BACKGROUNDHow well mouse models recapitulate the transcriptional profiles seen in humans remains debatable, with both conservation and diversity identified in various settings. The K18-hACE2 mouse model has been widely used for evaluation of new interventions for COVID-19. METHODHerein we use RNA-Seq data and bioinformatics approaches to compare the transcriptional responses in the SARS-CoV-2 infected lungs of K18-hACE2 mice with those seen in humans. RESULTSOverlap in differentially expressed genes was generally poor ({approx}20-30%), even when multiple studies were combined. The overlap was not substantially improved when a second mouse model was examined wherein hACE was expressed from the mouse ACE2 promoter. In contrast, analyses of immune signatures and inflammatory pathways illustrated highly significant concordances between the species. CONCLUSIONAs immunity and immunopathology are the focus of most studies, these hACE2 transgenic mouse models can thus be viewed as representative and relevant models of COVID-19.

In critically ill patients, normal eye protection mechanisms, such as tear production, blinking, and keeping the eye closed, are impaired. In addition, many other factors related to patients severe condition and treatment contribute to ocular surface disease. Reducing risk factors and proper eye care can have a significant impact on incidences of eye complications and patient quality of life after discharge from the intensive care unit (ICU). The aim of the study was to determine risk factors for ocular complication, especially those related to nursing care. The study was conducted in the ICU of a university hospital. Methods for estimating and analyzing medical records were used. The patients evaluation sheet covering 12 categories of risk factors for eye complications was worked out. The study group included 76 patients (34 patients with injuries and 42 without injuries). The ShapiroCWilk test, the Spearmans rank correlation test, the MannCWhitney U test and the Friedmans ANOVA test were used. The level of significance was set at = 0.05. The most important risk factors for eye complications in the study group were: lagophthalmos (p < 0.001), sedation (p < 0.01), use of some cardiological drugs and antibiotics (p < 0.01), mechanical ventilation (p < 0.05), use of an open suctioning system (p < 0.01), presence of injuries (p < 0.01) including craniofacial trauma (p < 0.001), high level of care intensity (p < 0.01), failure to follow eye care protocol (p < 0.001), length of hospitalization at the ICU (p < 0.001), and the frequency of ophthalmological consultations (p < 0.001). There was no correlation between the incidence of these complications and the age and gender of the patients. The exposure of critically ill patients to eye complications was high. It is necessary to disseminate protocols and guidelines for eye care in ICU patients to reduce the risk factors.

Objectives: To compare the chest computed tomography (CT) findings between survivors and non-survivors with Coronavirus Disease 2019 (COVID-19). Materials: and Methods Between 12 January 2020 to 20 February 2020, the records of 124 consecutive patients diagnosed with COVID-19 were retrospectively reviewed and divided into survivor (83/124) and non-survivor (41/124) groups. Chest CT findings were qualitatively compared on admission and serial chest CT scans were semi-quantitively evaluated between two groups using curve estimations. Results: Elder age (median: 69 vs. 43y, p<0.001), higher male ratio (31/41 vs. 32/83, p<0.001), and more comorbidities were observed in non-survivor group. On admission, significantly more bilateral (97.6% vs. 73.5%, p=0.005) and diffuse lesions (39.0% vs. 8.4%, p<0.001) with higher total CT score (median: 10 vs. 4) were observed in non-survivor group compared with survivor group. Besides, crazy-paving pattern was more predominant in non- survivor group than survivor group (39.0% vs. 12.0%, p=0.004). From the prediction of curve estimation, in survivor group total CT score increased in the first 20 days reaching the peak of 6 points and then gradual decreased for more than other 40 days (R2=0.545, p<0.001). In non- survivor group, total CT score rapidly increased over 10 points in the first 10 days and gradually increased afterwards until ARDS occurred with following death events (R2=0.711, p<0.001). Conclusions: Persistent progression with predominant crazy-paving pattern was the major manifestation of COVID-19 in non-survivors. Understanding this CT feature could help the clinical physician to predict the prognosis of the patients.

