bluuebunny/crossref_metadata_2025 huggingface dataset:
469. The Mental Health Implications of Job Loss for Never-married Women During the COVID-19 Pandemic
Authors: Kricorian Katherine
Published: December 2021

Background

The COVID-19 pandemic was associated with an array of social and economic events, influencing how the pandemic affected people of all genders. In particular, job losses surged during the COVID-19 pandemic, especially among women. We analyzed how the pandemic and rising job losses affected the mental health of unmarried women with and without children in order to identify possible health disparities, potential causal factors and opportunities for interventions.

Methods

Data were collected from Wave 3 (January 6-February 15, 2021) of the US Census COVID-19 Household Pulse online survey designed to measure the impact of COVID-19. Microdata files were downloaded from the Census website and included N=13,940 never-married female respondents aged 25-54 years old. Data were analyzed using χ2 tests, with z-tests for more granular between-group comparisons.

Results

When asked if they had felt anxiety in the past week, 31% of respondents without children in the household and 28% of those with children reported feeling anxiety nearly every day (p< .05). Among those who did not lose work during the pandemic, 24% of those without children felt anxiety nearly every day vs. 20% of those with children (p< .05). Among those who did experience pandemic-related job loss, 33% of those with children and 42% of those without children reported daily anxiety (p< .05).

Conclusion

Overall, COVID-19 job loss was associated with higher levels of anxiety for never-married adult women. Notably, respondents without children expressed significantly higher levels of anxiety than respondents with children, and this difference was even greater when comparing those who had lost jobs during the pandemic. Reasons are being further researched but may be related to mothers’ greater opportunities for social and community support, particularly when encountering difficult circumstances. These results have implications for the development of mental health programs serving women experiencing environmental stressors such as job loss, especially women without children who may not have the same mental health and community support.

Disclosures

All Authors: No reported disclosures
472. Clinical Outcomes of Solid Organ Transplant Recipients with Severe Acute Respiratory Syndrome Coronavirus 2: 2021 Update
Authors: Jandhyala Deeksha , Lewis Jessica , Adekunle Ruth
Published: December 2021

Background

The Centers for Disease Control and Prevention identified solid organ transplant (SOT) recipients as persons at high risk to develop severe illness secondary to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). We reviewed the clinical characteristics and outcomes of SOT recipients who had SARS-CoV-2 at our center.

Methods

This was a retrospective review of SOT recipients diagnosed with SARS-CoV-2 between March 1st 2020 and February 28th 2021 in the Medical University of South Carolina (MUSC) Health Care system. Subjects were included if they had undergone SOT at any time prior to a positive SARS-CoV-2 PCR. Descriptive statistics were used to analyze demographic and clinical characteristics. Primary outcomes included need for hospitalization, complications, and estimated all-cause mortality.

Results

96 SOT recipients were diagnosed with SARS-CoV-2. Seven patients were excluded as they initially tested positive and were admitted to another facility or had a simultaneously positive IgG. 89 SOT recipients were analyzed, of which, 39 (44%) were managed as an outpatient and 50 (56%) required admission. 13 (33%) of outpatient recipients were treated with a monoclonal antibody. Of those hospitalized, 24 (48%) were male, 34 (68%) were Black, and 34 (68%) were kidney transplant recipients. Median age at positive test was 53 years of age and median time from transplant to positive test was 3.1 years. Median length of stay was three days (range 0.1–108.6). 17 (34%) patients required supplemental oxygen and 11 (22%) received care in the intensive care unit. Complications, including bacterial infections (16%), fungal infections (2%), CMV reactivation (6%), and rejection (2%) were rare. Three patients (3%) died during the study time period.

Conclusion

The majority of SOT recipients with SARS-CoV-2 in our cohort required admission, however they experienced few complications and a low mortality, despite their high-risk status.

Disclosures

All Authors: No reported disclosures
473. Clinical Outcomes of a Pediatric COVID Monoclonal Antibody Program based at an Urban Academic Center
Authors: Lee Philip J , Cruz Carlos , Anosike I J
Published: December 2021

Background

Growing clinical evidence in adults has demonstrated use of COVID monoclonal antibody (mAB) therapy results in a reduction of hospitalization and/or emergency room (ER) visits with the greatest benefit following early administration. While the FDA has authorized use of mAB therapy in children ages 12-17 years, clinical outcomes in this population have yet to be described. This study aims to assess the pediatric clinical experience in a low social economic setting.

Methods

Retrospective study conducted among children and adolescents who tested positive for SARS-CoV-2 from 12/1/2020 to 6/1/2021, met ≥ 1 eligibility criterion based on pre-determined institutional guidelines. Individuals were identified by patient-level data linked to pharmacy and medical claims with ICD-10 codes for COVID-19. Electronic medical records were reviewed for demographic characteristics, comorbidities, time to receipt of mAB therapy from positive test, adverse effects, and clinical outcomes. Primary clinical end point was hospitalization and/or medical visit at 28 days. Descriptive summary statistics were used for the entire cohort.

Results

Overall, 17 met eligibility criteria. Thirteen patients with a mean age of 16 years, received casirivimab and imdevimab mAB therapy: 4 declined treatment. Among the treated patients, 61.5% (n=8) were male, 38.6% (n=5) Hispanic/Latino; 38.6% (n=5) non-Hispanic Black; 7.7% (n=1) White. Seven out of 12 had a BMI ≥ 95th% for gender and age. Eight patients (61.5%) met ≥ 1 criteria with obesity (n=8) as the most common factor followed by immunocompromised state (n=6, 46.2%) tied with neurodevelopmental disorder (n=6, 46.2%). Median time from positive test to mAB therapy was 2 days [IQR:1-3]. One patient had a severe adverse event. Overall, none required hospitalization/ER visit with COVID like symptoms.

