Healthcare Utilization Remains Elevated Among People Living with Post-COVID-19 Condition More Than One Year after Acute COVID-19 Illness

Objectives: Healthcare systems require comprehensive data for long-term resource allocation planning to support people living with post-COVID-19 condition (PCC). Limited information is available on long-term PCC-associated healthcare utilization patterns. In this study, we assess healthcare utilization rates six and 12-18 months following acute COVID-19 illness among COVID-19 survivors in British Columbia (BC), Canada by PCC status. Method(s): We used difference-in-difference analysis to assess healthcare utilization by all adult COVID-19 survivors in BC diagnosed with COVID-19 on/before November 18, 2021 during three time periods: (i) 26 weeks after the first 4 weeks of COVID-19 illness, and that exact period (ii) one or two years prior (baseline), and (iii) one year afterwards. PCC/non-PCC patients were matched 1:2 on age, sex, region, comorbidities, vaccination status, and COVID-19 index date +/-14 days. The total number of daily healthcare encounters (medical visit, emergency department visit, hospitalization) per person was calculated. Rate ratios (RR) for PCC-associated healthcare utilization were estimated using weighted Poisson regression. Result(s): The matched cohort (n= 7,092) included 2,364 PCC patients (54.9% female;mean age 39.8 [SD, 13.4] years). Healthcare utilization rates were comparable between the PCC and non-PCC groups at baseline (average: 39.3 vs. 32.7 visits per 1000 patients, respectively), but rose two-fold for the PCC group during the 26-week period post-acute illness (76.1 vs. 33.5). One year later, PCC-associated healthcare utilization rates declined but remained elevated relative to baseline rates (54.6 vs. 34.4). In multivariable Poisson regression models, PCC was associated with a 103% increase in healthcare utilization over 26 weeks post-acute illness (aRR: 2.03, 95% CI 1.71-2.41) and a 24% increase the next year (aRR: 1.24, 95% CI 1.03-1.48). Conclusion(s): The increased healthcare utilization rates noted among PCC patients one year following acute COVID-19 illness highlights the need for adequate planning to provide optimal support for people living with PCC.Copyright © 2023

Risk of Incident Diabetes Following Covid-19 Infection: A Population-Based Cohort Study

Intro: SARS-CoV-2 infection primarily affects the respiratory system. However, other organ systems may also be involved, leading to acute and chronic sequelae. Among other post-acute sequelae, incident diabetes is also being assessed but population-based evidence is still sparse. We evaluated the association between COVID-19 infection including severity of infection and diabetes incidence using population-based registries and datasets. Method(s): We conducted a population-based matched retrospective cohort study using data from the BC COVID-19 Cohort. The exposure was SARS-CoV-2 infection, and the primary outcome was incident diabetes identified >30 days after the specimen collection-date for COVID-19 test. We performed multivariable Cox proportional hazard modeling to assess the effect of COVID-19 infection and disease severity on diabetes. Stratified analyses were performed to evaluate the effect modification of SARS-CoV-2 infection on diabetes risk. Finally, we computed, the confounder-adjusted population attributable fraction from the Cox models Findings: During the median follow-up of 257 days, 608 (0.5%) events were observed among exposed and 1,864 (0.4%) among unexposed. Incident-diabetes rate/100,000 person-years was significantly higher among the exposed group vs. unexposed group (672.2 vs 508.7 respectively). The risk of incident diabetes was higher among those with COVID-19 infection (HR=1.16, 95% CI:1.06-1.28), and among males (aHR=1.22, 95%CI:1.06-1.40). The risk of diabetes was much higher among people with more severe disease (HRICU=3.32, 95%CI:1.99 - 5.54;HRhospitalized=1.97, 95%CI:1.33 - 2.93). Conclusion(s): SARS-CoV-2 infection is associated with higher risk of diabetes overall and among males. Severe SARS-CoV-2 infection is associated with higher risk of diabetes among both males and females. Furthermore, infection with SARS-CoV-2 could contribute to 3-5% increase in burden of diabetes, which will result in substantial number of diabetes cases with impact on healthcare needs for management of diabetes and its complications in addition to health of affected population.Copyright © 2023

Pre-text Representation Transfer for Deep Learning with Limited and Imbalanced Data: Application to CT-Based COVID-19 Detection

