Frequency and degradation of SARS-CoV-2 markers N1, N2, and E in sewage.

Coronavirus disease 2019 (COVID-19) is an infectious disease that is mainly spread through aerosolized droplets containing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is excreted in feces by infected individuals. Sewage surveillance has been applied widely to obtain data on the prevalence of COVID-19 in whole communities. We used SARS-CoV-2 gene targets N1, N2, and E to determine the prevalence of COVID-19 at both municipal and building levels. Frequency analysis of wastewater testing indicated that single markers detected only 85% or less of samples that were detected as positive for SARS-CoV-2 with the three markers combined, indicating the necessity of pairing markers to lower the false-negative rate. The best pair of markers in both municipal and building level monitoring was N1 and N2, which correctly identified 98% of positive samples detected with the three markers combined. The degradation rates of all three targets were assessed at two different temperatures (25 and 35 °C) as a possible explanation for observed differences between markers in frequency. Results indicated that all three RNA targets degrade at nearly the same rate, indicating that differences in degradation rate are not responsible for the observed differences in marker frequency.

How has COVID-19 impacted the civil registration and vital statistics system in Loreto, Perú? Evidence using process mapping and qualitative analysis.

OBJECTIVES: Accurate civil registration and vital statistics (CRVS) systems are the primary data source to measure the impact of the COVID-19 pandemic on mortality. This study assesses how the pandemic impacted CRVS system processes in Loreto region of Peru, one of the worst affected countries globally. DESIGN: Qualitative study. SETTING: Loreto, a remote region, which had the highest reported mortality rate in Peru during the pandemic. PARTICIPANTS: Semistructured individual interviews and documentary analysis were conducted between September 2020 and May 2021 with 28 key informants from eight institutions involved in death certification. Key informants were identified using a purposive sampling strategy commencing at the Health Directorate of Loreto, and the snowball method was used where a participant suggested another organisation or person. Information from key informants was used to compare business process maps of the CRVS system before and during the pandemic. RESULTS: During early May 2020, there were seven times more registered deaths than in earlier years, but key informants believed this underestimated mortality by 20%-30%. During the pandemic, families had to interact with more institutions during the death certification process. Several issues disrupted death certification processes, including the burden of increased deaths, the Environmental Health Directorate often removing a body without the family's express agreement, the creation of COVID-19 cemeteries where no death certificate was needed for burial, greater participation of funeral homes that often used outdated paper forms, and closure of civil registry offices. There was increased use of the online National Death System (SINADEF) but many users had problems with access. CONCLUSIONS: The pandemic substantially disrupted CRVS processes in Loreto, making death certification more difficult, placing greater burden on the family and leading to more participation from unregulated organisations such as funeral homes or cemeteries. These disruptions were impacted by limitations of the CRVS system's processes before the pandemic.

A series of COVID-19 autopsies with clinical and pathologic comparisons to both seasonal and pandemic influenza.

Autopsies of patients who have died from COVID-19 have been crucial in delineating patterns of injury associated with SARS-CoV-2 infection. Despite their utility, comprehensive autopsy studies are somewhat lacking relative to the global burden of disease, and very few comprehensive studies contextualize the findings to other fatal viral infections. We developed a novel autopsy protocol in order to perform postmortem examinations on victims of COVID-19 and herein describe detailed clinical information, gross findings, and histologic features observed in the first 16 complete COVID-19 autopsies. We also critically evaluated the role of ancillary studies used to establish a diagnosis of COVID-19 at autopsy, including immunohistochemistry (IHC), in situ hybridization (ISH), and electron microscopy (EM). IHC and ISH targeting SARS-CoV-2 were comparable in terms of the location and number of infected cells in lung tissue; however, nonspecific staining of bacteria was seen occasionally with IHC. EM was unrevealing in blindly sampled tissues. We then compared the clinical and histologic features present in this series to six archival cases of fatal seasonal influenza and six archival cases of pandemic influenza from the fourth wave of the 'Spanish Flu' in the winter of 1920. In addition to routine histology, the inflammatory infiltrates in the lungs of COVID-19 and seasonal influenza victims were compared using quantitative IHC. Our results demonstrate that the clinical and histologic features of COVID-19 are similar to those seen in fatal cases of influenza, and the two diseases tend to overlap histologically. There was no significant difference in the composition of the inflammatory infiltrate in COVID-19 and influenza at sites of acute lung injury at the time of autopsy. Our study underscores the relatively nonspecific clinical features and pathologic changes shared between severe cases of COVID-19 and influenza, while also providing important caveats to ancillary methods of viral detection.

