Suspected Coronavirus Disease 2019 Cases Research Articles

Committed for Social Change: Analysing the Role of Frontline Health Workers During Pandemic in Rural Odisha

The frontline health workers take health services directly to communities where access is either absent or often limited. The Aanganwadi workers and Accredited Social Health Activists (ASHA), among the most prominent frontline workers, act as essential to providing health facilities by bringing services to people’s doorsteps. They create awareness, provide nutritional support to children and mothers, promote universal immunisation, provide escort services for Reproductive and Child Health and so on. With the rise of coronavirus disease 2019 (COVID-19), ASHA and Anganwadi Workers (AWWs) have been expected to do supplemented work along with their regular duties. They are engaged in contact tracing, providing food supplements at the doorstep, screening the returning migrant workers, reporting suspected COVID-19 cases, doing door-to-door surveys and ensuring quarantine or isolation. However, they remain the least paid as Corona warriors and are exposed to Corona. The research found that AWWs and ASHAs are denied fundamental dignity and basic rights such as the right to recognition as workers, the right to the minimum salary and basic social security measures, which are the basic entitlement of the frontline workers in the State. The article critically analyses their role and rights during the pandemic.

Diagnostic Efficacy of Chest Computed Tomography for Coronavirus Disease 2019.

A significant discrepancy between the results of previous studies is identified regarding the diagnostic efficacy of chest computed tomography (CT) for coronavirus disease 2019 (COVID-19). We aimed to evaluate the diagnostic efficacy of chest CT for COVID-19. Suspected cases of COVID-19 with fever, cough, dyspnea, and evidence of pneumonia on chest CT scan were enrolled in the study. The accuracy, sensitivity, and specificity of chest CT were determined according to real-time reverse transcriptase-polymerase chain reaction (RT-PCR) results as the gold standard method. The study population comprised 356 suspected cases of COVID-19 (174 men and 182 women; age range 3-96 years; mean age ± standard deviation, 55.21 ± 18.38 years). COVID-19 patients were diagnosed using chest CT with 89.8% sensitivity, 78.1% accuracy, 21.3% specificity, 84.7% positive predictive value, and 30.23% negative predictive value. The odds ratio was 2.39 (95% confidence interval, 1.16-4.91). Typical CT manifestations of COVID-19 were observed in 48 (13.5%) patients with negative RT-PCR results and 30 (8.4%) patients with confirmed positive RT-PCR results had no radiological manifestations. Kappa coefficient of chest CT for diagnosis of COVID-19 was 0.78. The results show that when RT-PCR results are negative, chest CT could be considered as a complementary diagnostic method for the diagnosis of COVID-19 patients. A more comprehensive diagnostic method could be established by combining the chest CT examination, clinical symptoms, and RT-PCR assay.

Impact of the COVID-19 pandemic on pathological autopsy practices in Japan.

During the coronavirus disease 2019 (COVID-19) pandemic, autopsies have provided valuable insights into the pathogenesis of COVID-19. The precise effect of this pandemic on autopsy procedures in Japan, especially in instances unrelated to COVID-19, has not yet been established. Therefore, we conducted a questionnaire survey from December 2020 to January 2021 regarding the status of pathological autopsy practices in Japan during the first year of the COVID-19 pandemic. The questionnaire was sent to 678 medical facilities with pathologists, of which 227 responded. In cases where a confirmed diagnosis of COVID-19 was not made at the time of autopsy, many facilities counted them as suspected COVID-19 cases if pneumonia was suspected clinically. At around half of the sites, autopsies were prohibited for suspected COVID-19 cases. In addition, the number of autopsies of non-COVID-19 cases during the pandemic period was also investigated, and a significant decrease was observed compared with the incidence in the pre-pandemic period. The COVID-19 pandemic has affected not only the autopsies of COVID-19 cases but also the entire practice of pathological autopsies. It is necessary to establish a system that supports the implementation of pathological autopsy practices during the pandemic of an emerging infectious disease.

