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The COVID-19 pandemic upended college education and the experiences of students due to the rapid and uneven shift to online learning. This study examined the experiences of students with disabilities with online learning, with a consideration of surrounding stressors such as financial pressures. In a mixed method approach, we compared 28 undergraduate students with disabilities (including mental health concerns) to their peers during 2020, to assess differences and similarities in their educational concerns, stress levels, and COVID-19-related adversities. We found that students with disabilities entered the Spring quarter of 2020 with significantly higher concerns about classes going online, and reported more recent negative life events than other students. These differences between the two groups diminished 3 months later with the exception of recent negative life events. For a fuller understanding of students' experiences, we conducted qualitative analysis of open-ended interviews. We examined both positive and negative experiences with online learning among students with disabilities and mental health concerns. We describe how online learning enabled greater access-e.g., reducing the need for travel to campus-alongsideways inwhich online learning impeded academic engagement-e.g., reducing interpersonal interaction. We highlight a need for learning systems to meet the diverse and dynamic needs of students with disabilities.
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This was presented as the Food Systems Theme highlight. Diet related inequalities in the UK food system have been exacerbated by the Covid-19 pandemic, with low-income families experiencing more food insecurity(1) and purchasing less fruit and vegetables(2). To improve access to affordable and nutritious foods, UK supermarkets voluntarily increased weekly 4.25 Healthy Start voucher (HSV) amounts. Notably, one supermarket provided an additional 2 top- up voucher, redeemable against fruit and vegetables (FV) from 15th February - 31st August 2021. Investigating supermarket loyalty card transaction records, this study aimed to assess how increased HSV value affected FV purchases. Loyalty card transaction and redemption records from 150 opted in regular shoppers living in the Yorkshire and the Humber region and engaging in the HSV scheme were analysed. 133 of these shoppers' records were assessed from two equivalent time periods to the scheme in 2019 and 2020 and were analysed using a pre-post study design. The vouchers could be used on four different FV categories, plain fresh and prepared fruit and vegetables, and plain frozen, canned and packaged fruit and vegetables, according to internal definitions. The purchasing patterns of other FV were also analysed. Wilcoxon matched-pairs signed-rank tests were used to compare purchasing behaviour within the scheme period at a basket level, and against pre-scheme periods ata household level. A Spearman's Rho test was used to assess the association between behaviour and level of deprivation around stores. Examining 21,707 transactions from 133 households for 20 months before and during the scheme, showed that 0.8 more portions of FV per day per household were purchased during the scheme period compared to 2019 (pre-pandemic) baseline (2.6 in 2019 to 3.4 in 2021;P = 0.0017). The percentage of total FV weights within total food and drink baskets also increased by 1.6% (P = 0.0242), although the percentage of total FV spend did not change. Within the scheme period, 0.4% (P = 0.0012) and 1.6% (P = 0.0062) more FV was purchased according to price and weight respectively in top-up redeeming baskets compared to baskets with at least one FV item. This finding was associated with 5.5 more FV portions in top-up redeeming baskets during the scheme period (P < 0.0001). There was a higher proportion of top-up redeeming baskets in stores located in more deprived areas (r = -0.3288, P = 0.0373).In conclusion, this study provides novel data into how low-income households shop and how an increased HSV amount is associated with FV purchases. The data show that low-income families purchased more FV when supplied with an additional 2 to their HSV and provides evidence for a benefit to increasing support given to low-income families.
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Purpose: The SARS-CoV-2 pandemic has had a significant impact on the field of solid organ transplant(SOT). Immunization against SARS-CoV-2 is globally available since 2021. SOT recipients represent a vulnerable group with a higher risk of infection and worse outcomes from COVID-19 compared with the general population. There is a concern for the efficacy of SARS-CoV-2 vaccination amongst SOT recipients. We aimed to assess immunogenicity, safety and breakthrough infections after SARS-CoV-2 vaccination. Method(s): We conducted a systematic review and a meta-analysis using articles from 8 databases published from January 1,2020 to July 13,2021. We included studies reporting data regarding SOT and SARS-CoV-2 post vaccine antibody response or cellular response;safety of vaccination;and SARS-CoV-2 infection after at least one vaccine dose. A meta-analysis of postvaccine antibody response and death in breakthrough infections was conducted using a random-effects model. Result(s): Initially, we identified 572 potential studies. After careful review, we included 64 studies for systematic review and 46 studies for meta-analysis. We identified 6,710 SOT recipients. Pooled incidence of antibody positivity after completion of any vaccine schedule was 28.3% (95% confidence interval[CI] 22.5-34.8%). Pooled incidence of antibody positivity after messenger RNA vaccination with 2 doses and 3 doses were 29.3%(95%CI 23.58%-35.74%) and 57.4%(95%CI 48.63-65.78%), respectively. Twelve reports on interferon-gamma response to SARS-CoV-2 spike antigen peptides showed a positivity between 30.4% and 55.0% after messenger RNA vaccines. The most common side effect after vaccination was site pain. Only 5 cases developed rejection but no graft loss. The pooled incidence of death in breakthrough infections was 17.1%(95%CI 10.2%-27.2%). Conclusion(s): Our findings show that only 29% of SOT recipients could mount antibodies after 2 doses of messenger RNA vaccines, with an improved response seen after 3 doses (57%). Even with 3 doses, the immunogenicity is still suboptimal and further studies to investigate the optimal vaccination strategies in this population are needed.
