2nd March Research Articles

Incidence and mortality due to thromboembolic events during the COVID-19 pandemic: Multi-sourced population-based health records cohort study

BackgroundEvidence supports an excess of deaths during the COVID-19 pandemic. We report the incidence and mortality of thrombo-embolic events (TE) during the COVID-19 pandemic. MethodsMulti-sourced nationwide cohort study of adults (age ≥18 years) admitted to hospital with TE and deaths from TE in England (hospital and community) between 1st February 2018 and 31st July 2020. Relative risks, adjusted for age, sex, atrial fibrillation, co-morbidities and time trend comparing before and during the COVID-19 pandemic were estimated using Poisson regression. FindingsOf 272,423 patients admitted with TE to 195 hospitals, 86,577 (31.8%) were admitted after 2nd March 2020 (first COVID-19 death in the UK). The incidence of TE hospitalised increased during the COVID-19 pandemic from 1090 to 1590 per 100,000 (absolute risk change 45.9% [95% CI 45.1–46.6%], adjusted relative risk [ARR] 1.43 [95% CI 1.41–1.44]) driven particularly by pulmonary embolism; 1.49, 95% CI 1.46–1.52. TE were more frequent among those with COVID-19; 1.9% vs. 1.6%, absolute risk change 21.7%, 95% CI 21.0–22.4%, ARR 1.20, 95% CI 1.18–1.22. There was an increase in the overall mortality from TE during the pandemic (617, 6.7% proportional increase compared with the historical baseline), with more TE deaths occurring in the community compared with the historical rate (44% vs. 33%). InterpretationThe COVID-19 pandemic has resulted in an increase in the incidence of hospitalised TE. There were more deaths from TE in the community highlighting a number of mechanisms including the hypercoagulable state associated with COVID-19 infection and potential impact of delays in seeking help. Research in contextEvidence before this studyWe searched PubMed on 16 November 2020 for articles that documented the incidence and mortality of thrombo-embolic events (TE) during the COVID-19 pandemic using the search terms “COVID-19” OR “Coronavirus*” OR “2019-nCOV” OR “SARS-CoV” AND (“Thromboembolism” OR “Venous Thromboembolism” OR “thromboembol*”) with no language or time restrictions. The majority of data on TE in COVID-19 pertains to hospitalised patients from retrospective cohort studies. One study found that TE in hospitalised patients was associated with an increased mortality rate (adjusted hazard ratio 1.82; 95% CI 1.54–2.15). A systematic review and meta-analysis of 35 studies in 9249 hospitalised patients calculated an overall pooled incidence of TE of 17.8% (95% CI: 9.9–27.4%), rising to 22.9% (95% CI: 14.5–32.4%) in patients admitted to intensive care (ICU). The most contemporary data are from a cohort of 1114 patients (715 outpatient, 399 hospitalised, 170 admitted to ICU). With robust COVID-19-specific therapies and widespread thromboprophylaxis the prevalence of venous TE in ICU patients was reported as 7% (n = 12) when catheter-/device-related events were excluded, and among the outpatients there was no TE reported. No published studies have used nationwide data to investigate TE during the pandemic or the effect of the pandemic on outcomes of patients with TE but without Covid-19.Added value of this studyThis retrospective multi-sourced nationwide unlinked cohort study compares the overall incidence and mortality of TE prior to and during the COVID-19 pandemic. We found an increased incidence of TE despite only a small proportion having a diagnosis of COVID-19. This may highlight the lack of testing, particularly in the community during the initial phase of the pandemic, and the possibility of other factors contributing to TE risk, such as decreased daily activity mandated by home quarantine and alterations in medication concordance. Mortality from TE was higher in the community during the pandemic and this highlights that adverse societal effects of the pandemic, such as aversion to seeking medical assessment, may precipitate worse outcomes related to TE.Implications of all the available evidenceEvidence suggests that COVID-19 produces a hypercoagulable state and thromboprophylaxis is recommended in hospitalised patients to prevent excess mortality from TE. Whether to anticoagulate non-hospitalised ambulatory patients with COVID-19 will be answered by ongoing trials. Clinicians should consider the risks posed by decreased daily activity and fear of medical contact, and provide appropriate advice to patients.

