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Wastewater-based epidemiology (WBE) has been utilized for outbreak monitoring and response efforts in university settings during the coronavirus disease 2019 (COVID-19) pandemic. However, few studies examined the impact of university policies on the effectiveness of WBE to identify cases and mitigate transmission. The objective of this study was to retrospectively assess relationships between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) wastewater outcomes and COVID-19 cases in residential buildings of a large university campus across two academic semesters (August 2020-May 2021) under different COVID-19 mitigation policies. Clinical case surveillance data of student residents were obtained from the university COVID-19 response program. We collected and processed building-level wastewater for detection and quantification of SARS-CoV-2 RNA by RT-qPCR. The odds of obtaining a positive wastewater sample increased with COVID-19 clinical cases in the fall semester (OR = 1.50, P value = 0.02), with higher odds in the spring semester (OR = 2.63, P value < 0.0001). We observed linear associations between SARS-CoV-2 wastewater concentrations and COVID-19 clinical cases (parameter estimate = 1.2, P value = 0.006). Our study demonstrated the effectiveness of WBE in the university setting, though it may be limited under different COVID-19 mitigation policies. As a complementary surveillance tool, WBE should be accompanied by robust administrative and clinical testing efforts for the COVID-19 pandemic response. © 2022 American Chemical Society.
ABSTRACT
Wastewater-based epidemiology (WBE) has been utilized for outbreak monitoring and response efforts in university settings during the coronavirus disease 2019 (COVID-19) pandemic. However, few studies examined the impact of university policies on the effectiveness of WBE to identify cases and mitigate transmission. The objective of this study was to retrospectively assess relationships between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) wastewater outcomes and COVID-19 cases in residential buildings of a large university campus across two academic semesters (August 2020-May 2021) under different COVID-19 mitigation policies. Clinical case surveillance data of student residents were obtained from the university COVID-19 response program. We collected and processed building-level wastewater for detection and quantification of SARS-CoV-2 RNA by RT-qPCR. The odds of obtaining a positive wastewater sample increased with COVID-19 clinical cases in the fall semester (OR = 1.50, P value = 0.02), with higher odds in the spring semester (OR = 2.63, P value < 0.0001). We observed linear associations between SARS-CoV-2 wastewater concentrations and COVID-19 clinical cases (parameter estimate = 1.2, P value = 0.006). Our study demonstrated the effectiveness of WBE in the university setting, though it may be limited under different COVID-19 mitigation policies. As a complementary surveillance tool, WBE should be accompanied by robust administrative and clinical testing efforts for the COVID-19 pandemic response.
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SESSION TITLE: Late Breaking Procedures Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Mortality from intermediate risk (IR) Pulmonary Embolism (PE) ranges from 1.9% to 14.5% and exceeds 31% in high risk (HR) PE. Catheter based therapies for IR PE offer an alternative to parenteral thrombolysis, and catheter directed embolectomy (CDE) may be associated with a low risk of bleeding. Surgical Pulmonary Embolectomy (SPE) is performed when thrombolysis is contraindicated or advanced therapies for IR, or HR PE have failed. Our aim was to compare the safety and efficacy of CDE versus SPE. METHODS: We performed a retrospective review of 34 consecutive patients with acute PE diagnosed by Chest CT angiography (CTA) admitted to three urban teaching hospitals from 8/2019-12/2021, who received FlowTriever Retrieval/Aspiration suction thrombectomy (CDE), or SPE. RESULTS: 15 patients received SPE, and 19 patients received CDE. Indications for SPE included failed CDE due to cardiac arrest n=1, failed catheter thrombolysis n=1, hemodynamic instability, and CTA evidence of chronic thrombi, or distal thrombi not accessible to CDE. All SPE had high clot burden, and echo evidence of RV failure. All following data are presented as SPE vs CDE. There was no statistically significant difference between both cohorts with respect to;female (%) (47 Vs 58), race, initial systolic BP (126 Vs 122 mmHg), and heart rate (101 Vs 99/min). Mean age was higher for CDE (56.4 Vs 67.6, p< 0.05). SPE patients had higher rate of dyspnea (93% Vs 53%) and longer duration of symptoms. PESI score (105 Vs 131) and PESI class were similar (p> 0.05). SPE patients included 53% IR and 47% HR, and CDE patients included 53% IR and 47% HR. On CTA, saddle PE was seen in SPE group (53% Vs 39%, p = 0.63) and 1 patient from SPE group and 2 patients from CDE group had clot in transit. Mean troponin 0.41 Vs 0.28, BNP 275 Vs 317, and D-dimer 8.5 Vs 16.5 were not significantly different. Procedure time was shorter for CDE (median 243 Vs 93 minutes, p<0.001). Median hospital length of stay (LOS) was similar (7.7 Vs 7 days p= 0.579), but median ICU LOS was shorter in CDE group (128 Vs 46.3 hours p<0.001). Survival rate on discharge was 93.4% Vs 89.5% (SPE Vs CDE). Causes of 30-day post procedure mortality included cardiac arrest due to RV failure and hypotension after CDE (10.5%). There was no 30-day post procedure mortality in the SPE cohorts. One death occurred 60 days post SPE for massive PE, from complications related to severe COVID-19 pneumonia. Major bleeding (need for 2 units PRBC) occurred in 27% Vs 5.3% following SPE Vs CDE. CONCLUSIONS: Acute PE patients who received CDE were older, had a shorter duration of symptoms, less dyspnea, reduced procedure time and shorter ICU stay vs SPE treated patients, but similar length of stay. CLINICAL IMPLICATIONS: CDE and SPE provided satisfactory results and SPE was effective for patients who had worse dyspnea, distal and or more chronic thrombo-emboli. DISCLOSURES: No relevant relationships by Samuel Acquah No relevant relationships by Hafiza Noor Ul Ain Baloch No relevant relationships by Madeline Ehrlich No relevant relationships by Yoshiko Ishisaka No relevant relationships by Omar Lattouf no disclosure on file for Robert Lookstein;No relevant relationships by Janet Shapiro No relevant relationships by David Steiger
