Reverse Transcription-polymerase Chain Reaction Test Results Research Articles

COVID-19 diagnosis using clinical markers and multiple explainable artificial intelligence approaches: A case study from Ecuador

The COVID-19 pandemic erupted at the beginning of 2020 and proved fatal, causing many casualties worldwide. Immediate and precise screening of affected patients is critical for disease control. COVID-19 is often confused with various other respiratory disorders since the symptoms are similar. As of today, the reverse transcription-polymerase chain reaction (RT-PCR) test is utilized for diagnosing COVID-19. However, this approach is sometimes prone to producing erroneous and false negative results. Hence, finding a reliable diagnostic method that can validate the RT-PCR test results is crucial. Artificial intelligence (AI) and machine learning (ML) applications in COVID-19 diagnosis has proven to be beneficial. Hence, clinical markers have been utilized for COVID-19 diagnosis with the help of several classifiers in this study. Further, five different explainable artificial intelligence techniques have been utilized to interpret the predictions. Among all the algorithms, the k-nearest neighbor obtained the best performance with an accuracy, precision, recall and f1-score of 84%, 85%, 84% and 84%. According to this study, the combination of clinical markers such as eosinophils, lymphocytes, red blood cells and leukocytes was significant in differentiating COVID-19. The classifiers can be utilized synchronously with the standard RT-PCR procedure making diagnosis more reliable and efficient.

Udayana COVID-19 Scoring System: a simple diagnosing aid for early detection of COVID-19

Coronavirus Disease-19 (COVID-19) is a highly transmittable disease. While the most common symptoms of COVID-19 include fever, cough, and fatigue, severe symptoms could feature acute respiratory distress syndrome and severe pneumonia. Reverse-transcription polymerase chain reaction (RT-PCR) remains the gold standard for diagnosing COVID-19. Unfortunately, it has high cost, extensive waiting time, and low availability in remote areas. Therefore, we developed the Udayana COVID-19 Scoring System (UCSS) for quick detection of COVID-19. This study aims to determine the cutoff score and measure the sensitivity and specificity of the UCSS. We conducted an observational cross-sectional study from June 2020 to July 2020. A questionnaire consisting of 3 objective and subjective scores assesses COVID-19 symptoms and risk factors. Participants were patients suspected of COVID-19 awaiting RT-PCR test results. The UCSS total score then compared with the RT-PCR test result and analyzed to determine the cutoff score, sensitivity, and specificity. 150 participants were included in this study (74 male, 49.3%; mean age 42 ± 15.7). The UCSS total score was significantly correlated with RT-PCR test result (p-value = 0.000). The receiving operator characteristic analysis showed an optimal cutoff score of 7, with a sensitivity of 72% and specificity of 71%. Therefore, the UCSS’ accuracy is at a moderate level. The UCSS showed acceptable sensitivity and specificity, and has the potential to be used as a diagnostic aid for COVID-19 early detection. Further study in diverse areas and larger sample size are needed.

The 2020 İzmir earthquake and its effect on COVID-19 cases

On 30 October 2020, an earthquake measuring 6.9 moment magnitude occurred between Kusadasi and Samos, Türkiye, with a significant impact on buildings in the Bornova–Bayraklı district of İzmir. Immediately afterwards, a comprehensive study was commenced to investigate the relationship between the earthquake that occurred during the SARS-CoV-2 (COVID-19) pandemic and case numbers at the Ege University, Faculty of Medicine’s Hospital in Bornova, İzmir. This cross-sectional study was carried out based on the records of those admitted to the university hospital with suspicion of COVID-19 in the pre-earthquake and post-earthquake periods of the pandemic. The microbiology laboratory of the hospital used reverse transcription–polymerase chain reaction (RT-PCR) results as a dependent variable and compared with the time, age and gender as the independent variables, classified according to the timing of the earthquake. RT-PCR test results were positive in 11.60% of the whole study group; however, tests were 6.69% positive before the earthquake and increased to 23.42% afterwards (P < 0.001), which equated to an increase of 4.25 times (95% CI 4.04–4.47) when comparing pre- to post-earthquake RT-PCR positivity (P < 0.001). The positive COVID-19 RT-PCR detection rate among those aged 50 and over was greater by a factor of 1.15 (95% CI 1.06–1.23) compared to a younger age group (P < 0.001). There was no difference for the gender variable used in suspected case or contact tracing applications of COVID-19 PCR. However, when stratified by age and gender, in the female group, there was a 1.24-fold (95% CI 1.11–1.38) increase in the 50+ age group (26.2%) compared to the younger age group (22.2%) after the earthquake (P < 0.001). In the male group, the rate of laboratory diagnosis of COVID-19 before the earthquake was in the under-50 age group (7.6%) as compared to the >50 age group (5.2%; P < 0.001).

