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2.
Open Forum Infectious Diseases ; 8(SUPPL 1):S115, 2021.
Article in English | EMBASE | ID: covidwho-1746757

ABSTRACT

Background. From March 2020 through May 2021, Dallas County reported a total of 304,056 cases of COVID-19, including 4,073 deaths. During the month of December 2020, a post-holiday surge of cases led to peak daily average case rates of over 50 cases per 100,000. COVID-19 cases and deaths have since declined substantially following the rollout of COVID-19 vaccine delivery. As of June 8, 2021, about 1,831,588 Dallas County residents have received at least one COVID-19 vaccine dose and 910,067 are fully vaccinated. Recent county integration of immunization and case databases enabled identification and analysis of COVID-19 breakthrough infections. Methods. A COVID-19 breakthrough infection was defined as a positive test (PCR or antigen) collected from an individual ≥ 14 days after receiving the full series of an FDA-authorized COVID-19 vaccine. Nationally, 10,262 vaccine breakthrough infections had been reported from 46 US states and territories, through April 2021. Vaccine breakthrough cases were reviewed and medical records ed to collect demographic information, clinical characteristics, and medical conditions. Data analysis was performed using R, version 4.0.2 (2020). Results. Of the 700 vaccine breakthrough cases reported in Dallas County residents as of June 8, 2021, 304 (43%) were male and 396 (57%) female, with an average age of 53 years. The majority of the vaccine breakthrough cases were White (42%);25% were Hispanic/Latino;and 20% were Black. Almost all breakthrough cases were confirmed with PCR testing, with 451 (64%) cases receiving the Pfizer vaccine. Of breakthrough cases, 49% were symptomatic;52% (358) had underlying conditions including: tobacco use, obesity, or immunocompromised state;68 (10%) were hospitalized;and 11 (1.6%) died. Whole genome sequencing was performed on 51 cases, with 14 (27.5%) variants identified, including: eight B.1.1.7, two B.1.429 and one P.1 variants. Conclusion. Despite the high levels of vaccine efficacy documented in US vaccine trials, COVID-19 breakthrough infections, though currently uncommon, do occur and are important to investigate. Ongoing close public health surveillance of variants is needed to discern changes in patterns of vaccine efficacy and characteristics of populations at greatest risk of severe disease from COVID-19.

3.
Open Forum Infectious Diseases ; 8(SUPPL 1):S693, 2021.
Article in English | EMBASE | ID: covidwho-1746313

ABSTRACT

Background. During 2020, a total of 193,318 cases of COVID-19 were reported in Dallas, with daily average case rates exceeding 50 per 100,000 for over 7 weeks. An adaptable survey functionality within a newly implemented COVID-19 surveillance system provided an opportunity to assess case knowledge and attitudes about isolation and contact tracing efforts. Methods. COVID-19 illnesses were classified using the 2020 CSTE case definitions. Cases were interviewed and records reviewed for exposures and illness characteristics. Supplemental questionnaires assessing knowledge of public health recommendations were given to a convenience sample of 987 cases during the month of December 2020. Fishers exact and chi-square analyses were performed using SAS 9.4. Results. Of the 987 respondents, 99% reported beginning isolation on or before receipt of test results, and 1% were not in isolation at the time of public health interview. Of cases reporting contacts, 92% had advised household members to quarantine prior to interview, and 91% did not want public health to call their household. Of cases reporting non-household close contacts, 75% had advised these contacts to quarantine prior to interview, and 91.3% did not want the health department to call these persons. Cases ≥ 65 years were less likely to have notified their own close contacts (OR: 0.2;95% CI=0.1-0.8) of their test results, and more likely to prefer the health department to notify their household contacts of their positive result (OR: 4.1;95% CI=1.3-12.5). Compared with White cases, Hispanic cases were less likely to be aware that their test was positive at the time of interview (OR: 0.3;95% CI=0.1-0.7). Non-White cases were less likely to be aware of resources for food, rent and utility assistance prior to interview (OR: 0.25;95% CI=0.1-0.7). All respondents perceived the public health interview to have been of some value to them, most often to answer their questions about retesting (51%) and duration of isolation (48%). Conclusion. The aversion of a majority of COVID-19 cases for health department notification of their contacts is a significant deterrent to name-based contact tracing approaches. Acknowledgement of this limitation could better focus existing resources on the delivery of expedited notifications and information to contacts by proxy.

