COVID-related Mortality Research Articles

Changes in anticancer treatment plans in patients with solid cancer hospitalized with COVID-19: analysis of the nationwide BSMO-COVID registry providing lessons for the future

Solid cancer is an independent prognostic factor for poor outcome with COVID-19. As guidelines for patient management in that setting depend on retrospective efforts, we here present the first analyses of a nationwide database of patients with cancer hospitalized with COVID-19 in Belgium, with a focus on changes in anticancer treatment plans at the time of SARS-CoV-2 infection. Nineteen Belgian hospitals identified all patients with a history of solid cancer hospitalized with COVID-19 between March 2020 and February 2021. Demographic, cancer-specific and COVID-specific data were pseudonymously entered into a central Belgian Society of Medical Oncology (BSMO)-COVID database. The association between survival and primary cancer type was analyzed through multivariate multinomial logistic regression. Group comparisons for categorical variables were carried out through a Chi-square test. A total of 928 patients were registered in the database; most of them were aged ≥70 years (61.0%) and with poor performance scores [57.2% Eastern Cooperative Oncology Group (ECOG) ≥2]. Thirty-day COVID-related mortality was 19.8%. In multivariate analysis, a trend was seen for higher mortality in patients with lung cancer (27.6% versus 20.8%, P= 0.062) and lower mortality for patients with breast cancer (13.0% versus 23.3%, P= 0.052) compared with other tumour types. Non-curative treatment was associated with higher 30-day COVID-related mortality rates compared with curative or no active treatment (25.8% versus 14.3% versus 21.9%, respectively, P < 0.001). In 33% of patients under active treatment, the therapeutic plan was changed due to COVID-19 diagnosis, most frequently involving delays/interruptions in systemic treatments (18.6%). Thirty-day COVID-related mortality was not significantly different between patients with and without treatment modifications (21.4% versus 20.5%). Interruption in anticancer treatments at the time of SARS-CoV-2 infection was not associated with a reduction in COVID-related mortality in our cohort of patients with solid cancer, highlighting that treatment continuation should be strived for, especially in the curative setting.

S920 Seasonal Trends in Inflammatory Bowel Disease Mortality and Disruption by the COVID-19 Pandemic

Introduction: Studies have examined the seasonality of inflammatory bowel disease (IBD) disease onset and activity. Patterns suggest greater likelihood of disease remission in the summer and disease exacerbation in the winter. It is unknown whether IBD mortality trends follow a similar pattern. In this study, we investigated seasonal variations in IBD mortality and the impact of the pandemic on these trends. Methods: Using the National Vital Statistics System data set through the CDC WONDER website, data on IBD-related deaths among U.S. adults aged 25 years and older was obtained. IBD was defined as Crohn’s disease or ulcerative colitis based on ICD-10 codes. Age-standardized mortality rates (ASMRs) per 100,000 persons were calculated for all-cause, non-COVID-related, and COVID-related mortality in this population. Number of monthly COVID-19 cases in the general population were also obtained from the CDC website. Seasons were defined as winter (December to February), spring (March to May), summer (June to August), and fall (September to November). Winter’s year was defined using the year of December (i.e. Winter 2010 = December 2010 to February 2011). Mann-Whitney tests were performed to compare the median all-cause ASMRs of summer and winter pre-pandemic (prior to Winter 2019) and during the pandemic (Winter 2019 and beyond). Results: From January 2010 to December 2021, there were 34,648 IBD-related deaths, 3,242 (9.35%) of which occurred during the pandemic. Pre-pandemic, IBD mortality demonstrated peaks in winter and nadirs in summer (Figure). In fact, as seen in Table, median all-cause ASMR was significantly higher in winter compared to summer pre-pandemic (0.3484 vs 0.3144, p< 0.0001). In Winter 2020, there was still a peak in IBD-related mortality, but this was largely driven by COVID-19-related death (Figure). However, over the duration of the pandemic, the median all-cause mortality of winter versus summer ceased to be significantly different (0.4371 vs 0.4202, p >0.999) (Table). Conclusion: Using a nationwide dataset, we identified seasonal variation in IBD mortality rates, with peaks in winters and nadirs in summers. However, this trend was less apparent during the COVID-19 pandemic. Further investigation into why there is seasonal variation in IBD mortality is warranted, including why seasonal trends were disrupted during the pandemic.Figure 1.: All-Cause, Non-COVID-Related and COVID-Related Age-Standardized Mortality Rates Among IBD Decedents from 2010 to 2021 with Overall COVID-19 Case Numbers. Trends in ASMR per 100,000 persons are shown among all IBD decedents. COVID-19 case numbers are shown among all individuals in the U.S. ASMR=Age-Standardized Mortality Rate. COVID=coronavirus disease. IBD=inflammatory bowel disease. Summer=June-August. Winter=December-February. Table 1. - Difference in Median All-Cause ASMR in Summer and Winter Pre-Pandemic and During Pandemic Median All-Cause ASMR per 100,000 Persons Summer Winter P-Value Pre-Pandemic 0.3144, n=9 0.3484, n=9 < 0.0001 During Pandemic 0.4202, n=2 0.4371, n=2 > 0.9999 P-Values obtained by Mann-Whitney test. ASMR per 100,000 persons are shown among all IBD decedents. Summer=June-August. Winter=December-February. Pre-Pandemic=Summer 2010-Winter 2019. During Pandemic=Winter 2019-Summer 2021.

