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Saadiq M Moledina,* Alexander A Maini,* Alice Gargan, William Harland, Heloise Jenney, Georgina Phillips, Kate Thomas, Devkishan Chauhan, Michael Fertleman From the Cutrale Perioperative & Ageing Group, St Mary’s Hospital, Imperial College London, London, UK*These authors contributed equally to this workCorrespondence: Saadiq M MoledinaSt Mary’s Hospital, Imperial College London, Praed Street, Paddington, London W2 1NY, UKTel +44 02033126666Email smoledina1@doctors.org.ukBackground/Introduction: The coronavirus disease 2019 (COVID-19) pandemic has affected all aspects of inpatient hospital medicine with patients admitted from level 1 (general medical wards) to level 3 (intensive care). Often, there are subtle physiological differences in these cohorts of patients. In particular, in intensive care, patients tend to be younger and have increased disease severity. Data, to date, has combined outcomes from medical and intensive care cohorts, or looked exclusively at intensive care. We looked solely at the level 1 (medical) cohort to identify their clinical characteristics and predictors of outcome.Patients and Methods: This was a retrospective study of adult patients admitted to a central London teaching hospital with a diagnosis of COVID-19 from 23rd March to 7th April 2020 identified from the hospital electronic database. Any patients who required level 2 or 3 care were excluded.Results: A total of 229 patients were included for analysis. Increased age and frailty scores were associated with increased 30-day mortality. Reduced renal function and elevated troponin blood levels are also associated with poor outcome. Baseline observations showed that increased oxygen requirement was predictive for mortality. A trend of increased mortality with lower diastolic blood pressure was noted. Lymphopenia was not shown to be related to mortality.Conclusion: Urea and creatinine are the best predictors of mortality in the level 1 cohort. Unlike previous intensive care data, lymphopenia is not predictive of mortality. We suggest that these factors be considered when prognosticating and for resource allocation for the treatment and escalation of care for patients with COVID-19 infection.Keywords: COVID-19, mortality, frailty, ICU, renal dysfunction, lymphopenia

The COVID-19 pandemic has dramaticallyimpacted healthcare provision in the UK and burns services have had to adapt to ensure the continuityof a safe care. As we return to " normalit y" we reflect on lessons learnt from our response to this pandemic. A service evaluation was performed from patient notes between March 23rd and May8th 2020 and an anonymoussurveygiven to patients attending outpatient appointments. 258 patients were referred to our burns service and 148 patients completed the survey. Eleven burns were caused bytreatment or prevention of COVID-19. Patients delayed seeking medical attention due to concern of catching COVID-19 (36% adults, 8% children). There was a delayin referral of 17 patients despite them fulfilling the referral criteria. Infection rates were higher following delayed presentation (21% vs 6%). The majorityof burns were managed conservatively (237/258). Dressing changes were performed at home by32% of patients. The outreach team treated 22 patients. During the pandemic telemedicine has improved the efficiencyof outpatient burn care and outreach nurses have enabled treatment of vulnerable patients. More must be done to raise public awareness of preventable causes of burn injuryand to reassure them to seek help when burns occur.

Introduction COVID-19 has affected national guidelines and availability of resources, resulting in different approaches to treating burns. This project aimed to identify changes to burns management in the UK during the “first wave” of COVID-19, and how the lessons learned can be applied to the current “second wave”. Methods Between 11th July-15th September, 18 burns services across the UK completed a MDT survey and contributed data on service evaluation. The MDT survey captured perspectives of multiple stakeholders and included changes to burns services, disruptions to supply chain, and service improvements resulting from COVID-19. Service evaluation data was collected retrospectively and prospectively on patients who received inpatient/outpatient treatment during COVID-19. Patients in the retrospective cohort were first seen by burns services between 6th-30th April (coinciding with the UK’s COVID-19 peak), and the prospective cohort were first seen between 30th April-15th September. Each cohort consisted of 10-20 patients per burns service. Service evaluation covered key areas of burns aetiology, referral pathway changes, patient presentation delays to tertiary services, patient management decisions, and outpatient dressing clinic management. Data from the MDT survey and the service evaluation were analysed by descriptive statistics and thematic analysis. Results The changes to burns services include delays in burn referrals, increase in conservative management, and increased use of telemedicine. Conclusion Across the UK, safe and effective burns care continued to be delivered despite difficulties from the pandemic. We hope the learning points identified in this study will be of use during the “second wave” of the pandemic.

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