4.
Colorectal Disease ; 24(SUPPL 1):75, 2022.
Article in English | EMBASE | ID: covidwho-1745944

ABSTRACT

Purpose: Early in the coronavirus pandemic, guidelines and consensus have been proposed for the management of various general surgical emergencies to help surgeons serve the best interests of patients during an unprecedented time. There has been an agreement that certain conditions such as acute appendicitis should be managed conservatively with antibiotics whereas strong emphasis was put on the importance of timely surgical intervention on perianal and other superficial abscesses. Methods: Using ICD-10 codes, we investigated the impact of COVID-19 on surgical admissions due to perianal, pilonidal abscesses and acute appendicitis as comparison between March and November in 2020 and compared it to the same period in 2019. Results: The total number of surgical admissions due to perianal and pilonidal abscesses decreased by 22.5 and 31.7%, respectively, compared to the same period in 2019. Most of the decline was noted during the first wave, from March to July. Whereas acute appendicitis admissions remained comparatively constant between 2019 and 2020. Conclusion: Despite guidance regarding operative management of abscesses during the pandemic, the total number of surgical admissions due to perianal and pilonidal abscesses was reduced in comparison to the same period in 2019. Most of the decline was noted during the first wave, from March to July. This might result in higher rate of complications presenting at a later time.

5.
Molecular Genetics and Metabolism ; 132:S359, 2021.
Article in English | EMBASE | ID: covidwho-1735113

ABSTRACT

Introduction: On 1st October 2019, a consented pilot study to screennewborns for Duchenne muscular dystrophy was initiated in NYS. Thepilot study is a collaboration between Parent Project MuscularDystrophy, New York State Newborn Screening (NYS NBS) program,Northwell Health Hospitals, New York-Presbyterian Hospitals, NBSTranslational Research Network (NBSTRN), American College ofMedical Genetics (ACMG), and funders. Institutional Review Board(IRB) approved the study. However, the COVID-19 pandemic led todiscussions regarding ending the pilot study unless alternativeprotocols could be established.Methods: Prior to the pandemic, patient enrollment was conductedon-site. Study coordinators at hospitals consented families in-personusing e-consents built in REDCap™ (a secure web application forbuilding and managing online surveys and databases) on hospitalapproved tablets. The specimens were then shipped to the NBSprogram where they were tested for the NBS panel and procedureswere instituted to cross-check consent forms. Duchenne results werereleased on the standard NBS report. Any baby with a borderline resulthad to have a repeat NBS specimen collected and submitted to theprogram. Any baby with a positive result would be referred and seenby a clinical genetics team, and an additional blood specimen wascollected and submitted for second-tier molecular testing. Babies withpositive molecular test results would be followed by a specialist, andfamilies would be offered carrier testing and given information aboutDuchenne and the opportunity to participate in clinical trialsDuring the pandemic, fully remote patient screening, recruitment, andreporting processeswere implemented. The remote study effortswerecomplicated by staff retention issues, technical and software/Wi-Figlitches, computer illiteracy requiring extensive instructions (a subsetof patients), lack of email access. Paper consent mailing requiredsubstantial resources.Significant resources were required at the NBS program as well.Follow-up required research staff coordinate the redraw of thesamples with the parents and pediatrician’s office and referrals weremade by telehealth or in-person visits. For molecular testing, a buccalswab sample collection kit was mailed to the families opting fortelehealth.Conclusion: Despite the challenges, development of remote studyprocedures enabled successful continuation of the pilot during thepandemic. These newprotocols could be applicable in the absence of apandemic as a complementary method to in-person recruitmentprocess and follow up, which would facilitate enrollment of patientswho would otherwise be missed. Implementation of this hybridapproach leads to optimization of patient enrollment, which couldapply to a broad spectrum of future studies and clinical trials.

