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1.
Clin Infect Dis ; 2022 Mar 30.
Article in English | MEDLINE | ID: covidwho-1852998

ABSTRACT

We report the utility of rapid antigen tests (RAgT) in a cohort of US healthcare personnel with COVID-19 infection who met symptom criteria to return to work at day 5 or later of isolation. 11.9% of initial RAgT were negative. RAgT can be helpful to guide return to work decisions.

2.
Mayo Clin Proc ; 97(5): 943-950, 2022 May.
Article in English | MEDLINE | ID: covidwho-1702875

ABSTRACT

Bamlanivimab-etesevimab and casirivimab-imdevimab are authorized by the US Food and Drug Administration for emergency treatment of mild to moderate coronavirus disease 2019 (COVID-19) in high-risk persons. There has been no study comparing their clinical efficacy. In this retrospective study of 681 patients with mild to moderate COVID-19 during a period dominated by severe acute respiratory syndrome coronavirus 2 wild-type and alpha variants, 25 patients (3.7%) had progression to a severe outcome requiring hospitalization and oxygen supplementation within 30 days after monoclonal antibody infusion. Severe outcome was significantly higher among the 181 patients who were treated with casirivimab-imdevimab when compared with the 500 patients who received bamlanivimab-etesevimab (21 [6.6%] vs 13 [2.6%]; P=.01). Patients treated with casirivimab-imdevimab had higher odds of severe outcomes compared with those who received bamlanivimab-etesevimab (odds ratio, 2.67; 95% CI, 1.17 to 6.06). The demographic and clinical characteristics, and the time to monoclonal antibody infusion, of the 2 treatment cohorts were not significantly different. The reason behind this significant difference in the clinical outcomes is unclear, but our observations emphasize potential efficacy differences among antispike monoclonal antibodies against COVID-19. Further clinical studies using larger cohorts of patients are needed to confirm or refute these observations.


Subject(s)
COVID-19 , SARS-CoV-2 , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized , Antibodies, Neutralizing , COVID-19/drug therapy , Humans , Retrospective Studies
3.
Mayo Clin Proc ; 97(2): 327-332, 2022 02.
Article in English | MEDLINE | ID: covidwho-1665267

ABSTRACT

Anti-spike monoclonal antibodies have proven invaluable in preventing severe outcomes from COVID-19, including hospitalization and death. The rise of the SARS-CoV-2 delta variant begs the question of whether monoclonal antibodies maintain similar efficacy now as they had when the alpha and beta variants predominated, when they were first assessed and approved. We used a retrospective cohort to compare rates of severe outcomes in an epoch in which alpha and beta were predominant compared with delta. A total of 5356 patients were infused during the alpha/beta variant-predominant (n=4874) and delta variant-predominant (n=482) era. Overall, odds of severe infection were 3.0% of patients in the alpha/beta-predominant era compared with 4.9% in the delta-predominant cohort. The unadjusted odds ratio (OR) was higher for severe disease in the delta era (OR, 1.67; 95% CI, 0.96 to 2.89), particularly when adjusted for Charlson Comorbidity Index (adjusted OR, 2.04; 95% CI, 1.30 to 3.08). The higher odds of severe infection could be due to a more virulent delta variant, although the possibility of decreased anti-spike monoclonal antibody effectiveness in the clinical setting cannot be excluded. Research into the most effective strategies for using and improving anti-spike monoclonals for the treatment of emerging variants is warranted.


Subject(s)
Antibodies, Monoclonal/therapeutic use , COVID-19/drug therapy , Immunologic Factors/therapeutic use , SARS-CoV-2/immunology , Aged , Cohort Studies , Female , Humans , Male , Middle Aged , Patient Acuity , Retrospective Studies , United States/epidemiology
8.
Mayo Clin Proc ; 96(3): 601-618, 2021 03.
Article in English | MEDLINE | ID: covidwho-988744

ABSTRACT

OBJECTIVE: To report the Mayo Clinic experience with coronavirus disease 2019 (COVID-19) related to patient outcomes. METHODS: We conducted a retrospective chart review of patients with COVID-19 diagnosed between March 1, 2020, and July 31, 2020, at any of the Mayo Clinic sites. We abstracted pertinent comorbid conditions such as age, sex, body mass index, Charlson Comorbidity Index variables, and treatments received. Factors associated with hospitalization and mortality were assessed in univariate and multivariate models. RESULTS: A total of 7891 patients with confirmed COVID-19 infection with research authorization on file received care across the Mayo Clinic sites during the study period. Of these, 7217 patients were adults 18 years or older who were analyzed further. A total of 897 (11.4%) patients required hospitalization, and 354 (4.9%) received care in the intensive care unit (ICU). All hospitalized patients were reviewed by a COVID-19 Treatment Review Panel, and 77.5% (695 of 897) of inpatients received a COVID-19-directed therapy. Overall mortality was 1.2% (94 of 7891), with 7.1% (64 of 897) mortality in hospitalized patients and 11.3% (40 of 354) in patients requiring ICU care. CONCLUSION: Mayo Clinic outcomes of patients with COVID-19 infection in the ICU, hospital, and community compare favorably with those reported nationally. This likely reflects the impact of interprofessional multidisciplinary team evaluation, effective leveraging of clinical trials and available treatments, deployment of remote monitoring tools, and maintenance of adequate operating capacity to not require surge adjustments. These best practices can help guide other health care systems with the continuing response to the COVID-19 pandemic.


