Coronavirus Disease 2019 Test Results Research Articles

Clinical Impact of Coronavirus Disease 2019 Outbreaks in Korea on Seizures in Children

Purpose: Coronavirus disease 2019 (COVID-19) can be associated with neurological complications. This study investigated the impact of COVID-19 outbreaks on seizure incidence and duration in children in Korea. Methods: We retrospectively analyzed medical records from Kyungpook National University Children’s Hospital, including 768 children with seizures during the peak COVID-19 outbreaks in March and August 2022, and compared patterns with the same periods in 2021. We examined demographic and clinical characteristics, causes of seizures, underlying conditions, seizure durations, and COVID-19 test results. Results: Out of 16,373,836 COVID-19 cases during the first peak, 25.6% were children (4,184,383), and during the second peak, 20.5% of 6,400,244 cases were children (1,314,331). No significant age differences were observed between either peak and the previous year. However, when compared to the previous year, febrile seizures (FS) were more common during both peaks (25.9% vs. 65.1% in the first peak; 34.3% vs. 59.2% in the second peak). The prevalence of FS was significantly higher in the COVID-19-positive group (84.1%) than in the COVID-19-negative group (51.9%). The incidence of new-onset seizures or breakthrough seizures showed no significant difference. Seizure duration and the incidence of status epilepticus (SE) showed no significant changes, but SE was more common in the COVID-19-negative group (17.1% vs. 6.2%). The clinical features of FS were similar in both groups. Conclusion: COVID-19 appeared to increase the risk of FS in children, but there was no significant impact on the risk of breakthrough seizures or SE in children with epilepsy. Nevertheless, larger-scale studies are necessary.

Imaging Evaluation of Clinical and Subclinical Myocarditis in Multisystem Inflammatory Syndrome of Children with COVID-19 Using Cardiac Magnetic Resonance: The Results and Prognosis

Background: Coronavirus disease 2019 (COVID-19) has emerged as the most significant health crisis in recent years, leading to over 6 million deaths globally due to the disease. Objectives: Given the prevalence of multisystem inflammatory syndrome in children (MISC) following the COVID-19 pandemic, this study aims to examine the imaging findings and prognoses of clinical and subclinical myocarditis in children with MISC through cardiac magnetic resonance (CMR) imaging. Patients and Methods: This prospective cohort study carried out over eighteen months from May 2021 to November 2022, included 14 patients who underwent CMR imaging. A census of all eligible patients during the study period served as the sampling method. Inclusion criteria were patients with confirmed COVID-19 infection through serological tests, polymerase chain reaction (PCR), or recent exposure to COVID-19 patients. Exclusion criteria included patients with a history of congenital heart disease (CHD) or pulmonary disease. Additional diagnostic tests performed included blood sample tests, chest X-ray (CXR), electrocardiogram (ECG), and echocardiography. CMR imaging was conducted on patients with cardiac involvement. A diagnosis of myocardial inflammation was made if a patient met at least two of the Lake Louise Criteria. The Chi-square, Fisher's exact, and Mann-Whitney tests were used to examine the relationship between quantitative variables and treatment outcomes. Additionally, the Wilcoxon signed rank, and McNemar’s tests assessed changes in echocardiography findings from admission to follow-up. A significance level of 0.05 was set. Results: Among the 14 patients studied, 8 (57.10%) were girls and 6 (42.90%) were boys. The average age was 6.03 ± 3.71 years. The median time to CMR imaging after symptom onset was 4 weeks (interquartile range (IQR): 2 - 12, range: 30). Global function assessment using left ventricular ejection fraction (LVEF) showed that 5 (35.70%), 3 (21.40%), and 6 (42.90%) patients had normal function, mild dysfunction, and significant LV dysfunction, respectively. 71.40% of patients who recovered had mild tricuspid regurgitation (TR) and no cardiomegaly. Significant differences in mean values of polymorphonuclear neutrophil (PMN) (37.71 ± 11.75 vs. 81.44 ± 13.06), lymphocytes (48.71 ± 20.08 vs. 12.51 ± 7.26), hemoglobin (Hb) (12.60 ± 1.55 vs. 10.10 ± 1.62), mean corpuscular volume (MCV) (85.90 ± 5.67 vs. 79.37 ± 5.23), erythrocyte sedimentation rate (ESR) (8.86 ± 13.60 vs. 30.29 ± 21.33), and C-reactive protein (CRP) (18.91 ± 27.25 vs. 100.57 ± 85.67) were observed between non-recovered and recovered patients, respectively (P < 0.05). However, no statistically significant association was found between other variables, including N-terminal pro–B-type natriuretic peptide (NT-proBNP), D-dimer, and Troponin I (TPI), with treatment outcomes (P > 0.05). Conclusion: Our findings indicate that a negative COVID-19 test does not exclude an established clinical COVID-19 infection in children with MISC. The results suggest that all children with MISC and a history of COVID-19 infection should undergo assessment for myocardial fibrosis, regardless of ejection fraction (EF) as determined by Echocardiography, laboratory tests, and COVID-19 test results. Strain analysis, conducted during both the acute phase and subsequent follow-ups through CMR imaging or Echocardiography, is recommended to enhance the understanding of the prognosis.

