ABSTRACT
Asymptomatic subjects account for 25 to 45% of SARS-CoV-2 infections, and in particular, subjects on mild immunosuppressive therapy may have symptoms masked and could spread virus for an extended period of time. To determine the cumulative incidence of symptomatic and asymptomatic SARS-CoV-2 infections and associated risk factors, we conducted a prospective clinical and serological survey in a cohort of 278 liver transplant recipients (LTRs) from Central Italy. Three different serology tests were performed every 4 months in 259 LTRs between April 2020 and April 2021: one based on raw extract of whole SARS-CoV-2 virus and two on specific viral antigens (nucleoprotein and receptor binding domain) to detect specific IgG, IgM and IgA. Hundred fifteen LTRs who reported symptoms or close contact with a SARS-CoV-2-positive subject, or had a positive serological result underwent molecular testing by standard screening procedures (RT-PCR on naso-pharyngeal swab). Thirty-one past or active SARS-CoV-2 infections were identified: 14 had positive molecular test (64% symptomatic), and 17 had positive serology only (18% symptomatic). SARS-CoV-2 infection was not statistically related to gender, age, obesity, diabetes, renal impairment, type of anti-rejection therapy or time from transplant. Asymptomatic SARS-CoV-2 cases (61.3%) were more frequent in males and in those with glomerular filtrate rate >50 ml/min. Overall, the addition of repeated serology to standard diagnostic molecular protocols increased detection of SARS-CoV-2 infection from 5.1% to 10.9%. Anti-SARS-CoV-2 seroprevalence among our LTRs (11.2%) is comparable to the general population of Central Italy, considered a medium-impact area. Only one asymptomatic subject (6%) was found to carry SARS-CoV-2 in respiratory tract at the time of serological diagnosis.Copyright © 2021 The Authors
ABSTRACT
Background: Since March 2020 hospitals were required to respond to the SARS-CoV-2 pandemic by creating specialized isolation wards;our Internal Medicine (IM) was also called to continue caring for non-COVID-19 patients. Aim of our study was to compare the outcomes of admissions to IM between 2018- 2019 and 2020-2021. Methods: All admissions to IM for from 2018 to 2021 were included in a prospective database. Demographic and clinical data, length of stay (LOS) and outcome (discharge, death, transfer to Intensive Care Unit [ICU]) were analysed and compared between pre- and post-pandemic biennia. Results: 2577 admissions were included in the analysis (males, 48.4%, median age 80 years, median LOS 9 days, range 0-91). There were no differences in mortality or rate of transfer to ICU between the two biennia. Patients in 2020-2021 were significantly younger (mean age 75.5±14.8 vs 77.1±14.6 years, p=0.008) and had longer LOS (12.5±11.0 vs 11.0±9.1 days, p<0.001) compared to 2018-2019. LOS in 2020-2021 remained significantly longer after excluding SARS CoV2 cases (n=161, 14.4%). SARS CoV2-positive patients were significantly younger, had significantly longer LOS, and higher rate of transfer to ICU than SARS CoV2- nagative patients. In-hospital mortality did not differ between SARS CoV2-positive and negative patients. Conclusions: Our IM ward treated COVID-19 as well as non-SARSCoV- 2 acute patients throughout the pandemic. The challenges have resulted in an increased strain on hospital resources and LOS increased significantly.
ABSTRACT
Background and Aim: Respiratory infections are a leading cause of admission to Internal Medicine (IM) wards, and the 2020 SARSCoV- 2 pandemic dramatically increased this burden. Aim of our study was to assess the changes in admissions to IM for respiratory infections over the past 5 years and the impact on patient outcomes. Methods: All admissions to IM for acute pneumonia (AP) during 2015-2020 were included in a prospective database. Demographic and clinical data, length of stay (LOS) and outcome were analysed. Testing for SARS-CoV-2 began for all febrile patients in March 2020. Results: 745 admissions for AP were included in the analysis (males, 50.8%, mean age 76.5±15.4 years, median LOS 9 days, range 0-57). Admissions to IM for AP rose from 14.7% in 2015 to 20.1% in 2019 (18% overall), vs 27.2% in 2020 (p<0.001). In 2015-2019, 32% of admissions occurred in the first quarter vs 24.1% in 2020 (p=0.001). During 2020, 56 AP were SARS-CoV- 2-positive (38.6%, 95% in the fourth quarter). SARS-CoV-2 patients were younger and had a higher rate of intensive care therapy. Mean LOS in 2020 was 12.7±10.0 vs 10.9±7.6 days in 2015- 2019 (p=0.01). In-hospital mortality was not significantly different, although negative outcomes in the fourth quarter were significantly higher in 2020 (28.1% vs 15.1%, p=0.02). Conclusions: Admissions to IM for AP have been increasing even before the onset of the SARS-CoV-2 pandemic. In 2020 urgent admissions for AP were significantly higher than in previous years, requiring greater LOS, although SARS-CoV-2 infections were concentrated in the fourth quarter.