bluuebunny/crossref_metadata_2025 huggingface dataset:
503. The Misappropriation of COVID-19 Related TV Ad Expenditures
Authors: Vyas Kartavya J
Published: January 2021

Background

With nearly three-fourths of the U.S. population isolated in their homes between early March and the end of May, almost all of whom regularly watch television (TV), it was no surprise that companies began to purchase airtime on major television networks to advertise (ad) their brands and showcase their empathy with the populace. But how would the coronavirus disease 2019 (COVID-19) epidemic curve have changed had these same dollars been allocated to proven preventive interventions?

Methods

Performance and activity metrics on all COVID-19 related TV ads that have aired in the U.S. between February 26th and June 7th, 2020, were provided by iSpot.tv, Inc., including expenditures. COVID-19 incidence and mortality data were collected from the Centers for Disease Control and Prevention (CDC). Descriptive statistics were performed to calculate total TV ad expenditures and other performance metrics across industry categories. Leveraging a previously published stochastic agent-based model that was used to assess the cost-effectiveness of non-pharmaceutical interventions to control COVID-19, the number of cases that would have been prevented had these same dollars been used for preventive interventions was calculated using cost-effectiveness ratios (CERs), the cost divided by cases prevented.

Results

A total of 1,513 companies purchased TV airtime during the study period, totaling approximately 1.1 million airings, 215.5 billion impressions, and $2.7 billion in expenditures; most of the expenditures were spent by the restaurant (15.9%), electronics and communications (15.4%), and vehicle (13.7%) industries. The CERs for PPE and social distancing measures were $13,856 and $29,552, respectively; therefore, had all of these TV ad dollars instead been allocated to PPE or social distancing measures, approximately 194,908 and 91,386 cases of COVID-19 may have been prevented by the end of the study period, respectively.

Figure 2. COVID-19 cases prevented had TV ad expenditures been reallocated for interventions.

Conclusion

Americans were inundated with COVID-19 related TV ads during the early months of the pandemic and companies are now showing some signs to relent. In times of disaster, however, it is paramount that the private sector go beyond showcasing their empathy and truly become socially responsible by allocating their funds to proven prevention and control measures.

Disclosures

All Authors: No reported disclosures
504. Transmission of SARS-CoV-2 to Household Members of COVID Positive Healthcare Workers
Authors: Arshad Mehreen , Otero Sebastian , Mithal Leena B
Published: January 2021

Background

Healthcare workers (HCW) are at increased risk of SARS-CoV-2 infection. Infection prevention and control methods to prevent HCWs from bringing the virus home are lacking. We aimed to describe the various isolation practices of COVID positive (+) physicians and advanced practice providers to mitigate transmission risk to family members (FM) and understand HCW stress during this pandemic.

Methods

Survey responses were collected from 5/19/2020 - 6/12/2020 using a convenience sampling of HCW. Solicitations were done through email, listservs, institutional websites, and Facebook groups without geographic restriction. We collected data on demographics, details about HCW illness, health of FM, preventive measures taken, and HCW stress.

Results

The survey has so far been completed by 51 COVID+ respondents with FM in the home (Table 1). Half (55%) work in outpatient, 31% inpatient, and 8% in ER setting. Most HCW (83%) were diagnosed by PCR test; others were presumptive positive due to symptoms and exposure (14%). 64% had mild disease and 33% had moderate disease. Most common preventive measures were immediate showering after reaching home (59%) and changing clothes prior to going home (35%); 22% took no precautions. About 55% of FM developed symptoms of COVID. There were no significant differences between preventive measures taken by HCW whose FM remained asymptomatic. However, we noted that HCW whose FM remained symptom-free were more likely to sleep in a separate room (17% vs. 7%), refrain from physical contact with FM (22% vs.14%) and intimate contact with partners (22% vs. 11%). Over 88% reported increased stress level, many identifying health concerns and safety (26%) and impact on FM (28%) as the greatest source of stress. There was no difference in reported stress level between HCW whose FM became infected and those who were not. HCW with symptom-free FM were more concerned about transmission to their partner (p = 0.02).

Table 1

Table 2

Conclusion

This is the first survey of its kind which, although limited by total respondents, indicates that HCW are taking a variety of approaches to prevent transmission of SARS-CoV-2 to their FM. We did not find a significant impact of individual preventive measures on the risk of transmission. Regardless of the FM illness, most HCW have increased stress due to impact of COVID.

Disclosures

All Authors: No reported disclosures
508. Biomarker elevation during COVID-19: Differences between ambulatory and hospitalized individuals
Authors: Blair Paul W , Lanteri Charlotte , Striegel Deborah , Agan Brian , Maves Ryan C , Chenoweth Josh , Larson Derek , Mende Katrin , Colombo Rhonda , Lindholm David , Ganesan Anuradha , Richard Stephanie , Colombo Chris , Madar Cristian , Huprikar Nikhil , Tribble David , Dumler John S , Burgess Timothy , Burgess Timothy , Clark Danielle
Published: January 2021

Background

While the majority of illness due to COVID-19 does not require hospitalization, little has been described about the host inflammatory response in the ambulatory setting. Differences in the levels of inflammatory signaling proteins between outpatient and hospitalized populations could identify key maladaptive immune responses during COVID-19.

