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2.
Psycho-Oncology ; 31(SUPPL 1):93, 2022.
Article in English | EMBASE | ID: covidwho-1850161

ABSTRACT

Background/Purpose: In spring 2020, New York City was a global hotspot for COVID-19 and the inpatient palliative care (PC) service at our comprehensive cancer center was rapidly transitioned to a fully virtual platform. We aimed to explore PC specialists perceived self-efficacy in meeting the psychosocial needs of acute care oncology inpatients using telehealth during the first surge of COVID-19. Methods: We used a single-site qualitative design and convenience sampling of interdisciplinary PC specialists with at least 1 year of PC experience prior to the telehealth transition. In-depth semistructured interviews were conducted via Zoom and lasted one hour. Following interview transcription, interdisciplinary coding team members used an applied thematic text analysis approach. Each coder independently reviewed, synthesized, and interpreted interview content and then convened as a group to refine the codebook and reach consensus on recurring themes. Results: Eleven PC specialists participated: social worker (n = 1);pharmacist (n = 1);chaplain (n = 1);physician assistant (n = 1);physicians (n = 4);and nurse practitioners (n = 4). One-third had previous telehealth experience and n = 7 was “not at all comfortable” or “somewhat comfortable” with delivering telehealth prior to the virtual platform transition of the PC service. Major themes included telehealth barriers and positives;perceived self-efficacy;clinician distress;impact on the quality of relationships with patients, families, oncology teams, and PC colleagues;and barriers and facilitators to coping and self-care. Participants provided explicit service- and system-level recommendations to improve the quality of tele-PC consultation during future health crises. Conclusions and Implications: Study findings describe personal and professional experiences related to a resource-constrained infrastructure during COVID-19 and myriad consequences of PC specialists feeling ineffective at fulfilling their roles. Cancer centers should integrate PC specialist recommendations for future telehealth services to guide care delivery in the context of crisis. Additional research must be conducted to explore the long-term impact of COVID-19 related tele-PC on both specialists and care recipients.

3.
Psycho-Oncology ; 31(SUPPL 1):98, 2022.
Article in English | EMBASE | ID: covidwho-1850155

ABSTRACT

Background/Purpose: Caregivers of patients with Glioblastoma Multiforme (GBM) are at risk for existential distress due to complex care needs and patients' poor prognoses. We developed Meaning- Centered Psychotherapy for Cancer Caregivers (MCP-C) to assist caregivers in connecting to a sense of meaning and purpose despite challenges. The COVID-19 pandemic has exacerbated caregivers' distress and the need for caregiver-targeted services, but pandemicrelated precautions have prevented the delivery of care in-person. The purpose of this study was to evaluate the feasibility and acceptability of delivering MCP-C over telepsychiatry. Methods: This study was part of a RCT of MCP-C versus Enhanced Usual Care among 60 caregivers of patients with GBM >18 years old who scored >4 on the Distress Thermometer. Before March 2020, MCP-C sessions were delivered in-person, then shifted to telepsychiatry due to COVID-19. At baseline, caregivers reported their preference for treatment delivery modality and location. Posttreatment, nine caregivers (five with sessions in-person, four over telepsychiatry) completed qualitative interviews providing feedback which were transcribed and analyzed using an inductive thematic analytic approach. Results: Half of participants (51.7%) preferred to receive psychosocial support through a combination of in-person and virtual methods;48.3% preferred support to take place from their home. Twenty-one caregivers completed sessions in-person and nine virtually;63.3% completed all seven sessions of MCP-C. Caregivers felt in-person and telepsychiatry sessions were equally as valuable, though they reported telepsychiatry was more convenient and was the reason several caregivers ultimately enrolled. Conclusions and Implications: Caregivers of patients with GBM endorsed favorable perceptions MCP-C delivered over telepsychiatry. Virtual delivery was feasible and more acceptable to caregivers by eliminating traditional barriers to care. A larger randomized-controlled trial comparing in-person and virtual MCP-C is needed to evaluate the efficacy of MCP-C delivered over telepsychiatry.