Demographics and Results Table

The table describes the pediatric patients and clinical outcome of receiving monoclonal antibody treatment for COVID-19.

Conclusion

Though limited by numbers, our findings may suggest a role of mAB therapy in children and adolescents in our setting. With increasing rates of SARS-CoV-2 in this age group coupled with vaccine hesitancy, mAB therapy may serve as an important outpatient intervention with a need for further studies to assess clinical benefit and establish optimal, cost-effective, practice guidelines for these highly vulnerable patients.

Disclosures

All Authors: No reported disclosures
475. The Utility of Community-Academic Partnerships in Promoting the Equitable Delivery of COVID-19 Vaccines in Black Communities
Authors: Abdul-Mutakabbir Jacinda , Casey Samuel , Jews Veatrice , King Andrea , Simmons Kelvin , Peteet Bridgette , Belliard Juan Carlos , Hogue Michael , Peverini Ricardo
Published: December 2021

Background

In the U.S., non-Hispanic Black individuals are disproportionately represented amongst COVID-19 mortalities. The COVID-19 vaccines are poised to change this outcome; however, inequitable access and decades of medical mistreatment have resulted in healthcare mistrust and an associated low uptake within this group. Loma Linda University (LLU) houses the largest mass vaccination site in San Bernardino County (SBC) California; nevertheless, there has been a perpetual low representation of Black vaccinees. To increase the number of Black persons vaccinated, a selected team at LLU leveraged a community-academic partnership model to address vaccine hesitancy and increase access to the COVID-19 vaccines. The objective of this study was to evaluate the number of Black persons vaccinated in community settings compared to the mass clinic.

Methods

LLU developed a tiered approach to increase COVID-19 vaccinations within Black SBC communities. The first tier engaged faith leaders with the academic community in disseminating COVID-19 health information, the second included culturally representative LLU healthcare professionals in the delivery of COVID-19 educational webinars, and the third was to conduct low barrier, remote-site vaccination clinics, within targeted Black communities. Following these efforts, we compared the number of Black individuals vaccinated in the LLU mass clinic to those vaccinated in the community remote-site clinics.

Results

The remote-site COVID-19 vaccination clinics commenced in February 2021. From February 1 until April 30, 2021, 24,808 individuals were vaccinated in the LLU mass clinic with a first dose (Pfizer or Moderna) or single dose (Janssen) of a COVID-19 vaccine, however, only 908 (3.7%) were Black vaccinees. Contrastingly, the LLU remote site clinics vaccinated 1,542 individuals with a first or single dose of a COVID-19 vaccine. Of those vaccinees, 675 (44%) were Black.

Conclusion

The multi-tiered community approach (remote-site vaccination clinics) resulted in a necessary overrepresentation of Black vaccinees, previously underrepresented in the LLU traditional mass vaccination clinic effort (44% vs. 3.7%, respectively). Further research is warranted to examine the key elements to increase vaccinations amongst minoritized groups.

COVID-19 Vaccination Comparisons Between Models

This table includes data from the Loma Linda University Mass Vaccination Clinic and the Remote-Site Vaccination Efforts compared to the San Bernardino County Demographics

Disclosures

All Authors: No reported disclosures
478. Contemporaneous Evaluation of Kawasaki Disease and Multi-system Inflammatory Syndrome in Children in Northern Virginia
Authors: Nuibe Andrew , Rubbab Beenish , Levorson Rebecca E
Published: December 2021

Background

Multi-system inflammatory syndrome in children (MIS-C) can present like Kawasaki disease (KD). After Centers for Disease Control and Prevention guidance was issued in May 2020, we implemented local management strategies emphasizing limited laboratory work up of non-toxic children with suspected MIS-C or KD. We then re-evaluated our management recommendations to ensure appropriate resource utilization for children with MIS-C and KD.

Methods

We identified MIS-C and KD cases via convenience sampling of Pediatric Infectious Diseases records at Inova Fairfax Medical Center from May 1, 2020 to February 28, 2021. Manual chart review extracted clinical points of interest and descriptive statistics compared cohorts. Oral changes included edema, erythema, cracking, or strawberry tongue. Abdominal symptoms included pain, emesis, and diarrhea. Respiratory symptoms included shortness of breath, tachypnea, cough, and need for mechanical ventilation. Musculoskeletal symptoms included pain and edema. Neurological symptoms included headache, dizziness, altered mental status, and irritability.

Results

We identified 8 KD cases and 29 concurrent MIS-C cases. MIS-C cases tended to be older and have presenting abdominal symptoms (median age 8 years old versus 2 years old, p < 0.01) and hypotension (20 versus 0, p < 0.01), otherwise there was no difference in the frequency of oral changes, rash, conjunctivitis, musculoskeletal symptoms, or neurological symptoms. 7 KD cases and 8 MIS-C cases did not require intensive care. Patients with MIS-C who did not need intensive care still had a lower initial absolute lymphocyte count (ALC) (median 1275/µL, p < 0.01), lower initial platelet count (median 217/µL, p = 0.05), and higher initial C-reactive protein (CRP) (median 18.3 mg/dL, p = 0.06) compared to KD cases; other results were not different between the two cohorts.