A Retrospective Study on the Impact of COVID-19 on Emergency General Surgery.

BackgroundThe coronavirus pandemic has caused global disruption to all aspects of life. This disturbance has been most notable in the medical world. Political, societal, medical, and behavioral alterations have forced emergency surgical practices to adapt. This study investigated the impact of coronavirus 2019 (COVID-19) at a busy surgical center.MethodologyThis is a retrospective observational study. Three study periods were analyzed: pre-COVID, first wave, and second wave. Data were collected on referrals, diagnoses, investigations, management pathways, outcomes, patient behavior, and consultant practice. A one-way analysis of variance (ANOVA test) was used for the analysis of parametric data and the Mann-Whitney U test for non-parametric data.ResultsDeclining numbers of patients presented across the three periods. There was a severe disruption in performing emergency general surgeries during the first wave, propagated by alterations in clinical decision-making, as well as fluctuations in societal and patient behavior. Despite the effects of the second wave being significantly more profound in terms of hospitalization and COVID-related mortality, a paradoxical, gradual return to the norm was noted, which was seen in referral pathways, imaging decisions, and management strategies.ConclusionOur data is suggestive of society, both within and outside the medical sphere, adjusting to life with COVID-19.

The polarization of politics and public opinion and their effects on racial inequality in COVID mortality.

Evidence from the early months of the COVID-19 pandemic in the U.S. indicated that the virus had vastly different effects across races, with black Americans faring worse on dimensions including illness, hospitalization and death. New data suggests that our understanding of the pandemic’s racial inequities must be revised given the closing of the gap between black and white COVID-related mortality. Initial explanations for inequality in COVID-related outcomes concentrated on static factors—e.g., geography, urbanicity, segregation or age-structures—that are insufficient on their own to explain observed time-varying patterns in inequality. Drawing from a literature suggesting the relevance of political factors in explaining pandemic outcomes, we highlight the importance of political polarization—the partisan divide in pandemic-related policies and beliefs—that varies over time and across geographic units. Specifically, we investigate the role of polarization through two political factors, public opinion and state-level public health policies, using fine-grained data on disparities in public concern over COVID and in state containment/health policies to understand the changing pattern of inequality in mortality. We show that (1) apparent decreases in inequality are driven by increasing total deaths—mostly among white Americans—rather than decreasing mortality among black Americans (2) containment policies are associated with decreasing inequality, likely resulting from lower relative mortality among Blacks (3) as the partisan disparity in Americans who were “unconcerned” about COVID increased, racial inequality in COVID mortality decreased, generating the appearance of greater equality consistent with a “race to the bottom’’ explanation as overall deaths increased and substantively swamping the effects of containment policies.

POPULARITY OF AYURVEDIC MEDICINE AFTER COVID-19

Treatments for the current global COVID-19 pandemic are still being studied. There are many drugs like Antivirals and immunomodulators have had varying degrees of success in clinical trials. Traditional herbal treatments are widely used to treat a variety of ailments. for disease prevention and treatment, particularly in countries with limited resources. It is really worth noting that now in lower elevations, COVID-related mortality rates were lower. Countries in comparison to the western world other factors that contributed to the disparity nationality, temp, relative humidity, normal resistance, and nourishment are all factors to consider. Objective: The goal of this study was to find out popularity of traditional herbs were utilized in north India to protect against COVID. Method: From October to November 2021, a questionnaire-based study was done in Dehradun district at different place North India. The brief interview was conducted at the request of the participants. A pre-designed questionnaire was used to record responses (Annexure). The data was analyses using descriptive statistics. The interview drew a total of 500 participants. Mask was utilized by the majority of respondents 84%. The use of traditional herbs and spices was affirmed by 66% of the respondents. COVID positive was found in 4 % (n = 10) of the respondents' family members. Key world: COVID-19, Traditional herb, statistics, questionnaire, immunity

P1588: A SINGLE CENTER COMPARATIVE CLINICAL ANALYSIS OF THE SARS-COV-2 INFECTION BEFORE AND AFTER VACCINATION IN PATIENTS DIAGNOSED WITH HEMATOLOGIC MALIGNANCIES