Comparison of the performance of two real-time fluorescent quantitative PCR kits for the detection of SARS-CoV-2 nucleic acid: a study based on large real clinical samples

BackgroundThe global pandemic of coronavirus disease 2019 (COVID-19) has led to the development of multiple detection kits by national manufacturers for severe acute respiratory syndrome coronavirus 2 viral nucleic acid testing. The purpose of this study is to evaluate the performance of different kits (i.e., Maccura kit and Sansure kit) in real clinical work using clinical samples, which will help with the optimization of the test kits.MethodDuring the past three months (March–May 2022), 1399 pharyngeal swabs from suspected COVID-19 patients have been initially screened using the Maccura kit in Jilin, China, and the test results were verified using the Sansure kit. The cycle threshold (Ct) values generated by the two kits were compared at different viral load levels. Correlation and consistency of the Ct values were investigated using Spearman correlation, Deming regression, and Bland–Altman plots. The cut-off Ct values of the Maccura kit were recalculated by referencing the result of the Sansure kit as a standard. Furthermore, another 163 pharyngeal swabs from suspected COVID-19 patients were collected to verify the new cut-off values.ResultsAs a result of the Maccura kit testing, 1192 positive cases and 207 suspected COVID-19 cases were verified. After re-examination by the Sansure kit, 1118 positive cases were confirmed. The difference between the Ct values provided by the two kits was statistically significant, except for the N gene at high viral load. The Ct values obtained from the two kits presented a linear positive correlation. The Maccura kit used new cut-off Ct values of 35.00 (ORF1ab gene) and 35.07 (N gene). Based on that, the validation pass rate for the new cut-off Ct values was 91.41%.ConclusionSince the Maccura kit is found to have false positives in actual clinical work, recalculation of the cut-off values can reduce this occurrence. In order to improve the accuracy of the testing, laboratories should use two kits for COVID-19 testing, and the adjusting and optimizing of the kits for their situation are needed.

A conservation organisation's approach to COVID-19: Lessons learned from Madagascar.

The challenges in responding to the pandemic and in implementing and maintaining effective behaviour change are discussed. Although not an objective study of the effectiveness of the response or a comparison with other approaches, the lessons learned from this process are shared in the hope that they may inform responses to future shocks in low-income countries.

Epidemiology of COVID-19 in Kish Island from February to August 2020

Background: In March 2020, the world health organization declared the outbreak of novel coronavirus disease 2019 (COVID-19) as a pandemic. COVID-19 is a highly contagious disease. Kish is a touristic island that is located in the south of Iran. The aim of the present study was to investigate the epidemiology of COVID-19 on Kish island. Methods: In the present cross-sectional study, the residents of Kish Island, Iran, who were checked with COVID-19 polymerase chain reaction (PCR) test from February to August 2020 were included. The PCR test was obtained from symptomatic individuals or those people who had exposure to suspected COVID-19 cases. Data were collected from their medical records and analyzed based on their PCR test results. Results: A total of 4859 individuals were checked with COVID-19 PCR test. The result was positive in 1251 (25.75%) cases and negative in 3608 (74.25%). The mean age was 37.32 years. The majority of the individuals were men. Most of the participants were office employees. The number of housewives was approximately double in COVID-19 positive patients compared with the patients with negative results. About 40% of the individuals with positive results had a history of exposure to suspected COVID-19 cases. The prevalence of exposure to suspected COVID-19 cases and recent travel was significantly higher among positive cases (P<0.001). There was a significant correlation between the delay between the onset of the symptoms and performing PCR. Longer delays were seen among the deceased patients. Conclusion: It seems that more precise policies should be taken to avoid contact with symptomatic patients and people who had a history of travel to the island.

Real-world diagnostic value of a nationwide standardized COVID-19 triage chart in Turkey.

Effective triage is critical during the coronavirus disease 2019 (COVID-19) pandemic. An appropriate triage plan is crucial to direct suspected COVID-19 cases to a designated area, in order to separate such patients from other patients and staff. To report the diagnostic value of the "Possible Coronavirus Disease 2019 (COVID-19) Case Questioning Guide for Outpatients", a nationwide standard triage chart, and of the individual questions within the triage chart for detecting COVID-19 in patients admitted to our hospital. A total of 39,681 outpatients admitted to our hospital between April 1 and April 30, 2021, underwent triage questioning. The triage chart consisted of 3 symptom questions and 4 contact and travel questions. Patients who responded "yes" to at least 1 question were referred to the pandemic area; others were considered low-risk and did not undergo routine COVID-19 polymerase chain reaction (PCR) test. Briefly, 3529 outpatients were referred to the pandemic area; among them, 1055 were PCR-positive. Among 36,152 low-risk patients, 94 were PCR-positive. The sensitivity of the triage chart was 91.82%, specificity was 93.58%, positive likelihood ratio was 14.30, and negative likelihood ratio was 0.09. Triage questions were in moderate agreement with PCR results (Cohen's Kappa: 0.429, p < 0.0001). The diagnostic value of the triage chart was mainly attributed to the questions regarding possible COVID-19 infection symptoms rather than contact history. However, the questions included in the triage chart had none to slight agreement with the PCR test results in the pandemic outpatients. The triage chart has high sensitivity and specificity for discriminating possible COVID-19 cases in all outpatients, but has unsatisfactory diagnostic value for predicting PCR positivity in pandemic outpatients. Therefore, the current triage chart should be used accordingly, i.e., to define possible COVID-19 cases rather than PCR-positive cases. Further studies regarding COVID-19 triage for possible and PCR-positive cases should also focus on the individual diagnostic value of less prevalent symptoms.

