SEVERE MYOCARDITIS WITH CARDIOGENIC SHOCK IN ADULT-ONSET STILL'S DISEASE AFTER mRNA COVID-19 VACCINATION: A CASE OF ATYPICAL PRESENTATION

Background/Aims Adult-onset Still's disease is a systemic inflammatory disease of unknown aetiology. Post-COVID-19 vaccine adult-onset Still's disease has been reported and was associated with only mild myocarditis. Here we report the first case of adult-onset Still's disease after mRNA COVID-19 vaccination presenting with severe myocarditis with acute heart failure and cardiogenic shock. Methods We described the case history of the patient. Results A 72-year-old Chinese woman developed gradual onset of fever, shortness of breath, sore throat, generalised arthralgia, malaise and poor appetite 15 days after receiving the first dose of BNT162b2 mRNA COVID-19 vaccine. Physical examination revealed fever, bilateral ankle oedema and elevated jugular venous pressure. Significant investigation results are shown in Table 1. Extensive viral panel tests (including enterovirus, influenza and cytomegalovirus) were all negative. Echocardiography showed severely reduced left ventricular ejection fraction of 20%. The acute heart failure was complicated by cardiogenic shock requiring intensive care unit admission. Myocarditis was later diagnosed. Although the heart condition subsequently improved, there were persistent fever and arthralgia, as well as the development of generalised maculopapular skin rash. In view of that, series of investigations were performed, which revealed persistent neutrophilic leucocytosis, hyper-ferritinaemia and liver function derangement, while autoimmune panel was grossly unremarkable and septic/viral workup was negative (Table 1). Contrast PET-CT scan showed no features of malignancy. Adult-onset Still's disease was diagnosed, and the patient was treated with oral prednisolone 40mg daily. The patient's condition responded to the treatment;the fever subsided and the leucocyte count and inflammatory markers were normalised, and she was subsequently discharged. Three months after discharge, the patient was clinically well with prednisolone tapered down to 5mg daily. Reassessment echocardiogram showed full recovery with LVEF 60%. Conclusion Severe myocarditis with acute heart failure and cardiogenic shock is a possible initial presentation of adult-onset Still's disease after mRNA COVID-19 vaccination. After exclusion of more common aetiologies, it is important to consider adult-onset Still's disease as one of the differential diagnoses in the presence of compatible features following COVID-19 vaccination, such that appropriate and timely workup and treatment can be offered. (Table Presented).

Chronic spontaneous urticaria in Hong Kong: Clinical characteristics, real-world practice and implications for COVID-19 vaccination

Background: The real-world management and clinical characteristics of chronic spontaneous urticaria (CSU) in Hong Kong, and its implications for COVID-19 vaccination are unknown. We investigated the patient characteristics, effectiveness of an immunologist-led Urticaria Clinic, and the impact of CSU on COVID-19 vaccine uptake in Hong Kong. Method(s): Longitudinal clinical data of 257 CSU patients attending our immunologist-led Urticaria Clinic were analysed. Result(s): Most patients had experienced wheals (98.8%) and 65.4% had angioedema. 1.2% of CSU patients had angioedema without wheals. Two-thirds (66.5%) received inappropriate treatment prior to immunologist review. A significant proportion of patients had concomitant autoimmunity (14.8%) and history of suspected drug allergy (9.7%) respectively. Weekly Urticaria Activity Score (UAS7) was significantly lower after immunologist review (12.0 vs 0.00, p < 0.001). The change in UAS7 was significantly greater among patients with baseline UAS7 >=16 (-24.0 vs -2.00, p < 0.001);and, among those with uncontrolled disease despite second-line treatment, with access to omalizumab and/or ciclosporin (-26.0 vs -3.50, p < 0.001). Majority of patients received at least one (68.5%) and two doses (65.0%) of COVID-19 vaccine respectively. History of suspected drug allergy was associated with lower COVID-19 vaccine uptake (odds ratio: 0.47, p = 0.010). Conclusion(s): CSU patients in Hong Kong have unique clinical characteristics and a considerable proportion had received inappropriate treatment before immunologist review. An immunologist-led Urticaria Clinic was effective in CSU management. COVID-19 vaccination rates were lower than the general population in Hong Kong, and a history of suspected drug allergy was associated with lower COVID-19 vaccine uptake.

