As the spread of COVID19 in the US continues to grow, local and state officials face difficult decisions about when and how to transition to a new normal. The goal of this study is to project the number of COVID19 infections and resulting severe outcomes, and the need for hospital capacity under social distancing, particularly, shelter-in-place and voluntary quarantine for the State of Georgia. We developed an agent-based simulation model to project the infection spread. The model utilizes COVID19-specific parameters and data from Georgia on population interactions and demographics. The simulation study covered a seven and a half-month period, testing different social distancing scenarios, including baselines (no-intervention or school closure only) and combinations of shelter-in-place and voluntary quarantine with different timelines and compliance levels. The following outcomes are compared at the state and community levels: the number and percentage of cumulative and daily new symptomatic and asymptomatic infections, hospitalizations, and deaths; COVID19-related demand for hospital beds, ICU beds, and ventilators. The results suggest that shelter-in-place followed by voluntary quarantine reduced peak infections from approximately 180K under no intervention and 113K under school closure, respectively, to below 53K, and delayed the peak from April to July or later. Increasing shelter-in-place duration from four to five weeks yielded 2C9% and 3C11% decrease in cumulative infection and deaths, respectively. Regardless of the shelter-in-place duration, increasing voluntary quarantine compliance decreased daily new infections from almost 53K to 25K, and decreased cumulative infections by about 50%. The cumulative number of deaths ranged from 6,660 to 19,430 under different scenarios. Peak infection date varied across scenarios and counties; on average, increasing shelter-in-place duration delayed the peak day by 6 days. Overall, shelter-in-place followed by voluntary quarantine substantially reduced COVID19 infections, healthcare resource needs, and severe outcomes.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) C also known as COVID-19 C is primarily known for respiratory illness. While it is clear that patients with moderate to severe cases of COVID-19 will require pulmonary rehabilitation, physiatrists will need to consider effective management plans for COVID-19 survivors with extra-pulmonary involvement. This report will summarize key non-pulmonary considerations to guide rehabilitation clinicians who may be involved in the care of COVID-19 survivors with the best available early evidence.

COVID-19 has been declared as a global pandemic by World Health Organisation (WHO) Certain Muslims associated the emergence of Al-turyya with the fading of Coronavirus Disease 2019 (COVID-19) This article aimed to discuss the text and context of the Hadith and its link to the termination of COVID-19 Classical and contemporary scholars' opinions were analysed in this study The methodology used involved inductive and deductive supplemented with critical analysis determining the most appropriate opinion on this matter Further empirical study of the visibility of Al-turyya in the Islamic history were analysed using Stellarium Astronomy Software 0 20 0 The findings of the study revealed that the hadith refers to the disappearance of disease pertaining to fruits and crops and not to related to the end of any pandemic Additionally, the rise of Al-turyya showed no connection with pandemic termination in the Islamic history In conclusion, the claim that COVID-19 will disappear with the emergence of Al-turyya can be rejected ? Koninklijke Brill NV, Leiden, 2020

Tracheal intubation with Macintosh laryngoscope (MAC) might result in severe cardiovascular complications. The results of conducted studies investigating the effects of videolaryngoscopies on hemodynamic response of tracheal intubation are conflicting. We know little about the effects of videolaryngoscopies on cardiac output changes during tracheal intubation. We compared cardiac output (COP) and hemodynamic responses in normal blood pressure (n=60) and hypertensive patients (n=60) among 3 intubation devices: the MAC, the UE videolaryngoscopy ? (UE), and the UE video intubation stylet ? (VS). Cardiac index (CI), stroke volume index (SVI), heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded using LidcoRapid (V2)? preinduction, preintubation, and every minute for the first 5 min after intubation. We assessed oropharyngeal and laryngeal structures injury as well. Intubation time was significantly shorter than MAC groups (P<0.001) only in UE group of normotensive and hypertensive patients. In normotensive patients, there were no significant differences in any of COP variables or hemodynamic variables among the three devices. In hypertensive patients, SBP and DBP in the MAC group were significantly higher (P<0.05 or <0.01) than the UE and VS groups at 1, 2 and 3 min after intubation, but there were no significant differences in CI, SVI and HR among the three devices. There was no significant difference in oropharyngeal and laryngeal structures injury among all groups. It was concluded that both the UE and VS attenuate only the hemodynamic response to intubation as compared with the MAC in hypertensive patients, but not in normotensive patients.

