Flu Test Research Articles

Adopting Covid-19 and Flu Testing Strategies In An Underserved Community

Abstract Introduction/Objective The COVID-19 pandemic has had a significant impact on communities worldwide, while little is known about how medically underserved minority communities perceive and experience COVID-19 and/or COVID- 19/Flu combined testing. This research target at a medically underserved community in east Harris County, Texas, and was designed to 1) understand the perception of the single COVID-19 test as well as the COVID-19 and flu combined test, 2) implement different testing strategies in collaboration with the local community. Methods/Case Report Residents in the eligible communities who are age ≥ 18 years or older are recruited through community engagement groups and community originations. Participant’s demographic information, perception and histories of vaccination and testing were collected through a cross-sectional questionnaire. Participants willing to undergo testing were assisted by community health workers, who then collected feedback on test acceptability via follow-up questionnaires. Results (if a Case Study enter NA) A total of 325 individuals participated in the study from Sept 2022-June 2023. 52% of participants are minority ethnicity, including 35% African American and 17% Latino. 11% of participants are uninsured and 32% of participants are from households with income lower than 25,000 a year. We surveyed our participants on their opinion of COVID-19 and Flu testing and vaccination, majority of our participants have had more experience in COVID-19 (92% had been tested and 93% had been vaccinated) than Flu (64% had been tested and 85% had been vaccinated). 96% consider COVID-19 testing tolerable, with major barrier of being tested is fear of painful sampling (49%). PCR testing is the dominant testing method in the community (> 40%) for COVID-19, while only 16% received antigen testing. Conclusion Our findings suggest that while participants recognized the role of COVID-19 testing, there were significant barriers to access and uptake of testing, including concerns about painful sampling, inconvenience, and a lack of trust in the healthcare system. Participants also expressed a desire for clearer information about testing and more accessible testing sites. Participants have less experience with Flu testing and many of whom had never been tested in the past. Our study highlights the need for targeted community education and outreach efforts to increase testing uptake. Development and implementation of these efforts would better prepare us for combating other commutable diseases of public health significance in the future.

Assessing inorganic nanoparticle toxicity through omics approaches.

In the last two decades, the development of nanotechnology has resulted in inorganic nanoparticles playing crucial roles in key industries, ranging from healthcare to energy technologies. For instance, gold and silver nanoparticles are widely used in rapid COVID-19 and flu tests, titania and zinc oxide nanoparticles are commonly found in cosmetic products, and superparamagnetic iron oxide nanoparticles have been clinically exploited as contrast agents and anti-anemia medicines. As a result, human exposure to nanomaterials is continuously increasing, raising concerns about their potential adverse health effects. Historically, the study of nanoparticle toxicity has largely relied on macroscopic observations obtained in different in vitro and in vivo models, resulting in readouts such as median lethal dose, biodistribution profile, and/or histopathological assessment. In recent years, omics methodologies, including transcriptomics, epigenomics, proteomics, metabolomics, and lipidomics, are increasingly used to characterize the biological interactions of nanomaterials, providing a better and broader understanding of their impact and mechanisms of toxicity. These approaches have been able to identify important genes and gene products that mediate toxicological effects, as well as endogenous functions and pathways dysregulated by nanoparticles. Omics methods improve our understanding of nanoparticle biology, and unravel mechanistic insights into nanomedicine-based therapies. This review aims to provide a deeper understanding and new perspectives of omics approaches to characterize the toxicity and biological interactions of inorganic nanoparticles, and improve the safety of nanoparticle applications.

Importance of History Taking and Physical Examination Before Rapid Laboratory Test for Seasonal Influenza Virus: A Single-Center Multiple Logistic Analysis.