Labor force participation during COVID-19 and risk of depression: a Danish register study.

BACKGROUND: COVID-19 caused economic insecurity for businesses and their employees. Understanding effects of changes in labor force participation on depression risk during economic recession is fundamental for early diagnosis. The study evaluates if changes in labor force participation are associated with depression risk during COVID-19 in Denmark. METHODS: A register-based longitudinal study of Danes aged 25-67 years without depression 2 years prior to baseline defined as February 2020. An eight-level categorical variable on stable or changing labor force participation was defined from monthly employment percentage gradients in the Danish Register-based Evaluation and Marginalization Database from February 2020. The cohort was followed until 31 December 2020 for depressions overall and mild-, moderate- and severe depression. Sex-stratified cox regression models with hazard ratios (HR) and 95% confidence intervals (95% CI) were performed accounting for important confounders. RESULTS: In total, 1 619 240 (50.3%) men of mean age 45.6 years and 1 598 587 (49.7%) women of mean age 45.9 years were included. Becoming unemployed implied an increased HR of depression in men (HR 2.02; 95% CI 1.94-2.10) and women (2.19; 2.12-2.26) compared to a steady-state full-time employment. Being outside the labor force or employed part-time implied an elevated HR in men (3.02; 2.82-3.23 and 2.41; 2.35-2.48) and women (3.13; 2.30-3.31 and 2.30; 2.26-2.35), respectively, compared to a steady-state full-time employment. CONCLUSIONS: Changes in labor force participation were associated with higher risk of depression relative to a steady-state full-time employment particularly among individuals with low labor force participation during COVID-19.

Risk of body weight changes among Danish children and adolescents during the COVID-19 pandemic.

BACKGROUND: Knowledge of COVID-19 and the pandemic's effects on Danish children's body weight is limited. OBJECTIVE: Objectives were to investigate (I) risk of weight changes among Danish children with and without SARS-CoV-2, (II) associations between weight changes, psychological symptoms, and long COVID symptoms, and (III) weight distribution pre- and post-pandemic. METHODS: A national survey was administered to all Danish children aged 0-18 years, with prior COVID-19 (cases) and matched references including questions on weight, weight changes during the pandemic and long COVID-related symptoms. Descriptive statistics and logistic regression were used. Weight distribution was compared with a pre-pandemic database. RESULTS: In all, 17 627 cases and 54 656 references were included. The 4-18-year-old cases had lower odds of unintended weight gain. The 2-3-year-old cases had higher odds and the 15-18-year-old cases lower odds of weight loss compared to references. Regardless of COVID-19 status, any reported long COVID-related symptom was associated with a change in body weight. No sign of increasing obesity rates was found among Danish children post-pandemic. CONCLUSION: COVID-19 was associated with higher odds of weight loss in 2-3-year-olds and lower odds of unintended weight gain in 4-18-year-olds. Any long COVID-related symptom was associated with higher odds of weight changes regardless of COVID-19 status.

Factors related to COVID-19 vaccine hesitancy in Denmark: A national study in the autumn of 2021.

AIMS: The novelty of the COVID-19 pandemic and fast-developed vaccines may increase concerns about the safety and effectiveness of the COVID-19 vaccine and thereby influence vaccine hesitancy. The aims of this study were to examine (a) the main reasons for COVID-19 vaccine hesitancy and (b) factors associated with COVID-19 vaccine hesitancy. METHODS: A nationwide survey was conducted in the autumn of 2021 when most Danes had received at least one dose of a COVID-19 vaccine. The sample (N=13,570) was based on a random selection of individuals (⩾15 years), and data were collected via self-administered mailed questionnaires (digital and physical). The participants were asked whether they had been vaccinated against COVID-19, and if they had not, they were asked about their reasons for vaccine hesitancy. Logistic regression models were used to determine factors associated with vaccine hesitancy. RESULTS: In all, 5,384 (39.7%) individuals completed the questionnaire. The main reasons for vaccine hesitancy were worries about adverse effects (57.6%) and the belief that natural immunity is better than vaccination (43.8%). Factors associated with vaccine hesitancy included female sex, younger age, being divorced, a country of origin other than Denmark, lower educational level, being unemployed, previously infected with COVID-19 and being worried to a greater extent about oneself and others getting infected. Mental health indicators were not associated with vaccine hesitancy. CONCLUSIONS: COVID-19 vaccine hesitancy is likely to pose a challenge for population immunity. To reduce vaccine hesitancy and increase vaccination uptake, future vaccination programmes should focus on specific socio-demographic subgroups identified in this study.

