bluuebunny/crossref_metadata_2025 huggingface dataset:
489. A Case-Control Approach to an Outbreak of SARS-CoV-2 on an Acute Stroke Unit in the U.S
Authors: Lesho Emil P , Walsh Edward E , Gutowski Jennifer , Reno Lisa , Newhart Donna , Yu Stephanie , Bress Jonathan , Bronstein Melissa
Published: January 2021

Background

Detailed descriptions of hospital-acquired SARS-CoV-2 infections and transmission chains in healthcare settings are crucial to controlling outbreaks and improving patient safety. However, such reports are scarce. We sought to determine origins and factors associated with nosocomial transmission of SARS-CoV-2 in a 528-bed teaching hospital in Western New York.

Methods

The index patient, who had mental illness, wandered throughout the ward, would not wear a facemask, and was often kept seated at the nursing station, developed COVID-19 on day- 22 of hospitalization. A case-control approach was used, wherein all patients, staff, and 128 randomly selected environmental surfaces on the outbreak unit (case), and randomly selected patients, staff, and environmental surfaces on designated COVID-19 and non-COVID-19 units (control), were tested for SARS-COV-2 by RT-PCR and IgG SARS-COV-2 antibodies (SAR-Ab). Compliance with hand hygiene (HH) and COVID-specific personal protective equipment (PPE) was assessed.

Results

145 staff and 26 patients were potentially exposed resulting in 25 secondary cases (14 staff and 11 patients). 4/14 (29%) of the staff and 7/11 (64%) of the patients who tested positive, and later became ill, were asymptomatic at the time of testing (Figures 1–2). There was no difference in mean cycle threshold for SARS-COV-2 gene targets between asymptomatic and symptomatic individuals. 0/32 randomly selected staff from the positive and negative control wards tested positive. PPE compliance based on 354 observations was not significantly different between wards. Environmental surface contamination with SARS-COV-2 RNA was not different between outbreak and control wards. Mean monthly HH compliance, based on 20,146 observations, was lower on the outbreak ward (p < 0.006) (Figure 3). 142 staff volunteered for serologic testing. The proportion staff with detectable SAR-Ab was higher on the outbreak ward (OR 3.78: CI 1.01–14.25).

Figure 1

Figure 2

Figure 3

Conclusion

The risk of staff exposure was higher in an outbreak setting than on a dedicated COVID-19 unit (Figure 4). Noncompliant patient behavior, decreased hand hygiene, and pre-symptomatic transmission can contribute to nosocomial spread and are important considerations for ongoing infection control efforts.

Figure 4

Disclosures

All Authors: No reported disclosures
492. Canadian consensus of COVID-19 policy and management aspects
Authors: Tsang Kara , Mertz Dominik , Chagla Zain , Smaill Fiona , Khan Sarah
Published: January 2021

Background

As evidence rapidly changes, a need for consensus in hospital policy and management aspects of COVID-19 patient care are needed. This study describes areas where consensus exists and is needed in infection control, and occupational health policy.

Methods

An online survey was sent to the membership of the Association of Medical Microbiology and Infectious Disease (n~700). The survey included questions about COVID-19 patient and outbreak management, personal protective equipment (PPE), and occupational health considerations.

Results

Our preliminary results (n=24) were from infectious disease MD/NP or infection control medical directors. All respondents agreed treatment of COVID-19 patients should only occur in the context of a clinical trial. Of 18 centers with neonatal populations, the majority (64.2%) did not have any neonatal specific treatment guidelines. Well-babies born to COVID-19 positive moms, are all being tested (10 of 10 respondents). Variation in practice on when to remove a patient from additional precautions and potential aerosol generating medical procedures (Table 1, 2). Universal masking is in place for all clinical staff (100%), non-clinical staff (70.8%), essential visitors or patient caregivers (70.8%), and universal eye protection is in place for clinical staff (93.3%), but there was a lack of consensus in PPE conservation strategies (Table 3). Most staff do not use neck PPE (68.2%), however there was comments of it being requested by anesthesiologists at 2 sites (Table 2). Healthcare trainees or workers in these groups were restricted from caring for COVID-19 patients; Age >65 years (54.5%) and immunocompromised status (54.5%). COVID-19 positive staff can return to work 14 days after symptom onset (84.2%).