Disparities in COVID-19 vaccine intentions, testing and trusted sources by household language for children with medical complexity.

Children with medical complexity experienced health disparities during the coronavirus disease 2019 (COVID-19) pandemic. Language may compound these disparities since people speaking languages other than English (LOE) also experienced worse COVID-19 outcomes. Our objective was to investigate associations between household language for children with medical complexity and caregiver COVID-19 vaccine intentions, testing knowledge, and trusted sources of information. This cross-sectional survey of caregivers of children with medical complexity ages 5 to 17 years was conducted from April-June 2022. Children with medical complexity had at least 1 Complex Chronic Condition. Households were considered LOE if they reported speaking any language other than English. Multivariable logistic regression examined associations between LOE and COVID-19 vaccine intentions, interpretation of COVID-19 test results, and trusted sources of information. We included 1,338 caregivers of children with medical complexity (49% response rate), of which 133 (10%) had household LOE (31 total languages, 58% being Spanish). There was no association between household LOE and caregiver COVID-19 vaccine intentions. Caregivers in households with LOE had similar interpretations of positive COVID-19 test results, but significantly different interpretations of negative results. Odds of interpreting a negative test as expected (meaning the child does not have COVID-19 now or can still get the virus from others) were lower in LOE households (aOR [95% CI]: 0.56 [0.34-0.95]). Households with LOE were more likely to report trusting the US government to provide COVID-19 information (aOR [95% CI]: 1.86 [1.24-2.81]). Differences in COVID-19 test interpretations based on household language for children with medical complexity were observed and could contribute to disparities in outcomes. Opportunities for more inclusive public health messaging likely exist.

The Effect of COVID-19 in a University Hospital Neurosurgery Clinic Comparison to Prepandemic Period: A Retrospective Study with 6 months of Data

The coronavirus disease 2019 (COVID-19) pandemic affected all countries' health systems and people's lifestyles. In this study, we aimed to investigate its effects in a university hospital neurosurgery clinic. The 2019year's 6months' data as a prepandemic period compared to the 2020year's same period as a pandemic date. Demographic data were collected. Operations were divided into seven groups: tumor, spinal, vascular, cerebrospinal fluid disorders, hematoma, local, and minor surgery, respectively. We classified the hematoma cluster into subgroups to evaluate the etiology: epidural, acute subdural, subarachnoid hemorrhage, intracerebral hemorrhage, depressed skull fractures, and others. Patients' COVID-19 test results were collected. Total operations decreased from 972 to 795 (Δ18.2%) during the pandemic. All groups, except minor surgery cases, decreased compared to the prepandemic period. Also, vascular procedures for females increased during the pandemic period. While focusing on the hematoma subgroups, there was decreasing in epidural and subdural hematomas, depressed skull fractures, and total case numbers; an increase in subarachnoid hemorrhage and intracerebral hemorrhage. Overall mortality significantly increased to 9.6% from 6.8% during the pandemic (P= 0.033). Eight (1.0%) of 795 patients were COVID-19-positive; three of them died. Neurosurgery residents and academicians were unsatisfied with decreased number of operations, training, and research productivity. The pandemic and restrictions affected negatively the health system and people's access to healthcare. Our retrospective observational study aimed to evaluate these effects and take lessons for the next similar situations. People's access to health care should be considered when lockdown restrictions.

