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1.
Topics in Antiviral Medicine ; 30(1 SUPPL):347, 2022.
Article in English | EMBASE | ID: covidwho-1880115

ABSTRACT

Background: Case investigation and contact tracing (CI/CT) is a key component of the response to COVID-19. CI/CT seeks to ensure that people exposed to SARS-CoV2 learn of their exposure and that infected persons and their contacts adhere to isolation and quarantine (I/Q) guidance. CI/CT programs also have the potential to address pandemic-related health inequities through the provision of support services. We evaluated the Public Health-Seattle & King County (PHSKC) CI/CT program, including its reach, timeliness, and case-reported impact on I&Q adherence. Methods: The PHSKC CI/CT case interview assessed case demographics, recently visited places, contacts, and service needs. In March 2021, a random sample of cases completed an End of I&Q Survey to assess their adherence to I&Q guidance and opinions of CI/CT. We calculated descriptive statistics to evaluate survey and programmatic data collected between July 2020 and June 2021. Results: The PHSKC CI/CT team interviewed 42,018 cases (81% of cases contacted) a mean of 6.1 days after symptom onset, and 3.4 days after SARS-CoV2 testing. Cases disclosed the names and addresses of 10,650 worksites (mean= 0.8/interview) and 11,269 other recently visited locations (mean= 0.5/interview), and provided contact information for 61,969 household members (mean=2.7/interview) and 8,753 non-household contacts (mean= 0.3/interview). The CI/CT team helped arrange COVID-19 testing for 5,660 contacts from 3,104 households, facilitated grocery delivery for 7,257 households, and referred 9,127 households for financial assistance. End of I&Q Survey participants (n=304, 54% of sampled) reported self-notifying an average of 4 non-household contacts and 69% agreed that the information and referrals provided by the CI/CT team helped them stay in isolation. Conclusion: CI/CT reached many persons with COVID-19 and their household contacts and identified thousands of possible exposure venues. The intervention's effectiveness was likely limited by the inability to interview cases during their period of peak infectiousness and cases' reluctance to name non-household contacts, though cases notified many non-household contacts themselves. CI/CT was effective in linking people to testing, food, and financial assistance, and most cases reported that the intervention helped them isolate. These findings provide evidence that CI/CT can help mitigate the impact of COVID-19 on disproportionately impacted communities through the promotion of I&Q guidance and provision of support services.

4.
Circulation ; 144(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1632416

ABSTRACT

Cardiac microthrombi are postulated to underlie cardiac injury in critical COVID-19. To determine pathogenic mechanism(s) of cardiac injury in fatal COVID-19, we conducted a single-center prospective cohort study of 69 consecutive COVID-19 decedents. Microthrombi was the most commonly detected acute cardiac histopathologic feature (n=48, 70%). We tested associations of cardiac microthrombi with biomarkers of inflammation, cardiac injury, and fibrinolysis and with inhospital antiplatelet therapy, therapeutic anticoagulation, and corticosteroid treatment, while adjusting for multiple clinical factors, including COVID-19 therapies. Higher peak ESR and CRP during hospitalization were independently associated with higher odds of microthrombi (ESR, Pnonlinearity 0.015, Passociation=0.008;CRP per 20mg/L increase, OR 1.17, 95%CI 1.00-1.36). Using single nuclei RNA-sequence analysis, we discovered an enrichment of prothrombotic, anti-fibrinolytic, and extracellular matrix signaling amongst cardiac fibroblasts in microthrombi-positive COVID-19 hearts, compared with microthrombi-negative COVID-19 hearts and non-COVID-19 donor hearts. Our cumulative findings identify these specific transcriptomic changes in cardiac fibroblasts as salient features of COVID-19-associated cardiac microthrombi.

8.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277613

ABSTRACT

Rationale: Over 60 million people have had coronavirus disease 2019 (COVID-19), but consequences of severe infection are unknown. We sought to characterize interstitial lung abnormalities (ILA) after COVID-19, and to identify risk factors for the development of lung fibrosis.Methods: We performed a prospective single-center cohort study with 4-month follow-up after COVID-19 hospitalization. We sequentially enrolled 76 community-dwelling adults who were hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and required supplemental oxygen between March and May 2020. Participants had no prior history of interstitial lung disease and were discharged to acute rehabilitation or home, with sampling weighted to include half who were mechanically ventilated. We used a radiologic scoring system to quantify non-fibrotic ILA (ground glass opacities alone) and fibrotic ILA (defined as presence of reticulations, traction bronchiectasis, or honeycombing) on chest high-resolution computed tomography scans four months after hospital admission. We assessed measures of severity of illness during hospitalization, as well as pulmonary function and leukocyte telomere length at followup. Results: Participants had a mean age of 54 (SD14) years;most were male (61%) and Hispanic (57%). Thirty-two (43%) required mechanical ventilation. After a median (IQR) of 4.4 (4.0-4.8) months following hospital admission, the most common ILAs were ground glass opacities, reticulations, and traction bronchiectasis, which correlated with lower diffusion capacity (ρ -0.34, - 0.64, and -0.49, respectively, all p<0.01). A total of 31 participants (41%) had no ILA, 13 (17%) had only non-fibrotic ILA, and 32 (42%) had fibrotic ILA. Fibrotic ILA was more common in mechanically ventilated patients (72%) than non-mechanically ventilated patients (20%), (p=0.001). In adjusted analyses, each 1 point increase in admission SOFA score, additional day of ventilator support, and 10% decrease in blood leukocyte telomere length were associated with fibrotic ILA [OR 1.49 (95%CI 1.17 - 1.89), 1.07 (95%CI 1.03-1.12), and 1.35 (95%CI 1.06 - 1.72), respectively].Conclusions: Radiographic evidence of lung fibrosis four months after severe COVID-19 infection is associated with initial severity of illness, duration of mechanical ventilation, and telomere length.