Subject(s)
Biomedical Research , COVID-19/therapy , Pandemics , SARS-CoV-2 , Adolescent , COVID-19/epidemiology , Child , Child, Preschool , Female , Follow-Up Studies , Hospitalization/trends , Humans , Infant , Infant, Newborn , Intensive Care Units/statistics & numerical data , Male , Retrospective Studies
9.
Cell Death Discov ; 6(1): 138, 2020 Dec 02.
Article in English | MEDLINE | ID: covidwho-962237

ABSTRACT

Longitudinal characterization of SARS-CoV-2 PCR testing from COVID-19 patient's nasopharynx and its juxtaposition with blood-based IgG-seroconversion diagnostic assays is critical to understanding SARS-CoV-2 infection durations. Here, we retrospectively analyze 851 SARS-CoV-2-positive patients with at least two positive PCR tests and find that 99 of these patients remain SARS-CoV-2-positive after 4 weeks from their initial diagnosis date. For the 851-patient cohort, the mean lower bound of viral RNA shedding was 17.3 days (SD: 7.8), and the mean upper bound of viral RNA shedding from 668 patients transitioning to confirmed PCR-negative status was 22.7 days (SD: 11.8). Among 104 patients with an IgG test result, 90 patients were seropositive to date, with mean upper bound of time to seropositivity from initial diagnosis being 37.8 days (95% CI: 34.3-41.3). Our findings from juxtaposing IgG and PCR tests thus reveal that some SARS-CoV-2-positive patients are non-hospitalized and seropositive, yet actively shed viral RNA (14 of 90 patients). This study emphasizes the need for monitoring viral loads and neutralizing antibody titers in long-term non-hospitalized shedders as a means of characterizing the SARS-CoV-2 infection lifecycle.

10.
Infect Control Hosp Epidemiol ; 42(4): 388-391, 2021 04.
Article in English | MEDLINE | ID: covidwho-889081

ABSTRACT

OBJECTIVE: Presenteeism is an expensive and challenging problem in the healthcare industry. In anticipation of the staffing challenges expected with the COVID-19 pandemic, we examined a decade of payroll data for a healthcare workforce. We aimed to determine the effect of seasonal influenza-like illness (ILI) on absences to support COVID-19 staffing plans. DESIGN: Retrospective cohort study. SETTING: Large academic medical center in the United States. PARTICIPANTS: Employees of the academic medical center who were on payroll between the years of 2009 and 2019. METHODS: Biweekly institutional payroll data was evaluated for unscheduled absences as a marker for acute illness-related work absences. Linear regression models, stratified by payroll status (salaried vs hourly employees) were developed for unscheduled absences as a function of local ILI. RESULTS: Both hours worked and unscheduled absences were significantly related to the community prevalence of influenza-like illness in our cohort. These effects were stronger in hourly employees. CONCLUSIONS: Organizations should target their messaging at encouraging salaried staff to stay home when ill.


Subject(s)
Absenteeism , COVID-19/epidemiology , Health Personnel/statistics & numerical data , Presenteeism/statistics & numerical data , Workforce , Academic Medical Centers/organization & administration , Academic Medical Centers/statistics & numerical data , Epidemics , Health Personnel/psychology , Humans , Minnesota/epidemiology , Retrospective Studies
11.
J Microbiol Immunol Infect ; 54(1): 77-80, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-843763

ABSTRACT

This study aimed to determine if the crossing point of the initial positive SARS-CoV-2 PCR test correlated with patient demographics, subsequent hospitalization, or duration of positivity. Seventy-three patients with two or more positive PCR tests had a median time of 23 days to two consecutive negative results.


Subject(s)
COVID-19/virology , Hospitalization/statistics & numerical data , Polymerase Chain Reaction/statistics & numerical data , Adult , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , COVID-19 Testing/methods , COVID-19 Testing/statistics & numerical data , Female , Humans , Kaplan-Meier Estimate , Linear Models , Male , Middle Aged , Polymerase Chain Reaction/methods , Predictive Value of Tests , SARS-CoV-2/isolation & purification
12.
Mayo Clin Proc ; 95(9): 1942-1945, 2020 09.
Article in English | MEDLINE | ID: covidwho-625927

ABSTRACT

In a multicenter cohort of 22,315 patients tested for COVID-19, 1676 (7.5%) had repeat testing via real-time polymerase chain reaction following an initial negative test. Of those retested within 7 days of their first negative test, only 2.0% had a positive result. This suggests that repeat testing from the same source is unlikely to provide additional information.


Subject(s)
Betacoronavirus/isolation & purification , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Real-Time Polymerase Chain Reaction , COVID-19 , COVID-19 Testing , Female , Humans , Male , Pandemics , SARS-CoV-2 , Serologic Tests/methods
13.
Infect Control Hosp Epidemiol ; 41(8): 968-969, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-306266

ABSTRACT

To inform the efficient allocation of testing resources, we evaluated the characteristics of those tested for COVID-19 to determine predictors of a positive test. Recent travel and exposure to a confirmed case were both highly predictive of positive testing. Symptom-based screening strategies alone may be inadequate to control the ongoing pandemic.


Subject(s)
Betacoronavirus/isolation & purification , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Polymerase Chain Reaction , Travel , Adult , Asymptomatic Infections , COVID-19 , COVID-19 Testing , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Female , Humans , Logistic Models , Male , Middle Aged , Minnesota , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Risk Assessment , SARS-CoV-2
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