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Background: When the COVID-19 pandemic intersected with the longstanding global pandemic of traumatic injury, it exacerbated racial and ethnic disparities in injury burden. As Milwaukee, Wisconsin is a racially diverse yet segregated urban city due to historic and ongoing systemic efforts, this populace provided an opportunity to further characterize injury disparities. Method(s): We analyzed trauma registry data from the only adult Level 1 trauma center in Milwaukee, WI before and during the COVID-19 pandemic (N = 19,908 patients from 2015-2021). We retrospectively fit seasonal ARIMA models to monthly injury counts to determine baseline injury burden pre-COVID-19 (Jan 2015-Mar 2020). This baseline data was used to forecast injury by race and ethnicity from April 2020 to December 2021 and was compared to actual injury counts. Result(s): For all mechanisms of injury (MOI), counts during the pandemic were significantly higher than forecasted for Black or African American (mean absolute percentage error, MAPE = 23.17) and Hispanic or Latino (MAPE = 26.67) but not White patients (MAPE = 12.72). Increased injury for Black or African American patients was driven by increases in motor vehicle crashes (MVCs) and firearm-related injury;increased injury for Hispanic or Latino patients was driven by falls and MVCs. Conclusion(s): The exacerbation of injury burden disparities during COVID-19, particularly in specific MOI, underscores the need for primary injury prevention within specific overburdened communities. Injury prevention requires intervention through social determinants of health, including addressing the impact of structural racism, as primary drivers of injury burden disparities.Copyright © The Author(s) 2023.
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Background: People with HIV (PWH) have a higher risk of COVID-19 morbidity and mortality. SARS-CoV-2 vaccination is highly effective in preventing severe COVID-19, although medical mistrust may contribute to vaccine hesitancy among PWH. Method(s): PWH from 8 sites in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) completed the clinical assessment of patient-reported outcomes including a vaccine hesitancy instrument as part of routine care from 2/21-4/22. Participants were defined as vaccine hesitant if they had not yet received the SARS-CoV-2 vaccine and would probably or definitely not receive it. We assessed factors associated with SARS-CoV-2 vaccine hesitancy using logistic regression, and adjusted for demographics, unsuppressed viral load >200 copies/mL, calendar month and time on ART. Result(s): Overall, 3,278 PWH with a median age of 55 responded;19% were female sex at birth;93% were virally suppressed. At the time of survey, 27% reported they had not received the SARS-CoV-2 vaccine, of whom 27% (n=242;7% overall) reported vaccine hesitancy. Of these 242, 82% expressed concerns about vaccine efficacy;86% about side effects;38% reported distrust of healthcare, 53% reported concerns about vaccine contents (i.e. trackers, live virus);and 24% did not perceive risk from COVID-19. Factors associated with vaccine hesitancy included female sex (Adjusted Odds Ratio [AOR] 2.0;95% Confidence Interval (CI): 1.5-2.8;Table), Black vs. White race (AOR 1.8;95% CI: 1.3-2.5), age< 30 years (AOR 2.8;95% CI: 1.5-5.2), South/Midwest vs. Northeast region (AOR 1.7;95% CI: 1.2-2.4), years on ART (0.8;0.7-0.9) and unsuppressed viral load (AOR 2.2;95% CI: 1.4-3.5). Hesitancy decreased over time (AOR 0.9 per month;95% CI: 0.8-0.9). Vaccine side effects were the primary concern for women;vaccine contents for Black PWH and those who were unsuppressed;and lack of perceived COVID-19 risk for youth. Conclusion(s): Vaccine hesitancy was reported by approximately 7% of a U.S. multi-site cohort of PWH, and it was more prevalent among Black PWH, women, youth, those with unsuppressed viral loads, and residents of the South/ Midwest. The association between virologic non-suppression and vaccine hesitancy highlights the intertwined challenge of medical mistrust for both HIV and COVID-19. Although vaccine hesitancy decreased over time, renewed efforts will be needed to address concerns of PWH about the COVID-19 vaccine, given the ongoing need for revaccination with the evolution of the pandemic.