Methods

Samples were collected from 76 participants (41% female, mean 46.8 years of age) enrolled at five military treatment facilities between March 20, 2020 and June 17, 2020 in an ongoing prospective COVID-19 cohort. This analysis was restricted to those with positive SARS-CoV-2 (severe acute respiratory syndrome–coronavirus 2) RT-PCR testing and included hospitalized (N=29; 10 requiring an ICU stay) and non-hospitalized (N=43) participants. Severity markers (IL6, D-dimer, procalcitonin, ferritin, ICAM-1, IL5, lipocalin, RAGE, TNFR, VEGFA, IFNγ, IL1β) were measured in plasma (mg/dL) using the Ella immunoassay and natural log transformed. Univariate negative binomial regression was performed to determine relative risk of hospitalization. Using the full marker panel, we performed a Principal Component Analysis (PCA) to determine directions of maximal variance in the data. Pearson’s correlation coefficient was determined between analytes and each axis.

Results

Participants requiring ambulatory-, hospital-, and ICU-level care had samples collected at 44.0 (IQR: 35.0–51.0), 40.0 (13.0–51.0), and 47.5 (21.0–54.0) days, respectively. Higher unadjusted levels of IL6, D-dimer, procalcitonin, or ferritin were each associated with hospitalization (Table 1). The PCA showed a separation along axes between level of care and duration of symptoms (Fig 1). While significant correlations were noted with a number of biomarkers, PC1 most correlated with TNFR1 (r=0.88) and PC2 most correlated with IL6Ra (r=0.95). PC1 axis variation accounted for 36.5% of variance and the PC2 axis accounted for 20.0% of variance.

Figure 1. Principal Component Analysis (PCA) of biomarkers by level of care and symptom duration.

Conclusion

TNFR1 and IL6Ra levels correlated with differences in the proinflammatory states between hospitalized and non-hospitalized individuals including time points late in the course of illness. Further analysis of these preliminary findings is needed to evaluate for differences by stages of illness.

Disclosures

All Authors: No reported disclosures
511. Hospitalized COVID-19 Patients with Elevated Cardiac Troponin I Have Increased Length Of Stay But Similar Ventilation Time
Authors: Johnson Andre , Hanna George , Biswas Mimi , Kubomoto Scott
Published: January 2021

Background

Coronavirus disease 2019 (COVID-19) causes increased mortality and morbidity in patients with underlying cardiovascular disease. Elevated cardiac troponin I (cTnI) can suggest either a co-concurrent myocarditis or acute myocardial infarction. Understanding how laboratory values predict disease severity is important for clinicians to guide therapy and triage patients.

Methods

A cross sectional study was performed utilizing the 184 hospital United States database of HCA. Patients were selected based on inpatient visits to HCA facilities from February 2020 to May 2020 with a COVID-19 diagnosis and at least one cTnI lab test. Patients were divided according to an elevated or normal cTnI value based on the 99th percentile reference range of the test. Outcomes, such as length of stay, disposition, and time on the ventilator, were compared.

Results

3968 patients hospitalized with COVID-19 were identified. Of those, 3158 patients had at least one cTnI test throughout their hospitalization. 829 (26%) had at least one positive cTnI during their hospitalization. Patients with at least one positive cTnI were hospitalized on average for 8.7 days, whereas patients without positive cTnI were hospitalized on average for 6.3 days (p< 0.0001). 1499 patients without positive cTnI were sent home without health care, but only 196 with positive cTnI were discharged home without requiring home health (p < 0.0001). Need for mechanical ventilation was also higher in the elevated cTnI group. If intubated, patients in both groups required on average the same amount of ventilator time, 7 days (p = 0.7263).

Ventilation time between COVID-19 patients with and without elevated Troponins

Length of hospitalization stay between COVID-19 patient with and without elevated Troponins

Differences in discharge between COVID-19 patients with and without elevated Troponins

Conclusion

Patients with at least one positive cTnI during their hospitalization had increased length of stay and decreased likelihood of being discharged home without home health. Using a large nationwide database we confirmed previously published findings in smaller patient populations associating cardiovascular disease with COVID-19 severity. Once patients were intubated, both subsets of patients with and without elevated cTnI had similar days on the ventilator, suggesting the COVID-19 acute respiratory distress syndrome (ARDS) has a more complicated relationship to troponin levels. These findings suggest that patients with an increased cTnI should be triaged to receive aggressive management.

Disclosures

All Authors: No reported disclosures
513. Viral kinetics of SARS-CoV-2 in patients with COVID-19
Authors: Kim Da Young , Lee Ju-Hyung , Oh Hyeon Jeong , Seo Jun-won , Yun Na Ra , Kim Choon-Mee , Kim Dong-Min
Published: January 2021

Background

As only few studies have analyzed viral kinetics between the incubation and symptomatic periods of COVID-19 patients, we investigated the viral kinetics and compared viral loads between patients with mild and severe COVID-19.

Methods

We determined the viral kinetics of 10 patients diagnosed with COVID-19 at Chosun University Hospital. Six patients were classified into the “mild” group and 4 into the “severe” group according to supplemental oxygen use during admission. Samples were collected via nasopharyngeal swabs and sputum specimens. SARS-CoV-2 was detected using real-time reverse transcription-polymerase chain reaction (RT-PCR). Chest radiograph scores during hospitalization were obtained

Results

Ct values of the upper respiratory tract specimens were low during the early stages after symptom onset but gradually increased over time in both groups. The severe group had lower Ct values than the mild group. The Ct values of the RdRP and E genes on day 6 after symptom onset were significantly lower in the severe group than in the mild group (p < 0.05). Three of 6 patients had positive results on RT-PCR even before symptom onset; 2 of them had the lowest Ct values. The chest radiograph scores were higher in the severe group than in the mild group, and the score in the severe group was the highest at approximately 3 weeks after symptom onset.

