ABSTRACT
Background. Growing clinical evidence in adults has demonstrated use of COVID monoclonal antibody (mAB) therapy results in a reduction of hospitalization and/or emergency room (ER) visits with the greatest benefit following early administration. While the FDA has authorized use of mAB therapy in children ages 12-17 years, clinical outcomes in this population have yet to be described. This study aims to assess the pediatric clinical experience in a low social economic setting. Methods. Retrospective study conducted among children and adolescents who tested positive for SARS-CoV-2 from 12/1/2020 to 6/1/2021, met ≥ 1 eligibility criterion based on pre-determined institutional guidelines. Individuals were identified by patient-level data linked to pharmacy and medical claims with ICD-10 codes for COVID-19. Electronic medical records were reviewed for demographic characteristics, comorbidities, time to receipt of mAB therapy from positive test, adverse effects, and clinical outcomes. Primary clinical end point was hospitalization and/or medical visit at 28 days. Descriptive summary statistics were used for the entire cohort. Results. Overall, 17 met eligibility criteria. Thirteen patients with a mean age of 16 years, received casirivimab and imdevimab mAB therapy: 4 declined treatment. Among the treated patients, 61.5% (n=8) were male, 38.6% (n=5) Hispanic/Latino;38.6% (n=5) non-Hispanic Black;7.7% (n=1) White. Seven out of 12 had a BMI ≥ 95th% for gender and age. Eight patients (61.5%) met ≥ 1 criteria with obesity (n=8) as the most common factor followed by immunocompromised state (n=6, 46.2%) tied with neurodevelopmental disorder (n=6, 46.2%). Median time from positive test to mAB therapy was 2 days [IQR:1-3]. One patient had a severe adverse event. Overall, none required hospitalization/ER visit with COVID like symptoms. Demographics and Results Table The table describes the pediatric patients and clinical outcome of receiving monoclonal antibody treatment for COVID-19. Conclusion. Though limited by numbers, our findings may suggest a role of mAB therapy in children and adolescents in our setting. With increasing rates of SARSCoV-2 in this age group coupled with vaccine hesitancy, mAB therapy may serve as an important outpatient intervention with a need for further studies to assess clinical benefit and establish optimal, cost-effective, practice guidelines for these highly vulnerable patients.
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ABSTRACT
Due to the threat of COVID-19 pandemic, personal protection equipment (PPE) has raised lots of attentions to protect people from infection. This unprecedented virus can be spread through airborne, respiratory droplets and social contact. Although there are some devices and PPEs for people who are conscious and able to obey the social distance policy, to protect infants is still challenging. Baby is one of the vulnerable groups to the disease but there is no appropriate PPE when baby needs to be exposed to irresistible events like visiting a hospital, receiving vaccination or being accompanied by parents who come home from work). In this study, a concept of smart baby protective tent is developed. The simple hardware offers a quick assembly using PVC pipes, 3D-printed joints and a transparent cover sheet to create an independent and safe space from direct and indirect infection through breathing or saliva. With two additional parts, the smart baby protective tent can thereby provide clear air circulation and modern care. A fan system equipped with a clamp for a disposable medical-certified mask is applied to supply clean and circulated air for the babies. Functional sensors are attached to detect essential signals like body temperature, environment temperature, humidity, vibration, brightness, sound, CO2, and PM 2.5. These received signals are processed via a micro-controller and can be uploaded to personal social media in order to increase caregivers' awareness of the babies' situation inside the tent.
ABSTRACT
Background: Since the start of the pandemic there has been limited data on mortality in people living with HIV (PLWH) who have Coronavirus Disease 2019 (COVID-19) in the United States (US). We conducted a retrospective review to investigate potential risk factors associated with survival and need for medical ventilation for PLWH and COVID-19. Methods: This is a retrospective observational cohort from a large academic center across three campuses, conducted from January 1, 2020 to April 30, 2020. Thirty day readmissions were observed from January 1, 2020 to May 31, 2020. Our patients were identified by an ICD-10 code (B20) corresponding to HIV and positive SARSCoV- 2 PCR test. As a primary endpoint, we compared survivors vs. non-survivors. As a secondary endpoint, we compared patients who needed mechanical ventilator (MV) vs. those who did not need MV. Results: Seventy two PLWH (28 female patients (39%), median [IQR] age was 62 [-/+16] years) had positive SARS-CoV-2 PCR tests during this retrospective review. Median CD4+ count was 235 cells/ul and 11 (15%) had an HIV viral load >200 copies/ mL. The median length of stay was 5 days and 6 patients were directly discharged from the emergency department. Ten patients were readmitted within 30 days with SARSCoV- 2 - like symptoms and 2 are still inpatient. Twenty patients (27.8%) have expired. All non-survivors that expired had an undetectable HIV viral load (0%, p=0.02). The 11 patients with unsuppressed HIV viral loads at the start of the study period all survived, p=0.02. Non-survivors were more likely to have chronic kidney disease CKD (p< 0.01) acute kidney injury (p< 0.01), higher absolute neutrophils (p< 0.01), and elevated IL-6 levels (p< 0.01) compared to survivors. Fifteen patients (20.8%) required mechanical ventilation (MV), 3 (4.1%) of those patients survived. Patients that required MV were more likely to be male (p=0.01) obese (p< 0.01) and had higher absolute neutrophil counts (p=0.01) versus those that did not need MV. Patients with lower CD4 counts (< 200 cells/uL) did not require more mechanical ventilation (p=0.04). Conclusion: PLWH who had COVID-19 had a high mortality rate. Since all the patients who died had an undetectable HIV viral load across CD4 counts, our study suggests that patients with uncontrolled HIV are not at an increased risk of mortality.