Twelve-Month Longitudinal Serology in SARS-CoV-2 Naïve and Experienced Vaccine Recipients and Unvaccinated COVID-19-Infected Individuals.

Longitudinal data comparing SARS-CoV-2 serology in individuals following infection and vaccination over 12 months are limited. This study compared the magnitude, decay, and variability in serum IgG, IgA, and neutralizing activity induced by natural infection (n = 218) or mRNA vaccination in SARS-CoV-2 naïve (n = 143) or experienced (n = 122) individuals over time using enzyme-linked immunosorbent assays and an in vitro virus neutralization assay. Serological responses were found to be highly variable after natural infection compared with vaccination but durable through 12 months. Antibody levels in vaccinated, SARS-CoV-2 naïve individuals peaked by 1 month then declined through 9 months, culminating in non-detectable SARS-CoV-2-specific serum IgA. Individuals with both infection and vaccination showed SARS-CoV-2-specific IgG and IgA levels that were more robust and slower to decline than the other groups; neutralizing activity remained highest in this group at 9 months past vaccination. These data reinforce the benefit of vaccination after SARS-CoV-2 recovery.

SARS-CoV-2 Transmission Dynamics in Households With Children, Los Angeles, California.

Objectives: Studies of household transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) focused on households with children are limited. We investigated household secondary attack rate (SAR), transmission dynamics, and contributing factors in households with children. Materials and Methods: In this prospective case-ascertained study in Los Angeles County, California, all households members were enrolled if ≥1 member tested positive for SARS-CoV-2 by polymerase chain reaction (PCR). Nasopharyngeal PCRs, serology, and symptom data were obtained over multiple visits. Results: A total of 489 individuals in 105 households were enrolled from June to December 2020. The majority (77.3%) reported a household annual income of <$50,000, and most (92.9%) were of Hispanic/Latinx ethnicity. Children <18 years old accounted for 46.9% index cases, of whom 45.3% were asymptomatic. Household index cases were predominantly children during low community transmission and adults during the high community transmission period (χ2 = 7.647, p = 0.0036. The mean household SAR was 77.0% (95% CI: 69.4-84.6%). Child and adult index cases both efficiently transmitted SARS-CoV-2 within households [81.9%, (95% CI: 72.1-91.9%) vs. 72.4% (95% CI: 59.8-85.1%), p = 0.23]. Household income and pets were significantly associated with higher SAR in the multivariable analysis of household factors (p = 0.0013 and 0.004, respectively). Conclusions: The SAR in households with children in an urban setting with a large ethnic minority population is much higher than previously described. Children play important roles as index cases. SAR was disproportionately impacted by household income. Vaccination and public health efforts need special focus on children and vulnerable communities to help mitigate SARS-CoV-2 spread.

Changes in Self-management During the COVID-19 Pandemic Among Adults with Type 2 Diabetes at a Federally Qualified Health Center.

The COVID-19 pandemic affected how adults with diabetes perform self-management, and impacts may be greater among vulnerable populations. We assessed the impact of the pandemic on diabetes self-management among adults with type 2 diabetes at a Federally Qualified Health Center. Participants were surveyed by phone in Spanish and English from July to October of 2020. Most respondents (74%) were Latino and preferred to speak Spanish, with mean age of 54 years and mean HbA1c of 9.2%. Fifty-three percent reported less physical activity during the pandemic. While 43% had more difficulty obtaining healthy food, 38% reported eating more healthfully. Sixty-one percent had increased difficulty accessing medical care. Many felt more socially isolated (49%) and stressed (51%). Changes in diabetes self-management were both positive and negative for majority Latino patients in this low-resource community, which may require tailored approaches to mitigate negative impacts of the pandemic on physical and mental health.

PERSONAL PROTECTIVE EQUIPMENT COMPLIANCE: A QUALITY IMPROVEMENT INITIATIVE

B Introduction: b Studies prior to the Severe Acute Respiratory Syndrome CoronaVirus-2 (SARS-CoV-2) pandemic reported poor adherence to personal protective equipment (PPE) use with higher risk of contamination during doffing. B Methods: b We used an anonymous online survey (Research Electronic Data Capture) and bedside audits to gauge baseline compliance and opportunities for intervention. The pandemic heightened the importance of proper PPE use while make the process more complex due to changing guidelines and reuse of equipment, but data on compliance is limited. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins 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.)

