Confirmed Coronavirus Disease Research Articles

Investigation on the relationship between the number of coronavirus disease 2019 cases at the beginning of the epidemic and the decrease of PM2.5 in Hubei, China: The role of temperature changes

In response to the coronavirus disease 2019 pandemic, the Chinese government implemented blockade measures in Hubei, which largely affected the emission of pollutants. This work is aimed to explore the effects of epidemics on pollutants at different temperatures in Hubei, China. We applied for a panel nonlinear model with autonomous search thresholds to explore this, using daily average temperature as a threshold variable, and PM2.5 set as the explained variable, and the cumulative number of confirmed coronavirus disease 2019 cases set as the explanatory variable. An empirical analysis was conducted by running the proposed model and using nine cities in China most impacted by the pandemic. The results show that there was a non-linear negative relationship between the cumulative number of confirmed coronavirus disease 2019 cases and PM2.5. A more detailed non-linear relationship between the two was uncovered by the proposed panel threshold regression model. When the temperature crosses the threshold value (12.5 °C and 20.5 °C) in sequence, the estimated value was −0.0688, −0.0934, and −0.1520 in that order. This means that this negative non-linear relationship increased with increasing temperature. This work helps to explore the effect of coronavirus disease 2019 on pollutions at different temperatures and provides a methodological reference to study their nonlinear relationship.

Use of saliva as an alternative diagnostic method for diagnosis of COVID-19

Mass population testing has been recommended to contain the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. However, the use of nasopharyngeal swab specimens has caused many logistic challenges. This study investigated the sensitivity and specificity of saliva as a non-invasively-obtained specimen for molecular detection of SARS-CoV-2 RNA. In total, 153 patients with confirmed coronavirus disease 2019 (COVID-19) who had been admitted to the regional referral hospital or who self-isolated at home were included in this study. Nasopharyngeal swab specimens and saliva samples were collected on the same day, and were tested for SARS-CoV-2 infection using reverse transcriptase polymerase chain reaction. The sensitivity and specificity of saliva samples were 81.5% and 76.4%, respectively, in cases that had been confirmed as COVID-19 using nasopharyngeal swab samples. Positive predictive values and negative predictive values were 92.3% and 54.1%, respectively. The highest detection rates were found among samples collected 4-7 days since symptom onset. Saliva samples showed comparable performance to nasopharyngeal swab specimens for the diagnosis of COVID-19 in adults. The performance of saliva as a diagnostic specimen for COVID-19 testing is particularly significant during the first week of symptoms.

Early response to COVID-19 in Brazil: The impact of a targeted approach to suspected cases and on epidemiological surveillance efforts

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) entered Brazil before travel restrictions and border closures were imposed. This study reports the characteristics of suspected and confirmed coronavirus disease 2019 (COVID-19) cases among symptomatic international travelers in Brazil and their contacts. MethodsThe REDCap platform developed by the Brazilian Ministry of Health was analyzed to identify and investigate suspected cases of COVID-19 recorded during the period January 1 to March 20, 2020. The impact of Brazil's targeted approach to suspected cases from specific countries on epidemiological surveillance efforts during the early stages of the COVID-19 pandemic were analyzed. ResultsBased on molecular RT-PCR tests, there were 217 (4.2%) confirmed, 1030 (20.1%) unconfirmed, 722 (14.1%) suspected, and 3157 (61.6%) non-investigated cases among travelers returning from countries included on the alert list for surveillance, as defined by the Ministry of Health. Among the 3372 travelers who went to countries not included on the alert list, there were 66 (2.0%) confirmed, 845 (25.3%) unconfirmed, 521 (15.6%) suspected, and 1914 (57.2%) non-investigated cases. A comparison of the characteristics of confirmed cases returning from alert and non-alert countries did not reveal a statistically significant difference in symptoms. Almost half of the hospitalized travelers with known travel dates and hospitalization status (53.6%) were inbound from countries not included on the alert list, and RT-PCR tests were reported for only 30.5%. ConclusionsPolicies adopted at entry points to contain the introduction of SARS-CoV-2 in Brazil were not ideal. An analysis of the early response shows that surveillance of travelers, including testing strategies, data standards, and reporting systems, was insufficient.

