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1.
Ann Intern Med ; 2022 Jun 07.
Article in English | MEDLINE | ID: covidwho-1879626

ABSTRACT

BACKGROUND: In the MOVe-OUT trial, molnupiravir showed a clinically meaningful reduction in the risk for hospitalization or death in adults with mild to moderate COVID-19 and risk factors for progression to severe disease. OBJECTIVE: To identify other potential clinical benefits of molnupiravir versus placebo. DESIGN: Secondary analysis of the randomized, double-blind, placebo-controlled phase 3 component of MOVe-OUT. (ClinicalTrials.gov: NCT04575597). SETTING: 107 sites globally. PARTICIPANTS: 1433 nonhospitalized adults aged 18 years or older with mild to moderate COVID-19. INTERVENTION: Molnupiravir, 800 mg, or placebo every 12 hours for 5 days. MEASUREMENTS: Changes from baseline in C-reactive protein (CRP) concentration and oxygen saturation (Spo 2), need for respiratory interventions (including invasive mechanical ventilation), and need for medical services in all randomly assigned participants through day 29, and need for respiratory interventions and time to discharge in the subgroup of participants who were hospitalized after randomization. RESULTS: Participants receiving molnupiravir showed faster normalization of CRP and Spo 2, with improvements observed on day 3 of therapy, compared with placebo. Molnupiravir-treated participants had a decreased need for respiratory interventions versus placebo-treated participants (relative risk reduction [RRR], 34.3% [95% CI, 4.3% to 54.9%]), with similar findings in participants who were hospitalized after randomization (RRR, 21.3% [CI, 0.2% to 38.0%]). Hospitalized participants who received molnupiravir were discharged a median of 3 days before those who received placebo. Acute care visits (7.2% vs. 10.6%; RRR, 32.1% [CI, 4.4% to 51.7%]) and COVID-19-related acute care visits (6.6% vs. 10.0%; RRR, 33.8% [CI, 5.6% to 53.6%]) were less frequent in molnupiravir- versus placebo-treated participants. LIMITATIONS: Some analyses were performed post hoc. Longer-term benefits of molnupiravir therapy were not evaluated. Participants were not immunized against SARS-CoV-2. CONCLUSION: The findings suggest there are additional important clinical benefits of molnupiravir beyond reduction in hospitalization or death. PRIMARY FUNDING SOURCE: Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc.

2.
Genome biology ; 23(1), 2022.
Article in English | EuropePMC | ID: covidwho-1877242

ABSTRACT

Background SARS-CoV-2 infection results in a broad spectrum of COVID-19 disease, from mild or no symptoms to hospitalization and death. COVID-19 disease severity has been associated with some pre-existing conditions and the magnitude of the adaptive immune response to SARS-CoV-2, and a recent genome-wide association study (GWAS) of the risk of critical illness revealed a significant genetic component. To gain insight into how human genetic variation attenuates or exacerbates disease following SARS-CoV-2 infection, we implicated putatively functional COVID risk variants in the cis-regulatory landscapes of human immune cell types with established roles in disease severity and used high-resolution chromatin conformation capture to map these disease-associated elements to their effector genes. Results This functional genomic approach implicates 16 genes involved in viral replication, the interferon response, and inflammation. Several of these genes (PAXBP1, IFNAR2, OAS1, OAS3, TNFAIP8L1, GART) were differentially expressed in immune cells from patients with severe versus moderate COVID-19 disease, and we demonstrate a previously unappreciated role for GART in T cell-dependent antibody-producing B cell differentiation in a human tonsillar organoid model. Conclusions This study offers immunogenetic insight into the basis of COVID-19 disease severity and implicates new targets for therapeutics that limit SARS-CoV-2 infection and its resultant life-threatening inflammation. Supplementary Information The online version contains supplementary material available at 10.1186/s13059-022-02691-1.

