Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 48
Filter
1.
Phi Delta Kappan ; 104(2):44-49, 2022.
Article in English | Web of Science | ID: covidwho-2070661

ABSTRACT

The COVID-19 pandemic, societal racial reckonings, and pressure from parents and the media have put education leaders in a crisis. Carole Learned-Miller of the Leadership Academy in New York spoke with school and education organization leaders who saw their organizations through a variety of challenges, including the pandemic, racial inequities, a teacher strike, and a financial crisis. These leaders shared some of the principles that helped them through. These include building relationships, communicating clearly, listening to other views, having trusted advisers, being true to their values, and staying hopeful. Leaders describe how these principles helped them weather difficult times.

2.
Journal of the Intensive Care Society ; 23(1):28-29, 2022.
Article in English | EMBASE | ID: covidwho-2042995

ABSTRACT

Introduction: Prone positioning is commonly used when treating ventilated Covid-19 patients. Whilst there have been some reports of ICU proning-related injuries to the brachial plexus well before the pandemic (Goettler et al. 2002), it is usually a very uncommon complication. Despite guidance from the Faculty of Intensive Care Medicine on the care of the proned patient, cases of peripheral neuropathies following ICU admission have significantly increased during the Covid-19 pandemic at our centre (Miller et al. 2021). Nerve injury is associated with reduced quality of life, impaired activity participation and persistent pain (Bailey et al. 2009). Objectives: The aim of this quality improvement project was to identify the effect that new guideline development and related healthcare professional education had on the number and severity of peripheral neuropathies identified following Covid-19 ICU admission. Methods: Between March 2020 and May 2021, we collected clinical data from patients who sustained peripheral neuropathies during their inpatient stay for Covid-19. Data were collected via face-to-face patient assessments within acute nerve clinics or post-ICU rehabilitation wards. A grading system was used to categorise the peripheral nerve injuries into severe, intermediate and mild (Power et al. 2020). Electronic ICU clinical noting was examined to identify the frequency and duration of each proning episode for each patient who presented with nerve injury. Following the first surge in 2020 updated proning guidelines were developed with ICU team leaders and disseminated. This involved face-to-face education of frontline staff. Results: At our centre 93 patients survived Covid ICU between March -June 2020 (surge 1) and 21 of those sustained nerve injury (22.58%). 309 patients survived Covid ICU between September 2020 -May 2021 (surge 2) and 12 of those sustained nerve injury (3.88%). For patients who sustained nerve injury, the average number of prones changed between surges from 6 to 13. The average duration of each episode of proning changed from 17.8hrs to 18.6hrs. Despite the increase in prone frequency, nerve injury occurrence reduced (proportionate to the number of patients who survived Covid ICU) by 82%. 14/21 (66%) injuries acquired in the first surge were of high grade and 4/ 12 (33%) were of high grade during the second surge. Conclusion: Optimising positioning of the proned ventilated patient may reduce the incidence of nerve injury. However, we must also acknowledge that changes in medical management between surges (i.e. use of dexamethasone, remdesivir) may have contributed to this. Individuals still developed severe injury despite this change in practice. Further research looking into risk factors and further methods of optimising the prone positioning on ICU is warranted to reduce the occurrence of this potentially life-changing injury.

3.
ASAIO Journal ; 68:66, 2022.
Article in English | EMBASE | ID: covidwho-2032185

ABSTRACT

Background: The COVID-19 pandemic has led to a significant increase in the use of Veno-venous extracorporeal membrane oxygenation (VV ECMO) as a bridge to various outcomes including transplantation or recovery. Unlike other etiologies of acute respiratory distress syndrome (ARDS), utilization of VV ECMO in COVID-19 has been associated with longer duration of ECMO support requirements. Our team sought to evaluate outcomes associated with prolonged duration of ECMO support in this patient population. Methods: Single-center retrospective review of patients who were placed on ECMO due to COVID-19 associated ARDS. Specifically examining outcomes-mortality, transplantation and discharge rates-of patients requiring VV ECMO support more than 50 days in duration. Data collected between February 15,2020 to February 15, 2022. Results: Reviewed outcomes in 18 patients who required VV support for >50 days. Twenty three percent (n=4) mortality rate within cohort. Three patients (16%) continue to require ECMO support at time of submission. Sixty-one percent (n=11) patients were discharged, of which sixteen percent (n=3) required a lung transplant (Table). Summary: Prolonged VV ECMO at our center was associated with comparable outcomes to the national ELSO pulmonary ECMO cohort. With availability of device and staffing, prolonged ECMO runs can potentially be justified in a highly selected patient population (Table Presented).