Background Despite several rapid influenza diagnostic tests (RIDTs), they are predicting whether a patient has influenza before rapid testing is important. Here, we assessed factors predictive of a positive flu test via RIDTs by combining interviews and physical examination. Methods We analyzed the relationship between interviews and physical findings and results of RIDTs using multivariable logistic regression. Results Two hundred seventy-six children were enrolled throughout the 2018-2019 flu season. Accordingly, 115 patients (41.7%) were positive for flu A. Our logistic regression model identified age, body temperature, and the existence of upper respiratory symptoms as significant factors for predicting positive for RIDTs, with odds ratios (OR) of 1.17 [95% CI (confidence interval): 1.08-1.25]/+Δ1year old, 1.70 (95% CI: 1.27-2.27)/+Δ1 ℃, and 5.08 (95% CI: 2.57-10.00) for respiratory symptoms. In addition, the OR for sick contact was 7.67 (95% CI: 3.96-14.90). Our logistic regression model showed an area under the curve (AUC) of 0.84. History of vaccination was not identified as a significant factor in positive RIDTs. Conclusions The existence of sick contact was associated with a positive flu test via RIDTs. Although RIDTs are an easy and quick method for detecting the flu virus, we should perform the appropriate identification of cases for RIDTs by combining interviews and physical findings.

Syndrome of Inappropriate Secretion of Antidiuretic Hormone Associated with H1N1 Infection

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is related to several conditions. However, there are few reports associated with H1N1 virus infection. We describe a 36 year old patient with SIADH admitted to our department if internal medicine with fever, cough and myalgias. The labooratory analysis showed serum hypo-osmolar hyponatremia and high level of urinary sodium concentration. All other biological analysis were within normal range. Moreover, All bacterial and fungal cultures, blood and urine cultures were all negative for any microbial pathogen. The thoraco-abdominal CT scan was normal. Rapid flu test was positive for influenza type A 15 days after. The patient recovered with intravenous infusion of hypertonic saline and fluid restriction and he did not received any anti-viral drug. Despite a strong relationship betwwen H1N1 virus infection and SIADH needs to be established, physicians should be aware of this potential seroius effect and should monitor the serum sodium closely.
 Keywords : H1N1 infection, inappropriate secretion of antidiuretic hormone, hyponatremia

Choice Architecture to Assist Clinicians with Appropriate COVID-19 Test Ordering.

Despite improving supplies, SARS-CoV-2 nucleic acid amplification tests remain limited during surges and more so given concerns around COVID-19/influenza co-occurrence. Matching clinical guidelines to available supplies ensures resources remain available to meet clinical needs. We report a change in clinician practice after an electronic health record (EHR) order redesign to impact emergency department (ED) testing patterns. We included all ED visits between December 1, 2021 and January 18, 2022 across a hospital system to assess the impact of EHR order changes on provider behavior 3 weeks before and after the change. The EHR order redesign included embedded symptom-based order guidance. Primary outcomes were the proportion of COVID-19 + flu/respiratory syncytial virus (RSV) testing performed on symptomatic, admitted, and discharged patients, and the proportion of COVID-19 + flu testing on symptomatic, discharged patients. A total of 52 215 ED visits were included. For symptomatic, discharged patients, COVID-19 + flu/RSV testing decreased from 11.4 to 5.8 tests per 100 symptomatic visits, and the rate of COVID-19 + flu testing increased from 7.4 to 19.1 before and after the intervention, respectively. The rate of COVID-19 + flu/RSV testing increased from 5.7 to 13.1 tests per 100 symptomatic visits for symptomatic patients admitted to the hospital. All changes were significant (P < 0.0001). A simple EHR order redesign was associated with increased adherence to institutional guidelines for SARS-CoV-2 and influenza testing amidst supply chain limitations necessitating optimal allocation of scarce testing resources. With continually shifting resource availability, clinician education is not sufficient. Rather, system-based interventions embedded within exiting workflows can better align resources and serve testing needs of the community.

UNUSUAL CASE OF ANTI-SYNTHETASE SYNDROME CORRELATED WITH EXPOSURE TO COVID-19 INFECTION OR VACCINE

UNUSUAL CASE OF ANTI-SYNTHETASE SYNDROME CORRELATED WITH EXPOSURE TO COVID-19 INFECTION OR VACCINE

Investigation of Preventive Health Behaviors in the Begining Term of COVID / 19 Pandemic, Evidence From Turkey

