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1.
Ther Adv Hematol ; 12: 20406207211048364, 2021.
Article in English | MEDLINE | ID: covidwho-1582496

ABSTRACT

BACKGROUND: COVID-19 patients present with both elevated D-dimer and a higher incidence of pulmonary embolism (PE). This single-centre retrospective observational study investigated the prevalence of early PE in COVID-19 patients and its relation to D-dimer at presentation. METHODS: The study included 1038 COVID-19-positive patients, with 1222 emergency department (ED) attendances over 11 weeks (16 March to 31 May 2020). Computed tomography pulmonary angiogram (CTPA) for PE was performed in 123 patients within 48 h of ED presentation, of whom 118 had D-dimer results. The remaining 875 attendances had D-dimer performed. RESULTS: CTPA performed in 11.8% of patients within 48 h of ED presentation confirmed PE in 37.4% (46/123). Thrombosis was observed at all levels of pulmonary vasculature with and without right ventricular strain. In the CTPA cohort, patients with PE had significantly higher D-dimer, prothrombin time, C-reactive protein, troponin, total bilirubin, neutrophils, white cell count and lower albumin compared with non-PE patients. However, there was no difference in the median duration of inpatient stay or mortality. A receiver operator curve analysis demonstrated that D-dimer could discriminate between PE and non-PE COVID-19 patients (area under the curve of 0.79, p < 0.0001). Furthermore, 43% (n = 62/145) of patients with D-dimer >5000 ng/ml had CTPA with PE confirmed in 61% (n = 38/62), that is, 26% of >5000 ng/ml cohort. The sensitivity and specificity were related to D-dimer level; cutoffs of 2000, 3000, 4000, and 5000 ng/ml, respectively, had a sensitivity of 93%, 90%, 90% and 86%, and a specificity of 38%, 54%, 59% and 68%, and if implemented, an additional 229, 141, 106 and 83 CTPAs would be required. CONCLUSION: Our data suggested an increased PE prevalence in COVID-19 patients attending ED with an elevated D-dimer, and patients with levels >5000 ng/ml might benefit from CTPA to exclude concomitant PE.

2.
Clin Infect Dis ; 73(10): 1840-1848, 2021 11 16.
Article in English | MEDLINE | ID: covidwho-1522143

ABSTRACT

BACKGROUND: Within-household transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been identified as one of the main sources of spread of coronavirus disease 2019 (COVID-19) after lockdown restrictions and self-isolation guidelines are implemented. Secondary attack rates among household contacts are estimated to be 5-10 times higher than among non-household contacts, but it is unclear which individuals are more prone to transmit infection within their households. METHODS: Using address matching, a cohort was assembled of all individuals with laboratory-confirmed COVID-19 residing in private households in Ontario, Canada. Descriptive analyses were performed to compare characteristics of cases in households that experienced secondary transmission versus those that did not. Logistic regression models were fit to determine index case characteristics and neighborhood characteristics associated with transmission. RESULTS: Between January and July 2020, there were 26 714 individuals with COVID-19 residing in 21 226 households. Longer testing delays (≥5 vs 0 days; odds ratio [OR], 3.02; 95% confidence interval [CI], 2.53-3.60) and male gender (OR, 1.28; 95% CI, 1.18-1.38) were associated with greater odds of household secondary transmission, while being a healthcare worker (OR, .56; 95% CI, .50-.62) was associated with lower odds of transmission. Neighborhoods with larger average family size and a higher proportion of households with multiple persons per room were also associated with greater odds of transmission. CONCLUSIONS: It is important for individuals to get tested for SARS-CoV-2 infection as soon as symptoms appear, and to isolate away from household contacts; this is particularly important in neighborhoods with large family sizes and/or crowded households.


Subject(s)
COVID-19 , SARS-CoV-2 , Cohort Studies , Communicable Disease Control , Family Characteristics , Humans , Male , Ontario/epidemiology
3.
Int J Environ Res Public Health ; 18(10)2021 05 17.
Article in English | MEDLINE | ID: covidwho-1234721

