bluuebunny/crossref_metadata_2025 huggingface dataset:
447. COVID-19 Prevalence Among COVID-19 Exposed Health Care Workers at a Tertiary Care Center in San Bernardino County, Ca
Authors: Valenzuela Kathleen Louise , Veltman Jennifer , Wilson April
Published: January 2021

Background

We studied the prevalence of positive SARS-CoV2 antibody and positive SARS-CoV2 antigen among high risk health care workers at Loma Linda University Health System (LLUHS) who voluntarily obtained SARS-CoV2 antibody testing, and if indicated, antigen testing. The study determined that there is a significant decrease in the prevalence of SARS-CoV2 antigen among employees at LLUH compared to the community.

Methods

Employee Health and Occupational Medicine offered antibody testing to employees who were considered high risk, primarily working in the Coronavirus Disease 19 (COVID-19) designated units. We tested 658 subjects’ serum for the presence of IgM and IgG antibodies via the Nirmidas Qualitative SARS-CoV2 test. 29 subjects with a positive antibody test were subsequently tested for the presence of serum SARS-CoV2 antigen via PCR.

Results

There were 31 subjects who tested positive for IgM or IgG antibodies. 11 subjects had positive IgM with negative IgG. 3 subjects had negative IgM with positive IgG. 15 patients had positive IgM and positive IgG. 2 subjects had positive IgM with negative IgG, were subsequently retested, and then found to have positive IgM and positive IgG.

Of those 31 subjects with a positive antibody test, 2 were not tested for the COVID-19 antigen, 1 had an inconclusive test, 23 tested negative, and 5 tested positive. Of those 5 positive for the antigen, 2 had symptoms and 3 did not report symptoms or did not use the symptom questionnaire.

The community prevalence of positive SARS-CoV2 antigen in San Bernardino is 0.37%, as of June 16. The prevalence of positive SARS-CoV2 antigen among LLUH employees is 0.03% and the prevalence of positive antibody is 0.18%. The value of z is -7.3206, p is < .00001. Thus, the result is significant at p < .01.

Conclusion

The results of this testing supports the efficacy of the early protective measures that LLUHS implemented in preparation for the pandemic. Such protective measures include: mandated face masks, symptoms screening, testing for SARS-CoV2 antibody or antigen on patients admitted, a dedicated COVID-19 section of the emergency department as well as inpatient units, etc. Given the statistical significance of this study, the protective bundle can be used as a template for preventative measures for future pandemics.

Disclosures

All Authors: No reported disclosures
454. Healthcare Workers with COVID-19 infection: Experience from a Designated COVID-19 Clinic
Authors: Arya Radhika , Tran Jennifer , Foroughi Negar , Oluigbo Nnenna , Barbhaya Dweep , Neupane Rabin , Franco Stephanie M , Gandhi Kejal D , Fishbein Dawn
Published: January 2021

Background

Healthcare workers (HCW) are at the frontline of the COVID-19 pandemic, risking infection through hospital contacts. Data regarding predisposing factors in the healthcare field is limited. In this study, we characterized presenting symptoms, occupation and hospitalizations for HCW who tested COVID-19 positive.

Methods

This is a retrospective study of HCW who presented for screening to a designated COVID-19 clinic at the largest hospital in Washington, DC between 3/13/20 - 5/28/20. Variables extracted included profession, exposure, presenting symptoms, past medical history and outcomes. Univariate analysis was performed using Fischer’s exact tests, with significance defined as p < 0.05. IRB approval was obtained.

Results

There were a total of 881 HCW who presented for COVID-19 testing: 316 (35.8%) tested positive; 216 (68.4%) were female, mean age was 39. Cough was the most common presenting symptom (92.7%), followed by subjective fever (63.3%), myalgia (57.9%), and chills (46.8%)(Fig 1). RNs [110 (34.8%)] and physicians [39 (12.3%)] accounted for nearly 50% of cases. Hospitalizations occurred in 22(6.9%); 2(0.6%) died from COVID-19. See Fig 2 for symptoms associated with hospitalizations. African Americans (OR 4.52, CI95 1.54–12.50), and those with hypertension (3.14, 1.32–7.23) and obesity (2.98, 1.25–6.89) were more likely to be hospitalized.

Figure 1

Figure 2

Conclusion

HCW remain at risk for COVID-19 infection with respiratory and constitutional symptoms as the most common presentation. RNs were among the most affected. This study supports other reports that African Americans and those with pre-existing comorbidities have greater morbidity with COVID-19 – we have documented that these inequities are also prevalent amongst HCW. This should be considered when testing for and implementing practices to avoid risk of COVID-19 among HCW.

Disclosures

All Authors: No reported disclosures
460. Point-of-Care, In-Home SARS-CoV-2 IgG Antibody Testing to Assess Seroprevalence in At-Risk Health Care Workers
Authors: Meissner Eric G , Litwin Christine , Crocker Tricia , Mack Elizabeth , Card Lauren
Published: January 2021

Background

Health care workers are at significant risk for infection with the novel coronavirus SARS-CoV-2.

Methods

We utilized a point-of-care, lateral flow SARS-CoV-2 IgG immunoassay (RayBiotech) to conduct a seroprevalence study in a cohort of at-risk health care workers (n=339) and normal-risk controls (n=100) employed at an academic medical center. To minimize exposure risk while conducting the study, consents were performed electronically, tests were mailed and then self-administered at home using finger stick blood, and subjects uploaded a picture of the test result while answering an electronic questionnaire. We also validated the assay using de-identified serum samples from patients with PCR-proven SARS-CoV-2 infection.

