategic changes, modernize their business processes, analyse key technology operations, and evaluate the effectiveness of supply, human resources, financial, and management policies. In order to create a distinct competitive advantage, key activities in the sector, such as procurement, internal operations, and sales channels, will be strategically coordinated, and human resources, technology, finance, and management will be configured to assist. Therefore, industry-wide value chain analysis will explore the challenges related to the supply of information and communication raw materials, technology-based cooperation, and legal and regulatory issues. This research aims to assess the value chain of the telecommunication services and define the gaps, which are drawbacks of the development. This paper will be a foundation for further studies on industry profitability and competitiveness by focusing on the areas that are essential to value creation in end-to-end services such as mobile communications, internet, and cable television.

Maskne: A side effect of wearing face mask and face mask-wearing attitudes and behavior during 1st, 2nd and 3rd waves of COVID-19 in rural population of Haryana.

The term "maskne" originated during the SARS CoV-2 (COVID-19) pandemic; it is a variant of acne associated with continuous wearing of face mask. Maskne is mainly observational, and the most common cause of maskne is contact irritant dermatitis. The average mask use percentage by OPD cases visiting the hospital for a month in each wave of the COVID -19, that is, in the month of June 2020 during the first wave, in the month of April 2021 during the second wave and in the month of December 2021 during the third wave was calculated. We also included 30 patients with a diagnosis of irritant contact dermatitis aka maskne and 30 patients with diagnosis of acne vulgaris, all >18 years of age from April 2020 to December 2021. 66% of people wore masks coming to hospital in the month of June 2020 (first wave) which increased to 74% during the second wave in the month of April 2021 and during the third wave only 23% of people wore masks in the month of December 2021. Maskne and worsening of acne vulgaris can be due to wearing of dirty face masks for longer duration. Use of moisturizers and regular "mask breaks" are important aspects in management of maskne.

Bracing for a resurgence of Covid in a 3rd Wave: Uttarakhand Saga

Evidently, the resurgence of COVID in a 2nd wave happened due largely to ‘Risk Compensation’ by the community, exacerbated by extreme risk behavior of the community. ‘Risk compensation’ or ‘Peltzman effect’, where there is an attitudinal shift underestimating the risk and subsequent complacency in observing due measures is almost an axiomatic phenomenon and this was being predicted in case of COVID too(1). However the scale, extent and intensity of the re-surgence (second wave) which was exponential & ‘asymptotic‘ was unwarranted, also unprecedented. That this re-surgence was a predictable phenomenon and needed pro-active & pragmatic strategizing/ decision making (which would affect community behavior vis a vis religious congregation and or other public events abetting gathering of crowd etc) was not unknown.

Modeling the Waves of Covid-19

The challenges with modeling the spread of Covid-19 are its power-type growth during the middle stages of the waves with the exponents depending on time, and that the saturation of the waves is mainly due to the protective measures and other restriction mechanisms working in the same direction. The two-phase solution we propose for modeling the total number of detected cases of Covid-19 describes the actual curves for many its waves and in many countries almost with the accuracy of physics laws. Bessel functions play the key role in our approach. The differential equations we obtain are of universal type and can be used in behavioral psychology, invasion ecology (transient processes), etc. The initial transmission rate and the intensity of the restriction mechanisms are the key parameters. This theory provides a convincing explanation of the surprising uniformity of the Covid-19 waves in many places, and can be used for forecasting the epidemic spread. For instance, the early projections for the 3rd wave in the USA appeared sufficiently exact. The Delta-waves (2021) in India, South Africa, UK, and the Netherlands are discussed at the end.

Forecasting COVID-19 situation in Bangladesh

Forecasting the COVID-19 confirmed cases, deaths, and recoveries demands time to know the severity of the novel coronavirus. This research aims to predict all types of COVID-19 cases (verified people, deaths, and recoveries) from the deadliest 3rd wave data of the COVID-19 pandemic in Bangladesh. We used the official website of the Directorate General of Health Services as our data source. To identify and predict the upcoming trends of the COVID-19 situation of Bangladesh, we fit the Auto-Regressive Integrated Moving Average (ARIMA) model on the data from Mar. 01, 2021 to Jul. 31, 2021. The finding of the ARIMA model (forecast model) reveals that infected, deaths, and recoveries number will have experienced exponential growth in Bangladesh to October 2021. Our model reports that confirmed cases and deaths will escalate by four times, and the recoveries will improve by five times at a later point in October 2021 if the trend of the three scenarios of COVID-19 from March to July lasts. The prediction of the COVID-19 scenario for the next three months is very frightening in Bangladesh, so the strategic planner and field-level personnel need to search for suitable policies and strategies and adopt these for controlling the mass transmission of the virus.