COVID-19 Vaccination Breakthrough Infections in a Real-World Setting: Using Community Reporters to Evaluate Vaccine Effectiveness.

PurposeCoronavirus disease 2019 (COVID-19) has highlighted the need for new methods of pharmacovigilance. Here, we use adult community volunteers to obtain systematic information on vaccine effectiveness and the nature and severity of breakthrough infections.MethodsBetween December 15, 2020 and September 16, 2021, 11,826 unpaid community-based volunteers reported the following information to an on-line registry: COVID-19 test results, vaccination (Pfizer, Moderna, or Johnson & Johnson) and COVID-19 symptoms. COVID-19 infections were described based on vaccination status at the time of infection: 1) fully vaccinated, 2) partially vaccinated (received first of two-dose vaccines or were <14 days post-final dose), or 3) unvaccinated.ResultsAmong 8554 participants who received any COVID-19 vaccine, COVID-19 infections were reported by 74 (1.0%) of those who were fully vaccinated and 198 (2.3%) of those who were partially vaccinated at the time of infection. Among the 74 participants who reported a breakthrough infection after full vaccination, the median time from vaccination to reported positive test result was 104.5 days (interquartile range: 77–135 days), with no difference among vaccine manufacturers. One quarter (25.7%) of breakthrough infections in the fully vaccinated cases were asymptomatic and most (>97%) fully vaccinated participants reported no symptoms or only mild symptoms compared to 89.3% of the unvaccinated cases. Only 1.4% of fully vaccinated participants reported experiencing at least 3 moderate-to-severe symptoms compared to 7.8% in the unvaccinated.ConclusionPerson-generated health data, also referred to as patient-reported outcomes, is a useful approach for quantifying breakthrough infections and their severity and for comparing vaccines.Trial RegistrationClinicaltrials.gov NCT04368065, EU PAS Register EUPAS36240.

The association between salivary zinc levels and dysgeusia in COVID-19 patients.

Zinc insufficiency has been proposed to play a role in taste and smell impairment in Coronavirus disease 2019 (COVID-19) patients. Therefore, this study aimed at comparing salivary zinc levels in COVID-19 patients with and without dysgeusia. A total of 127 participants were recruited for this study. The patients were divided into three groups based on their COVID-19 test results and taste impairment. Groups I and II were COVID-19 positive with and without taste loss, respectively. Group III included the negative control participants. Salivary zinc levels were measured at baseline in all groups and three months after baseline in groups I and II. Wilcoxon signed-rank test was used to compare the zinc levels between baseline and three months after baseline within each group. Mann-Whitney U test was used to compare zinc levels between groups with different degrees of taste loss. Salivary zinc levels were significantly lower in the COVID-19 positive group with taste loss compared to levels in the group without taste loss or the negative controls (p<0.005). Three months after baseline, salivary zinc levels were significantly elevated in both COVID-19 positive groups (p<0.001). COVID-19 patients with dysgeusia had significantly lower levels of salivary zinc than positive and negative controls. Zinc levels were elevated after recovery, which may indicate that salivary zinc is directly associated with taste abnormalities and COVID-19 outcomes. This study showed that taste impairment is associated with lower salivary zinc levels in COVID-19 patients.

Long-Term Fine Particulate Matter Concentrations and Prevalence of Severe Acute Respiratory Syndrome Coronavirus 2: Differential Relationships by Socioeconomic Status Among Pregnant Individuals in New York City.

