Coronavirus Disease 2019 Guidelines Research Articles

Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19: Serologic Testing.

The role of serologic testing for SARS-CoV-2 has evolved during the pandemic as seroprevalence in global populations has increased. The Infectious Diseases Society of America (IDSA) convened an expert panel to perform a systematic review of the coronavirus disease 2019 (COVID-19) serology literature and construct updated best practice guidance related to SARS-CoV-2 serologic testing. This guideline is an update to the fourth in a series of rapid, frequently updated COVID-19 guidelines developed by IDSA. To develop evidence-based recommendations and identify unmet research needs pertaining to the use of anti-SARS-CoV-2 antibody tests for diagnosis, decisions related to vaccination and administration of monoclonal antibodies or convalescent plasma in immunocompromised patients, and identification of a serologic correlate of immunity. A multidisciplinary panel of infectious diseases clinicians, clinical microbiologists and experts in systematic literature reviewed, identified, and prioritized clinical questions related to the use of SARS-CoV-2 serologic tests. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make testing recommendations. The panel recommends against serologic testing to diagnose SARS-CoV-2 infection in the first two weeks after symptom onset (strong recommendations, low certainty of evidence). Serologic testing should not be used to provide evidence of COVID-19 in symptomatic patients with a high clinical suspicion and repeatedly negative nucleic acid amplification test results (strong recommendation, very low certainty of evidence). Serologic testing may assist with the diagnosis of multisystem inflammatory syndrome in children (strong recommendation, very low certainty of evidence). To seek evidence for prior SARS-CoV-2 infection, the panel suggests testing for IgG, IgG/IgM, or total antibodies to nucleocapsid protein three to five weeks after symptom onset (conditional recommendation, low certainty of evidence). In individuals with previous SARS-CoV-2 infection or vaccination, we suggest against routine serologic testing given no demonstrated benefit to improving patient outcomes (conditional recommendation, very low certainty of evidence.) The panel acknowledges further that a negative spike antibody test may be a useful metric to identify immunocompromised patients who are candidates for immune therapy. The high seroprevalence of antibodies against SARS-CoV-2 worldwide limits the utility of detecting anti-SARS CoV-2 antibody. The certainty of available evidence supporting the use of serology for diagnosis was graded as very low to low. Future studies should use serologic assays calibrated to a common reference standard.

COVID-19 Guidelines Adherence and Vaccine Acceptability Among Pregnant Women in Niger Foundation Hospital Enugu, South-Eastern Nigeria: A Mixed Method Study

Objectives: This study aimed to determine the acceptability of coronavirus disease 2019 (COVID-19) vaccines and adherence to the preventive protocol among pregnant antenatal attendees in Niger Foundations Hospital Enugu, South-Eastern Nigeria. Materials and Methods: Using a cross-sectional descriptive survey and in-depth interviews, we conducted a mixed method study from June to December 2021. We administered a structured questionnaire to 210 pregnant women to assess their knowledge and adherence to COVID-19 guidelines and interviewed 25 individuals. Quantitative and qualitative data were analyzed using SPSS v.28 and thematic analysis, respectively. Results: The participants’ age range was 20-43 years, with a mean of 29.9 (4.8) years. Most individuals (81.9%) had a university degree, 40.5% were skilled workers, and 73.3% had parity 0-1. They identified close contact (87.1%), respiratory distress (96.2%), and handwashing with soap (96.2%) as the commonest mode of transmission, symptom, and preventive strategy of COVID-19, respectively. Older women and individuals with higher parity had lower knowledge and adherence to COVID-19 precautions. Most participants rejected the vaccines due to fear of the side effects on themselves and the fetus. Conclusions: Although there was good adherence to COVID-19 protocols among the pregnant women in this study, vaccine acceptance/uptake rate was low. Education on vaccine advantages and correction of conspiracy theories are recommended.

