ABSTRACT
Lung transplant (LTx) recipients have increased risk of infection with SARS-CoV-2 and have reduced efficacy from COVID-19 vaccination. The Delta variant of SARS-CoV-2 has increased virulence compared to earlier variants. We hypothesized that LTx recipients would have increased susceptibility to Delta variant infection despite vaccination. We performed a retrospective cohort study of 314 LTx recipients followed between 1/1/2020-9/30/2021. Diagnosis of SARS-CoV-2 infection by PCR was recorded;Delta variant comprised >99% of strains from 6/1/2021-9/30/2021. Data regarding COVID-19 vaccination status, symptom development, hospitalization, intubation, and death were collected. Forty-four patients (14%) were diagnosed with COVID-19, 18 (41%) of which were Delta variant. The rate of infection with Delta was 4-fold higher than with earlier strains (Figure, 0.016 vs. 0.004 cases / patient months, p<0.001). Fifteen (83%) patients diagnosed with Delta variant were fully vaccinated at the time of infection (p<0.001). The rate of infection with Delta variant in vaccinated and unvaccinated individuals was similar (0.017/patient months with vaccine, 0.015/patient months without vaccine, p=0.84). The majority (>89%) of patients had respiratory symptoms in both groups. More patients with Delta variant received monoclonal antibody infusions (89% vs. 54%, p=0.021) and fewer patients with Delta variant had resolution of disease (50% vs. 92%, p<0.001). There was a trend towards greater O 2 needs with Delta variant (p=0.07). Hospitalization (38% vs. 23%), intubation (11% vs. 4%), and death (11% vs. 4%) were numerically greater with Delta variant, although not statistically significant. The incidence rate of SARS-CoV-2 infection was significantly greater with Delta variant in LTx recipients, despite high prevalence of full vaccination during the Delta wave. Further study in larger cohorts is needed to determine whether booster vaccines can reduce such infectivity. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
Background and aims: With the onset of the Coronavirus Disease 2019 (COVID-19) pandemic, healthcare providers abruptly changed their delivery of care to protect patients and staff from infection. One such change was to convert in-person advanced gastrointestinal endoscopy pre-procedure consultations to telemedicine visits. The use of telemedicine has been successfully used in the field of gastroenterology in managing symptoms and chronic conditions among established patients. However, to our knowledge, there is little literature on the utility of this modality for pre-procedure consultation visits, where patients often meet their proceduralists for the first time. The aim of this study was to compare overall patient satisfaction among those who had pre-procedure consultation visits by telemedicine, in –person, or a direct access procedure (instructions and procedure explained by a nurse practitioner or physicians assistant). Methods: Patients who had undergone an advanced endoscopic procedure at Long Island Jewish Hospital from the months of May 2020 to August 2020 were called by telephone and asked to complete a modified version of the validated patient satisfaction survey mGHAA-9. The survey was designed to assess patient satisfaction in their pre-procedure, intra-procedure, and post procedure experiences. Patients were grouped based on whether they had received an in-clinic consultation visit by the endoscopist, telemedicine consultation visit by the endoscopist, or direct access. Geographic location to the office, prior endoscopic experience, type of endoscopic procedure (diagnostic vs. therapeutic), and new gastrointestinal cancer diagnosis data were recorded. Results: Of the total 322 patients that were called, 123 agreed to participate (38%) and provided responses to the survey. There were 26 who had in person consultation visits, 32 who had telemedicine consultation visits, and 65 direct access visits. Overall mean satisfaction among the three groups did not reveal a statistically significant difference (p value= 0.983). Furthermore, sub-analysis of the preprocedure, intra procedure, and post procedure satisfaction scores did not reveal statistically significant differences (p=0.996, p=0.244, and p=0.998, respectively). However, patients with a new gastrointestinal cancer diagnosis had a statistically significant higher mean satisfaction score in those who had telemedicine visits with proceduralists compared to those who had direct access procedures (P=0.0116). Conclusion: Our study suggests that pre-procedure consultation visits by telemedicine, in-person, or direct access all have similar satisfaction scores among patients. However, telemedicine consultation visits with the endoscopist may be preferred over direct access in patients who have a clinically high suspicion for a new gastrointestinal cancer diagnosis. [Formula presented]