High-throughput screening of spike variants uncovers the key residues that alter the affinity and antigenicity of SARS-CoV-2

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has elicited a worldwide pandemic since late 2019. There has been ~675 million confirmed coronavirus disease 2019 (COVID-19) cases, leading to more than 6.8 million deaths as of March 1, 2023. Five SARS-CoV-2 variants of concern (VOCs) were tracked as they emerged and were subsequently characterized. However, it is still difficult to predict the next dominant variant due to the rapid evolution of its spike (S) glycoprotein, which affects the binding activity between cellular receptor angiotensin-converting enzyme 2 (ACE2) and blocks the presenting epitope from humoral monoclonal antibody (mAb) recognition. Here, we established a robust mammalian cell-surface-display platform to study the interactions of S-ACE2 and S-mAb on a large scale. A lentivirus library of S variants was generated via in silico chip synthesis followed by site-directed saturation mutagenesis, after which the enriched candidates were acquired through single-cell fluorescence sorting and analyzed by third-generation DNA sequencing technologies. The mutational landscape provides a blueprint for understanding the key residues of the S protein binding affinity to ACE2 and mAb evasion. It was found that S205F, Y453F, Q493A, Q493M, Q498H, Q498Y, N501F, and N501T showed a 3–12-fold increase in infectivity, of which Y453F, Q493A, and Q498Y exhibited at least a 10-fold resistance to mAbs REGN10933, LY-CoV555, and REGN10987, respectively. These methods for mammalian cells may assist in the precise control of SARS-CoV-2 in the future.

Early symptoms preceding post-infectious irritable bowel syndrome following COVID-19: a retrospective observational study incorporating daily gastrointestinal symptoms

BackgroundIntestinal microinflammation with immune dysfunction due to severe acute respiratory syndrome coronavirus 2 reportedly precipitates post-infectious irritable bowel syndrome. This study aimed to elucidate potential risk factors for subsequent development of irritable bowel syndrome, hypothesizing that it is associated with specific symptoms or patient backgrounds.MethodsThis single-center retrospective observational study (2020–2021) included adults with confirmed coronavirus disease requiring hospital admission and was conducted using real-world data retrieved from a hospital information system. Patient characteristics and detailed gastrointestinal symptoms were obtained and compared between patients with and without coronavirus disease-induced irritable bowel syndrome. Multivariate logistic models were used to validate the risk of developing irritable bowel syndrome. Moreover, daily gastrointestinal symptoms during hospitalization were examined in patients with irritable bowel syndrome.ResultsAmong the 571 eligible patients, 12 (2.1%) were diagnosed with irritable bowel syndrome following coronavirus disease. While nausea and diarrhea during hospitalization, elevated white blood cell count on admission, and intensive care unit admission were associated with the development of irritable bowel syndrome, nausea and diarrhea were identified as risk factors for its development following coronavirus disease, as revealed by the adjusted analyses (odds ratio, 4.00 [1.01–15.84] and 5.64 [1.21–26.31], respectively). Half of the patients with irritable bowel syndrome had both diarrhea and constipation until discharge, and constipation was frequently followed by diarrhea.ConclusionsWhile irritable bowel syndrome was rarely diagnosed following coronavirus disease, nausea and diarrhea during hospitalization precede the early signs of irritable bowel syndrome following coronavirus disease.

The impact of meteorological factors on the spread of COVID-19.

