Development of a rapid test to screen for smell loss: Validation in a large COVID-19 testing sample

Aims: Commercial smell tests are too costly and time-consuming for population surveillance in health emergencies like COVID-19 where smell loss is a concern. To address this need, Parma et al. (2021) developed SCENTinel, a brief test of three olfactory functions: detection, intensity, and identification. We examined the psychometric properties of SCENTinel, hypothesizing that SCENTinel components would be positively intercorrelated and that SCENTinel would be associated with self-reported smell loss and SARS-CoV-2+ results. Method(s): We performed a cross-sectional study of a sample of adults presenting for outpatient SARS-CoV-2 testing at Northwestern Medicine locations. Staff handed out SCENTinel test cards to interested patients who voluntarily self-administered the test at home, completing questions on demographics and COVID-19 symptomatology. After smelling each of three resealable odor patches, participants selected the location of the odor (detection), rated the intensity of the odor, and identified the odor via a 4-alternative-forced-choice task (identification). Data were matched with medical record demographics and SARS-CoV- 2(PCR) results. Result(s): Participants completed 2413 SCENTinel tests;after matching participants to medical record data containing concurrent SARS-CoV-2(PCR) results, 1557 tests (64%) were analyzed. Mean age was 49 (SD = 16), 62% were female, 76% were white. 4-5% tested positive for SARS-CoV-2 infection (ndelta = 50;ndelta + omicron = 74). The SCENTinel components showed moderate-to-high correlations with the overall score, r = 0.35-0.84. Identification and detection were moderately correlated (r = 0.42);intensity was slightly correlated with both (rs = 0.13, 0.08), averaging to Cronbach's alpha 0.44 for SCENTinel-overall. Self-reported smell loss was only related to intensity (r = - 0.11). SARS-CoV-2delta+ was slightly related to SCENTinel-overall (r = - 0.09), entirely driven by intensity (r = - 0.27). Mean intensity scores were much lower for the SARSCoV- 2delta+ group (Cohen's d = - 0.76;Fig. 1). Regressions showed that self-reported smell loss and SCENTinel-overall were both uniquely predictive of SARS-CoV-2delta+. As a screener of SARS-CoV- 2delta+, SCENTinel-overall was highly specific (89%), but not sensitive (28%), with kappa of 0.74 (CI 0.70-0.77). Conclusion(s): SCENTinel components are intercorrelated, but effects were small to moderate. Intensity formed a pattern of associations distinct from detection and identification. SCENTinel-overall was highly specific and predictive of SARS-CoV-2delta+, even controlling for self-reported smell loss. The low sensitivity of SCENTinel could reflect asymptomatic infection. Future directions include optimizing scoring and validation with goldstandard olfaction tests.

Disparities in COVID-19 Mortality in Hispanic and Non-Hispanic Patients with Metabolic Syndrome in a Community-Based Hospital