4.
Gut ; 71:A80-A81, 2022.
Article in English | EMBASE | ID: covidwho-2005360

ABSTRACT

Introduction As part of the national Hepatitis C (HCV) elimination strategy, NHS England aims to eliminate HCV by 2025. As part of this programme, identifying undiagnosed cases through HCV testing is critical. Unfortunately, the global COVID 19 pandemic led to a reduction in HCV testing in England, potentially slowing progress towards elimination. To mitigate the impact of this, innovative ways of increasing HCV testing are required. Individuals detained in police custody have higher rates of injecting drug use than the general population and may therefore be at risk of HCV transmission. Police custody suites may therefore provide an opportunity to offer HCV testing to 'at risk' individuals. In collaboration with local police custody healthcare staff, we developed a pilot of HCV testing for individuals in police custody. Here we describe the outcomes of this pilot Methods Since 01/07/2021, all individuals presenting to Northumbria police custody suites who were reviewed by a healthcare professional were offered Dried Blood Spot test (DBS) for HCV Antibody/RNA, HIV and HBsAg. Individuals were excluded if they were <16 years of age or alleged perpetrators of sexual violence. The Newcastle HCV team were responsible for informing people of their results and establishing those with a positive HCV result on a treatment pathway. Results Of the 3116 people in police custody identified as eligible to be offered BBV testing (See figure 1), 193 accepted (6%). A total of 19 were HCV Ab positive (10% of total individuals tested) and of these 12 were HCV RNA detected (63.0% of HCV Ab positive and 6% of total individuals tested). No cases of HIV or hepatitis B were identified. 137 (71.0%) individuals were negative for all BBV's. Unfortunately, 37 (19%) samples could not be processed by the lab due to insufficient samples (19.0%). This was identified as a training issue and addressed by senior custody suite staff. of the 12 cases of active HCV identified, 5 have commenced HCV antiviral treatment, 6 are awaiting treatment and 1 person is awaiting retesting as the result was 'weak positive'. of the 7 individuals who were HCV Antibody positive but RNA negative, 3 had self-cleared, 3 were known to have received antiviral treatment and achieved a sustained virological response and 1 patient was currently on treatment. Conclusions The pilot demonstrated that HCV screening can successfully be implemented into the police custody suites, leading to a diagnosis of active HCV in 6%. Wider implementation of this strategy could help progress towards HCV elimination.

5.
Antimicrobial Stewardship and Healthcare Epidemiology ; 2(1), 2022.
Article in English | Scopus | ID: covidwho-1984306

ABSTRACT

In this prospective, longitudinal study, we examined the risk factors for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among a cohort of chronic hemodialysis (HD) patients and healthcare personnel (HCPs) over a 6-month period. The risk of SARS-CoV-2 infection among HD patients and HCPs was consistently associated with a household member having SARS-CoV-2 infection. ©

6.
Appl Opt ; 61(19): 5559-5566, 2022 Jul 01.
Article in English | MEDLINE | ID: covidwho-1923648

ABSTRACT

As the COVID-19 pandemic was overtaking the world in the spring of 2020, the National Institute of Standards and Technology (NIST) began collaborating with the National Biodefense Analysis and Countermeasures Center to study the inactivation of SARS-CoV-2 after exposure to different ultraviolet (UV) and blue light wavelengths. This paper describes a 1 kHz pulsed laser and projection system used to study the doses required to inactive SARS-CoV-2 over the wavelength range of 222 to 488 nm. This paper builds on NIST's previous work for water pathogen inactivation using UV laser irradiation. The design of the laser and projection system and its performance in a Biosafety Level 3 (BSL-3) laboratory are given. The SARS-CoV-2 inactivation results (published elsewhere by Schuit, M.A., et al., expected 2022) demonstrate that a tunable laser projection system is an invaluable tool for this research.