Disposal of healthcare waste is a key issue of environmental sustainability in the world. The amount of healthcare waste is increasing every day, and it is necessary to adequately dispose of this kind of waste. There are various treatments for healthcare waste disposal, of which incineration of healthcare waste is one of the solutions. This paper suggests a model for selection of the type of incinerators that best solve the problem of healthcare waste in secondary healthcare institutions in Bosnia and Herzegovina. In the selection of incinerators, extended sustainability criteria were applied. Basic sustainability criteria: environmental, economic, and social criteria, were extended with the technical criterion. To assess which of the incinerators best meets the needs for healthcare waste collection, multi-criteria decision-making was used. For this purpose, a combination of two MCDA methods was applied in this paper, namely full consistency method (FUCOM) and compromise ranking of alternatives from distance to ideal solution (CRADIS). The FUCOM method was applied to determine the weights of the criteria, while the CRADIS method was applied to rank the alternatives. The best alternative of the six alternatives used is A2 (I8-M50), followed by alternative A1 (I8-M40), while the worst ranked alternative is A5 (I8-M100). These results were confirmed by applying the other six methods of multi-criteria analysis and the performed sensitivity analysis. The contribution of this paper is reflected through a new method of multi-criteria analysis that was used to solve decision-making problems. This method has shown simplicity and flexibility in operation and can be used in all problems when it is necessary to make a multi-criteria selection of alternatives.

Background: Most acute stroke (AS) patients in the United States are initially evaluated at a primary stroke center (PSC) and a significant proportion requires transfer to a comprehensive stroke center (CSC) for advanced treatment. A CSC typically accepts patients from multiple PSCs in its network, leading to capacity limits. This study uses a queueing model to estimate impacts on CSC capacity due to transfers from PSCs. Methods: The model assumes that the number of AS patients arriving at each PSC, proportion of AS patients transferred, and length of stay in the CSC Neurologic Intensive Care Unit (Neuro-ICU) by type of AS are random, while the transfer rates of ischemic and hemorrhagic AS patients are control variables. The main outcome measure is the"overflow"probability, namely, the probability of a CSC not having capacity (unavailability of a Neuro-ICU bed) to accept a transfer. Data simulations of the model, using a base case and an expanded case, were performed to illustrate the effects of changing key parameters, such as transfer rates from PSCs and CSC Neuro-ICU capacity on overflow capacity. Results: Data simulations of the model using a base case show that an increase of a PSC's ischemic stroke transfer rate from 15% to 55% raises the overflow probability from 30.62% to 36.13%. Further simulations of the expanded case show that to maintain an a priori CSC overflow probability of 30.62% when adding a PSC with a AS transfer rate of 15% to the network, other PSCs would need to decrease their transfer rate by 12.5% or the CSC Neuro-ICU would need to add 2 beds. Discussion: A queuing model can be used to estimate the effects of change in the size of a PSC-CSC network, change in AS transfer rates, or change in number of CSC Neuro-ICU beds of a CSC on its capacity on the overflow probability in the CSC.

Background and Objective: It is known that several viruses are involved in the pathogenesis of type 1 diabetes. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new worldwide spread virus that may act as a trigger for the autoimmune destruction of the -cells, as well, and thus lead to an increase in the incidence of type 1 diabetes. Material and Methods: The Romanian National Organization for the Protection of Children and Adolescents with Diabetes (ONROCAD) has collected information regarding new cases of type 1 diabetes in children aged 0 to 14 years from all over the country since 1996 and has computed the incidence of type 1 diabetes in this age group. Results: We observed a marked increase in the incidence of type 1 diabetes in the first year of the COVID-19 pandemic, with 16.9%, from 11.4/100,000 in 2019 to 13.3/100,000 in 2020, much higher compared to previous years (mean yearly increase was 5.1% in the period 1996C2015 and 0.8% in the interval 2015C2019). The proportion of newly diagnosed cases was significantly higher in the second half of 2020 compared to the second half of the previous years (57.8 vs. 51%, p < 0.0001). Conclusions: All these aspects suggest the role that SARS-CoV-2 could have in triggering pancreatic autoimmunity. To confirm this, however, collecting information from larger populations from different geographical regions, monitoring the incidence curves over a period of several years, and gathering background information on COVID-19 and/or data on COVID-19 specific antibodies are needed.

