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1.
Epidemiologia (Basel) ; 3(4): 518-532, 2022 Nov 10.
Article in English | MEDLINE | ID: covidwho-2109996

ABSTRACT

New York City (NYC) was deeply impacted by COVID-19 in spring 2020, with thousands of new cases daily. However, the pandemic's effects were not evenly distributed across the city, and the specific contributors have not yet been systematically considered. To help investigate that topic, this study analyzed the interaction of people with neighborhood businesses and other points of interest (POIs) in parts of three NYC neighborhoods in the spring of 2020 during the peak of the first COVID-19 wave through anonymized cellphone data and direct the observation of 1313 individuals leaving healthcare facilities. This study considered social vulnerability index (SVI) levels, population density, and POI visit behaviors from both cellphone data and firsthand observations of behavior around select NYC health facilities in different boroughs as various proxies. By considering equivalent businesses or groups of businesses by neighborhood, POI visits better aligned with COVID-19 infection levels than SVI. If tracking POI visit levels proves a reliable direct or relative proxy for disease transmission when checked against larger datasets, this method could be critical in both predictions of future outbreaks and the setting of customer density limits.

2.
Am J Epidemiol ; 191(11): 1897-1905, 2022 Oct 20.
Article in English | MEDLINE | ID: covidwho-2097303

ABSTRACT

We aimed to determine whether long-term ambient concentrations of fine particulate matter (particulate matter with an aerodynamic diameter less than or equal to 2.5 µm (PM2.5)) were associated with increased risk of testing positive for coronavirus disease 2019 (COVID-19) among pregnant individuals who were universally screened at delivery and whether socioeconomic status (SES) modified this relationship. We used obstetrical data collected from New-York Presbyterian Hospital/Columbia University Irving Medical Center in New York, New York, between March and December 2020, including data on Medicaid use (a proxy for low SES) and COVID-19 test results. We linked estimated 2018-2019 PM2.5 concentrations (300-m resolution) with census-tract-level population density, household size, income, and mobility (as measured by mobile-device use) on the basis of residential address. Analyses included 3,318 individuals; 5% tested positive for COVID-19 at delivery, 8% tested positive during pregnancy, and 48% used Medicaid. Average long-term PM2.5 concentrations were 7.4 (standard deviation, 0.8) µg/m3. In adjusted multilevel logistic regression models, we saw no association between PM2.5 and ever testing positive for COVID-19; however, odds were elevated among those using Medicaid (per 1-µg/m3 increase, odds ratio = 1.6, 95% confidence interval: 1.0, 2.5). Further, while only 22% of those testing positive showed symptoms, 69% of symptomatic individuals used Medicaid. SES, including unmeasured occupational exposures or increased susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to concurrent social and environmental exposures, may explain the increased odds of testing positive for COVID-19 being confined to vulnerable pregnant individuals using Medicaid.


Subject(s)
Air Pollutants , Air Pollution , COVID-19 , Pregnancy , Female , Humans , Particulate Matter/analysis , SARS-CoV-2 , Air Pollution/adverse effects , Air Pollutants/analysis , New York City/epidemiology , Prevalence , Environmental Exposure/adverse effects , Social Class
3.
Viruses ; 14(11)2022 Oct 30.
Article in English | MEDLINE | ID: covidwho-2090370

ABSTRACT

Pregnant patients have increased morbidity and mortality in the setting of SARS-CoV-2 infection. The exposure of pregnant patients in New York City to SARS-CoV-2 is not well understood due to early lack of access to testing and the presence of asymptomatic COVID-19 infections. Before the availability of vaccinations, preventative (shielding) measures, including but not limited to wearing a mask and quarantining at home to limit contact, were recommended for pregnant patients. Using universal testing data from 2196 patients who gave birth from April through December 2020 from one institution in New York City, and in comparison, with infection data of the general population in New York City, we estimated the exposure and real-world effectiveness of shielding in pregnant patients. Our Bayesian model shows that patients already pregnant at the onset of the pandemic had a 50% decrease in exposure compared to those who became pregnant after the onset of the pandemic and to the general population.


Subject(s)
COVID-19 , SARS-CoV-2 , Pregnancy , Female , Humans , COVID-19/epidemiology , COVID-19/prevention & control , Pandemics , New York City/epidemiology , Bayes Theorem
4.
J Community Psychol ; 2022 Oct 18.
Article in English | MEDLINE | ID: covidwho-2075028

ABSTRACT

To explore sociodemographic predictors for concern regarding COVID-19 transmission and how these factors interact with the identities of others, we conducted a web-based survey where we asked 568 respondents in the United States to indicate their level of COVID-19 concern in response to a series of images with short vignettes of masked and unmasked individuals of different racial/ethnic backgrounds. Using a linear mixed effects model, we found that regardless of the race of the image being presented in the vignette, concern regarding COVID-19 transmission was associated with respondents' older age (b = 0.029, p < 0.001), residing in NYC (b = 0.556, p = 0.009), being heterosexual (b = 1.075, p < 0.001), having higher levels of education, that is, completion of a Bachelor's degree (b = 1.10, p = 0.033) or graduate degree (b = 1.78, p < 0.001), and the person in the vignette being unmasked (b = 0.822, p < 0.001). Asian respondents were more likely than White respondents to be concerned regarding COVID-19. Individuals who self-reported themselves to be at high risk for COVID-19 were more likely to be concerned about COVID-19 over those who considered themselves to be low risk. These findings highlight the importance of acknowledging interactions between race, mask status, and residency in predicting COVID-19 concern.

