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1.
British Journal of Surgery ; 109:vi62, 2022.
Article in English | EMBASE | ID: covidwho-2042561

ABSTRACT

Aim: The Enhanced Recovery After Surgery (ERAS) protocol for total laryngectomies was first implemented in our tertiary head and neck centre from November 2019. It includes pre-operative carbohydrate loading and an early swallow test which facilitates recommencement of oral intake to improve outcomes. Protocol adherence rate and patient outcomes were measured to determine the effectiveness and benefits of ERAS in laryngectomy patients. Method: 22 total laryngectomy patients from November 2019 to September 2021 were enrolled onto the ERAS protocol, 18 primary and 3 salvage cases. An analysis of the respective patient cohorts was performed to determine adherence to the ERAS protocol and outcomes such as complications and length of inpatient stay were measured. Results: 19 patients (86%) received pre-operative carbohydrate loading successfully, while 3 patients were contraindicated due to background of diabetes. Early swallow test was performed in 59% of patients. Potential reasons for delay were stoma dehiscence or clinical suspicion of neo-pharyngeal leak. 59% of primary cases were deemed medically fit for discharge within the target timeframe of 12-14 days whereas no target was set for salvage cases due to expected poor healing. Main complication in primary cases was neo-pharyngeal leak followed by stoma dehiscence with 28% and 11% respectively. Conclusion: Limitations of our study include small sample size due to the COVID-19 pandemic. Despite its infancy, the ERAS protocol has achieved good outcomes in early recommencement of oral intake post-laryngectomy and encouraging early safe discharge from hospital. Future plans include establishment of Prehab Clinic and application of ERAS to neck dissection patients.

2.
European journal of preventive cardiology ; 29(Suppl 1), 2022.
Article in English | EuropePMC | ID: covidwho-1998656

ABSTRACT

Funding Acknowledgements Type of funding sources: None. Introduction The global COVID19 pandemic has led to significant morbidity and mortality to millions of cardiac patients across the globe. Inferior clinical standards, modified clinical pathways and limited hospital resources has unfortunately translated to significant premature cardiac deaths. Cardiac rehabilitation has also been hit significantly. Study Objectives The aim of this study was to assess the impact of cardiac rehabilitation during COVID-19, comparing the referral, adherence and outcomes with patients admitted a year previously. Methodology Patients were divided in two groups. Group 1 were those admitted between March-August 2019 (Pre-COVID). Group 2 included those admitted between March-August 2020 (during COVID). Program completion was defined as adherence to ≥6 sessions (Group 1) or ≥ 4 sessions (Group 2). Data was collected from electronic case summaries and cardiac rehabilitation unit medical records. Data was tabulated in SPSS v23. Categorical variables were presented as percentages. Statistical analysis was computed with SPSS v23. A p value of <0.05 was deemed statistically significant. Results 710 patients were admitted with a cardiac diagnosis (Group 1 n=360, Group 2 n=350), mean age 66.71 ± 13.21 years, dominant male population (n=548, 77.2%). Both groups had comparable proportions of smoking, hypertension, diabetes and hyperlipidaemia. The referral rate to cardiac rehabilitation was rather poor in both groups, though better in Group 1 (Group 1 38.3% vs 26.6%, p=0.001), partly because of temporary discontinuation of the rehabilitation program at the start of the pandemic. The completion rate was also unfortunately quite low. It was better in Group 2, possibly because of the shorter program duration (Group 1 23.5% vs Group 2 38.7%, p=0.018). The 1 year readmission rate was significantly higher in Group 1 (22.8% vs 15.1%, p=0.022)), possibly because patients were more open to seek medical advice before the pandemic. The 30 day death rate was comparable in both groups (5.0% vs 5.7%, p=0.672). The 1 year mortality was also comparable (Group 1 12.5% vs Group 2 10.6%, p=0.481) Cardiac rehabilitation did not impact the 1 year readmission rate, 30 day and 1 year mortality. Conclusion The 30 day and 1 year mortality in patients admitted during the first 6 months of the pandemic was comparable to the same timeframe the year before. The 1 year readmission rate was higher in patients admitted before COVID, possibly explained by patients being more inclined to seek medical advice. Referral to cardiac rehabilitation was generally low. Adherence to the program did not impact readmission and mortality.

