COVID-19 Exposure Research Articles

Behçet’s disease and COVID-19, retrospective analysis

Purpose This study aimed to investigate the impact of the COVID-19 pandemic and its consequences on the clinical condition of patients with Behçet’s uveitis and compare this with the pre-pandemic state. Patients and methods This retrospective observational study included patients with Behçet’s uveitis who had adequate follow-up before the pandemic (three visits before March 2020) and during the pandemic (two visits between March 2020 and September 2021). We compared uveitis activity, complication rates, and treatment changes during the pandemic with their preCOVID data. Patients who met the inclusion criteria were contacted by phone to confirm previous COVID-19 exposure and vaccination status. Results The study included 59 eyes of 30 patients with Behçet’s uveitis. There was a statistically significant difference between the preCOVID and COVID eras with respect to visual acuity, with median values changed from 1.033 to 1.3 (P=0.003). There was an increase in secondary glaucoma (16.9% to 30.5%, P=0.039), with a corresponding increase in antiglaucoma topical eye drops (20.3–35.6%) (P=0.012). The use of subtenon injections and systemic steroids decreased during the COVID-19 pandemic, but the difference was not statistically significant (P=0.687 and P=0.481, respectively). However, the average steroid dose and the number of subtenon injections per patient showed a statistically significant decrease during the pandemic (20 and 26.7 mg per day, respectively) compared to the preCOVID era (0 and 1 injection per patient) (P=0.007 and 0.027, respectively). Conclusion The COVID-19 pandemic did not result in increased uveitis activity, but a decrease in follow-up frequency led to more complications, mainly secondary glaucoma.

Anxiety, Stress Perception, and Coping Strategies among Students with COVID-19 Exposure.

Background: Studying anxiety, stress, and coping strategies during the COVID-19 pandemic is crucial to mitigate the negative effects associated with infection risk and disease consequences. Objective: This study aimed to investigate anxiety levels, stress perception, and coping strategies in relation to the presence of illness. Material and Methods: A cross-sectional online survey was conducted anonymously among 3950 university students from Poland (1822), Lithuania (232), and the Russian exclave of Kaliningrad (1896). Due to the nearly identical application of anti-epidemic measures, the respondents were treated as a unified group. The State-trait Anxiety Inventory (STAI), Perceived Stress Scale 10 (PSS-10), and mini-COPE scale questionnaires were used. Statistical analysis included the Shapiro-Wilk test to check normality, the Mann-Whitney U test for comparative analysis between groups, the Pearson χ2 test for categorical data, and Spearman coefficients for correlations between variables. Results: A significant proportion of young adults in the community exhibited symptoms of anxiety and stress during the COVID-19 pandemic. Among the 1212 men and 2738 women surveyed, 348 (28.7%) and 1020 (37.3%) individuals, respectively, were diagnosed with COVID-19 according to clinical protocols. Prolonged disease duration and more severe residual symptoms correlated with higher self-reported anxiety levels. Conclusions: The level of anxiety and stress varied depending on the duration of the disease, significantly impacting the choice of coping strategies. Overall, students displayed a proactive approach to coping activities but tended to postpone important decisions. Seeking social support was a prevalent coping mechanism, although respondents who had COVID-19 showed higher levels of concern for their own emotions, a tendency to discharge emotions through alcohol or other substances (male), and a greater reliance on religion (female). The study provides data that may be useful in developing educational and health policies focused on the mental well-being of university students and potentially other social groups.

The Internalization of Local Wisdom in the Buddhist Kampong for Mitigating COVID-19

Communities across the globe are grappling with the COVID-19 pandemic by leveraging their local wisdom, and the Buddhist Kampong in Sodong Hamlet is no exception. Buddhist Kampong has experienced minimal COVID-19 exposure, demonstrating a proficient response to the pandemic. However, this success story remains largely unknown to various stakeholders, necessitating comprehensive research to delineate and elucidate the intrinsic value of local wisdom and its assimilation process. Using an ethnographic approach, this two-year research project was carried out in Sodong Hamlet, Gelangkulon, Sampung Ponorogo, East Java, Indonesia. Primary and secondary sources were tapped, with research informants identified as traditional, religious, and community leaders. Data collection encompassed interviews, observations, and document recordings, all analyzed using an interactive model. The findings revealed a distinct value system within the Buddhist Kampong, shaping their approach to COVID-19 mitigation. This value system revolves around the principles of Memayu Hayuning Kulawarga, Memayu Hayuning Sasama, and Memayu Hayuning Bawana, influencing the community’s engagement in check-in rituals, care for sasomo and cooperation, and the restoration of padasan and diyang. The figures embodying this local wisdom guide community members in internalizing customs, religion, and parental teachings. The internalization process unfolds through exemplary habituation, socialization, and the cultivation of moral motivation, empowering citizens to navigate the challenges posed by the COVID-19 pandemic effectively.

