Suspected COVID-19 Research Articles

Suspected COVID-19 Immunization-Induced Probable Catastrophic Antiphospholipid Syndrome

In this report, we describe the case of a woman with suspected COVID-19 immunization-induced probable catastrophic antiphospholipid syndrome. The patient is a 35-year-old female with a past medical history significant for antiphospholipid syndrome, not on anticoagulation, who presented with a 5-day history of abdominal pain and distention, nausea, vomiting, and shortness of breath. She had received her first dose of the Pfizer COVID-19 vaccine one day prior to the onset of symptoms. After extensive workup at an outside hospital, she was found to be in acute heart failure exacerbated by severe mitral and tricuspid regurgitation. She was transferred to our hospital for escalation of care. EKG showed evidence of prior inferior and septal myocardial infarction. Transesophageal echocardiogram (TEE) showed reduced ejection fraction, severe mitral and tricuspid regurgitation, and a left ventricular thrombus. Cardiac MRI showed subendocardial late gadolinium enhancement indicative of ischemia. However, CTA of the coronary vessels showed no signs of obstruction. Therefore, her acute heart failure was thought to be due to small vessel thrombosis secondary to antiphospholipid syndrome. During admission, she had several absence seizure-like episodes. CT head showed several hypodensities of the deep white matter and brain MRI demonstrated multiple hyperintense T2 FLAIR signal foci with restriction diffusion and enhancement involving the cerebral hemisphere, consistent with subacute strokes attributed to being secondary to antiphospholipid syndrome or embolic from the left ventricular thrombus. She was treated with heparin for suspected catastrophic antiphospholipid syndrome and high-dose corticosteroid therapy for concomitant Systemic Lupus Erythematosus (SLE). She was discharged in a stable condition.

Comparable Detection of SARS-CoV-2 in Sputum and Oropharyngeal Swab Samples of Suspected COVID-19 Patients

The accurate detection of SARS-CoV-2 through respiratory sampling is critical for the prevention of further transmission and timely initiation of treatment. There is a diverse range of SARS-CoV-2 detection rates in reported studies, with uncertainty regarding the optimal sampling method for COVID-19 diagnosis and monitoring. Oropharyngeal sampling (OPS) is one of the most commonly used methods of respiratory sampling in Ghana and other parts of the world for the detection of SARS-CoV-2 viral RNA. However, this sampling technique has a number of drawbacks, which include difficulty in obtaining high-quality swab samples, increased risk of infection to healthcare workers, and increased cost from a regular supply of swabs, transport media, and personal protective equipment (PPE). This study, therefore, sought to evaluate the diagnostic performance of sputum specimens in the diagnosis of COVID-19. This was a cross-sectional analytical study conducted in two health facilities in Kumasi, Ghana, between April and September 2021. Paired samples (an oropharyngeal swab and sputum) were taken from each recruited patient and run concurrently for the detection of SARS-CoV-2 genes (the N and ORF1ab genes) using RT-qPCR. Of the 317 patients recruited, 50.8% were males, and 60.4% were young adults aged 20–39 years. A significant proportion (65.9%) of the patients did not have any co-morbidity, and the majority were with symptoms; predominantly cough (36.3%), headache (31.5%), general weakness (24.0%), fever (20.2%), and sore throat (16.1%). Being symptomatic (p = 0.003), having comorbidity (p = 0.001), and the reporting facility (p = 0.010) were significantly associated with the COVID-19 status. The sputum samples yielded more COVID-positive, 120/317 (37.9%), as compared to OPS, 83/317 (26.2%). The sputum samples were 85.5% (95% CI, 76.4–91.5) sensitive, 79.1% (95% CI, 73.4–83.7) specific, and with positive and negative predictive values of 59.2% and 93.9%, respectively, when compared with OPS. The overall median of the SARS-CoV-2 viral loads for sputum (3.70 × 103 copies/mL) were significantly higher than in OPS (1.18 × 102 copies/mL) (p = 0.003). Findings from the study suggest self-collected sputum as a useful alternative to OPS for the diagnosis of COVID-19, providing a comparable diagnostic performance and, thereby, easing the uncomfortable process and mitigating risk of aerosol transmission to healthcare workers.

The Associations of Suspected COVID-19 Symptoms with Anxiety and Depression as Modified by Hemodialysis Dietary Knowledge: A Multi-Dialysis Center Study.