We aimed to determine if long-term fine particulate matter (PM2.5) concentrations are associated with increased risk of testing positive for COVID-19 among pregnant individuals who were universally screened at delivery and if socioeconomic status (SES) modifies this relationship. We used obstetric data from Columbia University Irving Medical Center in New York City from March–December 2020, which included Medicaid use (low-SES surrogate) and coronavirus disease 2019 (COVID-19) test results. We linked 300m resolution estimated 2018-2019 PM2.5 concentrations and census tract-level population density, household size and income, and mobility estimates. Analyses included 3318 individuals; 5% tested positive for COVID-19 at delivery, 8% tested positive during pregnancy, 48% used Medicaid, and average long-term PM2.5 concentrations were 7.4 μg/m3 (SD = 0.8). In adjusted multilevel logistic regression models, we saw no association between PM2.5 and ever-testing positive for COVID-19; however, odds were elevated among those using Medicaid (odds ratio = 1.6, 95% CI 1.0, 2.5 per 1-μg/m3 increase). Further, while only 22% of those testing positive showed symptoms, 69% of symptomatic individuals used Medicaid. SES, including unmeasured occupational exposures or increased susceptibility to the virus due to co-social and environmental exposures, may explain the increased odds of testing positive for COVID-19 confined to vulnerable pregnant individuals using Medicaid.

The Safety of the Re-Opening of an Academic Medical Center Outpatient Endoscopy Unit During the COVID-19 Pandemic.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has spread globally leading to over 3,700,000 deaths. As COVID-19 cases stabilized, the re-opening of endoscopy centers potentially exposed patients and healthcare workers to viral infection. This study aims to determine risk of COVID-19 exposure among patients undergoing outpatient endoscopies in a tertiary care setting during the COVID-19 pandemic.MethodsPatients undergoing outpatient endoscopy were contacted post-procedure for any new COVID-19 symptoms or COVID-19 test results. Patient experiences and perception of personal safety were also determined.ResultsOf the 1,584 patients who completed elective endoscopy, 996 (62.9%) completed the survey. Two patients were diagnosed with COVID-19 within 14 days of procedure. The majority (99.7%) felt safe during their procedure and apprehension regarding endoscopy decreased over time.ConclusionThus, the risk of COVID-19 transmission during outpatient endoscopy is extremely low when following recommended society guidelines. Patients felt safe during the procedure and experienced less fear of exposure over time.

Comparison of Persistent Symptoms Following SARS-CoV-2 Infection by Antibody Status in Nonhospitalized Children and Adolescents.

The prevalence of long-term symptoms of coronavirus disease 2019 (COVID-19) in nonhospitalized pediatric populations in the United States is not well described. The objective of this analysis was to examine the presence of persistent COVID symptoms in children by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody status. Data were collected between October 2020 and May 2022 from the Texas Coronavirus Antibody REsponse Survey, a statewide prospective population-based survey among 5-90 years old. Serostatus was assessed by the Roche Elecsys Anti-SARS-CoV-2 Immunoassay for detection of antibodies to the SARS-CoV-2 nucleocapsid protein. Self-reported antigen/polymerase chain reaction COVID-19 test results and persistent COVID symptom status/type/duration were collected simultaneously. Risk ratios for persistent COVID symptoms were calculated versus adults and by age group, antibody status, symptom presence/severity, variant, body mass index and vaccine status. A total of 82 (4.5% of the total sample [n = 1813], 8.0% pre-Delta, 3.4% Delta and beyond) participants reported persistent COVID symptoms (n = 27 [1.5%] 4-12 weeks, n = 58 [3.3%] >12 weeks). Compared with adults, all pediatric age groups had a lower risk for persistent COVID symptoms regardless of length of symptoms reported. Additional increased risk for persistent COVID symptoms >12 weeks included severe symptoms with initial infection, not being vaccinated and having unhealthy weight (body mass index ≥85th percentile for age and sex). These findings highlight the existence of nonhospitalized youth who may also experience persistent COVID symptoms. Children and adolescents are less likely to experience persistent COVID symptoms than adults and more likely to be symptomatic, experience severe symptoms and have unhealthy weight compared with children/adolescents without persistent COVID symptoms.

Markers of Social and Emotional Health in College Students During the COVID-19 Pandemic.