Results

Between April 14th and May 6th 2020, 439 subjects were enrolled. Subjects were 68% female, 93% white, and most were physicians (38%) and nurses (27%). In addition, 37% had at least 1 respiratory symptom in the prior month, 34% had cared for a patient with known SARS-CoV-2 infection, 57% and 23% were worried about exposure at work or in the community, respectively, and 5 reported prior documented SARS-CoV-2 infection. On initial testing, 3 subjects had a positive IgG test, 336 had a negative test, and 87 had an inconclusive result. Of those with an inconclusive result who conducted a repeat test (85%), 96% had a negative result. All 3 positive IgG tests were in subjects reporting prior documented infection. Laboratory validation showed that of those with PCR-proven infection more than 13 days prior, 23/30 were IgG positive (76% sensitivity), whereas 1/26 with a negative prior PCR test were seropositive (95% specificity). Repeat longitudinal serologic testing every 30 days for up to 4 times is currently in progress.

Conclusion

We conducted a contact-free study in the setting of a pandemic to assess SARS-CoV-2 seroprevalence in an at-risk group of health care workers. The only subjects found to be IgG positive were those with prior documented infection, even though a substantial proportion of subjects reported significant potential occupational or community exposure and symptoms that were potentially compatible with SARS-COV-2 infection.

Disclosures

All Authors: No reported disclosures
464. Rapid whole genome sequence typing reveals multiple waves of SARS-CoV-2 spread
Authors: Moustafa Ahmed M , Planet Paul J , Planet Paul J
Published: January 2021

Background

As the pandemic SARS-CoV-2 virus has spread globally its genome has diversified and distinct clones can now be recognized, tracked, and traced. Identifying clonal groups allows for assessment of geographic spread, transmission events, and identification of more virulent or transmissible emerging strains.

Methods

All SARS-CoV-2 genomes (n=17,504) that are complete and high coverage were downloaded from GISAID on May 17th 2020. We developed a GNU-based Virus IDentification (GNUVID) tool that implements a whole genome multilocus sequence typing (wgMLST) scheme composed of all ten ORFs in the SARS-CoV-2 genome. The 10,422 genomes that passed our quality check were fed to the GNUVID tool, which assigned a ST profile to each genome. Global optimum eBURST was then used to cluster the STs in clonal complexes (CCs).

Results

Our ST/CC analysis uncovered strong associations of ST/CCs with certain geographical regions but also dynamic local changes in ST/CC prevalence. We also identified several unexpected putative global transmission events (e.g., from the US to the Middle East and reintroduction to China later in the pandemic). We have made our tool (GNUVID) available so that new WG sequences can be rapidly assigned to an ST/CC (https://github.com/ahmedmagds/GNUVID).

Conclusion

Our sequence typing system uncovered previously unappreciated transmission events and waves of expansion and replacement of SARS-CoV-2 STs and CCs in different geographical locations, suggesting complex dynamics in viral populations that previously seemed monomorphic. Because, our tool can be rapidly updated with new sequencing data it can track emerging clones and identifying new hotspots.

Disclosures

All Authors: No reported disclosures
465. Risk Factors Associated with Critical COVID-19 Requiring Mechanical Ventilation
Authors: Chris Robert B , Khalid Rabeeya , Ravichandran Urmila , Acree Mary Ellen , Grant Jennifer , Muthiah Chethra , Shah Nirav
Published: January 2021

Background

Mechanical ventilation of patients with COVID-19 is associated with high mortality. Understanding risk factors for developing mechanical ventilation may allow for more targeted monitoring and therapeutics that may improve outcomes.

Methods

We performed a retrospective case series of all patients admitted within thirty days of a positive Sars CoV-2 test to an integrated health system near Chicago, Illinois between March 12 and May 31, 2020. Covariates evaluated included demographics, symptoms on admission, vital signs, medications, comorbidities, census tract data and social history. Univariable analysis was performed and variables with an alpha of 0.05 or less were included in multivariable regression modeling to identify factors associated with mechanical ventilation. The area under the curve (AUC) was used to assess performance of the model.

Results

Of 990 patients admitted with COVID-19 12.6% (125) were mechanically ventilated. The median age was 68 (interquartile range 55–82), 48.4% (479) were female and 49.6% (491) were Caucasian. Independent factors associated with mechanical ventilation included female sex (Adjusted OR [AOR] 0.621, Confidence Interval [CI] 0.427–0.903; p=0.0363), body mass index (BMI) (AOR 1.035, CI 1.011–1.060; p=0.0175), percent of english speaking population within patient’s census tract (AOR 0.989, CI 0.979–0.998; p=0.0454), respiratory rate (AOR 1.054, CI 1.027–1.083; p=0.0011), oxygen saturation (AOR 0.922, CI 0.901–0.943; p< 0.0001), cerebrovascular accident (CVA) (AOR 0.176, CI 0.051–0.605; p=0.0207) and hematologic malignancy (AOR 3.668, CI 1.403–9.590; p=0.0261). AUC of the model was 0.8 (0.75–0.84).