Differences in perceived threat and trauma in children during the COVID-19 pandemic

BackgroundThe past 2 years of the COVID-19 pandemic were stressful for most children and adolescents; some children may have experienced a high level of stress and trauma. To date, no study has examined self-reported stress and trauma levels due to COVID-19 in children. This study aimed to assess perceived threat, exposure and trauma symptoms in children aged 7–13 years. In addition, we explored whether parent-reported factors could predict a higher risk of COVID-19 vulnerability in their children.MethodCross-sectional data were collected from 752 children to assess COVID-19 threat, exposure and trauma symptoms using the self- and parent-reported Child and Adolescent Trauma Screening Self-Report (CATS) Trauma questionnaire. We used exploratory analyses (factor analysis of mixed data and hierarchical clustering) to identify subgroups (i.e., clusters) of children sharing similar characteristics in the dataset. Linear regression modeling was applied to determine the likelihood of higher threat and vulnerability in children with parent-reported COVID-19 threat, exposure, CATS trauma symptoms, behaviors on the Child Behavior Checklist (CBCL), and posttraumatic growth (PTG).ResultsWe identified a high-risk group of children reporting clinically relevant trauma symptoms and COVID-19-related fears. Parents’ reports of trauma could be used to identify children at high risk.ConclusionsApproximately 25% of children reported moderate to clinically relevant levels of trauma symptom. It is especially important to offer adequate support to these children to ease the trauma and prevent their symptoms from developing into psychopathology.

Humoral and cellular responses to repeated COVID-19 exposure in multiple sclerosis patients receiving B-cell depleting therapies: a single-center, one-year, prospective study.

Multiple sclerosis patients treated with anti-CD20 therapy (aCD20-MS) are considered especially vulnerable to complications from SARS-CoV-2 infection due to severe B-cell depletion with limited viral antigen-specific immunoglobulin production. Therefore, multiple vaccine doses as part of the primary vaccination series and booster updates have been recommended for this group of immunocompromised individuals. Even though much less studied than antibody-mediated humoral responses, T-cell responses play an important role against CoV-2 infection and are induced efficiently in vaccinated aCD20-MS patients. For individuals with such decoupled adaptive immunity, an understanding of the contribution of T-cell mediated immunity is essential to better assess protection against CoV-2 infection. Here, we present results from a prospective, single-center study for the assessment of humoral and cellular immune responses induced in aCD20-MS patients (203 donors/350 samples) compared to a healthy control group (43/146) after initial exposure to CoV-2 spike antigen and subsequent re-challenges. Low rates of seroconversion and RBD-hACE2 blocking activity were observed in aCD20-MS patients, even after multiple exposures (responders after 1st exposure = 17.5%; 2nd exposure = 29.3%). Regarding cellular immunity, an increase in the number of spike-specific monofunctional IFNγ+-, IL-2+-, and polyfunctional IFNγ+/IL-2+-secreting T-cells after 2nd exposure was found most noticeably in healthy controls. Nevertheless, a persistently higher T-cell response was detected in aCD20-MS patients compared to control individuals before and after re-exposure (mean fold increase in spike-specific IFNγ+-, IL-2+-, and IFNγ+/IL-2+-T cells before re-exposure = 3.9X, 3.6X, 3.5X/P< 0.001; after = 3.2X, 1.4X, 2.2X/P = 0.002, P = 0.05, P = 0.004). Moreover, cellular responses against sublineage BA.2 of the currently circulating omicron variant were maintained, to a similar degree, in both groups (15-30% T-cell response drop compared to ancestral). Overall, these results highlight the potential for a severely impaired humoral response in aCD20-MS patients even after multiple exposures, while still generating a strong T-cell response. Evaluating both humoral and cellular responses in vaccinated or infected MS patients on B-cell depletion therapy is essential to better assess individual correlations of immune protection and has implications for the design of future vaccines and healthcare strategies.

