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1.
JAMA Internal Medicine ; 29:29, 2022.
Article in English | MEDLINE | ID: covidwho-1825745

ABSTRACT

Importance: As self-collected home antigen tests become widely available, a better understanding of their performance during the course of SARS-CoV-2 infection is needed. Objective: To evaluate the diagnostic performance of home antigen tests compared with reverse transcription-polymerase chain reaction (RT-PCR) and viral culture by days from illness onset, as well as user acceptability. Design, Setting, and Participants: This prospective cohort study was conducted from January to May 2021 in San Diego County, California, and metropolitan Denver, Colorado. The convenience sample included adults and children with RT-PCR-confirmed infection who used self-collected home antigen tests for 15 days and underwent at least 1 nasopharyngeal swab for RT-PCR, viral culture, and sequencing. Exposures: SARS-CoV-2 infection. Main Outcomes and Measures: The primary outcome was the daily sensitivity of home antigen tests to detect RT-PCR-confirmed cases. Secondary outcomes included the daily percentage of antigen test, RT-PCR, and viral culture results that were positive, and antigen test sensitivity compared with same-day RT-PCR and cultures. Antigen test use errors and acceptability were assessed for a subset of participants. Results: This study enrolled 225 persons with RT-PCR-confirmed infection (median [range] age, 29 [1-83] years;117 female participants [52%];10 [4%] Asian, 6 [3%] Black or African American, 50 [22%] Hispanic or Latino, 3 [1%] Native Hawaiian or Other Pacific Islander, 145 [64%] White, and 11 [5%] multiracial individuals) who completed 3044 antigen tests and 642 nasopharyngeal swabs. Antigen test sensitivity was 50% (95% CI, 45%-55%) during the infectious period, 64% (95% CI, 56%-70%) compared with same-day RT-PCR, and 84% (95% CI, 75%-90%) compared with same-day cultures. Antigen test sensitivity peaked 4 days after illness onset at 77% (95% CI, 69%-83%). Antigen test sensitivity improved with a second antigen test 1 to 2 days later, particularly early in the infection. Six days after illness onset, antigen test result positivity was 61% (95% CI, 53%-68%). Almost all (216 [96%]) surveyed individuals reported that they would be more likely to get tested for SARS-CoV-2 infection if home antigen tests were available over the counter. Conclusions and Relevance: The results of this cohort study of home antigen tests suggest that sensitivity for SARS-CoV-2 was moderate compared with RT-PCR and high compared with viral culture. The results also suggest that symptomatic individuals with an initial negative home antigen test result for SARS-CoV-2 infection should test again 1 to 2 days later because test sensitivity peaked several days after illness onset and improved with repeated testing.

2.
BMJ Open Gastroenterol ; 9(1), 2022.
Article in English | PubMed | ID: covidwho-1807372

ABSTRACT

BACKGROUND: Northern England has been experiencing a persistent rise in the number of primary liver cancers, largely driven by an increasing incidence of hepatocellular carcinoma (HCC) secondary to alcohol-related liver disease and non-alcoholic fatty liver disease. Here we review the effect of the COVID-19 pandemic on primary liver cancer services and patients in our region. OBJECTIVE: To assess the impact of the COVID-19 pandemic on patients with newly diagnosed liver cancer in our region. DESIGN: We prospectively audited our service for the first year of the pandemic (March 2020-February 2021), comparing mode of presentation, disease stage, treatments and outcomes to a retrospective observational consecutive cohort immediately prepandemic (March 2019-February 2020). RESULTS: We observed a marked decrease in HCC referrals compared with previous years, falling from 190 confirmed new cases to 120 (37%). Symptomatic became the the most common mode of presentation, with fewer tumours detected by surveillance or incidentally (% surveillance/incidental/symptomatic;34/42/24 prepandemic vs 27/33/40 in the pandemic, p=0.013). HCC tumour size was larger in the pandemic year (60±4.6 mm vs 48±2.6 mm, p=0.017), with a higher incidence of spontaneous tumour haemorrhage. The number of new cases of intrahepatic cholangiocarcinoma (ICC) fell only slightly, with symptomatic presentation typical. Patients received treatment appropriate for their cancer stage, with waiting times shorter for patients with HCC and unchanged for patients with ICC. Survival was associated with stage both before and during the pandemic. 9% acquired COVID-19 infection. CONCLUSION: The pandemic-associated reduction in referred patients in our region was attributed to the disruption of routine healthcare. For those referred, treatments and survival were appropriate for their stage at presentation. Non-referred or missing patients are expected to present with more advanced disease, with poorer outcomes. While protective measures are necessary during the pandemic, we recommend routine healthcare services continue, with patients encouraged to engage.