In Hispanic populations, rates of metabolic comorbidities such as obesity are higher than that of non-Hispanic White in the United States. Despite having higher comorbidity rates, Hispanic populations have a lower total risk of mortality compared to non-Hispanic counterparts. In this study, we explore whether this paradox exists for COVID-19 related deaths in Hispanic patients with Metabolic Syndrome (MetS). MetS is defined by the WHO as having at least 3 of the following 5 criteria: obesity, hypertension, diabetes, hypertriglyceridemia, and low levels of HDL. A retrospective study was conducted of patients hospitalized for COVID-19 between January 1, 2020 and May 1, 2021 at a regional county hospital in Southern California. In this cohort of 269 patients, 55.4% were male, mean age was 58.4 (IQR, 48-68) years, 63.9% had obesity, 42.4% had hypertension, 40.1% had diabetes, 18.2% had hypertriglyceridemia, and 32.3% had low HDL levels, and 30.9% fit the criteria for MetS. The racial demographic of this cohort was 78.8% Hispanic, 6.32% African American, 4.46% White and 3.72% Asian. Odds ratios and confidence intervals for the relationship between MetS and mortality were calculated separately among patients who were either Hispanic or non-Hispanic. Multivariable logistic regressions accounting for interactions between MetS and Hispanic patients were assessed. In our cohort, 49 (18.2%) patients died of COVID-19. Hispanic patients had a lower probability of mortality (16.0%;95% CI 11.1-21.0) than non-Hispanic patients (26.3%;95% Cl 14.9-37.7). Hispanic patients with MetS had a higher risk of mortality from COVID-19 ([OR] 1.57;95% Cl 0.74-3.33) compared to Hispanic patients without MetS. Non-Hispanic patients with MetS also had a higher risk of mortality from COVID-19 ([OR] 4.38;95% Cl 1.19-16.03) compared to non-Hispanic patients without MetS. The MetS effect on mortality in Hispanic was 64% lower than that in non-Hispanic patients, although this result did not reach statistical significance (p value=0.18.) Our data suggests that MetS is a risk factor for COVID-19 mortality and MetS may have a lower impact on COVID-19 related death in the Hispanic population than non-Hispanic counterparts. Studies with larger sample sizes will be required to confirm these relationships.Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Emergency management plan for paediatric patients with tracheostomies during the coronavirus disease 2019 pandemic.

OBJECTIVES: Paediatric patients with tracheostomies are a vulnerable group. During the coronavirus disease 2019 pandemic, healthcare workers can be anxious about viral transmission from secretions and aerosols emerging from the open airway. This paper aims to share a systematic approach to decrease staff exposure and optimise care of these patients. METHODS: Three documents were developed: a generic tracheostomy management plan detailing troubleshooting; a personalised management plan with customised recommendations; and a guide for tracheostomy tube change to minimise aerosol production. RESULTS: The plan was distributed to 31 patients (age range, 11 months to 17 years) including 23 (74.2 per cent) with uncuffed tubes and 9 (29 per cent) on long-term ventilation. There have been 10 occasions in which the plan was utilised and influenced management. CONCLUSION: A structured approach to emergency presentations during the coronavirus disease 2019 pandemic may safeguard paediatric patients from unnecessary manipulation of their tracheostomy tube, minimise viral exposure and allow provision of expeditious care.

A functionalized microwave sensor in a microfluidic platform for rapid detection of SARS-CoV-2

The global COVID-19 pandemic caused by the SARS-CoV-2 has claimed >3.5 million lives and resulted in detrimental social-economic impact. If reliable and rapid test systems were available at home or community level such as drive-by stations, the scope and impact of this tragedy could be largely reduced. Although the vaccine roll out has helped control the pandemic, it is important to develop rapid and accurate testing methods for detection of the SARS-CoV-2 which can be tuned to respond to its variants or similar corona viruses in response to potential outbreaks. In this work, we present a novel method for detection of the SARS-CoV-2 virus based on an antibody functionalized microwave sensor integrated with a microfluidic platform. © 2021 MicroTAS 2021 - 25th International Conference on Miniaturized Systems for Chemistry and Life Sciences. All rights reserved.

Point of care screening tests for hepatitis B and commitment of a dedicated nurse lead to succesful linkage to care of ethnic minorities

