Now showing items 1-20 of 413

    • Excess Mortality in COVID-19-Positive Versus COVID-19-Negative Inpatients With Diabetes: A Nationwide Study

      Spanakis, Elias K; Yoo, Ashley; Ajayi, Oluwagbemiga N; Siddiqui, Tariq; Khan, Mohd M; Seliger, Stephen L; Klonoff, David C; Feng, Zhaoyong; Sorkin, John D (American Diabetes Association, 2021-07-07)
    • Achieving global equity for COVID-19 vaccines: Stronger international partnerships and greater advocacy and solidarity are needed.

      Figueroa, J Peter; Hotez, Peter J; Batista, Carolina; Ben Amor, Yanis; Ergonul, Onder; Gilbert, Sarah; Gursel, Mayda; Hassanain, Mazen; Kang, Gagandeep; Kaslow, David C; et al. (Public Library of Science, 2021-09-13)
      Peter Figueroa and co-authors advocate for equity in the worldwide provision of COVID-19 vaccines.
    • Mass Critical Care Surge Response during COVID-19: Implementation of Contingency Strategies A Preliminary Report of findings from the Task Force for Mass Critical Care

      Dichter, Jeffrey R; Devereaux, Asha V; Sprung, Charles L; Mukherjee, Vikramjit; Persoff, Jason; Baum, Karyn D; Ornoff, Douglas; Uppal, Amit; Hossain, Tanzib; Henry, Kiersten N; et al. (Elsevier Ltd., 2021-09-06)
      Background: Following the publication of 2014 consensus statement regarding mass critical care during public health emergencies, much has been learned about surge responses and the care of overwhelming numbers of patients during the COVID-19 pandemic. Gaps in prior pandemic planning were identified and require modification in the midst of ongoing surge throughout the world. Methods: The Task Force for Mass Critical Care (TFMCC) adopted a modified version of established rapid guideline methodologies from the World Health Organization and the Guidelines International Network-McMaster Guideline Development Checklist. With a consensus development process incorporating expert opinion to define important questions and extract evidence, TFMCC developed relevant pandemic surge suggestions in a structured manner, incorporating peer-reviewed literature, “gray” evidence from lay media sources, and anecdotal experiential evidence. Results: Ten suggestions were identified regarding staffing, load-balancing, communication, and technology. Staffing models are suggested with resilience strategies to support critical care staff. Intensive care unit (ICU) surge strategies and strain indicators are suggested to enhance ICU prioritization tactics to maintain contingency level care and avoid crisis triage, with early transfer strategies to further load-balance care. We suggest intensivists and hospitalists be engaged with the incident command structure to ensure two-way communication, situational awareness, and the use of technology to support critical care delivery and families of patients in intensive care units (ICUs). Conclusions: A subcommittee from the Task Force for Mass Critical Care offers interim evidence-informed operational strategies to assist hospitals and communities to plan for and respond to surge capacity demands from COVID-19.
    • Comparison of Experiences in Two Birth Cohorts Comprising Young Families with Children under Four Years during the Initial COVID-19 Lockdown in Australia and the UK: A Qualitative Study

      Gibson, Lisa Y; Lockyer, Bridget; Dickerson, Josie; Endacott, Charlotte; Bridges, Sally; McEachan, Rosemary R C; Pickett, Kate E; Whalan, Sarah; Bear, Natasha L; Silva, Desiree T; et al. (MDPI AG, 2021-08-29)
      This study aims to understand the experience and impact of the initial COVID-19 lock-down in young families with children aged below 4 years. Free text questions were administered to participants in the ORIGINS (Australia) and Born in Bradford (UK) cohort studies to collect qualitative information on worries, concerns and enjoyable experiences during the pandemic. A total of 903 (400 for ORIGINS and 503 for BiB) participants completed the two surveys during April 2020. Despite varying in geography, levels of socio-economic disadvantage and their situational context during the pandemic, respondents from both cohorts reported similar worries and challenges during the lockdown period, including: employment/finances, health anxiety, mental health and social isolation, caring for children and child development. Families across the globe experienced both positive and negative immediate impacts of COVID-19. Population-based data can be used to in-form the development of support services, public health campaigns and universal interventions to assist families in future health crises. © 2021 by the authors.
    • RE: Clinical Characteristics and Outcomes of COVID-19-Infected Cancer Patients: A Systematic Review and Meta-Analysis