Coronavirus Disease (COVID-19) the African Story: A Review

Corona virus disease (COVID-19) is a global health threat that put panic in the minds of people worldwide. Although, the disease originate from China, but its effect covers the whole world. This review is to assess the effect of COVID-19 in the African continent. Data from already published researches were obtained, through which it was found that, Africa had its first confirmed index case of COVID-19 on the 14th of February, 2020, from Egypt, second case on 25th February, 2020, from Algeria while the 3rd was in Nigeria on the 27th of the same month. From there, the cases continue to spread throughout the continent. The review also highlighted on some factors that were thought can put Africa at higher risk of COVID-19; these include Africa China relation, which accounts for an average of 8 flights per day between the two regions, according to an investigation in 2018; endemic diseases that are common in the region and inefficient health system, among others. It was also observed according to the review that, world health organization (WHO) tried to upgrade the laboratory capacity for COVID-19 test in the continent at the time the disease hit the region. For that reason, between February 2nd and 10th March 2020, the laboratory capacity for COVID-19 test were raised, from 2 to 40 across the continent, WHO also provided 42,000 PCR test kits and 195,000 sample collection kits at around the same time. According to the review, as reported in WHO corona virus disease situation report of 9th July, 2020, at a point, in the progress of the disease in Africa, there were 493,131 cases with 11,643 deaths, indicating 25% cases increase and 18% deaths increase over a week. Based on the review, it can be concluded that, African countries are also victims of COVID-19, as a lot of them are still battling with the disease to date.

Community Empowerment through Processed Diversification and Marketing Strategy of the Wanita Gemari Polkahsar in Pemalang District

Pemalang is one of the sub-districts in the Pemalang district which has considerable fishery potential. One area of business is the processing of fisheries. Products in each group vary, such a fish thrown, salted fish, fish cake, and fish chips. Identifying the problem hasn’t added to the variety of fisheries processing products. Packaging is less attractive. The purpose of research is to increase knowledge, skill, and attitude through outsourcing activities about product diversification and the marketing strategy. The study was carried out on 2nd March – 15 Mei 2020. Counseling methods with group meetings, demonstrations of tutorials, lectures, and group discussion with the aim of Wanita Gemari Poklahsar. Counseling activities include (1) diversification of processed fish, (2) marketing strategy through packaging designs, and (3) counseling about online marketing. The T-test conducted with SPSS shows a significant value of 0,000, which indicates that the counseling activities have a substantial effect on improving the aspects of respondents’ knowledge, skills, and attitudes.

Variation of chickpea nodulation in a mediterranean agroecosystem: Relationship with soil characteristics and thresholds for significant contribution to plant growth

Received: January 19th, 2021 ; Accepted: February 28th, 2021 ; Published: March 22nd, 2021 ; Correspondence: cheneneyacine@gmail.com

Characterization of pulmonary impairment associated with COVID-19 in patients requiring mechanical ventilation.

ObjectiveTo detect early respiratory and hemodynamic instability to characterize pulmonary impairment in patients with severe COVID-19.MethodsWe retrospectively analyzed data collected from COVID-19 patients suffering from acute respiratory failure requiring intubation and mechanical ventilation. We used transpulmonary thermodilution assessment with a PiCCO™ device. We collected demographic, respiratory, hemodynamic and echocardiographic data within the first 48 hours after admission. Descriptive statistics were used to summarize the data.ResultsFifty-three patients with severe COVID-19 were admitted between March 22nd and April 7th. Twelve of them (22.6%) were monitored with a PiCCO™ device. Upon admission, the global-end diastolic volume indexed was normal (mean 738.8mL ± 209.2) and moderately increased at H48 (879mL ± 179), and the cardiac index was subnormal (2.84 ± 0.65). All patients showed extravascular lung water over 8mL/kg on admission (17.9 ± 8.9). We did not identify any argument for cardiogenic failure.ConclusionIn the case of severe COVID-19 pneumonia, hemodynamic and respiratory presentation is consistent with pulmonary edema without evidence of cardiogenic origin, favoring the diagnosis of acute respiratory distress syndrome.