COVID-19 Pandemic Impact on Socio-Economic Status, Agriculture, Livelihood, Food Security and Nutrition: Case of Myanmar

The COVID-19 novel coronavirus spread around the world since December 2019. The first official case in Myanmar was reported on March 23rd, 2020 where the first set of containment measures was introduced. In Myanmar, COVID-19 infection rate was low at the 1st wave but at the 2nd wave, confirmed cases increased in the months of August, September and October, 2020 while the 3rd wave came recently on June 2021 where infection rate is at first low, however, it became more serious on July 2021 compared to the previous one.

506 Role of inflammation and comorbidities in the association between heart failure and incident cancer in the HUNT3 cohort

Abstract Aims Conflicting data exist regarding the risk of cancer in patients with heart failure (HF). It was first reported that incident cancer is more common among patients with than without HF, whereas more recent studies indicate that this association is primarily driven by comorbidities. HF, cancer, and comorbidities, such as chronic kidney disease (CKD) and chronic obstructive pulmonary disease (COPD), share numerous risk factors, including a state of chronic low-grade inflammation reflected by elevated circulating levels of pro-inflammatory cytokines. The objective of this analysis was to assess whether chronic low-grade inflammation, as measured by levels of high-sensitivity C-reactive protein (hsCRP), and comorbidities mediate the association of HF with incident cancer. Methods We used data from the 3rd wave of the Nord-Trøndelag Health Study (HUNT3), a population-based study that enrolled 50 803 individuals ≥18-year-old between October 2006 and June 2008 in the Nord-Trøndelag County (Norway), and from the administrative health care records of the same region. Associations between baseline characteristics and the development of cancer were assessed using Cox proportional hazards regression models, using time from HUNT3 enrolment as the time scale. Analyses were performed using R statistical software, version 4.0.2. Results In HUNT3, hsCRP was measured in 47 571 individuals at the time of enrolment. Of these, we excluded 2308 patients because of missing information, leaving a cohort of 45 263 subjects. The prevalence of cardiovascular disease, comorbidities, and obesity was progressively higher with increasing concentrations of hsCRP. During a median follow-up of 12 years, there were 66/408 cases of incident cancer in patients with HF at baseline and 5024/47 163 in subjects without HF, with a more than 2-fold (HR 2.30; 95% CI 1.80–2.93; P < 0.001) increase in risk of developing cancer. After adjusting for age and sex, the excess risk decreased to 43% (HR 1.43; 95% CI 1.12–1.82). When including hsCRP in the model, the HF-related risk of cancer was 33% (HR 1.33; 95% CI 1.04–1.70; P = 0.022). Furthermore, when body mass index, CKD, COPD, and smoking and drinking habits were included in the model, the risk of cancer in HF patients compared to individuals without HF was no longer significant (HR 1.23; 95% CI 0.94–1.60; P = 0.127). Age, male sex, hsCRP, COPD, obesity, and smoking habits were all associated with an increased risk of cancer. Conclusions The increased risk of cancer in HF patients compared with the general population is at least in part explained by concomitant inflammation and comorbidities.

154. Antibiotic Use During Three Separate Waves of the COVID-19 Pandemic at a Large Academic Medical Center in Detroit, MI

