Asymptomatic COVID-19 Positive Patients Research Articles

Efficacy of Integrated Tele-Yoga Intervention on Physiological and Psychological Variables in Asymptomatic COVID-19 Positive Patients: A Confirmatory Randomized Control Trial

Background: A study was conducted on asymptomatic COVID-19 positive patients admitted in a COVID-19 hospital in Indore, India, during first wave of the pandemic. The objective of the study was to assess the efficacy of an integrated tele-yoga intervention as an adjunct to conventional management on physiological, psychological, and mindfulness variables. Methods: In a confirmatory randomized control trial, 60 asymptomatic COVID-19 patients in hospital confinement were randomly allocated to experimental and control groups (n = 30). The tele-yoga intervention included breathing exercise, pranayama, and meditation delivered over 30 min for 7 days to the experimental group while the control group continued treatment as usual. Assessment of physiological variables and psychological variables was carried out before intervention and on day 7 immediately after intervention. Data were analyzed using SPSS (v.16.0). Results: Mann-Whitney U test shows that there was a statistically significant difference between groups regarding all variables (p < 0.001). The physiological and psychological variables which included Oxygen saturation (2.07%), Heart rate (8.21%), Respiratory rate (10.04%), Systolic blood pressure (6.14%), Diastolic blood pressure (8.38%), Visual Analog Scale for stress (62.78%), COVID-19 Peritraumatic Distress Index (68.44%), and State Mindful Attention Awareness Scale (72.72%) showed significant changes in the experimental group compared to control group. Conclusion: The results of this study suggest that integrated tele-yoga might have therapeutic benefits in improving physiological, psychological, and mindfulness variables in asymptomatic COVID-19 patients.

Dental team member compliance with personal protective equipment and aerosol-generating procedure recommendations during the COVID-19 pandemic in Israel: An observational study.

Coronaviruses which have been responsible for numerous epidemics worldwide, share common transmission modalities and pose a risk within dental clinics. Updated, COVID-19-specific infection control and personal protective equipment (PPE) guidelines for dental settings, including minimizing aerosol-generating procedures (AGPs), were issued by the Israeli Ministry of Health (MoH) in spring 2020. This study investigated dental team members (dentists, dental assistants and hygienists) compliance with MoH recommendations exposed to asymptomatic COVID-19 positive patients. The MoH analysed exposure reports from dental clinics to asymptomatic SARS-CoV-2 positive patients following their reopening (April 2020). Exposure reports were verified against a COVID-19 national database. A cumulative transmission rate was calculated and compared to the rate in the population. One thousand three hundred twenty-third exposure reports were received (May 1-December 31, 2020) regarding dental team members who treated asymptomatic SARS-CoV-2 positive patients: 525 (39.7%) were dentists, 656 (49.6%) dental assistants and 126 (9.5%) hygienists. Practitioner type was not reported in 16 (1.2%) cases. Most dental team members reported full PPE use and performance of short/non-aerosol-generating procedures. Dentists and hygienists reported higher compliance compared with dental assistants. 8 (0.6%) dental team members (four dentists, four dental assistants) were positive post-exposure, with an average of 5.4 days (median 5 days, SD=4.8) from dental treatment to a positive COVID-19 test. Most dental team members complied fully with the MoH recommendations. Differences were found between the dental team members (hygienists being most adherent). Further efforts are required to encourage full compliance.

Asymptomatic COVID-19 Trauma Patients have Worse Outcomes and Resource Use: A Matched Cohort Study

Introduction: It is not known if asymptomatic COVID-19 trauma patients have a different outcome from COVID-19 negative patients. The aim of this study is to evaluate the impact of COVID-19 positivity on outcomes and resource use in the trauma population. Methods: All trauma patients admitted to an urban level 1 trauma center during March 2020 - October 2021 were collected and reviewed for COVID-19 status. COVID-19 positive patients with symptoms or initial chest radiographs consistent with infections were excluded. Propensity score model 1:3 matched asymptomatic COVID-19 positive to COVID-19 negative trauma patients for their age, BMI, MOA, ISS, SBP < 90, GCS<9 and comorbidities. Outcomes included mortality, complication and resource use. Results: A total of 185 asymptomatic COVID-19 positive patients were matched with 554 COVID-19 negative patients. Asymptomatic COVID-19 positive patients had higher rates of myocardial infarction and cardiac arrest (3.2% vs 0.9%, p = 0.023), higher ventilator days (3.33 vs 1.49, p < 0.001), ICU-LOS (4.92 vs 3.41 days, p = 0.034), overall LOS (11.41 vs 7.24 days, p < 0.001) and hospital charges (176.505.80 vs 107.591.93 $, p = 0.002). Conclusion: Asymptomatic COVID-19 trauma patients have significantly higher rates of cardiac events, longer LOS and higher hospital charges when compared with similar trauma patients who are COVID-19 negative.