PD41 Role Of Artificial Intelligence In Improving Access To COVID-19 Diagnosis During Pandemic

IntroductionThe evolution of advances in informatics, technology in medicine, and artificial intelligence (AI) offers opportunities to enhance health care during the coronavirus disease 2019 (COVID-19) pandemic. The challenge for biomedical engineers is to implement these developments in clinical practice to improve global health. Populations living in low-income countries do not have access to specialist care and quality diagnostic services for COVID-19. Therefore, an AI system based on a telemedicine platform for diagnosing COVID-19 could help mitigate the lack of highly trained radiologists at regional hospitals and serve as a triage system for rationalizing the use of reverse transcription polymerase chain reaction (RT-PCR) testing and other health resources in low-income countries. Thus, the utility of an AI system for diagnosing COVID-19 in Paraguay was investigated.MethodsThis is a descriptive multicenter observational feasibility study of an AI tool for the rapid detection of COVID-19 in chest computed tomography (CT) images of patients with respiratory difficulties who attended public hospitals across the country.ResultsBetween March 2020 and August 2021, 3,514 rapid diagnostic tests were carried out on patients with respiratory disorders to rule out COVID-19 in 14 hospitals nationwide. The average age of the patients was 48.6 years (52.8% were men); the most common age ranges were 27 to 59 years, followed by older than 60 years and 19 to 26 years. The most frequent findings on the CT images were severe pneumonia, bilateral pneumonia with pleural effusion, bilateral pulmonary emphysema, diffuse ground glass opacity, hemidiaphragmatic paresis, calcified granuloma in the lower right lobe, bilateral pleural effusion, sequelae of tuberculosis, bilateral emphysema, and fibrotic changes. Overall, there was 93 percent agreement and 7 percent discordance between the AI system and the RT-PCR test results. Compared with RT-PCR testing, the AI system had a sensitivity of 93 percent and a specificity of 80 percent.ConclusionsParaguay has an AI-based telemedicine screening system for the rapid detection of COVID-19 that uses chest CT images of patients with respiratory conditions.

Investigation of the presence of SARS-CoV-2 in the lacrimal sac and sustainability of lacrimal surgeries during the pandemic period

Objective: To investigate the reliability of dacryocystorhinostomy operations in terms of viral spread by examining the presence of severe acute respiratory syndrome (SARS) corona-virus type 2 (SARS-CoV-2) in the lacrimal sac.
 Methods: A total of 15 eyes in 14 patients of nasolacrimal duct obstruction that was scheduled for external dacryocystorhinostomy operation were prospectively included in the study. Patients who have coronavirus disease 2019 (COVID-19), had recovered from COVID-19, have a history of close contact with COVID-19 infected persons, and are with vaccination were not included in the study. A nasopharyngeal swab was taken from the surgery planned side of each patient 24 hours before their operation. All cases were real-time, reverse transcription-polymerase chain reaction (RT-PCR) negative. Lacrimal swabs were taken from the lacrimal sac during surgery in these cases. The compatibility of the RT-PCR test results from the lacrimal sac and nasopharyngeal swab was evaluated.
 Results: The mean age of the patients was 56.04 ± 14.91 years. The mean duration of nasolacrimal duct occlusion was 3.93 ± 3.40 years. RT-PCR was negative in the swabs taken from the lacrimal sac of all cases (100%). This result showed agreement with the RT-PCR test results of the nasopharyngeal swabs.
 Conclusions: Viral RNA of SARS-CoV-2 was not detected in the lacrimal sac in this study. Lacrimal sac surgeries can be performed by taking the necessary precautions.

The Value of Spiral Chest Computed Tomography Scan in the Diagnosis of Asymptomatic Coronavirus Carriers among Paranasal Sinus and Pharynx Surgery Candidates.

