ABSTRACT
The crew of USS Kidd experienced a COVID-19 outbreak identified in April 2020. This is the earliest documented COVID-19 study with RT-PCR, serology, and pre-exposure test data on the entirety of the exposed population (n=333). Case definitions included 121 confirmed (36.3% of crewmembers) and 18 probable (5.4% of crewmembers) based on laboratory diagnostic test results. At the time of testing positive, 62 (44.6%) cases reported no symptoms. Hispanic ethnicity (AOR: 2.71, CI: 1.40-5.25) and non-smoker status (AOR: 2.28, CI: 1.26-4.12) were identified as statistically significant risk factors. This study highlights the value of rapid, onboard diagnostic testing to quickly identify an outbreak and enumerate cases, as well as the serological testing to flag potential cases missed with standard viral case identification methodologies.
ABSTRACT
Historically, patients requiring mechanical ventilation support were precluded from lung transplant listing, attributable to increased short and long-term mortality. We present a case of successful bilateral lung transplant for a patient supported with mechanical ventilation for 10 months following an episode of COVID associated ARDS with resultant fibrosis. Our patient is a 65-year-old man with chronic respiratory failure secondary to COVID-19 associated ARDS and pulmonary fibrosis. He initially presented with acute hypoxic respiratory failure requiring intubation and later cannulation for VV-ECMO, which lasted 136 days. Due to severe critical illness myopathy, he remained ventilator dependent via tracheostomy and required a gastrostomy tube for nutrition. His course was further complicated by recurrent ventilator associated pneumonia (VAP) due to Pseudomonas Aeruginosa (PsA) and Stenotrophomonas Maltophilia as well as acute venous thromboembolism. Subsequently, the patient was transferred to our hospital for a lung transplant evaluation following persistent ventilator dependence for a total of nine months since his initial hospitalization. The primary barrier towards transplant listing was the patient's severe deconditioning and myopathy. Our patient underwent aggressive physical therapy, and by the time of listing, he was able to bear weight and walk three feet with physical therapy. The patient underwent bilateral lung transplant six days after listing. His course was complicated by ventilator associated pneumonia due to multi-drug resistant PsA. He required prolonged mechanical ventilator support post-operatively, but his tracheostomy was successfully decannulated on POD 38. He was discharged to an inpatient rehabilitation facility on post-op day 42 and discharged home around POD 70. He continues to follow-up and reports doing well with stable spirometry with no evidence of allograft rejection. This report describes the successful transplantation of a ventilator dependent patient for 10 months with associated severe myopathy. Despite our patient's high-risk status and severe myopathy, he demonstrated good rehabilitation potential with resulting good outcome post-transplantation. He is currently 19 months post-transplant, and his course has been uncomplicated since discharge. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
Background. Risk of infection with SARS-CoV-2 has remained high among health care personnel (HCP) throughout the pandemic, due to both exposure in the community and occupational settings. While vaccine uptake among health care workers is high, real-world continual monitoring of vaccine effectiveness (VE) among this population is crucial for informing future vaccination and prevention efforts. Methods. Data for this analysis came from a test-negative case-control study conducted among HCP working at two acute care hospitals in Monroe County, NY from December 2020 through March 2022, performed as part of the CDC Emerging Infections Program. Case participants were identified as HCP who had at least one COVID-19 like symptom, and a positive polymerase-chain-reaction (PCR) SARS-CoV-2 test during the study time period. Control participants had a negative SARS-CoV-2 PCR test, regardless of presence of COVID-19 like symptoms. Cases and controls were matched based on the study week of their test date. Conditional logistic regression was used to assess vaccine effectiveness against symptomatic infection. Effectiveness was assessed between December 2020-May 2021, May 2021-October 2021, and October 2021-March 2022. Results. From December 28th, 2020 through March 12th, 2022, 881 cases and 1794 controls were enrolled. Vaccine effectiveness against symptomatic infection was greatest from December 2020 through May 2021, with mRNA complete series effectiveness at 93.1% (95% CI: 86.9%-96.3%) with complete series VE falling to 25.1% (95% CI: 0.0%-50.9%) during May 2021-October 2021. Waning immunity following receipt of second dose was observed across all time periods. Vaccine effectiveness following receipt of one booster vaccine was found to be 59.2% (95% CI: 43.5-70.6), with evidence of waning immunity two months from receipt of the booster (VE: 46.6%;95% CI: 14.6%-66.7%). Conclusion. Protection provided by the COVID-19 mRNA vaccines against symptomatic infection is highly variable among HCP, based on the circulating dominant variant and the time since receipt of each dose. Monitoring of vaccine effectiveness, as well as waning immunity, among this high-risk population is essential to guide future vaccine policies.