Ct values when the RdRP gene and E gene were targeted to detect SARS-CoV-2 on the basis of the days after symptom onset in all the patients

Conclusion

Viral load and chest radiograph scores were significantly different between the severe and mild groups of COVID-19 patients.

Disclosures

All Authors: No reported disclosures
514. Clinical features and outcomes of 112 patients with SARS-CoV-2 infections requiring intensive care in a public healthcare system in South Florida
Authors: Niu Jianli , Sareli Candice , Sareli Aharon
Published: January 2021

Background

SARS-CoV-2 infections may result in intensive care unit (ICU) admission and mortality. We characterized patients with SARS-CoV-2 infections that required intensive care in a public healthcare system in South Florida.

Methods

Consecutive patients with SARS-CoV-2 infections, admitted to the ICUs of Memorial Healthcare System (MHS) in South Florida, from March 7 to May 14, 2020 were retrospectively reviewed. The primary outcome was the rate of in-ICU death. A Cox proportional hazards regression model was used to determine the independent risk factors for death during ICU stay.

Results

Of 702 patients with SARS-CoV-2 infections admitted to MHS from March 7 to May 14, 2020, 112 (16%) patients required ICU admission. The median age was 67 years (IQR 58–75) and 68 (61%) were men. The most common comorbidities were hypertension (88; 79%) and diabetes (43; 38%). All patients received hydroxychloroquine therapy, 42 (38%) received convalescent plasma transfusion, 39 (35%) received Tociluzimab, and 14 (13%) received Remdesivir. 90 (80%) patients required invasive mechanical ventilation for an average of 18 days (median = 14 days). 47 (42%) received vasopressors, and 34 (30%) received renal replacement therapy. As of May 14, 2020, 40 (36%) patients had died, 64 (57%) discharged alive, and 8 (7%) remained in the ICU. The ICU length of stay was comparable between discharged patients and those that died. An increased duration of mechanical ventilation was observed in discharged patients (Figure 1). Of 64 discharged patients, 9 (14%) were readmitted to ICU, with a median time to readmission of 4 days (IQR, 1.5–6.5). By multivariable Cox regression analysis, chronic pulmonary disease was one independent risk factor associated with in-ICU mortality, whereas renal replacement therapy, convalescent plasma transfusion, and tocilizumab administration were negatively associated with in-ICU mortality (Figure 2).

Figure 1. Clinical outcomes of critically ill COVID-19 patients required intensive care.

Figure 2. Forest plots for adjusted hazard ratio of in-ICU mortality in critically ill COVID-19 patients required intensive care.

Conclusion

In a public healthcare system in South Florida, patients with SARS-CoV-2 infection that required intensive care had 36% mortality. Mortality was associated with chronic pulmonary disease and inversely associated with renal replacement therapy, convalescent plasma transfusion, and tocilizumab administration.

Disclosures

All Authors: No reported disclosures
515. Risk Factors for Death, Intubation and Cardiac Arrest among COVID-19 Patients Hospitalized in Eastern North Carolina
Authors: Pona Adrian , Mao Yuxuan , Jiwani Rahim A , Afriyie Felix , Labbe Jonathan , Younes Ahmed , Badr Mai , Fang Xiangming , Zomorodian Laila , Lee Elisabeth , Cook Paul P
Published: January 2021

Background

Although majority of coronavirus disease 2019 (COVID-19) cases demonstrate mild to asymptomatic disease, COVID-19 can cause serious complications and death. However, risk factors for development of such complications are not well understood. The purpose of this study was to identify risk factors for intubation, cardiac arrest, and death in COVID-19 patients.

Methods

A retrospective chart review of COVID-19 subjects was conducted of the first 185 patients for whom we had complete data sets. Subjects were adult inpatients with a confirmed COVID-19 diagnosis who were hospitalized between March and May 2020 at Vidant Medical Center in Greenville, NC. Data including demographics, comorbidities, laboratory results, treatments, and outcomes were collected. Data were analyzed using logistic regression models and receiver operating characteristic curves in SAS 9.4.

Results

Of the first 185 subjects hospitalized for COVID-19, 26% of patients were intubated, 9% experienced cardiac arrest, and 17% died. Subjects who required intubation were more likely to exhibit elevated triglycerides, sepsis, acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), elevated troponin levels, altered mental status, leukocytosis, lymphopenia and elevated ferritin (P< 0.05) (Table 1). Troponin elevation, ARDS, AKI and thrombocytopenia were risks for cardiac arrest (P< 0.05) (Table 2). Risk of death was increased in those presenting with advanced age, critical or severe disease, lymphopenia or thrombocytopenia, and in those with history of coronary artery disease (CAD) (P< 0.05) (Table 3). Patients presenting with AKI, elevated Troponin, ARDS, pressor requirements, critical disease, and sepsis were at increased risk of intubation, cardiac arrest, and death (P< 0.05) (Tables 1–3).

Table 1: Top non-ICU related risk factors for intubation ordered by AUC.

Table 2: Top risk factors for cardiac arrest ordered by AUC.

Table 3: Top risk factors for death ordered by AUC.

Conclusion

In this rapidly evolving pandemic, clinician awareness of risk factors for clinically significant outcomes such as intubation and mortality is essential. Assessment of risk factors like those highlighted in this study can aid in clinical decision-making and predicting patient outcomes. As more data becomes available we aim to develop a validated scoring system to assist clinicians in patient care.