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Background: Disruptions in clinical services during the COVID-19 pandemic could compromise past progress towards meeting U.S. Ending the HIV Epidemic (EHE) goals. We examined changes in the proportion with virologic suppression (VS) before and since the onset of COVID-19 in a multi-site U.S. cohort of people with HIV (PWH) using an interrupted time series design. Method(s): We assessed VS (< 200 copies/mL) trajectories 1/1/2018-1/1/2022, comparing trends before and after March 21, 2020 at 8 HIV clinics within the U.S. Center for AIDS Research Network of Integrated Clinical Systems (CNICS'). Hierarchical mixed-effects logistic regression and interrupted time series analyses examined changes in the trend (i.e., slope) of VS over time, and maximum likelihood estimation was used to account for missing VS data among those lost to follow-up (LTFU) post-COVID-19. Analyses were adjusted for demographics, site, CDC transmission group, CD4 nadir, VS, time on ART. Result(s): Data from 17,999 participants were included, providing a total of 120,918 VS assessments. Median age was 53 (interquartile range 42-61);19% were female sex at birth;the mean time on ART was 9.5 years;18% were unsuppressed at any point;17.7% were LTFU. Among the overall population, prior gains in VS slowed during COVID-19 (adjusted odds ratio [AOR] 0.93 per quarter-year;95% CI: 0.88-0.98;p=0.004;Figure). Greater impacts occurred among women (AOR 0.90;95% CI 0.81-0.99;p=0.05), persons with a history of injection drug use (PWID) (AOR 0.77 95% CI: 0.66-0.90;p=0.001), and Black PWH (AOR 0.90;95% CI: 0.84-0.96;p=0.001) in whom prior positive VS trends plateaued or began to reverse (Figure). VS remained lower among those with unstable housing (AOR 0.44;95% CI: 0.40-0.50;p< 0.001) but stayed unchanged from the pre-pandemic period. Conclusion(s): Previous gains in VS slowed during the COVID-19 pandemic among PWH in a multi-site network of U.S. HIV clinics. Known disparities in VS according to housing status remain unchanged, but VS disparities worsened for PWH who were women, PWID, or Black. Changes in VS trends could be related to socioeconomic impacts of the pandemic, insurance lapses, reduction of in-person clinic services, fear of coming to clinics, or other factors. Renewed investment in HIV public health and clinical services will be vital to achieve the U.S. EHE goals following COVID-19, with additional targeted interventions to support key populations with persistent or worsening disparities needed.
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The emergence of the novel coronavirus (COVID-19) generated a need to quickly and accurately assemble up-to-date information related to its spread. In this research article, we propose two methods in which Twitter is useful when modelling the spread of COVID-19: (1) machine learning algorithms trained in English, Spanish, German, Portuguese and Italian are used to identify symptomatic individuals derived from Twitter. Using the geo-location attached to each tweet, we map users to a geographic location to produce a time-series of potential symptomatic individuals. We calibrate an extended SEIRD epidemiological model with combinations of low-latency data feeds, including the symptomatic tweets, with death data and infer the parameters of the model. We then evaluate the usefulness of the data feeds when making predictions of daily deaths in 50 US States, 16 Latin American countries, 2 European countries and 7 NHS (National Health Service) regions in the UK. We show that using symptomatic tweets can result in a 6% and 17% increase in mean squared error accuracy, on average, when predicting COVID-19 deaths in US States and the rest of the world, respectively, compared to using solely death data. (2) Origin/destination (O/D) matrices, for movements between seven NHS regions, are constructed by determining when a user has tweeted twice in a 24 h period in two different locations. We show that increasing and decreasing a social connectivity parameter within an SIR model affects the rate of spread of a disease. © 2023 by the authors.