ABSTRACT

Background: There has been an alarming increase in discrimination and violence towards Asians during the coronavirus (COVID-19) pandemic amid reports that the virus was first detected in China. In an incident involving a COVID-19-related physical assault, this study examined whether economic hardship experienced by participants during the pandemic and the race of the victim (Chinese, White) would influence support to compensate a victim and punish the assailant. The study also explored whether the perception that the victim experienced emotional and physical suffering due to the assault would mediate the relationships. Method: Participants in India and the United States reported on their own economic hardship due to the pandemic. They then read about an incident in which an innocent person suffered a COVID-19-related physical and verbal attack, and indicated if they would support punishing the assailant and financially compensating the victim. Results: When the victim was Chinese, participants experiencing a high degree of COVID-19 economic hardship were less likely to support financially compensating the victim or punishing the assailant compared to when the victim was White. Furthermore, when the victim was Chinese, the negative associations between economic hardship and financially compensating the victim and punishing the assailant were mediated by reduced recognition that the victim suffered emotional trauma and pain as a result of the attack. Conclusions: COVID-19-driven economic hardship experienced by participants predicted an array of reactions that reflected reduced recognition of the civil and human rights of a victim of a COVID-19-related assault. These findings have significant implications for mental health, public health, and the justice system, and underscore the pressing need for prompt action to mitigate economic hardship and to address racism and discrimination.


Subject(s)
COVID-19 , China/epidemiology , Humans , India/epidemiology , Punishment , SARS-CoV-2 , United States/epidemiology
4.
Clin Proteomics ; 18(1): 15, 2021 May 10.
Article in English | MEDLINE | ID: covidwho-1223761

ABSTRACT

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) global pandemic has had a profound, lasting impact on the world's population. A key aspect to providing care for those with COVID-19 and checking its further spread is early and accurate diagnosis of infection, which has been generally done via methods for amplifying and detecting viral RNA molecules. Detection and quantitation of peptides using targeted mass spectrometry-based strategies has been proposed as an alternative diagnostic tool due to direct detection of molecular indicators from non-invasively collected samples as well as the potential for high-throughput analysis in a clinical setting; many studies have revealed the presence of viral peptides within easily accessed patient samples. However, evidence suggests that some viral peptides could serve as better indicators of COVID-19 infection status than others, due to potential misidentification of peptides derived from human host proteins, poor spectral quality, high limits of detection etc. METHODS: In this study we have compiled a list of 636 peptides identified from Sudden Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) samples, including from in vitro and clinical sources. These datasets were rigorously analyzed using automated, Galaxy-based workflows containing tools such as PepQuery, BLAST-P, and the Multi-omic Visualization Platform as well as the open-source tools MetaTryp and Proteomics Data Viewer (PDV). RESULTS: Using PepQuery for confirming peptide spectrum matches, we were able to narrow down the 639-peptide possibilities to 87 peptides that were most robustly detected and specific to the SARS-CoV-2 virus. The specificity of these sequences to coronavirus taxa was confirmed using Unipept and BLAST-P. Through stringent p-value cutoff combined with manual verification of peptide spectrum match quality, 4 peptides derived from the nucleocapsid phosphoprotein and membrane protein were found to be most robustly detected across all cell culture and clinical samples, including those collected non-invasively. CONCLUSION: We propose that these peptides would be of the most value for clinical proteomics applications seeking to detect COVID-19 from patient samples. We also contend that samples harvested from the upper respiratory tract and oral cavity have the highest potential for diagnosis of SARS-CoV-2 infection from easily collected patient samples using mass spectrometry-based proteomics assays.

5.
J Occup Environ Med ; 63(7): 574-580, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1216688

ABSTRACT

OBJECTIVE: To analyze workplace outbreaks by industry sector in the first wave of the pandemic, and associated household cases. METHODS: Number, size, and duration of outbreaks were described by sector, and outbreak cases were compared to sporadic cases in the same time frame. Address matching identified household cases with onset ≥2 days before, ≥2 days after, or within 1 day of the workplace outbreak case. RESULTS: There were 199 outbreaks with 1245 cases, and 68% of outbreaks and 80% of cases belonged to (1) Manufacturing, (2) Agriculture, Forestry, Fishing, Hunting, (3) Transportation and Warehousing. There were 608 household cases associated with 339 (31%) outbreak cases, increasing the burden of illness by 56%. CONCLUSIONS: Workplace outbreaks primarily occurred in three sectors. Prevention measures should target industry sectors at risk to prevent spread in and out of the workplace.


Subject(s)
COVID-19/epidemiology , COVID-19/transmission , Disease Outbreaks/statistics & numerical data , Public Health Surveillance/methods , Workplace , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/prevention & control , Female , Humans , Male , Middle Aged , Ontario/epidemiology , Pandemics , SARS-CoV-2 , Young Adult
6.
J Racial Ethn Health Disparities ; 8(4): 799-802, 2021 08.
Article in English | MEDLINE | ID: covidwho-1216285

ABSTRACT

Strikingly ignoring the critical impact of systemic racism in vulnerabilities to the deadly coronavirus, phase one of the vaccine rollout is not reaching the Black population that has suffered the most from COVID. An urgent need exists for a race-conscious approach that ensures equitable opportunities to both access and receive the vaccines.


