ABSTRACT
BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic has affected over 61 million U.S. citizens, and up to 30-80% of COVID-19 survivors may go on to develop post-acute sequelae of SARS-CoV-2 (PASC). These sequelae can be debilitating and often impair quality of life and daily function. Although it has been suggested that severity of acute COVID-19 infection is directly related to PASC development, this association remains unclear. METHODS: This prospective cohort study was conducted through consecutive recruitment of confirmed and probable COVID-19 patients with persistent symptoms lasting ≥3 weeks from disease onset or positive SARS-CoV-2 test from academic PASC clinics at Emory University and Grady Memorial Hospital in Atlanta, GA during January-December 2021. Sociodemographic, comorbidity, and acute COVID-19 data were collected. Severe acute COVID- 19 was defined as requiring hospitalization, and critical acute COVID-19 required intensive care. New or worsening symptoms persisting ≥3 weeks from COVID-19 onset were collected using a standardized review of systems, and confirmed by clinician interview. Differences in PASC symptom type were assessed by calculating risk ratios (RR) and 95% confidence intervals (CI) using the Taylor series, and difference in PASC duration was assessed using student's t-test. Two-tailed p-values ≤0.05 were considered significant. RESULTS: Of 269 enrollees, median age was 52 years (range 18-93) and there were more women (74%) than men (26%). There were 152 (57%) African American, 76 (28%) White, and 21 (8%) Hispanic. Among PASC patients, the most common symptoms were dyspnea (68%), fatigue (63%), brain fog (48%), dizziness (27%), chest pain (25%), cough (23%) and headache (23%) with a median PASC duration of 132 days (range 21-523). Acute COVID-19 severity was asymptomatic in one participant, mild in 149 (55%), severe in 95 (35%), and critical in 23 (9%). Asymptomatic- mild acute COVID-19 patients had more persistent dyspnea (RR: 1.33, 95%, CI: 1.09- 1.61), fatigue (RR: 1.53, 95%CI: 1.22-1.91), brain fog (RR: 2.00, 95%CI: 1.44-2.67), dizziness (RR: 2.03, 95%CI: 1.27-3.25), and headache (RR: 2.07, 95%CI: 1.22-3.48) compared with severe-critical acute disease, who had a non-significant trend towards more cough and chest pain. Asymptomatic-mild participants were further from incident infection (153 days) compared to severe-critical participants (110 days) (p=0.04). CONCLUSIONS: Contrary to previous observations, COVID-19 survivors who experienced asymptomatic-mild infections may develop higher rates of prevalent PASC symptoms compared to those with severe- critical antecedent infections. These findings are not attributable to PASC duration, as longer PASC duration has been previously associated with fewer symptoms. To ensure early identification and linkage to specialized care, clinicians should be aware of PASC in patients with antecedent asymptomatic-mild acute COVID-19 infections.
ABSTRACT
This study assessed whether changes in surveillance operations affected reporting in South Sudan;testing and case numbers reported during April 6, 2020-February 21, 2021, were analyzed relative to the timing of funding, policy, and strategy changes. South Sudan, with a population of approximately 11 million, began COVID-19 surveillance in February 2020 and reported 6,931 cases through February 21, 2021. Surveillance data analyzed were from point of entry screening, testing of symptomatic persons who contacted an alert hotline, contact tracing, sentinel surveillance, and outbound travel screening. After travel restrictions were relaxed in early May 2020, international land and air travel resumed and mandatory requirements for negative pretravel test results were initiated. The percentage of all testing accounted for by travel screening increased >300%, from 21.1% to 91.0% during the analysis period, despite yielding the lowest percentage of positive tests among all sources. Although testing of symptomatic persons and contact tracing yielded the highest percentage of COVID-19 cases, the percentage of all testing from these sources decreased 88%, from 52.6% to 6.3% after support for these activities was reduced. Collectively, testing increased over the project period, but shifted toward sources least likely to yield positive results, possibly resulting in underreporting of cases. Policy, funding, and strategy decisions related to the COVID-19 pandemic response, such as those implemented in South Sudan, are important issues to consider when interpreting the epidemiology of COVID-19 outbreaks.
ABSTRACT
Purpose : One of the most important clinical data points in evaluating ophthalmology patients is visual acuity (VA). During the COVID-19 pandemic, eye health providers are utilizing telehealth to decrease patient and provider risk related to in-person clinic visits, while still providing high-quality care. This study sought to compare at-home VA tests with in-office clinical VA measurements to determine the validity of at-home VA testing for telehealth visits. Methods : Patients from 1 comprehensive and 3 subspecialty ophthalmology clinics had VA greater than or equal to 20/200 in the study eye. The patients were prospectively randomized to perform 2 of 3 at-home VA tests (printed chart - University of Arizona/Banner Eye Care Letter Distance Chart;mobile phone app - Verana Vision Test;website test - Farsight.care) within 3 days of their standard of care clinic visit. Patients also completed a survey to assess usability of home tests. At the clinic visit, best corrected Snellen distance acuity was measured to serve as the reference standard. Results : Of the 44 patients (84 eyes) enrolled, 60% were female and the mean age was 66 years (range 22 to 80). The mean difference between printed chart and Snellen, website test and Snellen, and mobile app and Snellen acuity data was 0.10 (95% CI: 0.09-0.11), 0.13 (95% CI: 0.12-0.14), and 0.12 (95% CI: 0.11-0.13) LogMAR, respectively. The highest degree of correlation was between the website and Snellen tests (0.74, 95% CI: 0.59-0.84) (Table 1). Patients found the tests easy to perform at home and were neutral regarding confidence in their results and desire to continue with home testing. In the survey, there was no significant difference for between the 3 tests regarding any of the 4 questions (P = 0.32- 0.62), although there was a trend toward a more positive response with the printed chart (Table 2). Conclusions : These data suggest that some at-home visual acuity tests are comparable in accuracy to in-clinic Snellen visual acuity tests (within 1 line of difference). Patient surveys indicated the tests were easy to understand and complete at home. Further development and validation of at-home vision testing modalities are needed to provide accurate and accessible tele-ophthalmology care.