Conclusion

We observed differences in the initial ALC, platelet count, and CRP between KD and MIS-C cases not requiring intensive care, whereas other labs such as ferritin, troponin, B-natriuretic peptide, and initial echocardiograms did not significantly differ between the two cohorts. Thus, our diagnostic management recommending limited laboratory evaluation for non-toxic patients with suspected KD or MIS-C is reasonable.

Disclosures

All Authors: No reported disclosures
479. Real-world Evaluation of SARS-CoV-2 Monoclonal Antibodies in Solid Organ Transplant Recipients
Authors: Zeitler Kristen , Piccicacco Nicholas , Bowman Lyndsey , Montero Jose , Cancio Margarita , Houston Sally , Kim Kami
Published: December 2021

Background

Patients with COVID-19 infection at highest risk for poor outcomes include immunocompromised patients, such as solid organ transplant (SOT) recipients. Monoclonal antibody (mAb) infusions were developed to promote passive immunity. Analysis of the first 200 patients who received SARS-CoV-2 mAb at our hospital showed a 27 % absolute reduction in hospitalization and emergency department (ED) visits. Understanding the role of SARS-CoV-2 mAb therapy in management of the SOT population is likely to inform decision making for these patients.

Methods

We conducted a retrospective chart review of SOT patients diagnosed with COVID-19 who received mAb therapy between 11/18/20 and 04/26/21. Patients were excluded if they were < 18 years of age or if they weighed < 40 kg. We compared those patients who were hospitalized or visited the ED within 29 days of mAb therapy to those who recovered without further visits to our hospital.

Results

A total of 50 SOT patients receiving mAb therapy were included in this analysis. Bamlanivimab was given to 33 patients, while 9 patients received bamlanivimab/etesevimab and 8 patients received casirivimab/imdevimab. Twelve (24 %) patients were hospitalized or visited the ED within 29 days of mAb therapy; 38 patients did not. These 2 groups did not significantly differ by age, gender, body mass index, time from SOT, or other risk factors for severe COVID-19 illness per FDA Emergency Use Authorization guidance. Both groups were primarily made up of kidney transplant recipients (66.7 % and 68.4 %, respectively). Significantly more patients in the hospitalization/ED group were receiving antimetabolites as part of their immunosuppression (IS) regimen prior to COVID-19 diagnosis (100 % vs 68.4 %, p = 0.047). Patients in the hospitalization/ED group received mAbs within a median of 6 days (IQR 3.8) of symptom onset compared to 4 days (IQR 4) (p = 0.006).

Conclusion

SOT recipients were more likely to be hospitalized or visit the ED due to COVID-19 after mAb if they were receiving antimetabolite IS or received mAb later after symptom onset. These data stress the importance of early mAb administration in all SOT patients, particularly in those on antimetabolite therapy.

Disclosures

Lyndsey Bowman, PharmD, Veloxis Pharmaceuticals (Advisor or Review Panel member, Speaker’s Bureau) Kami Kim, MD, Regeneron Pharmaceuticals Inc. (Scientific Research Study Investigator)Sanford Guide (Other Financial or Material Support, Editorial Board Member)
482. SARS-CoV-2 Prevalence in Feces of Very Young Children, A Longitudinal Study
Authors: Nashed Lydia M , Mani Jyoti , Hazrati Sahel , Richards Tiana , Nerikar Naya , Ravi Shreeya , Mattei Lisa , Levy Shira , Maxwell George , Hourigan Suchitra
Published: December 2021

Background

Understanding the disease burden of SARS- CoV-2 in young children has been challenging as the majority are asymptomatic or experience mild symptoms and were rarely tested. SARS-CoV-2 is traditionally detected through respiratory secretions but has also been reported in feces where shedding may continue for weeks after respiratory samples show resolution. We examined the prevalence of SARS-CoV-2 in already collected fecal samples from young children through the pandemic as well as associated demographic factors.

Methods

As part of an ongoing longitudinal microbiome study in Northern Virginia, serial stools samples were collected from infants before and throughout the Covid-19 pandemic. Reverse transcription quantitative-PCR detecting SARS-CoV-2 nucleocapsid gene in the N1 and N2 regions was performed. Penalized logistic regression models were developed to evaluate the association between fecal positivity and potential risk factors.

Results

The overall prevalence of SARS-CoV-2 in infant feces was 1.69 % (13 samples) with a prevalence at delivery, 2, 6, 12 and 24 months of 0, 0, 2.56, 1.96, and 0.85 % respectively. Fecal positivity was first detected 31 days before the reported first case of Covid-19 in Northern Virginia; prevalence rates peaked in September at 4.5% (Figure 1). Only one infant who tested positive was symptomatic with COVID-19 21 days before his stool was collected. Of the 13 positive samples, 8 reported Hispanic ethnicity and 7 reported an essential worker (Table 1). Penalized logistic regression model showed association between Hispanic ethnicity and testing positive (OR 5.04 (95% CI 1.7 – 15.0)) that remained after controlling for the presences of an essential worker (OR 4.7 (95% CI 1.6 – 14.0)).