Role of Modified RALES and Brixia Scores Section in Predicting the COVID-19 Positivity among the Suspected Patients: A Cross-sectional Observational Study

Introduction: Computed Tomography (CT) chest plays an important role in triaging and managing patients of suspected COVID-19, especially in those where Coronavirus Disease 2019 (COVID-19) report is pending but CT chest has constraints of availability and cost. Chest X-ray (CXR) is a readily available investigation and is cheaper than a CT chest. Hence, any scoring on CXR which proves to be helpful in triaging and managing suspected COVID19 patients will alleviate the dependency on CT chest. Modified Radiographic Assessment of Lung Edema Score (mRALES) and Brixia scores have been used to assess severity of disease and prognosis in COVID-19 confirmed cases. However, these two scores have never been used as a method to predict the confirmed COVID-19 pateints among the the suspected COVID-19 cases. Aim: To evaluate the role of mRALES and Brixia score along with clinical and laboratory parameters in predicting confirmed positive cases among suspected COVID-19 patients. Materials and Methods: This retrospective cross-sectional, observational study was conducted in Department of Medicine at Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India, from 1st to 15th December 2020. Case records of patients admitted with severe acute respiratory illness (suspected COVID-19) were accessed and used to fill up a proforma where clinical and laboratory parameters were recorded. Chest radiographs (posteroanterior and anteroposterior) of the patients were evaluated to calculate mRALES and Brixia scores. Sensitivity, specificity, positive preditive value and negative predictive value were calculated. The p-value &lt;0.05 was considered as statistically significant. Results: Out of the 113 patients, 62 were males and 51 females. The COVID-19 positivity rate was 15.04% (n=17). Mean age of patients was 52.64±15.63 years. Overall, the mean mRALES and Brixia scores were not statistically different between suspected (mRALES=3.94±2.51, Brixia=7.29±4.642), and confirmed COVID19 (mRALES=4.25±2.56, Brixia=7.73±4.84) patients. However, in the subgroup of patients with history of obstructive airway disease, Brixia score was significantly higher among COVID-19 positive patients (7.09±4.70) as compared to COVID-19 suspected patients (0.53±4.31). Presence of low TLC {&lt;9550/mm3 with sensitivity of 70.62%, specificity of 67.3%, Positive Predictive Value (PPV) of 26.7% and Negative Predictive Value (NPV) of 92.4%} and low ANC {&lt; 7580/mm3 with sensitivity of 64.7%, specificity of 63.2%, PPV of 22.9% and NPV of 90.5%} significantly predicted the COVID-19 positivity among the suspected COVID-19 patients. Conclusion: mRALES and Brixia scores on CXR are not significantly different between suspected and confirmed COVID-19 patients and hence, cannot be used to judge who among suspected COVID-19 patients will turn out to be COVID-19 positive later. However, a TLC of less than 9550/ mm3 and an ANC of less than 7580/mm3 can predict COVID-19 positivity among suspected patients.

Diagnostic Accuracy of Rapid Antigen Test for COVID-19 Infection: A Retrospective Analysis