COVID-19 outbreaks in residential care homes in Hong Kong and effectiveness of vaccine against severe outcomes

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A Social Needs Screening Tool Facilitates Reduced Length of Stay and Total Encounter Cost for Surgical Patients

Introduction &Objective: Prolonged length of stay (LOS) after surgery has been shown to worsen patient recovery and utilize health system resources unnecessarily. Logistical and social support barriers to optimizing surgical care have been under-examined. The primary objective of this study was to implement a social needs screening tool amongst patients undergoing urologic surgical care and measure its impact on length of stay and total direct cost. Method(s): This was a single institution prospective cohort study where a social needs screening tool was applied to patients undergoing elective surgery in seven surgical departments (Urology, Ophthalmology, OHNS, Vascular, Neurosurgery, Orthopedics, and Plastics) from July 1, 2020 to June 30, 2021. Social needs screening was conducted by a staff member via phone or electronic messaging after surgery was scheduled. Patient ability to obtain mandatory COVID testing, transportation to and from the hospital for surgery, availability of a post-operative caregiver, and current mood were queried during screening. Referral to Social Work Services was conducted if the patient reported a resource deficiency. LOS and total direct cost were collected for each encounter and compared to a historical control cohort of patients from the same departments from January 1, 2019 to February 28, 2020 that did not undergo social needs screening. Result(s): 3284 patients were screen-eligible during the study period and were compared to 3360 control encounters. Of the screened patients, 190 screened positive and required social work support. There were no significant differences in age, gender, and race between the screened and control cohorts. Screen-positive patients were more likely to reside in a county outside of the greater San Francisco Bay Area and more likely to have government insurance as their primary payor (p < 0.05). Median and average LOS was lower in the intervention (1, 2.67 days) compared to the control cohort (2, 3.58 days). Median and average direct cost was lower in the intervention ($11,661;$20,406) compared to the control ($18,193;$30,084) cohort. Conclusion(s): The implementation of a social needs screening tool to proactively address logistical barriers to care reduces LOS and total direct cost for surgical patients, optimizing comprehensive healthcare delivery.

Differences in Physical and Mental Health of Older Adults over the Covid-19 Pandemic from Face-to-Face versus Hybrid Methods

Background/Purpose: As a result of the COVID-19 pandemic, changes in data collection methods have been introduced in research to ensure continuity despite physical distancing and lockdown restrictions. Our objective was to compare differences in physical and mental health of older adults participating in falls research using data collection methods pre-covid-19 pandemic (face-to-face) and during the pandemic (hybrid). Method(s): Individuals aged 60 years and over with at least one fall in the past 12 months, and controls with no history of falls in the past 12 months were recruited. Pre-pandemic, individuals were interviewed face-to-face exclusively, those interviews after the start of the pandemic were conducted virtually with physical assessments conducted face-to-face to minimize physical contact. Cognitive status, physical performance, psychological status, quality of life, physical activity, and social participation were measured. Result(s): Of the 145 participants of similar socio-demographic backgrounds, 69 were interviewed face-to-face, while 76 were assessed using a hybrid method. Differences were observed in presence of fall characteristics, with fewer fallers seeing a doctor and more fallers attending the emergency department after the start of the pandemic. After adjustment for baseline differences, participants interviewed using hybrid status had lower depression scores (OR (95%CI)=0.29(0.14-0.61)) and stress scores (OR(95%CI)=0.33(0.15-0.72)), but greater fear of falling (OR(95%CI)=2.16(1.04-4.48)) and reduced social participation (OR(95%CI)=2.64(1.20-5.79)). Conclusion(s): Alterations in data collection methods to overcome pandemic restrictions should take into consideration potential differences in individuals who agree to participate as well as the influence of major life events on the psychological status of participants. Copyright © 2022, Full Universe Integrated Marketing Limited. All rights reserved.

