Prolonged Viable Viral Shedding in Immunocompromised Patients with Covid-19

Background: Immunocompromised patients with COVID-19 tend to shed viable virus for a prolonged period. Therefore, for moderately or severely immunocompromised patients with COVID-19, CDC recommends an isolation period of at least 20 days and ending isolation in conjunction with serial testing and consultation with an infectious disease specialist. However, data on viral kinetics and risk factors for prolonged viral shedding in these patients are limited. Method(s): From February 1, 2022 to April 1, 2022, we collected weekly saliva samples from immunocompromised patients with COVID-19 admitted to a tertiary hospital in Seoul, South Korea. Genomic and subgenomic RNAs were measured, and virus culture was performed. Result(s): A total of 41 patients were enrolled;29 (70%) were receiving chemotherapy against hematologic malignancies and the remaining 12 (30%) had undergone solid organ transplantation. Of the 41 patients, 14 (34%) had received 3 doses or more of COVID-19 vaccines. Real-time RT-PCR revealed that 7 (17%) were infected with Omicron BA.1, and 33 (80%) with Omicron BA.2. The median duration of viable virus shedding was 4 weeks (IQR 3-6). Patients undergoing B-cell depleting therapy shed viable virus for longer than the comparator (p=0.01). Multivariable analysis showed that 3-dose or more vaccination (HR 0.33, 95% CI 0.12 - 0.93, p = 0.04) and B-cell depleting therapy (HR 12.50, 95% CI 2.44 - 100.00, p = 0.003) independently affected viable virus shedding of SARS-CoV-2. Conclusion(s): Immunocompromised patients with COVID-19 shed viable virus for median 4 weeks. B-cell depleting therapy increases the risk of prolonged viable viral shedding, while completion of a primary vaccine series reduces this risk. Overall distribution of samples according to genomic viral copy number and culture positivity. Red dot indicates positive culture results, whereas blue dot indicated negative culture results. (Figure Presented).

Misinformation and the Paradox of Trust during the covid-19 pandemic in the U.S.: pathways to Risk perception and compliance behaviors

As declared "infodemic” by the World Health Organization, the proliferation of Covid-19 misinformation has posed a significant challenge to public health efforts to tackle the pandemic. Despite initial evidence on the association between misinformation and behavior, researchers have yet to fully identify intervening variables to account for the behavioral effects of Covid-19 misinformation. To address this question, this study aims to examine whether and how consuming misinformation would predict public trust in health and political institutions, and in turn, shape risk perception and adherence to preventive behaviors. We conducted a web-based survey using a nationally representative sample of 1,400 U.S. adults in October 2020. We found that Covid-19 misinformation exposure was linked to lower trust in public health experts but higher trust in government, which led to a decrease in the perceived severity of Covid-19 and less compliance with public health guidance. Our findings uncover the complex social and psychological processes by which misinformation consumption undermines public health efforts during the pandemic crisis. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

How does a Rational Agent Act in an Epidemic?

The evolution of a disease in a large population is a function of the top-down policy measures from a centralized planner and the self-interested decisions (to be socially active) of individual agents in a large heterogeneous population. This paper is concerned with understanding the latter based on a mean-field type optimal control model. Specifically, the model is used to investigate the role of partial information on an agent's decision-making and study the impact of such decisions by a large number of agents on the spread of the virus in the population. The motivation comes from the presymptomatic and asymptomatic spread of the COVID-19 virus, where an agent unwittingly spreads the virus. We show that even in a setting with fully rational agents, limited information on the viral state can result in epidemic growth. © 2022 IEEE.

Effect of androgen receptor directed therapy in prostate cancer patients with COVID-19