Haematological Traits in Symptomatic and Asymptomatic COVID-19 Positive Patients for Predicting Severity and Hospitalization.

ObjectiveThe present investigation aims on the clinical attributes and haematological parameters between symptomatic (COVID–19 ICU) and asymptomatic (COVID–19 homes isolation) patients as predisposing sign for COVID-19 related mortality.Materials and MethodsA retrospective cohort research was conducted of admitted patients to ICU, who were suffering from severe COVID-19 in Aseer Central Hospital, Abha, Kingdom of Saudi Arabia (KSA) from July 2020 until September 2020. The study included individuals with COVID −19 and ICU admission as symptomatic group and others who are COVID–19 positives with quarantine as asymptomatic group. Epidemiological, clinical and haematological laboratory data were retrospectively collected, analysed with control subjects.ResultsOf the 38 ICU patients studied, the most common symptoms were fever and respiratory distress (100%), cough (86.8%). Majority were of Saudi origin (78.9%). Eighteen (47.4%) COVID-19 ICU patients showed leukocytosis, 6 (15.8%) had severe thrombocytopenia (with most having thrombocytopenia), 18 (47.4%) were anaemic. A significant correlation was observed between the WBC, RBC, Hb, platelets, neutrophil and lymphocyte count between ICU inmates compared with quarantine (p < 0.001) and RBC, Hb, neutrophil and lymphocyte count with control groups (p < 0.001).ConclusionFrom the observations it is evident that, the blood tests have potential clinical value in predicting COVID-19 progression. Further, patient characteristics including age, leukocyte count, RBC, platelets and differential leukocyte counts may be significant predictors for monitoring the progression of the critical illness observed in SARS-COV-2 patients. Also, treatment procedures can be re-defined further to reduce COVID–19 mortalities in more critically ill COVID-19 individuals.

Clinical significance of chest CT for the exclusion of COVID-19 in pre-admission screening: Is it worthwhile using chest CT with reverse-transcription polymerase chain reaction test?

BackgroundA single reverse-transcription polymerase chain reaction (RT-PCR) test is not sufficient to exclude COVID-19 in hospital pre-admission screening. However, repeated RT-PCR tests are time-consuming. This study investigates the utility of chest computed tomography (CT) for COVID-19 screening in asymptomatic patients.MethodsBetween April 2020 and March 2021, RT-PCR testing and chest CT were performed to screen COVID-19 in 10 823 asymptomatic patients prior to admission. Chest CT findings were retrospectively evaluated using the reporting system of the Radiological Society of North America. Using RT-PCR results as a reference, we assessed the diagnostic efficacy of chest CT during both the low- and high-prevalence periods of the COVID-19 pandemic.ResultsFollowing a positive RT-PCR test, 20 asymptomatic patients (0.18%) were diagnosed with COVID-19; in the low-prevalence period, 5 of 6556 patients (0.076%) were positive; and in the high-prevalence period, 15 of 4267 patients (0.35%) were positive. Of the 20 asymptomatic COVID-19 positive patients, chest CT results were positive for COVID-19 pneumonia in 8 patients. Chest CT results were false-positive in 185 patients (1.7% false-positive rate, and 60% false-negative rate). Pneumonia that was classified as a “typical appearance” of COVID-19 reported as false-positives in 36 of 39 patients (92.3%). Across the study period, the diagnostic efficacy of “typical appearance” on chest CT were characterized by a sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of 15%, 99.7%, 99.7%, 7.7%, and 99.8%; 20%, 99.6%, 99.6%, 4%, and 99.9%; and 13.3%, 99.7%, 99.7%, 14.3%, and 99.7%, in the entire study, low-, and high-prevalence periods, respectively.ConclusionsAddition of chest CT to RT-PCR testing provides no benefit to the detection of COVID-19 in asymptomatic patients.