PLEOMORPHIC CARCINOMA IN THE MIDST OF COVID

SESSION TITLE: Pathology Identifying Chest Infections Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Pleomorphic carcinoma is a subtype of sarcomatoid carcinomas that represents <1 % of all primary lung neoplasms. This case highlights a recent diagnosis of a patient with pleomorphic carcinoma in the midst of COVID-19 pneumonia. CASE PRESENTATION: A 75 year old female with a 180-pack year smoking history presented to the emergency department with dyspnea and chest discomfort. Vital signs significant for oxygen saturation at 93% on room air. The patient had been admitted to the hospital 7 months prior for acute hypoxemic respiratory failure due to COVID-19 pneumonia. At that point, computed tomography (CT) of the chest showed a right lower lobe 5.5 cm juxtapleural lesion measuring fluid attenuation by Hounsfield units without intralesional enhancement. The lesion was initially thought to be secondary to the patient's COVID-19 pneumonia and was not investigated further. The patient was subsequently lost to follow up. Seven months later the patient presented with worsening shortness of breath. Chest CT revealed large right complex pleural effusion with near complete lung collapse. The patient underwent pigtail catheter placement with partial re-expansion of the lung. Pleural fluid analysis showed an exudative effusion with no malignant cells on cytology. Follow-up CT imaging showed a large mass-like area in the right mid and lower hemithorax. Video assisted thorascopic surgery (VATS) decortication and thoracotomy revealed a right lower lobe abscess and empyema. Pathology samples collected during procedure showed malignant cells of sarcamatoid features found in right lung and intraparenchymal lymph nodes. Histology and immunostaining showed a tumor composed of a component of poorly differentiated adenocarcinoma and more than 10% spindle/pleomorphic cells. Immunostaining showed the poorly differentiated adenocarcinoma component was positive for moc 31, Ber-EP4, cytokeratin AE1/AE3, CAM 5.2, lack TTF-1 and p40. The spindle/pleomorphic component was negative for cytokeratins. DISCUSSION: Pulmonary pleomorphic carcinoma (PC) is a rare, poorly differentiated non-small cell lung cancer (NSCLC) that contains at least 10% spindle and/or giant cells or a carcinoma consisting only of spindle and giant cells. PC has poor response to conventional treatments for NSCLC and subsequently poor 5 year survival. It more common in men and smokers. COVID-19 causes a variety of pulmonary radiographic manifestations, including nodules and mass-like consolidations. Superimposed bacterial infections are also common. Our case, however, highlights the importance of serial radiographic monitoring and, when indicated, tissue sampling to rule out alternative explanations for abnormal CT findings. CONCLUSIONS: Appropriate screening and careful follow up of suspicious lung lesions is vital to ensure prompt diagnosis and treatment of lung malignancy. Reference #1: WHO Classification of Tumours Editorial Board. Thoracic Tumours. In: WHO Classification of Tumours,Earke 5th ed, IARC Publications, 2021. Vol 5. Reference #2: Ito K, Oizumi S, Fukumoto S, Harada M, Ishida T, Fujita Y, Harada T, Kojima T, Yokouchi H, Nishimura M;Hokkaido Lung Cancer Clinical Study Group. Clinical characteristics of pleomorphic carcinoma of the lung. Lung Cancer. 2010 May;68(2):204-10. doi: 10.1016/j.lungcan.2009.06.002. Epub 2009 Jul 3. PMID: 19577320. Reference #3: Maneenil K, Xue Z, Liu M, Boland J, Wu F, Stoddard SM, Molina J, Yang P. Sarcomatoid Carcinoma of the Lung: The Mayo Clinic Experience in 127 Patients. Clin Lung Cancer. 2018 May;19(3):e323-e333. doi: 10.1016/j.cllc.2017.12.008. Epub 2017 Dec 21. PMID: 29454534. DISCLOSURES: No relevant relationships by Rachel Earle No relevant relationships by Samantha Gillenwater No relevant relationships by Miquel Gonzalez No relevant relationships by Sikandar Khan No relevant relationships by Christopher Lau no disclosure submitted for Jinesh Mehta;

