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This scoping review examines the techniques used by academic librarians for outreach to distance learning faculty From 533 initial records, librarians included 16 articles and identified five recurring themes: in-person visits, synchronous workshops, electronic communication, branding and personalization, and campus partnerships. Despite the prevalence of literature about outreach and marketing in academic libraries, there has been little research on connecting with distance education faculty. This review highlights the need for continued exploration of this topic, including how the COVID-19 pandemic has continued to blur what it means to be a distance learning faculty. © 2023 Elsevier Inc.
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Black women pursued graduate and professional school, post-degree options, and employment at a time when their economic future and livelihood were unknown. The novel Coronavirus (COVID-19) complicated what many Black women were already experiencing. Guided by critical race feminism, the purpose of our exploratory study was to highlight how and to what extent COVID exacerbated Black women's economic trajectories via their financial obligations, financial support, and financial stability. We offer two implications for practice: disrupting systemic oppression/inequities and developing a critical awareness of Black women's economic precarity. © 2022 NASPA.
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BACKGROUND: The arrival of the Delta variant of SARS-CoV-2 was associated with increased transmissibility and illness of greater severity. Reports of nosocomial outbreaks of Delta variant COVID-19 in acute care hospitals have been described but control measures varied widely. AIM: Epidemiological investigation of a linked two-ward COVID-19 Delta variant outbreak was conducted to elucidate its source, risk factors, and control measures. METHODS: Investigations included epidemiologic analysis, detailed case review serial SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR) testing of patients and healthcare workers (HCWs), viral culture, environmental swabbing, HCW-unaware personal protective equipment (PPE) audits, ventilation assessments, and the use of whole genome sequencing (WGS). FINDINGS: This linked two-ward outbreak resulted in 17 patient and 12 HCW cases, despite an 83% vaccination rate. In this setting, suboptimal adherence and compliance to PPE protocols, suboptimal hand hygiene, multi-bedded rooms, and a contaminated vital signs cart with potential fomite or spread via the hands of HCWs were identified as significant risk factors for nosocomial COVID-19 infection. Sudden onset of symptoms, within 72 h, was observed in 79% of all Ward 2 patients, and 93% of all cases (patients and HCWs) on Ward 2 occurred within one incubation period, consistent with a point-source outbreak. RT-PCR assays showed low cycle threshold (CT) values, indicating high viral load from environmental swabs including the vital signs cart. WGS results with ≤3 SNP differences between specimens were observed. CONCLUSION: Outbreaks on both wards settled rapidly, within 3 weeks, using a `back-to-basics' approach without extraordinary measures or changes to standard PPE requirements. Strict adherence to recommended PPE, hand hygiene, education, co-operation from HCWs, including testing and interviews, and additional measures such as limiting movement of patients and staff temporarily were all deemed to have contributed to prompt resolution of the outbreak.
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INTRODUCTION: There is a wide range in the reported incidence of pneumothorax (PTX) and pneumomediastinum (PMN) in patients with coronavirus disease 2019 (COVID-19). PTX alone and PTX/PMN combined has also been associated with higher mortality in patients with COVID-19 related acute respiratory distress syndrome (ARDS), however, current data regarding outcomes or predictors of PTX and PMN in COVID-19 ARDS is limited. The purpose of this study was to determine if the incidence of PTX/PMN in a large cohort with COVID-19 related respiratory failure was associated with mortality. Further, we looked to determine which clinical factors or ventilator management strategies may have impacted mortality in underserved patient population with PTX. METHOD(S): We conducted a retrospective analysis of data from a single center COVID-19 intensive care unit of an urban tertiary safety net hospital including all adult patients admitted with COVID-19 associated ARDS requiring mechanical ventilation between March 2020 and January 2021. Following identification of a cohort with radiographic evidence of PTX and/or PMN, demographics, ventilator data, radiographic data, position, information regarding chest tube and sedation management and outcome data were obtained from the electronic medical record. RESULT(S): Among 502 patients admitted to the ICU with COVID-19 related ARDS, PTX was identified in 103/ 502 (20.5%), predominantly affecting Hispanic (88%) and male (66%) patients. Thirty-four patients had PMN (18.7%) alone. Of patients with documented PTX, 60 (50.8%) had preceding or co-morbid PMN. PTX with/without PMN was associated with increased mortality (OR 2.19, p=0.0027) even after adjustment for ventilator days. There was no significant association between PMN alone and mortality (OR 0.82, p=0.60). Conservative management without tube thoracostomy was rarely possible (18.4% of PTX). Time to development of PTX was not associated with mortality, but PTX was associated with longer survival times (HR 2.10;p< 0.001). CONCLUSION(S): There is a high incidence of PTX/PMN in critically ill patients with COVID-19. PTX, but not PMN alone, is associated with higher mortality in ICU patients.