Background: An impaired humoral and cellular immunogenicity to the mRNA SARS-CoV-2 vaccines has been reported in patients diagnosed with hematologic malignancies. Data regarding the effectiveness of SARS-CoV-2 vaccination on COVID-19 evolution an immunocompromised population are still scarce. Aims: To compare disease severity and mortality in a real-life cohort according to the vaccination status of patients diagnosed with hematologic malignancies developing COVID-19 disease. Methods: We retrospectively collected clinical data from the patients with a current or prior history of hematologic malignancy in the last 5 years at Vall d´Hebron Hospital whom suffered a SARS-CoV-2 infection. Patients were unvaccinated between March 2020 and May 2021, and partially or completely vaccinated between May 2021 and January 2022. The primary endpoint was COVID-related mortality according to vaccination status. Secondary endpoints included rate and length of hospitalization, ICU admission, need for supplemental oxygen including high flow oxygen therapy and mechanical ventilation, and severity of COVID-19 disease. Results: Overall, 113 vaccinated and 81 unvaccinated patients developed COVID-19. Both groups were similar in age (median 69 and 72 years, respectively), gender predominance, diagnosis (mainly lymphoproliferative diseases [58% and 53%]), and administered active treatment (mostly anti-CD20 monoclonal antibodies [38% and 37%]). In contrast, more patients received active treatment (78% vs. 48%; p=<0.001) in the vaccinated cohort. Vaccinated patients developed infection by the delta variant in 27% (17/62) and by the omicron variant in 73% of the sequenced cases (45/62). Genotype analysis of the variant in unvaccinated cases is ongoing. Despite the fact that 96% of patients received 2 vaccine doses and 73% also a third boost dose, in only 67% (59/88) of patients basal IgG anti-spike antibodies were detected after vaccination. In comparison with the unvaccinated cohort of patients, vaccinated patients had less severe (17% vs. 42%; p=0.01) and critical (13% vs 28%; p=0.03) COVID-19 infection, lower rates of hospitalization (42% vs. 90%; p=<0.001) with shorter length of stay (median 13 days (IQR 7-34) vs. 11 days (IQR 6-16), and fewer patients needed supplemental oxygen (34% vs. 73%; p=0). Admission rates to ICU were similar between both cohorts. Finally, mortality rate was lower in the vaccinated patients in comparison with the unvaccinated cohort (HR: 0.19 (95%CI 0.09, 0.38); p=<0.001). Of note, in hospitalized patients only, the mortality of the vaccinated cohort was also lower (HR: 0.38 (95%CI 0.19, 0.76); p=0.007). Among vaccinated patients who suffered a severe/critical infection, 52% did not have vaccine seroconversion. Of the vaccinated patients who died (11/113), 6/8 had negative anti-S IgG, 5/9 were infected by the delta variant and 4/9 by omicron, and 10/11 were on active treatment (5/11 with monoclonal antibodies). Image:Summary/Conclusion: In our series, despite the heterogeneity of infection by different viral variants and treatment availability for COVID-19 during the evolution of the pandemic, vaccination has been widely effective at reducing need of hospitalization, severity and mortality of the SARS-CoV-2 infection in hematological patients. Nevertheless, a subgroup of vaccinated patients remains with an adverse outcome and requires further identification and management improvement.

P660: SEROLOGIC RESPONSE TO THE SECOND AND THIRD DOSE OF THE SARS-COV-2 VACCINE IN PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA: RESULTS OF A PROSPECTIVE, CENTRALIZED, MULTICENTER STUDY.