5.
International Journal of Disaster Risk Reduction ; 81, 2022.
Article in English | Web of Science | ID: covidwho-2069095

ABSTRACT

With the publication of the Health Emergency and Disaster Risk Management (H-EDRM) Frame-work in 2019, the World Health Organization (WHO) emphasized the need for disaster prepared-ness in all sectors of the health system, including primary health care (PHC). PHC disaster pre-paredness plays a crucial role in guaranteeing continuity of care and responding to the health needs of vulnerable populations during disasters. While this is universally acknowledged as an important component of disaster management (DM), there is still a severe paucity of scholarship addressing how to practically ensure that a PHC system is prepared for disasters. The objective of this study is to propose a new framework that describes key characteristics for PHC disaster pre-paredness and lays the groundwork to deliver operational recommendations to assess and im-prove PHC disaster preparedness. A systematic literature review was performed and a total of 145 records were analyzed. Twenty-five characteristics that contribute to a well-prepared PHC system were identified and categorized according to the WHO Health System Building Blocks to form a new PHC disaster preparedness framework. The findings will contribute to the elaboration of a set of guidelines for PHC systems to follow in order to assess and then boost their disaster pre-paredness. This manuscript will hopefully help to raise awareness among international policy -makers and health practitioners on the importance to design interventions that integrate the PHC system into overall DM strategies, as well as to assess the preparedness of PHC systems in differ-ent political, developmental, and cultural contexts.

6.
Sustainability ; 14(19):12851, 2022.
Article in English | ProQuest Central | ID: covidwho-2066470

ABSTRACT

This paper aims to examine the responses of commercial real estate markets to COVID-19 and the implications for post-pandemic cities. Using data of Florida’s metropolitan areas in a fixed effect regression model, we find that sales volumes of retail properties decline instantly under the shock of COVID-19 but are followed by a strong recovery after one quarter. Meanwhile, COVID-19 depresses the growth rate of rent for office property, but the impact is short-term, and the office rental market bounces back to about 70 percent one quarter later. In comparison, industrial properties witness a rise in the growth rate of sales and rent price. Results indicate that urban planners may consider adjusting the amount of lands allocated to different usages to meet the evolving demands of urban space in the post-pandemic era.

7.
BMJ Leader ; 2022.
Article in English | ProQuest Central | ID: covidwho-2064257

ABSTRACT

Tell us a little bit about your leadership role and how it is changing as a result of the pandemic? I hold three roles, first as a clinician practising infectious diseases at two of the University of Toronto’s academic teaching hospitals. [...]as a scientist and professor studying epidemics of emerging diseases and teaching medical trainees. At BlueDot, my leadership role has evolved significantly over the course of a pandemic. [...]recently, I was overseeing multiple teams including product development, engineering, data analytics, marketing and commercialisation. [...]it was that formative experience that inspired me to create BlueDot.

8.
American Journal of Transplantation ; 22(Supplement 3):918-919, 2022.
Article in English | EMBASE | ID: covidwho-2063442