We investigated daily COVID-19 cases and deaths in the 337 lower tier local authority regions in England and Wales to better understand how the disease propagated over a 15-month period. Population density scaling models revealed residual variance and skewness to be sensitive indicators of the dynamics of propagation. Lockdowns and schools reopening coincided with increased variance indicative of conditions with local impact and country scale heterogeneity. University reopening and December holidays reduced variance indicative of country scale homogenisation which reached a minimum in mid-January 2021. Homogeneous propagation was associated with better correspondence with normally distributed residuals while heterogeneous propagation was more consistent with skewed models. Skewness varied from strongly negative to strongly positive revealing an unappreciated feature of community propagation. Hot spots and super-spreading events are well understood descriptors of regional disease dynamics that would be expected to be associated with positively skewed distributions. Positively skewed behaviour was observed; however, negative skewness indicative of cold-spots and super-isolation dominated for approximately 8 months during the period of study. In contrast, death metrics showed near constant behaviour in scaling, variance, and skewness metrics over the full period with rural regions preferentially affected, an observation consistent with regional age demographics in England and Wales. Regional positions relative to density scaling laws were remarkably persistent after the first 5C9 days of the available data set. The determinants of this persistent behaviour probably precede the pandemic and remain unchanged.

The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the pathogen responsible for Coronavirus Disease 2019 (COVID-19) Whilst most children and young people develop mild symptoms, recent reports suggest a novel paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) Case definition and classification are preliminary, treatment is empiric and disease-associated outcomes are unclear Here, we report 29 patients with PIMS-TS who were diagnosed, admitted and treated in the English North West between March and June 2020 Consistent with patterns observed internationally, cases peaked approximately 4 weeks after the initial surge of COVID-19-like symptoms in the UK population Clinical symptoms included fever (100%), skin rashes (72%), cardiovascular involvement (86%), conjunctivitis (62%) and respiratory involvement (21%) Some patients had clinical features partially resembling Kawasaki disease (KD), toxic shock syndrome and cytokine storm syndrome Male gender (69%), black, Asian and other minority ethnicities (BAME, 59%) were over-represented Immune modulating treatment was used in all, including intravenous immunoglobulin (IVIG), corticosteroids and cytokine blockers Notably, 32% of patients treated with IVIG alone went into remission The rest required additional treatment, usually corticosteroids, with the exception of two patients who were treated with TNF inhibition and IL-1 blockade, respectively Another patient received IL-1 inhibition as primary therapy, with associated rapid and sustained remission Randomized and prospective studies are needed to investigate efficacy and safety of treatment, especially as resources of IVIG may be depleted secondary to high demand during future waves of COVID-19

BACKGROUND: There is an increased attention to stroke following SARS-CoV-2. The goal of this study was to better depict the short-term risk of stroke and its associated factors among SARS-CoV-2 hospitalized patients. METHODS: This multicentre, multinational observational study includes hospitalized SARS-CoV-2 patients from North and South America (United States, Canada, and Brazil), Europe (Greece, Italy, Finland, and Turkey), Asia (Lebanon, Iran, and India), and Oceania (New Zealand). The outcome was the risk of subsequent stroke. Centres were included by non-probability sampling. The counts and clinical characteristics including laboratory findings and imaging of the patients with and without a subsequent stroke were recorded according to a predefined protocol. Quality, risk of bias, and heterogeneity assessments were conducted according to ROBINS-E and Cochrane Q-test. The risk of subsequent stroke was estimated through meta-analyses with random effect models. Bivariate logistic regression was used to determine the parameters with predictive outcome value. The study was reported according to the STROBE, MOOSE, and EQUATOR guidelines. FINDINGS: We received data from 26,175 hospitalized SARS-CoV-2 patients from 99 tertiary centres in 65 regions of 11 countries until May 1st, 2020. A total of 17,799 patients were included in meta-analyses. Among them, 156(0.9%) patients had a stroke-123(79%) ischaemic stroke, 27(17%) intracerebral/subarachnoid hemorrhage, and 6(4%) cerebral sinus thrombosis. Subsequent stroke risks calculated with meta-analyses, under low to moderate heterogeneity, were 0.5% among all centres in all countries, and 0.7% among countries with higher health expenditures. The need for mechanical ventilation (OR: 1.9, 95% CI:1.1-3.5, p = 0.03) and the presence of ischaemic heart disease (OR: 2.5, 95% CI:1.4-4.7, p = 0.006) were predictive of stroke. INTERPRETATION: The results of this multi-national study on hospitalized patients with SARS-CoV-2 infection indicated an overall stroke risk of 0.5%(pooled risk: 0.9%). The need for mechanical ventilation and the history of ischaemic heart disease are the independent predictors of stroke among SARS-CoV-2 patients. FUNDING: None.