Table 1. Areas of COVID-19 management lacking consensus. Not all respondents answered every question. The percentage in brackets was calculated with the number of respondents per question as the denominator.

Table 2. Procedures considered as aerosol generating medical procedures (AGMPs). Respondents (n=24) were allowed to select more than one option.

Table 3. Personal protective equipment (PPE) conservation strategies (n=24). Not all respondents answered every question. The percentage in brackets was calculated with the number of respondents per question as the denominator. NA corresponds to the question not asked in the survey.

Conclusion

Across Canada, while there are areas of consensus in outbreak definitions, universal masking of clinical staff. There is significant variation in practice with respect to discontinuing additional precautions or outbreak measures, asymptomatic testing, AGMP definitions, PPE conservation strategies including reprocessing. As evidence evolves, national infection control guidelines will be important to improve standardization of practice and optimize patient care and staff safety.

Disclosures

All Authors: No reported disclosures
496. Higher SARS-CoV-2 RT-PCR Cycle Threshold (Ct) Values Associated with Longer Symptom Duration Among Patients Hospitalized with COVID-19
Authors: Brown Lillian B , Winston Lisa Gail , Haller Barbara , Pham Phong , Marcelo Beatrice , Cheung Wendy , Lynch Kara , Jain Vivek
Published: January 2021

Background

Most diagnostic tests for SARS-CoV-2, the causative agent of COVID-19, are RT-PCR based. This method is sensitive but cannot distinguish replicating from non-replicating virus. RT-PCR cycle threshold (Ct) values are inversely correlated with viral load, and higher Ct values have been correlated with lower in vitro viral infectivity. However, relatively few data exist on the association between Ct values and patients’ duration of symptoms remains unclear. We thus evaluated Ct values and symptom duration in a cohort of patients hospitalized with COVID-19.

Methods

We assessed all patients admitted to San Francisco General Hospital between April 1 and May 18, 2020 with confirmed COVID-19 infection based on RT-PCR testing (Abbott m2000 platform). We included patients having diagnostic testing for suspected COVID-19 and patients having asymptomatic testing per hospital policy. For symptomatic patients, date of symptom onset was abstracted from hospital records, and time from symptom onset to test date was calculated. RT-PCR Ct values were manually extracted. Median Ct and IQR were calculated for patients with < 10 days of symptoms, ≥10 days of symptoms, and asymptomatic disease. Between-group comparisons were performed using the Kruskal-Wallis test.

Results

Among 61 patients with positive RT-PCR tests, 40 patients reported < 10 days of symptoms at the time of testing, 15 reported ≥10 days of symptoms, and 6 were asymptomatic. The median Ct value was 14.2 cycles (IQR, 10.2, 18.3) among patients reporting < 10 days of symptoms, 19.7 cycles (IQR, 15.3, 23.9) among patients reporting ≥10 days of symptoms, and 26.3 (IQR, 25.0, 29.1) among asymptomatic patients. Ct values were significantly lower among patients with < 10 days of symptoms compared to patients with >=10 days of symptoms (p=0.01) and when compared to asymptomatic patients (p=0.0002) [Figure].

Cycle threshold (Ct) by days of symptoms at time of testing

Conclusion

SARS-CoV-2 RT-PCR cycle threshold values were higher (indicating lower viral load) in patients with longer symptom duration and were highest in asymptomatic patients. These results add to emerging data suggesting that strategies for optimal isolation of patients in both community and hospital settings could be informed by a combination of symptom duration and RT-PCR Ct values.

