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2.
New Zealand Medical Journal ; 133(1519):70-80, 2020.
Article in English | Scopus | ID: covidwho-1755597

ABSTRACT

AIM: There is concern the low incidence of coronavirus disease 2019 (COVID-19) in children reflects undertesting in this population. This study sought to describe the age-distribution of SARS-CoV-2 testing in the Northern Region of New Zealand. METHODS: A retrospective single-centre review of all SARS-CoV-2 tests performed at LabPLUS, Auckland City Hospital, between 12 February and 18 April 2020. RESULTS: A total of 22,333 tests were performed, with 313 (1.40%) positive results. The age-adjusted SARS-CoV-2 testing rate was three times higher in adults than in children. The overall proportion of positive tests was lower in children (0.86%) than adults (1.45%). However, within the paediatric population the proportion of tests positive differed significantly between those <10 years old (0.08%) and those 10-14 years old (2.6%). CONCLUSION: The lower proportion of tests positive in children <10 years of age suggests they are appropriately tested relative to their rates of disease. A large high school-associated cluster makes the higher proportion of tests positive in children 10-14 years old difficult to interpret. Older children may have a higher risk of infection and increasing testing in intermediate and high school aged children may be indicated. © 2020 New Zealand Medical Association. All rights reserved.

3.
Annals of Emergency Medicine ; 78(4):S105-S106, 2021.
Article in English | EMBASE | ID: covidwho-1748253

ABSTRACT

Study Objectives: Social determinants of health (SDOH) impact patients’ health outcomes, yet screening methods in emergency departments (EDs) are inconsistent. Patients who seek care in EDs may be at greater risk for adverse SDOH than those seen by their primary care physician (PCP), but little comparable data is available. The authors sought to identify SDOH among ED Fast Track patients during the COVID-19 pandemic at an urban, safety-net hospital, measure preferred methods of resource referrals and barriers to accessing resources, and compare the prevalence of adverse SDOH among of ED Fast Track patients to that of adult PCP clinic patients. Methods: ED Fast Track patients were screened using a validated SDOH screener, and asked about the impact of COVID-19 on their SDOH. This was a convenience sample conducted from 1/15/21 to 4/13/21 and determined to be exempt by the IRB. Trained study staff completed screening and provided a printed resource guide. A two-week follow-up telephone survey assessed for barriers to resource connection. ED Fast Track patient data was then compared to concurrent SDOH data for adult PCP clinic patients, which collected the same validated SDOH screening data but was self-reported. Results: Among 414 adult ED Fast Track patients, 296 (71.5%) screened positive for at least one adverse SDOH, most commonly education (38.41%), food (35.0%), and housing insecurity (20.5%). Most (56.8%) endorsed COVID-19 affecting their SDOH. Fewer patients (36/156, 23.1%) reported attempting to connect with a resource. Barriers to accessing resources included having no time to call or visit the resource (59%), not recalling being given the resource guide (41%) or having lost it (28%). When compared to adult PCP clinic patients (Table 1), ED Fast Track patients were 10 times more likely to report at least one adverse SDOH (OR 10.0, 95% CI 6.9-14.4), 13 times more likely to report housing needs (OR 13.1, 95% CI 5.2-32.7), 8 times more likely to have food insecurity (OR 8.2, 95% CI 4.7-14.1) and 11 times more likely to have employment difficulty (OR 11.1, 95% CI 5.7-21.6). Conclusion: Most ED Fast Track patients reported at least one adverse SDOH negatively impacted by the COVID-19 pandemic. Providing printed resource guides at ED discharge may be insufficient for linking patients to resources. ED Fast Track patients were far more likely to report adverse SDOH than adult PCP clinic patients based on the unadjusted odds ratio analyses. This finding, however, is limited by the negative impact of COVID-19 on ambulatory SDOH screening rate, and a potential selection bias as patients with adverse SDOH may have experienced difficulty accessing their PCP clinics. This finding further emphasizes the need to standardize and expand SDOH screening and strengthen further resources from EDs. [Formula presented]