3.
Clin Infect Dis ; 2021 Nov 03.
Article in English | MEDLINE | ID: covidwho-1852978

ABSTRACT

BACKGROUND: Myocarditis following COVID-19 mRNA vaccines (Pfizer-BioNTech and Moderna) have been increasingly reported. Incidence rates in the general population are lacking, with pericarditis rather than myocarditis diagnostic codes being used to estimate background rates. This comparison is critical to balance the risk of vaccination with the risk of no vaccination. METHODS: A retrospective case-series was performed utilizing the Mayo Clinic COVID-19 Vaccine Registry. We measured the incidence rate ratio for myocarditis temporally related to COVID-19 mRNA vaccination compared to myocarditis in a comparable population from 2016 through 2020. Clinical characteristics and outcomes of the affected patients was collected. A total of 21 individuals were identified, but ultimately 7 patients met the inclusion criteria for vaccine-associated myocarditis. RESULTS: The overall incidence rate ratio (IRR) of COVID-19 related myocarditis was 4.18 (CI95% 1.63, 8.98) which was entirely attributable to an increased IRR among adult males (IRR 6.69, CI95% 2.35, 15.52) compared to females (IRR 1.41, CI95% 0.03, 8.45).All cases occurred within 2 weeks of a dose of the COVID-19 mRNA vaccine with the majority occurring within 3 days (range 1-13 days) following the second dose (6/7 patients, 86%). Overall, cases were mild, and all patients survived. CONCLUSIONS: Myocarditis is a rare adverse event associated with COVID-19 mRNA vaccines, and in adult males it occurs with significantly higher incidence than the background population rate. Recurrence of myocarditis after a subsequent mRNA vaccine dose is not known at this time.

4.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-335849

ABSTRACT

Introduction: In the context of the COVID-19 pandemic, upstream interventions that tackle social determinants of health inequalities have never been more important. Evaluations of upstream cash transfer trials have failed to capture comprehensively the impacts that such systems might have on population health through inadequate design of the interventions themselves and failure to implement consistent, thorough research measures that can be used in microsimulations to model long-term impact. In this article, we describe the process of developing a generic, adaptive protocol resource to address this issue and the challenges involved in that process. Methods: We outline two types of prospective intervention based on trials currently under discussion. In developing the remainder of the resource, we establish six key principles, implement a modular approach based on types of measure and their prospective resource intensity, and source (validated where possible) measures and baseline data primarily from routine collection and large, longitudinal cohort studies. Through these measures, we seek to cover all areas of health impact identified in our theoretical model. Results: We find that, in general, self-reported measures alongside routinely collected linked respondent data may provide data capable of demonstrating comprehensive health impact. However, we also suggest that, where possible, physiological measures should be included to elucidate underlying biological effects that may not be accurately captured through self-reporting alone and can enable modelling of long-term health outcomes. Discussion: We suggest that while Open Access evaluation instruments are available and usable to measure most constructs of interest, there remain some areas for which further development is necessary. This includes self-reported wellbeing measures that require paid licences but are used in a range of nationally important longitudinal studies instead of Open Access alternatives.

5.
Physics of Fluids ; 34(4):1-25, 2022.
Article in English | Academic Search Complete | ID: covidwho-1830315

ABSTRACT

Given the recent acceptance of the central role of airborne transmission for SARS-CoV-2, increased attention has been paid to the dispersion of respiratory droplets in different scenarios. Studies including numerical simulations have been conducted on methods for breaking the chains of transmission. Here, we present the first such study on the impact of body position while coughing on the dispersion of respiratory droplets. Four scenarios are examined, including normal standing, bending the head at different angles, coughing into the elbow in still air, and a gentle breeze from the front and behind. The model showed that an uncovered cough is dangerous and causes many droplets to enter the environment, posing a cross-contamination threat to the others. Droplets with an initial diameter smaller than 62.5 μm remain suspended in windless air for more than 3 min. In the presence of wind, these droplets move with the wind flow and may travel long distances greater than 3.5 m. The model showed that covering the mouth with the elbow while coughing is clearly the best strategy for reducing airborne transmission of exhaled pathogens. About 62% of the initial number of droplets deposit on the cougher's elbow immediately after the cough and have no chance of spreading through the air in both windless and windy conditions. Covering the cough in windless or light breeze conditions also causes the upward thermal plume around the body to expel many small droplets. [ FROM AUTHOR] Copyright of Physics of Fluids is the property of American Institute of Physics and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