3.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793888

ABSTRACT

Introduction: Patients discharged from the intensive care unit (ICU) post coronavirus-19 (COVID-19) pneumonitis may experience longterm morbidity related to their critical illness, the treatment for this and the ICU environment. Methods: We performed a prospective cohort study in a post-ICU (PICS) follow-up clinic at Tallaght University Hospital in October 2020 for patients who had been admitted to the ICU in our institution with COVID-19 pneumonitis six months earlier. Our clinic was staffed by critical care physicians, a psychologist, a physiotherapist and a research nurse. Our aim was to characterise the cognitive, psychological and physical consequences of COVID-19 in patients admitted to the ICU and discharged alive. Results: A total of 22 patients attended the 6-month PICS follow-up clinic following admission to ICU with COVID-19 pneumonitis. The majority of these patients were male and obese. The most common comorbidities were hypertension, diabetes mellitus and ischaemic heart disease. The median ICU length of stay was 21 days (IQR 2-75 days) with a median hospital length of stay of 37 days (IQR 8-130 days). The mean ICU Mobility Scale (IMS) score at the PICS clinic was low at 9.8 (SD 0.4). Only 59% of patients were independent with regard to their activities of daily living (ADLs). 8/14 (57%) of patients had returned to work by 6 months post ICU discharge. Their mean Intensive Care Psychological Assessment Tool (IPAT) score was high at 6.7 (SD 4.6) with a high mean Post-Traumatic Stress Disorder (PTSD) score of 21.1 (SD 17.5). Conclusions: In this single centre prospective cohort study, we found that patients have a high burden of physical and psychological impairment at 6 months following ICU discharge post COVID-19 pneumonitis;in many cases requiring specialist referrals for long-term input. We advocate for increased resources for this much needed follow-up multidisciplinary intervention for an ever-growing population of patients.

4.
Open Forum Infectious Diseases ; 8(SUPPL 1):S288-S289, 2021.
Article in English | EMBASE | ID: covidwho-1746621

ABSTRACT

Background. In December 2020, B.1.1.7 lineage of SARS-CoV-2 was first detected in the United States and has since become the dominant lineage. Previous investigations involving B.1.1.7 suggested higher rates of transmission relative to non-B.1.1.7 lineages. We conducted a household transmission investigation to determine the secondary infection rates (SIR) of B.1.1.7 and non-B.1.1.7 SARS-CoV-2 lineages. Methods. From January-April 2021, we enrolled members of households in San Diego County, CA, and Denver, CO metropolitan area (Tri-County), with a confirmed SARS-CoV-2 infection in a household member with illness onset date in the previous 10 days. CDC investigators visited households at enrollment and 14 days later at closeout to obtain demographic and clinical data and nasopharyngeal (NP) samples on all consenting household members. Interim visits, with collection of NP swabs, occurred if a participant became symptomatic during follow-up. NP samples were tested for SARS-CoV-2 using TaqPath™ RT-PCR test, where failure to amplify the spike protein results in S-Gene target failure (SGTF) may indicate B.1.1.7 lineage. Demographic characteristics and SIR were compared among SGTF and non-SGTF households using two-sided p-values with chi-square tests;95% confidence intervals (CI) were calculated with Wilson score intervals. Results. 552 persons from 151 households were enrolled. 91 (60%) households were classified as SGTF, 57 (38%) non-SGTF, and 3 (2%) indeterminant. SGTF and non-SGTF households had similar sex distribution (49% female and 52% female, respectively;P=0.54) and age (median 30 years, interquartile range (IQR 14-47) and 31 years (IQR 15-45), respectively). Hispanic people accounted for 24% and 32% of enrolled members of SGTF and non-SGTF households, respectively (p=0.04). At least one secondary case occurred in 61% of SGTF and 58% of non-SGTF households (P=0.66). SIR was 52% (95%[CI] 46%-59%) for SGTF and 45% (95% CI 37%-53%) for non-SGTF households (P=0.18). Conclusion. SIRs were high in both SGTF and non-SGTF households;our findings did not support an increase in SIR for SGTF relative to non-SGTF households in this setting. Sequence confirmed SARS-CoV-2 samples will provide further information on lineage specific SIRs.