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Background: C auris is an emerging often multidrug resistant pathogen capable of causing severe morbidity and mortality. C auris has been increasingly isolated from patients in skilled nursing facilities and hospitals, and has been associated with facility outbreaks. A resilient pathogen, C. auris survives harsh disinfectants, desiccation and readily colonizes the environment posing an especially great risk to immunocompromised patients with large open wounds and long lengths of stay. Methods: From 7/1/21 - 8/30/21 we noted a cluster of 4 patients with C auris in clinical cultures from the Burn ICU (BICU). A multidisciplinary team involving infection prevention, nursing/medical directors, health and safety, engineering, environmental services, and hospital leadership investigated the cluster as a potential outbreak. Mitigation measures involved a multi-modal response of C auris admission screening, weekly point prevalence testing of all BICU patients, environmental surface cultures, enhanced room cleaning, staff education, hand hygiene and personal protective equipment usage audits. Results: 11 cases of C auris were identified on our BICU from 7/1/21 - 2/28/22. 5 (45.5%) cases from clinical isolates, 1 (9.1%) from a BICU point prevalence screen on 12/15/21, 5 (45.5%) as a part of weekly point prevalence screens started on 1/1/22. 6 (54.5%) patients were admitted for burn related injuries, 2 (18.2%) for Steven Johnson Syndrome, 2 (18.2%) for necrotizing wounds, and 1 (9.1%) for COVID-19 pneumonia. Cases occurred in 6/10 rooms in the Burn ICU. One (9.1%) patient expired during this outbreak (not deemed to be from C auris infection). Conclusion: Resilient infections like C auris pose a risk of nosocomial transmission and potential high morbidity and mortality to burn patients with impaired immune defense and large open wounds. A multidisciplinary team using targeted interventions including screening, education, enhanced cleaning eradicated the outbreak in our BICU. As of 5/1/22, we went 13 + weeks without identifying a new case. The last patient with C auris was discharged 3/16/22. To prevent future outbreaks, we created a standardized response plan and instituted a universal screening protocol for C auris targeting all patient admissions from skilled nursing facilities and admissions to all ICUs. Disclosures: Jorge Paiva Parada, MD MPH, Shionogi: Honoraria.
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Background: Multimorbidity is most prevalent in older adults and is associated with higher symptom burden, lower quality of life, increased functional decline, and caregiver burden that warrants holistic intervention. Continued rise in the prevalence of multimorbidity is expected, especially among older adults. The COVID-19 pandemic required that a co-design event with patients, family caregivers, and health care providers discussing their preferences surrounding multimorbidity management be virtual. Objective(s): To discuss the challenges of organizing a virtual co-design event. Method(s): A virtual co-design event was held using Health Insurance Portability and Accountability Act-compliant Zoom technology. Patients (age 55 or older and living with multimorbidity), family caregivers, and health care providers interviewed in a prior phase of the project were invited to the codesign event. Data regarding participants' disease trajectory and improvement priorities were collected. The experiences of the study team, including event facilitators, were used to identify challenges and opportunities. Result(s): Four male patients, two female health care providers, and seven facilitators participated in the event. Five improvement priorities were identified: (1) patient-provider relationship, (2) communication, (3) availability of resources, (4) caregiver support, and (5) care coordination and follow-up. Conclusion(s): Virtual events could be a valuable tool to get diverse groups of participants to provide input;however, the recruitment process and the technological literacy of some older adults pose challenges. Using a virtual platform requires consideration of participants' access to technology, their technological literacy, the use of innovative human-centered design, and the need for holding multiple events to yield comprehensive data. Recruiting more diverse groups of participants-e.g., groups that include family caregivers and female patients-is critical, as they may present different needs and outcomes..
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Background: During the COVID-19 pandemic, patients experienced significant care disruptions, including lab monitoring. We investigated changes in the time between viral load (VL) checks for people with HIV associated with the pandemic. Methods: This was an observational analysis of VLs of people with HIV in routine care at a large subspecialty clinic. At pandemic onset, the clinic temporarily closed its onsite laboratory. The exposure was time period (time-varying): pre-pandemic (January 1st 2019-March 15th, 2020);pandemic lab-closed (March 16th-July 12th, 2020);and pandemic lab-open (July 13th-December 31st, 2020). We estimated time from an index VL to a subsequent VL, stratified by whether the index VL was suppressed (<= 200 copies/mL). We also calculated cumulative incidence of a non-suppressed VL following a suppressed index VL, and of re-suppression following a loss of viral suppression. Results: Compared to pre-pandemic, hazard ratios for next VL check were: 0.34 (95% CI: 0.30, 0.37, lab-closed) and 0.73 (CI: 0.68, 0.78, lab-open) for suppressed patients;0.56 (CI: 0.42, 0.79, lab-closed) and 0.92 (95% CI: 0.76, 1.10, lab-open) for non-suppressed patients. The 12-month cumulative incidence of loss of suppression was the same in the pandemic lab-open (4%) and pre-pandemic period (4%). The hazard of re-suppression following loss of suppression was lower during the pandemic lab-open versus the pre-pandemic period (hazard ratio: 0.68, 95% CI: 0.50, 0.92). Conclusions: Early pandemic restrictions and lab closure significantly delayed VL monitoring. Once the lab re-opened, non-suppressed patients resumed normal monitoring. Suppressed patients still had a delay, but no significant loss of suppression.
