Psychosocial Distress in Parents with Children Awaiting Surgery during the COVID-19 Pandemic

Due to resource restrictions related to the COVID-19 pandemic, many pediatric patients are facing substantial delays for surgery, potentially resulting in additional distress for caregivers. We aimed to assess the experiences and psychosocial distress of parents during COVID-19 as they relate to the pandemic, waiting for surgery, and the combined effects of both events. The was a cross-sectional qualitative study. Parents with children who faced treatment delays during the initial wave of the COVID-19 pandemic for elective, non-emergent procedures across a variety of surgical specialties were recruited. Semi-structured telephone interviews and thematic analysis were utilized. Thematic saturation was reached with eighteen participants. Four themes were identified: coping with COVID-19, distress levels, quality and nature of communication with the surgical team, and the experience of COVID-19 related hospital restrictions. Participants reported varying levels of distress due to the delay in surgery, such as the fear of developmental delay or disease progression for their child. They also indicated their own physical and mental health had been impacted by emotional distress related to both COVID-19 and delays in treatment. Most participants experienced the COVID-19-related hospital restrictions as distressing. This related predominantly to limiting in-hospital caregivers to only one caregiver. Participants were found to have substantial levels of psychosocial distress. Targeted social and emotional support may be helpful in reducing parental distress as the pandemic timeframe continues. Within the limits of individual health systems, reducing restrictions to the number of allowed care givers may help allay distress felt by parents.

Physician Perspectives on the Impact of the COVID-19 Pandemic on Family-Centered Rounds

BACKGROUND The coronavirus disease 2019 pandemic has required modifications to family-centered rounds (FCR), although the specific changes and the effects on patients, families, and providers are not well known. In this study, we explore physician perspectives on changes made to FCR during the initial wave of the coronavirus disease 2019 pandemic and recommendations for the future. METHODS Semistructured individual interviews were conducted with 20 pediatric attending and resident physicians who cared for hospitalized patients between March and May 2020 on pediatric hospital medicine and subspecialty services that typically perform FCR. Transcripts were reviewed by using principles of framework analysis to iteratively develop a codebook. Review of coded segments, with attention to code co-occurrences, was used to clarify themes in the data relating to the research objective and the conceptual framework. RESULTS The rounding format changed for all providers and varied on the basis of clinical service and phase of the pandemic. Themes highlighted specific areas of change: (1) the process of FCR, (2) reaching consensus with families, (3) collaboration with members of the medical team, and (4) resident education, modeling, and supervision. Participants offered recommendations, including standardization of rounds, intentional involvement of nursing staff, and inclusion of families through virtual or small-group bedside rounds. CONCLUSIONS The pandemic led to a variety of modifications to FCR, and these changes had varied effects on communication and education. These findings provide insight into the state of FCR during the pandemic and may frame future recommendations for the development of shared guidelines for circumstances requiring limited bedside rounding.

Home, but Left Alone: Time at Home and Child Abuse and Neglect During COVID-19

We use high-frequency mobile phone movement data and quick-release administrative data from Georgia to examine how time at home during the COVID-19 pandemic is related to child maltreatment referrals. Findings show that referrals plummeted by 58% relative to previous years, driven by fewer referrals from education personnel. After this initial decline, however, each 15 minutes at home was associated with an increase in referrals of material neglect by 3.5% and supervisory neglect by 1%. Our results describe how children have fared during the initial wave of the pandemic, and the results have long-term implications for child development and well-being.

TP5.2.12 30-Day mortality in vascular surgery during the COVID pandemic: 1st wave outcomes

Aims To assess the 30-day mortality rate in patients undergoing vascular procedures in a single vascular centre during the first wave of the Covid-19 pandemic. Methods Retrospective analysis of all vascular operations undertaken at our unit from 11th March 2020 to 16th November 2020. Thirty-day mortality rate, ASA grade, 30-day Covid-19 PCR test positivity and cause of death were assessed. Mortality rate was compared to previous five-year average with a Chi- Square test. Results Within the observed period, 237 vascular operations were performed (49% operative reduction). 57 patients (24%) were operated electively through the “Green pathway” (day case) and there were no perioperative positive Covid-19 tests. 180 patients were operated through the “Amber” (elective Inpatient) or “Red” (emergency) pathway. Eight inpatients (4.4%) died within 30 days from surgery, similar to the average 30-day mortality observed in the previous years (5.9% p > 0.05). Three patients (1.42%) tested positive preoperatively but were all asymptomatic from Covid-19. One patient who died tested positive for Covid-19 but was asymptomatic from a respiratory aspect and died of cardiovascular disease. Conclusion We found no difference in 30-day post-operative mortality rate during the initial wave of Covid-19. Only 3 patients undergoing emergency operations tested positive. This study does reinforce the “Green pathway” strategy for elective patients to ensure minimising exposure to Covid-19 but we also did not witness any difference in mortality rate in the “Amber” or “Red” pathway. The impact of the second or third “wave” on current numbers will need to be studied further.

Rapid emergence and spread of SARS-CoV-2 gamma (P.1) variant in Haiti

After an initial wave of COVID-19 in Haiti in summer 2020 (primarily lineage B.1), seropositivity for anti-SARS-CoV-2 IgG was ~40%. Variant P.1 (gamma) was introduced in February 2021, with an initially limited introduction followed by exponential local dissemination within this unvaccinated population with prior exposure to earlier SARS-CoV-2 lineages.

923 How Did the Initial Wave Of COVID-19 Affect CEPOD Waiting Times for Vascular Surgery? A Comparative Audit

Aim Many vascular patients present acutely, relying on emergency theatre availability when surgical intervention is required. The prioritisation of the CEPOD operating list is a challenge, and the additional pressures of the COVID-19 pandemic have necessitated changes to established practice. The purpose of this audit was to review the effects of the pandemic on the CEPOD waiting times for vascular patients at the main centre for the South West Wales Vascular Network. Method The CEPOD waiting times for vascular patients during the initial wave of the COVID-19 pandemic were compared with the same period the previous year. Data was analysed according to booking category and procedure type. Results 98 emergency vascular procedures were performed during the initial wave of the COVID pandemic, compared to 133 in 2019. In 2019, amputations (major and minor) accounted for 47% of cases, which rose to 53% during the pandemic. Median waiting times for category 1 and 2a operations were significantly shorter in 2020, whilst category 3 waiting times rose. There was no significant difference overall in the proportion of patients operated on within the target timescale, regardless of CEPOD booking category. Conclusions Managing the impact of COVID-19 required change to established practice. Although fewer procedures were performed, significant logistical challenges were faced. By adjusting the organisation of CEPOD, the most urgent vascular cases were performed quicker during this time. It is important to identify and promote the positive organisational changes that have arisen as a result of COVID-19, and to continue to review procedures as the pandemic progresses.