4.
PubMed; 2020.
Preprint in English | PubMed | ID: ppcovidwho-333616

ABSTRACT

OBJECTIVE: Patients with autoimmune diseases were advised to shield to avoid COVID-19, but information on their prognosis is lacking. We characterised 30-day outcomes and mortality after hospitalisation with COVID-19 among patients with prevalent autoimmune diseases, and compared outcomes after hospital admissions among similar patients with seasonal influenza. DESIGN: Multinational network cohort study. SETTING: Electronic health records data from Columbia University Irving Medical Center (CUIMC) (NYC, United States [US]), Optum [US], Department of Veterans Affairs (VA) (US), Information System for Research in Primary Care-Hospitalisation Linked Data (SIDIAP-H) (Spain), and claims data from IQVIA Open Claims (US) and Health Insurance and Review Assessment (HIRA) (South Korea). PARTICIPANTS: All patients with prevalent autoimmune diseases, diagnosed and/or hospitalised between January and June 2020 with COVID-19, and similar patients hospitalised with influenza in 2017-2018 were included. MAIN OUTCOME MEASURES: 30-day complications during hospitalisation and death. RESULTS: We studied 133,589 patients diagnosed and 48,418 hospitalised with COVID-19 with prevalent autoimmune diseases. The majority of participants were female (60.5% to 65.9%) and aged >=50 years. The most prevalent autoimmune conditions were psoriasis (3.5 to 32.5%), rheumatoid arthritis (3.9 to 18.9%), and vasculitis (3.3 to 17.6%). Amongst hospitalised patients, Type 1 diabetes was the most common autoimmune condition (4.8% to 7.5%) in US databases, rheumatoid arthritis in HIRA (18.9%), and psoriasis in SIDIAP-H (26.4%). Compared to 70,660 hospitalised with influenza, those admitted with COVID-19 had more respiratory complications including pneumonia and acute respiratory distress syndrome, and higher 30-day mortality (2.2% to 4.3% versus 6.3% to 24.6%). CONCLUSIONS: Patients with autoimmune diseases had high rates of respiratory complications and 30-day mortality following a hospitalization with COVID-19. Compared to influenza, COVID-19 is a more severe disease, leading to more complications and higher mortality. Future studies should investigate predictors of poor outcomes in COVID-19 patients with autoimmune diseases. WHAT IS ALREADY KNOWN ABOUT THIS TOPIC: Patients with autoimmune conditions may be at increased risk of COVID-19 infection andcomplications. There is a paucity of evidence characterising the outcomes of hospitalised COVID-19 patients with prevalent autoimmune conditions. WHAT THIS STUDY ADDS: Most people with autoimmune diseases who required hospitalisation for COVID-19 were women, aged 50 years or older, and had substantial previous comorbidities.Patients who were hospitalised with COVID-19 and had prevalent autoimmune diseases had higher prevalence of hypertension, chronic kidney disease, heart disease, and Type 2 diabetes as compared to those with prevalent autoimmune diseases who were diagnosed with COVID-19.A variable proportion of 6% to 25% across data sources died within one month of hospitalisation with COVID-19 and prevalent autoimmune diseases.For people with autoimmune diseases, COVID-19 hospitalisation was associated with worse outcomes and 30-day mortality compared to admission with influenza in the 2017-2018 season.

5.
PubMed; 2020.
Preprint in English | PubMed | ID: ppcovidwho-333508

ABSTRACT

BACKGROUND: Serological tests are crucial tools for assessments of SARS-CoV-2 exposure, infection and potential immunity. Their appropriate use and interpretation require accurate assay performance data. METHOD: We conducted an evaluation of 10 lateral flow assays (LFAs) and two ELISAs to detect anti-SARS-CoV-2 antibodies. The specimen set comprised 128 plasma or serum samples from 79 symptomatic SARS-CoV-2 RT-PCR-positive individuals;108 pre-COVID-19 negative controls;and 52 recent samples from individuals who underwent respiratory viral testing but were not diagnosed with Coronavirus Disease 2019 (COVID-19). Samples were blinded and LFA results were interpreted by two independent readers, using a standardized intensity scoring system. RESULTS: Among specimens from SARS-CoV-2 RT-PCR-positive individuals, the percent seropositive increased with time interval, peaking at 81.8-100.0% in samples taken >20 days after symptom onset. Test specificity ranged from 84.3-100.0% in pre-COVID-19 specimens. Specificity was higher when weak LFA bands were considered negative, but this decreased sensitivity. IgM detection was more variable than IgG, and detection was highest when IgM and IgG results were combined. Agreement between ELISAs and LFAs ranged from 75.7-94.8%. No consistent cross-reactivity was observed. CONCLUSION: Our evaluation showed heterogeneous assay performance. Reader training is key to reliable LFA performance, and can be tailored for survey goals. Informed use of serology will require evaluations covering the full spectrum of SARS-CoV-2 infections, from asymptomatic and mild infection to severe disease, and later convalescence. Well-designed studies to elucidate the mechanisms and serological correlates of protective immunity will be crucial to guide rational clinical and public health policies.

