Pandemic Declaration Research Articles

Comparison of Tumor Size and Gene Expression at Presentation in Uveal Melanoma Patients before and during the COVID-19 Pandemic

Introduction: The aim of this study was to compare the clinical and gene expression variables of uveal melanoma patients presenting before and after the start of the COVID-19 pandemic as surrogate markers in order to assess the pandemic’s potential impact on care. Methods: We conducted a retrospective chart review of uveal melanoma patients at Retina Consultants of Texas and assessed tumor size, staging, and gene expression data during two time periods: May 2019 to February 2020 (Group 1: Before the COVID-19 pandemic declaration by the WHO in March 2020) and May 2020 to March 2021 (Group 2: After the start of the COVID-19 pandemic). Results: A total of 80 patients with uveal melanoma were studied (Group 1: 40 [50%] and Group 2: 40 [50%]). There was no statistically significant difference in the tumor thickness (p = 0.768), largest base dimension (p = 0.758), Collaborative Ocular Melanoma Study size class (p = 0.762), and American Joint Committee on Cancer stages (p = 0.872) between the two groups. Additionally, there was no difference in the tumors’ gene expression data including gene expression profile class (p = 0.587) and PRAME expressivity (p = 0.861) between the two groups. Discussion/Conclusion: The COVID-19 pandemic had no effect on the presentation of uveal melanoma patients across all tumor characteristics including size, staging, and gene expression data, suggesting there was not a significant diagnostic delay in care for uveal melanoma patients at our center due to the pandemic.

The Financial Market in China under the COVID-19

ABSTRACT The main aim of this study is to investigate the effects of COVID-19 on financial markets in China. Results of correlation analysis indicate that higher financial correlation among provinces emerged after the official announcement regarding COVID-19 in China. The Minimum Spanning Tree (MST) results after the pandemic announcement denote that Shanghai, Beijing, Jiangsu, Zhejiang, and Chongqing become the new cores, and the overall linking type exhibits cluster mode, which is varied from the intertwined connection mode. In addition, through Ensemble Empirical Mode Decomposition (EEMD) and Wavelet analysis, we found that financial markets in China are more susceptible to unexpected incidents.

Impacts of Covid-19 interventions on air quality: evidence from Brazilian metropolitan regions

The Covid-19 pandemic has negatively disrupted the way our economy and society functions. Nonetheless, there have also been some positive externalities of the pandemic on the environment. This paper aims to evaluate the concentration of nitrogen dioxide in Brazilian metropolitan regions after the policies adopted to confront Covid-19. In terms of methodological approach, the study employs cross-sectional quantitative analyses to compare the period of 36 days, i.e., 12 March to 16 April—before (in 2019) and after (in 2020) the pandemic declaration. The data were obtained from the Sentinel 5-P low-Earth polar satellite concerning Brazilian metropolitan regions (n = 24). Thorough spatial and statistical analyses were undertaken to identify the pre- and during pandemic nitrogen dioxide concentrations. Complementarily, Spearman’s correlation test was performed with variables that impact air quality. The study results a fall in nitrogen dioxide concentration levels in 21 of the 24 metropolitan regions which was observed. The Spearman’s correlation coefficient between the nitrogen dioxide variation and the vehicle density was 0.485, at a significance level of 0.05. With these findings in mind, the paper advocates that while the pandemic has a significant negative consequence on the health of population globally, a series of measures that result in a new social organization directly interfere in the reduction of air pollution that contributes to the quality of the air we breathe.

Momentary social interactions and affect in later life varied across the early stages of the COVID-19 pandemic.

The COVID-19 pandemic has impacted many different facets of life. The infectious nature of the disease has led to significant changes in social interactions in everyday life. The present study examined how older adults’ patterns of everyday momentary social interactions (i.e., with no one, partner, family, and friends) and their affect varied across the early stages of the pandemic and whether the magnitude of affective benefits associated with social interactions changed across time. A total of 188 adults aged 50 or above (Mage = 62.05) completed momentary assessments in early March, late March, May, and July 2020. Overall, older adults spent more time in solitude and less time interacting with their friends after the declaration of the pandemic. Further, negative affect (NA) spiked after the pandemic declaration and then returned to pre-pandemic level. Finally, momentary interactions with close social ties were consistently associated with higher positive affect (PA) and lower NA whereas momentary solitude was associated with lower PA, but not related to NA. The magnitude of associations between specific social interactions (or solitude) and affect varied across time, and the onset of the pandemic appeared associated with this variation. During the presumably most stressful period, solitude was not associated with lower PA and family interaction was not associated with higher PA as they were at other times. Further, interactions with friends seemed to have diminished affective benefits following the onset of the pandemic.