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Background: Monoclonal antibodies have been the mainstay of treatment of COVID-19 in patients at high-risk of mortality from COVID-19. We aimed to study our experience with monoclonal antibodies (mAb) in kidney transplant recipients with COVID-19 at our center. Method(s): We reviewed 93 of our kidney transplant recipients who were infected with COVID-19 and received mAb treatment. The mAb infusion received was the one active against the variant that was circulating during that period (39 received either bamlanivimab or casirivimab/imdevimab, 41 received sotrovimab and 13 received bebtelovimab). All patients were on standard immunosuppression with tacrolimus and prednisone, and 88% were on mycophenolate prior to COVID-19 diagnosis, which was subsequently reduced or held for at least 2 weeks. Result(s): Of the 93 patients, median age was 54 (IQR 44-64), 44% were male, 42% were Hispanic, 36% were African American. 76% have received deceased donor kidney transplant, 94% had history of hypertension, 47% diabetes mellitus, 18% coronary artery disease. All the patients had mild symptoms without initial hypoxia requiring supplemental O2 and only 5 patients (5.4%) were admitted to the hospital. While 33 patients (35%) were unvaccinated at the time of COVID-19 diagnosis, 60 patients (65%) have received at least 2 doses of COVID vaccination at time of diagnosis and of those 27 patients (29%) have received a third dose. There was only one death (1%) in a patient that was re-hospitalized with severe COVID-19. There was no allograft loss. The rate of re-infection after mAb treatment was 6.5%. There was no serious adverse event related to the mAb infusion. Conclusion(s): Our experience suggests that monoclonal antibodies are a safe therapeutic to reduce the need for COVID-19 related hospitalization in this high-risk kidney transplant population, while one third of those were unvaccinated at the time of COVID-19 diagnosis.
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Background: We aimed to investigate the variation in mortality from SARS-CoV-2 infection in kidney transplant recipients Methods: Between March 16, 2020 and May 4, 2022, 537 patients were diagnosed with SARS-CoV-2 infection by RT-PCR. Result(s): 59% were male, median age 58 (IQR: 45-67), predominantly Hispanic (51.2%) and African American (29%). 75.4% received a deceased-donor renal transplant, 55% received anti-thymocyte induction. Most patients were on triple immunosuppression (96% on calcineurin inhibitors, 87% on anti-metabolite, and 99% on prednisone). While the mortality rate was 37 % (47/128) during first peak between March 16 and April 30, 2020, it has significantly decreased to 11% (7/61) from May 1, 2020 to end of December 2020 with social distancing and use of facemask. Between January 1, 2021 and November 5, 2021 with use of vaccination and monoclonal antibodies, the mortality rate further decreased to 7.7% (10/129). Between November 6, 2021 till May 4, 2022 which corresponds to the period when the Omicron variant and subvariants are prevalent, the mortality rate was 5.5% (12/219). Among those diagnosed during the period when Omicron was prevalent, 188/219 (85.8%) have received 2 doses of COVID vaccine and 82/219 (37.4%) have received a third dose. Since the beginning of use of monoclonal antibodies, 93 patients received a combination of casirivimab/imdevimab when initial SARS-CoV-2 variants were dominant and sotrovimab then bebtelovimab during the period of Omicron and its subvariants. Only one death occurred in patients who received monoclonal antibody treatment and that patient was hospitalized for severe COVID-19. We identified 23 re-infections. Most of re-infected patients have already received at least 2 doses of COVID vaccine but only 5 received a third dose. None of the re-infected patients was hospitalized and none of them died. Conclusion(s): In summary, mortality from SARS-CoV-2 infection in kidney transplant recipients has significantly decreased over time. This could be explained by initial exposure to higher viral load due to lack of personal protection and social distancing. However, since the judicious use of monoclonal antibodies and vaccination, in addition to social distancing protocols and use of facemask, the mortality in kidney transplant recipients has decreased over time.