BACKGROUND: Patients with Type 2 Diabetes (T2DM) and patients on maintenance hemodialysis (MHD) are at a high risk of adverse clinical course of COVID-19 To date, the causes of high mortality in these groups are not fully understood Data about peculiarity of clinical course and Tocilizumab (TCZ) administration in patients with T2DM receiving MHD due to outcome of diabetic kidney disease (DKD) are not yet highlighted in current publications AIMS: Identification of risk factors (RF) of adverse COVID-19 outcome and evaluation of TCZ administration in patients with T2DM receiving MHD due to DKD MATERIALS AND METHODS: The patients treated in Moscow City Hospital 52 were included in retrospective observational study The observation period was from 04 15 to 07 30 2020 The study endpoints were the outcomes of hospitalization - discharge or lethal outcome Data were collected from electronic medical database The following independent variables were analysed: gender, age, body mass index, time from the onset of symptoms to hospital admission, cardiovascular and general comorbidity (Charlson Index, CCI), cardiovascular event (CVE) during hospitalization, treatment in ICU, mechanical ventilation (MV), degree of lung damage according to CT data, level of prandial glycemia at admission, MHD-associated parameters (vintage, type of vascular access, frequency of complications) The autopsy reports were evaluated for the purpose of lethal structure investigation In a subgroup treated TCZ the time from symptoms onset to TCZ administration and number of laboratory indicators were evaluated RESULTS: 53 patients were included, mean age 68 9 y, males - 49% General mortality in observation cohort was 45%, mortality in ICU - 81%, mortality on MV - 95% High cardiovascular and general comorbidity was revealed (mean CCI - 8,3 1,5 points) The causes of outcomes according to autopsy reports data: CVE 37,5% (among them - acute myocardial infarction during hospitalization), severe respiratory failure - 62,5% The independent predictors of lethal outcome were: MV (OR 106;95% CI 11,5-984; &lt;0,001), 3-4 degree of lung damage according to CT data (R 6,2;95% CI 1,803-21,449; = 0,005), CVE during hospitalization (R 18,9;95% CI 3,631-98,383; &lt;0,001);CCI 10 points (R 4,33;95% CI 1,001-18,767; = 0,043), level of prandial glycemia at admission 10 mmol/l (R 10,4;95% CI 2,726-39,802; &lt;0,001) For risk identification of upcoming lethal outcome a predictive model was created with the use of discovered RF as variables The predictive value of this model is 92,45% (positive prognostic value - 96,5%, negative prognostic value - 87,5%) In TCZ treated subgroup the laboratory markers of adverse outcome were detected with application of correlation analysis Among them: increasing level of CPR 24-48 hours before lethal outcome (r = 0,82), the reduction of lymphocytes count after TCZ administration (r = -0,49), increasing of leukocytes and further reduction of lymphocytes count 24-48 hours before lethal outcome (r = 0,55 r = -0,52, resp )) CONCLUSIONS: The number of RF of adverse COVID-19 outcome in patients with T2DM receiving MHD due to DKD are identified CVE is one of the leading causes of mortality in study cohort According to our experience the preventive (instead of rescue) strategy of TCZ administration should be used