Background: TMPRSS2 is one of the two key enzymes that SARS-CoV-2 requires for its entry to the cell. TMPRSS2 is regulated by androgen receptor. It is well described Androgen Receptor Directed Therapy (ARDT) downregulates the expression of TMPRSS2. We hypothesized that the ARDT has a protective role in patients with prostate cancer (PCa) from poor outcome of COVID-19. Methods: A retrospective chart review of PCa patients with COVID-19 between March to October 2020 in the Yale-New Haven Health System was performed. Demographics, comorbidities, home medications, laboratory data, treatment, and clinical outcomes of COVID-19 were collected. ARDT was defined as the use of GnRH agonist, GnRH antagonist, or androgen receptor antagonist. This study was reviewed and approved by the Institutional Review Boards of Yale University. Results: A total of 146 (1.1%) prostate cancer cases were identified from the 13,642 cases of COVID-19. The clinical characteristics are summarized in the table. Twenty-five (17%) were on active ARDT and 121 (83%) not on ARDT (non-ARDT). The rates of hospitalization were the same: 52%, between the ARDT and non-ARDT group. Of those admitted, mean duration of hospitalization were 9.2 days (Range 1-25) and 14.9 days (Range: 2-47) in ARDT and non-ARDT groups, respectively (p=0.14). Rates of hospital stay >30 days were 0% versus 14.3% (9/63) in ARDT and non-ARDT groups, respectively (p=0.15). Intubation rates were 0% versus 11% (7/63) for ARDT and non-ARDT groups, respectively (p=0.21). Mortality rates were 8% and 13.2%, in ARDT and non-ARDT groups, respectively (p=0.47). Conclusions: The prevalence of PCa was infrequent. Despite advanced stage of the cancer in ARDT group, there was a trend toward decreased severity of COVID-19 and mortality rates compared to non-ARDT group.

Heart Disease, Advanced Age, Minority Race, and Hispanic Ethnicity Are Associated With Mortality in COVID-19 Patients

BACKGROUND: The objective of this study was to determine the associations between heart disease, obesity, and demographic factors and increased COVID-19 mortality. METHODS: We extracted deidentified patient-level data from the Froedtert Health System and Children's Hospital of Wisconsin and used descriptive statistics and multivariable logistic regression to characterize relationships between heart disease, obesity, age group, sex, race and ethnicity and mortality following COVID-19 diagnosis. RESULTS: We found heart disease (adjusted odds ratio [AOR] 2.85;95% CI, 2.11-8.83) and other demographic factors are significant predictors of increased mortality in COVID-19 patients. However, obesity was not a significant predictor of mortality (AOR 1.04;95% CI, 0.53- 3.10). DISCUSSION: These unique results indicate some comorbid conditions and patient demographics contribute more strongly to mortality in COVID-19 patients.

Reliability Assessment of Telemedicine Data by Analyzing Photoplethysmography with Deep Neural Network Technology

Photoplethysmography (PPG) is often used in telemedicine because it enables convenient measurement and provides data related to cardiopulmonary function. However PPG is difficult analyze using an automated algorithm because of its vulnerability to motion artefacts and the diversity of the waveforms according to the characteristics of individuals and diseases. Recently, as the use of telemedicine has become more frequent due to the outbreak of COVID19, the application of deep neural network (DNN) technology in the analysis of PPG and selection of reliable data has increased. In this study, PPG was analyzed using DNN techniques to reproduce the long-term potential (LTP) phenomenon in the brain. Moreover, the reliability of measuring saturation pulse oxymetry (SPO2) simultaneously was evaluated using the LTP-DNN. The LTP-DNN was able to evaluate faultless data by inspecting 58 PPG datasets, including 29 fault data, and could determine the possibility of failure in SPO2 measurement as well. Even in a moving situation, the LTP-DNN provides more accurate heartrate (HR) measurements than commercial SPO2 devices do. It can also be used to normalize the PPG waveform to identify waveform differences between individuals.

Inhibition of SARS-CoV-2 Virus Entry by the Crude Polysaccharides of Seaweeds and Abalone Viscera In Vitro

Much attention is being devoted to the potential of marine sulfated polysaccharides as antiviral agents in preventing COVID-19. In this study, sulfated fucoidan and crude polysaccharides, extracted from six seaweed species (Undaria pinnatifida sporophyll, Laminaria japonica, Hizikia fusiforme, Sargassum horneri, Codium fragile, Porphyra tenera) and Haliotis discus hannai (abalone viscera), were screened for their inhibitory activity against SARS-CoV-2 virus entry. Most of them showed significant antiviral activities at an IC50 of 12~289 mug/mL against SARS-CoV-2 pseudovirus in HEK293/ACE2, except for P. tenera (IC50 > 1000 mug/mL). The crude polysaccharide of S. horneri showed the strongest antiviral activity, with an IC50 of 12 mug/mL, to prevent COVID-19 entry, and abalone viscera and H. fusiforme could also inhibit SARS-CoV-2 infection with an IC50 of 33 mug/mL and 47 mug/mL, respectively. The common properties of these crude polysaccharides, which have strong antiviral activity, are high molecular weight (>800 kDa), high total carbohydrate (62.7~99.1%), high fucose content (37.3~66.2%), and highly branched polysaccharides. These results indicated that the crude polysaccharides from seaweeds and abalone viscera can effectively inhibit SARS-CoV-2 entry.