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Purpose : Coronavirus-19 (COVID-19) has been associated with ophthalmic manifestations. The relationship between tear film SARS-CoV-2 RNA, timing of illness and eye disease are unknown. We evaluated hospitalized COVID-19 inpatients for retinopathy and tear film viral RNA. Methods : Hospitalized COVID-19 inpatients were offered enrollment from January-June 2021. Full dilated ophthalmic examination and conjunctival swabs were taken for triplex RT-PCR for SARS-CoV-2 RNA targeting N2, E and RNAse P. Demographic, clinical outcomes and laboratory data were collected. Univariate and multivariate analyses of systemic disease and laboratory risk factors for retinopathy and SARS-CoV-2 RNA detection were assessed. Results : Sixty patients were prospectively enrolled in this cross-sectional, observational study. The mean age was 58.8 years (Standard deviation [SD] 15.2 years) and 29 (48%) were female. Retinopathy associated with COVID-19 in 12 of 60 patients (20%). Univariate analyses revealed that younger age, greater body mass index (BMI) and extracorporeal membrane (ECMO) requirement were associated with increased odds of COVID-19 retinopathy. The mean age (SD) of patients with COVID-19 retinopathy was 49.0. (11.6) compared to 61.2 (15.1) years in individuals without retinopathy (p=0.01). The mean BMI was 38.8 (9.8) in patients with retinopathy compared to 31.8 (9.0) in those without retinal disease findings (p=0.04). ECMO requirement was observed in 33% of patients with retinopathy compared to 8% in those without retinopathy (p=0.04). Multivariate analyses trended towards increased risk of retinopathy with younger age (aOR 0.95 (95% CI 0.90- 1.01, p=0.095) and with increased BMI (aOR. 1.08, 95% CI 1.00-1.18, p=0.056). Fifteen of 60 patients (25%) tested positive in their tear film for SARS-CoV-2 RNA with a trend towards a shorter length of illness and hospitalization in patients who were positive. The N2 gene was particularly sensitive with 18 of 19 eyes (94.7%) showing N2-positivity (with or without E gene detection), including 2 patients in whom the B.117 / B.1.525 alpha or ?United Kingdom? variant was detected. Conclusions : A 20% rate of retinopathy was observed and SARS-CoV-2 RNA within tear film was detected in 25% of hospitalized COVID-19 patients. Continued infection control precautions are required given the risk of viral RNA in tear film, which may also be sensitive for the detection of COVID-19 variants.
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Introduction: The benefits of reorganisation (System optimisation) of stroke services to create sustainable, high-quality larger units are well known. This frequently takes many years of planning and public consultation. We report the benefits of co locating two smaller acute stroke units (600 confirmed strokes each per year) onto one non-acute site, planned and delivered to support the wider COVID 19 response in England. Methods: Planned and delivered over 10 days in May 2020: Innovations introduced: 1) Prehospital: telemedicine assessment between stroke specialist and ambulance crew;improving sensitivity and specificity of triage to support time critical access to Thrombolysis and Thrombectomy. 2) Adherence to a National Optimal Stroke Imaging Pathway (NOSIP): 24/7 access to CTA, CTP with AI support and 12hrs access to MRI. 3) Autonomy of stroke bed base 4) Inpatient stroke care redesign: to deliver initial acute care (72 hours) and early rehabilitation (post 72 hours) with medical and therapy care delivered routinely 7 days per week. Monthly evaluation of quality indicators (SSNAP) enabled evaluation, benchmarked against local (pre-pandemic) and national performance. Mortality and length of stay outcomes analysed. Results: Significant and sustained improvement across all 10 domains of care with increased thrombolysis rates >20%, thrombectomy rates >5%, statistically significant relative mortality risk of 59.6% (65 lives saved) and 38% reduction in length of stay (17 to 11 days). Conclusions: Sustainable improvements to stroke services may be delivered rapidly, incorporating innovative solutions to deliver sustainable high-quality stroke care, whilst supporting the wider health care response to the COVID pandemic. (Figure Presented).