European countries struggled to fight against the second and the third waves of the COVID-19 pandemic, as the Test-Trace-Isolate (TTI) strategy widely adopted over the summer and early fall 2020 failed to contain the spread of the disease effectively. This paper sheds light on the effectiveness of such a strategy in two European countries (Spain and Italy) by analysing data from June to December 2020, collected via a large-scale online citizen survey with 95,251 and 43,393 answers in Spain and Italy, respectively. Our analysis describes several weaknesses in each of the three pillars of the TTI strategy: Test, Trace, and Isolate. We find that 40% of respondents had to wait more than 48 hours to obtain coronavirus tests results, while literature has shown that a delay of more than one day might make tracing all cases inefficient. We also identify limitations in the manual contact tracing capabilities in both countries, as only 29% of respondents in close contact with a confirmed infected individual reported having been contact traced. Moreover, our analysis shows that more than 45% of respondents report being unable to self-isolate if needed. We also analyse the mitigation strategies deployed to contain the second wave of coronavirus. We find that these interventions were particularly effective in Italy, where close contacts were reduced by more than 20% in the general population. Finally, we analyse the participants perceptions about the coronavirus risk associated with different daily activities. We observe that they are often gender- and age-dependent, and not aligned with the actual risk identified by the literature. This finding emphasises the importance of deploying public-health communication campaigns to debunk misconceptions about SARS-CoV-2. Overall, our work illustrates the value of online citizen surveys to quickly and efficiently collect large-scale population data to support and evaluate policy decisions to combat the spread of infectious diseases, such as coronavirus.

Sociopolitical events impact population health; parents' perspective of such events crosses demographics, geography, and generations. We elicited changes in U.S. parents' hopes and worries for their children 1 year after the 2016 election via an online survey of school climate, discrimination against child, family health care and security, and macrolevel/future concerns (e.g., environment, postsecondary options). Among n = 1189 respondents, national security (39%), the environment (30.5%), and "continued place in America" (25.7%) were most worrisome. In general linear mixed models, employment buffered against social and material stressors such as discrimination (odds ratio [OR] = 0.67; 95% confidence interval [CI] = 0.49-0.92), and family health care/security (OR = 0.62; 95% CI = 0.45-0.86) while being of a dominant religion and ethnicity buffered future macrolevel (Christianity, OR = 70; 95% CI = 0.54-0.92/non-Hispanic, OR = 59; 95% CI = 0.39-0.90) and existential "continued place in America" (Christianity, OR = 69; 95% CI = 0.51-0.94/non-Hispanic, OR = 56; 95% CI = 0.36-0.88) worries. Qualitative comments underscored macrolevel worries. Parents represent a unique vantage for gauging how sociopolitical events impact health and well-being.

The COVID-19 pandemic is a devastating global health crisis. Until vaccines or effective medications are widely administered within nations, the best hope for mitigating virus transmission is by changing collective behavior and supporting non-pharmaceutical interventions. In a large-scale international collaboration (Study 1, N = 49,968 across 67 countries), we investigated why people reported adopting public health behaviors (e.g., spatial distancing and stricter hygiene) and endorsed public policy interventions (e.g., closing bars and restaurants) during the pandemic (April-May, 2020). Respondents who identified more strongly with their nation consistently reported greater engagement in public health behaviors and support for public health policies. Study 2 (N = 42 countries) conceptually replicates the central finding using aggregate indices of national identity (World Values Survey) and a measure of actual behavior change during the pandemic (Google mobility report). Higher levels of national identification were associated with lower mobility (r = -.40). We discuss the implications of links between national identity, leadership, and public health for managing COVID-19 and future pandemics.