ABSTRACT
This report describes SARS-CoV-2 genomic surveillance conducted by the Department of Defense (DoD) Global Emerging Infections Surveillance Branch and the Next-Generation Sequencing and Bioinformatics Consortium (NGSBC) in response to the COVID-19 pandemic. Samples and sequence data were from SARS-CoV-2 infections occurring among Military Health System (MHS) beneficiaries from 1 March to 31 December 2020. There were 1,366 MHS samples sequenced from 10 countries, 36 U.S states or territories, and 5 Geographic Combatant Commands, representing approxi-mately 2% of DoD cases in 2020. Genomes from these samples were compared with other public sequences;observed trends were similar to those of Centers for Disease Control and Prevention national surveillance in the U.S. with B.1, B.1.2, and other sub-lineages comprising the dominant variants of SARS-CoV-2. Sequence data were used to monitor transmission dynamics on U.S. Navy ships and at military training centers and installations. As new variants emerge, DoD medical and public health practitioners should maxi-mize the use of genomic surveillance resources within DoD to inform force health protection measures. © 2022, Armed Forces Health Surveillance Center. All rights reserved.
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COVID-19 has heightened social inequalities, particularly for those with non-communicable diseases (NCDs), such as cancer, and health services for NCDs have been significantly disrupted. Breast cancer (BC) is the most common cancer for women in Ireland, and the impact of the pandemic on BC care needs to be established. The purpose of this study is to explore the health care experience of women with BC during the pandemic and to investigate whether these experiences vary based on social determinants of health (SDH). The study included semi-structured qualitative interviews with 37 women who had previously participated in a related quantitative study. Individuals were selected through stratified purposive sampling to ensure data was available on information-rich cases based on SDH. Interviews were conducted in early 2021 and thematic analysis was conducted using NVivo software. Three major themes, with additional subthemes, emerged from analysis: breast cancer services;breast cancer support and communication;and mental well-being. There were differences in women's experiences within the themes that were dependent upon the SDH, including socio-economic status (SES), region, and time since diagnosis. For example, most women experienced disrupted BC services throughout the pandemic, but disruptions were more severe for women of lower SES. Table 1 provides quotation examples as evidence for these different experiences. The pandemic has impacted women with BC considerably, but the impact differed by social inequalities and time of diagnosis. This study highlights areas for improvement in the context of BC care in Ireland and the findings will inform further policy and practice. (Table Presented).
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Introduction: Multimodal exercise training can ameliorate the physiological decline associated with ageing. This study aimed to investigate whether 12 weeks of a home-based online multimodal training and health education intervention could improve functional ability and perceptions of physical and mental health in middle-aged and older adults. Methods: Sixty-one male (N = 18, 59.1 ± 7.0 years) and female (N = 43, 60.9 ± 6.8 years) participants with various clinical conditions completed two 60-minute training sessions per week for 12 weeks delivered online via Zoom. All sessions included aerobic, resistance, balance, and flexibility exercises. One weekly session incorporated 15 minutes of health and fitness education. The pre/post testing sessions were conducted in a local community centre in line with COVID-19 public health guidelines. Paired samples t-tests and the Wilcoxon signed rank tests were utilised to compare scores pre and post intervention. Results: There were significant improvements in participants 6-minute walk (p < 0.0001), sit-to-stand (p < 0.0001), timed-up-and-go (p < 0.0001), sit-and-reach (p < 0.0001), squat jump (p < 0.0001), core endurance (p < 0.0001), grip strength (right hand p = 0.03, left hand p = 0.04) and balance (right leg p < 0.0001, left leg p = 0.004) tests post intervention. Perceptions of physical (p < 0.0001) and mental (p < 0.0001) health also improved significantly. Discussion: Twelve weeks of online multimodal training and health education can significantly improve cardiovascular fitness, strength, power, balance, flexibility, and perceptions of physical health, mental health, and quality of life in middle-aged and older adults. While there are some limitations to online interventions, the benefits are numerous and equal to those reported for onsite interventions and should be considered for wider rollout in this population. Copyright: © 2021 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.
