Nasopharyngeal RT-PCR Research Articles

Measurement of Severe Acute Respiratory Syndrome Coronavirus 2 Antigens in Plasma of Pediatric Patients With Acute Coronavirus Disease 2019 or Multisystem Inflammatory Syndrome in Children Using an Ultrasensitive and Quantitative Immunoassay.

BackgroundDetection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigens in blood has high sensitivity in adults with acute coronavirus disease 2019 (COVID-19), but sensitivity in pediatric patients is unclear. Recent data suggest that persistent SARS-CoV-2 spike antigenemia may contribute to multisystem inflammatory syndrome in children (MIS-C). We quantified SARS-CoV-2 nucleocapsid (N) and spike (S) antigens in blood of pediatric patients with either acute COVID-19 or MIS-C using ultrasensitive immunoassays (Meso Scale Discovery).MethodsPlasma was collected from inpatients (<21 years) enrolled across 15 hospitals in 15 US states. Acute COVID-19 patients (n = 36) had a range of disease severity and positive nasopharyngeal SARS-CoV-2 RT-PCR within 24 hours of blood collection. Patients with MIS-C (n = 53) met CDC criteria and tested positive for SARS-CoV-2 (RT-PCR or serology). Controls were patients pre–COVID-19 (n = 67) or within 24 hours of negative RT-PCR (n = 43).ResultsSpecificities of N and S assays were 95–97% and 100%, respectively. In acute COVID-19 patients, N/S plasma assays had 89%/64% sensitivity; sensitivities in patients with concurrent nasopharyngeal swab cycle threshold (Ct) ≤35 were 93%/63%. Antigen concentrations ranged from 1.28–3844 pg/mL (N) and 1.65–1071 pg/mL (S) and correlated with disease severity. In MIS-C, antigens were detected in 3/53 (5.7%) samples (3 N-positive: 1.7, 1.9, 121.1 pg/mL; 1 S-positive: 2.3 pg/mL); the patient with highest N had positive nasopharyngeal RT-PCR (Ct 22.3) concurrent with blood draw.ConclusionsUltrasensitive blood SARS-CoV-2 antigen measurement has high diagnostic yield in children with acute COVID-19. Antigens were undetectable in most MIS-C patients, suggesting that persistent antigenemia is not a common contributor to MIS-C pathogenesis.

Performance of Rapid Antibody Test and RT-PCR as Frontline Test for COVID-19 Diagnosis in Pregnancy: an Experience in Indonesia

Ensuring an accurate diagnosis is critical for limiting the spread of SARS-CoV-2 and for the clinical management of COVID-19, especially in pregnant women. For now real-time reverse transcription polymerase chain reaction (RT-qPCR) is the currently recommended laboratory method for the diagnosis of acute SARS-CoV-2 infection. More recently, several easy-to-perform rapid antigen detection tests have been developed and are recommended as first-line screening test in several countries. The purpose of this study was to evaluate the comparative performance of a rapid antibody test and RT-PCR for the detection of SARS-CoV-2 infection, as a front-line test for the diagnosis of COVID-19 in pregnancy. This research method is a descriptive study to describe comparation of sensitivity and specificity between rapid SARS-CoV-2 antibody test to the gold standard nasopharyngeal RT-PCR swab test. Of the 271 samples, only 257 were eligible and fourteen cases were excluded from the study due to a lack of rapid antibody test and RT-PCR results. The results of this study showed that the rapid SARS-CoV-2 antibody test sensitivity was 80.95%, and the specificity was 90.68%, the NPV (negative predictive value) and the PPV (positive prognosis value) were 98.17% and 43.59%, respectively. Based only on the results of IgM and IgG, IgM and IgG sensitivity were 33.33% (7/21) and 71.43% (15/21), respectively, and the specificity was 91.1% (215/236, 21 false positive) and 91.53% (216/236, 20 false positive), respectively. The use of rapid antibody tests during pregnancy is a screening tool and is not currently applicable for diagnostic tool. To minimize false positives and negatives results, the use of rapid antibody tests should be combined with the RT-PCR test results.