      Huang, Yuting; Rivero-Hinojosa, Samuel; Ma, Yuchi; Yang, Feng; Fu, Deliang (Oxford University Press, 2021-07-28)
    • Murine Monoclonal Antibodies against the Receptor Binding Domain of SARS-CoV-2 Neutralize Authentic Wild-Type SARS-CoV-2 as Well as B.1.1.7 and B.1.351 Viruses and Protect in a Mouse Model in a Neutralization-Dependent Manner

      Amanat, Fatima; Strohmeier, Shirin; Lee, Wen-Hsin; Bangaru, Sandhya; Ward, Andrew B; Coughlan, Lynda; Krammer, Florian (American Society for Microbiology, 2021-07-27)
      After first emerging in late 2019 in China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has since caused a pandemic leading to millions of infections and deaths worldwide. Vaccines have been developed and authorized, but the supply of these vaccines is currently limited. With new variants of the virus now emerging and spreading globally, it is essential to develop therapeutics that are broadly protective and bind conserved epitopes in the receptor binding domain (RBD) or the full-length spike protein of SARS-CoV-2. In this study, we generated mouse monoclonal antibodies (MAbs) against different epitopes on the RBD and assessed binding and neutralization of authentic SARS-CoV-2. We demonstrate that antibodies with neutralizing activity, but not nonneutralizing antibodies, lower viral titers in the lungs when administered in a prophylactic setting in vivo in a mouse challenge model. In addition, most of the MAbs cross-neutralize the B.1.351 as well as the B.1.1.7 variant in vitro. IMPORTANCE Cross-neutralization of SARS-CoV-2 variants by RBD-targeting antibodies is still not well understood, and very little is known about the potential protective effect of nonneutralizing antibodies in vivo. Using a panel of mouse monoclonal antibodies, we investigate both of these points.
    • Reversal of SARS-CoV2-Induced Hypoxia by Nebulized Sodium Ibuprofenate in a Compassionate Use Program

      Salva, Oscar; Doreski, Pablo A; Giler, Celia S; Quinodoz, Dario C; Guzmán, Lucia G; Muñoz, Sonia E; Carrillo, Mariana N; Porta, Daniela J; Ambasch, Germán; Coscia, Esteban; et al. (Adis, 2021-08-30)
      Introduction: Sodium ibuprofenate in hypertonic saline (NaIHS) administered directly to the lungs by nebulization and inhalation has antibacterial and anti-inflammatory effects, with the potential to deliver these benefits to hypoxic patients. We describe a compassionate use program that offered this therapy to hospitalized COVID-19 patients. Methods: NaIHS (50 mg ibuprofen, tid) was provided in addition to standard of care (SOC) to hospitalized COVID-19 patients until oxygen saturation levels of > 94% were achieved on ambient air. Patients wore a containment hood to diminish aerosolization. Outcome data from participating patients treated at multiple hospitals in Argentina between April 4 and October 31, 2020, are summarized. Results were compared with a retrospective contemporaneous control (CC) group of hospitalized COVID-19 patients with SOC alone during the same time frame from a subset of participating hospitals from Córdoba and Buenos Aires. Results: The evolution of 383 patients treated with SOC + NaIHS [56 on mechanical ventilation (MV) at baseline] and 195 CC (21 on MV at baseline) are summarized. At baseline, NaIHS-treated patients had basal oxygen saturation of 90.7 ± 0.2% (74.3% were on supplemental oxygen at baseline) and a basal respiratory rate of 22.7 ± 0.3 breath/min. In the CC group, basal oxygen saturation was 92.6 ± 0.4% (52.1% were on oxygen supplementation at baseline) and respiratory rate was 19.3 ± 0.3 breath/min. Despite greater pulmonary compromise at baseline in the NaIHS-treated group, the length of treatment (LOT) was 9.1 ± 0.2 gs with an average length of stay (ALOS) of 11.5 ± 0.3 days, in comparison with an ALOS of 13.3 ± 0.9 days in the CC group. In patients on MV who received NaIHS, the ALOS was lower than in the CC group. In both NaIHS-treated groups, a rapid reversal of deterioration in oxygenation and NEWS2 scores was observed acutely after initiation of NaIHS therapy. No serious adverse events were considered related to ibuprofen therapy. Mortality was lower in both NaIHS groups compared with CC groups. Conclusions: Treatment of COVID-19 pneumonitis with inhalational nebulized NaIHS was associated with rapid improvement in hypoxia and vital signs, with no serious adverse events attributed to therapy. Nebulized NaIHS s worthy of further study in randomized, placebo-controlled trials ( NCT04382768). © 2021, The Author(s).
    • Coronavirus disease 2019 (COVID-19) symptoms, patient contacts, polymerase chain reaction (PCR) positivity and seropositivity among healthcare personnel in a Maryland healthcare system