4.
European Journal of Preventive Cardiology ; 29(SUPPL 1):i332, 2022.
Article in English | EMBASE | ID: covidwho-1915594

ABSTRACT

Introduction: The global COVID19 pandemic has led to significant morbidity and mortality to millions of cardiac patients across the globe. Inferior clinical standards, modified clinical pathways and limited hospital resources has unfortunately translated to significant premature cardiac deaths. Cardiac rehabilitation has also been hit significantly. Study Objectives The aim of this study was to assess the impact of cardiac rehabilitation during COVID-19, comparing the referral, adherence and outcomes with patients admitted a year previously. Methodology: Patients were divided in two groups. Group 1 were those admitted between March-August 2019 (Pre-COVID). Group 2 included those admitted between March-August 2020 (during COVID). Program completion was defined as adherence to ≥6 sessions (Group 1) or ≥ 4 sessions (Group 2). Data was collected from electronic case summaries and cardiac rehabilitation unit medical records. Data was tabulated in SPSS v23. Categorical variables were presented as percentages. Statistical analysis was computed with SPSS v23. A p value of <0.05 was deemed statistically significant. Results: 710 patients were admitted with a cardiac diagnosis (Group 1 n=360, Group 2 n=350), mean age 66.71 ± 13.21 years, dominant male population (n=548, 77.2%). Both groups had comparable proportions of smoking, hypertension, diabetes and hyperlipidaemia. The referral rate to cardiac rehabilitation was rather poor in both groups, though better in Group 1 (Group 1 38.3% vs 26.6%, p=0.001), partly because of temporary discontinuation of the rehabilitation program at the start of the pandemic. The completion rate was also unfortunately quite low. It was better in Group 2, possibly because of the shorter program duration (Group 1 23.5% vs Group 2 38.7%, p=0.018). The 1 year readmission rate was significantly higher in Group 1 (22.8% vs 15.1%, p=0.022)), possibly because patients were more open to seek medical advice before the pandemic. The 30 day death rate was comparable in both groups (5.0% vs 5.7%, p=0.672). The 1 year mortality was also comparable (Group 1 12.5% vs Group 2 10.6%, p=0.481) Cardiac rehabilitation did not impact the 1 year readmission rate, 30 day and 1 year mortality. Conclusion: The 30 day and 1 year mortality in patients admitted during the first 6 months of the pandemic was comparable to the same timeframe the year before. The 1 year readmission rate was higher in patients admitted before COVID, possibly explained by patients being more inclined to seek medical advice. Referral to cardiac rehabilitation was generally low. Adherence to the program did not impact readmission and mortality.

