Asymptomatic Coronavirus Disease 2019 Infection Research Articles

Asymptomatic Children as a Missing Link in Preventing COVID-19 Transmission.

Investigating the prevalence of the coronavirus disease 2019 (COVID-19) infection in asymptomatic children who have been in close contact with symptomatic individuals is instrumental for refining public health approaches, protecting vulnerable populations, and mitigating the broader impact of the pandemic. Accordingly, this study aimed to evaluate the incidence of COVID-19 infection in asymptomatic children who had been in close contact with parents exhibiting COVID-19 symptoms. Study Design: A cross-sectional study. The present cross-sectional study was conducted on 175 asymptomatic children who had been in close contact with COVID-19 confirmed cases in Hamadan County from March 2021 to August 2021. Reverse transcription polymerase chain reaction (RT-PCR) testing was performed on all asymptomatic children who had been in close contact with an individual with COVID-19. Furthermore, multiple logistic regressions were conducted to determine the predictors of COVID-19 transmission from family members to children. Out of the 175 children in close contact with index cases, 53 (30.29%) tested positive for COVID-19 through PCR. Regarding factors related to the index case, male cases (Adjusted odds ratio [AOR]=2.29; 95% confidence interval [CI]: 1.03-5.09, P=0.041), rural dwellers (AOR=3.22; 95% CI: 1.02-10.16, P=0.046), illiterate cases (AOR=8.45; 95% CI: 1.76-40.65, P=0.008), and cases presenting with nasal congestion symptoms (AOR=9.12; 95% CI: 2.22-37.40, P=0.002) were more prone to transmitting the virus to children who had close contact with them. The findings of the present study suggested that asymptomatic COVID-19 infection in household contacts is significant in children who were in close contact with a COVID-19-positive patient. Therefore, it is crucial to continue to monitor this group closely.

The Effect of asymptomatic versus mild symptomatic COVID-19 infection on male athletic performance: A cross-sectional clinical research

Objective: Novel Coronavirus Disease 2019 (COVID-19) pandemic has affected the whole world and still host many obscurities. Researches involving athletes investigated the lifestyle, athletic performance and psychological alterations compared to pre-pandemics and returning-to-sports process. But, knowledge about the past symptomatic COVID-19 effects on athletic performance is immature. Athletes are prone to asymptomatic or mild symptomatic COVID-19 rather than severe form; so this study aimed to compare the muscular athletic performance, cardiorespiratory function and psychological condition after COVID-19 between asymptomatic and mild symptomatic athletes. Materials and Methods: This case-control designed study recruited a total of 40 young adult male long-distance runners who survived COVID-19 asymptomatically (n=20), and with mild symptoms (n=20). All of the subjects had completed the isolation period and been approved to return-to-sports. The age, anthropometric properties, athletic license term and dominant hand and foot sides of the subjects were recorded. The muscular strength of upper limb, isokinetic and isometric muscular strengths of lower limb flexor and extensors, and VO2max were measured. The self-reported depression, anxiety and COVID-19-related fear were evaluated. Results: The values of all muscular strength parameters, VO2max and anxiety level were similar between the groups (p>0.05). However, the levels of depression (p=0.048) and COVID-19-related fear (p=0.012) were significantly higher in mild symptomatic group in comparison with asymptomatic (p<0.05). Conclusions: Mild symptomatic COVID-19 did not affect muscular athletic performance and cardiorespiratory fitness, but caused psychological disorder in comparison with asymptomatic infection. In case of COVID-19, the psychological state of the athlete should be paid close attention. We suggest the supply of adequate and quick psychological support while targeting the previous level of physical fitness and athletic performance in the returning-to-sports process.

The impact of immunocompromise on outcomes of COVID-19 in children and young people-a systematic review and meta-analysis.

