ABSTRACT
Background. Early in the pandemic, heath care workers (HCWs) were deemed to be at high risk of acquiring SARS-CoV-2 from their patients and distanced themselves from their families. This study aimed to estimate the seropositivity of a cohort of healthcare over time while also looking for associations between seroconversion and hospital and community SARS CoV-2 exposures. Methods. This is a prospective cohort study of HCWs from patient care (PC) and non-patient care (NPC) areas conducted from April 2020 through Dec 2020 at Hurley Medical Center in Flint, Michigan (MI). The first case of SARS-CoV-2 was diagnosed in MI on 3/10/2020. In early April 2020, HCWs underwent serum testing for total SARS-CoV-2 anti-spike protein antibody and completed a questionnaire to collect data on demographics, travel, job characteristics, in and out of hospital SARS-CoV-2 exposures, and use of personal protective equipment (PPE). The serum testing and survey were offered to the same HCWs in late May 2020 and again in December 2020. Statistical analysis such as Fisher's exact test and Student's t-test were used to determine if there was an association with SARS-CoV-2 antibody status for categorical and continuous variables, respectively. Results. At baseline, 20/192 (10.4%) of HCWs were seropositive for SARS-CoV-2 total antibody with 9/20 (45%) providing PC. Job title was known for all participants however, initial survey completion was 79.6%. Eight weeks later, 13/ 131 (9.9%) were positive of which 5/13 (38.4%) were new seroconversions, 2/5 (40%) in PC. Eight months after the initial draw, 16/120 (13.3%) were positive with 13/16 (81.3%) new, 7/13 in PC (54%). The number of HCWs who tested positive at any time during the study was 38/192 (19.8%). No significant associations were found between seroconversion and taking care of COVID patients, any direct patient care duties, or other variables collected at the two-sided threshold of 0.05. Conclusion. No association in this small study was found between PC and SARS-CoV-2 antibody seroconversion. HCWs in NPC areas were as likely to test positive as those in PC likely reflecting community prevalence. Universal masking at the medical center and use of full PPE to care for probable and confirmed COVID patients likely prevented higher rates of PC acquisition.
ABSTRACT
Background. Approximately 2.4 million cases of SARS-CoV-2 infection have been reported in MI, leading to 35,935 deaths. We aimed to study the mortality trends in patients with SARS-CoV-2 infection during the pandemic in Flint, MI. Methods. Hurley Medical Center, is a 443-bed inner city teaching hospital in Flint, MI. We retrospectively collected basic demographics, treatment data, and outcomes on adults (>= 18 years (yrs) of age) with confirmed SARS-CoV-2 infection, admitted and discharged from our facility from 03/2020 through 02/2022. The 2-year span was further divided into 6-time periods (Table 1). Results. During the 2-year study period, the overall crude 90-day mortality rate was 16% (269/1668) and the In-hospital case fatality rate was 15% (244/1668). 90-day mortality was lowest in the time period 5 (Table 1). Men comprised 50% of the cohort and were 1.5 times more likely to die than women (p-value 0.001). African Americans comprised 51% and whites 44% of the cohort. A specific race was not associated with mortality (Table 2). Non-survivors tended to be older, mean age of 68 vs 57 yrs (p-value < .0001). See Table 3 for mean Body Mass Index (BMI). Hypertension (HTN) was the most common co-morbidity (61%), and was strongly associated with mortality (p-value < 0.005) (Table 4). During the study period, 12% of the cohort (207/1668) had received at least one dose of available COVID-19 vaccines (including single dose of Johnson and Johnson's Jansen vaccine). 89% of non-survivors were unvaccinated (adjusted Odds ratio for mortality 1.61, 95% CI 1.03 - 2.53, p-value 0.038). Conclusion. Despite substantial changes in supportive care and management, SARS-CoV-2 infection regardless of the circulating variants carried a significant mortality risk. Trend towards improving mortality can partly be attributed to better supportive care-treatments, and some background immunity from prior infection or vaccination. Immunization against COVID-19 is highly protective against severe disease. Vaccination coverage in this high-risk cohort was low, at only 12%. Vaccination coverage in Flint and surrounding areas remains low at less than 50% as reported by Genesee County health department. Public health efforts should be focused at overcoming the barriers to vaccine acceptance in this high-risk unique population.