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Multisystem inflammatory syndrome in adults presents with extrapulmonary organ dysfunction in patients with a recent COVID-19 infection. A 22-year-old man with a history of ataxia with vitamin E deficiency and recent asymptomatic COVID-19 infection presented with retropharyngeal edema treated as phlegmon. He developed cardiac dysfunction and required vasopressor support with evidence of high inflammatory markers. Multisystem inflammatory syndrome in adults was diagnosed, and he rapidly improved with intravenous (IV) corticosteroids. Multisystem inflammatory syndrome in adults can rarely present with retropharyngeal phlegmon. We identified 2 reported cases in adults and 5 in children with an age range of 4 to 51 years. COVID-19 infection was established in all cases but was often previously unknown. All patients recovered with IV corticosteroids with or without IV immunoglobulin. In conclusion, multisystem inflammatory syndrome in adults can present with retropharyngeal edema, and previous COVID-19 infection may not be apparent.
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Background The use of general anesthesia (GA) during mechanical thrombectomy has been shown to be safe for those patients undergoing mechanical thrombectomy. One criticism of GA, however, is the extra time it takes to perform. Processes that reduce time to reperfusion can improve outcome. We sought to look at the effect of pre-transfer intubation (PTI) on patient flow and outcome. Methods A system wide stroke program was implemented during the COVID pandemic;the program consists of a comprehensive stroke center with 10 network hospitals, 8 referring for thrombectomy. Patients were referred for mechanical thrombectomy based on AHA guidelines and VIZ AI software processing performed at the sending facilities. All patients were transferred directly to the endovascular suite. PTI was implemented for patients with high NIHSS. Data was collected from November 2020 through mid-March 2021 during the peak months of the COVID-19 surge in Georgia. Results 52 patients underwent mechanical thrombectomy. 38 patients were from network hospital emergency departments;19% were COVID positive. 16 patients underwent PTI, and 22 patients were intubated in the endovascular suite. Initial NIHSS was significantly higher in PTI patients (17 versus 11, p < 0.05). The Door-in-Door-Out time was not significantly different;176 ± 68 min with PTI and 140 ± 37 min for those intubated at the CSC (p = 0.065). Door to groin puncture at the CSC was significantly shorter for PTI, 18 ± 6 min, compared to those intubated at the CSC, 32 ± 19 min (p < 0.05). Despite a higher initial NIHSS, there was no significant difference in the NIHSS at discharge nor the percent of patients that were independent at discharge, mRS 0-2. There was a trend toward a larger change in NIHSS in the PTI group. There were no adverse events associated with PTI and all patients had a persistent LVO on the initial angiogram. Conclusion An established protocol of pre-transfer intubation is safe and feasible. Intubation prior to transfer does not negatively affect DIDO yet significantly decreases door to groin time at the CSC.
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Since 2015, there has been a huge increase in laws that ostensibly seek to counter misinformation. Since the pandemic began, this trend has only accelerated. Both authoritarian and democratic governments have introduced more new policies to fight misinformation in 2019 and in 2020. In authoritarian states pandemic-related misinformation provided a new justification for repressive policies. Questions of political motivations aside, as the continuing problem of pandemic misinformation illustrates, it’s unclear how effective these laws are. © 2021 Bulletin of the Atomic Scientists.
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As I preparedmy presidential address, what came to mind wasMischel's (1977: 346) work on situational strength, when he asked: "When are situations most likely to exert powerful effects and, conversely,when are person variables likely to bemost influential?" Situations matter most when they are strong, as they constrain options and provide clear signals about expectations. My presidential year provided a strong situation in the form of COVID-19 and the surging visibility of racial inequality in society. Both of thesewere united in their focus on the absence of health-the loss of life from COVID-19 or from racist brutality. © 2021 Academy of Management. All rights reserved.
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Session Description: Physician stress and burnout have been recognized problems for the past several years and have received a great deal of attention and study. This year the COVID-19 pandemic and the separate, subsequent social unrest have acted as multipliers to the preexisting conditions facing not only physicians, but entire health care teams. Panelists take a full 360° look at the situation and how effective intervention can help mitigate symptoms and improve provider health during this troubling, uncertain time.