Clinical studies suggest that warmer climates slow the spread of viral infections. In addition, exposure to cold weakens human immunity. This study describes the relationship between meteorological indicators, the number of cases, and mortality in patients with confirmed coronavirus disease 2019 (COVID-19). This was a retrospective observational study. Adult patients who presented to the emergency department with confirmed COVID-19 were included in the study. Meteorological data [mean temperature, minimum (min) temperature, maximum (max) temperature, relative humidity, and wind speed] for the city of Istanbul were collected from the Istanbul Meteorology 1st Regional Directorate. The study population consisted of 169,058 patients. The highest number of patients were admitted in December (n = 21,610) and the highest number of deaths (n = 46) occurred in November. In a correlation analysis, a statistically significant, negative correlation was found between the number of COVID-19 patients and mean temperature (rho = -0.734, P < 0.001), max temperature (rho = -0.696, P < 0.001) or min temperature (rho = -0.748, P < 0.001). Besides, the total number of patients correlated significantly and positively with the mean relative humidity (rho = 0.399 and P = 0.012). The correlation analysis also showed a significant negative relationship between the mean, maximum, and min temperatures and the number of deaths and mortality. Our results indicate an increased number of COVID-19 cases during the 39-week study period when the mean, max, and min temperatures were consistently low and the mean relative humidity was consistently high.

Tracking the Genomic Evolution of SARS-CoV-2 for 29 Months in South Korea.

The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has continued, with the persistent emergence of variants of concern (VOCs). Therefore, this study aimed to track the genomic evolution of SARS-CoV-2 strains by sequencing the spike protein for 29 months, which accounted for the majority of the COVID-19 pandemic period. A total of 109 swabs from patients with confirmed coronavirus disease 2019 (COVID-19) infection were randomly collected between March 2020 and July 2022. After genomic sequencing, we analyzed the naming systems and phylogenetic trees. Five surge peaks of COVID-19 cases have been reported in South Korea, resulting in 14,000,000 cumulative confirmed cases and 17,000 deaths. Among the sequenced samples, 34 wild-type strains and 75 VOCs, including 4 Alpha, 33 Delta, 2 Epsilon, and 36 Omicron VOCs, were identified. Omicron strains were comprised of 8 BA.1.1 (21 K), 27 BA.2 (21 L), and 1 BA.2.12.1 (22C). Phylogenetic analysis of the identified isolates and representative sequences of SARS-CoV-2 strains revealed clusters that presented the WHO VOCs. Specific or unique mutations for each VOC waxed and waned according to the variant waves. Our findings allowed recognition of the overall trends of SARS-CoV-2 isolates, which implicated replication advantage, immune evasion, and disease management.

Challenges and Risks in Out-of-Hospital Transport of Patients During the Coronavirus Disease 2019 Pandemic

Objective: Norwegian critical care resources are regionalized making air ambulances transport of suspected or confirmed coronavirus disease 2019 (COVID-19)-positive patients a necessity. We prospectively observed pre- and interhospital transportation of patients with suspected or confirmed COVID-19 in our physician-manned emergency medical services.Methods: This was a prospective, observational quality assurance study of primary and secondary missions conducted by 2 Norwegian air ambulances during the COVID-19 pandemic.Results: Forty-one (24.1%) were primary missions, whereas 129 (75.9%) were interhospital transports. Most patients (158 [92.9%]) were transported with ground-based vehicles, and 12 (7.1%) were transported by rotor wing aircrafts. One hundred thirty-four of 170 patients (78.8%) were COVID-19 positive at the time of transportation. The median (interquartile range) fraction of inspired oxygen concentration was 0.60 (0.50-0.80), the positive end-expiratory pressure was 11 cm H2O (8-13.5 cm H2O), and the peak inspiratory pressure was 26 cm H2O (22-30 cm H2O). Some degree of elevated treatment challenge was reported in 157 (87.7%) transports, and in 139 (77.7%), the patient risk was considered elevated. The physician stated that some degree of elevated risk for the provider was elevated in 131 (73.2%) of the transports.Conclusion: The capacity of the physician-manned emergency medical services to safely transfer patients remains essential to maintain resilient critical care capacity, and the perceived elevated risks should be considered in capacity planning.

