bluuebunny/crossref_metadata_2025 huggingface dataset:
441. Clinical Characteristics of Pediatric SARS-CoV-2 Infection and Coronavirus Disease 2019 (COVID-19) in Kuwait
Authors: Alsharrah Danah Y , Al-Haddad Fatemah , Aljamaan Sarah , Al-Yaseen Muneera , Al-Mutairi Nahar , Ayed Mariam , Papenburg Jesse , Alghounaim Mohammad
Published: January 2021

Background

Clinical presentation of coronavirus disease-2019 (COVID-19) ranges from asymptomatic to severe and life threatening. National-level registries found that children, generally, have less severe disease when compared to adults. However, most asymptomatically infected children will not present to hospital and may be missed. We aimed to describe the clinical characteristics in pediatric COVID-19 patients in Kuwait, and to estimate the potential duration of viral shedding.

Methods

A retrospective cohort study was performed in Jaber Alahmad Hospital (JAH) from Feb. 29th to Apr. 30th, 2020. During the study period and as part of the public health measures to contain COVID-19, all SARS-CoV-2 infected patients 1 month-18 years old, regardless of symptoms, were hospitalized at JAH, and were included. Demographics, clinical data, and laboratory results were collected. Polymerase chain reaction (PCR) negativity was defined as having two consecutive negative PCR results from a respiratory specimen. Descriptive statistics and multivariable regression analyses were performed.

Results

A total of 134 pediatric SARS-CoV-2 infections were identified. Of those, 91 patients (67.9%) were asymptomatic, the remaining cases had mild COVID-19 illness and mild pneumonia. The median age was 8.8 years (IQR: 4.7–12.4), 55.2% were males, and 89.5% were healthy. Cough and fever were the most commonly reported symptoms. The median duration to PCR negativity was 15 days (IQR: 13–19) for symptomatic patients and 15.5 days (IQR: 14–21) for asymptomatic patients. Predictors for symptoms included abnormal procalcitonin (aOR 6.6; 95% CI 1.48 -29.3), C-reactive protein (aOR 9.10; 95% CI 1.29–32.13), and X-ray finding of pneumonia (aOR 6.44; 95% CI 1.29–32.13).

Conclusion

Asymptomatic SARS-CoV-2 infection is very common in children. Among symptomatic patients, the disease seems to be mild. Children exhibit substantial duration of viral shedding, as measured by PCR positivity, regardless of symptoms.

Disclosures

Jesse Papenburg, MD, AbbVie (Consultant, Scientific Research Study Investigator, Research Grant or Support, Speaker’s Bureau)BD Diagnostics (Research Grant or Support)Cepheid (Speaker’s Bureau)MedImmune (Scientific Research Study Investigator)Sanofi Pasteur (Scientific Research Study Investigator)Seegene (Research Grant or Support, Speaker’s Bureau)
444. Coronavirus Disease 2019 (COVID-19) Among Healthcare Workers in Southeast Michigan
Authors: Vahia Amit T , Chaudhry Zohra Sarfraz , Weinmann Allison J , Samuel Linoj , Tibbetts Robert , Alangaden George J , Suleyman Geehan
Published: January 2021

Background

Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has significantly impacted Michigan, with over 60,000 cases and 5,700 deaths to date. During the surge, Metropolitan Detroit was the epicenter of the outbreak, accounting for 80% of cases and 86% of deaths statewide. Healthcare workers (HCW) are particularly at risk; however, rates of infection based on job category has not been described previously in the United States. We describe the impact of the outbreak on our workforce.

Background Michigan COVID

Figure 1

Methods

This was a retrospective review of employees with COVID-19 at Henry Ford Health System (HFHS), a comprehensive, integrated, health care organization in Southeast Michigan includes 5 hospitals and 9 emergency departments from 3/10/2020–6/10/2020. Employees exhibiting symptoms and/or signs consistent with COVID-19 infection were referred to employee health and tested for SARS-CoV-2. All employees with positive polymerase chain reaction (PCR) of upper respiratory tract were included. Data were obtained from a dedicated analytics dashboard that tracked all testing and results for employees. Rate (number positives/total tested) of infection for each job category was determined.

Results

A total 5352 (16%) of 33538 employees were tested, of whom 1036 (19%) tested positive. The number of infected workers represents approximately 3.1 % of the workforce. The sharp increase of COVID-19 admissions correlated with the rise in HCW COVID-19 positivity (Figure 1). The number of HCW tested largely correlated with the disease burden at each hospital (Figure2). Table 1 shows total population of symptomatic HCW tested and demonstrates volume of testing and positivity were higher among HCW with close patient contact. The positivity rates in specific clinical support staff are shown in Table 2. Notably, there were high rates of positivity among non-clinical business and management employees tested suggesting community-transmission.

Table 1

Table 2

Figure 2

Conclusion

COVID-19 risk is highest among HCW in high volume settings with close patient contact. Community exposure may be an important factor that contributes to this risk. Strategies to minimize transmission in healthcare settings should be combined with HCW education emphasizing measures to avoid exposure within the community.

Disclosures

All Authors: No reported disclosures
445. Correlative Factors for State to State Differences in the Prevalence and Case Fatality Rates of SARS-CoV-2, COVID-19 Infections in the United States of America
Authors: Kamar Amanda J , Doniparthi Meghana , Nhan Nhan , Zhou Ying , Colton James A , Ehrenpreis Eli D
Published: January 2021

Background

Individual States of the USA have ethnic, economic, community health and education differences that influence the prevalence and outcomes of COVID-19 infection. We hypothesized that Statewide differences in the prevalence and fatality rates of COVID-19 infections are dependent on factors that may be determined by mathematical modeling.