Introduction: For the diagnosis of Coronavirus Disease 2019 (COVID-19) disease, Real-Time Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) is a laboratory-based technique and is considered a gold standard test, but is time consuming. A Rapid Antigen Test (RAT) is used for screening which is an immunoassay that identifies the presence of a viral antigen causing infection at the point of care. The RAT is quick, inexpensive, easily accessible and doesn’t need lab handling or sample preprocessing. Aim: To measure the sensitivity, specificity, Negative Predictive Value (NPV) and Positive Predictive Value (PPV) of RAT in comparison to RT-PCR. Materials and Methods: This retrospective study was conducted in Department of Community Medicine at Government Medical College (tertiary care centre), Surat, Gujarat, India, using secondary data from 1st July 2020 to 5th Dec 2020. The samples were collected from all the patients of Acute Respiratory Illness (ARI), Severe Acute Respiratory Illness (SARI), Influenza Like Illness (ILI), the suspected COVID-19 cases and all walk in patients for testing or treatment purposes. A total of 264 participants enrolled in the study underwent both the RAT and RT-PCR tests. The sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated using MS Excel Statistical Package for the Social Sciences (SPSS) version 17.0. Results: Total 264 cases were analysed, amongst which 161 (60.9%) were males and 103 (39.1%) were females and the mean age of the patient was 41.6 years and 36.8 years for males and females, respectively. The overall sensitivity was 52.47%, specificity was 87.11%, PPV was 71.62% and the NPV was 74.73%. While among symptomatic patients sensitivity was 55.55%, specificity was 88.54%, PPV was 76.97% and NPV was 74.35%. Conclusion: Because of the low sensitivity of the RAT, if used alone a high number of false negative cases will be resulted. Hence, it is employed in community and clinical settings as sequential screening in conjunction with RT-PCR, which results in improved net gain and aids in disease transmission control.

430. Strategies for Prevention of COVID-19 Transmission in Hospitals

BackgroundInfection control measures against the coronavirus disease 2019 (COVID-19) within a hospital often rely on expert experience and intuition due to the lack of clear guidelines. This study surveyed current strategies for the prevention of the spread of COVID-19 in medical institutions.MethodsUpon systematic review of the guidelines at the national level, 14 key topics were selected. Six hospitals were provided an open survey that assessed their responses to these topics between August 11 and 25, 2020. Using these data, an online questionnaire was developed and sent to the infection control teams of 46 hospitals in South Korea. The survey was conducted between January 31, 2021, and February 20, 2021.ResultsAll 46 hospitals responded to the survey, and 24 hospitals (52.2%) had treated 100 or more cases of COVID-19. All hospitals operated screening clinics, and the criteria were respiratory symptoms (100%), fever (97.8%), and epidemiological association (93.5%). It was found that 89.1% (41/46) of hospitals allowed symptomatic patients to visit their general outpatient clinics if fever or respiratory symptoms were not associated with COVID-19. Most hospitals (87.2%; 34/39) conducted polymerase chain reaction (PCR) tests for all hospitalized patients. Moreover, 76.1% (35/46) of hospitals implemented preemptive isolation policies for hospitalized patients, of which 97.1% (34/35) were released from isolation after a single negative PCR test. A little over half of the hospitals (58.7%; 27/46) treated patients that met the national criteria for release from isolation but consistently had positive PCR results. Of these hospitals, 63% (17/27) used N95/KF94 masks, and 40.7% (11/27) used surgical masks without other personal protective equipment for treating them. Most hospitals (76.9%; 20/26) accommodated them in shared rooms when the cycle threshold value of the PCR test was more than a certain value (34.6%; 9/26), or after a certain period that satisfied the national criteria (26.9%; 7/26). Finally, 76.1% (35/46) of hospitals performed emergency procedures or operations on suspected patients.Table 1. Screening and selective treatment policy to prevent COVID-19 patients from entering the hospital NoteValues are presented as number (%) Abbreviations: COVID-19, coronavirus disease 2019; PCR, polymerase chain reaction 1 This question requested the respondent to select multiple items. 2 Suspected cases of COVID-19 include fever, respiratory symptoms, and epidemiological associations with COVID-19 patients. NoteValues are presented as number (%) Abbreviations: COVID-19, coronavirus disease 2019; PCR, polymerase chain reaction; PAPR, powered air-purifying respirator; Ct, cycle threshold 1 This question requested the respondent to select multiple items. 2 It includes infectious diseases, pulmonology, and the infection control and prevention office. 3 One hospital that wrote a non-categorical answer for the question was excluded. The hospital made a decision after discussing it with an infectious diseases specialist.ConclusionVarious guidelines were being applied by each medical institution, but there was a lack of an explicit set of national guidelines to support them.Disclosures All Authors: No reported disclosures

Accuracy of screening methods of COVID-19 in pregnancy: a cohort study.

