Daily Rapid Antigen Exit Testing to Tailor University COVID-19 Isolation Policy.

We evaluated daily rapid antigen test (RAT) data from 323 COVID-19-positive university students in Connecticut, USA, during an Omicron-dominant period. Day 5 positivity was 47% for twice-weekly screeners and 26%-28% for less-frequent screeners, approximately halving each subsequent day. Testing negative >10 days before diagnosis (event time ratio (ETR) 0.85 [95% CI 0.75-0.96]) and prior infection >90 days (ETR 0.50 [95% CI 0.33-0.76]) were significantly associated with shorter RAT positivity duration. Symptoms before or at diagnosis (ETR 1.13 [95% CI 1.02-1.25]) and receipt of 3 vaccine doses (ETR 1.20 [95% CI 1.04-1.39]) were significantly associated with prolonged positivity. Exit RATs enabled 53%-74% of students to leave isolation early when they began isolation at the time of the first positive test, but 15%-22% remained positive beyond the recommended isolation period. Factors associated with RAT positivity duration should be further explored to determine relationships with infection duration.

Translation and validation of the Overactive Bladder Symptom Score (OABSS) in Chinese during the COVID-19 telehealth Surge

Introduction: Overactive bladder (OAB) is a prevalent disease that may affect up to 16% of the population. Barriers to health care exist in the Chinese patient population due to language and cultural differences. Our aim was to create a validated Chinese Overactive Bladder Symptom Score (OABSS) which could capture the full range of OAB symptoms, quantify OAB severity, and be administered both in the clinic and remotely in the wake of the telehealth surge during COVID-19. Methods: The English version of the OABSS was translated into Chinese. The 5th question in the survey served as a proxy for OAB status (OAB-positive and OAB-negative). A hybrid and remote model were created in our translation and validation efforts. In the hybrid model, patients were seen in clinic and called over the phone to readminister the survey. In the remote model, patients were called twice to administer the survey. Internal validity was calculated using Cronbach’s coefficient alpha, test-retest reliability was measured using Spearman’s correlation, and t-test was used to assess discriminant validity between groups and between visits. Results: A total of 63 patients and 73 patients were included in the final analysis of the hybrid and remote models, respectively. An acceptable degree of internal validity was appreciated in both hybrid and remote models by Cronbach’s alpha score of 0.79 and 0.75, respectively. There were strong associations between responses from visit 1 to visit 2 in both models. Spearman’s coefficients ranged from 0.43 to 0.91, with all 7 questions and total OAB score showing statistically significant associations (p<0.001). In both models, no significant differences in total OAB score were seen between visits 1 and 2 in both OAB-positive and OAB-negative groups. However, the OAB-positive group had significantly higher mean OAB scores in both visits 1 and 2 compared to the OAB-negative group. Conclusion: Through several methods of determining survey validity, the Chinese version of the OABSS proved to be a useful tool in assessing OAB severity and gives providers an opportunity to assess Chinese speaking patients remotely. As telehealth visits increase in frequency, OAB symptoms can continue to be monitored adequately.

Messaging Strategies for Mitigating COVID-19 Through Vaccination and Nonpharmaceutical Interventions

With new coronavirus disease 2019 (COVID-19) vaccines authorized by the U.S. Food and Drug Administration and likely more to come, the (extraordinarily complex) logistics of deploying them have gotten underway. Public health officials across the country face a daunting task: convincing the majority of individuals to queue up for shots while also maintaining a steady supply of doses and efficient appointment sign-ups. The road ahead is still long and, even with increasing vaccination, will still require adherence with other effective public health behaviors, such as mask-wearing. This article addresses the importance of effectively matching the message, the audience, and the sender for messages to promote uptake of vaccination and of such behaviors as mask-wearing. It offers suggestions about how to leverage such factors as variations in risk perception and variation among U.S. subcultures regarding tendencies to follow rules and to act for the good of the group. The authors also review evidence that suggests health messages should engage directly with misinformation to refute it.

Predictors of biliary intervention in patients hospitalized for COVID-19.

BACKGROUND: Gastrointestinal complications of coronavirus disease-2019 (COVID-19) include abnormal liver function and acalculous cholecystitis. Cholecystostomy performed during the COVID-19 pandemic reflected a shift toward non-surgical treatment of cholecystitis and increased number of critically ill patients suffering from acalculous cholecystitis. PURPOSE: (1) To determine demographic, clinical, laboratory, and ultrasound features associated with cholecystostomy placement during hospitalization for COVID-19. (2) To develop multivariable logistic regression modeling for likelihood of biliary intervention. METHODS: This retrospective review received institutional review board approval. Informed consent was waived. Between March 2020 and June 2020, patients with confirmed SARS-CoV2 infection admitted to New York-Presbyterian Hospital (NYP)/Weill Cornell Medical Center, NYP/Lower Manhattan Hospital, and NYP/Queens were evaluated for inclusion in this study. Inclusion criteria were (1) patient age ≥ 18, (2) confirmed COVID-19 infection by polymerase chain reaction testing of a nasopharyngeal swab, and (3) abdominal ultrasound performed during hospitalization. Exclusion criteria were (1) history of cholecystectomy and (2) biliary intervention performed prior to abdominal ultrasound. Patients were stratified into two groups based on whether they received cholecystostomy during hospitalization. Differences in demographics, medical history, clinical status, medications, laboratory values, and ultrasound findings between the two groups were evaluated using Chi-square test or Fisher's exact test for categorical variables and t test or Wilcoxon-rank sum test for continuous variables. Multivariable logistic regression was used to model likelihood of biliary intervention. RESULTS: Nine patients underwent cholecystostomy placement and formed the "Intervention Group." 203 patients formed the "No Intervention Group." Liver size and diuretics use during hospitalization were the only variables which were significantly different between the two groups, with p-values of 0.02 and 0.046, respectively. After controlling for diuretics use, the odds of receiving cholecystostomy increased by 30% with every centimeter increase in liver size (p = 0.03). ICU admission approached significance (p = 0.16), as did mechanical ventilation (p = 0.09), septic shock (p = 0.08), serum alkaline phosphatase level (p = 0.16), and portal vein patency (0.14). CONCLUSION: Patients requiring biliary intervention during hospital admission for COVID-19 were likely to harbor liver injury in the form of liver enlargement and require diuretics use.