Characteristics of patients admitted with COVID-19

Multivariable logistic regression to identify risk factors associated with mechanical ventilation

Conclusion

Risk factors associated with mechanical ventilation included male gender, elevated BMI, census tract with lower percentage of english speakers, increased respiratory rate, low oxygen saturation, hematologic malignancy and not having a CVA. We suspect that history of CVA may have been associated with overall patient debility in which aggressive measures such as intubation were not deemed appropriate. Identifying patients with risk factors associated with mechanical ventilation may allow for early and targeted interventions to improve outcomes.

Disclosures

All Authors: No reported disclosures
467. Spatial-Temporal Prediction Model of COVID-19 Mortality across 62 Counties in New York State
Authors: Xiao Yunyu , Zeng Chengbo
Published: January 2021

Background

COVID-19 pandemic has resulted in considerable morbidity and mortality. New York State (NY) is the hotspot with most coronavirus cases, while there are spatial/temporal variations. Yet, few examined county-level factors of mortality in COVID-19 patients in NY. Based on the sociological framework in health, this study links large and representative public data to understand COVID-19 mortality in NY over different stages of pandemic.

Methods

Mortality cases were from Mar 17 (state of emergency; 0.1 per 100,000), Apr 18 (coronavirus peak; 87.4), Apr 25 (expand testing; 108.7), and May 11 (daily reduced to original; 137.6). Three domains (compositional, contextual, and collective) and 28 county-level predictors of mortality were extracted from American Community Survey, Area Health Resources, US Crime Data, and Religious Data systems for each county. Compositional domain covered socio-demographic characteristics in local areas (e.g., age, sex, race/ethnicity, housing). Contextual domain covered include social and physical opportunities (e.g., health insurance coverage, transportation, mental health providers). Collective domain covered neighborhood safety and religious adherents. Mixed effect regression with the least absolute shrinkage selection operator (LASSO) was used to select the predictors and estimate the parameters after adjusting the time effect and cumulative prevalence of COVID-19.

有道词典

; 0.1 per 100,000 people

详细X

;每100000人0.1

Results

NYC and the nearby boroughs (i.e., Bronx, Kings, Manhattan, Queens) had the highest cumulative mortality (231.69 per 100,000 people). Counties far from New York Cities (e.g., Allegany, Cortland, Delaware) had the lowest cumulative mortality. Spatial variation showed counties with larger population density (β=.01, p=.022) and/or higher proportion of people with at least high school education (β=227.24, p=.03) were at risk of higher cumulative mortality in COVID-19.

Conclusion

Unique spatial clustering mortality risk of COVID-19s was detected, highlighting important but understudied roles of contextual and collective factors. Tailored policy efforts shall be designed to support counties with large population density and high levels of education to prevent the mortality related to COVID-19 infection in NY.

Disclosures

All Authors: No reported disclosures
470. The Effects of Arrival Quarantine on Subsequent COVID-19 Testing in a Cohort of Military Basic Trainees
Authors: Marcus Joseph E , Frankel Dianne , Pawlak Mary , Casey Theresa , Enriquez Erin , Yun Heather
Published: January 2021

Background

The COVID-19 pandemic has been associated with significant spread in congregate settings and various forms of non-pharmaceutical interventions (NPI) have been implemented to prevent spread. Basic Military Training at Joint Base-San Antonio is the entrance to the US Air Force and has been associated with respiratory outbreaks in the past. A two-week arrival quarantine was implemented in March 2020. Effects on subsequent testing for COVID-19 after an arrival quarantine is unknown.

Methods

The first four weekly cohorts of trainees who underwent an arrival quarantine between March 16-April 13 were monitored during their 7 week training for COVID-19 symptoms. Symptoms, medical testing, and days removed from training were collected on every patient with possible COVID-19 symptoms including cough, shortness of breath, or fever. Testing during the two-week arrival quarantine were compared to the subsequent five weeks of training. Nominal variables were compared by chi squared or Fisher’s exact test as appropriate. Continuous variables were compared by Mann-Whitney U Test.

Results

A total of 2,573 started training during study period, 89 (3.4%) had symptoms concerning for COVID-19 and were tested. 5 (6%) patients tested positive, all of whom in the arrival quarantine. Compared to patients who completed quarantine (n=29), patients in the arrival quarantine who tested negative for COVID-19 (n=54) were tested more often (26 trainees a week vs. 5.8 later in training, p=< 0.0001), and received more rapid flu tests (74% vs. 38%, p=0.001) and multiplex respiratory PCR (15% vs. 0%, p=0.05). Trainees in quarantine were isolated longer for symptoms than patients who completed quarantine (median 3 vs. 2, p=0.01). There was no difference in presenting symptoms for trainees in quarantine or after quarantine.

Conclusion

Arrival quarantine appears to be an effective NPI, which in conjunction with other interventions prevented any COVID-19 transmission after quarantine completion. For those who went through arrival quarantine, there was more intense initial testing and initial longer symptomatic patient isolation, this was balanced by fewer symptomatic patients, less testing, and shorter isolations later in training.