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Elective surgical suspension during the COVID-19 pandemic resulted in a sizeable surgical case backlog throughout the world. As we ramp back up, how do we decide which cases take priority? Potential future waves (or a future pandemic) may lead to additional surgical shutdown and subsequent reopening. Deciding which cases to prioritise in the face of limited health system capacity has emerged as a new challenge for healthcare leaders. Here we present an ethically grounded and operationally efficient surgical prioritisation framework for healthcare leaders and practitioners, drawing insights from decision analysis and organisational sciences.
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Background: Coronavirus disease 2019 (COVID-19) is the cause of a global pandemic which has strained the resources of health systems around the world. Health systems, patients, and healthcare providers may benefit from knowledge regarding which factors predict length of stay (LOS), and therefore healthcare resource allocation, in patients presenting with COVID-19. Methods: 559 patients were retrospectively identified who were admitted to Temple University Hospital in Philadelphia, PA between February and May of 2020. All patients tested positive for COVID-19 by nasopharyngeal swab and received computed tomography screening for viral pneumonia. We collected data present at time of hospital admission and performed a retrospective analysis to determine factors associated with hospital LOS. Results: Mean hospital LOS for our cohort was 9.0 days. In this cohort, most patients received antibiotics. 100% of patients received glucocorticoids and 8.1% received remdesivir. 31.2% participated in clinical trials of monoclonal antibodies. 26.8% of patients required intensive care during their hospitalization, 17.4% required invasive or noninvasive mechanical ventilation, and 11.1% died. On multivariable linear regression analysis, increasing leukocyte count and a diagnosis of diabetes mellitus predicted decreased LOS. Increased respiratory support within the first 24 hours, patient age, creatinine, and total bilirubin were associated with increased LOS. Conclusion: Patient past medical history, admission laboratory values, and severity of hypoxemia at hospital admission may predict LOS in patients hospitalized for COVID-19. (Table Presented).
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Media critics frequently complain about the tendency of reporters to cover political news using partisan conflict or partisan game frames, which describe policy disagreement as sites of partisan conflict where the parties can score "wins" or "losses." Such frames, thought to decrease trust and increase partisan polarization, may be particularly dangerous when used in the coverage of public health crises such as the COVID-19 pandemic. We report a survey experiment where 2,455 respondents were assigned to read coverage of the pandemic that was framed in non-partisan terms, in terms of partisan conflict, or as a game where one party was winning and the other losing. Contrary to expectations, we find no effect of these frames across a broad range of opinions about and actions related to the pandemic, with the exception of a small negative effect of partisan game-framed coverage on the desire to consume news about the pandemic. These results suggest that partisan framing may not have negative effects during a public health crisis or, alternately, that such effects are difficult to detect in real-time using traditional survey experiments. [ABSTRACT FROM AUTHOR] Copyright of Journal of Elections, Public Opinion & Parties is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
ABSTRACT
Resilience matters now more than ever in healthcare, with the COVID-19 pandemic putting healthcare providers and systems under unprecedented strain. In popular culture and everyday conversation, resilience is often framed as an individual character trait where some people are better able to cope with and bounce back from adversity than others. Research in the management literature highlights that resilience is more complicated than that - it's not just something you have, it's something you do. Drawing on research on managing unexpected events, coordinating under challenging conditions, and learning in teams, we distill some counter-intuitive findings about resilience into actionable lessons for healthcare leaders.