5.
Topics in Antiviral Medicine ; 30(1 SUPPL):18, 2022.
Article in English | EMBASE | ID: covidwho-1880294

ABSTRACT

Background: The Sisonke Phase IIIB open-label implementation study vaccinated health care workers (HCWs) with the single dose Ad26.COV2.S vaccine during two phases of the South African Covid-19 epidemic, dominated first by the Beta followed by the Delta variant of concern. Methods: HCWs were vaccinated over 3 months (17 February-17 May 2021). Safety was monitored by self-reporting, facility reporting and linkage to national databases. Vaccine effectiveness (VE) against Covid-19 related hospitalisation, hospitalisation requiring critical or intensive care and death, ascertained 28 days or more post vaccination was assessed up until 17 July 2021. Nested sub-cohorts (A and B) from two national medical schemes were evaluated to assess VE using a matched retrospective cohort design. Results: Over the 3-month period, 477234 HCWs were vaccinated in 122 vaccination sites across South Africa. VE derived from the sub-cohorts comprising 215 813 HCWs was 83% (95% CI 75-89) to prevent Covid-19 deaths, 75% (95% CI 69-82) to prevent hospital admissions requiring critical or intensive care and 67% (95% CI 62-71) to prevent Covid-19 related hospitalisations. The VE was maintained in older HCWs and those with comorbidities including HIV infection. VE remained consistent throughout the Beta and Delta dominant phases of the study. 10279 adverse events were reported and 139 (1.4%) were serious, including two cases of thrombosis with thrombocytopenia syndrome and four cases of Guillain-Barré syndrome who recovered. Conclusion: The single dose Ad26.COV2.S was safe and effective against severe Covid-19 disease and death post-vaccination, and against both Beta and Delta variants providing real-world evidence for its use globally.

6.
Topics in Antiviral Medicine ; 30(1 SUPPL):331-332, 2022.
Article in English | EMBASE | ID: covidwho-1880280

ABSTRACT

Background: SARS-CoV2 antibody testing is an important auxillary test especially for retrospective diagnosis or in patients with long COVID-19 or multisystem inflammatory syndrome of childhood. Epidemiological serology studies may also assist public health planning. Access to formal laboratory testing is not universal in many low-and middle-income (LMIC) countries and rapid lateral flow antibody tests are an attractive alternative. Performance of these tests has been inconsistent. A large-scale study was undertaken in South Africa, during the beta and delta waves, to assess the field-based performance of rapid point of care (POC) COVID-19 antibody tests. Methods: Symptomatic, ambulatory persons under investigation (PUIs) aged 18 years and older, presenting for SARS-CoV-2 diagnosis at public health facilities in three provinces, South Africa were enrolled at baseline. All patients completed a questionnaire regarding symptoms. Nasopharyngeal swabs were taken and processed for SARS-CoV-2 PCR testing using a GeneXpert (Cepheid, USA), or manual assay (ThermoFisher TaqPath assay or Seegene Allplex assay) on a real-time platform at routine accredited National Health Laboratory Service laboratories as per routine national protocols. Concomitantly, trained study staff performed three facility-based POC lateral flow antibody tests on a on a fingerstick sample and blood was collected for formal serology. POC tests were selected following a rapid in-laboratory evaluation. Asymptomatic contacts of people with confirmed COVID-19 were recruited into the asymptomatic study arm and rapid tests and PCR were performed. PCR and rapid positive patients and 500 negative controls were followed up at 5-14 days. Antibody tests were compared with formal serology performed on 2 platforms-Euroimmun (Euroimmun, Lubeck) IgA and IgG anti-S antibodies and Abbott Architect IgG test. Results: The sensitivity (S), specificity (Sp), positive (PPV) and negative predictive (NPV) values of tests for PUIs and contacts were calculated (Table 1)∗. Analyses using serology as a reference are forthcoming. Conclusion: Compared with PCR, performance of rapid POC COVID-19 antibody tests was poor with low sensitivity. This may reflect the patient cohort tested as humoral responses typically develop from day 7-14. The tests are unlikely to be useful for acute diagnosis but sensitivity may improve at later timepoints and further follow up data will be analysed by duration of symptom onset, severity of symptoms and wave (beta versus delta).