Aim: In this study, it is aimed to determine the level of the compliance of individuals to preventive health behaviors before, during, and after the pandemic to interrupt or reduce the spread of the virus in the Covid-19 pandemic.&#x0D; Materials and Method: This study is a descriptive and cross-sectional study. "Demographic Information Form" and "Questionnaire of Health Behaviors Regarding Influenza" were used as data collection tools. The questionnaire form prepared was designed as 16 questions, 5-point Likert type (1 = Strongly disagree to 5 = Strongly agree). The questionnaire contains the answers of the participants regarding the 14 rule implementation situations before, during, and after the flu. The universe of this study was individuals living in 81 provinces in Turkey between 1-9 April 2020. In this study, the snowball-sampling method was used. The data were collected with an online questionnaire on google forms. 517 people were surveyed from 81 cities in Turkey. In the analysis, SPSS 25.0 statistical software was used to evaluate the data.&#x0D; Results: As a result of the evaluation of the Health Behavior Towards Flu test results; the Cronbach Alpha (α) values were found (0.78) before, during (0.86), and after (0.83). When the participant's compliance with the 14 rules in influenza according to demographic variables was examined according to their learning of these rules, it was determined that; gender, literate in terms of education, and housewives made a significant difference in the course (before-during-after) of the pandemic, In addition, the application situations of the participants before-during-after learning the 14 rules in influenza were compared; while the information was effective during (illness) and after (illness) the informing process and was statistically significant (p

Cepheid Xpert Xpress Flu/RSV evaluation performed by minimally trained non-laboratory operators in a CLIA-waived environment

The COVID-19 pandemic highlighted the significance of readily available and easily performed viral testing for surveillance during future infectious pandemics. The objectives of this study were: to assess the performance of the Xpert Xpress Flu and/or RSV test, a multiplex PCR assay for detecting influenza A and B virus and respiratory syncytial virus nucleic acids in respiratory tract specimens, relative to the Quidel Lyra Influenza A+B assay and the Prodesse ProFlu+ assay, and the system's ease of use by minimally trained operators. Overall, the Xpert Xpress Flu/RSV test demonstrated a high positive and negative percent agreement with the comparator assays, and was easy to use and interpret results, based on the operators’ feedback. We concluded that the Xpert Xpress Flu/RSV test is sensitive, specific, and easy to use for the diagnosis of influenza and RSV by minimally trained operators and can be a valuable tool in future infectious clusters or pandemics.

Patient perceptions of acute infectious disease point-of-care tests and treatment within community pharmacy settings

BackgroundCommunity pharmacies are well-positioned to help patients overcome many health care barriers they experience when trying to receive care. Community pharmacists are ready and equipped to provide patient care interventions like the test-and-treat model for acute infectious diseases. ObjectivesThe objective of this study was to determine patients’ experiences with rapid strep and influenza tests administered at community pharmacies, focusing on what impacted patients’ decisions to receive care, their perception of the care received, and if offering these tests in community pharmacies expanded their access to care. MethodsSeven independently owned pharmacies in Tennessee and Kentucky from November 2020 to April 2021 recruited study participants. Qualitative semi-structured key informant interviews were conducted using the theory of planned behavior as a theoretical framework. Participant interviews were audio recorded, transcribed, and independently coded by 2 investigators and reviewed by a third investigator. A qualitative analysis was completed, with a selection of supporting quotations for each theme. Qualitative analysis identified participant perceptions of rapid strep and flu POCT and treatments provided in community pharmacies, consistency and quality of patient care, and if these interventions expanded their access to care. ResultsA total of 11 patients participated in the interviews; of which, 9 (81.8%) participants were female, and participants ages ranged from 22 to 64 years (median, 40 years). Of 11, 7 participants received a strep test, 3 participants received a flu test, and 1 participant received both the tests. The analysis uncovered 10 major themes within the following 4 different categories: (1) convenience to patients, (2) quality of care received, (3) improved access to care, and (4) additional interventions for which patients want expanded access to care. ConclusionPharmacies offering services like rapid strep and flu tests provide convenience and quality care that can help expand patient access to health care and could help provide expanded access for underserved populations.