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Background. New York City emerged as the Epicenter for Covid-19 due to novel Coronavirus SARS-CoV-2 soon after it was declared a Global Pandemic in early 2020 by the WHO. Covid-19 presents with a wide spectrum of illness from asymptomatic to severe respiratory failure, shock, multiorgan failure and death. Although the overall fatality rate is low, there is significant mortality among hospitalized patients. There is limited information exploring the impact of Covid-19 in community hospital settings in ethnically diverse populations. We aimed to identify risk factors for Covid-19 mortality in our institution. Methods. We conducted a retrospective cohort study of hospitalized in our institution for Covid 19 from March 1st to June 21st 2020. It comprised of 425 discharged patients and 245 expired patients. Information was extracted from our EMR which included demographics, presenting symptoms, and laboratory data. We propensity matched 245 expired patients with a concurrent cohort of discharged patients. Statistically significant covariates were applied in matching, which included age, gender, race, body mass index (BMI), diabetes mellitus, and hypertension. The admission clinical attributes and laboratory parameters and outcomes were analyzed. Results. The mean age of the matched cohort was 66.9 years. Expired patients had a higher incidence of dyspnea (P < 0.001) and headache (0.031). In addition, expired patients had elevated CRP- hs (mg/dl) ≥ 123 (< .0001), SGOT or AST (IU/L) ≥ 54 (p < 0.001), SGPT or ALT (IU/L) ≥ 41 (p < 0.001), and creatinine (mg/dl) ≥ 1.135 (0.001), lower WBC counts (k/ul) ≥ 8.42 (0.009). Furthermore, on multivariate logistic regression, dyspnea (OR = 2.56, P < 0.001), creatinine ≥ 1.135 (OR = 1.79, P = 0.007), LDH(U/L) > 465 (OR = 2.18, P = 0.001), systolic blood pressure < 90 mm Hg (OR = 4.28, p = .02), respiratory rate > 24 (OR = 2.88, p = .001), absolute lymphocyte percent (≤ 12%) (OR = 1.68, p = .001) and procalcitonin (ng/ml) ≥ 0.305 (OR = 1.71, P = .027) predicted in- hospital mortality in all matched patients. Conclusion. Our case series provides admission clinical characteristics and laboratory parameters that predict in- hospital mortality in propensity Covid 19 matched patients with a large Hispanic population. These risk factors will require further validation.
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Background. As part of our outpatient Antimicrobial Stewardship Program, we do surveillance of diagnoses and antibiotic use for common upper respiratory tract infections such as acute upper respiratory tract infection, acute bronchitis, sinusitis, and pharyngitis. We sought to evaluate the impact of the Covid-19 pandemic on the incidence rate of upper respiratory tract infection diagnoses per clinic visit during October 2020 to March 2021 season compared to the three prior respiratory seasons. We also sought to reflect of impact of increase in televisits and overlapping symptoms of COVID 19 and upper respiratory tract infections. Methods. Our cohort study extending from October 2017 to March 2021. We collected number of diagnoses of upper respiratory infections and number of unique clinic visits during four consecutive respiratory seasons at our primary care sites via electronic health records. Results. During the recent October 2020 to March 2021 respiratory season which coincided with the second NYC Covid-19 wave, we had 11569 unique clinic visits and 39 diagnoses of an upper respiratory tract infection - incident rate of 1.29. In the three prior respiratory seasons combined, we had 40939 unique clinic visits and 833 diagnoses of an upper respiratory tract infection - incident rate of 1.49. The incident rates showed a dramatic decline using the test based method and the chi square-statistic p< 0.0001 with an incident rate ratio using a poisson exact method of 6.0359. Statistical comparisons of the current season to each prior individual season yielded similar results. The percentage of Tele-visits during the current season was 19% compared to 0% in the 3 prior seasons. Conclusion. During the first respiratory season from October 2020 to March 2021 in midst of the Covid-19 pandemic which also coincided with the second Covid-19 wave in New York, we saw a statistically significant decrease in incidence of common upper respiratory tract infection diagnoses per clinic visit compared to the three prior respiratory seasons. Overlapping signs and symptoms of upper respiratory tract infections and Covid-19 with the added percentage in Tele-visits did not cause an increase in incidence rates of upper respiratory tract infection diagnoses. Covid-19 related mitigation efforts may have played a role.
