Atypical case of infective endocarditis.

A man in his late 40s presented to the emergency department with generalised tiredness and breathlessness. He was a known case of chronic obstructive pulmonary disease and also had a recent history of COVID-19. At arrival, he was in respiratory failure. Blood culture grew Streptococcus parasanguinis, a commensal gram-positive bacterium and a primary coloniser of the human oral cavity. Echocardiogram revealed the presence of a flail mitral valve with vegetation suggestive of infective endocarditis. Although biomarkers of inflammation/infection had improved, he continued to be in cardiac failure, and hence he underwent mitral valve replacement with a mechanical valve. This case is unique in many ways; the patient was young, had a history of COVID-19, had native valve infective endocarditis and presented with type 2 respiratory failure and not the usual 'typical' manifestations of infective endocarditis. He had refractory heart failure requiring early valve replacement. His blood culture grew S. parasanguinis, a rare cause for infective endocarditis.

Diverse Presentation of Mucormycosis: A Post COVID Catastrophe - A Case Series

The corona virus disease-19 (COVID-19) produced by SARS-CoV-2 has resulted in a wide spectrum of illness ranging from mild to life-threatening conditions thus enhancing the incidence of opportunistic infections among individuals harbouring comorbidities. Mucormycosis is a dreadful angio-invasive opportunistic infection produced by zygomycetes fungus in an immunocompromised host. The clinical manifestations of mucormycosis include rhino-orbital-cerebral (ROC), pulmonary, cutaneous, gastrointestinal, with ROC accounting for around 40% of cases. Diabetes, neutropenia, iron overload, cancer, and organ transplant are all major culprits. Both Aspergillus and Candida have been identified as the primary fungal pathogens causing co-infection in COVID-19 preyed individuals. The most predominant variety, Rhizopus Oryzae, is responsible for roughly 60% of mucormycosis infections in humans, as well as 90% of the Rhino-orbital-cerebral (ROCM) variant. Mucormycosis is the most widespread ailment in India. Until lately, India was declared to be the world's diabetes capital, with the second-largest number of people suffering from diabetes mellitus (DM). Diabetes has been recognised as the most common predictive marker for mucormycosis which explains the dramatic rise in Mucor cases in India lately particularly during second wave of COVID-19. The inflammatory onslaught caused by COVID 19 has debilitated patients' immune systems, making individuals vulnerable to mucormycosis outbreaks. The possible explanation that Mucorales spores appear to be expediting germination in people with COVID-19 is due to the perfect scenario of oxygen deprivation (hypoxia), hyperglycemia (steroid-induced), acidic form of media (metabolic acidosis, diabetic ketoacidosis), increased iron levels (elevated ferritin), and significantly reduced phagocytic activity of white blood cells (WBC) due to immunosuppression (SARS-CoV-2 or steroid mediated or associated comorbidities). Copyright © 2022 International Medical Sciences Academy. All rights reserved.

Health Equity Is No Spectator Sport: The Radical Rooting of a Post-Pandemic Bioethics.

The relationship between equality and equity has been theorized and described in many ways. Recently, this relationship has been popularly illustrated via a meme depicting three people watching a baseball game while standing on boxes. The meme's analogy, that achieving health equity is the ability to view a spectator sport, is a neoliberal account of health. The analogy defines equality at the expense of equity, characterizes health as individualistic, describes health equity as a static outcome, and implies that the bioethical questions for achieving health equity are about the distribution and redistribution of resources. As the SARS CoV-2 pandemic vividly reminded us, health equity is no spectator sport. Health equity is the intentional removal of obstacles to health and the enabling of human flourishing to assure that everyone has fair and just opportunities for health. That relational and radical account of health equity requires different analogies. This article reimagines and re-illustrates the relationship between equality and equity using an organic analogy of three plants. The analogy calls for bioethics to nurture communal relationships and engage community leaders in pursuit of communal flourishing.

SARS-CoV-2 Infection and Vaccination Cutaneous Manifestations for the Inpatient Dermatologist.