Study puts influenza to the test, suggesting major practice deficits

A new analysis, published February 2022 in Chest by Deshpande and colleagues, looked at the relationship between how often patients were tested for influenza and their clinical outcomes. The analysis, based on a robust multihospital cohort, focused specifically on community-acquired pneumonia (CAP) patients, underscoring several key findings between flu testing tendencies and their effects on a patients’ mortality and morbidity. The study supports the hypothesis that routine flu testing in CAP patients increases the likelihood of optimal treatment and reduced mortality.

The impact of a rapid home test on telehealth decision-making for influenza: a clinical vignette study

BackgroundHome testing for influenza has the potential to aid triage and management decisions for patients with influenza-like illness. As yet, little is known about the effect of the home influenza testing on clinical decision-making via telehealth. The goal of this study was to determine the clinicians’ decision thresholds for influenza and whether the availability of a home influenza test affects clinical decisions.MethodsWe identified primary care physicians at 4 different sites in the US, largely via in-person continuing education meetings. Clinicians were asked for each vignette whether to treat empirically (“rule in”), ask the patient come to the clinic for further evaluation (“test”), or neither test nor treat (“rule out”). They were then given the results of a home influenza test, and were again asked to select from these three options. We measured the agreement of physician estimates of the likelihood of influenza with the probability based on a clinical prediction model. The test and treatment thresholds of influenza were determined based on mixed-effect logistic regressions.ResultsIn total, 202 clinicians made 570 sets of clinical decisions. Agreement between estimated and actual probability of influenza was fair. The test and treatment thresholds were 24% (95% CI: 22% to 25%) and 63% (95% CI: 58% to 65%) before revealing the actual likelihood of influenza. After providing the results of a home flu test the thresholds were similar, 26% (95% CI: 24% to 29%) and 59% (95% CI: 56% to 62%). However, approximately half of clinicians changed their cliical management decision after being given the home influenza test result, largely by categorizing more patients in the “rule out” and “rule in” groups, and reducing the need for in-person evaluation from 41% of patients to only 20%.ConclusionIn the context of a telehealth visit for a patient with influenza-like illness, we identified a test threshold of approximately 25% and a treatment threshold of approximately 60%. Adding the home influenza test results reduced uncertainty and significantly decreased the need for in-person visits.

The clinical picture of influenza against other respiratory tract infections in a general practitioner practice.

Influenza is an acute infectious disease caused by an RNA virus. In Poland, influenza occurs seasonally during the epidemic period lasting from October to April. The peak of influenza incidence in Poland falls in the first quarter of the year, with a comparable number of cases in January, February and March. Influenza can be severe in some patients, requiring hospitalization, or even fatal, especially in high-risk patients. Analysis of the frequency and course of influenza in primary care patients compared to other respiratory tract infections. The study included a group of 631 adult patients with symptoms of respiratory infection who saw their GP (general practitioner) in the period from December 2018 to April 2020. Patients reporting symptoms of respiratory tract infection were included in the study. Special attention was paid to influenza-like symptoms, i.e. sudden onset fever and ≥ 1 respiratory clinical symptom such as cough, sore throat, rhinitis or feeling of stuffy nose and ≥ 1 systemic symptom such as headache, muscle pain, sweating or chills, fatigue persisting < 72 h. Rapid antigen tests were performed in case of influenza-like symptoms. Influenza was diagnosed in patients with the above symptoms and a positive antigen test. In the study group, 356 rapid flu tests were performed. Age, comorbidities, nicotinism, vaccination status, clinical symptoms, ordered x-rays, laboratory tests, the result of the Actim Influenza A&B rapid antigen test (Medix Biochemica) for influenza virus infection, and the final diagnosis were taken into account. Influenza was diagnosed in 91 patients (in one person on the basis of clinical symptoms, without confirmation with a rapid antigen test), including 50 women and 41 men. The mean age of the patients was 47 years, the age range was 22-89 years. In 90 patients the infection with the influenza virus was confirmed with the Actim Influenza A&B test (Medix Biochemica). One patient was diagnosed with influenza on the basis of typical clinical symptoms, despite a negative antigen test, and prior contact with a person with confirmed influenza. Fever, cough, myalgia, tachypnoea, chest pain and reported respiratory disturbances, confirmed by abnormal results of physical examination, were more frequent in patients with symptoms of influenza and a positive antigen test than in other infections. Influenza was significantly more often observed in patients with impaired glucose tolerance, atherosclerosis, and muscle diseases. Influenza was mainly diagnosed in unvaccinated patients.

