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1.
Agency for Healthcare Research and Quality ; 22(23):11, 2022.
Article in English | MEDLINE | ID: covidwho-2127370

ABSTRACT

OBJECTIVES: To summarize current evidence on exposures to infectious pathogens in the emergency medical services (EMS) and 911 workforce, and on practices for preventing, recognizing, and controlling occupationally acquired infectious diseases and related exposures in that workforce.

2.
American Journal of Transplantation ; 22(Supplement 3):641-642, 2022.
Article in English | EMBASE | ID: covidwho-2063495

ABSTRACT

Purpose: We report the immunogenicity and safety of a third BNT162b2 vaccine in pediatric solid organ transplant recipients (pSOTRs). Method(s): Samples from pSOTRs (12-18 years) enrolled in our multicenter, observational study (COVID-19 Antibody Testing of Recipients of Solid Organ Transplants and Patients with Chronic Diseases) who received a third vaccine (V3) were analyzed for antibodies to SARS-CoV-2 spike protein receptor-binding domain, with a positive cutoff of >=0.8 and maximum titer of >2500 U/mL. Pre-V3 samples were 1-3 months after vaccine 2, and post-V3 were 1 month after vaccine 3. Result(s): Thirty-seven pSOTRs (46% heart, 24% liver, 27% kidney, 3% multi) received V3. Median (interquartile range [IQR]) age was 15 (14-16) years;42% were male and 78% white. pSOTRs were median (IQR) 9 (6-13) years from transplant. Four (11%) patients had prior SARS-CoV-2 infection. Antibody titers were positive in 26/37 (70%) patients pre-V3 and 32/37 (86%) post-V3 (Figure). Median (IQR) antibody titers were higher post-V3 (2500 [1581-2500] U/mL) than pre-V3 (211 [0.8-2500] U/mL) in paired analysis (p<0.001). 6/11 (55%) pSOTRs with negative pre-V3 titers seroconverted, with a post-V3 median (IQR) titer of 418 (132-1581) U/ mL. Transplant within 3 years was associated with negative post-V3 titer (p=0.037). Main side effects after V3 were pain (71%) and fatigue (50%). No patients reported allergic reaction, myocarditis, or rejection. One patient tested positive for SARSCoV- 2 between vaccines 2 and 3, with negative pre- and post-V3 titers. At time of first vaccine, this patient was transplanted a year ago, treated for rejection recently, and taking 3 immunosuppression agents including an antimetabolite. Conclusion(s): In this limited cohort, 86% of pSOTRs had a positive antibody response after three SARS-CoV-2 vaccines with no adverse events. Importantly, 55% of pSOTRs with prior negative response seroconverted post-V3, and 100% of pSOTRs with positive response increased their antibody titer or remained at maximum titer. Our preliminary results suggest the benefit of a third vaccine for adolescent pSOTRs based on antibody response;larger studies are needed to assess vaccine effectiveness.

4.
Journal of Clinical Oncology ; 39(15):3, 2021.
Article in English | Web of Science | ID: covidwho-1533354
5.
Journal of Clinical Oncology ; 39(28):2, 2021.
Article in English | Web of Science | ID: covidwho-1486613
6.
Journal of Clinical Oncology ; 39(28):3, 2021.
Article in English | Web of Science | ID: covidwho-1486611
8.
American Journal of Respiratory and Critical Care Medicine ; 203(9):1, 2021.
Article in English | Web of Science | ID: covidwho-1407361
9.
American Journal of Respiratory and Critical Care Medicine ; 203(9):1, 2021.
Article in English | Web of Science | ID: covidwho-1407360
10.
American Journal of Respiratory and Critical Care Medicine ; 203(9):2, 2021.
Article in English | Web of Science | ID: covidwho-1407352
11.
American Journal of Respiratory and Critical Care Medicine ; 203(9):2, 2021.
Article in English | Web of Science | ID: covidwho-1407351
12.
Journal of Clinical Oncology ; 39(15 SUPPL), 2021.
Article in English | EMBASE | ID: covidwho-1339363