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Objective: To explore older Australians’ experiences of using computermediated communication (CMC) to engage with their social networks and communities. Background: Use of CMC among older adults has been associated with favourable social outcomes. How older adults engage with others to foster these outcomes is less well known. Understanding this may be useful when developing programs to encourage older adults’ use of CMC for social purposes. Methods: In-depth semi-structured interviews with 12 adults (five women, seven men;aged 69 to 81) were conducted. Interview questions focused on individuals’ use of CMC to engage with online communities. Data were transcribed and thematically analysed. Results: Two overarching themes relating to a sense of Belonging and Support emerged. Belonging was most heavily emphasised, and included subthemes on how participants experienced their close social networks online, as well as their broader engagement with building interests and identity. Support arose to a lesser extent, and included subthemes relating to how CMC was used not only for the provision and receipt of such, but also to signal availability or need for support. Throughout, participants consistently weighed the benefits of CMC against the disadvantages. Conclusion: The findings highlight the importance of social networks and online communities for older adults and, in particular, how CMC facilitates feelings of belongingness and provides opportunities for reciprocal instrumental, emotional, and informational support. Future research needs to consider the importance of having a sense of belonging when describing the social functioning of digitally literate older adults. © 2021, Griffith University. All rights reserved.
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Introduction: Covid-19 restrictions necessitated adapting the NIHR-funded Gentle Years Yoga trial for adults aged ≥65 years with multi-morbidity from face-to-face to online yoga classes. This study qualitatively explored participant and provider experiences and acceptability of this delivery format. Methods: Yoga participants recruited for a 12-week online yoga intervention across four sites and the yoga teachers (YTs) delivering these classes were purposively sampled and consented. Individual interviews were conducted via Zoom or telephone, audio-recorded, independently transcribed, and thematically analysed. Results: Interviews were conducted from October 2020 to January 2021 with four YTs, and 10 yoga participants aged 66-71 years with 2-5 chronic health conditions. Four themes predominated across all interviews. 1) IT skills. In contrast to perceived negative media portrayal, many participants were active engagers with computer technology, often self-taught in response to Covid-19 social restrictions. Engagement with the online yoga classes required minimal IT proficiency and identified issues appeared trial-related rather than skills-based. 2) Improved accessibility. No safety concerns and multiple accessibility benefits were associated with online classes. Many participants preferred online over face-to-face delivery as they removed transport, mobility, and acute health barriers. 3) Facilitated self-practice. Lack of external distractions associated with face-to-face classes enabled participants to better engage with a personal yoga practice. Many participants had integrated yoga into their daily routine and acute health management. 4) Teacher attributes. Communication limitations inherent with online delivery required a more interactive approach from YTs;engagement facilitators included simple instruction, physical demonstrations, and non-verbal feedback. Conclusion: Online group-based yoga classes provided health and pragmatic benefits to multi-morbid older adults. Preferences for continued online options post-Covid, together with streamlining IT access, suggests online classes are both acceptable and sought by some older adults. Future exploration of online inclusion barriers will optimise accessibility in an older adult population. Keywords: Older adults;Yoga;Multimorbidity;Clinical trial;Online
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Purpose: Rare cases of potential COVID 19 re-infection have been reported throughout the world. Methods: We describe two renal transplant recipients with possible SARS-COV-2 re-infection. Results: Patient #1 is a 63-year-old man with a history of renal transplant in February 2010, who initially experienced symptoms consistent with COVID-19 in April 2020 along with several family members. Due to limitations in outpatient testing, no SARS-CoV2 testing was able to be performed but he was treated as presumed COVID-19 infection due to high community prevalence and three weeks following his symptoms, SARS-CoV2 IgG was positive. The patient subsequently had four negative PCR tests from July-September 2020. In October, he was admitted for hypoxic respiratory failure and was found to be SARS-COV-2 positive by PCR and SARS-COV-IgG was negative (Figure 1). The patient was treated with Remdesivir and recovered. Patient #2 is a 64-year-old man with history of renal transplant in 2003, who was found to be SARS-COV-2 positive by RT-PCR in April 2020 after presenting with hypoxia. The patient had an uneventful hospital course and was discharged off supplemental oxygen. He had two negative SARS-COV-2 PCR tests in August and September and his SAR-COV-2 IgG was positive. In September, he was readmitted with hypoxic respiratory failure requiring intubation and ICU admission and was again found to be SARS-COV-2 positive by PCR. The patient had a complicated hospital course and expired on September 30th (Figure 1). Conclusions: Potential cases of SARS-COV-2 re-infection have been previously reported, but it is unclear whether these are true re-infections versus reactivation of a prior infection, prolonged viral shedding, or dynamic RT-PCR results. In our cases, we believe prolonged viral shedding from the initial infection or inaccurate testing is less likely given the prolonged time interval between the two events, the multiple negative tests in between, and the severity of the second episodes. While both of these patients were suspected of having re-infections, this could not be confirmed as genomic analysis was not performed. Future studies of similar cases are needed to determine factors contributing to re-infection.