6.
PubMed; 2022.
Preprint in English | PubMed | ID: ppcovidwho-331840

ABSTRACT

Phage Immunoprecipitation-Sequencing (PhIP-Seq) allows for unbiased, proteome-wide autoantibody discovery across a variety of disease settings, with identification of disease-specific autoantigens providing new insight into previously poorly understood forms of immune dysregulation. Despite several successful implementations of PhIP-Seq for autoantigen discovery, including our previous work (Vazquez et al. 2020), current protocols are inherently difficult to scale to accommodate large cohorts of cases and importantly, healthy controls. Here, we develop and validate a high throughput extension of PhIP-seq in various etiologies of autoimmune and inflammatory diseases, including APS1, IPEX, RAG1/2 deficiency, Kawasaki Disease (KD), Multisystem Inflammatory Syndrome in Children (MIS-C), and finally, mild and severe forms of COVID19. We demonstrate that these scaled datasets enable machine-learning approaches that result in robust prediction of disease status, as well as the ability to detect both known and novel autoantigens, such as PDYN in APS1 patients, and intestinally expressed proteins BEST4 and BTNL8 in IPEX patients. Remarkably, BEST4 antibodies were also found in 2 patients with RAG1/2 deficiency, one of whom had very early onset IBD. Scaled PhIP-Seq examination of both MIS-C and KD demonstrated rare, overlapping antigens, including CGNL1, as well as several strongly enriched putative pneumonia-associated antigens in severe COVID19, including the endosomal protein EEA1. Together, scaled PhIP-Seq provides a valuable tool for broadly assessing both rare and common autoantigen overlap between autoimmune diseases of varying origins and etiologies.

7.
Psycho-Oncology ; 31:93-93, 2022.
Article in English | Web of Science | ID: covidwho-1756023
8.
PubMed; 2020.
Preprint in English | PubMed | ID: ppcovidwho-330665

ABSTRACT

Early identification of symptoms and comorbidities most predictive of COVID-19 is critical to identify infection, guide policies to effectively contain the pandemic, and improve health systems' response. Here, we characterised socio-demographics and comorbidity in 3,316,107persons tested and 219,072 persons tested positive for SARS-CoV-2 since January 2020, and their key health outcomes in the month following the first positive test. Routine care data from primary care electronic health records (EHR) from Spain, hospital EHR from the United States (US), and claims data from South Korea and the US were used. The majority of study participants were women aged 18-65 years old. Positive/tested ratio varied greatly geographically (2.2:100 to 31.2:100) and over time (from 50:100 in February-April to 6.8:100 in May-June). Fever, cough and dyspnoea were the most common symptoms at presentation. Between 4%-38% required admission and 1-10.5% died within a month from their first positive test. Observed disparity in testing practices led to variable baseline characteristics and outcomes, both nationally (US) and internationally. Our findings highlight the importance of large scale characterization of COVID-19 international cohorts to inform planning and resource allocation including testing as countries face a second wave.