6.
J Am Heart Assoc ; 11(9): e024451, 2022 May 03.
Article in English | MEDLINE | ID: covidwho-1807755

ABSTRACT

Background Early reports from the COVID-19 pandemic identified coronary thrombosis leading to ST-segment-elevation myocardial infarction (STEMI) as a complication of COVID-19 infection. However, the epidemiology of STEMI in patients with COVID-19 is not well characterized. We sought to determine the incidence, diagnostic and therapeutic approaches, and outcomes in STEMI patients hospitalized for COVID-19. Methods and Results Patients with data on presentation ECG and in-hospital myocardial infarction were identified from January 14, 2020 to November 30, 2020, from 105 sites participating in the American Heart Association COVID-19 Cardiovascular Disease Registry. Patient characteristics, resource use, and clinical outcomes were summarized and compared based on the presence or absence of STEMI. Among 15 621 COVID-19 hospitalizations, 54 (0.35%) patients experienced in-hospital STEMI. Among patients with STEMI, the majority (n=40, 74%) underwent transthoracic echocardiography, but only half (n=27, 50%) underwent coronary angiography. Half of all patients with COVID-19 and STEMI (n=27, 50%) did not undergo any form of primary reperfusion therapy. Rates of all-cause shock (47% versus 14%), cardiac arrest (22% versus 4.8%), new heart failure (17% versus 1.4%), and need for new renal replacement therapy (11% versus 4.3%) were multifold higher in patients with STEMI compared with those without STEMI (P<0.050 for all). Rates of in-hospital death were 41% in patients with STEMI, compared with 16% in those without STEMI (P<0.001). Conclusions STEMI in hospitalized patients with COVID-19 is rare but associated with poor in-hospital outcomes. Rates of coronary angiography and primary reperfusion were low in this population of patients with STEMI and COVID-19. Adaptations of systems of care to ensure timely contemporary treatment for this population are needed.


Subject(s)
COVID-19 , Cardiovascular Diseases , Myocardial Infarction , ST Elevation Myocardial Infarction , American Heart Association , COVID-19/epidemiology , COVID-19/therapy , Cardiovascular Diseases/epidemiology , Hospital Mortality , Humans , Myocardial Infarction/epidemiology , Pandemics , Registries , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/epidemiology , ST Elevation Myocardial Infarction/therapy , United States/epidemiology
7.
Dissertation Abstracts International Section A: Humanities and Social Sciences ; 83(4-A):No Pagination Specified, 2022.
Article in English | APA PsycInfo | ID: covidwho-1717112

ABSTRACT

Online instruction is not a new concept in higher education. Schools now exist that are entirely online, and some are slowly moving more options over to the virtual realm. Though this transition is taking place at many schools, it has required institutional planning to update infrastructure and necessary systems, and it has required dedication to training faculty members on the nuance of delivering online courses. The introduction of the COVID-19 pandemic caused schools to rapidly react to the necessity of the moment. Suddenly faculty members who have received no formal training on how to deliver an online course were asked to transition their entire curriculum to that format. Schools that had no online coursework infrastructure had to improvise. The purpose of this phenomenological study was to explore the faculty experience of transitioning their faculty responsibilities online due to the COVID-19 pandemic. Interviews were conducted with six full-time faculty members who were faculty at the time of transition necessitated by the COVID-19 pandemic. Though this study did not specify it, there were only female participants. From the data collection and interpretation process, five themes emerged that captured the experiences of faculty members when they had to transition their coursework online. The five themes were: Experience with Communication, Distrust and Power, Work and Family Sacrifice, Rapid Change, and A Glimpse Behind the Veil. There were multiple subthemes under each theme.This study has implications for how schools and faculty members can best prepare for future instances of rapid transition to a virtual format. This study helps to establish academic literature that focuses on the faculty experience due to the COVID-19 pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