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SESSION TITLE: Close Critical Care Calls SESSION TYPE: Case Reports PRESENTED ON: 10/18/2022 11:15 am - 12:15 pm INTRODUCTION: With the development of resistant organisms, additional therapies are needed to effectively treat patients with severe infections. The Seraph®-100 Microbind Affinity Blood Filter utilizes immobilized heparinized microbeads, acting similar as the human glycocalyx, to bind and remove these substrates. In vitro and pre-clinical studies have shown up to 99% clearance of Enterococcus faecalis exposed to the Seraph®-100 blood filter. This novel extracorporeal blood purification system could assist with infection source control and reduction of vasopressor requirements. CASE PRESENTATION: A 30-year-old male with no significant past medical history was admitted due to severe ARDS secondary to COVID-19 infection and required extracorporeal membrane oxygenation (ECMO) after an unsuccessful trial of conventional supportive therapies. The patient's hospital course was complicated by multiple infections, including bacteremia from methicillin susceptible Staphylococcus aureus, candidemia and Enterobacter ventilator associated pneumonia. These infections initially improved with use of appropriate intravenous antimicrobials. However, the patient experienced an acute hemodynamic decompensation requiring multiple vasoactive medications. He was empirically started on broad spectrum anti-microbials including meropenem, vancomycin, and isavuconazole. Blood cultures revealed Enterococcus faecalis, susceptible to broad-spectrum antibiotics. After 24 hours of broad-spectrum antimicrobials without improvements in vasopressor requirements, the Seraph-100® blood filter was used in-parallel with the ECMO circuit. Immediate improvement in vasopressors was noted with discontinuation of vasopressin and decrease in norepinephrine by 75%. The patient finished a 2-week course of intravenous ampicillin/sulbactam. His respiratory status subsequently improved and he was able to be removed from ECMO 24 days later. DISCUSSION: Initial studies have shown the Seraph-100 is capable of clearing the SARS-Cov-2 virus and use has been associated with decreased mortality in patients with SARS-Cov-2. The ability to remove additional pathogens including bacteria, fungi and viruses would aid in obtaining source control and augment the effects of intravenous antibiotics. This case not only illustrates the benefits with the use of the Seraph ®-100 blood filter along with broad spectrum antibiotics, but also the ability to use this extracorporeal blood purification system in-line with ECMO. CONCLUSIONS: With the emergence of multi-drug resistant pathogens, additional treatment options are urgently needed. The Seraph®-100 may be a useful adjunct to broad spectrum antimicrobials and may improve hemodynamics in patients with vasopressor-dependent septic shock. Further prospective studies are needed to assess clinical improvements with the use of the Seraph-100 Microbind blood filter in patients with bacteremia and those requiring ECMO. Reference #1: Olson SW, Oliver JD, Collen J, et al. Treatment for Severe Coronavirus Disease 2019 With the Seraph 100 Microbind Affinity Blood Filter. Critical Care Explor. 2020;2(8):e0180. Reference #2: Chitty, Stephen, Mobbs, Sarah, Chung, Kevin et al., for the PURIFY INVESTIGATORS. A Multicenter Evaluation of Blood Purification with Seraph 100 Microbind Affinity Blood Filter for the Treatment of Severe COVID-19: A Preliminary Report. medRxiv 2021.04.20.21255810;doi: https://doi.org/10.1101/2021.04.20.21255810 Reference #3: Seffer, Malin-Theres, et al. "Heparin 2.0: a new approach to the infection crisis.” Blood Purification 50.1 (2021): 28-34. DISCLOSURES: No relevant relationships by Joshua Boster No relevant relationships by Henry Danchi Speaker/Speaker's Bureau relationship with Janssen Please note: $1001 - $5000 by Michael Morris, value=Honoraria Speaker/Speaker's Bureau relationship with GSK Please note: $1001 - $5000 by Michael Morris, value=Honoraria Removed 03/29/2022 by Michael Morris No releva t relationships by Mai Nguyen No relevant relationships by Melissa Rosas No relevant relationships by Steven Stoffel No relevant relationships by Robert Walter
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SESSION TITLE: Long COVID: It Can Take Your Breath Away SESSION TYPE: Original Investigations PRESENTED ON: 10/16/2022 10:30 am - 11:30 am PURPOSE: As the novel coronavirus SARS-CoV-2 swept the globe causing COVID-19 infection, a syndrome now known as “long COVID” has been well described in 10-30% of those who have experienced COVID-19. This study hoped to characterize changes in anatomical structure and physiology that may explain the ongoing dyspnea experienced by some individuals affected by the COVID-19 pandemic. METHODS: Patients with a history of symptomatic COVID-19 confirmed by positive PCR or antibody testing, between the age of 18-65, without pre-existing significant cardiopulmonary disease, and currently experiencing ongoing exertional or respiratory symptoms at least 3 months after onset of initial COVID symptoms were enrolled into this study. Each participant underwent standardized testing for underlying cardiopulmonary pathology by performance of a high-resolution chest CT, transthoracic echocardiography, electrocardiogram, full pulmonary function testing with lung volumes and diffusing capacity, impulse oscillometry, and a six minute walk test. RESULTS: To date, 63 patients have enrolled in the study with ongoing completion of study procedures. Of the current patients enrolled, 