ABSTRACT
BackgroundUnderstanding the local epidemiology, including mortality, of COVID-19 is important for guiding optimal mitigation strategies such as vaccine implementation, need for study of more effective treatment, and redoubling of focused infection control measures. MethodsA retrospective observational cohort study design was utilized. We included adult patients diagnosed in the hospital or emergency department with COVID-19 from March 8, 2020 through May 17, 2020 at Grady Memorial Hospital (Atlanta, GA). Medical chart data abstraction was performed to collect clinical, laboratory and outcome data. Death, defined as inpatient mortality or discharge to hospice, was the primary outcome. ResultsAmong 360 persons with laboratory-confirmed COVID-19, 50% were [≥] 60 years, and most (80%) were Black and had a BMI [≥]25 kg/m2 (64%). A total of 53 patients (15%) had an outcome of death with the majority (n=46, 88%) occurring in persons [≥] 60 years. Persons [≥] 60 years were less likely to have typical COVID-19 symptoms while more likely to have multiple comorbidities, multifocal pneumonia, and to be admitted to intensive care. The death rate was 27% among persons [≥]60 years versus 4% in those <60 years (p<.01). Furthermore, most deaths (n=40, 75%) occurred among residents of long-term care facilities (LCFs). ConclusionsWe describe early COVID-19 cases among predominantly Black and older patients from a single center safety net hospital. COVID-19 related mortality occurred predominantly among older patients from LCFs highlighting the need for improved preparedness and supporting prioritization of vaccination efforts in such settings.
ABSTRACT
BackgroundRapid and accurate testing for SARS-CoV-2 is an essential tool in the medical and public health response to the COVID-19 pandemic. An ideal test for COVID-19 would combine the sensitivity of laboratory-based PCR combined with the speed and ease of use of point-of-care (POC) or home-based rapid antigen testing. MethodsTo evaluate the performance of the Diagnostic Analyzer for Selective Hybridization (DASH) SARS-CoV-2 POC PCR (sample insertion to result time of 16 minutes), we conducted a cross-sectional study of adults with and without symptoms of COVID-19 at four clinical sites. We collected two bilateral anterior nasal swabs from each participant and information on COVID-19 symptoms, vaccination, and exposure. One swab was tested with the DASH SARS-CoV-2 POC PCR and the second in a central laboratory using Cepheid Xpert Xpress SARS-CoV-2 PCR. We assessed test concordance and calculated sensitivity, specificity, negative and positive predictive values using Xpert as the "gold standard." ResultsWe enrolled 315 and analyzed 313 participants with median age 42 years; 65% were female, 62% symptomatic, 75% had received [≥]2 doses of mRNA COVID-19 vaccine, and 16% currently COVID-19 positive. There were concordant results for 307 tests indicating an overall agreement for DASH of 0.98 [95% CI 0.96, 0.99] compared to Xpert. DASH performed at 0.96 [95% CI 0.86, 1.00] sensitivity and 0.98 [95% CI 0.96, 1.00] specificity, with a positive predictive value of 0.85 [95% CI 0.73, 0.96] and negative predictive value of 0.996 [95% CI 0.99, 1.00]. The six discordant tests between DASH and Xpert all had high Ct values (>30) on the respective positive assay. DASH and Xpert Ct values were highly correlated (R=0.89 [95% CI 0.81, 0.94]). ConclusionsDASH POC SARS-CoV-2 PCR was accurate, easy to use, and provided fast results in real-life clinical settings with an overall performance similar to an EUA-approved laboratory-based PCR. Its compact design and ease of use are optimal for a variety of healthcare, and potentially community settings, including areas with lack of access to central laboratory-based PCR testing. SummaryDASH is an accurate, easy to use, and fast point-of-care test with applications for diagnosis and screening of SARS-CoV-2 infection.
