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1.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-333723

ABSTRACT

BACKGROUND: High frequency, rapid turnaround SARS-CoV-2 testing continues to be proposed as a way of efficiently identifying and mitigating transmission in congregate settings. However, two SARS-CoV-2 outbreaks occurred among intercollegiate university athletic programs during the fall 2020 semester despite mandatory directly observed daily antigen testing. METHODS: During the fall 2020 semester, athletes and staff in both programs were tested daily using Quidel's Sofia SARS Antigen Fluorescent Immunoassay (FIA), with positive antigen results requiring confirmatory testing with real-time reverse transcription polymerase chain reaction (RT-PCR). We used genomic sequencing to investigate transmission dynamics in these two outbreaks. RESULTS: In Outbreak 1, 32 confirmed cases occurred within a university athletics program after the index patient attended a meeting while infectious despite a negative antigen test on the day of the meeting. Among isolates sequenced from Outbreak 1, 24 (92%) of 26 were closely related, suggesting sustained transmission following an initial introduction event. In Outbreak 2, 12 confirmed cases occurred among athletes from two university programs that faced each other in an athletic competition despite receiving negative antigen test results on the day of the competition. Sequences from both teams were closely related and unique from strains circulating in the community, suggesting transmission during intercollegiate competition. CONCLUSIONS: These findings suggest that antigen testing alone, even when mandated and directly observed, may not be sufficient as an intervention to prevent SARS-CoV-2 outbreaks in congregate settings, and highlights the importance of supplementing serial antigen testing with appropriate mitigation strategies to prevent SARS-CoV-2 outbreak in congregate settings. SUMMARY: High frequency, rapid turnaround SARS-CoV-2 testing continues to be proposed as a way of efficiently identifying and mitigating transmission in congregate settings. However, here we describe two SARS-CoV-2 outbreaks occurred among intercollegiate university athletic programs during the fall 2020 semester.

2.
Biology ; 10(9), 2021.
Article in English | CAB Abstracts | ID: covidwho-1523857

ABSTRACT

Human-to-animal and animal-to-animal transmission of SARS-CoV-2 has been documented;however, investigations into SARS-CoV-2 transmission in congregate animal settings are lacking. We investigated four animal shelters in the United States that had identified animals with exposure to shelter employees with laboratory-confirmed COVID-19. Of the 96 cats and dogs with specimens collected, only one dog had detectable SARS-CoV-2 neutralizing antibodies;no animal specimens had detectable viral RNA. These data indicate a low probability of human-to-animal transmission events in cats and dogs in shelter settings with early implementation of infection prevention interventions.

3.
Otolaryngology - Head and Neck Surgery ; 165(1 SUPPL):P210-P211, 2021.
Article in English | EMBASE | ID: covidwho-1467856

ABSTRACT

Introduction: Coronavirus disease 2019 affected the timing of management of patients with cutaneous malignancies, delaying their surgical care by several months. The study objective is to determine the impact of delays on patients' oncologic and reconstructive management in comparison to 2 standard years. Method: A retrospective review of all patients with surgical management for their cutaneous malignancies at a single institution in the departments of otolaryngology and plastic surgery was conducted from January 2018 to January 2021. The 2020 group was considered to have delayed care due to the health care restrictions. Demographics, malignancy characteristics, ablative and reconstructive surgery, and adjuvant management were all evaluated comparing the pre-2020 and 2020 groups. Univariate analysis was performed using a 2-sample t test for continuous variables and chi-squared test and Fisher exact test for categorical variables. Significance was determined if P < .05. Results: In total 80 patients underwent cutaneous malignancy management and reconstruction during the time period, in which the squamous cell carcinoma was the most common pathology (38.75%) and the nose was the most common subsite (38.75%). In 2020 there were no cutaneous cases that were managed surgically between February and June compared with cases occurring monthly during the prior standard years, suggesting a delay in care anywhere from 1 to 4 months during this time. Despite delays, there was no significant difference between the pre-2020 and 2020 groups in terms of staging, oncologic management, or reconstruction. There were no differences in the variables between the groups. Conclusion: There was no significant difference in presentation, oncologic management, or reconstruction required for patients requiring a several-month delay in care for the management of cutaneous malignancy compared with the 2 prior standard years. This suggests that this delay did not significantly affect management of cutaneous malignancy in this subset of patients, leading us to understand more about urgency of management in patients with cutaneous malignancies.