ABSTRACT
Background. Data on the real-world effectiveness of Remdesivir (RDV) has yielded conflicting results. US Food and Drug Administration granted full approval for RDV on 10/22/20. On 11/20/20, the World Health Organization issued a conditional recommendation against its routine administration in hospitalized patients, regardless of disease severity. We aimed to examine the association between COVID-19 therapeutics and survival among the recipients. Methods. Hurley Medical Center, is a 443-bed teaching hospital in Flint, MI. We retrospectively collected basic demographics, treatment data, and outcomes on adults (>= 18 years of age) with confirmed SARS-CoV-2 infection, hospitalized at our facility from 03/2020 through 02/2022. Mortality predictors were identified using logistic regression. Results. During the study period, overall crude 90-day mortality rate was 16% (269/1668). Supplemental oxygen was required by 1,213 patients and 378 needed ventilatory support. Early in the pandemic, 159/1668 patients received Hydroxychloroquine (HCQ). Based on institutional protocol, 51% (858/1668) of the patient received RDV (Figure 1, 2). After adjusting for age, gender, race and Body Mass Index, HCQ was associated with increased risk of mortality (Odds ratio (OR) 1.72, 95% Confidence Interval (CI) 1.14 - 2.59, p-value 0.010). Mortality in the RDV group was also noted to be higher (162/269) (adjusted OR for mortality 1.37, 95% CI 1.03 - 1.83, p-value 0.032). Supplemental oxygen use was associated with mortality regardless of RDV use (adjusted OR 3.39, 95% CI 2.15 - 5.36, p-value < 0.001). RDV showed no mortality benefit in the group requiring mechanical ventilation (MV) (adjusted OR 0.77, 95% CI 0.55 - 1.09, p-value 0.152) (adjusted OR for mortality with MV 18.62, 95% CI 13.02 - 26.63, p-value < 0.001). (Figure Presented) Conclusion. This study adds to the growing evidence that more efficacious treatments against COVID-19 respiratory failure are needed once a patient is hospitalized and that antiviral therapies at this late stage may not have the desired effect. This study has several limitations including its retrospective nature and that the RDV group was likely sicker with higher disease severity. We also did not assess the effect of combination therapy such as RDV and steroids on mortality. A need for further studies remains.
ABSTRACT
Background. Bamlanivimab (BAM), a neutralizing IgG1 monoclonal antibody (mAb), received emergency use authorization (EUA) by the U.S. Food and Drug Administration (FDA) for treatment of mild to moderate COVID-19 infection in patients 12 years of age and older weighing at least 40 kg at high risk for progressive and severe disease on Nov 10, 2020. The purpose of this study is to describe our experience with this treatment modality. Methods. Hurley Medical Center (HMC), is a 443-bed inner city teaching hospital in Flint, MI. HMC administered its first BAM infusion on Nov 19, 2020. Through April 30, 2021, 407 patients with confirmed SARS-CoV-2 infection, received a mAb infusion. 62/407 patients received the combination mAb therapy of BAM + Etesevimab, as the EUA for BAM monotherapy was revoked on 04/16/21. We retrospectively collected basic demographic data and hospitalization to our facility within 14 days of receiving mAb therapy on these patients. Results. During the 5.5 month study period, patients receiving mAb therapy at HMC had a mean age of 56 years (yrs) (± standard deviation) (± 15.4) and a mean Body Mass Index (BMI) of 34 kg/m (± 8.5) (Tables 1,2). African Americans (AA) comprised 48% (194/407) (Table 3) and females comprised 54% (220/407) of the cohort. 6% (25/407) of the patients required hospitalization within 14 days of mAb infusion, had a mean age of 58 yrs (± 17) (p-value 0.62) and a mean BMI of 32 kg/m (± 9) (p-value 0.33). Females and AA comprised 56% (14/25) and 48% (12/25) of this subgroup respectively (p-value 1.0). No deaths were reported within 30 days of infusion in this cohort. Conclusion. Previously published reports cite a hospitalization rate in untreated high-risk COVID-19 infected patients of 9-15%. During the period of study, the county hospitalization rate and county mortality rate for all comers with COVID-19 was 6.6% and 2.7% respectively while our high risk cohort had a hospitalization rate of 6% and with no deaths reported. Our cohort had much lower rates of hospitalization and death than would be expected especially in a group which comprised of 48% AA in an underserved area. mAb therapy seems to have a protective effect with significant reduction in the hospitalization and mortality rate among high-risk patients with COVID-19 infection and should be prioritized for administration.