INCIDENCE OF INFLUENZA VIRUS PNEUMONIA DURING THE TIME OF CORONOVIRUS-2019 PANDEMIC

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Since the beginning of coronarvirus-2019 pandemic, prevention has been the core measure to mitigate the spread of the virus. Prevention measures included universal masking, frequent hand sanitization, and social distancing are among the measures that proved to be effective. However, these measures are also known to be effective against transmission of influenza virus. We hypothesize that during the times of Covid-19 pandemic, the incidence of influenza pneumonias will also decrease. METHODS: We utilized the Jersey Shore University Medical Center Laboratory database to identify the number of influenza tests sent before and during the pandemic. We extracted the data over the last six months in 2019 to represent the pre-pandemic period and compared them to the data of the last six months in the year of 2020 to represent the during-pandemic period. In addition, we compared the rate of decrease in monthly incidences of Influenza cases between Feb-April 2020 in our hospital (when preventive measures were applied state wide in NJ) to Feb-April of 2017 in the Mid-Atalatnic District (obtained from the Healthcare Cost and Utilization Project National Inpatient Sample 2017) to better elicit the effect of preventive measures as opposed to the natural course. RESULTS: During the last six months of 2019, there was a total of 10,304 flu tests sent inpatient. Of them, 674 tests were positive (6.5%). In comparison, there was a total of 5,406 total tests of influenza A and B sent during the last six months of year 2020; among them, only 1 case was positive (0.02%). Relative risk was 0.003. By examining the Mid-atalantic district trend of monthly incidences of influenza, it appears that influenza cases in all hospitalizations decreased from 2.5% in Feburary 2017 to 1.2% in March 2017 to 0.7% in April 2017 (Monthly decrease of 40-50%); while the incidence in our hospital decreased from 9.6% in Feburary 2020 to 2.7% in March 2020 to 0.7% (Monthly decrease of 70-75%). CONCLUSIONS: The incidence of influenza virus pneumonia has decreased significantly during the time of Covid-19 pandemic, likely due to widely encouraged preventive measures. CLINICAL IMPLICATIONS: Masking, frequent hand sanitization and social distancing proved to be very effective in reducing the incidence of influenza pneumonia. Preventive measures may be adopted in patients with high risk of mortality from influenza pneumonia, even if Covid-19 pandemic resolves. DISCLOSURES: No relevant relationships by Abbas Alshami, source=Web Response No relevant relationships by Steven Douedi, source=Web Response No relevant relationships by Ali Nadhim, source=Web Response No relevant relationships by Swapnil Patel, source=Web Response No relevant relationships by Daniel Shenouda, source=Web Response No relevant relationships by Joseph Varon, source=Web Response

The incidence of influenza in children was decreased in the first flu season after COVID-19 pandemic in Wuhan

Wuhan, China was the first city to discover COVID-19. With the government's macro-control and the active cooperation of the public, the spread of COVID-19 has been effectively controlled. In order to understand the additional impact of these measures on the prevalence of common influenza, we have collected flu test data from the Pediatric Clinic of Zhongnan Hospital of Wuhan University from September to December 2020, and compared them with the same period in 2018 and 2019. It is found that compared with the same period in 2018 and 2019, the rate of children's influenza activity in 2020 has significantly decreased, which indicates that the protective measures against COVID-19 have effectively reduced the level of influenza activity.

Febrile infants without respiratory symptoms or sick contacts: are chest radiographs or RSV/influenza testing indicated?