Methods

Two separate statistical regression models were developed using COVID-19 case prevalence and case fatality rates functioning as dependent variables. We obtained data from the prevalence and deaths from COVID-19 cases for each state in the USA that was posted at 4 PM Central Standard Time on April 29, 2020 from the Worldometer website. Publicly available databases were utilized to obtain data for the independent variables in the model.

Results

Models are represented as follows:

Statewide COVID-19 Prevalence Model

Log (Statewide COVID_19 case prevalence) = 1.847* (100–250 individuals/mile2) +3.0025*(250+ individuals/mile2) + 1.021* (% African American population) +1.029* (% Hispanic American population +2.164 *(% adults aged 85+)

Model results are shown in Table 1.

Statewide COVID-19 Case Fatality Rate Model

Log (Statewide COVID_19 case fatality rate) =2.194* (100–250 individuals/mile2) +2.758* (250+ individuals/mile2) +1.031* (% African American population) + 1.032* (% Hispanic American population) + 0.942 (% Native American population)+ 1.108 (% Asian American population) + 2.275 (% adults aged 85+)

Model results are shown in Table 2.

Table 1: COVID-19 Statewide Prevalence Model

Table 2: COVID-19 Statewide Case Fatality Model

Conclusion

Higher State population density (See Figure 1 and Figure 2) and higher State populations of elderly persons correspond to increased prevalence and case-fatality rates of COVID-19 infections. Statewide data also shows health disparities for COVID-19 infections in Hispanic Americans, African Americans, and Asian Americans. Paradoxically, States with larger populations of Native Americans who have known poor outcomes from COVID-19 infection demonstrate a decrease in case-fatality rates, suggesting a large effect of healthcare inequality in this population.

Figure 1: ANOVA one-way analysis of the association between COVID-19 prevalence and population density

Figure 2: ANOVA one-way analysis of the association between COVID-19 death prevalence and population density

Disclosures

Eli D. Ehrenpreis, MD, FACG, AGAF, E2Bio Consultants (Board Member, Chief Executive Officer)E2Bio Life Sciences (Shareholder, Chief Executive Officer)Level Ex, Inc. (Consultant)
448. Disproportionate Burden of COVID-19 on Latinx Residents among Hospitalized Patients at San Francisco’s Public Health Hospital
Authors: Jain Vivek , Brown Lillian B , Marquez Carina , Rubio Luis , Spottiswoode Natasha , Churnet Bethlehem , Brooks Katherine , Zhou Mengyu , Muldoon Timothy , Hendrickson Carolyn , Cattamanchi Adithya , Gomez Antonio , Haas Brian , Charlebois Edwin , Luetkemeyer Annie , Luetkemeyer Annie , Gandhi Monica , Havlir Diane , Ranji Sumant , Winston Lisa Gail
Published: January 2021

Background

San Francisco implemented one of the earliest shelter-in-place public health mandates in the U.S., with flattened curves of diagnoses and deaths. We describe demographics, clinical features and outcomes of COVID-19 patients admitted to a public health hospital in a high population-density city with an early containment response.

Methods

We analyzed inpatients with COVID-19 admitted to San Francisco General Hospital (SFGH) from 3/5/2020–5/11/2020. SFGH serves a network of >63,000 patients (32% Latinx/24% Asian/19% African American/19% Caucasian). Demographic and clinical data through 5/18/2020 were abstracted from hospital records, along with ICU and ventilator utilization, lengths of stay, and in-hospital deaths.

Results

Of 157 admitted patients, 105/157 (67%) were male, median age was 49 (range 19-96y), and 127/157 (81%) of patients with COVID-19 were Latinx. Crowded living conditions were common: 60/157 (38%) lived in multi-family shared housing, 12/1578 (8%) with multigenerational families, and 8/157 (5%) were homeless living in shelters. Of 102 patients with ascertained occupations, most had frontline essential jobs: 23% food service, 14% construction/home maintenance, and 10% cleaning. Overall, 86/157 (55%) of patients lived in neighborhoods home to majority Latinx and African-American populations. Overall, 45/157 (29%) of patients needed ICU care, and 26/157 (17%) required mechanical ventilation; 20/26 (77%) of ventilated patients were successfully extubated, and 137/157 (87%) were discharged home. Median hospitalization duration was 4 days (IQR, 2–10), and only 6/157 (4%) patients died in hospital.

Conclusion

In San Francisco, where early COVID-19 mitigation was enacted, we report a stark, disproportionate COVID-19 burden on Latinx patients, who accounted for 81% of hospitalizations despite making up only 32% of the patient base and 15% of San Francisco’s total population. Latinx inpatients frequently lived in high-density settings, increasing household risk, and frequently worked essential jobs, potentially limiting the opportunity to effectively distance from others. We also report here favorable clinical outcomes and low overall mortality. However, an effective COVID-19 response must urgently address racial and ethnic disparities.

Disclosures

All Authors: No reported disclosures
451. Evaluation of Exposure History in Healthcare Personnel with Coronavirus 2019 Disease
Authors: Silva Sandra , Mana Thriveen , Bhullar Davinder , Tabor Beatrice , Donskey Curtis
Published: January 2021

Background

During the Coronavirus Disease 2019 (COVID-19) pandemic, many healthcare personnel (HCP) have developed COVID-19. However, there is uncertainty regarding whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was acquired at work versus in the community.

Methods

We conducted a cohort study to examine exposure history of personnel with COVID-19 infection or asymptomatic carriage in a VA healthcare system. High-risk exposures were classified based Centers for Disease Control and Prevention criteria.