Impact of National Lockdown for Sars-Cov-2 Pandemic on Incident Tuberculosis and Transmission

Introduction The nationwide lockdown for COVID-19 and ongoing mitigation measures are having a significant impact on healthcare delivery for other disease including tuberculosis (TB). Leicester has faced a particularly prolonged period of disruption after imposition of local lockdown measures within 7 weeks of the national lockdown. Objectives To evaluate the impact of the national lockdown and post-lockdown periods on tuberculosis presentation and transmission in Leicester, UK. Methods We performed retrospective analysis of all notified tuberculosis cases and their contacts comparing the pre-lockdown period (January 2019-March 2020) with lockdown and post-lockdown periods (April-Sept 2020). AFB smear status, Xpert DNA load, culture status, time to culture positivity, CXR severity scores, hospital admission rate and proportion of screened contacts identified with latent tuberculosis infection (LTBI) were reviewed. Data was extracted from hospital systems. Statistical analyses used SPSS (v.26). Results 307 index cases (146 pulmonary) and 460 family contacts of pulmonary TB were included for analysis. Overall, TB incidence in 2020 has been lower than 2019 (144 vs. 129 cases from Jan-Sept). There has been a marked fall in cases during the lockdown with no comparable rebound increase Introduction The nationwide lockdown for COVID-19 and ongoing mitigation measures are having a significant impact on healthcare delivery for other disease including tuberculosis (TB). Leicester has faced a particularly prolonged period of disruption after imposition of local lockdown measures within 7 weeks of the national lockdown. Objectives To evaluate the impact of the national lockdown and post-lockdown periods on tuberculosis presentation and transmission in Leicester, UK. Methods We performed retrospective analysis of all notified tuberculosis cases and their contacts comparing the pre-lockdown period (January 2019-March 2020) with lockdown and post-lockdown periods (April-Sept 2020). AFB smear status, Xpert DNA load, culture status, time to culture positivity, CXR severity scores, hospital admission rate and proportion of screened contacts identified with latent tuberculosis infection (LTBI) were reviewed. Data was extracted from hospital systems. Statistical analyses used SPSS (v.26). Results 307 index cases (146 pulmonary) and 460 family contacts of pulmonary TB were included for analysis. Overall, TB incidence in 2020 has been lower than 2019 (144 vs. 129 cases from Jan-Sept). There has been a marked fall in cases during the lockdown with no comparable rebound increase.

Environmental contamination in the isolation rooms of COVID-19 patients with severe pneumonia requiring mechanical ventilation or high-flow oxygen therapy.

BACKGROUND: Identifying the extent of environmental contamination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is essential for infection control and prevention. The extent of environmental contamination has not been fully investigated in the context of severe coronavirus disease (COVID-19) patients. AIM: To investigate environmental SARS-CoV-2 contamination in the isolation rooms of severe COVID-19 patients requiring mechanical ventilation or high-flow oxygen therapy. METHODS: Environmental swab samples and air samples were collected from the isolation rooms of three COVID-19 patients with severe pneumonia. Patients 1 and 2 received mechanical ventilation with a closed suction system, while patient 3 received high-flow oxygen therapy and non-invasive ventilation. Real-time reverse transcription-polymerase chain reaction (rRT-PCR) was used to detect SARS-CoV-2; viral cultures were performed for samples not negative on rRT-PCR. FINDINGS: Of the 48 swab samples collected in the rooms of patients 1 and 2, only samples from the outside surfaces of the endotracheal tubes tested positive for SARS-CoV-2 by rRT-PCR. However, in patient 3's room, 13 of the 28 environmental samples (fomites, fixed structures, and ventilation exit on the ceiling) showed positive results. Air samples were negative for SARS-CoV-2. Viable viruses were identified on the surface of the endotracheal tube of patient 1 and seven sites in patient 3's room. CONCLUSION: Environmental contamination of SARS-CoV-2 may be a route of viral transmission. However, it might be minimized when patients receive mechanical ventilation with a closed suction system. These findings can provide evidence for guidelines for the safe use of personal protective equipment.