6.
Gastroenterology ; 160(6):S-216, 2021.
Article in English | EMBASE | ID: covidwho-1592398

ABSTRACT

BACKGROUND: The indirect health impact of COVID-19 caused by delayed access to care or deferred medical procedures is yet to be fully appreciated. METHODS: We conducted a hospital system-wide audit of all inpatient gastrointestinal (GI) consults performed during the lockdown phase (3/23/2020 – 5/10/2020, n = 558) and the reopening phase (6/1/2020 –7/19/2020, n = 713) of the pandemic and compared against data from 2019 in order to discover any changes in disease burdens. GI diagnoses were derived from the patients' discharge summaries and verified by an independent review of the associated GI consult notes. RESULTS: The volume of inpatient consults was reduced by 27.7% during the lockdown phase compared to the same period in 2019. Yet, the proportion of consults for swallowing disorders (food impaction or chronic dysphagia from eosinophilic esophagitis or achalasia) was increased by 50.9% (p = 0.04). Coincidentally, all outpatient esophageal motility study or elective endoscopic dilation procedures at our hospital system were post-poned during this phase. While the volume of consults was restored during the reopening phase to 101% of that of the same period in 2019. The proportion of consults for swallowing disorders remained elevated by 47.7% (p = 0.02). In comparison, there was no significant change in the proportions of consults for foreign/caustic substance ingestion, inflammatory bowel diseases, or gastrointestinal bleeding during either the lockdown phase or the reopening phase. CONCLUSIONS: There was a significant surge in the demand for inpatient consults for swallowing disorders following the onset of the COVID-19 pandemic, coinciding with the postponement of elective endoscopic procedures. Resources should be allocated to manage patients with underlying esophageal motility disorders more effectively as the pan-demic continues.

7.
Gastroenterology ; 160(6):S-778, 2021.
Article in English | EMBASE | ID: covidwho-1592397

ABSTRACT

Background: The indirect health impact of COVID-19 caused by delayed access to care and the psychosocial distress of the pandemic is yet to be fully appreciated. METHODS: We conducted a hospital system-wide audit of all inpatient gastrointestinal (GI) consults performed during the lockdown phase (3/23/2020 - 5/10/2020, n = 558) and the reopening phase (6/1/2020 - 7/19/2020, n = 713) of the pandemic and compared against data from 2019 in order to discover any changes in disease burdens. GI diagnoses were derived from the patients' discharge summaries and verified by an indepedent review of the associated GI consult notes. RESULTS: The volume of consults was reduced by 27.7% during the lockdown phase compared to the same period in 2019. Yet, the proportion of consults for alcohol-related GI and liver diseases (alcoholic hepatitis, alcoholic cirrhosis, alcoholic pancreatitis, and alcoholic gastritis) has increased by 59.6% (p = 0.03). In comparison, there was no signi ficant changeinthepro portions of consultsfornon-alcohol-relatedliver diseases, biliary obstruction/injury, inflammatory bowel diseases, or gastrointestinal bleeding. The volume of consults was restored during the reopening phase to 101% of that of the same period in 2019. The proportion of consults for alcohol-related GI and liver diseases remained elevated by 78.7% (p = 0.01), while that of alcoholic hepatitis, in particular, was increased by 127.2% (p < 0.01). The proportion of patients with alcohol-related GI and liver diseases requiring inpatient endoscopic interventions was also significantly higher (34.6% vs. 13.8%, p = 0.04). There was, however, no statistical difference in the average age, Maddrey's discriminant function, or Model for End-Stage Liver Disease score, amongst those patients with alcoholic hepatitis oralcoholic cirrhosis in 2020 compared tothose in2019. CONCLUSIONS: Volumes of inpatient consults had decreased sharply at the onset of the COVID-19 pandemic but have quickly returned to normal levels despite the ongoing infection control restrictions. There is a surge in the demands for inpatient consults and inpatient endoscopic interventions for alcohol-related GI and liver diseases, particularly alcoholic hepatitis. Primary care physicians and gastroenterologists should proactively screen for and aggressively address alcohol use disorder.

