Impact of COVID-19 Pandemic on Trauma CT Imaging.

Purpose: The goal of this study was to understand the impact of COVID-19 pandemic and associated lockdown measures on the volume, rate, and type of trauma presenting to the emergency department (ED) by using trauma-initiated CT studies to capture patient data. Materials and Methods: We performed a retrospective observational study comparing patients undergoing CT scans for trauma during the 1st and 2nd lockdown periods compared to corresponding prepandemic months. During two lockdown periods, public places such as restaurants, libraries, parks, and shops across the province were shut down. Government-led messaging advised that people should stay at home and practice social distancing. The rate of trauma-initiated CT scans and the proportion of different types of traumas were compared between time periods. Results: There was no significant difference in overall trauma-initiated CT scans between the prepandemic and pandemic levels. Motor vehicle collision (MVC) cases decreased from 18.2% to 15.6% during the first lockdown period (p = 0.049) and also reduced from 29.1% to 25.2% during the second lockdown period (p = 0.013). Trauma from falls increased from 19.1% to 27.5% (p = 0.036) during the first lockdown, despite no significant change during the 2nd lockdown. Furthermore, the percentage of stab injuries increased from 25.0% to 38.9% while blunt trauma decreased from 68.5% to 54.3% during two lockdowns (p = 0.015). Conclusion: The total number of trauma-initiated CT scans did not significantly decrease during the lockdown periods. Stabbings and falls increased during lockdown periods while MVCs and blunt trauma decreased.

Visual dysfunction in survivors of COVID-19: Case series

This case series aims to expand knowledge on COVID-19 diagnosis and functional vision status and highlight the importance of best practices with regards to comprehensive vision screening. Case Series. Outpatient rehabilitation clinics in Minnesota, USA and Texas, USA. Five adults admitted to rehabilitation with diagnosed post-acute sequelae of COVID-19, inclusive of visual dysfunction. Three participants had no remarkable history of visual dysfunction or acquired brain injury;two participants had prior neurological history: one with mild traumatic brain injury and one with concussion, both are significant for visual dysfunction following the acute events. All patients were treated in acute and outpatient rehabilitation settings following the positive visual screen. N/A. This case series highlights visual dysfunction in five patients diagnosed with COVID-19, with and without prior history of neurological disorders. All five participants described newly acquired or a recrudescence of visual symptoms which impacted daily function. 5 out of 5 patients had confirmatory findings following comprehensive visual assessment. Visual symptoms consistent between the cases included, but were not limited to, blurred vision, diplopia, photophobia, impaired near-point focus, headaches, and general visual discomfort and asthenopia throughout their day. Individuals diagnosed with COVID-19 present with a wide-range of symptoms and often neurological sequelae, without a predictable pattern. Despite the substantial impact of COVID-19 globally, and the massive increase in research efforts, certain domains remain poorly understood. One such domain is vision and the impact that visual impairment attributed to COVID-19 has on functional independence. This case series supports new evidence for visual sequelae in COVID-19 with and without history of a neurological disorder. Such findings motivate new research questions such as the pathophysiological differences between acute onset versus recrudesced visual dysfunction. It is imperative that consistent and comprehensive visual screening is performed for individuals who are diagnosed with COVID-19. Universal awareness of potential visual dysfunction following COVID-19 infection is essential for timely screening, referrals and treatment to optimize patient outcomes. There are no relevant author disclosures.

Avoiding false positive SARS-CoV-2 rapid antigen test results with point-of-care molecular testing on residual test buffer (preprint)

Objectives: Antigen-based rapid diagnostic tests (Ag-RDTs) have been widely used for the detection of SARS-CoV-2 during the Covid-19 pandemic. In settings of low disease prevalence, such as asymptomatic community testing, national guidelines recommend molecular confirmation of positive Ag-RDT results. This often requires patients to be recalled for repeat specimen recollection and subsequent testing in reference laboratories. This project assessed the use of a point-of-care molecular method for SARS-CoV-2 detection on-site at a volunteer-led asymptomatic community testing site, using the residual test buffer (RTB) from positive Ag-RDTs. Methods: The Abbott COVID-19 ID NOW assay was performed on RTB from two Ag-RDTs: the Abbott Panbio COVID-19 Ag Rapid Test Device and the BTNX Rapid Response COVID-19 Antigen Rapid Test Device. All RTBs were tested using real-time RT-PCR at a reference laboratory using the ThermoFisher TaqPath COVID-19 Combo kit which was used to assign positive Ag-RDTs results as true or false positives. Analytical specificity of the ID NOW was assessed with a panel of various respiratory organisms. Results: Of 419 positive Ag-RDTs from 5148 tests performed, ID NOW testing of the RTB was positive in 100% of the samples characterized as true positives by RT-PCR. No SARS-CoV-2 detections by ID NOW were observed from 10 specimens characterized as false positive Ag-RDTs, or from contrived specimens with various respiratory organisms. Conclusions: The use of on-site molecular testing on RTB provides a suitable option for rapid confirmatory testing of positive Ag-RDTs, thereby obviating the need for specimen recollection for molecular testing at local reference laboratories.