Disclosures

All Authors: No reported disclosures
471. The Rochester Regional COVID-19 Registry: One Small Step toward a Unified National Action Plan
Authors: Hanna John J , Chen Tara , Newhart Donna , Schantz Katherine , Rozzi Kathleen , Bress Jonathan , Lesho Emil P
Published: January 2021

Background

On June 19, 2020, the Academies of Sciences, Engineering, and Medicine hosted a public meeting on “Data Needs to Monitor the Evolution of SARS-CoV-2”. The Office of the Assistant Secretary for Preparedness and Response (ASPR/HHS) and other agencies are seeking to track and correlate viral genome sequences with clinical and epidemiological (CE) data. A crucial part of that framework is obtaining detailed CE data from frontline facilities. In response, we sought to contribute by creating a registry of detailed CE data from SARS-COV -2 infected patients at five hospitals, spanning eleven counties in Western New York.

Methods

In addition to the usual demographics, comorbidities, and categories of outpatient prescriptions, the registry has 75 laboratory, 2 imaging, 19 therapeutic, and 4 outcome-related parameters. Mann-Whitney U Test for continuous variables and Chi-squared and Fisher Exact Test for categorical variables were performed in R and Minitab.

Results

The registry currently includes data from 399 patients: 236 ambulatory and 163 inpatient. Several comorbidities were associated with requirement for admission compared to ambulatory status, including obesity and kidney, liver, and cardiovascular disease (all p < /= 0.01) (Table 1). Use of angiotensin inhibitors and receptor blockers, statins, and acid suppressants was higher in admitted vs. ambulatory patients (all p < /=0.001) (Table 1 and Figure). Diabetes mellitus and statin use were more common in patients who required intensive care, p=0.04 and 0.01 respectively (Table 2).

Table 1

Figure

Table 2

Conclusion

The registry captures detailed clinical information from SARS-COV-2 infections, providing a valuable resource for researchers, planners, and policy makers. It also provides a framework for surge planning, predictive modeling, and linking CE data to whole genome sequencing data for precision epidemiology. As SARS-COV-2 reports from China, Italy, and New York City may not be fully generalizable to other regions, especially those not as severely affected or those in suburban and rural settings, reports from other areas are needed. To our knowledge, this is one of the largest U.S. case series outside of New York City.

Disclosures

All Authors: No reported disclosures
472. The Utility of Infectious Diseases E-consults in the Era of COVID-19
Authors: Saad Hala , Yagnik Kruti , King Helen , Bedimo Roger , Medford Richard J
Published: January 2021

Background

During the COVID-19 pandemic, rapid Infectious Diseases (ID) consultation has been required to answer novel questions regarding SARS-CoV-2 testing and infection prevention. We sought to evaluate the utility of e-consults to triage and provide rapid ID recommendations to providers.

Methods

We performed a retrospective study reviewing ID e-consults in three institutions in the North Texas region: Clements University Hospital (CUH), Parkland Hospital and Health System (PHHS), and the VA North Texas Health Care System (VA) from March 1, 2020 to May 15, 2020. Variables collected include age, sex, ethnicity, comorbidities, time to completion, reason for consult and outcome of consult (initiation or removal of personal protective equipment (PPE) and recommendation to test or retest for COVID-19).

Results

We performed all analysis using R studio (Version 1.3.959). Characteristics of 198 patients included: 112(57%) male, 86(43%) female, 86(43%) Caucasian, 71(36%) Hispanic, 42(21%) African American, 6(3%) Asian and mean(sd) age of 55.1(15.9). Patient comorbidities included: 89(45%) with a heart condition, 77(39%) diabetes, 30(15%) asthma and 14(7%) liver disease.

Median time to completion for all hospitals was 4 hours(h); ((CUH (4h) vs PHHS (2h), p< 0.05; VA (5.5h) vs PHHS (2h) p< 0.05)). Most common reasons for e-consult included: (63)32% regarding re-testing ((CUH 14(21%) vs PHHS 43(50%), p< 0.05; CUH vs VA 14(27%), p< 0.05; PHHS vs VA, p< 0.05)), (61)31% testing ((CUH 25(37%) vs PHHS 39(45%), p< 0.05; CUH vs VA 7(16%), p< 0.05; PHHS vs VA, p< 0.05)) and 61(31%) infection prevention (IP). Based on the e-consult recommendation, 53(27%) of patients were tested ((CUH 31(45%) vs PHHS 11(13%), p< 0.05, CUH vs VA 11(25%), PHHS vs VA, p< 0.05)), 45(23%) were re-tested, 44(22%) of patients had PPE started on and 19% had PPE removed ((CUH 0(0%) vs PHHS 16(19%), p< 0.05; CUH vs VA 21(48%), p< 0.05; PHHS vs VA, p< 0.05)).

Reason for Consult

Conclusion

E-consult services can provide prompt ID input during the COVID-19 pandemic, minimizing the risk of infection to the patient and health care workers while preserving PPE and testing supplies.

Disclosures

Roger Bedimo, MD, MS, Gilead Sciences (Consultant)Merck & Co. (Advisor or Review Panel member)ViiV Healthcare (Advisor or Review Panel member, Research Grant or Support)
473. Using Serosurveillance for SARS-CoV-2 to Conserve PCR Tests in a Resource Constrained Combat Environment
Authors: White Brian K , Sachdeva Mohit , Bova Jacob , Nichols Shawnn , Stuart Rory P , Rutherford Ashley E , Comes Ryan , Cybulski Daniel , Case Alex M
Published: January 2021

Background

In March 2020, COVID-19 threatened combat operations in Afghanistan. At that time, the NATO Resolute Support mission involved nearly 17,000 troops from 38 partner nations, plus civilians who support the mission, scattered throughout Afghanistan. While Afghanistan did not initially report many confirmed cases, large numbers of cases were reported from neighboring countries with known migration across the borders (sometimes thousands/day). Military medical leaders advised commanders regarding the potential health risks to the force, balancing with risks to the mission. Quarantine and isolation protocols were established. Public health interventions of social distancing, cloth mask wear, enhanced environmental cleaning, active case finding, and emphasis on hand hygiene and cough etiquette were enforced. However, many base locations were unable to alleviate close living quarters. Testing was identified as a means to assess risk to the population. Testing capabilities were limited, particularly PCR. When this testing strategy was established, the utilization and interpretation of antibody tests was quite controversial. With rapid antibody kits, the time to detection of both IgM and IgG are similar; detection of either cannot identify the time since exposure.