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Purpose: We aimed to investigate the mortality from SARS-CoV-2 in kidney transplant recipients in the Bronx, New York, one of the epicenters of the pandemic over the period of the pandemic. Methods: Between March 16 and November 30, 2020, 158 patients were tested positive by SARS-CoV-2 RT-PCR. Results: 94 (59.5%) were male, at a median age of 62 years old (IQR: 51-71), predominantly Hispanic (54.4%) and African American (29.7%). 127 patients were admitted to the hospital and 29 were observed at home. 75.3% received a deceased-donor renal transplant, 57% received anti-thymocyte globulin induction. Most patients were on triple immunosuppression (94.3% on calcineurin inhibitors, 86.7% on anti-metabolite, 96.7% on prednisone). Hypertension was present in 96.2%, diabetes mellitus in 62.7%, heart disease in 19.6% and lung disease in 8.9% of the patients. The figure shows the number of RT-PCR positivity and mortality over the course of the pandemic starting on March 16, 2020. A total of 50 (31.6%) died as of November 30, 2020. The mortality rate was 40% (17/43) in patients diagnosed between March 16 and 31,2020, 39% (23/59) in patients diagnosed between April 1 and 15,2020 and 29% (7/24) in patients diagnosed between April 16 and 30, 2020. Since May 1st 2020, the mortality rate has significantly decreased to 9% (3/32). Conclusions: In summary, mortality from SARS-CoV-2 infection in kidney transplant recipients was higher during the first 6 weeks of the pandemic and has significantly decreased over time. This could be explained by initial exposure of the patients with higher viral load due to lack of personal protection and social distancing due to the fact that there is no current proven treatment for SARS-CoV-2 infection and clinical approach to patients has not been changed since the beginning of the pandemic.
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Purpose: We aimed to investigate the prevalence and dynamics of SARS-CoV-2 IgG in kidney transplant recipients in the Bronx, New York, one of the epicenters of the pandemic Methods: Between March 16 and November 30, 2020, 158 patients tested positive by SARS-CoV-2 RT-PCR. From May 3 to November 30, 2020, 1042 patients were screened for SARS-CoV-2 IgG antibodies and 164 (15.7%) were tested positive (Figure). Results: Sixty of the 164 patients were previously diagnosed COVID-19 by RTPCR, while the remaining 104 did not have significant symptoms and had not been previously tested by RT-PCR. Overall prevalence of COVID-19 diagnosis by RT-PCR and/or SARS-CoV-2 IgG in 1130 patients were 23.2%. Seventy RT-PCR positive patients were screened for SARS-CoV-2 IgG antibody at a median of 43 days postdiagnosis (IQR: 29-57) and 60 (85.7%) were positive. A total of 39 patients out 164 who previously tested positive for SARS-CoV-2 IgG (25 diagnosed with IgG and 14 with RT-PCR) were retested at a median time of 105 days (IQR: 83-116). Twenty patients (51.3%) became seronegative at a median time of 107 days (IQR: 87-134) from their first positive SARS-CoV-2 IgG. Six patients out of 14 (43%) who were diagnosed by positive RT-PCR became seronegative at a median time of 105 days (IQR: 83-166) from their first positive SARS-CoV-2 IgG while 14 patients out of 25 (56%) who were initially diagnosed by a positive SARS-CoV-2 IgG, became seronegative at a median time of 112 days (IQR: 91-138) from date of diagnosis Conclusions: . In summary, 40% of kidney transplant recipients were asymptomatic or mildly symptomatic and developed SARS-CoV-2 IgG without requiring testing by SARS-CoV-2 RT-PCR. However, half of the patients who initially developed antibodies lost them over time raising the questions of lasting immunity against SARS-CoV-2 and how effective are those antibodies.