Subject(s)
COVID-19 , Disinfection , Humans , Disinfection/methods , SARS-CoV-2 , Pandemics , Ultraviolet Rays , Lasers , Water
7.
ASAIO Journal ; 68(SUPPL 1):5, 2022.
Article in English | EMBASE | ID: covidwho-1912945

ABSTRACT

Purpose of study: Due to the high incidence of ARDS in those with COVID-19, ECMO centers began utilizing this therapy in early phases of the pandemic. Although receiving care at a high volume ECMO center has been associated with improved mortality amongst this patient population, there are significant obstacles associated with providing this service to those residing far from such centers. Amidst a pandemic, these challenges are compounded. Our urban, academic medical center serves as one of the highest volume ECMO referral centers in the Southeastern United States;amidst the pandemic we expanded our geographical boundaries to provide aid to those in need. Authors sought to describe characteristics of patients transported, evaluate for potential predictors of treatment success and to review our remote cannulation training and process. Additionally to identify transport associated challenges and lessons learned. Methods: Retrospective case series of critically ill, adult patients (≥18 years of age) with laboratory-confirmed COVID-19 transported to our medical center by our ECMO transport team from March 24, 2020 through June 8, 2021. Our team examined: age, gender, body mass index, ratio of arterial partial pressure to fractional inspired oxygen (P/F ratio);duration of mechanical ventilation, ECMO support and ICU admission. Descriptive statistics including mean, standard deviation, ranges, median, percentages and associated interquartile ranges (IQR) were used. Summary of results: 63 adult patients admitted to the Intensive Care Unit (ICU) with COVID associated ARDS requiring ECMO support were admitted to our ECMO center. The mean age of those transferred was 44 years old [SD 12;IQR 36-56] (Table 1). Fifty nine percent [n=37] of patients were male, fifty two percent [n=33] were African American, and the average body mass index (BMI) of our cohort was 39.7 [SD 11.3;IQR 31-48.5]. Medical history of hypertension and diabetes were commonly noted in forty six and twenty four percent of patients respectively (Table 1). All but one patient [n=62] required mechanical ventilation during their hospitalization. The majority of patients [77.8%;n=35] had severe ARDS -defined as P/F ratio less than 100-on transfer. Median days of admission and mechanical ventilation at the time of ECMO initiation were 8 days [IQR 5-12] and 4 days [IQR 2-6] respectively. Majority of patients [92% n=58] were transferred from facilities outside of our healthcare system and via ambulance [98.3% n=57]. Amidst those, eighty seven percent [n=55] were remotely cannulated (Table 2). Transport distances ranged from 2.2 to 236 miles [median 22.5 miles;IQR 8.3-79] and round trip transport times-not including time for pre cannulation preparation, cannulation, initiation of ECMO support and preparing patients for transport-ranged from 18 to 476 minutes [median 83 min;IQR 44-194]. Median duration of ECMO support was 17 days [IQR 9.5-34.5]. Duration of mechanical ventilator support was a median of 24 days [IQR 14-34]. Length of stay in the intensive care unit (ICU) [median 36 days;IQR 17-49] and hospital [median 39 days;IQR 25-57] varied. Amongst those discharged thus far, sixty percent survived [n=31]. Twenty nine percent percent [n=10] were discharged to their homes, fifty three percent [n=18] to rehabilitation facilities and nine percent [n=3] were back to the referral medical centers for continuation of care once they were determined to no longer have need for ECMO or transplantation. The majority of factors evaluated were not found to be statistically significant predictors of treatment success. Although ICU and hospital duration were noted to have p-values of significance, the associated odds ratios and small sample size make true clinical significance difficult to interpret.