Disclosures

Paul P. Cook, MD, Contrafect (Grant/Research Support, Scientific Research Study Investigator)Gilead (Grant/Research Support, Scientific Research Study Investigator)Leonard-Meron (Grant/Research Support, Scientific Research Study Investigator)Lilly (Grant/Research Support, Scientific Research Study Investigator)
517. Association of the predictive risk scores of CALL points and COVID-GRAM with IL-6, duration of oxygen therapy, D-dimer among patients with COVID-19
Authors: Yoshihara Hanako , Kurihara Ibuki , Fukuchi Takahiko , Sugawara Hitoshi
Published: January 2021

Background

The coronavirus disease 2019 (COVID-19) outbreak has caused a global pandemic. Critically ill patients with COVID-19 can develop acute respiratory distress syndrome (ARDS) and thrombosis. Angiotensin-converting enzyme 2 is a functional receptor for severe acute respiratory syndrome coronavirus 2 to gain entry in cells. This receptor is widely expressed in some hematopoietic cells, including monocytes and macrophages. Infection of these cells results in secretion of interleukin (IL)-6 and other inflammatory cytokines. IL-6 and other inflammatory cytokines can cause ARDS and thrombosis. Elevated IL-6 levels are expected to cause more severe cytokine release syndrome. In this study we investigated the association of the predictive risk scores with the IL-6 level, duration of oxygen therapy (DOT), and D-dimer level.

Methods

We enrolled 20 consecutive patients diagnosed with COVID-19 from April 3, 2020, to April 30, 2020, and determined the predictive risk scores of CALL points (Dong J et al. CID 2020) and COVID-GRAM (Liang W et al. JAMA Int. Med2020) on admission. We statically analyzed the regressions between these two scores and the values of IL-6 and D-dimer and DOT.

Results

The regression lines between CALL points and the values of IL-6, D-dimer, DOT were Y=-2.09 + 0.618X (r=0.821), Y=-0.783 + 0.213X (r=0.510), and Y=-5.32 + 1.26X (r=0.744), respectively. The regression lines between COVID-GRAM and the values of IL-6, D-dimer, and DOT were Y=-0.820 + 0.0344X (r=0.935), Y=-2.70 + 0.0205X (r=0.774), and Y=-1.92 + 0.0491X (r=0.765), respectively. These correlation coefficients were statistically significant. The correlation coefficients of CALL points were in the descending order of IL-6, DOT, and D-dimer. The correlation coefficients of COVID-GRAM were in the descending order of IL-6, D-dimer, and DOT. The coefficient between COVID-GRAM and IL-6 was the highest.

Conclusion

These predictive risk scores of CALL points and COVID-GRAM can be surrogate markers for the IL-6 level in patients with COVID-19. Further research is required to understand the prediction of severity in patients with COVID-19.

Disclosures

All Authors: No reported disclosures
518. Factors Associated with Severe COVID-19 among Patients Hospitalized in Rhode Island
Authors: Pandita Aakriti , Gillani Fizza S , Shi Yiyun , hardesty Anna , Aridi Jad , McCarthy Meghan , Chiang Silvia , Beckwith Curt
Published: January 2021

Background

To better understand patient factors that impact clinical outcomes in COVID-19, we performed a retrospective cohort study of patients hospitalized with COVID-19 in Rhode Island to identify patient and clinical characteristics associated with severe disease.

Methods

We analyzed 259 patients admitted to our academic medical center during a three month period with confirmed COVID-19. Clinical data was extracted via chart review and lab results within the first 24 hours of admission were extracted directly from electronic medical records. Patients were divided in two groups based upon the highest level of supplemental oxygen (O2) required during hospitalization: severe COVID-19 (high flow O2, non-invasive, or invasive mechanical ventilation) and non-severe COVID-19 (low flow O2 or no supplemental O2). SAS 9.4 (Cary, NC) was used for statistical analyses. Chi-square or Fisher’s exact tests for categorical variables and the Student’s t-test for continuous variables were used to compare demographics, baseline comorbidities, and clinical data between the severe and non-severe groups.

Table 1: Demographics

Results

Of 259 patients, 166 (64%) had non-severe disease, and 93 (36%) severe disease; median age [IQR] was 62 [51,73]. There were 138(53%) males and 75 (29%) Hispanics. Among non-Hispanics,124(48%) were White, 48(19%) African Americans, and 12(5%) other races. Sixty (23%) were admitted from a nursing facility and the in-hospital mortality rate was 15% (38/259). Severe COVID-19 was associated with older age (p=0.02), admission from nursing facility (p=0.009), increased BMI (p=0.03), diabetes mellitus (p=0.0002), and COPD (p=0.03). At the time of presentation, severe COVID-19 was associated with tachypnea, hypoxia, hypotension (all p< 0.0001), elevated BUN (p=0.002) and AST (p=0.001), and acute or chronic kidney injury (p=0.01). Median hospital stay [IQR] was 11 days [7,18] in the severe vs. 6 days [3,11] in the non-severe group. In the severe group, 72% required ICU admission and 39% died.

Table 2: Medical comorbidities

Table 3: Presenting symptoms and signs in the first 48 hours of admission

Table 4: Basic labs in the first 24 hours

Conclusion

In this cohort of patients with COVID-19, specific comorbidities, and vital signs at presentation were associated with severe COVID-19. These findings help clinicians with early identification and triage of high risk patients.

Disclosures

All Authors: No reported disclosures
523. COVID-19 Preparedness in Hospice and Palliative Care
Authors: Pogorzelska-Maziarz Monika , Kates Jeannette , Shang Jingjing , Gerolamo Angela M
Published: January 2021

Background

Due to the emergence of COVID-19 and resulting pandemic, there is an increased demand for palliative care and hospice care services. However, the impact of COVID-19 on the hospice and palliative agencies is unknown.