Background: Patients with chronic lymphocytic leukemia (CLL) show high infection-related morbidity and mortality due to variable degree of humoral and cellular immune deficiency. High Covid-related mortality and reduced response to the SARS-Cov-2 vaccine have been reported in this patient population. Aims: We carried out a prospective multicenter study to define the rate of CLL patients with an appropriate immune response after the mRNA SARS-CoV2 vaccine (Pfizer-BioNTech; Moderna). Methods: Two-hundred patients with CLL received the first dose of the SARS-CoV-2 vaccine between February and August 2021. Centralized assessment of the anti-SARS-Cov-2 IgG levels (Sero Index, Kantaro Quantitative SARS-CoV-2 IgG Antibody, RUO-R&D System) was performed at the Istituto Superiore di Sanità of Rome, Italy. The median follow-up of this study is 10.7 months (range 1-12.9). Results: The median age of patients was 70 years, the median IgG level was 635 mg/dl, 61% of patients were IGHV unmutated, and 34% showed TP53 disruption. The majority of patients, 83.5%, were previously treated. Prior treatment included chemoimmunotherapy in 20 (10%) patients, ibrutinib–based therapy in 72 (36%; front-line, 21%; advanced line, 15%), venetoclax-based therapy in 75 (37.5%; front-line, 13.5%; advanced line, 24%). Overall, 135 (77.5%) patients had been previously treated with rituximab, 33 (16.5%) of them within 12 months before vaccination. We assessed the serologic response after the second dose of the SARS-CoV2 vaccine in 195 patients while five were excluded from the analysis (positive test before vaccination, 3 patients; lost to the follow-up, 1; Richter syndrome, 1). Adequate levels of anti-SARS-Cov-2 IgG were detected in 76/195 (39%) patients. Age (<70 vs.≥ 70 years; p <0.0001), CIRS value (<6 vs. ≥6; p=0.005), beta-2 microglobulin (<3.5 vs. ≥ 3.5mg/dl; p=0.04), IgG levels (<550 vs. ≤ 550 mg/dl; p <0.0001), prior treatment (p=0.0001), number of prior treatments (0 + 1 vs. ≥ 2; p=0.002) and the time between prior rituximab and vaccination (>12 vs. ≤12 month; p=0.001) showed a significant impact on the humoral response. In multivariate analysis only age (OR: 0.92 [95% CI: 0.92-0.97] p=0.0001), IgG levels (OR: 0.28 [95% CI: 0.13-0.58] p<0.001), and the time between prior rituximab and vaccination (OR: 0.10 [95% CI: 0.03-0.37] p=0.001), revealed a significant and independent impact on response. When the analysis was restricted to patients who received targeted therapy, in addition to the younger age (OR: 0.96 [95% CI: 0.92-0.99] p=0.04), higher IgG levels at baseline (OR: 0.31 [95% CI: 0.12-0.79] p=0.014), longer time between the start of ibrutinib or venetoclax-based therapy and vaccination (<18 vs.≥18 months; OR: 0.17 [95% CI: 0.06-0.44], p <0.0001) showed a favorable and independent impact on response. Ninety-three% (182/195) of patients received a third dose of the vaccine. A significant increase in the rate of serologic responses, 51.5% (85/165 evaluated patients, p=0.019), was observed after the booster dose. Moreover, a response was detected in 25% (26/103 evaluated patients) of previously seronegative patients. Summary/Conclusion: In this prospective, multicenter, centralized study, we recorded an effective immune response to the SARS-CoV-2 vaccine in about a third of patients with CLL. Younger age, higher IgG levels, no prior treatment, or stable disease after targeted therapy that suggest preserved immunocompetence were associated with a greater likelihood of achieving an effective immune response. A booster dose of the SARS-CoV-2 vaccine proved beneficial also in previously seronegative patients.

Short and medium-term outcomes of patients with solid cancer hospitalized with COVID-19 in Belgium according to cancer diagnosis and treatment characteristics.

e24053 Background: Solid cancer is an independent prognostic factor for COVID-19 related mortality. Adverse prognostic factors in these patients include low performance status, lung cancer, advanced cancer stage and recent diagnosis. In this study, we further evaluated prognostic effects of cancer diagnosis and treatment variables and characterized changes in anticancer treatment plans due to COVID-19 diagnosis in a nation-wide cohort study. Methods: Patients with a history of solid cancer hospitalized with COVID-19 between March 2020 and February 2021 in one of the 20 participating institutions in Belgium were included. Patient demographics, comorbidities, COVID-19 hospitalization course and treatment, cancer and anticancer treatment characteristics, treatment changes due to COVID-19 and clinical outcomes in-hospital and during follow-up were retrospectively registered in a central database. The primary objective was to evaluate potential differences in 30-day and 3-month COVID-19-related mortality according to cancer and anticancer treatment characteristics. Results: A total of 946 patients (median age 73y, interquartile range 64-81y) were included. Pre-existing comorbidities were present in 90.1% of patients, and 21.9% had a history of &gt; 1 malignancy. Half of the patients (n = 463, 49.3%) had received anticancer treatment ≤3 months before COVID-19 diagnosis (“active cancer”), of whom 286 (63.1%) in the non-curative setting. The overall 30-day and 3-month COVID-19-related mortality rates in this cohort were 21.4% (n = 178) and 24.1% (n = 194), respectively. COVID-related 3-month mortality was comparable in patients with active cancer (n = 96, 24.3%) and in patients with non-active cancer (n = 97, 24.0%), but within the first group COVID-related mortality was higher in those receiving systemic treatment in the non-curative (28.3%) versus the curative setting (15.2%). A change in the anticancer treatment plan due to COVID-19 was recorded in 148/463 patients with active cancer (32.0%). In patients with changes in systemic treatment plans (n = 146), treatment was delayed in 94 patients (in half of cases for &gt; 1 month) and cancelled in 42 patients. The main reason for modifications in anti-cancer treatment was COVID-19 related complications (79.6%), followed by fear for/existence of anticancer treatment related toxicity (14.8%). Conclusions: Our nation-wide analysis in patients with solid cancer hospitalized with COVID-19 shows comparable 3-month mortality among patients who did and who did not receive anticancer treatment in the three months before COVID-19 diagnosis. Changes in anticancer treatment were very frequent in patients hospitalized with COVID-19. Further monitoring of the long-term impact of COVID-19-related changes to anticancer treatment plans is warranted.