8.
British Journal of Surgery ; 108:1, 2021.
Article in English | Web of Science | ID: covidwho-1539394
9.
British Journal of Surgery ; 108:216-216, 2021.
Article in English | Web of Science | ID: covidwho-1539381
10.
Colorectal Disease ; 23(SUPPL 1):29, 2021.
Article in English | EMBASE | ID: covidwho-1457936

ABSTRACT

Purpose: Early in the coronavirus pandemic, guidelines and consensus have been proposed for the management of various general surgical emergencies to help surgeons serve the best interests of patients during an unprecedented time. There has been an agreement that certain conditions such as acute appendicitis should be managed conservatively with antibiotics whereas strong emphasis was put on the importance of timely surgical intervention on perianal and other superficial abscesses. Methods: Using ICD-10 codes, we investigated the impact of COVID-19 on surgical admissions due to perianal, pilonidal abscesses and acute appendicitis as comparison between March and November in 2020 and compared it to the same period in 2019. Results: The total number of surgical admissions due to perianal and pilonidal abscesses decreased by 22.5 and 31.7%, respectively, compared to the same period in 2019. Most of the decline was noted during the first wave, from March to July. Whereas acute appendicitis admissions remained comparatively constant between 2019 and 2020. Conclusion: Despite guidance regarding operative management of abscesses during the pandemic, the total number of surgical admissions due to perianal and pilonidal abscesses was reduced in comparison to the same period in 2019. Most of the decline was noted during the first wave, from March to July. This might result in higher rate of complications presenting at a later time.

11.
World Leisure Journal ; : 15, 2021.
Article in English | Web of Science | ID: covidwho-1349722

ABSTRACT

Leisure in the daily lives of older adults plays an important role in aging well. However, the practice of social distancing and stay-at-home orders during the COVID-19 pandemic has severely hindered leisure involvement. We knew little about how the reduction in leisure participation during the pandemic affected older adults' leisure lifestyles. The purpose of the study was to explore how older adults adapted in times when their leisure opportunities were constrained. Data were collected through a multi-author blog. Participants (n = 28) were invited to create posts, share photos, and comment on the posts of others. Data were analyzed thematically. The findings demonstrated that older adults gradually adapted to the pandemic in a manner that closely aligned with the Selective Optimization with Compensation (SOC) model. The article discusses how the SOC model could be applied in the context of external adversity.

12.
British Journal of Surgery ; 108(SUPPL 2):ii21, 2021.
Article in English | EMBASE | ID: covidwho-1254452

ABSTRACT

Background: The United Kingdom now has one of the highest death rates from COVID 19, with over 40,000 deaths (1). It has been posited that the identification of care workers with immunity or increased resistance could be important in developing future strategies. Method: This was a retrospectively conducted survey of general surgical staff at a tertiary surgical unit. Results: We surveyed 215 staff that had undergone antibody testing. Of the 175/215 who reported contact with COVID-19 positive patients, 6/ 215 had a positive PCR result and 15/215 reported a positive antibody test. Only 3/6 that had a positive PCR test demonstrated antibodies. Conclusions: Our immunity rate of 7% is extremely low and is concerning especially in respect of the anticipated herd immunity which would mitigate many of the issues presently being confronted and it is likely to be many months at least before this makes realistic contribution. Continued testing for the presence of COVID-19 antibodies will contribute to crucial seroprevalence data that can be used by public health bodies whose advice will necessarily evolve as increasing data sets become available.

13.
Gastroenterology ; 160(6):S216-S216, 2021.
Article in English | Web of Science | ID: covidwho-1250027
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