Despite children and young people (CYP) having a low risk for severe coronavirus disease 2019 (COVID-19) outcomes, there is still a degree of uncertainty related to their risk in the context of immunodeficiency or immunosuppression, primarily due to significant reporting bias in most studies, as CYP characteristically experience milder or asymptomatic COVID-19 infection and the severe outcomes tend to be overestimated. A comprehensive systematic review to identify globally relevant studies in immunosuppressed CYP and CYP in general population (defined as younger than 25 years of age) up to 31 October 2021 (to exclude vaccinated populations) was performed. Studies were included if they reported the two primary outcomes of our study, admission to intensive therapy unit (ITU) and mortality, while data on other outcomes, such as hospitalization and need for mechanical ventilation were also collected. A meta-analysis estimated the pooled proportion for each severe COVID-19 outcome, using the inverse variance method. Random effects models were used to account for interstudy heterogeneity. The systematic review identified 30 eligible studies for each of the two populations investigated: immunosuppressed CYP (n = 793) and CYP in general population (n = 102,022). Our meta-analysis found higher estimated prevalence for hospitalization (46% vs. 16%), ITU admission (12% vs. 2%), mechanical ventilation (8% vs. 1%), and increased mortality due to severe COVID-19 infection (6.5% vs. 0.2%) in immunocompromised CYP compared with CYP in general population. This shows an overall trend for more severe outcomes of COVID-19 infection in immunocompromised CYP, similar to adult studies. This is the only up-to-date meta-analysis in immunocompromised CYP with high global relevance, which excluded reports from hospitalized cohorts alone and included 35% studies from low- and middle-income countries. Future research is required to characterize individual subgroups of immunocompromised patients, as well as impact of vaccination on severe COVID-19 outcomes. PROSPERO identifier, CRD42021278598.

The temporal effects of asymptomatic COVID-19 infection on peri-operative complications in patients receiving total joint arthroplasty.

Recent coronavirus disease 2019 (COVID-19) infection may pose increased risk of post-operative complications after total joint arthroplasty (TJA). Current recommendations suggest waiting four-weeks before elective surgery in asymptomatic patients. The purpose of this study was to propensity-score-match patients who had positive COVID-19-test between (1) 0-2weeks and (2) 2-4weeks before TJA with a matching group without COVID-19 history to determine rates of complications at 90-days and 1-year post-operatively. We queried a national-database for patients who tested positively for COVID-19 within 1-month (n = 1749) before TJA. A propensity-score-match analysis was conducted to limit influence of confounders. They were separated into mutually exclusive asymptomatic cohorts based on time of positive COVID-19-test before TJA: within 2-weeks (n = 1749) and between 2-to-4 weeks (n = 599). Asymptomatic patients were patients with positive test without symptoms of fever, shortness of breath, nausea, vomiting, diarrhea, loss of taste or smell, cough, bronchitis, pneumonia, lung infections, septic shock, and multiple-organ-dysfunction. Complications analyzed: 90-day and 1-year periprosthetic-joint infections (PJIs), surgical-site infections(SSIs), wound complications, cardiac complications, transfusions, and venous thromboembolisms. Asymptomatic patients who have COVID-19 demonstrated increased incidence of PJI in patients who had TJA performed within two weeks from positive test at 90-days compared to patients who did not test positive for COVID-19 (3.0 vs. 1.5%; p = 0.023). Upon totaling all 90-day post-operative complications, no significant difference was found amongst asymptomatic patients who tested positive for COVID-19 for total complications at 90-days (p = 0.936). Asymptomatic patients who test positive for COVID-19 don't have increased risk for post-operative complications after TJA. However, two-fold increased risk in PJI for patients who tested positive for COVID-19 in first 2-weeks cannot be ignored. These results should be taken into consideration when surgeons consider performing TJA. We recommend asymptomatic patients consider waiting two-weeks before TJA to mitigate risk of PJI. Nevertheless, there's reassurance these patients are not at increased total complication risk.

Real-World Effectiveness of Four Types of COVID-19 Vaccines.