Subject(s)
COVID-19 Vaccines/supply & distribution , COVID-19/ethnology , Health Care Rationing/methods , Racism/prevention & control , African Americans/statistics & numerical data , COVID-19/prevention & control , Health Status Disparities , Humans , United States/epidemiology
7.
PLoS One ; 16(4): e0249586, 2021.
Article in English | MEDLINE | ID: covidwho-1170005

ABSTRACT

Medical procedures that produce aerosolized particles are under great scrutiny due to the recent concerns surrounding the COVID-19 virus and increased risk for nosocomial infections. For example, thoracostomies, tracheotomies and intubations/extubations produce aerosols that can linger in the air. The lingering time is dependent on particle size where, e.g., 500 µm (0.5 mm) particles may quickly fall to the floor, while 1 µm particles may float for extended lengths of time. Here, a method is presented to characterize the size of <40 µm to >600 µm particles resulting from surgery in an operating room (OR). The particles are measured in-situ (next to a patient on an operating table) through a 75mm aperture in a ∼400 mm rectangular enclosure with minimal flow restriction. The particles and gasses exiting a patient are vented through an enclosed laser sheet while a camera captures images of the side-scattered light from the entrained particles. A similar optical configuration was described by Anfinrud et al.; however, we present here an extended method which provides a calibration method for determining particle size. The use of a laser sheet with side-scattered light provides a large FOV and bright image of the particles; however, the particle image dilation caused by scattering does not allow direct measurement of particle size. The calibration routine presented here is accomplished by measuring fixed particle distribution ranges with a calibrated shadow imaging system and mapping these measurements to the in-situ imaging system. The technique used for generating and measuring these particles is described. The result is a three-part process where 1) particles of varying sizes are produced and measured using a calibrated, high-resolution shadow imaging method, 2) the same particle generators are measured with the in-situ imaging system, and 3) a correlation mapping is made between the (dilated) laser image size and the measured particle size. Additionally, experimental and operational details of the imaging system are described such as requirements for the enclosure volume, light management, air filtration and control of various laser reflections. Details related to the OR environment and requirements for achieving close proximity to a patient are discussed as well.


Subject(s)
Aerosols/chemistry , Operating Rooms/organization & administration , Particle Size , COVID-19/prevention & control , COVID-19/virology , Humans
8.
J Glob Infect Dis ; 13(1): 42-43, 2021.
Article in English | MEDLINE | ID: covidwho-1134316

ABSTRACT

The ongoing COVID-19 pandemic has affected most countries in the world, with significant economic and public health implications. There is rising concern that patients who recover from COVID-19 may be at risk of reinfection. Another potential concern is the uncommon clinical scenario of a patient having persistent SARS-CoV-2 RNA test over 3 months after the initial COVID-19 infection, as the patient presented. Whether presenting as a long-term infection (12 weeks) or reinfection, patients with COVID-19 will continue to have a severe inflammatory and prothrombotic state that could carry potential life-threatening thrombosis.

9.
J Proteome Res ; 20(2): 1451-1454, 2021 02 05.
Article in English | MEDLINE | ID: covidwho-1006441

ABSTRACT

In this Letter, we reanalyze published mass spectrometry data sets of clinical samples with a focus on determining the coinfection status of individuals infected with SARS-CoV-2 coronavirus. We demonstrate the use of ComPIL 2.0 software along with a metaproteomics workflow within the Galaxy platform to detect cohabitating potential pathogens in COVID-19 patients using mass spectrometry-based analysis. From a sample collected from gargling solutions, we detected Streptococcus pneumoniae (opportunistic and multidrug-resistant pathogen) and Lactobacillus rhamnosus (a probiotic component) along with SARS-Cov-2. We could also detect Pseudomonas sps. Bc-h from COVID-19 positive samples and Acinetobacter ursingii and Pseudomonas monteilii from COVID-19 negative samples collected from oro- and nasopharyngeal samples. We believe that the early detection and characterization of coinfections by using metaproteomics from COVID-19 patients will potentially impact the diagnosis and treatment of patients affected by SARS-CoV-2 infection.