Introduction The nasopharynx and oropharynx are the main colonization sites of coronavirus. Therefore, patients with paranasal sinuses and pharyngeal problems (ear, nose, and throat [ENT] patients) predispose coronavirus infection. Ear, nose, and throat patients with concomitant asymptomatic coronavirus infection may develop severe pneumonia following surgical procedures. As a result, presurgical screening for coronavirus infection is a substantial concern.Objective We evaluated the usefulness of a spiral chest computed tomography (CT) scan in the diagnosis of asymptomatic coronavirus infection in the presurgical assessment of ENT patients Methods In this study, candidates of paranasal sinus or pharyngeal surgery were evaluated for coronavirus infection. Patients with neither history of coronavirus disease 2019 (COVID-19) nor compatible symptoms and signs were screened for asymptomatic coronavirus infection. These patients composed two groups: the first group underwent a reverse transcription polymerase chain reaction (RT-PCR) test of nasopharyngeal sample and spiral chest CT scan, but for the second one, only the latter was performed. Results In the first group, which consisted of 106 patients, 11 (10.4%) cases had positive RT-PCR test results, and 17 (16%) patients showed positive findings in favor of coronavirus infection in the spiral chest CT scan. In the second group, which consisted of 173 patients, 34 (19.7%) cases had positive chest CT scan results. Conclusion The chest CT scan has a valuable role in the early diagnosis of asymptomatic coronavirus carriers in patients highly predisposed to infection, especially in low resource areas, where the RT-PCR test is unavailable.

Assessment of Clinical Effectiveness of BNT162b2 COVID-19 Vaccine in US Adolescents

The emergence of the B.1.617.2 (Delta) variant of SARS-CoV-2 has led to increases in both infections and hospitalizations among adolescents. Little is known about the effectiveness of the BNT162b2 vaccine in adolescents in the general population, as opposed to a clinical trial population. To estimate the effectiveness of the BNT162b2 vaccine in adolescents aged 12 to 18 years. This was a matched case-control study among adolescents (aged 12-18 years) who had results from a SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) test. Immunization histories, relevant clinical data, and RT-PCR test results were obtained from the Yale New Haven Health System's medical records between June 1, 2021, and August 15, 2021, when the Delta variant caused 92% of infections in Connecticut. Case participants were defined as adolescents who had a positive test result and an associated medical encounter. Control participants were defined as those who had a negative test result and were matched to a case participant by age, county of residence, and date of testing. Adolescents were defined as fully immunized if they had received 2 doses of vaccine at least 14 days before focal time. The primary outcome measured was SARS-CoV-2 infection confirmed by RT-PCR. The vaccine's effectiveness (VE) was estimated using matched odds ratios from conditional logistic regression models. Secondary measures included estimated VE by clinical symptoms, number of vaccine doses received, and elapsed time from immunization. A total of 6901 adolescents were tested for SARS-CoV-2. The final sample comprised 186 case participants and 356 matched control participants. The median age was 14 (IQR, 13-16) years, 262 (48%) identified as female, 81 (15%) as Black, 82 (15%) as Hispanic, and 297 (55%) as White. Overall, 134 (25%) were fully immunized (case participants, 10 [5%]; control participants, 124 [35%]). The median time between immunization and the SARS-CoV-2 test was 62 days (range, 17-129 days). Within 4 months of receiving 2 doses, VE against any infection was estimated to be 91% (95% CI, 80%-96%); against asymptomatic infection, 85% (95% CI, 57%-95%). Effectiveness after a single dose was estimated to be 74% (95% CI, 18%-92%). In this retrospective case-control study of US adolescents, 2 doses of BNT162b2 vaccine appeared to provide excellent protection for at least 4 months after immunization against both symptomatic and asymptomatic SARS-CoV-2 infections.

The Value of Lung Ultrasound to Detect the Early Pleural and Pulmonary Pathologies in Nonhospitalized COVID-19-Suspected Cases in a Population With a Low Prevalence of COVID-19 Infection: A Prospective Study in 297 Subjects.