Religious Leaders and COVID-19 Guidelines Enforcement in Rural Communities of Nigeria

The global response to the outbreak of novel Coronavirus Disease 2019 (COVID-19) in Wuhan, China, and its rapid spread to over 200 countries/territories has been intense. Following the discovery of its index case on 27 February 2020 in Lagos, Nigeria, various measures were adopted at the federal, state and local levels to contain its spread. The enforcement of COVID-19 Guidelines/Protocols commenced on 30 March 2020 in the affected states and the Federal Capital Territory (FCT). Thus, it is acknowledged that religious institutions and their leaders are crucial stakeholders in implementing these guidelines. This study used a qualitative research design to examine how religious leaders in Ijebu North-East Local Government Area responded to the enforcement of COVID-19 guidelines during total and relaxed lockdowns. It reveals that prominent Imāms at their respective mosques during the total lockdown suspended daily Salāwāt, Fridays congregational prayers (As-Salāt al-Jumu‘at), daily Ramadān Tafsīrul-Qur’ān, Iftārus-Sawm, Tarāwīh and Tahajjud, and celebration of ‘Īd-el-Fitri, ‘Īd-el-Adhā and Mawlud-en-Nabiyy. They offered their host communities spiritual and socio-welfare support in addition to disseminating information on COVID-19 prevention methods. During the relaxed lockdown, the NCDC’s COVID-19 Guidelines for Re-Opening Places of Worship were strictly followed. Inadequate resources, the lack of belief in the existence of COVID-19, un-Islamic traits of some wealthy Muslims, and a sense of distrust among some followers were identified challenges. The study concludes by suggesting how mosque leaders can proactively assist governments in eradicating coronavirus and related diseases.

What we learned from steroid therapy in the COVID-19 pandemic.

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a pandemic named coronavirus disease 2019 (COVID-19) that has become the greatest worldwide public health threat. Although different treatment recommendations are offered for COVID-19 infection, steroid treatment remains important. We aimed to demonstrate the effect of pulse steroid therapy (PST) on inflammatory markers and patient outcomes in moderate/severe COVID-19 pneumonia. We retrospectively analyzed the patients 18 years and older hospitalized in our hospital's COVID-19 clinics between April 1, 2020, to June 30, 2020, and July 1, 2021, to November 30, 2021. Patients in the moderate/severe COVID-19 pneumonia category, according to the World Health Organization COVID-19 guidelines, were included in the study. The demographic characteristics of the patients, treatments, inflammatory markers, and patient outcomes (need for intensive care, length of hospital stay, high-flow nasal oxygen (HFNO) requirement, mechanical ventilation (MV), and mortality rates) were recorded and analyzed. Patients who received PST had more advanced age (P < 0.01), more comorbidities (P < 0.001), and more HFNO need (P < 001) compared with the patients who did not receive PST. There was no statistically significant difference between clinical outcomes: the need for intensive care, length of hospital stay, need for MV, and mortality rates (P = 0.54, P = 0.3, P = 0.14, and P = 0.09, respectively). When we evaluated the unvaccinated patients, there was a statistically significant difference in the MV need and mortality rates between those who received PST and those who did not (P = 0.017, P = 0.014, respectively). It was observed that PST provided similar mortality, ICU, and MV requirements in patients with older age and comorbidities. Lower MV requirements and mortality were observed in the unvaccinated group receiving PST compared with the unvaccinated group not receiving steroids. PST is still promising in COVID-19 infection, and more studies are needed for standard doses and applications.

Literature review on COVID-19 vaccine efficacy in the immunocompromised population, and possible implications to future vaccination in kidney transplant patients.

Since the emergence of the virulent coronavirus in 2019, efforts to tackle the coronavirus-disease-2019 (COVID-19) pandemic have been made globally. The development of the coronavirus disease (COVID) vaccine was a significant breakthrough in ways to tackle the virus. Various research studies have been conducted to identify how the virus works and ways to manage COVID, including the efficacy of the vaccines. However, there is limited data on how these measures work for the immunocompromised, despite the grave impact of these virulent strains in this population. Specifically, this review aims to focus on kidney transplant recipients (KTRs). Studies have suggested that there is significantly lower vaccine response in some immunocompromised groups despite additional booster doses, and hence warrants an augmented or alternative protection against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for these patients. This suggests a need for alternative or more tailored approach in providing adequate protection against the COVID-19 in these cohorts. Some suggested ways include withholding immunosuppressants before and/or after vaccination, increasing the vaccine doses or reducing intervals and providing a mixture of monoclonal antibody (mAb) or antiviral therapy. However, the appropriate degree of alteration and augmentation, as well as its safety and effectiveness remains to be determined. Furthermore, continuous emergence of more virulent strains, such as the Omicron and its sub-lineages or the Deltacron, emphasises the need for ongoing research to assess the effectiveness of the current treatment against these new variants. Overall, active interest and appropriate updates to COVID-19 guidelines is necessary.