      O'Hara, Lyndsay M; Schrank, Gregory M; Frisch, Melissa; Hogan, Regina; Deal, Kellie E; Harris, Anthony D; Leekha, Surbhi (Cambridge University Press, 2021-08-20)
      In a large system-wide healthcare personnel (HCP) testing experience using SARS-CoV-2 PCR and serologic testing early in the COVID-19 pandemic, we did not find increased infection risk related to COVID-19 patient contact. Our findings support workplace policies for HCP protection and underscore the role of community exposure and asymptomatic infection. © 2021 by The Society for Healthcare Epidemiology of America.
    • Cardiac Coaches: A Student-Led Inpatient Cardiac Rehabilitation Program in the COVID-19 Era

      Berg, Lars J; Arons, Danielle; Deng, Joseph; Green, Alexis L; Taneja, Monica; Wang, Chaoyang; Liu, Stanley S (Lippincott Williams and Wilkins, 2021-09)
    • Brief Report: Impact of the COVID-19 Pandemic on Asian American Families with Children with Developmental Disabilities

      Dababnah, Sarah; Kim, Irang; Wang, Yao; Reyes, Charina (Plenum, 2021-09-01)
      Discrimination against Asians and Asian Americans increased during the COVID-19 pandemic. Yet, even prior to the pandemic, little research explored the experiences of Asian American families of children with autism and other developmental disabilities. This brief report summarizes the results of a survey conducted between May and July 2020, in the immediate aftermath of state and local lockdowns due to the pandemic. Twenty-five Asian American caregivers of children with autism and other developmental disabilities completed the survey and reported on the pandemic's impact on their household. Most of the caregivers were mothers, immigrants, Chinese, raising children with autism, and highly educated. Participants' primary concerns were the disruption of their children's educational and therapeutic services. We discuss research limitations and implications.
    • Fab and Fc contribute to maximal protection against SARS-CoV-2 following NVX-CoV2373 subunit vaccine with Matrix-M™ vaccination

      Gorman, Matthew J; Patel, Nita; Guebre-Xabier, Mimi; Zhu, Alex L; Atyeo, Caroline; Pullen, Krista M; Loos, Carolin; Goez-Gazi, Yenny; Carrion, Ricardo; Tian, Jing-Hui; et al. (Elsevier Inc., 2021-08-31)
      Recently approved vaccines have shown remarkable efficacy in limiting SARS-CoV-2 associated disease. However, with the variety of vaccines, immunization strategies, and waning antibody titers, defining correlates of immunity across a spectrum of antibody titers is urgently required. Thus, we profiled the humoral immune response in a cohort of non-human primates immunized with a recombinant SARS-CoV-2 spike glycoprotein (NVX-CoV2373) at two doses, administered as a single or two-dose regimen. Both antigen dose and boosting significantly altered neutralization titers and Fc-effector profiles, driving unique vaccine-induced antibody fingerprints Combined differences in antibody effector functions and neutralization were associated with distinct levels of protection in the upper and lower respiratory tract. Moreover, NVX-CoV2373 elicited antibodies that functionally targeted emerging SARS-CoV-2 variants. Collectively, the data presented here suggest that a single dose may prevent disease via combined Fc/Fab functions, but that two doses may be essential to block further transmission of SARS-CoV-2 and emerging variants.
    • A pandemic recap: lessons we have learned