8.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-317873

ABSTRACT

The onset of the 2020 global COVID-19 pandemic led to a marked increase in positive discussion of Universal Basic Income (UBI) in political and media circles. However, we do not know whether there was a corresponding increase in support for the policy in the public at large, or why. Here, we present three studies carried out during 2020 in UK and US samples. In study 1 (n=802, April 2020), people expressed much stronger support for a UBI policy for the times of the pandemic and its aftermath than for normal times. This was largely explained by the increased importance they attached, in the pandemic context, to a system that is simple and efficient to administer, and that reduces stress and anxiety in society. In study 2 (n=400, May 2020), we pitted UBI against a conditional targeted social transfer system. Preferences for UBI were stronger for pandemic times than for normal times. This was partially explained by a number of perceived advantages, such as simplicity of administration and suitability for a changing world. In study 3 (n= 397, September 2020), we found that the headline results of studies 1 and 2 persisted six months after the onset of the pandemic, albeit with attenuated effect sizes. Our results illustrate how a changing social and economic situation can bring about markedly different policy preferences, through changes in citizens’ perceptions of what is currently important.

9.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-313781

ABSTRACT

Respiratory Aerosols from breathing and talking have found wide acceptance as a transmission route for viruses such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Previous studies have found particles with diameters ranging from 10 nm to 145 µm, exhibited from different regions in the respiratory system. We present the first chamber study, in which respiratory aerosols have been simultaneously measured with carbon dioxide (CO2) to establish the correlation between the two concentrations. CO2 concentrations are easily available through low-cost sensors and could be used to estimate viral exposure through this correlation, whereas source-specific aerosol measurements are complicated and not possible with low cost sensors. The increase in both PM10 and CO2 was linear over ten minutes in a 2 m3 chamber for all participants, suggesting a strong correlation. On average, talking released more particles than breathing, with 14,600 ± 16,800 min-1 (one-σ standard deviation) and 6,210 ± 5,630 min-1 on average, respectively, while CO2 increased with 139 ± 33 ppm min-1 during talking and 143 ± 29 ppm min-1 during breathing. Assuming a typical viral load of 7 × 106 RNA copies per ml of oral fluid, ten minutes of talking and breathing are estimated to produce 7 and 16 suspended RNA copies, respectively, correlating to a CO2 concentration of around 1.800 ppm in a 2 m3 chamber. This provides a strong argument for keeping indoor spaces well ventilated and shows how CO2 concentrations, measured with low-cost sensors, could be used as a proxy for viral exposure.

10.
PLoS One ; 17(1): e0258828, 2022.
Article in English | MEDLINE | ID: covidwho-1638062

ABSTRACT

The role of human behavior to thwart transmission of infectious diseases like COVID-19 is evident. Psychological and behavioral science are key areas to understand decision-making processes underlying engagement in preventive health behaviors. Here we adapt well validated methods from behavioral economic discounting and demand frameworks to evaluate variables (e.g., delay, cost, probability) known to impact health behavior engagement. We examine the contribution of these mechanisms within a broader response class of behaviors reflecting adherence to public health recommendations made during the COVID-19 pandemic. Four crowdsourced samples (total N = 1,366) completed individual experiments probing a response class including social (physical) distancing, facemask wearing, COVID-19 testing, and COVID-19 vaccination. We also measure the extent to which choice architecture manipulations (e.g., framing, opt-in/opt-out) may promote (or discourage) behavior engagement. We find that people are more likely to socially distance when specified activities are framed as high risk, that facemask use during social interaction decreases systematically with greater social relationship, that describing delay until testing (rather than delay until results) increases testing likelihood, and that framing vaccine safety in a positive valence improves vaccine acceptance. These findings collectively emphasize the flexibility of methods from diverse areas of behavioral science for informing public health crisis management.