Methods

A novel surveillance plan was established whereby subpopulations at highest risk for exposure to the virus were screened with antibody tests from 17 Apr-1 Jun, 2020. High risk populations included: those leaving quarantine, base defense guards, isolation unit guards, medical personnel, dining facility workers, and those who interact with local populations. Individuals with detectable antibody (either IgM or IgG) were further evaluated with PCR tests.

Results

In the first six weeks of this testing strategy, 1957 antibody tests were utilized. A total of 37 specimens were identified antibody positives with seroprevalence of 2% (Figure 1). Thirteen were identified to have positive IgG, 22 with IgM, and 2 with both. PCR was performed on those with detectable antibody, 13 (35%) had positive PCR.

Conclusion

Serosurveillance of populations at high risk for exposure to the virus is a logical way to conserve testing resources in a constrained combat environment.

Disclosures

Alex M. Case, n/a, United States Air Force (Employee)
474. Using telemedicine to provide virtual care for COVID-19 patients at home
Authors: Horton Lucy E , Jenks Jeffrey D , Bharti Ajay , Ritter Michele L , Bordeaux Kathleen
Published: January 2021

Background

In response to the COVID-19 pandemic in San Diego, California, the Infectious Disease Division at the University of California San Diego established a COVID-19 Clinic dedicated solely to managing patients safely in their homes. This strategy was developed in response to: i) concerns regarding transmission of infection in the healthcare setting, ii) avoiding overwhelming the healthcare system with COVID-19 patients, iii) providing patients with expedited access to specialists, and iv) reducing the burden on the emergency department and urgent care.

Methods

The COVID-19 clinic staff is comprised of a dedicated nurse, administrative assistant, and four infectious diseases (ID) physicians who aim to see patients within 24 hours of referral via virtual clinics 5 days a week. An ID physician initially assesses each patient in a direct telemedicine visit and answers their questions, assesses disease severity, provides both symptom management and emotional support, and education about self-isolation and transmission-based precautions. The patients are then triaged to daily nursing phone calls and follow up visits as needed.

Results

Over a period of 12 weeks (March 27 to June 16, 2020), the clinic has seen 179 patients. To assess the impact of the clinic, patients are asked to complete a 6-point verbal patients satisfaction survey after their visit. Of the 133 patients who have completed the survey to date, the vast majority reported high satisfaction with their encounters with the COVID-19 physician, with a mean score of 4.8 or higher on all six questions (on a scale of 1 to 5). When asked “Did you feel comfortable talking to your COVID-19 ID physician?” on a scale of 1 to 5, the average score was 4.9. When asked “Did the physician do a good job answering your questions?” the average was 4.9. Patients reported feeling safer after talking with their physician (mean score 4.8), and felt better educated on how to self-quarantine at home (mean score 4.85) and when to seek care from an emergency room, urgent care or hospital (mean score 4.83).

Conclusion

The UCSD COVID-19 Clinic demonstrates how telemedicine can be utilized in response to a public health crisis by creating a virtual clinic to provide ID care for patients in their homes.

Disclosures

All Authors: No reported disclosures
478. Psychological Distress among Infectious Disease Physicians during the Response to the COVID-19 Outbreak in the Republic of Korea
Authors: Park Se Yoon , Kim Bongyoung , Jung Dong Sik , Jung Sook In , Oh Won Sup , kim Shin-Woo , Peck Kyong Ran , Chang Hyun-Ha
Published: January 2021

Background

This study aimed to investigate psychological distress among infectious disease (ID) physicians during the coronavirus disease (COVID-19) outbreak in the Republic of Korea.

Methods

Using an online-based survey link sent via text message and email, we conducted a survey from April 21 to 25, 2020, targeting all ID physicians currently working in ID (n = 265). The questionnaire was based on the Maslach Burnout Inventory-Human Services Survey and the Depression, Anxiety, and Stress Scales, and information was collected on factors protecting against psychological distress and difficulties in relation to COVID-19.

Results

Of 265 ID physicians, 115 (43.3%) responded, showing burnout (97, 90.4%), depression (20, 17.4%), anxiety (23, 20.0%), and stress (5, 4.3%). There were no differences in terms of distress between ID physicians who were directly involved in the care of patients with COVID-19 or not (Table 1). Greater than 50% of physicians valued their work and felt recognized by others, whereas < 10% indicated that sufficient human and financial support and private time had been provided during the outbreak. The most challenging issues concerned a lack of human resources for COVID-19 treatment or infection control, a shortage of personal protective equipment or airborne infection isolation rooms, pressure for research, and lack of guidelines for COVID-19 management (Figure 1).

Table 1.