Prevalence of Ophthalmic Manifestations in COVID-19 Positive Indoor Patients during Second Wave at Rural Tertiary Care Hospital of Gujarat: A Prospective Observational Study

Introduction: Coronavirus Disease-2019 (COVID-19) can affect multiple system of body including eye. In eye, it can cause mild conjunctivitis, posterior segment involvement, neurosensory involvement and lethal opportunistic infection like mucormycosis. Associated co-morbidities, severity of COVID19 infection and corticosteroids used in its management can affect ophthalmic involvement. Aim: To determine the frequency and various types of ophthalmic manifestation of patients with COVID-19. Materials and Methods: This prospective observational study was conducted on indoor patients of Shree Krishna Hospital, a rural, tertiary care hospital affiliated with Pramukh Swami Medical College, Karansad, Gujarat, India, from 1st May 2021 to 1st January 2022. Second wave of COVID-19 was from 13th March 2021 to 19th June 2021. Patients’ demographic data, details of COVID-19 infection severity score, oxygen requirement, use of corticosteroids, history of various co-morbidities and stages of Rhino-Orbital-Cerebral Mucormycosis (ROCM) (if present) were noted. Bedside ophthalmic examination was done with torch light, fluorescent strip, cobalt blue light of direct ophthalmoscope and fundus examination with indirect ophthalmoscopy under institutional COVID-19 guidelines. Descriptive Statistics {Mean, (SD), Frequency, (%)} were used for analysis of the collected data. Results: Out of 649 COVID-19 patients, 368 were male and 281 were female with mean age of 52.58 (±15.38) years. All over prevalence of ophthalmic manifestations was 9.86% (n=64 out of 649 patients). A total of 63 patients (9.71%) did not require any oxygen supplement, 352 patients (54.24%) required nasal prongs, 201 patients (30.97%) required non invasive ventilator support and 33 patients (5.08%) required mechanical ventilation. The 378 patients (58.24%) received cortico-steroids in oral or intravenous form. A total of 325 patients (50.1%) had diabetes,267 patients (41.1%) had hypertension, 29 patients (4.5%) had chronic kidney disease and 15 patients (2.3%) had thyroid disease. A total of 52 patients (8.01%) had conjunctivitis. Mean age of patients with conjunctivitis was 50.04 (±15.28) with male preponderance (n=30, 57.7%). Most common systemic presentation was fever (n=29,55.8%). Patients with conjunctivitis had high D-dimer (&gt;500 ng/mL) (n=42;80.8%) and C-Reactive Protein (CRP) values (&gt;3 mg/L) (n=39;75%). A total of 144 patients (22.2%) were vaccinated with COVID-19 vaccine first dose while ten patients (19.23%) out of 52 patients having conjunctivitis were vaccinated. Out of 649 patients, prevalence of ROCM was 1.85% (n=12) with mean age 58.58 years (±9.71 years) and male preponderance (n=8, 66.66%). Nine out of twelve patients had high blood sugar levels (mean level 340 mg/ dL) at the time of admission. Out of twelve, eight patients had received corticosteroids for management of COVID-19 infection. Six patients of ROCM (50%) did not require any oxygen support while two patient (16.7%) required nasal prongs for mean 7.50 days and four patient (33.3%) required non invasive ventilator support for mean 7.33 days (±2.5 days). One patient had stage 2C disease, one had stage 3B, five patients had stage 3C while five patients had stage 4C disease. Conclusion: Ocular manifestations of COVID-19 range from conjunctivitis to ROCM. Conjunctivitis has mild and self-limited course while ROCM is sight threatening and life-threatening condition, if not treated appropriately.

Machine Learning-Based Scoring System for Early Prognosis Evaluation of Patients with Coronavirus Disease 2019