There is a scarcity of evidence regarding the real-world effectiveness of coronavirus disease 2019 (COVID-19) vaccines. This was the first study to evaluate the effectiveness of four types of vaccines against asymptomatic and symptomatic infection, and COVID-19 outcomes among the general population. This was a matched comparison group quasi-experimental study conducted in Jordan between 1 January and 29 August 2021. In the first part of the study, 1200 fully vaccinated individuals were matched with 1200 unvaccinated control participants. In order to measure vaccine effectiveness, the infection rates of both vaccinated and unvaccinated groups were calculated. The second part of the study included measuring specific anti-SARS CoV-2 immune cells and antibodies. BNT162b2 (Pfizer, New York, NY, USA) showed a significantly higher effectiveness against asymptomatic COVID-19 infection (91.7%) and hospitalization (99.5%) than BBIBP-CorV (Sinopharm, Beijing, China) (88.4% and 98.7%, respectively) and ChAdOx1 nCoV-19 (AstraZeneca, Cambridge, UK) (84.3%, and 98.9%, respectively). The effectiveness rates of the Sputnik V (Gamaleya Research Institute, Moscow, Russia) vaccine against asymptomatic, symptomatic, and hospitalization were 100%, 100%, and 66.7%, respectively. The highest median anti-spike (S) IgG values were seen in individuals who received BNT162b2 (2.9 AU/mL) and ChAdOx1 nCoV-19 (2.8 AU/mL) vaccines. The levels of anti-S IgG were significantly decreased after 7 months of vaccination with BNT162b2 and BBIBP-CorV. There were significant decreases in the median number of neutralizing antibodies one month and seven months after receiving BNT162b2 (from 88.5 to 75.2 4 Bioequivalent Allergen Unit per milliliter/mL), BBIBP-CorV (from 69.5 to 51.5 BAU/mL), and ChAdOx1 nCoV-19 (from 69.2 to 58.BAU/mL) vaccines. The highest percentage of T cells specific to COVID-19 vaccine was found in individuals who received BNT162b2 (88.5%). All four vaccines evaluated in this study showed effectiveness against asymptomatic COVID-19 infection, symptomatic infection, hospitalization, and death. Furthermore, BNT162b2, BBIBP-CorV, and ChAdOx1 nCoV-19 induced high levels of immunology markers within one month of vaccination.

Limitation of Interpreting a Single COVID Cycle Threshold Value

Abstract The United States reported its first case of coronavirus disease 2019 (COVID-19) in January 2020. There was limited testing capacity at the time, and the causative agent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was indeed extremely infectious. Testing, therefore, has become a vital part of controlling the COVID-19 pandemic. Nucleic acid amplification tests, such as polymerase chain reaction platform, a value called cycle threshold (Ct) is reported. This number represents the number of polymerase chain reaction test cycles it takes for the sample to become positive. It is inversely proportional to the amount of viral RNA present in the sample. Therefore, a high Ct value infers a low quantity of viral RNA, and conversely, a low Ct value implies high viral RNA, which in turn correlates with infectivity. When interpreted appropriately with the right clinical context, it could be used to assess the infectiousness of an individual. In September 2021, a 73-year-old man who previously completed a primary series of Moderna vaccine (2 injections) presented to the hospital with chest pain. Cardiac catheterization showed multivessel coronary artery disease and was deemed to have unstable angina. The plan was to undergo coronary aortic bypass graft surgery. Preoperative routine testing revealed a positive COVID-19 polymerase chain reaction test with a high Ct value. During the hospital stay, it was shown that he had a decreased Ct value and thus was determined to have an acute case of asymptomatic COVID-19 infection. His surgery was delayed according to the isolation protocol per Centers for Disease Control and Prevention for safety precautions. He eventually underwent coronary aortic bypass graft after completion of isolation and had an uneventful postoperative course. It was also documented that he had serological seroconversion consistent with acute COVID-19 infection. This case illustrates that reporting Ct values is useful in a certain clinical context, but clinicians need to be familiar with the transmissibility and history of SARS-CoV-2 infection as well as understanding the interpretation of positive tests. The appropriate clinical approach and management should be assessed based on exposure history, epidemiology, physical examination, radiographic assessment, and laboratory studies.