4.
International Journal of Rheumatic Diseases ; 24(SUPPL 2):161-162, 2021.
Article in English | EMBASE | ID: covidwho-1457989

ABSTRACT

Background/Purpose: The global coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulted in significant mortality, social disorder and economic hardships. We set out to understand why certain individuals could resolve the disease successfully without serious complications by immune profiling of PBMCs from convalescent COVID-19 patients (n = 14) with mild disease trajectory. Methods: We designed 7 peptides targeting the receptor binding region (RBD) of the spike protein of SARS-CoV-2, that encompass broad HLA class I / II alleles, with the aid of the Immune Epitope Database and Analysis Resource (IEDB) website. The RBD site was chosen as it was shown to be protective when neutralising antibodies against this region could negate binding of viral spike protein to host cell ACE-2 receptor. Convalescent COVID-19 patients enrolled in this study were screened and selected for positive antibody titre against the RBD region. PBMCs from convalescent COVID-19 patients were stimulated with/without the peptides for 72hrs and immune profiled (n = 70 markers across two panels) with the high dimensional single cell mass cytometry platform (CyToF). Results: Convalescent COVID-19 patients elicited a robust recall memory T follicular helper response (CD3 + CD4 + CD45RO + CXCR5 + Tigit + ;∗∗∗∗ p < 0.0001) demonstrating peptide efficacy. Unsupervised clustering (FlowSOM) of the CD4 T cell immune landscape reaffirmed increase in memory T follicular subsets and additionally CD4 + CD45RO + CXCR5 -subsets. Further gating of antigen specific memory cells (CD45RO + CD69 + ) revealed an increase in Tbet + CXCR3 + T effectors in both CD4 and CD8 compartments. Strikingly we detected a parallel increase in CD4 + Treg (CD25 + FoxP3 + ) CXCR3 + Tbet + CD45RO + CD152 + Tigit + expression. Conclusions: COVID-19 patients that successfully resolve the viral infection not only mount a robust T effector and follicular response but also in tandem a similar T regulatory profile.

5.
Asian Medicine ; 16(1):128-135, 2021.
Article in English | Scopus | ID: covidwho-1394318

ABSTRACT

I wrote this journal in March 2020 prior to the World Health Organization declaring the COVID-19 infection as a worldwide pandemic on March 11. The situation in Singapore was unfolding even as public healthcare institutions were tasked to lead the charge to contain the novel coronavirus as it was then called. This journal describes my experiences and impressions during my work in an isolation ward at the National University Hospital during this early period. I was to be catapulted into Pandemic Team 3 in the second and third weeks of February 2020. The urgency of hospital measures to respond to the novel coronavirus meant that the general medicine consultant roster which I was on was hijacked to support the pandemic wards. I thought wryly to myself that it was a stroke of genius to commandeer the ready-made roster of senior physicians;it would have been difficult for the roster monster to solicit senior physicians to volunteer when there were still so many unknowns about this virus. Graphic images of the dire situation in Wuhan, China, were circulating widely on social media. It was heart-wrenching to read of Dr. Li Wen Liang’s death. He had highlighted the mysterious pneumonia-causing virus. The video clip of him singing at a karaoke session that went viral underscored the tragedy of a young life cut short. Questions raced in my mind. “Are we helpless to prevent the spread of this virus?” “Is the situation in China to be replicated here in Singapore?” This seemed incredulous, yet, might it be possible? The immediate responses that jumped up within me was “yes, it’s possible, but let’s pray not. Whatever has to be done, must be done.” © Koninklijke Brill NV, Leiden, 2021.

6.
Medizinische Klinik-Intensivmedizin Und Notfallmedizin ; 116(SUPPL 2):52-52, 2021.
Article in English | Web of Science | ID: covidwho-1260328
7.
Intervention ; 19(1):15-20, 2021.
Article in English | Scopus | ID: covidwho-1183960

ABSTRACT

COVID-19, a watershed moment in global health, has brought health inequalities into sharp focus exposing structural disadvantage and institutional discrimination experienced by disenfranchised populations. Focusing on urban refugees and asylum seekers in Malaysia who are deemed of irregular status under the law, this field report outlines the legal and policy responses of the government and the impact of COVID-19 on refugees. It also highlights the organisational response of an organisation working with refugees in the greater Kuala Lumpur area. As pandemics become a reality of our times, it is imperative that pandemic preparedness and mitigation strategies adopt inclusive and universal approaches that include migrant populations such as refugees and asylum seekers. © 2021 Lippincott Williams and Wilkins. All rights reserved.