Abstract Background The global spread of coronavirus disease 2019 (COVID-19) continues to threaten human health security, exerting considerable pressure on healthcare systems worldwide. While prognostic models for COVID-19 hospitalized or intensive care patients are currently available, prognostic models developed for large cohorts of thousands of individuals are still lacking. Methods Between February 4 and April 16, 2020, we enrolled 3,974 patients admitted with COVID-19 disease in the Wuhan Huo-Shen-Shan Hospital and the Maternal and Child Hospital, Hubei Province, China. (1) Screening of key prognostic factors: A univariate Cox regression analysis was performed on 2,649 patients in the training set, and factors affecting prognosis were initially screened. Subsequently, a random survival forest model was established through machine analysis to further screen for factors that are important for prognosis. Finally, multivariate Cox regression analysis was used to determine the synergy among various factors related to prognosis. (2) Establishment of a scoring system: The nomogram algorithm established a COVID-19 patient death risk assessment scoring system for the nine selected key prognostic factors, calculated the C index, drew calibration curves and drew training set patient survival curves. (3) Verification of the scoring system: The scoring system assessed 1,325 patients in the test set, splitting them into high- and low-risk groups, calculated the C-index, and drew calibration and survival curves. Results The cross-sectional study found that age, clinical classification, sex, pulmonary insufficiency, hypoproteinemia, and four other factors (underlying diseases: blood diseases, malignant tumor; complications: digestive tract bleeding, heart dysfunction) have important significance for the prognosis of the enrolled patients with COVID-19. Herein, we report the discovery of the effects of hypoproteinemia and hematological diseases on the prognosis of COVID-19. Meanwhile, the scoring system established here can effectively evaluate objective scores for the early prognoses of patients with COVID-19 and can divide them into high- and low-risk groups (using a scoring threshold of 117.77, a score below which is considered low risk). The efficacy of the system was better than that of clinical classification using the current COVID-19 guidelines (C indexes, 0.95 vs. 0.89). Conclusions Age, clinical typing, sex, pulmonary insufficiency, hypoproteinemia, and four other factors were important for COVID-19 survival. Compared with general statistical methods, this method can quickly and accurately screen out the relevant factors affecting prognosis, provide an order of importance, and establish a scoring system based on the nomogram model, which is of great clinical significance.

Navajo Nation Stores Show Resilience During COVID-19 Pandemic.

On April 8, 2020, the Navajo Nation issued an administrative order limiting business operations. Facing high coronavirus disease 2019 (COVID-19) rates and limited food infrastructure, a survey was conducted among Navajo Nation store managers to assess: (1) COVID-19 adaptations; (2) challenges; (3) changes in customer volume and purchasing; and (4) suggestions for additional support. Purposive sampling identified 29 stores in Navajo communities. Representatives from 20 stores (19 store managers/owners, 1 other; 7 grocery, and 13 convenience/other stores) were interviewed by phone or in-person to reach saturation (new information threshold < 5%). Responses were coded using frequencies and inductive thematic analysis. All 20 stores implemented COVID-19 guidelines (Centers for Disease Control and Prevention [CDC]/Navajo Nation) and most received orientation/support from local chapters, community organizations, or health centers. Stores implemented staff policies (50%, handwashing, vaccinations, protective personal equipment (PPE), sick leave, temperature checks), environmental changes (50%, hand sanitizer, checkout dividers), customer protocols (40%, limit customers, mask requirements, closed restrooms), and deep cleaning (40%). Most stores (65%) reported challenges including stress/anxiety, changing guidelines, supply chain and customer compliance; 30% reported infection or loss of staff. Weekday customer volume was slightly higher vs. pre-COVID, but weekend lower. Stores reported consistent or more healthy food purchases (50%), more nonfood essentials (20%), or shelf-stable foods (10%). Desired support included further orientation (30%), leadership support (20%), overtime/time to learn guidelines (20%), and signage/handouts (15%). Despite a high COVID-19 burden and limited food store infrastructure, Navajo Nation stores adapted by implementing staff, environmental and customer policies. Local support, staffing, and small store offerings were key factors in healthy food access.

European society of clinical microbiology and infectious diseases guidelines for coronavirus disease 2019: an update on treatment of patients with mild/moderate disease

ScopeDespite the large availability of vaccines, coronavirus disease 2019 (COVID-19), induced by severe acute respiratory syndrome coronavirus 2, continues to be a major threat for health-care providers and fragile people. A number of options are now available for outpatients with mild-to-moderate COVID-19 at the risk of disease progression for the prevention of deaths or hospitalization. MethodsA European Society of Clinical Microbiology and Infectious Diseases COVID-19 guidelines task force was established by the European Society of Clinical Microbiology and Infectious Diseases Executive Committee. A small group was established, half appointed by the chair and the remaining selected based on an open call. Each panel met virtually once a week. For all decisions, a simple majority vote was used. A long list of clinical questions using the population, intervention, comparison, outcome format was developed at the beginning of the process. For each population, intervention, comparison, outcome, two panel members performed a literature search, with a third panelist involved in case of inconsistent results. Voting was based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RecommendationsIn this update, we focus on anti-viral agents, monoclonal antibodies (mAbs) and other treatment options proposed for patients with mild or moderate COVID-19 who are at the risk of hospitalization or death. Although the use of anti-virals is recommended, especially nirmatrelvir/ritonavir and remdesivir or, alternatively, molnupirarvir, the administration of mAbs against the spike protein strictly depends on circulating variants or the ability to test timely for variants and sub-variants. At the time of writing (April–June 2022), the only active mAb was tixagevimab/cilgavimab given the predominance of the Omicron BA.2, BA.3, BA.4 and BA.5 sub-lineages in Europe. However, considering that the epidemiological scenario is extremely dynamic, constant monitoring of variants of concern is mandatory.