All pregnant women in labor should be universally screened for Coronavirus Disease 2019 (COVID-19) during pandemic periods using reverse transcriptase polymerase chain reaction (RT-PCR) test. In many low-middle income countries, screening method was developed as an initial examination because of limited availability of RT-PCR tests. This study aims to evaluate the screening methods of COVID-19 accuracy in pregnant women. We recruited all pregnant women with suspicion of COVID-19 from April to August 2020 at Airlangga University Hospital, Surabaya, Indonesia. The participant was divided into two groups based on RT-PCR results: COVID-19 and non-COVID-19 group. The proportion of positive signs and symptoms, rapid antibody test, abnormal findings in chest X-ray, and neutrophil to lymphocyte ratio (NLR) value were then compared between both groups. The sensitivity, specificity, positive predictive value (PPV), negative predictive values (NPV), and diagnostic accuracy (DOR) were calculated. A total 141 pregnant women with suspected COVID-19 cases were recruited for this study. This consist of 62 COVID-19 cases (43.9%) and 79 non-COVID-19 pregnant women (56.1%). The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of each parameter are as follow: clinical sign and symptoms (24.19%, 75.95%, 3.92%, 96.11%, 65.87%), rapid antibody test (72.73%, 35.06%, 4.35%, 96.94%, 36.53%), chest X-ray (40.68%, 59.45%, 3.92%, 96.11%, 58.76%), and NLR >5.8 (41.38%, 72%, 5.66%, 96.80%, 70.81%). The use of combined screening methods can classify pregnant women with high-risk COVID-19 before definitively diagnosed with RT-PCR. This practice will help to reduce RT-PCR need in a limited resources country.

Hybrid-based framework for COVID-19 prediction via federated machine learning models.

The COronaVIrus Disease 2019 (COVID-19) pandemic is unfortunately highly transmissible across the people. In order to detect and track the suspected COVID-19 infected people and consequently limit the pandemic spread, this paper entails a framework integrating the machine learning (ML), cloud, fog, and Internet of Things (IoT) technologies to propose a novel smart COVID-19 disease monitoring and prognosis system. The proposal leverages the IoT devices that collect streaming data from both medical (e.g., X-ray machine, lung ultrasound machine, etc.) and non-medical (e.g., bracelet, smartwatch, etc.) devices. Moreover, the proposed hybrid fog-cloud framework provides two kinds of federated ML as a service (federated MLaaS); (i) the distributed batch MLaaS that is implemented on the cloud environment for a long-term decision-making, and (ii) the distributed stream MLaaS, which is installed into a hybrid fog-cloud environment for a short-term decision-making. The stream MLaaS uses a shared federated prediction model stored into the cloud, whereas the real-time symptom data processing and COVID-19 prediction are done into the fog. The federated ML models are determined after evaluating a set of both batch and stream ML algorithms from the Python’s libraries. The evaluation considers both the quantitative (i.e., performance in terms of accuracy, precision, root mean squared error, and F1 score) and qualitative (i.e., quality of service in terms of server latency, response time, and network latency) metrics to assess these algorithms. This evaluation shows that the stream ML algorithms have the potential to be integrated into the COVID-19 prognosis allowing the early predictions of the suspected COVID-19 cases.

Computed tomography findings in 3,557 COVID-19 infected children: a systematic review.

Although it was assumed in the early stages of the coronavirus disease 2019 (COVID-19) outbreak that the novel coronavirus infection was uncommon among children, the number of infected children has since been increasing significantly. Real-time polymerase chain reaction (RT-PCR) is the gold standard modality for the diagnosis of COVID-19 infection. In adults, chest CT is performed as an adjunct for identifying suspected COVID-19 cases along with patients' management and follow-up. However, CT findings in COVID-19 children studies have shown a diverse incidence of abnormal CT and finding patterns that made CT scan necessity to have remained controversial. The aim of the present review was to comprehensively determine the imaging findings of chest CT scans of confirmed COVID-19-infected pediatric patients through a systematic review of the available published studies. A systematic literature search was performed in the PubMed, Embase, Scopus, and Web of Science core collection databases (four databases including SSCI, SCIE, AHCI, and ESCI) to find original articles containing chest CT findings in children with COVID-19 through May 7, 2021. This review included 81 articles published in English that in total included 3,557 pediatric patients. This review included 81 articles published in English that in total included 3,557 pediatric patients. Among the total confirmed coronavirus-infected cases (via RT-PCR test), two-thirds had abnormal chest CT findings; among these patients, 549 (37.8%) had bilateral lung involvement, and 475 (32.7%) had unilateral disease. Regarding the types of lung lesions, ground glass opacities were observed in 794 (54.7%) of patients, and consolidation was observed in 10.2%; moreover, halo sign, discrete pulmonary nodules, interstitial abnormalities or reticulations, and vascular thickening shadows were reported in 7.4%, 2.6%, 9.7% and 1.7% of the patients, respectively. This review revealed that chest CT scan manifestations in majority of COVID-19 positive children are mild, so regarding the risk of radiation exposure, it is reasonable to confine CT scan to individual cases that its benefits outweigh the risks.