Association of parent-child interactions with parental psychological distress and resilience during the COVID-19 pandemic.

The effects of psychological distress/resilience on parent-child engagement (e.g., family dinners, reading) during the COVID-19 pandemic have not been well studied. Among very young children from underrepresented backgrounds enrolled in the ongoing longitudinal Bronx Mother Baby Health Study of healthy term infants, we (1) examined associations between exposures to COVID-19-related events, demographic factors and parental psychological distress and resilience; and (2) correlated these factors with parent-child engagement activities. Between June 2020-August 2021, parents of 105 Bronx Mother Baby Health Study participants aged birth-25 months completed questionnaires related to exposures to COVID-19-related events, frequency of positive parent-child engagement activities, food and housing insecurity, and parental psychological distress and resilience. Families were also asked open ended questions about the pandemic's impact. 29.8% and 47.6% of parents reported food and housing insecurity, respectively. Greater exposures to COVID-19-related events were associated with increased parental psychological distress. Positive parent-child interactions were associated with demographic factors and higher levels of maternal education, but not with exposures to COVID-19-related events. This study adds to a growing body of literature on the negative impacts of COVID-19 exposures and psychosocial stressors on families during the pandemic, supporting the need for enhanced mental health resources and social supports for families.

656-P: COVID-19 Exposure and Perceived Impact Associated with Poor Psychosocial, Behavioral, and Physical Health

Aim: To describe the exposure and impact of COVID-19 in teens with T1D and associations with health outcomes. Methods: In the first month of an intervention trial to reduce distress in teens with T1D, COVID-19 emerged. Thus, in addition to planned surveys (Table), participants reported on COVID-19 exposure and perceived impact of the pandemic. Subscales assessed: 1) COVID-19 exposure - a tally of whether teen/important contact was diagnosed, hospitalized, or died, 2) Pandemic-impact - overall worry/feelings about the pandemic (range: 2-10), and 3) T1D-impact - pandemic effect on diabetes care (range: 13-65). Higher scores indicated more exposure or perceived impact. Pearson correlations described all associations. Results: Of the 172 teens (A1C M=8.7%±2.0%, 56% female, 73% White, 19% Hispanic), 50% reported no exposures, 23% reported 1, 24% 2-3, and 2% 4-7 exposures. Mean pandemic-impact score was 5.6±1.6 (range=2-10), while mean T1D-impact was 36.8±6.9 (range=18-54). Table summarizes associations of subscales with A1C and behavioral markers. Conclusions: COVID-19 exposure and perceived impact were consistently linked with worse psychosocial and behavioral metrics and A1C for teens with T1D. In particular, associations with T1D-impact were strong. These findings suggest the impact of stressful life events should be monitored within the context of T1D management. Disclosure J.Yi-frazier: None. M.Bradford: None. C.Zhou: None. A.Rosenberg: None. M.E.Hilliard: None. M.B.O'donnell: None. B.M.Ellisor: None. S.Garcia perez: None. F.Malik: None. Y.Rojas: None. D.Desalvo: Consultant; Dexcom, Inc., Research Support; Insulet Corporation. C.Pihoker: None. S.R.Scott: None. Funding National Institutes of Health (R01DK121224)

1194-P: Impact of COVID-19 on Gestational Diabetes Mellitus (GDM) Screening and Outcomes

Background: To minimize COVID-19 exposure, a modified 1-step strategy (MS) option was offered in addition to the standard (SS) GDM screening strategies (definitions in Fig 1A). Objectives: To assess the use of, and obstetrical and neonatal outcomes associated with, modified GDM screening during COVID-19. Methods: Primiparous pregnancies in Alberta, Canada (N=35,836; Jan 1, 2020 to Dec 31, 2021) were categorized by GDM screening status. Results: 87.4% underwent SS, 10.1% MS, and 2.5% had no GDM screening. MS use was highest in 2020-Q3 (second wave; Fig 1B). There was no difference in GDM rates between SS (11.1%) and MS (12.7%). MS screened women with GDM had worse outcomes than those screened using SS (Table). Conclusions: GDM screening rates were not impacted by COVID-19. The uptake of MS was low to modest and appeared to identify higher-risk GDM women. Disclosure V.Liyanage: None. O.Barrett: None. D.P.Ngwezi: None. A.Savu: None. R.O.Yeung: Research Support; Novo Nordisk Foundation, Abbott, Canadian Institutes of Health Research, Alberta Agriculture and Forestry, Alberta Canola. S.Butalia: None. P.Kaul: None.