Obstetric services in the UK during the COVID-19 pandemic: A national survey

BackgroundThe management of obstetric patients with coronavirus disease 2019 (COVID-19) due to human-to-human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires unique considerations. Many aspects of labour and delivery practice required adaptation in response to the global pandemic and were supported by guidelines from the Royal College of Obstetrics and Gynaecologists. The adoption and adherence to these guidelines is unknown. MethodsParticipating centres in “Quality of Recovery in Obstetric Anaesthesia study—a multicentre study” (ObsQoR) completed an electronic survey based on the provision of services and care related to COVID-19 in October 2021. The survey was designed against the Royal College of Obstetricians and Gynaecologists COVID-19 guidelines. ResultsOne hundred and five of the 107 participating centres completed the survey (98% response rate representing 54% of all UK obstetric units). The median [IQR] annual number of deliveries among the included sites was 4389 [3000–5325]. Ninety-nine of the 103 (94.3%) sites had guidelines for the management of peripartum women with COVID-19. Sixty-one of 105 (58.1%) sites had specific guidance for venous thromboembolism (VTE) prophylaxis. Thirty-seven of 104 (35.6%) centres restricted parturient birthing plans if a positive diagnosis of COVID-19 was made. A COVID-19 vaccination referral pathway encouraging full vaccination for all pregnant women was present in 63/103 centres (61.2%). ConclusionWe found variability in care delivered and adherence to guidelines related to COVID-19. The clinical implications for this related to quality of peripartum care is unclear, however there remains scope to improve pathways for immunisation, birth plans and VTE prophylaxis.

Educational impact of an active learning session with 6-lead mobile electrocardiography on medical students’ knowledge of cardiovascular physiology during the COVID-19 pandemic in the United States: a survey-based observational study

Mobile electrocardiogram (ECG) devices are valuable tools for teaching ECG interpretation. The primary purpose of this follow-up study was to determine if an ECG active learning session could be safely and effectively performed during the coronavirus disease 2019 (COVID-19) pandemic using a newly developed mobile 6-lead ECG device. Additionally, we examined the educational impact of these active learning sessions on student knowledge of cardiovascular physiology and the utility of the mobile 6-lead ECG device in a classroom setting. In this study, first-year medical students (MS1) performed four active learning activities using the new mobile 6-lead ECG device. Data were collected from 42 MS1s through a quantitative survey administered in September 2020. Overall, students felt the activity enhanced their understanding of the course material and that the activity was performed safely and in compliance with local COVID-19 guidelines. These results emphasize student preference for hands-on, small group learning activities in spite of the pandemic.

A path toward disability-inclusive health in Zimbabwe Part 2: A qualitative study on the national response to COVID-19

BackgroundPeople with disabilities are at higher risk of adverse coronavirus disease 2019 (COVID-19) outcomes. Additionally, measures to mitigate COVID-19 transmission have impacted health service provision and access, which may particularly disadvantage people with disabilities.ObjectivesTo explore the perspectives and experiences of people with disabilities in accessing health services in Zimbabwe during the pandemic, to identify perceived challenges and facilitators to inclusive health and key actions to improve accessibility.MethodsWe used in-depth interviews with 24 people with disabilities (identified through purposive sampling) and with 10 key informants (from expert recommendation) to explore the impact of COVID-19 on access to health care. Interviews were transcribed, coded and thematically analysed. We used the disability-inclusive health ‘Missing Billion’ framework to map and inform barriers to inclusive health care during COVID-19 and disparities in outcomes faced by people with disabilities.ResultsPeople with disabilities demonstrated good awareness of COVID-19 mitigation strategies, but faced difficulties accessing COVID-19 information and health services. Challenges to the implementation of COVID-19 guidelines related to a person’s functional impairment and financial ability to do so. A key supply-side constraint was the perceived de-prioritisation of rehabilitation services. Further restrictions on access to health services and rehabilitation decreased an individual’s functional ability and exacerbated pre-existing conditions.ConclusionThe immediate health and financial impacts of the COVID-19 pandemic on people with disabilities in Zimbabwe were severe. Government departments should include people with disabilities in all communications and activities related to the pandemic through a twin-track approach, meaning inclusion in mainstream activities and targeting with specific interventions where necessary.