ObjectivesThis prospective study aimed to evaluate the value of B‐mode lung ultrasound (LUS) for the early diagnosis of coronavirus disease 2019 (COVID‐19) infection in nonhospitalized COVID‐19 suspected cases in a population with a low prevalence of disease.MethodsFrom April 2020 to June 2020, in an ambulatory testing center for COVID‐19‐suspected cases, 297 subjects were examined by LUS before a nasopharyngeal swab was taken for a reverse transcription polymerase chain reaction (RT‐PCR) test. The following LUS findings were defined as pathological ultrasound findings and were analyzed: the presence of 1) pleural effusion, 2) B‐lines, 3) fragmented visceral pleura, 4) consolidation, and 5) air bronchogram in the consolidation. The LUS findings were compared with the RT‐PCR test results.ResultsThe result of the RT‐PCR test for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) was positive in 11 and negative in 286 subjects, and the prevalence of COVID‐19 infection in the study participants was 3.7%. On LUS, a pathological finding could be detected in 56/297 (18.9%) study participants. The LUS revealed a sensitivity of 27.3%, a specificity of 81.5%, a positive predictive value of 5.4%, a negative predictive value of 96.7%, and a diagnostic accuracy of 79.9% for the identification of COVID‐19 infection.ConclusionsFor the identification of COVID‐19 infection, LUS is highly sensitive to the patient spectrum and to the prevalence of the disease. Due to the low diagnostic performance in nonhospitalized COVID‐19 cases in low‐prevalence areas, LUS cannot be considered to be an adequate method for making a diagnosis in this group.

Comparison of computed tomography (CT) findings with RT‐PCR in the diagnosis of COVID‐19 in children

AimThis study aimed to compare chest computed tomography (CT) findings with reverse‐transcription polymerase chain reaction (RT‐PCR) test results in children with probable or definitive diagnosis of coronavirus disease 2019 (COVID‐19).MethodsIn this retrospective archive study, pediatric patients who were followed up in the hospital with a possible or definitive diagnosis of COVID‐19 and who had chest CT at presentation were included. CT scan images of the patients were reinterpreted by a pediatric radiologist and compared with their RT‐PCR test results.ResultsOf the total of 89 patients, 33 had negative and 56 had positive RT‐PCR tests. The presence of pulmonary lesions and consolidation was statistically significantly higher in the RT‐PCR negative group than in the RT‐PCR positive group (p = 0.037 and 0.001, respectively). Lobe involvement of 0%–25% was higher in the RT‐PCR positive group (p = 0.001), and lobe involvements of 25%–50% and 50%–75% were significantly higher in the RT‐PCR negative group (p = 0.001 and 0.005, respectively). Central and perihilar involvement was found to be statistically significant in the RT‐PCR negative group (p = 0.008 and 0.005, respectively).ConclusionChest CT findings may provide some clues in predicting RT‐PCR positivity in children with a probable diagnosis of COVID‐19. Lobe involvement percentage of up to 25% is a finding in favor of patients with positive RT‐PCR test, whereas 25%–75% lobe involvement, central and perihilar involvement, and consolidation can be interpreted in favor of patients with negative RT‐PCR test.

SARS-CoV-2 Transmission Risk Among National Basketball Association Players, Staff, and Vendors Exposed to Individuals With Positive Test Results After COVID-19 Recovery During the 2020 Regular and Postseason

Clinical data are lacking regarding the risk of viral transmission from individuals who have positive reverse-transcription-polymerase chain reaction (RT-PCR) SARS-CoV-2 test results after recovery from COVID-19. To describe case characteristics, including viral dynamics and transmission of infection, for individuals who have clinically recovered from SARS-CoV-2 infection but continued to have positive test results following discontinuation of isolation precautions. This retrospective cohort study used data collected from June 11, 2020, to October 19, 2020, as part of the National Basketball Association (NBA) closed campus occupational health program in Orlando, Florida, which required daily RT-PCR testing and ad hoc serological testing for SARS-CoV-2 IgG antibodies. Nearly 4000 NBA players, staff, and vendors participated in the NBA's regular and postseason occupational health program in Orlando. Persistent positive cases were those who recovered from a documented SARS-CoV-2 infection, satisfied US Centers for Disease Control and Prevention criteria for discontinuation of isolation precautions, and had at least 1 postinfection positive RT-PCR test(s) result. Person-days of participation in indoor, unmasked activities that involved direct exposure between persistent positive cases and noninfected individuals. Transmission of SARS-CoV-2 following interaction with persistent positive individuals, as measured by the number of new COVID-19 cases in the Orlando campus program. Among 3648 individuals who participated, 36 (1%) were persistent positive cases, most of whom were younger than 30 years (24 [67%]) and male (34 [94%]). Antibodies were detected in 33 individuals (91.7%); all remained asymptomatic following the index persistent positive RT-PCR result. Cycle threshold values for persistent positive RT-PCR test results were typically above the Roche cobas SARS-CoV-2 limit of detection. Cases were monitored for up to 100 days (mean [SD], 51 [23.9] days), during which there were at least 1480 person-days of direct exposure activities, with no transmission events or secondary infections of SARS-CoV-2 detected (0 new cases). In this retrospective cohort study of the 2020 NBA closed campus occupational health program, recovered individuals who continued to test positive for SARS-CoV-2 following discontinuation of isolation were not infectious to others. These findings support time-based US Centers of Disease Control and Prevention recommendations for ending isolation.

