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2.
World Academy of Sciences Journal ; 4(4):1-6, 2022.
Article in English | Academic Search Complete | ID: covidwho-1954166

ABSTRACT

The use of convalescent plasma in coronavirus disease 2019 (COVID‑19) in the general population has not been shown to have a clear benefit. However, there are limited data available on its use in specific populations, such as in persons with human immunodeficiency virus (HIV;PWH). The present case series study describes 12 hospitalized PWH who received convalescent plasma for severe COVID‑19 between March 2020 and July 2020. Demographics, pre‑existing comorbidities, HIV status, and COVID‑19 management were reported and examined in a multivariate analysis. A high mortality rate of 58%, (7 out of 12 PWH) was observed in those receiving the convalescent plasma. By contrast, a brief review of 13 previously published cohorts of PWH hospi‑ talized with COVID‑19 revealed a cumulative mortality of 19% (85 of 439 PWH). In the present case series study, PWH had a significantly higher relative risk for in‑hospital COVID‑19‑associated mortality compared with individuals without HIV (unadjusted range, 2.10‑2.52;and adjusted range, 1.79‑2.08;P<0.02 in all analyses). Covariate‑adjustments were made for patient demographics, pre‑existing co‑morbidities, and mechanical ventilation needs. The high mortality rate of the present case series may be related to random sampling or an adverse effect of convalescent plasma in PWH and severe COVID‑19. Additional research is thus required to investigate the risks and benefits of the use of COVID‑19 convalescent plasma in PWH. [ FROM AUTHOR] Copyright of World Academy of Sciences Journal is the property of Spandidos Publications UK Ltd 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.)

3.
Sci Rep ; 11(1): 12110, 2021 06 08.
Article in English | MEDLINE | ID: covidwho-1517640

ABSTRACT

Wearing surgical masks or other similar face coverings can reduce the emission of expiratory particles produced via breathing, talking, coughing, or sneezing. Although it is well established that some fraction of the expiratory airflow leaks around the edges of the mask, it is unclear how these leakage airflows affect the overall efficiency with which masks block emission of expiratory aerosol particles. Here, we show experimentally that the aerosol particle concentrations in the leakage airflows around a surgical mask are reduced compared to no mask wearing, with the magnitude of reduction dependent on the direction of escape (out the top, the sides, or the bottom). Because the actual leakage flowrate in each direction is difficult to measure, we use a Monte Carlo approach to estimate flow-corrected particle emission rates for particles having diameters in the range 0.5-20 µm. in all orientations. From these, we derive a flow-weighted overall number-based particle removal efficiency for the mask. The overall mask efficiency, accounting both for air that passes through the mask and for leakage flows, is reduced compared to the through-mask filtration efficiency, from 93 to 70% for talking, but from only 94-90% for coughing. These results demonstrate that leakage flows due to imperfect sealing do decrease mask efficiencies for reducing emission of expiratory particles, but even with such leakage surgical masks provide substantial control.


Subject(s)
Aerosols , Communicable Disease Control/methods , Cough , Exhalation , Filtration , Masks , Virus Diseases/prevention & control , Adolescent , Adult , COVID-19/prevention & control , Equipment Failure , Female , Humans , Male , Middle Aged , Monte Carlo Method , Particle Size , Probability , Respiration , Sneezing , Young Adult
4.
Mayo Clin Proc ; 96(5): 1262-1275, 2021 05.
Article in English | MEDLINE | ID: covidwho-1219471

ABSTRACT

To determine the effect of COVID-19 convalescent plasma on mortality, we aggregated patient outcome data from 10 randomized clinical trials, 20 matched control studies, 2 dose-response studies, and 96 case reports or case series. Studies published between January 1, 2020, and January 16, 2021, were identified through a systematic search of online PubMed and MEDLINE databases. Random effects analyses of randomized clinical trials and matched control data demonstrated that patients with COVID-19 transfused with convalescent plasma exhibited a lower mortality rate compared with patients receiving standard treatments. Additional analyses showed that early transfusion (within 3 days of hospital admission) of higher titer plasma is associated with lower patient mortality. These data provide evidence favoring the efficacy of human convalescent plasma as a therapeutic agent in hospitalized patients with COVID-19.