A descriptive study of a SARS-CoV-2 super spreader event: A funeral and a house-party in a district municipality of the Eastern Cape Province, South Africa, 2020

Background: Coronavirus Disease 2019 (COVID-19) is a respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). According to the World Health Organisation, modes of transmission for SARS-CoV-2 include contact, droplet and airborne transmission has also been reported. On 16 March 2020, Nelson Mandela Bay District in the Eastern Cape Province recorded its first case of SARS-CoV-2, which was travel related. On 21 March 2020, over 1000 people attended a funeral of a healthcare worker in one of the townships within the district. This study aims to quantify the incident infections associated with a single funeral and describe the chain of transmission. Methods: This is a retrospective descriptive study that uses COVID-19 data collected between March and April 2020 in Nelson Mandela Bay district. Interviews were conducted with newly reported COVID-19 cases by healthcare professionals through telephonic platforms and face-to-face. Data obtained through the interviews included possible exposures, risk factors, and demographics. Data analysis was done using Microsoft Excel. Results: Four-hundred-and-twelve cases of COVID-19 were reported within the district during the study period. Of the first 100 cases reported within the district, 42% (42/100) were linked to the funeral; these included people who attended the funeral and those who had contact with the funeral attendees. Conclusion: While funerals cannot be avoided, adherence to COVID-19 guidelines on funerals can help reduce infection transmission rates. Platforms such as virtual funeral services and virtual memorial services can help reduce the risk of COVID-19 transmission associated with these types of events.

Interaction between science advice and policymaking in time of COVID-19: a French perspective.

BackgroundIn the coronavirus disease 2019 (COVID-19) context, many governments relied on scientific consultative bodies to advise their policy, but their contribution remains poorly documented. This article aims to fill this gap by reviewing the role played by the French High Council for Public Health (HCSP) in the French government’s response to COVID-19.MethodsWe studied the time distribution of the COVID-19 guidelines produced by the HCSP until November 2020, computed their delay of production and analyzed the thematic areas they cover. To assess their use by the authorities, we looked for references to these guidelines in the regulatory texts, protocols and press communicates issued by national and local authorities until January 2021.ResultsThe HCSP was strongly demanded with 102 guidelines produced following 97 official requests and two self-referrals. Most of them (N = 43) concerned protective measures to constrain the infection, while health inequalities and mental health were poorly addressed. Timing was very constraint as half of the guidelines were requested within 4 days. In total, 73% of the guidelines were used by policymakers to implement new obligations or within communication toward the public at national and local levels.ConclusionsThis article informs on the HCSP’s contribution during the crisis and stresses the difficulties it encountered to provide quality recommendations in very short times. It prompts governments to enlarge the competencies of their advisory boards and to consider the multidimensional aspects of health in policy design.

Impact of COVID-19 on Radiology Trainee Safety, Education, and Wellness: Challenges Experienced and Proposed Solutions for the Future.

Impact of COVID-19 on Radiology Trainee Safety, Education, and Wellness: Challenges Experienced and Proposed Solutions for the Future.

Health care providers' awareness of breastfeeding practice recommendations during COVID-19 pandemic and associated factors in Northwest Ethiopia, 2021: A multicenter study.

