BACKGROUND:Periprosthetic joint infection (PJI) following arthroplasty performed for trauma (e.g., hip fracture) may differ from PJI after elective arthroplasty in terms of timing, microbiology, and outcomes, but comparative data remain limited. METHODS:We conducted a 20-year single-center retrospective cohort study (2003 to 2023) at a tertiary referral hospital, of which 41 (20%) followed trauma-related arthroplasty and 162 (80%) followed elective procedures. Adults diagnosed with PJI were identified using Hospital In-Patient Enquiry coding (ICD-10 T84.5) and an infectious diseases outpatient parenteral antimicrobial therapy database, with chart confirmation. The primary outcome was treatment success ("cure") at 12 months, defined as cessation of antimicrobial therapy, functional restoration of the prosthetic joint, and no evidence of recurrent infection. The main exposure was arthroplasty indication (trauma versus elective). Analyses included descriptive statistics, Kaplan-Meier analysis for time from arthroplasty to infection, and multivariable logistic regressions for cure. RESULTS:Trauma cases had a lower body mass index (median 26 versus 29, P = 0.004) and occurred earlier, with a median time from arthroplasty to infection of 12 weeks compared with 56 weeks in elective cases (log-rank Chi-square 27.5, P = 0.001). Microbiology differed: gram-negative organisms (26.8 versus 8.6%, P = 0.0042), Enterococcus species (19.5 versus 0.6%, P = 0.045), and Candida species (9.8 versus 1.2%, P = 0.004) were more frequent after trauma, whereas Streptococci were identified only in elective cases (17.3 versus 0%, P = 0.004). The six-month mortality was higher after trauma (17 versus 5%, P = 0.014). The cure at 12 months did not differ significantly (51 versus 60%, P = 0.281). In adjusted analyses, increasing age reduced odds of cure, whereas two-stage revision increased odds; trauma-related arthroplasty was not an independent predictor. CONCLUSIONS:Trauma-related PJI represents a distinct phenotype with earlier onset, different pathogen spectrum, and higher early mortality, supporting tailored perioperative management in trauma arthroplasty.

Mycobacterium abscessus (M. abscessus) is a rapidly growing nontuberculous mycobacterium (NTM). We present the case of a 57-year-old female on immunosuppressive therapy for polymyalgia rheumatica (PMR) who developed disseminated M. abscessus infection with vertebral osteomyelitis following bariatric surgery abroad. Her case highlights core treatment principles of disseminated NTM infections.

Viral haemorrhagic fevers (VHF) are high consequence infectious diseases (HCID) with the potential for outbreaks and considerable mortality. Accessible, up-to-date national guidelines are essential to ensure adequate preparedness. This includes prompt confirmation/exclusion of a VHF diagnosis through sample procurement and processing. Here, we assess and recommend improvements for the VHF testing algorithm in Ireland, for the purpose of ensuring alignment with international best practice. Irish VHF laboratory guidelines were reviewed. Each step of the process was compared to relevant international guidance. Gaps in current practice were identified, root causes identified, and recommendations for improvements proposed. Eight process categories were identified during process mapping. Compared with international best practice, gaps were identified in Irish guidelines for each category. Notable examples include the lack of scheduled access to out of hours testing and uncertainty around testing procedures for non-virological tests (haematology, biochemistry, and microbiology). Although Irish guidelines largely align with international recommendations, important gaps were identified. These gaps risk a delayed diagnosis (of either VHF or alternative causes), sub-standard clinical care due to delayed baseline laboratory investigations, delayed patient transfer to the National Isolation Unit (NIU), and excessive resources maintaining patient isolation subsequently proven to be unnecessary. Refining the VHF diagnostic process would improve patient management and ensure a more efficient use of resources. Internationally, test repertoires for VHF and alternative diagnoses are mostly devised by dedicated specialist services with appropriate laboratory biosafety measures, and we recommend that Ireland moves towards this model.