Objective: Research on effects of the coronavirus disease 2019 (COVID-19) pandemic on the mental health of youth have mostly focused on the occurrence of negative states such as anxiety and depression. The objective of this study was to assess the social and emotional health of university students in India, as influenced by COVID-19 test results and the experience of isolation or quarantine.Methods: A cross-sectional online survey was conducted in India during July and early August 2021 among university students aged 20-25 years. The Social Emotional Health Survey-Higher Education (SEHS-HE) was used to assess 4 domains: belief in self, belief in others, emotional competence, and engaged living.Results: There were 187 respondents from 78 institutions in 14 of 29 states of India. The sample was 51% male. The mean SEHS-HE scores were approximately 75% of the maximum score in each domain. In multivariable regression analysis, sex, residence with family, and a negative COVID-19 report had little effect on SEHS-HE domains. COVID-19 positivity was associated with significantly lower scores on all domains (P < .01). Isolation/quarantine was associated with significantly or near-significantly higher scores on all domains (P < .01). In all cases, β coefficients and the proportion of the variance explained by the regression were small.Conclusions: Major pandemic-related internal and environmental determinants of SEHS-HE remain to be identified. Strategies to improve the well-being of college students should be directed toward those who have tested positive for the disease. The experience of isolation/quarantine is not pathoplastic.

Investigation of a cluster of Legionnaires' disease during the outbreak of coronavirus disease 2019 pandemic in northeastern Taiwan, June 2021.

PurposeTo describe the investigation and intervention of a cluster of Legionnaires’ disease detected during the outbreak of coronavirus disease 2019 (COVID-19) pandemic.MethodsFrom June 7 to 22, 2021, 15 cases in the neighborhood near our hospital were detected. Information about residence, workplace, hospital visit, and potential exposures was collected. Sampling and decontamination were performed for potential sources.ResultsAll 15 patients had pneumonia when visiting the emergency room with negative COVID-19 test results. Most patients were male (73.3%) with the mean age of 65.7 years. The most common comorbidities were diabetes mellitus (40.0%) and hypertension (40%). The most common symptom was fever (93.3%). Two (13.3%) patients needed mechanical ventilators. Fever subsided within 2 days of treatment for most cases (85.7%). Five cases had exposure history at our hospital, and the other 10 lived or worked in the area within 2 km of our hospital, mostly in buildings A and B. Water sampling was carried out for our hospital, buildings A and B; one water sample from a cooling tower in our hospital cultured positive for Legionella bacteria. Early testing and treatment for suspected cases were carried out for the outbreak, and all cases were discharged with pneumonia resolution.ConclusionThis was a community outbreak of Legionnaires' disease near our hospital. COVID-19 tests were repeated frequently before testing for Legionnaires' disease during the COVID-19 pandemic. Early recognition of Legionnaires’ disease and timely treatment improved outcome.

Cryptogenic Organizing Pneumonia Obscured by a Presumed COVID-19 Pneumonia: A Case Report

Interstitial lung disease (ILD) is a group of more than 200 conditions with various etiologies that result in a wide range of inflammation and/or fibrosis of the pulmonary interstitium. Cryptogenic Organizing Pneumonia (COP) is a type of idiopathic ILD that requires a high index of suspicion with an appropriate workup to make the diagnosis. The Coronavirus Disease 2019 (COVID-19) pandemic has enabled COVID-19 pneumonia to become a top differential diagnosis, which has consequently introduced bias into medical decision-making. We present a case of COP that was misdiagnosed for COVID-19 pneumonia for months despite several negative COVID-19 test results. This case also raises awareness of the cognitive bias that likely allowed for the misdiagnosis, resulting in delayed appropriate treatment for this patient.

Obsessive-Compulsive Disorder During the COVID-19 Pandemic: Preliminary Findings From a Study in the United Arab Emirates.