Endocytosis is a fundamental process occurring in all eukaryotic cells. Live cell imaging of endocytosis has helped to decipher many of its mechanisms and regulations. With the pulsed-pH (ppH) protocol, one can detect the formation of individual endocytic vesicles (EVs) with an unmatched temporal resolution of 2 s. The ppH protocol makes use of cargo protein (e.g., the transferrin receptor) coupled to a pH-sensitive fluorescent protein, such as superecliptic pHluorin (SEP), which is brightly fluorescent at pH 7.4 but not fluorescent at pH <6.0. If the SEP moiety is at the surface, its fluorescence will decrease when cells are exposed to a low pH (5.5) buffer. If the SEP moiety has been internalized, SEP will remain fluorescent even during application of the low pH buffer. Fast perfusion enables the complete exchange of low and high pH extracellular solutions every 2 s, defining the temporal resolution of the technique. Unlike other imaging-based endocytosis assays, the ppH protocol detects EVs without a priori hypotheses on the dynamics of vesicle formation. Here, we explain how the ppH protocol quantifies the endocytic activity of living cells and the recruitment of associated proteins in real time. We provide a step-by-step procedure for expression of the reporter proteins with transient transfection, live cell image acquisition with synchronized pH changes and automated analysis. The whole protocol can be performed in 2 d to provide quantitative information on the endocytic process being studied.

The COVID-19 pandemic has brought to the forefront an urgent need for the rapid development of highly efficacious vaccines, particularly in light of the ongoing emergence of multiple variants of concern. Plant-based recombinant protein platforms are emerging as cost-effective and highly scalable alternatives to conventional protein production. Viral glycoproteins, however, are historically challenging to produce in plants. Herein, we report the production of plant-expressed wild-type glycosylated SARS-CoV-2 Spike RBD (receptor-binding domain) protein that is recognized by anti-RBD antibodies and exhibits high-affinity binding to the SARS-CoV-2 receptor ACE2 (angiotensin-converting enzyme 2). Moreover, our plant-expressed RBD was readily detected by IgM, IgA, and IgG antibodies from naturally infected convalescent, vaccinated, or convalescent and vaccinated individuals. We further demonstrate that RBD binding to the ACE2 receptor was efficiently neutralized by antibodies from sera of SARS-CoV-2 convalescent and partially and fully vaccinated individuals. Collectively, these findings demonstrate that recombinant RBD produced in planta exhibits suitable biochemical and antigenic features for use in a subunit vaccine platform.

In this paper, the latest global COVID-19 pandemic prediction is addressed. Each country worldwide has faced this pandemic differently, reflected in its statistical number of confirmed and death cases. Predicting the number of confirmed and death cases could allow us to know the future number of cases and provide each country with the necessary information to make decisions based on the predictions. Recent works are focused only on confirmed COVID-19 cases or a specific country. In this work, the firefly algorithm designs an ensemble neural network architecture for each one of 26 countries. In this work, we propose the firefly algorithm for ensemble neural network optimization applied to COVID-19 time series prediction with type-2 fuzzy logic in a weighted average integration method. The proposed method finds the number of artificial neural networks needed to form an ensemble neural network and their architecture using a type-2 fuzzy inference system to combine the responses of individual artificial neural networks to perform a final prediction. The advantages of the type-2 fuzzy weighted average integration (FWA) method over the conventional average method and type-1 fuzzy weighted average integration are shown.

BACKGROUND: Providing health care at a distance has evolved over the past decades, resulting in a myriad of terms and styles of care delivery Telehealth is defined as any health care service delivered at a distance Nursing services have been delivered by a wide range of specialty nurses for many years using various technological formats Clinical experience suggests that few WOC nurses had extensively adopted these technologies and principles into their practice as recently as 2019 However, the COVID-19 pandemic of 2020 has forced both administrators and clinicians to rapidly adapt or introduce telemedicine technologies to deliver specialty care including WOC nurse services CASES: Three WOC nurses were chosen to describe the use of telehealth technologies to illustrate opportunities for WOC nurses to integrate telehealth nursing into a health care setting Two adapted telehealth technology into their practice before the pandemic, and one started telehealth practice as a means to provide care after the onset of the pandemic Disadvantages and advantages are discussed to provide further information regarding WOC patient care using these technologies CONCLUSION: The pandemic crisis has accelerated the need for health care to reimagine the delivery of care to patients Telehealth technologies and principles have emerged as essential for WOC nurses to deliver safe and effective care