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Background: The SARS-CoV-2 pandemic has caused over 400,000 deaths worldwide thus far, and poses therapeutic challenges for millions of patients. There is currently no treatment for SARS-CoV-2 infection approved by the United States Food and Drug Administration. Multiple agents have been used off-label to treat SARS-CoV-2 infection based on small observational cohorts and in vitro data. Here we present the experience of a large academic medical center in treating SARSCoV- 2 infection. Methods: We performed a retrospective cohort study of patients admitted for greater than 24 hours with a nasopharyngeal, oropharyngeal, and/or bronchoalveolar lavage sample positive for SARS-CoV-2 by polymerase chain reaction (PCR). Demographic data, comorbidities, clinical data, and treatment data were collected from the electronic medical record. Off-label therapies were used at the discretion of the treating providers guided by regularly updated treatment guidelines assembled by infectious diseases physicians and antimicrobial stewardship pharmacists. The primary outcome assessed was in-hospital mortality. Secondary outcomes included admission to the intensive care unit (ICU), endotracheal intubation, initiation of vasopressors, and drug-related adverse events. Results: Data collection was completed for 448 patients admitted between March 18, 2020 and May 8, 2020. All-cause in-hospital mortality was 13.4% (60/448) during this time. Mortality rates increased with age, up to 45% for patients over 80 years old. Male sex, hypertension, chronic pulmonary disease, end-stage renal disease, chronic liver disease were also risk factors for increased mortality. QTc interval prolongation occurred significantly more frequently in patients who received hydroxychloroquine (HCQ) with or without azithromycin(AZM) than those who did not (HCQ 6%, HCQ+AZM 7.8% vs all other patients, 0%, p< .0001). Review of treatment trends showed close adherence to the treatment recommendations at that time (Figure 1). Conclusion: SARS-CoV-2 infection is associated with significant inpatient mortality, and use of off-label treatments was associated with significant drug-related adverse events. Treatment regimens changed rapidly, and providers adhered closely to institutional guidelines as they evolved. (Table Presented).
ABSTRACT
Background: Contact tracing is a critical component in controlling the spread of infectious diseases. During the COVID-19 pandemic, the demands for contract tracing far exceeded the resources available to infection prevention and control (IPC) programs. Leveraging our Poison Control Center, our organization established a Contact Tracing Center (CTC) with content expertise and oversight by IPC and Occupational Health. The CTC identifies exposed patients and employees, provides testing guidance and scheduling, and offers post-exposure recommendations for employees. We describe patient outcomes due to employee exposures in a pediatric healthcare system. Methods: Exposure data about employee to patient exposures (EPE) were captured real-time by scripted telephone interviews by our CTC. Chart review was performed to determine outcomes of exposed patients. A concerning exposure from a direct patient care provider to a patient was defined as unprotected contact at less than 6 feet for greater than 5 minutes in the 24 hours prior to developing symptoms. Data were analyzed to determine COVID-19 conversion rates for children exposed to pre-symptomatic and symptomatic employees based upon exposure risk stratification, window of exposure, and employees who worked with symptoms. Results: From March 2020 - present, we identified 38 EPE that involved 10 employees;26 EPE were pre-symptomatic and 12 EPE symptomatic exposures. The average number of EPE per employee was 3.8 (SD 3.01). There were no secondary transmission events to patients from either pre-symptomatic or symptomatic employees. After instituting universal masking, the number of concerning exposures to patients were 3 compared to 35 prior to universal masking. Conclusion: We describe the experience of a novel Contact Tracing Center, leveraging alternate staffing pools to track EPE resulting in no secondary transmission to patients either before or after universal masking. We credit sick policy adherence, high hand hygiene compliance, use of standard precautions, universal masking, robust contact tracing operations and a strong data collection system to identify process gaps.