      Coccolini, Federico; Cicuttin, Enrico; Cremonini, Camilla; Tartaglia, Dario; Viaggi, Bruno; Kuriyama, Akira; Picetti, Edoardo; Ball, Chad; Abu-Zidan, Fikri; Ceresoli, Marco; et al. (Springer Nature, 2021-09-10)
      On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making. With the present paper, international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making.
    • Analysis of antibody responses after COVID-19 vaccination in liver transplant recipients and those with chronic liver diseases

      Thuluvath, Paul J; Robarts, Polly; Chauhan, Mahak (Elsevier Inc., 2021-08-26)
      Background & Aims: Liver transplant (LT) recipients or other immunocompromised patients were not included in the registration trials of vaccine studies against SARS-CoV-2. Although clinical efficacy of COVID vaccines in immunocompromised patients was unknown, many societies had recommended vaccination of this highly vulnerable patient population. Methods: In this prospective study, we determined antibody (Ab) response to spike protein, 4 weeks after the 2nd dose of mRNA vaccines or after the single dose of Johnson & Johnson vaccine, in LT recipients and those with chronic liver diseases (CLD) with and without cirrhosis. Results: Of the 233 patients enrolled so far, 62 had LT, 79 had cirrhosis (10 decompensated) and 92 had CLD without cirrhosis. Ab titers were defined as undetectable (<0.40 U/mL), suboptimal (0.40 - 250 U/mL) and adequate (>250 U/mL). Of the 62 patients who had LT, Ab levels were undetectable in 11 patients and suboptimal (median titer 17.6, range 0.47 - 212 U/mL) in 27 patients. Among 79 patients with cirrhosis, 3 had undetectable Ab and 15 had suboptimal (median titer 41.3, range 0.49 - 221 U/L) response. Of the 92 patients without cirrhosis, four had undetectable Ab and 19 had suboptimal (median titer 95.5, range 4.9 - 234 U/L) Ab response. Liver transplantation, use of 2 or more immunosuppression medications and vaccination with a single dose of Johnson & Johnson vaccine were associated with poor immune response on multivariable analysis. No patient had any serious adverse events. Conclusions: Poor antibody response after SARS-CoV-2 vaccination was seen in 61% of LT recipients and 24% of those with CLD.
    • The impact of COVID-19 in an assisted living community

      Resnick, Barbara; Galik, Elizabeth; Holmes, Sarah; McPherson, Rachel (Elsevier Inc., 2021-08-10)
      The purpose of this study was to use routinely collected resident assessment data from a single site to evaluate the impact of COVID-19 restrictions on cognition, physical function and behavioral symptoms of residents with dementia. Specifically, it was hypothesized that controlling for age and sex, there would be a decline in cognition and function and an increase in behavioral symptoms at 12 months post implementation of COVID-19 restrictions. Twelve residents from a single memory care site with required Resident Assessments completed prior to and 12 month post initiation of the pandemic and associated quarantines were included. No significant change was noted in function or behavioral symptoms but there was a statistically significant decline in cognition over the 12 month period. Although this study did not support our hypothesis, the findings supported some prior research also noting little significant change among the majority of individuals over the course of the pandemic regardless of regulations.
    • An International Virtual COVID-19 Critical Care Training Forum for Healthcare Workers