29 have had a high resolution chest CT completed;16 or 55% had radiographic evidence of pulmonary pathology. Most common were a nodular pattern (38%), mosaic attenuation (34%), residual ground glass opacities (28%), septal thickening (14%). Thirty-six participants performed the six minute walk test with an average walk distance of 1338.9 feet ± 520.4 feet with no participants desaturating below 90%. Pulmonary function testing has been completed in 36 participants with normal mean values. Impulse oscillometry testing performed on 30 individuals revealed mixed results with resistance at 5 Hz (R5) showing no substantive change to bronchodilator with a -14% ± 5%, however the area of reactance showed a potentially significant bronchodilator response with bronchodilator change of -43% ± 41%. CONCLUSIONS: In this interim analysis, we evaluated the radiographic and physiologic changes seen in a group of patients at least three months after symptomatic infection with COVID-19. There were radiographic changes in 50% of patients with a reticulonodular pattern as the most often reported finding. However, this finding did not correlate with PFT or exercise findings in the cohort;few showed significant PFT changes and the 6MWT did not show desaturations or limitation in walking distance. Pulmonary function testing and impulse oscillometry showed no statistically substantive physiologic derangements that might explain the ongoing symptoms of the group evaluated. CLINICAL IMPLICATIONS: Other than radiographic findings, there were no unified findings that could shed further light on the effects of COVID-19 that would predispose an individual to ongoing symptoms. DISCLOSURES: No relevant relationships by Brian Agan no disclosure on file for Timothy Burgess;no disclosure on file for Anuradha Ganesan;No relevant relationships by Stephen Goertzen No relevant relationships by Travis Harrell no disclosure on file for Nikhil Huprikar;No relevant relationships by David Lindholm No relevant relationships by Katrin Mende Speaker/Speaker's Bureau relationship with Janssen Please note: $1001 - $5000 by Michael Morris, value=Honoraria Speaker/Speaker's Bureau relationship with GSK Please note: $1001 - $5000 by Michael Morris, value=Honoraria Removed 03/29/2022 by Michael Morris no disclosure on file for Simon Pollett;no disclosure on file for Julia Rozman;No relevant relationships by Mark Simons No relevant relationships by David Tribble No relevant relationships by Robert Walter
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SESSION TITLE: Lung Cancer Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: The outbreak of the SARS-CoV-2 virus identified a need for healthcare systems to transform in order to accommodate the large volume of patients. As a result, innovative new methods to monitor patients have emerged. One type of innovation are remote patient monitoring (RPM) devices, which allow for home vital sign (VS) measurements and telemonitoring. We present a case utilizing this technology to monitor a middle-aged male with metastatic colon cancer to the lung, who required regular debulking therapy as a means of palliation. CASE PRESENTATION: A 59 year-old male with a history of stage IV colon adenocarcinoma with metastasis to the lungs status post lung wedge resection and radiation therapy 7 years previously was found to have an enlarging left lower lobe (LLL) mass. Fiberoptic bronchoscopy revealed resurgence of his metastasis. While undergoing palliative chemotherapy, the patient became increasingly dyspneic. Serial PET CTs showed evolution of his left lung mass with left upper and lower lobe collapse due to endobronchial disease prompting bronchoscopy with argon plasma coagulation (APC) for tumor debulking within the left mainstem bronchus and dilation of the LLL airways. While the patient's symptoms improved, he became dyspneic over several months, and interval CT scans demonstrated invasion of the left mainstem bronchus with complete collapse of the left lung. Repeat dilation and APC were performed with improvement in symptoms. Due to rapid tumor growth, he was enrolled in the continuous RPM (CRPM) program for 24/7 nursing-led telemonitoring. He completed daily questionnaires on a vendor-provided digital tablet, and his VS, composed of heart rate (HR), respiratory rate (RR), SpO2, and temperature, were automatically uploaded to a network using an FDA-approved wearable device. Intermittent readings using peripheral devices to measure blood pressure and spirometry were gathered. His VS mirrored his tumor progression, indicated by elevation in his mean RR and HR while his SpO2 declined necessitating 2L of oxygen. Further evaluation showed tumor invasion into the left mainstem bronchus and began to invade his right mainstem. Successive APC and cryotherapy were performed every 2-3 months with a total of 8 debulking bronchoscopies. Once his disease progressed to obstruct his entire left mainstem, the patient unenrolled from the CRPM program and enrolled in hospice care. DISCUSSION: Several RPM devices have previously been used, but require self-reported VS rather than automated, continuous oximetry. Our CRPM program was piloted as a means to monitor COVID-19 patients following hospital discharge. However, our patient displayed benefit from his 180 day CRPM enrollment while receiving palliative tumor debulking procedures in order to fulfill his wish to maximize time at home. CONCLUSIONS: RPM devices offer a novel method of monitoring patients outside of healthcare facilities. Reference #1: Gordon WJ, Henderson D, DeSharone A, et al. Remote Patient Monitoring Program for Hospital Discharged COVID-19 Patients. Appl Clin Inform. 