Adherence to Anticoagulation Ambulatory during the Beginning of Coronavirus Pandemic

INTRODUCTION: Treatment with Vitamin K Antagonists is already proven to be significant in reducing thromboembolic events in patients with indications for systemic anticoagulation. In the context of ambulatory adherence, the SARS-CoV2 coronavirus pandemic emerged as a challenge for managing patients undergoing anticoagulation. 
 
 METHODS: To avoid crowding and follow the recommended measures of social distancing, the Anticoagulation Ambulatory of the Hospital Universitário de Santa Maria started to adopt a differentiated model of care, with a collection of hospital prothrombin time and immediate home return, followed by teleconsultation, with medication adjustment, as necessary. The present study aimed to assess adherence to the new care model, as well as the profile of patients seen. A retrospective cohort study was conducted, analyzing consultations between March and May 2020. 
 
 RESULTS: The results demonstrate a low-educated population (76% had completed elementary school at most). The most common indications for the use of oral anticoagulation were atrial fibrillation (33.6%), followed by mechanical aortic valve prosthesis (31.3%) and mechanical mitral valve prosthesis (17.2%). Regarding adherence, especially to blood collection in the scheduled period, there was low adherence in the initial weeks of the pandemic declaration, with substantial improvement in adherence in the last two weeks of analysis. 
 
 CONCLUSION: Determining the clinical characteristics and profile of patients helps to determine the local needs of this population and implement active search strategies to improve adherence rates, which may reduce unfavorable outcomes.

Evaluation of Urgent Retinal Practice and Safety Measures for Physicians and Patients During COVID-19 Pandemic.

PurposeTo assess the impact of the COVID-19 pandemic on urgent retina practice and factors influencing adherence of physicians and patients to safety measures.MethodsIn this clinical audit, urgent or emergent vitreoretinal surgical disorders that presented to our hospital during the period of 15th March–15th May 2020 were compared with the period just before the pandemic declaration (15th December 2019–15th February 2020). Additionally, two questionnaires assessing the adherence to safety measures were circulated to the medical personnel and a sample of patients. The collected data were analyzed, and accordingly, recommendations were proposed to the hospital administration and specific corrective measures were applied. The outcome of applying these corrective measures was assessed in the re-audit cycle during the period of 15th June–15th August 2020.ResultsThere was a significant decrease in the number of urgent or emergent vitreoretinal surgical disorders that presented to our hospital during the pandemic (161 versus 302 cases in a similar period before the pandemic; p = 0.022). Just with the pandemic recession, there was a significant increase in the number of urgent cases (391 versus 161 cases during the pandemic; p = 0.006), also there was an increased number of complex cases. Residents and fellows were less compliant than attending physicians in adherence to safety measures.ConclusionDelayed presentation of urgent retinal cases during the pandemic highlights the importance of public awareness of urgent conditions that need immediate medical or surgical care. Attention to young physicians during the pandemic is crucial as they are less adherent to safety measures due to work overload.

IDF21-0214 COVID-19 & Diabetes in Canada: Two Global Pandemics Colliding & An Opportunity For Optimizing Data-Driven Diabetes Care Delivery & Outcomes in British Columbia (BC)