516-P: A One-Year Curriculum for Diabetes Self-Management Education to Promote Lasting Lifestyle Changes

The use of telehealth for Diabetes Self-Management Education and Support (DSMES) is expanding. There is a need among people with diabetes (PWD) to manage their diabetes, as they represent 20% of ICU admissions, 30% of hospitalized cases and have an increased risk of COVID-related mortality. While people at risk for diabetes or prediabetes may join a 1-year CDC accredited diabetes prevention program to make lifestyle changes to reduce their diabetes risk, PWD are often offered short-term DSMES programs that do not necessarily incorporate long-term goals. We developed a year-long intensive Diabetes Self-Management Education and Support (iDSMES) program combining Virtual Diabetes Conversation Map® and selected modified modules from the PreventT2® curriculum to suit PWD. The curriculum included 18 maps/modules. Our team of certified lifestyle coaches/diabetes educators/Conversation Map® Trainers used shared decision-making and problem-solving approaches to improve glycemic control and diabetes self-management. We hypothesized that iDSMES would improve diabetes outcomes in PWD. Fourteen PWD (12F/2M) with a BMI of 25 or above underwent the iDSMES in a group with their lifestyle coaches using the Zoom® platform. We collected their fasting blood glucose, weight, blood pressure, and physical activity minutes at each session (every three weeks) and assessed their Hemoglobin A1c quarterly. Nine PWD completed the iDSMES and lost an average of 8.8% of their initial body weight (a total of 203lbs) . We observed a 1% decrease in their A1c, 10mg/dL decrease in fasting blood glucose, and mm Hg decrease in systolic and diastolic blood pressure, respectively. There was also a 110-minute increase in their physical activity. A year-long iDSMES distance learning program effectively enhances lasting lifestyle changes to improve diabetes self-management in PWD. A 5-year follow-up is warranted to assess factors affecting the maintenance of accomplished lifestyle changes. Disclosure H.Sallam: None. W.Pan: None. M.L.Ferguson: None. W.Lee: None. K.H.Mckinney: None. H.Serag: None. Funding Texas Department of State Health Services (#HHS000740800001)

Telepsychiatry in Older Adults- Taking the lessons learned from the pandemic into the future

Older adults were disproportionately affected by the COVID pandemic, not just by COVID-related mortality but also by social isolation. We will present an interactive workshop in which audience members are invited to share their clinical experiences and conceptualize how tele-psychiatry or tele-medicine may have changed access to care and patient outcomes. We will discuss the effect of the pandemic-induced social isolation and lack of access to care on older adults. We will talk about our telepsychiatry journey at UConn Health, and invite audience experiences. We will discuss telepsychiatry policies and how they changed with the pandemic, and the impact that had on creating a telepsychiatry practice. We will share results from a provider and patient survey, comparing older adults to the general population. We will also discuss lessons learned from this project, and best practices that increase access to care for older adults. We will review existing literature on telepsychiatry in older adults. Lastly, we will take a peek at the future, at how telepsychiatry and digital health as a whole can influence the future of mental health treatment for older adults.

Effect of COVID-19 on presentations of decompensated liver disease in Scotland

Background and aimsSARS-CoV-2 and consequent pandemic has presented unique challenges. Beyond the direct COVID-related mortality in those with liver disease, we sought to determine the effect of lockdown on people...

P-EGS20 Safe emergency laparoscopic cholecystectomy in the first 12 months of the Covid-19 pandemic

BackgroundThe World Health Organisation declared a global pandemic on the 11th March 2020 regarding the COVID-19 infection. This has had a dramatic impact on both acute and elective hospital services that will take a considerable time to recover from. Initial emergency intercollegiate surgical guidance released in March 2020 raised concern regarding laparoscopic surgery and advised to pursue alternative non-surgical or radiological treatment options for the safety of patients and theatre teams. The aim of this study was to assess the safety of emergency laparoscopic cholecystectomy (ELC) for patients presenting to our centre with acute gallstone pathology during the pandemic.MethodsRetrospective analysis of all cholecystectomies undertaken in the department during the first year of the pandemic from 11th March 2020 to 11th March 2021. This period encapsulated two recognised peaks of the pandemic in the United Kingdom. Demographic data, elective/emergency, operative time, postop ITU admissions due to COVID and COVID related mortality was collected. Operative numbers and times were compared with historical data (HD) from the previous five years over the same time frame.Results399 laparoscopic cholecystectomies were performed during the first year of the pandemic which was less than the previous five-year average of 570 cholecystectomies per annum (30% reduction). 247 (61.9%) were performed as an emergency on patients presenting with acute gallstone pathology compared to 35% (HD) performed acutely on average historically. Average age was 56 yrs (16-88 range). Average operative time for ELC during the pandemic was 69 minutes compared to 78 minutes HD (NS). No patients were admitted to ITU with post-operative Covid infections and there were no 30 day post-operative deaths. ConclusionsWe performed more ELC’s in the first year of the pandemic compared to the previous five-year average as we were conscious of the inevitable long waiting lists, we would certainly be faced with in the coming months. The Covid-19 pandemic was a global healthcare crisis and one the NHS had never encountered before. At the time there was no high-quality evidence on the safety of laparoscopy on patients presenting acutely. This study adds to the growing body of evidence that with consistent preoperative testing, PPE and appropriate patient flow pathways that emergency laparoscopic cholecystectomies are safe to perform in the current climate.

