ABSTRACT
Healthcare workers (HCWs) assessed by dermatologists during the first wave of the COVID-19 pandemic had high rates of irritant hand dermatitis, facial dermatitis and acne triggered by wearing personal protective equipment (PPE) (Ferguson FJ, Street G, Cunningham L et al. Occupational dermatology in the time of the COVID-19 pandemic: a report of experience from London and Manchester, UK. Br J Dermatol 2021;184: 180-2). We report data from a tertiary National Health Service trust during the second COVID-19 wave in winter 2020-21. At its peak, the Trust had 835 COVID-positive inpatients and 263 intensive care unit (ICU) beds - one of the largest ICUs in Europe. Building on the published experience of dermatology units, we ran 30 dermatology pop-up clinics over 3 weeks in allocated rest areas across the Trust: 08.00-09.00 h and 13.00-14.00 h on weekdays, from 18 January 2021. HCWs requiring formal dermatology referral were provided with letters to their line managers. In 3 weeks, 401 HCWs were assessed: 327 females and 74 males (mean age 35 2 years). The most frequently seen occupation was nurses (n = 130;32 4%) followed by doctors (n = 74;18 4%). On average, staff spent 9 5 h in PPE per shift. Consistent with the existing literature, the most common diagnosis was irritant hand dermatitis (n = 186;46 4%). There was an increased incidence of acne (n = 171;42 6%) vs. the first wave, where the reported incidence was 17% in a multicentre study (O'Neill H, Narang I, Buckley DA et al. Occupational dermatoses during the COVID-19 pandemic: a multicentre audit in the UK and Ireland. Br J Dermatol 2021;184: 575-7). Less common in the second wave was facial eczema (n = 50, 12 5%) and pressure injury (n = 30;7 5%). Thirty-one (16 7%) of the HCWs with hand dermatitis required the prescription of potent topical corticosteroids, suggesting at least moderate symptoms. The majority received emollient samples. It was rare for HCWs to require formal referral (n = 11;2 7%). In our cohort, at least four (1 0%) HCWs required time off work owing to their skin problems. Our data support previous reports of increased occupational dermatoses in HCWs during the COVID-19 pandemic. We highlight the sheer scale of the issue, with 401 HCWs presenting for dermatological assessment in only 3 weeks in one trust. Compared with our experience during the first wave, acne exacerbated or precipitated by masks is increasingly common, which may be due to emollient use to prevent facial eczema or injury when wearing masks.
ABSTRACT
Objective To analyze the potential factors influencing the viral shedding time (duration of nucleic acid positivity) in elderly patients with mild and asymptomatic infection. Methods The clinical data of 1141 elderly (>=60 years) patients with mild and asymptomatic Omicron infection who were admitted to National Exhibition and Convention Center (Shanghai) Cabin Hospital from April 14, 2022 to May 1, 2022 were retrospectively collected, viral shedding time of patients were compared between different groups (age, gender, number of vaccination, hypertension, diabetes). Pearson analysis was adopted to analyze the relationship between age and viral shedding time. Kaplan-Meier curve and Log-rank test were used to evaluate the viral shedding time in elderly patients with different clinical characteristics. Multivariate Cox proportional-hazards regression model was adopted to analyze the factors influencing viral shedding time in elderly patients with Omicron. Results Among 1441 patients, 791(54.9%) males and 650(45.1%) females. There were 513(35.6%) patients receiving 0 dose of vaccine, 29(2.0%) patients received 1 dose of vaccine, 405(28.1%) patients received 2 doses of vaccine, 494(34.3%) patients received 3 doses of vaccine. Compared with patients aged 60 to 70 years, patients aged 70 to 80 years had longer viral shedding time (P<0.001). The viral shedding time in patients with hypertension and diabetes was longer than that in patients without hypertension and diabetes (P<0.05). In terms of vaccination, the viral shedding time of patients receiving 2 or 3 doses of vaccine was significantly shorter than that of patients receiving 1 dose of vaccine or none (P<0.05). There was a positive correlation between patient age and viral shedding time, with an R2=0.029 (P<0.001). Kaplan-Meier curve showed that there existed significant difference in viral shedding time between the patients with different vaccination doses (P<0.001), and patients with age >=70, hypertension and diabetes were all associated with prolonged viral shedding time (P<0.05). Cox regression analysis showed that the age >=70 years was a risk factor for prolonged viral shedding time, and 2 or 3 doses of vaccine was a protective factor for prolonged viral shedding time (P<0.05). Conclusions Among the elderly population, the viral shedding time would gradually increase with age. Patients who received >=2 doses of vaccine would have reduced viral shedding time compared with those who received <2 doses of vaccine.Copyright © 2022 Authors. All rights reserved.
ABSTRACT
Objective To analyze the potential factors influencing the viral shedding time (duration of nucleic acid positivity) in elderly patients with mild and asymptomatic infection. Methods The clinical data of 1141 elderly (>=60 years) patients with mild and asymptomatic Omicron infection who were admitted to National Exhibition and Convention Center (Shanghai) Cabin Hospital from April 14, 2022 to May 1, 2022 were retrospectively collected, viral shedding time of patients were compared between different groups (age, gender, number of vaccination, hypertension, diabetes). Pearson analysis was adopted to analyze the relationship between age and viral shedding time. Kaplan-Meier curve and Log-rank test were used to evaluate the viral shedding time in elderly patients with different clinical characteristics. Multivariate Cox proportional-hazards regression model was adopted to analyze the factors influencing viral shedding time in elderly patients with Omicron. Results Among 1441 patients, 791(54.9%) males and 650(45.1%) females. There were 513(35.6%) patients receiving 0 dose of vaccine, 29(2.0%) patients received 1 dose of vaccine, 405(28.1%) patients received 2 doses of vaccine, 494(34.3%) patients received 3 doses of vaccine. Compared with patients aged 60 to 70 years, patients aged 70 to 80 years had longer viral shedding time (P<0.001). The viral shedding time in patients with hypertension and diabetes was longer than that in patients without hypertension and diabetes (P<0.05). In terms of vaccination, the viral shedding time of patients receiving 2 or 3 doses of vaccine was significantly shorter than that of patients receiving 1 dose of vaccine or none (P<0.05). There was a positive correlation between patient age and viral shedding time, with an R2=0.029 (P<0.001). Kaplan-Meier curve showed that there existed significant difference in viral shedding time between the patients with different vaccination doses (P<0.001), and patients with age >=70, hypertension and diabetes were all associated with prolonged viral shedding time (P<0.05). Cox regression analysis showed that the age >=70 years was a risk factor for prolonged viral shedding time, and 2 or 3 doses of vaccine was a protective factor for prolonged viral shedding time (P<0.05). Conclusions Among the elderly population, the viral shedding time would gradually increase with age. Patients who received >=2 doses of vaccine would have reduced viral shedding time compared with those who received <2 doses of vaccine. Copyright © 2022 Authors. All rights reserved.