Prolonged respiratory viral infection associated with presence of coinfections in an urban birth cohort

Background. Prolonged infection by respiratory viruses has been reported, especially in hospitalized or immunocompromised children. However, little is known of factors contributing to prolonged respiratory viral infection, particularly in asymptomatic and less severe infections. We examined characteristics associated with prolonged viral infection in a community-based birth cohort. Methods. The PREVAIL cohort is a CDC-sponsored two-year birth cohort in Cincinnati, Ohio conducted during 4/2017 to 8/2020. Mid-turbinate nasal swabs were collected weekly from children and tested using the Luminex Respiratory Pathogen Panel. The primary outcome was prolonged viral infection, which was defined as a viral nucleic acid detection lasting 4 or more weeks. Proportions of prolonged viral infections were compared using Fisher's exact test with Holms corrections. Adjusted odds ratios (aOR) and 95% confidence intervals were calculated using a mixed effects logistic regression model while controlling for within-subject clustering, viral species, child age, child sex, symptom status, and coinfection. This analysis was limited to subjects who provided at least 70% of weekly samples. Results. Among 101 children, providing 7871 child-weeks of follow-up, we identified 780 viral infections. The median duration of infection across all respiratory viruses was 1 week, except for bocavirus and coronavirus NL63, each with 2 weeks;40% of bocavirus and >10% of adenovirus, coronavirus NL63, RSV A, human metapneumovirus, and parainfluenza 1 infections were associated with prolonged infection (>4 weeks). No prolonged infections were detected for influenza A or B, coronavirus 229E or HKU1, or parainfluenza 2 or 4 infections. Viral coinfection (aOR=3.1, 95% CI 1.9, 5.0) and female sex (aOR 1.8, 95%CI 1.1, 2.9) were significantly associated with prolonged infection, while symptom status and child age were not. Conclusion. In the PREVAIL cohort, detection of respiratory viruses lasting 4 weeks or longer was common for certain respiratory pathogens and was especially prolonged for bocavirus. Biological factors such as the presence of additional viral infections or child sex may affect the likelihood of prolonged infection. (Figure Presented).

Prevention and early treatment of the long-term physical effects of COVID-19 in adults: design of a randomised controlled trial of resistance exercise-CISCO-21.

BACKGROUND: Coronavirus disease-19 (COVID-19) infection causes persistent health problems such as breathlessness, chest pain and fatigue, and therapies for the prevention and early treatment of post-COVID-19 syndromes are needed. Accordingly, we are investigating the effect of a resistance exercise intervention on exercise capacity and health status following COVID-19 infection. METHODS: A two-arm randomised, controlled clinical trial including 220 adults with a diagnosis of COVID-19 in the preceding 6 months. Participants will be classified according to clinical presentation: Group A, not hospitalised due to COVID but persisting symptoms for at least 4 weeks leading to medical review; Group B, discharged after an admission for COVID and with persistent symptoms for at least 4 weeks; or Group C, convalescing in hospital after an admission for COVID. Participants will be randomised to usual care or usual care plus a personalised and pragmatic resistance exercise intervention for 12 weeks. The primary outcome is the incremental shuttle walks test (ISWT) 3 months after randomisation with secondary outcomes including spirometry, grip strength, short performance physical battery (SPPB), frailty status, contacts with healthcare professionals, hospitalisation and questionnaires assessing health-related quality of life, physical activity, fatigue and dyspnoea. DISCUSSION: Ethical approval has been granted by the National Health Service (NHS) West of Scotland Research Ethics Committee (REC) (reference: GN20CA537) and recruitment is ongoing. Trial findings will be disseminated through patient and public forums, scientific conferences and journals. TRIAL REGISTRATION: ClinicialTrials.gov NCT04900961 . Prospectively registered on 25 May 2021.

IMPROVING ACCESS TO CALL BELLS: LESSONS FROM THE PANDEMIC

Introduction Call bells are a simple safety measure linked to prevention of falls. The National Audit of Inpatient falls 2017 highlighted that access to call bells was highly variable across trusts and recommended regular auditing. The national average of access to call bells was 81%. The winter covid pandemic posed a significant burden on staffing levels due to absence and redeployment. Experienced nursing staff are essential to maintaining good quality care to elderly patients. Method We conducted an audit of access to call bells on a geriatric ward in December 2020 (mid-pandemic) compared to April 2021 (post-pandemic). Patients receiving 1:1 or cohort nursing care were not included. Result A total of 40 patients were audited. Mean age mid-pandemic was 88.7 compared to 86.4 post-pandemic. The average frailty score was 5.4 and 5.5 respectively. 47.4% of patients mid-pandemic had a documented dementia or delirium, versus 28.6% post-pandemic. The percentage of patients with access to a call bell mid-pandemic was 42.1% compared to 85.7% post-pandemic, a statistically significant difference (χ2 = 8.3, P = 0.004). Relative risk of call bell unavailability was 4.1 times greater in the December cohort than in April (RR 4.1, 95% CI 1.3–12.4). Staffing was reported to be below expected levels in December 2020 with not all nurses/HCAs having experience in geriatric care compared to expected staffing levels of experienced ward staff in April 2021. Conclusion Access of call bells to elderly patients remains a simple intervention in preventing inpatient falls. In light of the threat of new covid variants and future winter pressures we remain hopeful that the importance of adequate levels of experienced nursing staff for our elderly population is not underestimated. We are currently implementing a ‘5 moments for call bell access’ quality improvement project and recommend further auditing across departments within the Trust.

TCT CONNECT-215 Demographics and In-Hospital Outcomes of COVID-19 Patients Undergoing an Invasive Strategy for Acute Coronary Syndrome: The Global Multi-Centre Prospective COVID-ACS Registry

Background: The demographics, angiographic findings, and in-hospital outcomes of coronavirus disease-2019 (COVID-19) – positive patients undergoing an invasive strategy for suspected acute coronary syndromes (ACS) are not well defined. COVID-19–positive ACS patients may have different etiology and outcomes. Patient presentation times from small sample published data appear longer. Methods: Anonymized data on 234 patients in 81 global centers are presented from this prospective registry for the period March 1, 2020, to May 31, 2020. As of submission date, a further 84 patients have been submitted. All were required to be COVID-19–positive (or have a high index of clinical suspicion, i.e., clinical status plus chest x ray/computed tomography scan findings) and to undergo coronary angiography for suspected ACS. Results: Results are shown in Tables 1–3 and compared with National United Kingdom British Cardiovascular Intervention Society/Myocardial Ischaemia National Audit Project databases of non–COVID-19 ACS patients where available and appropriate. Major findings were: significantly higher proportion of COVID-19–positive patients had hypertension, hyperlipidemia, and renal dysfunction. In the ST-segment elevation myocardial infarction (STEMI) subgroup, symptom-to-door time was >double and door-to-balloon increased by median 20 minutes. Mortality was quadruple and in-patient stay double in this group. Similarly, mortality was significantly higher in non-STEMI COVID-19–positive cohort and in-patient stay also double. The high mortality may be due to the high incidence of cardiogenic shock (13.4% vs. 5%), with its 67% mortality. [Formula presented] Conclusion: These novel data indicate that COVID-19–positive ACS patients present later, have higher incidence of cardiogenic shock, and much higher mortality, which are likely to be inter-related. In-patient stay is prolonged compared to non–COVID-19 ACS. Categories: CORONARY: Acute Coronary Syndromes