The COVID-19 pandemic has created novel barriers in providing and accessing all forms of healthcare, including dentistry. The national dental response during the first peak of the pandemic resulted in rapid changes in the provision of service, to safeguard providers and users of dental care.Such rapidly leveraged changes resulted in several issues in service delivery, requiring careful input from managers and commissioners within NHS England and Improvement, trainees and consultants in dental public health within Public Health England, and frontline dental teams working across the health and social care system. The local response from Lancashire and South Cumbria is outlined within this article.Teamwork, communication and reflexive, iterative learning from these groups ensured the delivery of an Urgent Dental Care service during the first lockdown of the pandemic.The impact of COVID-19 has enabled considerable learning which will inform future pandemic planning, alongside providing the opportunity to deliver meaningful change within NHS dentistry as the service continues to recover.

Introduction Ageing affects homeostasis and immunosenescence, resulting in aberrant fever and immune responses to infection in older adults This study assesses heritability of basal temperature and explores effects of ageing on basal temperature and temperature in response to SARS-CoV-2 infection Methods Observational study using multiple cohorts Participants: (a) Twin volunteers: 1089 healthy adults enrolled in Twins-UK, mean age 59 (17);tympanic temperature measurements;(b) Community-based: 3972 adults using the COVID Symptom Study mobile application, age 43 (13);self-reported test-positive for SARS-CoV-2 infection;self-reported temperature measurements;(c) Hospitalised: cohorts of 520 and 757 adult patients with emergency admission to two teaching hospitals between 01/03/2020C04/05/2020, age 62 (17) and 68 (17) respectively;RT-PCR-confirmed SARS-CoV-2 infection Analysis (a) heritability analysed using saturated and ACE univariate models;linear mixed-effect model for associations between basal temperature and age, sex and BMI (b&c) multivariable linear regression for associations between temperature and age, sex and BMI;multivariable logistic regression for associations between fever(&gt;/= 37 8C) and age, sex and BMI Results Basal temperature in twins demonstrated 50% heritability (95%CI[42C57%]) In healthy twin, community-based and hospitalised cohorts, increasing age is associated with lower temperatures, and increasing BMI with higher temperatures: (a) Twins (age:p &lt; 0 001;BMI:p = 0 002);(b) Community-based (age: p &lt; 0 001;BMI: p &lt; 0 001);(c) Hospitalised (1st hospital: age: p = 0 106;BMI: p = 0 033;2nd hospital: age: p &lt; 0 001;BMI: p = 0 010) Increasing age was negatively and BMI positively associated with fever (1st hospital: Age: OR = 0 99, p = 0 033;BMI: OR = 1 00, p = 0 045;2nd hospital: Age: OR = 0 99, p = 0 010;BMI: OR 1 02, p = 0 038) Conclusions Heritability of basal temperature suggests a genetic component to thermoregulation Associations observed between increasing age and lower temperatures and higher BMI and higher temperatures are important in understanding effects of ageing and obesity on basal temperature and the fever response In older adults, findings have important implications for defining fever thresholds and diagnosing infections, including SARS-CoV-2

AIMS To estimate the prevalence of cats testing positive for antibodies to feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV) antigens in domestic cats entering a New Zealand animal shelter, based on a commercial point-of-care ELISA, to identify risk factors associated with cats testing positive, and to compare the results obtained from the ELISA with those obtained using PCR-based testing. METHOD A cross-sectional study was performed on 388 cats entering the Royal New Zealand Society for the Prevention of Cruelty to Animals animal shelter in Auckland, New Zealand between 7 February 2014 and 30 May 2014. Whole blood samples were collected from each cat and tested for FIV antibody and FeLV antigen using a commercial point-of-care ELISA. Information on the signalment and health status of the cat at the time of entry was also recorded. Blood and saliva samples from a subset of cats were tested for FIV and FeLV proviral DNA using a real-time PCR assay. RESULTS Of the 388 cats in the study sample, 146 (37.6%) had been relinquished by owners, 237 (62.4%) were strays, and 5 (1.3%) were of unknown origin. Overall, 53/388 (13.7%) cats tested positive for FIV antibodies and 4/388 (1.0%) were positive for FeLV antigen. Stray cats had a higher FIV seroprevalence than relinquished cats (42/237 (17.8%) vs. 11/146 (7.5%); p=0.008). Of 53 cats that were FIV-seropositive, 51 (96%) tested positive for FIV proviral DNA using PCR testing of blood. Of these 51 cats, 28 (55%) were positive by PCR testing of saliva. Of the four cats that were FeLV antigen-positive by ELISA, two (50%) were positive for FeLV proviral DNA by PCR testing of blood. The odds of a cat being seropositive for FIV were greater for intact compared to desexed cats (OR=3.3; 95% CI=1.6-7.4) and for male compared to female cats (OR=6.5; 95% CI=3.2-14.0). CONCLUSIONS AND CLINICAL RELEVANCE The seroprevalence for FIV was 14% among cats entering an animal shelter in Auckland, whereas the prevalence of FeLV antigen-positive cats was only 1%. These findings suggest differences in the transmission dynamics of each virus in free-roaming cat populations in New Zealand. Our study also highlights the potential role of desexing cats in reducing transmission of FIV. However, further data from first-opinion veterinary practices are required to confirm that these findings may be generalised to the wider domestic cat population in New Zealand.