Surface disinfectants are part of broader preventive strategies preventing the transmission of bacteria, fungi and viruses in medical institutions. To evaluate their virucidal efficacy, these products must be tested with appropriate model viruses with different physico-chemical properties under conditions representing practical application in hospitals. The aim of this study was to evaluate a quantitative carrier assay. Furthermore, different putative model viruses like adenovirus type 5 (AdV-5) and different animal parvoviruses were evaluated with respect to their tenacity and practicability in laboratory handling. To evaluate the robustness of the method, some of the viruses were tested in parallel in different laboratories in a multi-center study. Different biocides, which are common active ingredients of surface disinfectants, were used in the test. After drying on stainless steel discs as the carrier, model viruses were exposed to different concentrations of three alcohols, peracetic acid (PAA) or glutaraldehyde (GDA), with a fixed exposure time of 5 minutes. Residual virus was determined after treatment by endpoint titration. All parvoviruses exhibited a similar stability with respect to GDA, while AdV-5 was more susceptible. For PAA, the porcine parvovirus was more sensitive than the other parvoviruses, and again, AdV-5 presented a higher susceptibility than the parvoviruses. All parvoviruses were resistant to alcohols, while AdV-5 was only stable when treated with 2-propanol. The analysis of the results of the multi-center study showed a high reproducibility of this test system. In conclusion, two viruses with different physico-chemical properties can be recommended as appropriate model viruses for the evaluation of the virucidal efficacy of surface disinfectants: AdV-5, which has a high clinical impact, and murine parvovirus (MVM) with the highest practicability among the parvoviruses tested.

BACKGROUND: Posttraumatic stress disorder (PTSD) is the most prevalent type of psychiatric disorder among children after an earthquake. This study investigated the role of trauma experiences, personality traits, and genotype in the maintenance of PTSD symptoms. METHODS: In a previous large-scale epidemiological investigation 1 year after the Wenchuan earthquake, 215 children with PTSD symptoms were selected at random with their blood samples collected. All of them were followed up, and their PTSD symptoms were assessed 3 years later. The adolescent version of the UCLA PTSD Reaction Index, the earthquake exposure scale, and the Junior Eysenck Personality Questionnaire were used to determine PTSD symptoms, trauma experiences, and personality traits, respectively. We sequenced candidate genes involved in the regulation of long-term potentiation via NMDA-type receptors to identify the related SNP variations. RESULTS: Being trapped for a longer period of time, feeling one's own or a family member's life to be in danger, losing a close family member or friend, extraversion, neuroticism, TrkB, G72 and CNTF were found to be associated with the maintenance of PTSD symptoms. CONCLUSIONS: Experiences, personality traits, and genotype influenced the maintenance of PTSD in child survivors who were considered to be followed up without medicine. This result could help to identify potential targets for treatment and promote the rational allocation of medical resources.

Autophagy is a cellular process that sequesters cargo in double-membraned vesicles termed autophagosomes and delivers this cargo to lysosomes to be degraded. It is enhanced during nutrient starvation to increase the rate of amino acid turnover. Diverse roles for autophagy have been reported for viral infections, including the assembly of viral replication complexes on autophagic membranes and protection of host cells from cell death. Here, we show that autophagosomes accumulate in Semliki Forest virus (SFV)-infected cells. Despite this, disruption of autophagy had no effect on the viral replication rate or formation of viral replication complexes. Also, viral proteins rarely colocalized with autophagosome markers, suggesting that SFV did not utilize autophagic membranes for its replication. Further, we found that SFV infection, unlike nutrient starvation, did not inactivate the constitutive negative regulator of autophagosome formation, mammalian target of rapamycin, suggesting that SFV-dependent accumulation of autophagosomes was not a result of enhanced autophagosome formation. In starved cells, addition of NH(4)Cl, an inhibitor of lysosomal acidification, caused a dramatic accumulation of starvation-induced autophagosomes, while in SFV-infected cells, NH(4)Cl did not further increase levels of autophagosomes. These results suggest that accumulation of autophagosomes in SFV-infected cells is due to an inhibition of autophagosome degradation rather than enhanced rates of autophagosome formation. Finally, we show that the accumulation of autophagosomes in SFV-infected cells is dependent on the expression of the viral glycoprotein spike complex.