BackgroundInpatient antibiotic use early on in the COVID-19 pandemic may have increased due to the inability to distinguish between bacterial and COVID-19 pneumonia. The purpose of this study was to determine the impact of COVID-19 on antimicrobial usage during three separate waves of the COVID-19 pandemic.MethodsWe conducted a retrospective review of patients admitted to Detroit Medical Center between 3/10/19 to 4/24/21. Median days of therapy per 1000 adjusted patient days (DOT/1000 pt days) was evaluated for all administered antibiotics included in our pneumonia guidelines during 4 separate time periods: pre-COVID (3/3/19-4/27/19); 1st wave (3/8/20-5/2/20); 2nd wave (12/6/21-1/30/21); and 3rd wave (3/7/21-4/24/21). Antibiotics included in our pneumonia guidelines include: amoxicillin, azithromycin, aztreonam, ceftriaxone, cefepime, ciprofloxacin, doxycycline, linezolid, meropenem, moxifloxacin, piperacillin-tazobactam, tobramycin, and vancomycin. The percent change in antibiotic use between the separate time periods was also evaluated.ResultsAn increase in antibiotics was seen during the 1st wave compared to the pre-COVID period (2639 [IQR 2339-3439] DOT/1000 pt days vs. 2432 [IQR 2291-2499] DOT/1000 pt days, p=0.08). This corresponded to an increase of 8.5% during the 1st wave. This increase did not persist during the 2nd and 3rd waves of the pandemic, and the use decreased by 8% and 16%, respectively, compared to the pre-COVID period. There was an increased use of ceftriaxone (+6.5%, p=0.23), doxycycline (+46%, p=0.13), linezolid (+61%, p=0.014), cefepime (+50%, p=0.001), and meropenem (+29%, p=0.25) during the 1st wave compared to the pre-COVID period. Linezolid (+39%, p=0.013), cefepime (+47%, p=0.08) and tobramycin (+47%, p=0.05) use remained high during the 3rd wave compared to the pre-COVID period, but the use was lower when compared to the 1st and 2nd waves.Figure 1. Antibiotic Use 01/2019 to 04/2019 ConclusionAntibiotics used to treat bacterial pneumonia during the 1st wave of the pandemic increased and there was a shift to broader spectrum agents during that period. The increased use was not sustained during the 2nd and 3rd waves of the pandemic, possibly due to the increased awareness of the differences between patients who present with COVID-19 pneumonia and bacterial pneumonia.Disclosures All Authors: No reported disclosures

Spatial clustering behaviour of Covid-19 conditioned by the development level: Case study for the administrative units in Romania

Spatial analyses related to Covid-19 have been so far conducted at county, regional or national level, without a thorough assessment at the continuous local level of administrative-territorial units like cities, towns, or communes. To address this gap, we employ daily data on the infection rate provided for Romanian administrative units from March to May 2021. Using the global and local Moran I spatial autocorrelation coefficients, we identify significant clustering processes in the Covid-19 infection rate. Additional analysis based on spatially smoothed rate maps and spatial regressions prove that this clustering pattern is influenced by the development level of localities, proxied by unemployment rate and Local Human Development Index. Results show the features of the 3rd wave in Romania, characterized by a quadratic trend.

Validity and Reliability of Google Classroom Assisted Economics Learning Impact Instrument Using the Rasch Measurement Model

The 7th shift of the Malaysian Education Development Plan (2013-2025) highlights the Ministry of Education's efforts to leverage the use of ICT to improve the quality of learning in Malaysia. Currently, Malaysia is at the final phase in the implementation of the 3rd wave (2021-2025) of the development plan, in line with its aim to catalyse changes in the education system. In line with recent technology advances, the call is welcomed by educationists. However, there are still questions on whether ICT is accepted by students and whether it is more effective to support the learning of economics compared to the traditional teaching method. In this regard, it is important for teachers to practice effective teaching methods. The use of an effective teaching method could address issues related to students’ economic achievement due to the lack of interests, self-efficacy and negative attitude. This pilot study is aimed to evaluate the validity and reliability of Google Classroom-supported economics learning impact instruments. Forty-six economics students were selected from three schools. The Rasch measurement model was used to test the reliability of the instrument through analysing the item’s reliability, individual reliability, Cronbach's alpha value, individual-item discrimination, standardised residual correlation, item polarity, and item fit. The study found that the instrument has good validity and reliability. The reliability of the item and instrument respondents reliability test is high at 0.82 and 0.91, proving that the instrument is suitable for use in the actual study. It is hoped that the findings of this study will contribute to the development of knowledge, particularly in developing questionnaires among Malaysia teachers and provide economics teachers a tool for assessing the impact of learning. Appropriate follow-up actions by teachers can be taken to improve effective learning processes in the future. It is suggested for this questionnaire to be used in a real-world study on the impact of using Google Classroom-based learning on students’ interest, self-efficacy, attitude and acceptance.