ABSTRACT

Background: Impact of COVID19 on cancer care delivery and outcomes remains unknown. Few trials have investigated patients' perceived risks and benefits, and cancer care delivery (CCD) alterations related to COVID19. We sought to identify differences on behaviors and social determinants of health in Hispanics and other underrepresented populations (H/UP) compared to the general population (GP). Methods: An IRB-approved validated 27-item questionnaire was offered in English and Spanish to all pts. receiving cancer care at participating cancer centers over a 4 month period. Examined variables included demographic information, social risk and behavioral factors, preferred sources of health information, and overall satisfaction with CCD during the pandemic. Results: A total of 180 pts were enrolled in the study. Compared to GP, H/UP's perceived risk of COVID19 was higher with 93% vs 87% more likely to cancel or avoid social gatherings and 54% vs 46% more likely to change daily routine. H/UP appeared more concerned with personal and financial safety;if unable to find work/get paid for 2 weeks, 26% H/UP vs 10% GP would struggle to keep up with expenses. 40% H/UP vs 10% GP have concerns on perceived ability to secure food on short term and consider COVID19 a major threat to their health (70% vs 46%) and financial situation (63% vs 35%). H/UP's perceived benefits of protective measures is higher with 81% vs 60% routinely practicing social distancing (SD) and 79% vs 66% in agreement with punitive actions for not following SD. Analysis demonstrated no significant difference by age, gender, level of education, marital status, however Hispanic ethnicity and Spanish as primary language was a statistically significant variable (p = 0.025) in perceived risks and satisfaction with CCD. No major differences were noted on sources of health information although more H/UP relied on social media (33% vs 24%). H/UP appeared to be more skeptical about availability and safety of targeted vaccines (40% vs 15%). Satisfaction regarding CCD was comparable (84% vs 86%), although more H/UP perceived CCD alterations (15% vs 10%). Going forward, H/UP would prefer to incorporate virtual visits (VV) when possible (36% vs 25%). Conclusions: COVID19- related societal, financial, health and personal fears are increased in H/UP which likely negatively affects quality of life of these at-risk populations. H/UP's trust in SD recommendations is heightened although linguistically and culturally appropriate information may be deficient. H/UP's belief in vaccine availability and safety is comparable to GP, although recent reports suggest deeper fear and emphasize their fear of experimentation. Interventions aimed to decrease these differences could incorporate standard communications with special attention to social media. H/UP would prefer to incorporate VV into their care, although most do not possess appropriate technology to do so.

13.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277594

ABSTRACT

Introduction: On March 11, 2020, COVID-19 was declared a pandemic by the World Health Organization. The disease has had a major impact on public health and the global economy with more than 70 million people infected worldwide and more than 1.5 million mortalities. However, less is known about the long-term consequences of the disease. Objective: Evaluate the long-term health effects of COVID-19 on hospitalized and non-hospitalized subjects. Methods: We identified all patients who presented to the COVID-19 recovery clinic at the University of Texas Medical Branch (UTMB) in the period from March 16, 2020, to October 8, 2020. Data regarding persistent symptoms, patient health questionnaire (PHQ-9) score, generalized anxiety disorder (GAD- 7) questionnaire score and six-minute walk distance was collected. Comparisons between patients with a history of hospitalization for COVID-19 related symptoms and those who were not hospitalized were performed using Chi-square test or Fisher's exact test for categorical variables, and independent t-test for numeric values. Results: We identified a total of 93 patients who presented to the COVID-19 recovery clinic during the study period. Patients were predominantly females (69.9%), mean age was 52 years and the majority were white (58%). Obesity (body mass index ≥30) was present in 62% of subjects and 73% had at least one comorbidity. The most common noted comorbidities were hypertension (53.8%), asthma (29%) and diabetes (22.6%). The mean duration from positive COVID-19 test to clinic visit was 62 days (Table 1). Persistent fatigue, cough and dyspnea on exertion were reported by 60%, 57% and 56% of patients, respectively. The mean six-minute walk distance was 952 feet. Of the entire cohort, 46 (49.5%) were not hospitalized for COVID-19 related symptoms, these patients were younger (48 vs 56 years, P 0.006), and out of the comorbidities studied, obesity was less common (50% vs 74.4%, P 0.037) compared to those who were hospitalized. The mean six-minute walk distance was greater in the non-hospitalized cohort (1067 vs 841 feet, P 0.016) compared to those who were hospitalized. There was no difference between both groups in the prevalence of persistent symptoms, depression or anxiety. Conclusion: Persistent symptoms including fatigue, dyspnea, depression and anxiety were common in patients who recovered from COVID-19, regardless of their hospitalization history. Performance on the six-minute walk test was lower in patients who were hospitalized.