Vaccination status and long COVID symptoms in patients discharged from hospital

Effective vaccination against coronavirus mitigates the risk of hospitalisation and mortality; however, it is unclear whether vaccination status influences long COVID symptoms in patients who require hospitalisation. The available evidence is limited to outpatients with mild disease. Here, we evaluated 412 patients (age: 60 ± 16 years, 65% males) consecutively admitted to two Hospitals in Brazil due to confirmed coronavirus disease 2019 (COVID-19). Compared with patients with complete vaccination (n = 185) before infection or hospitalisation, those with no or incomplete vaccination (n = 227) were younger and had a lower frequency of several comorbidities. Data during hospitalisation revealed that the no or incomplete vaccination group required more admissions to the intensive care unit (ICU), used more corticosteroids, and had higher rates of pulmonary embolism or deep venous thrombosis than the complete vaccination group. Ninety days after hospital discharge, patients with no or incomplete vaccination presented a higher frequency of symptoms (≥ 1) than patients with complete vaccination (40 vs. 27%; p = 0.013). After adjusting for confounders, no or incomplete vaccination (odds ratio [OR] 1.819; 95% confidence interval [CI] 1.175–2.815), female sex (OR 2.435; 95% CI 1.575–3.764) and ICU admission during hospitalisation (OR 1.697; 95% CI 1.062–2.712) were independently associated with ≥ 1 symptom 90 days after hospital discharge. In conclusion, even in patients with severe COVID-19, vaccination mitigates the probability of long COVID symptoms.

Chest CT features of coronavirus disease 2019 (COVID-19) in pediatric patients and its correlation with the clinical condition

BackgroundAll pediatric health organizations are concerned about the impact of coronavirus disease on children, especially on those with other comorbidities; fortunately, pediatric cases appear to be less severe than in adults (De Luca et al. in Pediatr Respir Rev 5:9–14, 2020). The purpose of this study is to characterize chest CT findings of children with and without comorbidities who had confirmed coronavirus disease (COVID-19) and to investigate the relation between chest CT findings and the clinical severity of COVID-19 pneumonia and their laboratory findings.ResultsThe study was conducted on 36 patients, 72.2% of whom had associated comorbidities. Twenty-three patients (63.88%) had abnormal CT findings. Consolidative patches were the most common radiological sign (55.6%) followed by ground glass opacities (50%). The lesions were bilateral (58.3%), having predominantly peripheral distribution (38.9%) with predominant left lower lobe affection (25%). Cases with clinically severe chest conditions had significantly more prevalent consolidative patches (p = 0.026) which show a higher CT density (p = 0.01) and a significantly higher CT severity score (SS) compared to other groups (p = 0.029). The cutoff of severity score 4/20 had 100% sensitivity and 78.12% specificity in the diagnosis of severe cases. There were no statistically significant differences between patients with or without comorbidities regarding CT-SS or any radiological signs.ConclusionsConsolidation was the most common radiological finding in children with COVID-19 and was more prevalent and denser in severe cases. The CT-SS may be used as a complementary tool for the evaluation of the severity of the chest condition. Chest CT-SS more than 4 can be used as an indicator of severe cases, yet no significant difference in CT-SS between patients with associated comorbidities or not.

Severity of COVID-19 Pneumonia in Kidney Transplant Recipients According to SARS-CoV-2 Vaccination.

We reviewed 24 kidney transplantat recipients (KTRs) who had radiologically confirmed coronavirus disease 2019 (COVID-19) pneumonia. Enrolled KTRs were divided into a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-vaccination (+) group (n = 18) and a vaccination (-) group (n = 6). Clinical outcomes of the two groups including death, pulmonary outcome, and renal outcome were compared. COVID-19 pneumonia was worse in vaccination (-) KTRs. Two out of six vaccination (-) KTRs needed continuous renal replacement therapy (CRRT) and mechanical ventilator (MV) and expired. In contrast, only one KTR expired and required CRRT and MV out of 18 vaccination (+) KTRs. Our results suggest that SARS-CoV-2 vaccination attenuates severity of COVID-19 pneumonia in KTRs.