8.
J Photochem Photobiol B ; 233: 112503, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1907356

ABSTRACT

Numerous studies have demonstrated that SARS-CoV-2 can be inactivated by ultraviolet (UV) radiation. However, there are few data available on the relative efficacy of different wavelengths of UV radiation and visible light, which complicates assessments of UV decontamination interventions. The present study evaluated the effects of monochromatic radiation at 16 wavelengths from 222 nm through 488 nm on SARS-CoV-2 in liquid aliquots and dried droplets of water and simulated saliva. The data were used to generate a set of action spectra which quantify the susceptibility of SARS-CoV-2 to genome damage and inactivation across the tested wavelengths. UVC wavelengths (≤280 nm) were most effective for inactivating SARS-CoV-2, although inactivation rates were dependent on sample type. Results from this study suggest that UV radiation can effectively inactivate SARS-CoV-2 in liquids and dried droplets, and provide a foundation for understanding the factors which affect the efficacy of different wavelengths in real-world settings.


Subject(s)
COVID-19 , SARS-CoV-2 , Disinfection/methods , Humans , Light , Ultraviolet Rays , Virus Inactivation/radiation effects
9.
Journal of Clinical Urology ; 15(1):82, 2022.
Article in English | EMBASE | ID: covidwho-1869011

ABSTRACT

Introduction: Recent NHSEI policy and the COVID-19 pandemic are increasing the proportions of consultations occurring non-face-to-face (F2F). Here we describe a nurse-led non-F2F clinic for the metabolic assessment of kidney stone patients. Method: A metabolic assessment may be indicated in patients forming urate stones, CaPO4 stones, or recurrent stones or with clinical features suggesting a metabolic cause. In otherwise uncomplicated clinical scenarios, these patients are reviewed in a non-F2F clinic run by an endo-urological specialist nurse. A stone history is taken by telephone. Blood tests are arranged in primary care. A collapsible 24-hour urine collection container is posted to the patient and returned via the primary care sample collection service. The cases are reviewed at the Metabolic Stone MDT by the nurse, nephrologist and urologist. Results: A total of 145 patients were eligible with six DNAs, leaving 139 patients reviewed through the non-F2F clinic between March 2020 and June 2021. Demographics were 81 males: 58 females, age range 17-83. About 126 of 139 (91%) patients completed the tests, which is a significantly higher rate than completion rates typically reported. Stone analysis was also available in 97 patients (28 CaOx;54 CaPO4;15 urate). Around 102 patients (81%) were discharged with dietary advice, while 24 patients (19%) were referred for consultant review. Two patients had primary hyperparathyroidism. Nineteen patients had hypercalciuria, all requiring consultant review. Conclusion: Nurse-led non-F2F review streamlines the metabolic assessment of stone-formers, reducing the need for hospital attendances and reducing consultant workload.