Abstract 109: Regional Cerebral Hypoperfusion In Patients Recovered From Mild COVID-19

Background: Cerebral hypoperfusion have been described in both severe and mild forms of symptomatic coronavirus disease 2019 (COVID-19) infection. The purpose of this study was to investigate global and regional gray matter (GM) and white matter (WM) cerebral blood flow (CBF) in asymptomatic COVID-19 infection patients compared with age-gender-race matched controls. Methods: Cases with mild COVID-19 infection and age-gender-race matched healthy controls, were drawn from the ABC@UofSC data repository. Demographics, risk factors and data from the Montreal Cognitive Assessment (MOCA score) were collected within a week of magnetic resonance imaging (MRI) perfusion image acquisition using pseudo-continuous arterial spin labeling. Mean CBF values for GM, WM and whole brain were calculated by averaging CBF values of standard space normalized CBF image values falling within GM and WM masks. Whole-brain, region of interest (ROI) based analyses were used to create standardized cerebral blood flow maps and further explore differences between the two groups. Results: Twenty-eight cases with prior mild COVID-19 infection were compared with 28 age-, gender-, race-matched controls. The MOCA score was similar between cases and controls. Whole-brain CBF (46.7±5.6 vs. 49.3±3.7, p=0.05), GM-specific CBF (64.2±8.9 vs. 67.6±6.0, p=0.10), and WM-specific CBF (29.3±2.6 vs. 31.0±1.6, p=0.03) were noted to be lower in COVID-19 cases as compared to controls. Further analysis identified several brain regions with lower CBF than the CONTROL group colors representing Z-scores shown in the figure. Predictive models based on these data predicted COVID-19 group membership with a high degree of accuracy (85.2%) suggesting CBF patterns as a key imaging marker of mild infection. Conclusion: In this study, lower white matter CBF, as well as widespread regional CBF changes identified using quantitative MRI, were found in patients recovered from mild to moderate COVID-19 infection.

The Effects of Asymptomatic Coronavirus Disease-2019 on Placenta at Third Trimester Pregnancy: A Comprehensive Study

Objective: By the time coronavirus disease-2019 (COVID-19) had been announced as pandemic, the disease was shown to have a great risk among pregnant woman if lower respiratory system is involved. We aimed to describe clinical characteristics of deliveries with asymptomatic COVID-19 infection, investigate transplacental transmission, and compare first-line histopathological findings with healthy controls. Material and Methods: We conducted a prospective cohort study of consecutive term deliveries at our tertiary hospital's obstetric unit between March and November 2021. Forty-five patients with asymptomatic reverse transcription-polymerase chain reaction (RT-PCR) positivity were matched with 45 controls with negative RT-PCR testing. All newborns of mothers with positive RT-PCR results for COVID19 underwent a nasopharyngeal swab following delivery, and Apgar scores of the newborns were extracted from pediatric charts. Placentas were transported and fixated in 10% formaldehyde solution before pathological evaluation. Results: There were no significant differences in Apgar scores, birth weights, head circumferences, birth height, and genders between the 2 groups. RT-PCR results were negative in all of the newborns, indicating no vertical transmission. Placental focal and global calcification, and choriamnionitis frequencies were similar between the groups, whereas placental fibrin deposits were significantly more frequent in the placentas of infected pregnancies. Conclusion: There was no evidence of vertical transmission and any characteristic feature in the placentas of pregnancies with asymptomatic COVID-19 infection. Although no significant clinical implication was found, increased perivillous fibrin deposition in the study group could be a baseline step for the progression of perinatal infection.

Asemptomatik COVID-19 ve Pulmoner Emboli İlişkisi: Olgu-Kontrol Çalışması

Objective: The incidence of pulmonary embolism (PE) has increased in coronavirus disease-2019 (COVID-19) infection. The aim of study is to determine whether there is an increase in the frequency of PE in asymptomatic COVID-19 patients. Material and Methods: Patients who were diagnosed with PE our hospital, who did not have COVID-19 and who were not vaccinated against COVID-19 were included in the study group and severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) antibody levels were examined. The control group was consisted of patients who did not have PE, had not had COVID-19 and were not vaccinated and SARSCoV-2 antibody levels were examined. The antibody positivity rates, antibody titer levels of both groups were compared. Results: A total of 32 patients, 16 in the study group and 16 in the control group, were included in the study. Of all patients, 22 (68.8%) were male, 10 (31.3%) were female. While the mean age of men was 47.36±14.86, women was 51±24.463 (p=0.671). There was no statistically difference between the 2 groups in terms of mean age (p=0.346). When the groups were compared in terms of SARS-CoV-2 antibody, antibody positivity was found in 7 (43.8%) patients in both the study group and the control group (p=1.000). There wasn't difference between the groups antibody titers (p=0.275). The rate of asymptomatic COVID19 infection in patients with PE was found to be similar to the population followed with non-PE diagnoses. Conclusion: The results of study show that there is no increase in the risk of PE in patients with asymptomatic COVID-19 infection.