Fetal brain vulnerability to SARS-CoV-2 infection

Whether or not SARS-CoV-2 can cross from mother to fetus during a prenatal infection has been controversial; however, recent evidence such as viral RNA detection in umbilical cord blood and amniotic fluid, as well as the discovery of additional entry receptors in fetal tissues suggests a potential for viral transmission to and infection of the fetus. Furthermore, neonates exposed to maternal COVID-19 during later development have displayed neurodevelopmental and motor skill deficiencies, suggesting the potential for consequential neurological infection or inflammation in utero. Thus, we investigated transmission potential of SARS-CoV-2 and the consequences of infection on the developing brain using human ACE2 knock-in mice. In this model, we found that viral transmission to the fetal tissues, including the brain, occurred at later developmental stages, and that infection primarily targeted male fetuses. In the brain, SARS-CoV-2 infection largely occurred within the vasculature, but also within other cells such as neurons, glia, and choroid plexus cells; however, viral replication and increased cell death were not observed in fetal tissues. Interestingly, early gross developmental differences were observed between infected and mock-infected offspring, and high levels of gliosis were seen in the infected brains 7 days post initial infection despite viral clearance at this time point. In the pregnant mice, we also observed more severe COVID-19 infections, with greater weight loss and viral dissemination to the brain, compared to non-pregnant mice. Surprisingly, we did not observe an increase in maternal inflammation or the antiviral IFN response in these infected mice, despite showing clinical signs of disease. Overall, these findings have concerning implications regarding neurodevelopment and pregnancy complications of the mother following prenatal COVID-19 exposure.

The Assessment of Neurological Development of the Infants with Prenatal COVID-19 Exposure

Objective: The effects of prenatal coronavirus 2019 disease (COVID-19) exposure on the infantile neurological development are unknown. It has been considered that the inflammatory, thrombotic, and vascular changes occurred in the placentas taken from pregnant women diagnosed with COVID-19 and the inflammatory nature of COVID-19 infection may lead to negative obstetric and neurological events. We aimed to assess the potential neurological effects of prenatal COVID-19 exposure on the infant.&#x0D; Methods: The present study included 2–12-month-old infants born to women with positive real-time reverse transcription polymerase chain reaction test results for COVID-19 from the population of pregnant patients under routine follow-up. The neurological examinations and the Denver II Developmental Screening Test (DDST II) were performed for 41 infants aged 2–12 months to assess the neurological effects of prenatal COVID-19 exposure.&#x0D; Results: The average gestational age of the infants was 38.7 ± 1.9 weeks, and the average birth weight was 3198 ± 543 g. Eight of the infants had a history of hospitalization in the neonatal intensive care unit. The neurological examination and the neuromotor development of 40 (96%) infants were normal for their age group. Only one infant had abnormal neurological examination and DDST II result.&#x0D; Conclusion: The findings of the study suggest that prenatal COVID-19 exposure has no negative neurological impact on infants. Long-term prospective studies with larger sample sizes are needed for more comprehensive assessment of the neurological effects of prenatal COVID-19 exposure on the infants.

Post-traumatic stress disorder, anxiety, depression and burnout in nursing home staff in South France during the COVID-19 pandemic