Subject(s)
COVID-19/prevention & control , Health Behavior , Vaccination/psychology , Adult , COVID-19/economics , COVID-19/epidemiology , COVID-19/virology , COVID-19 Testing/economics , Female , Humans , Male , Masks , Middle Aged , Pandemics , Physical Distancing , Risk , SARS-CoV-2/isolation & purification , Surveys and Questionnaires , Young Adult
11.
N Engl J Med ; 386(6): 509-520, 2022 02 10.
Article in English | MEDLINE | ID: covidwho-1574650

ABSTRACT

BACKGROUND: New treatments are needed to reduce the risk of progression of coronavirus disease 2019 (Covid-19). Molnupiravir is an oral, small-molecule antiviral prodrug that is active against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We conducted a phase 3, double-blind, randomized, placebo-controlled trial to evaluate the efficacy and safety of treatment with molnupiravir started within 5 days after the onset of signs or symptoms in nonhospitalized, unvaccinated adults with mild-to-moderate, laboratory-confirmed Covid-19 and at least one risk factor for severe Covid-19 illness. Participants in the trial were randomly assigned to receive 800 mg of molnupiravir or placebo twice daily for 5 days. The primary efficacy end point was the incidence hospitalization or death at day 29; the incidence of adverse events was the primary safety end point. A planned interim analysis was performed when 50% of 1550 participants (target enrollment) had been followed through day 29. RESULTS: A total of 1433 participants underwent randomization; 716 were assigned to receive molnupiravir and 717 to receive placebo. With the exception of an imbalance in sex, baseline characteristics were similar in the two groups. The superiority of molnupiravir was demonstrated at the interim analysis; the risk of hospitalization for any cause or death through day 29 was lower with molnupiravir (28 of 385 participants [7.3%]) than with placebo (53 of 377 [14.1%]) (difference, -6.8 percentage points; 95% confidence interval [CI], -11.3 to -2.4; P = 0.001). In the analysis of all participants who had undergone randomization, the percentage of participants who were hospitalized or died through day 29 was lower in the molnupiravir group than in the placebo group (6.8% [48 of 709] vs. 9.7% [68 of 699]; difference, -3.0 percentage points; 95% CI, -5.9 to -0.1). Results of subgroup analyses were largely consistent with these overall results; in some subgroups, such as patients with evidence of previous SARS-CoV-2 infection, those with low baseline viral load, and those with diabetes, the point estimate for the difference favored placebo. One death was reported in the molnupiravir group and 9 were reported in the placebo group through day 29. Adverse events were reported in 216 of 710 participants (30.4%) in the molnupiravir group and 231 of 701 (33.0%) in the placebo group. CONCLUSIONS: Early treatment with molnupiravir reduced the risk of hospitalization or death in at-risk, unvaccinated adults with Covid-19. (Funded by Merck Sharp and Dohme; MOVe-OUT ClinicalTrials.gov number, NCT04575597.).


Subject(s)
Antiviral Agents/therapeutic use , COVID-19/drug therapy , Cytidine/analogs & derivatives , Hydroxylamines/therapeutic use , Administration, Oral , Adolescent , Adult , Aged , Aged, 80 and over , Antiviral Agents/adverse effects , COVID-19/virology , Cytidine/adverse effects , Cytidine/therapeutic use , Double-Blind Method , Female , Humans , Hydroxylamines/adverse effects , Male , Middle Aged , SARS-CoV-2/isolation & purification , Treatment Outcome , Viral Load , Young Adult
13.
Transl Res ; 242: 38-55, 2022 04.
Article in English | MEDLINE | ID: covidwho-1550105