Diagnostic value of white blood cell parameters for COVID-19: Is there a role for HFLC and IG?

IntroductionAs the Coronavirus disease 2019 (COVID‐19) pandemic is still ongoing with patients overwhelming healthcare facilities, we aimed to investigate the ability of white blood cell count (WBC) and their subsets, high fluorescence lymphocyte cells (HFLC), immature granulocyte count (IG), and C‐reactive protein (CRP) to aid diagnosis of COVID‐19 during the triage process and as indicators of disease progression to serious and critical condition.MethodsWe collected clinical and laboratory data of patients, suspected COVID‐19 cases, admitted at the emergency department of University General Hospital of Ioannina (Ioannina, Greece). We selected 197 negative and 368 positive cases, confirmed by polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2. COVID‐19 cases were classified into mild, serious, and critical disease. Receiver operating characteristic curve and binary logistic regression analysis were utilized for assessing the diagnosing ability of biomarkers.ResultsWBC, neutrophil count (NEUT), and HFLC can discriminate efficiently negative cases from mild and serious COVID‐19, whereas eosinopenia and basopenia are early indicators of the disease. The combined WBC‐HFLC marker is the best diagnostic marker for both mild (sensitivity: 90.6% and specificity: 64.1%) and serious (sensitivity: 90.3% and specificity: 73.4%) disease. CRP and Lymphocyte count are early indicators of progression to serious disease whereas WBC, NEUT, IG, and neutrophil‐to‐lymphocyte ratio are the best indicators of critical disease.ConclusionLymphopenia is not useful in screening patients with COVID‐19. HFLC is a good diagnostic marker for mild and serious disease either as a single marker or combined with WBC whereas IG is a good indicator of progression to critical disease.

The Experience of the Fight Against COVID-19 in Clinical Laboratory Departments from Chengdu, China.

ObjectiveIn order to fight against coronavirus disease 2019 (COVID-19) better and to share our experience as a reference for clinical laboratory departments.MethodsThis was a retrospective study conducted in the clinical laboratory department of Chengdu Women’s and Children’s Central Hospital in Chengdu, China, from April 2020 to January 2021. The number of nucleic acid and antibody testing specimens of suspected COVID-19 cases was analyzed. The key points of suspected-case sample processing and detection in the clinical laboratory department were summarized. The laboratory was directly involved in the sample processing and testing of suspected cases, the release of reports, and the transfer of specimens to the fever clinic.ResultsThe number of COVID-19 nucleic acid test specimens in our laboratory ranged from 102 to 2170 per day, and the number of antibody test specimens ranged from 24 to 391 per day. There were four main considerations in the treatment and detection of suspected-case specimens in the clinical laboratory: biosafety management in clinical laboratory departments, measures to ensure the health of the staff, the eight time points for processing suspected-case samples (turn-around time), and key points for the detection of suspected case specimens.ConclusionThe laboratory developed a protective process for COVID-19 antibody and nucleic acid detection during the pandemic. At present, the detection of COVID-19 antibodies and nucleic acids in the clinical laboratory department is orderly, and there have been no cases of laboratory infection.

COVID-19 Pandemic: Impact on Admission, Diagnosis, and Treatment of Non-COVID-19 Patients Admitted to SARI ICU

ABSTRACTBackground: Coronavirus disease 2019 (COVID-19) pandemic has caused a huge burden on healthcare services worldwide, severely affecting the management of non-COVID-19 patients as well. The Government of India has updated guidelines for the clinical management of COVID-19 illness, including severe acute respiratory infections (SARI) definition for triaging suspected COVID-19 cases in an isolated intensive care unit (ICU). The aim of this study was to estimate the adherence of clinicians in triaging COVID-19 suspects as per SARI definition to SARI ICU. This study also observed the impact of such triaging on admission, diagnosis, and treatment process of non-COVID-19 patients admitted to SARI ICU.Patients and methods: This cross-sectional study was conducted in a designated SARI ICU of two tertiary care medical college hospitals involving 78 patients from the month of June to July 2020. Data related to demographics, the severity of illness, advanced life supports, delay in diagnosis, intervention, and treatment of patients in SARI ICU due to suspected COVID-19 status were documented.Results: Adherence to SARI definition for triaging COVID-19-suspect cases was 19.2%. Despite hindrance in diagnosis (17.9%) and treatment (12.8%), mortality among patients in SARI ICU was limited to 14.10%. Results were insignificant when checked for various factors associated with mortality.Conclusion: Nonadherence to SARI definition may lead to undue delay in diagnosis, intervention, and treatment of non-COVID-19 cases. This may result in increased morbidity, mortality, and economic burden on patients and the healthcare system.key message: A rationale and just utilization of healthcare resources are need of the hour in the face of an enormous volume of SARI cases during COVID-19 pandemic. SARI criteria as implemented by the Ministry of Health and Family Welfare (MOHFW), Government of India, are a very important tool in triaging of COVID-19-suspect cases. Adequate measures should be in place in order to mitigate the inadequacies and deficiencies in the treatment of non-COVID-19 cases, which have occurred as a result of COVID-19 pandemic.How to cite this article: Arunachala S, Venkatesh BT, Bhatt MT, Puranik A, Rao S, Ravindranath S. COVID-19 Pandemic: Impact on Admission, Diagnosis, and Treatment of Non-COVID-19 Patients Admitted to SARI ICU. Indian J Crit Care Med 2021;25(8):853–859.