The coronavirus pandemic has shed light on the detrimental impact of neoliberal policies on public health and well-being and as a result, there have been calls for increases in public spending to rectify the lack of public health services. However, neoliberal right-wing parties have dismissed such calls, pointing instead to Asian countries as examples in successfully controlling the pandemic without high public health spending, attributing this to the entrepreneurial orientation of their governments, as opposed to their public services. This article refutes this idea, instead charting the reasons that Asian countries have better controlled the pandemic including prior experience of pandemics, cultural factors, and various successful public health policies. The article concludes by looking at the example of Trump and demonstrating the inadequacies of the business model for dealing with the coronavirus pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has led to economic contraction and significant restrictions on society. The shock to the economy could lead to a deterioration of physical health outcomes, including dental health. The present study investigated the association between worsened socioeconomic conditions due to the COVID-19 pandemic and dental pain in Japan. The mediating effects of psychological distress and oral healthCrelated behaviors were also evaluated. Cross-sectional data from the Japan COVID-19 and Society Internet Survey conducted from August to September 2020 (n = 25,482; age range, 15C79 y) were analyzed. Multivariable logistic regression models were fitted to evaluate the independent associations of household income reduction, work reduction, and job loss due to the COVID-19 pandemic with dental pain within a month. Dental pain was reported by 9.8%. Household income reduction, work reduction, and job loss were independently associated with dental pain after adjusting for confounders (odds ratios: 1.42 [95% confidence interval (CI), 1.28?1.57], 1.58 [95% CI, 1.41?1.76], 2.17 [95% CI, 1.64?2.88], respectively). The association related to household income reduction was mediated by psychological distress, postponing dental visits, toothbrushing behavior, and between-meals eating behavior by 21.3% (95% CI, 14.0?31.6), 12.4% (95% CI, 7.2?19.6), 1.5% (95% CI, ?0.01 to 4.5), and 9.3% (95% CI, 5.4?15.2), respectively. Our findings showed that worsened socioeconomic conditions due to the COVID-19 pandemic deteriorated dental health. Policies that protect income and job loss may reduce dental health problems after the pandemic.

The spread of the COVID-19 pandemic since the end of 2019 has forced an unprecedented lockdown worldwide, and environmental quality was significantly affected by the pandemic and its induced lockdown. The objective of this study is to examine the role of renewable energy, non-renewable energy and COVID-19 case on CO(2) emission in the context of United Kingdom. Several non-linear techniques such as Fourier ADL cointegration test, Non-Linear ARDL, Markov switching regression, and Breitung and Candelon (BC) causality test are employed to attain this objective. The result reveals that there is long run cointegration among the variables in this study. The results demonstrate that positive (negative) shift in renewable energy development decrease (increase) CO(2) emissions while positive (negative) shocks in fossil fuel energy increase CO(2) emissions. Moreover, negative (positive) variation in COVID case leads to a decrease (increase) in CO(2) emissions. Moreover, an uni-directional causal impact was found to run from all the variables C renewable energy, fossil fuel, and COVID-19 case to CO(2) emissions. Finally, several policy recommendations are provided.

Anti-immigrant, anti-Semitic, and anti-Muslim violent extremism is on the rise in Western nations while jihadist terrorism continues throughout the Middle East and Africa. Despite significant efforts by governmental, non-governmental, and civic society organizations to address violent extremism, little progress has been made to prevent it. White supremacist organizations are now organizing globally through a variety of next generation communication networks using techniques developed by ISIS and Al-Qaeda. Throughout, relatively few social work academics have engaged in preventing violent extremism (PVE) scholarship. Though the profession is referenced frequently in the PVE literature, it is dominated by those in psychology and political science. Few articles in major social work journals have discussed social works role or advanced PVE research. What has been published has mainly been critical of social work in this arena for legitimate fears of securitization, lack of resources/training, and the potential to discriminate against particular groups. The profession has a long history of impactful work in violence prevention in a myriad of practice areas. Given this wealth of experience and focus on social justice, social work should be a leader in this field. Areas of potential engagement in practice and research are discussed.