The high mortality rate in nursing homes during the COVID-19 pandemic may be linked to psychological disorders in staff. Hence, we assessed the prevalence and associated factors of probable post-traumatic stress disorder (PTSD), anxiety, depression, and burnout of nursing home staff during the COVID-19 pandemic in a cross-sectional study including 66 randomly selected nursing homes in southern France. 537 of the contacted 3 821 nursing home workers (14.0%) responded between April and October 2021. We collected information on center organization, severity of COVID-19 exposure, and socio-demographic information in an online survey. The prevalence of probable PTSD (PCL-5), anxiety and depressive disorders (Hospital Anxiety Depression Scale) and the sub-scores of burnout syndrome (Maslach Burnout Inventory Human Services Survey for Medical Personnel) were assessed. Probable PTSD was reported in 115/537 responders (21.4% (95% CI [18.0%–24.9%])). After adjustment, low-level exposure to COVID-19 in nursing home residents (AOR, 0.5; 95% CI [0.3–0.9]), fear of managing COVID-19 residents (AOR, 3.5; 95% CI [1.9–6.4]), conflicts with residents (AOR, 2.3; 95% CI, [1.2–4.4]), conflicts with colleagues (AOR, 3.6; 95% CI [1.7–8.6]), cancellation of leave (AOR, 4.8; 95% CI [2.0–11.7]) and temporary worker employment (AOR, 3.4; 95% CI [1.7–6.9]) were associated with higher prevalence of probable PTSD. The prevalence of probable anxiety and depression were 28.8% (95% CI [24.9%–32.7%]) and 10.4% (95% CI [7.8%–13.1%]), respectively. Psychological disorders were observed in nearly one third of nursing home workers during the COVID-19 pandemic. Hence, continuous surveys and preventive measures are needed in this particularly at-risk population.

The Factors Associated with the Development of COVID-19 Symptoms among Employees in a U.S. Healthcare Institution.

Healthcare workers have experienced increased occupational health risks caused by COVID-19 disease. The purpose of this project was to examine the relationships between reporting COVID-19 symptoms by employees in a healthcare institution in the United States and employees' demographics, vaccination status, co-morbid conditions, and body mass index (BMI). This project employed a cross-sectional design. It involved the analysis of data on COVID-19 exposure and infection incidents among employees in the healthcare institution. The dataset contained more than 20,000 entries. The results indicate that being female, African American, between 20 and 30 years old, diagnosed with diabetes, diagnosed with chronic obstructive pulmonary disease (COPD), or on immunosuppressive medicines is associated with greater reporting of COVID-19 symptoms by the employees. Furthermore, BMI is associated with reporting COVID-19 symptoms; the higher the BMI, the greater the likelihood of reporting a symptomatic infection. Moreover, having COPD, being 20-30 years old, being 40-50 years old, BMI, and vaccination status were significantly associated with employees reporting symptoms while controlling for other variables associated with reporting the symptoms among the employees. These findings may be applicable to other infectious disease outbreaks or pandemics.

Racial, Ethnic, and Sex Differences in Methadone-Involved Overdose Deaths Before and After the US Federal Policy Change Expanding Take-home Methadone Doses

In March 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) permitted states to relax restrictions on take-home methadone doses for treatment-adherent patients to minimize COVID-19 exposures. To assess whether the methadone take-home policy change was associated with drug overdose deaths among different racial, ethnic, and sex groups. Interrupted time series analysis from January 1, 2018, to June 30, 2022. Data analysis was conducted from February 18, 2023, to February 28, 2023. In this population-based cohort study of drug overdose mortality including 14 529 methadone-involved deaths, monthly counts of methadone-involved drug overdose deaths were obtained for 6 demographic groups: Hispanic men and women, non-Hispanic Black men and women, and non-Hispanic White men and women. On March 16, 2020, in response to the first wave of the COVID-19 pandemic, SAMHSA issued an exemption to the states that permitted up to 28 days of take-home methadone for stable patients and 14 days for less stable patients. Monthly methadone-involved overdose deaths. From January 1, 2018, to June 30, 2022 (54 months), there were 14 529 methadone-involved deaths in the United States; 14 112 (97.1%) occurred in the study's 6 demographic groups (Black men, 1234; Black women, 754; Hispanic men, 1061; Hispanic women, 520; White men, 5991; and White women, 4552). Among Black men, there was a decrease in monthly methadone deaths associated with the March 2020 policy change (change of slope from the preintervention period, -0.55 [95% CI, -0.95 to -0.15]). Hispanic men also experienced a decrease in monthly methadone deaths associated with the policy change (-0.42 [95% CI, -0.68 to -0.17]). Among Black women, Hispanic women, White men, and White women, the policy change was not associated with a change in monthly methadone deaths (Black women, -0.27 [95% CI, -1.13 to 0.59]; Hispanic women, 0.29 [95% CI, -0.46 to 1.04]; White men, -0.08 [95% CI, -1.05 to 0.88]; and White women, -0.43 [95% CI, -1.26 to 0.40]). In this interrupted time series study of monthly methadone-involved overdose deaths, the take-home policy may have helped reduce deaths for Black and Hispanic men but had no association with deaths of Black or Hispanic women or White men or women.