Patients with acute swollen joints are often presumed to have septic arthritis, leading to intravenous antibiotics and arthroscopic washout. Previously at our centre, joint fluid aspirates often lacked crystal analysis, resulting in excess culture-negative septic arthritis diagnoses. We developed a ‘Hot Joint Pathway’, hypothesising that since acute crystal arthropathy can be misdiagnosed as ‘culture-negative septic arthritis’, introducing the pathway would improve diagnostic accuracy.This pathway provides a structured approach for investigating acutely swollen joints, distinguishing septic arthritis from crystal arthritis. Key features include a secure messaging app for multidisciplinary discussion and rheumatology-led point-of-care polarised light microscopy (POC PLM) <24 hours 6 days per week. A service evaluation of hospital inpatient data identified patients labelled with septic arthritis admitted between two periods: before (1 January 2019–30 November 2020) and after (27 September 2022–29 February 2024) pathway implementation. Emergency department (ED) patients discussed via the app were also analysed (27 September 2022–25 September 2023).Among ED patients, 92% received rheumatology input, and 100% underwent joint aspiration with rheumatologist-led crystal analysis in <24 hours. 68% avoided hospital admission, receiving same-day discharge. Of these, 53% were diagnosed with crystal arthropathy and were discharged with planned outpatient follow-up.Diagnostic accuracy increased for inpatients following pathway introduction. Joint aspirates increased from 50% to 76% (p=0.034). Culture-negative cases of septic arthritis reduced from 34% to 17% and culture positive cases increased from 41% to 76% (p<0.005). Crystal analysis increased from 19% to 28%. Positive blood cultures increased from 28% to 41%. Mean length of stay decreased from 26 to 23 days.A structured care pathway combining rheumatology-led POC PLM and multidisciplinary discussion increases diagnostic accuracy, facilitates admission avoidance and reduces hospital stay for patients with acute swollen joints. Rheumatology-led PLM is essential for the success of this pathway.

PURPOSE:To compare the performance of multiple international guidelines in selecting patients for head CT prior to lumbar puncture (LP) in suspected meningitis, focusing on identification of potential contraindications to immediate LP.METHODS:Retrospective study of 196 patients with suspected meningitis presenting to an emergency department between March 2013 and March 2023 and undergoing head CT prior to LP. UK Joint Specialist Society Guidelines (UK), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Infectious Diseases Society of America (IDSA) guidelines were evaluated by cross-referencing imaging criteria with clinical characteristics present at time of presentation. Sensitivity of each guideline for recommending neuroimaging in cases with brain shift on CT was evaluated, along with the number of normal studies and incidental or spurious findings.RESULTS:2/196 (1%) patients had abnormal CTs with evidence of brain shift, while 14/196 (7%) had other abnormalities on CT without brain shift. UK, ESCMID and IDSA guidelines recommended imaging in 10%, 14% and 33% of cases respectively. All three guidelines recommended imaging pre-LP in 2/2 (100%) cases with brain shift. IDSA guidelines recommended more CT studies with normal findings (59 vs 16 and 24 for UK and ESCMID guidelines respectively) and CT abnormalities without brain shift (4 vs 1 and 2 respectively) than the other guidelines.CONCLUSION:UK, ESCMID and IDSA guidelines are all effective at identifying the small cohort of patients who benefit from a head CT prior to LP. Following the more selective UK/ESCMID guidelines limits the number of normal studies and incidental or spurious CT findings.

This paper presents a comparative analysis of Outpatient Parenteral Antimicrobial Therapy (OPAT) structures and delivery options across different countries. OPAT, a cost-effective alternative to inpatient care for patients requiring IV antimicrobial therapy, has demonstrated multiple benefits such as patient satisfaction, economic cost savings, and reduced hospital-acquired infections. Despite these advantages, there is considerable international variation in OPAT use and implementation. By examining the OPAT structures of multiple countries, we aim to identify areas of variation and explore opportunities for expansion and improvement of OPAT services.