Performance of Rapid Antibody Test and RT-PCR as Frontline Test for COVID-19 Diagnosis in Pregnancy: an Experience in Indonesia

Ensuring an accurate diagnosis is critical for limiting the spread of SARS-CoV-2 and for the clinical management of COVID-19, especially in pregnant women. For now real-time reverse transcription polymerase chain reaction (RT-qPCR) is the currently recommended laboratory method for the diagnosis of acute SARS-CoV-2 infection. More recently, several easy-to-perform rapid antigen detection tests have been developed and are recommended as first-line screening test in several countries. The purpose of this study was to evaluate the comparative performance of a rapid antibody test and RT-PCR for the detection of SARS-CoV-2 infection, as a front-line test for the diagnosis of COVID-19 in pregnancy. This research method is a descriptive study to describe comparation of sensitivity and specificity between rapid SARS-CoV-2 antibody test to the gold standard nasopharyngeal RT-PCR swab test. Of the 271 samples, only 257 were eligible and fourteen cases were excluded from the study due to a lack of rapid antibody test and RT-PCR results. The results of this study showed that the rapid SARS-CoV-2 antibody test sensitivity was 80.95%, and the specificity was 90.68%, the NPV (negative predictive value) and the PPV (positive prognosis value) were 98.17% and 43.59%, respectively. Based only on the results of IgM and IgG, IgM and IgG sensitivity were 33.33% (7/21) and 71.43% (15/21), respectively, and the specificity was 91.1% (215/236, 21 false positive) and 91.53% (216/236, 20 false positive), respectively. The use of rapid antibody tests during pregnancy is a screening tool and is not currently applicable for diagnostic tool. To minimize false positives and negatives results, the use of rapid antibody tests should be combined with the RT-PCR test results.

Long COVID-19 symptoms: Clinical characteristics and recovery rate among non-severe outpatients over a six-month follow-up

BackgroundTo describe persistent symptoms in long COVID-19 non-severe outpatients and report the 6-month clinical recovery (CR) rate. MethodsObservational study enrolling outpatients (≥ 18 years) with confirmed non-severe COVID-19 (positive nasopharyngeal RT-PCR or presence of SARS-CoV-2 antibodies) who consulted for persistent symptoms after the first pandemic wave (March-May 2020). CR was assessed at the 6-month visit and defined as complete (no symptom), partial (persistent symptoms of lower intensity) or lack of recovery (no improvement). ResultsSixty-three patients (79% women, mean age: 48 years) enrolled; main symptoms (mean 81 days after acute infection): asthenia/myalgia (77%), dyspnea (51%), headaches (35%), cough (33%). At 6 months (n=56), 30% had complete, 57% partial, and 13% lack of recovery. The proportion of patients with>2 persistent symptoms was 26% at 6 months (main symptoms: dyspnea [54%] and asthenia/myalgia [46%]). ConclusionWe observed a slow but high recovery rate at 6 months among these outpatients.

Medium-Term Outcomes of COVID-19 Infection After Kidney Transplantation for Ongoing Living and Deceased Kidney Transplantations within the COVID-19 Pandemic.

To present the early to midterm experience of two referral kidney transplantation centers with living and deceased kidney transplantations that were performed within the COVID-19 pandemic. All cases performed in two referral centers in Iran within the COVID-19 pandemic were investigated. Transplantations were performed from May 2020 to February 2021. The protocol for screening included nasopharyngeal RT-PCR with chest CT scan for living and deceased transplantations in center A and RTPCR for living transplantations and chest CT scan for deceased transplantations in center B. Patients were followed for 14-26 months after transplantation regarding COVID-19 infection and its outcomes in case of infection. 103 kidney transplantations were performed during the study period including 54 (52.4%) living and 49 (47.6%) deceased kidney transplantations. Twenty-four recipients (23.3%) and a living donor (1%) were infected with COVID-19. The severity of COVID-19 infection was mild, moderate, severe, and critical in 16 (66.6%), 4 (16.6%), 2 (8.4%), and 2 patients (8.4%), respectively. Two mortalities were observed within transplantation recipients with COVID-19 infection (1.9%). 87.5% (7/8) COVID-19 infections in center B were observed in recipients of deceased transplantations who were screened only by chest CT scan. The results of this study indicate a low frequency of COVID-19 mortality (1.9% for the whole cohort and 8.3% within COVID-19 infected patients) for recipients of living and deceased kidney transplantation that were performed within the COVID-19 pandemic. The above findings highlight for the first time in a large study the probability of living kidney transplantation during the COVID-19 pandemic in case strict screening of donors and recipients and close supervision of operating rooms and wards are implemented. We further hypothesize the inadequacy of chest CT scan for screening of COVID-19 in kidney transplantation surgery candidates.