2020;11(05). doi:10.1055/s-0040-1721039 Reference #2: O'Carroll O, MacCann R, O'Reilly A, et al. Remote monitoring of oxygen saturation in individuals with COVID-19 pneumonia. Eur Respir J. 2020;56(2). doi:10.1183/13993003.01492-2020 Reference #3: Grutters LA, Majoor KI, Mattern ESK, Hardeman JA, van Swol CFP, Vorselaars ADM. Home telemonitoring makes early hospital discharge of COVID-19 patients possible. J Am Med Informatics Assoc. 2020;27(11). doi:10.1093/jamia/ocaa168 DISCLOSURES: No relevant relationships by Kevin Loudermilk Speaker/Speaker's Bureau relationship with Janssen Please note: $1001 - $5000 by Michael Morris, value=Honoraria Speaker/Speaker's Bureau relationship with GSK Please note: $1001 - $5000 by Michael Morris, value=Honoraria Removed 03/29/2022 by Michael Morris No relevant relationships by Michal Sobieszczyk No relevant relations ips by Robert Walter No relevant relationships by Whittney Warren
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Background. Rapid antigen tests (e.g., Abbott's BinaxNOW) are cheaper and faster than nucleic acid amplification tests (e.g., real-time reverse transcription polymerase chain reaction [RT-PCR]) for SARS-CoV-2 infection, with variable reported sensitivity. A horse racetrack in California experienced a COVID-19 outbreak among staff and used BinaxNOW to supplement RT-PCR. Utility of BinaxNOW in detecting SARS-CoV-2 infection in a workplace outbreak was assessed. Methods. Between November 25-December 22, 2020, anterior nasal swabs were collected from racetrack staff for six rounds of paired BinaxNOW and RT-PCR tests. BinaxNOW tests were interpreted according to manufacturer instructions. RT-PCR was performed at the state public health lab using the ThermoFisher TaqPath COVID-19 Combo Kit. Staff with positive results on either test were isolated and removed from subsequent testing. Viral cultures were attempted on specimens with cycle threshold (Ct) < 30. Results. Overall, 769 paired results from 342 staff were analyzed. Most were of Hispanic ethnicity (62.0%) and ages ranged from 18 to 92 years (median 52). BinaxNOW performance compared to RT-PCR (95% CI) was as follows: positive percent agreement (PPA) 43.3% (34.6%-52.4%);negative percent agreement (NPA) 100% (99.4%-100%);positive predictive value (PPV) 100% (93.5%-100%);negative predictive value 89.9% (87.5%-92.0%). Among 127 RT-PCR-positive specimens, those with paired BinaxNOW-positive results (n = 55) had a lower mean Ct value than those with paired BinaxNOW-negative results (n = 72) (17.8 vs. 28.5) (p < 0.001). In dual positive pairs, median time from specimen collected to RT-PCR result reported was 4 days (range 1-6), compared to the 15-minute BinaxNOW reporting time. Of 100 Ct < 30 specimens, 51 resulted in positive virus isolation, 45 (88.2%) of which were BinaxNOW-positive. Conclusion. High NPA and PPV support immediate isolation of BinaxNOWpositive individuals, while low PPA supports confirmatory testing following BinaxNOW-negative results. BinaxNOW performed better in paired specimens with lower Ct value and positive viral cultures, which could suggest that among RT-PCRpositive specimens, those that are BinaxNOW-negative may be less likely to contain infectious virus than those that are BinaxNOW-positive.
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Background. The Coronavirus disease of 2019 (COVID-19) global health crisis has resulted in an unprecedented strain on healthcare systems, reorganization of medical training programs and disruption in professional and personal lives of medical trainees. The impact of COVID-19 on infectious disease (ID) fellows, who are frontline healthcare professionals, has not been assessed. Methods. We conducted a national survey of adult and pediatric ID fellows to assess impact on educational activities, availability of personal protective equipment (PPE), well-being, and career prospects. Anxiety and burnout were assessed by 7-item generalized anxiety disorder scale and abbreviated Maslach burnout inventory respectively. Invitations to participate in the survey were sent via email to all ID fellows through Accreditation Council for Graduate Medical Education (ACGME) fellowship directors. Survey responses collected from August 1 to September 30, 2020 have been reported. Results. 136 fellows completed the survey (Table 1). 84% reported their institution had provided evidence-based didactics for management of COVID-19 and 53% indicated their general ID didactics were affected by the pandemic. 86% of fellows were involved in care of patients with COVID-19, and 31% reported a shortage of PPE affecting their clinical duties. Those living in highly impacted states (CA, FL, NY, TX) at the time of the survey were 1.70 times as likely to experience moderate to severe anxiety (vs. minimal to moderate) than those in other states;similarly, those who saw ≥11 COVID-19 patients weekly and reported PPE shortages were 2.5 and 2.0 times as likely, respectively, to experience moderate to severe anxiety compared to their peers who took care of 10 or fewer COVID-19 patients and did not experience PPE shortages. Burnout scores were not significant (Table 2). Conclusion. It is imperative that ID fellows feel adequately protected and supported during this pandemic. Pandemic preparedness should be included in the ID fellowship curriculum. Interventions for anxiety and burnout reduction should be implemented. ID fellowship programs should continue to accept feedback from fellows to ensure their ongoing safety, well-being, and education as we navigate this pandemic.