Subject(s)
COVID-19/therapy , COVID-19/mortality , Humans , Immunization, Passive/methods , Mortality , SARS-CoV-2/immunology , Time-to-Treatment
5.
Lancet Microbe ; 1(7): e283-e289, 2020 11.
Article in English | MEDLINE | ID: covidwho-1087375

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic. The proportion of infected individuals who seroconvert is still an open question. In addition, it has been shown in some individuals that viral genome can be detected up to 3 months after symptom resolution. We investigated both seroconversion and PCR positivity in a large cohort of convalescent serum donors in the New York City (NY, USA) region. METHODS: In this observational study, we ran an outreach programme in the New York City area. We recruited participants via the REDCap (Vanderbilt University, Nashville, TN, USA) online survey response. Individuals with confirmed or suspected SARS-CoV-2 infection were screened via PCR for presence of viral genome and via ELISA for presence of anti-SARS-CoV-2 spike antibodies. One-way ANOVA and Fisher's exact test were used to measure the association of age, gender, symptom duration, and days from symptom onset and resolution with positive antibody results. FINDINGS: Between March 26 and April 10, 2020, we measured SARS-CoV-2 antibody titres in 1343 people. Of the 624 participants with confirmed SARS-CoV-2 infection who had serologies done after 4 weeks, all but three seroconverted to the SARS-CoV-2 spike protein, whereas 269 (37%) of 719 participants with suspected SARS-CoV-2 infection seroconverted. PCR positivity was detected up to 28 days from symptom resolution. INTERPRETATION: Most patients with confirmed COVID-19 seroconvert, potentially providing immunity to reinfection. We also report that in a large proportion of individuals, viral genome can be detected via PCR in the upper respiratory tract for weeks after symptom resolution, but it is unclear whether this signal represents infectious virus. Analysis of our large cohort suggests that most patients with mild COVID-19 seroconvert 4 weeks after illness, and raises questions about the use of PCR to clear positive individuals. FUNDING: None.


Subject(s)
COVID-19 , Antibodies, Viral , COVID-19/diagnosis , COVID-19/therapy , Humans , Immunization, Passive , New York City/epidemiology , Polymerase Chain Reaction , SARS-CoV-2/genetics , Spike Glycoprotein, Coronavirus
6.
Transfusion ; 61(1): 78-93, 2021 01.
Article in English | MEDLINE | ID: covidwho-894803

ABSTRACT

BACKGROUND: Convalescent plasma (CP) for treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown preliminary signs of effectiveness in moderate to severely ill patients in reducing mortality. While studies have demonstrated a low risk of serious adverse events, the comprehensive incidence and nature of the spectrum of transfusion reactions to CP is unknown. We retrospectively examined 427 adult inpatient CP transfusions to determine incidence and types of reactions, as well as clinical parameters and risk factors associated with transfusion reactions. STUDY DESIGN AND METHODS: Retrospective analysis was performed for 427 transfusions to 215 adult patients with coronavirus 2019 (COVID-19) within the Mount Sinai Health System, through the US Food and Drug Administration emergency investigational new drug and the Mayo Clinic Expanded Access Protocol to Convalescent Plasma approval pathways. Transfusions were blindly evaluated by two reviewers and adjudicated by a third reviewer in discordant cases. Patient demographics and clinical and laboratory parameters were compared and analyzed. RESULTS: Fifty-five reactions from 427 transfusions were identified (12.9% incidence), and 13 were attributed to transfusion (3.1% incidence). Reactions were classified as underlying COVID-19 (76%), febrile nonhemolytic (10.9%), transfusion-associated circulatory overload (9.1%), and allergic (1.8%) and hypotensive (1.8%) reactions. Statistical analysis identified increased transfusion reaction risk for ABO blood group B or Sequential Organ Failure Assessment scores of 12 to 13, and decreased risk within the age group of 80 to 89 years. CONCLUSION: Our findings support the use of CP as a safe, therapeutic option from a transfusion reaction perspective, in the setting of COVID-19. Further studies are needed to confirm the clinical significance of ABO group B, age, and predisposing disease severity in the incidence of transfusion reaction events.


Subject(s)
COVID-19/therapy , SARS-CoV-2/pathogenicity , Aged , Blood Transfusion , Female , Humans , Immunization, Passive/methods , Male , Middle Aged , Retrospective Studies , Transfusion Reaction
7.
Genet Med ; 23(3): 576-580, 2021 03.
Article in English | MEDLINE | ID: covidwho-872688

ABSTRACT

PURPOSE: Rare genetic conditions like Down syndrome (DS) are historically understudied. Infection is a leading cause of mortality in DS, along with cardiac anomalies. Currently, it is unknown how the COVID-19 pandemic affects individuals with DS. Herein, we report an analysis of individuals with DS who were hospitalized with COVID-19 in New York, New York, USA. METHODS: In this retrospective, dual-center study of 7246 patients hospitalized with COVID-19, we analyzed all patients with DS admitted in the Mount Sinai Health System and Columbia University Irving Medical Center. We assessed hospitalization rates, clinical characteristics, and outcomes. RESULTS: We identified 12 patients with DS. Hospitalized individuals with DS are on average ten years younger than patients without DS. Patients with DS have more severe disease than controls, particularly an increased incidence of sepsis and mechanical ventilation. CONCLUSION: We demonstrate that individuals with DS who are hospitalized with COVID-19 are younger than their non-DS counterparts, and that they have more severe disease than age-matched controls. We conclude that particular care should be considered for both the prevention and treatment of COVID-19 in these patients.