Objectives:Periprosthetic joint infection (PJI) is a complication of joint arthroplasty and is seen in 1-2% of cases. Since its initiation in 2013, the national outpatient parenteral antimicrobial therapy (OPAT) program has facilitated the outpatient management of intravenous antimicrobials for PJI. This study aims to describe the clinical epidemiology of patients on OPAT with PJI between 2013 and 2021. Methods:A retrospective analysis of patients discharged on OPAT between January 1, 2013 to August 31, 2021 was performed using data available from the national OPAT program. This study focused on those with a PJI. Data were analyzed using STATA/SE version 17.0. Results:From January 1, 2013 until August 31, 2021, there were 14,749 patients managed through the national OPAT program, 8.35% (1232 of 14,749) of which were PJI. Of these, 53% (653 of 1232) were hip arthroplasty, 22.7% (280 of 1232) were knee arthroplasty, and 24.3% (299 of 1232) were "other." The mean age was 64.5 years (SD 14.15 years). Of those on OPAT, 66.15% (815 of 1232) were health care-administered OPAT, whereas 33.85% (417 of 1232) were self-administered (S) OPAT (S-OPAT). Patients on S-OPAT were statistically younger (61 vs 66 years old, P <0.001, 95% confidence interval 14.1-63.6). The most common antimicrobial prescribed was daptomycin (35.8%; 441 of 1232), followed by ceftriaxone (21.2%; 262 of 1232). The median duration on the OPAT program was 27 days (interquartile range 14.5-35 days). Conclusion:OPAT use in PJI is growing. Cumulatively, it has saved 26,992 hospital bed-days. Although S-OPAT is the preferred strategy and should be considered for all patients, our data demonstrate that health care-administered OPAT is required more frequently in older patients.

Abstract Background During the advent of the COVID-19 pandemic, multiple cases were reported of the association between SARS-CoV-2 and invasive pulmonary aspergillosis. The diagnosis of Covid associated pulmonary aspergillosis (CAPA) remains difficult, especially in critically unwell patients. We describe those treated with VV ECMO and diagnosed with CAPA in the national centre for ECMO in Ireland during the COVID-19 pandemic, as well as their treatment course and outcomes. Methods We retrospectively collected data on all patients who received ECMO during the COVID-19 pandemic in Ireland’s national ECMO centre between May 2020 and January 2022. Data was collected from electronic health care records and cross referenced with positive microbiological samples. The 2020 ECMM/ ISCHAM consensus criteria was used to classify CAPA diagnoses. Results 37 patients with diagnosed SARS-CoV-2 infection were treated using ECMO. The average age was 46 years (SD 9.3). 15 (41%) of those were female. The mean number of days spent in an intensive care unit (ICU) was 50 (IQR 45-67). 14 (38%) had diagnosed Hypertension, 10 (27%) had Diabetes Mellitus and 1 (2.7%) had known Chronic Kidney Disease requiring dialysis. CAPA was diagnosed in 7 (19%) cases. Using the criteria, no cases were proven as histology samples were not obtained. 1 (14%) case fitted the criteria for possible diagnosis while 6 (86%) cases fitted criteria for probable diagnosis based on biochemical, microbiological and radiological findings. Of these, all received steroids prior to diagnosis, while 3 (43%) also received tociluzumab. 6 (86%) patients received dual antifungal agents and 1 (14%) patient received voriconazole alone. In terms of outcome, 15 (41%) were discharged to another intensive care unit, 1 (3%) discharged to another acute hospital and 2 (5%) to a rehabilitation unit. 16 (43%) patients died while 3 (8%) were discharged home. Of the 7 patients diagnosed with CAPA, 5 (71%) patients died in ICU while 2 (29%) were transferred to other units with final outcome unknown. Conclusion Although 2020 guidelines available from ECMM/ISCHAM are used to define strict diagnostic criteria of CAPA, our study demonstrates the need for further research into how other factors may contribute to this diagnosis, including pre-determined risk factors or the use of ECMO. Disclosures All Authors: No reported disclosures

Abstract Background The Irish Outpatient Parenteral Antimicrobial Therapy (OPAT) programme, a national centrally administered outpatient antibiotic provision service was established in 2013 within the public hospital system and is operated by the Health Service Executive (HSE). Ireland is relatively unique in having a nationally coordinated OPAT programme with complete summary data since its establishment. Here we describe the programme usage over ten years and show the data can be used to identify important trends in national antimicrobial usage, including stewardship issues, with relevant lessons for other OPAT centres. Methods Using data extracted from the national electronic portal we describe summary statistics from January 2013 to December 2022 (10 years). Results Over the ten-year period 17,559 OPAT episodes were facilitated across 42 healthcare institutions. These episodes represented 14,955 unique care episodes with the remainder being extensions or changes to active episodes. 12388 episodes were home OPAT delivered by a healthcare worker versus 5170 self OPAT where patients were taught to self-administer the antimicrobials. The median OPAT duration of therapy was 14 days with an average of 19.9 days. The median age of a referred patient was 59 years with an average age of 56 years. The top five diagnoses of osteomyelitis, abscesses, cellulitis, bacteraemia, and pyelonephritis accounted for 53% of all referrals. 81.5% of patients were prescribed a single antimicrobial, 17.9% two agents and 0.6% three. Four antibiotics – ceftriaxone, daptomycin, cefazolin and flucloxacillin continuous infusion account of 59% of the 44 different antimicrobials prescribed via the programme. Five of the 42 healthcare institutions accounted for 57.25% of all OPAT prescriptions. The number of beds in a hospital was not the strongest predictor of OPAT usage. The total number of bed days saved in the 10-year period was 292,860. Conclusion Within a health system operating on 11,171 beds available per day, for a population of just over 5 million people, with an average daily running cost of €878 per acute bed, the National OPAT programme has already contributed to significant bed day and consequent financial savings. Starting an infectious diseases clinical service significantly increases OPAT utilisation rates. ID Specialist appointed to centre for first time in 2021 Disclosures All Authors: No reported disclosures