Annotating medical images for disease detection is often tedious and expensive. Moreover, the available training samples for a given task are generally scarce and imbalanced. These conditions are not conducive for learning effective deep neural models. Hence, it is common to ‘transfer' neural networks trained on natural images to the medical image domain. However, this paradigm lacks in performance due to the large domain gap between the natural and medical image data. To address that, we propose a novel concept of Pre-text Representation Transfer (PRT). In contrast to the conventional transfer learning, which fine-tunes a source model after replacing its classification layers, PRT retains the original classification layers and updates the representation layers through an unsupervised pre-text task. The task is performed with (original, not synthetic) medical images, without utilizing any annotations. This enables representation transfer with a large amount of training data. This high-fidelity representation transfer allows us to use the resulting model as a more effective feature extractor. Moreover, we can also subsequently perform the traditional transfer learning with this model. We devise a collaborative representation based classification layer for the case when we leverage the model as a feature extractor. We fuse the output of this layer with the predictions of a model induced with the traditional transfer learning performed over our pre-text transferred model. The utility of our technique for limited and imbalanced data classification problem is demonstrated with an extensive five-fold evaluation for three large-scale models, tested for five different class-imbalance ratios for CT based COVID-19 detection. Our results show a consistent gain over the conventional transfer learning with the proposed method. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Timing of elimination of hepatitis C virus in Canada's provinces

BACKGROUND: Infection with chronic hepatitis C virus is a global public health concern. A recent study concluded that Canada is on track to achieve hepatitis C elimination goals set by the World Health Organization if treatment levels are maintained. However, recently a falling temporal trend in treatments in Canada was observed, with most provinces seeing a decrease before the global coronavirus pandemic. This study assesses the timing of elimination of hepatitis C in the 10 provinces of Canada. METHODS: Previously published disease and economic burden model of hepatitis C infection was populated with the latest epidemiological and cost data for each Canadian province. Five scenarios were modelled: maintaining the status quo, decreasing diagnosis and treatment levels by 10% annually, decreasing diagnosis and treatment levels by 20% annually, increasing them by 10% annually, and assuming a scenario with no post-coronavirus pandemic recovery in treatment levels. Year of achieving hepatitis C elimination, necessary annual treatments for elimination, and associated disease and economic burden were determined for each province. RESULTS: If status quo is maintained, Manitoba, Ontario, and Quebec are off track to achieve hepatitis C elimination by 2030 and would require 540, 7,700, and 2,800 annual treatments, respectively, to get on track. Timely elimination would save 170 lives and CAD$122.6 million in direct medical costs in these three provinces. CONCLUSIONS: Three of Canada's provinces-two of them most populous in the country-are off track to achieve the hepatitis C elimination goal. Building frameworks and innovative approaches to prevention, testing, and treatment will be necessary to achieve this goal.

British Columbia's Index of Multiple Deprivation for Community Health Service Areas

Area-based socio-economic indicators, such as the Canadian Index of Multiple Deprivation (CIMD), have been used in equity analyses to inform strategies to improve needs-based, timely, and effective patient care and public health services to communities. The CIMD comprises four dimensions of deprivation: residential instability, economic dependency, ethno-cultural composition, and situational vulnerability. Using the CIMD methodology, the British Columbia Index of Multiple Deprivation (BCIMD) was developed to create indexes at the Community Health Services Area (CHSA) level in British Columbia (BC). BCIMD indexes are reported by quintiles, where quintile 1 represents the least deprived (or ethno-culturally diverse), and quintile 5 is the most deprived (or diverse). Distinctive characteristics of a community can be captured using the BCIMD, where a given CHSA may have a high level of deprivation in one dimension and a low level of deprivation in another. The utility of this data as a surveillance tool to monitor population demography has been used to inform decision making in healthcare by stakeholders in the regional health authorities and governmental agencies. The data have also been linked to health care data, such as COVID-19 case incidence and vaccination coverage, to understand the epidemiology of disease burden through an equity lens. Dataset:http://www.bccdc.ca/Our-Services-Site/Documents/BCIMD%20CHSA%202016%20PCA%20Scores.xlsx (accessed on 15 January 2022). Dataset License: CC0.

BOOSTING DEEP TRANSFER LEARNING FOR COVID-19 CLASSIFICATION

COVID-19 classification using chest Computed Tomography (CT) has been found pragmatically useful by several studies. Due to the lack of annotated samples, these studies recommend transfer learning and explore the choices of pre-trained models and data augmentation. However, it is still unknown if there are better strategies than vanilla transfer learning for more accurate COVID-19 classification with limited CT data. This paper provides an affirmative answer, devising a novel ‘model’ augmentation technique that allows a considerable performance boost to transfer learning for the task. Our method systematically reduces the distributional shift between the source and target domains and considers augmenting deep learning with complementary representation learning techniques. We establish the efficacy of our method with publicly available datasets and models, along with identifying contrasting observations in the previous studies. © 2021 IEEE

