Decline in prevalence of tuberculosis following an intensive case-finding campaign and the COVID-19 pandemic in an urban Ugandan community (preprint)

Background: Systematic screening is a potential tool for reducing the prevalence of tuberculosis and counteracting COVID-related disruptions in care. Repeated community-wide screening can also measure changes in the prevalence of tuberculosis over time. Methods: We conducted serial, cross-sectional tuberculosis case-finding campaigns in one community in Kampala, Uganda, in 2019 and 2021. Both campaigns sought sputum for tuberculosis testing (Xpert MTB/RIF Ultra) from all adolescents and adults. We estimated the prevalence of tuberculosis among screening participants in each campaign and compared characteristics of people with tuberculosis across campaigns. We simultaneously enrolled and characterized community residents who were diagnosed with tuberculosis through routine care and assessed trends in facility-based diagnosis. Results: We successfully screened 12,033 community residents (35% of the estimated adult/adolescent population) in 2019 and 11,595 (33%) in 2021. In 2019, 0.94% (95% CI 0.77-1.13%) of participants tested Xpert-positive (including trace). This proportion fell to 0.52% (95%CI 0.40-0.67%) in 2021; the prevalence ratio was 0.55 [95%CI: 0.40-0.75]). There was no change in the age (median 26 vs 26), sex (56% vs 59% female), or prevalence of chronic cough (49% vs 54%) among those testing positive. By contrast, the rate of routine facility-based diagnosis remained steady in the eight months before each campaign (210 [95%CI 155-279] vs. 240 [95%CI 181-312] per 100,000 per year). Conclusions: Following an intensive initial case-finding campaign in an urban Ugandan community in 2019, the burden of prevalent tuberculosis as measured by systematic screening had decreased by 45% in 2021, despite the intervening COVID-19 pandemic.

Management and Outcomes of Critically-Ill Patients with COVID-19 Pneumonia at a Safety-net Hospital in San Francisco, a Region with Early Public Health Interventions: A Case Series (preprint)

Background: Following early implementation of public health measures, San Francisco has experienced a slow rise and a low peak level of coronavirus disease 2019 (COVID-19) cases and deaths. Methods and Findings: We included all patients with COVID-19 pneumonia admitted to the intensive care unit (ICU) at the safety net hospital for San Francisco through April 8, 2020. Each patient had [≥]15 days of follow-up. Among 26 patients, the median age was 54 years (interquartile range, 43 to 62), 65% were men, and 77% were Latinx. Mechanical ventilation was initiated for 11 (42%) patients within 24 hours of ICU admission and 20 patients (77%) overall. The median duration of mechanical ventilation was 13.5 days (interquartile range, 5 to 20). Patients were managed with lung protective ventilation (tidal volume <8 ml/kg of ideal body weight and plateau pressure [≤]30 cmH2O on 98% and 78% of ventilator days, respectively). Prone positioning was used for 13 of 20 (65%) ventilated patients for a median of 5 days (interquartile range, 2 to 10). Seventeen (65%) patients were discharged home, 1 (4%) was discharged to nursing home, 3 (12%) were discharged from the ICU, and 2 (8%) remain intubated in the ICU at the time of this report. Three (12%) patients have died. Conclusions: Good outcomes were achieved in critically ill patients with COVID-19 by using standard therapies for acute respiratory distress syndrome (ARDS) such as lung protective ventilation and prone positioning. Ensuring hospitals can deliver sustained high-quality and evidence-based critical care to patients with ARDS should remain a priority.