Objective: To investigate the prevalence of obsessive-compulsive disorder (OCD) during the coronavirus disease 2019 (COVID-19) pandemic among the general population of the United Arab Emirates. Methods: An online survey of a convenience sample was conducted between October 2020 and January 2021. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to assess symptoms of OCD. The rate of OCD symptoms in those who had positive COVID-19 test results was compared with those who had no previous COVID-19 diagnosis. Results: The total number of participants was 702, including 371 males and 325 females (6 skipped the question regarding sex). Most participants reported no previous psychiatric history (84.3%). Previous psychiatric diagnoses were reported by 15.7% of participants (n = 110) and included generalized anxiety (27.3%), phobia (1.8%), depression (19.1%), bipolar mood disorder (1.8%), OCD (6.3%), and panic attacks (8.2%). There were 39 (5.6%) participants who had past psychiatric history but were unsure of the exact diagnosis. Presence of history of OCD for the total sample was reported by 7 (1%) participants. A family history of OCD was reported by 34 (4.8%) participants. A total of 218 (31.1%) participants scored mild, moderate, severe, or extreme OCD symptoms. Clinically significant OCD symptoms were reported by 75 participants (10.7% of the total sample). The mean (SD) score of the Y-BOCS was 6.63 (7.13) for the COVID-positive group and 4.9 (6.34) for the COVID-negative group, which was statistically significant (P = .0008). Conclusions: The study findings indicate an increased prevalence of OCD during the COVID-19 pandemic, which is significantly higher among people with positive COVID-19 infection compared to those with negative COVID-19 test results.

COVID-19 Pandemisi Sırasında Erişkin Kardiyovasküler Cerrahi: Retrospektif Tek Merkezli Deneyim

Objective: Coronavirus disease-2019 (COVID-19), caused by a novel coronavirus, has become a worldwide pandemic. In order to control the global spread of this contagious disease, elective surgeries including cardiac and vascular procedures were postponed. In this article we present our experience during the initial phase of the pandemic in view of safety protocols. Material and Methods: The study included all elective, urgent, and emergent procedures that were performed from March 11, 2020 to June 30, 2021 at the department of cardiovascular surgery. Patients' demographics, preoperative COVID-19 (reverse transcription-polymerase chain reaction) test results, surgical procedures, complications and outcomes were prospectively collected. We also developed our own protocol to proceed with our surgical activity without delay. Results: A total of 86 cardiac and vascular procedures were performed during the study period. The median age was 64 years (range 23-79), 59 (69%) were males. There were 42 (48%) elective procedures, and 13 (15%) patients had emergency procedures. 57 (66%) patients underwent coronary artery bypass graft surgery. 10 (12%) patients underwent valvular procedures. Peripheral vascular surgeries were performed in 18 (21%) patients. The median length of stay in the hospital was 9 days (range 1-60). A positive COVID-19 test was identified in 4 patients, two of them were detected in the immediate postoperative period and died. In-hospital mortality was 9%. Conclusion: Cardiovascular procedures could be performed safely with a relatively low risk during the outbreak, particularly for elective patients with proper management and strict infection control and isolation protocols.

What has changed in children's appendicitis during the COVID-19 pandemic?

The present study aimed to investigate the changes in the course of acute appendicitis during the pandemic period by comparing the cases treated during the coronavirus disease 2019 (COVID-19) pandemic with those in the pre-pandemic period. The study was conducted with 601 children aged 1-18 years who were operated for acute appendicitis between May 1, 2019, and February 29, 2020 (Group I) and between March 1 and December 31, 2020 (Group II). The demographic and disease characteristics as well as the treatment processes were compared between the groups. It was found that 59.1% (n=355) of the cases included in the study were in Group I and 40.9% (n=246) were in Group II. During the pandemic period; due to the concerns of families about contracting a contagious disease for both themselves and their children, and warnings by health professionals and government officials that they should not leave their homes and not come to the hospital unless there is an emergency, the time to apply to the hospital has been extended. Before the pandemic, 20.3% of the patients presented to the hospital on the 1st day of their complaints, where during the pandemic, only 2% of the patients reported to the hospital on the 1st day, and 15% presented after 4 days or more. As a result, the rate of perforated appendicitis, which was formerly 10.4%, increased to 24.8% during the pandemic period (p<0.01). During the pandemic, we operated on four patients with positive COVID-19 test results. There were no complications related to COVID-19 and surgery in our patients. Concern of the current pandemic resulted in late presentation to the hospital, increase in the number of perforated appendicitis, and prolonged hospital stay.