10.
Journal of Investigative Medicine ; 70(4):1160-1161, 2022.
Article in English | EMBASE | ID: covidwho-1868764

ABSTRACT

Purpose of Study Amidst the COVID 19 pandemic, hospitals implemented changes in labor and delivery practice, including limiting maternal and neonatal length of stay. A key aspect of neonatal care during the first few days of life is trending bilirubin. Modifications in newborn length of stay may lead to premature infant discharge before bilirubin rises enough to require phototherapy. The purpose of this study is to determine if there was a significant increase in the number of neonates presenting to our Emergency Department and admitted for hyperbilirubinemia in the COVID 19 era. Methods Used A retrospective chart review of infants 0-7 days old presenting to the Emergency Department (ED) with jaundice from March 01-November 01 of 2017, 2018, 2019 and 2020 was completed. Data collected included gestational age, day of life (DOL) at presentation, peak serum bilirubin level, presence of hyperbilirubinemia and neurotoxic risk factors, and length of stay (LOS). Chi square and t-tests determined differences between the study periods. Logistic regression was used to describe associations between COVID era and management of hyperbilirubinemia after adjusting for gestational age and peak serum bilirubin. Summary of Results Our analysis included 209 infants, 144 from the pre-pandemic period (48/year) and 65 after the onset of the pandemic. There was a statistically significant increase in the number of infants presenting to the ED with hyperbilirubinemia in the COVID era (p=0.04, table 1). A larger proportion of infants presenting with hyperbilirubinemia were admitted in the COVID era (41% vs 20%, p=0.001). A higher percentage of patients had a LOS of 2 or more days in the COVID era as compared to pre-pandemic (21.5% vs 6.3%, p=0.001). After adjusting for gestational age or peak serum bilirubin, infants presenting to the ED with hyperbilirubinemia had higher odds of being admitted (OR 2.8, 95% CI 1.5-5.2) and having a LOS of 2 or more days (OR 3.5, 95% CI 1.5-9.9). Conclusions Our study indicates that the number of patients presenting to the emergency department with hyperbilirubinemia in the first week of life increased following the onset of the pandemic. These patients had a higher likelihood of admission and longer length of stay compared to pre-pandemic visits. While some of these results may be attributable to earlier post-partum discharge, this was not due to variations in gestational age or peak bilirubin levels. Further studies show examine causes for these changes, particularly around decisions to admit infants with hyperbilirubinemia and the inability to perform home nursing visits during the early days of the pandemic. (Table Presented).

11.
Oncology Nursing Forum ; 49(2):1, 2022.
Article in English | Web of Science | ID: covidwho-1849133
12.
Annals of Behavioral Medicine ; 56(SUPP 1):S435-S435, 2022.
Article in English | Web of Science | ID: covidwho-1848694
13.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816908

ABSTRACT

Background and Purpose: Until a vaccine is widely available, adherence to COVID-19 preventive behaviors is the most effective way to prevent the spread of the COVID-19 pandemic. While there is a general paucity of information on COVID-19 infection and its impact on cancer patients, immunocompromised individuals, such as cancer patients, are likely at greater risk for both COVID-19 morbidity and mortality. In addition, a cancer diagnosis can cause stress, anxiety, depression, psychological distress, and poor quality of life. While the recommendations for COVID-19 parallel the common recommendations for managing infection risk, the enhanced social isolation and limited social distancing can be even more difficult for patients resulting in increased risk for psychological distress and deteriorations in health outcomes. Depressive disorders frequently result in substantial functional impairment, as well as increased emotional, economic, and productivity costs. It is important to understand how the COVID-19 pandemic impacts psychological and psychosocial factors, as well as health behaviors of cancer patients and survivors, and how various contextual factors may play risk and protective roles. The purpose of this study, therefore, is to determine differences in stress, mental health and coping behaviors, and adherence to COVID-19 preventive behaviors during the COVID-19 pandemic among three groups of adults (in active cancer treatment, cancer survivors, and those without a history of cancer). This study focuses on determining how sociodemographic characteristics and cancer status influence COVID-19 mental health/coping mechanisms, as well as how mental health/coping mechanisms and cancer status may predict adherence to preventive COVID-19 behaviors. Methods: Panel survey firm Qualtrics was used to administer an online survey among 897 U.S. adults in May of 2020. Quota sampling was utilized to ensure a sample consisting of approximately one-third: cancer patients currently in treatment (32.0%, n = 287), cancer survivors not currently in treatment (33.6%, n=301), and respondents with no cancer history (34.4%, n = 309). Survey items assessed demographic variables, depression, coping, and adherence to COVID-19 preventive behaviors. Results and Discussion: Preliminary analyses show that cancer patients report higher levels of depressive symptoms than survivors and the control group. In addition, cancer patients in active treatment use both avoidance and approach-focused coping more frequently than both survivors and the control group. Regression analyses show that avoidance coping predicts lower adherence to COVID-19 preventive behaviors, while approach-focused coping predicts higher adherence. Analyses are ongoing.