Purpose of Review: The overall purpose of this review was to characterize and summarize cutaneous eruptions associated with coronavirus disease 2019 (COVID-19) as well as COVID-19 vaccination. Recent Findings: Cutaneous eruptions associated with COVID-19 infection have a reported frequency of 1-20%. Increased COVID-19 disease severity has been associated with morbilliform exanthems, urticaria, retiform purpura, and livedo racemosa. Papulovesicular eruptions were associated with a milder COVID-19 disease course. A range of dermatoses have also been reported with COVID-19 vaccination but have rarely prevented subsequent vaccination. Summary: Dermatologists should be aware of the associations between COVID-19 disease severity and cutaneous eruptions. Livedo racemosa and retiform purpura are particularly associated with increased disease severity and death. In the setting of COVID-19 vaccination, cutaneous eruptions can largely be managed symptomatically and very rarely do these reactions prevent subsequent vaccination.

Leveraging Convolutional Neural Networks for Face Mask Detection

COVID-19 has made face masks an imperative whenever an individual is going out in public. However, many people are remiss in fulfilling their duty to society. They are deviating from the lockdown norms and violating the regulatory measures set by the government. Such a situation only proliferates the spread of COVID-19 and makes it difficult to control it. In this paper, we use Convolutional Neural Networks (CNNs) to detect whether a person is wearing a face mask. This research uses TensorFlow and Keras to build a CNN which detects face masks with an accuracy of over 98% within 10 epochs. This algorithm will be a boon in places like malls or public areas where automated doors can be shut tight if the prospect trying to enter the store is not wearing a mask. Overall, this paper will help create products that can be used to safely break the COVID-19 chain. © 2022 IEEE.

Estimating power for a multi-site treatment study leveraging natural history ABCA4- related retinopathy data

Purpose : A clinical trial of oral metformin for treatment of ABCA4 retinopathy was initiated at National Eye Institute (NEI) (ClinicalTrials.gov: NCT04545736). Power analysis was based on a single site (NEI) with high-resolution Optical Coherence Tomography (OCT) volume scans and equally spaced visits. To aid recruitment, an additional site with lower density volume scans is considered and unequally spaced visits introduced to account for missed visits due to the Coronavirus Disease 2019 pandemic. The aims were to determine the effects of adding a site that uses a mix of low- and high-resolution images and an increased number of natural history visits and spacing between visits on power. Methods : A longitudinal spline regression is proposed for the primary outcome analysis, comparing growth rate in square-root transformed ellipsoid zone band loss area on OCT between the treatment phase (current study) and pre-treatment phase (natural history study), with a knot at the baseline visit when patients initiate treatment. Data were simulated using the observed mean, variance and inter-eye correlation for baseline values (from the last available pre-treatment visit) and pre-treatment growth rates from available natural history data at NEI;expected improvement in the primary outcome due to treatment;and other salient features of the study. Low-resolution values were derived from the natural history high-resolution images at NEI. The number of pre-treatment visits and spacing between visits were varied keeping other factors constant for a fixed sample size, while accounting for the appropriate resolution values at each site. The resultant power for detecting a treatment effect was estimated based on 2000 simulated datasets. Results : The power estimated when accounting for a mix of low- and high-resolution values at the second site was the same as that with all high-resolution values at 80%. An increase from 4 to 6 pre-treatment visits increased power by 15% and increasing the spacing between visits from 6 to 12 months increased power by 6% for the study. Conclusions : Increasing the number of pre-treatment visits and spacing between visits increased power. Derivation of low-resolution values from high-resolution images may be the reason for the high correlation between the two resolutions, which may explain why including a mix of low- and high-resolution values did not decrease power.

Clinical relevance of increased antibody titres in older adults upon vaccination with squalene-adjuvanted versus non-adjuvanted influenza vaccines.

In older adults, the serum antibody response to inactivated influenza vaccine (IIV) is often lower than in adolescents and non-elderly adults which may translate into suboptimal protection against influenza. To counteract this expression of immunosenescence, the use of adjuvanted IIV formulations has been explored. Four recent studies (three meta-analyses and one clinical trial) found an antibody increase of up to 1.5-fold in older adults, when a squalene-adjuvanted (MF59™) IIV was used. The clinical relevance of this increase may well continue to be a matter of debate. We would favour a threshold of 1.5 to consider an adjuvanted vaccine formulation superior to standard aqueous IIV because it exceeds the inevitable variation of antibody responses to non-adjuvanted IIV. It is also the same as the upper FDA equivalence limit for IIV lot-to-lot consistency. A corresponding threshold for the seroresponse rate difference could then be +5%.