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The COVID-19 pandemic has caused worldwide social disruption, but these social disruptions are not equally distributed across communities. For Marshallese Islanders, living in the United States under the Compact of Free Association (1986), these disruptions are especially concerning due to strong cultural values for direct, face-to-face communication in informal settings, called talk story. The Marshallese have been deeply affected by the COVID-19 pandemic, with infections, hospitalizations, and mortality rates that far exceed other populations in the United States. The Marshallese have a strong collectivist culture, and the COVID-19 pandemic and the public health responses intended to mitigate its spread have affected many aspects of Marshallese culture and everyday life. In this essay we explore Marshallese experiences during the pandemic, and creative resilience practiced by the community in meeting culturally important social needs through the use of telecommunication technologies. For the Marshallese, the COVID-19 pandemic’s social effects were most salient when discussing the rhythms of everyday life, including visiting neighbors, friends, elders, cultural celebrations, and sharing of food with others in their community. We argue that combining health research with nuanced culturally grounded perspectives allows us to see a more complete picture of the impact of the COVID-19 pandemic, particularly for communities with historical traumas. © 2022 selection and editorial matter, Irene Gammel and Jason Wang;individual chapters, the contributors.
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BACKGROUND: Data from the COVID-19 pandemic describes increases in drug use and related harms, especially fatal overdose. However, evidence is needed to better understand the pathways from pandemic-related factors to substance use behaviours. Thus, we investigated stockpiling drugs among people who use drugs (PWUD) in five cities in the United States and Canada. METHODS: We used data from two waves of interviews among participants in nine prospective cohorts to estimate the prevalence and correlates of stockpiling drugs in the previous month. Longitudinal correlates were identified using bivariate and multivariate generalized linear mixed-effects modeling analyses. RESULTS: From May 2020 to February 2021, we recruited 1873 individuals who completed 2242 interviews, of whom 217 (11.6%) reported stockpiling drugs in the last month at baseline. In the multivariate model, stockpiling drugs was significantly and positively associated with reporting being greatly impacted by COVID-19 (Adjusted Odds Ratio [AOR]= 1.21, 95% CI: 1.09-1.45), and at least daily use of methamphetamine (AOR = 4.67, 95% CI: 2.75-7.94) in the past month. CONCLUSIONS: We observed that approximately one-in-ten participants reported stocking up on drugs during the COVID-19 pandemic. This behaviour was associated with important drug-related risk factors including high-intensity methamphetamine use. While these correlations need further inquiry, it is possible that addressing the impact of COVID-19 on vulnerable PWUD could help limit drug stockpiling, which may lower rates of high-intensity stimulant use.
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Introduction: The COVID-19 vaccine was approved for use in adolescents ages 12-17 on May 10, 2021. There have since been case reports of myocarditis shortly after the COVID-19 vaccine, mostly in adolescent males. Among these cases, coronary vasospasm has not been described. Case Description: A 16 year old previously healthy male presented with two days of chest pain and subjective fevers three days after receiving the second dose of the Pfizer COVID-19 vaccine. High-sensitivity troponin I was 10,819 ng/L (reference range: 3-57), and ECG showed mild diffuse ST segment elevations (Image 1). He was admitted for suspected myopericarditis and treated with ketorolac, prednisone, and IVIG. Shortly after admission, he experienced sudden crushing, substernal chest pain. An ECG obtained during the episode showed striking ST segment elevation in the inferolateral leads (Image 2). He was started on a nitroglycerin drip, supplemental oxygen, low dose aspirin and received 3 doses of morphine. The acute chest pain responded rapidly to these measures, and the nitroglycerin drip was stopped after 24 hours without recurrence of symptoms. An echocardiogram was normal. Cardiac MRI showed subepicardial enhancement without evidence of acute infarction. He was discharged on hospital day #4, chest pain free for 24 hours with downtrending troponin. Discussion: Our patient's initial presentation of chest pain with elevated troponin and mild diffuse ST segment elevation is consistent with myopericarditis, similar to described cases occurring after the COVID-19 vaccine. During an acute, more severe, episode of chest pain, there was further localized ST segment elevation consistent with myocardial ischemia. Serial ECGs demonstrated improvement as the chest pain resolved, suggesting acute coronary artery vasospasm. Intravenous nitroglycerin, the mainstay of treatment for coronary vasospasm, was therapeutic with no recurrence of chest pain. Interestingly, our patient's acute inferolateral ST segment elevations during the episode of severe chest pain correlated with the distribution of myocardial enhancement noted on cardiac MRI, implicating subepicardial myocarditis as the likely cause. This complication has been reported in adults with viral myocarditis. Conclusion: This case highlights the importance of recognizing coronary vasospasm as a potential complication of COVID vaccine-induced myopericarditis.