Remdesivir for the Treatment of Hospitalised Patients with COVID-19 (DisCoVeRy): A Randomised, Controlled, Open-Label Trial

Remdesivir for the Treatment of Hospitalised Patients with COVID-19 (DisCoVeRy): A Randomised, Controlled, Open-Label Trial

Logistic growth model and modified versions for the cumulative number of confirmed cases of COVID-19 in Saudi Arabia

In this study, mathematical modeling is applied to investigate the epidemiology of COVID-19 in Saudi Arabia. The aim was to estimate the cumulative number of infected cases using a logistic growth function and three modified models. The daily cumulative number of confirmed cases was collected from the online COVID-19 dashboard provided by the Ministry of Health. The period covered in this study began from 2nd March until the 20th August 2020. Data was fitted to the logistic growth function and three modified versions by using an online tool which implements the least squares estimate method. The results show all models fit significantly. The predictions from all these models are very similar and encouraging. According to the results the growth rate should decline from approximately 21st Jun 2020 onwards and the maximum number of cumulative confirmed infected cases in Saudi Arabia would be around 324,000 predicting an end to the pandemic by April 2021.

Association of Demographic and Occupational Factors with SARS-CoV-2 Vaccine Uptake in Kenya

The outbreak of the Severe Acute Respiratory Syndrome Coronavirus 2 has triggered adoption and diffusion of public and infection control measures. After numerous clinical trials, various brands of vaccines were developed to attenuate further spread of the virus. The vaccines come at a time when misinformation is scuttling synergies to fight the flu-like disease. Uncertainty surrounding the safety of the vaccines translates to fear of health outcomes among users yet hesitancy in vaccine uptake has direct threats to health. Using a digital cross-sectional survey data among 171 respondents that was conducted between 2nd March and 5th March 2021, the study reveals variation on the update of the vaccine. The study recommends public sensitization and education about the vaccines for greater proportion of acceptance and uptake.

Rhino orbital mucormycosis.

We are presenting the case of a 75- year-old female who tested positive for COVID-19 in the 2nd week March with an high-resolution computed tomography (HRCT) score of 4/25 on the very next day for which she visited a hospital in sevagram where she was admitted for 7 days after which she was discharged and kept into home isolation under constant monitoring. After 2 months on the 6th of May 2021 she was brought to hospital in Sawangi, with complaints of pain over the right side of the face which was sudden in onset, continuous, dull aching, radiating to forehead on the right side with the history of associated swelling over the right side of the face which was initially small in size and gradually increased to present size of 3 x 2 cm approx, with history of difficulty in mastication, deglutition and speech were altered, nasal stiffness over the right side since 15 days. She is known case of hypothyroidism for 20 years, diabetes mellitus and hypertension for 10 years with chronic kidney disease. On extraoral examination patient´s face was asymmetrical due to fungal infection and diffused swelling over the right side of the face and opthalmoplagia, blurring of vision, ptosis, chemosis and restricted eye movements. Intraoral examination reveals mouth opening of 25mm with diffuse gingival swelling seen in the upper right maxillary alveolar region extending anteroposteriorly from 11 to 26 regions. Magnetic resonance imaging brain and orbit reveals invasive fungal sinusitis with the cutaneous collection and intracranial extension of mucormycosis.