5.
Journal of Cystic Fibrosis ; 20:S108, 2021.
Article in English | EMBASE | ID: covidwho-1735128

ABSTRACT

Objectives: The COVID-19 pandemic ushered in a whole new range of changes and challenges for cystic fibrosis (CF) teams which wereintroduced at a rapid rate. A proposal was put forward for UK CF SocialWorkers (SW) to meet virtually to discuss emerging issues for people withCF, professional and personal impacts of COVID-19. We aimed to exploreSWexperiences of new ways of working during COVID-19.Methods: All 45 UKCF, SWwere invited to complete an online anonymised24 item questionnaire with a mix of Likert scale matrix and open-endedquestions. There was a focus on transition to homeworking, what workedwell and what didn’t, and an exploration of what practices developedduring the pandemic SW would like to see employed permanently.Results: Response rate = 38% (17/45) Paediatric (3) Adult (13) Lifespan (1).Pre-COVID-19, 76% of SW had never worked from home (WFH);now 47%were entirely home-based with a further 29% WFH a few days per week.57% felt the transition to homeworking went smoothly and 75% feltmanagement were supportive. 76% ceased all face-to-face contact withpatients with increased use of video technology to facilitate remoteconsultations. 65% expressed concerns about returning to pre-COVIDworking patterns and most wanted flexible working arrangements tocontinue. 82% attended at least one virtual meeting, 76% found thesemeetings very useful and 100% felt they should continue.Conclusions: Attendance at the SW virtual meetings has grown, indicatingSWvalue the sharing of insights and experience. In light of the escalation ofremote working and working in isolation, CF SW are rethinking peersupport and online learning events. Initially informal in content, thesemeetings have evolved into a structured format with plans to broaden thecontext to make them more purposeful. Plans for future working anddiscussing emerging needs for patients with CF will need to be exploredfurther

8.
Neurology ; 96(15 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1407805

ABSTRACT

Objective: To assess the clinical course and outcomes of COVID-19 in patients with pre-existing neurologic disorders and the impact of COVID-19 on neurologic disorder during and after COVID-19. Background: In March of 2020, as COVID-19 increased in the United States, several risk factors for severe COVID-19 emerged, including age, hypertension, diabetes, and immunocompromised state. Neurologic disorders were not among these risk factors, and no information existed on the course and outcomes of COVID-19 in patients with various neurologic disorders. Design/Methods: After receiving IRB approval, a structured questionnaire was distributed via various media platforms between April-October 2020 to the US neurologists and neurology trainees with questions pertaining to their patients with pre-existing neurologic disorders who had COVID-19 infection confirmed either by SARS-Co-V2 PCR or IgG test. Results: Over a 6-month period, 66 patients, (age range 1-94, mean 49.2 years, 39 females, 27 males) were submitted, with most frequent neurologic disorders being chronic migraine (23%), epilepsy (12%) and multiple sclerosis (MS) (11%). Of these, 58% had a mild-to-moderate course of COVID-19 requiring no hospitalization, 41% required hospitalization or intensive care unit admission, and 5 patients died (2 were in their 90s with a history of stroke, 2 in their 60s with malignancy, and one 31-year-old male with MS.) COVID-19 resulted in exacerbation of the underlying neurologic disorder during or after COVID-19 in 57% of patients. Common persistent symptoms after COVID-19 included fatigue, exercise intolerance and headache. Conclusions: In this cohort, majority of patients with pre-existing neurologic disorders had a mild-to-moderate course of COVID-19 requiring no hospitalization, but many experienced exacerbation of their pre-existing neurologic disorder during or after COVID-19 and had persistent symptoms of fatigue, exercise intolerance and headache. Large prospective studies are needed to determine which neurologic disorders present a significant risk in order to protect the most vulnerable patient population.