Prevention of coronavirus disease 2019 (COVID-19) transmission to newborns is one of the basic components of perinatal care in the era of the COVID-19 pandemic. As such, scientific evidence is compulsory for evidence-based practices. However, there was a scarcity of evidence on health care providers' awareness of breastfeeding practice recommendations during the COVID-19 pandemic in Ethiopia, particularly in the study setting. The study aimed at assessing healthcare providers' awareness of breastfeeding practice recommendations during the COVID-19 pandemic and associated factors among healthcare providers in northwest Ethiopia, 2021. A multicenter cross-sectional study was conducted among 405 healthcare providers working in hospitals of Gondar province from November 15, 2020, to March 10, 2021. A simple random sampling technique was employed to select the study subjects. Data were collected via a structured-self-administered questionnaire. EPI INFO version 7.1.2 and SPSS version 25 were used for data entry and analysis respectively. Binary logistic regression analyses were done to identify associated factors and the adjusted odds ratio (AOR) with its 95% confidence interval (CI) at a p-value of <0.05 was used to declare significant association. The healthcare providers' awareness of breastfeeding practice recommendations during the COVID-19 pandemic was 40.7% (95% CI: 35.9, 45.6). Working in a tertiary hospital (AOR = 3.69; 95% CI: 2.24, 6.08), using COVID-19 guideline updates (AOR = 3.34; 95% CI: 2.1, 5.3), being trained on COVID-19 (AOR = 2.78; 95% CI: 1.74, 4.47), owning a smartphone and/or a computer (AOR = 2.26; 95% CI: 1.39, 3.68), and perceiving that COVID-19 is dangerous (AOR = 1.78; 95% CI: 1.05, 3.01) were factors positively associated with healthcare providers' awareness of breastfeeding practice recommendations during the pandemic of COVID-19. Only two in five healthcare providers were aware of recommendations on breastfeeding practice during the COVID-19 pandemic and related to information of accessibility information on COVID-19. Therefore, expanding COVID-19 related information through the provision of COVID-19 training and guidelines to all levels of hospitals would improve health care providers' awareness of breastfeeding practice recommendations amid the COVID-19 pandemic.

Antibiotic prescribing patterns among patients admitted to an academic teaching hospital for COVID-19 during the first wave of the pandemic in Toronto: A retrospective, controlled study.

Empirical antibiotics are not recommended for coronavirus disease 2019 (COVID-19). In this retrospective study, patients admitted to Toronto General Hospital's general internal medicine from the emergency department for COVID-19 between March 1 and August 31, 2020 were compared with those admitted for community-acquired pneumonia (CAP) in 2020 and 2019 in the same months. The primary outcome was antibiotics use pattern: prevalence and concordance with COVID-19 or CAP guidelines. The secondary outcome was antibiotic consumption in days of therapy (DOT)/100 patient-days. We extracted data from electronic medical records. We used logistic regression to model the association between disease and receipt of antibiotics, linear regression to compare DOT. The COVID-19, CAP 2020, and CAP 2019 groups had 67, 73, and 120 patients, respectively. Median age was 71 years; 58.5% were male. Prevalence of antibiotic use was 70.2%, 97.3%, and 90.8% for COVID-19, CAP 2020, and CAP 2019, respectively. Compared with CAP 2019, the adjusted odds ratio (aOR) for receiving antibiotics was 0.23 (95% CI 0.10 to 0.53, p = 0.001) and 3.42 (95% CI 0.73 to 15.95, p = 0.117) for COVID-19 and CAP 2020, respectively. Among patients receiving antibiotics within 48 hours of admission, compared with CAP 2019, the aOR for guideline-concordant combination regimens was 2.28 (95% CI 1.08 to 4.83, p = 0.031) for COVID-19, and 1.06 (95% CI 0.55 to 2.05, p = 0.856) for CAP 2020. Difference in mean DOT/100 patient-days was -24.29 (p = 0.009) comparing COVID-19 with CAP 2019, and +28.56 (p = 0.003) comparing CAP 2020 with CAP 2019. There are opportunities for antimicrobial stewardship to address unnecessary antibiotic use.

Factors associated with psychosocial problems in Korean nursing and non-nursing students during the COVID-19 pandemic.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has changed our lives in many ways, including school closures and social distancing practices. These abrupt life changes may have led to psychosocial problems in college students. This study aimed to identify the factors associated with psychosocial problems in South Korean nursing and non-nursing students.MethodsThis descriptive cross-sectional survey was conducted with 139 nursing and 147 non-nursing students (N = 286) between August 6 and October 30, 2020. We investigated participants’ general characteristics (that is, sociodemographic and health-promoting behaviors), sensitivity to COVID-19 infection, COVID-19 pandemic response indicators, and psychosocial problems. The factors associated with psychosocial problems were determined using multiple regression analysis.ResultsAmong the COVID-19 pandemic response indicators, perceived health status during the COVID-19 pandemic was verified as a factor associated with psychosocial problems in nursing (β = − 5.831, p < .001) and non-nursing students (β = − 8.513, p < .001). Perceived stress (β = 1.263, p = .045), trust in policy (β = .892, p < .001), and religion (β = − 1.424, p = .004) were verified as correlates of psychosocial problems in non-nursing students.ConclusionAs the COVID-19 pandemic continues, the stakeholders can use our study results to identify students experiencing psychosocial problems and subsequently as a theoretical background for developing intervention programs for those at a high risk of psychosocial problems. Additionally, it can be used as primary data for future research and practice regarding COVID-19 guidelines among students.