Results

Of 578 personnel tested, 49 (8%) had nasopharyngeal swabs with positive PCR results, including 45 (92%) with and 4 (8%) without COVID-19 symptoms. Of the 49 cases, 21 (43%) had a documented high-risk exposure at work, including 14 exposures to COVID-19 patients and 7 exposures to colonized or infected personnel. Exposures to infected patients most often were a result of delays in recognition of COVID-19 due to atypical presentations. Exposures to personnel with COVID-19 most often involved activities such as meals when facemasks were not worn. Most cases occurred among nurses (26, 53%) and administrative personnel (10, 20%); only 3 physicians developed COVID-19. No cases occurred in personnel working on COVID-19 wards. All personnel had mild or moderate disease.

Conclusion

Forty-three percent of healthcare personnel with COVID-19 had prior high-risk exposures at work. Improved detection of patients with atypical presentations and efforts to reduce high-risk contacts among personnel may reduce the risk for acquisition of SARS-CoV-2.

Disclosures

All Authors: No reported disclosures
452. Familial Cluster of COVID-19 Cases Associated with High Prevalence of Anosmia, Ageusia, and Gastrointestinal Symptoms
Authors: Ho Bethany E , Ho Andrea P , Ho Michaela A , Ho Elizabeth C
Published: January 2021

Background

Patients with COVID-19 most commonly report respiratory symptoms, with a minority reporting gastrointestinal (GI) symptoms in currently available reports. Additionally, little is known about the symptoms of anosmia/hyposmia, ageusia, and dysgeusia anecdotally seen in COVID-19 patients, which may be considered both GI and sensory/neurological manifestations of infection.

Methods

We interviewed 7 patients via oral inquiries and a questionnaire, collecting data on subject symptoms and their durations. Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to confirm 2 of these cases.

Results

We report a familial cluster of 7 COVID-19 cases, 5 of whom reported sensory symptoms of anosmia/hyposmia (5/7), ageusia/hypogeusia (5/7), and/or dysgeusia (3/7). All 7 cases reported GI involvement with one or more symptom of: nausea (5/7), diarrhea (4/7), abdominal pain (3/7), anorexia (3/7), and emesis (2/7).

Figure 1. Timeline of Symptoms and Exposure to Index Case in Familial COVID-19 Cluster

Conclusion

This frequency of GI symptoms is high relative to currently available epidemiological reports, which also infrequently report on sensory symptoms. The mechanistic underpinnings of GI and sensory symptoms in COVID-19 warrant close consideration and analysis, especially as it relates to reducing disease transmission. COVID-19 exhibits wide variation in duration, severity, and progression of symptoms, even within a familial cluster.

Disclosures

All Authors: No reported disclosures
455. Hepatic Laboratory Abnormalities Associated with Disease Severity in Patients with COVID-19: A Pooled Analysis of 6 Retrospective Cohort Studies Including 755 Patients
Authors: Cheng Ce , Lang Anqi , Finnigan Nancy
Published: January 2021

Background

Patients with COVID-19 are at high risks of developing significant pulmonary complications. However, its possible hepatic involvement has not been researched extensively. This study amis to analyze liver abnormality associated with disease severity in patients with COVID-19.

Methods

This was a pooled analysis of 6 retrospective, cohorts studies including 755 Chinese adult patients (> 18 years) diagnosed with COVID-19, admitted from January through February 2020. These patients were classified into two groups: non- severe and severe, based on interim guidelines of World Health Organization and the National Health Commission of China. Patients would be classified into severe group if one of three following criteria were met: respiratory rate > 30 breaths/min, SpO2 < 93% on room air, or PaO2/FiO2 ≤ 300mmHg. Results were analyzed with Student’s t- test, Pearson’s Chi-Squared test and Wilcoxon rank-sum test by SAS Enterprise Guide 7.1.

Table 1: Pooled Results

Results

755 Chinese adult patients (>18 years) with COVID-19 were included. Gender of male (OR 1.95; 95% CI 1.26–3.0; P=0.0022), and Wuhan region (OR 2.17; 95% CI 1.4–3.34; P= 0.0004) were significantly associated with the severe group compared with the non-severe group. Also the severe group had a significant lower albumin (g/dL) (3.5±1.1 vs. 4.1±1.0, P= 0.001), higher AST (U/L) (34.1±24.8 vs. 22.3±17.9, P= 0.001), and higher CRP (mg/L) (54.1±122.2 vs. 9.3±59.0, P= 0.0135) compared with the non-severe group. Surprisingly, no significant difference of age between these two groups was identified. Furthermore, no significant difference of ALT, Total bilirubin, D-dimer or INR with disease severity were identified.

Table 2: Lab Results And Age With Disease Severity

Table 3: Age And Location With Disease Severity

Figure 1: Variables Comparison Severe vs. Non- Severe

Conclusion

This study demonstrated that male gender and of Wuhan origin were significantly higher in proportion in the severe group. Of Wuhan origin as a risk factor of severe COVID-19 could be explained by limited medical resources for overwhelming COVID-19 patients in Wuhan during the period of January and February 2020. It is unclear why male was the risk factor of severe COVID-19 based on our data. Also, there were significant lower Albumin, higher AST and CRP in severe COVID-19, but their values were not too impressive. However due to limited data and studies, future studies are needed to elucidate risks factors associated with severe COVID-19.