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Background. Solid organ transplantation (SOT) profoundly impacts vulnerable recipients with chronic end organ diseases. The COVID-19 pandemic disrupted healthcare systems, including organ transplants. We aimed to evaluate the responses of SOT centers to COVID-19 at the beginning of the pandemic around the world. Methods. We conducted a web-based survey amongst transplant centers, sent to members of The American Society of Transplantation Infectious Diseases Community of Practice Group, between April and May 2020. The survey included basic information of each transplant center (number and types of transplants in 2019), the countermeasures employed against COVID-19 such as timing of postponing of transplantation, and management of outpatient clinics including implementation of telemedicine and screening for in-person visits. Results. A total of 65 centers from 19 countries responded (Table 1). Regarding the percentage of hospitalized patients with COVID-19 at the time of the survey, 39 (60%) centers reported < 10%, two centers reported > 80%. All centers reduced their services to some extent as shown in Table 2. Centers reported postponing living donor kidney transplant (50/58, 86%), deceased donor kidney transplant (20/57, 35%), living donor liver transplant (32/42, 80%), deceased donor liver transplant (17/41, 41%), lung transplant (20/31, 65%), heart transplant for LVAD (18/33, 55%) and non-LVAD patients (18/33, 55%). In March and April 2020, cancellation of pre- and post- transplant clinics were reported by 36/64 (56%) and 17/65 (26%) centers. Postponing clinic appointments were reported by 56/65 (86%) centers. Most institutions (54/64, 85%) used telemedicine. Screening for COVID-19 for clinic visits was done by telephone, in-person questionnaires and/or temperature checks. Conclusion. During the early phase of the pandemic, when management strategies were highly uncertain, non-urgent and living donor transplants were frequently postponed. Emergent liver transplants continued regardless. These findings could help us navigate SOT in future epidemics. Limitations included a small sample and lack of assessment of clinical outcomes from postponing SOT.
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Background. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been raging since the end of 2019 and has shown worse outcomes in solid organ transplant recipients (SOTR). The clinical differences as well as outcomes between these respiratory viruses have not been well defined in SOTR. Methods. This is a retrospective cohort study of adult SOTR with nasopharyngeal swab or bronchoalveolar lavage PCR positive for either SARS-CoV-2, non-SARSCoV-2 coronavirus, influenza, or respiratory syncytial virus (RSV) from January 2017 to October 2020;both inpatient and outpatient. The follow up period was up to three months. Clinical characteristics and outcomes were evaluated. Development of lower respiratory tract infection (LRTI) was defined as new pulmonary infiltrates with or without symptoms. For statistical analysis, Fischer's exact test and log rank test were performed. Results. During study period, 157 SARS-CoV-2, 72 non-SARS-CoV-2 coronavirus, 100 influenza, 50 RSV infections were identified. Patient characteristics and outcomes are shown in tables 1 and 2, respectively. Secondary infections were not statistically significantly different between SARS-CoV-2 vs. non-SARS-CoV-2 coronavirus and influenza (p=0.25, 0.56) respectively, while it was statistically significant between SARS-CoV-2 and RSV (p=0.0009). Development of LRTI was higher in SARS-CoV-2 when compared to non-SARS-CoV-2 coronavirus (p=0.03), influenza (p=0.0001) and RSV (p=0.003). Admission to ICU was higher with SARS-CoV-2 compared to non-SARS-CoV-2 coronavirus (p=0.01), influenza (p=0.0001) and RSV (p=0.007). SARS-CoV-2 also had higher rates of mechanical ventilation when compared to non-SARS-CoV-2 coronavirus (p=0.01), influenza (p=0.01) and RSV (p=0.03). With time to event analysis, higher mortality with SARS-CoV-2 as compared to non-SARSCoV-2 coronavirus, influenza, and RSV (p=0.01) was shown (Figure 1). Conclusion. We found higher incidence of ICU admission, mechanical ventilation, and mortality among SARS-CoV-2 SOTR vs other respiratory viruses. To validate these results, multicenter study is warranted.
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Computational modeling is an effective tool for studying complex disease. However, solutions to many models are purely mathematical and cannot immediately provide clinical insights. To overcome this barrier, we propose a series of quantitative scoring metrics that can be used in combination with drug-target interaction data to identify solutions that are readily clinically actionable. Furthermore, we introduce methods for the prediction and ranking of pharmaceutical interventions that closely align with these high-scoring solutions, with an emphasis on robustness across multiple solutions. We demonstrate these methods on a previously-described model of COVID-19 induced cytokine storm. These scoring methods ultimately identify multiple pharmaceutical candidates that have been shown to be effective in reducing mortality rates in COVID-19 patients. © 2021 IEEE.