Worldwide, governments have reacted to the COVID-19 pandemic with emergency orders and policies restricting rights to movement, assembly, and education that have impacted daily lives and livelihoods in profound ways. But some leaders, such as President Jair Bolsonaro in Brazil, have resisted taking such steps, denying the seriousness of the pandemic and sabotaging local control measures, thereby compromising population health. Facing one of the worlds highest rates of COVID-19 infections and deaths, multiple political actors in Brazil have resorted to judicialization to advance the right to health and other protections in the country. Responding to this litigation has provided the countrys Supreme Court an opportunity to assertively confront and counter the executives necropolitics. In this article, we probe the malleable form and the constitutional basis of the Supreme Courts decisions, assessing their impact on the separation of powers, on the protection of human rights (for example, on those of prisoners, indigenous peoples, and essential workers), and relative to the implementation of evidence-based interventions (for example, lockdowns and vaccination). While the courts actions open up a distinct legal-political field (sometimes called supremocracy)oscillating between progressive imperatives, neoliberal valuations, and conservative decisionsthe capacity of the judiciary to significantly address systemic violence and to robustly advance human rights remains to be seen.

Reflecting a burgeoning political interest in supporting young children around the world, global demand for reliable, valid, and scalable assessments of early childhood development (ECD) is on the rise. One of the more popular sets of tools for measuring the ECD of children under age 3 is the Caregiver Reported Early Development Instruments (CREDI), which includes both a long form for research and evaluation and a short form for population-level monitoring. In this commentary, we describe the goals and limitations of the CREDI, research to support its use as a population-level ECD instrument, as well as the major gaps in its evidence base. We also discuss how the work of Alderman and colleagues (in this issue) addresses some of these outstanding gaps, highlighting several critical areas for future research.

Healthy aging is informed by theoretical developments within gerontology, the accumulation of biopsychosocial data on health and well-being in later life, and the perspectives of older persons themselves This article reviews this progress, consolidates recent advances with respect to proximal and distal influences, as well as risk and protective factors, for health and well-being in later life Measures used to assess various aspects of healthy aging in a variety of settings are discussed A refined Psychological and Contextual Model of Healthy Aging is presented to capture the current state of research and possibly assist in refining future research directions Both proximal and distal protective and risk factors for healthy aging are enumerated Finally, future research directions for a greater realization of healthy aging for all are offered