The utility of remdesivir in SARS-CoV-2: A single tertiary care center experience from a developing country

BackgroundRemdesivir is a monophosphoramidate prodrug of an adenosine analog, and it has a broad-spectrum antiviral activity against paramyxoviruses, flaviviruses, and coronaviruses. Remdesivir is associated with decreased hospital stay and improved outcomes in coronavirus- disease 2019 (COVID-19). MethodologyOf 846 suspected COVID-19 patients admitted to the hospital, 612 SARS-CoV-2 nasopharyngeal RT-PCR positive patients were evaluated for enrollment in this prospective cohort study. 159 RT-PCR positive patients were given remdesivir. Their clinical, biochemical parameters, hospital stay, and outcomes related to morbidity and mortality were followed. ResultsOut of the 159 patients, 141 recovered after remdesivir use. The Chi-square test for independence examined the relation between the day of the first dose, dose of remdesivir, and clinical outcome. The standardized case fatality ratio (CFR) in the 453 hospitalized patients who did not receive remdesivir was 32.89% (N = 149) as compared to 11.32% (N = 18) in the patients who received remdesivir. These findings are in keeping with the therapeutic value of remdesivir in symptomatic SARS-CoV-2 infection of varying severity. ConclusionThe use of remdesivir is associated with a decrease in the severity of the SARS-CoV-2 infection. Its use is also associated with a decreased length of hospital stay and lower mortality than the patients who did not receive remdesivir.

Decompensated Neuro-Behçet’s Disease Following Covid-19 Infection

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) emerged in December 2019. Beside respiratory insufficiency, neurological complications have been observed with COVID-19. Here, we report a case of meningo-encephalitis following Covid-19 infection who decompensated a Neuro-Behçet’s disease. Case Presentation: A 45-year-old-man which is followed for Neuro-Behçet disease, hospitalized in the intensive care unit for altered state of consciousness. Brain magnetic resonance imaging (MRI) revealed a hyperintense area adjacent to right occipital horn. Cerebrospinal fluid (CSF) analysis revealed a meningitis with polymorphonuclear (PMN) cell predominance. The nasopharyngeal RTPCR was positive for SARS-CoV-2. The patient was treated with therapeutic anticoagulation, aciclovir and methylprednisolone sodium succinate and made a complete recovery. Conclusion: Our study identified a considerable burden of COVID-19 in patients with chronic neurological disorders.

Diagnostic accuracy of a SARS-CoV-2 rapid test and optimal time for seropositivity according to the onset of symptoms.