Conclusion

Prevalence of SARS- CoV-2 in infant stool correlated with the prevalence of COVID-19 during the pandemic, with higher rates in those of Hispanic ethnicity corelating with regional trends. Fecal positivity in asymptomatic infants even before quarantine restrictions supports the early but silent transmission of SARS-CoV-2. This study likely underestimates true prevalence rates as stool samples were stored without viral preservative. There are many socioeconomic factors that predispose to disease while ethnicity may be a mediating or confounding factor

Disclosures

All Authors: No reported disclosures
483. Disease Severity and Clinical Manifestations of SARS-CoV-2 Infection Among Infants Over the First Year of the Pandemic in Canada
Authors: Piché-Renaud Pierre-Philippe , Panetta Luc , Farrar Daniel , Hepburn Charlotte Moore , Drouin Olivier , Kakkar Fatima , Morris Shaun
Published: December 2021

Background

There is limited data on outcomes of SARS-CoV-2 infection among infants (< 1 year of age). In the absence of any approved vaccines for infants, understanding the risk factors for hospitalization and severe disease from COVID-19 in this age group will help inform clinical management and targeted public health interventions. The objective of this study was to describe the clinical manifestations, disease severity, and risk factors for hospitalization among infants with SARS-CoV-2 infection in Canada.

Methods

This is a nationwide prospective observational study using the infrastructure of the Canadian Paediatric Surveillance Program. All cases of infants aged < 1 year of age with microbiologically confirmed SARS-CoV-2 infection were reported from April 8th 2020 to May 11th 2021, and classified by disease severity, and primary cause of hospitalization. Logistic regression was performed to identify risk factors for hospitalization and severe disease.

Results

A total of 393 cases were reported, including 229 (58.3%) non-hospitalized and 164 (41.7%) hospitalized infants. The most common symptoms included fever (63.4%), runny nose (45.0%), cough (35.1%) and decreased oral intake (24.9%). Significant risk factors for hospitalization included younger age and presence of comorbid conditions (excluding prematurity), as shown in the Table. Among hospitalized infants, 108 (65.9%) were admitted because of COVID-19-related illness, and 52 (31.7%) were admitted for reasons other than COVID-19. A total of 31 (7.9%) infants developed severe or critical disease. Risk factors for severe disease included prematurity and younger age (Table).

Conclusion

We describe one of the largest cohort of infants with SARS-CoV-2 infection. Severe disease in this age group is uncommon, with younger age and prematurity being significant risk factors for severe COVID-19.

Disclosures

Pierre-Philippe Piché-Renaud, MD, Pfizer Global Medical Grants (Competitive grant program) (Research Grant or Support, Investigator-led project on the impact of COVID-19 on routine childhood immunizations) Olivier Drouin, MDCM MsC MPH, Covis Pharma (Research Grant or Support) Shaun Morris, MD, MPH, DTM&H, FRCPC, FAAP, GSK (Speaker’s Bureau)Pfizer (Advisor or Review Panel member)Pfizer (Grant/Research Support)
485. Pediatrics Institutional COVID-19 Review
Authors: Karna Prakash , Farrand Lauren , Hasan Uzma
Published: December 2021

Background

Coronavirus disease (COVID-19) caused by SARS-COV2 represents global public health concern, with varied severity of illness in different ages and racial groups. This study aims to describe clinical presentation and outcomes in children aged 0-21 years in a community hospital setting in New Jersey.

Methods

This is a retrospective medical record review of pediatric patients (0-21 years) admitted to Saint Barnabas Medical Center between March 2020- December 2020 with confirmed diagnosis of COVID-19 infection. Diagnosis of COVID-19 infection is based on ICD-10 diagnosis code. Data was extracted from electronic medical records, including demographics, pre-existing conditions, presenting symptoms, treatments used and outcomes.

Results

We identified 48 cases of pediatric COVID-19 patients at Saint Barnabas Medical Center during period of 03/20-12/20. Review of demographic data showed 29 patients (60%) were female, and 19 (40%) were male. Race distribution was 38% black, 17% white, 4 % Asian Indian, and 41% others/unknown. Age distribution was as follows: 40% >15 yrs, 15% 11-15 yrs, 15% 0-1 yrs, 13% 6-10 yrs, 13% 1-5 yrs, and 6% newborn. Fever (65%) was the most frequent symptom identified, followed by cough (31%), nausea/vomiting (29%), abdominal pain (19%), shortness of breath (17%), rash (15%), diarrhea (10%), headache (10%), myalgia/body-aches (8%), chest pain (6%), red eyes (6%), and loss of taste/smell (2%). Of 48 patients, 10 (21%) had positive chest X-ray findings of lung infiltrates or opacities, 4 (8%) had abnormal echocardiogram findings, and 1 (2%) had abnormal CT chest. 21 of 48 patients had underlying comorbid conditions, with Diabetes and Asthma being the most common. No deaths were reported. 8 of 48 COVID-19 patients were diagnosed with MIS-C. Of these MIS-C patients, 5 (63%) were male and 3 (38%) were female. 6 of 8 affected patients were black (75%). 50% of MIS-C patients were between 6-10 years. 3 of 8 patients (38%) had abnormal echocardiogram findings.

Conclusion

This review supports clinical findings from other studies and also suggests certain racial ethnicities may be disproportionately impacted, which warrants further exploration to determine genetics vs environmental factors that lead to increased predisposition to severe illness.

Disclosures

All Authors: No reported disclosures
486. Characteristics Associated with SARS-CoV-2 Infection in Children
Authors: Curtis Sudbury F , Williams Amanda , Kwon Michelle , Musser Leah , Gavigan Patrick , Ericson Jessica E
Published: December 2021

Background

We sought to describe the range of Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in children.

Methods

Patients < 18 years of age who had a positive nasopharyngeal polymerase chain reaction (PCR) for SARS-CoV-2 at a single health system in central Pennsylvania from 3/19/2020-12/31/2020 were identified. Using a random number generator, 150 additional patients < 18 years of age who had a negative PCR test were also identified. Asymptomatic patients and those without clinical data in the electronic medical record were excluded from analysis. Demographic characteristics, symptoms present at the time of testing, and outcomes were compared between PCR-positive and negative patients. Odds ratios were calculated using univariable and multivariable logistic regression models to patients with positive vs. negative PCR tests.