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Background: The natural history of the longer-term effects of SARS-CoV-2 (COVID-19), known as Post-Acute Sequelae of SARS-CoV-2 (PASC), is limited. Disease characterization and definition changed over time and identification via standard diagnosis codes was only recently enacted. We aim to identify a cohort of individuals with, or at-risk for, PASC among Kaiser Permanente Mid-Atlantic States (KPMAS) members, and to identify the clinical conditions of greater burden for those with PASC. Methods: Within our electronic health record system (including internal/external records), we identified adult patients (≥18 years) who had a detectable SARS-CoV-2 RT-PCR result between 1/1/2020-12/31/2020. Non-COVID disease diagnoses/conditions were categorized into specific time intervals based on the first positive SARS-CoV-2 test as the index date (T0), defined as: 1) "prevalent": diagnoses in 4 years prior to T0 and excluded from later consideration;2) "persistent/acute": new disease diagnoses 0-30 days post-T0 and persisted 30-120 days further, and not included as prevalent;3) "incident/late": new disease diagnoses 30-120 days post-T0, not previously identified as prevalent or persistent/acute. Diagnoses were grouped using Clinical Classification Software (CCS) to isolate conditions for PASC. Final CCS distributions were computed relative to the condition counts for each time interval, validated by infectious disease physicians to identify conditions of focus (COF). Results: From the resulting 31,390 patients, we identified the 14 most common COF (Table 1). The most common persistent/acute COF were other lower respiratory disease (4.5%) and respiratory failure (2.7%). Most common incident/late COF (i.e., >2.0% of those testing COVID+) were abdominal pain, gastrointestinal disorders, other nervous system disorders, nonspecific chest pain, dizziness or vertigo, malaise and fatigue, anxiety disorders, mental health disorders, other lower respiratory disease (not previously diagnosed), and cardiac dysrhythmias. No other COF were >2.0% in the persistent or incident time periods. Conclusion: We have identified conditions clinically associated with COVID-19 that persist from infection or present as incident beyond the acute COVID-19 period. This condition list should be utilized in clinical practice when following up with COVID-19 patients. Further research is needed to understand how these conditions compare to people who did not have COVID-19 and to describe their severity, persistence, and resolution.
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Background: People who use unregulated drugs (PWUD) in Canada and the United States (US) are contending with the intersection of two simultaneous health crises: the COVID-19 pandemic and the longstanding drug poisoning crisis. However, the possible contributions of COVID-related factors to increases in overdoses during the pandemic are not well understood. Our study objectives were to assess the prevalence of non-fatal overdose and identify factors associated with overdose among participants in nine prospective cohorts of PWUD in urban centers in Canada (Vancouver, BC) and the US (Baltimore, MD;Miami, FL;Chicago, IL;Los Angeles, CA) during the COVID-19 pandemic. We further sought to examine the prevalence of and identify factors associated with reporting being highly impacted day-to-day by COVID-19. Methods: Data were derived from the nine cohorts in the NIDA-funded C3PNO consortium between May, 2020 and April, 2021. Multivariable logistic regression was used to identify factors associated with nonfatal overdose and day-to-day impact among participants who had used unregulated drugs in the past month. Results: Among 885 participants, 253 (28.6%) were female and 41 (4.6%) had reported experiencing a non-fatal overdose. Most of the sample reported being worried and approximately half reported being highly impacted day-to-day by the pandemic. In multivariable analyses, individuals who had experienced an overdose were more likely to be female (Adjusted Odds Ratio [AOR]=2.18;95% Confidence Interval [CI]:1.10-4.30);unstably housed/homeless (AOR = 2.16;95% CI: 1.11-4.26);engaged in medications for opioid use disorder (MOUD) (AOR = 2.45;95% CI: 1.19-4.97);and highly impacted day-to-day by COVID-19 (AOR = 2.42;95% CI: 1.22-5.10). In a second multivariable model, highly-impacted individuals were more likely to report higher levels of COVID-related worry (AOR = 1.30;95% CI: 1.23-1.37) and stocking up on drugs (AOR = 1.59, 95% CI: 1.09-2.32) due to the pandemic. Conclusion: Our findings indicate a need for a multi-level approach involving the spectrum of care services to meet the elevated risks of overdose in the context of the dual crises, particularly among women, those unstably housed/homeless and those who reported being highly impacted day-to-day by the pandemic. Efforts to prevent overdose, however, should prioritize addressing the root causes of the drug poisoning crisis, such as the continuous exposure to toxic and contaminated unregulated drug supplies among PWUD.