Human Milk SARS-CoV-2 Antibodies up to 6 Months After Vaccination.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific antibodies have been detected in human milk up to 6 weeks post-coronavirus disease 2019 (COVID-19) vaccination. We evaluated SARS-CoV-2-specific antibodies, neutralization activity, effect of pasteurization, and persistence through 6 months after vaccination. METHODS: This prospective longitudinal study enrolled 30 pregnant or lactating women. SARS-CoV-2 antibodies and neutralization capacity were analyzed using an enzyme-linked immunosorbent assay compared at prevaccination and 1, 3, and 6 months postvaccination, and through Holder pasteurization. RESULTS: Human milk SARS-CoV-2-specific IgG levels peaked at 1 month postvaccination and persisted above prevaccination levels for at least 6 months (P = .005). SARS-CoV-2-specific IgA was detected at 1 and 3 months (both P < .001) but waned by 6 months compared with baseline (P = .07). Milk SARS-CoV-2-specific IgG and IgA correlated with serum IgG at the same time point (R2 = 0.37, P < .001 and R2 = 0.19, P < .001). Neutralization activity was seen in 83.3%, 70.4%, and 25.0% of milk samples at 1, 3, and 6 months postvaccination. Neutralization most strongly correlated with SARS-CoV-2-specific IgG (R2 = 0.57, P < .001). Pre- and postpasteurization samples showed similar IgG (0.84 vs 1.07, P = .36) and neutralizing activity (57.7% vs 58.7% inhibition, P = .27), but lower IgM and IgA levels postpasteurization (0.09 vs 0.06, P = .004 and 0.21 vs 0.18, P = .043). CONCLUSIONS: The data suggest that human milk SARS-CoV-2-specific antibodies may be available to milk-fed infants for up to 6 months. In addition, donor milk from vaccinated mothers retain IgG and neutralizing activity.

Clinical manifestations of COVID-19 differ by age and obesity status.

BACKGROUND: Age and obesity status are associated with severe outcomes among hospitalized individuals with COVID-19. It remains unclear whether age and obesity are risk factors for milder COVID-19 illness. METHODS: We prospectively enrolled SARS-CoV-2-exposed individuals. Participants recorded symptoms for 28 days and were tested for SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR) and serology. Type, number, and duration of symptoms and SARS-CoV-2 laboratory parameters were compared by age and obesity status. RESULTS: Of 552 individuals enrolled from June 2020 to January 2021, 470 (85.1%) tested positive for SARS-CoV-2 including 261 (55.5%) adults ≥18 years, 61 (13.0%) adolescents 12-17 years, and 148 (31.5%) children <12 years. Children had fewer symptoms (median 2 vs. 3, p < 0.001) lasting fewer days (median 5 vs. 7, p < 0.001) compared with adolescents/adults. Body mass index of 300 (63.8%) individuals classified with overweight or obesity (OWOB). Individuals with OWOB suffered more symptoms compared with individuals without OWOB (median 3 vs. 2, p = 0.037), including more cough and shortness of breath (p = 0.023 and 0.026, respectively). Adolescents with OWOB were more likely to be symptomatic (66.7% vs. 34.2%, p = 0.008) and have longer respiratory symptoms (median 7 vs. 4 days, p = 0.049) compared with adolescents without OWOB. Lower RT-PCR Ct values were found in children and symptomatic individuals compared with adolescent and adults and asymptomatic individuals, respectively (p = 0.001 and 0.022). CONCLUSIONS: Adolescents and adults with OWOB experience more respiratory symptoms from COVID-19 despite similar viral loads. These findings underscore the importance of vaccinating individuals with OWOB.

Impact of COVID-19 on Diabetes Self-Management and Care

Stay at home orders, changes in business and clinic operations, and financial concerns related to the COVID-19 pandemic may have affected how adults with diabetes obtained food, medications, medical care, and performed diabetes self-management. These impacts may be most pronounced among people in low-resource urban communities. We assessed the experiences of adults with type 2 diabetes participating in a federally-qualified health center diabetes management program. Of 72 patients called, 61 completed telephone surveys from July to October 2020 in Spanish and English. 74% of respondents were Latino with Spanish as their preferred language. Respondents' mean age was 54 years, 62% were female, and 57% had less than a high school degree. Five patients reported testing positive for COVID-19, and 7 lived with someone who tested positive. Of 33 respondents who worked outside the home before COVID-19, 61% had lost their jobs or now worked fewer hours. When asked how diabetes management behaviors changed during the pandemic, 53% of respondents reported less physical activity, while 25% reported more. 18% reported eating less healthfully, while 38% reported eating more healthfully. 43% found it more difficult to obtain healthy food. 15% reported taking their medications more regularly, while 5% reported less. 61% reported increased difficulty accessing medical care. 41% felt more worried about being able to manage their diabetes during the pandemic and 49% felt more socially isolated. Changes in diabetes self-management behaviors related to COVID-19 were both positive and negative for patients in this low-resource urban setting. Programs supporting patients with diabetes could help patients adapt to pandemic changes by facilitating access to medications and health care, providing virtual support for self-management and other health habits, connecting patients with financial and food security concerns to community resources, and addressing stress and social isolation through virtual diabetes support groups.