Disclosures

All Authors: No reported disclosures
497. Impact of a customized travel and exposure screening tool during the COVID-19 pandemic
Authors: Privette Grayson , Osborne Jennifer , Keough Karen , Kitt Eimear , Sammons Julia S , Paras Emma , Shelov Eric , Handy Lori
Published: January 2021

Background

Screening for communicable diseases at entry to any healthcare setting due to a patient’s travel or exposure history is an important tenet of reducing transmission of pathogens among patients and healthcare providers. We identified multiple screening tools across our enterprise leading to inconsistent documentation by staff and inability to rapidly change screening questions. We aimed to develop a customized screening tool within our electronic health record to address these challenges and provide real-time screening data to our Department of Infection Prevention.

Methods

Stakeholders from all clinical areas as well as family consultants and registration staff provided input on needs for an optimized screening tool. Process mapping across clinical areas of prior screening tools identified variation in decision support and screening questions for both countries and diseases, and demonstrated lack of clear communication between registration staff and clinical teams. Questions and decision support needed to identify communicable diseases in a waiting room setting were identified with stakeholders. Our informatics team reviewed multiple tool options available in the EHR including a built-in travel module with print groups and best practice alerts, a smartform, and flowsheets.

Results

Our informatics team designed a universal flowsheet with cascading rows that included clinical decision support with travel, exposure, and symptom screening. During the period of peak COVID-19 transmission in our region, an average of 1644 patients were screened daily. Of those, 2.8% screened positive for travel to an area of increased transmission with 14.9% of those who traveled reporting respiratory symptoms. An additional 4.1% of total patients screened positive for exposure to COVID-19, while 7.7% reported respiratory symptoms. Nine real-time updates to locations of increased disease transmission and symptoms have been made.

Customized travel and exposure screening flowsheet cascade

Conclusion

Utilizing a custom-built flowsheet model in our EHR permitted real time changes to screening to support appropriate use of infection prevention measures. Customizable travel and exposure screening is critical for identification of patients with concern for COVID-19 and other emerging pathogens.

Disclosures

All Authors: No reported disclosures
498. Impact of COVID-19 on UK Foundation Doctors: Education and Safety
Authors: Blackburn Ben , Ferryman James T , Alattas Adla
Published: January 2021

Background

Transmission of a novel coronavirus (SARS-COV2) from China has caused a global pandemic, resulting in an unprecedented burden on healthcare systems worldwide.

Frontline healthcare workers face considerable risk due to the potential for repeated exposure to infected individuals, many of whom may be asymptomatic given the lengthy incubation period of 5–10 days. With rising incidence, prevalence, and mortality rates, appropriate training and support is paramount in safeguarding the wellbeing of NHS staff and patients. Foundation doctors are among frontline staff being redeployed to areas of need. They are a vital resource within the NHS; and are uniquely positioned to support and staff medical teams.

Methods

A 24 question digital survey with a mix of open-ended, multiple-choice, and rating-scale questions was distributed to the 18 UK Foundation Schools. Questions established trainee demographics and the quantity of COVID-19 training received; with focused questions relating to personal safety and support for vulnerable individuals.

Results

714 doctors completed the survey; 55% in FY2, 43% in FY1, and 2% above FY2 level. 74% of respondents reported receiving no formal training on COVID-19. Mean confidence was 84% in diagnosing COVID-19, and 56% in managing it. 75% did not receive formal training on the requisite safety precautions for suspected COVID-19 cases. 67% had not been fit tested and 75% of those who failed their fit test were not provided with alternative equipment. 30 doctors reported being pregnant and none had received additional support regarding protective measures. 47 doctors reported being immunocompromised and 42 of them had received no additional support in view of their increased risk. 93% of doctors had not received definitive guidance regarding the impact of this on their ARCP sign-off and progression of training.

Conclusion

Alarming proportions of Foundation trainees are not currently being provided with formal training or support for their personal safety during the COVID-19 outbreak. This is remediable through the urgent implementation of formal COVID-19 training, standardised across NHS trusts to ensure a consistent standard of care for the protection of trainees and patients.