7.
Topics in Antiviral Medicine ; 30(1 SUPPL):331, 2022.
Article in English | EMBASE | ID: covidwho-1880279

ABSTRACT

Background: Access to SARS-CoV-2 polymerase chain reaction (PCR) testing is a bottleneck globally, especially in low-and middle-income countries (LMICs). Reliable point-of-care (POC) diagnostics for coronavirus disease 2019 (COVID-19) are cheaper and easier to scale-up than PCR especially in LMICs, and will facilitate interruption of transmission. We report the field-based effectiveness of rapid point-of-care (POC) antigen COVID-19 tests during the beta and delta waves, in South Africa. Methods: We enrolled symptomatic, ambulatory persons under investigation (PUIs) aged 18 years and older, presenting for SARS-CoV-2 diagnosis at public health facilities in three provinces, South Africa. All patients completed a questionnaire regarding symptoms. Nasopharyngeal swabs were taken and processed for SARS-CoV-2 PCR testing using either GeneXpert (Cepheid, USA), or with a manual assay (ThermoFisher TaqPath assay or Seegene Allplex assay) on a real-time PCR platform at routine, accredited National Health Laboratory Service laboratories, as per routine national protocols. Concomitantly, trained study staff performed three facility-based POC antigen tests on a nasal/nasopharyngeal swab, as recommended by the manufacturer. Asymptomatic contacts of people with confirmed COVID-19 were recruited into the asymptomatic study arm and rapid tests and PCR were performed. The sensitivity (S), specificity (Sp), positive (PPV) and negative predictive (NPV) values of tests for PUIs and contacts were calculated using PCR as the reference standard. Results: Between Oct 2020-2021 1816 participants were enrolled;472 (26%) tested PCR or rapid test positive;235 positives (49.8%) and 532 negatives were followed up at 5-14 days;574 asymptomatic contacts were enrolled, of which 21 (3.7%) were PCR positive. Performance of the three antigen tests are shown in Table 1∗. Conclusion: In a real world setting, during the beta and delta waves, compared with PCR the sensitivity of rapid antigen tests ranged from 35-68%. This may reflect low viral loads at diagnosis. Further work will compare antigen test performance in patients with high versus lower cycle threshold (Ct) values. Meanwhile, PCR testing capacity needs urgent scale-up in LMICs and improved POC diagnostics are needed to facilitate COVID-19 diagnosis in LMICs.

8.
Embase; 2021.
Preprint in English | EMBASE | ID: ppcovidwho-330496

ABSTRACT

The Janssen (Johnson & Johnson) Ad26.COV2.S non-replicating viral vector vaccine has been widely deployed for COVID-19 vaccination programs in resource-limited settings. Here we confirm that neutralizing and binding responses to Ad26.COV2.S vaccination are stable for 6 months post-vaccination, when tested against multiple SARS-CoV-2 variants. Secondly, using longitudinal samples from individuals who experienced clinically mild breakthrough infections 4 to 5 months after vaccination, we show dramatically boosted binding antibodies, Fc effector function and neutralization. These high titer responses are of similar magnitude to humoral immune responses measured in severely ill, hospitalized donors, and are cross-reactive against diverse SARS-CoV-2 variants, including the extremely neutralization resistant Omicron (B.1.1.529) variant that currently dominates global infections, as well as SARS-CoV-1. These data have implications for population immunity in areas where the Ad26.COV2.S vaccine has been widely deployed, but where ongoing infections continue to occur at high levels.

10.
South African Medical Journal ; 112(2 b), 2022.
Article in English | EMBASE | ID: covidwho-1706330

ABSTRACT

Sisonke is a multicentre, open-label, single-arm phase 3B vaccine implementation study of healthcare workers (HCWs) in South Africa, with prospective surveillance for 2 years. The primary endpoint is the rate of severe COVID-19, including hospitalisations and deaths. The Sisonke study enrolled and vaccinated participants nationally at potential vaccination roll-out sites between 17 February and 26 May 2021. After May 2021, additional HCWs were vaccinated as part of a sub-study at selected clinical research sites. We discuss 10 lessons learnt to strengthen national and global vaccination strategies: (i) consistently advocate for vaccination to reduce public hesitancy;(ii) an electronic vaccination data system (EVDS) is critical;(iii) facilitate access to a choice of vaccination sites, such as religious and community centres, schools, shopping malls and drive-through centres;(iv) let digitally literate people help elderly and marginalised people to register for vaccination;(v) develop clear 'how to' guides for vaccine storage, pharmacy staff and vaccinators;(vi) leverage instant messaging platforms, such as WhatsApp, for quick communication among staff at vaccination centres;(vii) safety is paramount - rapid health assessments are needed at vaccination centres to identify people at high risk of serious adverse events, including anaphylaxis or thrombosis with thrombocytopenia syndrome. Be transparent about adverse events and contextualise vaccination benefits, while acknowledging the small risks;(viii) provide real-time, responsive support to vaccinees post vaccination and implement an accessible national vaccine adverse events surveillance system;(ix) develop efficient systems to monitor and investigate COVID-19 breakthrough infections;and (x) flexibility and teamwork are essential in vaccination centres across national, provincial and district levels and between public and private sectors.