BackgroundSerious bacterial infection rates in febrile infants < 60 days are about 8–11%. Less than 1% of febrile infants with no respiratory symptoms will have pneumonia however, chest radiography (CXR) rates remain between 30 and 60%. Rapid Respiratory Syncytial Virus (RSV) and influenza (flu) testing is common, however, there is not enough data to determine if febrile infants without any respiratory symptoms should be tested. The goal of this study is to determine the rate of positive CXR and RSV/flu results in febrile infants with no respiratory symptoms and no sick contacts.MethodsWell-appearing febrile infants between 7 and 60 days of age who presented to the pediatric emergency department (PED) from September 1st, 2015 through October 30th, 2017 were enrolled. Demographic data, respiratory symptoms, CXR findings and RSV/flu results were collected. SAS statistical software was used for analysis.Results129 infants met enrollment criteria. Of the 129 infants, 58 (45.0%) had no respiratory symptoms and no sick contacts. Of these 58, 36 (62.1%) received a CXR and none of them had any abnormal findings, 48 (82.8%) had RSV/flu testing, no patients tested positive for RSV and only one patient tested positive for flu. Costs of CXR and RSV/flu testing for this cohort was $19,788.ConclusionThe absence of positive CXRs in this patient population reinforces the current recommendations that CXR is not indicated. The low incidence of RSV/flu indicate that routine testing may not be necessary in this population especially outside of the flu season. Reduced testing could decrease overall costs to the healthcare system as well as radiation exposure to this population.

PHARMACISTS FORGE AHEAD WITH POINT-OF-CARE TESTING, DESPITE BARRIERS

PHARMACISTS FORGE AHEAD WITH POINT-OF-CARE TESTING, DESPITE BARRIERS

Co-infection of COVID-19 and influenza A in a hemodialysis patient: a case report

BackgroundCoronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus that was first discovered in December 2019 in Wuhan, China. With the growing numbers of community spread cases worldwide, the World Health Organization (WHO) declared the COVID-19 outbreak as a pandemic on March 11, 2020. Like influenza viruses, SARS-CoV-2 is thought to be mainly transmitted by droplets and direct contact, and COVID-19 has a similar disease presentation to influenza. Here we present a case of influenza A and COVID-19 co-infection in a 60-year-old man with end-stage renal disease (ESRD) on hemodialysis.Case presentationA 60-year-old man with ESRD on hemodialysis presented for worsening cough, shortness of breath, and diarrhea. The patient first developed a mild fever (37.8 °C) during hemodialysis 3 days prior to presentation and has been experiencing worsening flu-like symptoms, including fever of up to 38.6 °C, non-productive cough, generalized abdominal pain, nausea, vomiting, and liquid green diarrhea. He lives alone at home with no known sick contacts and denies any recent travel or visits to healthcare facilities other than the local dialysis center. Rapid flu test was positive for influenza A. Procalcitonin was elevated at 5.21 ng/mL with a normal white blood cell (WBC) count. Computed tomography (CT) chest demonstrated multifocal areas of consolidation and extensive mediastinal and hilar adenopathy concerning for pneumonia. He was admitted to the biocontainment unit of Nebraska Medicine for concerns of possible COVID-19 and was started on oseltamivir for influenza and vancomycin/cefepime for the probable bacterial cause of his pneumonia and diarrhea. Gastrointestinal (GI) pathogen panel and Clostridioides difficile toxin assay were negative. On the second day of admission, initial nasopharyngeal swab came back positive for SARS-CoV-2 by real-time reverse-transcriptase polymerase chain reaction (RT-PCR). The patient received supportive care and resumed bedside hemodialysis in strict isolation, and eventually fully recovered from COVID-19.ConclusionsWe presented a case of co-infection of influenza and SARS-CoV-2 in a hemodialysis patient. The possibility of SARS-CoV-2 co-infection should not be overlooked even when other viruses including influenza can explain the clinical symptoms, especially in high-risk patients.

Time Trend of Swine Flu at a Tertiary Care Centre of Western Rajasthan: A Decadal Analysis

Background: Swine flu had been established as seasonal influenza, but antigenic variation continues to result in epidemics that necessitate continued surveillance. Present study aims to describe the time trend of swine flu from its initiation in 2009 to 2019 from western zone of Rajasthan.&#x0D; Material and Methods: This secondary analysis of swine flu data from established seasonal disease reporting was conducted at a tertiary care centre of western Rajasthan which was the only swine flu testing centre in this area. Only Lab confirmed cases from this centre were included for month wise distribution.&#x0D; Results: First case from Jodhpur was seen in August 2009. Large peaked outbreaks were seen around every 4 years namely 2009-10, 2014-15, 2018-19 corresponding to the antigenic variation of this virus namely California, Michigan and Brisbane strain respectively. Cases were seen in mostly in winters with peak in December/January. Mortality rate among these lab confirmed cases varied from 0–22% in different outbreaks.&#x0D; Conclusion: Continued laboratory surveillance is necessary to identify the time pattern of outbreaks and for early identification of emergence of new strain to ensure early and timely preparedness for impending epidemics.