Is Surgery with General Anesthesia a Safe Option in Asymptomatic COVID-19 Positive Patients?

Is Surgery with General Anesthesia a Safe Option in Asymptomatic COVID-19 Positive Patients?

S1278 Asymptomatic Pediatric COVID-19 Positive Patients Captured Through Pre-operative Screening Program for Ambulatory Surgeries at a Tertiary Care Hospital

Introduction: Our hospital implemented universal pre-operative COVID-19 screening in April 2020 to reduce risk of transmission to caregivers as well to avert a potential anesthetic risk in COVID positive patients. The aim of this project was to determine the prevalence of asymptomatic COVID-19 infection among pediatric patients undergoing ambulatory procedures and surgeries, overall and for Pediatric Gastroenterology (GI) cases specifically. Methods: A retrospective chart review identified pediatric patients (≤21 years) who underwent ambulatory pre-operative COVID-19 testing between April 1, 2020-March 31, 2021. Demographic and health-related data was collected to identify asymptomatic COVID-19 positive patients scheduled for GI procedures and other ambulatory surgeries. We compared the proportion of patients who tested positive by age group, co-morbid condition, and surgical specialty. We also compared pediatric case rates to Ohio case rates. The study was IRB approved. Results: 4,663 asymptomatic pediatric patients underwent pre-operative COVID-19 testing by PCR and 81 patients were identified as positive (1.73%). In COVID-19 positive patients, 56% were male and 44% were female. Mean age was 12 years and patients 13-18 years were the age group with the highest fraction of positive tests (35%). 11% of patients screened were undergoing a GI-related procedure with a positivity rate of 1.3%. The peak in asymptomatic positives across all procedures occurred in November 2020 (30%), which preceded the peak in COVID-19 cases in Ohio by several weeks. Most prevalent co-morbid condition was asthma (15%) and 8% had inflammatory bowel disease. 5 patients were undergoing chemotherapy and none were on biologic therapy. 94% of cases were deferred. 25% of cases that proceeded required post-operative admission. Conclusion: Asymptomatic COVID-19 positive patients were identified before 1.73% of pediatric ambulatory procedures and before 1.3% of GI procedures. These case rates were higher than the concurrent adult case rate at our institution. The higher rate of asymptomatic COVID-19 infection in pre-operative pediatric ambulatory patients may reflect the milder disease in this age group. The peak in pediatric asymptomatic case positivity seemed to predict the subsequent peak case rate in the state of Ohio by a few weeks. As the pandemic continues with a large percentage of pediatric patients unvaccinated, pre-operative COVID-19 testing has important implications for pediatric GI and other ambulatory procedures.

Abstract S09-04: Asymptomatic detection of COVID-19 among cancer patients receiving infusional anti-cancer therapy

