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BACKGROUND: New York City (NYC) bore the greatest burden of COVID-19 in the United States early in the pandemic. In this case series, we describe characteristics and outcomes of racially and ethnically diverse patients tested for and hospitalized with COVID-19 in New York City's public hospital system. METHODS: We reviewed the electronic health records of all patients who received a SARS-CoV-2 test between March 5 and April 9, 2020, with follow up through April 16, 2020. The primary outcomes were a positive test, hospitalization, and death. Demographics and comorbidities were also assessed. RESULTS: 22254 patients were tested for SARS-CoV-2. 13442 (61%) were positive; among those, the median age was 52.7 years (interquartile range [IQR] 39.5-64.5), 7481 (56%) were male, 3518 (26%) were Black, and 4593 (34%) were Hispanic. Nearly half (4669, 46%) had at least one chronic disease (27% diabetes, 30% hypertension, and 21% cardiovascular disease). Of those testing positive, 6248 (46%) were hospitalized. The median age was 61.6 years (IQR 49.7-72.9); 3851 (62%) were male, 1950 (31%) were Black, and 2102 (34%) were Hispanic. More than half (3269, 53%) had at least one chronic disease (33% diabetes, 37% hypertension, 24% cardiovascular disease, 11% chronic kidney disease). 1724 (28%) hospitalized patients died. The median age was 71.0 years (IQR 60.0, 80.9); 1087 (63%) were male, 506 (29%) were Black, and 528 (31%) were Hispanic. Chronic diseases were common (35% diabetes, 37% hypertension, 28% cardiovascular disease, 15% chronic kidney disease). Male sex, older age, diabetes, cardiac history, and chronic kidney disease were significantly associated with testing positive, hospitalization, and death. Racial/ethnic disparities were observed across all outcomes. CONCLUSIONS AND RELEVANCE: This is the largest and most racially/ethnically diverse case series of patients tested and hospitalized for COVID-19 in New York City to date. Our findings highlight disparities in outcomes that can inform prevention and testing recommendations.
Subject(s)
COVID-19 , Ethnicity , Hospitals, Public , Pandemics , SARS-CoV-2 , Adolescent , Adult , Age Factors , Aged , COVID-19/ethnology , COVID-19/mortality , COVID-19/therapy , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Male , Middle Aged , New York City/epidemiology , New York City/ethnology , Retrospective Studies , Risk Factors , Sex FactorsABSTRACT
Background: Kidney transplant recipients are at high risk of mortality and complications related to COVID-19. Vaccination remains the most important strategy to prevent severe disease in this vulnerable population. The goal of this study was to evaluate the antibody response to mRNA vaccines in kidney transplant recipients. Method(s): We studied anti-spike IgG response to mRNA vaccines (BNT162b2 and mRNA-1273) against SARS-CoV-2 in adult kidney transplant recipients in a single center. Preserved blood samples of kidney transplant patients undergoing routine monitoring were used. The LABScreen COVID Plus Assay (One Lambda) was used to detect SARSCoV-2 antibody response. Categorical variables were compared using the Fisher's exact test, and continuous variables were compared using a t-test. Result(s): Among 120 subjects receiving two doses of vaccines, only 74 (61.7%) elicited a positive response with anti-Spike antibody. After a third dose/first booster vaccine, 35 out of 43 (81.4%) kidney subjects had a positive response. There was no statistically significant difference between the responders and non-responders in terms of age, gender, race, blood group, time since transplant, vaccine type. A third dose vaccine produced statistically significant increase in antibody response compared to 2 doses only. A third dose induced a serological response in 7 out of 8 subjects (87.5%) who did not respond after 2 doses of vaccine. None of the patients developed donor specific HLA antibody in response to COVID-19 infection or the vaccine. Conclusion(s): In this single center retrospective study, we demonstrated that the antibody response to SARS-CoV-2 mRNA vaccine was most prevalent after 4 months since the second dose. In addition, a third dose induced an antibody response in a larger number of kidney transplant recipients (81.3% vs 61.67%, p value 0.018), suggesting that this patient population may benefit from receiving multiple doses of mRNA vaccines.
