Rapid screening for severe acute respiratory syndrome coronavirus 2 infection with a combined point-of-care antigen test and an immunoglobulin G antibody test.

Rapid screening and diagnosis of coronavirus disease 2019 in the emergency department is important for controlling infections. When polymerase chain reaction tests cannot be rapidly performed, rapid antigen testing is often used, albeit with insufficient sensitivity. Therefore, we evaluated the diagnostic accuracy of combining rapid antigen and antibody test results. This was a retrospective review of patients who visited our emergency department between February and May 2021 and underwent rapid antigen, immunoglobulin G antibody, and reverse transcription-polymerase chain reaction tests. The study included 1,070 patients, of whom 56 (5.2%) tested positive on reverse transcription-polymerase chain reaction. The sensitivity, specificity, and area under the curve of rapid antigen testing were 73.7%, 100.0%, and 0.87, respectively. The combined rapid antigen and antibody test result had improved diagnostic accuracy, with 91.2% sensitivity, 97.9% specificity, and an area under the curve of 0.95. The results of the rapid antigen and antibody tests could be combined as a reliable alternative to reverse transcription-polymerase chain reaction.

Combining IL-6 and SARS-CoV-2 RNAaemia-based risk stratification for fatal outcomes of COVID-19.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic rapidly increases the use of mechanical ventilation (MV). Such cases further require extracorporeal membrane oxygenation (ECMO) and have a high mortality. OBJECTIVE: We aimed to identify prognostic biomarkers pathophysiologically reflecting future deterioration of COVID-19. METHODS: Clinical, laboratory, and outcome data were collected from 102 patients with moderate to severe COVID-19. Interleukin (IL)-6 level and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA copy number in plasma were assessed with ELISA kit and quantitative PCR. RESULTS: Twelve patients died or required ECMO owing to acute respiratory distress syndrome despite the use of MV. Among various variables, a ratio of oxygen saturation to fraction of inspired oxygen (SpO2/FiO2), IL-6, and SARS-CoV-2 RNA on admission before intubation were strongly predictive of fatal outcomes after the MV use. Moreover, among these variables, combining SpO2/FiO2, IL-6, and SARS-CoV-2 RNA showed the highest accuracy (area under the curve: 0.934). In patients with low SpO2/FiO2 (< 261), fatal event-rate after the MV use at the 30-day was significantly higher in patients with high IL-6 (> 49 pg/mL) and SARS-CoV-2 RNAaemia (> 1.5 copies/µL) compared to those with high IL-6 or RNAaemia or without high IL-6 and RNAaemia (88% vs. 22% or 8%, log-rank test P = 0.0097 or P < 0.0001, respectively). CONCLUSIONS: Combining SpO2/FiO2 with high IL-6 and SARS-CoV-2 RNAaemia which reflect hyperinflammation and viral overload allows accurately and before intubation identifying COVID-19 patients at high risk for ECMO use or in-hospital death despite the use of MV.

Environmental maintenance with effective and useful zoning to protect patients and medical staff from COVID-19 infection.

AIM: The coronavirus disease 2019 (COVID-19) pandemic has accelerated all over the world, and global health-care systems have become overwhelmed with potentially infectious patients seeking testing and care. It is essential to set up effective and useful zoning to prevent the spread of infection to and from medical staff or other patients with effective use of standard precautions with personal protective equipment (PPE). METHODS: We repurposed a general ward into an acute care unit for severe COVID-19 patients taking into consideration airflow, the direction of movement of medical staff, and prevention of the spread of infection to medical staff and other patients. We checked the daily condition and body temperature of all medical staff for 60 days. RESULTS: There was no evidence of COVID-19 infection in any medical staff or other patients during the period thanks to effective and useful zoning with PPE. CONCLUSION: Special wards and rooms should be set up for future protection of medical staff and other patients, and prevent the explosion of COVID-19 infection with effective and useful zoning with PPE.