ABSTRACT

Purpose: CMS introduced new performance metrics for Organ Procurement Organizations (OPO). CDC death records define donation eligible deaths, the denominator of the donation and transplant rate metrics. The COVID-19 pandemic has had an unprecedented and geographically varied impact on United States death statistics. Thus, we examined the potential impact of COVID-19 on the calculation of the OPO performance metrics. Method(s): Eligible deaths include hospitalized decedents with "donation appropriate" diagnoses. We extracted death certificate data from the CDC WONDER system for baseline years (2015-2019) and the CDC COVID Data Tracker (after 2019). CDC aggregates data by state and broad disease groups including Circulatory Death (CD), death from Cerebrovascular Disease ICD-10 i60-i69 and Ischemic Heart Disease ICD-10 i20-i25. Deaths related to COVID (ICD-10 U07.1) were separately grouped. The proportion of CD during the pandemic was compared to baseline and correlated with COVID. Result(s): At baseline, CD accounted for 66.2% of OPO eligible deaths, increasing markedly in 2020 and 2021. (Figure A) The week of April 11, 2020, the national proportion of CD peaked at +23.8% over baseline, paralleling the dramatic increase in the proportion of deaths due to COVID (20%). Early in the pandemic, the proportion of CD and COVID deaths were strongly correlated (2020 r=.44). This attenuated over time (2021: r=.25). The CD and COVID death association evolved as the pandemic spread geographically. (Figure B) In 2020, the change in proportion of CD varied from New York (+20.6%) to Massachusetts (-6.5%). The COVID - CD correlation was highest in the Northeast and Florida, (New Jersey [.78], New York [.75] and Florida [.75]). By 2021, the change in proportion of CD was highest in Mississippi (+14.5%) and lowest in West Virginia (-28.6%), while the COVID - CD correlation diminished and spread west (Florida [.65], Tennessee [.54] and California [.53]. Conclusion(s): Accurate eligible death assessment has been difficult, leading to a shift in calculations based on ICD-10 coded death certificates instead of OPO reported deaths. CD constitutes 2/3 of recorded donation eligible deaths historically, which has been substantially, but variably, impacted by the COVID-19 pandemic. Thus, these metrics based on CDC data may be sensitive to unanticipated and uneven shocks such as disease outbreaks, leading to inaccurate estimates of donor potential. CMS metrics should be refined to better account for external shocks such as the COVID-19 pandemic. (Figure Presented).

9.
American Journal of Transplantation ; 22(Supplement 3):775, 2022.
Article in English | EMBASE | ID: covidwho-2063408

ABSTRACT

Purpose: We aimed to investigate the mortality from SARS-CoV-2 in kidney transplant recipients in the Bronx, New York since the beginning of the pandemic Methods: Between March 16, 2020 and November 5, 2021, 453 patients were diagnosed with SARS-CoV-2 infection. 316 were diagnosed by RT-PCR while the remaining 137 tested positive for anti-SARS-CoV-2 nucleocapsid IgG and did not have significant symptoms and had not been previously tested by RT-PCR Results: Of the 316 patients diagnosed by RT-PCR, 214 patients were hospitalized while 102 patients were managed at home as outpatient. 194 (61.3%) were male, median age 61 years old (IQR: 48-69), predominantly Hispanic (56.2%) and African American (29.5%). 75% received a deceased-donor renal transplant, 58% received anti-thymocyte induction. Most patients were on triple immunosuppression (95% on calcineurin inhibitors, 87% on anti-metabolite, and 97% on prednisone). Hypertension was the most common comorbidity followed by diabetes mellitus, heart disease and lung disease. A total of 65 patients (20.5%) died. The mortality rate was 37 % (47/128) in patients diagnosed between March 16 and April 30, 2020. From May 1, 2020 to end of December 2020 mortality rate has significantly decreased to 11% (7/61). Since the beginning of 2021 till November 5, 2021 the mortality rate is 7.7% (10/129). Twenty-seven patients were diagnosed with COVID-19 despite being partially of fully vaccinated (25 fully vaccinated, 2 after one dose of vaccine). 13/27 (48%) were managed at home while 14/27 (52%) were hospitalized and 2 (7%) of them died. Twenty-eight patients received treatment with casirivimab and imdevimab post diagnosis of SARS-CoV-2 starting 2021 and none of those patients have died. Conclusion(s): In summary, mortality from SARS-CoV-2 infection in kidney transplant recipients was higher earlier at the pandemic and has significantly decreased over time. This could be explained by initial exposure of the patients with higher viral load due to lack of personal protection and social distancing. However, since the judicious use of monoclonal antibodies and vaccination, in addition to social distancing protocols and use of facemask, the mortality in kidney transplant recipients has decreased over time.

10.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P174-P175, 2022.
Article in English | EMBASE | ID: covidwho-2064411

ABSTRACT

Introduction: Studies have shown that COVID-19 viral glycoproteins bind to angiotensin-converting enzyme 2 (ACE2) receptors in the airway, causing downregulation of the ACE protein and leading to angioedema-like symptoms. Further, compared with previous variants, the Omicron variant of SARS-CoV-2 appears to replicate more readily in the upper airway than in the lungs. To our knowledge, this is the first case series to explore presentations involving the upper airway in patients with SARS-CoV-2 infection during the Omicron wave of the COVID-19 pandemic. Method(s): We reviewed a case series of adult patients who presented to a single New York City emergency department between December 2021 and January 2022 with acute upper airway symptoms that prompted otolaryngology consultation and who tested positive for SARS-CoV-2. Result(s): Between December 2021 and January 2022, there were at least 3 SARS-CoV-2-positive patients who presented to the New York-Presbyterian Hospital with upper airway conditions requiring evaluation by an otolaryngologist. Conditions included supraglottitis, tracheitis, and epiglottitis. Two patients had received the COVID vaccine;1 had not. One patient required intubation;2 were maintained on room air. One patient was admitted to the intensive care unit, 1 to the step-down unit, and 1 to the floor. Length of stay varied from 3 to 11 days, 1 for nonairway issues. All 3 had methicillinsusceptible/ methicillin-resistant Staphylococcus aureus nasal swabs;2 were positive. All had respiratory viral panels that were negative. One had a throat culture that was negative. All received antibiotics. Conclusion(s): To date, there have been no studies exploring the upper airway manifestations of SARS-CoV-2 infection in the Omicron wave. These data provide important clinical correlates that are highly relevant to otolaryngologists.