Characteristics of ischemic stroke in patients with confirmed coronavirus disease 2019 infection in Vojvodina, Serbia

Introduction. The World Health Organization declared a pandemic of coronavirus disease 2019 on March 11, 2020. The literature has shown that coronavirus disease 2019 is associated with thromboembolic complications, including ischemic stroke. This retrospective study aims to present the characteristics of ischemic stroke in patients with coronavirus disease 2019. Material and Methods. This retrospective study was conducted in the period from April 2020 to January 2022 at the Clinical Center of Vojvodina, and included 58 patients with confirmed coronavirus disease 2019 and a new-onset ischemic stroke. Results. The reason for hospitalization in 42 (72.41%) patients was a new-onset ischemic stroke and 16 of them (38.09%) had a previously confirmed coronavirus disease 2019. In 16 patients (27.58%), ischemic stroke occurred during hospital treatment due to severe clinical manifestations of coronavirus disease 2019. In most coronavirus disease 2019 positive patients the etiology of ischemic stroke was unknown. In most cases (43.1%), the ischemic stroke was a partial infarction of the anterior circulation. Nine patients (15.51%) received intravenous thrombolytic therapy (alteplase) in the appropriate time frame. Lethal outcome occurred in 21 patients, of which in 11 patients complications of coronavirus disease 2019 were the cause of death. Conclusion. A large number of cases with stroke and thrombotic complications in patients with coronavirus disease 2019 is a good indicator that severe acute respiratory syndrome coronavirus 2 does not only cause respiratory infections, but is a systemic infection. The etiology of most ischemic strokes was unknown, which is probably related to difficult functioning of the health system during the pandemic.

Identifying Factors of Stigma Among Patients with Confirmed Coronavirus Disease (COVID-19) in Indonesia

Latar Belakang. Pandemi COVID-19 telah muncul sebagai bencana dan menjadi krisis kesehatan global bagi umat manusia. Pandemi tidak hanya dihantui oleh tragedi dengan angka kematian nasional sekitar 5% penderita, tetapi juga distigmatisasi oleh masyarakat.Tujuan. Penelitian ini bertujuan untuk mengkaji faktor stigma terkait pandemi COVID-19 dan dampaknya pada pasien konfirmasi COVID-19 di Indonesia.Metode. Studi kasus ini dilakukan pada tahun 2020 dengan mengumpulkan informasi dari sumber primer yang meliputi wawancara secara virtual dengan 4 penyintas COVID-19 di Indonesia.Hasil. Hasil penelitian menunjukkan bahwa faktor stigma terdiri dari tiga faktor yaitu penyakit masih baru dan banyak informasi yang belum diketahui; kita sering takut akan hal yang tidak diketahui; dan ketakutan akan hal yang tidak diketahui dapat dengan mudah dikaitkan dengan 'orang lain'.Kesimpulan. Pada awal pandemi COVID-19, masyarakat di Indonesia belum memahami secara jelas tentang wabah COVID-19, termasuk penularannya, penanganannya, dan cara pencegahannya. Kesalahpahaman ini dapat menyebabkan stigmatisasi dan kemungkinan memperpanjang pandemi dan lamanya pembatasan sosial berskala besar. ABSTRACT Background. The COVID-19 pandemic has emerged as a disaster and is a global health crisis for human beings. The pandemic is not only haunted by tragedies of national fatality rate was about 5% of the sufferers, but also stigmatized by the community.Aim. This study aims to assess the factors of the stigma associated with the COVID-19 pandemic and its impact among patients with confirmed COVID-19 in Indonesia.Method. This case study was conducted in 2020 by collecting information from primary sources that include interviews virtually with 4 COVID-19 survivors in Indonesia. Result. The result of this study shows that factors of stigma consist of three factors which consist of the disease is new and much information remains unknown; we are often afraid of the unknown; and the fear of the unknown can easily be associated with ‘others’.Conclusion. In the beginning of the COVID-19 pandemic, people in Indonesia did not clearly understand the COVID-19 epidemic, including its transmission, management, and how to avoid it. This misunderstanding can lead to stigmatization and possibly extend the pandemic and the length of large-scale social restrictions.