14.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277582

ABSTRACT

Rationale. Chronic obstructive Pulmonary Disease (COPD) has been associated with severe coronavirus disease 2019 (COVID-19) in Chinese and European cohorts. To date, no studies have evaluated the outcomes of COVID-19 in a selected cohort of patients with COPD in the United States (USA). We hypothesize that patients with COPD infected with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV2) will have higher likelihood of 14-day hospitalization, mechanical ventilation use, and mortality compared to non-COPD SARS-CoV2 positive patients. Methods. We performed a retrospective analysis of electronic health records (EHR) from facilities across the 4 geographical regions of the USA (Optum Covid-19 Biweekly Data). We defined COVID-19 positive as having International Classification of Disease-10 (ICD-10) code of U07.1, or positive laboratory test results. COPD patients are defined by having at least 2-outpatient visits or 1- inpatient visit with any COPD diagnosis codes within a year prior to COVID-19 positive date. Results. We studied a cohort of 150,775 patients with COVID-19 between March and August 2020 in the United States. COPD was identified in 6,056 (4%) patients. The baseline characteristics of the cohort are presented in table 1. The percentage of patients with COPD and COVID-19 admitted to the hospital in 14-days for any cause was greater than that for non-COPD COVID-19 patients (28.7% vs 10.42%, p< 0.0001). The mean length of stay was longer for COPD with COVID-19 individuals than that for non-COPD COVID-19 patients (12.3 days vs 9.0 days, p<0.001). Amongst all hospitalized, the percentage of patients who required ICU was greater for COPD patients with COVID-19 than that for non-COPD patients (26.4% vs 16.11%, p<0.001). In addition, mechanical ventilation use was higher in COPD vs non-COPD COVID-19 patients (26.4% vs 16.11%, p<0.001) Moreover, the percentage of patients who died in 30 days was greater for COPD than that for non-COPD COVID-19 patients (13.6% vs 7.25%, p<0.0001). Discussion. Patients with COPD and COVID-19 have worse outcomes compared to non-COPD COVID-19 patients.

15.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277572

ABSTRACT

Introduction: The United States has reported 13 million patients infected with SARS-CoV-2 and more than 270,000 deaths. Currently, controversy exists regarding the cause of death due to SARS-CoV-2 that is directly related to the infection or to a co-existing condition. Objective: Assess the relationship of SARS-CoV-2 infection on the cause of death in hospitalized patients. Methods: We reviewed hospital discharge summaries of patients admitted to the University of Texas Medical Branch from 3/10/2020 to 10/22/2020, with positive nasopharyngeal SARS-CoV-2 nucleic acid assay test results that expired during their hospitalization. Deidentified discharge summaries were reviewed by 2 intensivists and classified as 1) COVID-19 related, 2) COVID-19 unrelated, or 3) indeterminate. COVID-19 related cause of death was defined as a patient with acute respiratory symptoms and radiographic findings of lower respiratory tract disease requiring oxygen or mechanical ventilation. Deaths not related to COVID-19 were defined as absence of acute respiratory symptoms and radiographic findings. An indeterminate cause of death was defined as acute respiratory failure symptoms without radiographic findings. For classification disagreement, a separate group of three intensivists arbitrated to determine the cause of death. Demographics, comorbidities, prescribed medications, and ventilatory support data were collected. Comparison between COVID-19 related death group and COVID-19 unrelated death group was performed with t-test and Chi-square test. Results: We identified 15,393 patients with positive polymerase chain reaction (PCR) results for SARS-CoV-2 nucleic acid. 1052 patients were admitted within 14 days of positive test results and 100 patients expired during hospitalization. Case fatality rate was 0.65% for the total cohort and 9.5% for the hospitalized group. Hospitalized patients were predominantly male and >65 years (Table 1). Obesity (BMI>30) was present in 38% and common comorbidities were hypertension (47%), diabetes (30%) and heart failure (20%). Cause of death was classified as COVID-19 related in 85% and not COVID-19 related in 5%. The cause of death was indeterminate in 10% due to insufficient information or atypical presentation. Dexamethasone was more frequently prescribed to the COVID-related death group (p=0.0009). No differences in supplemental oxygen or mechanical ventilation were observed between groups. Length of stay was significantly greater in the COVID-19 related death group compared to the COVID-19 unrelated death group (14.21 vs 8.2 days, p=0.005). Conclusion: In hospitalized patients with SARS-CoV-2 infection, a direct cause of death was attributed to COVID- 19 in 85% of patients while an additional 10% had an atypical presentation.