4.
Physiotherapy (United Kingdom) ; 114:e77-e78, 2022.
Article in English | EMBASE | ID: covidwho-1701805

ABSTRACT

Keywords: OASIS;Clinical guidelines;Virtual Purpose: The OsteoArthritis Self-management & Independent-living Support Group (OASIS Group) was set up in response to NICE Guidance CG177 in 2014, to create a cost effective yet high quality and efficient treatment pathway for people living with hip and knee osteoarthritis (Roberts & Busby 2020). The world was then changed dramatically with the appearance of the COVID-19 pandemic, which forced significant changes to ways of professional working. After the closure of non-essential services, the OASIS team were forced to revisit the NICE Guidelines in order to develop a virtual service for people with osteoarthritis (OA). Methods: During the restoration of services, the OASIS group was developed into a virtual programme to focus on the core treatment of enhancing understanding OA and its management, alongside a home exercise plan and weight loss advice. Converting to a virtual platform still required safeguards to be in place to protect patient's information and maintain confidentiality. The following documents needed to be created to ensure Information Governance principles were observed and were approved by Health & Safety and Legal teams within the trust: • Standard Operating Procedures (SOP) for managing unwell patients • SOP for using Microsoft Teams for group consultations • Risk assessment • User-agreement • Safe-home checklist • Screening tool Patient educational material from the OASIS group was converted to a virtual format to be presented to patients at each session. Patients have also been involved in the co-creation of an educational guidebook alongside the team to develop appropriate tools to aid self management. Digital versions of outcome measures, working within licencing restrictions, were also created to monitor the effectiveness of the programme. Results: The move to a virtual platform for the delivery of the OASIS programme has allowed the most vulnerable patients to access services safely. In a time when they are shielding to protect their health, the remote OASIS group provides them with a tailored treatment programme to educate and empower them to self manage their long-term condition. Conclusion(s): Moving forwards, the virtual platform is now a viable option even with the return of face-face appointments, for those people who struggle to access the service. It remains a sustainable and cost effective service to tackle the ever-growing problem of OA. Patient satisfaction and feedback will be collected after each group to ensure high quality care that meets the needs of its users. Following pilot groups, outcomes will be collected and analysed to monitor the effectiveness of the programme and compare to the original OASIS group. Impact: Development of the remote OASIS group removes the restraints of location and facility availability allowing access from a wider proportion of the population. It maintains group interactions and provides a service that keeps people safe whilst still addressing their health care needs. The foundation of processes and documents that have been developed for use with the remote OASIS programme have formed a template for future groups to be based upon. Work is underway with Keele University to develop a lower back pain virtual group, using the experiences and expertise of OASIS at its core. Funding acknowledgements: This work was not funded.

5.
Journal of European Competition Law & Practice ; 12(10):734-745, 2021.
Article in English | Web of Science | ID: covidwho-1677307
6.
Obesity ; 29(SUPPL 2):189-190, 2021.
Article in English | EMBASE | ID: covidwho-1616053

ABSTRACT

Background: Individuals living in rural areas have higher obesity and obesity related co-morbidities than their urban counterparts. Understanding rural-urban differences associated with weight management may inform the development of effective weight management interventions for adults living in rural areas. Methods: The International Weight Control Registry (IWCR) is an online registry designed to assess factors contributing to successes and challenges with weight loss and weight loss maintenance across the world. We examined demographics, weight history and weight management strategies in a sample of urban and rural residents in the Midwestern U.S. (IA, IL, IN, KS, MI, MN, MO, ND, NE, OH, SD, WI). Participants were classified as rural or urban by the Rural-Urban Commuting Area Code. Analyses included Chi-square tests for proportions and independent t-test and Wilcoxon rank sum test for continuous variables. Results: The sample was 45% rural (n = 78 of a total N = 174) with a mean age of 50.3 years. Rural residents were more likely to be white, non-college graduates, and have lower family income compared with urban areas (p < 0.05). Rural and urban residents reported similar weight histories and strategies for weight management. Work-related physical activity was higher and weekday sitting time was lower in rural compared to urban residents (p < 0.01). These data could potentially be impacted by the relative number of residents working from home during COVID-19 (Urban: 59% vs. Rural: 37%, p < 0.05). Rural residents were more likely to report a lack of neighborhood walkability (p < 0.01) and healthy food availability (p < 0.05) compared with urban residents. Conclusions: These data suggest rural-urban differences in demographic characteristics, opportunity for leisure time physical activity, and the availability of heathy foods should be considered in the development of weight management interventions. The consistency of the observed findings will be evaluated at the regional, national and international levels as the size of the available sample in the IWCR increases.