Figure 2: Locations of Patients by Cities

Locations of Severe COVID-19 by Cities

Disclosures

All Authors: No reported disclosures
457. Low Rates of COVID-19 in a Vulnerable Population: Learning from Early and Decisive Public Health Policies
Authors: Donaldson Mira , Edeer Nazde , Bhangu Gurjeet , Greiner Jesse , Murray Melanie
Published: January 2021

Background

Disasters, including pandemics, disproportionately affect vulnerable populations. The Downtown Eastside (DTES) neighborhood of Vancouver has high prevalence of mental illness, substance use, infectious disease and homelessness. While studies have described clinical characteristics of COVID-19 patients in other centres worldwide, data is lacking on marginalized groups. We describe the clinical characteristics and outcomes of COVID-19 patients seen at two urban hospitals who care for the vulnerable population in the DTES of Vancouver, British Columbia (BC), Canada.

Methods

A retrospective chart review was conducted on all COVID-19 patients ≥19 years seen at either centre from January 1 to June 10, 2020. Descriptive statistics assessed demographics, comorbidities, presenting symptoms, laboratory values and outcomes, and were compared between subjects managed as inpatients (died vs. discharged) and outpatients.

Results

Of 71 COVID-19 subjects, mean age was 57y (SD 20); 36 (51%) were male. Time to presentation, symptoms and laboratory values were similar to other reports. 58 (82%) presented from the community, 3 (4%) from long-term care/rehabilitation centres, and 8 (11%) had no fixed address (NFA) or lived in the DTES. 45 (64%) had a known exposure, 20 (28%) were healthcare workers, 85% involved in direct patient care; 0/20 were admitted to hospital. Of the 8 NFA/DTES subjects, mean age was 46y (SD 13), 50% were male, 5 (63%) were admitted to hospital and all survived.

Admitted subjects (n=34) were older (mean age 69 vs 46y, p< 0.001), 62% were male, and had more comorbidities (mean [SD] 3 [3] vs. 1 [2], p< 0.001). Eight (24%) died, 26 (76%) were discharged, 29% developed acute respiratory distress syndrome, 21% secondary infection, 18% renal failure, and 15% cardiac dysfunction. Of patients admitted to intensive care, 5/10 died.

Conclusion

Our results concur with other studies showing older age and comorbidities contribute to more severe COVID-19 disease. 64% of subjects had a known exposure, and only 11% had NFA/DTES residence. Given that there is no financial barrier to access healthcare in Canada and these hospitals serve our most vulnerable populations, our results may indicate that BC Public Health has done an effective job of tracking and limiting community spread of COVID-19.

Disclosures

All Authors: No reported disclosures
458. Molecular SARS-CoV-2 Testing During the COVID-19 Outbreak: Experiences of a Hospital in Southeast Michigan, USA
Authors: Mathew Trini A , Hopkins Jonathan , Kamerer Diane , Ali Shagufta N , Ortiz Daniel , Johnson Paul , Chittick Paul , Carpenter Christopher F
Published: January 2021

Background

The novel Coronavirus SARS CoV-2 (COVID-19) outbreak was complicated by the lack of diagnostic testing kits. In early March 2020, leadership at Beaumont Hospital, Royal Oak Michigan (Beaumont) identified the need to develop high capacity testing modalities with appropriate sensitivity and specificity and rapid turnaround time. We describe the molecular diagnostic testing experience since initial rollout on March 16, 2020 at Beaumont, and results of repeat testing during the peak of the COVID-19 pandemic in MI.

Methods

Beaumont is an 1100 bed hospital in Southeast MI. In March, testing was initially performed with the EUA Luminex NxTAG CoV Extended Panel until March 28, 2020 when testing was converted to the EUA Cepheid Xpert Xpress SARS-CoV-2 for quicker turnaround times. Each assay was validated with a combination of patient samples and contrived specimens.

Results

During the initial week of testing there was > 20 % specimen positivity. As the prevalence grew the positivity rate reached 68% by the end of March (Figure 1). Many state and hospital initiatives were implemented during the outbreak, including social distancing and screening of asymptomatic patients to increase case-finding and prevent transmission. We also adopted a process for clinical review of symptomatic patients who initially tested negative for SARS-CoV-2 by a group of infectious disease physicians (Figure 2). This process was expanded to include other trained clinicians who were redeployed from other departments in the hospital. Repeat testing was performed to allow consideration of discontinuation of isolation precautions. During the surge of community cases from March 16 to April 30, 2020, we identified patients with negative PCR tests who subsequently had repeat testing based on clinical evaluation, with 7.1% (39/551) returning positive for SARS- CoV2. Of the patients who expired due to COVID-19 during this period, 4.3% (9/206) initially tested negative before ultimately testing positive.

Figure 1 BH RO testing Epicurve

Figure 2: Screening tool for repeat COVID19 testing and precautions

Conclusion

Many state and hospital initiatives helped us flatten the curve for COVID-19. Our hospital testing experience indicate that repeat testing may be warranted for those patients with clinical features suggestive of COVID-19. We will further analyze these cases and clinical features that prompted repeat testing.

Disclosures

All Authors: No reported disclosures
462. Prevalence and Outcome of Asymptomatic Procedural Patients with COVID-19 Infection
Authors: Maki Gina , Abdollah Firas , Dabaja Ali , Suleyman Geehan
Published: January 2021

Background

Guidelines recommend testing for SARS-COV-2 in asymptomatic individuals who are undergoing time-sensitive major surgery or aerosol generating procedures (AGPs) to guide infection prevention practices, including PPE use, and minimize risk of potential poor outcomes associated with COVID-19 infection by delaying the procedure in positive patients. However, evidence to support these recommendations are limited. We describe the outcome of asymptomatic patients with SARS-COV-2 undergoing surgery or AGPs.