ABSTRACT

The remarkable success of SARS CoV-2 mRNA-based vaccines and the ensuing interest in mRNA vaccines and therapeutics have highlighted the need for a scalable clinical-enabling manufacturing process to produce such products, and robust analytical methods to demonstrate safety, potency, and purity. To date, production processes have either not been disclosed or are bench-scale in nature and cannot be readily adapted to clinical and commercial scale production. To address these needs, we have advanced an aqueous-based scalable process that is readily adaptable to GMP-compliant manufacturing, and developed the required analytical methods for product characterization, quality control release, and stability testing. We also have demonstrated the products produced at manufacturing scale under such approaches display good potency and protection in relevant animal models with mRNA products encoding both vaccine immunogens and antibodies. Finally, we discuss continued challenges in raw material identification, sourcing and supply, and the cold chain requirements for mRNA therapeutic and vaccine products. While ultimate solutions have yet to be elucidated, we discuss approaches that can be taken that are aligned with regulatory guidance.


Subject(s)
COVID-19 , Vaccines , Animals , COVID-19/prevention & control , Humans , RNA, Messenger/genetics , SARS-CoV-2/genetics
15.
Clin Microbiol Rev ; 34(3)2021 06 16.
Article in English | MEDLINE | ID: covidwho-1501522

ABSTRACT

Public health laboratories (PHLs) continue to face internal and external challenges to their abilities to provide successful, timely responses to public health crises and emerging threats. These laboratories are mandated to maintain the health of their communities by identifying, diagnosing, and warning constituents of potential and real health emergencies. Due to the changing characteristics of public health threats and their cross-jurisdictional nature, laboratories are facing increased pressure to ensure that they respond in a consistent and coordinated manner. Here, the Association of Public Health Laboratories (APHL) Emerging Leader Program Cohort 11 members have compiled stories from subject matter experts (SMEs) at PHLs with direct involvement in crises to determine the characteristics of a successful response. Experts examined a diverse selection of emerging threats from across PHLs, including infectious diseases, opioids, natural disasters, and government shutdowns. While no public health crisis will be identical to another, overarching themes were consistent across subjects. Experiences from SMEs that could improve future responses to emerging threats are highlighted.


Subject(s)
COVID-19 Testing/methods , COVID-19/diagnosis , Hemorrhagic Fever, Ebola/diagnosis , Measles/diagnosis , Opioid-Related Disorders/diagnosis , Public Health/methods , COVID-19/epidemiology , Clinical Laboratory Techniques , Hemorrhagic Fever, Ebola/epidemiology , Humans , Laboratories , Measles/epidemiology , Opioid-Related Disorders/epidemiology
16.
Clin Infect Dis ; 2021 Nov 03.
Article in English | MEDLINE | ID: covidwho-1501062

ABSTRACT

BACKGROUND: Myocarditis following COVID-19 mRNA vaccines (Pfizer-BioNTech and Moderna) have been increasingly reported. Incidence rates in the general population are lacking, with pericarditis rather than myocarditis diagnostic codes being used to estimate background rates. This comparison is critical to balance the risk of vaccination with the risk of no vaccination. METHODS: A retrospective case-series was performed utilizing the Mayo Clinic COVID-19 Vaccine Registry. We measured the incidence rate ratio for myocarditis temporally related to COVID-19 mRNA vaccination compared to myocarditis in a comparable population from 2016 through 2020. Clinical characteristics and outcomes of the affected patients was collected. A total of 21 individuals were identified, but ultimately 7 patients met the inclusion criteria for vaccine-associated myocarditis. RESULTS: The overall incidence rate ratio (IRR) of COVID-19 related myocarditis was 4.18 (CI95% 1.63, 8.98) which was entirely attributable to an increased IRR among adult males (IRR 6.69, CI95% 2.35, 15.52) compared to females (IRR 1.41, CI95% 0.03, 8.45).All cases occurred within 2 weeks of a dose of the COVID-19 mRNA vaccine with the majority occurring within 3 days (range 1-13 days) following the second dose (6/7 patients, 86%). Overall, cases were mild, and all patients survived. CONCLUSIONS: Myocarditis is a rare adverse event associated with COVID-19 mRNA vaccines, and in adult males it occurs with significantly higher incidence than the background population rate. Recurrence of myocarditis after a subsequent mRNA vaccine dose is not known at this time.