Figure 1. Difficulties in response to the COVID-19 outbreak. Abbreviations: COVID-19, coronavirus disease 19; HCWs, healthcare workers; ICPs, infection control practitioners; IRB, Institutional Review Board; PPE, personal protective equipment

Conclusion

During the COVID-19 outbreak in the ROK, most respondents reported psychological distress. Preparing strategies for infectious disease outbreaks that support ID physicians is essential.

Disclosures

All Authors: No reported disclosures
483. OPAT Delivery during COVID-19
Authors: Swartwood Michael J , Boerneke Renae A , Kinlaw Alan C , Mavrogiorgos Nikolaos , Marx Ashley , Ciccone Emily J , Schranz Asher J , Bowman Mary C , Farel Claire E
Published: January 2021

Background

In 2020, COVID-19 spurred unprecedented change in the delivery of routine clinical care. The UNC OPAT program staff, previously accustomed to in-person collaboration in the hospital, became geographically distant amid North Carolina’s partial shutdown starting in March 2020. Team members relied on teleworking and many OPAT clinic visits shifted to phone and video telehealth. We assessed how COVID-19 impacted our care of OPAT patients including follow-up visits and readmissions.

Methods

UNC’s OPAT database contains clinical and demographic information on all patients on OPAT for at least 14 days who received specialized monitoring program led by an infectious diseases (ID) pharmacist, after evaluation by an ID physician. For all OPAT courses that ended between 3/1/20 and 5/20/20 (last available data cut), we assessed the length of OPAT treatment course, readmissions, adverse events, follow-up ID clinic visits, and the method of follow up visit utilized. We compared these measurements to historical baseline data from 3/1/19 to 5/20/19.

Results

During the 2020 period, 73 patients completed OPAT, with median OPAT enrollment lasting 36 days, which was similar to 2019 data (70 patients; median OPAT enrollment of 35 days). During the 2019 period, 93% of patients attended a follow up visit with an infectious diseases clinician, all of which took place in person. During the 2020 (COVID-19) period, 85% of patients attended an ID follow up visit; contrary to 2019, 42% of these visits took place in person, 45% were by phone and 13% were via a telemedicine video service. Readmission rates were similar across the two time periods (16% during COVID-19 vs 14% during 2019 comparison time period, P=0.72).

Conclusion

UNC OPAT continued through the emergence of COVID-19 as an essential service for a high patient volume by adapting its care delivery and follow-up visit protocols to include virtual care options. Readmission rates for OPAT patients during COVID-19 were comparable to historical baseline data.

Disclosures

All Authors: No reported disclosures
484. The Impact of SARS-CoV-2 on Reproduction Rates of Seasonal Influenza and RSV
Authors: Sherman Amy C , Babiker Ahmed , Sieben Andrew , Pyden Alexander , Steinberg James P , Colleen Kraft , Koelle Katia , Kanjilal Sanjat
Published: January 2021

Background

The COVID-19 pandemic caused by SARS-CoV-2 has precipitated a global health crisis. In an effort to decrease person-to-person transmission, societal-level non-pharmacologic interventions (NPIs) to maintain social distancing have been enacted. As SARS-CoV-2 shares similar routes of transmission with other respiratory viruses, implementation of these NPIs may have decreased transmission for multiple viral pathogens. We compared influenza and respiratory syncytial (RSV) rates in prior seasons to rates during the 2019 - 2020 season at two large academic centers in Atlanta and Boston.

Methods

The clinical records were queried for adults with respiratory virus testing conducted at the Emory Healthcare system and associated clinics in Atlanta and the Mass General Brigham (MGB) Healthcare System in Boston. Total cases for influenza A and B, RSV and SARS-CoV-2 were analyzed for each week of the past 5 seasons (07/01/2015-05/30/2020) for the Atlanta and Boston sites. Systematic changes in viral infection rates were calculated using viral reproduction rates, R(t), between consecutive weeks. R(t) is the ratio of the number of positive cases in one week to the number of positive cases in the previous week. We used statistical bootstrapping to determine whether R(t) for influenza and RSV were lower in 2019–2020 following the introduction of SARS-CoV-2. Analyses were conducted using R (v 4.0.0).

Absolute respiratory virus activity by season, Boston (panel A) v. Atlanta (panel B)

Results

For the 2019–2020 Atlanta season, R(t) < 1 (which reflects steady decline in infection rates) occurred at week 28 for influenza A, week 33 for influenza B, and week 35 for RSV, which corresponded with the increase of SARS-Cov-2 cases. The R(t) of these viruses stayed at or near 1 during weeks 33–35 in prior seasons, and R(t) was greater than 1 up to week 47. Data from MGB sites showed similar trends with a sudden decline in R(t) to < 1 at the start of the SARS-CoV-2 pandemic.

Conclusion

We note decreased transmission of influenza and RSV during a time window where widespread movement restrictions and social distancing were imposed to control COVID-19. This trend was most pronounced for influenza A in Atlanta and influenza B in Boston. These data suggest that NPIs can have important effects across multiple pathogens.

Disclosures

Kraft Colleen, MD, MSc, Rebiotix (Advisor or Review Panel member)
490. A Randomized Crossover Study to Evaluate Interventions to Reduce Contamination during Reuse of N95 Respirators
Authors: Li Daniel , Alhmidi Heba , Pearlmutter Basya , Cadnum Jennifer , Wilson Brigid , Donskey Curtis
Published: January 2021

Background

During the Coronavirus Disease 2019 pandemic, shortages of personal protective equipment (PPE) have forced many healthcare facilities to require personnel to reuse N95 respirators. We hypothesized that use of correct technique such as changing gloves after N95 contact or providing rapid decontamination between each use would reduce the risk for contamination.