Primary infection with bovine respiratory syncytial virus (BRSV) predisposes cattle to secondary infection with bacteria that cause bovine respiratory disease complex (BRDC). However, the interaction between BRSV and bacteria is unclear. This in vitro study examined the adherence of Pasteurella multocida (PM) to BRSV-infected cells was assessed in colony forming unit assays, by flow cytometry analysis, and by indirect immunofluorescence analysis (IFA) of epithelial cells (A549, HEp-2, and MDBK). An in vitro model based on infection of BRSV-infected epithelial cells revealed that PM adherence to BRSV-infected cells was 2- to 8-fold higher than uninfected cells. This was confirmed by flow cytometry analysis and IFA. Epithelial cell expression of mRNA encoding cytokines and chemokines increased after exposure to PM, but increased further after co-infection with BRSV and PM. BRSV-mediated adherence of PM to epithelial cells may underlie the serious symptoms of BRDC.

BACKGROUND Corona virus disease 2019 (COVID-19) is a multi-systemic illness that can present with cardiac complications. This report describes the preliminary findings of cardiac manifestations seen in patients managed in three centres in Lagos, Nigeria. METHODS Ten patients, part of an ongoing study of patients admitted in three centres in Lagos, Nigeria, with COVID-19 diagnosed with reverse transcriptase polymerase chain reaction (RT-PCR) or serology were retrospectively studied for cardiac manifestations. RESULTS The mean (SD) age was 52.5 18.79 years (with a minimum of 17 years and maximum of 79 years). Six patients were female and four were male. Hypertension was seen in 70%, diabetes in 50% and obesity in 60% of patients. All had elevated inflammatory markers. Only four patients had bilateral pneumonia. The rest had only cardiac manifestations. Six patients presented with de novo heart failure and one had decompensated heart failure. A set of three patients had individually fulminant myocarditis, probable pulmonary embolism and stress cardiomyopathy, respectively. CONCLUSIONS This study shows that co-morbidities are common in patients with COVID-19 and cardiac complications. The array of cardiac complications is large, with the commonest being heart failure.

OBJECTIVES: To understand what we can learn from the impact of the COVID-19 pandemic and lockdown about what enables work participation for people with inflammatory arthritis and chronic pain conditions. DESIGN: Qualitative interviews embedded within an observational questionnaire study of individuals with musculoskeletal (MSK) conditions. SETTING: UK primary care (general practices), and secondary care-based rheumatology services. PARTICIPANTS: Individuals with axial spondyloarthritis, psoriatic arthritis and MSK pain from three established cohorts completed an online/paper-based questionnaire (JulyCDecember 2020). A subset of respondents were selected for semistructured interviews. PRIMARY AND SECONDARY OUTCOME MEASURES: The survey quantified the effects of lockdown on work circumstances. Qualitative interviews explored the impacts of these changes and the advantages and disadvantages of changes in work circumstances. RESULTS: 491 people (52% female, median age 49 years) who were employed at the time of lockdown responded to the questionnaire. The qualitative analysis included 157 free-text comments on work from the questionnaire and data collected within 18 interviews. Participants reported impacts on mental and physical health, and significant financial anxieties. The impact of work changes varied depending on individual and home circumstances. Some felt forced to ignore advice to shield and continue working. The flexibility offered by home working and changes in commuting enabled greater physical activity for some, while others missed the exercise normally undertaken as part of their commute. Others reported a constant need to be present online, which heightened anxiety and worsened MSK symptoms. CONCLUSION: Lockdown showed that flexible working arrangements, which consider the positive and negative aspects of commuting, posture, movement, and work environment matter for work participation, and can have wider benefits in terms of health and well-being for those with long-term MSK conditions. Incorporating these into new models of work will help make the workplace more equitable and inclusive for people with long-term MSK conditions.