Age-based spatial disparities of COVID-19 incidence rates in the United States counties.

COVID-19 incidence disparities have been documented in the literature, but the different driving factors among age groups have yet to be explicitly explained. This study proposes a community-based COVID-19 spatial disparity model, considering different levels of geographic units (individual and community), various contextual variables, multiple COVID-19 outcomes, and different geographic contextual elements. The model assumes the existence of age nonstationarity effects on health determinants, suggesting that health effects of contextual variables vary among place and age groups. Based on this conceptual model and theory, the study selected 62 county-level variables for 1,748 U.S. counties during the pandemic, and created an Adjustable COVID-19 Potential Exposure Index (ACOVIDPEI) using principal component analysis (PCA). The validation was done with 71,521,009 COVID-19 patients in the U.S. from January 2020 through June 2022, with high incidence rates shifting from the Midwest, South Carolina, North Carolina, Arizona, and Tennessee to the West and East coasts. This study corroborates the age nonstationarity effect of health determinants on COVID-19 exposures. These results empirically identify the geographic disparities of COVID-19 incidence rates among age groups and provide the evidentiary guide for targeting pandemic recovery, mitigation, and preparedness in communities.

Integrating Contact Tracers Into Point-of-Care Testing Workflow to Accelerate the Tracing of People With Exposure to COVID-19, August-December 2020, New York City.

We assessed the timeliness of contact tracing following rapid-positive COVID-19 test result at point-of-care testing (POCT) sites in New York City (NYC). Interviewed case-patients to elicit exposed contacts and conducted COVID-19 exposure notifications. Twenty-two COVID-19 POCT sites in NYC, the 2 NYC international airports, and 1 ferry terminal. Case-patients with rapid-positive COVID-19 test results and their named contacts. We quantified the proportions of interviewed individuals with COVID-19 and notified contacts and assessed the timeliness between the dates of the rapid-positive COVID-19 test results and the interviews or notifications. In total, 11 683 individuals with rapid-positive COVID-19 test results were referred for contact tracing on the day of their diagnosis; 8878 (76) of whom were interviewed within 1 day of diagnosis, of whom 5499 (62%) named 11 486 contacts. A median of 1.24 contacts were identified from each interview. The odds of eliciting contacts were significantly higher among individuals reporting COVID-19 symptoms than among persons with no symptoms (51% vs 36%; adjusted odds ratio [aOR] = 1.37; 95% confidence interval [CI], 1.11-1.70) or living with 1 or more persons than living alone (89% vs 38%; aOR = 12.11; 95% CI, 10.73-13.68). Among the 8878 interviewed case-patients, 8317 (94%) were interviewed within 1 day of their rapid-positive COVID-19 test results and 91% of contact notifications were completed within 1 day of contact identification. The median interval from test result to interview date and from case investigation interview to contact notification were both 0 days (IQR = 0). The integration of contact tracers into COVID-19 POCT workflow achieved timely case investigation and contact notification. Accelerated contact tracing can be used to curb COVID-19 transmission during local outbreaks.

Racial and Ethnic Differences in Self-Reported COVID-19 Exposure Risks, Concerns, and Behaviors Among Diverse Participants in the Women's Health Initiative Study.

Racial and ethnic disparities in coronavirus disease 2019 (COVID-19) risk are well-documented; however, few studies in older adults have examined multiple factors related to COVID-19 exposure, concerns, and behaviors or conducted race- and ethnicity-stratified analyses. The Women's Health Initiative (WHI) provides a unique opportunity to address those gaps. We conducted a secondary analysis of WHI data from a supplemental survey of 48 492 older adults (mean age 84 years). In multivariable-adjusted modified Poisson regression analyses, we examined predisposing factors and COVID-19 exposure risk, concerns, and behaviors. We hypothesized that women from minoritized racial or ethnic groups, compared to non-Hispanic White women, would be more likely to report: exposure to COVID-19, a family or friend dying from COVID-19, difficulty getting routine medical care or deciding to forego care to avoid COVID-19 exposure, and having concerns about the COVID-19 pandemic. Asian women and non-Hispanic Black/African American women had a higher risk of being somewhat/very concerned about risk of getting COVID-19 compared to non-Hispanic White women and each was significantly more likely than non-Hispanic White women to report forgoing medical care to avoid COVID-19 exposure. However, Asian women were 35% less likely than non-Hispanic White women to report difficulty getting routine medical care since March 2020 (adjusted relative risk 0.65; 95% confidence interval 0.57, 0.75). We documented COVID-related racial and ethnic disparities in COVID-19 exposure risk, concerns, and care-related behaviors that disfavored minoritized racial and ethnic groups, particularly non-Hispanic Black/African American women.