Abstract Introduction Little is known about the rates of asymptomatic COVID-19 carriers among cancer patients. The rate of asymptomatic carriers is important to understand in this population given the use of myelosuppressive and immunomodulating therapies and the risk of transmission to other patients in shared infusion centers. At UC San Diego, in June 2020, we implemented a COVID-19 asymptomatic screening protocol in which cancer patients receiving anti-cancer therapy in an infusion center must undergo symptom-based screening and then SARS-CoV-2 PCR testing prior to their infusion. Here, we describe the results of this asymptomatic screening protocol. Methods This was a single-center retrospective analysis of patients with active cancer receiving infusional anti-cancer therapy in 5 infusion centers who underwent at least 1 asymptomatic SARS-CoV-2 PCR test between 6/1- 12/1/2020. The primary endpoint was the rate of COVID-19 positivity among asymptomatic patients. Symptomatic patients were excluded. Secondary endpoints included COVID-19-related outcomes and patterns of oncologic management for asymptomatic COVID-19 positive patients. Results A cohort of 2,202 cancer patients received at least 1 asymptomatic SARS-CoV-2 PCR test prior to receipt of infusional anti-cancer therapy. 0.95% (N=21/2202) of patients were found to be PCR-positive on asymptomatic screening. Among positive patients, 9.5% (N=2/21) had hematologic malignancies and 90.5% (N=19/21) had solid tumors. In terms of therapy, 76.2% (N=16) were treated with cytotoxic chemotherapy, 9.5% (N=2) with targeted therapy, 4.7% (N=1) with immunotherapy, and 9.5% (N=2) were on a clinical trial. With a median follow-up of 122 days from positive PCR test (range: 8-186), only 2 of 21 (9.5%) of the cohort ultimately developed COVID-related symptoms. Both patients had a diagnosis of acute leukemia and 1 patient required hospitalization for COVID-related complications. No patients died from COVID-related complications. With regards to oncologic management, 95.2% (N=20/21) of patients had their therapy delayed or deferred with a median delay of 21 days (range: 7-77 days). Only 1 patient proceeded with cytotoxic chemotherapy on schedule in the setting of adjuvant chemoradiation for oropharyngeal squamous cell carcinoma. Among the overall cohort, an additional 26 patients (1.2%) developed cases of symptomatic COVID-19 infection during the study period. Conclusions A strategy of asymptomatic screening of cancer patients receiving anti-cancer therapy in an infusion center detected an extremely low rate of asymptomatic carriers of COVID-19. This low rate of asymptomatic carriers may be due to a number of factors including multiple symptom-based screenings prior to infusion, behavior modification among patients, and/or differential immune responses to COVID-19 infection. Asymptomatic carriers in this cohort appeared to have favorable outcomes with few developing symptoms or requiring hospitalization, though the number of positive patients in our cohort is low, precluding definitive conclusions in this population. Citation Format: Justin A. Shaya, Angelo Cabal, Francesca Torriani, Joseph Califano, Scott Lippman, Assuntina Sacco, Rana R. McKay. Asymptomatic detection of COVID-19 among cancer patients receiving infusional anti-cancer therapy [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr S09-04.

Abstract 16323: Ruling Out Sars-cov-2 Infection With a Fast-track 0/1,5-hour Molecular Testing in Patients With Acute Coronary Syndromes

Introduction: Timely reperfusion with PCI remains the main goal in STEMI patients. In the Covid 19 period, the fear of contagion reduced the number of hospitalized patients for myocardial infarction, and a substantial delay in the hospitalizations was also observed. The fear of the operators to treat non-tested patients did not facilitate the hospitalization and treatment of ACS patients with suspected Covid-19. Hypothesis: This study aimed to evaluate the feasibility of a fast-tract protocol to rule out SARS-CoV-2 infection in patients with suspected acute coronary syndrome. Methods: In fifty-one patients (mean age 65 ± 12 y) the real-time PCR to extract RNA for SARS-CoV-2 detection was performed with an automated FDA-approved molecular test (Xpert Xpress Cepheid, Sunnyvale, USA). With its 45-minute processing time and with very high sensitivity, this system was tested in patients transferred from spokes centers or from the field to our HUB center. As soon as the patient had arrived in the Cath Lab, the interventional cardiologist, with adequate protection systems, performed the nasopharyngeal swab that was processed with the rapid Cepheid system. In the meanwhile, coronary angiography (CA) or PCI were performed. At the end of the CA/PCI, based on the test response, patients were transferred to the Covid or non Covid areas. Results: The time to perform the nasopharyngeal swab in the cath lab was: 10 + 10 minutes. The time spent to transport the nasopharyngeal test to the laboratory was: 30 + 20 minutes. The time to load 300 ul of biological material and extraction, amplification, and detection of viral nucleic acid, targeting the viral genomic regions N2 and E using the rapid test was 68 + 15 minutes. The result of the test was immediately made readily available through the hospital computer system. The total time from the execution of the nasopharyngeal swab to the result was 109 ± 26 minutes. Conclusions: This study demonstrates the feasibility of a fast-track protocol with a rapid test to ruling out SARS-CoV-2 Infection in ACS. This pathway allows quick patient stratification and it could of particular importance to detect asymptomatic Covid-19 positive patients with ACS.

Notes from the Field: Dynamic Triaging Using Quality Improvement (QI) Methodology to Prevent the Admission of Asymptomatic COVID Positive Obstetric Patients in New Delhi, India.