Thrombocytopathy vs Platelet hyper-reactivity in COVID-19: diverse pathologies, disease outcomes and therapeutic implications

Coagulopathy is an evident complication of COVID-19 with predominance of a prothrombotic state. Platelet activation plays a key role. The terms “hyper-reactivity” and “hyperactivity” used in recent literature may not be clear or sufficient to explain the pathological events involved in COVID-related thrombosis (CRT). Inflammation may play a bigger role compared to thrombosis in COVID-related mortality because a smaller percentage of patients with COVID-19 die due to direct effects of thrombosis. Not all COVID-19 patients have thrombocytopenia and a few show thrombocytosis. We believe the platelet pathology is more complex than just activation or hyper-activation, particularly due to the platelets’ role in inflammation. Understanding the pathology and consequences of platelets’ role may help optimize management strategies and diminish CRT-associated morbidity and mortality. In this viewpoint report, we examine the published evidence of platelet hyper-reactivity in COVID-19 with a focused analysis of the key pathologies, diverse alterations, disease outcomes, and therapeutic targets. We believe that COVID-19 is a disease of inflammation and pathologic platelets, and based on the complexity and diverse pathologies, we propose the term “thrombocytopathy” as a more reflective term of the platelets’ involvement in COVID-19. In our opinion, thrombocytopathy is the unpredictable pathologic alterations of platelets in function, morphology and number, caused by different factors with a variety of presentations.

Association of Heart and Lung Radiation Dose With COVID-Related Mortality

Purpose/Objective(s)Studies have suggested that prior radiation dose to normal lung tissue is associated with poor COVID-19 outcomes. However, radiation dose to the heart may be an equally important consideration, given the impact of COVID-19 on cardiovascular/thrombotic complications, and of cardiac dose on overall mortality after breast and lung radiation therapy. We hypothesized that prior heart radiation dose is independently associated with COVID-related mortality (CRM) after adjusting for prior lung radiation dose among COVID-19 positive patients.Materials/MethodsWe retrospectively reviewed the plans of the first 203 patients with a history of radiation therapy in our department to have a documented episode of COVID-19 infection resulting in either death or resolution. For non-metastatic patients with complete treatment plan information and a simulation scan including the entirety of the heart and lungs, we calculated mean bilateral lung dose (MLD [Gy]), bilateral lung V5 (LV5 [%]) and V20 (LV20 [%]), mean heart dose (MHD [Gy]), heart V5 (HV5 [%]), and V30 (HV30 [%]). Each dosimetric parameter was dichotomized at the upper tercile. Our primary endpoint was CRM. The relationship between dosimetric parameters and mortality was evaluated by univariable chi-square analysis and multivariable logistic regression with odds ratios (OR) and 95% confidence intervals (CI).ResultsOf the 203 patients with documented COVID-19 infection included in our study, 37 experienced CRM (18%). Of the 53 non-metastatic dosimetrically evaluable patients comprising the study cohort, 9 experienced CRM (17%). The most common sites of disease in the study cohort were breast (N = 34), among whom 3 patients (9%) experienced CRM, and lung/thoracic (N = 11), among whom 4 (36%) experienced CRM. In the study cohort, median lung doses were MLD 4.7 Gy, LV5 17.9%, and LV20 8.0%; median heart doses were MHD 1.8 Gy, HV5 2.9%, and HV30 0.1%. On univariable analysis, CRM was higher for patients with MLD ≥7.2 Gy vs. < 7.2 Gy (33.3% vs. 8.6%, P = 0.033), LV5 ≥25.9% vs. < 25.9% (33.3% vs. 8.6%, P = 0.033), MHD ≥2.9 Gy vs. < 2.9 Gy (41.2% vs. 5.6%, P < 0.005), HV5 ≥9.4% vs. < 9.4% (38.9% vs. 5.7%, P = 0.007), and HV30 ≥1.9% vs. < 1.9% (41.2% vs. 5.6%, P = 0.005). Multivariable analysis showed in one model that MHD ≥2.9 Gy vs. < 2.9 Gy was associated with CRM (OR 8.7, CI 1.4-51.9, P = 0.02) while MLD ≥7.2 Gy vs. < 7.2 Gy was not (OR 2.9, CI 0.5-15.8, P = 0.22), and in another model that HV5 ≥9.4% vs. < 9.4% was associated with CRM (OR 7.4, CI 1.2-45.0, P = 0.03) while LV5 ≥25.9% vs. < 25.9% was not (OR 2.2, CI 0.4-13.1, P = 0.37).ConclusionPrior heart radiation dose appeared to serve as a better predictor of COVID-related mortality than prior lung radiation dose. Future studies of the relationship between radiation therapy and COVID outcomes should include measures of heart exposure, especially given the known cardiovascular sequelae of COVID-19.