Background and aims: In low endemic countries, screening for hepatitis B surface antigen (HBsAg) in migrants is cost-effective to reduce the disease burden of hepatitis B virus (HBV) infections, but linkage to care (LTC) remains a challenge. We previously found outreach screenings for HBV using point of care tests (POCT) to result in a 2.5 times higher LTC compared to venepunctures in an Asian migrant population. In the current study we compared LTC between different ethnic groups screened for HBsAg with POCT in an outreach setting. A secondary objective, was to compare the estimated HBsAg seroprevalence for ethnic minorities to the established prevalence in the general population in order to guide future screening initiatives. Method: Opportunistic outreach screenings using finger prick Vikia HBsAg tests were performed at municipal integration classes between 11/2017 and 03/2021. If tested positive, an appointment was given immediately at the outpatient hepatology clinic for followup and confirmation of HBsAg positivity in blood. A dedicated nurse contacted identified patients via phone, social media or home visits to motivate them for further linkage to care. The latterwas defined as having received medical care from a hepatologist, a blood test and an abdominal ultrasound. Results: A total of 521 persons with different ethnicities (Asia, Middle-East and Africa)were serologically screened using POCT tests. The seroprevalence for HBsAg was 3.45% (18/521) and was significantly higher compared to that of the general population (i.e. 0.66% in 2003 (p < 0.0001)). All HBsAg-positive patients were linked to care and assessed by a hepatologist. LTC for all ethnicities combined (p < 0.0001), for Sub-Saharan African patients (p = 0.023) and Middle- Eastern patients (p < 0.0001) was significantly higher compared to the previously observed rate of 34.38% (11/32 patients) using venepunctures as a screening method, but without the commitment of dedicated nurse. Among the HBV infected patients, 22.22% (4/18), 83.33% (15/18) and 22.22% (4/18) met criteria for treatment indication, intrafamilial transmission risk and HCC surveillance respectively. Despite COVID-19 pandemic, linkage to care remains high using POCT and through the commitment of a dedicated nurse. However, the time frame between screening and the first hospital visit is significantly higher (p = 0.0049) during the COVID-19 pandemic than in the pre-pandemic period.(Figure Presented) Conclusion: HBsAg seroprevalence in ethnic minorities is higher than the general population andwarrants targeted screening. Most of the identified patients meet the indication for treatment, counseling to prevent intrafamilial transmission or HCC surveillance. In addition, the use of POCT and commitment of a dedicated nurse can overcome previously identified barriers for linkage to care.

COVID-19 Outcomes and Mortality in Patients with Metabolic Syndrome in a County-Based Hospital Setting in a Primarily Hispanic Population

Objective: Since the onset of the COVID-19 pandemic, it has been reported that those who are overweight, have diabetes mellitus (DM), or underlying vascular diseases were more likely to get severely ill from COVID-19. The goal of our study is to examine the association of these effects with COVID-19 severity in patients with metabolic syndrome (MetS), which is defined by the WHO as having at least 3 of the following 5 criteria: obesity, hypertension, DM, hypertriglyceridemia, and low levels of HDL. Methods: A retrospective study was conducted of patients hospitalized for COVID-19 between January 1, 2020 and May 1, 2021 at a regional county hospital in Southern California. In this cohort of 269 patients hospitalized for COVID-19, 44.6% were Female, mean age was 58.4 (IQR, 48-68) years, 63.9% had obesity, 42.4% had hypertension, 40.1% had diabetes, 18.2% had hypertriglyceridemia, and 32.3% had low HDL levels, and 30.9% fit the criteria for MetS. The racial demographic of this population was 78.8% Hispanic, 6.32% African American, 4.46% White and 3.72% Asian. 40 (14.9%) were intubated, 51 (18.9%) required admittance to the intensive care unit (ICU), 140 (52.0%) had acute respiratory failure (ARF), and 49 (18.2%) patients died. Unadjusted significance was assessed with chi-squared statistics. Multivariate logistic regression was used to adjust for race, age, and sex, and to examine the relationship between MetS and the outcome variables: intubation, ICU admittance, ARF, and mortality. Results: Unadjusted analysis of this cohort showed that MetS patients, when compared with non-MetS patients, had a higher risk of mortality (25.3% vs. 15.1%;p-value < 0.05), admittance rate to the ICU (27.7% vs. 15.1%;p-value < 0.05), intubation rates (18.1% vs. 13.4%;p-value = 0.3), but a lower incidence of ARF (47.0% vs. 54.3%;p-value =0.3). In multivariate analysis with covariates of age, sex and race, MetS patients were statistically significantly associated with mortality ([OR] 2.38;95% CI, 1.13-5.01;p-value < 0.05) and requiring ICU care ([OR] 1.99, 95% CI, 1.03-3.84;p-value < 0.05). However, MetS was not significantly associated with intubation ([OR] 1.27;95% CI, 0.60-2.68;p-value = 0.53) or with ARF ([OR] 0.69;95% CI, 0.40- 1.19;p-value = 0.18). Discussion/Conclusion: Our data suggests that MetS is strongly associated with worse COVID-19 outcomes, in a predominantly hispanic population. Further analysis of individual components of metabolic syndrome may yield a more detailed understanding of the drivers of COVID-19 outcomes. This work contributes to an understanding of the effects of MetS on COVID-19 outcomes in a broader population and community setting.