How Midwestern College students protected their families in the first year of COVID-19.

College students routinely visit their families due to geographic proximity and their financial dependence. Consequently, the potential of transmitting COVID-19 from campus to their families' homes is consequential. Family members are key sources of support for one another in nearly all matters but there is little research uncovering the mechanisms by which families have protected each other in the pandemic. Through an exploratory qualitative study, we examined the perspectives of a diverse, randomly sampled, group of students from a Midwestern University (pseudonym), in a college town, to identify COVID-19 prevention practices with their family members. We interviewed 33 students between the end of December 2020 and mid-April 2021 and conducted a thematic analysis through an iterative process. Students navigated major differences in opinions and undertook significant actions in attempts to protect their family members from COVID-19 exposure. Students' actions were rooted in the greater good of public health; prosocial behavior was on display. Larger public health initiatives could target the broader population by involving students as messengers.

COVID-19 induced remission of biliary and renal cell carcinomas.

e14598 Background: Clear cell renal carcinoma and cholangiocarcinoma are resistant to standard therapy. Complete remissions are rare. SARS-CoV-2 (COVID-19) boosts anti-viral immune responses but effects on cancers are unknown. Case reports of hematologic cancer remissions after COVID infection are emerging. Anti PD1/PD-L1 antibody therapy have prolonged remission in 20% of solid tumor patients. mRNA COVID-19 vaccines and COVID-19 active infections create anti-viral immune responses - increased IgG titers, SARS-CoV-2-specific antibodies, and boost T-cell response. Anti PD-1/PD-L1 antibodies immune responses, are presumed independent of the immune response to COVID vaccination/infection. Two previous case reports of hematologic remission were seen after COVID infection. (Hodgkins, multiple myeloma). There are no cases of solid cancer remission after COVID-19 exposure. Methods: Three patients with solid cancers and complete/near complete radiographic remissions after COVID-19 exposure. Two on low carbohydrate diets. History, dietary course and clinical outcomes are presented. Results: Case 1: 58 year old male diagnosed with stage IV clear cell renal carcinoma (lung nodules, mediastinal nodes). After 5 years he progressed on Sunitinib and began Nivolumab. His cancer stabilized but hypophysitis, diarrhea, severe jaw pain ended his treatment. After COVID-19 booster vaccine, he became anorexic, lost 50 lbs over 8 weeks (267 to 211 lb). Relapse was suspected but PET CT showed complete resolution of his lung nodules and adenopathy. Asymptomatic and in remission over 9 months post vaccine. Case 2: 51 year old male heavily pretreated stage 4 renal cell cancer, bone, liver, nodal metastases. On Nivolumab with stable disease but after COVID booster vaccine had high fever, fatigue, myalgia. PET CT scans later showed near complete resolution of his bony, hepatic and nodal metastatic sites. Case 3: 75 year old male with unresectable cholangiocarcinoma on second line Atezolizumab. COVID-19 infection was followed by complete radiographic remission. Conclusions: Effects of SARS-CoV-2 (COVID-19) on cancers remain unknown. Few case reports of cancer remissions after infections are emerging. These are two cases of renal cell cancers in complete remission after COVID-19 vaccination while on immunotherapy. Both followed low glycemic diets. Third case was a complete remission of biliary cancer after an acute COVID-19 infection. Proposed anti-cancer mechanisms - pathogen specific T cell action, anti-inflammatory effects against COVID-19 infection, cross-reactivity against tumor antigens, natural killer cell activation. COVID-19 proteins have oncolytic properties - HIV related B cell apoptosis and Coxsackievirus A21 oncolytic effects on myeloma and CD138+ plasma cells via intercellular adhesion molecule interaction. COVID-19’s effects plus the anti PD-1/PD-L1 antibodies immune response may be synergistic and merits further research.