14.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816905

ABSTRACT

Purpose: To determine patterns of and factors associated with COVID-19-related preventive behaviors practiced by cancer survivors. Methods: Participants (N=897) were recruited through a commercial survey administration and sampling company, Qualtrics, in June 2020. Quota sampling was utilized to ensure the sample would consist of approximately one-third of cancer patients currently in treatment, one-third of cancer survivors not currently in treatment, and one-third of individuals without a history of cancer. Survey items collected information on socio-demographic characteristics (age, gender, race, and education attainment) and COVID-19-related preventive behaviors in the past week. Eight items focused on handwashing, avoiding contact with sick people, staying home when feeling sick, respiratory hygiene, avoiding touching face, social distancing, avoiding large gatherings, and wearing a mask were reported on a 4-point Likert scale (never to frequently). Differences between groups were assessed using one-way ANOVAs with Tukey post hoc tests. Results: Respondents were 49.6 years (SD=17.3) on average, 51.6% female, and 48.9% had a Bachelor's degree or higher education attainment. Most respondents were White (66.7%), with 16.8% Black and 16.5% Hispanic participants. Those with no history of cancer were more likely to avoid someone ill (p<.01) and stay home when sick (p<.001) than cancer survivors not currently in treatment. However, survivors were less likely to stay home when sick than cancer patients in treatment (p=001) and less likely to avoid touching their face (p<.05) than those with no cancer history. Analyses are ongoing and will explore factors related to COVID-19 preventive behaviors within each group. Conclusions: There are differences in COVID-19-related preventive behaviors by cancer status. Future research should examine the factors underlying these differences and adapt prevention efforts using this information.

15.
J. Res. Natl. Inst. Stand. Technol. ; 126:33, 2022.
Article in English | Web of Science | ID: covidwho-1791943

ABSTRACT

The development of an international, precompetitive, collaborative, ultraviolet (UV) research consortium is discussed as an opportunity to lay the groundwork for a new UV commercial industry and the supply chain to support this industry. History has demonstrated that consortia can offer promising approaches to solve many common, current industry challenges, such as the paucity of data regarding the doses of ultraviolet-C (UV-C, 200 nm to 280 nm) radiation necessary to achieve the desired reductions in healthcare pathogens and the ability of mobile disinfection devices to deliver adequate doses to the different types of surfaces in a whole-room environment. Standard methods for testing are only in the initial stages of development, making it difficult to choose a specific UV-C device for a healthcare application. Currently, the public interest in UV-C disinfection applications is elevated due to the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes the respiratory coronavirus disease 19 (COVID-19). By channeling the expertise of different UV industry stakeholder sectors into a unified international consortium, innovation in UV measurements and data could be developed to support test methods and standards development for UV healthcare equipment. As discussed in this paper, several successful examples of consortia are applicable to the UV industry to help solve these types of common problems. It is anticipated that a consortium for the industry could lead to UV applications for disinfection becoming globally prolific and commonplace in residential, work, business, and school settings as well as in transportation (bus, rail, air, ship) environments. Aggressive elimination of infectious agents by UV-C technologies would also help to reduce the evolution of antibiotic-resistant bacteria.

16.
J. Res. Natl. Inst. Stand. Technol. ; 126:29, 2022.
Article in English | Web of Science | ID: covidwho-1791942

ABSTRACT

Data for interpreting virus inactivation on N95 face filtering respirators (FFRs) by ultraviolet (UV) radiation are important in developing UV strategies for N95 FFR disinfection and reuse for any situation, whether it be everyday practices, contingency planning for expected shortages, or crisis planning for known shortages. Data regarding the integrity, form, fit, and function of N95 FFR materials following UV radiation exposure are equally important. This article provides these data for N95 FFRs following UV-C irradiation (200 nm to 280 nm) in a commercial UV-C enclosure. Viral inactivation was determined by examining the inactivation of OC43, a betacoronavirus, inoculated on N95 FFRs. Different metrological approaches were used to examine irradiated N95 FFRs to determine if there were any discernible physical differences between non-irradiated N95 FFRs and those irradiated using the UV-C enclosure. Material integrity was examined using high-resolution scanning electron microscopy. Form, fit, and function were examined using flow resistance, tensile strength, and particle filtration measurements. A separate examination of filter efficiency, fit, and strap tensile stress measurements was performed by the National Personal Protective Technology Laboratory. Data from these metrological examinations provide evidence that N95 FFR disinfection and reuse using the UV-C enclosure can be effective.

