Sexually Transmitted Infection Testing in the National Veterans Health Administration Patient Cohort During the Coronavirus Disease 2019 Pandemic.

Background: We performed a retrospective study of chlamydia, gonorrhea, syphilis, and human immunodeficiency virus (HIV) testing in the Veterans Health Administration (VHA) during 2019-2021. Methods: We determined the annual number of chlamydia, gonorrhea, syphilis, and HIV tests from 2019 through 2021 using electronic health record data. We calculated rates by age, birth sex, race, census region, rurality, HIV status, and use of preexposure prophylaxis. Results: The VHA system experienced a 24% drop in chlamydia/gonorrhea testing, a 25% drop in syphilis testing, and a 29% drop in HIV testing in 2020 versus 2019. By the conclusion of 2021, testing rates had recovered to 90% of baseline for chlamydia/gonorrhea, 91% for syphilis, and 88% for HIV. Declines and subsequent improvements in sexually transmitted infection (STI) testing occurred unequally across age, sex, race, and geographic groups. Testing for all 4 STIs in 2021 remained below baseline in rural Veterans. Excluding those aged <25 years, women experienced a steeper decline and slower recovery in chlamydia/gonorrhea testing relative to men, but quicker recovery in HIV testing. Asian Americans and Hawaiian/Pacific Islanders had a steeper decline and a slower recovery in testing for chlamydia/gonorrhea. Black and White Veterans had slower recovery in HIV testing compared with other race groups. People living with HIV experienced a smaller drop in testing for syphilis compared with people without HIV, followed by a near-total recovery of testing by 2021. Conclusions: After dramatic reductions from 2019 to 2020, STI testing rates returned to near-baseline in 2021. Testing recovery lagged in rural, female, Asian American, Hawaiian/Pacific Islander, and Black Veterans.

Sexually transmitted infection testing in the national Veterans Health Administration patient cohort during the COVID-19 pandemic

Objectives We performed a retrospective study of chlamydia, gonorrhea, syphilis, and HIV testing in the Veterans Health Administration (VHA) during 2019-2021. Methods We determined the annual number of chlamydia, gonorrhea, syphilis, and HIV tests from 2019-2021 using electronic health record data. We calculated rates by age, birth sex, race, census region, rurality, HIV status, and use of PrEP. Results The VHA system experienced a 24% drop in chlamydia/gonorrhea testing, a 25% drop in syphilis testing, and a 29% drop in HIV testing in 2020 versus 2019. By the conclusion of 2021, testing rates had recovered to 90% of baseline for chlamydia/gonorrhea, 91% for syphilis, and 88% for HIV. Declines and subsequent improvements in STI testing occurred unequally across age, sex, race, and geographic groups. Testing for all four STIs in 2021 remained below baseline in rural Veterans. Excluding those <25, women experienced a steeper decline and slower recovery in chlamydia/gonorrhea testing relative to men, but quicker recovery in HIV testing. Asian Americans and Hawaiian/Pacific Islanders had a steeper decline and a slower recovery in testing for chlamydia/gonorrhea. Black and White Veterans had slower recovery in HIV testing compared with other race groups. People living with HIV experienced a smaller drop in testing for syphilis compared with people without HIV, followed by a near-total recovery of testing by 2021. Conclusion After dramatic reductions from 2019-2020, STI testing rates returned to near-baseline in 2021. Testing recovery lagged in rural, women, Asian American, Hawaiian/Pacific Islander, and Black Veterans.

Exploring emergent barriers to hospital-based violence intervention programming during the COVID-19 pandemic.