During the COVID-19 pandemic, it is essential to evaluate hemodialysis patients’ dietary knowledge, especially among those with COVID-19 related symptoms, in order to identify appropriate strategies in managing their mental health. The study’s purposes were to test the psychometric properties of the hemodialysis dietary knowledge (HDK) scale, and to investigate the modifying impact of HDK on the associations of suspected COVID-19 symptoms (S-COVID-19-S) with anxiety and depression among hemodialysis patients. A cross-sectional study was conducted from July 2020 to March 2021 at eight hospitals across Vietnam. Data of 875 hemodialysis patients were analyzed, including socio-demographic, anxiety (the generalized anxiety disorder scale, GAD-7), depression (the patient health questionnaire, PHQ-9), S-COVID-19-S, HDK, health literacy, and digital healthy diet literacy. Confirmatory factor analysis (CFA) and logistic regression models were used to analyze the data. The HDK scale demonstrates the satisfactory construct validity with good model fit (Goodness of Fit Index, GFI = 0.96; Adjusted Goodness of Fit Index, AGFI = 0.90; Standardized Root Mean Square Residual, SRMR = 0.05; Root Mean Square Error of Approximation, RMSEA = 0.09; Normed Fit Index, NFI = 0.96; Comparative Fit Index, CFI = 0.96, and Parsimony goodness of Fit Index, PGFI = 0.43), criterion validity (as correlated with HL (r = 0.22, p < 0.01) and DDL (r = 0.19, p < 0.01), and reliability (Cronbach alpha = 0.70)). In the multivariate analysis, S-COVID-19-S was associated with a higher likelihood of anxiety (odds ratio, OR, 20.76; 95% confidence interval, 95%CI, 8.85, 48.70; p < 0.001) and depression (OR, 12.95; 95%CI, 6.67, 25.14, p < 0.001). A higher HDK score was associated with a lower likelihood of anxiety (OR, 0.70; 95%CI, 0.64, 0.77; p < 0.001) and depression (OR, 0.72; 95%CI, 0.66, 0.79; p < 0.001). In the interaction analysis, the negative impacts of S-COVID-19-S on anxiety and depression were mitigated by higher HDK scores (p < 0.001). In conclusion, HDK is a valid and reliable tool to measure dietary knowledge in hemodialysis patients. Higher HDK scores potentially protect patients with S-COVID-19-S from anxiety and depression during the pandemic.

An Automated System for the Classification of COVID-19, Suspected COVID-19 and Healthy Lung CT Images based on Local Binary Pattern and Deep Learning Features

Because of the inadequate capacity and a substantial surge of probable COVID-19 cases, several health systems around worldwide have collapsed. As a result, the requirement for a rapid, effective, and precise way to reduce radiologists' workload in diagnosing suspected instances has arisen. The goal of the present study is to develop a novel system to automatically diagnose and classify lung CT scans into three categories: suspected covid-19, covid-19, and healthy lung scans. Before feature extraction using convolutional neural network (CNN) and Local Binary Pattern (LBP) approaches, the CT scans are first pre-processed through implementing a set of algorithms. Lastly, with the use of the support vector machine (SVM) model, such features are divided into three groups. The maximum accuracy attained in classifying a dataset of 351 CT scans of the lungs was 98.22%. The outcomes of the experiments show that merging the extracted features increases the effectiveness of lung classification CT scans.

Combined RT-PCR and Host Response Point-of-Care Testing in Patients Hospitalised with Suspected COVID-19: A Prospective Diagnostic Accuracy Study.

IntroductionRT-PCR has suboptimal sensitivity for the diagnosis of COVID-19. A composite reference standard comprising RT-PCR plus radiological and clinical features has been recommended for diagnostic accuracy studies. The FebriDx finger prick point-of-care test detects an antiviral host response protein (MxA) in 10 min. We evaluated the diagnostic accuracy of FebriDx and RT-PCR compared to a composite reference standard.MethodsAdults presenting to hospital with suspected COVID-19 were tested by FebriDx and RT-PCR. A composite reference standard was used to classify patients as having COVID-19 based on RT-PCR positivity, or RT-PCR negativity with COVID-19 radiological findings or other clinical criteria. Measures of accuracy were calculated for MxA alone, RT-PCR alone, and both combined. This study is registered with the ISRCTN (ISRCTN14966673) and has completed.ResultsA total of 478 patients were tested, with valid results in 475. Of these 475 patients, 222 (46.7%) were classified as having COVID-19; 192 (40.4%) were RT-PCR positive, and 30 (6.3%) were RT-PCR negative and diagnosed on radiological/clinical criteria. Sensitivity of FebriDx MxA vs the composite reference standard was 186/222 (83.8%, 95% CI 78.3–88.4) and was similar to the sensitivity of RT-PCR (192/222 (86.5%, 95% CI 81.3–90.7), (difference of 2.7%, 95% CI − 3.9 to 9.3, p = 0.42). The sensitivity of combined FebriDx and RT-PCR was 208/222 (93.7%) which was superior to both RT-PCR alone (difference of 9.9, 95% CI 4.1–15.9; p = 0.001) and FebriDx MxA alone (difference of 7.2, 95% CI 1.6–12.9; p = 0.011).ConclusionSensitivity of combined FebriDx and RT-PCR testing was superior to each alone for the detection of COVID-19 in hospital and may improve infection control and treatment decisions.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40121-022-00646-4.