11.
American Journal of Transplantation ; 22(Supplement 3):441, 2022.
Article in English | EMBASE | ID: covidwho-2063357

ABSTRACT

Purpose: Rapid evolution of the SARS-CoV-2 pandemic over the past 24 months has demanded agility in managing selection criteria for deceased organ donors, with the goal of saving every possible life while avoiding disease transmission to recipients. At 1 large organ procurement organization (OPO), the detection of any SARS-CoV-2 in a naso-pharyngeal (NP) specimen by polymerase chain reaction (PCR) was initially an absolute contraindication to organ donation. That approach gradually became more refined utilizing clinical evidence along with detection of low levels of viremia. Method(s): A retrospective analysis of all patients with authorization for organ donation after brain death or circulatory death from 3/16/2020 - 11/9/2021 was undertaken. Patients with any positive result for a COVID-19 test were identified. Donors with any positive result of an NP +/- broncho-alveolar fluid (BAL) PCR were selected for this analysis. Organ allocation was accompanied by the expectation of written confirmation that the recipient had provided informed consent for use of an organ from a SARS-CoV-2 donor. Result(s): A total of 18 deceased donors from whom 49 organs were transplanted, were identified. Multiple test results were often available for a single patient. Results were mixed in all 18 donors. At least one of the positive NP PCR test results included a cycle threshold in 16/18 patients and ranged from 31.4 to 42.5. In 2 donors a BAL PCR was also positive;1 heart was donated from one of these donors. With a follow-up of > 53 days for all transplants, no known transmission of SARS-CoV-2 to recipients or transplant teams has been reported. Conclusion(s): Available laboratory testing for SARS-CoV-2 and deepening understanding of COVID-19, increasing treatment options, and evolution of infection prevention practices have facilitated a growing confidence in safely transplanting non-lung organs from donors with a positive SARS-CoV-2 test. (Figure Presented).

12.
AJN American Journal of Nursing ; 122(10):15-15, 2022.
Article in English | Academic Search Complete | ID: covidwho-2062991

ABSTRACT

The article announces the appointment of Ann Kurth as the next president of the New York Academy of Medicine (NYAM), the first nurse and first nonphysician to lead the institution.

13.
International Conference on Transportation and Development 2022, ICTD 2022 ; 4:133-141, 2022.
Article in English | Scopus | ID: covidwho-2062377

ABSTRACT

The COVID-19 pandemic has impacted a wide range of human activities, from food delivery habits to major moving and travel decisions. Results indicate multiple pandemic-related factors have influenced millions of relocation decisions by Americans (e.g., health risk, financial pressures, more space, and employment), and there are various positive economic and social outcomes of this influence (e.g., remote work and education), enabling more affordable living and opportunity. This paper addresses COVID-19 impacts on mobility, especially involving permanent relocations. Survey design and data analysis with U-Haul targeted customers in Austin, New York, San Diego, and Chicago to understand mobility, new moving dynamics, and motivations. © ASCE. All rights reserved.