Methods

We conducted a randomized crossover study using simulated patient care interactions to compare the effectiveness of interventions to reduce contamination of personnel and the environment with high-level N95 contamination (107 plaque-forming units [PFU] of bacteriophage MS2 applied to front of respirator). Ten healthcare personnel performed 4 randomly-assigned standardized examinations of mannequins including: 1) Control (PPE donning and doffing not including glove change after N95 contact); 2) Glove change after any N95 contact; 3) Control with 1-minute ultraviolet-C light (UV-C) treatment between simulations; 4) Control with 30-second steam treatment between simulations. A second trial was conducted with groups 1–3 using a lower inoculum (105 PFU). The frequencies of participant and environmental contamination were compared.

Results

As shown in Figure 1.A, use of a highly contaminated N95 respirator resulted in frequent MS2 contamination in the Control, Glove change, and UV-C groups, but was dramatically reduced with steam treatment of the N95. With the lower level of contamination, MS2 contamination occurred less frequently across all groups, and was significantly reduced in the UV group, compared to the Control (Figure 1.B).

Figure 1: Bacteriophage MS2 contamination during simulated patient care interactions with contaminated N95 respirators

Conclusion

Reuse of contaminated N95 respirators resulted in contamination of personnel and the environment even when correct technique was used. Rapid decontamination technologies can reduce the risk for transmission.

Disclosures

All Authors: No reported disclosures
491. Aerosol-Generating Medical Procedures: Transmission of SARS-CoV-2 and Emerging Viruses
Authors: Judson Seth D , Munster Vincent J
Published: January 2021

Background

During the pandemic of coronavirus disease 2019 (COVID-19), many questions arose regarding risks for hospital-acquired or nosocomial transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Aerosol generating medical procedures (AGMPs), techniques that can generate infectious, virus-laden aerosols, could potentially amplify transmission among healthcare workers (HCWs). Thus, it was widely recommended that HCWs use airborne precautions when performing AGMPs. However, in clinical settings it is often unclear what procedures constitute AGMPs and how the risk varies by procedure or pathogen. We set out to further define AGMPs and assess the risk for nosocomial transmission of SARS-CoV-2 and other high-risk viruses via AGMPs.

Methods

We identified potential AGMPs and emerging viruses that were high-risk for nosocomial transmission through reviewing experimental and clinical data. Potential AGMPs were those associated with previous virus transmission or mechanically capable of transmission. High-risk viruses were defined as those that cause severe disease in humans for which limited therapies or interventions exist, are infectious via aerosols in humans or non-human primates (NHPs), found in the respiratory tract of infected humans or NHPs, and had previous evidence of nosocomial transmission.

Results

We identified multiple potential AGMPs, which could be divided into those that generate aerosols or induce a patient to form aerosols, as well as eight families of high-risk viruses. All of the viruses were emerging zoonotic RNA viruses. In the family Coronaviridae, we identified potential evidence for SARS-CoV-1, MERS-CoV, and SARS-CoV-2 transmission via AGMPs. SARS-CoV-1 and SARS-CoV-2 were also found to be similarly stable when aerosolized.

Conclusion

Multiple emerging zoonotic viruses pose a high risk for nosocomial transmission through a variety of AGMPs. Given the similar stability of SARS-CoV-2 with SARS-CoV-1 when aerosolized and prior nosocomial transmission of SARS-CoV-1 via AGMPs, we suspect that certain AGMPs pose an increased risk for SARS-CoV-2 transmission. Additional experimental studies and on-site clinical sampling during AGMPs are necessary to further risk stratify AGMPs.

Disclosures

All Authors: No reported disclosures
495. Effectiveness of Personal Protective Equipment in Preventing Transmission of COVID-19 in Healthcare Workers
Authors: Li Aldon , Rieg Gunter , Maldonado Ana Miranda , Concepcion June
Published: January 2021

Background

Human-to-human transmission of the SARS-CoV-2 occurs during exposure to infectious respiratory particles generated by humans with COVID-19. Global personal protective equipment (PPE) shortages necessitate further studies looking at the correlation between PPE use and transmission of COVID-19 to healthcare workers (HCW). This study aims to provide data on test positivity rates of HCW wearing different PPE.

Methods

Retrospective Case Series. During the study period from Mar-Apr 2020, HCW were tested for SARS-CoV-2 if they 1) were exposed to COVID-19 case OR 2) had symptoms of potential COVID-19 disease per CDC criteria. Respirator masks defined as N95 or higher were used in high risk departments (Emergency and Urgent Care (ERUC), Medical/Surgical (MSU), and Intensive Care (ICU) units). Medical masks defined as surgical or procedural masks were used in low risk, outpatient departments. All departments used gowns, gloves, eye protection, and appropriate masks.