National rates of gun violence have risen during the COVID-19 pandemic. There are many contributing factors to this increase, including the compounding consequences of social isolation, unstable housing, decreased economic stability, and ineffective and violent policing of communities of color. The effects of these factors are exacerbated by the pandemic's impact on the provision and availability of psychosocial services for individuals in marginalized communities, particularly those who have been violently injured. Hospital-based violence intervention programs (HVIPs) have been identified as a crucial intervention strategy in reducing repeat violent injury. The ongoing COVID-19 pandemic has engendered, significant barriers in HVIPs' attempts to assist program participants in achieving their health-related and social goals. This research offers insight into the complexities of providing social services during the convergence of two public health crises-COVID-19 and gun violence-at the HVIPs associated with the two busiest trauma centers in the state of Maryland. In considering the effects of inadequate financial support and resources, issues with staffing, and the shift to virtual programming due to restrictions on in-person care, we suggest possible changes to violence prevention programming to increase the quality of care provided to participants in a manner reflective of their unique structural positions.

EXERCISE CAPACITY AND HEALTH-RELATED QUALITY OF LIFE IN SURVIVORS OF COVID-19 PNEUMONIA

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: To determine the effect of COVID-19 pneumonia on exercise capacity and quality of life among healthcare workers of the Philippine Heart Center who survived the disease. METHODS: This was a prospective cohort study conducted at the Philippine Heart Center (PHC) from September 2020 to January 2021. PHC Healthcare workers aged =/> 19 years old, discharged from PHC as a case of recovered COVID-19 Pneumonia were included. Those with signs and symptoms of possible COVID-19 reinfection, history of pulmonary resection, neurological or psychiatric disease, COPD, lung malignancies, or fulfilled any of the contraindications for a 6-Minute walk test (6MWT) were excluded. Participants were evaluated at the research site at 3 and 6 months from onset of illness (+/-2 weeks). During each visit, they were assessed for signs and symptoms of possible COVID-19 reinfection, vital signs were taken, 6MWT and the RAND free version of the Medical Outcomes Study 36-item Short Form General Health Survey (SF-36) questionnaires were completed. One-way ANOVA, Kruskal-Wallis test and Fisher's exact test were used to determine the difference of mean, rank and frequency within the three different COVID-19 severities. Paired Sample T-test or Wilcoxon Sign rank test was used to determine the difference of mean or rank from 3rd month to 6th month. Shapiro-Wilk was used to test the normality of the continuous variables. Null hypotheses was rejected at 0.05α-level of significance. RESULTS: Our study revealed that 3 months from illness-onset, COVID-19 survivors had lower average 6MWD (374 meters;326-404) compared to the general Filipino population. The 6MWD was also proportional to the severity of the disease, mild: 393;369-426 vs moderate: 318;304-326, vs severe:147;129-167, p=0.001.Those who had mild (p=0.000) and moderate disease (p= 0.0076) had significant improvements in the 6MWD six months from the onset of illness, in contrast to those who had severe COVID-19 disease (p=0.431). Although there was appreciable improvement in the 6MWD for mild and moderate disease, the actual 6MWD achieved was still subpar with the reference values for the general Filipino population. Majority of the domains of the SF-36 where all lower compared with the general Filipino population. Among these, physical functioning, social functioning, role limitations due to physical problems and general health scored the lowest in our study. CONCLUSIONS: We have demonstrated that statistically significant, but not clinically relevant improvements on exercise capacity may be observed on healthcare workers who survived COVID-19 pneumonia. Furthermore, impairment on exercise capacity and health-related quality of life still persists in patients with COVID-19 pneumonia even after 6 months. CLINICAL IMPLICATIONS: This finding underscores the need for large-scale follow up and early intervention to improve residual impairments in patients who had COVID-19. DISCLOSURES: No relevant relationships by Jamaica Ross David, source=Web Response No relevant relationships by Maria Encarnita Limpin, source=Web Response no disclosure on file for Bernice Ong-Dela Cruz;

Evaluating the sensitivity of SARS-CoV-2 infection rates on college campuses to wastewater surveillance.