Streamlining Patient Management of Suspected COVID-19 Patients in the Emergency Department: Incorporation of Pulmonary CT Angiography into the Triaging Algorithm.

Purpose: To evaluate the use of pulmonary computed tomography (CT) angiography during initial admission at an emergency department (ED), to identify COVID-19 patients with accompanying pulmonary embolism (PE) and its impact on clinical management. Methods: We performed a retrospective analysis of COVID-19 patients that underwent pulmonary CT angiography at the ED. CT scans were evaluated for the presence and extent of PE and for imaging changes suspicious of COVID-19. Patients were subdivided into two groups: (1) Group A consisted of patients with proven COVID-19 based on real-time polymerase chain reaction (RT-PCR), and (2) Group B of patients suspected for COVID-19, comprising patients positive on RT-PCR and/or COVID-19-suspicious CT findings. To assess the differences between patients with and without pulmonary embolism, Fisher’s exact test was used. Results: A total of 308 patients were admitted to the ED for diagnostic work-up of dyspnea and suspected COVID-19, and 95 patients underwent pulmonary CT angiography. PE was detected in 13.6% (3/22) of patients in Group A and 20.7% (6/29) in Group B. No significant differences were observed between patients with and without PE concerning hospitalization (Group B: 100% (6/6) vs. 91.3% (21/23)), the necessity of oxygen therapy (Group B: 66% (4/6) vs. 43.5% (10/23)), and death (Group B: 33% (2/6) vs. 4.3% (1/23) p > 0.05, respectively). Conclusions: In 20.7% of COVID-19 patients, PE was detected upon admission to the ED. Although the incorporation of early pulmonary CT angiography in patients suspicious of COVID-19 may be beneficial to identify concomitant PE, further studies are necessary to corroborate these findings.

Exploring Demographic Properties and Amplification Efficiency of N and ORF-1ab Gene in Suspected COVID-19 Patients in Dhaka, Bangladesh

Background: In late December 2019, an outbreak of pneumonia with an unknown cause occurs in Wuhan, China. Later, the causative agent was identified as SARS-CoV-2. Early laboratory diagnosis plays an important role in any outbreak by cutting the spread of infection by isolating the infected person. Nucleic acid detection via PCR remains the gold standard because no alternative scientific method for detecting SARS-CoV-2 is available. Objective: The goal of this study was to learn more about the demographic characteristics of SARS-CoV-2-affected people and the sensitivity pattern of the N &amp; ORF-1ab gene among them. Methods: A swab from the nasopharynx for nucleic acid detection was collected from 3183 SARS-CoV-2 suspected cases attending outdoors and indoors at Aichi Hospital and Japan East-West Hospital. Results: 649 (20.4%) were found PCR positive. Among the positive cases, the male was 478 (73.7%) and the female was 171 (26.3%), mean age was 40.35 ± 14.551 years, ranging from 4 – to 90 years. The highest prevalence of SARS-CoV-2 was identified in the 21–40 years old group (50.7%), followed by the 41–60 years old group (33.1%). The N gene was found to be 100% positive and ORF-1ab was 22.03% positive. Conclusion: According to the findings of this study, males and younger generations are at an elevated risk of contracting the virus, and maybe a source of infection for other family members. According to this study, the N gene has higher sensitivity and amplification efficiency than ORF-1ab. Update Dent. Coll. j: 2022; 12(1): 27-31

Medicolegal Autopsy, Collection and Submission of Postmortem Specimens from Deceased Persons with Known or Suspected COVID-19