Differences between radiological findings of COVID-19 and non-COVID-19 infections in pediatric patients

BackgroundThis study aimed to reveal the differences between coronavirus disease 2019 (COVID-19) infections and non-COVID-19 respiratory tract infections in pediatric patients.MethodsSixty pediatric patients admitted to the hospital between March 11, 2020 and April 15, 2020 with respiratory tract infections were evaluated retrospectively. Among them, 20 patients with reverse transcription-polymerase chain reaction (RT-PCR) tests and chest computed tomography (CT) examinations were included in the study. According to the RT-PCR test results, the patients were divided into the COVID-19 and non-COVID-19 groups. The clinical observations, laboratory results, and radiological features from the two groups were then compared.ResultsAccording to the RT-PCR test results, 12 patients were assigned to the COVID-19 group and 8 to the non-COVID-19 group. There were no significant differences between the two groups in terms of clinical or laboratory features. In terms of radiological features, the presence of bronchiectasis and peribronchial thickening was statistically significantly higher in the non-COVID-19 group (P = 0.010 and P = 0.010, respectively).ConclusionsIn pediatric cases, diagnosing COVID-19 using radiological imaging methods plays an important role in determining the correct treatment approach by eliminating the possibility of other infections.

Chest CT findings and their correlation with RT-PCR testing in pediatric COVID-19 patients

Objectives: To compare the reverse transcription-polymerase chain reaction (RT-PCR) test results and chest computerized tomography (CT) findings in pediatric patients with a pre-diagnosis of COVID-19. Materials and Methods: The thorax CT examinations and RT-PCR test results were retrospectively evaluated in 177 children. According to the test results, the patients were divided into two groups as 'COVID-19-positive' and 'COVID-19-negative'. Results: In the COVID-19-positive group, 65.71% of the patients with a family history of COVID-19 (p<0.01). In the same group, 50.00% of patients with normal CT findings were older than 16 years (p<0.01), and single-lobe involvement was more common (54.54%, p<0.01). The most observed CT finding was consolidation with ground-glass opacities (GGO) in both groups. Fibrotic bands (51.46%, p<0.01), reticular pattern (34.95%, p<0.01), atelectasis (9.71%, p<0.01), mosaic perfusion (26.21%, p<0.01), and pleural effusion (19.42%, p<0.01) were mostly seen in the COVID-19-negative group. In patients with underlying diseases, the sensitivity values were calculated as 0.441 for CT and 0.863 for the RT-PCR test. Conclusion: In patients with a family history of COVID-19, the chest CT showed focal GGO with or without consolidation as the most common finding. If CT findings diffuse and severe, the patient most likely does not have COVID-19. The RT-PCR test results are more reliable than CT in children with underlying diseases. © 2021 Ankara Yildirim Beyazit University.

The incidence and geographical spread of SARS-CoV-2 in Rio de Janeiro, Brazil based on RT-PCR test results.

INTRODUCTION Rio de Janeiro has hardly experienced coronavirus disease. METHODS Here, 87,442 reverse transcription polymerase chain reaction (RT-PCR) test results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were reported among Rio de Janeiro residents (March to September 2020). RESULTS Overall, RT-PCR positivity of 44.6% decreased over time towards 20%. Positivity was greater among males (OR=1.22; 95%CI:1.19-1.26); Black (OR=1.10; 95%CI:1.02-1.19), Brown (OR=1.16; 95%CI:1.10-1.22), and indigenous people (OR=2.11; 95%CI:0.88-5.03) compared to Whites and increased with age; with epidemic spread from the capital to inland regions. CONCLUSIONS SARS-CoV-2 keeps spreading in Rio de Janeiro, and reopening of activities may fuel the epidemic.