Airport Personnel and Coronavirus Disease-2019: A Seroprevalence Study in Taiwan

Introduction Many countries tried to lifted the travel restriction to revive their stagnant tourism-based economies. However, infection risks among airport personnel are incompletely understood. We therefore conducted this seroepidemiological study targeting airport personnel. Methods This cross-sectional study was conducted from October 20th, 2020 to February 28th, 2021 at the Taoyuan International Airport in Taiwan. All adults who worked at Taoyuan International Airport and were older than 20-years of age were eligible for participation. Serological tests were collected and study participants were asked to complete an online questionnaire which collected self reported data including demographic characteristics, occupation, exposure risk assessment, recent symptoms, and self-perceived risk of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Continuous data were expressed with median and interquartile ranges; categorical data were expressed with counts and proportions. Results A total of 450 volunteers agreed to participate in the study. Most of the participants worked as ground crew (40.7%). Approximately 43.6% of participants did not feel any symptoms in the 3-months prior to serologic testing. Only 8 participants (1.8%) reported close contact with confirmed coronavirus disease-2019 (COVID-19) cases. Overall, none of the study participants had serologic confirmation of immunoglobulin G (IgG) antibodies against SARS-CoV-2. Conclusion The SARS-CoV-2 infection rate among airport personnel was low. This study demonstrates that a well-designed border control strategy may work and so that transmission of SARS-CoV-2 may be controllable.

Early use of airway pressure release ventilation in acute respiratory distress syndrome induced by coronavirus disease 2019: a case report

BackgroundCoronavirus disease 2019 is a highly transmissible and pathogenic viral infection caused by severe acute respiratory syndrome coronavirus 2, a novel coronavirus that was identified in early January 2020 in Wuhan, China, and has become a pandemic disease worldwide. The symptoms of coronavirus disease 2019 range from asymptomatic to severe respiratory failure. In moderate and severe cases, oxygen therapy is needed. In severe cases, high-flow nasal cannula, noninvasive ventilation, and invasive mechanical ventilation are needed. Many ventilation methods in mechanical ventilation can be used, but not all are suitable for coronavirus disease 2019 patients. Airway pressure release ventilation, which is one of the mechanical ventilation methods, can be considered for patients with moderate-to-severe acute respiratory distress syndrome. It was found that oxygenation in the airway pressure release ventilation method was better than in the conventional method. How about airway pressure release ventilation in coronavirus disease 2019 patients? We report a case of confirmed coronavirus disease 2019 in which airway pressure release ventilation mode was used.Case presentationIn this case study, we report a 74-year-old Chinese with a history of hypertension and uncontrolled diabetes mellitus type 2. He came to our hospital with the chief complaint of difficulty in breathing. He was fully awake with an oxygen saturation of 82% on room air. The patient was admitted and diagnosed with severe coronavirus disease 2019, and he was given a nonrebreathing mask at 15 L per minute, and oxygen saturation went back to 95%. After a few hours with a nonrebreathing mask, his condition worsened. On the third day after admission, saturation went down despite using noninvasive ventilation. We decided to intubate the patient and used airway pressure release ventilation mode. Finally, after 14 days of being intubated, the patient could be extubated and discharged after 45 days of hospitalization.ConclusionEarly use of airway pressure release ventilation may be considered as one of the ventilation strategies to treat severe coronavirus disease 2019 acute respiratory distress syndrome. Although reports on airway pressure release ventilation and protocols on its initiation and titration methods are limited, it may be worthwhile to consider, given its known ability to maximize alveolar recruitment, preserve alveolar epithelial integrity, and surfactant, all of which are crucial for handling the “fragile” lungs of coronavirus disease 2019 patients.

The effectiveness of Paxlovid treatment in long-term care facilities in South Korea during the outbreak of the Omicron variant of SARS-CoV-2.

On November 5, 2021, Pfizer Inc. announced Paxlovid (nirmatrelvir +ritonavir) asa treatment method that could reduce the risk of hospitalization or death for patients withconfirmed coronavirus disease 2019 (COVID-19). From February 6, 2022 to April 2, 2022, the incidence of COVID-19 and the effectsof treatment with Paxlovid were analyzed in 2,241 patients and workers at 5 long-term carefacilities during the outbreak of the Omicron variant of severe acute respiratory syndromecoronavirus 2 in South Korea. The rate of severe illness or death in the group given Paxlovid was 51% lower thanthat of the non-Paxlovid group (adjusted risk ratio [aRR], 0.49; 95% confidence interval [CI],0.24-0.98). Compared to unvaccinated patients, patients who had completed 3 doses of thevaccine had a 71% reduced rate of severe illness or death (aRR, 0.29; 95% CI, 0.13-0.64) and a65% reduced death rate (aRR, 0.35; 95% CI, 0.15-0.79). Patients given Paxlovid showed a lower rate of severe illness or death and alower fatality rate than those who did not receive Paxlovid. Patients who received 3 dosesof the vaccine had a lower rate of severe illness or death and a lower fatality rate than theunvaccinated group.