Methods

We implemented a system-wide policy to test all patients requiring intubation or other AGPs at Henry Ford Health System (HFHS), a 5-hospital system in southeast Michigan. This was a retrospective review of asymptomatic surgical patients with COVID-19 infection between 5/1/2020–5/31/2020. All patients with positive polymerase chain reaction (PCR) of upper respiratory tract were included. Demographics, comorbidities, procedural/surgical categories, symptoms and outcomes were evaluated.

Results

4381 COVID-19 PCR tests were performed pre-procedurally during the study period, of which 18 (0.4%) were positive. Summary of characteristics is presented in Table 1. Mean age was 49.7 years, and the majority were female (61%) and black (67%). Six (33%) of 18 surgeries were performed despite positive COVID-19 PCR as shown in Table 2. Of those who had the procedure performed, none developed symptoms within 14 days. Two (11%) patients developed symptoms within 14 days of positive PCR after their procedures were canceled. None of those who had their procedure delayed developed any symptoms. Of the total patients, none required hospitalization or died.

Table 1. Characteristics of asymptomatic patients with COVID-19 infection

Table 2. Outcome of procedure in asymptomatic patients with COVID-19

Conclusion

The prevalence of COVID-19 infection was very low in our asymptomatic patient population. Decisions around SARS-CoV-2 testing in asymptomatic patients undergoing procedures should be based on exposure history and prevalence of disease in the community to avoid unnecessary testing and diversion of resources away from symptomatic patients.

Disclosures

All Authors: No reported disclosures
463. Random Sampling of Asymptomatic Hospital Employees: A Period Prevalence Study
Authors: Huang Felicia Scaggs , Schaffzin Joshua K , Simmons Jeff , Goebel Mary Jo , Thrasher Terri , Wong Hector , Macaluso Maurizio
Published: January 2021

Background

Novel coronavirus disease 2019 (COVID-19) has had a significant impact on the work force in hospital settings. Despite rigorous screening practices implemented at many institutions, reports have documented transmission from asymptomatic and presymptomatic individuals in community environments. Evidence of nosocomial transmission between healthcare workers and patients in the early phase of the pandemic has further compounded the fears of safety in the workplace. We sought to determine the asymptomatic carriage rate of employees to inform messaging and response in the context of universal masking and eye protection.

Methods

We conducted a period prevalence study in asymptomatic hospital employees at a quaternary pediatric hospital during April to June 2020. Eligible employees included clinical staff, administrative staff, food services workers, and environmental services workers who had passed the temperature and symptom screening evaluation on entry to the campus. Samples were obtained from both nares of consenting individuals and ran daily on a validated polymerase chain reaction (PCR) platform.

Results

A total of 1394 employees consented to participate by June 15, 2020 and none of them had a positive result for COVID-19. Thus, the prevalence rate among asymptomatic employees was zero during this period (95%CI 0%-0.26%). Thirteen employees developed symptoms after initial enrollment and testing of which 1 tested positive for COVID-19. Based on these data, we estimate a monthly incidence rate of 0.8 new COVID-19 cases per 1000 asymptomatic employees (95%CI 0.2 - 4.4 per 1000). Of note, at the time of submission the R0 for our region was 1.4, and the prevalence of COVID-19 infection among symptomatic employees was 9.9% (68/686 tested in our system, 95%CI: 7.8%-12.3%).

Conclusion

We did not identify any COVID-19-positive asymptomatic hospital employees who passed screening measures. This suggests very low risk of nosocomial transmission to other employees, patients, and families. Along with low community prevalence and capture of COVID-19-positive symptomatic employees, we could confidently advise staff that universal surgical masking and eye protection were likely adequate to prevent significant exposure.

Disclosures

All Authors: No reported disclosures
466. SARS-CoV-2 Diagnosis And Point Prevalence in a Non-Cohorted Tertiary Care Center
Authors: Schrank Spencer , McAleese Katherine , Spence Amanda B , Natarajan Madhuri , Timpone Joseph , Chang Joseph , Balba Gayle p , Kumar Princy
Published: January 2021

Background

The CDC recommends testing for SARS-CoV-2 in patients who present with symptoms consistent with COVID-19 and to cohort hospitalized patients diagnosed with COVID-19. Up to 35% of persons infected with SARS-CoV-2 are asymptomatic; however, no recommendations exist for universal testing in hospitalized patients. We assessed the point prevalence of SARS-CoV-2 infection amongst hospitalized patients at a tertiary care center during a time when there was a regional surge of cases.

Methods

Nasopharyngeal SARS-CoV-2 PCR testing was performed on inpatients at Georgetown University Hospital on 4/27/20, excluding those who were SARS-CoV-2 positive, tested within 72 hours or admitted to pediatric, psychiatric, labor & delivery or ICUs. Patients within the hospital were not cohorted based on COVID-19 status. Patient demographics and comorbidities were obtained from the EMR and analyzed for significance based on SARS-CoV-2 status.

Results

Hospital census on the testing date was 297; 204/297(68.7%) met inclusion criteria; 78/297(26.3%) were known COVID-19 patients. Within the study group 78/204 (38.2%) had known COVID-19, 21/204 (10.3%) were PUIs (4 of whom tested positive), 31/204 (15.1%) tested negative for COVID-19 within 72 hours and 74/204 (36.3%) met criteria for testing. The median age was 62 years (IQR, 53 to 70), 59%(n=122) were male, 56%(n= 115) were Black, and 90%(n=185) had at least one co-morbidity. 0/74 of those tested on 4/27/20 were positive for SARS-CoV-2, and none were diagnosed with COVID-19 within 28 days. In adjusted analyses, patients who were hospitalized for COVID-19 were more likely to be Black(OR=10.53 95% CI 3.02, 36.68, p=0.0002); male(OR=3.27 95% CI 1.26, 8.47, p=0.0143); reside in group/nursing homes(OR= 11.78 95%CI 3.03, 45.76, p=0.0004); have a history of prior stroke(OR= 6.25 95%CI 1.49, 26.12, p=0.012); but less likely to smoke(OR=0.10 95%CI 0.02, 0.48, p=0.0039), or have active malignancy (OR= 0.11 95%CI 0.01, 0.73, p=0.0223).