7.
American Journal of Obstetrics and Gynecology ; 226(1):S230-S231, 2022.
Article in English | EMBASE | ID: covidwho-1588480

ABSTRACT

Objective: Prompt postpartum follow-up for women with hypertension is recommended. We hypothesized that use of home blood pressure monitoring may be beneficial to improve engagement. Our aim was to utilize home blood pressure monitoring with in-person and audio-only virtual visits in women with severe hypertension. Study Design: From March 2020 – September 2020 women with severe hypertension requiring oral antihypertensive therapy postpartum were provided a blood pressure cuff at time of hospital discharge and taught to take home measurements twice daily. Follow-up was scheduled within 10 days. Due to the COVID pandemic, audio-only virtual visits were prioritized, but left to the discretion of the discharge provider. Home blood pressure logs were reviewed at each encounter and documented in the medical record. Severe hypertension was defined as 160/110 mmHg or greater. Subsequent in-person or virtual visits were determined by the provider. Follow-up data and blood pressure values up to 6 weeks postpartum were retrospectively obtained. Statistical analysis included χ2 and McNemar’s test, with a P value <.05 considered significant. Results: Blood pressure cuffs were given to 206 women. Ten (5%) women on antihypertensive therapy represented to the hospital for hypertension. Ten women were lost to follow up after discharge from the hospital, leaving 196 women (95%) who presented for at least 1 postpartum visit. Systolic and diastolic values at the first visit were significantly lower at the last postpartum visit when compared to the first. Additionally, by the last postpartum visit, women were are on less blood pressure medications than at time of discharge from the hospital (P=.048). Composite blood pressure ranges above 140/90, 150/100, and 160/110 mmHg were significantly lower at the last visit when compared to the first, except for severe diastolic values (Figure 1). Conclusion: Use of audio-only virtual visits with in person follow-up for women with severe hypertension allowed for decreased oral antihypertensive medications and a reduction in blood pressure 140/90mmHg or greater. [Formula presented] [Formula presented]

8.
American Journal of Obstetrics and Gynecology ; 226(1):S741-S742, 2022.
Article in English | EMBASE | ID: covidwho-1588406

ABSTRACT

Objective: Postpartum follow-up within 10 days is currently recommended for women with hypertension, though many women do not complete this visit. Methods beyond in-person visits may be necessary to achieve this. Our goal was to explore the use of home blood pressure monitoring with audio-only virtual visits and in-person postpartum visits for women with severe hypertension. Study Design: From March 2020 – September 2020 women with severe hypertension requiring oral antihypertensive therapy postpartum were provided a blood pressure cuff at time of hospital discharge and taught to take home measurements twice daily. Follow-up was scheduled within 10 days. Due to the COVID pandemic, audio-only virtual visits were prioritized, but left to the discretion of the discharge provider. Demographic and follow-up data up to six weeks postpartum were compiled retrospectively from the medical record. Severe hypertension was defined as blood pressure 160/110 mmHg or greater. Statistical analysis included χ2 and Student-t test, with P value <.05 considered significant. Results: Blood pressure cuffs were given to 206 women: 181 women with severe hypertension in the immediate postpartum period, and 25 who were re-admitted to the hospital with delayed-onset hypertension. Table 1 shows their demographics. Sixty-seven (32%) had pre-existing hypertension. There were 196 (95%) who had one postpartum visit, 165 (80%) had two visits. Average number of days to completion of follow-up appointment was 9 ± 6 days, with 146 (71%) following up at 10 days or less. Ten (5%) women did not return after discharge. Sixty-nine women had their first visit in-person, and 137 women had a virtual encounter. Virtual visits were more likely to be completed within 10 days (118/137 (86%) v 28/69 (41%), p<.001), and had less loss to follow-up after discharge (2/137 (1%) v 8/69 (12%), p<.001). Conclusion: In women with severe hypertension, follow-up within 10 days was more likely with audio-only virtual visits compared to clinic visits, offering an appropriate point of access to postpartum care. [Formula presented] [Formula presented]