9.
Open Forum Infectious Diseases ; 8(SUPPL 1):S805, 2021.
Article in English | EMBASE | ID: covidwho-1746280

ABSTRACT

Background. Limited data are available on whether there are differences in the immune response to SARS-CoV-2 vaccination by HIV status or by mRNA vaccine type. Methods. We saved residual outpatient laboratory samples of all previously mRNA-vaccinated individuals in the adult medicine clinics of a public hospital with a large outpatient HIV clinic during May 2021, and then excluded individuals with prior SARS-CoV-2 infection. We next 1:1 matched 100 PLWH to 100 outpatient HIVnegative adult medicine patients receiving care for chronic medical conditions on days since completion of second vaccination (minimum 10), sex, age +/-5 years, and the type of mRNA vaccine received. We defined a non-response as reciprocal pseudovirus neutralizing titer< 10 and anti-RBD IgG< 10 relative fluorescent units, and compared non-response by HIV status using mixed models. Results. In each matched group there were 13 women;25 received the mRNA-1273 vaccine and 75 received the BNT162b2 vaccine;the median age was 59. The median time from second vaccination was 35 days (IQR: 20-63). Among PLWH, the median CD4+ T-cell count was 511 (IQR: 351-796) and 5 individuals had HIV RNA > 200. We found 2.4-fold greater odds of pseudovirus neutralizing antibody non-response among PLWH compared to people without HIV (95% CI=1.1-5.4). Although few individuals in each group did not mount an IgG response (12 among PLWH vs. 5;p=0.08), continuous anti-RBD IgG concentrations were 43% lower among PLWH (95% CI=0.36-0.88). Among PLWH, when adjusting for age, sex, and days post-vaccination, each 100-cell increase in CD4+T-cell count was associated with 22% higher neutralizing antibody titers (GMR 1.22;95% CI=1.09-1.37). Unsuppressed HIV RNA >200 was associated with 89% lower neutralizing antibody titers (GMR 0.11;95% CI=0.01-0.84). Receipt of the BNT162b2 vs. mRNA-1273 vaccine was associated with 77% lower neutralizing titers (GMR 0.23;95% CI=0.08-0.65) among PLWH. Post-mRNA Vaccination SARS-CoV-2 IgG Concentrations and Pseudovirus Neutralizing Titers by HIV Status and Vaccine Conclusion. PLWH had lower than expected response to mRNA SARS-CoV-2 vaccines, with the highest non-response among those with low CD4+ counts, unsuppressed HIV RNA, and those who received the BNT162b2 vaccine. Immunization strategies to improve immune responses among PLWH should be studied, and may include booster vaccination or preference of the mRNA-1273 vaccine in this group.

10.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-330358

ABSTRACT

OBJECTIVES: To perform an international comparison of the trajectory of laboratory values among hospitalized patients with COVID-19 who develop severe disease and identify optimal timing of laboratory value collection to predict severity across hospitals and regions. DESIGN: Retrospective cohort study. SETTING: The Consortium for Clinical Characterization of COVID-19 by EHR (4CE), an international multi-site data-sharing collaborative of 342 hospitals in the US and in Europe. PARTICIPANTS: Patients hospitalized with COVID-19, admitted before or after PCR-confirmed result for SARS-CoV-2. Primary and secondary outcome measures: Patients were categorized as ever-severe or never-severe using the validated 4CE severity criteria. Eighteen laboratory tests associated with poor COVID-19-related outcomes were evaluated for predictive accuracy by area under the curve (AUC), compared between the severity categories. Subgroup analysis was performed to validate a subset of laboratory values as predictive of severity against a published algorithm. A subset of laboratory values (CRP, albumin, LDH, neutrophil count, D-dimer, and procalcitonin) was compared between North American and European sites for severity prediction. RESULTS: Of 36,447 patients with COVID-19, 19,953 (43.7%) were categorized as ever-severe. Most patients (78.7%) were 50 years of age or older and male (60.5%). Longitudinal trajectories of CRP, albumin, LDH, neutrophil count, D-dimer, and procalcitonin showed association with disease severity. Significant differences of laboratory values at admission were found between the two groups. With the exception of D-dimer, predictive discrimination of laboratory values did not improve after admission. Sub-group analysis using age, D-dimer, CRP, and lymphocyte count as predictive of severity at admission showed similar discrimination to a published algorithm (AUC=0.88 and 0.91, respectively). Both models deteriorated in predictive accuracy as the disease progressed. On average, no difference in severity prediction was found between North American and European sites. CONCLUSIONS: Laboratory test values at admission can be used to predict severity in patients with COVID-19. Prediction models show consistency across international sites highlighting the potential generalizability of these models.