Prevalence of Asymptomatic COVID-19 Infection in Hemodialysis Patients and the Risk of Hypercoagulability: Should we Consider Routine Screening?

Coronavirus disease 2019 (COVID-19) has become a pandemic in late 2019. Its clinical presentation varies from asymptomatic infection to severe respiratory failure. Infection control strategies to minimize the risk of transmission of COVID-19 in end-stage renal disease (ESRD) patients receiving in-center hemodialysis (HD) have been implemented. Development of humoral response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in adult patients with ESRD receiving HD has not been sufficiently reported. A total of 179 asymptomatic HD patients undergoing regular HD were screened for COVID-19 infection. Infection with SARS-CoV-2 was confirmed through a real-time reverse transcription polymerase chain reaction assay of nasopharyngeal swab specimens. They were classified into positive and negative groups according to the results of PCR. Of the 179 asymptomatic patients, we found that 23 patients (12.8%) were positive for COVID-19. Their mean age was 45.61 ± 13.38 years. There was a significant difference between both groups regarding C-reactive protein, lymphocytes, and platelet counts (P < 0.001). Also, TAT (thrombin-antithrombin complex) and D-dimer levels were significantly increased among the positive group (11.47 ± 1.51 vs. 7.53 ± 1.64 mcq/L, P < 0.001; 1171.52 ± 267.6 vs. 542.76 ± 107.06 ng/mL, P < 0.001, respectively). Asymptomatic SARS-CoV-2 infection is detected in HD patients. They carry the risk of hypercoagulability complications. We need more strict infection control measures and proactive diagnosis to limit the spread of the infection and lethal thromboembolic complications.

Coronavirus Disease 2019-Associated Cerebral Mucormycosis in an Immunocompetent Child

AbstractMucormycosis is a rare opportunistic fungal infection observed in immunocompromised individuals or in those with uncontrolled diabetes mellitus. During the coronavirus disease 2019 (COVID-19) pandemic, there has been a steep increase in the incidence of mucormycosis among adults. However, the infection is extremely rare in the pediatric population, and its occurrence post-COVID-19 infection has been reported in very few cases. We present a case of cerebral mucormycosis in a 6-year-old immunocompetent girl that was histopathologically confirmed by stereotactic brain biopsy. The fungal infection occurred following asymptomatic COVID-19 infection. This report describes the diagnostic journey and management. It highlights the unusual presentation of cerebral mucormycosis in our case and the role of posaconazole in the successful treatment.

Pulmonary thromboembolism in mild and asymptomatic COVID-19 cases. A clinical conundrum in post-COVID era

We present a case series of patients with pulmonary embolism of unknown etiology who did not have any risk factors. According to the findings, the most likely cause of the pulmonary embolism was undiagnosed, asymptomatic, or mild Corona Virus disease-2019 (COVID-19) infections in the recent past. In the current post-pandemic era, where there has been a surge of sudden unexplained deaths and pulmonary embolism cases, this case series emphasizes the importance of pulmonary embolism evaluation in patients seeking medical care for dyspnea. Physicians should be aware of the possibility of pulmonary embolism as a late complication in patients with mild, asymptomatic, or undiagnosed COVID-19 infection.

Pulmonary Thromboembolism in Mild and Asymptomatic COVID-19 Cases – A Clinical Conundrum in Post COVID era

We present a case series of patients with pulmonary embolism of unknown etiology who did not have any risk factors. According to the findings, the most likely cause of the pulmonary embolism was undiagnosed, asymptomatic, or mild Corona Virus disease-2019 (COVID-19) infections in the recent past. In the current post-pandemic era, where there has been a surge of sudden unexplained deaths and pulmonary embolism cases, this case series emphasizes the importance of pulmonary embolism evaluation in patients seeking medical care for dyspnea. Physicians should be aware of the possibility of pulmonary embolism as a late complication in patients with mild, asymptomatic, or undiagnosed COVID-19 infection.