Background: Diabetes is a key ambulatory care sensitive condition to measure the effectiveness of primary care. In Canada, diabetes is a serious, prevalent, complex & costly problem affecting the entire healthcare system spectrum. Global healthcare systems, including diabetes & primary care, have been sidelined by COVID-19 (SARS-CoV2 corona virus) after initial December 2019 reports from China & official mid-March 2020 pandemic declaration by WHO. In the province of British Columbia (BC) & throughout Canada, travel restrictions, home-isolation & other pandemic-safe strategies finally began mid-March 2020. By July-Oct 2020, COVID-19 resurgence & escalation were evident in BC, Canada & world-wide. By July 2021, there were contagious SARS-CoV2 variants globally, fuelled by delayed vaccinations & other factors. Worse COVID-19 prognosis & increased mortality have been associated with diabetes, advanced age and/or major co-morbidities. Purpose: The BC Provincial Diabetes Evaluation is a quality improvement environmental scan project (now in its Knowledge Translation Phase) to better understand BC's diabetes risk factors; major gaps, barriers & impact on diabetes care services; & best practice solutions for data-driven, diabetes care management redesign so that people with diabetes receive improved, timely, appropriate, cost-effective diabetes care that is locally/culturally/ethnically-sensitive, no matter where they live in BC; with emphasis now on the COVID-19 global pandemic as a driver for change. Methods: 1. Retrospective, open quantitative multi-source data analysis 2. Prospective, open qualitative data analysis 3. Diabetes performance measures; co-morbidities (CKD, CAD, CHF); major procedures/surgeries (renal dialysis, PCI, lower limb amputation) Results: BC has 5.02 million people, ethnic diversity & >70% rural/remote/isolated geography. Aboriginal, Chinese & South Asian people are at highest risk of diabetes & account for the highest rates of diabetes, diabetes complications, hospitalizations, major surgeries/procedures & premature mortality in BC. For over 40 years, intermittent efforts in BC & Canada to improve chronic disease & diabetes management had little positive effect, unfortunately. Ideally, healthcare services & planning should be driven by strong data & strong evidence. No provincial/centralized diabetes program/service/strategy exists for BC’s 470,000 diabetes people. Eighty-precent of diabetes care in BC is provided by family physicians (primary care). To assist with pandemic responses such as COVID-19, our BC Provincial Diabetes Evaluation innovative tools such as Diabetes Heat Maps, Diabetes Snapshot Reports & geographically-specific, multi-source, quantitative & qualitative data analysis could be useful for improving data-driven decisions & care delivery; plus accurately locating & profiling BC’s diabetes high COVID-19 risk populations:•Elderly, cardiac, renal disease: poor COVID-19 prognosis•By age groups, gender, health determinants & premature mortality•Insulin users•No onsite, reliable lab testing (e.g. HbA1c, SCr)•Insufficient physician & healthcare•By urban, rural/remote/isolated areas Conclusion: Without coordinated BC provincial diabetes care planning or services, a fragmented, non-standardized, patchwork system has resulted with negative health outcomes & high impact on the entire healthcare system in BC (similar across Canada). Our BC Provincial Diabetes Evaluation Knowledge Translation findings will help with diabetes care management redesign; & improve the trajectory of diabetes, diabetes outcomes & healthcare utilization in BC. The time is now for data-driven improvements in BC’s diabetes care, with COVID-19 as a driver for change.

Does the Pandemic Declaration influence the Firm Value of the Untact Firms?

Purpose The purpose of this study is to examine the impact of the Pandamic Declaration on ‘untact firms’ listed in KOSPI and KOSDAQ market in order to verify Investor Mania Hypothesis. Design/methodology/approach This study collected financial data for 44 untact firms in KOSPI and KOSDAQ market. Then, we employed ESM(Event Study Methodology), EGARCH model and DID(Difference-In-Difference) for analysis. Findings - First, in contrast with the benchmarking index, KOSPI 200 which shows a negative (-) abnormal return trend, the untact firms have positive abnormal return trend consistently. Second, after the Pandemic Declaration, the variability of abnormal return for the untact firms is found to be significantly positive. Third, we find that the cumulative abnormal return and volatility of the untact firms significantly increase after the Pandemic Declaration. Research implications or Originality - Based on the Investor Mania Hypothesis, we confirm that the market potential of untact firms after the Pandemic Declaration is observed when compared with the KOSPI 200.

Self-perception of health and physical activity among adults before and amidst the COVID-19 pandemic: United States, 2019–2020

The compounded impact of the COVID-19 lockdowns on self-perception of health (SPoH) and physical activity (PA) levels among U.S. adults remains to be explored. We sought to: (1) describe the SPoH and PA levels among U.S. adults; (2) explore the relationship between SPoH and PA before and amidst the COVID-19 pandemic. We analyzed data from the 2019 and 2020 Health Information National Trends Survey (HINTS). COVID-19 was declared a pandemic by the World Health Organization on March 11th, 2020. This date was chosen to demarcate the responses as before and amidst the COVID-19 pandemic. Weighted prevalence estimates were presented alongside adjusted odds ratios from multivariable logistic regression of general SPoH and PA levels for U.S. adults before and amidst COVID-19 pandemic. We analyzed data for 9328 participants. Over half of the U.S. adult population reported performing no muscle strengthening exercise in 2019. The number of inactive people has slightly increased in 2020 (27.8%), compared to 2019 (26.5%). Overall, levels of PA for active people were comparable in 2020 pre and post the WHO pandemic declaration date (36.4% and 39.8%; respectively). Higher odds of negative SPoH were observed among black individuals, current cigarettes smokers, with annual income less than $35,000, physically inactive individuals, people who do not perform muscle-strengthening exercise, and who were very obese. Negative SPoH were associated with lack of moderate exercise, and lack of muscle-strengthening training among U.S. adults before and amidst the pandemic. Pandemic policies and recommendations should include and facilitate PA, specifically among vulnerable populations.