14.
Chest ; 162(4):A2248-A2249, 2022.
Article in English | EMBASE | ID: covidwho-2060919

ABSTRACT

SESSION TITLE: Unique Inflammatory and Autoimmune Complications of COVID-19 Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Common variable immunodeficiency (CVID) is a primary immunodeficiency disorder characterized by low serum IgG, IgA and/or IgM, and poor specific antibody production. CVID is estimated to affect as many as 1 in 25,000 individuals. Chronic lung disease is a common problem in patients with CVID. About 10-20% of patients have lymphocytic infiltrates and/or sarcoid-like granulomas, with several histological findings, termed granulomatous and lymphocytic interstitial lung disease (GLILD). CASE PRESENTATION: Patient is a 61-year-old Caucasian woman with a history significant for CVID in remission who presented to the Pulmonary Clinic with a chief compliant of dyspnea of exertion (DOE). Patient was not suffering from any respiratory complaints until the diagnosis of severe COVID-19 pneumonia 4 months prior. For the following months, patient was slowly improving but was still suffering from severe DOE that has negatively impacted her quality of life. Patient has a remote history of smoking, having quit 10 years ago. Patient denied any joint pain, stiffness, swelling, skin rash, muscle ache, or weakness. No known history of SLE, Rheumatoid Arthritis, or other collagen vascular disorders had been reported. Patient denied any exposure to birds. Physical exam was significant only for bilateral basal rales with no wheezing or crackles. No skin rash, joints deformities, or clubbing was noticed. Laboratory studies revealed ESR was 17 with a CRP of 10.6. Negative ANA, SM, RNP, and SSA/SSB antibodies. Her Immunoglobulins levels were low with IgG 382 (nl > 610) and IgA < 2 (nl > 85). Her PFT revealed severe restrictive process with TLC 46% of predicted and severe reduction in DLCO at 35%. CT chest revealed diffuse central groundglass opacities, and interstitial thickening with traction bronchiectasis. Lung biopsy via VATS revealed lung parenchymal with focal, noncaseating granulomas, foci of focal interstitial lymphocytic infiltration and fibrosis;features consistent with Granulomatosis-Lymphocytic Interstitial Lung Disease (GLILD). Systemic steroid initiated and for the following weeks patient reports significant improvement in DOE. Her PFT at 3 month follow up showed significant improvement in FVC (5% increase), TLC (11% increase), and DLCO (5% increase). DISCUSSION: The respiratory manifestations of CVID follow two main mechanisms: injury due to acute or recurrent infections and damage due to poorly understood immune-mediated processes. Severe COVID-19 results in dysregulated immune and inflammatory response that can worsen an underlying lung disease. Previous cases have been reported about CVID with GLILD complicated with COVID-19 infection but not vice versa. CONCLUSIONS: To our knowledge, this is a rare case of CVID complicated by GLILD triggered by recent COVID-19 infection. However, little is known about the association between COVID-19 infection and GLILD and further investigation is needed. Reference #1: Ho HE, Mathew S, Peluso MJ, Cunningham-Rundles C. Clinical outcomes and features of COVID-19 in patients with primary immunodeficiencies in New York City. J Allergy Clin Immunol Pract. 2020;S2213–2198(20):31102–8. Reference #2: Prasse A, Kayser G, Warnatz K. Common variable immunodeficiency-associated granulomatous and interstitial lung disease. Curr Opin Pulm Med. 2013;19:503–9. Reference #3: Cunningham-Rundles C, Bodian C. Common variable immunodeficiency: clinical and immunological features of 248 patients. Clin Immunol. 1999;92:34–48. DISCLOSURES: No relevant relationships by husam nayef No relevant relationships by Arshia Vahabzadeh No relevant relationships by Zaid Yaqoob No relevant relationships by Mohammad Zalt

15.
Chest ; 162(4):A1465, 2022.
Article in English | EMBASE | ID: covidwho-2060821

ABSTRACT

SESSION TITLE: Actionable Improvements in Safety and Quality SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Ventilator alarms are an audible and visual safeguard within a system which alerts clinicians to potentially critical changes within the patient or ventilator unit. They are a crucial aspect of patient care;however, not every alarm that is generated by the ventilator will provide actionable information. Unfortunately, this can contribute significantly to the overall alarm burden in the intensive care unit. This has been especially true with the marked increase in ventilator use during the COVID-19 pandemic. The individual impact of each alarm can easily become dampened due to the sheer quantity of alarms, ventilator-related and others. Excessive alarming may lead to cognitive overload and alarm fatigue for providers, and eventually, adversely impact patient outcomes. This potentially can lead to missed life-sustaining interventions and medical errors. METHODS: As part of a quality improvement initiative, we evaluated ventilator alarms through the month of October 2021 in the medical intensive care unit within Bellevue Hospital Center in New York City. Respiratory therapists recorded ventilator parameters and extracted alarm data daily from every ventilator within the medical intensive care unit. Ventilator logs were exported from each individual Servo-U ventilator unit in use onto a USB flash drive and the captured data was uploaded to a secure network for review. For each ventilator, data regarding specific alarm type and priority as defined by the manufacturer, as well as time, frequency, and duration was obtained for review. RESULTS: From October 4, 2021, to October 31, 2021, a total of 30,230 ventilator alarms were initiated over 672 hours in the MICU. This provided an approximate mean of 45 alarms per ventilator hour. Data was collected daily from all MICU ventilators in use which averaged about 12 ventilators per day (between 6-16). The top four alarms as defined by the ventilator were “airway pressure high,” “respiratory rate high,” “PEEP [positive end expiratory pressure] low,” and “expiratory minute volume low.” 18,451 alarms over the month were “airway pressure high.” 3,982 alarms were defined as “respiratory rate high.” 2,220 alarms were “PEEP low” and 2,041 alarms were “expiratory minute volume low.” CONCLUSIONS: Ventilator alarms, both nuisance and actionable alarms, contribute significantly to the alarm burden in the medical intensive care unit. Dedicated research is necessary to ensure safer alarm practices. CLINICAL IMPLICATIONS: Evaluating baseline alarm data allows for assessments as well as analyses of trends and patterns that are contributing to the excessive noise within the intensive care units. This gives hospitals an opportunity to provide targeted multidisciplinary educational initiatives and create standardized protocols to enhance the quality and safety surrounding ventilator alarms within intensive care units. DISCLOSURES: No relevant relationships by Kerry Hena No relevant relationships by Charmel Rogers no disclosure on file for Amit Uppal;No relevant relationships by Tatiana Weinstein