CT chest interpretation of novel coronavirus disease (COVID-19): Our experience with the first 60 patients at MGM Medical College, Aurangabad, India

Introduction: In December 2019, the outbreak of a novel corona virus infection occurred in Wuhan City, China. Early discussions suggested that computed tomography (CT) should be the preferred modality for the diagnosis of COVID-19. However, the use of CT for COVID-19 diagnosis is controversial. Also, the detailed CT features of COVID-19 have been reported in only a small number of articles in the literature. Objective: To evaluate lung abnormalities on thin-section CT scans in patients with COVID-19. Materials and Methods: This study included the first 60 clinically suspected patients for COVID-19 infection. The patients have further investigated for COVID-19 infection by reverse transcription-polymerase chain reaction (RT-PCR) test and CT chest. We identified CT patterns suggestive of COVID-19 infection and calculated the total CT severity score. The imaging reports of the CT chest study were compared with the RT-PCR test results. Results: In our study, we had 37 male patients and 23 female patients. COVID-19 pneumonia was diagnosed in 55 of the 60 patients, but five patients did not show any commonly described findings of COVID-19 pneumonia. Of the 55 patients, the majority of them had ground-glass opacities. The bilateral lower lobes were involved in the majority of the cases. RT-PCR results show that, of the 60 patients, 37 were positive for COVID-19 and 23 were negative for COVID-19. The mean total lung severity score for the 60 patients was 11.5 (range, 0–25). Mediastinal lymphadenopathy was notably absent in all 60 patients and only five patients had traces of bilateral pleural effusion and only one patient had air trapping. In terms of the distribution of disease in the axial plane, peripheral distribution was found in most of the cases. The patients with higher CT scores required ICU admission and ventilator support, and had a poor prognosis. Conclusion: We found that chest CT may be useful as a standard method for the rapid diagnosis of COVID-19 to optimize the management of patients in hospital settings where nucleic acid testing kits are not available or available in limited quantities. Chest CT plays a crucial role in the early detection of COVID-19, particularly for those patients with a negative RT-PCR.

Telemonitoring of Children with COVID-19: Experience Report of the First 100 Cases.

Introduction:The first case of coronavirus disease 2019 (COVID-19) in Brazil was diagnosed in February 2020. On March 20, the Ministry of Health issued Ordinance no. 467, regulating the use of telemedicine during the pandemic period. One of the various modalities of telemedicine is telemonitoring.Objective:To report our experience with telemonitoring and evaluate its applicability in the follow-up of the first 100 children who received the diagnosis of COVID-19 after visiting the emergency department of Sabará Hospital Infantil (“Hospital Sabará”) and who had no indications for hospitalization.Methods:The care records of the children were retrospectively analyzed, and telephone contact with the families of patients who did not complete the proposed telemonitoring protocol was initiated.Results:The average age of the children was 5.5 years, and a slight male predominance (54/100) was observed. Comorbidities were present in 24/100. The source of infection was family members living in the same household in 88/100 and other sources in 12/100. In the first telemonitoring, 44% of the evaluated patients were asymptomatic. In the second telemonitoring, 81% of the patients were asymptomatic. Telemonitoring was completed by 70% of the children. A total of 14 children returned to the emergency department, 11 of whom spontaneously (2/11 were admitted) and 3 under the indication of telemedicine (3/3 were admitted).Conclusions:Telemonitoring proved to be a clinically valuable resource in the follow-up of children with COVID-19, as it allowed continuity of care and identified patients with indications to return to the emergency department of Hospital Sabará and for hospitalization, thus avoiding unnecessary emergency department visits.

Factors Associated with Positive SARS-CoV-2 Test Results in Outpatient Health Facilities and Emergency Departments Among Children and Adolescents Aged