Medical Education Blog and Podcast Utilization During the COVID-19 Pandemic.

IntroductionThe coronavirus disease 2019 (COVID-19) pandemic disrupted traditional in-person learning models. Free Open Access Medical (FOAM) education resources naturally filled this void, so we evaluated how medical blog and podcast utilization changed during the early months of the pandemic.MethodsAcademic medical podcast and blog producers were surveyed on blog and podcast utilization immediately before (January-March 2020) and after (April-May 2020) the COVID-19 pandemic declaration and subsequent lockdown. Utilization is quantified in terms of blog post pageviews and podcast downloads. Linear regression was used to estimate the effect of publication during the COVID-19 period on 30-day downloads or pageviews. A linear mixed model was developed to confirm this relationship after adjustment for independent predictors of higher 30-day downloads or pageviews, using the podcast or blog as a random intercept.ResultsCompared to the pre-pandemic period, downloads and pageviews per unique blog and podcast publication significantly increased for blogs (median 30-day pageviews 802 to 1860, p<0.0001) but not for podcasts (median 30-day downloads 2726 to 1781, p=0.27). Publications that contained COVID-19 content were strongly associated with higher monthly utilization (β=7.21, 95% CI 6.29-8.14 p<0.001), and even non-COVID-19 material had higher utilization in the early pandemic (median 30-day downloads/pageviews 868 to 1380, p<0.0001).DiscussionThe increased blog pageviews during the early months of the COVID-19 pandemic demonstrated the important role of blogs in rapid knowledge translation. Podcasts did not experience a similar increase in utilization.

Evaluation of Stigma Related to Perceived Risk for Coronavirus-19 Transmission Relative to the Other Stigmatized Conditions Opioid Use and Depression.

BackgroundThe coronavirus-19 (COVID-19) pandemic was initially characterized by misinformation and fear related to transmission that has been previously shown to produce stigma toward persons perceived to be at risk for transmission. This study evaluated perceptions toward scenarios with variable levels of perceived risk for COVID-19 acquisition, and compared stigma to COVID-19 to depression and opioid use disorder.MethodsRespondents (N = 280) from the United States completed a web-based survey 6 months after pandemic declaration. Questions included demographics and COVID-19 misconceptions, expected response to hypothetical scenarios with variable risk for COVID-19, and the Attribution Questionnaire-9 for COVID-19, depression, and opioid use disorder.ResultsParticipants had several COVID-19 misconceptions, including that opioids increased immunity (63.6%), persons were more susceptible based upon racial/ethnic background (63.2%), and underlying health conditions did not influence risk (58.9%). Respondents were highly likely (64/100) to assume someone coughing had COVID-19 and the majority (93.5%) recommended quarantining persons with recent travel. However, the majority of respondents (>70% in all cases) also believed they would not change their COVID-19-related behavior when interacting with persons of different racial, ethnic, and age backgrounds. Finally, persons with COVID-19 engendered greater pity, less fear, less blame, less anger, and more willingness to help from respondents relative to persons with opioid use disorder.ConclusionStigma ratings toward persons perceived at risk of transmitting COVID-19, collected soon after the onset of the pandemic, showed less evidence of stigma relative to persons with opioid use disorder despite pronounced misconceptions regarding COVID-19 risk. Data provide a foundation for additional research in this area.

Impact of COVID-19 Pandemic Declaration on New Oncology Trial Commencements: An Interrupted Time Series with Segmented Regression Analysis.