16.
Chest ; 162(4):A1321, 2022.
Article in English | EMBASE | ID: covidwho-2060804

ABSTRACT

SESSION TITLE: What Lessons Will We Take From the Pandemic? SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: COVID-19 surges due to variants continue to intermittently strain healthcare resources, highlighting the need to refine crisis standards of care (CSC) guidelines and study how they may perform in actuality. Studies to date, focusing on excess deaths or exacerbations of existing health disparities, simulate retrospective patient cohorts that synchronize patient presentation to a single point in time, rather than the reality where patients present continually throughout time. This artificial static model may not be an accurate reflection of patient throughput and dynamic resource strain, which occurs in reality, and might distort patient cohorts and mislead CSC simulated outcomes. METHODS: All intubated COVID-19 patients in a single healthcare system in New York City during the first surge (1/1/20 to 6/30/20) were included. A crisis period requiring CSC activation was defined as occurring once 95% of pre-pandemic ventilators were utilized and lasted 2 weeks in duration, consistent with prior simulated length of CSC for this cohort under the New York State Ventilator Allocation Guidelines (NY). NY, Maryland (MD), Pittsburgh (PA), Saskatchewan Canada (SAC), and California (CA) CSC policies were reviewed for exclusionary and other criteria that would affect patient triage (admission diagnosis, comorbidities, occupation, or other patient circumstances). NY, MD, SAC, and CA all use exclusionary criteria. Subsequently NY and SAC only use a SOFA score for triage whereas MD, PA, and CA all integrate tiered comorbidities in addition to a SOFA score to generate an overall triage score. Partial triage priority is provided by PA, SAC, and CA for certain occupations and by PA for those socially disadvantaged. Patient charts were reviewed to determine if they would satisfy triage criteria from any of these guidelines and if they would be relevant during the specific crisis period. RESULTS: 936 patients were included in the total cohort, of which 573 were involved during the crisis period. Those not involved during the crisis period required a ventilator when less than 95% of all ventilators were utilized and would not be relevant during a CSC simulation. NY, MD, PA, SAC, and CA would have excluded 1, 3, 0, 79, and 4 patients respectively for the entire cohort, but 0, 0, 0, 29 (36.7%), and 2 (50%) during the specific crisis period. MD, PA, & CA would have modified 49, 88, & 102 individual’s triage score due to comorbidities in the entire cohort but only 17 (34.7%), 40 (45.5%), and 41 (40.2%) during the crisis period respectively. CONCLUSIONS: CSC simulations that include patients outside the crisis period will include patients that may not be relevant to understanding how CSC might perform. CLINICAL IMPLICATIONS: Understanding CSC performance, particularly when studying excess deaths or exacerbating social disparities, requires incorporating patient throughput for an accurate real-world understanding. DISCLOSURES: No relevant relationships by Deepak Pradhan No relevant relationships by Brandon Walsh