11.
Embase;
Preprint in English | EMBASE | ID: ppcovidwho-327037

ABSTRACT

Following the results of the ENSEMBLE 2 study, which demonstrated improved vaccine efficacy of a two-dose regimen of Ad26.COV.2 vaccine given 2 months apart, we expanded the Sisonke study which had provided single dose Ad26.COV.2 vaccine to almost 500 000 health care workers (HCW) in South Africa to include a booster dose of the Ad26.COV.2. Sisonke 2 enrolled 227 310 HCW from the 8 November to the 17 December 2021. Enrolment commenced before the onset of the Omicron driven fourth wave in South Africa affording us an opportunity to evaluate early VE in preventing hospital admissions of a homologous boost of the Ad26.COV.2 vaccine given 6-9 months after the initial vaccination in HCW. We estimated vaccine effectiveness (VE) of the Ad26.COV2.S vaccine booster in 69 092 HCW as compared to unvaccinated individuals enrolled in the same managed care organization using a test negative design. We compared VE against COVID19 admission for omicron during the period 15 November to 20 December 2021. After adjusting for confounders, we observed that VE for hospitalisation increased over time since booster dose, from 63% (95%CI 31-81%);to 84% (95% CI 67-92%) and then 85% (95% CI: 54-95%), 0-13 days, 14-27 days, and 1-2 months post-boost. We provide the first evidence of the effectiveness of a homologous Ad26.COV.2 vaccine boost given 6-9 months after the initial single vaccination series during a period of omicron variant circulation. This data is important given the increased reliance on the Ad26.COV.2 vaccine in Africa.

12.
Embase;
Preprint in English | EMBASE | ID: ppcovidwho-327015

ABSTRACT

Omicron has been shown to be highly transmissible and have extensive evasion of neutralizing antibody immunity elicited by vaccination and previous SARS-CoV-2 infection. Omicron infections are rapidly expanding worldwide often in the face of high levels of Delta infections. Here we characterized developing immunity to Omicron and investigated whether neutralizing immunity elicited by Omicron also enhances neutralizing immunity of the Delta variant. We enrolled both previously vaccinated and unvaccinated individuals who were infected with SARS-CoV-2 in the Omicron infection wave in South Africa soon after symptom onset. We then measured their ability to neutralize both Omicron and Delta virus at enrollment versus a median of 14 days after enrollment. Neutralization of Omicron increased 14-fold over this time, showing a developing antibody response to the variant. Importantly, there was an enhancement of Delta virus neutralization, which increased 4.4-fold. The increase in Delta variant neutralization in individuals infected with Omicron may result in decreased ability of Delta to re-infect those individuals. Along with emerging data indicating that Omicron, at this time in the pandemic, is less pathogenic than Delta, such an outcome may have positive implications in terms of decreasing the Covid-19 burden of severe disease.