11.
MEDLINE; 2021.
Preprint in English | MEDLINE | ID: ppcovidwho-329682

ABSTRACT

Blood clots are a central feature of coronavirus disease-2019 (COVID-19) and can culminate in pulmonary embolism, stroke, and sudden death. However, it is not known how abnormal blood clots form in COVID-19 or why they occur even in asymptomatic and convalescent patients. Here we report that the Spike protein from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds to the blood coagulation factor fibrinogen and induces structurally abnormal blood clots with heightened proinflammatory activity. SARS-CoV-2 Spike virions enhanced fibrin-mediated microglia activation and induced fibrinogen-dependent lung pathology. COVID-19 patients had fibrin autoantibodies that persisted long after acute infection. Monoclonal antibody 5B8, targeting the cryptic inflammatory fibrin epitope, inhibited thromboinflammation. Our results reveal a procoagulant role for the SARS-CoV-2 Spike and propose fibrin-targeting interventions as a treatment for thromboinflammation in COVID-19. One-Sentence Summary: SARS-CoV-2 spike induces structurally abnormal blood clots and thromboinflammation neutralized by a fibrin-targeting antibody.

12.
Gastroenterology ; 160(6):S-260-S-261, 2021.
Article in English | EMBASE | ID: covidwho-1598666

ABSTRACT

Background: The medical and psychological impacts of the COVID-19 pandemic on individuals affected by eosinophilic esophagitis (EoE) remain largely unknown. We seek to describe the current perceptions of COVID-19 in the EoE population of the United States (US). Methods: For this cross-sectional study, we anonymously surveyed individuals aged 18 years or older who self-identified as having EoE or as being a caregiver for someone with EoE. This survey was sent via an invitation and link to email subscribers of the American Partnership for Eosinophilic Disorders in November 2020. Our primary aim was to describe patients’ and caregivers’ perceptions of COVID-19. We collected patient demographics and asked five multiple-choice questions that assessed the responder’s anxiety related to the pandemic, belief on whether patients with EoE are at higher risk of acquiring COVID-19, willingness to take an approved vaccine, experiences with access to medical care during the pandemic, and use of social media to learn about the impact of COVID-19 on EoE. Our secondary exploratory aim was to identify patient characteristics associated with a positive response to each question. All variables were treated as categorical variables (with age dichotomized into age <48 and >48). Variables were analyzed with proportions and compared using chi-square tests. Results: The majority of responders were female (84.7%) and white (91.9%) (Table 1). The responses to COVID-19 questions are shown in Figure 1. Notably, majority (53%) of responders are anxious about the pandemic, 20% believe that patients with EoE are at higher risk of acquiring COVID-19, 41% are agreeable to taking an approved vaccine, 44% report interruptions in EoE-related care (either missed upper endoscopy or clinic visit) for themself or the person they care for, and only 24% have found social media to be useful to learn about the impact of COVID-19 on the EoE population. Caregivers are more concerned than patients that EoE patients are at higher risk of acquiring COVID-19 (OR 3.65, 95% CI 1.25-12.02). The older age group is less likely to use social media to learn about COVID-19 in the context of EoE (OR 0.35, 95% CI 0.13-0.90). There is a trend toward females being more likely to have interruptions in EoE-related care compared to males (OR 2.95, 95% CI 0.83-12.15). Conclusion: Our pilot data suggests that COVID-19 has led to anxiety and interruptions in care in the EoE population of the US. EoE care providers should take measures to address anxiety and create care plans that decrease pandemic-related delays. Further efforts should be made to study the risk of COVID-19 in EoE patients and to disperse such research on social media for easy accessibility. If and when a safe and efficacious vaccination is approved, providers will be critical in educating the EoE population on risks and benefits of vaccination. (Table presented) Baseline characteristics of all survey responders (Figure presented) Percentage of participants who responded “Yes” to each COVID-19 related question