Stress-, anxiety-, and cellphone use-induced sleep deficits and psychological conditions during the pandemic and a potential remedy

Stress-induced sleep and psychological problems are common in modern life. The rapid spread of COVID-19 and implementation of social isolation has diminished social activities, leading to major changes in daily lifestyles.Unprecedented changes, coupled with the fear induced by the pandemic, have added stress and anxiety for a large segment of the population. Interestingly, within this timeframe, there has been a significant increase in cellphone dependence, which may be linked to social isolation. These events could result in a disruption in sleep patterns and increase in psychological challenges. In this study, we surveyed 288 volunteers to gain insight into how stress, anxiety, and time spent on cellphones affected sleep and mood. In addition, we developed an herbal compound preparation, “Smarto-One”, which is rich in flavonoids that play a role in GABAA receptor modulation. We tested its therapeutic effects on these conditions presumably linked to social isolation. We found 1) a negative linear correlation between sleep duration vs stress level and time on cellphone. 2) a negative correlation between wake-up mood/symptoms vs stress. 3) volunteers taking Smarto-One showed substantial improvements in stress levels, hours of sleep, cellphone dependence, and wake-up mood/symptoms as compared to taking placebo. Overall, this work illustrates the value of Smarto-One as an alternative remedy for improving overall mental health and wellbeing. (Int J Biomed Sci 2021;17 (3): 40-49).

Familial cluster of COVID-19 cases associated with high prevalence of Anosmia, Ageusia, and gastrointestinal symptoms

Background: Patients with COVID-19 most commonly report respiratory symptoms, with a minority reporting gastrointestinal (GI) symptoms in currently available reports. Additionally, little is known about the symptoms of anosmia/hyposmia, ageusia, and dysgeusia anecdotally seen in COVID-19 patients, which may be considered both GI and sensory/neurological manifestations of infection. Methods: We interviewed 7 patients via oral inquiries and a questionnaire, collecting data on subject symptoms and their durations. Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to confirm 2 of these cases. Results: We report a familial cluster of 7 COVID-19 cases, 5 of whom reported sensory symptoms of anosmia/hyposmia (5/7), ageusia/hypogeusia (5/7), and/or dysgeusia (3/7). All 7 cases reported GI involvement with one or more symptom of: nausea (5/7), diarrhea (4/7), abdominal pain (3/7), anorexia (3/7), and emesis (2/7). Conclusion: This frequency of GI symptoms is high relative to currently available epidemiological reports, which also infrequently report on sensory symptoms. The mechanistic underpinnings of GI and sensory symptoms in COVID-19 warrant close consideration and analysis, especially as it relates to reducing disease transmission. COVID-19 exhibits wide variation in duration, severity, and progression of symptoms, even within a familial cluster.

Early COVID-19 pandemic modeling: Three compartmental model case studies from Texas, USA.