WHO declared COVID-19 a global pandemic on 11th March, 2020. The heightened fear regarding COVID-19 is a result of many things. It is a new pathogen with some unknown characteristics, and misinformation is all over the news and social media. In this pandemic situation, to combat any known or unknown biohazard risk associated with medicolegal autopsy, handling autopsy specimens, each section of the diagnostic procedure and laboratory processes have some specific guidelines for handling infectious agents like spread of SARS-CoV-2 that convey excessive risk for exposure and possible infection and/or occupational injury. These risks typically are associated with design flaws or lack of or inadequacy of safety procedures and training. However, we still lack a concrete guideline in our country on medicolegal autopsy, collection and submission of postmortem specimens from deceased persons with known or suspected covid-19 cases during this pandemic situation. This review aims to provide some evidence-based recommendations for biosafety and infection control practices during autopsy procedures, specimen collection, handling and submission for biochemical and toxicological analysis. The guidance can be followed by coroners, forensic investigators, biochemist and pathologist as well as other workers involved in postmortem service and respective authority/department. Mediscope 2022;9(1): 41-46

Breastfeeding/Breast Milk Safety in Infants of Mothers with Suspected or Confirmed COVID-19 Infection.

The purpose of this systematic review was to determine whether suspected or confirmed COVID-19 infected mothers in the lactation period can breastfeed their infants; and whether suspected or confirmed COVID-19 infected mothers can breastfeed their infants by taking some precautions. The study also aimed to present the measures that can be taken in line with the evidence. The studies conducted after November 2019 and including infants of suspected or confirmed COVID-19 infected mothers were reviewed between 2019 and 2020. A literature review was conducted in five electronic databases (MEDLINE, PubMed, ScienceDirect, Web of Science, and Scopus) to reach original quantitative studies in English. The present authors retrieved 46 of the 1,229 studies included after screening. Three studies were cross-sectional studies, 30 were case studies, and 13 were cohorts. In most of the sources examined, it was concluded that most of the breastfed infants had negative findings for SARS-Cov-2 infection in PCR. In line with the limited data available, it was concluded that most of the breastfed infants had negative findings for SARS-Cov-2 infection in PCR; and breastfeeding mothers should initiate breastfeeding by taking protective measures. Key Words: Breastfeeding, COVID-19, Suspected COVID-19 infected mothers, Confirmed COVID-19 infected mothers.

A Cross-sectional Study of Clinical and Chest CT Images of Suspected COVID-19 Patients Admitted at a Tertiary Care Hospital

A Cross-sectional Study of Clinical and Chest CT Images of Suspected COVID-19 Patients Admitted at a Tertiary Care Hospital

A Cross-sectional Study of Clinical and Chest CT Images of Suspected COVID-19 Patients

A Cross-sectional Study of Clinical and Chest CT Images of Suspected COVID-19 Patients

Evaluation of Swab Diagnostic Performance for Suspected Covid-19 Patients Using ID NOW

Evaluation of Swab Diagnostic Performance for Suspected Covid-19 Patients Using ID NOW

Left Ventricular Apical Mass with Normal Ejection Fraction in a Suspected COVID-19 Patient Suffering from Acute Ischemic Stroke.

Left Ventricular Apical Mass with Normal Ejection Fraction in a Suspected COVID-19 Patient Suffering from Acute Ischemic Stroke.

Suspected COVID-19 Cases Admitted in a Tertiary Care Hospital. Correlation of Demographic and Clinical Characteristics with Viral Load Results and Hospitalization

Background: The current pandemic outbreak of COVID-19 due to the SARS-CoV-2 virus affected the health care systems, health services and economy globally. It also affected the health of the population worldwide, with high mortality and morbidity rates. The present study aimed to study the patients that were admitted to a tertiary care hospital and to investigate the potential correlation between hospitalization and RT-PCR for SARS-CoV-2 results with demographic characteristics and clinical characteristics. Moreover, it aimed to examine a mathematical formula that might describe the correlation of the aforementioned parameters.&#x0D; Methods: The study population included 1244 patients admitted to the Nikea General Hospital "Agios Panteleimon", Piraeus, Greece. Patient age, gender, underlying diseases, travel history, symptoms, etiology for hospital admission and contact with confirmed cases were recorded. Potential correlation of hospitalization and RT-PCR for SARS-CoV-2 results with the aforementioned characteristics were identified by chi-square test of independence and logistic regression analysis.&#x0D; Results: We observed significant correlation of hospitalization with fever, cough, dyspnea, pneumonia, travel history and etiology for hospital admission. We observed significant correlation of RT-PCR for SARS-CoV-2 results with rapid antigen test result, hospitalization etiology for hospital admission and contact with confirmed COVI-19 case.&#x0D; Conclusions: According to the logistic regression model, RT-PCR for SARS-CoV-2 result, fever, dyspnea, pneumonia, and underlying disease are the most important predictors for hospitalization in the population under study. Contact with confirmed COVID-19 case is the most important predictor for RT-PCR for SARS-CoV-2 result.