Point-of-care serological tests for SARS-CoV-2 have been used for COVID-19 diagnosis. However, their accuracy over time regarding the onset of symptoms is not fully understood. We aimed to assess the accuracy of a point-of-care lateral flow immunoassay (LFI). Subjects, aged over 18 years, presenting clinical symptoms suggestive of acute SARS-CoV-2 infection were tested once by both nasopharyngeal and oropharyngeal RT-PCR and LFI. The accuracy of LFI was assessed in periodic intervals of three days in relation to the onset of symptoms. The optimal cut-off point was defined as the number of days required to achieve the best sensitivity and specificity. This cut-off point was also used to compare LFI accuracy according to participants' status: outpatient or hospitalized. In total, 959 patients were included, 379 (39.52%) tested positive for SARS-CoV-2 with RT-PCR, and 272 (28.36%) tested positive with LFI. LFI best performance was achieved after 10 days of the onset of symptoms, with sensitivity and specificity of 84.9% (95%CI: 79.8-89.1) and 94.4% (95%CI: 91.0-96.8), respectively. Although the specificity was similar (94.6% vs. 88.9%, p = 0.051), the sensitivity was higher in hospitalized patients than in outpatients (91.7% vs. 82.1%, p = 0.032) after 10 days of the onset of symptoms. Best sensitivity of point-of-care LFI was found 10 days after the onset of symptoms which may limit its use in acute care. Specificity remained high regardless of the number of days since the onset of symptoms.

Risk Factors Associated with Prolonged Nasopharyngeal Carriage of SARS-CoV-2 and Length of Stay among Patients Admitted to a COVID-19 Referral Center in Manila, Philippines.

Prolonged nasopharyngeal carriage of SARS-CoV-2 has been linked to prolonged hospital stay and delayed radiologic recovery. To determine if clinical risk factors are associated with prolonged nasopharyngeal carriage or longer hospital stay, we performed a descriptive analysis of 169 moderate to severe COVID-19 patients admitted at the Philippine General Hospital from March to June 2020. Length of nasopharyngeal RT-PCR positivity and clinical demographic data were extracted from existing patient records. Chi-square test, Mann-Whitney U test, and regression analysis were performed to describe the association of clinical risk factors with prolonged nasopharyngeal carriage and length of hospital stay. The median duration of carriage was 19 days (IQR 12.0-30.0 days). No comorbidities or inflammatory markers had a statistically significant association with prolonged nasopharyngeal carriage defined as >24 days of nasopharyngeal RT-PCR positivity. Characteristics associated with a statistically significant longer hospital stay included chronic kidney disease stages 3-5, severe disease, and use of empiric antibiotics on admission. Prolonged carriage >24 days, hsCRP, and D-dimer at admission, also had a statistically significant but weak correlation with length of stay. Among patients with moderate disease, comorbidities and inflammatory markers were not associated with prolonged COVID-19 nasopharyngeal carriage. Prolonged nasopharyngeal carriage >24 days was associated with longer hospital stay, while D-dimer and hsCRP levels at admission, also had statistically significant but small effects on increasing the hospital length of stay.

Cardiac rehabilitation in COVID-19 pandemic period

BackgroundCOVID-19 pandemic constitutes a challenge in cardiovascular disease management. Little is known about COVID-19 prevalence and incidence in cardiac rehabilitation (CR) programs.AimTo evaluate the prevalence and incidence of COVID-19 in patients undergoing CR in ambulatory setting.MethodsFrom august to October 2020, all patients admitted in a single ambulatory CR program were screened for COVID-19 infection before and after CR, through naso-pharyngeal RT-PCR and serology assays before and after the CR. Number of patients was reduced from 9 to 4 in each group, 2 meters distancing respected, and all patients and staff had to wear surgical mask during sessions. Hand washing and material disinfection were systematic before and after each session for both patients and health professionals.ResultsAmong the 81 patients included, 63 (76%) were male, mean age was 57 ± 11 years (Table 1). None (0%) had positive RT-PCR before entering CR and only 2 (2.7%) were tested positive after CR. These two patients were asymptomatic. After serological analysis, 3 patients (3.8%) had anti-bodies against SARS-COV-2 before and after participating CR (Fig. 1). These 3 patients were negative on nasal swab before and after CR. No seroconversion was observed. In total (before and after CR), 5 patients (6.0%) were tested positive with COVID-19. Those 5 patients were younger (mean age 51 years old versus 58, P = 0.02), with better functional capacity before and after CR: respectively 7.1 METs (versus 5.2 METs, P = 0.01) and 8.3 METs (versus 6.3 METs, P = 0.03). In COVID+ patients, improvement of functional capacity was similar to COVID–patients: respectively 0.8 METs (P = 0.9) and 15 Watts (P = 0.9).ConclusionCR is not associated with risk of infection with SARS-COV-2, provided that basic sanitary measures are stricly applied. It is also associated with functional capacity improvement, even in patients who previously had COVID-19.

