Summary SARS-CoV-2 Spike protein is critical for virus infection via engagement of ACE2 1 , and is a major antibody target. Here we report chronic SARS-CoV-2 with reduced sensitivity to neutralising antibodies in an immune suppressed individual treated with convalescent plasma, generating whole genome ultradeep sequences over 23 time points spanning 101 days. Little change was observed in the overall viral population structure following two courses of remdesivir over the first 57 days. However, following convalescent plasma therapy we observed large, dynamic virus population shifts, with the emergence of a dominant viral strain bearing D796H in S2 and ΔH69/ΔV70 in the S1 N-terminal domain NTD of the Spike protein. As passively transferred serum antibodies diminished, viruses with the escape genotype diminished in frequency, before returning during a final, unsuccessful course of convalescent plasma. In vitro , the Spike escape double mutant bearing ΔH69/ΔV70 and D796H conferred modestly decreased sensitivity to convalescent plasma, whilst maintaining infectivity similar to wild type. D796H appeared to be the main contributor to decreased susceptibility but incurred an infectivity defect. The ΔH69/ΔV70 single mutant had two-fold higher infectivity compared to wild type, possibly compensating for the reduced infectivity of D796H. These data reveal strong selection on SARS-CoV-2 during convalescent plasma therapy associated with emergence of viral variants with evidence of reduced susceptibility to neutralising antibodies.

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All health professions face numerous stressors within their clinical practice, including time pressures, workload, multiple roles and emotional issues. Frequent workplace stress can impact on the physical and mental wellbeing of health professionals and result in burnout and, in some cases, traumatic stress-like symptoms. These outcomes can impact not only on the wellbeing of health professionals but also on their ability to practise effectively. It is therefore imperative that a preventive approach is adopted. Developing resilience-promoting environments within the health professions can be explored as a means to reduce negative, and increase positive, outcomes of stress in health professionals.This literature review seeks to elucidate the processes and characteristics (both individual and contextual) that enhance resilience in the health professions. It explores relevant literature from five health professions (nursing, social work, psychology, counselling and medicine) to identify the individual and contextual resilience-enhancing qualities of each profession.Commonalities and differences between the disciplines are identified in order to arrive at a definitive explanation of resilience across health professions. Implications for clinical practice and recommendations for further research are also discussed.

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Background: Hope is considered to be important for health, recovery and rehabilitation