Soluble ACE2 as a Risk or Prognostic Factor in COVID-19 Patients: A Cross-sectional Study.

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus. The first known receptor for this virus in the human body is angiotensin-converting enzyme 2 (ACE2), the same receptor for the SARS virus. Methods: A total of 38 hospitalized adult (18 years) patients with laboratory or clinically confirmed coronavirus disease 2019 (COVID-19) were identified in the infectious disease ward of Tehran Imam Khomeini hospital complex in this single-center cross-sectional study. A blood sample was taken at the time of hospitalization and a second one was taken 48 hours later. Blood samples are kept frozen at -80 degrees Celsius. After the complete collection of samples, the ACE2 level of the samples was measured using a serum sACE2 detection ELISA kit. The data were analyzed using SPSS v26. P value of 0.05 was considered statistically significant. An analysis of covariance was performed to examine the mean differences in day 7 serum ACE2 concentration among the 2 groups after adjusting for the baseline serum ACE2 concentration. The 1-way multivariate analysis of variance was used to determine whether there were any differences between independent groups (mechanical ventilation yes/no) on serum ACE2 levels at 3 different times. Results: The mean age of patients was 64.13 ± 16.49 years, 21 patients (55.3%) were men, 16 patients (42%) were polymerase chain reaction test positive, and 15 patients (39.5%) died. A total of 35 individuals (92.1%) had chest computed tomography images that indicated lung involvement. A comparison of the 2 groups of patients who died and were discharged revealed that serum ACE2 at the first (p=0.033) and third (7th day) measurements were statistically different (p=0.026). Patients had a mean of serum ACE2. The results indicated that the day 7 serum ACE2 concentration did significantly differ between the 2 groups after controlling for the baseline serum ACE2 concentration (p=0.023). The model explained about 73.61% of the variance in the 7-day serum ACE2 concentration. Specifically, after adjusting for the baseline concentration, survived patients had the lowest level of serum ACE2 concentration (1 ± 0.65) on the 7th day compared with the deceased patient group (2.83 ± 1.12). Conclusion: Soluble ACE2 in the serum of COVID-19 patients who died, later on, was significantly higher than the discharged patients when the samples were taken seven days after admission. It is suggested that serum soluble ACE2 level could be used as a prognostic factor for COVID-19 patients' outcomes and also their need for mechanical ventilation.

1105. A Matched-Group Comparison of Interventions for COVID-19 During the First and Second Waves of the COVID-19 Pandemic in a County Hospital in Chicago.

Abstract Background The COVID-19 pandemic continually challenges the scientific community to develop and evaluate viable treatments. In May 2020, remdesivir became the first medication to receive emergency use authorization for the treatment of COVID-19, while dexamethasone became standard of care for patients requiring supplementary oxygen in late 2020. Methods This was a retrospective observational study of hospitalized adult patients with confirmed coronavirus disease 2019 (COVID-19) admitted in the first wave (3/2020-7/2020) and second wave (10/2020-1/2021) at Cook County Hospital. Variables on demographic, clinical data and outcomes were extracted from the EMR. The measured intervention was use of dexamethasone with remdesivir during the second wave; patients were matched by age and diabetic status to patients in the first wave who had received only remdesivir. The primary outcome was mortality; secondary outcomes were ICU admission and intubation. Conditional logistic regression was used to examine associations between use of dexamethasone and each outcome, controlling for glucose levels, use of remdesivir and severity of disease. Results 621 patients were admitted in the first wave (3/2020-7/2020) versus 355 in the second wave (12/2020-1/2021). Median age was 55 years and 56 years, respectively. Most patients were Hispanic and Black. In the first wave, 296 patients (48%) were admitted with severe COVID-19 (defined as oxygen saturation on room air at or below 94%) versus 163 patients (46%) in the second wave. Logistic regression showed no association between use of dexamethasone and ICU admission, mortality or intubation. Use of remdesivir showed no association with any of the outcomes. Glucose and severe/critical disease were strongly associated with ICU admission (p=0.01 and p=0.003) and mortality (p=0.06 for both). Conclusion Despite promising medications, in this study the mortality and disease severity of COVID-19 was very similar to that seen in the first wave. This could be due to patients presenting with more advanced disease and undiagnosed or poorly-controlled comorbidities that may offset the potential benefit of these treatments. Enhancing access to care and decreasing health inequalities may be more worthwhile than finding a “miracle drug”. Disclosures All Authors: No reported disclosures.