13.
Embase;
Preprint in English | EMBASE | ID: ppcovidwho-326997

ABSTRACT

The SARS-CoV-2 Omicron variant has multiple Spike (S) protein mutations that contribute to escape from the neutralizing antibody responses, and reducing vaccine protection from infection. The extent to which other components of the adaptive response such as T cells may still target Omicron and contribute to protection from severe outcomes is unknown. We assessed the ability of T cells to react with Omicron spike in participants who were vaccinated with Ad26.CoV2.S or BNT162b2, and in unvaccinated convalescent COVID-19 patients (n = 70). We found that 70-80% of the CD4 and CD8 T cell response to spike was maintained across study groups. Moreover, the magnitude of Omicron cross-reactive T cells was similar to that of the Beta and Delta variants, despite Omicron harbouring considerably more mutations. Additionally, in Omicron-infected hospitalized patients (n = 19), there were comparable T cell responses to ancestral spike, nucleocapsid and membrane proteins to those found in patients hospitalized in previous waves dominated by the ancestral, Beta or Delta variants (n = 49). These results demonstrate that despite Omicron’s extensive mutations and reduced susceptibility to neutralizing antibodies, the majority of T cell response, induced by vaccination or natural infection, crossrecognises the variant. Well-preserved T cell immunity to Omicron is likely to contribute to protection from severe COVID-19, supporting early clinical observations from South Africa.

14.
Embase;
Preprint in English | EMBASE | ID: ppcovidwho-326920

ABSTRACT

Background: The Sisonke open-label phase 3b implementation study aimed to assess the safety and effectiveness of the Janssen Ad26.CoV2.S vaccine among health care workers (HCWs) in South Africa. Here, we present the safety data. Methods: We monitored adverse events (AEs) at vaccination sites, through self-reporting triggered by text messages after vaccination, health care provider reports and by active case finding. The frequency and incidence rate of non-serious and serious AEs were evaluated from day of first vaccination (17 February 2021) until 28 days after the final vaccination (15 June 2021). COVID-19 breakthrough infections, hospitalisations and deaths were ascertained via linkage of the electronic vaccination register with existing national databases. Findings: Of 477,234 participants, 10,279 (2.2%) reported AEs, of which 139 (1.4%) were serious. Women reported more AEs than men (2.3% vs. 1.6%). AE reports decreased with increasing age (3.2% for 18–30, 2.1% for 31-45, 1.8% for 46-55 and 1.5% in >55-year-olds). Participants with previous COVID-19 infection reported slightly more AEs (2.6% vs. 2.1%). The commonest reactogenicity events were headache and body aches, followed by injection site pain and fever, and most occurred within 48 hours of vaccination. Two cases of Thrombosis with Thrombocytopenia Syndrome and four cases of Guillain-Barre Syndrome were reported post-vaccination. Serious AEs and AEs of special interest including vascular and nervous system events, immune system disorders and deaths occurred at lower than the expected population rates. Interpretation: The single-dose Ad26.CoV2.S vaccine had an acceptable safety profile supporting the continued use of this vaccine in our setting.

15.
MEDLINE;
Preprint in English | MEDLINE | ID: ppcovidwho-325667

ABSTRACT

Omicron variant (B.1.1.529) infections are rapidly expanding worldwide, often in settings where the Delta variant (B.1.617.2) was dominant. We investigated whether neutralizing immunity elicited by Omicron infection would also neutralize the Delta variant and the role of prior vaccination. We enrolled 23 South African participants infected with Omicron a median of 5 days post-symptoms onset (study baseline) with a last follow-up sample taken a median of 23 days post-symptoms onset. Ten participants were breakthrough cases vaccinated with Pfizer BNT162b2 or Johnson and Johnson Ad26.CoV2.S. In vaccinated participants, neutralization of Omicron increased from a geometric mean titer (GMT) FRNT50 of 28 to 378 (13.7-fold). Unvaccinated participants had similar Omicron neutralization at baseline but increased from 26 to only 113 (4.4-fold) at follow-up. Delta virus neutralization increased from 129 to 790, (6.1-fold) in vaccinated but only 18 to 46 (2.5-fold, not statistically significant) in unvaccinated participants. Therefore, in Omicron infected vaccinated individuals, Delta neutralization was 2.1-fold higher at follow-up relative to Omicron. In a separate group previously infected with Delta, neutralization of Delta was 22.5-fold higher than Omicron. Based on relative neutralization levels, Omicron re-infection would be expected to be more likely than Delta in Delta infected individuals, and in Omicron infected individuals who are vaccinated. This may give Omicron an advantage over Delta which may lead to decreasing Delta infections in regions with high infection frequencies and high vaccine coverage.