COVID-19: a Disease with a Potpourri of Histopathologic Findings-a Literature Review and Comparison to the Closely Related SARS and MERS.

Since the coronavirus disease 2019 (COVID-19) pandemic has hit the entire world, there is ample knowledge regarding its clinical course and prognostic biomarkers. Still, the pathophysiology of COVID-19 is poorly understood. Since the first guidelines published in February 2020 for autopsy of both confirmed and suspected COVID-19 cases, there has been an increasing number of autopsies and literature reporting histopathological findings. However, our knowledge about the immunological response of various organ systems to the virus, as well as response patterns, is inadequate but is essential to understand and initiate timely and targeted antiviral, anti-inflammatory, or anticoagulative therapy. Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is primarily considered a respiratory virus, current evidence shows that it causes life-threatening complications in almost all organ systems including the heart, brain, kidney, spleen, liver, and eyes. Hence, in this article, we reviewed the published case reports and case series in order to increase our understanding of COVID-19 pathophysiology. The main histopathological findings of the lungs include diffuse alveolar damage with activated type II pneumocytes, fibroblasts, protein-rich exudate, and hyaline membranes. Other significant histopathological findings include cardiomegaly, right ventricular dilation, splenic pulp atrophy, kidneys with severe podocytopathy, and collapsing glomerulopathy, and the brain showed hypoxic changes in the cerebellum and cerebrum. Furthermore, in this review, we also explained different pathological findings of SARS-CoV and MERS and compared them to SARS-CoV-2. This comprehensive review will improve our understanding of COVID-19 pathophysiology and various disease stages, hence promoting the application of targeted therapy.

Providing care in isolation while awaiting SARS-CoV-2 test results: Considering differential diagnoses and avoiding anchoring bias.

Isolation of confirmed or suspected coronavirus disease 2019 (COVID-19) cases is essential but, as symptoms of COVID-19 are non-specific and test results not immediately available, case identification at admission remains challenging. To inform optimization of triage algorithms, patient flow and patient care, we analyzed characteristics of patients admitted to an isolation ward, both severe acute respiratory syndrome coronavirus 2019 (SARS-CoV-2) positive patients and patients in which initial suspicion was not confirmed after appropriate testing.Data from patients with confirmed or suspected COVID-19 treated in an isolation unit were analyzed retrospectively. Symptoms, comorbidities and clinical findings were analyzed descriptively and associations between patient characteristics and final SARS-CoV-2 status were assessed using univariate regression.Eighty three patients (49 SARS-CoV-2 negative and 34 positive) were included in the final analysis. Of initially suspected COVID-19 cases, 59% proved to be SARS-CoV-2-negative. These patients had more comorbidities (Charlson Comorbidity Index median 5(interquartile range [IQR] 2.5, 7) vs 2.7(IQR 1, 4)), and higher proportion of active malignancy than patients with confirmed COVID-19 (47% vs 15%; P = .004), while immunosuppression was frequent in both patient groups (20% vs 21%; P = .984). Of SARS-CoV-2 negative patients, 31% were diagnosed with non-infectious diseases.A high proportion of patients (59%) triaged to the isolation unit were tested negative for SARS-CoV-2. Of these, many suffered from active malignancy (47%) and were immunosuppressed (20%). Non-infectious diseases were diagnosed in 31%, highlighting the need for appropriate patient flow, timely expert medical care including evaluation for differential diagnostics while providing isolation and ruling out of COVID-19 in these patients with complex underlying diseases.