9.
Blood ; 138:2699, 2021.
Article in English | EMBASE | ID: covidwho-1582323

ABSTRACT

Background: Successful vaccination against SARS-CoV2 is highly effective in preventing serious COVID-19 illness and is particularly recommended for at risk populations including patients with multiple myeloma (MM). However, there is uncertainty to which extent modern intensified therapies targeting plasma cell features might attenuate vaccination responses;some early vaccination recommendations for MM have proposed extended treatment breaks of several weeks to maximise vaccination success. Such an approach can be challenging in UHiR MM and pPCL, where maintaining treatment intensity is hallmark for preventing rapid relapse of the aggressive tumor. To address this uncertainty, we measured post-vaccination serological responses in patients treated uniformly with intensified Dara-VR consolidation and Dara-R maintenance post-ASCT for UHiR NDMM or pPCL in the UK OPTIMUM/MUKnine trial (NCT03188172). Methods: Between Sep 2017 and Jul 2019, 107 patients with UHiR NDMM or pPCL were recruited to OPTIMUM and received intensified post-ASCT consolidation with Dara-VR(d) for 18 cycles followed by maintenance with Dara-R until progression. In an exploratory analysis, centrally stored serum samples available for patients with a completed and documented vaccination history of two doses of an anti-SARS-CoV2 vaccine were analyzed for serological vaccine responses Total IgG/IgA/IgM Anti-SARS-CoV-2 spike glycoprotein was measured by ELISA (MK654;The Binding Site). As per UK national guidance and local availability, patients received two vaccine doses 12 weeks apart of either tozinameran (Pfizer/Biontech) or vaxzevria (AstraZeneca);serum taken at least 3 weeks after patients received their second dose was analyzed. Results were correlated with baseline characteristics and annotated with treatment and response data. Patient with available matched serological and vaccination status data at time of data cut-off (09 JUL 2021) were included. Collection of vaccination status data is ongoing and updated results comprising additional patients enrolled in OPTIMUM, as well as antigen levels, will be presented. Data will also comprise longitudinal antibody level measurements for patient with available sequential material. Results: Serological vaccine response data was available for 40 OPTIMUM patients with documented completed double vaccination status. Median patient age was 58.5 years (range 39-70) and clinical and molecular tumor features were similar to the overall trial safety population. All patients had received their second dose before June 2021. Of the 40 patients, 42.5% had received tozinameran and 57.5% vaxzevria. Baseline characteristics of the two groups were comparable. At time of second vaccine dose, 55% of patients were receiving Dara-VR consolidation treatment and 45% Dara-R maintenance. There was no recommendation to pause trial treatment for purposes of vaccination and no extended times off treatment for this reason were reported. Overall, 72.5% of patients had a positive vaccine antibody level as per manufacturer cut-point for high specificity evidence of antigen exposure (infection or vaccine). The response rate was nominally higher for vaxzevria (91.3%) than for tozinameran (47.1%), a dysbalance that will be further investigated with ongoing extension of the cohort. Of note, 90% of patients analyzed had reached a complete response (CR) of their MM prior to being vaccinated, and the majority of patients not in CR had a positive vaccine response. Response rates were nominally slightly higher in patients in receipt of Dara-R maintenance at time of second dose with 77.8% compared to Dara-VR consolidation with 68.2%. Conclusions: These results show a high serological response rate to COVID-19 vaccination in UHiR MM patients receiving intensified post-ASCT consolidation and maintenance therapy in remission. Findings suggest that continuation of intensified post-ASCT therapy for patients with aggressive tumors and a high risk of relapse are compatible with serological responses to commonly used COVID-19 vaccines. Disclosures: Jen er: Janssen: Consultancy, Honoraria, Speakers Bureau;BMS/Celgene: Consultancy, Honoraria, Speakers Bureau;Takeda: Consultancy;Pfizer: Consultancy. Hall: BMS/Celgene: Research Funding;Janssen: Research Funding. Garg: University Hospital Leicester: Current Employment;Takeda Janssen Novartis Sanofi: Other: Travel Accommodations, Expenses;Amgen Janssen Novartis Sanofi Takeda: Honoraria. Jackson: J and J: Consultancy, Honoraria, Speakers Bureau;GSK: Consultancy, Honoraria, Speakers Bureau;takeda: Consultancy, Honoraria, Research Funding, Speakers Bureau;amgen: Consultancy, Honoraria, Speakers Bureau;celgene BMS: Consultancy, Honoraria, Research Funding, Speakers Bureau;oncopeptides: Consultancy;Sanofi: Honoraria, Speakers Bureau. Pratt: Binding Site: Consultancy;BMS/Celgene: Consultancy;Gilead: Consultancy;Janssen: Consultancy;Takeda: Consultancy;Amgen: Consultancy. Cook: Karyopharm: Consultancy;Sanofi: Consultancy;Takeda: Consultancy, Research Funding;Janssen: Consultancy, Research Funding;BMS/Celgene: Consultancy, Research Funding;Amgen: Consultancy. Drayson: Abingdon Health: Current holder of individual stocks in a privately-held company. Kaiser: BMS/Celgene: Consultancy, Other: Travel support, Research Funding;Janssen: Consultancy, Other: Educational support, Research Funding;GSK: Consultancy;Karyopharm: Consultancy, Research Funding;Pfizer: Consultancy;Amgen: Honoraria;Seattle Genetics: Consultancy;Takeda: Consultancy, Other: Educational support;AbbVie: Consultancy.