Impact of COVID-19 social distancing regulations on outpatient diagnostic imaging volumes and no-show rates.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted outpatient radiology practices, necessitating change in practice infrastructure and workflow. OBJECTIVE: The purpose of this study was to assess the consequences of social distancing regulations on 1) outpatient imaging volume and 2) no-show rates per imaging modality. METHODS: Volume and no-show rates of a large, multicenter metropolitan healthcare system outpatient practice were retrospectively stratified by modality including radiography, CT, MRI, ultrasonography, PET, DEXA, and mammography from January 2 to July 21, 2020. Trends were assessed relative to timepoints of significant state and local social distancing regulatory changes. RESULTS: The decline in imaging volume and rise in no-show rates was first noted on March 10, 2020 following the declaration of a state of emergency in New York State (NYS). Total outpatient imaging volume declined 85% from baseline over the following 5 days. Decreases varied by modality: 88% for radiography, 75% for CT, 73% for MR, 61% for PET, 80% for ultrasonography, 90% for DEXA, and 85% for mammography. Imaging volume and no-show rate recovery preceded the mask mandate of April 15, 2020, and further trended along with New York City's reopening phases. No-show rates recovered within 2 months of the height of the pandemic, however, outpatient imaging volume has yet to recover to baseline after 3 months. CONCLUSION: The total outpatient imaging volume declined alongside an increase in the no-show rate following the declaration of a state of emergency in NYS. No-show rates recovered within 2 months of the height of the pandemic with imaging volume yet to recover after 3 months. CLINICAL IMPACT: Understanding the impact of social distancing regulations on outpatient imaging volume and no-show rates can potentially aid other outpatient radiology practices and healthcare systems in anticipating upcoming changes as the COVID-19 pandemic evolves.

Sources of Revenue Loss and Recovery in Radiology Practices During the Coronavirus Disease 2019 (COVID-19) Pandemic.

RATIONALE AND OBJECTIVES: This study seeks to quantify the financial impact of COVID-19 on radiology departments, and to describe the structure of both volume and revenue recovery. MATERIALS AND METHODS: Radiology studies from a large academic health system were retrospectively studied from the first 33 weeks of 2020. Volume and work relative value unit (wRVU) data were aggregated on a weekly basis for three periods: Presurge (weeks 1-9), surge (10-19), and recovery (20-33), and analyzed compared to the pre-COVID baseline stratified by modality, specialty, patient service location, and facility type. Mean and median wRVU per study were used as a surrogate for case complexity. RESULTS: During the pandemic surge, case volumes fell 57%, while wRVUs fell by 69% relative to the pre-COVID-19 baseline. Mean wRVU per study was 1.13 in the presurge period, 1.03 during the surge, and 1.19 in the recovery. Categories with the greatest mean complexity declines were radiography (-14.7%), cardiothoracic imaging (-16.2%), and community hospitals overall (-15.9%). Breast imaging (+6.5%), interventional (+5.5%), and outpatient (+12.1%) complexity increased. During the recovery, significant increases in complexity were seen in cardiothoracic (0.46 to 0.49), abdominal (1.80 to 1.91), and neuroradiology (2.46 to 2.56) at stand-alone outpatient centers with similar changes at community hospitals. At academic hospitals, only breast imaging complexity remained elevated (1.32 from 1.17) during the recovery. CONCLUSION: Reliance on volume alone underestimates the financial impact of the COVID-19 pandemic as there was a disproportionate loss in high-RVU studies. However, increased complexity of outpatient cases has stabilized overall losses during the recovery.