16.
Circulation ; 144(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1629952

ABSTRACT

Introduction: Transplant centers saw a reduction in solid organ transplantation since the beginning of the coronavirus 2019 (COVID-19) pandemic in the United States. Limited data exists on the impact of COVID-19 on pediatric heart transplant volume and variation in transplant practices. We hypothesized that pediatric heart transplant activity decreased during COVID-19 with associated increased waitlist mortality. Methods: The United Network for Organ Sharing (UNOS) database was used to identify waitlisted patients from 2017-2020. Regional and Statewide data was obtained from US Census Bureau. CovidActNow project was used for Covid-19 mortality rates. Results: Among pediatric patients, average time on the waiting list decreased by 28 days. Even though the average number of pediatric transplants (n=39) did not change during 2020, there was a temporal decline in the first quarter followed by an increase. Overall pediatric waitlist mortality decreased from 5.31 to 4.73, however female mortality increased by 2%. Regional differences in pediatric mortality included: Northeast, decreased by 7.5%;Midwest, decreased by 9%;West, increased by 3.5%;and South, increased by 13%. North Dakota (0.55), Oklahoma (0.21) and Hawaii (0.33) showed higher mortality per 100,000 than other states. In adults, average time on waiting list increased by 40 days and there was an increase in the number of transplants from 242.06 to 266.09. Adult waitlist mortality had a larger decrease from 18.44 to 15.70 with increase in female mortality of 7%. Regional differences in adult mortality included: Northeast, decreased by 3%;Midwest, increased by 5.5%;West, increased by 4.5% and South, decreased by 5%. Iowa (0.37), Wyoming (0.22), Arkansas (0.18) and Vermont (0.19) had higher mortality per 100,000 than other states . Conclusions: Pediatric heart transplant volume declined in early 2020 followed by an increase, while transplant volume in adults increased. Although, overall waitlist mortality for pediatrics decreased, female waitlist mortality increased. Regional differences in waitlist mortality were also observed. Future studies are needed to understand this initial correlation and to determine the impact of COVID-9 on heart transplant recipients.

17.
Int J Infect Dis ; 116: 38-42, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1629350

ABSTRACT

INTRODUCTION: The coronavirus disease 2019 (COVID-19) first reported in Wuhan, China in December 2019 is a global pandemic that is threatening the health and wellbeing of people worldwide. To date there have been more than 274 million reported cases and 5.3 million deaths. The Omicron variant first documented in the City of Tshwane, Gauteng Province, South Africa on 9 November 2021 led to exponential increases in cases and a sharp rise in hospital admissions. The clinical profile of patients admitted at a large hospital in Tshwane is compared with previous waves. METHODS: 466 hospital COVID-19 admissions since 14 November 2021 were compared to 3962 admissions since 4 May 2020, prior to the Omicron outbreak. Ninety-eight patient records at peak bed occupancy during the outbreak were reviewed for primary indication for admission, clinical severity, oxygen supplementation level, vaccination and prior COVID-19 infection. Provincial and city-wide daily cases and reported deaths, hospital admissions and excess deaths data were sourced from the National Institute for Communicable Diseases, the National Department of Health and the South African Medical Research Council. RESULTS: For the Omicron and previous waves, deaths and ICU admissions were 4.5% vs 21.3% (p<0.00001), and 1% vs 4.3% (p<0.00001) respectively; length of stay was 4.0 days vs 8.8 days; and mean age was 39 years vs 49,8 years. Admissions in the Omicron wave peaked and declined rapidly with peak bed occupancy at 51% of the highest previous peak during the Delta wave. Sixty two (63%) patients in COVID-19 wards had incidental COVID-19 following a positive SARS-CoV-2 PCR test . Only one third (36) had COVID-19 pneumonia, of which 72% had mild to moderate disease. The remaining 28% required high care or ICU admission. Fewer than half (45%) of patients in COVID-19 wards required oxygen supplementation compared to 99.5% in the first wave. The death rate in the face of an exponential increase in cases during the Omicron wave at the city and provincial levels shows a decoupling of cases and deaths compared to previous waves, corroborating the clinical findings of decreased severity of disease seen in patients admitted to the Steve Biko Academic Hospital. CONCLUSION: There was decreased severity of COVID-19 disease in the Omicron-driven fourth wave in the City of Tshwane, its first global epicentre.


