ABSTRACT
Background. Children <=5 years of age have the highest rates of pneumococcal colonization and play an important role in the spread of pneumococcus. Our objective was to determine whether the public health measures (physical distancing, masking, and shelter-in-place orders) implemented to slow the spread of SARS-CoV-2 pandemic had an impact on pneumococcal colonization rates among children aged <=5 years with and without respiratory symptoms during the first year of SARS-CoV-2 pandemic (4/1/20 to 3/31/21). Methods. This is a single center retrospective cohort study. The study period was divided in 3 four-month periods to represent the initial period of strict adherence to public health measures (period 1: Apr-Jul), relaxation of some of these measures (period 2: Aug-Nov) and Northern hemisphere winter season (period 3: Dec-Mar). We used salvaged mid-turbinate samples obtained as part of routine care from patients without respiratory symptoms but screened for SARS-CoV-2 prior to surgery or aerosol generating procedures (asymptomatic) or from patients with respiratory symptoms tested for SARS-CoV-2 and/or other respiratory viruses (symptomatic). Samples were evaluated for pneumococcal colonization by real-time PCR using CDC lytA primers. Sample size was calculated based on the assumption of lower colonization rates in period 1 and gradual increase (10-15%) in the following study periods. Results. A total of 311 patients were included (185 asymptomatic and 126 symptomatic). Demographics, SARS-CoV-2 PCR and pneumococcal colonization results are shown in Table 1. Pneumococcal colonization rates for asymptomatic and symptomatic children were 14% and 22% (p=0.06), respectively. The odds of colonization of asymptomatic children were similar during period 2 (OR 0.96 [95%CI 0.34-2.67]) and period 3 (OR 0.53 [95%CI 0.17-1.62]), using period 1 as reference and after adjusting for age, sex, and SARS-COV-2 results. The odds of colonization of symptomatic children were also similar across the 3 study periods (period 2 OR 1.28 [95%CI 0.41-4.01] and period 3 OR 0.73 [95% CI 0.24-2.18]). Table 1. Characteristics of asymptomatic and symptomatic groups Conclusion. Pneumococcal colonization rates were not significantly impacted by public health measures implemented during the first year of the SARS-CoV-2 pandemic and did not correlate with SARS-CoV-2 positivity.
ABSTRACT
Background: Delays in acute care for diabetic ketoacidosis, appendicitis and malignancy resulted in more severe initial presentations for these problems during the COVID-19 pandemic. It is unknown whether the pandemic also caused delays in care for more common problems such as pediatric acute otitis media (AOM). Delays in presentation for AOM may have secondarily resulted in decreased delayed prescribing or watchful waiting (WW). We hypothesized that there was a greater time to presentation for AOM in 2020 (during the pandemic) with an increased percentage of patients presenting outside of the delayed antibiotic prescribing window compared to those who presented in 2019 (pre-pandemic). Methods: This is a retrospective secondary analysis of data collected for a national quality improvement project across 24 institutions with freestanding pediatric urgent care sites conducted in calendar years 2019 and 2020. 2020 data collection began after the pandemic was declared in the US. We included all submitted records with a diagnosis of AOM. Records were excluded if they had a codiagnosis for which an antibiotic is almost always required. The primary outcome compared the median time to presentation measured in days between 2019 and 2020 using the Wilcoxon rank-sum test. Pearson's chi-square test was used to compare categorical factors between 2019 and 2020. Results: Our analysis included 1,983 and 402 encounters diagnosed with AOM in 2019 and 2020. There was no significant difference in time to presentation for AOM between 2019 and 2020 (p=0.761). Similarly, the rate of delayed antibiotic prescriptions for eligible encounters was not different (p=0.419). Among patients without associated fever, the median time to presentation was shorter in 2019 compared to 2020, (2 days vs 3 days, p=0.02). However, when fever was present, the directionality was changed (3 days in 2019 and 2 days in 2020 p=0.04). Conclusion: Despite a growing body of evidence of delayed pediatric care during the COVID-19 pandemic, there was no difference in time to presentation, albeit many fewer diagnoses, for AOM in a national pediatric urgent care database. Both time periods had a median time to presentation of 2 days;however, children with fever had a shorter time to presentation during the pandemic. Only a small percentage of AOM encounters were eligible for delayed antibiotics due to presentation after 2 days of symptoms.
ABSTRACT
INTRODUCTION AND OBJECTIVE: Natural and humancaused disasters, such as the COVID-19 pandemic, often have bigger negative effects on health status and healthcare access of racial/ethnic minority patients. The purpose of this study was two-fold, to assess if 1) a longer surgical wait time (SWT, ≥ 90 days) affects renal cell carcinoma (RCC) tumor characteristics at nephrectomy and 2) race/ethnicity was associated with a longer SWT and upstaging in the pre-COVID-19 pandemic time with focus on Hispanic Americans (HAs) and Native Americans (NAs) who have heavier burden of RCC in Arizona. METHODS: Medical records of patients diagnosed with RCC who underwent nephrectomy between 2010 and 2020 (through March, before the COIVD-19 pandemic worsened) at Banner-University Medical Center Tucson were reviewed (n=489). Patients with a prior cancer diagnosis were excluded. SWT was defined as the date of diagnostic imaging examination (e.g., CT and MRI) to date of nephrectomy. Logistic regression analysis was performed to assess if race/ethnicity was associated with longer SWT or upstaging. RESULTS: A total of 393 patients were included, 34.2% and 8.3% of patients were HAs and NAs respectively. While 49.2% of HA patients had a longer SWT, only 36.1% of non-Hispanic White (NHW) patients had a longer SWT. Longer SWT did not have a significant impact on tumor characteristics. Tumor size increased (≥ 2cm) in 9.9% of patients with a longer SWT, while 8.9% of patients with a shorter SWT had increased tumor size. Pathologic upstaging was seen in 26.4% and 25.7% of patients with longer and shorter SWT, respectively. Patients with public insurance coverage had increased odds of longer SWT (OR, 2.89;95% CI: 1.53-5.45). Public insurance coverage was higher among HAs and NAs, representing 66.1% and 70.0% of coverage compared to 56.7% in NHWs. Compared to NHWs, HAs had significantly increased odds of a longer SWT in patients with early-stage RCC (TNM Stage I or II) (OR 2.38, 95% CI: 1.25-4.53). HAs and NAs had increased odds of upstaging (OR 2.24, 95% CI: 1.07-4.66 for HAs and OR 3.79, 95% CI: 1.32-10.88 for NAs). Among patients with <90 days of SWT, HAs had significantly increased odds of upstaging (OR 4.19, 95% C.I.: 1.47-12.48), but not among patients with ≥90 days of SWT (OR 0.97, 95% C.I.: 0.26-3.64). CONCLUSIONS: While delay in surgical care for early-stage RCC is safe in a general population, it may negatively impact high risk populations, such as HAs who may choose an active surveillance of small kidney mass.