Disclosures

All Authors: No reported disclosures
501. Serum IgG Antibody Testing Against Severe Acute Respiratory Syndrome Coronavirus 2 in Healthcare Workers
Authors: Juskowich Joy J , Dimachkie Ziad , Fanning Mary , Sarwari Arif R , Lerfald Nathan M , Bage Seyoum , Simmons Matthew E , Stanley Jonathan E , Bhandari Ruchi , Khakoo Rashida A
Published: January 2021

Background

With the COVID-19 pandemic, many changes were made in healthcare institutions including but not limited to canceling elective surgeries, limiting face-to-face clinic visits, and implementing visitor restrictions. Phased reopening began at West Virginia University (WVU) Medicine on May 25, 2020. While preparing for transition, concern was raised regarding potential for more employee exposures to persons with SARS-CoV-2 infection. In West Virginia (WV), we did not get the predicted surge of SARS-CoV-2. Current cumulative percent positivity for SARS-CoV-2 PCR in WV is 2332 positives of 133,142 tests (1.75%). We provided appropriate personal protective equipment (PPE), including controlled air purifying respirators for all healthcare workers (HCW) caring for persons with suspected or confirmed COVID-19 from the beginning. Policies requiring masks for all HCW and patients took effect on March 27, 2020 and April 29, 2020, respectively. We hypothesized that due to appropriate PPE use there would be no difference in SARS-CoV-2 antibody positivity in HCW working in high versus low risk areas.

Methods

Serum samples from 1042 randomly selected HCW across 4 WVU Medicine hospitals, ranging from 170 to 690 beds with 121 cumulative SARS-CoV-2 PCR positive patients at the time of the study, were tested for SARS-CoV-2 IgG between May 26, 2020 and June 5, 2020. Physicians, nurses, and respiratory therapists were characterized as high or low risk based on work location. Environmental services (EVS) workers were included but not risk-stratified. A questionnaire was used to obtain information on demographics, chronic medical conditions, symptoms, and exposures.

Results

SARS-CoV-2 IgG was positive in 9 of 1042 (0.86%) randomly selected HCW. Seroprevalence was lower in high risk 5/835 (0.60%) versus low risk 4/176 (2.27%) group. This was not statistically significant. No EVS workers tested positive 0/31 (0%). Of 9 HCW who tested positive, 2 had previously tested positive for SARS-CoV-2 PCR.

Conclusion

SARS-CoV-2 IgG seroprevalence in a large sample of HCW across 4 WVU Medicine hospitals was low (0.86%). Low seroprevalence among HCW in high risk areas may be related to appropriate PPE use. Seroprevalence in HCW not caring for patients with COVID-19 could be from community or other inadvertent exposure.

Disclosures

All Authors: No reported disclosures
507. Activation of Macrophages Enhances Susceptibility to SARS-CoV-2 Antibody-Dependent Enhancement and Promotes Damage to Downstream Epithelial Cells
Authors: DeMarco Jennifer K , Severson William E , DeMarco Daniel R , Gabbard Jon , Palmer Kenneth E
Published: January 2021

Background

The distinct shift in peripheral monocyte activation and infiltration of these cells into the respiratory tract observed in severe cases of COVID-19 suggests that like SARS-CoV-1, the acute respiratory distress syndrome (ARDs) observed in SARS-CoV-2 infections may result from damage to the respiratory epithelia by improperly activated macrophages (MPs). In this study, we examined the ability of non-neutralizing antibodies to sensitize MPs to killing by SARS-CoV-2, as well as the impact of these cells on downstream epithelial cells.

Methods

Raw 264.7 cells were seeded into 96-well plates at a density of 1x104/well and incubated overnight in the presence or absence of heat-inactivated LPS derived from either E. coli (EC) or S. enteritidis (Sal). Cells were then treated with non-neutralizing antibodies or vehicle control at the time of infection with SARS-CoV-2. Viability was assessed 48 hours post-infection by luminescence following the addition of CellTiter-Glo® (Promega).