This study aimed to assess the trend in oncology trial commencements registered on ClinicalTrials.gov and to evaluate the contributing factors by comparing the trends in the pre- and post-COVID-19 pandemic era. The ClinicalTrials.gov database was searched to identify oncology study trials starting from 1 January 2018 to 28 February 2021. Data on the variables of start/complete date, phase, status, funding source, center, country and study type were extracted. According to the time point of the COVID-19 pandemic declaration by the World Health Organization (WHO), March 2020, we analyzed the extracted data, including interrupted time series (ITS) analysis and multivariable regression analysis. We identified 18,561 new oncology trials during the study period. A total of 5678 oncology trials in the prepandemic period and 6134 in the postpandemic period were included in the comparative analysis. The year 2020 had the most newly launched trials (32.3%), and the majority of trials were planned to be conducted for longer than two years (70.3%). The results of ITS show the trend in the commencement of oncology trials was significantly increased after the pandemic declaration (coefficient = 27.99; 95% CI = 19.27 to 36.71). Drug intervention trials were the largest contributor to the increased trial number compared to different interventions, such as trials of devices or procedures (OR = 1.14; 95% CI = 1.03 to 1.26, OR = 1.09; 95% CI = 0.91 to 1.29, and OR = 1.12; 95% CI = 0.96 to 1.31, respectively), whereas the United Kingdom was the highest contributor to the number of decreased trials (OR = 0.67; 95% CI = 0.51 to 0.89 p = 0.01) in the postpandemic era. The interruption in oncology trial initiation was diminished shortly after the COVID-19 pandemic declaration, which was influenced by several factors, such as interventions or national responses. Based on the current outcomes, appropriate strategies for developing oncology trials can be planned to mitigate the impact of future crises on oncology trials.

Injury-Related Emergency Department Visits During the COVID-19 Pandemic

IntroductionOn March 13, 2020, the U.S. declared COVID-19 to be a national emergency. As communities adopted mitigation strategies, there were potential changes in the trends of injuries treated in emergency department. This study provides national estimates of injury-related emergency department visits in the U.S. before and during the pandemic.MethodsA secondary retrospective cohort study was conducted using trained, on-site hospital coders collecting data for injury-related emergency department cases from medical records from a nationally representative sample of 66 U.S. hospital emergency departments. Injury emergency department visit estimates in the year before the pandemic (January 1, 2019–December 31, 2019) were compared with estimates of the year of pandemic declaration (January 1, 2020–December 31, 2020) for overall nonfatal injury-related emergency department visits, motor vehicle, falls-related, self-harm-, assault-related, and poisoning-related emergency department visits.ResultsThere was an estimated 1.7 million (25%) decrease in nonfatal injury-related emergency department visits during April through June 2020 compared with those of the same timeframe in 2019. Similar decreases were observed for emergency department visits because of motor vehicle‒related injuries (199,329; 23.3%) and falls-related injuries (497,971; 25.1%). Monthly 2020 estimates remained relatively in line with 2019 estimates for self-harm‒, assault-, and poisoning-related emergency department visits.ConclusionsThese findings provide updates for clinical and public health practitioners on the changing profile of injury-related emergency department visits during the COVID-19 pandemic. Understanding the short- and long-term impacts of the pandemic is important to preventing future injuries.

Global consumption of antimicrobials: impact of the WHO Global Action Plan on Antimicrobial Resistance and 2019 coronavirus pandemic (COVID-19).

Little is known about the effect of the COVID-19 pandemic on antimicrobial consumption worldwide. To describe the impact of the WHO Global Action Plan on Antimicrobial Resistance (GAP-AMR) on antimicrobial consumption pre-pandemic and to evaluate the impact of the COVID-19 pandemic on antimicrobial consumption worldwide. A cross-sectional time-series analysis using a dataset of monthly purchases of antimicrobials (antibiotics, antivirals and antifungals) from August 2014 to August 2020. Antimicrobial consumption per 1000 population was assessed pre-pandemic by economic development status using linear regression models. Interventional autoregressive integrated moving average (ARIMA) models tested for significant changes with pandemic declaration (March 2020) and during its first stage from April to August 2020, worldwide and by country development status. Prior to the pandemic, antimicrobial consumption decreased worldwide, with a greater apparent decrease in developed versus developing countries (-8.4%, P = 0.020 versus -1.2%, P = 0.660). Relative to 2019, antimicrobial consumption increased by 11.2%, P < 0.001 in March 2020. The greatest increase was for antivirals in both developed and developing countries (48.2%, P < 0.001; 110.0%, P < 0.001) followed by antibiotics (6.9%, P < 0.001; 5.9%, P = 0.003). From April to August 2020, antimicrobial consumption decreased worldwide by 18.7% (P < 0.001) compared with the previous year. Specifically, antibiotic consumption significantly decreased in both developed and developing countries (-28.0%, P < 0.001; -16.8%, P < 0.001). The global decrease in antimicrobial consumption pre-pandemic suggests a positive impact of the WHO GAP-AMR. During the pandemic, an initial increase in antimicrobial consumption was followed by a decrease worldwide. AMR plans should specify measures to ensure full implementation of AMR efforts during health crises such as the COVID-19 pandemic.