10.
New Zealand Medical Journal ; 134(1542):134-136, 2021.
Article in English | MEDLINE | ID: covidwho-1414298
13.
Lung Cancer ; 156:S11-S11, 2021.
Article in English | Web of Science | ID: covidwho-1273857
14.
New Zealand Medical Journal ; 133(1525):127-131, 2020.
Article in English | GIM | ID: covidwho-1235517

ABSTRACT

The aim of the article was to present a comparison of nine SARS-CoV-2 serological assays evaluated in the Auckland region, to determine assay performance in the relevant epidemiological context. Three categories of samples were used: pre-pandemic, pandemic-RT-PCR-negative and pandemic-RT-PCR-positive. Pre-pandemic sera tested on the Abbott, in-house ELISA, cPASS and Euroimmun S1 protein assays were from healthy volunteers and patients with respiratory infections and/or symptoms (n=113). Pre-pandemic sera tested on the Euroimmun N protein, EDI IgG and Roche assays were archived blood bank sera (n=40). Pandemic samples from patients at Auckland City Hospital and Middlemore Hospital, March to May 2020, were tested on all platforms (n=103), with the exception of the Euroimmun N protein and EDI assays on which only Auckland City Hospital samples were tested (n=90). Due to volume constraints, all pandemic samples were not tested on the Abbott assay. This evaluation demonstrates that the IgG, total antibody (IgG plus IgM) and surrogate viral neutralisation assays are broadly comparable with sensitivities between 77.8-100% and specificities of 94.2-100%. In contrast, the IgA and IgM assays demonstrated poor specificity and sensitivity, respectively. This study presents a local evaluation of nine serological assays, with results specific to the epidemiological context of New Zealand. The IgG, the total antibody and surrogate viral neutralisation assays demonstrated high specificity and reasonable sensitivity. The application of these assays needs to incorporate local laboratory workflow and logistics, with respect to anticipated testing volume. These data support deployment of serological assays in New Zealand for testing high-risk groups to assist contact tracing and public health investigations.

15.
Crit Public Health ; 32(1): 31-43, 2022 Jan 01.
Article in English | MEDLINE | ID: covidwho-1201296

ABSTRACT

In order to combat the COVID-19 pandemic, policymakers around the globe have increasingly invested in digital health technologies to support the 'test, track and trace' approach of containing the spread of the novel coronavirus. These technologies include mobile 'contact tracing' applications (apps), which can trace individuals likely to have come into contact with those who have reported symptoms or tested positive for the virus and request that they self-isolate. This paper takes a critical public health perspective that advocates for 'genuine participation' in public health interventions and emphasises the need to take citizen's knowledge into account during public health decision-making. In doing so, it presents and discusses the findings of a UK interview study that explored public views on the possibility of using a COVID-19 contact-tracing app public health intervention at the time the United Kingdom (UK) Government announced their decision to develop such a technology. Findings illustrated interviewees' range and degree of understandings, misconceptions, and concerns about the possibility of using an app. In particular, concerns about privacy and surveillance predominated. Interviewees associated these concerns much more broadly than health by identifying with pre-existent British national narratives associated with individual liberty and autonomy. In extending and contributing to ongoing sociological research with public health, we argue that understanding and responding to these matters is vital, and that our findings demonstrate the need for a forward-looking, anticipatory strategy for public engagement as part of the responsible innovation of the COVID-19 contact-tracing app in the UK.