13.
Blood ; 138:2756, 2021.
Article in English | EMBASE | ID: covidwho-1582429

ABSTRACT

The anti-CD38 monoclonal antibody Daratumumab has shown impressive activity in combination with other agents for the treatment of multiple myeloma (MM), improving progression free survival and overall survival in several phase 3 studies. We conducted a phase 1b study of intravenous Daratumumab (16 mg/kg) with weekly subcutaneous bortezomib (1.3-1.5 mg/m 2 ), cyclophosphamide (150-300 mg/m 2), and dexamethasone (40 mg) (CyBorD-DARA) as induction before autologous stem cell transplantation (ASCT), followed by CyBorD-DARA consolidation (2 cycles) and monthly DARA +/- bortezomib (in high-risk disease) maintenance for 24 months. We hypothesized that the addition of cyclophosphamide could lead to enhanced antibody dependent cellular phagocytosis (ADCP). This trial was registered at www.clinicaltrials.gov as NCT02955810. We previously reported the initial results of this study. 1. In addition to a favourable safety profile we observed promising anti-MM activity with 10 of 13 patients (77%) in whom assessment was possible achieving measurable residual disease (MRD) negativity at a sensitivity of 10 -5 by next generation sequencing (NGS) after ASCT. We now report the results at EOT, with a focus on MRD. Eligible patients were ≤70 years of age with untreated transplant-eligible MM. 18 patients were enrolled. Median age was 56.5 years (range, 32-66 years), 61% were male and 94% of patients had Eastern Cooperative Oncology Group performance status ≤1. The International Staging System stages were I, II, and III in 78%, 17%, and 6% of patients, respectively. 29% of patients had high-risk genetic features by fluorescent in situ hybridisation (FISH) or gene expression profiling, including 17p deletion in 12% and t(4;14) and t(14;16) in 6% each. On an ITT basis, the rates of very good partial remission or better (≥VGPR) after ASCT, consolidation and at end of treatment (EOT) (after completion of 24 months of DARA) were 94%, 94% and 81% respectively, and rates of complete response or better (≥CR) were 50%, 63% and 63% respectively. Measurable residual disease (MRD) assessment was possible in 13 patients after induction, ASCT and consolidation, and 10 at EOT. Sustained MRD negativity (ie. MRD negativity after ASCT, consolidation and at EOT) to a level of 10 -5 by NGS was achieved in 33% (ITT). Of 13 patients who remained on study at EOT in VGPR or better, 54% were MRD negative (MRD was unavailable in 23%). 7 patients were MRD negative after both ASCT and consolidation. Of these patients, all evaluable at EOT(6/7) remained MRD negative, with 1 patient unable to undergo MRD assessment due to the COVID-19 pandemic, but remaining in CR. Nausea and diarrhoea occurred in 89% of patients, but were mostly grade 1-2 (Grade ≥3 nausea 17%;diarrhoea 6%). Neutropenia occurred in 44% (Grade ≥3 17%), anaemia in 39% (Grade ≥3 22%), and thrombocytopenia in 33% (Grade ≥3 22%). The rate of neutropenic sepsis was 11%. Infusion-related reactions occurred in 50% (Grade ≥3 6%) and peripheral neuropathy occurred in 33% (Grade ≥3 0%) The most commonly reported serious adverse event (SAE) was sepsis in 22%. One patient developed abnormal liver function tests leading to discontinuation from the trial. CyBorD-DARA induction, consolidation and DARA-maintenance is an effective and well-tolerated IMiD free regimen in transplant-eligible patients with MM. MRD negativity at a level of > 10 -5 after ASCT and consolidation may be predictive of sustained MRD negativity at EOT. References: 1. Naicker SD, et al. Cyclophosphamide alters the tumor cell secretome to potentiate the anti-myeloma activity of daratumumab through augmentation of macrophage-mediated antibody dependent cellular phagocytosis. Oncoimmunology. 2021 Jan 25;10(1):1859263. doi: 10.1080/2162402X.2020.1859263. PMID: 33552684;PMCID: PMC7849715. 2. O'Dwyer M, et al. CyBorD-DARA is potent initial induction for MM and enhances ADCP: initial results of the 16-BCNI-001/CTRIAL-IE 16-02 study. Blood Adv. 2019 Jun 25;3(12):1815-1825. doi: 10.1182/bloodadvances.2019000010. PMID: 31201169;PMCI : PMC6595251. Disclosures: O'Dwyer: ONK Therapeutics: Current Employment, Current equity holder in publicly-traded company, Membership on an entity's Board of Directors or advisory committees;Janssen: Consultancy;Bristol Myers Squibb: Research Funding. Quinn: Takeda: Honoraria. Szegezdi: ONK Therapeutics: Research Funding.