Results

We included 544 patients in analysis, 412 (76%) of which had a positive SARS-CoV-2 PCR. PCR-positive patients were statistically more likely to have a known contact, no comorbidities, and to present with cough, cold-like symptoms, headache, or loss of taste and smell. All patients who presented with loss of taste and smell were PCR positive at time of presentation. Positive patients were statistically less likely to present with fever or emesis than negative patients. Multivariable regression identified increased age, cough, cold symptoms, headache, and non-white race as predictive of PCR positivity. Patients who tested positive were statistically less likely to be admitted to the hospital and less likely to require respiratory support than negative patients.

Conclusion

Loss of taste and smell is a specific, though uncommon, indicator of SARS-CoV-2 infection in the pediatric population. Headache, cough, and cold-like symptoms are also suggestive of SARS-CoV-2 infection, while fever and gastrointestinal symptoms appear less common. This data suggests that screening questions developed for adults may be less applicable in children. Future research, including more dedicated and prospective studies, is warranted to identify patients in whom a positive SARS-CoV-2 test is sufficiently likely to warrant isolation and testing.

Disclosures

All Authors: No reported disclosures
487. Experience with Remdesivir for Treatment of SARS-CoV-2 in Patients with Liver Cirrhosis
Authors: Saunders-Hao Patricia , Jain Sumeet , Hirsch Bruce , Gautam-Goyal Pranisha
Published: December 2021

Background

Remdesivir is a nucleotide analogue antiviral that was FDA approved for the treatment of hospitalized patients with coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). Remdesivir has been associated with elevations in serum aminotransferase levels but most cases being mild to moderate and reversible upon discontinuation. Although national COVID-19 guidelines and the American Association for the Study of Liver Diseases (AASLD) currently recommend remdesivir for use in hospitalized patients requiring supplemental oxygen, data is limited using remdesivir in patients with chronic liver disease. Here, we describe our experience with remdesivir in patients with liver cirrhosis.

Methods

Patients with liver cirrhosis who received remdesivir were identified either prospectively or retrospectively by primary or secondary ICD-10 codes indicating liver disease. Data collected included patient demographics, underlying cause of cirrhosis, co-morbidities, Child-Pugh score, laboratory values (serum aminotransferase levels, serum creatinine) during and following remdesivir, adverse reactions attributed to remdesivir, and mortality (in-hospital, 30-day, and 90-day).

Results

A total of 4 patients with underlying liver cirrhosis completed a 5-day course of remdesivir treatment. On admission, Child-Pugh class was A for 1 patient, B for 2 patients, and C for 1 patient. Causes for cirrhosis were nonalcoholic steatohepatitis (NASH), hepatic amyloidosis, and chronic hepatitis B. There were no acute elevations in aminotransferase levels or adverse events attributed to remdesivir therapy. Mortality was high with 50% in-hospital mortality. Of the 2 other patients who survived to discharge, one was discharged to home hospice and the other was readmitted within 30 days and expired during that admission.

Conclusion

Since there is limited data available using remdesivir in patients with advanced liver disease, we did not identify any safety concerns related to remdesivir in our cirrhotic patients. Mortality was high illustrating the poor outcomes of patients with advanced liver disease and COVID-19. Patients with cirrhosis should be offered remdesivir if clinically appropriate.

Disclosures

All Authors: No reported disclosures
489. SARS-CoV-2 Seroprevalence and Antibody Response Among Pregnant People in Seattle, WA
Authors: LaCourse Sylvia , Kachikis Alisa , Kinderknecht Kelsey L , Galang Romeo R , Zapata Lauren B , Yamamoto Krissy M , Salerno Carol C , Greninger Alexander L , Englund Janet A , Drake Alison
Published: December 2021

Background

Antenatal care is a unique opportunity to assess SARS-CoV-2 seroprevalence and antibody response in pregnant people, including those with previously unknown infection.

Methods

Pregnant people were screened for SARS-CoV-2 IgG during antenatal care or delivery in Seattle, Washington with Abbott Architect chemiluminescent immunoassay which provides quantitative index (positive ≥1.4). Participants with IgG+ results or identified with RT-PCR+ results via medical records were invited to enroll in a longitudinal evaluation of antibody responses. We report preliminary results of an ongoing seroprevalence and longitudinal study with planned 18-month follow-up.

Results

Between September 9, 2020–May 7, 2021, we screened 1304 pregnant people; 62 (4.8%) tested SARS-CoV-2 IgG+, including 28 (45%) with known prior SARS-CoV-2 infection. Among participants testing IgG+, median age was 32 years (interquartile range [IQR] 26–35) and median gestational age was 21 weeks (IQR 12–38) at screening; median IgG index was 3.2 (IQR 2.1–4.9, range 1.4–9.9), including 3.9 (IQR 2.3–5.8) among those with vs. 2.7 (IQR 1.9–4.2) among those without prior RT-PCR+ results (p=0.05 by Wilcoxon rank-sum). Of 30 longitudinal study participants enrolled, 24 tested IgG+ at baseline (75% with prior RT-PCR+ result) and 6 tested IgG- on enrollment but were identified as previously RT-PCR+ via medical records; 24/30 (80%) reported previous symptoms. Of 24 participants testing IgG+ at baseline, 14 (58%) had first follow-up IgG results at median of 66 days (IQR 42–104) since initial testing, with median IgG index of 2.0 (IQR 1.0–3.8). 9/14 (64%) participants with repeat IgG testing remained IgG+ at first follow-up (≤280 days after first RT-PCR+ result for those with and ≥104 days after first IgG detection for those without prior RT-PCR+ results), while 5/14 (26%) had a negative Abbott IgG test at a median of 81 days (IQR 75–112) since initial testing.