16.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277497

ABSTRACT

Rationale. The association between smoking status and severe Coronavirus Disease-2019 (COVID-19) remains controversial. To assess the risk of 14-day hospitalization, as a marker of severe COVID-19, in patients who are ever-smokers and tested positive for the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) compared to those who are never smokers and tested positive for the virus in a single academic health system in the United States. Methods. We conducted a retrospective cohort study of patients who tested positive for SARS-CoV-2 in the University of Texas Medical Branch Health System between March 1st and October 30th 2020 to identify the risk of 14-day hospitalization in ever-smokers compared to non-smokers. Results. In our study period, we identified 5,738 patients who met the inclusion criteria and had documentation of smoking habits. Out of this group, 636 (11%) were consider to be ever-smokers. One hundred and ninety one patients were current smokers and 445 were former smokers. Of the 5,738 patients, 35.1% were male, average age was 43.8 (SD± 17.6), 37.4% were Caucasian, 51.5% were obese (BMI≥30), 3.19 % had vaping history, and 76.5% had at least one comorbidity. We identified 624 (10.8%) patients who were admitted in 14 days and 49(0.8%) who died in 14 days during hospitalization. The percentage of ever smokers admitted in 14 days was greater than that of never smokers (17.9% vs 10%, p<0.0001). In addition, the percentage of smokers who died in 14 days was greater than that of never smokers (2.8% vs 0.6%, p<0.0001). However, after adjusting for other covariates the odds for 14-day hospitalization among ever smokers with COVID-19 was not significant (OR 0.96, 95% CI 0.7-1.2). Conclusions. In our single center study, smoking status was not associated with severe COVID-19 infection.

17.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277098

ABSTRACT

Rationale: Medical trainees are at risk of psychological and emotional distress during the coronavirus disease 2019 (COVID-19) pandemic. The aim of the study was to assess the prevalence and explore the factors associated with depression and anxiety among medical trainees taking care of patients with COVID-19 in the United States (US). Methods: The study is cross-sectional, anonymous, web-based survey of medical trainees distributed in the US via email and social media between April 14, 2020 and May 5, 2020. Participants were stratified based on whether they were in a residency or fellowship program. Practice settings were stratified based on hospital type (academic or community-based) and location. Study outcomes were prevalence and factors associated with depression and anxiety using the 9-item Patient Health Questionnaire (PHQ-9;range: 0- 27) and the 7-item Generalized Anxiety Disorder (GAD 7;range 0-21) questionnaires, respectively. Univariate analysis utilizing summary statistics and Chi-square test were performed to show the association of covariates with outcomes. We performed a multivariate analysis with logistic regression for each outcome. A p-value < 0.05 was considered significant. Results: In all, 239 trainee submitted surveys, predominantly females (51.9%), aged 31-40 (52.3%), and non-Hispanic White (59.8%). Overall, the prevalence for both depression and anxiety was 45.6%. Higher likelihood of depression and anxiety was observed among medical trainees who have COVID-19 exposure, those uncomfortable with infection control policies, and those not provided adequate PPE. Trainees who reported increased stress due to didactics, and those who had continued didactics once a week, also had a higher likelihood of depression and anxiety. Depression alone was more common in those who provided service in emergency department (ED).Multivariate analysis (Table 1) revealed greater odds of depression among females (odds ratio [OR] = 1.95;95% confidence interval [CI] = 1.01-3.74), and those who reported increased stress due to didactics (OR = 4.1;95% CI = 2-8.4). Similarly increased odds for anxiety were observed among medical trainees, and those who reported increased stress due to didactics (OR = 2.6;95% CI = 1.3-5.2). Conclusion: The majority of trainees surveyed had a high burden of depression and anxiety early in the COVID- 19 pandemic in the US, which was associated with increased stress due to didactics. Organizations and institutions will need to develop preventive and management strategies to optimize and sustain the mental health of medical trainees, particularly under pandemic conditions.

18.
Clinical Infectious Diseases ; 71(11):2976-2980, 2020.
Article in English | Web of Science | ID: covidwho-1059931

ABSTRACT

In early-to-mid March 2020, 20 of 46 (43%) COVID-19 cases at a tertiary care hospital in San Francisco, California were travel related. Cases were significantly associated with travel to either Europe (odds ratio, 6.1) or New York (odds ratio, 32.9). Viral genomes recovered from 9 of 12 (75%) cases co-clustered with lineages circulating in Europe.

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