17.
Open Forum Infectious Diseases ; 8(SUPPL 1):S281, 2021.
Article in English | EMBASE | ID: covidwho-1746640

ABSTRACT

Background. Immunocompromised (IC) patients (pts) can have prolonged SARS-CoV-2 PCR positivity, even after resolution of COVID-19 symptoms. This study aimed to determine if viable virus could be detected in samples collected > 21 days after an initial positive (pos) SARS-CoV-2 PCR in IC pts. Methods. We obtained 20 remnant SARS-CoV-2 PCR pos nasopharyngeal swabs from IC pts (bone marrow or solid organ transplant, high dose steroids, immunosuppressive medications) with a pos repeat PCR within the previous 30 days. The repeat specimens were cultured on Vero-hACE2-TMPRSS2 cells and incubated for 96 hours to assess viral viability. Viable RNA and infectious virus in the cultured cells were measured by qPCR and infectious plaque assays. RNA sequencing was performed on a HiSeq platform (Illumina). Samples also underwent SARS-CoV-2 antigen (Ag) testing (BD Veritor). Clinical data were extracted from the electronic health record by chart review. Results. Pt characteristics are in Table 1. Viral cultures from the repeat specimen were negative (neg) for 18 pts and pos for 2 (Table 2). Pt 1 is a 60M treated with obinatuzumab 19 days prior to his first pos PCR test, with repeat specimen collected 21 days later (cycle threshold (Ct) not available). Pt 1 had a low viral titer (27 PFU/mL) & a D614G mutation on sequencing. Pt 2 is a 75M treated with rituximab 10 days prior to his first pos PCR test, with repeat specimen collected 23 days later (Ct 27.56/27.74). Pt 2 had a high viral titer (2e6 PFU/mL) and D614G, S98F, and S813I mutations. Demographics of Study Population (N=20) Characteristics of patients with a positive SARS-CoV-2 viral culture Conclusion. 90% of specimens collected > 21 days after an initial pos SARS-CoV-2 PCR did not have viable virus detected on their repeat specimen. The 2 pts with pos viral cultures had active hematologic malignancies treated with an anti-CD20 mAb at the time of COVID-19 diagnosis. One pt had a high concentration of active, viable virus. No known variants of concern were noted in this cohort, collected in Q2 2020, though prolonged replication is a risk for variant development. Further data are needed about risk factors for persistent viable viral shedding & methods to prevent transmission of viable virus from IC hosts.