14.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-296920

ABSTRACT

Background: Routinely collected real world data (RWD) have great utility in aiding the novel coronavirus disease (COVID-19) pandemic response [1,2]. Here we present the international Observational Health Data Sciences and Informatics (OHDSI) [3] Characterizing Health Associated Risks, and Your Baseline Disease In SARS-COV-2 (CHARYBDIS) framework for standardisation and analysis of COVID-19 RWD.

15.
American Journal of Clinical Pathology ; 156:S32-S32, 2021.
Article in English | Web of Science | ID: covidwho-1532435
16.
Journal of Gastroenterology and Hepatology ; 36:127-127, 2021.
Article in English | Web of Science | ID: covidwho-1411195
17.
Journal of Clinical Oncology ; 39(15 SUPPL), 2021.
Article in English | EMBASE | ID: covidwho-1339194

ABSTRACT

Background: Despite growing evidence of mindbody therapies for physical and psychological health among patients with cancer, their access remains limited. The COVID-19 pandemic has further disrupted the delivery of necessary cancer and supportive care;thus, the need to support patients with cancer is unprecedented. To expand the reach and access of mind-body therapies, we developed, implemented, and evaluated a novel virtual mind-body program for patients with cancer. Methods: We rapidly developed a 7-day a week virtual mind-body program, Integrative Medicine at Home (IM@Home), for patients with cancer (ages ≥18 years) and deployed it on April 1 , 2020. IM@Home included mind-body group therapy classes in fitness, meditation, yoga, dance, tai chi, and music delivered using Zoom video conferencing. Classes ranged from 30-45 minutes and were led by an integrative medicine clinician. Patients had the option to register for a 1-month, 3-month, or 6-month membership to gain unlimited access to all virtual mind-body classes. Multi-method evaluation was conducted using the RE-AIM conceptual framework to guide surveys and qualitative interviews. Surveys were analyzed using descriptive statistics and interviews were analyzed using grounded theory. Results: Between April 2020 and January 2021, IM@Home registered over 32,000 class participants, with a weekly average attendance of 700-800 participants. In a 4-month postdeployment survey (n = 131), nearly all participants were satisfied with IM@Home (93.9%) and would recommend the program to friends and family (95.4%). A majority of participants also found IM@Home to be simple to use (87.0%) and said the program had a variety of classes that interested them (93.1%). Three-quarters of participants (74.8%) were taking 3 to 7 classes a week (range: 1 to 15 classes), among which the most popular classes were fitness (88.7%), chair yoga (37.1%), and tai chi (33.1%). Most participants preferred a 3- month membership (51.6%), followed by a 6- month membership (19.5%). In qualitative interviews (n = 30), participants reported IM@Home helped them to: 1) maintain structured routines and stay motivated to exercise;2) cope with COVID-19-related and cancer-related stressors;and 3) connect with their fellow cancer patient community and foster social relationships during a time of isolation. Conclusions: Virtual mind-body programming, through IM@Home, reached many patients with cancer to address their physical and psychological challenges during COVID-19. As patients with cancer experience high physical and psychological symptom burden following diagnosis, future clinical trials are needed to evaluate the specific effects of IM@Home when integrated into active treatment and survivorship care.

18.
Gastroenterology ; 160(6):S260-S261, 2021.
Article in English | Web of Science | ID: covidwho-1250782
19.
Topics in Antiviral Medicine ; 29(1):242, 2021.
Article in English | EMBASE | ID: covidwho-1250732