TELEMEDICINE IN POST-CIED CARE

Background: Previously, all patients post-CIED implant returned to the clinic to have wound assessment, reinforce device knowledge, and confirm remote connectivity. This did not offer any tailored options for patient follow-up. Narrative: At the onset of COVID-19, wound checks post-CIED implants were changed from in person visits to telemedicine. For the few patients who had wound healing/hematoma issues identified, the patient was asked to come to clinic for further assessment. The objective of the telemedicine visit was to assess incision healing post-CIED implant. The visit also allowed the provider to ensure remote connectivity and review expectations for establishing routine device follow up. Many patients preferred the convenience of the telemedicine as it reduced travel cost and hassle of getting to the clinic, making it a more time efficient visit. For those who scheduled for a telemedicine visit, expectations of the video visit is set at the time of discharge. We need to ask the patient if they are willing to take off the Steri-Strips at time of the telemedicine visit and send them home with the needed supplies for the telemedicine visit. If patient declined removing the Steri-Strips, they were instructed to let the bandage gradually come off. They were then instructed to notify clinic for any concerning signs/symptoms. Challenges with the video quality, at times, necessitated higher quality photos to be taken and sent in for better assessment of incision site. We identified specific patients, ie, patients taking anticoagulation medication or those who had a higher risk of infection, benefitted from an in clinic visit to allow a more accurate assessment of the pocket and incision line. Therefore, those patients were required to return to clinic. Conclusion: What started out as a pandemic necessity, expanded the opportunities for telemedicine assessments to evaluate wound healing and to provide education through a telemedicine format.

THE COVID-19 PANDEMIC AND MENTAL HEALTH: EFFECTS OF SOCIAL SUPPORT AND SELF-REGULATION

Social support has been widely associated with various morbidity and mortality. How does social support availability help youths cope with the global pandemic of Covid-19 and maintain their mental well-being? Utilizing data from a UK national birth cohort, namely the Millennium Cohort Study, this research investigated the joint role of social support availability and self-regulation against such major life stressors, inclusding G × E mechanisms. Results from 4095 cohort members (399 males (47.20%) and 2602 females (63.54%), others refused to report) suggested that social support availability at the outburst of Covid-19 pandemic, as well as age 7 emotional self-regulation (rated by cohort members' parents) contributes to youths' better mental health (viz., mental well-being and non-specific psychological distress) shortly after the outburst of Covid-19 (;B;s > 0.072, ps < .018). Most importantly, age 7 cognitive self-regulation and social support availability jointly predicted better their well-being 4 months later after the local outbursts of pandemic (for mental well-being, B = 0.309, p = .017, 95% CI = [0.056, 0.562];and for non-specific psychological distress, B =-0.299, p = .043, 95% CI = [-0.587,-0.011]). Johnson-Neyman plots (false discovery rate limited) suggested that it was those high but not low in cognitive self-regulation that benefited more from the perceived social support availability. Within the ranges of significance (81.19% for mental well-being and 80.94% for non-specific psychological well-being), social support availability positively predicted mental health and such effect increased gradually as the increase of age 7 cognitive self-regulation. Findings filled in the research gap such that social support and self-regulation have been investigated separately as two coping mechanisms, by revealing that self-regulation (i.e., internal resources) determines the utility of social support availability (i.e., external resources). Findings here inspired new research questions for the field, such as whether relevant developmental trajectories of self-regulation and social support might intertwin to cast on health trajectories, and whether these processes are subject to potential G × E interactions such as the exposure to childhood adversity or relevant genetic risks. Models to examine these hypotheses will be discussed.