Subject(s)
Bacterial Infections/diagnosis , COVID-19/diagnosis , Proteomics/methods , SARS-CoV-2/metabolism , Acinetobacter/isolation & purification , Bacterial Infections/complications , Bacterial Infections/microbiology , COVID-19/complications , COVID-19/virology , Coinfection/microbiology , Coinfection/virology , Humans , Mass Spectrometry/methods , Nasopharynx/microbiology , Nasopharynx/virology , Pseudomonas/isolation & purification , SARS-CoV-2/physiology , Streptococcus pneumoniae/isolation & purification
10.
BMJ Open ; 10(11): e042946, 2020 11 06.
Article in English | MEDLINE | ID: covidwho-913770

ABSTRACT

OBJECTIVES: To identify the diagnostic accuracy of common imaging modalities, chest X-ray (CXR) and CT, for diagnosis of COVID-19 in the general emergency population in the UK and to find the association between imaging features and outcomes in these patients. DESIGN: Retrospective analysis of electronic patient records. SETTING: Tertiary academic health science centre and designated centre for high consequence infectious diseases in London, UK. PARTICIPANTS: 1198 patients who attended the emergency department with paired reverse transcriptase PCR (RT-PCR) swabs for SARS-CoV-2 and CXR between 16 March and 16 April 2020. MAIN OUTCOME MEASURES: Sensitivity and specificity of CXR and CT for diagnosis of COVID-19 using the British Society of Thoracic Imaging reporting templates. Reference standard was any RT-PCR positive naso-oropharyngeal swab within 30 days of attendance. ORs of CXR in association with vital signs, laboratory values and 30-day outcomes were calculated. RESULTS: Sensitivity and specificity of CXR for COVID-19 diagnosis were 0.56 (95% CI 0.51 to 0.60) and 0.60 (95% CI 0.54 to 0.65), respectively. For CT scans, these were 0.85 (95% CI 0.79 to 0.90) and 0.50 (95% CI 0.41 to 0.60), respectively. This gave a statistically significant mean increase in sensitivity with CT of 29% (95% CI 19% to 38%, p<0.0001) compared with CXR. Specificity was not significantly different between the two modalities.CXR findings were not statistically significantly or clinically meaningfully associated with vital signs, laboratory parameters or 30-day outcomes. CONCLUSIONS: CT has substantially improved diagnostic performance over CXR in COVID-19. CT should be strongly considered in the initial assessment for suspected COVID-19. This gives potential for increased sensitivity and considerably faster turnaround time, where capacity allows and balanced against excess radiation exposure risk.


Subject(s)
COVID-19/diagnosis , Emergency Service, Hospital , Lung/diagnostic imaging , Propensity Score , Radiography, Thoracic/methods , SARS-CoV-2 , Tomography, X-Ray Computed/methods , COVID-19/epidemiology , COVID-19 Testing/methods , Data Management , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies
13.
Health Secur ; 18(3): 237-240, 2020.
Article in English | MEDLINE | ID: covidwho-101945

ABSTRACT

The COVID-19 pandemic has resulted in a surge of patients that exceeds available human and physical resources in many settings, triggering the implementation of crisis standards of care. High-quality respiratory protection is essential to reduce exposure among healthcare workers, yet dire shortages of personal protective equipment in the United States threaten the health and safety of this essential workforce. In the context of rapidly changing conditions and incomplete data, this article outlines 3 important strategies to improve healthcare workers' respiratory protection. At a minimum, healthcare workers delivering care to patients with confirmed or suspected COVID-19 should wear N95 respirators and full-face shields. Several mechanisms exist to boost and protect the supply of N95 respirators, including rigorous decontamination protocols, invoking the Defense Production Act, expanded use of reusable elastomeric respirators, and repurposing industrial N95 respirators. Finally, homemade facial coverings do not protect healthcare workers and should be avoided. These strategies, coupled with longer-term strategies of investments in protective equipment research, infrastructure, and data systems, provide a framework to protect healthcare workers immediately and enhance preparedness efforts for future pandemics.


Subject(s)
Coronavirus Infections/prevention & control , Health Personnel , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Occupational Exposure/prevention & control , Pandemics/prevention & control , Personal Protective Equipment/statistics & numerical data , Pneumonia, Viral/prevention & control , COVID-19 , Communicable Disease Control/organization & administration , Coronavirus Infections/epidemiology , Delivery of Health Care/organization & administration , Female , Humans , Male , Occupational Health , Pandemics/statistics & numerical data , Patient Safety , Pneumonia, Viral/epidemiology , United States
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