The Psychological Impact of COVID-19 on Arthroplasty Surgeons.

BackgroundAfter the COVID-19 pandemic declaration in March 2020, all the elective total joint replacement surgeries in Canada were abruptly canceled for an indefinite period of time. The principal objective of this study was to determine the prevalence of psychological morbidity experienced by arthroplasty surgeons during the peak of the first wave of the COVID-19 pandemic. Secondary objectives included characterizing influential variables affecting the surgeon’s well-being and suggesting directives for improvement.MethodsThis study surveyed Canadian Arthroplasty Society (CAS) members regarding their psychological well-being using the validated General Health Questionnaire (GHQ-12), the Center for Epidemiological Studies Depression (CES-D) scale, and the Personal Wellbeing Index-Adult (PWI-A). As well, the survey included questions regarding concerns about COVID-19, precautionary measures, personal well-being, and sociodemographic characteristics.ResultsA total of 80 surgeons (52% of those surveyed) completed the questionnaire, representing all 10 provinces in Canada. The prevalence of emotional distress and depression were 38% and 29%, respectively. Psychological morbidity most commonly resulted from concerns of loss of income/operating time, experiences of emotional conflict, and generalized safety worries. The surgeons commonly (93%) demonstrated insight in recognizing the impact of COVID-19 on their emotional health.ConclusionCanadian arthroplasty surgeons demonstrated emotional resilience and insight during COVID-19. Continual communication, as well as remuneration action plans, could improve the mental well-being of at-risk individuals.

Physical Activity in Cardiac Implantable Electronic Device Recipients During the COVID-19 Pandemic

ObjectiveTo characterize the physical activity (PA) level in patients with a cardiac implantable electronic device (CIED) during the coronavirus disease 2019 (COVID-19) pandemic and compare PA level during the pandemic in 2020 with the year 2019. MethodsWe performed a retrospective analysis of PA activity in individuals implanted with a CIED enrolled in the BIOTRONIK CERTITUDE Registry. Mean daily and weekly PA from January to August 2020 was compared with 2019. ResultsA total of 21,660 individuals met eligibility criteria, with mean age of 72.6±11.6 years, and 12,411 (57.3)% were males. A significant decline in daily PA was noted following the pandemic declaration in 2020, with a maximum mean reduction of -24.5±36.3 minutes (P<.0001) observed in April 2020 compared with 2019. PA in 2020 increased from April to May (120.6±67.4 to 129.2±70.9 min/d). PA was lower for all months in 2020 compared with 2019. The decrease in PA was observed in all prespecified groups based on age, sex, type of device, and region of the country. ConclusionAfter the declaration of the coronavirus disease 2019 pandemic, a significant decline in daily PA was observed in individuals with a CIED. Future investigation to establish the impact of this reduction on short and long-term cardiovascular outcomes is required.

Impact of Covid-19 pandemic on the management of breast cancer patients

Background: In 2019, the world that we know has changed. The emergence of a novel virus called COVID-19, culminated in pandemic declaration by the WHO. Breast teams had the task to ensure safe and effective delivery of cancer treatment. This observational study was conducted to evaluate the management of breast cancer patients during the first COVID-19 outbreak period, in accordance with the National Institute of Health and Care Excellence (NICE) and Association of Breast Surgery (ABS) guidelines. Materials and Methods: We retrospectively assessed the management of our newly diagnosed breast cancer patients during the period from March 2020 until June 2020. This entailed the review of patient notes and documentation stored in the local electronic surgical database. Results: A total of 65 patients were included in the study. 81.5 % (n=53) received standard treatment in line with NICE guidelines, in contrast with 12 patients (18.5%) whose management has been modified according to the pandemic ABS guidance. New guidelines meant all patients planned for mastectomy will not have immediate breast reconstruction. High Risk patients were put on endocrine treatment if they were eligible. Conclusions: The COVID-19 pandemic resulted in a significant modification in treatment of our newly diagnosed breast cancer patients. Despite the deviation from standard NICE guidelines, our practice was in line with the pertinent pandemic ABS guidance. It would be of interest to follow-up these patients and investigate the long-term effects of these practice modifications on clinical outcomes.