Results

While no decrease in cell viability was observed with SARS-CoV-2 alone, the presence of non-neutralizing antibodies against either the nucleocapsid or spike protein of SARS-CoV-2 decreased cell survival to 35.98% and 53.67% of the cell control, respectively (p< 0.0001 and p=0.0003). Activation of MPs with Sal-derived LPS sensitized MPs to viral killing, even in the absence of non-neutralizing antibody (20.12% viability, p< 0.0001). This was not observed in MPs activated by EC LPS. MP activation by both Sal and EC LPS further enhanced viral killing in the presence of anti-nucleocapsid, reducing cell viability to 12.21% (0.0001) and 6.46% (p< 0.0001). Finally, supernatants collected from naïve MPs subjected to ADE markedly increased the susceptibility of Vero E6 cells to SARS-CoV-2 nearly 9.8-fold (p< 0.0001).

Conclusion

Here we demonstrate that naïve MPs, normally resistant to infection by SARS-CoV-2, are rendered susceptible to viral killing by activation and the presence of non-neutralizing antibodies to SARS-CoV-2. Furthermore, MPs secrete an as yet, unknown factor that enhances the susceptibility of Vero E6 to SARS-CoV-2. Taken together, these data suggest that MPs play an important role in determining the severity of SARS-CoV-2 infection.

Disclosures

All Authors: No reported disclosures
509. Comparision of CD4+ T Cells in Patients with Severe vs Critical COVID -19
Authors: Gomez-Gomez Brenda , Espinosa-Aguilar Luis , Garcia-Guerrero Javier , Hoyo-Ulloa Irma , Mendoza-Aguilar Raquel , Moreno-Sanchez Francisco , Acosta Benjamin Valente , Ontañon-Zurita Diego
Published: January 2021

Background

Over the past few years, it has been shown that T cells play an essential role in antiviral immunity, in the course of the COVID-19 pandemic some studies reported an association between lymphocytopenia and exhaustion of the surviving remaining T cells which are apparently functional in patients with acute COVID-19, specially in those with severe forms of presentation. Some studies have reported an association where less than 800 CD4 + T cells are negatively related to the survival of seriously ill patients with COVID -19.

Methods

We included 19 patients admitted to our hospital (ABC Medical Center) from May 7 to 15, 2020 with a confirmed diagnosis of COVID-19 and were randomized into 2 groups according to the severity of the presentation (severe or critical) A determination of CD4 + T cells was made at admission, we also reported the need for invasive mechanical ventilation at some point of the hospitalization for each group, all patients were followed until their hospital discharge. One patient was excluded because he was still admitted at the time of the analysis.

Results

Of the 18 patients included, 9 (50%) fulfilled criteria of severe and 9 (50%) of critical. The mean of CD4 + T cell was 455 (256–697) for the severe and 285.44 (145–430) for the critical (CI 95% P 0.46), the determination of CD8+ T cell was 212 (88–392) for the severe and 201 (59–534) for the critical (CI 95% P 1.19), of the critical patients 8 (88.9%) required invasive mechanical ventilation and only one non-invasive mechanical ventilation, while the severe patients only required support with supplemental oxygen by nasal cannula (9 (100%)).The mean lenght of hospitalization was 12.73 days (3–34) and all the patients survived until they were discharged home.

Conclusion

As it has been reported in some studies, the pathogenesis of SARS-CoV-2 infection in humans is associated with a reduction and functional exhaustion of T cells in patients with COVID-19.In this study we presume that lower levels of CD4+T cells can be associated with critical forms of COVID 19 as the majority of critical patients in our report had < 300 CD4 +T cell count, while we need further studies with a greater number of patients and follow-up to establish reliable determinations, we propose than the levels of CD4+T cell count could be use as a good predictor of severity in COVID-19

Disclosures

All Authors: No reported disclosures
510. Elevated IL-1β level as a predictor of inflammation and death in COVID-19
Authors: Swartz Talia H , Gnjatic Sacha , Aberg Judith A , Merad Miriam , Sigel Keith
Published: January 2021

Background

SARS-Cov-2 (severe acute respiratory disease coronavirus 2) causes Coronavirus Disease 2019 (COVID19) and is associated with respiratory failure and death in severe disease. This is associated with high levels of cytokines such as IL-6, IL-8 and TNF-alpha which are predictors of severe outcomes. SARS-CoV-2 leads to activation of the NLRP3 inflammasome which results in secretion of the cytokine IL-1ß. While high levels of IL-1ß are not observed in most patients with severe COVID-19, there is a subset of patients with high IL-1ß levels. Here we sought to characterize these patients and determine whether high IL-1ß levels are associated with adverse outcomes and death in COVID-19.