9.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277106

ABSTRACT

Introduction: Before the COVID-19 pandemic, 20-30% of family members had symptoms of Post-Traumatic Stress Disorder (PTSD) or anxiety, while 15-30% had symptoms of depression. Interventions supporting family members have reduced burden of these symptoms. COVID-19 has resulted in prolonged ICU stays, high morbidity/mortality, and hospital policies severely limiting family presence at the bedside. We hypothesized the combination of prolonged critical illness and the necessary reduction of family presence would lead to high rates of PTSD, anxiety, and depression;likely higher than observed in previous studies. Methods: This was a multicenter study including 12 US hospitals, 8 academic and 4 community-based hospitals. A consecutive sample of family members of all patients with COVID-19 receiving ICU admission during the spring US peak in 2020 were called 3-4 months after the patients' ICU admission, except for New York City hospitals where a random sample was generated given the large number of hospitalizations. Consented participants completed the Impact-of- Events Scale-6 (IES-6;scored 0-30, higher scores indicate more symptoms of PTSD), Hospital-Anxiety- Depression Score (HADS, scored 0-20 for anxiety and 0-20 for depression, higher scores indicate more symptoms), and a subset of questions from Family-Satisfaction in the ICU-27 (FS-ICU27;scored on a Likert scale 1 to 5, with higher scores indicating more positive responses) selected as most likely impacted by restrictive family presence.Results: There were 945 eligible family members during the study period. Of those, 594 were contacted and 269 (45.3%) consented and completed surveys. The mean IES-6 score was 12.6 (95% CI 11.8- 13.4) with 65.4% having a score of 10 or greater, consistent with high levels of symptoms of PTSD. The mean score on the HADS-anxiety was 9.4 (95% CI 8.8-10.1) with 59.5% having a score of 8 or greater, consistent with high levels of symptoms of anxiety. Finally, the mean score for the HADS-depression was 8.0 (95% CI 7.3-8.7) with 47.6% having scores of 8 or greater, consistent with high level of symptoms of depression. The mean response for the FSICU27 questions of “I felt I had control” was 3.5 (95% CI 3.3-3.6), “I felt supported” was 3.8 (95% CI 3.6-4.0), and “I felt included” was 4.3 (95% CI 4.2-4.4).Conclusion: The consequences of a family member admitted to the ICU with COVID-19 infection are significant. We identify rates of PTSD, anxiety, and depression higher than recorded in non-COVID population. Further analysis is warranted to understand modifiable risk factors for developing these symptoms.

10.
Thorax ; 29:29, 2021.
Article in English | MEDLINE | ID: covidwho-1209856

ABSTRACT

The risk factors for development of fibrotic-like radiographic abnormalities after severe COVID-19 are incompletely described and the extent to which CT findings correlate with symptoms and physical function after hospitalisation remains unclear. At 4 months after hospitalisation, fibrotic-like patterns were more common in those who underwent mechanical ventilation (72%) than in those who did not (20%). We demonstrate that severity of initial illness, duration of mechanical ventilation, lactate dehydrogenase on admission and leucocyte telomere length are independent risk factors for fibrotic-like radiographic abnormalities. These fibrotic-like changes correlate with lung function, cough and measures of frailty, but not with dyspnoea.

12.
Global Sustainability ; 2020.
Article in English | Scopus | ID: covidwho-879140

ABSTRACT

The 'climate crisis' describes human-caused global warming and climate change and its consequences. It conveys the sense of urgency surrounding humanity's failure to take sufficient action to slow down, stop and reverse global warming. The leading direct cause of the climate crisis is carbon dioxide (CO2) released as a by-product of burning fossil fuels,i which supply ∼87% of the world's energy. The second most important cause of the climate crisis is deforestation to create more land for crops and livestock. The solutions have been stated as simply 'leave the fossil carbon in the ground' and 'end deforestation'. Rather than address fossil fuel supplies, climate policies focus almost exclusively on the demand side, blaming fossil fuel users for greenhouse gas emissions. The fundamental reason that we are not solving the climate crisis is not a lack of green energy solutions. It is that governments continue with energy strategies that prioritize fossil fuels. These entrenched energy policies subsidize the discovery, extraction, transport and sale of fossil fuels, with the aim of ensuring a cheap, plentiful, steady supply of fossil energy into the future. This paper compares the climate crisis to two other environmental crises: Ozone depletion and the COVID-19 pandemic. Halting and reversing damage to the ozone layer is one of humanity's greatest environmental success stories. The world's response to COVID-19 demonstrates that it is possible for governments to take decisive action to avert an imminent crisis. The approach to solving both of these crises was the same: (1) identify the precise cause of the problem through expert scientific advice;(2) with support by the public, pass legislation focused on the cause of the problem;and (3) employ a robust feedback mechanism to assess progress and adjust the approach. This is not yet being done to solve the climate crisis, but working within the 2015 Paris Climate Agreement framework, it could be. Every nation can contribute to solving the climate crisis by: (1) changing their energy strategy to green energy sources instead of fossil fuels;and (2) critically reviewing every law, policy and trade agreement (including transport, food production, food sources and land use) that affects the climate crisis. © 2020 The Author(s).

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