The Relationship between Internet Patient Satisfaction Ratings and COVID-19 Outcomes.

Our prior research showed that patient experience-as reported by Google, Yelp, and the Hospital Consumer Assessment of Healthcare Providers and Systems survey-is associated with health outcomes. Upon learning that COVID-19 mortality rates differed among U.S. geographic areas, we sought to determine if COVID-19 outcomes were associated with patient experience. We reviewed daily, U.S.-county-level-accrued COVID-19 infections and deaths during the first year of the pandemic using each locality's mean online patient review rating, correcting for county-level demographic factors. We found doctor star ratings were significantly associated with COVID-19 outcomes. We estimated the absolute risk reduction (ARR) and relative risk reduction (RRR) for each outcome by comparing the real-world-observed outcomes, observed with the mean star rating, to the outcomes predicted by our model with a 0.3 unit higher average star rating. Geographic areas with higher patient satisfaction online review ratings in our models had substantially better COVID-19 outcomes. Our models predict that, had medical practices nationwide maintained a 4-star average online review rating-a 0.3-star increase above the current national average-the U.S may have experienced a nearly 11% lower COVID-19 infection rate and a nearly 17% lower death rate among those infected.

COVID-19 Recurrence Without Seroconversion in a Patient With Mannose-Binding Lectin Deficiency.

INTRODUCTION: The SARS-CoV-2 virus has infected more than 63,000,000 people worldwide after emerging from Wuhan, China in December 2019. This outbreak was declared a Public Health Emergency in January 2020, and a pandemic in March. While rare, reinfection with the virus has been reported on multiple occasions. CASE PRESENTATION: We present a case report of an individual with mannose binding lectin deficiency who tested positive on two separate occasions, months apart, and did not develop IgG antibodies to SARS-CoV-2. This patient Is a 30- year-old female healthcare worker with a past medical history of ITP, pancreatitis, GERD, anxiety and recurrent pneumonia. She presented in March 2020 with fever, nasal congestion, and dry cough. She was diagnosed with COVID-19 in March 2020, via PCR through employee health. She was treated with a course azithromycin and hydroxychloroquine. Symptoms resolved, however in June 2020, SARS-CoV-2 IgG antibodies were negative. Seven months later in October, she once again developed symptoms which were milder. She was found to have a decreased level of mannose binding lectin, normal immunoglobulin levels, and normal streptococcus pneumonia IgG antibodies. On immune work-up after recovery, she was found to have a decreased level of mannose binding lectin (<50 ng/mL), normal immunoglobulin levels, and protective Streptococcus pneumoniae IgG antibodies with appropriate vaccine response. Her SARS-CoV-2 IgG returned back as positive 8 weeks after her second infection. DISCUSSION: This case illustrates that patients with mannose binding lectin deficiency may be at greater risk of re-infection than the general population.