Reducing Emergency Department Use for Ambulatory Oncology Patients Requiring Palliative Care: A Quality Improvement Initiative

Background/aims: At the Odette Cancer Centre in Toronto, Canada, almost 1 in 5 ambulatory palliative oncology patients presents to our local Emergency Department (ED) every month. Of these visits, approximately 50% are potentially avoidable as they result in a direct discharge home, or in an acute care admission of < 48 hours. For a palliative cancer patient, ED visits are frustrating, costly and are considered an indicator of poor-quality end-of-life care. To improve end-of-life care for this vulnerable population, reducing ED visits is imperative. Methods: We conducted an interrupted time series following the Model for Improvement with an aim to reduce the monthly ED visit rate for the patients of our oncology palliative care clinic by 20% over 1 year. A patient-informed root cause analysis was performed to guide the implementation of a bundle of three change concepts: (1) improving patients' after-hours access to hospital and home care (2) increasing video virtual visits;and (3) enabling early identification of caregiver burnout. Results: Monthly ED visit rates declined by 24% (p < 0.001) with evidence of sustained improvement. The percentage of ED visits that resulted in a hospital admission of < 48 hours remained unchanged. Fidelity was attained by the interventions associated with the first change concept. Conclusions: Improving patients' after-hours access to hospital and home care was associated with a clinically and statistically significant reduction in ED visits. This is the first study in the palliative oncology population to implement patient-informed interventions to reduce ED use. The study occurred during the COVID-19 pandemic which constitutes a significant confounding factor. Continued evaluation post-pandemic will serve to better understand ongoing trends in ED use.

ONLINE PROMOTION OF PUBLIC HEALTH

The need for competency-based training for the public health workforce is well recognised and documented. In the promotion of public health and associated community initiatives, a sound knowledge base is an essential and irreplaceable requirement apart from the experience of the professionals, and to some extend that of the public members. Traditional mode of learning is gradually substituted by a blended learning model of face-to-face and online methods. This is a natural adoption arising from the fast development and population-wide use of the information technology. The need for online learning is often also due to human and financial resource limitations, and now more substantially with the COVID-19 pandemic affecting the entire world. An effective distance education programme and training model for public health practitioners includes a standardised process for development, review, evaluation and continuous quality improvement, and should address topics related to regulatory responsibilities of public health practitioners, e.g. compliance with codes and regulations governing housing, food safety, water supplies, waste management, etc., public health surveillance, case investigation, disease prevention, health promotion and emergency preparedness. Online learning is equally applicable to continuing education for the practitioners. In the community, social network technologies have become part of health education, campaigns and wider public health promotion because social support, peer pressure and information sharing in online communities affect health behaviours. Moreover, mobile health monitoring of patients with chronic diseases in the community is becoming a daily e-application with home monitoring and wearable devices. Even the elderly is learning about health and other disciplines from the e-platform such as MOOCs to keep their connectivity with the society. The chapter reviews the extent and scope of the application of online learning in the promotion of public health among the practitioners and in the community both internationally and locally. It also proposed the ways for maximisation of community engagement and further development. © 2022 selection and editorial matter, Ben Y.F. Fong and Martin C.S. Wong;individual chapters, the contributors.

Evaluation of Rapid Antigen Detection Kits for Detection of SARS-CoV-2 B.1.1.529

Background Currently, there is a lack of studies evaluating rapid antigen detection (RAD) kits to detect SARS-CoV-2 B.1.1.529. Objective To evaluate the analytical sensitivity of seven RAD kits to detect SARS-CoV-2 B.1.1.529. Study design The analytical sensitivity was determined by means of limit of detection (LOD). A dilution set using a respiratory specimen collected from a COVID-19 patient infected with SARS-CoV-2 B.1.1.529 was prepared. RT-PCR was used as a reference method. Results The LOD results showed that all seven RAD kits had comparable analytical sensitivity for detection of SARS-CoV-2 B.1.1.529. Conclusions The RAD kits selected in the current study may be used for first-line screening of the recently emerged SARS-CoV-2 B.1.1.529.

Rapid antigen test during a COVID-19 outbreak in a private hospital in Hong Kong.