As college campuses reopened in fall 2020, we saw a large-scale experiment unfold on the efficacy of various strategies to contain the SARS-CoV-2 virus. Traditional individual surveillance testing via nasal swabs and/or saliva is among the measures that colleges are pursuing to reduce the spread of the virus on campus. Additionally, some colleges are testing wastewater on their campuses for signs of infection, which can provide an early warning signal for campuses to locate COVID-positive individuals. However, a representation of wastewater surveillance has not yet been incorporated into epidemiological models for college campuses, nor has the efficacy of wastewater screening been evaluated relative to traditional individual surveillance testing, within the structure of these models. Here, we implement a new model component for wastewater surveillance within an established epidemiological model for college campuses. We use a hypothetical residential university to evaluate the efficacy of wastewater surveillance for maintaining low infection rates. We find that wastewater sampling with a 1-day lag to initiate individual screening tests, plus completing the subsequent tests within a 4-day period can keep overall infections within 5% of the infection rates seen with traditional individual surveillance testing. Our results also indicate that wastewater surveillance can effectively reduce the number of false positive cases by identifying subpopulations for surveillance testing where infectious individuals are more likely to be found. Through a Monte Carlo risk analysis, we find that surveillance testing that relies solely on wastewater sampling can be fragile against scenarios with high viral reproductive numbers and high rates of infection of campus community members by outside sources. These results point to the practical importance of additional surveillance measures to limit the spread of the virus on campus and the necessity of a proactive response to the initial signs of outbreak.

COVID-19 vaccination in haematology patients: an Australian and New Zealand consensus position statement.

Australia and New Zealand have achieved excellent community control of COVID-19 infection. In light of the imminent COVID-19 vaccination roll out in both countries, representatives from the Haematology Society of Australia and New Zealand and infectious diseases specialists have collaborated on this consensus position statement regarding COVID-19 vaccination in patients with haematological disorders. It is our recommendation that patients with haematological malignancies, and some benign haematological disorders, should have expedited access to high-efficacy COVID-19 vaccines, given that these patients are at high risk of morbidity and mortality from COVID-19 infection. Vaccination should not replace other public health measures in these patients, given that the effectiveness of COVID-19 vaccination, specifically in patients with haematological malignancies, is not known. Given the limited available data, prospective collection of safety and efficacy data of COVID-19 vaccination in this patient group is a priority.

6 COVID-19 outbreak investigation in a London army barracks. Understanding prevalence, seroconversion, transmission risk factors and control measures for COVID-19

IntroductionMilitary Establishments are at increased risk of rapid spread of respiratory infections. Little was known in March 2020 about SARS-CoV-2 prevalence, serological conversion, asymptomatic transmission or risk factors for transmission, particularly in military populations. Early identification, swift implementation of control measures, and investigation of a potential outbreak with Public Health England in an Army barracks following one confirmed case and 11 symptomatic personnel, allowed exploration of these questions.MethodsAll adult personnel, including civilians working or living at the Barracks were invited to participate at initial visit and day-36 follow-up. Participants completed a symptom and transmission risk factor questionnaire;gave nasal and throat swabs for SARS-CoV-2 RT-PCR, infectious virus isolation, whole genome sequencing (WGS);and blood samples to detect SARS-CoV-2 and neutralising antibodies. Risk factors were statistically analysed using STATA v15.0, described in univariate analysis by relative risks and assessed using Fisher’s Exact test.ResultsAt first visit, 24/304 (8%) participants were RT-PCR positive and infectious virus recovered from 7/24 (29%). Seropositivity was 7% (19/285). 64% of all positive participants were asymptomatic. WGS identified more than three separate introductions, and evidence of asymptomatic transmission through genetically indistinguishable samples. Significant transmission risk factors included contact with a confirmed case, female gender, and two-person shared bathrooms. After 36 days, there were no new cases, all previously RT-PCR positive participants seroconverted, but not all developed neutralising antibodies;seropositivity was 13% (25/193).ConclusionsMost positive military personnel were asymptomatic, but those with symptoms reported ageusia or anosmia. Some RT-PCR positive participants, but none who were simultaneously positive for neutralising antibodies, had infectious virus. Initial infection rates were five times general London estimates, but effective implementation of control measures including enhanced cleaning, social distancing, and prompt isolation mitigated on-site spread. 36 days later seropositivity was below London’s rate. Ongoing risks include new COVID-19 introduction into the barracks from off-site personnel, asymptomatic transmission between cases and contacts, and use of two-person bathrooms.