Results

In low risk departments, 124/1578 (7.9%) of HCW tested positive, compared to 118/1499 (7.9%) of HCW who worked in high risk departments (p=0.9886). In high risk departments, 55/626 of HCW who worked in MSU, 37/459 of HCW who worked in ERUC, and 26/414 who worked in ICU tested positive. In a logistic regression model comparing tested individuals in high risk departments to those in ambulatory settings, a slightly lower risk of a positive test among ICU employees (OR=0.786, CI=0.508–1.217) was found, and a similar risk among ERUC employees (OR=1.028, CI=0.701–1.508) and MSU employees (OR=1.129, CI=0.810–1.574) was found, but the differences were not statistically significant (p=0.5364).

Conclusion

HCW in ambulatory settings who used medical masks did not test positive at a higher rate than providers in high risk departments using respirators. The slightly lower positive rate in ICU providers may suggest respirator masks are beneficial in settings with higher risk of aerosolizing generating procedures, or it maybe related to training and familiarity with infection control procedures. The level of mask used was equally appropriate across all risk level care settings, providing evidence for local strategies to optimize PPE stewardship based on department assignments while protecting HCW during the COVID-19 pandemic.

Disclosures

All Authors: No reported disclosures
499. Infection with Coronavirus Disease 19 (COVID-19) in Healthcare Personnel with Exposure to COVID-19
Authors: Kang Minji , Granda Christopher , Torriani Francesca J , Taplitz Randy , Myers Frank , Isakari Marcia , Abeles Shira
Published: January 2021

Background

As of June 2, 2020, 67,113 cases and 321 deaths due to Coronavirus Disease 19 (COVID-19) have been reported in healthcare personnel (HCP) in the United States. Given the close contact of HCP with individuals with COVID-19, it is important to quantify the risk of acquiring COVID-19 in the healthcare setting.

Methods

We conducted a retrospective cohort study of HCP exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at our academic medical center from March 15, 2020 to May 16, 2020. Exposure during the study period was defined as having contact with patients or other HCP with COVID-19 within 6 feet of distance for at least 90 seconds when HCP’s eyes, nose, or mouth were not covered. HCP with exposures were monitored for symptoms consistent with COVID-19 for 14 days from last exposure and those who developed symptoms were tested for SARS-CoV-2 using RT-PCR.

Results

We identified 33 exposure events; 19 of which were patient-to-HCP exposures and 14 of which were HCP-to-HCP exposures. These 33 events resulted in 959 exposed HCP among whom 238 (25%) developed one or more symptoms of COVID-19 and required SARS-CoV-2 RT-PCR testing. Testing was performed at 7.1 ± 5.0 (mean ± SD) days from exposure. Of the 238 HCP who were tested, 82% were female and 49% were registered nurses (Table 1). Five HCP tested positive for SARS-CoV-2 by RT-PCR, but one was presumed to have acquired the disease from a household member with confirmed COVID-19. Among the four HCP who were infected due to occupational exposure, three were nurses while one was an environmental service worker (Table 1).

Conclusion

Despite exposures among HCP, the risk of acquiring symptomatic COVID-19 in the healthcare setting was low with less than 1% of HCP with occupational exposure subsequently diagnosed with COVID-19. With the definition of exposure now changed to at least 15 minutes of close contact without personal protective equipment, we anticipate fewer exposures at our healthcare facility and that much of COVID-19 transmission affecting HCP are due to community exposures.

Disclosures

All Authors: No reported disclosures
500. Novel Use of a Targeted Ultraviolet Light Device for the Decontamination of a Single-Use Filtering Facepiece Respirator
Authors: Truitt Christopher L , Goldwater Wesley
Published: January 2021

Background

The use of disposable or single-use filtering facepiece respirators (FFRs), like N95s, are an important component of personal protective equipment for healthcare personnel in treating patients with a respiratory virus and not approved for reuse. The current pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in the limited availability of respirators. As a result, the decontamination of FFRs is a potential solution for reuse in order to conserve supplies. However, the efficacy of disinfection for a contaminated FFR needs to be evaluated. This experiment examined the effectiveness of a targeted ultraviolet C (UVC) device for the decontamination of a single-use respirator.

Methods

To mimic an aerosolized droplet contaminating a cellulose based respirator, a 6 mm cotton disk was inoculated with a 10 μL aliquot of Bacillus subtilis endospores. The disks were placed directly under the UVC light with 6 inches between the bulb and disk. The samples were then exposed for 90 seconds, 3 minutes, 5 minutes, and 10 minutes, respectively. After specified exposure time, the disks were turned over, and the other side was exposed for the same time interval as the previous side. Disks were placed in a 10 mL nutrient broth and incubated at 30°C for 48 hours. Lastly, the serially diluted specimens were plated onto nutrient agar, incubated for 48 hours, and the log10 colony forming units (CFU) reductions were enumerated by comparing disks after decontamination versus untreated controls.

Results

The log10 CFU reduction of B. subtilis spores over all time intervals were significant when compared to controls. The mean reduction of spores on the cotton disks were 2.5 log after 90 seconds, 4 log after 3 minutes, and >6 log for both 5 and 10 minutes with no measurable recovery of spores for the last two exposures.

Conclusion

The use of targeted UVC was very successful in reducing the B. subtilis spores from a cotton disk within 90 seconds, and the 100% elimination of the spores after 5 minutes. Even though a pandemic virus was not used, the sporicidal efficacy suggests this device could be effective at inactivating SARS-CoV-2. Based upon these findings, a targeted UVC device could be utilized for the decontamination of a single-use respirator needed during times of shortages.

Disclosures

All Authors: No reported disclosures