Methods

An electronic survey was disseminated via the Hospice & Palliative Nurses Association newsletter, posted to the Sigma Theta Tau Hospice and Palliative Care Community Group discussion board and advertised through social media from May 7–28, 2020. Summary statistics were computed.

Results

We collected 36 surveys representing all U.S. regions. Most respondents (78%) reported that their agency has cared for confirmed COVID-19 patients. Only half of agencies had access to laboratory facilities for surveillance and detection of the presence of outbreaks in both patients and staff (58%) and the ability to test patients and providers for COVID-19 (55%). Due to COVID-19, participants stated that the agency added new protocols regarding aerosol-generating procedures policies (58%), use of surface barriers (61%) and PPE usage (e.g. donning and doffing) in patient homes (56%). The majority (76%) reported that their agency required field clinicians to call ahead to ascertain COVID-19 exposure/symptoms before a home visit.

More than half (58%) reported that their agency lacked supplies, including N95 respirators (45%), cleaning/disinfectant product (23%), alcohol based sanitizer (18%), eye protection (18%), gowns (18%), and surgical masks (14%). Overall, participants shared that field clinicians had to reuse (76%), extend (73%) or ration (30%) PPE supplies. Respondents reported that their agency accessed supplemental PPE through state/local resources (67%), private/community donations (67%), and do-it-yourself efforts (55%). One third (31%) reported that their agency was experiencing staffing shortages due to COVID-19; of these, 60% reported that shortages were due to staff infected with/quarantined due to COVID-19.

Conclusion

Our findings suggest that COVID-19 has presented significant challenges for palliative care and hospice agencies as they provide care to patients and families at an unprecedented rate.

Disclosures

All Authors: No reported disclosures
525. Characteristics of HIV SARS-COV-2 Coinfection in a Highly HIV Seropositive Population in New York City
Authors: Willner Debra M , Bengualid Victoria , Bisono-Garcia Bismarck , Trigueros Ricardo , Berger Judith
Published: January 2021

Background

The HIV and COVID-19 co-infection prevalence has not been described extensively. Given the high prevalence of HIV positive patients in our population-our Designated AIDS Center (DAC) caters to approximately 600 patients-of which 68% are virally suppressed, this relationship is of great interest. The objectives of this analysis are to report the characteristics of HIV and COVID-19 patients, and to evaluate for any associations of HIV with COVID-19 outcomes.

Methods

Retrospective chart review of all patients admitted with both HIV and confirmed COVID-19. Collected demographics, past medical history, HIV history including therapy, compliance, viral loads, and CD4 counts, and COVID-19 disease course. Evaluate baseline clinical status utilizing the World Health Organization’s Ordinal Scale for Clinical Improvement, and note disease outcomes. Analyzed mortality and disease severity as compared to the general COVID-19 patient population.

Results

39 patients were identified with HIV and COVID-19 from March 15th –June 18th 2020. Baseline characteristics of these patients are listed in Figure 1. Of the available labs, 60% of patients were virally suppressed, and 87% had CD4+ counts above 200/µL. On admission, most patients either did not require oxygen support, or received support through noninvasive methods. In Figure 2 we see the final outcome of the patients, with 77% of the patients discharged, and a mortality rate of 18%. Of note, the only baseline characteristic that had a significant correlation with mortality among our patients was age > 60 (p = 0.03).

Baseline Characteristics of HIV COVID-19 Patients and Pertinent COVID-19 Admission Statistics

COVID-19 Outcomes

Conclusion

Mortality in our HIV COVID-19 population was 18%, significantly lower than the 33% in COVID-19 patients overall at our institution. 39 patients with HIV were admitted for confirmed COVID-19 infections, which only amounts to 6.5% of the DAC population, although it is possible that our patients were admitted to other facilities for COVID-19. In our patients, compliance, viral suppression, and CD4+ counts did not correlate with outcomes. Although our mortality was significantly lower than the overall hospital mortality, larger studies are needed to fully evaluate the mortality relationship and determine the protective effects of antiviral therapy and/or decreased immune response in HIV patients with COVID-19.

Disclosures

All Authors: No reported disclosures
526. Clinical Presenting Characteristics of Pediatric COVID-19 Infection in a Tertiary Care Children’s Hospital in Detroit
Authors: Ang Jocelyn Y , Kannikeswaran Nirupama , Asmar Basim
Published: January 2021

Background

There is limited data regarding the presenting clinical characteristics of COVID-19 in children. Our objective is to describe the clinical presentations and outcomes of COVID-19 infection early in the pandemic at our institution.

Methods

We performed a retrospective chart review of children up to 18 years who underwent testing for SARS CoV-2 from March 1st to May 10th 2020 at our pediatric emergency department. We abstracted patient’s demographics, clinical presentation, diagnostic studies and patient disposition. We classified the severity of clinical illness based on published criteria. We excluded patients diagnosed with Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19.

Results

SARS CoV-2 testing was performed on 481 patients of whom 43 (8.9%) tested positive. Of these, 4 were diagnosed with MIS-C. Data of 39 patients were analyzed. Patients’ demographics, co-morbidities, presenting signs and symptoms and disposition are shown in Table 1. Age range was 47 days – 18 years. Infants representing one third (14/39; 35.9%) of our study cohort. There was equal sex distribution. Asthma or obesity was present in 17 (44%). The most common presenting symptoms included fever, cough, shortness of breath and diarrhea. Chest radiograph showed pneumonia in 12 (30.8%) patients. Two thirds (27/39; 69.2%) were asymptomatic or had mild disease; six patients (15.4%) had severe or critical illness (Figure 1). Nineteen (48%) patients were admitted to the general pediatric service. Eleven (28%) were admitted to the Intensive Care Units (ICU). The characteristics, presenting symptoms and interventions performed in the PICU cohort are shown in Table 2. Half of these patients required mechanical ventilation. There was one death in a 3 month old infant unrelated to SARS CoV-2. Majority of the infants required hospitalization (12/14; 85.7%), including 4 to the PICU (one each for non accidental trauma, ingestion, seizure and pneumonia).