Conclusion

Nearly half of pregnant people testing SARS-CoV-2 IgG+ reported no known prior SARS-CoV-2 diagnosis or symptoms. SARS-CoV-2 IgG antibody response and durability in pregnancy has implications for maternal and neonatal protection and susceptibility and highlights potential benefits of vaccination in this population.

Disclosures

Sylvia LaCourse, MD, Merck (Grant/Research Support) Alisa Kachikis, MD, MS, GlaxoSmithKline (Consultant)Pfizer (Consultant) Alexander L. Greninger, MD, PhD, Abbott (Grant/Research Support)Gilead (Grant/Research Support)Merck (Grant/Research Support) Janet A. Englund, MD, AstraZeneca (Consultant, Grant/Research Support)GlaxoSmithKline (Research Grant or Support)Meissa Vaccines (Consultant)Pfizer (Research Grant or Support)Sanofi Pasteur (Consultant)Teva Pharmaceuticals (Consultant) Alison Drake, PhD, MPH, Merck (Grant/Research Support)
490. Uptake and Perceptions of COVID-19 Vaccines Among US Pregnant Women
Authors: Regan Annette , Swathi Pallavi Aytha , Nosek Marcianna , Gu Ning Yan
Published: December 2021

Background

Compared to the non-pregnant population, pregnant persons are at increased risk for severe COVID-19 related illness, including higher rates of admission to intensive care and greater mortality. Despite the potential benefits of COVID-19 vaccines for pregnant persons, current guidelines for the use of COVID-19 vaccines during pregnancy are limited, and the uptake of COVID-19 vaccines among US pregnant adults is unclear.

Methods

As part of an ongoing national longitudinal cohort study, 1,372 pregnant and recently postpartum pregnant persons participated in an online baseline survey, including questions on COVID-19 vaccination status and perceptions of COVID-19 vaccines. Preliminary analyses were restricted to 1,041 individuals who were pregnant during vaccine availability (after 14 December 2020). Post-stratification survey weights were applied to ensure results are representative of the general population. Weighted percentages and odds ratios were estimated based on survey responses.

Results

39.4% (95% CI 33.7, 45.1%) of respondents received a COVID-19 vaccine during pregnancy. Predictors of vaccination included belief that COVID-19 was a serious disease (OR 2.49; 95% CI 1.41, 4.11) and concerns about giving birth during the COVID-19 pandemic (OR 1.83, 95% CI 1.10, 3.04). The most common reason for receiving a COVID-19 vaccine was to protect themselves (21.2%) or their baby (39.1%). Among unvaccinated respondents, 14.9% planned to receive a vaccine during their pregnancy and 35.3% after pregnancy, 28.6% had no intention of receiving a vaccine, and the remaining 21.1% were uncertain. Among those who never planned to vaccinate, the most common reason was concern about side effects (57.2%). Percent of pregnant persons receiving at least one dose of COVID-19 vaccine, by month of delivery (postpartum participants) or estimated month of delivery (pregnant participants).

Conclusion

Our results indicate that despite the lack of clear recommendations for vaccination during pregnancy, more than one-third of pregnant persons received a COVID-19 vaccine during pregnancy. Evaluation of the health effects of COVID-19 vaccination during pregnancy, including the ability to protect pregnant persons and their infants from infection, is needed.

Disclosures

All Authors: No reported disclosures
492. Impact of the COVID-19 Pandemic on Diabetes Surrogate Markers in a Population of People Living with HIV
Authors: Maxwell Tyler , Kanner Esther , Hernandez Nubriel , Molino Suzanne , Yager Jessica E , Ramdeen Shannon , Sharma Roopali
Published: December 2021

Background

COVID-19 has become a worldwide pandemic that brought changes in sociological, economic and health perspectives. The impact of the pandemic on health maintenance is not yet understood, but aspects of the lockdown are being assessed for their impact on society. Diabetes and HIV are diseases that require frequent follow-up to achieve outcomes. Changes to routines during the lockdown, such as physical activity, eating habits, and psychological burden, may result in complications for this patient population.

Methods

This is a multi-center, retrospective cohort study performed between October 2019 to October 2020 at two medical centers in Brooklyn, NY. All adult patients with diagnoses of diabetes and HIV were screened for inclusion. Exclusion criteria included pregnancy and long-term steroid use. Electronic medical records were reviewed to obtain demographic, laboratory data, and appointment retention data. The primary endpoint was the mean change in HbA1c (A1c) values before and after the pandemic. Endpoints were evaluated using paired T-tests and Wilcoxon Sign-Rank tests, where appropriate, and a repeated measures logistic regression model was used to analyze appointment retention rates.

Results

Baseline characteristics are summarized in Table 1. No significance was observed between baseline A1c values and those taken either up to 3 months (p= 0.862) or up to 6 months (p= 0.977) after the start of the pandemic, as shown in Table 2. Similarly, no difference was observed in HIV surrogate markers. A1c significantly decreased from between the 3-month and 6-month study dates, after the start of the pandemic (p= 0.022). Table 3 shows patients were more likely to fulfill a scheduled appointment during the pandemic with an odds ratio of 1.455 (95% CI, 1.119-1.891).