Conclusion

The use of CDC testing criteria for PUIs were successful in identifying COVID-19 patients and limiting the need for routine testing in all hospitalized patients during a time when access to testing was limited. Nosocomial transmission did not occur in our institution despite a lack of cohorting.

Disclosures

Princy Kumar, MD, Gilead Sciences Inc. (Scientific Research Study Investigator)
468. Specimen pooling conserves additional testing resources when patients’ infection status is correlated: A simulation study
Authors: Rewley Jeffrey
Published: January 2021

Background

In the early stages of a novel pandemic, testing is simultaneously in high need but low supply, making efficient use of tests of paramount importance. One approach to improve the efficiency of tests is to mix samples from multiple individuals, only testing individuals when the pooled sample returns a positive.

Methods

I build on current models which assume patients’ sero-status is independent by allowing for correlation betweenconsecutive tests (e.g. if a family were all infected and were all tested together). In this model, I simulate 10,000 patients being tested in sequence, with population sero-prevalence ranging from 1% to 25%, using batch sizes from 3 to 10, and assuming the increased probability of consecutive infections ranged from 0% to 50%.

Results

I find that as the likelihood of consecutive infected patients increases, the efficiency of specimen pooling increases. As well, the optimal size of the batch increases in the presence of clustered sequences of infected patients.

Heat map indicating the manner in which the number of tests needed is reduced as population prevalence and correlation between cases changes. Red indicates that there is no reduction in the number of tests, and blue indicates a near 100% reduction in the number of tests, with intermediate colors indicating intermediate fractions.

Conclusion

This analysis indicates further improvements in specimen pooling efficiency can begained by taking advantage of the pattern of patient testing.

Disclosures

Jeffrey Rewley, PhD, MS, American Board of Internal Medicine (Employee)
469. Temporal, Spatial, and Demographic Relationships of SARS-COV-2 Gene Target Cycle Thresholds
Authors: Reno Lisa , Newhart Donna , Clifford Robert , Bress Jonathan , Yu Stephanie , Hanna John J , Walsh Edward E , Lesho Emil P
Published: January 2021

Background

The optimum duration of isolation precautions (IP) for SARS-COV-2-infected individuals is uncertain. Most healthcare facilities must rely on surrogates of infectivity such as illness duration or nucleic acid amplification (NA). The availability of NA remains limited in many locations, requiring laboratories to alternate platforms to provide uninterrupted support. Regulatory-driven repeat testing further stresses scarce resources. A target gene cycle threshold (Ct) of 24 has been shown to correlate with culture negativity. We sought to evaluate temporal, spatial, and demographic relationships of SARS-COV-2 Ct that could inform local infection control efforts and testing policy.

Methods

From 03-14-20 to 06-01-20, nasopharyngeal swabs from inpatients were prospectively tested weekly on an emergency-use authorized laboratory developed assay, or 1 of 3 commercial platforms targeting the RNA-dependent RNA polymerase, N, ORF1ab, S, and/or PanSARS-E genes. A regional COVID-19 registry was also queried.

Results

70 inpatients were prospectively evaluated (Table). Mean time to negative was 28.5 days from symptom onset (SO) and 24.1 days from initial test. Initial Ct values were significantly lower compared to those on week 3 (Figure 1). 3.3%, 8.9%, 31.3% and 50.0% tested negative at weeks 1,2,3, and 4 respectively. Trajectories did not differ by race, gender or comorbidity. 13% had isolation precautions (IP) discontinued during admission (mean time to discontinuation 15.8 days; range 12–40). None were linked to new transmissions. 20% reverted to positive after being negative. 0% of a growing number of patients across our health system (27 at time of submission), who have had IP discontinued, were linked to new infections. Data from 180 consecutive patients were available for retrospective evaluation. Mean Ct did not differ between treated-and-released (23.0) and admitted patients (22.6), nor between ward (23.1) and intensive care unit patients (20.2) (all p > 0.4).

Table

Figure 1

Conclusion

Linear regression revealed that a Ct of 24 and negative Ct value will occur 8.8 and 36 days after SO (Figure 2). These findings are consistent with smaller cohorts, and they add to the growing body of evidence that test-driven approaches for maintenance of IP or patient disposition should be reconsidered.

Figure 2

Disclosures

All Authors: No reported disclosures
476. Gilead Sciences’ Commitment to the COVID-19 Pandemic
Authors: Lee EunYoung , Osinusi Anu , Chokkalingam Anand , Brainard Diana M , Tran Tram , Dau Lauren , Ferrinho Diogo , Wang ChenYu , Juneja Kavita
Published: January 2021

Background

COVID-19 has spread rapidly: from the first case in Dec 2019, the declaration of a global pandemic in Mar 2020, to Jun 18, 2020 with >8 M confirmed cases and >400,000 deaths worldwide. Throughout this rapid spread, Gilead has focused on contributing antiviral expertise and resources to help patients (pts) and communities fighting COVID-19

Methods

Gilead is supporting the efforts of governments, partnering with professionals, and community-based org., and collaborating with healthcare providers to accelerate research and access to remdesivir (RDV), the first medicine with demonstrated efficacy in treatment of COVID-19. This is a review of the programs initiated in RDV research, access, research grants and collaborative education

Results

In Jan 2020 Gilead began working with government and regulatory authorities to make RDV accessible to pts globally through the compassionate use and expanded access programs. These programs has treated >2000 COVID-19 pts. By Feb 2020, several phase 3 randomized trials on RDV were initiated. Based on trials completed and published data (n= >2000), RDV was granted emergency use authorization in the US on May 1, 2020 with full approval in 5 countries thereafter and several under review elsewhere. Collectively there will be >12,000 pts enrolled in RDV clinical programs by Dec 2020.