BackgroundThe long-term effects of SARS-CoV-2 infection and optimal follow-up approach are not well-recognised. Here we describe the implementation of a post-COVID clinic in an Irish tertiary centre after the first wave of the pandemic. This study describes the characteristics of our patient cohort and the operations and outcomes of the clinic, exploring some of the risk factors for developing post-COVID syndrome and the appropriateness of the triage system employed. MethodsAll SARS-CoV-2 positive patients from March 10(th) to June 14(th) 2020 were telephone-triaged as red, amber or green based on ongoing symptoms with clinic appointments scheduled accordingly. All clinic visits were face-to-face with the infectious diseases medical team and a proforma for each patient was completed. Data were collected retrospectively by reviewing the proformas and the electronic medical record (EMR). Results311 patients attended the clinic. Median time from illness to clinic appointment was 95 days (IQR 77-105.5). 204 patients (66%) were female, 192 (62%) were hospital staff, and the median age was 43 years (IQR 31-53). 138 patients (44%) had required hospital admission. At their first clinic visit 219 patients (70%) had ongoing symptoms. A further appointment was made for 62 patients (20%). 34 patients (11%) were discussed at an MDT meeting, and 55 (18%) were referred onward to a specialist service. 85% of those triaged green, 73% of those triaged amber, and 39% of those triaged red did not receive further follow up after one clinic visit. Patients were more likely to require follow up with reported dyspnoea (OR 5.6; 95% CI 2.8-11.3; p <0.001), cough (OR 3.0; 95% CI 1.1-8.4, p = 0.04), and palpitations (OR 3.6; 95% CI 1.0-12.3; p = 0.04). Female sex was associated with increased odds of a higher triage category (OR 1.8; 95% CI 1.08 to 3.20; p = 0.02), as was requiring admission to hospital (OR 4.0; 95% CI 2.34 to 6.90; p < 0.001). ConclusionThe long-term effects of COVID-19 are significant with 70% of our cohort experiencing persistent symptoms. Persistent dyspnoea, cough and palpitations were associated with increased need for follow up. This study also suggests that a traffic light telephone-triage service followed by a face-to-face medical-led clinic could be an effective way of identifying patients who require further management.

Introduction Acquired methaemoglobinaemia is a rare, potentially fatal condition which is associated with exposure to a number of oxidising drugs or toxins. We present a case of acquired methaemoglobinaemia secondary to short course dapsone. Case Description A 36-year-old female, ex-intravenous drug user, presented to hospital reporting one-day history of bilateral lower limb pain. Her background history included HIV (off treatment). Her only regular medication was co-trimoxazole 960mg OD for pneumocystis jirovecii pneumonia prophylaxis. Four days prior to presentation she had run out of co-trimoxazole, and had taken a friends supply of dapsone 100mg OD. Examination was remarkable for central and peripheral cyanosis. Blood pressure was 95/52mmHg, SpO2 of 72%, respiratory rate of 24/min and a heart rate of 123 beats/min. Due to desaturation to 72%, the patient was commenced on non-invasive ventilation (NIV), 40 Litres, 100% FiO2. Arterial blood gas analysis revealed a pH of 7.51, pO2-49.7 kPa, pCO2-3.58 kPa. The obvious mis-match of low SpO2 oximetry and elevated pO2 on ABG excluded a true hypoxaemia, indicating a possible haemoglobinopathy. The FMetHb was elevated at 21.4%. Serial ABG analyses showed rising methaemoglobin (FMetHb of 25.1%), with characteristic reddish/brown colour of arterial blood. A methylene blue 1mg/kg infusion was administered, with rapid improvement in cyanosis and FMetHb of 10.6% one-hour post treatment. Discussion The vast majority of case reports to date of dapsone-induced methaemoglobinaemia are described following an overdose or those taking chronic therapeutic dose. The present patient highlights a rare case of moderate-severe presentation of methaemoglobinaemia after just four days of therapeutic dapsone.

© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Since cases were first described in December 2019, SARSCoV2 has posed a distinct challenge to healthcare delivery, and Ireland has been no exception. Hospital bed numbers per capita in Ireland are at 2.9 per 1000 inhabitants, bed occupancy is the highest in the European Union, care is predominantly delivered in 4 to 6bedded wards, and singleroom isolation facilities are in short supply, risking being overwhelmed by high caseloads. Droplet spread within environments increasingly appears to travel further than the initially predicted 2 m 3 and one Irish hospital has reported as many as 49% of their COVID19 cases occurring via nosocomial transmission, and higher (32%) mortality in this group. We therefore identified a need to manage patients safely at home to minimise spread to susceptible patients and staff. As SARSCoV2 infection’s natural history includes a rapid deterioration, characteristically in the second week of the illness in those who develop severe disease, 6 the challenge of safely caring for such patients in the community was raised. Given that COVID19 causes pneumonitis and impaired oxygenation, it is advised that patients with mildmoderate COVID19 are monitored for progression. Finger probe oxygen saturation (SpO 2 ) monitoring is therefore a feasible method of home monitoring. Within months of the pandemic being declared a number of centres internationally (including those within Australia, Canada, China, The Netherlands and the UK) began to implement COVID19 virtual monitoring programmes, taking a variety of forms, ranging from telephone support alone to remote assessments of patients’ symptoms in combination with collecting biometric data. Ireland’s national Health Service Executive (HSE) developed an early partnership with the digital health firm patientMpower in February 2020, with rollout of a new Summary box

Introduction The use of remote monitoring technology to manage the care of patients with COVID-19 has been implemented to help reduce the burden placed on healthcare systems during the pandemic and protect the well-being of both staff and patients. Remote monitoring allows patients to record their signs and symptoms remotely (eg, while self-isolating at home) rather than requiring hospitalisation. Healthcare staff can, therefore, continually monitor their symptoms and be notified when the patient is showing signs of clinical deterioration. However, given the recency of the COVID-19 outbreak, there is a lack of research regarding the acceptance of remote monitoring interventions to manage COVID-19. This study will aim to evaluate the use of remote monitoring for managing COVID-19 cases from the perspective of both the patient and healthcare staff. Methods and analysis Discharged patients from a large urban teaching hospital in Ireland, who have undergone remote monitoring for COVID-19, will be recruited to take part in a cross-sectional study consisting of a quantitative survey and a qualitative interview. A mixed methods design will be used to understand the experiences of remote monitoring from the perspective of the patient. Healthcare staff who have been involved in the provision of remote monitoring of patients with COVID-19 will be recruited to take part in a qualitative interview to understand their experiences with the process. Structural equation modelling will be used to examine the acceptance of the remote monitoring technology. Latent class analysis will be used to identify COVID-19 symptom profiles. Interview data will be examined using thematic analysis. Ethics and dissemination Ethical approval has been granted by the ethical review boards at University College Dublin and the National Research Ethics Committee for COVID-19-related Research. Findings will be disseminated via publications in scientific journals, policy briefs, short reports and social media.