Cross sectional investigation of a COVID-19 outbreak at a London Army barracks: Neutralising antibodies and virus isolation.

BACKGROUND: Military personnel in enclosed societies are at increased risk of respiratory infections. We investigated an outbreak of Coronavirus Disease 2019 in a London Army barracks early in the pandemic. METHODS: Army personnel, their families and civilians had nasal and throat swabs for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) by reverse transcriptase -polymerase chain reaction (RT-PCR), virus isolation and whole genome sequencing, along with blood samples for SARS-CoV-2 antibodies. All tests were repeated 36 days later. FINDINGS: During the first visit, 304 (254 Army personnel, 10 family members, 36 civilians, 4 not stated) participated and 24/304 (8%) were SARS-CoV-2 RT-PCR positive. Infectious virus was isolated from 7/24 (29%). Of the 285 who provided a blood sample, 7% (19/285) were antibody positive and 63% (12/19) had neutralising antibodies. Twenty-two (22/34, 64%) individuals with laboratory-confirmed infection were asymptomatic. Nine SARS-CoV-2 RT-PCR positive participants were also antibody positive but those who had neutralising antibodies did not have infectious virus. At the second visit, no new infections were detected, and 13% (25/193) were seropositive, including 52% (13/25) with neutralising antibodies. Risk factors for SARS-CoV-2 antibody positivity included contact with a confirmed case (RR 25.2; 95% CI 14-45), being female (RR 2.5; 95% CI 1.0-6.0) and two-person shared bathroom (RR 2.6; 95% CI 1.1-6.4). INTERPRETATION: We identified high rates of asymptomatic SARS-CoV-2 infection. Public Health control measures can mitigate spread but virus re-introduction from asymptomatic individuals remains a risk. Most seropositive individuals had neutralising antibodies and infectious virus was not recovered from anyone with neutralising antibodies. FUNDING: PHE.

Remote monitoring using donor-derived, cell-free DNA after kidney transplantation during the coronavirus disease 2019 pandemic.

BACKGROUND: Donor-derived, cell-free DNA (dd-cfDNA) level correlates with allograft injury with clinical validity and utility for quiescence and active acute rejection (AR) in kidney transplant recipients. We analyzed trends in dd-cfDNA level immediately preceding and during the coronavirus disease 2019 (COVID-19) pandemic with implemented "shelter in place" and a tele-health strategy with remote home phlebotomy to limit COVID-19 exposure. METHODS: During COVID-19 in the United States (US), we surveyed weekly (January 6, 2020-May 25, 2020) metrics for dd-cfDNA corresponding to both a low risk for active rejection (dd-cfDNA < 0.5%) and cohorts with indeterminate levels of 0.5% to 1.0% and > 1.0%. During the study timeframe, over 11,000 patient samples (67%) from 150 kidney transplantation centers were transitioned from standard facility-based to remote phlebotomy. RESULTS: The proportion of dd-cfDNA samples, analyzed in 21 weekly aggregated cohorts by risk-stratification category, was unchanged during the COVID-19 escalation in the US. Linearized slopes for numbers of samples corresponding to indeterminate risk for AR cohorts of > 1.0% and 0.5% to 1.0% were -0.31 and -0.12, respectively; indicating that prevalence of these "at risk for AR cohorts" decreased during remote surveillance. Approximately 73% of samples corresponded to low risk of AR (dd-cfDNA < 0.5%), while an additional 15% of samples had dd-cfDNA level ≤ 1.0%. CONCLUSION: The combination of remote home phlebotomy including dd-cfDNA analysis and a tele-health program offer a new paradigm that may substantially improve patient compliance and assuage anxiety regarding the state of kidney allograft health during the COVID-19 pandemic. Further prospective multi-center studies with robust outcomes data are warranted.