8.
Morbidity and Mortality Weekly Report ; 69(51/52):1642-1647, 2021.
Article in English | GIM | ID: covidwho-1151365

ABSTRACT

Antigen tests for SARS-CoV-2 are inexpensive and can return results within 15 minutes, but test performance data in asymptomatic and symptomatic persons are limited. Compared with real-time reverse transcription-polymerase chain reaction (RT-PCR) testing, the Sofia antigen test had a sensitivity of 80.0% and specificity of 98.9% among symptomatic persons;accuracy was lower (sensitivity 41.2% and specificity 98.4%) when used for screening of asymptomatic persons. To account for reduced antigen test accuracy, confirmatory testing with a nucleic acid amplification test (e.g., RT-PCR) should be considered after negative antigen test results in symptomatic persons and positive antigen test results in asymptomatic persons. Among 227 paired specimens from symptomatic participants, 34 (15.0%) were antigen-positive, and 40 (17.6%) were real-time RT-PCR-positive. The median interval from symptom onset to specimen collection was 3 days. Among symptomatic participants, antigen testing sensitivity was 80.0% (32 of 40), specificity was 98.9% (185 of 187), PPV was 94.1% (32 of 34), and NPV was 95.9% (185 of 193). For specimens collected within 5 days of reported symptom onset (72.4%;152 of 210), sensitivity was 74.2% (23 of 31), and specificity was 99.2% (120 of 121). Among 871 paired specimens from asymptomatic participants, 21 (2.4%) were antigen-positive and 17 (2.0%) were real-time RT-PCR-positive. Antigen testing sensitivity was 41.2% (seven of 17), specificity was 98.4% (840 of 854), PPV was 33.3% (seven of 21), and NPV was 98.8% (840 of 850). Test performance was not significantly (p>0.05) different when excluding 53 (6.1%) of 871 participants who were asymptomatic at the time of testing but had reported one or more symptoms in the preceding 14 days. Virus was recovered from 34 (46.6%) of 73 positive specimens, including 32 (82.1%) of 39 specimens with concordant positive results and two (11.1%) of 18 with false-negative antigen results;no virus was recovered from 16 specimens with false-positive antigen test results. The two specimens with false-negative antigen results that were culture-positive were from two symptomatic participants who had specimens collected at day 2 and day 4 after symptom onset.

9.
Thorax ; 76(SUPPL 1):A165-A166, 2021.
Article in English | EMBASE | ID: covidwho-1147404

ABSTRACT

Background: All Hospital Trusts in England are expected to offer influenza vaccination to eligible inpatients during Winter 2020-21. There is currently no data on which to model need and uptake of this approach by clinicians and patients. (Figure presented) In 2018 addressing vaccination status was added to the COPD 'Bundle' used in our hospital, electronic influenza vaccine prescription was introduced following NICE guidance recommending offering vaccination to eligible inpatients and checking vaccination status and offering to appropriate patients was included in respiratory ward reviews. Aim: To evaluate the uptake and characteristics of inpatients offered and accepting influenza vaccination over Winter 2018-19 and 2019-20 in one Acute Trust. Methods: Data on inpatient influenza vaccine prescriptions between October-March 2018-19 and 2019-20 was obtained from our electronic prescribing system. Electronic records of each admission were reviewed and analysed for patient demographics, reason for admission, indication for vaccination, ward and mortality at June 2020. Results: See table 1 for results. 159 inpatient vaccinations were administered over 2 years. Mean (range) age was 62 (18-94) years and mortality at 1+ year was 28%. 114 (72%) were on our 23-bed respiratory ward. By year 2, 32% (28/88) vaccines were administered on other wards. 2/3 vaccines were for patients with COPD or asthma. Discussion: Our data suggests that offering influenza vaccination to inpatients is a feasible and sustainable intervention for which there is patient demand. Approximately 2 vaccinations/week were administered on a 23-bed respiratory ward. Inpatients were also vaccinated on other wards;with >60% increase on elderly-care wards in year 2. This was largely due to prescribing by trainees who had completed a respiratory rotation and continued to offer vaccination in subsequent roles. The high snap-shot mortality at June 2020 (28% 1 year+) is a reminder of the high risk of death for inpatients eligible for influenza vaccination. Our findings suggest that clinicians want to offer vaccination and that there are groups of unvaccinated inpatients who take up the offer of influenza vaccination. In the era of COVID-19, it is particularly important this population is vaccinated. Face-to-face contact during admission is an opportunity we should be using to do this.

10.
Journal of Investigative Medicine ; 69(1):117-118, 2021.
Article in English | Web of Science | ID: covidwho-1079092
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