Table 1. Patient demographics, signs and symptoms of COVID-19 infection in Children

Table 2: PICU patients: Characteristics, Interventions and pharmacotherapy

Figure 1: Severity of Ill ness in the study cohort

Conclusion

Majority (17; 43%) of our children with COVID-19 had a mild disease. Eleven (28%) including 4 infants required critical care; 5 required mechanical ventilation. There was no COVID-19 related mortality. Larger studies are needed to further define the spectrum of COVID- 19 and risk factors associated with severe disease in children.

Disclosures

All Authors: No reported disclosures
528. Coronavirus Disease 2019 in Children Cared for at Texas Children’s Hospital: Implications of Repeat Testing on Infection Control Strategies
Authors: Foster Catherine , Marquez Lucila , Koy Tjin , Singh Ila , Campbell Judith
Published: January 2021

Background

Accurate diagnosis of coronavirus disease 2019 (COVID-19) is key for source control and interrupting disease transmission. To better understand the length of viral shedding in children and potential infection control implications, we describe 51 children with COVID-19 who underwent repeat testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at Texas Children’s Hospital (TCH).

Methods

We performed a retrospective chart review of all pediatric patients (< 21 years of age) with ≥ 2 nasopharyngeal specimens tested for SARS-CoV-2 by reverse transcription-polymerase chain reaction (rt-PCR) and at least one positive result between 3/13/2020 and 6/7/2020 through the TCH Molecular Microbiology Laboratory.

Results

Fifty-one patients met inclusion criteria. The median age was 8.6 years (0.02–19.2 years). Sixteen (31%) children were hospitalized. Fourteen (27%) patients underwent testing for surveillance purposes (including 3 admitted patients). Two SARS-CoV-2 tests were performed in 25 (49%) children; while 12 (24%) children had 3 tests, 4 (8%) children had 4 tests, and 10 (20%) children had ≥ 5 tests (including 1 patient with underlying malignancy who had 9 SARS-CoV-2 PCRs performed). SARS-CoV-2 testing timeline for 9 hospitalized children is shown (Fig 1). The median time between collection of tests 1 and 2 was 14 days (n=51, range 1, 53 days). For children with conversion (first detected to first not-detected sample), the median time was 15 days (n=31, range 1, 45 days). For patients with consecutive positive SARS-CoV-2 PCRs, the median time of positivity was 10 days (n=19, range 2, 31). One patient with malignancy had 5 tests over 6 weeks in the outpatient setting and each time alternated between detected and not-detected. Following diagnosis with COVID-19, one patient with sickle cell disease likely had re-infection and had a positive test after having 2 consecutive negative tests; his last SARS-CoV-2 rt-PCR was positive 68 days after initial positive.

Fig 1. Timing of Repeat SARS-CoV-2 PCRs in Select Hospitalized Children with COVID-19

Conclusion

We observed variation in the duration of SARS-CoV-2 rt-PCR positivity in children with COVID-19. For children with COVID-19, a single negative molecular assay for SARS-CoV-2 may not be predictive of sustained negativity.

Disclosures

All Authors: No reported disclosures
530. COVID-19 in kidney transplant recipients: Single-center experience and case-control study
Authors: Hardesty Anna , Pandita Aakriti , Shi Yiyun , Vieira Kendra , Rogers Ralph , Merhi Basma , Osband Adena , Bayliss George , Gohh Reginald , Morrissey Paul , Beckwith Curt , Farmakiotis Dimitrios
Published: January 2021

Background

Organ transplant recipients (OTR) are considered high-risk for morbidity and mortality from COVID-19. Case-fatality rates (CFR) vary significantly in different case series, and some patients were still hospitalized at the time of analyses. To our knowledge, no case-control study of COVID-19 in OTR has been published to-date.

Methods

We captured kidney transplant recipients (KTR) diagnosed with COVID-19 between 3/1 and 5/18/2020. After exclusion of KTR on hemodialysis and off immunosuppression (IS), we compared the clinical course of COVID-19 between hospitalized KTR and non-transplant patients, matched by sex and age (controls). All patients were discharged from the hospital or died.

Results

16 KTR had COVID-19. All 3 KTR off IS, who were excluded from further analyses, survived. Median age was 54 (range: 34–65) years; 5/13 KTR (38.4%) were men. Median time from transplant was 41 (range: 1–203) months. Two KTR, both transplanted >10 years ago, were managed as outpatients. IS was reduced in 12/13 (92.3%), most often by discontinuation of the antimetabolite. IL6 levels were >1,000 (normal: < 5) pg/mL in 3 KTR. Tacrolimus or sirolimus levels were >10 ng/mL in 6/9 KTR (67%) (Table 1). Eleven KTR were hospitalized (84.6%) and matched with 44 controls. One KTR, the only one treated with hydroxychloroquine, died (CFR 5.8%; 7.6% in KTR on IS; 9% in hospitalized KTR on IS). Four controls died (CFR: 9%; state CFR: 5.2%; inpatient CFR: 16.6%). There were no significant differences in length of stay or worst oxygenation status between hospitalized KTR and controls. Four KTR (30.7%), received remdesivir, 4 convalescent plasma, 3 (23%) tocilizumab. KTR received more often broad-spectrum antibiotics, convalescent plasma or tocilizumab, compared to controls (Table 2).