INTRODUCTION: In response to two nosocomial clusters of coronavirus disease 2019 (COVID-19) in our hospital, we adopted a series of strict infection control measures, including regular rapid antigen test (RAT) screening for high-risk patients, visitors, and healthcare workers. We evaluated the diagnostic performance of a locally developed RAT, the INDICAID COVID-19 Rapid Antigen Test (Phase Scientific, Hong Kong), using respiratory samples from both symptomatic and asymptomatic individuals. METHODS: Real-time reverse-transcription polymerase chain reaction (rRT-PCR)-confirmed deep throat saliva (DTS) and pooled nasopharyngeal swab and throat swab (NPS/TS) samples collected from 1 November to 30 November 2020 were tested by INDICAID. Screening RATs were performed on asymptomatic healthcare workers during a 16-week period (1 December 2020 to 22 March 2021). RESULTS: In total, 20 rRT-PCR-confirmed samples (16 DTS, four pooled NPS/TS) were available for RAT. Using the original sample, RAT results were positive in 17/20 samples, indicating 85% sensitivity (95% confidence interval [CI]=62.11%-96.79%). Negative RAT results were associated with higher cycle threshold (Ct) values. For samples with Ct values <25, the sensitivity was 100%. Of the 49 801 RATs collected from healthcare workers, 33 false positives and one rRT-PCR-confirmed case were detected. The overall specificity was 99.93% (95% CI=99.91%-99.95%). The positive and negative predictive values were 2.94% (95% CI=2.11%-4.09%) and 100%, respectively. CONCLUSION: The INDICAID COVID-19 RAT demonstrated good sensitivity for specimens with high viral loads and satisfactory specificity for low-risk, asymptomatic healthcare workers.

Prevalence of COVID-19 Amongst Arizona First Responders

COVID-19 continues to be a major public health crisis in the United States and around the world. In the state of Arizona alone there have been over 887,000 cases, and 17,779 deaths reported since the pandemic first began. First responders, including firefighters, law enforcement officers, and emergency medical services personnel, are in continuous contact with the public and are therefore believed to be at high risk for COVID-19. A retrospective study analyzing COVID-19 antigen positivity rates among first responders in the Phoenix metropolitan area between December 27, 2020 and February 6, 2021 was conducted. A total of 201 first responders received COVID-19 antigen testing and a total of 45 tested positive yielding a 22.4% positivity rate. Positivity rates among firefighters were equivalent to, or above, the rate of the general public in both Phoenix and Arizona. Continued vigilance is required to ensure the safety of first responders during this continued pandemic. © 2021, Springer Nature Switzerland AG.

Performance of the Roche/Snibe electrochemiluminescent anti-SARS-COV-2 spike assays compared to the Roche/Abbott IgG nucleocapsid and Abbott IgM spike assays.

INTRODUCTION: We evaluated the Roche Elecsys Anti-SARS-CoV-2 and Snibe SARS-CoV-2 S-RBD IgG spike chemiluminescent immunoassays and compared them to existing Roche/Abbott nucleocapsid and Abbott IgM spike assays. METHODS: We enrolled 184 SARS-CoV-2 RT-PCR positive samples and 215 controls (172 pre-pandemic, and 43 cross-reactivity) to evaluate the Roche spike antibody (anti-SARS-CoV-2-S) assay. For the Snibe evaluation, we included 119 RT-PCR positive samples and 249 controls (200 pre-pandemice, 49 cross-reactivity). 98 cases had been tested on three spike assays (Roche total antibody, Snibe IgG and Abbott IgM). RESULTS: The Roche anti-SARS-CoV-2-S assay had a CV of 0.5% (0.82U/mL) and 2.3% (8.72U/mL) and was linear from 1.16 to 240U/mL. The Snibe assay was linear from 6.43 to 77.7AU/mL, CV of 5.5% (0.43AU/mL) and 8.8% (0.18AU/mL). The Snibe spike assay was significantly more sensitive than the Abbott IgG assay at 0-6 days POS (35.2% vs 3.6%, mean difference 29.6%, 95% CI 17.5 to 41.8, p < 0.0001). Optimized LORs significantly improved the sensitivity of the Roche spike (48.1%-56.7%) and both nucleocapsid assays (Roche 43.3%-65.5%, Abbott 3.6%-18.5%) in early disease. CONCLUSION: Although both spike assays showed higher sensitivity than their nucleocapsid counterparts, lower, optimized LORs provided the most significant improvements to sensitivity.