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Background: The COVID-19 pandemic disrupted the normal delivery of HIV care, altered social support networks, and caused economic insecurity. People with HIV (PWH) are vulnerable to such disruptions, particularly if they have a history of substance use. We describe engagement in care and adherence to antiretroviral therapy (ART) for PWH during the pandemic. Methods: From May 2020 to February 2021, 773 PWH enrolled in 6 existing cohorts completed 1495 surveys about substance use and engagement in HIV care during the COVID-19 pandemic. We described the prevalence and correlates of having missed a visit with an HIV provider in the past month and having missed a dose of ART in the past week. Results: Thirteen percent of people missed an HIV visit in the past month. Missing a visit was associated with unstable housing, food insecurity, anxiety, low resiliency, disruptions to mental health care, and substance use including cigarette smoking, hazardous alcohol use, cocaine, and cannabis use. Nineteen percent of people reported missing at least one dose of ART in the week prior to their survey. Missing a dose of ART was associated with being a man, low resiliency, disruptions to mental health care, cigarette smoking, hazardous alcohol use, cocaine, and cannabis use, and experiencing disruptions to substance use treatment. Conclusion: Social determinants of health, substance use, and disruptions to mental health and substance use treatment were associated with poorer engagement in HIV care. Close attention to continuity of care during times of social disruption is especially critical for PWH.
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Background: Post-Acute Sequelae of SARS-CoV-2 Infection (PASC) is a novel condition generally defined as new onset or persistence of symptoms related to SARS-CoV-2 beyond convalescence or first 30 days post-diagnosis. PASC has not been well defined by conditions or timeline manifestation. We measured PASC incidence in an integrated health system population (Kaiser Permanente Mid-Atlantic States;KPMAS) and provided supporting evidence for PASC-related conditions of focus (COF) identified from our previous research. Importantly, KPMAS is a closed healthcare system with high ascertainment of COVID-19 among our members, as well as PASC conditions and symptoms. Methods: Using KPMAS electronic health records, we identified adult patients (≥18 years) who had a SARS-CoV-2 RT-PCR test result (detected or undetected) from 1/1/2020 to 12/31/2020. We defined 3 diagnostic time intervals, predicated on the first test date of identified PASC phenotypes. These time intervals were defined as: T1) "Prevalent": 4 years prior to PCR test identifying prevalent conditions;T2) "Acute/Persistent": 0-30 days post-PCR and persisted in 30-120 day follow-up;T3) "Incident/Late": 30-120 days post-PCR identifying incident conditions/symptoms. We enforced mutual exclusivity per patient by removing conditions and symptoms from T2 previously identified in T1 and those from T3 previously identified in T1 or T2. Diagnoses were grouped using Clinical Classification Software (CCS). The PCR-positive patients (cases) were matched to PCR-negative patients (controls) by month of test, age group, race, sex, and medical center. We prioritized 1:3 (case:control) matching, followed by 1:2, then 1:1. Risk ratios with 95% confidence intervals comparing case to control COF were calculated to determine significant COF. Results: Matching successfully resulted in 28,118 cases and 70,293 controls. Demographic differences were negligible and showed no association (Highest Cramer's V: Age-.0511). Overall, risk of COF was 12% greater among cases than controls (Table 1). During T3, risk was significantly higher among cases for the following COF: anosmia, cardiac dysrhythmia, diabetes, genitourinary disorders, malaise, and nonspecific chest pain. Conclusion: We delineated significant COF among those experiencing incident PASC in our KPMAS population. Our findings contribute to the overall evaluation of PASC and provide supporting evidence for an accepted definition. Further understanding the severity and duration of these conditions will be crucial.
