ABSTRACT
Although, recently convolutional neural networks (CNNs) based prognostic models have been developed for COVID-19 severity prediction, most of these studies have analyzed characteristics of lung infiltrates (ground-glass opacities and consolidations) on chest radiographs or CT. However, none of the studies have explored the possible lung deformations due to the disease. Our hypothesis is that more severe disease results in more pronounced deformation. The key contributions of this work are three-fold: (1) A new lung deformation based biomarker analyzing regions of differential distensions between COVID-19 patients with mild and severe disease. (2) Integrating 3D-CNN characterization of lung deformation regions and lung infiltrates on lung CT into a novel framework (LuMiRa) for prognosticating COVID-19 severity. (3) Validating LuMiRa on one of the largest multi-institutional cohort till date (N = 948 patients). We found that majority of the shape deformations were observed in the mediastinal surface of both the lungs and in left interior lobe. On a testing cohort based on two institutions, Av (N = 419) and Bv (N = 113), LuMiRa yielded an area under the receiver operating characteristic curve (AUC) of 0.89 and 0.77 respectively showing significant improvement over a 3D-CNN trained over just lung infiltrates (AUC = 0.85 (p < 0.001), AUC = 0.75 (p = 0.01)). Additionally, LuMiRa performed significantly better than machine learning models trained on clinical and radiomic features (0.82, 0.78 and 0.72, 0.72 on Av and Bv respectively). © 2021, Springer Nature Switzerland AG.
ABSTRACT
The COVID-19 pandemic and phased nationwide lockdown have impacted negatively on individuals with tuberculosis (TB) and routine TB services. Through a literature review and the perspective of members of a national TB Think Tank task team, we describe the impact of the pandemic and lockdown on TB patients and services as well as the potential long-term setback to TB control in South Africa (SA). Strategies to mitigate risk and impact are explored, together with opportunities to leverage synergies from both diseases to the benefit of the National TB Programme (NTP). With the emergence of COVID-19, activities to address this new pandemic have been prioritised across all sectors. Within the health system, the health workforce and resources have been redirected away from routine services towards the new disease priority. The social determinants of health have deteriorated during the lockdown, potentially increasing progression to TB disease and impacting negatively on people with TB and their households, resulting in additional barriers to accessing TB care, with early reports of a decline in TB testing rates. Fewer TB diagnoses, less attention to adherence and support during TB treatment, poorer treatment outcomes and consequent increased transmission will increase the TB burden and TB-related mortality. People with TB or a history of TB are likely to be vulnerable to COVID-19. Modifications to current treatment practices are suggested to reduce visits to health facilities and minimise the risks of COVID-19 exposure. The COVID-19 pandemic has the potential to negatively impact on TB control in TB-endemic settings such as SA. However, there are COVID-19-related health systems-strengthening developments that may help the NTP mitigate the impact of the pandemic on TB control. By integrating TB case finding into the advanced screening, testing, tracing and monitoring systems established for COVID-19, TB case finding and linkage to care could increase, with many more TB patients starting treatment. Similarly, integrating knowledge and awareness of TB into the increased healthcare worker and community education on infectious respiratory diseases, behavioural practices around infection prevention and control, and cough etiquette, including destigmatisation of mask use, may contribute to reducing TB transmission. However, these potential gains could be overwhelmed by the impact of increasing poverty and other social determinants of health on the burden of TB.