Management strategies and outcomes in renal transplant recipients recovering from COVID-19: A retrospective, multicentre, cohort study.

Background: There is an enormous knowledge gap on management strategies, clinical outcomes, and follow-up after kidney transplantation (KT) in recipients that have recovered from coronavirus disease (COVID-19). Methods: We conducted a multi-center, retrospective analysis in 23 Indian transplant centres between June 26, 2020 to December 1, 2021 on KT recipients who recovered after COVID-19 infections. We analyzed clinical and biopsy-confirmed acute rejection (AR) incidence and used cox-proportional modeling to estimate multivariate-adjusted hazard ratios (HR) for predictors of AR. We also performed competing risk analysis. Additional outcome measures included graft loss, all-cause mortality, waiting time from a positive real-time polymerase test (RT-PCR) to KT, laboratory parameters, and quality of life in follow-up. Findings: Among 372 KT which included 38(10·21%) ABO-incompatible, 12(3·22%) sensitized, 64(17·20%) coexisting donors with COVID-19 history and 20 (5·37%) recipients with residual radiographic abnormalities, the incidence of AR was 34 (9·1%) with 1(0·26%) death censored graft loss, and 4(1·07%) all-cause mortality over a median (interquartile range) follow-up of 241 (106-350) days. In our cox hazard proportional analysis, absence of oxygen requirement during COVID-19 compared to oxygen need [HR = 0·14(0·03-0·59); p-value = 0·0071], and use of thymoglobulin use compared to other induction strategies [HR = 0·17(0·03-0.95); p-value = 0·044] had a lower risk for AR. Degree of Human leukocyte antigen (HLA) DR mismatch had the highest risk of AR [HR = 10.2(1·74-65·83); p-value = 0·011]. With competing risk analysis, with death as a competing event, HLA DR mismatch, and oxygen requirement continued to be associated with AR. Age, gender, obesity, inflammatory markers, dialysis vintage, steroid use, sensitization and ABO-incompatibility have not been associated with a higher risk of AR. The median duration between COVID-19 real time polymerase test negativity to transplant was 88(40-145) days (overall), and ranged from 88(40-137), 65(42-120), 110(49-190), and 127(64-161) days in World Health Organization ordinal scale ≤ 3, 4, 5, and 6-7, respectively. There was no difference in quality of life, tacrolimus levels, blood counts, and mean serum creatinine assessed in patients with a past COVID-19 infection independent of severity. Interpretation: Our findings support that the outcomes of KT after COVID-19 recovery are excellent with absence of COVID-19 sequelae during follow-up. Additionally, there does not seem to be a need for changes in the induction/immunosuppression regimen based on the severity of COVID-19. Funding: Sanofi.

Effectiveness of a synchronous online, group health and wellness program for people who work with youths and adults with intellectual disabilities

Background. A health promotion program was designed and implemented for people who work with youths and adults with intellectual disabilities. The objectives were to evaluate the effectiveness of a synchronous online group health promotion program and to promote worker well-being. Method. It is an investigation with a quantitative, descriptive and interactive approach, with a quasi-experimental design, pre- and posttest for paired samples. Instruments: General Health Questionnaire (GHQ 12), Pemberton Happiness Index, Maslach Burnout Inventory (MBI), Beck Anxiety Inventory (BAI) and an ad hoc sociodemographic form. The intervention program carried out, "Well-being and health", consists of 8 group synchronous online sessions (on Google meet), with a weekly frequency, lasting 120 minutes. Results. Participation was voluntary and all signed an informed consent. A total of 35 workers with an average age of 31.11 years participated. After the intervention, there was an increase in personal well-being and personal fulfillment at work, and a reduction in the level of psychological discomfort, anxiety, emotional exhaustion and depersonalization. Statistically significant differences were observed in the scores pre- and posttest of psychological distress and emotional exhaustion. Conclusion. The results allow us to conclude that participating in a synchronous online group health promotion program was effective to increase the well-being and health of workers.