Efficacy of anti-severe acute respiratory syndrome coronavirus 2 mRNA vaccines in adults with severe acquired aplastic anemia with or without allogeneic hematopoietic stem cell transplantation.

Efficacy of anti-severe acute respiratory syndrome coronavirus 2 mRNA vaccines in adults with severe acquired aplastic anemia with or without allogeneic hematopoietic stem cell transplantation.

Clinical and epidemiological investigation of a child with asymptomatic COVID-19 infection following reoccurrence

ObjectiveTo investigate the case of a child infected with coronavirus disease 2019 (COVID-19) who had subsequent viral reactivation.MethodsWe retrospectively analyzed the clinical manifestations, epidemiological data, laboratory and imaging examinations, treatment, and follow-up of the child. And then, we searched related literature using PubMed.ResultsThe 9-year-old boy was exposed to COVID-19 in Malawi and tested positive for NAT in Haikou, China. He was asymptomatic and admitted to our hospital. After six negative NATs, he was discharged from the hospital and quarantined in a hotel. His infection was reactivated again after 22 days (interval between first and last positive NATs). The cycle threshold (Ct) values of positive tests were 25 and 31, and the gene sequencing viral loads were very low. The viral strain Kenya/P2601/2020, a variant of the hCoV-19/Wuhan/IVDC-HB-01/2019 genome (GISAID accession IL: EPI_ISL_402119), was found when polymerase chain reaction enrichment was used to sequence the virus. However, people around him tested negative for COVID-19.ConclusionFirst, we confirmed the reactivation of COVID-19 in a child. The risk of recurrent infection with SARS-CoV-2 was low, and the policy of strictly isolating patients carrying long-term viral ribonucleic acid should be reconsidered. The interval positivity was most likely due to incorrect sampling and/or testing methods. SGS and aB testing are recommended for children with viral reactivation. Second, SARS-CoV-2 viral reactivation cannot be ruled out. The possible mechanisms, such as prolonged infection and viral latent reactivation, need further investigation.

Asymptomatic COVID-19 Infection Induced First Episode Psychosis: A Case Series

Aims: We presented 3 similar cases of 1st episode psychosis that occurred after Corona Virus Disease -2019 (COVID-19) infection which we treated at our institute’s on going post-COVID-19 mental health clinic, to provide more evidence to the existing literature and to describe whether an asymptomatic COVID-19 infection can also induce psychosis in previously healthy individuals and tried to elaborate the probable etiology and nature of the psychotic symptoms.&#x0D; Presentation of the Cases: All the 3 cases had COVID-19 infection, few days before their psychotic symptoms started for the 1st time. They didn’t have any history of regular substance or medication use that are known to induce psychosis or any previous history of psychiatric disease or family history of psychiatric disease, without any abnormality in physical examinations and laboratory investigations. All the cases had history of stress which were not overwhelming (except the 3rd case) and were mostly related to COVID-19 infection and pandemic associated social and financial stress. 1st case (54 years, married male) developed delusion of persecution, delusion of reference, 2nd and 3rd person auditory hallucinations, 2nd case (61 years, widower male) developed delusion of persecution, 2nd person auditory hallucination (commanding type), disinhibited behaviour (disrobing in public) and the 3rd case (32 years, unmarried male) developed delusion of persecution and delusional misidentification (Intermetamorphosis). All of them responded well to commonly used antipsychotics within 4 weeks that prompted a diagnosis of Acute and Transient Psychotic disorder according to ICD-10 criteria.&#x0D; Discussion: This study points out that even an asymptomatic COVID-19 can induce psychosis for the first time in life, where the etiology most probably is the direct effect of the virus itself on brain or the COVID-19 and pandemic related stress which is supported by the fact that factors like family history of psychiatric disease, substance use or medication use or any comorbidity that can induce psychosis were also absent. The psychopathological findings were persecutory delusion and auditory hallucinations with one case having Intermetamorphosis phenomenon which is a rare finding and perhaps a novel finding in post-COVID-19 Psychosis.&#x0D; Conclusion: All COVID-19 infected individuals should be screened early for appearance of any symptom that raises the suspicion of psychosis. Large studies are needed to ascertain the etiology of post-COVID-19 psychosis.