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Introduction: Telemedicine is designed to increase healthcare access and is increasingly used during the COVID-19 pandemic. However, its use among historically vulnerable populations is poorly characterized and may further exacerbate healthcare disparities. We aimed to characterize telemedicine use among a diverse surgical population in the Deep South during the COVID-19 pandemic. Methods: All patients seen in gastrointestinal (GI) surgery clinics at a tertiary care academic center in Alabama were reviewed from March 18, 2020 to September 30, 2020. Demographics including age, race, sex, insurance, date of service, and home ZIP code were recorded. Internet availability according to the FCC and median income of home ZIP codes were recorded. Patients were stratified by clinic visit type (in-person versus telemedicine, and within telemedicine, phone versus video) and compared by socioecological factors. Chi-square and ANOVA tests were performed to compare patient groups and logistic regression was used to predict telemedicine use. Results: Of the 2,580 GI surgery patients seen, 50.5% (n=1,302) were in-person and 49.5% (n=1,278) were via telemedicine, including video (43.4%) and phone (56.6%) visits. Patients were predominantly female (59.3%) and white (62.1%), with private insurance (53.8%) and a mean age of 52.1 years. Patients seen in-person and via telemedicine were similar except patients using telemedicine lived further from the hospital (mean distance 60.6 mi vs 49.6 mi, p<0.001). Living 100 mi or more from the hospital and in a ZIP code with the highest quintile of median income were independent predictors of telemedicine use (OR 1.51, 95% CI 1.16-1.97;OR 1.39, 95% CI 1.04-1.85, respectively). Among patients who used telemedicine, those with phone use were more likely to be Black compared to those with video use (35.3%, vs 29.4%, p=0.043). Patients with phone use were older (mean age = 54.0 yr vs 50.5 yr, p<0.001) and came from ZIP codes with lower median income ($35,618 vs $37,846, p=0.037). They were more likely to have Medicaid (10.7% vs 6.1%) or Medicare (32.1% vs 25.0%) and less likely to be privately insured (50.5% vs 60.2%) compared to patients with video use (p=0.001). Living 100 mi or more from the hospital was an independent predictor of video use (OR 2.27, 95% CI 1.56-3.30). Having Medicaid and age greater than 80 were independent predictors of phone use (OR 0.46, 95% CI 0.29-0.73;OR 0.37, 95% CI 0.16-0.86, respectively). Conclusion: Patients who live further from the hospital are more likely to use telemedicine. Phone visits are used more by patients who are Black, older, from lower income ZIP codes, publicly insured, and live closer to the hospital. Variations in patient telemedicine use exist across a diverse surgical population in the Deep South, suggesting telemedicine be tailored to patient preferences and available resources.
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Background: Telemedicine offers the opportunity to provide clinical services at a distance, thereby bridging geographic and other barriers to medical care. With the need to socially distance during the COVID-19 pandemic, clinical practices rapidly transitioned to telemedicine across the United States. Telemedicine will remain an important component of healthcare delivery but if not utilized in an equitable manner could exacerbate health disparities. To understand usage among medically underserved communities, we investigated acceptability and experiences with telemedicine among people undergoing community-based HCV screening as part of a larger ongoing point-of-diagnosis HCV treatment study (NOW Study). Methods: We performed descriptive and comparative analysis of self-report data about sociodemographic, clinical history, mobile device and internet access, and telemedicine experience and satisfaction information collected at the time of HCV screening between December 2020 and May 2021. Results: Among 92 participants (median age 42 years;75% men;50% non-White;73% with recent injection drug use);55% had reactive HCV antibody and 35% had active HCV. Most (86%) recently used a smartphone, tablet (44%), or laptop (37%) to access the internet (table 1). Many accessed the internet via their cellular network (70%) or relied on public or personal wireless (26%). The majority (74%) were somewhat or very interested in a telemedicine visit. Thirty (33%) had participated in a telemedicine visit (36% video, 33% telephone, 30% both);some (26%) participated prior to the COVID-19 pandemic and all had a visit during the pandemic. All but one participant (97%) described their telemedicine visit as somewhat or extremely helpful, easy (73%), and convenient (67%). Interest for future telemedicine care was higher among those with past experience compared to no experience (93% vs 65%, p=0.003;table 1). Despite general interest in telemedicine, 69% preferred in-person clinic visits when possible. No statistically significant differences emerged in age, race/ethnicity, gender, and HCV status when comparing 1) interested vs. not interested and 2) with vs. without a prior telemedicine visit. Conclusion: Within our population at high-risk for HCV, digital access was high, many had a previous telemedicine experience they found satisfying, and generally high interest in future telemedicine care. Nonetheless, when given the choice, the majority preferred in-person care.