Table 1

Table 2

Conclusion

Unlike early reports from the pandemic epicenters, the clinical course and outcomes of KTR with COVID-19 in our small case series were comparable to those of non-transplant patients. Calcineurin or mTOR inhibitor levels were high, likely due to diarrhea and COVID-19-related hepatic dysfunction. Extremely high IL6 levels were common. The role of IS and potential benefits from investigational treatments remain to be elucidated. A larger multi-institutional study is underway.

Disclosures

All Authors: No reported disclosures
534. Halting a SARS-COV2 Outbreak in a Veterans Affairs Nursing Home
Authors: Psevdos George , Papamanoli Aikaterini , Barrett Nancy , Bailey Lisa , Thorne Monique , Ford Florence M , Lobo Zeena
Published: January 2021

Background

Health care systems have been significantly overwhelmed during the SARS-CoV-2 (SC2) pandemic. Cases in the USA have exceeded 1.9 million with over 40% of deaths occurring in nursing homes and assisting living facilities. We describe our experience in controlling an outbreak in our community living centers (CLC)

Methods

We retrospectively reviewed the charts of Veterans with positive nasopharyngeal (NP) RT-PCR for SC2 from March 24 to April 18, 2020 in 2 neighboring CLC units (80 bed capacity), at Northport Affairs Medical Center.

Results

Twenty five Veterans (24 men) tested positive for SC2. Of these, 5 remained asymptomatic, 9 got hospitalized, 6 died. No coinfection with influenza or other respiratory viruses identified. 11 health care workers (HCW) tested positive. Figure 1 shows test results by date. Table 1 summarizes the demographic characteristics, medical history, and laboratory findings. The median age was 74 years, with no difference in age between recovered and deceased, 73 vs. 77, P:0.105. Simplified acute physiology score (SAPS) II score was higher in the deceased group (P=0.001) and so were D-dimer (admission and peak levels), CRP, LDH, and peak ferritin/procalcitonin levels. There was no ICU admission. Figure 2 illustrates the CLC 1 and 2 outline of beds depicting positive cases in sequence of detection. Initial spread of the virus was fast, affecting residents and HCW. CLC visits were prohibited, floating of staff minimized, internal group activities halted, infection control measures and education on proper use of personal protective equipment provided. A SC2 (or “COVID”) unit was created in CLC1 and all patients and staff got tested. Withdrawal of isolation precautions required resolution of symptoms, and two sequential negative NP PCR tests which were obtained after 14 days from diagnosis. If the PCR was positive, a repeat test was obtained in 72 hours. 13 patients had persistent positive PCR for average 32 days (19 to 52) since diagnosis. 7/13 got tested and all were positive for SC2 IgG antibody.

SARS-CoV -2 Outbreak in VA Nursing Home, Dates of Tests

Bed Outline of CLCs Depicting the Location And Numerical Sequence of Positive Tests

Comparison Between Recovered vs Deceased Nursing Home Veterans with COVID-19

Conclusion

Controlling SARS-CoV-2 outbreaks in nursing homes is a unique challenge as the virus can spread quickly among residents and staff. Mortality rate in our cohort was 24%. Prompt, effective isolation and broad testing was instrumental in halting the SC2 (COVID-19) outbreak.

Disclosures

All Authors: No reported disclosures
535. Harm reduction strategies and positive behaviors of medical providers in mitigating the effects of COVID-19 among HIV-infected children and HIV-exposed infants
Authors: Ebeid Mariam , Smith Amy , Inagaki Kengo , Palmer April , Santos Roberto
Published: January 2021

Background

There are limited data on the disease course of COVID-19 among children with HIV and among HIV-exposed infants. It is sensible to maximize the preventive effort against SARS-CoV-2 infections in this group of patients using harm reduction strategies and positive behaviors provided by medical providers.

Methods

A quality improvement project was started in the 2nd week of April in our Children’s Hospital Subspecialty Clinic caring for children with HIV and HIV-exposed infants on antiretroviral therapy (ART). All patients are offered Telehealth at baseline and at 4 weeks after interventions making sure they remain adherent to their ART, with enough supply of ART for 4 weeks, and discussed harm reduction strategies (hand washing, use of hand sanitizer & face mask, social distancing, shelter-at-home) via telehealth and video clips. The goal was an increase of hand hygiene performance by 25% at 4 weeks after interventions. The number of hand washing and hand sanitizer use per day was categorized as < 5, 5–10, and >10 per day and was analyzed by Cochran-Armitage test for trend. Adherence to ART was categorized as < 50%, 50–90%, >90–100% per week.

Results

There are 19 patients included: 11 with HIV infections (9–20 yo) and 8 HIV-exposed infants (2 weeks-6 months old), where parents received the intervention. At baseline, 32% of the participants washed hands >10 times a day, which increased to 71% after intervention (p value: 0.013). While 21% of participants washed hands < 5 times a day at baseline, all participants washed their hands 5 times or more after the intervention. Sanitizer use of >10 times a day increased from 21% to 43% (p value: 0.026). (Fig. 1 and 2) This was notable increase, as 47% used hand sanitizers < 5 times a day pre-intervention. No one was diagnosed with COVID-19, and all remained asymptomatic at 4-week follow up. All children with HIV remained adherent (>90–100% per week) to their ART.