The risk of post-traumatic stress disorder (PTSD) in Italian Highly Specialized Research Hospitals staff within two months of the pandemic declaration: an on-line survey.

The whole hospital system was stressed and at risk in the first phase of the pandemic. This study examined the prevalence of post-traumatic stress disorder (PTSD) in all hospital staff, medical and non-medical, within two months of the pandemic declaration. Survey concerned staff 4510 health workers of Italian Highly Specialized Research Hospitals. Subjects were asked to complete an on-line self-reported questionnaire, the PTSD Checklist 5 (PCL-5) and subjective perception of safety related to personal protective equipment (PPE). The sample included staff working in hospitals with or without COVID-19 patient admissions. Overall, 11.56% of the hospitals staff met the symptoms criteria for probable PTSD. The sample included 80.63% (3467) medical staff workers and 19.37% (833) non-medical staff workers. The 31.91% of participants worked in COVID-19 hospitals/wards. The prevalence of positive screening for PTSD symptoms in medical staff was 12.42% (426) and in non-medical staff, 8.59% (70). Among medical staff, anesthesiologists had a significant prevalence of PTSD (22.35%), followed by health care assistants/technicians (15.38%) and physicians (10.11%). Among non-medical staff, personnel involved in cleaning, catering, maintenance, security, and transportation, the symptoms of PTSD reached a rate of 12.24% and in administrative staff 8.47%. Risk factors associated with PTSD included working as an anesthesiologist, perceiving PPE as inadequate, and working in COVID-19 hospitals/wards. In the present study, as in other studies, the prevalence of PTSD symptoms among hospital workers was significatively higher than the lifetime prevalence of PTSD in the general population, showing the pandemic's incredible impact.

Monetary policy application and stock market reaction during Covid-19 Pandemic: Evidence from Turkey

We investigate whether the pandemic announcement and three monetary policies changed after that (reducing target interest rate) have an impact on the return, liquidity, and volatility in the Turkish stock market. We find that there is a negative reaction to the pandemic announcement and the announcement of the first decline in interest rates, but we discover a positive reaction to the second and third reduction in interest rates in terms of stock return and liquidity. Moreover, the stock return and liquidity of firms that are listed on the BIST-100 index and have associated derivatives are affected less by the pandemic. Results also suggest that the smallest, illiquid, volatile, and highly searched companies on Google are affected more by the pandemic announcement and the first decline in the interest rate.

Effect of Institution and COVID-19 on Access to Adult Arthroplasty Surgery.

BackgroundAlthough insurance status is important to patients’ ability to access care, it varies significantly by race, age, and socioeconomic status. Novel coronavirus disease 2019 (COVID-19) negatively impacted access to care, while simultaneously widening pre-existing health-care disparities. The purpose of the present study was to document this phenomena within orthopedics.MethodsPatients undergoing hip or knee arthroplasty at two medical centers in San Francisco, California, were evaluated. One cohort came from the University of California San Francisco (UCSF), a tertiary center, and the other from Zuckerberg San Francisco General Hospital (ZSFGH), a safety-net hospital. Patients who underwent arthroplasty before the pandemic (March 2020) and those after pandemic declaration were evaluated. Patient demographics, surgical wait times, and operative volumes were compared.ResultsTwo-hundred sixty-nine (pre-COVID, 184; post-COVID, 85) cases at UCSF and 63 (pre-COVID, 47; post-COVID, 16) cases at ZSFGH met inclusion criteria. Patients at ZSFGH had a significantly higher body mass index, were more often racial minorities, and were less likely to speak English. Patients at ZSFGH were less likely to have private insurance. A comparison of case volumes showed a larger decrease at ZSFGH than at UCSF after COVID. Wait times between the two sites before and after COVID showed a larger increase in wait times at ZSFGH. Notably, wait times at ZSFGH before COVID were more than double the wait times at UCSF after COVID.ConclusionsCOVID-19 worsened access to primary hip and knee arthroplasties at two academic medical centers in San Francisco. The pandemic also worsened pre-existing disparities. Racial minorities, non-English speakers, and those with nonprivate insurance were affected the most.