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Background: The mortality rate of kidney transplant recipients with COVID-19 is significantly higher than the general population, indicating a need for effective treatment to minimize potential severe symptoms in this population. We sought to evaluate the efficacy of monoclonal antibody therapy in decreasing the severity of COVID-19 symptoms among our kidney transplant recipients. Methods: We reviewed 17 kidney transplant recipients who were infected with SARS-CoV2 and received treatment with monoclonal antibody therapy. All patients were on standard immunosuppression with Tacrolimus and Prednisone, and 88% were on Mycophenolate prior to COVID diagnosis, which was subsequently reduced or held for at least 2 weeks. Results: Of the 17 patients reviewed, median age was 61 years (range 42 to 77 years), 47% were male, 59% were Hispanic, and 29% were African American. Additionally 94% had history of hypertension, 47% diabetes mellitus, 18% coronary artery disease, and median BMI was 28.8 (range 23.4 to 41.9). Eighteen percent were transplanted <1 year, 29% between 1-5 years, 24% 6-10 years, and the remaining >10 years. All patients had mild symptoms without evidence of hypoxia, and 94% received monoclonal antibody therapy within 7 days of diagnosis. Bamlanivimab 700mg was the most commonly administered agent at 59%, while 18% received Bamlanivimab 700mg and Etesevimab 1400mg. Casirivimab 1200 mg and imdevimab 1200 mg was used in 24%. Only 2 out of the 17 patients (11.8%) required hospitalization, and both were non-COVID-19 related reasons. Five out of 17 patients (29.4%) were evaluated in the Emergency Department but not admitted. All 17 patients (100%) recovered from their COVID-19 illness. There were no episodes of graft failure. Conclusions: Our experience suggests that monoclonal antibody therapies may be beneficial in preventing severe COVID-19 in renal transplant recipients and possibly reduce the need for COVID-19 related hospitalization in this high risk population. However, larger studies are needed to confirm these findings.
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Background: Kidney transplant recipient's response rate to COVID-19 vaccination is reportedly less than 54% after the 2nd dose, significantly lower than general population and dialysis patients, reported as between 85-90% and 95-100%, respectively. Methods: We studied SARS-CoV-2 anti-spike IgG levels in our kidney transplant recipients after their COVID-19 vaccination using the OrthoV IgG platform. Results: 69 kidney transplant recipients received a SARS-CoV-2 vaccine (47 Pfizer, 20 Moderna and 2 Johnson and Johnson) at a median 36 months after transplantation (range, 3 months to 22 years). 61% were male, 39% Black, 29% Hispanic with a median age of 60 (range 22-82). 72% were deceased-donor kidney transplant recipients. 23 patients had previous history of COVID-19 diagnosed by SARS-CoV-2 PCR and/or antinucleocapsid antibody and 21 of those patients (91%) developed anti-spike IgG after 1st or 2nd dose with a median level of 13.2 (11.2-16.2). 46 patients without history of previous COVID-19, 17 (37%) developed anti-spike IgG at a median of 28 days (range 10-72) after the second vaccine dose with a median level of 5.7 (1.22-15.4). Patients who didn't develop anti-spike IgG tended to be older, of African-American descent, on MMF > 1 g/day, have lower CD3 and CD4 counts. Conclusions: In summary, most kidney transplant recipients without history of COVID-19 did not produce anti-spike IgG after being fully vaccinated and it is associated with augmented immunosuppression, lower T cell counts, African-American race and older age.
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BACKGROUND: Coronavirus disease 2019 (COVID-19) has brought significant challenges to society globally, particularly in the area of healthcare provision. A pressing need existed in protecting those tasked with delivering healthcare solutions during the COVID-19 crisis by providing solutions for preserving adequate supplies of effective personal protective equipment (PPE). AIM: To evaluate and validate available methods for the decontamination of N95 filtering facepiece respirators (FFRs) while maintaining functionality during re-use. METHODS: Multiple low-temperature steam and vaporized hydrogen peroxide (VHP) technologies were assessed for inactivation of Mycobacterium spp. and feline calicivirus (employed as representatives of the contamination challenge). FINDINGS: Virus (≥3log10) and Mycobacterium spp. (≥6log10) inactivation was achieved on various types of N95 FFRs using an array of heat (65-71oC), humidity (>50% relative humidity) and VHP without affecting the performance of the PPE. CONCLUSION: The methods have been validated and were authorized by the US Food and Drug Administration under a temporary emergency use authorization. Based on the findings, opportunities exist for development and deployment of decontamination methods made from simple, general purpose materials and equipment should a future need arise.