Conclusion

The degree of hand hygiene among children with HIV and HIV-exposed infants was increased 4 weeks after the intervention consisting of harm reduction strategies and positive behaviors by medical providers. All patients remained healthy and adherent to ART 4 weeks after the project began. COVID-19 pandemic is an opportunity for impactful health education that can positively affect the patients’ life.

Disclosures

All Authors: No reported disclosures
542. SARS CoV-2-Associated Multisystem Inflammatory Syndrome of Children (MIS-C) in the Washington DC Metropolitan Region
Authors: DeBiasi Roberta L , Smith Karen L , Bell Michael , Berul Charles , Ansusinha Emily , Bundy Vanessa , Delaney Meghan , Diab Yaser , Hahn Andrea , Hamdy Rana F , Hanisch Benjamin , Harik Nada , Harahsheh Ashraf S , Herstek Jessica , Kline Jaclyn , Koay Wei Li A , Krishnan Anita , Jantausch Barbara , Majumdar Suvankar , Parikh Kavita , Pershad Jay , Ronis Tova , Sadler Eleanor D , Sharma Hemant , Sharron Matthew P , Srinivasalu Hemalatha , Sule Sangeeta , Wells Elizabeth , Wessel David
Published: January 2021

Background

Background: Multi-system Inflammatory Syndrome of Children (MIS-C) has recently emerged internationally as a serious inflammatory complication of SARS-CoV-2 infection with significant morbidity for the pediatric population.

Methods

This observational retrospective cohort study includes 33 children meeting CDC criteria for MIS-C treated between March 15 and June 17, 2020 at Children’s National Hospital in Washington DC. Clinical and demographic data were extracted from medical records and are summarized.

Results

Of 33 hospitalized MIS-C patients, 42% were critically ill, and 58% were non-critically ill. The median age was 8.9 years (0.7–18.7 years). More males (58 %) than females (43 %) were represented in the MIS-C cohort. The majority (75%) of children had no underlying medical condition. Criteria for incomplete or complete Kawasaki Disease (KD) were present in 39% of patients, while an additional 9% had some features of KD. However the remaining 52% of MIS-C patients presented with other sub-phenotypes including prominent severe abdominal pain and/or nonspecific multiorgan dysfunction. 30% presented with shock requiring volume and/or inotropic support. SARS-CoV-2 antibodies were present in 61% of patients. Virus was detectable by PCR in 36% of patients. At the time of initial evaluation, 39% (13/33) of children had identified cardiac abnormalities including myocardial dysfunction (5/33; 15%), coronary ectasia (4/33; 12%), coronary aneurysm (3/33; 9%), or pericardial effusion 5/33; 15%) either alone or in combination. Cytokine profiling identified elevation of several cytokines in this cohort, including IL-6. Treatment has included intravenous immunoglobulin, aspirin, anakinra and other immunomodulatory therapies, with overall rapid response to therapy. No deaths have occurred.

Conclusion

The emergence of MIS-C late in the surge of SARS-CoV-2 circulation in the Washington DC metropolitan region has added to the already significant burden of hospitalized and critically ill children in our region. A significant percentage of these children present with cardiac dysfunction and abnormalities, whether or not with KD features at presentation. Detailed characterization of immune responses and long term outcome of these patients is a priority.

Disclosures

Andrea Hahn, MD, MS, Johnson and Johnson (Consultant)
546. Capturing Clinician’s Experiences Repurposing Drugs to Inform Future Studies During COVID-19
Authors: Duggal Mili , Stone Heather , Paul Parvesh , Charles Reema , Sacks Leonard , Southall Noel
Published: January 2021

Background

CURE ID is an internet-based repository developed collaboratively by FDA and NCATS/NIH, with the support of WHO and IDSA. It encourages clinicians globally to share novel uses of existing drugs for patients with difficult-to-treat infections. It is designed to serve as a rapid communication platform for healthcare providers during an outbreak, providing for systematic case-sharing, discussion, and the latest literature. Besides case reports, CURE ID offers a discussion platform for clinicians, disease-specific clinical trials curated from clincialtrials.gov, and a newsfeed that shows relevant journal articles and news related to COVID-19 and other infectious diseases.

Methods

The CURE ID team extracted individual case reports on patient-level treatments and outcomes of COVID-19 infection from the published literature and gathered clinician-submitted cases through the electronic case report form. Additionally, CURE ID partnered with the University of Pennsylvania’s CORONA database to further populate the CURE ID database with published cases.

Results

As of submission, lopinavir-Ritonavir (n=51) was the most commonly reported drug used. The following were also reported: hydroxychloroquine (n=31), azithromycin (n=28), arbidol (n=22), interferon alfa-2B (n=18), moxifloxacin (n=18), methylprednisolone (n=17), ivermectin (n=14), lopinavir (n=12), oseltamivir (n=12). The other drugs reported were danoprevir-ritonavir, intravenous immunoglobulins, interferon, interferon alfa, and tocilizumab. CURE ID currently includes more than 150 detailed COVID case reports of 65 repurposed drugs. We expect case reporting for specific drugs to be dynamic and additional data to accrue. Updated results will be presented.

Conclusion

Several drugs are being repurposed to treat COVID-19. CURE ID gives clinicians an opportunity to share their treatment experiences and discuss their questions with a global community of healthcare providers. By utilizing the CURE ID platform, in conjunction with data gathered from other registries, observational studies and clinical trials, hypotheses can be generated that may inform future clinical trials and ultimately, potentially find safe and effective treatments for this deadly disease.

Disclosures

All Authors: No reported disclosures