16.
Open Forum Infectious Diseases ; 7(SUPPL 1):S337, 2020.
Article in English | EMBASE | ID: covidwho-1185901

ABSTRACT

Background: Solid organ transplant (SOT) recipients are more susceptible to viral infection and present with differing viral kinetics when compared to non-immunocompromised cohorts. The duration of viral shedding in SOT recipients with SARS-CoV-2 infection is unknown. Methods: All SOT recipients with a diagnosed of SARS-CoV-2 by nasopharyngeal of bronchoalveolar lavage RT-qPCR from March 06, 2020 to May 31, 2020 were identified. Viral shedding duration was obtained by evaluating all subsequent SARS-CoV-2 PCR results following initial positivity over time. Severity classification was defined as mild (outpatient), moderate (hospitalized), and severe (ICU level care). Data were obtained from electronic medical record case review and analyzed with Stata 16. Results: 71 patients with a positive SARS-CoV-2 PCR test were identified. 50 (70.4%) were classified as mild/moderate disease, while 21 (29.5%) had severe disease. Median age was 56.5 (IQR 45 - 61.3) years, and 56.9% (n = 41) were male. Older age was significantly associated with severe disease. A disproportionate number of patients were African American/Black or Hispanic at 72.2% (n=52). Interestingly, Caucasian race was significantly associated with less severe outcomes (p=0.038). The majority of patients were kidney transplant recipients (46, 63.9%), followed by liver (13, 18.1%), heart (6, 8.3%), lung (3, 4.2%), and pancreas (9, 12.5%) with a median duration from transplantation at 5 (IQR 3 - 17) years. Overall mortality was 5.6% (n=4), with all deaths occurring only in those with severe disease (19.1%, n=4). Prolonged viral shedding was observed in few patients, with median duration of SARS-CoV-2 PCR positivity at 32 (IQR 18.5 - 41.0) days. One kidney recipient was observed with up to 64 days of positive SARS-CoV-2 RT-PCR from initial diagnosis despite not developing severe disease. Demographics and Outcomes Duration of Viral Shedding in SOT Patients with COVID-19 Conclusion: COVID-19 can lead to significant outcomes in SOT with increased mortality in those with severe disease, as well as prolonged viral shedding. Further studies are needed to elucidate the full duration of viral shedding in this population.

17.
Open Forum Infectious Diseases ; 7(SUPPL 1):S325-S326, 2020.
Article in English | EMBASE | ID: covidwho-1185881

ABSTRACT

Background: The rapid spread of SARS-CoV-2, the causative agent of Coronavirus disease 2019 (COVID-19), has been accompanied by the emergence of viral mutations, some of which may have distinct virological and clinical consequences. While whole genome sequencing efforts have worked to map this viral diversity at the population level, little is known about how SARS-CoV-2 may diversify within a host over time. This is particularly important for understanding the emergence of viral resistance to therapeutic interventions and immune pressure. The goal of this study was to assess the change in viral load and viral genome sequence within patients over time and determine if these changes correlate with clinical and/or demographic parameters. Methods: Hospitalized patients admitted to Northwestern Memorial Hospital with a positive SARS-CoV-2 test were enrolled in a longitudinal study for the serial collection of nasopharyngeal specimens. Swabs were administered to patients by hospital staff every 4 ± 1 days for up to 32 days or until the patients were discharged. RNA was extracted from each specimen and viral loads were calculated by quantitative reverse transcriptase PCR (qRT-PCR). Specimens with qRT-PCR cycle threshold values less than or equal to 30 were subject to whole viral genome sequencing by reverse transcription, multiplex PCR, and deep sequencing. Variant populations sizes were estimated and subject to phylogenetic analysis relative to publicly available SARS-CoV-2 sequences. Sequence and viral load data were subsequently correlated to available demographic and clinical data. Results: 60 patients were enrolled from March 26th to June 20th, 2020. We observed an overall decrease in nasopharyngeal viral load over time across all patients. However, the temporal dynamics of viral load differed on a patient-by-patient basis. Several mutations were also observed to have emerged within patients over time. Distribution of SARS-CoV-2 viral loads in serially collected nasopharyngeal swabs in hospitalized adults as determined by qRT-PCR. Samples were collected every 4 ± 1 days (T#1-8) and viral load is displayed by log(copy number). Conclusion: These data indicate that SARS-CoV-2 viral loads in the nasopharynx decrease over time and that the virus can accumulate mutations during replication within individual patients. Future studies will examine if some of these mutations may provide fitness advantages in the presence of therapeutic and/or immune selective pressures.