Increasing manufacturing of RDV began at-risk in Jan 2020. By May 2020 Gilead has decreased production time, increased supply and committed to donating all its 1.5 M doses. Under the licensing agreements with generic drug manufacturers, RDV will be available in 127 countries upon approval.

Gilead has committed to supporting research grants to enhance the understanding of the clinical course and outcomes in vulnerable population, long-term sequelae, and evaluate real world safety and effectiveness of COVID-19 therapies.

Finally, Gilead has provided corporate grants to support the efforts of community-based orgs and public health entities to expand education on COVID-19

Conclusion

Gilead has initiated a global, multifaceted rapid response that reflects the unprecedented emergency posed by SARS-COV-2. This includes increasing RDV production, access, timely initiation of phase 3 RDV trials, and establishment of grants programs for community projects, research and education

Disclosures

EunYoung Lee, PharmD, Gilead Sciences (Employee) Anu Osinusi, MD, Gilead Sciences (Employee) Anand Chokkalingam, PhD, Gilead Sciences (Employee) Diana M. Brainard, MD, Gilead Sciences (Employee) Tram Tran, MD, Gilead Sciences (Employee) Lauren Dau, PharmD, Gilead Sciences (Employee) Diogo Ferrinho, PharmD, Gilead Sciences (Employee) ChenYu Wang, PhD, Gilead Sciences (Employee) Kavita Juneja, MD, Gilead Sciences (Employee)Gilead Sciences (Employee)
477. Implementing a Follow-up Call Program for Ambulatory patients with COVID-19 in a Tertiary Center in Mexico City
Authors: Pinto Yamile G Serrano , Crabtree-Ramírez Brenda , Ortiz Cristian E Espejo , Hernández-Alemon Aldo , Iruegas-Núñez David A , Hernández-Martínez Ingrid V , Gómez-Islas Valeria E , Oropeza-Viveros Dulce M , Castro Gómez Sandra Erika , Esquinca-González Alexia , García-Fong Kevin R , Gómez-Vázquez Eduardo , Arias-Delgado Karen A , Guerrero-Torres Lorena , Lopez Iñiguez Alvaro
Published: January 2021

Background

The Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán is a teaching hospital which was converted into a Coronavirus disease 2019 (COVID-19) designated hospital on mid-March 2020. In Mexico City, the COVID-19 peak started in mid-April 2020. A considerable proportion of those diagnosed with SARS-CoV-2 infection were treated by ambulatory care. We aimed to describe the clinical characteristics at diagnosis of ambulatory patients diagnosed with COVID-19, their willingness to donate plasma and their clinical outcomes at one month of the follow-up call program implementation.

Methods

A call strategy follow-up program (FUP) was established on April 19, 2020. All ambulatory patients received at least 3 calls every 48–72 hours, followed by 2 weekly calls. A team of voluntary medical students, general practitioners, fellows, and medical specialists was assembled for this purpose. Signs of alarm (fever >72 hours, shortness of breath, respiratory insufficiency) and other clinical signs were collected on every call. Willingness to donate plasma and possibility of a correct home isolation were also addressed.

Results

From April 19 to May 18, 2020, a total of 360 patients tested positive for SARS-CoV2, of whom 350 were followed. Their median age was 44 years (33–51), and 55% were female. 145 (41%) had completed all FUP calls and 194 (55%) referred to be asymptomatic in their last call. We identified 8 patients with signs of alarm during the calls, and 2 of them required hospitalization. During the FUP, 66% referred fatigue that limited their activities, 56% anosmia or dysgeusia, 32% headache, and 22% diarrhea. 90% were capable to properly isolate in their homes. Willingness to donate plasma was assessed in 89 patients, of whom, 75 (84%) manifested their willingness to donate.

Conclusion

Ambulatory follow-up is feasible and effective to identify those in need of hospitalization. Remarkably, half of the ambulatory patients had no comorbidities and presented anosmia/dysgeusia as the most frequent symptoms during follow-up. Willingness to donate plasma was high in this cohort.

Disclosures

All Authors: No reported disclosures
481. Epidemic – Pandemic Impacts Inventory (EPII) Survey Results for Persons Living with HIV in Chicago’s West and Southwest Communities
Authors: Hunt Bijou R , Anderson Rachel , Sinha Paarul , Cetrone Hollyn , Glick Nancy
Published: January 2021

Background

The rapid spread of COVID-19 in recent months has caused local and regional governments to enact protective measures that have hindered economies and imposed demanding restrictions on daily life. Households may be experiencing physical, psychological, social, and economic challenges due to these preventative measures. Populations with fewer resources and/or pre-existing conditions may be at higher risk for these negative, life-altering effects. Therefore, we investigated COVID-19 impact on daily life among persons living with HIV (PLH) in Chicago’s under-resourced, largely minority, west and southwest side communities.

Methods

We modified the EPII, a survey designed to measure pandemic disease impact over nine domains of life, to assess how COVID-19 affected PLH receiving outpatient HIV care. From 5/11–29/2020, participants (n=49) completed the survey online or over the phone and received a $10 grocery gift card. We present the proportion of respondents who reported that they or any household member was impacted by select survey items.