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Purpose: Coronavirus disease 2019 (COVID-19) is associated with increased mortality and morbidity in immunosuppressed patients. Data on management and outcomes in HIV-infected solid organ transplant (SOT) recipients is lacking. Methods: Single center, retrospective case series of HIV-infected SOT recipients who were diagnosed with COVID-19 by nasopharyngeal reverse transcriptasepolymerase chain reaction (RT-PCR) between April to November 2020. All patients had anti-retroviral therapy (ART) induced HIV viral load suppression at diagnosis. Results: Six consecutive patients were identified (Table.1). Four patients required hospitalization;2 were managed outpatient. Four were symptomatic with fever (75%), cough (50%), dyspnea (50%) and diarrhea (25%). An increase in inflammatory markers was seen in all patients, however only 4 (66%) required supplemental oxygen. Median time of follow up was 75 (range, 14-205) days. On diagnosis, first mycophenolate mofetil was discontinued or dose decreased by half. Calcineurin inhibitors and prednisone were continued. In addition, investigational therapies hydroxychloroquine, tocilizumab, remdesivir, dexamethasone were used in 3 (50%), 1 (17%), 1 (17%), 1 (17%), respectively (Table 2). All patients were on protease inhibitor sparing ART. A decrease in CD4 count from baseline was seen at the time of diagnosis which recovered over time. Overall, 5 (83%) survived, 1 (17%) died, 1 (17%) kidney transplant recipient had biopsy-proven acute T-cell mediated rejection 9 days after diagnosis with subsequent graft loss. Secondary infections were diagnosed with positive blood or respiratory cultures in 3 (50%). Death reported was due to septic shock from a secondary infection. Three patients had a negative SARS-CoV-2 RT-PCR at a median of 25 (range, 20-56) days from diagnosis. Conclusions: We report good outcomes in this unique, high risk cohort of HIVinfected SOT recipients. Balancing a decrease in immunosuppression and monitoring graft function to avoid graft loss is extremely important. Further studies are needed to determine the cumulative effect of HIV infection and organ transplant status on the severity of COVID-19.
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Purpose: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been raging since the end of 2019. The clinical differences between non-SARSCoV-2 coronavirus and SARS-CoV-2 in solid organ transplant recipients (SOTR) are not well defined. Methods: This is a case control study of adult SOTR with PCR positive nasopharyngeal sample or bronchoalveolar lavage, for either SARS-CoV-2 or non-SARS-CoV-2 coronavirus, from 1/2017 to 10/2020. Follow up period was up to three months. Secondary infections were diagnosed by culture or viral PCR from a sterile specimen. Clinical outcomes were compared amongst both groups. Results: Seventy-two non-SARS-CoV-2 coronavirus and 129 SARS-CoV-2 infections were identified. Patient's demographic information and outcomes are shown in table 1 and 2 respectively. Secondary infections and ICU admissions were statistically significantly different between both groups, and higher mortality was observed in the SARS-CoV-2 group. With time to event analysis, there was trend to higher mortality with SARS-CoV-2 infection as compared to non-SARS-CoV-2 (p=0.06)(figure). Conclusions: Our study shows SOTR with SARS-CoV-2 infection may have a significant worse outcome as compared to non-SARS-CoV-2. Secondary infection was also common after this respiratory viral infection in both groups.
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Purpose: Solid organ transplant recipients (SOTr) are at high risk for severe disease with SARS-CoV-2. Data on efficacy of potential treatment options and long-term outcomes are lacking. We describe our experience with use of remdesivir and convalescent plasma in SOTr with COVID-19. Methods: Single-center, retrospective cohort study of SOTr diagnosed with SARSCoV- 2 infection by PCR from March 1st to September 30th, 2020. Multivariate logistic regression analysis was performed based on univariate analysis to identify the risk factors for higher mortality. Results: 129 SOTr were identified (Table. 1). Median time from transplant to diagnosis of infection was 27 (IQR, 8-73) months. 48 (37.2%) and 27 (21%) patients received remdesivir and convalescent plasma, respectively (Table 2). 5/48 (10.4%) patients developed mild transaminitis that did not warrant discontinuation of therapy. No adverse effects were seen with convalescent plasma. Anti-metabolite agents were decreased or stopped in majority of the patients (81%). During follow-up, 12 (9%) patients developed clinically suspected acute rejection. Death, graft loss, and secondary infection occurred in 15 (12%), 20 (16%), and 20 (16%) recipients, respectively. RT-PCR negativity was achieved at a median of 37 (IQR, 25-41) days. Risk factors identified for high mortality were elevated creatinine (p=0.029, Odds ratio[OR] 1.5, 95% Confidence Interval[CI] 1.0- 2.1) and older age (p=0.003, OR 1.1, 95% CI 1.0 - 1.2) at the time of diagnosis. Conclusions: SARS-CoV-2 RT-PCR positive SOT recipients in our cohort had favorable outcomes. Use of remdesivir and convalescent plasma was found to be safe. Older age and elevated creatinine at the time of diagnosis were found to be risk factors for higher mortality.