Impact of COVID-19 pandemic on hcv care cascade in rwanda: Ecological study from july 2019 to june 2020

Background: Many services including those related to hepatitis C virus (HCV) care were disrupted during the COVID-19 pandemic. We assessed the impact of the COVID-19 pandemic on the HCV care cascade in Rwanda. Methods: This study used data from the Rwanda Health Management Information System. We included data for all individuals who received HCV services from screening to treatment and cure [sustained virological response at week 12 (SVR12)], from July 2019 to June 2020. We defined HCV care cascade as: 1) HCV antibody (Ab) positive, 2) HCV RNA tested, 3) HCV RNA detectable, 4) patients eligible for treatment, 5) patients on treatment, 6) assessed for SVR12, 7) achieved SVR12. Results: Between July 2019 and June 2020, 1,909,450 persons were screened for HCV in Rwanda (95,899 screened from July to December 2019, and 1,813,551 from January to June 2020). From January 2020, HCV elimination plan was implemented, with an increased allocation of resources for HCV-related services. Overall, 60,961 people (3.19%) were screened positive for HCV-Ab, the highest prevalence in November 2019 (11.9%), and the lowest in June 2020 (1.47%). Among those who were HCVAb positive, 31.33% (47.54% in 2019 vs 29.1% in 2020) were tested for HCV RNA, and 77.63% of those had a detectable viral load (77.63% in both 2019 and 2020). Of 25,056 people eligible for HCV treatment (people over 17 years old, nonpregnant or breastfeeding women, patients without HCC), 69.76% started treatment (95.14% in 2019 vs 52.15% in 2020). Among 6,714 who completed HCV treatment, 50.59% (22.34% in 2019 vs 74.49% in 2020) were assessed for SVR12. From July 2019 to June 2020, the number of people screened for HCV-Ab increased, while the proportion of patients tested for HCV RNA among those who were HCVAb positive decreased from October 2019. Conclusion: The number of people screened and treated for HCV increased in Rwanda during the study period. Overall, more people were screened during the period of early 2020 compared to the later part of 2019, suggesting that the COVID-19 pandemic did not disrupt screening. However, the proportion of patients who received subsequent services in the HCV care cascade are still low and decreased in 2020 compared to 2019, which is likely due to the impact of the COVID-19 pandemic. There is a need to plan the re-engagement of individuals who may have experienced delays in hepatitis care during the COVID-19 pandemic in order to achieve the hepatitis elimination goals. .

Hepatitis c screening and diagnosis in a canadian provincial correctional system during the COVID-19 pandemic

Background: Increased hepatitis C virus (HCV) testing among people in prison (PIP) is key for HCV elimination efforts to be successful. Efforts to improve health care in all British Columbia (BC) Provincial Correctional Centres (PCCs) have been made in recent years, beginning with the transfer of health services from BC Corrections to BC Provincial Health Services Authority (PHSA) in 2017. However, the state of emergency declared in BC in early 2020 in response to the COVID-19 pandemic may have undermined these efforts. This study aims to examine patterns in HCV screening and diagnosis in all 10 BC PCCs before and during the COVID-19 pandemic. Methods: Data from the BC Sexually Transmitted and Blood-Borne Infections Data Mart, which contains laboratory data accounting for >95% of all anti-HCV and >99% of all HCV RNA and genotype tests performed in BC, were used for this study. The number of anti-HCV, HCV RNA and HCV genotype tests that were ordered from BC PCCs between April 1 2011 and March 31 2021 was determined for quarterly periods. New HCV diagnoses were defined as the number of 1st-time HCV-positive test episodes (anti-HCV, RNA or genotype) among HCV tests ordered from BC PCCs. Total intake numbers were provided by BC Corrections per calendar year. Results: The number of HCV antibody, RNA, and genotype tests ordered from BC PCCs in the 1st quarter of 2020 had increased by 412% (n=486), 530% (n=252) and 827% (n=139) respectively (Figure 1), compared to the 1st quarter of 2017 (prior to the transfer of health services to PHSA). Following the beginning of the COVID-19 pandemic, the number of HCV antibody, RNA, and genotype tests ordered from BC PCCs in the 2nd quarter of 2020 had decreased by 66% (n=165), 67% (n=83) and 68% (n=44), respectively (Figure 1), compared to the 1st quarter of 2020. The total number of HCV tests as a proportion of intakes to BC PCCs in 2019 was 17% (2518/15303), which increased to 23% (2112/9283) in 2020. Conclusion: The transfer of health services in BC PCCs to PHSA led to increased volume of HCV screening, with concomitant increases in new HCV diagnoses among PIP in BC from 4th quarter 2017 onwards. The COVID-19 pandemic led to health care challenges in prisons in BC (including the suspension of non-urgent HCV testing in the entire province for several weeks), and at the same time, the number of HCV tests and new diagnoses decreased. This may have been partly due to reduced intakes to BC PCCs over 2020, as the total number of HCV tests ordered as a proportion of intakes increased in 2020, compared to the previous year. Those people diverted away from the correctional system due to decarceration efforts triggered by COVID-19 may have missed out on HCV screening during 2020, therefore further efforts to increase HCV screening in correctional settings and the community will be needed.