Results

More than half of respondents reported a household member getting laid off and/or furloughed (63%), increased mental health (45%) or sleep problems (51%), less physical activity (61%), and increased screen time (82%); 45% were unable to pay important bills. Positive changes included eating healthier foods (53%), more time for enjoyable activities (63%), more quality time with friends or family (65%), and paying more attention to personal health (76%). We observed differences by gender, age, and race/ethnicity over all domains (Table 1). Finally, 80% of those who participated in telehealth services were satisfied with their experience.

Table 1.

Conclusion

Overall, respondents struggled with employment, emotional and physical health effects of COVID-19, yet also experienced aspects of positive life change. In the future, these results should be compared with results from a general population to determine whether PLH are disproportionately burdened. Regardless, COVID-19 has negatively impacted daily life for everyone, including PLH, and these individuals may need additional resources compared to their less resource-challenged counterparts.

Disclosures

All Authors: No reported disclosures
482. Impact of COVID-19 Pandemic on Psychosocial and Clinical Factors among people with and without HIV living in Miami
Authors: Uribe Patricia RaccamarichClaudia S , Zetina Ana S Salazar , Montgomerie Emily K , Salguero Douglas , Mantero Alejandro M , Barreto Irma S , Vazquez Andres , Martinez Paola , Morgan Kristiana , Yanes Nicolle L Rodriguez , Brophy Theodora , Maddalon Marissa , McGaugh Angela , Weiss Deborah Jones , Alcaide Maria L
Published: January 2021

Background

As the COronaVIrus Disease 2019 (COVID-19) continues to unfold, drastic changes in daily life pose significant challenges on mental and clinical health. While public health interventions such as national lockdowns and social distancing are enforced to reduce the spread of COVID-19, the psychosocial and physical consequences have yet to be determined that may disproportionately affect people living with HIV (PLWH).

Methods

To evaluate the impact of COVID-related stress on mental and clinical health, we conducted a 20-minute questionnaire eliciting sociodemographic information, clinical and psychological factors from people living in Miami, Fl. All individuals >18 years with or without a history of COVID-19 were included. Participating PLWH were recruited from an existing HIV registry and HIV uninfected participants from community flyers and word of mouth.

Results

A total of 135 participants were recruited from 05/2020-06/2020. The mean age was 50 years old, 73/135 (54%) were female, and 102/135 (75%) were PLWH. Among participating PLWH, 60/102 (58.8%) self-identified as African American, and 9/102 (8.8%) were positive for COVID-19 by a commercially approved test. Among HIV-negative participants, 15/33 (45.5%) self-identified as White and 11/33 (33%) were positive for COVID-19. Both PLWH and HIV-negative participants described significant disruptions in health care access (47%), difficulty paying basic needs (41%), and feelings of anxiety and depression (48%); there was no statistically significant difference by HIV status. However, HIV negative participants were less likely to experience job loss and income disruption compared to PLWH during the pandemic (70% for HIV-negative vs 48% for PLWH; OR 0.40, p=0.03).

Conclusion

The impact of COVID-19 on emotional and clinical health is significant in both PLWH and HIV-negative groups. These findings highlight the need for providing mental and physical health care during the pandemic, especially for coping with stress and anxiety during these difficult times and ensuring adequate access to health care.

Disclosures

All Authors: No reported disclosures
485. Title: The Porous Boundaries Between Communities and Correctional Facilities: The Introduction of a Medical Recovery Site Resulting in Reduced COVID-19 Household Transmission Tied to Recently Incarcerated Individuals
Authors: Pocock Katherine , Close Ryan M , McAuley James
Published: January 2021

Background

In April 2020, a COVID-19 outbreak at a rural, resource-limited Department of Corrections on a Native American reservation in Arizona led to multiple epidemiologically linked cases to household contacts of recently incarcerated individuals. We describe the role of a medical recovery site for isolation of recently released inmates with active COVID-19 infection in reducing household transmission of cases tied to the correctional facility.

Methods

On April 16th, an individual was contact traced to the correctional facility and was laboratory-confirmed positive, an asymptomatic index case in the jail. Testing of all inmates continued from April 16th-30th. On April 24th, decarceration began. All inmates released from facility April 24th-April 30th were contact traced for 14 days to monitor for new household cases. On April 30th, the tribe opened a medical recovery site for isolation. After opening, all individuals with active infection agreed to go to site after release.

Results

Between April 24th-30th, 16 inmates were released from facility, seven were laboratory-confirmed positive. Secondary infections only occurred in households of positives. Of the seven households, four experienced secondary transmission of virus. There were 27 household contacts, six secondary infections (secondary attack rate of 30.0%). There were four hospitalizations and one death, though cause of death was not due to COVID-19 despite incidental finding. After opening of medical recovery site, all individuals with active infection (12 cases) agreed to isolation at site. This intervention resulted in no further epidemiologically linked cases from recently released incarcerated individuals to community.

Figure 1: Household Secondary Infections with Epidemiological Links to Previously Incarcerated Inmates Before and After Opening of Medical Recovery Site

Conclusion

Prior to establishment of a medical recovery site on a Native American reservation, a significant burden of disease in the community was linked to recently incarcerated individuals. After opening, all actively infected individuals agreed to isolation at site, resulting in no further household transmission of COVID-19 from an actively infected recently incarcerated case. This outbreak highlights porous boundaries between correctional facilities and surrounding communities, requiring attention and resources to limit transmission of disease to protect local populations.

Disclosures

All Authors: No reported disclosures