      Cypro, Alexander; McGuire, W Cameron; Rolfsen, Mark; Jones, Neal; Shah, Nirav G; Cribbs, Sushma K; Kaul, Viren; Bojanowski, Christine M; Pedraza, Isabel; Lynch, Lauren; et al. (American Thoracic Society, 2021-02-24)
      Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic resulted in redeployment of non-critical care-trained providers to intensive care units across the world. Concurrently, traditional venues for delivery of medical education faced major disruptions. The need for a virtual forum to fill knowledge gaps for healthcare workers caring for patients with coronavirus disease (COVID-19) was apparent in the early stages of the pandemic. Objective: The weekly, open-access COVID-19 Critical Care Training Forum (CCCTF) organized by the American Thoracic Society (ATS) provided a global audience access to timely content relevant to their learning needs. The goals of the forum were threefold: to aid healthcare providers in assessment and treatment of patients with COVID-19, to reduce provider anxiety, and to disseminate best practices. Methods: The first 13 ATS CCCTF sessions streamed live from April to July 2020. Structured debriefs followed each session and participant feedback was evaluated in planning of subsequent sessions. A second set of 14 sessions streamed from August to November 2020. Content experts were recruited from academic institutions across the United States. Results: As of July 2020, the ATS CCCTF had 2,494 live participants and 7,687 downloads for a total of 10,181 views. The majority of participants had both completed training (58.6%) and trained in critical care (53.8%). Physicians made up a majority (82.2%) of the audience that spanned the globe (61% were international attendees). Conclusion: We describe the rapid and successful implementation of an open-access medical education forum to address training and knowledge gaps among healthcare personnel caring for patients with COVID-19.
    • ACE2 expression in rat brain: Implications for COVID-19 associated neurological manifestations

      Hernández, Vito S; Zetter, Mario A; Guerra, Enrique C; Hernández-Araiza, Ileana; Karuzin, Nikita; Hernández-Pérez, Oscar R; Eiden, Lee E; Zhang, Limei (Elsevier Inc., 2021-08-13)
      We examined cell type-specific expression and distribution of rat brain angiotensin-converting enzyme 2 (ACE2), the receptor for SARS-CoV-2, in the rodent brain. ACE2 is ubiquitously present in brain vasculature, with the highest density of ACE2 expressing capillaries found in the olfactory bulb, the hypothalamic paraventricular, supraoptic, and mammillary nuclei, the midbrain substantia nigra and ventral tegmental area, and the hindbrain pontine nucleus, the pre-Bötzinger complex, and nucleus of tractus solitarius. ACE2 was expressed in astrocytes and astrocytic foot processes, pericytes and endothelial cells, key components of the blood-brain barrier. We found discrete neuronal groups immunopositive for ACE2 in brainstem respiratory rhythm generating centers, including the pontine nucleus, the parafascicular/retrotrapezoid nucleus, the parabrachial nucleus, the Bötzinger, and pre-Bötzinger complexes and the nucleus of tractus solitarius; in the arousal-related pontine reticular nucleus and gigantocellular reticular nuclei; in brainstem aminergic nuclei, including substantia nigra, ventral tegmental area, dorsal raphe, and locus coeruleus; in the epithalamic habenula, hypothalamic paraventricular and supramammillary nuclei; and in the hippocampus. Identification of ACE2-expressing neurons in rat brain within well-established functional circuits facilitates prediction of possible neurological manifestations of brain ACE2 dysregulation during and after COVID-19 infection.
    • The prevalence of insomnia among health care workers amid the COVID-19 pandemic: An umbrella review of meta-analyses

      Sahebi, Ali; Abdi, Kamel; Moayedi, Siamak; Torres, Mercedes; Golitaleb, Mohamad (Elsevier Inc., 2021-08-08)
      The PRISMA guideline was used to conduct this review. By searching relevant keywords in databases of Scopus, PubMed, Web of Science, and Google Scholar, studies that reported the prevalence of insomnia among HCWs during the COVID-19 pandemic (January 2020 to the end of January 2021) and had been published in English were identified and evaluated. The random effects model was used for meta-analysis, and the I2 index was used to assess heterogeneity. The Egger test was used to determine publication bias. Based on the results of the primary search, 96 studies were identified, and ultimately 10 eligible studies entered the meta-analysis phase.
    • Warp Speed for Coronavirus Disease 2019 (COVID-19) Vaccines: Why Are Children Stuck in Neutral?