Nigeria's financing of health care during the COVID-19 pandemic: Challenges and recommendations.

An analysis of the financing of Nigeria's health‐care system in response to coronavirus disease 2019 (COVID‐19) pandemic was conducted. Nigeria projected that it would need US$330 million to control its COVID‐19 pandemic. However, it raised more than US$560.52 million, of which more than 90% came from the private sector and the donor/philanthropist community. The pooled COVID‐19 fund is mainly being expended on temporary public health and clinical care measures, with little invested to strengthen the health system beyond the pandemic. The poor turn‐around time for COVID‐19 test results and the stigma associated with the disease results in most persons with mild to moderate symptoms seeking care from alternatives to the health‐care institutions designated for COVID‐19 health care. The huge out‐of‐pocket expenses, and the inability of most Nigerians to earn money because of measures instituted to contain the pandemic, will likely cause many Nigerians to become economically impoverished by the COVID‐19 pandemic. COVID‐19‐related commodity procurement was least responsive to the needs of those most in need of care and support. The government needs to institute several fiscal policies. Immediate response to ease the financial impact of COVID‐19 require inclusion of COVID‐19 management in health insurance packages and an increase in domestic government health spending.

A Retrospective Cohort Study of Clinical Factors Associated with Transitions of Care among COVID-19 Patients.

Coronavirus Disease 2019 (COVID-19) is an international health crisis. In this article, we report on patient characteristics associated with care transitions of: 1) hospital admission from the emergency department (ED) and 2) escalation to the intensive care unit (ICU). Analysis of data from the electronic medical record (EMR) was performed for patients with COVID-19 seen in the ED of a large Western U.S. Health System from April to August of 2020, totaling 10,079 encounters. Of these, 5172 resulted in admission as an inpatient within 72 h. Inpatient encounters (n = 6079) were also considered for patients with positive COVID-19 test results, of which 970 resulted in a transfer to the ICU or in-hospital mortality. Laboratory results, vital signs, symptoms, and comorbidities were investigated for each of these care transitions. Different top risk factors were found, but two factors common to hospital admission and ICU transfer were respiratory rate and the need for oxygen support. Comorbidities common to both settings were cerebrovascular disease and congestive heart failure. Regarding laboratory results, the neutrophil-to-lymphocyte ratio was associated with transitions to higher levels of care, along with the ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT).

Association of renin-angiotensin system blockers with COVID-19 diagnosis and prognosis in patients with hypertension: a population-based study.

ABSTRACTBackgroundThe effect of renin–angiotensin system (RAS) blockade either by angiotensin-converting enzyme inhibitors (ACEis) or angiotensin-receptor blockers (ARBs) on coronavirus disease 2019 (COVID-19) susceptibility, mortality and severity is inadequately described. We examined the association between RAS blockade and COVID-19 diagnosis and prognosis in a large population-based cohort of patients with hypertension (HTN).MethodsThis is a cohort study using regional health records. We identified all individuals aged 18–95 years from 87 healthcare reference areas of the main health provider in Catalonia (Spain), with a history of HTN from primary care records. Data were linked to COVID-19 test results, hospital, pharmacy and mortality records from 1 March 2020 to 14 August 2020. We defined exposure to RAS blockers as the dispensation of ACEi/ARBs during the 3 months before COVID-19 diagnosis or 1 March 2020. Primary outcomes were: COVID-19 infection and severe progression in hospitalized patients with COVID-19 (the composite of need for invasive respiratory support or death). For both outcomes and for each exposure of interest (RAS blockade, ACEi or ARB) we estimated associations in age-, sex-, healthcare area- and propensity score-matched samples.ResultsFrom a cohort of 1 365 215 inhabitants we identified 305 972 patients with HTN history. Recent use of ACEi/ARBs in patients with HTN was associated with a lower 6-month cumulative incidence of COVID-19 diagnosis {3.78% [95% confidence interval (CI) 3.69–3.86%] versus 4.53% (95% CI 4.40–4.65%); P < 0.001}. In the 12 344 patients with COVID-19 infection, the use of ACEi/ARBs was not associated with a higher risk of hospitalization with need for invasive respiratory support or death [OR = 0.91 (0.71–1.15); P = 0.426].ConclusionsRAS blockade in patients with HTN is not associated with higher risk of COVID-19 infection or with a worse progression of the disease.