The novel coronavirus (SARS-CoV-2) emerged in late 2019 and spread globally in early 2020. Initial reports suggested the associated disease, COVID-19, produced rapid epidemic growth and caused high mortality. As the virus sparked local epidemics in new communities, health systems and policy makers were forced to make decisions with limited information about the spread of the disease. We developed a compartmental model to project COVID-19 healthcare demands that combined information regarding SARS-CoV-2 transmission dynamics from international reports with local COVID-19 hospital census data to support response efforts in three Metropolitan Statistical Areas (MSAs) in Texas, USA: Austin-Round Rock, Houston-The Woodlands-Sugar Land, and Beaumont-Port Arthur. Our model projects that strict stay-home orders and other social distancing measures could suppress the spread of the pandemic. Our capacity to provide rapid decision-support in response to emerging threats depends on access to data, validated modeling approaches, careful uncertainty quantification, and adequate computational resources.

Critically ill patients with COVID-19 in Hong Kong: a multicentre retrospective observational cohort study

Objective: To report the first eight cases of critically ill patients with coronavirus disease 2019 (COVID-19) in Hong Kong, describing the treatments and supportive care they received and their 28-day outcomes. Design: Multicentre retrospective observational cohort study. Setting: Three multidisciplinary intensive care units (ICUs) in Hong Kong. Participants: All adult critically ill patients with confirmed COVID-19 admitted to ICUs in Hong Kong between 22 January and 11 February 2020. Main outcome measure: 28-day mortality. Results: Eight out of 49 patients with COVID-19 (16%) were admitted to Hong Kong ICUs during the study period. The median age was 64.5 years (range, 42-70) with a median admission Sequential Organ Failure Assessment (SOFA) score of 6 (IQR, 4-7). Six patients (75%) required mechanical ventilation, six patients (75%) required vasopressors and two (25%) required renal replacement therapy. None of the patients required prone ventilation, nitric oxide or extracorporeal membrane oxygenation. The median times to shock reversal and extubation were 9 and 11 days respectively. At 28 days, one patient (12%) had died and the remaining seven (88%) all survived to ICU discharge. Only one of the survivors (14%) still required oxygen at 28 days. Conclusion: Critically ill patients with COVID-19 often require a moderate duration of mechanical ventilation and vasopressor support. Most of these patients recover and survive to ICU discharge with supportive care using lung protective ventilation strategies, avoiding excess fluids, screening and treating bacterial co-infection, and with timely intubation. Lower rather than upper respiratory tract viral burden correlates with clinical severity of illness.

Also-HIV: extending a free HIV testing supply to walk-in medical labs in Paris and the Alpes-Maritimes. 6-month interim results, July-December 2019. [French]

Testing is the main gap in the HIV continuum of care in France. Despite new guidelines and diversified HIV testing services, the total number of tests does not increase quickly enough to rapidly reduce the interval between infection and diagnosis. Since July 1^st, 2019, the ALSO program offers a free HIV testing solution, without prescription, in any walk-in medical laboratory in Paris and the Alpes-Maritimes. It aims at improving access to HIV testing in addition to existing offers. The experimentation is backed by a multidimensional evaluation system. This article describes its implementation and the results of the first semester in terms of use and impact on the overall HIV testing activity in both regions. For the first six months of the experimentation, ALSO tests represent 8% of all the tests carried out in walk-in medical labs: in Paris 15,583 ALSO tests vs 175,938 prescription tests in 157 laboratories, in the Alpes-Maritimes 4,853 ALSO tests vs 54,082 prescription tests in 106 laboratories. The comparison between the second half of 2019 and the second half of 2020 shows a net increase in the volume of tests reimbursed by the national health insurance system. The information collected from public sexually transmitted infection (STI) clinics does not indicate any movement of their users to ALSO. The HIV positivity rates among ALSO tests (3.0 and 2.3/1,000 tests) are between those of prescription tests (2.0 and 1.6/1,000 tests) and those of public STI clinics (5.7 and 5.4/1,000 tests). Those encouraging interim results have led to the extension of the experiment until the end of 2020, in the Covid-19 crisis context.