ABSTRACT

Background: Although data are mixed, most cohorts show a similar or lower COVID-19 incidence among people living with HIV (PLWH) compared to the general population. However, incidence may be impacted by lower testing rates among vulnerable populations. We compared SARS-CoV-2 seroprevalence and IgG levels, and disease severity, among patients with and without HIV receiving care within a county hospital system over a three-month period. Methods: From August through October 2020, remnant serum samples were collected from all PLWH who underwent routine outpatient laboratory testing at San Francisco General Hospital which houses a large HIV clinic (Ward 86). Patients with HIV were matched on time of collection (same day) and age (+/- 5 years) to 1-2 adults without HIV. SARS-CoV-2 levels of IgG levels was quantified in serum using the Pylon IgG assay (100% specificity on internal validation). Seroprevalence was compared by HIV status via conditional logit models, adjusting for sex. For those with reactive results, IgG levels were compared by HIV status using log-transformed generalized estimating equations. Severe disease, assessed via chart review, was defined as requiring oxygen. Results: Among 1,411 individuals (46% PLWH), the median age was 58 (IQR: 49-65), 64% were men. COVID-19 seroprevalence was 3.1% among PLWH compared to 6.8% among people without HIV (adjusted odds ratio 0.41;95% confidence interval (CI): 0.25-0.68, p<0.001). Among those with reactive COVID-19 IgG results (n=72, 20 in PLWH);antibody levels were 47% lower among PLWH (95% CI: 19-65% lower;p=0.003;Figure);however, there was a trend towards higher disease severity among PLWH [15% (n=3) vs. 4% (n=2);p=0.13]. Conclusion: Both seroprevalence, and absolute SARS-CoV-2 IgG levels in those with reactive results, were lower among PLWH, within a time and agematched population of outpatients receiving routine laboratory testing in an urban hospital. PLWH may have had higher adherence to non-pharmaceutical interventions (NPIs) than those without HIV, leading to lower COVID-19 seroprevalence and, possibly, lower COVID-19 IgG levels if infected with a lower viral inoculum due to NPIs. Alternatively, PLWH may mount lower antibody responses to SARS-CoV-2, as has been demonstrated with hepatitis B and yellow fever vaccines. Further studies of COVID-19 susceptibility and immunity are needed among PLWH. Moreover, PLWH should be enrolled in SARS-CoV-2 vaccine studies or followed after vaccination to ensure they mount sufficient humoral responses.

20.
Open Forum Infectious Diseases ; 7(SUPPL 1):S314, 2020.
Article in English | EMBASE | ID: covidwho-1185857

ABSTRACT

Background: Most diagnostic tests for SARS-CoV-2, the causative agent of COVID-19, are RT-PCR based. This method is sensitive but cannot distinguish replicating from non-replicating virus. RT-PCR cycle threshold (Ct) values are inversely correlated with viral load, and higher Ct values have been correlated with lower in vitro viral infectivity. However, relatively few data exist on the association between Ct values and patients' duration of symptoms remains unclear. We thus evaluated Ct values and symptom duration in a cohort of patients hospitalized with COVID-19. Methods: We assessed all patients admitted to San Francisco General Hospital between April 1 and May 18, 2020 with confirmed COVID-19 infection based on RT-PCR testing (Abbott m2000 platform). We included patients having diagnostic testing for suspected COVID-19 and patients having asymptomatic testing per hospital policy. For symptomatic patients, date of symptom onset was abstracted from hospital records, and time from symptom onset to test date was calculated. RT-PCR Ct values were manually extracted. Median Ct and IQR were calculated for patients with < 10 days of symptoms, ≥10 days of symptoms, and asymptomatic disease. Betweengroup comparisons were performed using the Kruskal-Wallis test. Results: Among 61 patients with positive RT-PCR tests, 40 patients reported < 10 days of symptoms at the time of testing, 15 reported ≥10 days of symptoms, and 6 were asymptomatic. The median Ct value was 14.2 cycles (IQR, 10.2, 18.3) among patients reporting < 10 days of symptoms, 19.7 cycles (IQR, 15.3, 23.9) among patients reporting ≥10 days of symptoms, and 26.3 (IQR, 25.0, 29.1) among asymptomatic patients. Ct values were significantly lower among patients with < 10 days of symptoms compared to patients with >=10 days of symptoms (p=0.01) and when compared to asymptomatic patients (p=0.0002) [Figure]. Conclusion: SARS-CoV-2 RT-PCR cycle threshold values were higher (indicating lower viral load) in patients with longer symptom duration and were highest in asymptomatic patients. These results add to emerging data suggesting that strategies for optimal isolation of patients in both community and hospital settings could be informed by a combination of symptom duration and RT-PCR Ct values. (Table Presented).

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