Covid-19 and leptospirosis, pulmonary involvement and response to steroids: A comparative observational study from a rural Tertiary care center in Kerala.

Background: COVID-19 is an emerging infectious disease with a global outreach. Leptospirosis is a zoonotic disease mainly confined to tropical areas. In both cases, most of those affected are asymptomatic or have only mild respiratory disease. Those who turn critical develop acute respiratory distress syndrome (ARDS) and/or multiple-organ failure occurs rapidly, with high fatality. Methodology: This is a retrospective observational study from 2020 involving COVID-19 and leptospirosis patients. The data were collected using a semi-structured proforma, and analysis was performed using Easy R (EZR) software. Results: There were five patients with COVIDC-19 and four patients with leptospirosis; with pulmonary involvement. All the patients were males. There was no significant difference in age, the onset of pulmonary involvement, time of initiation of steroids, duration of steroids, and outcome between the two groups. However, in the case of COVID-19, it took a longer period for clearing of infiltrates. Conclusion: Though COVID-19 and leptospirosis are two different diseases, both of them show a similar life-saving response to steroids, the common factor in the pathogenesis being cytokine storm. Primary care physicians in tropical areas of the world should be aware of the similarities between these two diseases, especially the initial clinical presentation, the pathogenesis, and the response to steroids.

A Multicenter Cohort Study From India of 75 Kidney Transplants in Recipients Recovered After COVID-19.

BACKGROUND: There is limited current knowledge on feasibility and safety of kidney transplantation in coronavirus disease-19 (COVID-19) survivors. METHODS: We present a retrospective cohort study of 75 kidney transplants in patients who recovered from polymerase chain reaction (PCR)-confirmed COVID-19 performed across 22 transplant centers in India from July 3, 2020, to January 31, 2021. We detail demographics, clinical manifestations, immunosuppression regimen, laboratory findings, treatment, and outcomes. Patients with a previous diagnosis of COVID-19 were accepted after documenting 2 negative severe acute respiratory syndrome coronavirus 2 PCR tests, normal chest imaging with complete resolution of symptom for at least 28 d and significant social distancing for 14 d before surgery. RESULTS: Clinical severity in patients ranged from asymptomatic (n = 17, 22.7%), mild (n = 36.48%), moderate (n = 15.20%), and severe (n = 7.9.3%) disease. Median duration between PCR positive to transplant was 60 d (overall) and increased significantly from asymptomatic, mild, moderate, and severe disease (49, 57, 83, 94 d, P 0.019), respectively. All recipients and donors were asymptomatic with normal creatinine after surgery at a median (interquartile range) follow-up of 81 (56-117) d without any complications relating to surgery or COVID-19. Patient and graft survival was 100%, and acute rejection was reported in 6.6%. CONCLUSIONS: Prospective kidney transplant recipients post-COVID-19 can be considered for transplantation after comprehensive donor and recipient screening before surgery using a combination of clinical, radiologic, and laboratory criteria, careful pretransplant evaluation, and individualized risk-benefit analysis. Further large-scale prospective studies with longer follow-up will better clarify our initial findings. To date, this remains the first and the largest study of kidney transplantation in COVID-19 survivors.

Individual Differences in Belief in Fake News about Election Fraud after the 2020 U.S. Election.

Fake news is a serious problem because it misinforms people about important issues. The present study examined belief in false headlines about election fraud after the 2020 U.S. presidential election. Belief in election fraud had dangerous consequences, including the deadly insurrection at the U.S. Capitol in January 2021. In the present study, participants rated the truthfulness of true and false headlines about the election, and then completed individual difference measures eight days after the election. Participants with more conservative ideology, greater presidential approval of the outgoing president, greater endorsement of general conspiracy narratives and poorer cognitive reflection demonstrated greater belief in false headlines about election fraud. Additionally, consuming more politically conservative election news was associated with greater belief in false headlines. Identifying the factors related to susceptibility to false claims of election fraud offers a path toward countering the influence of these claims by tailoring interventions aimed at decreasing belief in misinformation and decreasing conspiracy beliefs to those most susceptible.