      Anderson, Evan J; Campbell, James D; Creech, C Buddy; Frenck, Robert; Kamidani, Satoshi; Munoz, Flor M; Nachman, Sharon; Spearman, Paul (Oxford University Press, 2020-09-18)
      While adult clinical trials of coronavirus disease 2019 (COVID-19) vaccines have moved quickly into phase 3 clinical trials, clinical trials have not started in children in the United States. The direct COVID-19 impact upon children is greater than that observed for a number of other pathogens for which we now have effective pediatric vaccines. Additionally, the role of children in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission has clearly been underappreciated. Carefully conducted phase 2 clinical trials can adequately address potential COVID-19 vaccine safety concerns. Delaying phase 2 vaccine clinical trials in children will delay our recovery from COVID-19 and unnecessarily prolong its impact upon children's education, health, and emotional well-being, and equitable access to opportunities for development and social success. Given the potential direct and indirect benefits of pediatric vaccination, implementation of phase 2 clinical trials for COVID-19 vaccines should begin now.
    • Performance of 4 Automated SARS-CoV-2 Serology Assay Platforms in a Large Cohort Including Susceptible COVID-19-Negative and COVID-19-Positive Patients

      Ward, Matthew D; Mullins, Kristin E; Pickett, Elizabeth; Merrill, VeRonika; Ruiz, Mark; Rebuck, Heather; Duh, Show-Hong; Christenson, Robert H (Oxford University Press, 2021-03-10)
      BACKGROUND: Anti-SARS-CoV-2 serological responses may have a vital role in controlling the spread of the disease. However, the comparative performance of automated serological assays has not been determined in susceptible patients with significant comorbidities. METHODS: In this study, we used large numbers of samples from patients who were negative (n = 2030) or positive (n = 112) for COVID-19 to compare the performance of 4 serological assay platforms: Siemens Healthineers Atellica IM Analyzer, Siemens Healthineers Dimension EXL Systems, Abbott ARCHITECT, and Roche cobas. RESULTS: All 4 serology assay platforms exhibited comparable negative percentage of agreement with negative COVID-19 status ranging from 99.2% to 99.7% and positive percentage of agreement from 84.8% to 87.5% with positive real-time reverse transcriptase PCR results. Of the 2142 total samples, only 38 samples (1.8%) yielded discordant results on one or more platforms. However, only 1.1% (23/2030) of results from the COVID-19-negative cohort were discordant. whereas discordance was 10-fold higher for the COVID-19-positive cohort, at 11.3% (15/112). Of the total 38 discordant results, 34 were discordant on only one platform. CONCLUSIONS: Serology assay performance was comparable across the 4 platforms assessed in a large population of patients who were COVID-19 negative with relevant comorbidities. The pattern of discordance shows that samples were discordant on a single assay platform, and the discordance rate was 10-fold higher in the population that was COVID-19 positive.
    • G6PD distribution in sub-Saharan Africa and potential risks of using chloroquine/hydroxychloroquine based treatments for COVID-19

      da Rocha, Jorge E B; Othman, Houcemeddine; Tiemessen, Caroline T; Botha, Gerrit; Ramsay, Michèle; Masimirembwa, Collen; Adebamowo, Clement; Choudhury, Ananyo; Brandenburg, Jean-Tristan; Matshaba, Mogomotsi; et al. (Springer Nature, 2021-07-23)
      Chloroquine/hydroxychloroquine have been proposed as potential treatments for COVID-19. These drugs have warning labels for use in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Analysis of whole genome sequence data of 458 individuals from sub-Saharan Africa showed significant G6PD variation across the continent. We identified nine variants, of which four are potentially deleterious to G6PD function, and one (rs1050828) that is known to cause G6PD deficiency. We supplemented data for the rs1050828 variant with genotype array data from over 11,000 Africans. Although this variant is common in Africans overall, large allele frequency differences exist between sub-populations. African sub-populations in the same country can show significant differences in allele frequency (e.g. 16.0% in Tsonga vs 0.8% in Xhosa, both in South Africa, p = 2.4 × 10-3). The high prevalence of variants in the G6PD gene found in this analysis suggests that it may be a significant interaction factor in clinical trials of chloroquine and hydroxychloroquine for treatment of COVID-19 in Africans.