As of December 14, 2020, children and adolescents aged <18 years have accounted for 10.2% of coronavirus disease 2019 (COVID-19) cases reported in the United States.* Mitigation strategies to prevent infection with SARS-CoV-2, the virus that causes COVID-19, among persons of all ages, are important for pandemic control. Characterization of risk factors for SARS-CoV-2 infection among children and adolescents can inform efforts by parents, school and program administrators, and public health officials to reduce SARS-CoV-2 transmission. To assess school, community, and close contact exposures associated with pediatric COVID-19, a case-control study was conducted to compare exposures reported by parents or guardians of children and adolescents aged <18 years with SARS-CoV-2 infection confirmed by reverse transcription-polymerase chain reaction (RT-PCR) testing (case-patients) with exposures reported among those who received negative SARS-CoV-2 RT-PCR test results (control participants). Among 397 children and adolescents investigated, in-person school or child care attendance ≤14 days before the SARS-CoV-2 test was reported for 62% of case-patients and 68% of control participants and was not associated with a positive SARS-CoV-2 test result (adjusted odds ratio [aOR]=0.8, 95% confidence interval [CI]=0.5-1.3). Among 236 children aged ≥2 years who attended child care or school during the 2 weeks before SARS-CoV-2 testing, parents of 64% of case-patients and 76% of control participants reported that their child and all staff members wore masks inside the facility (aOR=0.4, 95% CI=0.2-0.8). In the 2 weeks preceding SARS-CoV-2 testing, case-patients were more likely to have had close contact with a person with known COVID-19 (aOR = 3.2, 95% CI = 2.0-5.0), have attended gatherings† with persons outside their household, including social functions (aOR=2.4, 95% CI=1.1-5.5) or activities with other children (aOR=3.3, 95% CI=1.3-8.4), or have had visitors in the home (aOR=1.9, 95% CI=1.2-2.9) than were control participants. Close contacts with persons with COVID-19 and gatherings contribute to SARS-CoV-2 infections in children and adolescents. Consistent use of masks, social distancing, isolation of infected persons, and quarantine of those who are exposed to the virus continue to be important to prevent COVID-19 spread.

Association of Underlying Diseases and Clinical Characteristics with Mortality in Patients with 2019 Novel Coronavirus in Iran

Objectives: The first case of 2019 novel coronavirus disease (COVID-19) was reported in Iran in February 2020. Here, we report the epidemiological and clinical characteristics of patients with COVID-19 and factors associated with mortality in these patients. Methods: A retrospective cohort study was conducted from February 22, 2020, to March 24, 2020, in Golestan Hospital in Kermanshah, Iran. Demographic data including underlying diseases and clinical data including the presenting symptoms, chest computed tomography (CT) scan, reverse transcription polymerase chain reaction (RT-PCR) test results, and outcomes were extracted from electronic medical records. Simple and multiple logistic regression methods were used to explore the factors associated with mortality. Results: Of 245 patients admitted with COVID-19, 155 (63.30%) were male. The mean age of the subjects was 54.68 ± 19.21. Forty-five (18.48%) patients had underlying diseases. Common symptoms were dyspnea (n = 137; 55.9%), cough (n = 93; 38.0%), and fever (n = 78; 31.8%). All patients had pneumonia with abnormal findings on chest CT scan (100%), and RT-PCR test results were positive in 87 (35.50%) patients. Of the total admitted cases, 38 (15.5%) patients died during hospitalization. An old age (OR = 1.09; 95% CI: 1.02 to 1.06), history of heart disease (OR = 5.07; 95% CI: 1.46 to 17.58), hypertension (OR = 5.82; 95% CI: 1.13 to 30.04), smoking (OR = 11.44; 95% CI: 1.01 to 29.53), history of at least one underlying disease (OR = 3.31; 95%CI: 1.54 to 7.09), and symptoms of decreased consciousness at the time of admission (OR = 24.23; 95% CI: 2.62 to 223.39) were associated with mortality. Also, the symptoms of cough (OR = 0.383; 95% CI: 0.17 to 0.88) and fever (OR = 0.278; 95% CI: 0.10 to 0.74) had a negative association with mortality. Conclusions: In the current study, factors including old age, smoking, symptoms of decreased consciousness, and underlying diseases such as heart disease, hypertension, and history of at least one underlying disease were associated with mortality. Factors associated with mortality should be considered so that we can better manage patients with COVID-19.

COVID-19 Outbreak at an Overnight Summer School Retreat - Wisconsin, July-August 2020.