Resuming post living donor liver transplantation in the COVID-19 pandemic: real-life experience, single-center experience

BackgroundSolid organ transplantation (SOT) service has been disrupted during the current coronavirus disease 2019 (COVID-19) pandemic, which deferred the service in most centers worldwide. As the pandemic persists, there will be an urgency to identify the best and safest practices for resuming activities as areas re-open. Resuming activity is a difficult issue, in particular, the decision of reopening after a period of slowing down or complete cessation of activities.ObjectivesTo share our experience in resuming living donor liver transplantation (LDLT) in the context of the COVID-19 pandemic in the Liver Transplantation Unit of El-Manial Specialized Hospital, Cairo University, Egypt, and to review the obstacles that we have faced.Material and methodsThis study is a single-center study. We resumed LDLT by the 26th of August 2020 after a period of closure from the 1st of March 2020. We have taken a lot of steps in order to prevent COVID-19 transmission among transplant patients and healthcare workers (HCWs).ResultsIn our study, we reported three LDLT recipients, once resuming the transplantation till now. All our recipients and donors tested negative for SARS-CoV-2 by nasopharyngeal RT-PCR a day before the transplantation. Unfortunately, one of them developed COVID-19 infection. We managed rapidly to isolate him in a single room, restricting one team of HCWs to deal with him with strict personal protective measures. Finally, the patient improved and was discharged in a good condition. The second patient ran a smooth course apart from FK neurotoxicity which improved with proper management. The third patient experienced a sharp rise in bilirubin and transaminases on day 14 that was attributed to drug toxicity vs. rejection and managed by discontinuing the offending drugs and pulse steroids. In addition, one of our head nurses tested positive for SARS-CoV-2 that was manageable with self-isolation.ConclusionCareful patient, donor, personnel screening is mandatory. Adequate supply of personal protective equipments, effective infection control policies, and appropriate administrative modifications are needed for a safe return of LDLT practice.

Frequent Placental SARS-CoV-2 in Patients with COVID-19-Associated Hypertensive Disorders of Pregnancy

Introduction: Studies described an increased frequency of hypertensive disorders of pregnancy (HDP) after a COVID-19 episode. There is limited evidence about SARS-CoV-2 viral load in placenta. This study aimed to investigate the relationship between SARS-CoV-2 viral load in the placenta and clinical development of HDP after COVID-19 throughout different periods of gestation. Methods: This is a case-control study in women with and without gestational hypertensive disorders after SARS-CoV-2 infection diagnosed by RT-PCR during pregnancy. Patients were matched by gestational age at the moment of COVID-19 diagnosis. We performed an analysis of SARS-CoV-2 RNA levels in placenta. Results: A total of 28 women were enrolled. Sixteen patients were diagnosed with COVID-19 during the third trimester and the remaining 12 patients in the other trimesters. Ten placentas (35.7%) were positive for SARS-CoV-2, 9 of them (9/14, 64.3%) belonged to the HDP group versus 1 (1/14, 7.2%) in the control group (p = 0.009). Those cases with the highest loads of viral RNA developed severe preeclampsia (PE). Conclusion: Among women diagnosed with COVID-19 during pregnancy, the presence of SARS-CoV-2 in the placenta was more frequent among women suffering from PE or gestational hypertension. Furthermore, the most severe cases of HDP were associated with high placental viral load, not necessarily associated with a positive nasopharyngeal RT-PCR at delivery. Our data suggest that SARS-CoV-2 infection during pregnancy could trigger gestational hypertensive disorders through persistent placental infection and resulting placental damage.