9.
Atherosclerosis ; 331:e140, 2021.
Article in English | EMBASE | ID: covidwho-1401206

ABSTRACT

Background and Aims: Hypolipidaemia is a known consequence of sepsis, predominantly from HDL-C (HDL-cholesterol) lowering. The dynamic of lipoprotein responses is in COVID-19 is not yet elucidated. We aim to describe a lipoprotein response pattern in patients with severe COVID-19 admitted to Intensive Care Department (ICU) at TUH during the first wave of the pandemic in Ireland. Methods: A multidisciplinary team extracted the clinical data and laboratory results of all patients diagnosed with COVID-19 by RT-PCR and admitted to the ICU department in March and April 2020. Data are presented as means, apart from laboratory data where patients had more than one set of results in 24 hours, when median results were calculated for each 24-h period. Results: Twenty-five patients were admitted to ICU (table 1). Presenting comorbidities included hypertension in 10, cardiovascular disease in 5 and diabetes mellitus in 8 patients. Lipoprotein median concentrations demonstrated initial reduction at admission to ICU, followed by rise in concentration during ICU stay (table 1 and figure 1). A significant negative correlation was observed between ICU outcome and HDL-C area under the curve (AUC) (R=-0.506, p=0.004) and LDL-AUC (R=-0.575, p=0.003). Delta LDL-AUC had the strongest correlation with ICU length of stay (LOS) (R=0.455, p=0.02), hospital LOS (R=0.484, p=0.02) and ICU outcomes (R=-0.454, p=0.02). Individual lipoprotein parameters did not demonstrate significant correlation. [Formula presented] [Formula presented] Conclusions: Lipoprotein concentrations (HDL-C and LDL-C) upon ICU admission are low in severe COVID-19 pneumonia patients and subsequent changes in concentrations may be associated with patient outcomes.

10.
23rd International Conference on Human-Computer Interaction, HCII 2021 ; 1421:591-598, 2021.
Article in English | Scopus | ID: covidwho-1355947

ABSTRACT

Digital technologies have been widely utilized to assist with disease detection and management throughout the Covid-19 pandemic. The prevalence of smartphone usage amongst populations has assisted the provision of mobile applications that citizens can use to manage their health. Covid-19 symptom checker smartphone apps enable users to enter their health characteristics and receive validated advice related to self-isolation, testing and whether to seek clinical care. Moreover, the collection of symptom data can assist healthcare providers with disease surveillance and resource allocation. However, the adoption of symptom checker apps can be influenced by several factors including the functionality of the app, and data privacy and protection policies. In this study, we reviewed nine symptom checker apps that were available on the Android and iOS platforms. We analyzed characteristics related to the functionality and accessibility of the apps, and factors that related to privacy, transparency and trust. We found that most of the apps were multifunctional and several (n = 4) combined contact tracing and symptom checking functionalities. Moreover, there was variation in the quantity of personal data collected and symptom checking questions. For all the apps reviewed information related to privacy and data protection was available, however, there was variability in the content and readability of this material. Information regarding the technical profile of the apps was also inconsistent. For several of the apps, access to the symptom checking functionality was restricted by location. This review suggests that symptom checker apps provide an effective tool for public health management during the Covid-19 pandemic. © 2021, Springer Nature Switzerland AG.

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