Vaccinating Adolescents and Children Significantly Reduces COVID-19 Morbidity and Mortality across All Ages: A Population-Based Modeling Study Using the UK as an Example.

Debate persists around the risk–benefit balance of vaccinating adolescents and children against COVID-19. Central to this debate is quantifying the contribution of adolescents and children to the transmission of SARS-CoV-2, and the potential impact of vaccinating these age groups. In this study, we present a novel SEIR mathematical disease transmission model that quantifies the impact of different vaccination strategies on population-level SARS-CoV-2 infections and clinical outcomes. The model employs both age- and time-dependent social mixing patterns to capture the impact of changes in restrictions. The model was used to assess the impact of vaccinating adolescents and children on the natural history of the COVID-19 pandemic across all age groups, using the UK as an example. The base case model demonstrates significant increases in COVID-19 disease burden in the UK following a relaxation of restrictions, if vaccines are limited to those ≥18 years and vulnerable adolescents (≥12 years). Including adolescents and children in the vaccination program could reduce overall COVID-related mortality by 57%, and reduce cases of long COVID by 75%. This study demonstrates that vaccinating adolescents and children has the potential to play a vital role in reducing SARS-CoV-2 infections, and subsequent COVID-19 morbidity and mortality, across all ages. Our results have major global public health implications and provide valuable information to inform a potential pandemic exit strategy.

Comparing mortality from covid-19 to mortality due to overdose: A micromort analysis

ObjectiveTo compare the mortality risk due to covid-19 with death due to overdose in British Columbia, Canada. The opioid epidemic was declared a public health emergency in 2016. MethodsMortality risk was calculated in micromorts with covid-19 data for January–October 2020, derived from the BC center for Disease Control, and illicit drug toxicity deaths for January 2010–September 2020, derived from the BC Coroners Service. Age-stratified covid-19 incidence and deaths per 100,000 population and age-stratified illicit drug toxicity death rates per 100,000 population were calculated. A micromort is a unit of risk equivalent to a one-in-a-million chance of death. ResultsDuring the covid-19 pandemic, illicit drug toxicity deaths reached 1.0 micromorts per day, representing an increase of 0.5 micromorts per day relative to 2019 rates. In comparison, covid-19 mortality risk was 0.05 micromorts per day among individuals from the general population living in British Columbia and 21.1 micromorts per day among those infected with covid-19. Covid-related mortality risk was significantly lower among individuals aged <60 years, relative to older adults, whereas drug toxicity-related mortality was highest for individuals aged 30–59 years. ConclusionsThe mortality associated with covid-19 is apparent and distributed unevenly across subpopulations. The mortality due to overdose has increased during covid-19 and exceeds mortality due to covid-19. Our results instantiate the triple threat caused by covid-19 (i.e., public health crisis, economic crisis and mental health crisis) and quantitatively highlight the externality of increased mortality due to deaths of despair in response to public health efforts to reduce covid-related mortality.

Increased Pace of Aging in COVID-Related Mortality.

Identifying prognostic biomarkers and risk stratification for COVID-19 patients is a challenging necessity. One of the core survival factors is patient age. However, chronological age is often severely biased due to dormant conditions and existing comorbidities. In this retrospective cohort study, we analyzed the data from 5315 COVID-19 patients (1689 lethal cases) admitted to 11 public hospitals in New York City from 1 March 2020 to 1 December. We calculated patients’ pace of aging with BloodAge—a deep learning aging clock trained on clinical blood tests. We further constructed survival models to explore the prognostic value of biological age compared to that of chronological age. A COVID-19 score was developed to support a practical patient stratification in a clinical setting. Lethal COVID-19 cases had higher predicted age, compared to non-lethal cases ( = 0.8–1.6 years). Increased pace of aging was a significant risk factor of COVID-related mortality (hazard ratio = 1.026 per year, 95% CI = 1.001–1.052). According to our logistic regression model, the pace of aging had a greater impact (adjusted odds ratio = 1.09 ± 0.00, per year) than chronological age (1.04 ± 0.00, per year) on the lethal infection outcome. Our results show that a biological age measure, derived from routine clinical blood tests, adds predictive power to COVID-19 survival models.