487. Experience with Remdesivir for Treatment of SARS-CoV-2 in Patients with Liver Cirrhosis

BackgroundRemdesivir is a nucleotide analogue antiviral that was FDA approved for the treatment of hospitalized patients with coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). Remdesivir has been associated with elevations in serum aminotransferase levels but most cases being mild to moderate and reversible upon discontinuation. Although national COVID-19 guidelines and the American Association for the Study of Liver Diseases (AASLD) currently recommend remdesivir for use in hospitalized patients requiring supplemental oxygen, data is limited using remdesivir in patients with chronic liver disease. Here, we describe our experience with remdesivir in patients with liver cirrhosis.MethodsPatients with liver cirrhosis who received remdesivir were identified either prospectively or retrospectively by primary or secondary ICD-10 codes indicating liver disease. Data collected included patient demographics, underlying cause of cirrhosis, co-morbidities, Child-Pugh score, laboratory values (serum aminotransferase levels, serum creatinine) during and following remdesivir, adverse reactions attributed to remdesivir, and mortality (in-hospital, 30-day, and 90-day).ResultsA total of 4 patients with underlying liver cirrhosis completed a 5-day course of remdesivir treatment. On admission, Child-Pugh class was A for 1 patient, B for 2 patients, and C for 1 patient. Causes for cirrhosis were nonalcoholic steatohepatitis (NASH), hepatic amyloidosis, and chronic hepatitis B. There were no acute elevations in aminotransferase levels or adverse events attributed to remdesivir therapy. Mortality was high with 50% in-hospital mortality. Of the 2 other patients who survived to discharge, one was discharged to home hospice and the other was readmitted within 30 days and expired during that admission.ConclusionSince there is limited data available using remdesivir in patients with advanced liver disease, we did not identify any safety concerns related to remdesivir in our cirrhotic patients. Mortality was high illustrating the poor outcomes of patients with advanced liver disease and COVID-19. Patients with cirrhosis should be offered remdesivir if clinically appropriate.Disclosures All Authors: No reported disclosures

ESCMID COVID-19 living guidelines: drug treatment and clinical management

ScopeIn January 2021, the ESCMID Executive Committee decided to launch a new initiative to develop ESCMID guidelines on several COVID-19-related issues, including treatment of COVID-19. MethodsAn ESCMID COVID-19 guidelines task force was established by the ESCMID Executive Committee. A small group was established, half appointed by the chair, and the remaining selected with an open call. Each panel met virtually once a week. For all decisions, a simple majority vote was used. A long list of clinical questions using the PICO (population, intervention, comparison, outcome) format was developed at the beginning of the process. For each PICO, two panel members performed a literature search with a third panellist involved in case of inconsistent results. Voting was based on the GRADE approach. Questions addressed by the guideline and recommendationsA synthesis of the available evidence and recommendations is provided for each of the 15 PICOs, which cover use of hydroxychloroquine, bamlanivimab alone or in combination with etesevimab, casirivimab combined with imdevimab, ivermectin, azithromycin and empirical antibiotics, colchicine, corticosteroids, convalescent plasma, favipiravir, remdesivir, tocilizumab and interferon β-1a, as well as the utility of antifungal prophylaxis and enoxaparin. In general, the panel recommended against the use of hydroxychloroquine, ivermectin, azithromycin, colchicine and interferon β-1a. Conditional recommendations were given for the use of monoclonal antibodies in high-risk outpatients with mild–moderate COVID-19, and remdesivir. There was insufficient evidence to make a recommendation for use of favipiravir and antifungal prophylaxis, and it was recommended that antibiotics should not be routinely prescribed in patients with COVID-19 unless bacterial coinfection or secondary infection is suspected or confirmed. Tocilizumab and corticosteroids were recommended for treatment of severe COVID-19 but not in outpatients with non-severe COVID-19. ScopeThe aim of the present guidance is to provide evidence-based recommendations for management of adults with coronavirus disease 2019 (COVID-19). More specifically, the goal is to aid clinicians managing patients with COVID-19 at various levels of severity including outpatients, hospitalized patients, and those admitted to intensive care unit. Considering the composition of the panel, mostly clinical microbiologists or infectious disease specialists with no pulmonology or intensive care background, we focus only on pharmacological treatment and do not give recommendations on oxygen supplement/support. Similarly, as no paediatricians were included in the panel; the recommendations are only for adult patients with COVID-19. Considering the current literature, no guidance was given for special populations such as the immunocompromised.