17.
Chest ; 162(4):A1111-A1112, 2022.
Article in English | EMBASE | ID: covidwho-2060770

ABSTRACT

SESSION TITLE: Impact of Health Disparities and Differences SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Vulnerable patients, including minorities and underserved populations whose care relies on public hospitals, have limited access to advanced cardiac or respiratory care in shock centers or extracorporeal membrane oxygenation (ECMO)-capable hospitals, especially when socioeconomic or insurance barriers play a role in patient selection. Our aim is to describe the implementation of an ECMO program for cardiac and respiratory failure during the COVID-19 pandemic in the largest public health system in the country, as a strategy to mitigate healthcare disparities and improve access to care for minorities. METHODS: We collected clinical, demographic and socioeconomic data of all patients undergoing ECMO at Bellevue Hospital Center, the shock and ECMO center for New York City’s Health and Hospitals’ network. This public health system includes 11 Hospitals and provides care to 1 million New Yorkers. The decision to proceed with ECMO took place with a multidisciplinary team discussion, which was also in charge of providing longitudinal care during their hospitalization. RESULTS: A total of 49 patients were included [30 veno-venous (VV) ECMO, 19 venoarterial (VA) ECMO, including 9 extracorporeal cardiopulmonary resuscitation (ECPR)] from April 1st, 2020 to March 30th, 2022. The median age was 42.6 years, 57% were male, 38% were Hispanic, 35% African American, 14% white, 6% Asian and 8.2% had other ethnicities;33% were uninsured, 49% lived below the poverty level reported for New York City and 20% were undocumented. Level of education was 8th grade or less in 2.1%, high school in 24.5%, ≤ 2 years of college in 10.2%, >4 years of college in 12.2% and unknown in 51%. ECMO survival was 56% for VV ECMO, 44% for VA ECMO and 33% for ECPR. Survival to discharge was 56% for VV, 33% for VA and 33% for ECPR. One VV ECMO patient was bridged to lung transplant, there were no patients bridged to LVAD or heart transplant. Bleeding complications occurred in 3 patients (6%) and there were no procedural related complications. CONCLUSIONS: Our multidisciplinary ECMO program demonstrates feasibility to provide care to underserved and vulnerable populations with outcomes comparable to the national average, despite the challenges related to the potential limitations in bridging strategies for such patients. While socioeconomic and insurance status have a key role in bridging options for ECMO, they should not be a major determinant in denying patients advanced cardiopulmonary support if clinically indicated. CLINICAL IMPLICATIONS: Access to advance cardiorespiratory therapies including ECMO for vulnerable populations is a present need and is feasible with a multidisciplinary team DISCLOSURES: Speaker/Speaker's Bureau relationship with Zoll Please note: 3 years Added 04/04/2022 by Carlos Alviar, value=Honoraria No relevant relationships by Fariha Asef No relevant relationships by Sripal Bangalore No relevant relationships by Samuel Bernard No relevant relationships by Lauren Bianco No relevant relationships by Nishay Chitkara No relevant relationships by Jennifer Cruz No relevant relationships by Michael DiVita Research support relationship with Eurofins Viracor Please note: 12/1/2021 ongoing Added 12/23/2021 by Randal Goldberg, value=Grant/Research Support No relevant relationships by Kerry Hena No relevant relationships by William Howe No relevant relationships by Norma Keller no disclosure on file for Ma-Rosario Mertola;no disclosure on file for Thor Milland;No relevant relationships by vikramjit mukherjee No relevant relationships by Kayla Nunemacher No relevant relationships by Mansi Patel No relevant relationships by Radu Postelnicu No relevant relationships by Deepak Pradhan No relevant relationships by Vito Stasolla no disclosure on file for Amit Uppal;No relevant relationships by Susan Vlahakis No relevant relationships by Kah Loon Wan no disclosure on file for Victoria Yunaev;

18.
Chest ; 162(4):A679, 2022.
Article in English | EMBASE | ID: covidwho-2060667

ABSTRACT

SESSION TITLE: Acute COVID-19 and Beyond: from Hospital to Homebound SESSION TYPE: Original Investigations PRESENTED ON: 10/18/2022 02:45 pm - 03:45 pm PURPOSE: Minimally-biased clustering (MBC) has identified hypoinflammatory (hypo-I) and hyperinflammatory (hyper-I) subphenotypes in ARDS. The hyper-I type exhibits higher inflammatory markers, clinical severity, and mortality. Similar subphenotypes were recently identified in COVID-19-related ARDS. Lower PCR cycle threshold was associated with higher mortality in the hypo-I type, implying an association between viral load (VL) and clinical outcomes in patients with dampened inflammatory responses. In a recent randomized clinical trial (RCT), convalescent plasma (CP) improved survival in severe COVID-19. We hypothesized that the anti-viral effect of CP would more significantly benefit patients without acute hyperinflammation, for whom VL may be associated with mortality. METHODS: From 4/2020-11/2020, 223 adults >18 years of age in New York and Rio de Janeiro with laboratory-confirmed severe COVID-19 were enrolled in a double-blind RCT evaluating the efficacy of CP. 150 patients received CP;73 received control plasma. Hierarchical clustering (HC) of clinical and laboratory data was used to identify sub-groups in the study population. Primary and secondary outcomes were clinical status at 28 days by modified WHO ordinal score (higher scores indicating worse status) and 28-day mortality. Welch’s t-tests, chi-squared tests, and Fisher’s exact tests were used to compare clinical and laboratory data across clusters. Proportional odds and logistic regression were used to assess the association between cluster-derived subgroups and outcome and the interaction between subgroups and randomized treatment assignment. RESULTS: HC identified two clusters (C1;N=156 and C2;N=67) in the population. Patients in C2 had significantly higher markers of inflammation (sedimentation rate, C-reactive protein, interleukin-6), coagulation (D-dimer), and cardiac injury (cardiac troponin) as well as relative lymphopenia, hypoalbuminemia, and lower bicarbonate. At 28 days, patients in C2 had significantly worse clinical status (OR of 1-pt ordinal score increase 3.10, 95% CI 1.72-5.60, p=0.0002) and higher mortality (28.4% vs. 11.5%, OR 3.03, 95% CI 1.47-6.26, p=0.003). There was no significant between-cluster heterogeneity of CP treatment effect on either ordinal score (OR 0.56, 95% CI 0.16-1.95, p=0.36) or mortality (OR 0.52, 95% CI 0.12-2.30, p=0.38). CONCLUSIONS: C2 exhibited elevated inflammatory markers and lymphopenia indicative of an acute hyperinflammatory response. C2 exhibited poorer clinical status and higher mortality at 28 days. There was no evidence of significant heterogeneity of CP treatment effect on 28-day clinical outcomes. CLINICAL IMPLICATIONS: The previously shown mortality benefit of CP in severe COVID may not differ based on inflammatory state. Using MBC methods on larger samples, e.g., patient data from a meta-analysis of CP trials, may reveal a significant impact of inflammatory state on CP effect. DISCLOSURES: No relevant relationships by Matthew Cummings Received a grant sub-award from Amazon relationship with Amazon Please note: 4/2020 -12/2020 Added 03/10/2022 by Max O'Donnell, value=Grant/Research Support No relevant relationships by Tejus Satish No relevant relationships by Allison Wolf