470. The Effects of Arrival Quarantine on Subsequent COVID-19 Testing in a Cohort of Military Basic Trainees

BackgroundThe COVID-19 pandemic has been associated with significant spread in congregate settings and various forms of non-pharmaceutical interventions (NPI) have been implemented to prevent spread. Basic Military Training at Joint Base-San Antonio is the entrance to the US Air Force and has been associated with respiratory outbreaks in the past. A two-week arrival quarantine was implemented in March 2020. Effects on subsequent testing for COVID-19 after an arrival quarantine is unknown.MethodsThe first four weekly cohorts of trainees who underwent an arrival quarantine between March 16-April 13 were monitored during their 7 week training for COVID-19 symptoms. Symptoms, medical testing, and days removed from training were collected on every patient with possible COVID-19 symptoms including cough, shortness of breath, or fever. Testing during the two-week arrival quarantine were compared to the subsequent five weeks of training. Nominal variables were compared by chi squared or Fisher’s exact test as appropriate. Continuous variables were compared by Mann-Whitney U Test.ResultsA total of 2,573 started training during study period, 89 (3.4%) had symptoms concerning for COVID-19 and were tested. 5 (6%) patients tested positive, all of whom in the arrival quarantine. Compared to patients who completed quarantine (n=29), patients in the arrival quarantine who tested negative for COVID-19 (n=54) were tested more often (26 trainees a week vs. 5.8 later in training, p=< 0.0001), and received more rapid flu tests (74% vs. 38%, p=0.001) and multiplex respiratory PCR (15% vs. 0%, p=0.05). Trainees in quarantine were isolated longer for symptoms than patients who completed quarantine (median 3 vs. 2, p=0.01). There was no difference in presenting symptoms for trainees in quarantine or after quarantine.ConclusionArrival quarantine appears to be an effective NPI, which in conjunction with other interventions prevented any COVID-19 transmission after quarantine completion. For those who went through arrival quarantine, there was more intense initial testing and initial longer symptomatic patient isolation, this was balanced by fewer symptomatic patients, less testing, and shorter isolations later in training.Disclosures All Authors: No reported disclosures

49. Clinical Utility of Oseltamivir Restriction Policy

BackgroundInappropriate use of oseltamivir and antibiotics for upper respiratory tract infections may increase risk of microbial resistance. Restriction policies have been used to curtail inappropriate use of oseltamivir and antimicrobials in suspected or confirmed influenza patients. We assessed the impact of Infectious Diseases (ID) consult on the management of oseltamivir and concomitant antibiotics.MethodsA single‐center, retrospective study of patients ≥ 17 years, admitted for greater than 24 hours who received oseltamivir from October 1, 2018 to May 1, 2019 were evaluated. Demographics, Charlson Weighted Index of Comorbidity (CWIC), length of hospital stay (LOS), discharge disposition, rapid flu test, respiratory viral panel, sputum and blood cultures, antibiotic regimen and duration were collected. Continuous variables were analyzed using Students t‐test and categorical variables with Chi square test.Results298 patients were screened and 182 patients met the inclusion criteria. Please see table below for results. Oseltamivir was appropriately continued in 92.9% in the ID consult group compared to 89.3% in the non-ID consult group (p = 0.51). Antibiotic interventions were appropriate in 63.2% of the ID consult group compared to 40% in non-ID group (p = 0.36).Results Summary ConclusionOseltamivir interventions were appropriate and similar in between groups. Further, there was higher percentage of appropriate antibiotic interventions in the ID physician group. Duration of antibiotics was longer in the ID physicians consulted group which may be due to higher severity of illness in the group.Disclosures All Authors: No reported disclosures