Metabolomics in the Diagnosis and Prognosis of COVID-19.

Coronavirus disease 2019 (COVID-19) pandemic triggered an unprecedented global effort in developing rapid and inexpensive diagnostic and prognostic tools. Since the genome of SARS-CoV-2 was uncovered, detection of viral RNA by RT-qPCR has played the most significant role in preventing the spread of the virus through early detection and tracing of suspected COVID-19 cases and through screening of at-risk population. However, a large number of alternative test methods based on SARS-CoV-2 RNA or proteins or host factors associated with SARS-CoV-2 infection have been developed and evaluated. The application of metabolomics in infectious disease diagnostics is an evolving area of science that was boosted by the urgency of COVID-19 pandemic. Metabolomics approaches that rely on the analysis of volatile organic compounds exhaled by COVID-19 patients hold promise for applications in a large-scale screening of population in point-of-care (POC) setting. On the other hand, successful application of mass-spectrometry to detect specific spectral signatures associated with COVID-19 in nasopharyngeal swab specimens may significantly save the cost and turnaround time of COVID-19 testing in the diagnostic microbiology and virology laboratories. Active research is also ongoing on the discovery of potential metabolomics-based prognostic markers for the disease that can be applied to serum or plasma specimens. Several metabolic pathways related to amino acid, lipid and energy metabolism were found to be affected by severe disease with COVID-19. In particular, tryptophan metabolism via the kynurenine pathway were persistently dysregulated in several independent studies, suggesting the roles of several metabolites of this pathway such as tryptophan, kynurenine and 3-hydroxykynurenine as potential prognostic markers of the disease. However, standardization of the test methods and large-scale clinical validation are necessary before these tests can be applied in a clinical setting. With rapidly expanding data on the metabolic profiles of COVID-19 patients with varying degrees of severity, it is likely that metabolomics will play an important role in near future in predicting the outcome of the disease with a greater degree of certainty.

Whole-Genome Sequencing: The Key to Unlocking a Nosocomial Outbreak of Coronavirus Disease 2019 (COVID-19)

Background: Accurately tracing nosocomial transmission of coronavirus disease 2019 (COVID-19) is critical to developing effective infection prevention policies. Given the high prevalence and variable incubation period of SARS-CoV-2 infection, the utility of traditional contact tracing is limited. We describe a nosocomial outbreak in which whole-genome sequencing (WGS) was pivotal to identifying the primary case. Methods: This study was conducted at a New York City academic hospital. The index case was identified on August 13, 2020, and the last case on September 9, 2020. Hospital policy required all inpatients to be screened for COVID-19 on admission by SARS-CoV-2 molecular amplification testing. All healthcare workers (HCWs) were required to wear masks and eye protection for patient care. After a patient (patient 1), who tested SARS-CoV-2 negative on admission, was positive on preprocedure screening on hospital day 9, contact tracing was initiated. Two patients (patients 2 and 3) and 13 HCWs with high-risk exposures (HREs) to patient 1 were quarantined and referred for testing. Additional surveillance testing was performed on 18 inpatients and 84 HCWs on the affected unit. Patients 2 and 3 and 3 HCWs (HCW-1, -2, and -3), only 1 of whom had a high-risk exposure to patient 1, tested positive. WGS was performed to further investigate this outbreak. Results: The outbreak variant (clade 20A) was found in samples from 6 patients and 2 HCWs. Patients 2 and 3 were roommates of patient 1 in the 2 days before patient 1’s positive test, and they did not consistently wear masks in the room. HCW-1 placed a peripheral IV in patient 1 the day before patient 1’s positive test without wearing eye protection. Four additional cases in this cluster (patients 4–6 and HCW-4) were identified by surveillance WGS of positive tests. A review indicated that patient 1 was located ~3 m (~10 feet) away from patient 4 in the emergency department (ED) for 6 hours on hospital day 1, when the admission SARS-CoV-2 test from patient 4 was not positive. No epidemiologic link was found to patient 5 or 6 or HCW-4. The specimen from HCW-2 was inadequate for WGS. The specimen from HCW-3 was not linked to this cluster. Conclusions: This complex nosocomial outbreak highlights the importance of WGS in understanding transmission events. Patient 4 was not identified by traditional contact tracing but was linked to patient 1 and was recognized as the primary case through WGS, having likely infected patient 1 in the ED. Based on these findings, we focused our corrective actions on more promptly isolating suspected COVID-19 cases in the ED, increasing inpatient masking, and improving HCW adherence to universal eye protection.Funding: NoDisclosures: None