An event study analysis of Bitcoin and Altcoins under COVID-19

Operating through blockchain, cryptocurrencies eliminate intermediaries and encourage transparency between parties. Although Bitcoin continues to be the most widely used cryptocurrency, its increased attractiveness to investors has led to the emergence of Altcoins (alternative cryptocurrencies other than Bitcoin). Employing an event study approach using the daily price series for the sample period from 1 January 2018 to 17 July 2020, the study aims to determine the impact of Covid-19 on the value of both Bitcoin and Altcoins. The evidence shows that the abnormal returns of Bitcoin and Altcoins around Covid-19 dates are negative and Altcoins are more adversely affected by the pandemic than Bitcoin. The study also documents that most altcoins rely on the same block chain technology aiming to complement or improve certain Bitcoin characteristics, and the high correlation between Bitcoin and Altcoins are likely to fail cross-currency hedging strategies during the pandemic crisis.

Changes in neuro-endovascular procedural volume during the Covid-19 Pandemic: An international multicenter study

Objective: The effect of Coronavirus disease 2019 (COVID-19) pandemic on performance of neuro-endovascular procedures has not been quantified. Background: The effect of Coronavirus disease 2019 (COVID-19) pandemic on performance of neuro-endovascular procedures has not been quantified. Design/Methods: We performed an audit of performance of neuro-endovascular procedures at 18 institutions (7 countries) for two periods;January to April 2019 and 2020, to identify changes in various core procedures. We divided the region where the hospital was located based on the median value of total number of COVID-19 cases per 100,00 population-into high and low prevalent regions Results: Between 2019 and 2020, there was a reduction in number of cerebral angiograms (30.9% reduction), mechanical thrombectomy (8% reduction), carotid artery stent placement for symptomatic (22.7% reduction) and asymptomatic (43.4% reduction) stenoses, intracranial angioplasty and/or stent placement (45% reduction), and endovascular treatment of unruptured intracranial aneurysms (44.6% reduction) and ruptured (22.9% reduction) and unruptured brain arteriovenous malformations (66.4% reduction). There was an increase in treatment of ruptured intracranial aneurysms (10% increase) and other neuro-endovascular procedures (34.9% increase). There was no relationship between procedural volume change and intuitional location in high or low COVID-19 prevalent regions. The procedural volume reduction was mainly observed in March-April 2020. Conclusions: We provided an international multicenter view of changes in neuro-endovascular practices to better understand the gaps in provision of care and identify individual procedures which are susceptible to change.

Global impact of the COVID-19 pandemic on stroke care and intravenous thrombolysis

Objective: The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods. Background: The COVID-19 pandemic led to widespread repercussions on the delivery of health care worldwide. Design/Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by ICD-10 codes and/or classifications in stroke center databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI,-11.7 to-11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI,-13.8 to-12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI,-13.7 to-10.3, p=0.001). There were greater declines in primary compared to comprehensive stroke centers (CSC) for stroke hospitalizations (-17.3% vs-10.3%, p<0.0001) and IVT (-15.5% vs-12.6%, p=0.0001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) months of the pandemic, with greater recovery in hospitals with lower COVID-19 hospitalization volume, high volume stroke center, and CSC. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months, with greater recovery in hospitals with lower COVID-19 hospitalizations, high volume stroke centers, and CSCs.

In vitro diagnostics for the medical dermatologist. Part II: Hypercoagulability tests.

The skin often provides initial clues of hypercoagulability with features such as livedo reticularis, livedo racemosa, retiform purpura, necrosis, and ulcerations. Because these cutaneous manifestations are nonspecific, laboratory testing is often needed to evaluate for underlying causes of hypercoagulability. Importantly, these disorders are reported to be the most common mimicker, resulting in an erroneous diagnosis of pyoderma gangrenosum. Understanding inherent properties of, and indications for, available tests is necessary for appropriate ordering and interpretation of results. Additionally, ordering of these tests in an indiscriminate manner may lead to inaccurate results, complicating the interpretation and approach to management. This second article in this continuing medical education series summarizes information on methodology, test characteristics, and limitations of several in vitro laboratory tests used for the work up of hypercoagulability and vasculopathic disease as it pertains to dermatologic disease.