COVID-19 vaccine hesitancy among lymphoma patients in Poland

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has affected the health of the entire population. Neoplastic diseases of the immune system are associated with increased COVID-related mortality. Vaccination is the only effective way to reduce morbidity and mortality, yet vaccine hesitancy has been observed. The aim of this study was to assess attitudes towards vaccination among lymphoma patients and to identify vaccine hesitancy predictors. Material and methods: The study was conducted on 280 patients with lymphoma who took part anonymously in a web-based survey prepared by the Pokonaj Chłoniaka Foundation. The survey assessed: attitude to and perception of COVID-19 vaccines, the perceived likelihood of COVID-19 infection, personal experiences with COVID-19, and demographic data. Results: In our sample, almost one patient in three was vaccine-hesitant. The percentage was higher among patients living in the countryside, villages and smaller towns and in those not educated beyond high school level. The acceptance of vaccination increased with patient age. The high number of skeptical patients could be potentially dangerous, with regard to the high COVID-related complications and mortality. Conclusions: Clear and easily understood information on COVID vaccines can reduce the risk of COVID-related issues. This subject should be addressed in educational campaigns focused particularly on the identified groups of vaccination skeptics.

The relationship of extent of initial radiological involvement with the need of intensive care, mortality rates, and laboratory parameters in Covid-19

Background/aim It is very important for the efficient use of limited capacity and the success of treatment to predict patients who may need ICU with high mortality rate in the Covid-19 outbreak. In our study, it was aimed to investigate the value of the radiological involvement on initial CT in demonstrating the ICU transfer and mortality rate of patients.Materials and methods All PCR-positive patients were included in the study, whose CT, PCR, and laboratory values were obtained simultaneously at the time of first admission. Patients were divided into 4 groups in terms of the extent of radiological lesions. These groups were compared in terms of intensive care transfer needs and Covid-related mortality rates.Results A total of 477 patients were included in the study. Ninety of them were group 0 (no lung involvement), 162 were group 1 (mild lesion), 89 were group 2 (moderate lesion), and 136 were group 3 (severe lung involvement). A significant relationship was found between the extensiveness of the radiological lesion on CT and admission to intensive care and mortality rate. As the initial radiological involvement amounts increased, the rate of ICU transfer and mortality increased. The mortality rates of the groups were 0%, 3%, 12.3%, and 12.5%, respectively, and the difference was significant (p < 0.001). Similarly, the ICU transfer rates of the groups were 2.2%, 5.6%, 13.5%, and 17.7%, respectively, and the difference was significant (p < 0.001).Conclusion In conclusion, in our study, the strong relationship between the initial radiological extent assessment and the need for intensive care and mortality rates has been demonstrated, and we believe that our results will make a significant contribution to increase the success of the health system in predicting patients who may progress, helping clinicians and managing pandemics.

COVID-19 treatment combinations and associations with mortality in a large multi-site healthcare system.

During the early months of the COVID-19 pandemic, mortality associated with the disease declined in the United States. The standard of care for pharmacological interventions evolved during this period as new and repurposed treatments were used alone and in combination. Though these medications have been studied individually, data are limited regarding the relative impact of different medication combinations. The objectives of this study were to evaluate the association of COVID-19-related mortality and observed medication combinations and to determine whether changes in medication-related practice patterns and measured patient characteristics, alone, explain the decline in mortality seen early in the COVID-19 pandemic. A retrospective cohort study was conducted at a multi-hospital healthcare system exploring the association of mortality and combinations of remdesivir, corticosteroids, anticoagulants, tocilizumab, and hydroxychloroquine. Multivariable logistic regression was used to identify predictors of mortality for both the overall population and the population stratified by intensive care and non-intensive care unit admissions. A separate model was created to control for the change in unmeasured variables over time. For all patients, four treatment combinations were associated with lower mortality: Anticoagulation Only (OR 0.24, p < 0.0001), Anticoagulation and Remdesivir (OR 0.25, p = 0.0031), Anticoagulation and Corticosteroids (OR 0.53, p = 0.0263), and Anticoagulation, Corticosteroids and Remdesivir (OR 0.42, p = 0.026). For non-intensive care unit patients, the same combinations were significantly associated with lower mortality. For patients admitted to the intensive care unit, Anticoagulation Only was the sole treatment category associated with decreased mortality. When adjusted for demographics, clinical characteristics, and all treatment combinations there was an absolute decrease in the mortality rate by 2.5% between early and late periods of the study. However, when including an additional control for changes in unmeasured variables overtime, the absolute mortality rate decreased by 5.4%. This study found that anticoagulation was the most significant treatment for the reduction of COVID-related mortality. Anticoagulation Only was the sole treatment category associated with a significant decrease in mortality for both intensive care and non-intensive care patients. Treatment combinations that additionally included corticosteroids and/or remdesivir were also associated with decreased mortality, though only in the non-intensive care stratum. Further, we found that factors other than measured changes in demographics, clinical characteristics or pharmacological interventions accounted for an additional decrease in the COVID-19-related mortality rate over time.