19.
Embase; 2022.
Preprint in English | EMBASE | ID: ppcovidwho-344499

ABSTRACT

Importance: Communication and adoption of modern study design and analytical techniques is of high importance for the improvement of clinical research from observational data. Objective(s): To compare (1) a modern method for causal inference including a target trial emulation framework and doubly robust estimation to (2) approaches common in the clinical literature such as Cox proportional hazards models. To do this, we estimate the effect of corticosteroids on mortality for moderate-to-severe coronavirus disease 2019 (COVID-19) patients. We use the World Health Organization's (WHO) meta-analysis of corticosteroid randomized controlled trials (RCTs) as a benchmark. Design(s): Retrospective cohort study using longitudinal electronic health record data for 28 days from time of hospitalization. Setting(s): Multi-center New York City hospital system. Participant(s): Adult patients hospitalized between March 1-May 15, 2020 with COVID-19 and not on corticosteroids for chronic use. Intervention(s): Corticosteroid exposure defined as >0.5mg/kg methylprednisolone equivalent in a 24-hour period. For target trial emulation, interventions are (1) corticosteroids for six days if and when patient meets criteria for severe hypoxia and (2) no corticosteroids. For approaches common in clinical literature, treatment definitions used for variables in Cox regression models vary by study design (no time frame, one-, and five-days from time of severe hypoxia). Main outcome: 28-day mortality from time of hospitalization. Result(s): 3,298 patients (median age 65 (IQR 53-77), 60% male). 423 receive corticosteroids at any point during hospitalization, 699 die within 28 days of hospitalization. Target trial emulation estimates corticosteroids to reduce 28-day mortality from 32.2% (95% CI 30.9-33.5) to 25.7% (24.5-26.9). This estimate is qualitatively identical to the WHO's RCT meta-analysis odds ratio of 0.66 (0.53-0.82)). Hazard ratios using methods comparable to current corticosteroid research range in size and direction from 0.50 (0.41-0.62) to 1.08 (0.80-1.47). Conclusion and Relevance: Clinical research based on observational data can unveil true causal relationships;however, the correctness of these effect estimates requires designing the study and analyzing the data based on principles which are different from the current standard in clinical research. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license.

20.
Investigative Ophthalmology and Visual Science ; 63(7):1385-A0081, 2022.
Article in English | EMBASE | ID: covidwho-2058685

ABSTRACT

Purpose : The most common cause of blurry vision in the United States is refractive error. Despite being a correctable condition, over 8.2 million people are estimated to have their refractive error go undiagnosed or untreated. Minorities and low-income groups in particular have significantly increased odds of inadequate correction and double the rates of near-vision impairment. We aimed to address this gap in care through the provision of refractive glasses during community-based tele-ophthalmology screenings. Methods : Eight free eye screening events were held in Newark and West New York, NJ. Demographic information, intraocular pressure, visual acuity, auto-refraction, retinal imaging, and optical coherence tomography were obtained from each subject as part of a comprehensive tele-ophthalmology protocol. Reading glasses were provided as needed based on the recommendation of a certified telemedicine reader. Eligible recipients completed surveys on site regarding access to eye care. They were surveyed again by phone after one month to assess degree of satisfaction and vision improvement. Results : 38 subjects (mean age 53, 47% male) qualified for presbyopia correction and received reading glasses. 97% were Hispanic and 3% were African American. Of the 33 that returned surveys, 88% reported not seeing an eye doctor annually. The most common reason was lack of insurance or inability to pay (71%). Others included having no need to see an eye doctor (10%), disliking eye doctors (7%), not knowing the importance of regular eye exams (3%), and COVID-19 (3%). Of the 25 subjects that were reached for follow-up, 92% reported using the glasses daily. Those that did not reported the power was too strong or they did not feel they needed them. Subjects noted an average improvement in vision of 4.4 out of 5 and an average satisfaction of 4.7 out of 5 (Figure 1). Conclusions : Glasses distribution is an effective way to address refractive error in underserved communities. Given the gaps in knowledge and utilization of eye care identified in our study, there is an obvious need for continued outreach to these areas. Further studies will include larger populations and evaluate mobile refraction devices to increase ease and reach of glasses provision.

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