COVID-19 – Law and Policy Response in India: A Prologue

India’s official response to COVID began as early as January 17, 2020 with an advisory issued to avoid travel to China. On 30th January, 2020, World Health Organization (“WHO”) declared it as a public health emergency of international concern, WHO’s highest level of alert under global health law. The first reported case in India was confirmed in Thrissur, Kerala in traveller from Wuhan. Nobody would have imagined that it would be a long haul for all, when the Prime Minister gave a call for ‘Janta Curfew’ on March 22nd 2020 in his address to the nation. The first order of 21 days lockdown was issued on 24 March “to take effective measures to prevent spread of Covid-19 across the country and for maintenance of essential services and supplies including health infrastructure”. India’s critical response to COVID have been lauded globally which included a series of countrywide lockdown measures. Various High Courts around the country and Supreme Court did not stop working during the pandemic and kept upholding the rule of law and fundamental rights of the people. The aforesaid rendition of law and policy response in India during COVID-19 gives a glimpse of management of COVID-19 in India through different law and policy measures. Comparatively, India has been able to manage the pandemic well and brings forward the hope of the world towards India as a responsible country.

Surprising Changes in Aerosol Loading over India amid COVID-19 Lockdown

Using ground-based and satellite observation along with aerosol reanalysis products, we show a widespread reduction in aerosol loading over the Indian subcontinent during the COVID-19 (COronaVIrus Disease 2019) lockdown. The pre-lockdown and lockdown period considered in the present study is 20th February–20th March 2020 and 24th March–22nd April 2020. In terms of aerosol optical depth (AOD), loading has reduced up to 40% over the most populated region of India. However, the central part of India shows an unexpected increase (~+20%) in AOD. A simultaneous increase (decrease) in mid-tropospheric relative humidity (wind speed (WS) at 850 hPa) by +85 ± 6.0% (–12 ± 3.9%) occurred during the lockdown. It is found that on a daily scale, the mean AOD is positively (negatively) correlated with mid-tropospheric RH (WS) with a statistically significant linear correlation coefficient of 0.53 (−0.43). An increase (decrease) in RH (WS) of 20% (1 m s–1) was observed to increase AOD by 0.10 (0.04). Thus, we hypothesize that during the lockdown, the increased AOD over central India was due to increased atmospheric moisture coupled with stagnant circulation condition.

Analysis of the government regulations on COVID-19 pandemics in Indonesia: implementation and challenges

COVID-19 started in China and then spread to other countries. The Indonesian government officially announced the first case of COVID-19 on 2nd March 2020. Previously, on 4th February, the Ministry of Health issued a Decree of the Minister of Health number HK.01.07 of 2020 regarding “Determination of Novel Coronavirus Infection (2019-Ncov Infection) as a Disease That Can Cause Outbreaks And Efforts to Overcome it”. WHO then declared COVID-19 as a pandemic on 11th March 2021. After that, the central government issued various regulations related to the handling of COVID-19. This paper aims to study the regulations issued by the Indonesian government regarding the handling of COVID-19. The research method uses a content analysis method using nVivo software. The study results show that the regulations are quantified, consisting of 30% related to social, 10% related to the budget, 25% related to health, 20% related to COVID-19 handling organizations, and 15% related to economic recovery. This paper also presents the challenges related to the implementation of these regulations

How Kerala and Rajasthan Mitigated COVID-19: A Comparative Study

All the countries of the world have been taking all the possible precautionary measures to combat COVID-19. In India, although there are many states which were affected by this flareup, the authors had taken only two states, i.e., Kerala and Rajasthan. Both the states did their best to combat this pandemic. Kerala was the first state to witness the first case in India on 30th January 2020 whereas in Rajasthan, the first case was tested on 2nd March 2020. After announcing this flareup as a pandemic by WHO, all the states did their best to break the chain of transmission, till date the recovery rate of India is 63.30%, Kerala is 47%, and Rajasthan is 73%. The high rate of recovery and low rate of case fatality show the benefits of early lockdown and the precautionary measures taken by Government of India and State governments (Kerala and Rajasthan). This paper implies the comparative study of all the precautionary measures and situation of COVID-19 in the two states.