Conclusion

No significance was found in surrogate markers for health maintenance before and after the pandemic. Patients were more likely to keep an appointment after the start of the pandemic and A1c values significantly declined from 3 months to 6 months into the pandemic. Although COVID-19 did not appear to change overall health maintenance of T2DM within our population, our results imply that pandemic measures, such as telehealth appointments, positively affected appointment adherence, which is key to success in this population.

Disclosures

Jessica E. Yager, MD MPH, Abbott Laboratories (Shareholder)Amgen Inc (Shareholder)Becton Dickenson & Co (Shareholder)Edwards Lifesciences Corp (Shareholder)Gilead Sciences, Inc. (Grant/Research Support, Recipient of FOCUS grant)
494. Characteristics and Outcomes of COVID-19 in Hospitalized Native American Patients: A Single-Site Retrospective Analysis
Authors: Jones T Shaifer , Stone Myles , Nham Amy , Bratsch Nicole A , Thompson Trevor N , Jentoft Christopher , Close Ryan M
Published: December 2021

Background

COVID-19 continues to threaten public health, particularly in Native American (NA) communities, which experienced some of the highest rates of COVID-19 infection and mortality in the US. Although the risk factors and clinical characteristics of COVID-19 are well documented in the general population, there has been little research on NA patients.

Methods

We present descriptive data based on chart reviews of COVID-19 patients hospitalized between April 1 and July 31, 2020 at the Whiteriver Service Unit (WRSU), an Indian Health Service site on the Fort Apache Reservation.

Results

Of the 2,262 COVID-19 cases during the observation period, 490 (22%) were hospitalized and 35 (1.6%) died within 28 days. Compared to previous reports, hospitalized patients at WRSU were younger (median age 54), more likely to be female (55% female), and more likely to have comorbidities (92% at least 1, median 2). Patients under 50 (n=200) often had a history of alcohol abuse (51%) or polysubstance abuse (20%). One third of hospitalized patients (34%) were monitored at home and referred for treatment through a high-risk outreach program. Patients were admitted much earlier at WRSU than in other locations, with a median interval of 4 days from symptom onset to hospitalization compared to 7 days reported elsewhere, but over half were still transferred to higher care. Although WRSU patients had higher rates of comorbidities, the 28-day hospital mortality rate from COVID-19 was nearly half of what has been previously reported (35/490, 7% vs 15-20% reported elsewhere, p < 0.001). This trend persisted after controlling for age. Multivariate logistic regression showed that increasing age, male sex, and high BMI were significantly associated with higher risk of death from COVID-19 (overall model p < 0.001).

Characteristics and outcomes of hospitalized COVID-19 patients at WRSU

Conclusion

Hospitalized patients at WRSU tended to be younger but with more comorbidities than previous studies. This may reflect the fact that NAs tend to acquire comorbidities at younger ages than the general population. This may also reflect the high rates of substance abuse in younger patients, which could be an additional risk factor for severe COVID-19. We believe that the low mortality rates at WRSU are a result of our outreach program, which likely decreased the interval between symptom onset and medical treatment.

Disclosures

All Authors: No reported disclosures
495. Evaluation of Antigen Testing for Detection of COVID-19 Vaccine Breakthrough Cases in Long-Term Care
Authors: Linder Meghan , Humphrey-King Sarah , Pierce Rebecca , Hearn Sheri L , Sutton Melissa , Sevey Shane , Fontana John , Cieslak Paul , Tran Dat
Published: December 2021

Background

Long-term care facilities (LTCFs) are at high risk for severe COVID-19 outbreaks due to their congregate nature and vulnerable population. Oregon Health Authority (OHA) deployed point-of-care antigen (Ag) tests to promptly identify COVID-19 cases in LTCFs. However, their performance in identifying vaccine breakthrough cases has not been evaluated.

Methods

During 2/25/21–5/25/21, OHA supported testing of residents and staff for two outbreaks at a single LTCF. Paired nasal swabs were collected and tested for SARS-CoV-2 by CDC Influenza SARS-CoV-2 Multiplex PCR Assay (molecular test) and Abbott BinaxNOW COVID-19 Ag Card (Ag test) twice weekly during the outbreaks. Participants were considered fully vaccinated if ≥ 14 days had passed since completion of a vaccine series; all others were deemed unvaccinated. A vaccine breakthrough case was defined as a positive Ag or molecular test from a fully vaccinated person’s specimen. Performance characteristics of the Ag test were assessed, with molecular test as the reference standard. Cycle threshold (Ct) values were compared by one-sided independent t-tests.

Results

94 unvaccinated residents and staff provided 563 paired samples; SARS-CoV-2 was detected in 21 (12 by Ag and molecular test, 6 by molecular test only, 3 by Ag test only), yielding Ag test sensitivity of 66.7% (95% CI: 43.8–83.7%) and specificity of 99.4% (95% CI: 98.4–99.8%). Mean Ct values were higher for specimens positive by PCR but negative by Ag than those positive by both (30.0 vs. 20.7, P < .01). 81 vaccinated persons provided 925 paired samples; SARS-CoV-2 was detected in 5 (1 by Ag and molecular test, 4 by molecular test only), yielding Ag test sensitivity of 20% (95% CI: 3.6–62.5%) and specificity of 100% (95% CI: 99.6–100%). Mean Ct values for specimens from vaccinated cases were higher than those from unvaccinated cases (30.2 vs. 23.8, P < .05). The lone Ag-positive breakthrough case had a Ct of 20; all others had Ct > 29.