COVID-19 pneumonia: Relationship between initial chest X-rays and laboratory findings

ObjectiveTo analyze the initial findings in chest X-rays of patients with RT-PCR positive for SARS-CoV-2, and to determine whether there is a relationship between the severity of these findings and the clinical and laboratory findings. Materials and methodsThis retrospective study analyzed the relationship between initial chest X-rays and initial laboratory tests in symptomatic adults with nasopharyngeal RT-PCR results positive for SARS-CoV-2 seen at our center between February 29 and March 23, 2020. Among other radiologic findings, we analyzed ground-glass opacities, consolidations, linear opacities, and pleural effusion. We also used a scale of radiologic severity to assess the distribution and extent of these findings. Among initial laboratory findings, we analyzed leukocytes, lymphocytes, platelets, neutrophil-to-lymphocyte ratio, and C-reactive protein. ResultsOf 761 symptomatic patients, 639 (84%) required hospitalization and 122 were discharged to their homes. The need for admission increased with increasing scores on the scale of radiologic severity. The extent of initial lung involvement was significantly associated with the laboratory parameters analyzed (P<.05 for platelets, P<.01 for lymphocytes, and P<.001 for the remaining parameters), as well as with the time from the onset of symptoms (P<.001). ConclusionIt can be useful to use a scale of radiologic severity to classify chest X-ray findings in diagnosing patients with COVID-19, because the greater the radiologic severity, the greater the need for hospitalization and the greater the alteration in laboratory parameters.

Evaluation of a saliva molecular point of care for the detection of SARS-CoV-2 in ambulatory care

Rapid identification of SARS-CoV-2-infected individuals is a cornerstone for the control of virus spread. The sensitivity of SARS-CoV-2 RNA detection by RT-PCR is similar in saliva and nasopharyngeal swabs. Rapid molecular point-of-care tests in saliva could facilitate, broaden and speed up the diagnosis. We conducted a prospective study in two community COVID-19 screening centers to evaluate the performances of a CE-marked RT-LAMP assay (EasyCoV) designed for the detection of SARS-CoV2 RNA from fresh saliva samples, compared to nasopharyngeal RT-PCR, to saliva RT-PCR and to nasopharyngeal antigen testing. Overall, 117 of the 1718 participants (7%) tested positive with nasopharyngeal RT-PCR. Compared to nasopharyngeal RT-PCR, the sensitivity and specificity of the RT-LAMP assay in saliva were 34% and 97%, respectively. The Ct values of nasopharyngeal RT-PCR were significantly lower in the 40 true positive subjects with saliva RT-LAMP (Ct 25.9) than in the 48 false negative subjects with saliva RT-LAMP (Ct 28.4) (p = 0.028). Considering six alternate criteria for reference tests, including saliva RT-PCR and nasopharyngeal antigen, the sensitivity of saliva RT-LAMP ranged between 27 and 44%. The detection of SARS-CoV-2 in crude saliva samples with an RT-LAMP assay had a lower sensitivity than nasopharyngeal RT-PCR, saliva RT-PCR and nasopharyngeal antigen testing.Registration number: NCT04578509.

Machine learning and COVID-19: a tool for healthcare setting choice by primary care physicians

BackgroundPrimary care physicians have a crucial role in determining the appropriate healthcare setting for their confirmed or suspect COVID-19 patients. Machine learning provides science-based tools that can be used for clinical decision-making which have already been applied to the fight against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) both in the therapeutic and the prevention area. The aim of this study was to develop a machine learning-based tool to support primary care physicians to decide between home monitoring and hospitalization for their patients before diagnostic test results are available.MethodsA retrospective cohort study with data from a hospital setting was performed. Patients' medical history and clinical, laboratory and radiological findings were collected and the dataset was used to train a predictive model for COVID-19 severity. The patients were divided between confirmed and suspect cases on the basis of the positivity of the nasopharyngeal RT-PCR test results. A splitting algorithm was recursively used to choose the predictor. A decision tree was built.ResultsA total of 198 subjects were enrolled for the study. Out of them, 28 cases were classified as mild disease, 62 as moderate disease, 64 as severe disease, and 44 as critical disease, according to WHO guidelines. The G2 value was used to determine the contribution of each obtained value to build the decision tree. The tree was, therefore, built choosing values that maximized G2 and LogWorth. SpO2 (cut point = 92%) was chosen for the optimal first split. The correspondence between inputs and outcomes was validated.ConclusionsOur tool provides accurate clinical severity prediction for both confirmed and suspect COVID-19 patients. We, therefore, propose its implementation in the everyday life challenges of primary care physicians to support their clinical decision-making in providing appropriate and timely care for their patients.Key messages Primary care physicians have a crucial role in determining the appropriate healthcare setting for their confirmed or suspect COVID-19 patients.We propose a tool that provides an accurate clinical severity prediction for both confirmed and suspect COVID-19 patients to help choosing the appropriate healthcare setting for them.