During July 2-August 11, 2020, an outbreak of coronavirus disease 2019 (COVID-19) occurred at a boys' overnight summer school retreat in Wisconsin. The retreat included 152 high school-aged boys, counselors, and staff members from 21 states and territories and two foreign countries. All attendees were required to provide documentation of either a positive serologic test result* within the past 3 months or a negative reverse transcription-polymerase chain reaction (RT-PCR) tests result for SARS-CoV-2 (the virus that causes COVID-19) ≤7 days before travel, to self-quarantine within their households for 7 days before travel, and to wear masks during travel. On July 15, the Wisconsin Department of Health Services (WDHS) began an investigation after being notified that two students at the retreat had received positive SARS-CoV-2 RT-PCR test results. WDHS offered RT-PCR testing to attendees on July 28 and serologic testing on August 5 and 6. Seventy-eight (51%) attendees received positive RT-PCR results (confirmed cases), and 38 (25%) met clinical criteria for COVID-19 without a positive RT-PCR result (probable cases). By the end of the retreat, 118 (78%) persons had received a positive serologic test result. Among 24 attendees with a documented positive serologic test result before the retreat, all received negative RT-PCR results. After RT-PCR testing on July 28, WDHS recommended that remaining susceptible persons (asymptomatic and with negative RT-PCR test results) quarantine from other students and staff members at the retreat. Recommended end dates for isolation or quarantine were based on established guidance (1,2) and determined in coordination with CDC. All attendees were cleared for interstate and commercial air travel to return home on August 11. This outbreak investigation documented rapid spread of SARS-CoV-2, likely from a single student, among adolescents and young adults in a congregate setting. Mitigation plans that include prearrival quarantine and testing, cohorting, symptom monitoring, early identification and isolation of cases, mask use, enhanced hygiene and disinfection practices, and maximal outdoor programming are necessary to prevent COVID-19 outbreaks in these settings (3,4).

The Negative RT-PCR Test is Enough to Rule Out Covıd-19 in Cancer Patients or Not? Covıd-19 or Not?

At the end of 2019, a new coronavirus pneumonia turned into an epidemic in China and then spread to other countries around the world. This disease was identified as the COVID-19 (SARS-CoV-2) disease. SARS-CoV-2 RNA is detected by Reverse-Transcription Polymerase Chain Reaction (RT-PCR). A positive test for SARS-CoV-2 may confirm the diagnosis of COVID-19, but the results of false negativity and false positivity can be confusing. This article describes the negative COVID-19 RNA RT-PCR test results of four cancer patients with symptoms/clinical findings suggestive of COVID-19 and also computed tomography findings consistent with viral pneumonia.

Efficacy of Chest CT for COVID-19 Pneumonia Diagnosis in France.

BackgroundThe role and performance of chest CT in the diagnosis of the coronavirus disease 2019 (COVID-19) pandemic remains under active investigation.PurposeTo evaluate the French national experience using Chest CT for COVID-19, results of chest CT and RT-PCR were compared together and with the final discharge diagnosis used as reference standard.Materials and MethodsA structured CT scan survey (NCT04339686) was sent to 26 hospital radiology departments in France between March 2 and April 24 2020. These dates correspond to the peak of the national COVID-19 epidemic. Radiology departments were selected to reflect the estimated geographical prevalence heterogeneities of the epidemic. All symptomatic patients suspected of having a COVID-19 pneumonia who underwent within 48 hours both initial chest CT and at least one RT-PCR testing were included. The final discharge diagnosis, based on multiparametric items, was recorded. Data for each center were prospectively collected and gathered each week. Test efficacy was determined by using Mann-Whitney Test, Student’s t-test, Chi-square test and Pearson’s correlation. A p value <.05 determined statistical significance.ResultsTwenty-six of 26 hospital radiology departments responded to the survey with 7500 patients entered; 2652 did not have RT-PCR results or had unknown or excess delay between RT-PCR and CT. After exclusions, 4824 patients (mean age 64, ± 19 yrs, 2669 males) were included. Using final diagnosis as the reference, 2564 of the 4824 patients were positive for COVID-19 (53%). Sensitivity, specificity, NPV and PPV of chest CT for diagnosing COVID-19 were 2319/2564 (90%, 95% confidence interval [CI]: 89, 91), 2056/2260 (91%, 95%CI: 91, 92%), 2056/2300 (89%, 95%CI; 87, 90%) and 2319/2524 (92%, 95%CI 91, 93%) respectively. There was no significant difference for chest CT efficacy among the 26 geographically separate sites, each with varying amounts of disease prevalence.ConclusionUse of chest CT for the initial diagnosis and triage of suspected COVID-19 patients was successful.