Examining Asymmetric Relationship between India VIX, Nifty 50 Returns and Trading Volume: A case of Quantile Regression

The study investigated one of the vital issues on market microstructure, the relationship between volatility, stock returns and trading volume on Indian stock market for daily frequency from 2nd March 2009 to 31st July 2018. The investor’s fear gauge measure of VIX was used as a volatility variable. The asymmetric impact of returns was estimated on volume and volatility changes. The MWALD granger test revealed that trading volume is undirectionally caused be negative returns and implied volatility VIX. Feedback relationship exists between positive returns, negative returns and VIX. Also positive and negative returns have a bi-directional causality. But the results of Toda-Yamamoto only capture the central values of dependent variable’s distribution. Therefore we also estimate Quantile Regression models. The asymmetric significant relation of stock returns on changes of volatility and volume distribution was found and stronger at extreme ends of dependent variable’s distribution. The study supports the behavioral justification for negative return-volatility contemporaneous relationship but not unconditionally. The evidence of volatility feedback and leverage hypothesis was also significant for lagged period. The contemporaneous negative relationship was found between volatility and volume changes highlighting that investors in India are risk-averse and informed. But the positive lagged effect of changes in volatility on trading volume supports SAIH and affirms the fact that when information gets assimilated with time, noise traders entre the market and increase liquidity. Thus their presence increases trading volume with increase in VIX level.

Clinical and epidemiological profile of patients infected by COVID-19 at a tertiary care centre in North India.

A worldwide outbreak of a respiratory illness, first detected in December 2019 in Wuhan city, Hubei province, China is ongoing. The disease is caused by a novel coronavirus, SARS-CoV-2 and on February 11, 2020, was officially named Coronavirus Disease 2019 (COVID-19) by the World Health Organization. Within few weeks, it has spread globally to the extent that World Health Organization declared it as a global pandemic on March 11, 2020. India's first positive case was reported on January 30th in Kerala. Before March 3rd, India had 3 cases of coronavirus in Kerala all of which were treated and discharged. On March 3rd, India's 4th case was diagnosed in the state of Rajasthan. Indian government had announced a number of preventive measures to minimize the entry and spread of coronavirus. On March 3rd, India announced the suspension of all visas issued to Italy, Iran, South Korea and Japan. India banned international flights from March 22nd. A 21-day lockdown across the country was imposed from March 26th, which later got further extended. Rigorous contact tracing and tracking of COVID patients and monitoring home quarantine helped in preventing community transmission.The aim of this work is to describe the experience with clinical and epidemiologic features, as well as with the management of COVID-19 patients in north India. This is a descriptive study of the 17 COVID-19 infected patients confirmed with polymerase chain reaction (PCR) and admitted to a tertiary care centre in India from March 11th 2020 to April 16th 2020. The present work also provides insight in to treatment provided and final outcome of the patients infected with COVID-19 in India. Laboratory investigations in COVID-19 patients in the Indian subcontinent reveal lymphopenia as predominant finding in hemogram. Patients with older age and associated comorbidities (COPD, hypertension and diabetes) seem to have greater risk for lung injury, thereby requiring oxygen support during the course of disease.

Preparing For the COVID-19 Pandemic: The Perspective of a Department of Anesthesiology in a Tertiary Hospital in Portugal

Since the detection of the first cases of COVID-19, reported by the People's Republic of China on the 31st December 2019, up to the confirmation of the first cases in Portugal, on the 2nd March, countries like Italy and Spain faced the collapse of their healthcare systems. Anticipating this possibility, the Portuguese National Health Service carried out measures to prepare for this reality. This paper describes the changes implemented in the Anesthesiology department of a tertiary hospital center in Portugal, aiming to ensure the safety of both patients and healthcare professionals. The measures implemented had to do mostly with scientific preparation and team reorganization; management of personal protective equipment; redesigning the department's clinical common areas, separation of patient circuits with creation of a designated COVID Operating Room, Post-Anesthetic Care Unit; rescheduling of elective surgery and testing all patients before anesthesia procedures and consulting other hospital departments. The reported data covers the period between the 2nd March and the 30th April of 2020. In this period, 64 cases with COVID-19 or with high clinical suspicion were approached. To date, there have been no cases of in-hospital spread to other patients or to professionals in this department. With this paper we intend to start a reflection that will end up with the optimization of strategies that allows health systems to deal better with COVID-19, keeping patients and health providers safe.