17.
Sustainability ; 13(21):12203, 2021.
Article in English | MDPI | ID: covidwho-1502516

ABSTRACT

Respiratory aerosols from breathing and talking are an important transmission route for viruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Previous studies have found that particles with diameters ranging from 10 nm to 145 μm are produced from different regions in the respiratory system and especially smaller particles can remain airborne for long periods while carrying viral RNA. We present the first study in which respiratory aerosols have been simultaneously measured with carbon dioxide (CO2) to establish the correlation between the two concentrations. CO2 concentrations are easily available through low-cost sensors and could be used to estimate viral exposure through this correlation, whereas source-specific aerosol measurements are complicated and not possible with low-cost sensors. The increase in both respiratory aerosols and CO2 was linear over ten minutes in a 2 m3 chamber for all participants, suggesting a strong correlation. On average, talking released more particles than breathing, with 14,600 ± 16,800 min−1 (one-σ standard deviation) and 6210 ± 5630 min−1 on average, respectively, while CO2 increased with 139 ± 33 ppm min−1 during talking and 143 ± 29 ppm min−1 during breathing. Assuming a typical viral load of 7×106 RNA copies per mL of oral fluid, ten minutes of talking and breathing are estimated to produce 1 and 16 suspended RNA copies, respectively, correlating to a CO2 concentration of around 1800 ppm in a 2 m3 chamber. However, viral loads can vary by several orders of magnitude depending on the stage of the disease and the individual. It was therefore concluded that, by measuring CO2 concentrations, only the number and volume concentrations of released particles can be estimated with reasonable certainty, while the number of suspended RNA copies cannot.

18.
Diabetes ; 70, 2021.
Article in English | ProQuest Central | ID: covidwho-1362234

ABSTRACT

Recent studies suggest COVID-19 infection has a detrimental effect on glycemic control in patients with diabetes in the acute care setting. However, there is limited information about the impact of COVID-19 on glycemic control in the months following infection. In this retrospective observational study, we examined the correlation between COVID-19 infection and glycemic control in adult patients with elevated A1c in a single health system (n=3,295). Patients were selected from a cohort of those age 18 years or older who were tested for COVID-19 between 3/1/2020 and 11/1/2020. COVID positive patients were identified through positive SARS-CoV-2 PCR or a COVID flag in the EMR. COVID negative patients were randomly selected in a 3:1 ratio from all patients who had a negative COVID test in the same week as each positive patient. Patients from this cohort were included if they had a baseline A1c ≥ 5.7% measured in the preceding six months and at least two weeks prior to their COVID positive (n=670) or COVID negative (n=2,625) test date, as well as an endpoint A1c ≥ 5.7% at least three months after this date. The study population was 54% female, 60% White, 20% Hispanic, and 13% Black with a mean BMI 32 ± 7.3 kg/m2, age 64.1 ± 13.6 yrs, and baseline A1c of 7.7± 1.6 %;81% of patients had a diagnosis of type 2 diabetes. In a linear regression model, COVID-19 infection was significantly associated with increased endpoint A1c (coefficient = 0.14, 95% CI [0.03 - 0.25], p = 0.01). Baseline A1c, male sex, and Hispanic ethnicity were also significantly associated with increased A1c, while age and median income based on zip code were associated with decreased A1c. In conclusion, prior COVID-19 infection appears to be associated with worse glycemic control at least 3 months post-infection compared to patients who did not contract COVID-19. Additional research is needed to determine if this association is present in other patient populations as well as the physiologic and socio-demographic causes for this finding.