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Background. During the COVID-19 pandemic, patients at the John G. Bartlett Specialty practice experienced disruptions in viral load (VL) monitoring due to 1) conversion to telemedicine visits and 2) closure of the onsite lab from March 16-July 13, 2021. We described the impact of the pandemic on VL monitoring. Methods. We measured time from all index VLs collected during 3 periods: January 1, 2019 to March 15, 2020 (pre-pandemic);March 16 to July 12, 2020 (pandemic, closed onsite lab);and July 13 to December 31, 2020 (pandemic, open onsite lab) until a subsequent VL, 1 year after the index VL, or administrative censoring on December 31, 2020, whichever came first. We classified follow-up time according to these periods (treating period as a time-varying variable). We report hazard ratios (HRs) and 95% Confidence Intervals (CI) from a Cox proportional hazards model comparing the hazard of a VL during the pandemic periods to the pre-pandemic period, stratified by whether the index VL was suppressed (≤200 copies/mL). We tested for interactions between patient characteristics (age, sex at birth, race, ethnicity, and recent substance use) and period, to investigate differential effects of the pandemic on delayed VL. Results. After 7,760 suppressed VL measurements, median times to subsequent VL during the pre-pandemic, pandemic (closed lab) and pandemic (open lab) periods, were 4.6 (HR=1.0), 8.9 (HR=0.34, CI:0.30, 0.37), and 5.8 (HR=0.73, CI:0.68,0.78) months respectively. After 1,025 non-suppressed VL measurements, median times to subsequent VL were 2.0 (HR=1.0), 3.9 (HR=0.57, CI:0.42,0.79), and 2.1 (HR=0.92, CI:0.76,1.10) months respectively. Time to subsequent VL after an index suppressed VL was less affected by the pandemic for patients who are white;had private insurance;or had no recent cocaine or heroin use. The effect of the pandemic on time to subsequent VL after a non-suppressed index VL did not significantly differ across patient characteristics. Conclusion. Onsite lab closure disrupted VL collection for all groups. Once the onsite lab opened, the pandemic period was still associated with a delay among suppressed patients, but not non-suppressed patients. Further studies are needed to investigate if these delays are associated with lapses in viral suppression.
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After-school programs provide a range of support for students. During school closures due to the COVID-19 pandemic, many after-school programs were also forced to dose or to find new ways to provide services to youth, such as through virtual after-school programming. We surveyed 244 youth who participated in virtual after-school programs about their access to virtual programming as well as their experiences. We considered their pre-closure experiences as well. We also surveyed 8 program directors of after-school programs who were providing virtual programming. We found that Internet access hindered the ability of more than 1 in 4 students to access the programs. Pre-closure program experiences, including ongoing relationships with program staff and positive peer relationships contributed to more positive experiences with virtual programming. Whenever students were able to access the programs, they generally reported positive experiences. This work has implications for after-school program providers, parents, and policymakers.