Weight loss during the pandemic: Suboptimal follow up and rapid morbidity progression in the world of telemedicine

Background Telemedicine has been widely used during the COVID-19 pandemic but hasn't been embraced by all patients. Valuable objective information is lost and diagnoses delayed due to inaccurate patient self-report or delays in face to face visits. The lack of obtaining vital information such as weight loss may lead to delays in diagnoses and disease progression. Sometimes this delay is irreparable. Materials & Methods We discuss 3 cases of weight loss occurring during this COVID pandemic reflecting our concern: 1) 87 yo female w/PMH HTN, CAD, dementia presented to the ER 8/2020 with wt. loss, decreased oral intake, and mandibular pain for 5 months. PE and testing revealed extensive disease involving her mandible and neck. She was diagnosed with mandibular SCC, palliative Rx was initiated, and hospice care arranged after discharge. 2) 86 yo male w/PMH dementia, HF, CKD presented with fatigue and wt. loss over 5 months. A malignancy work-up was started but a month later he went to the ER with melena. His family declined further interventions and hospice care was initiated. 3) 84 yo male w/PMH HTN, Paget's disease, BPH had 3 virtual visits over 6 months. On the last visit his son reported concern for wt. loss. An in-person visit documented a weight loss of 27 lb in 9 months. A w/u demonstrated a spiculated nodule. Biopsies showed non-necrotizing granuloma and BAL grew MAC. He was started on Rx and gained 10 lbs. Results These cases expose consequences of delays in face to face care and inaccurate patient self-reporting during this pandemic. The first case highlights the rapid progression of frailty in a patient with dementia and newly diagnosed SCC due to delay in care. In the 2nd case, a delay in care and w/u of fatigue and weight loss resulted in cachexia and irreversible disease. The 3rd case highlights our reliance on accurate patient self-report when conducting telemedicine visits. Conclusions Telemedicine visits are likely to remain during COVID-19 surges. It's important to be mindful that we rely on patient self-report which if inaccurate or delayed, may lead to rapidly developing geriatric syndromes. These cases are reminders of the devastating effect of the current pandemic in delays of in-person visits.

Improving frequency of video-visits at a veterans affairs long term care facility: Value of the effort and lessons learned

Background During the COVID-19 pandemic, telemedicine has been used increasingly. Video visits are superior to phone visits through the addition of visual cues. Recent evidence highlights there are challenges associated with the use of this technology especially with older adults with physical or cognitive limitations. Hence, residents with comorbidities followed by subspecialists may have delays in care during the pandemic. This pilot study tested the feasibility of streamlining video visits for veterans in long term care facilities (LTCFs) Materials & Methods We surveyed appointments during the period of July-Sept 2020 for over 100 veterans in a Veterans Affairs LTCF. Barriers to telemedicine were identified by surveying staff and providers and a viable model for streamlining video visits for veterans was developed. Aiming to increase access to video visits, iPads were acquired through the VA. Staff were trained to set up and troubleshoot tele-visits. Subspecialists were notified of the video visit capability. The use of video visits is being tracked during the 2nd COVID surge. We will compare the number of video visits before and after our intervention and address challenges faced. Results During the first COVID surge in spring 2020 no video visits were conducted. Prior to our intervention and during the summer of 2020, we identified 121 in person visits to subspecialties, only 3 took place as video visits. After our intervention, we are assessing whether the number of video visits for nursing home residents is increasing. Detailed data will be presented during AGS 2021. Some of the challenges we are facing include suboptimal wi-fi reception, staff shortages and confidentiality issues. We are speculating that increasing the number of video visits will allow for decreased COVID exposure, decrease transportation expenses and improve appointment compliance. Conclusions Video visits are important during COVID surge to ensure veterans receive medical care in a safe and timely fashion. Results from this study will further inform the development of protocols for making video visits more accessible to this cohort.