OC15.03: Differential nasopharyngeal microbiota profile of pregnant women with and without SARS‐CoV‐2 infection

Nasopharyngeal microbiota has been implicated with respiratory infections; however, no previous evidence is reported during SARS-CoV-2 in pregnancy. The aim of this study was to characterise the nasopharyngeal microbiota in pregnant women with and without SARS-CoV-2 infection. Pregnant women from a multicentre prospective population-based cohort (March-June 2020 in Barcelona, Spain) in which the status of SARS-CoV-2 infection was known by a nasopharyngeal RT-PCR and antibodies in peripheral blood. DNA was extracted from nasopharyngeal swab samples, and the V3-V4 region of the 16S rRNA of bacteria was amplified using regions' specific primers. Differential abundance of taxa was tested, alpha and beta diversity were evaluated. Among 76 women, 38 were classified as positive and 38 for as negative for SARS-CoV-2 infection. All positive women were diagnosed by antibodies and 14 (37%) had also a positive RT-PCR. SARS-CoV-2 infection altered the overall composition of the nasopharyngeal microbiota (F=1.36, p = 0.001) with higher relative abundance of Tenericutes and Bacteroidetes phylum, as well as higher abundance of Prevotellaceae family. Infected women presented a different pattern of microbiota profiling due to beta diversity, and higher richness (Observed ASV<0.001) and evenness (Shannon index <0.001) at alpha diversity. These changes persisted after the acute infection revealed by a negative RT-PCR but positive antibodies, suggesting a long-lasting effect of SARS-CoV-2 in the nasopharyngeal microbiota. No significant differences were reported in mild vs. severe cases, suggesting a role of the SARS-CoV-2 infection itself but not on its severity. This is the first study on nasopharyngeal microbiota during pregnancy. SARS-CoV-2 infection altered the overall structure and diversity of the nasopharyngeal microbiota profiling and this effect seems to persist after the acute moment of the infection.

Is the Presence of a Typical Triad of COVID-19 Symptoms (Cough, Dyspnea, and Fever) Enough to Make a Decision About Diagnostic Testing? From the Perspective of an Emergency Department

Objective: The aim of this study is to show the consistence between the recommended guidelines regarding the triad of symptoms—cough, dyspnea, and fever—and the diagnosis of COVID-19. Methods: A prospective observational study conducted at a tertiary emergency department between April 2, 2020 and May 15, 2020 in Turkey. Detailed patient history, main presenting complaints and imaging findings were recorded. For COVID-19 confirmation, nasopharyngeal RT-PCR was used. The relationship between complaints and COVID-19 test results were analyzed. Results: Of the 1226, suspected COVID-19 patients, 127 were positive, 471 were negative, and 628 were discharged without any tests. The most common presenting complaints of the COVID-19 positive patients were throat pain (25.2%), dyspnea (15%), cough (22%), malaise and fatigue (11.8%), and fever (8.7%). There was no statistically significant difference between the positive and negative test groups as they had fever (χ2, p = 0.30), cough (χ2, p = 0.67) and dyspnea (χ2, p = 0.14). Conclusion: Considering that it is difficult to diagnose COVID-19 in emergency settings, testing decision and diagnosis should not depend only on classical symptoms;otherwise, patients with atypical and rare symptoms may be missed. Instead, patient history, clinical status, and radiological findings should be considered together.