Subject(s)
COVID-19 , Adult , COVID-19/epidemiology , Disease Outbreaks , Hospitals , Humans , SARS-CoV-2 , Severity of Illness Index , South Africa/epidemiology
18.
J Laryngol Otol ; 135(9): 815-819, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1333849

ABSTRACT

OBJECTIVE: To review patient satisfaction with the change in practice towards telephone consultations during and after the coronavirus disease 2019 pandemic for head and neck cancer follow up. METHOD: A retrospective analysis was conducted of head and neck cancer telephone appointments during a six-month period in a tertiary referral centre. RESULTS: Patients found the telephone consultations beneficial (98 per cent), with 30 per cent stating they were relieved to not have to attend hospital. Patients who travelled further, those with lower stage disease and patients with a greater interval from initial treatment were most satisfied with the telephone consultations. Sixty-eight per cent of patients stated they would be happy to have telephone consultations as part of their regular follow up after the pandemic. CONCLUSION: Patients found the telephone consultations beneficial and 30 per cent considered them preferable to face-to-face appointments. This study demonstrates that telephone consultations can be used as an adjunct to face-to-face appointments in an effort to reduce hospital attendances whilst maintaining close follow up.


Subject(s)
Aftercare , Head and Neck Neoplasms/therapy , Patient Satisfaction , Referral and Consultation , Adult , Aftercare/methods , Aftercare/psychology , Aftercare/standards , Aged , Aged, 80 and over , Humans , Middle Aged , Patient Satisfaction/statistics & numerical data , Retrospective Studies , Telephone , Tertiary Care Centers
20.
S Afr Med J ; 111(3): 198-202, 2021 01 28.
Article in English | MEDLINE | ID: covidwho-1168066

ABSTRACT

Recent studies have shown that the detection of SARS-CoV-2 genetic material in wastewater may provide the basis for a surveillance system to track the environmental dissemination of this virus in communities. An effective wastewater-based epidemiology (WBE) system may prove critical in South Africa (SA), where health systems infrastructure, testing capacity, personal protective equipment and human resource capacity are constrained. In this proof-of-concept study, we investigated the potential of SARS-CoV-2 RNA surveillance in untreated wastewater as the basis for a system to monitor COVID-19 prevalence in the population, an early warning system for increased transmission, and a monitoring system to assess the effectiveness of interventions. The laboratory confirmed the presence (qualitative analysis) and determined the RNA copy number of SARS-CoV-2 viral RNA by reverse transcription polymerase chain reaction (quantitative) analysis from 24-hour composite samples collected on 18 June 2020 from five wastewater treatment plants in Western Cape Province, SA. The study has shown that a WBE system for monitoring the status and trends of COVID-19 mass infection in SA is viable, and its development and implementation may facilitate the rapid identification of hotspots for evidence-informed interventions.


Subject(s)
RNA, Viral/isolation & purification , SARS-CoV-2/isolation & purification , Waste Water/virology , COVID-19/epidemiology , Environmental Monitoring , Epidemiological Monitoring , Humans , Pneumonia, Viral/epidemiology , Proof of Concept Study , South Africa/epidemiology
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