Practices and attitudes of bariatric surgeons in Israel during the first phase of the COVID-19 pandemic

IntroductionIsrael ranks very high globally in performing bariatric surgery (BS) per capita. In the first phase of the COVID-19 pandemic the bariatric surgeons’ community faced many concerns and challenges, especially in light of a decree issued by the Ministry of Health (MOH) on March 22nd, to ban all elective surgery in public hospitals. The aim of this study is to portray the practices and attitudes of Israeli bariatric surgeons in the first phase of the pandemic.MethodsAnonymous web-based questionnaire sent to all active bariatric surgeons in Israel. Statistical analysis was performed using SAS software package.Results53 out of 63 (84%) active surgeons responded to the survey. 18% practice in the public sector only, 4% in the private sector only and 78% in both sectors. 76% practice BS for more than 10 years and 68% perform more than 100 procedures a year. Almost all the surgeons (98%) experienced a tremendous decrease in operations. Nevertheless, there were substantial differences by sectors. In the public sector, 86% of the surgeons ceased to operate while 14% did not comply with the government’s decree. In the public sector 69% of the surgeons were instructed by the administrators to stop operating. The majority of surgeons who continued to operate (77%) changed nothing in the indications or contra-indications for surgery. Among the surgeons who opted to refrain from operating on special sub-groups, the most frequent reasons were pulmonary disease (82%), age above 60 (64%), Ischemic heart disease (55%) and living in heavily affected communities. Roughly only half (57%) of the surgeons implemented changes in informed consent and operating room (OR) measures, contrary to guidelines and recommendations by leading professional societies. When asked about future conditions for reestablishing elective procedures, the reply frequencies were as follows: no special measures - 40%; PCR negativity - 27%; IgG positivity - 15%; waiting until the end of the pandemic- 9%.ConclusionsWe showed in this nation-wide survey that the variance between surgeons, regarding present and future reactions to the COVID-19 pandemic, is high. There were substantial differences between the private and the public sectors. Although the instructions given by the MOH for the public sector were quite clear, the compliance by surgeons and administrators was far from complete. The administrators in the public sector, but more so in the private sector were ambiguous in instructing staff, leading surgeons to a more “personal non-structured” practice in the first phase of the pandemic. These facts must be considered by regulators, administrators and surgeons when planning for reestablishing elective BS or in case a second wave of the pandemic is on its way.

Psychological Response & Perceived Risk Associated with Coronavirus Disease

Background: The Coronavirus Disease 2019 (COVID-19) was declared a pandemic by WHO as it is found to be excessively transmissible & to spread throughout the world. The disease has caused a worldwide impact because of the need to establish worldwide activity by extensive social distancing and quarantine due to the daily rising death toll. Through this study, we examined intend to examine the psychological effects, perceptual vulnerability, and perceived stress developed among the general population.
 Methodology: The study was conducted from 2nd March to 26th May 2020. A total of 2188 of subjects replied to our informal online survey internationally. The respondent's demographic details and data regarding precautionary measures, perceptual vulnerability, perceived stress, and level of susceptibility of COVID-19 was collected. The perceived stress scale (PSS-10) was used for assessment of perceived anxiety, stigmatization, and fear of developing COVID-19.
 Results: As per the study findings, moderate perceived stress was observed among 66.6% of the respondents. Among the protective measures, washing hands was most frequent 56.2%, but the use of face mask wasn't widespread, i.e. 48.9% rarely or never used face masks. 37.1% felt anxious around sick people, 58.5% were usually bothered by the people sneezing without covering their mouths. 32.3% occasionally felt agitated because of no control over the current situation & 18.6% frequently felt stressed and/or nervous. The contact history revealed that 11.2% had close contact, 20.9% had a non-close contact, and 12.9% were those who had suspected connection with a confirmed case.
 Conclusion: Evidently, COVID-19 has numerous psychological impacts, and the responses vary due to perceived vulnerability & stress. The social distancing, disease fear, and quarantine may have some negative effects which may have some lasting consequences on general population.