Repurposing cefuroxime for treatment of COVID-19: a scoping review of in silico studies.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative agent of Coronavirus disease 19 (COVID-19), is a novel human Coronavirus that is responsible for about 300,000 deaths worldwide. To date, there is no confirmed treatment or vaccine prevention strategy against COVID-19. Due to the urgent need for effective treatment, drug repurposing is regarded as the immediate option. Potential drugs can often be identified via in silico drug screening experiments. Consequently, there has been an explosion of in silico experiments to find drug candidates or investigate anecdotal claims. One drug with several anecdotal accounts of benefit is Cefuroxime. The aim of this study was to identify and summarize in silico evidence for possible activity of Cefuroxime against SARS-CoV-2.To this end, we performed a scoping review of literature of in silico drug repurposing experiments for SARS-CoV-2 using PRISMA-ScR. We searched Medline, Embase, Scopus, Web of Knowledge, and Google Scholar for original studies published between 1st Feb, 2020 and 15th May, 2020 that screened drug libraries, and identified Cefuroxime as a top-ranked potential inhibitor drug against SARS-CoV-2 proteins. Six studies were identified. These studies reported Cefuroxime as a potential inhibitor of 3 key SARS-CoV-2 proteins; main protease, RNA dependent RNA polymerase, and ACE2-Spike complex. We provided a summary of the methodology and findings of the identified studies. Our scoping review identified significant in silico evidence that Cefuroxime may be a potential multi-target inhibitor of SARS-CoV-2. Further in vitro and in vivo studies are required to evaluate the potential of Cefuroxime for COVID-19.Communicated by Ramaswamy H. Sarma.

Generation of false positive SARS-CoV-2 antigen results with testing conditions outside manufacturer recommendations: A scientific approach to pandemic misinformation (preprint)

Objectives: Antigen-based rapid diagnostics tests (Ag-RDTs) are useful tools for SARS-CoV-2 detection. However, misleading demonstrations of the Abbott Panbio COVID-19 Ag-RDT on social media claimed that SARS-CoV-2 antigen could be detected in municipal water and food products. To offer a scientific rebuttal to pandemic misinformation and disinformation, this study explored the impact of using the Panbio SARS-CoV-2 assay with conditions falling outside of manufacturer recommendations. Methods: Using Panbio, various water and food products, laboratory buffers, and SARS-CoV-2-negative clinical specimens were tested, with and without manufacturer buffer. Additional experiments were conducted to assess the role of each Panbio buffer component (tricine, NaCl, pH, and tween-20), as well as the impact of temperatures (4{degrees}C, 20{degrees}C , and 45{degrees}C) and humidity (90%) on assay performance. Results: Direct sample testing (without the kit buffer), resulted in false positive signals resembling those obtained with SARS-CoV-2-positive controls tested under proper conditions. The likely explanation of these artifacts is non-specific interactions between the SARS-CoV-2-specific conjugated and capture antibodies, as proteinase K treatment abrogated this phenomenon, and thermal shift assays showed pH-induced conformational changes under conditions promoting artifact formation. Omitting, altering, and reverse engineering the kit buffer all supported the importance of maintaining buffering capacity, ionic strength, and pH for accurate kit function. Interestingly, the Panbio assay could tolerate some extremes of temperature and humidity outside of manufacturer claims. Conclusions: Our data support strict adherence to manufacturer instructions to avoid false positive SARS-CoV-2 Ag-RDT reactions, otherwise resulting in anxiety, overuse of public health resources, and dissemination of misinformation.

Use of the FebriDx point-of-care assay as part of a triage algorithm for medical admissions with possible COVID-19 (preprint)

Background: Patients admitted to hospital with COVID-19 must be rapidly identified and isolated to prevent nosocomial transmission. However, isolation facilities are often limited, and SARS-CoV-2 RT-PCR results are too slow to inform emergency department triage. We evaluated a pragmatic triage algorithm to isolate patients with suspected COVID-19 using simple clinical criteria and the FebriDx assay. Methods: All medical admissions in a large UK hospital were triaged as likely, possible or unlikely COVID-19 based on clinical criteria. Patients triaged as possible COVID-19 underwent FebriDx lateral flow assay on capillary blood, and those who tested MxA positive were isolated. We evaluated the accuracy of the algorithm and the FebriDx assay compared to SARS-CoV-2 RT-PCR from nasopharyngeal swabs as the reference standard. Results: Between 10th August 2020 and 4th November 2020, 136/3,443 medical admissions (4.0%) were diagnosed with RT-PCR confirmed COVID-19. Prevalence of COVID-19 was 45.7% (80/175) in those triaged as likely, 4.1% (50/1,225) in possible and 6/2,033 (0.3%) in unlikely COVID-19. Compared to SARS-CoV-2 RT-PCR, clinical triage had sensitivity of 95.6% (130/136) and specificity of 61.5% (2027/3297), whilst the triage algorithm including FebriDx had sensitivity of 92.6% (126/136) and specificity of 86.4% (2849/3297). The triage algorithm reduced the need for 2,859 patients to be admitted to isolation rooms. The patients missed by the algorithm had mild or asymptomatic COVID-19. Conclusions: A simple triage algorithm including FebriDx assay had good sensitivity and is a useful rule-out for COVID-19. The algorithm is useful for managing medical admissions from the emergency department.