Background: In March 2020, the Brazilian Ministry of Health (MoH) announced COVID-19 countrywide community transmission and issued guidelines on social distancing measures. Using real life data, we aimed to analyze the impact of COVID-19 on HIV care in Brazil, and summarize the actions taken by the MoH to guarantee proper health care for people living with HIV (PLWHIV). Methods: We obtained MoH electronic records, from January-October 2019/2020, on HIV self test (HIVST), viral load (VL), CD4+ T counts (CD4), genotyping, and antiretroviral (ART) prescription, including post- (PEP) and pre-exposure (PrEP) prophylaxis. We used descriptive statistics to quantify COVID-19 impact on HIV care in Brazil and compared indicators of both years by unpaired T-tests. Results: In April 2020, PEP and PrEP dispenses fell 57% and 53%, respectively, when compared to January, and new PrEP users dropped 70%. Four months supplies provision and telemedicine resulted on 64% and 53% increase on PEP and PrEP dispenses and 288% rise on new PrEP users in October, when compared to April. The number of HIVST distributed by MoH and PLWHIV who had the first CD4 and VL before ART initiation dropped 35% and 48%, respectively, when comparing April to January 2020, reflecting the pandemic impact on HIV diagnosis. In return, MoH recommended HIVST for key/ priority populations, pregnant women, patients with TB, STI, viral hepatitis, immunossupressed, or hospitalized due to respiratory syndrome. When comparing to April, HIVST distribution raised 95% in October and the number of PLWHIV who had the first CD4 and VL before ART initiation was 56% higher, in September. When comparing 2020 to 2019, the number of PLWHIV who started ART and those that had the first CD4 and VL before ART initiation was 29% and 48% lower in April 2020, respectively;but 18% and 15% in September. Considering January-October, the proportion of PLWHIV overdue for ART dispensation raised 11% and ART dispense for 30 days dropped 53% in 2020;but increased 27% and 105%, for 60 and 90 days, respectively. The use of telemedicine, annual VL for those clinically stables, and 90-days ART supply held link to public health services and viral load suppresion. Conclusion: PLWHIV are vulnerable during COVID-19 pandemic due to compromised immune system or care continuum interruption by community containment measures. Monitoring of HIV care indicators associated to timely actions is an effective way to overcome COVID-19 pandemic challenges and guarantee proper health care for PLWHIV.

Objective: We aimed to use SARS-CoV-2 antibody tests to assess the asymptomatic seroprevalence of individuals in high-risk hospital cohorts who's previous COVID-19 exposure is unknown; staff, and patients requiring haemodialysis or chemotherapy after the first wave.Methods: In a single Center, study participants had five SARS-CoV-2 antibody tests done simultaneously; one rapid diagnostic test (RDT) (Superbio Colloidal Gold IgM/IgG), and four laboratory tests (Roche Elecsys® Anti-SARS-CoV-2 IgG [RE], Abbott Architect i2000SR IgG [AAr], Abbott Alinity IgG [AAl], and Abbott Architect IgM CMIA). To determine seroprevalence, only positive test results on laboratory assay were considered true positives.Results: There were 157 participants, of whom 103 (65.6%) were female with a median age of 50 years (range 19–90). The IgG component of the RDT showed a high number of false positives (n = 18), was inferior to the laboratory assays (p < 0.001 RDT vs. AAl/AAr, p < 0.001 RDT vs. RE), and had reduced specificity (85.5% vs. AAl/AAr, 87.2% vs. RE). Sero-concordance was 97.5% between IgG laboratory assays (RE vs. AAl/AAr). Specificity of the IgM component of the RDT compared to Abbott IgM CMIA was 95.4%. Ten participants had positivity in at least one laboratory assay, seven (9.9%) of which were seen in HCWs. Two (4.1%) hematology/oncology (H/O) patients and a single (2.7%) haemodialysis (HD) were asymptomatically seropositive. Asymptomatic seroprevalence of HCWs compared to patients was not significant (p = 0.105).Conclusion: HCWs (9.9%) had higher, although non-significant asymptomatic seroprevalence of SARS-CoV-2 antibodies compared to high-risk patients (H/O 4.1%, HD 2.7%). An IgM/IgG rapid diagnostic test was inferior to laboratory assays. Sero-concordance of 97.5% was found between IgG laboratory assays, RE vs. AAl/AAr.

Background: Although citizens in countries worldwide took coordinated steps to support collective public health during the COVID-19 pandemic, the processes that encourage citizens to adhere with COVID-19 restrictions are not fully understood. Method: A three-wave study with a sample of Irish citizens ( N Wave 1 = 1,800) was conducted during the COVID-19 pandemic in order to examine the effect of national trust on individual and normative compliance with COVID-19 restrictions directly or indirectly through social cohesion. Two longitudinal mediation models were tested. Results: In the first model, national trust significantly and positively predicted social cohesion, which in turn significantly and positively predicted personal compliance with COVID-19 restrictions. The second model showed a similar pattern, whereby national trust significantly predicted social cohesion, which in turn predicted normative compliance with the restrictions. Conclusions: National trust and social cohesion both work to promote adherence to COVID19 guidelines.