Subject(s)
COVID-19/pathology , Down Syndrome , Adult , Comorbidity , Down Syndrome/complications , Female , Hospitalization , Humans , Male , Middle Aged , New York/epidemiology , Pandemics , Retrospective Studies
8.
Sci Rep ; 10(1): 15665, 2020 09 24.
Article in English | MEDLINE | ID: covidwho-797901

ABSTRACT

The COVID-19 pandemic triggered a surge in demand for facemasks to protect against disease transmission. In response to shortages, many public health authorities have recommended homemade masks as acceptable alternatives to surgical masks and N95 respirators. Although mask wearing is intended, in part, to protect others from exhaled, virus-containing particles, few studies have examined particle emission by mask-wearers into the surrounding air. Here, we measured outward emissions of micron-scale aerosol particles by healthy humans performing various expiratory activities while wearing different types of medical-grade or homemade masks. Both surgical masks and unvented KN95 respirators, even without fit-testing, reduce the outward particle emission rates by 90% and 74% on average during speaking and coughing, respectively, compared to wearing no mask, corroborating their effectiveness at reducing outward emission. These masks similarly decreased the outward particle emission of a coughing superemitter, who for unclear reasons emitted up to two orders of magnitude more expiratory particles via coughing than average. In contrast, shedding of non-expiratory micron-scale particulates from friable cellulosic fibers in homemade cotton-fabric masks confounded explicit determination of their efficacy at reducing expiratory particle emission. Audio analysis of the speech and coughing intensity confirmed that people speak more loudly, but do not cough more loudly, when wearing a mask. Further work is needed to establish the efficacy of cloth masks at blocking expiratory particles for speech and coughing at varied intensity and to assess whether virus-contaminated fabrics can generate aerosolized fomites, but the results strongly corroborate the efficacy of medical-grade masks and highlight the importance of regular washing of homemade masks.


Subject(s)
Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Masks , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Primary Prevention/methods , Respiratory Protective Devices , Adolescent , Adult , Aerosols , Betacoronavirus , COVID-19 , Cough/virology , Exhalation , Female , Filtration/instrumentation , Humans , Inhalation Exposure , Male , Middle Aged , Primary Prevention/instrumentation , SARS-CoV-2 , Young Adult
9.
Nat Med ; 26(11): 1708-1713, 2020 11.
Article in English | MEDLINE | ID: covidwho-772953

ABSTRACT

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a new human disease with few effective treatments1. Convalescent plasma, donated by persons who have recovered from COVID-19, is the acellular component of blood that contains antibodies, including those that specifically recognize SARS-CoV-2. These antibodies, when transfused into patients infected with SARS-CoV-2, are thought to exert an antiviral effect, suppressing virus replication before patients have mounted their own humoral immune responses2,3. Virus-specific antibodies from recovered persons are often the first available therapy for an emerging infectious disease, a stopgap treatment while new antivirals and vaccines are being developed1,2. This retrospective, propensity score-matched case-control study assessed the effectiveness of convalescent plasma therapy in 39 patients with severe or life-threatening COVID-19 at The Mount Sinai Hospital in New York City. Oxygen requirements on day 14 after transfusion worsened in 17.9% of plasma recipients versus 28.2% of propensity score-matched controls who were hospitalized with COVID-19 (adjusted odds ratio (OR), 0.86; 95% confidence interval (CI), 0.75-0.98; chi-square test P value = 0.025). Survival also improved in plasma recipients (adjusted hazard ratio (HR), 0.34; 95% CI, 0.13-0.89; chi-square test P = 0.027). Convalescent plasma is potentially effective against COVID-19, but adequately powered, randomized controlled trials are needed.


Subject(s)
COVID-19/pathology , COVID-19/therapy , Adult , Aged , Antibodies, Viral/blood , COVID-19/epidemiology , Case-Control Studies , Female , Humans , Immunization, Passive , Male , Middle Aged , Pandemics , Propensity Score , Retrospective Studies , SARS-CoV-2/immunology , Severity of Illness Index , Treatment Outcome
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