Computed Tomography Thorax Patterns in the Patients of Chronic Kidney Disease with Microbiologically Confirmed Coronavirus Disease-2019: An Experience from a Tertiary Care Hospital

Introduction: A retrospective study aimed at analyzing the patterns in the CT scans of patients of CKD infected with COVID-19 in the period of two months. We reviewed the CT scans for the pattern of Lung involvement, number of lobe involved, distribution of the lesions and characteristic appearances, along with other coexisting features. Methodology: After consent, we studied the parameters of interest among the patients admitted in the dedicated COVID-19 hospital in Bengaluru, Karnataka, who were admitted during the months of October and November 2020. Each CT scan was reported by in-house radiologist and results were analyzed. Results: We found that of the 92 CKD patients, 51 had got a CT thorax done, out of which 45 had lung parenchymal involvement of COVID-19; of which 44 were bilateral. 26 of the patients had only peripheral lesions and 19 had both central and peripheral distribution. The most common finding was GGOs occurring in 43 of them while 30 of them had GGOs with consolidation. This study shows that the CT patterns in patients of CKD with COVID-19 involves mainly peripheral distribution of lesions with majority involving &gt;2 lobes, with GGOs being most common finding; similar to those without CKD, but the incidence of pleural effusions and mediastinal lymphadenopathy is slightly higher, possibly because of coexistent comorbidities contributing to the same. Conclusion: We conclude that though some patients with CKD and COVID-19 can have a normal lung, the involvement of lungs is more severe and extensive in distribution, implying a more severe involvement of the lung. Hence, further Studies are required on larger population to ascertain the findings and further resources should be allocated for the benefit of this significantly vulnerable patients in this era.

Emfisema Subkutis sebagai Komplikasi pada Pasien Covid-19 dengan Penggunaan Ventilasi Mekanik

Background. The incidence of subcutaneous emphysema in patients with severe pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus infection has been in the spotlight recently. Subcutaneous emphysema is a rare complication. With the increasing prevalence of subcutaneous emphysema in patients with confirmed coronavirus disease (COVID-19), it is necessary to know what factors can cause this and how to treat it. Case Description. Two patients, a man and a woman aged 50 and 70 years, diagnosed with COVID-19, came to the Emergency Room (IGD) of Bunda Menteng General Hospital, Jakarta, with symptoms of acute respiratory distress syndrome (ARDS). Both patients experienced severe shortness of breath with a respiratory rate above 30 times per minute. Then the two patients were treated in the intensive care Unit (ICU) isolation room and required mechanical ventilation assistance. After 3-4 days of mechanical ventilation treatment, subcutaneous emphysema develops, characterized by subcutaneous crepitus. After chest x-rays were carried out in both patients, the results were subcutaneous emphysema and pneumomediastinum. Several invasive procedures have been performed, such as subcutaneous insertion of an intravenous cannula, mediastinoscopy, and chest tube insertion. Conclusion. Complications of subcutaneous emphysema in COVID-19 patients are rare and require further research to determine the cause, where the infection is still the focus. With this case report, it is hoped that clinicians will pay more attention to the initial clinical findings of subcutaneous emphysema to reduce even more severe complications such as pneumothorax.