Factors Associated With the Quality of Life of Nursing Home Residents During the COVID-19 Pandemic: A Cross-Sectional Study.

Quality of life (QoL) of nursing home (NH) residents is critical, yet understudied, particularly during the COVID-19 pandemic. Our objective was to examine whether COVID-19 outbreaks, lack of access to geriatric professionals, and care aide burnout were associated with NH residents' QoL. Cross-sectional study (July to December 2021). We purposefully selected 9 NHs in Alberta, Canada, based on their COVID-19 exposure (no or minor/short outbreaks vs repeated or extensive outbreaks). We included data for 689 residents from 18 care units. We used the DEMQOL-CH to assess resident QoL through video-based care aide interviews. Independent variables included a COVID-19 outbreak in the NH in the past 2weeks (health authority records), care unit-levels of care aide burnout (9-item short-form Maslach Burnout Inventory), and resident access to geriatric professionals (validated facility survey). We ran mixed-effects regression models, adjusted for facility and care unit (validated surveys), and resident covariates (Resident Assessment Instrument-Minimum Data Set 2.0). Recent COVID-19 outbreaks (β= 0.189; 95% CI: 0.058-0.320), higher proportions of emotionally exhausted care aides on a care unit (β= 0.681; 95% CI: 0.246-1.115), and lack of access to geriatric professionals (β= 0.216; 95% CI: 0.003-0.428) were significantly associated with poorer resident QoL. Policies aimed at reducing infection outbreaks, better supporting staff, and increasing access to specialist providers may help to mitigate how COVID-19 has negatively affected NH resident QoL.

Healthcare personnel at non–acute-care facilities are at risk of COVID-19 from workplace and community exposures

Background: Healthcare personnel (HCP) working in non–acute-care facilities are at high risk of COVID-19. We sought to determine SARS-CoV-2 seroprevalence, and analyzed behaviors and activities related to COVID-19 acquisition in this cohort. Methods: Between May and June 2021, HCP were enrolled at a skilled nursing facility and a memory care facility in St. Louis, Missouri. Data regarding demographics, prior SARS-CoV-2 testing, symptoms consistent with COVID-19 in the previous 6 months, COVID-19 vaccination, personal protective equipment (PPE) use, and COVID-19 exposures were collected via survey. Blood specimens were obtained to determine SARS-CoV-2 nucleocapsid IgG antibody seroprevalence (Abbott Laboratories). Study protocol was approved by the Washington University Institutional Review Board. Results: The survey was completed by 74 HCP. 82% of participants were female, and 31% reported &gt;10 years of healthcare experience. The overall SARS-CoV-2 seropositivity rate was 8.9% (5 HCP). Of the surveyed HCP, 50% reported symptoms concerning for COVID-19 in the prior 6 months. Headache (38%), fatigue (35%) and fever (27%) were the most common self-reported symptoms. Among symptomatic HCP, only 35% sought medical care for these symptoms. All HCP reported having taken at least 1 COVID-19 test prior to study enrollment. Of note, 18.9% (14 HCP) had a self-reported prior positive SARS-CoV-2 PCR test, of whom 9 HCP were seronegative. All seronegative HCP with a self-reported history of COVID-19 reported infection &gt;3 months before study participation. Completion of a primary COVID-19 vaccination series was reported by 86% of HCP. Known exposure to COVID-19 at work was reported by 28% of HCP. When asked about PPE at the time of workplace exposure, N95 mask use was reported by 81%, gloves by 57%, gowns by 33%, face shields by 29% and surgical masks by 14%. Known specific exposure to COVID-19 outside work was reported by 31% of HCP. Conclusions: One year after the initial COVID-19 pandemic impacted the St. Louis region, HCP at non–acute-care facilities had a SARS-CoV-2 seroprevalence of 8.9%. Similar frequency of exposures were reported from both the workplace and community, with high rates of PPE use at the workplace. HCP in such settings remain at high risk of COVID-19 exposure from workplace and community exposures. Ongoing efforts are needed to maintain PPE use to prevent SARS-CoV-2 transmission within non–acute-care facilities, and continue access to timely COVID-19 screening for HCP.Disclosure: None