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.

COVID-19 Pandemic and Maternal Perspectives

Aim Coronavirus (COVID-19) pandemic has affected perinatal women worldwide. Our study aimed to describe the opinions of perinatal women about COVID-19 related knowledge, attitude, and practices. Methods Pregnant and Postnatal women (n=223) were included and those who did not consent, and less than 16 weeks' gestation, were excluded. SPSS version 26 was used for descriptive statistics. Results Most of the women had good knowledge about COVID 19 regarding its nature, transmission, & symptoms. Their information sources were news (139/206=67.5%) and the internet (85/206=41%). Women understood the uncertainty around its effect on pregnancy;as it is a novel infection. A substantial number of women were concerned (130/206=63%), upset by social isolation (86/206=42%), negatively impacted by the visitor restrictions in hospital (154/206=75%), and faced COVID-19 related reduced household finances (97/206=47%). Most of them used hand washing (201/206=98%) & social distancing (191/206=93%) as preventive measures. They reported compromised contact with General Physician (GP) service as compared to the hospital service (85/206=41% Vs 31/206=15% respectively) during the pandemic. Conclusions The main challenges of the COVID-19 pandemic for perinatal women are the jeopardized GP & hospital services & psychological distress. It is imperative to incorporate telemedicine & virtual visits to tackle the burden of the COVID-19 pandemic. Perinatal women, are particularly vulnerable to the psychological impacts of the COVID-19 pandemic & societal lockdown, thus necessitating holistic interventions.

Vertical transmission, maternal thrombocytopenia, & postpartum haemorrhage in coronavirus infection - a case report

Objective New evidence is emerging regarding the effects of Coronavirus (COVID-19) in pregnancy. We report this case to highlight COVID-19 complications and challenges in the 3rd trimester of pregnancy. Case report A 35 years old, Para 1, had an uneventful pregnancy up to 36 weeks' gestation, when she was admitted with reduced fetal movements, feeling unwell, fever, and cough with a positive COVID-19 PCR. She was febrile, tachycardiac, and normotensive with no proteinuria. Symptomatic treatment was commenced with infection control measures. Cardiotocograph (CTG) was reassuring initially. Her platelet count was 66 9 109/L and her liver function tests (LFT) were mildly deranged. Peripheral blood film showed no signs of Microangiopathic hemolytic anemia. The hematologist suggested that thrombocytopenia was most likely related to COVID-19 & her isolated mildly prolonged APTT was corrected by Vitamin K. She was induced in view of intermittent decelerations on CTG and progressive thrombocytopenia. However, CTG became abnormal and she had a lower segment cesarean section under General Anastasia (because of thrombocytopenia). She delivered a 2.8 kg baby boy (APGAR score of 6 and 9 at 5 and 10 mins respectively, normal cord pH). Delivery was complicated by a Postpartum hemorrhage of 2 L, for which she was transfused one unit of platelets, and two units of red cells, along with oxytocics and antibiotics. Neonate was COVID-19 positive and had hyperbilirubinemia, which settled subsequently. The subsequent recovery of the mother was uneventful, with improvement in her platelet count and LFT. She was discharged home with her baby on the 4th postoperative day after the debriefing. She was prescribed thromboprophylaxis for 6 weeks and followed up as an outpatient. Discussion The management of COVID-19 in pregnancy should include a multidisciplinary approach, foeto-maternal surveillance, infection control measures, delivery planning, and psychological support. Rasmussen SA advocates the use of empiric antibiotics for secondary bacterial infection risk & mechanical support in case of respiratory compromise. Thrombocytopenia is a known complication of COVID-19 in pregnancy. Thromboprophylaxis is challenging in such patients and depends on risks and benefits, clotting profile, and the timing of delivery. Moreover, the differential diagnosis for epigastric pain in pregnancy with COVID-19 infection varies from gastritis and preeclampsia to hepatic and myocardial injury. Vertical transmission is a known risk of maternal COVID-19 infection. Conclusion As obstetric teams face COVID-19 pandemic associated foeto-maternal challenges, there is a need for holistic interventions for caveats arising from COVID-19 complications.