A single undiagnosed COVID-19 positive patient admitted in the green zone has the potential to infect many Health Care Workers (HCWs) and other patients at any given time with resultant spread of infection and reduction in the available workforce. Despite the existing triaging strategy at the Obstetric unit of a tertiary hospital in New Delhi, where all COVID-19 suspects obstetric patients were tested and admitted in orange zone and non-suspects in green zone, asymptomatic COVID-19 positive patients were found admitted in the green zone. This was the trigger to undertake a quality improvement (QI) initiative to prevent the admission of asymptomatic COVID-19 positive patients in green zones. The QI project aimed at reducing the admission of COVID-19 positive patients in the green zone of the unit from 20% to 10% in 4 weeks' time starting 13/6/2020 by means of dynamic triaging. A COVID-19 action team was made and after an initial analysis of the problem multiple Plan-Do-Study-Act (PDSA) cycles were run to test the change ideas. The main change ideas were revised testing strategies and creating gray Zones for patients awaiting COVID-19 test results. The admission of unsuspected COVID-19 positive cases in the green zone of the unit reduced from 20% to 0% during the stipulated period. There was a significant reduction in the number of HCWs, posted in the green zone, being quarantined or test positive for COVID-19 infection as well. The authors conclude that Quality Improvement methods have the potential to develop effective strategies to prevent spread of the deadly Corona virus.

Preadmission COVID-19 testing is an unnecessary use of resources

Background: Preadmission testing has been recommended nationwide across specialties in hospitals as a screening tool for detecting asymptomatic COVID-19 positive patients prior to procedures. Healthcare workers (HCW) have been using these results to decide whether or not the patient can have the procedure done as well as to determine whether HCW should use PPE. However, the majorities of these recommendations are from expert opinion and not evidenced based investigations. In the absence of actual data on the benefits of universal screening in asymptomatic patients, clinicians should really consider the possible pros and cons of this. We set out to review previously published research on COVID-19 testing to determine if universal screening can be justified with science. Conclusion: At this time, there is no evidence-based data for a universal screening program of asymptomatic patients in the absence of contact tracing. Universal PPE use, hand hygiene and the practice of personal prevention measures should be the major component in decreasing the spread of COVID-19 in the hospital setting. Keywords: 2019-nCoV, acute respiratory distress syndrome, autoimmune, COVID-19, healthcare worker, novel coronavirus 2019, pandemic, personal protective equipment, polymerase chain reaction, preadmission testing, SARS coronavirus, severe acute respiratory syndrome coronavirus 2, severe acute respiratory syndrome

COVID - 19 - a New Challenging Disease for Intensivists and Cardiologists. From Basic Science to the Clinical Setting

A novel coronavirus causing Acute Respiratory Distress Syndrome (SARS-CoV-2) has been considered the cause of a large number of lower respiratory tract infections leading to severe respiratory failure in many cases. However, the evidence-based hospital reports show that the COVID -19 infestation may range from an asymptomatic or minimally symptomatic course with an almost bizarre deterioration of life parameters (“silent hypoxia”) through to critically ill patients with multiple organ failure including that of the lungs, kidneys, nervous system and other organs. Moreover, this coronavirus disease may cause significant lung damage in asymptomatic COVID-19 positive patients who recover at home.The virus enters through the angiotensin-converting enzyme 2 receptor (ACE2) widely expressed in the cardiovascular system and other organs and tissues, which can result in myocardial injury, myocarditis, acute myocardial infarction, heart failure, arrhythmias, brain stroke, acute pleuritis, pneumonia and venous thromboembolic events. COVID -19 - induced failure of some central mechanisms controlling breathing and the circulation may explain the mismatch between the clinical symptoms and the objective physiologic life parameters in many patients treated by intensivists or cardiologists. The severity of coronavirus disease is dependent on numerous factors including the magnitude of the host immune response, the impairment of central and peripheral nervous system, age, co-morbidities (e.g. diabetes, arterial hypertension, obesity, chronic heart failure) and presumably genetic proclivity. A brand-new treatment approach with use of alternative or experimental therapies such us Extracorporeal Membrane Oxygenation (ECMO), plasmapheresis, proinflammatory interleukins - targeted drugs, covalescent plasma transfusion, virus replication inhibitors is obviously needed in some COVID-19 patients.