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Background During the first wave of the pandemic in 2020, Covid-19 symptoms of cough, fever and loss of taste/smell were identified in the adult population and aided diagnostic PCR testing. However, children with similar symptoms appeared less likely to test positive or to develop severe disease. As part of a multi-centre observational cohort study from 16th April 2020 to 3rd July 2020, 992 paediatric participants aged 2-15 years, were recruited and underwent SARSCoV- 2 antibody testing and provided symptom data. Objectives To identify the proportion of healthy children who demonstrated antibody response to SARS-CoV-2 infection in this cohort of healthcare worker's children. To identify the symptoms experienced by participants who had the presence of SARS-CoV-2 antibodies. To assess if there was correlation between different symptoms experienced and SARS-CoV-2 antibody titres in a paediatric population. Methods 1007 participants were enrolled and 992 were included in the final analysis. Participants were identified across 5 UK sites-Belfast, Glasgow, Cardiff, Manchester and London. All participants were healthy children of NHS healthcare workers. Participants underwent phlebotomy and provided blood samples for SARS-CoV-2 antibody testing and information on their symptoms in the form of an electronic case report form (CRF). Serum and/or plasma was tested for antibodies to SARS-CoV-2 using nucleocapsid and spike protein assays. Study data was recorded on a CRF using REDCap and information recorded included age, sex, previous health, recent symptoms and potential predictors of presence of SARs-CoV-2 antibodies including contact with confirmed or suspected cases. Results Of the 992 patients included, 962/992 (97%) had complete CRFs. The median age of study participants was 10.1 years (2.03-15.99yrs) and 51% were male. There were 68/992 participants with positive SARS-CoV-2 antibodies, giving a seroprevalence of 6.9%. Of those with positive SARSCoV- 2 antibody tests, 34/68 (50%) were asymptomatic. In the symptomatic participants (34/68), the most commonly reported symptoms were fever 21/68 (31%), gastrointestinal symptoms 13/68 (19%) and headache 12/68 (18%). The presence of fever, cough or change in smell/taste was reported by 26/68 (38%) of antibody positive participants. None of the participants experienced severe symptoms requiring hospital admission. One of the assays (Abbott Architect SARS-CoV-2 IgG assay), indicated a small but significant increase in mean antibody titres between asymptomatic 4.3 S/C (95% CI 3.4 to 5.2) and symptomatic participants 5.5 S/C (95% CI 4.7 to 6.2), but this was not replicated with Roche Elecsys or DiaSorin LIAISON assays which found no significant difference. Conclusions Following the first wave of the pandemic, 68/992 (6.9%) of children of healthcare workers in UK had evidence of previous SARS-CoV-2 infection. Importantly, only 50% of these children experienced symptoms and this highlights the potential for asymptomatic children to be missed by current NHS testing guidelines. The symptoms which adults often experience, namely pyrexia, cough and loss of taste/smell, were only experienced by 38% of children who had SARSCoV- 2 antibodies. These children were more likely to experience gastrointestinal symptoms or lethargy and headache and therefore raises the question of whether this should be factored into current symptomatic testing guidelines.
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Background: Botanical molecules, such as curcumin, have been extensively studied as a potential anti-cancer therapeutics. Research has recently identified a combination of three synthetically manufactured natural molecules for clinical study in oncology. An optimized ratio of isovanillin, harmine, and curcumin has shown preclinical evidence of in-vitro and in-vivo activity with evidence of super enhancer modulation providing rationale for clinical study. Methods: Phase I, multicenter, open-label, dose-escalation, safety, pharmacodynamic and pharmacokinetic study of GZ17-6.02 given orally on a daily x 28 day of schedule in patients with advanced solid tumors or lymphoma. The dose escalation followed a standard 3+3 design. Thirty-six patients have accrued to the study, 24 in the dose escalation phase and 12 in the dose expansion phase at the recommended phase two dose (RP2D) of 375mg bid. Results: GZ17-6.02 has demonstrated to be generally well tolerated with an acceptable safety profile. Grade 3/4 transaminitis was observed in 6 out of 32 evaluable patients and was the dose limiting toxicity. Transaminitis was readily reversible upon discontinuation, no elevations of bilirubin were observed and 3 of the 6 cases of elevated transaminitis occurred above the RP2D. Grade 3/4 dizziness was observed in one patient. Two patients contracted COVID-19 while on study, though no dose interruptions or modifications were necessary. An investigator assessed partial response was reported in a patient with EGFR mutated Non-Small Cell Lung Cancer. Stable disease was observed in six additional patients at various dose levels within the study. Additional evidence of radiological tumor regression was also observed. Clinical benefit was observed in seven patients as assessed by investigators. Conclusions: GZ17-6.02 was biologically active and demonstrated an acceptable and manageable safety profile in a heavily pretreated patient population with various malignancies. This phase 1 data provides rational for further investigation in a phase 2 setting to determine GZ17-6.02’s safety and potential efficacy in defined patient populations, both as monotherapy and in combination with other therapeutics. Clinical trial identification: NCT03775525 Legal entity responsible for the study: Genzada Pharmaceuticals USA, Inc. Funding: Genzada Pharmaceuticals USA, Inc. Disclosure: R.P. Moore: Financial Interests, Personal and Institutional, Member: Genzada Pharmaceuticals. J. Bailes: Financial Interests, Personal and Institutional, Member: Genzada Pharmaceuticals. All other authors have declared no conflicts of interest.