The role of long-term air pollution for COVID-19 infection and severity during pregnancy

BACKGROUND AND AIM: Ambient air pollution may increase risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but this remains unstudied in a cohort with universal Coronavirus Disease 2019 (COVID-19) testing. We fill this gap using a cohort of pregnant women from Columbia University hospitals, who as of March 13, 2020 all received SARS-CoV-2 nasopharyngeal quantitative polymerase-chain-reaction (PCR) testing and were queried about prior COVID-19 test results and symptoms upon labor unit admission. We aimed to evaluate the association between long-term air pollution exposure and COVID-19 and the role of racial/ethnic and socioeconomic factors in this association. METHODS: We used electronic health record data on all deliveries at Columbia University Irving Medical Center and Allen Hospital in New York City, that took place between March 13, 2020 and December 31, 2020. Our outcome measures were (1) positive COVID-19 PCR at delivery and (2) ever-testing positive for COVID-19 and being symptomatic. We estimated long-term fine particle (PM2.5) exposure using 300m resolution New York City Community Air Survey predictions at mothers’ addresses at the time of delivery. We used logistic regression models controlled for potential confounders including maternal race/ethnicity, delivery hospital, Borough of residence, birthdate, and census tract-level median household income and average household size. RESULTS:Analyses included 3941 women; 4.7% (n=186) tested positive for COVID-19 at delivery and 15.4% (n=45) of those who ever tested positive for COVID-19 had symptoms. Mean (standard deviation) 2017 residential PM2.5 concentrations were 7.5 (0.6) μg/m3. In adjusted models, we observed no association between PM2.5 concentrations and testing positive for COVID-19 at delivery (OR = 0.94, 95% CI: 0.64, 1.37) or being symptomatic with COVID-19 (OR = 1.04, 95% CI: 0.56, 1.93). CONCLUSIONS:Long-term air pollution exposure was not associated with increased risk of COVID-19 among pregnant women in New York City. KEYWORDS: Long-term exposure, COVID-19, Pregnancy outcomes

Patient Perceptions of Receiving COVID-19 Test Results via an Online Patient Portal: An Open Results Survey.

In the United States, attention has been focused on "open notes" and "open results" since the Office of the National Coordinator for Health Information Technology implemented the 21st Century Cures Act Final Rule on information blocking. Open notes is an established best practice, but open results remains controversial, especially for diseases associated with stigma, morbidity, and mortality. Coronavirus disease 2019 (COVID-19) is associated with all three of these effects and represents an ideal disease for the study of open results for sensitive test results. This study evaluates patient perspectives related to receiving COVID-19 test results via an online patient portal prior to discussion with a clinician. We surveyed adults who underwent COVID-19 testing between March 1, 2020 and October 21, 2020 who agreed to be directly contacted about COVID-19-related research about their perspectives on receiving test results via a patient portal. We evaluated user roles (i.e., patient vs. care partner), demographic information, ease of use, impact of immediate release, notification of results, impact of viewing results on health management, and importance of sharing results with others. Users were mostly patients themselves. Users found the portal easy to use but expressed mixed preferences about the means of notification of result availability (e.g., email, text, or phone call). Users found immediate access to results useful for managing their health, employment, and family/childcare. Many users shared their results and encouraged others to get tested. Our cohort consisted mostly of non-Hispanic white, highly educated, English-speaking patients. Overall, patients found open results useful for COVID-19 testing and few expressed increased worries from receiving their results via the patient portal. The demographics of our cohort highlight the need for further research in patient portal equity in the age of open results.