18.
Open Forum Infectious Diseases ; 7(SUPPL 1):S324, 2020.
Article in English | EMBASE | ID: covidwho-1185877

ABSTRACT

Background: The rapid spread of SARS-CoV-2, the causative agent of Coronavirus disease 2019 (COVID-19), has been accompanied by the emergence of distinct viral clades, although their clinical significance has yet to be fully elucidated. While whole genome sequencing efforts have identified viral diversity over time, less is known about the clinical significance of this diversity. This study assessed the nasopharyngeal viral loads within patients over time to determine if these changes affect clinical parameters. Methods: Samples were collected from patients presenting to Northwestern Memorial Hospital in Chicago, IL with a positive SARS-CoV-2 RT-PCR from nasopharyngeal swabs. Cycle threshold (Ct) values less than 35 were considered positive, and whole genome sequencing was performed by reverse transcription, multiplex PCR, and Nanopore sequencing. Phylogenetic analysis was conducted on sequenced isolates and compared with publicly available global sequences. Sequence characteristics and viral loads were correlated with each clade. Results: 177 samples were analyzed from March 14, 2020, through May 1, 2020. Most of the sequences (92.6%) clustered in three main clades [Figure 1]. Clade IDs were ordered by relative abundance as Clades 1 (n=122, 68.9%), 2 (n=34, 19.2%), and 3 (n=8, 4.5%). Over this time, Clade 1 viruses have been increasing in incidence across the USA and globally while Clade 2 viruses were uniquely predominant in Illinois with limited global distribution. Ct values were compared across clades [Figure 2]. Significantly lower average Ct values (higher viral loads) were observed in Clade 1 relative to both Clade 2 (p=0.0002) and Clade 3 (p=0.0011). These findings were independent of time from symptom onset to specimen collection. Phylogenetic Analysis of SARS-CoV-2 Isolates with Number of Clades and Clade Distribution Conclusion: These data suggest that SARS-CoV-2 genotype may impact viral load in the upper airways. It remains to be determined whether this difference in clades may impact transmission potential and overall viral spread. Further longitudinal studies with more specimens and associated clinical data are needed.