Clinical and Laboratory Features of PCR-Confirmed and Clinically Suspected COVID-19 Pediatric Patients: A Single Hospital-Based Experience During the First COVID-19 Wave in the United Arab Emirates

ObjectiveThis study investigated clinical and laboratory differences between confirmed (RT-PCR-positive) and clinically suspected (RT-PCR-negative) COVID-19 pediatric patients, and explored factors associated with disease severity at presentation and duration of hospitalization.MethodsMedical charts of COVID-19-confirmed and clinically suspected pediatric patients admitted to a tertiary hospital in Abu Dhabi were reviewed. Sociodemographic information and clinical and laboratory outcomes were retrieved and analyzed.ResultsBetween 1 April to 30 June, 2020, 173 patients (mean age: 3.6 ± SD 3.2 years) presented with respiratory symptoms. Of them, 18.0% had confirmed contact with COVID-19 cases, 66.5% had symptoms for ≤3 days, and 86.7% were with moderate to severe disease. Twenty-eight (16.1%) patients tested positive while the rest (83.8%) tested negative in RT-PCR. COVID-19-confirmed and clinically suspected patients were statistically similar (p > 0.05) in all sociodemographic data, disease severity, and vital signs except residence status (89.3% vs. 58.6% were residents, respectively, p = 0.002) and contact with confirmed COVID-19 cases (82.1% vs. 5.5%, respectively, p < 0.001). Fever (100 and 91.0%) and cough (100 and 95.9%) were the most common symptoms in both confirmed and clinically suspected COVID-19 patients. All patients were statistically comparable in mean white blood cell and platelet counts and hemoglobin concentration, except in mean concentration of neutrophils (higher in clinically suspected, p = 0.019). C-reactive protein was two times higher in clinically suspected compared to confirmed patients (p = 0.043). Lymphocyte (OR: 1.31, p < 0.001), LDH (OR: 1.01, p = 0.001), D-dimer (OR: 1.92, p < 0.001), and ferritin levels after 24–36 h (OR: 9.25, p < 0.05), and SGPT (OR: 1.04, p < 0.05) were all associated with disease severity. Elevated ferritin (>300 μg/L) after 24–36 h was the only correlated factor with disease severity (aOR: 17.38, p < 0.05). Confirmed compared with clinically suspected patients (aOR: 4.00, 95% CI: 2.92–5.10) and children with moderate compared with mild disease (aOR: 5.87, 95% CI: 1.08–32.06) had longer hospitalization.ConclusionIn pediatric patients with negative RT-PCR, COVID-19 is still suspected based on clinical symptoms and epidemiological data. A tentative diagnosis can be made based on a thorough examination, and proper medical management can be initiated promptly.

Chest CT Scan Involvement Patterns in Patients with Suspected Covid-19 Symptoms

Chest CT Scan Involvement Patterns in Patients with Suspected Covid-19 Symptoms

Intelligent IoT (IIoT) Device to Identifying Suspected COVID-19 Infections Using Sensor Fusion Algorithm and Real-Time Mask Detection Based on the Enhanced MobileNetV2 Model.

This paper employs a unique sensor fusion (SF) approach to detect a COVID-19 suspect and the enhanced MobileNetV2 model is used for face mask detection on an Internet-of-Things (IoT) platform. The SF algorithm avoids incorrect predictions of the suspect. Health data are continuously monitored and recorded on the ThingSpeak cloud server. When a COVID-19 suspect is detected, an emergency email is sent to healthcare personnel with the GPS position of the suspect. A lightweight and fast deep learning model is used to recognize appropriate mask positioning; this restricts virus transmission. When tested with the real-world masked face dataset (RMFD) dataset, the enhanced MobileNetV2 neural network is optimal for Raspberry Pi. Our IoT device and deep learning model are 98.50% (compared to commercial devices) and 99.26% accurate, respectively, and the time required for face mask evaluation is 31.1 milliseconds. The proposed device is useful for remote monitoring of covid patients. Thus, the method will find medical application in the detection of COVID-19-positive patients. The device is also wearable.