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Purpose: There was a critical need to understand the impact that the COVID-19 pandemic had on our patients awaiting transplantation, including infection rates, morbidity, mortality, and wait list (WL) readiness. Methods: Retrospective single-center study of active kidney and pancreas WL patients. Clinicians called patients using a questionnaire to assess patient status, screen for COVID-19 symptoms and exposures, assess changes to psychosocial demographics, and instruct patients who needed follow-up care. Results: Active waitlist patients as of 4/2020 were contacted (Figure 1). Patients were stratified into 3 groups based on SARS-CoV2 testing: (1) No Test (NT) (n=357), (2) Test Neg (TNeg) (n=39), and (3) Test Pos (TPos) (n=30). Groups were similar at baseline, but differed with respect to ethnicity and diabetes status (Table 1). Black patients had a disproportionately higher rate of testing positive at 40% (n=12), even though as a group they represented 32% of our waitlist. Hispanic patients comprised 26% of the total WL patients, 43% of the COVID-19 positive patients were Hispanic. Diabetics had the highest rate of SARS CoV2 infection (p=0.02). Mortality due to COVID-19 among the WL population was 1.6% (n=7);of note, 2 additional patient deaths were reported to the center before the systematic WL calling process started. Patients who had known exposures to individuals with COVID-19 were more likely to have developed COVID-19 (p=0.001). Of the 30 TPos patients, 53% (n=16) had an exposure to a known COVID-19 infected person. This exposure was shown to be significant (p=0.001) for patients who ultimately tested positive for COVID-19. Symptoms among Tpos patients included fever (86%), body aches (68%), fatigue (64%) and cough (64%). Few patients (1%) reported changes to their social support, transportation access, and insurance coverage. Conclusions: During the COVID-19 pandemic solid organ transplant candidates on the WL represent a vulnerable population as a result of their end stage organ failure, and co-morbid conditions. Our systematic phone call process of WL patients identified a 7% COVID-19 incidence, 1.6% mortality rate due to COVID-19, and a low number of patients experiencing changes to their readiness for transplant. More research is needed to identify trends among the transplant WL population. It is important to uncover any geographic or socioeconomic differences across transplant centers.
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TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: The long-term implications of COVID-19 pneumonia remain under investigation. Many of those that suffered from the illness continue to experience symptoms weeks to months following their initial recovery. We assessed patients with COVID-19 pneumonia who were discharged from the hospital to an outpatient-based continuous remote patient monitoring (CRPM) program. METHODS: Forty hospitalized patients diagnosed with COVID-19 pneumonia between the ages of 28 and 78 were referred to a designated CRPM team for evaluation and enrollment in a remote monitoring pilot program prior to discharge between the dates of December 2020 and April 2021. Enrolled patients were issued an FDA-approved biophysiologic monitoring device, digital tablet for video teleconferencing, and an in-home Wi-Fi/Mobile Data hub following nursing-led training prior to departing the medical facility. The provided equipment was capable of continuous, near-real time monitoring of SpO2, heart rate, respiration rate, surface/axillary temperature, and mobility data;intermittent data was also collected via a linked automatic blood pressure cuff and portable spirometer. Patients were monitored 24 hours, 7 days per week during their enrollment by dedicated tele-health nursing staff and received serial automated prompts to perform blood pressure assessments and spirometry using the included equipment. Initial and final pulse oximetry and spirometric data was reviewed, consisting of forced vital capacity (FVC), forced expiratory volume at one second (FEV1), FEV1/FVC ratio. Patients were disenrolled from the program in the following circumstances: the patient was readmitted to the hospital, the patient chose to disenroll themselves, or the supervising physician determined the patient to be stable for ≥ 72 hours. RESULTS: Forty patients enrolled in the pilot program. Twenty-seven of these patients completed initial and final spirometry and pulse oximetry prior to program discharge. Total days of enrollment were on average 31 ± 25 days. Initial pulse oximetric data returned with a mean of 95 ± 1.6%. Of note, 13 of the 27 patients required supplemental oxygen following hospital discharge. Initial spirometric data for these individuals returned with mean values for FVC (L) of 1.77 ± 0.82, FEV1(L) of 1.22 ± 0.47, and FEV1/FVC of 75 ± 20%. Prior to program disenrollment, mean pulse oximetry was measured at 97 ± 1.9% with only 2 of the 27 patients continuing to require oxygen. Final spirometric data returned with mean values for FVC (L) of 2.61 ± 1.16, FEV1(L) of 1.89 ± 0.72, and FEV1/FVC of 78 ± 19%. CONCLUSIONS: This study evaluated early and late home-tested spirometry and pulse oximetry in patients with COVID-19 pneumonia discharged from the hospital to a CRPM pilot program. Nearly half of the patients (48%) required supplemental oxygen at the time of discharge with only 7.4% requiring oxygen once discharged from the pilot program. Spirometric data indicated an increase of 47.5% in FVC, an increase of 55% for FEV1, an increase of 4.1% in FEV1/FVC between initial and final testing. Correlation with in-lab spirometry testing and percent predicted values will aid in determining the accuracy of the deficits identified on home testing. CLINICAL IMPLICATIONS: This study provides insight into the rate of lung function recovery in hospitalized COVID-19 pneumonia patients, and introduces a novel method to closely monitor recovering patients on an outpatient-basis. DISCLOSURES: No relevant relationships by Sean Hipp, source=Web Response No relevant relationships by Theresa Kinshella, source=Web Response No relevant relationships by Kevin Loudermilk, source=Web Response Speaker/Speaker's Bureau relationship with Janssen Please note: $1001 - $5000 Added 12/02/2020 by Michael Morris, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with GSK Please note: $1001 - $5000 Added 12/02/2020 by Michael Morris, source=Web Response, value=Honoraria No relevant relationships by Caitlin Smith, ource=Web Response No relevant relationships by Robert Walter, source=Web Response No relevant relationships by Daniel Yourk, source=Web Response