Coronavirus Disease 2019 Outcomes, Patient Vaccination Status, and Cancer-Related Delays During the Omicron Wave: A Brief Report From the TERAVOLT Analysis

IntroductionThe Thoracic Centers International coronavirus disease 2019 (COVID-19) Collaboration (TERAVOLT) registry found approximately 30% mortality in patients with thoracic malignancies during the initial COVID-19 surges. Data from South Africa suggested a decrease in severity and mortality with the Omicron wave. Our objective was to assess mortality of patients with thoracic malignancies with the Omicron-predominant wave and evaluate efficacy of vaccination. MethodsA prospective, multicenter observational study was conducted. A total of 28 institutions contributed data from January 14, 2022, to February 4, 2022. Inclusion criteria were any thoracic cancer and a COVID-19 diagnosis on or after November 1, 2021. End points included mortality, hospitalization, symptomatic COVID-19 infection, asymptomatic COVID-19 infection, and delay in cancer therapy. Analysis was done through contingency tables and a multivariable logistic model. ResultsWe enrolled a total of 346 patients. Median age was 65 years, 52.3% were female, 74.2% were current or former smokers, 86% had NSCLC, 72% had stage IV at time of COVID-19 diagnosis, and 66% were receiving cancer therapy. Variant was unknown for 70%; for those known, Omicron represented 82%. Overall mortality was 3.2%. Using multivariate analysis, COVID-19 vaccination with booster compared with no vaccination had a protective effect on hospitalization or death (OR = 0.30, confidence interval: 0.15–0.57, p = 0.0003), whereas vaccination without booster did not (OR = 0.64, confidence interval: 0.33–1.24, p = 0.1864). Cancer care was delayed in 56.4% of the patients. ConclusionsTERAVOLT found reduced patient mortality with the most recent COVID-19 surge. COVID-19 vaccination with booster improved outcomes of hospitalization or death. Delays in cancer therapy remain an issue, which has the potential to worsen cancer-related mortality.

Society of Family Planning Clinical Recommendations: Contraceptive Care in the Context of Pandemic Response

The coronavirus disease 2019 (COVID-19) pandemic has posed a burden to healthcare systems around the world and has changed the way people access health services, including contraception. This document sets forth guidance from the Society of Family Planning for providing contraceptive care in the context of the COVID-19 pandemic, including when access to healthcare is restricted due to pandemic response. It also outlines the role of telehealth for providing contraceptive care beyond the pandemic. Clinicians can use synchronous telemedicine visits and other forms of telehealth to provide many aspects of contraceptive care. Both audio-video and audio-only visits are acceptable forms of telemedicine. Access to permanent contraception should be maintained, especially in the postpartum period. Combined hormonal contraceptive (CHC) users who have asymptomatic or mild COVID-19 infection may continue their contraceptive method, while those admitted to the hospital with severe infection should suspend CHC use until they are clinically recovered. CHC users who take Paxlovid for mild-moderate COVID-19 infection can consider a back-up contraceptive method for the duration of therapy, but clinically relevant drug interactions are unlikely. Future research should examine contraceptive outcomes in people who receive care via telemedicine; and access to telemedicine among historically excluded populations such as adolescents, people of color, people of low socioeconomic status, disabled people, or people who do not speak English as a primary language.

New-Onset Mania and Psychosis in Adolescents in the Context of COVID-19 Infection

There is a growing body of evidence that coronavirus disease 2019 (COVID-19) is linked with neuropsychiatric complications such as psychosis and delirium in adults. Much less is known about the neuropsychiatric manifestations of this virus in the child and adolescent population. This case series discusses two unique adolescent patients who presented with new-onset mania and psychosis in the context of an otherwise asymptomatic COVID-19 infection, which raises several questions about whether and how the virus precipitates mania and psychosis, whether these symptoms are transient or predisposes patients to a chronic psychiatric disorder, and confounding variables that may have contributed to the symptoms. These questions can then be points for future research and longitudinal follow-up that can better improve our knowledge about the relationship between this complicated virus and how it affects children psychiatrically.

Vaccination

Vaccination