ABSTRACT
Objectives: Universal testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within birthing units is an effective strategy to contain infection and estimate community prevalence. Given the high-prevalence of COVID-19 cases in Ontario, the objective of this study was to determine the prevalence of active and recovered SARS-CoV-2 infection among pregnant individuals in Ottawa through universal SARS-CoV-2 and serology testing. Methods: From October 19th to November 27th, 2020, pregnant individuals admitted to triage assessment units at The Ottawa Hospital (TOH) were consented for SARS-CoV-2 testing. Swab and serology samples were analyzed using digital droplet polymerase chain reaction (ddPCR) and enzyme-linked immunosorbent assays, respectively. SARS-CoV-2 seropositivity was defined as a positive result for immunoglobulin (Ig) G, either alone or in combination with IgM and/or IgA. Results: From the 395 enrolled participants, 284 swab and 353 serology samples were collected. We found that 18 of 395 (4.6%) participants had evidence of SARS-CoV-2 exposure: 2/284 (0.70%) were positive for SARS-CoV-2 and 16/353 (4.5%) were positive for anti–SARS-CoV-2 IgG. Seropositive participants were similar to seronegative participants in terms of demographics, clinical characteristics, and pregnancy outcomes. Conclusions: The prevalence of SARS-CoV-2 ddPCR positivity and seropositivity in the obstetrical population at TOH was 0.70% and 4.5%, respectively in the fall of 2020. According to local public health data, the infection rate peaked at 0.6% during the study time period. Universal SARS-CoV-2 testing programs may help approximate community prevalence, however, justification of this strategy depends on testing capabilities and the local context of COVID-19 infection. Keywords: pregnancy;COVID-19;SARS-CoV-2;universal testing;seroprevalence
ABSTRACT
Background: The impact of COVID-19 on cancer patients may be attributed not only to its direct effects on the immune system but also to delays in diagnosis and treatment. Data on the effects of COVID-19 on pancreatic ductal adenocarcinoma (PDAC) patients are scarce. Therefore, we set out to determine the impact of the pandemic on diagnosis and treatment initiation. We hypothesized that time from diagnosis to treatment would be increased in the COVID era compared to the pre-COVID era. Methods: We conducted an IRB-approved retrospective chart review of 488 patients diagnosed with PDAC from March 2019 to September 2020 at two academic medical centers. Patients were divided into two groups, based on the date of initial pathologic diagnosis. We defined the pre-COVID era as March 2019 to March 2020, the 12-month time period before California's statewide lockdown. The COVID era was defined as the 6 months following the lockdown, March 2020 to September 2020. Demographics, clinical stage, and treatment type were recorded. In addition, initial clinical encounter date, pathologic diagnosis date, and initial treatment date were also collected. All data were gathered at two large-scale academic institutions. Descriptive statistics were used in the analysis. Results: There were 333 patients diagnosed during the pre-COVID era and 155 patients during the COVID era. While race/ethnicity and age at diagnosis were statistically similar for both groups, females made up a significantly larger proportion of COVID era patients than preCOVID era patients (p= 0.02). There was no significant difference in clinical stage at diagnosis between the two groups (p= 0.84). In the pre-COVID era, 19.5% of cases were resectable, 11.1% borderline resectable, 20.1% locally advanced, and 31.8% metastatic. In the COVID era, 17.4% of patients were resectable, 11% borderline resectable, 23.9% locally advanced, and 32.9% metastatic. Median time from pathologic diagnosis to initiation of treatment was 32 days for the pre-COVID era patients and 28 days for the COVID era patients (p= 0.38). Initial treatment type was also similar between the two groups (p= 0.29). Conclusions: Fortunately, our data indicate that the COVID-19 pandemic has not significantly prevented PDAC patients from seeking care. Additionally, it does not appear that COVID-19 has delayed treatment initiation or changed initial treatment type. We believe that the successful adoption of telemedicine and other safety protocols have allowed patients with PDAC to continue receiving appropriate care during the pandemic.