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INTRODUCTION: Limited information is available to guide antimicrobial stewardship interventions in COVID-19 infections. Two meta-analyses have been published to date showing a rate of bacterial co-infection between 7-8% in COVID-19, with only 1 case of methicillin-resistant Staphylococcus aureus (MRSA) among those publications. METHODS: In an effort to optimize use of anti-MRSA therapy, the COVID-19 Task Force at this large, hybrid community and academic medical center implemented routine MRSA nasal swabs for all COVID-19 patients, suspected or confirmed, requiring anti-MRSA therapy. This retrospective review was conducted to evaluate the use of MRSA nasal swabs in patients admitted between April 13, 2020 and July 26, 2020. Electronic health record-generated reports were created to identify patients with a diagnosis code of COVID-19 infection or COVID-19 rule out who also received an MRSA nasal swab. RESULTS: Out of 263 patients identified with MRSA nasal swabs, 113 patients were included in the final analysis. Almost 75% of patients required ICU admission and the overall mortality rate was 41.6%. A total of 12 swabs (10.6%) resulted as positive for MRSA. In response to swab results, 54 patients (47.8%) had anti-MRSA agents discontinued and another 37 patients (32.7%) were never started on anti-MRSA therapy (collectively referred to as ?discontinued? in this report). The median duration of anti-MRSA therapy overall was 12 hours (12 hours in the discontinued group versus 120 hours in the continued group). Sputum cultures were obtained in 29 patients, with pathogens identified in 13. Most pathogens were gram-negative, including Pseudomonas aeruginosa in 8 cases. Methicillin-resistant Staphylococcus aureus was isolated in sputum cultures of two patients;both had MRSA positive nasal swabs and were continued on anti- MRSA therapy. CONCLUSIONS: With implementation of MRSA nasal swabs in COVID-19 patients, anti-MRSA therapy was reduced in 80.5% of patients in the study cohort, with median duration 12 hours for anti-MRSA therapy. Of the 22 patients with therapy continued, 11 were for pneumonia and MRSA positive swab and 10 for treatment of an alternative indication. MRSA nasal swabs may serve as an effective antimicrobial stewardship tool in COVID-19 pneumonia.
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The SARS-CoV-19 pandemic continues to be globally related with significant morbidity and mortality, making protective measures to prevent transmission of the virus still necessary. Healthcare employees are exposed to a higher risk of infection and this is particularly true when performing aerosol-generating procedures such as bronchoscopy.Since the publication of recommendations for performing a bronchoscopy in the times of COVID-19 more than six months ago, the risk situation has not changed significantly, but due to the considerable gain in knowledge in the meantime, an update of the recommendations was necessary.The updated recommendations include the reduction of aerosol formation, the personal protection of the people involved in the procedure, as well as measures to better organize the processes in the endoscopy suite in order to perform bronchoscopic procedures securely even in times of COVID-19.
Subject(s)
COVID-19 , Pandemics , Bronchoscopy , Health Personnel , Humans , SARS-CoV-2ABSTRACT
Background New York City (NYC) has borne the greatest burden of COVID-19 in the United States, but information about characteristics and outcomes of racially/ethnically diverse individuals tested and hospitalized for COVID-19 remains limited. In this case series, we describe characteristics and outcomes of patients tested for and hospitalized with COVID-19 in New York City's public hospital system. Methods We reviewed the electronic health records of all patients who received a SARS-CoV-2 test between March 5 and April 9, 2020, with follow up through April 16, 2020. The primary outcomes were a positive test, hospitalization, and death. Demographics and comorbidities were also assessed. Results 22254 patients were tested for SARS-CoV-2. 13442 (61%) were positive; among those, the median age was 52.7 years (interquartile range [IQR] 39.5-64.5), 7481 (56%) were male, 3518 (26%) were Black, and 4593 (34%) were Hispanic. Nearly half (4669, 46%) had at least one chronic disease (27% diabetes, 30% hypertension, and 21% cardiovascular disease). Of those testing positive, 6248 (46%) were hospitalized. The median age was 61.6 years (IQR 49.7-72.9); 3851 (62%) were male, 1950 (31%) were Black, and 2102 (34%) were Hispanic. More than half (3269, 53%) had at least one chronic disease (33% diabetes, 37% hypertension, 24% cardiovascular disease, 11% chronic kidney disease). 1724 (28%) hospitalized patients died. The median age was 71.0 years (IQR 60.0, 80.9); 1087 (63%) were male, 506 (29%) were Black, and 528 (31%) were Hispanic. Chronic diseases were common (35% diabetes, 37% hypertension, 28% cardiovascular disease, 15% chronic kidney disease). Male sex, older age, diabetes, cardiac history, and chronic kidney disease were significantly associated with testing positive, hospitalization, and death. Racial/ethnic disparities were observed across all outcomes. Conclusions and Relevance This is the largest and most racially/ethnically diverse case series of patients tested and hospitalized for COVID-19 in the United States to date. Our findings highlight disparities in outcomes that can inform prevention and testing recommendations.
Subject(s)
Cardiovascular Diseases , Diabetes Mellitus , Chronic Disease , Hypertension , Death , COVID-19 , Renal Insufficiency, ChronicABSTRACT
COVID-19, caused by coronavirus SARS-CoV-2 is a new and ongoing infectious disease affecting healthcare systems worldwide. Healthcare worker are at high risk for COIVD-19 and many have been infected or even died in countries severely affected by COVID-19 like China or Italy. Bronchoscopy causes cough and aerosol production and has to be considered a significant risk for the staff to get infected. Particular recommendations should guide to prevent spreading COVID-19 and to protect healthcare worker when performing a bronchoscopy.