VP31.14: Impact of COVID‐19 infection on pregnancy outcome: a population‐based study

To describe the impact of COVID-19 infection throughout gestation on pregnancy outcomes in a population-based study. A multicentric, prospective population-based study including pregnant women consecutively attended at first/second trimester or at delivery at three University hospitals in Barcelona, Spain, (March-June 2020). COVID-19 infection status was known by antibodies (IgG and IgM/IgA) measured in all participants and nasopharyngeal RT-PCR performed at delivery. The primary outcome was a composite score of pregnancy complications including miscarriage, pre-eclampsia, preterm delivery, perinatal death, and/or small-for-gestational age (SGA). Secondary outcomes were individual components of the primary outcome plus labour induction and Caesarean section. Outcomes were compared between COVID-19 positive vs. negative women, and also between positive symptomatic vs. positive asymptomatic women. Of 2,225 pregnant women, 317 (14.2%) were positive for COVID-19 antibodies (n = 314, 99.1%) and/or RT-PCR (n = 36, 11.4%). The primary outcome was similar in COVID-19 positive (20.8%) vs. negative (20%) women (p = 0.74). There were no differences between positive and negative women in the rate of miscarriage (1.4% vs 2.3%), pre-eclampsia (5.4% vs 3.8%), perinatal death (0.9% vs 0.6%), SGA (12.9% vs 12.8%), induction of labour (31.5% vs 32.1%) and Caesarean section (27.1% vs 24.6%); however, the rate of preterm delivery increased in infected women (9.1% vs 5.8%, p = 0.03), particularly for late-onset preterm birth (34-37wks) (6.6% vs 3.5%, p = 0.01). This risk increased even more considering women with symptomatic COVID-19, compared to non-infected (14% vs 5.8%, p < 0.001), and positive asymptomatic women (14% vs 6.9%, p = 0.02). This large population-based study of COVID-19 during pregnancy was able to capture a real picture of the infection throughout gestation. COVID-19 did not increase the risk of perinatal complications, with the exception of preterm delivery, particularly for symptomatic COVID-19 cases.

OP03.02: Clinical spectrum of COVID‐19 infection throughout gestation

To describe the clinical presentation of COVID-19 infection throughout gestation in a population-based study. A multicentric, prospective population-based study including pregnant women consecutively attended at first/second trimester or at delivery at three University hospitals in Barcelona, Spain (March-June 2020). COVID-19 infection status was known by antibodies (IgG and IgM/IgA) measured in all participants and nasopharyngeal RT-PCR performed at delivery. In all participants, COVID-19 symptoms between mid-February 2020 and the time of testing for COVID-19 were recorded using a structured questionnaire. Of 2,225 pregnant women, 317 (14.2%) were positive for COVID-19 antibodies (n = 314, 99.1%) and/or RT-PCR (n = 36, 11.4%). The prevalence of the infection was similar between early (15.3%, 141/921) and late (13.5%, 176/1,304) pregnancy, whereas the clinical presentation was different. Women in the first/second trimester were mostly asymptomatic, compared to third trimester women (79% vs. 60%, p < 0.001), and the most frequent symptoms were loss of taste/smell (11%), fever (10%), dry cough (9%), and myalgia (6%); none of them were hospitalised for COVID-19. On the contrary, symptomatic women in late pregnancy presented a higher rate of dry cough (21%), fever (18%), and dyspnea (13%), and 15 (9%) required hospitalisation for COVID-19; 7 had a pneumonia (4%), of which 3 required intensive care unit admission, although mechanical ventilation was just needed for one of them. All women were discharged well and no maternal deaths were reported. This large population-based study based was able to capture a real picture of COVID-19 infection throughout gestation. The majority of infections were asymptomatic or mild, and the small proportion of severe cases were close to delivery.

Neutralization antibody titers against SARS-CoV-2 in an infant born to a mother with COVID-19

Neutralization antibody titers against SARS-CoV-2 in an infant born to a mother with COVID-19