Interfacility Transport of Mechanically Ventilated Patients with Suspected COVID-19 in the Prone Position

Objective Prone positioning during mechanical ventilation in patients with severe respiratory failure is an important intervention with both physiologic and empiric rationale for its use. This study describes a consecutive cohort of patients with severe hypoxemic respiratory failure due to COVID-19 who were transported in the prone position in order to determine the incidence of serious adverse events (SAEs) during transport. Methods This retrospective study used prospectively collected data from a provincial air and land critical care transport system where specially trained critical care paramedic crews transported intubated and mechanically ventilated patients with COVID-19 in the prone position. SAEs were determined a priori, and included markers of new hemodynamic or respiratory instability, new resuscitative measures, and equipment or vehicle malfunction. Two authors independently reviewed each patient care record to identify SAEs during transport, and the ability of the crews to successfully manage such events. Results From April 2020 to June 2021, 127 intubated and mechanically ventilated patients were transported in the prone position. Of these, 117 were transported by land vehicle, 7 by rotor-wing, and 3 by fixed wing aircraft. 67 (52.8%) were vasopressor-dependent, 5 (3.9%) were receiving inhaled vasodilators, 9 (7.1%) were hypoxic (SpO2 < 88%), and 3 (2.4%) were hypotensive (SBP < 90 or MAP < 65 mm Hg) when the transport crew made patient contact at the sending hospital. Of the 122 (96.1%) patients in which a pre-transport PaO2/FiO2 ratio was available, the mean (median; range) was 86.7 (81; 47–144), with 27 patients greater having a ratio greater than 100. The mean (median; range) transport time was 49 (45; 14–176) minutes. There were 19 SAEs in 18 (14.2%) patients during transport, the most common of which was new hypoxia requiring ventilator adjustments (15 of 18 patients). All SAEs were successfully managed by the transport crews. No patient experienced tracheal tube obstruction, unintentional extubation, cardiac arrest, or died during transport. Conclusion Patients with severe hypoxemic respiratory failure due to COVID-19 can be safely transported in the prone position by specially trained critical care paramedic crews.

Limited Additive Diagnostic Impact of Isolated Gastrointestinal Involvement for the Triage of Children with Suspected COVID-19.

The strategy for the selection of patients with a suspected SARS-CoV-2 infection is relevant for the organization of a children’s hospital to provide optimal separation into COVID-19 and non-COVID-19 areas and pathways. We analyzed the proportion of children with COVID-19 presenting with gastrointestinal (GI) symptoms in 137 consecutive patients admitted between January 2020 and August 2021. GI symptoms were present as follows: diarrhea in 35 patients (26%), vomiting in 16 (12%), and both of them in five (3%); the combination of fever, respiratory symptoms, and diarrhea was observed in 16 patients (12%). Of the 676 adult patients with COVID-19 admitted to our hospital in the same time interval, 62 (9.2%) had diarrhea, 30 (4.4%) had vomiting, and 11 (1.6%) had nausea; only one patient, a 38-year-old male, presented with isolated GI symptoms at the diagnosis. Although diarrhea was observed in one quarter of cases, one-half of them had the complete triad of fever, respiratory syndrome, and diarrhea, and only five had isolated diarrhea, of which two were diagnosed with a Campylobacter infection. The occurrence of either respiratory symptoms or gastrointestinal symptoms in our patients was not related to the patient age, while younger children were more likely to have a fever. Of the 137 patients, 73 (53%) could be tested for their serum level of SARS-CoV-2 specific IgG antibodies. The observed titer ranged between 0 (n = 3) and 1729 BAU/mL (median, 425 BAU/mL). Of 137 consecutive patients with COVID-19 admitted to our referral children’s hospital, only three presented with an isolated GI manifestation. It is interesting to note that this finding turned out to be fully in keeping with what was observed on adult patients with COVID-19 in our hospital. The additive diagnostic impact of gastrointestinal involvement for the triage of children with suspected COVID-19 appears limited.

The Diagnostic Accuracy and Prognostic Value of Lung ultrasound in Suspected COVID-19 a retrospective service evaluation.

We read with interest the paper from Knight et al in Acute Medicine1 in particular the use of a lung ultrasound (LUS) score to predict outcome in patients with suspected COVID-19. LUS has been shown to be useful in the diagnosis and prognosis for COVID-19 by other authors. We have carried out a service evaluation project on our data from East Surrey Hospital looking into prognostic and diagnostic performance of LUS in suspected COVID-19. In contrast to the data used by Knight et al we had discharge diagnosis data available which allowed us to split the cohort into patients with COVID-19 and patients with other diagnoses and compare the LUS score between the two groups.