COVID-19 in Cancer Patients on Systemic Anti-Cancer Therapies – Outcomes from CAPITOL (COVID-19 Cancer PatIenTOutcomes in North London)

Background: Patients with cancer are hypothesised to be at increased risk of contracting COVID-19, leading to changes in treatment pathways in those treated with systemic anti-cancer treatments (SACT). We investigated the outcomes of patients receiving SACT to assess whether they were at greater risk of contracting COVID-19 or having more severe outcomes. Methods: We collected data on all patients receiving SACT in two cancer centres as part of CAPITOL (COVID-19 CAncer PatIenT Outcomes in North London). The primary outcome was the effect of clinical characteristics on the incidence and severity of COVID-19 infection in patients on SACT. We used univariable and multivariable models to analyse outcomes, adjusting for age, gender and comorbidities. Findings: We analysed 2871 patients receiving SACT from 2nd March to 31st May 2020; 68 (2.4%) were diagnosed with COVID-19. Cancer patients receiving SACT were more likely to die if they contracted COVID-19 than those who did not (adjusted (adj.) OR 9·84; 95% CI 5·73 – 16·9). Receiving chemotherapy increased the risk of developing COVID-19 (adj. OR 2·99; 95% CI = 1·72 - 5·21), with high dose chemotherapy significantly increasing risk (adj. OR 2·36, 95% CI 1·35 – 6·48), as did the presence of comorbidities (adjusted OR 2·29; 95% CI 1·19 - 4·38), and having a respiratory or intrathoracic neoplasm (adj. OR 2·12; 95% CI 1·04 - 4·36). Receiving targeted treatment had a protective effect (adj. OR 0·53; 95% CI 0·30 – 0·95). Treatment intent (curative versus palliative), hormonal- or immunotherapy and solid versus haematological cancers had no significant effect on risk. Interpretation: Patients on SACT are more likely to die if they contract COVID-19. Those on chemotherapy, particularly high dose chemotherapy, are more likely to contract COVID-19, while targeted treatment appears to be protective. Funding: None.Declaration of Interests: NJH reports grants from CRUK Clinical Trial Fellowship, outside the submitted work. VEC, WW, TAF, SD, JB KK, DH, KKS, RK, NC, MD, EB, JB, MF and DH have no conflicts of interest to disclose. Ethics Approval Statement: Research and development approval were sought from University College Hospital, which is where the study was primarily conducted, the ethical approval was granted by the ethics committee of University College London Hospital NHSFoundation Trust.

Reductions in commuting mobility correlate with geographic differences in SARS-CoV-2 prevalence in New York City

SARS-CoV-2-related mortality and hospitalizations differ substantially between New York City neighborhoods. Mitigation efforts require knowing the extent to which these disparities reflect differences in prevalence and understanding the associated drivers. Here, we report the prevalence of SARS-CoV-2 in New York City boroughs inferred using tests administered to 1,746 pregnant women hospitalized for delivery between March 22nd and May 3rd, 2020. We also assess the relationship between prevalence and commuting-style movements into and out of each borough. Prevalence ranged from 11.3% (95% credible interval [8.9%, 13.9%]) in Manhattan to 26.0% (15.3%, 38.9%) in South Queens, with an estimated city-wide prevalence of 15.6% (13.9%, 17.4%). Prevalence was lowest in boroughs with the greatest reductions in morning movements out of and evening movements into the borough (Pearson R = −0.88 [−0.52, −0.99]). Widespread testing is needed to further specify disparities in prevalence and assess the risk of future outbreaks.