Conclusion

Ag test performance and reduced sensitivity on specimens with high Ct values found in this population are consistent with published data. Molecular testing maximizes identification of vaccine breakthrough cases. More studies are needed to estimate the proportion of breakthrough cases missed by Ag testing and their risk of transmitting the virus in LTCFs.

Disclosures

All Authors: No reported disclosures
497. Moderate Versus High Dose Corticosteroids in Adult Patients with Severe COVID-19: Less Is More
Authors: Joshi Seema , Soman Sana , Jain Saniya , Yako Atheel , Hojeij Marwa , Massoud Louis , Alsaadi Ayman , Smith Zachary R , Alangaden George J , Kenney Rachel , Mayur Ramesh
Published: December 2021

Background

The early administration of corticosteroids (CS) in patients with severe COVID-19 (hospitalized with need for supplemental oxygen) has been the only therapy to improve survival. However, the optimal dosing of CS remains unclear. Beginning March 2020 methylprednisolone (MP) in a dose of 40mg twice daily (high dose CS - HDC) was adopted at our institution. Based on emerging trials, this dose of MP was reduced to 16mg twice daily (moderate dose CS – MDC) in November 2020. The study aims to evaluate the outcome difference in patients receiving HDC versus MDC.

Methods

This pre-post quasi-experimental study was done at Henry Ford Hospital, an 877-bed tertiary care hospital in Detroit, Michigan. Consecutive patients in the HDC group from September 1, 2020 to November 15, 2020 were compared to the MDC group from November 30, 2020 to January 20, 2021. Only hospitalized patients with severe COVID-19 were included. The primary outcome was 28-day mortality. Secondary outcomes included progression to mechanical ventilation, length of hospital stay, discharge on supplemental oxygen and CS-associated adverse events. Patient demographics were evaluated using descriptive statistics. Bivariate and multivariable logistic regression analysis was planned to test the association between primary outcome and exposure.

Results

470 patients were evaluated, 218 and 252 in the HDC and MDC groups respectively. Clinical characteristics and severity of illness on admission were comparable in both groups (Table 1). Among comorbidities - lung disease, cardiovascular disease and hypertension were higher in MDC. Antibiotic and tocilizumab use were lower in MDC. Significantly more patients in MDC group received oral CS. There was no difference in mortality between HDC and MDC through bivariate and multivariate analysis (14.7% and 13.5%, p < 0.712, adjusted OR 0.913 [0.514-1.619]) (Table 2,3). Median length of hospital stay was 5 and 6 days in HDC and MDC respectively (p < 0.001). There was no difference in CS-associated adverse events.

Conclusion

The survival in severe COVID-19 patients treated with MDC is comparable to HDC. Oral corticosteroids are an equally effective option.

Disclosures

Rachel Kenney, PharmD, Medtronic, Inc. (Other Financial or Material Support, spouse is an employee and shareholder)
501. Implementation and Outcomes of a Program to Coordinate and Administer Monoclonal Antibody Therapy to Long-Term Care Facility Residents with COVID-19
Authors: Watkins Andrew B , Brand Lisa M , Schwedhelm Michelle , Jensen Heather L , Scott Brandon , German Dan K , Strand Kyle P , Kamal-Ahmed Ishrat , Lawler James , Salman Ashraf M
Published: December 2021

Background

Long-term care facility (LTCF) residents are at increased risk of severe COVID-19, with CMS data indicating > 20% mortality. BLAZE-1 trial noted lower hospitalization rates in high-risk patients receiving monoclonal antibody (mAb) vs placebo (4.2% vs 14.6%) for mild to moderate infections, making it a treatment option for LTCF residents; however, many LTCF lack staff to prepare and administer mAb therapy. To address this need, Region VII Disaster Health Response Ecosystem (R7DHRE) coordinated via NE Medical Emergency Operations Center (NEMEOC) an ASPR pilot project to facilitate infusion of COVID-19 mAb therapeutics for LTCF residents in the state.

Methods

R7DHRE partnered with Great Plains Health, Nebraska DHHS, Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP) and Infection Control Assessment and Promotion Program (ICAP) to surveil cases in the state, establish distribution/administration pathways, and educate providers on mAb therapeutics. A multi-hub-and-spoke model was created to allow LTCF to work with regional hospitals or pharmacy services to administer drug in their facilities, reducing time to therapy and transmission risk associated with patient transport. A centralized request process was created using a REDCap platform and verification of patient eligibility by ASAP. This request link, informational documents, fact sheets, and custom-built order form templates were hosted on a dedicated ASAP webpage, and details were shared during weekly ICAP LTCF webinars. Outcomes data, including 14- and 28-day COVID-related hospitalizations and mortality, were collected using databases from Nebraska Health Information Initiative and Nebraska DHHS.

Results

Through this program, 513 doses were administered to LTCF residents. Average time from symptom onset to infusion was 2.6 days. COVID- related hospitalization and mortality rates were lower than previously reported for LTCF residents (Table 1).

Table 1. Debographics and Outcomes of mAb Infusions

Conclusion

By utilizing existing relationships with LTCFs in the region, we established a program to promptly distribute, prepare, and administer monoclonal antibody therapy to LTCF residents in need, preventing COVID-related hospitalizations and deaths.

Disclosures

James Lawler, MD, MPH, FIDSA, Kinsa Health (Advisor or Review Panel member)Takeda Pharmaceuticals (Advisor or Review Panel member) M. Salman Ashraf, MBBS, Merck & Co. Inc (Grant/Research Support, I have recieved grant funding for an investigator initiated research project from Merck & Con. Inc. However, I do not see any direct conflict of interest related to the submitted abstract)