Applying learning from 1st to the 3rd wave of the covid19 pandemic: nutritional provision in critical care

Rationale: The aim of this analysis was to compare route and adequacy of nutrition support in patients with COVID19 admitted to an intensive care unit (ICU) between March-June 2020 (T1) compared to January-April 2021 (T2). Methods: Parameters related to nutrition support were collected from the records of all patients admitted to ICU with COVID19 with length of stay of ≥7days on mechanical ventilation requiring artificial nutrition support. Data was collected during the late acute phase which was defined as day 4-7 post intubation. Energy and protein intake was compared to calculated estimated nutritional requirements. Results: 35 patients met the inclusion criteria in T1, 94% were on enteral nutrition (EN), 3% parenteral nutrition (PN) and 3% EN+PN. In T2, there were 54 patients (92% EN, 2% PN and 6% EN+PN). Tabled 1March – June 2020 (N=35)January – April 2021 (N=54)P valueEnergy (% requirements met)85 (24)96 (23.0)0.022Protein (% requirements met)68 (28)79 (26.1)0.076 Open table in a new tab Of patients who achieved <70% of energy and protein requirements in T1 (n=17) 35% had constipation or ileus and 47% had GI intolerance (high gastric residual volumes or vomiting). In T2 (n=19), 84% experienced constipation or ileus and 63% had GI intolerance. 35% of patients in T1 had hypernatraemia vs. 47% in T2 and 41% in T1 had hyperglycaemia vs. 100% in T2 despite only 12% and 32% of patients respectively having a history of diabetes. Conclusion: Despite a higher incidence of GI intolerance in T2, a statistically significant improvement in energy targets was noted. There was a clinically significant trend in protein intake which may be attributed to prompt initiation of modular protein supplements or perhaps an earlier transition from fat-based sedation. Meeting protein requirements while preventing overfeeding remains a challenge in the ICU. Disclosure of Interest: None declared.

Risk factors and features of COVID-19 course in pregnant women: a comparative analysis of epidemic outbreaks in 2020 and 2021

Aim. To compare risk factors, features of COVID-19 course and outcomes in pregnant women during epidemic increase in incidence in 2020 and 2021.&#x0D; Materials and methods. The study included 163 pregnant women with laboratory-confirmed SARS-CoV-2 infection within May December 2020 (1st2nd waves of the epidemic) and 158 pregnant women who had new coronavirus infection within May August 2021 (3rd wave of the epidemic). Patients in all groups were comparable in age (1835 years), social status, parity, body mass index, and had no known risk factors for COVID-19.&#x0D; Results. Iron deficiency anemia, smoking, belonging to the Buryat ethnic group were recognized as persistent risk factors for COVID-19 in pregnant women. Over the 1st year of the pandemic, in pregnant women, the following clinical manifestations of novel coronavirus infection were commonly seen: anosmia (87.7%), somnolence (68.7%), shortness of breath even with a mild lung damage (68.1%). In the 3rd wave of the 2nd year of the pandemic, the leading signs and symptoms were cough (70.3% vs 38.7%, p0.001), runny nose (46.2% vs 3.7%, p0001), sore throat (367% vs 37%, p0.001); an increase in body temperature above 38C (19.6% vs 7,4%, p=0.006), pneumonia detected by computed tomography (61.4% vs 21.4%; p0.001). There was a significant increase in the incidence of severe lung lesions (with computed tomography 34: 17.7% vs 4.9%; p0.001) and admissions to intensive care units (11.4% vs 6.4%; p= 0041). There was a need for invasive mechanical ventilation (1.89% vs 0%; p=0.118). There was 1 death (0.63% vs 0%; p= 0.492), which was associated with the fulminant course of COVID-19.&#x0D; Conclusion. Persistent COVID-19 confounders in pregnant women who have no known risk factors in the third trimester of gestation are iron deficiency anemia, smoking, and belonging to the Buryat ethnic group. The clinical course of SARS-CoV-2 infection has changed and became more unfavorable: symptoms of acute respiratory disease (cough, runny nose, sore throat) began to prevail, the rate and severity of pneumonia and rate of mortality increased.