19.
Diabetes ; 70, 2021.
Article in English | ProQuest Central | ID: covidwho-1362233

ABSTRACT

People with diabetes (DM) hospitalized with COVID-19 infection have a 2-3 fold higher risk of death compared with those without DM, and mechanical ventilation (MV) has been identified as a major risk factor for death. While stress hyperglycemia (StH) has been established as a risk factor for death in some critically ill cohorts, it is not a well-established risk factor for MV in COVID-19. The COVIDEastDM consortium pooled data from 5 academic hospitals on the East Coast of the US to study the relationship between hyperglycemia and COVID-19 outcomes. Data were obtained retrospectively from electronic records of adults with COVID-19 and either DM or StH (defined in this cohort as day-1 admission blood glucose >180 mg/dl and A1c <6.5%). This analysis included 3,435 individuals, of which 1,001 (29.1%) required MV and 748 (21.8%) died. The mean age was 67 ± 15 yrs., BMI 30.4 ± 7.7 kg/m2, A1c 7.98 ± 2.21 % and glucose 184 ± 104 mg/dl. Additionally, 57% were male, 4 % Asian,19% Black, 52% White, and 28% Hispanic. In a univariate analysis, risk factors for MV included younger age (OR 0.98 [95% CI 0.97, 0.99] per year older), male sex (OR 1.4 [1.2, 1.7]), BMI (OR 1.013 [1.003, 1.023] per kg/m2), Hispanic ethnicity (OR 1.16 [1.07, 1.28]) and the presence of diabetic ketoacidosis (n=38) at admission (OR 3.9 [2.0, 7.5]). Patients with StH were more likely to require MV (OR 1.93, [1.10, 3.39]). In a multivariate analysis, this relationship was continuous, with both lower A1c and higher glucose increasing risk of MV (p< 0.01 for higher glucose, p<0.001 for lower A1c). Patients who required MV were more likely to die than those who did not require MV (OR 5.1, [4.3, 6.1]) and StH predicted mortality in the multivariate analysis. Thus, in patients hospitalized with COVID19 infection, StH is a strong predictor of both MV and death in COVID-19 infected adults. While it is unclear if StH is a cause or effect of severe COVID-19, its presence early in the hospital course identifies higher risk patients and could potentially impact management.

20.
Clin Microbiol Rev ; 34(3)2021 06 16.
Article in English | MEDLINE | ID: covidwho-1226708

ABSTRACT

Public health laboratories (PHLs) continue to face internal and external challenges to their abilities to provide successful, timely responses to public health crises and emerging threats. These laboratories are mandated to maintain the health of their communities by identifying, diagnosing, and warning constituents of potential and real health emergencies. Due to the changing characteristics of public health threats and their cross-jurisdictional nature, laboratories are facing increased pressure to ensure that they respond in a consistent and coordinated manner. Here, the Association of Public Health Laboratories (APHL) Emerging Leader Program Cohort 11 members have compiled stories from subject matter experts (SMEs) at PHLs with direct involvement in crises to determine the characteristics of a successful response. Experts examined a diverse selection of emerging threats from across PHLs, including infectious diseases, opioids, natural disasters, and government shutdowns. While no public health crisis will be identical to another, overarching themes were consistent across subjects. Experiences from SMEs that could improve future responses to emerging threats are highlighted.


Subject(s)
COVID-19 Testing/methods , COVID-19/diagnosis , Hemorrhagic Fever, Ebola/diagnosis , Measles/diagnosis , Opioid-Related Disorders/diagnosis , Public Health/methods , COVID-19/epidemiology , Clinical Laboratory Techniques , Hemorrhagic Fever, Ebola/epidemiology , Humans , Laboratories , Measles/epidemiology , Opioid-Related Disorders/epidemiology
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