19.
MEDLINE;
Preprint in English | MEDLINE | ID: ppcovidwho-326681

ABSTRACT

As novel SARS-CoV-2 variants continue to emerge, it is critical that their potential to cause severe disease and evade vaccine-induced immunity is rapidly assessed in humans and studied in animal models. In early January 2021, a novel variant of concern (VOC) designated B.1.429 comprising 2 lineages, B.1.427 and B.1.429, was originally detected in California (CA) and shown to enhance infectivity in vitro and decrease antibody neutralization by plasma from convalescent patients and vaccine recipients. Here we examine the virulence, transmissibility, and susceptibility to pre-existing immunity for B 1.427 and B 1.429 in the Syrian hamster model. We find that both strains exhibit enhanced virulence as measured by increased body weight loss compared to hamsters infected with ancestral B.1 (614G), with B.1.429 causing the most body weight loss among all 3 lineages. Faster dissemination from airways to parenchyma and more severe lung pathology at both early and late stages were also observed with B.1.429 infections relative to B.1. (614G) and B.1.427 infections. In addition, subgenomic viral RNA (sgRNA) levels were highest in oral swabs of hamsters infected with B.1.429, however sgRNA levels in lungs were similar in all three strains. This demonstrates that B.1.429 replicates to higher levels than ancestral B.1 (614G) or B.1.427 in the upper respiratory tract (URT) but not in the lungs. In multi-virus in-vivo competition experiments, we found that epsilon (B.1.427/B.1.429) and gamma (P.1) dramatically outcompete alpha (B.1.1.7), beta (B.1.351) and zeta (P.2) in the lungs. In the URT gamma, and epsilon dominate, but the highly infectious alpha variant also maintains a moderate size niche. We did not observe significant differences in airborne transmission efficiency among the B.1.427, B.1.429 and ancestral B.1 (614G) variants in hamsters. These results demonstrate enhanced virulence and high relative fitness of the epsilon (B.1.427/B.1.429) variant in Syrian hamsters compared to an ancestral B.1 (614G) strain. Author Summary: In the last 12 months new variants of SARS-CoV-2 have arisen in the UK, South Africa, Brazil, India, and California. New SARS-CoV-2 variants will continue to emerge for the foreseeable future in the human population and the potential for these new variants to produce severe disease and evade vaccines needs to be understood. In this study, we used the hamster model to determine the epsilon (B.1.427/429) SARS-CoV-2 strains that emerged in California in late 2020 cause more severe disease and infected hamsters have higher viral loads in the upper respiratory tract compared to the prior B.1 (614G) strain. These findings are consistent with human clinical data and help explain the emergence and rapid spread of this strain in early 2021.

20.
Cardiopulmonary Physical Therapy Journal ; 33(1):e27, 2022.
Article in English | EMBASE | ID: covidwho-1677323

ABSTRACT

BACKGROUND AND PURPOSE: The World Health Organization categorized COVID-19 as a pandemic on March 11th, 2020. Since then, maximizing survival of those infected has been the major focus of many health services. Those who suffered from the virus are now experiencing ongoing symptoms that may last several months or more. These symptoms can include fatigue, pain, muscle atrophy, weakness, and functional impairments. Due to the lack of evidence on the long-term effects of COVID-19 healthcare providers may take into account research from other relevant and more extensively studied respiratory illnesses. The purpose of this case report is to highlight the use of available research from SARS-COV in the rehabilitation of a young, previously healthy patient with severe effects of COVID-19. CASE DESCRIPTION: The patient is a 45-year-old male diagnosed with COVID19 in May 2020. He was diagnosed with a severe case and admitted to the Intensive Care Unit with hypoxemia for 4 days. His past medical history included celiac disease, post-traumatic stress disorder, and two pulmonary embolisms from COVID-19 for which he was prescribed Apixaban. He was evaluated by physical therapy in the Veterans Affairs Telehealth system in September 2020. The patient's chief complaint was fatigue and inability to perform his usual functions. This was demonstrated by the inability to ambulate greater than 2 min without rest breaks. At the time of evaluation his gait speed was >35 m/s highlighting his severely deconditioned state. The patient was treated for 12 visits over 6 months using interval training with a rate of perceived exertion progression three days per week utilizing concepts from high intensity interval training. This intervention was based upon available research on treatments of similar respiratory conditions such as SARS-COV. OUTCOMES: The patient's meaningful functional improvements included the following: patient specific functional scale improved from a range of 0-2 to a range of 8-10, 2-minute step test from 93 to 100 steps, 5 times sit to stand from 15 to 11 seconds, and 6 -minute walk test from 540 m to 600 m. Patient's PROMIS score was also taken 4 months into treatment falling into normal ranges with a T-score of 47.7 for the global physical health score. DISCUSSION: Due to limited available evidence on the treatment of long-term effects of COVID19 clinicians may interpret the best evidence for similar conditions such as SAR-COV. In the absence of evidence for effective treatments in outpatient physical therapy for a patient with novel COVID-19, using evidence from conditions with similar physiological effects seemed to be an effective strategy. Interval training reduces the ventilatory demand of exercise and reduces the sense of breathing effort as sustained traditional aerobic exercise may not be tolerated in this population. This case highlights an approach that warrants further study in this population.

SELECTION OF CITATIONS
SEARCH DETAIL