19.
Thorax ; 76(SUPPL 1):A20-A21, 2021.
Article in English | EMBASE | ID: covidwho-1146168

ABSTRACT

Objective: Asthma diagnostic guidelines from NICE mandate up to five tests in a sequential algorithm, three of which are aerosol generating procedures (AGPs) [spirometry, reversibility (BDR), bronchial challenge testing (BCT)]. The SARS-CoV-2 pandemic has resulted in significant restrictions to AGPs, highlighting the urgent need for an alternative diagnostic model. We aimed to develop a 'rule-in' diagnostic model using non AGPs [chest auscultation, exhaled nitric oxide (FeNO), two week-peak flow variability (PEFv) and serum eosinophils (eos)] which would enable GPs to confidently diagnose asthma in a subgroup of patients and reduce the need for AGPs and onward referral. Methods: Symptomatic but untreated patients with physician-suspected asthma were referred into the RADicA (Rapid Access Diagnostics in Asthma) study. Patients underwent clinical consultation followed by tests including FeNO, spirometry, BDR, PEFv, BCT, and eos. Asthma diagnosis was made on the basis of all available information (including response to eight weeks inhaled corticosteroid treatment) by a panel of respiratory physicians. Data from patients coded as 'definite asthma' or 'not asthma' were evaluated, individually and in combination in order to investigate which non-AGP tests could predict asthma. PEFv was classified as a non-AGP because it is not performed in the clinical setting. Results: Of 61 symptomatic adults [median (IQR) age 32(26-44)yrs, 62% female] 61% had 'definite asthma' by expert panel decision. Each of the four non-AGP tests were able to predict asthma with low sensitivity and high specificity (figure 1). Using established cut-offs (PEFv>20%, FeNO≥40ppb, eos>0.4 × 109/L), an algorithm which simply required the presence of two or more positive tests was able to 'rule-in' asthma with a specificity (95% CI) of 100(78-100)%, sensitivity 20(8-39)%. In comparison using all available tests required for the NICE algorithm resulted in a sensitivity of 53(34-72)%, specificity 100(79-100)%. Conclusion: Four simple non-AGPs could be used in primary care to accurately diagnose asthma. The majority of patients (Figure presented) with negative tests would still require further investigation, and so it is clear that AGPs, or novel alternatives, are still required for the diagnosis of asthma in most patients.

20.
PLoS One ; 16(2): e0246123, 2021.
Article in English | MEDLINE | ID: covidwho-1082172

ABSTRACT

BACKGROUND: Nasal High Flow (NHF) therapy delivers flows of heated humidified gases up to 60 LPM (litres per minute) via a nasal cannula. Particles of oral/nasal fluid released by patients undergoing NHF therapy may pose a cross-infection risk, which is a potential concern for treating COVID-19 patients. METHODS: Liquid particles within the exhaled breath of healthy participants were measured with two protocols: (1) high speed camera imaging and counting exhaled particles under high magnification (6 participants) and (2) measuring the deposition of a chemical marker (riboflavin-5-monophosphate) at a distance of 100 and 500 mm on filter papers through which air was drawn (10 participants). The filter papers were assayed with HPLC. Breathing conditions tested included quiet (resting) breathing and vigorous breathing (which here means nasal snorting, voluntary coughing and voluntary sneezing). Unsupported (natural) breathing and NHF at 30 and 60 LPM were compared. RESULTS: Imaging: During quiet breathing, no particles were recorded with unsupported breathing or 30 LPM NHF (detection limit for single particles 33 µm). Particles were detected from 2 of 6 participants at 60 LPM quiet breathing at approximately 10% of the rate caused by unsupported vigorous breathing. Unsupported vigorous breathing released the greatest numbers of particles. Vigorous breathing with NHF at 60 LPM, released half the number of particles compared to vigorous breathing without NHF.Chemical marker tests: No oral/nasal fluid was detected in quiet breathing without NHF (detection limit 0.28 µL/m3). In quiet breathing with NHF at 60 LPM, small quantities were detected in 4 out of 29 quiet breathing tests, not exceeding 17 µL/m3. Vigorous breathing released 200-1000 times more fluid than the quiet breathing with NHF. The quantities detected in vigorous breathing were similar whether using NHF or not. CONCLUSION: During quiet breathing, 60 LPM NHF therapy may cause oral/nasal fluid to be released as particles, at levels of tens of µL per cubic metre of air. Vigorous breathing (snort, cough or sneeze) releases 200 to 1000 times more oral/nasal fluid than quiet breathing (p < 0.001 with both imaging and chemical marker methods). During vigorous breathing, 60 LPM NHF therapy caused no statistically significant difference in the quantity of oral/nasal fluid released compared to unsupported breathing. NHF use does not increase the risk of dispersing infectious aerosols above the risk of unsupported vigorous breathing. Standard infection prevention and control measures should apply when dealing with a patient who has an acute respiratory infection, independent of which, if any, respiratory support is being used. CLINICAL TRIAL REGISTRATION: ACTRN12614000924651.


Subject(s)
Exhalation , Oxygen Inhalation Therapy/adverse effects , Oxygen Inhalation Therapy/methods , Adult , Breath Tests/methods , COVID-19/therapy , Cannula , Female , Humans , Male , Microscopy, Video , Nose/chemistry , Respiration , Respiratory Rate
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