In a knowledge-based society, the study of Intellectual Capital (IC) has established itself as a vibrant topic in the area of strategic management. The purpose of this paper is to explore the concept of IC in the hotel industry and to assess its impact on business performance. Although hotels are not primarily seen as knowledge-intensive, they are service providers, highlight their intangibility and face unpredictable and complex environments, which has been illustrated by the current COVID-19 crisis. Therefore, both the individual knowledge of employees working in hotels and the organisational knowledge expressed in routines, systems, customer databases, etc., are considered important elements for their effective leadership and management in a turbulent environment. Empirical studies that have investigated the relationship between IC and hotel performance are scarce and offer mixed evidence. In our study we propose to introduce the role of the company leader as a key aspect in the management of knowledge and intangibles within the hotel. Specifically, the main objective of our study is to analyse the moderating influence of the gender of hotel managers on the Cl-hotel performance relationship, showing that hotels managed by women have a more pronounced impact on the positive influence of CI on hotel performance. Our results have been obtained from questionnaires addressed to a sample of 212 hotels between 3 and 5 stars located in Spain. The analysis technique used was Partial Least Squares (PLS). The main contributions of this paper include the theoretical review of the concept of intellectual capital in a sector as relevant as the hotel sector in Spain, which is going through such an exceptional situation with the current crisis. In addition, important managerial implications emerge in order to make the most of the existing knowledge resources in hotels.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of Coronavirus Disease 2019 (COVID-19), has caused a global pandemic, and safe, effective vaccines are urgently needed1. Strong, Th1-skewed T cell responses can drive protective humoral and cell-mediated immune responses2 and might reduce the potential for disease enhancement3. Cytotoxic T cells clear virus-infected host cells and contribute to control of infection4. Studies of patients infected with SARS-CoV-2 have suggested a protective role for both humoral and cell-mediated immune responses in recovery from COVID-19 (refs. 5,6). ChAdOx1 nCoV-19 (AZD1222) is a candidate SARS-CoV-2 vaccine comprising a replication-deficient simian adenovirus expressing full-length SARS-CoV-2 spike protein. We recently reported preliminary safety and immunogenicity data from a phase 1/2 trial of the ChAdOx1 nCoV-19 vaccine (NCT04400838)7 given as either a one- or two-dose regimen. The vaccine was tolerated, with induction of neutralizing antibodies and antigen-specific T cells against the SARS-CoV-2 spike protein. Here we describe, in detail, exploratory analyses of the immune responses in adults, aged 18-55 years, up to 8 weeks after vaccination with a single dose of ChAdOx1 nCoV-19 in this trial, demonstrating an induction of a Th1-biased response characterized by interferon- and tumor necrosis factor- cytokine secretion by CD4+ T cells and antibody production predominantly of IgG1 and IgG3 subclasses. CD8+ T cells, of monofunctional, polyfunctional and cytotoxic phenotypes, were also induced. Taken together, these results suggest a favorable immune profile induced by ChAdOx1 nCoV-19 vaccine, supporting the progression of this vaccine candidate to ongoing phase 2/3 trials to assess vaccine efficacy.

BACKGROUND: Critically ill coronavirus disease 2019 (COVID-19) patients have frequent thrombotic complications and laboratory evidence of hypercoagulability The relationship of coagulation tests and thrombosis requires investigation to identify best diagnostic and treatment approaches We assessed for hypercoagulable characteristics in critically ill COVID-19 patients using rotational thromboelastometry (ROTEM) and explored relationships of D-dimer and ROTEM measurements with thrombotic complications METHODS: Critically ill adult COVID-19 patients receiving ROTEM testing between March and April 2020 were analyzed Patients receiving therapeutic anticoagulation before ROTEM were excluded Rotational thromboelastometry measurements from COVID-19 patients were compared with non-COVID-19 patients matched by age, sex, and body mass index Intergroup differences in ROTEM measurements were assessed using t tests Correlations of D-dimer levels to ROTEM measurements were assessed in COVID-19 patients who had available concurrent testing Intergroup differences of D-dimer and ROTEM measurements were explored in COVID-19 patients with and without thrombosis RESULTS: Of 30 COVID-19 patients receiving ROTEM, we identified hypercoagulability from elevated fibrinogen compared with non-COVID-19 patients (fibrinogen assay maximum clot firmness [MCF], 47 +/- 13 mm vs 20 +/- 7 mm;mean intergroup difference, 27 4 mm;95% confidence interval [CI], 22 1-32 7 mm;p &lt; 0 0001) In our COVID-19 cohort, thrombotic complications were identified in 33% In COVID-19 patients developing thrombotic complications, we identified higher D-dimer levels (17 5 +/- 4 3 mug/mL vs 8 0 +/- 6 3 mug/mL;mean difference, 9 5 mug/mL;95% CI, 13 9-5 1;p &lt; 0 0001) but lower fibrinogen assay MCF (39 7 +/- 10 8 mm vs 50 1 +/- 12 0 mm;mean difference, -11 2 mm;95% CI, -2 1 to -20 2;p = 0 02) compared with patients without thrombosis We identified negative correlations of D-dimer levels and ROTEM MCF in these patients (r = -0 61;p = 0 001) CONCLUSION: We identified elevated D-dimer levels and hypercoagulable blood clot characteristics from increased fibrinogen on ROTEM testing in critically ill COVID-19 patients However, we identified lower, albeit still hypercoagulable, ROTEM measurements of fibrinogen in COVID-19 patients with thrombotic complications compared with those without Further work is required to externally validate these findings and to investigate the mechanistic drivers for these relationships to identify best diagnostic and treatment approaches for these patients LEVEL OF EVIDENCE: Epidemiologic, level IV