Methods

We identified 90 patients with high IL-1ß levels (greater or equal to 2 pg/ml) and laboratory confirmed COVID-19 hospitalized in our hospital system in New York March 12 and May 8, 2020. We collected baseline clinical characteristics, laboratory values, COVID-19 treatment, and outcomes from this group and the group with IL-1ß levels below 2 pg/ml. Baseline clinical characteristics and outcomes were compared.

Results

Comparing patients by IL-1ß level had similar demographics (age, sex, race/ethnicity, smoking status and comorbid disease prevalence). The group had comparable levels of adverse markers of disease severity but the patients with high IL-1ß had increased inflammatory biomarkers including IL-8 (629 vs. 68 pg/ml, p< 0.0001), TNF-alpha (30 vs. 51 pg/ml, p< 0.0001), IL-6 (173 vs. 5075 pg/ml, p< 0.0001), CRP (141 vs. 178, p=0.0007), d-dimer (2.6 vs. 4 p=0.0002), and increased rates of death (30% vs. 20%, p=0.008).

Conclusion

Demographic and comorbid conditions are not effective at predicting high IL-1ß serum levels in COVID-19 patients, however those individuals with high levels are at risk for adverse outcomes of severe disease and death. Further investigation is required to probe the mechanism of NLRP3 inflammasome activation and IL-1ß signaling and the role of this cytokine in mediated inflammation and death in COVID-19.

Disclosures

Judith A. Aberg, MD, Theratechnology (Consultant)
512. Kinetics of SARS-CoV-2 IgG responses among hospitalized patients with COVID-19
Authors: Beenhouwer David O , Chintalacharuvu Koteswara , Winnett Alexander , Goldin Evan , Bhattacharya Debika , Graber Christopher J , Goetz Matthew B , Fulcher Jennifer A
Published: January 2021

Background

The kinetics of antibody responses to SARS-CoV-2 infection are not fully understood. We analyzed IgG responses to the SARS-CoV-2 Spike protein receptor binding domain (RBD) in COVID-19 patients admitted to VA Greater Los Angeles (VAGLA) and correlated with clinical outcomes.

Methods

Serially admitted patients from March 20-May 10, 2020 with at least one available residual serum specimen were included in this analysis. Serum samples selected for analysis included first, last, and intermediaries spaced ≥ 5 days apart, as available. Anti-RBD IgG was detected with an enzyme immunoassay (EIA) using recombinant RBD protein. Serum from an uninfected individual collected April 2019 was used as control. The average optical density of the control in triplicate plus 3 standard deviations was considered the threshold positive/negative value. The highest dilution above the threshold value was considered the IgG titer. Clinical groups were defined as asymptomatic, moderate/severe (no ICU) or critical (mechanical ventilation, cytokine storm and/or death).

Results

Of the 43 consecutive patients admitted to VAGLA with COVID-19 in this analysis, 40 developed detectable RBD IgG responses with maximum inverse titers (MIT) ranging 100-819,200, geometric mean 12,152. Five patients remained asymptomatic but had positive EIAs with median MIT 3200 (IQR 800–3200). Twenty-five had moderate-severe illness with median MIT 25600 (IQR 6400–102400). Ten patients with critical disease had median MIT 38400 (IQR 8800–51200). The median time to positive IgG was 10 days for asymptomatic (IQR 10,10), 4 days for moderate-severe (IQR 3,15), and 7 days for critical (IQR 3.5,14.5). The figure depicts RBD IgG titers over time after onset of symptoms. Asymptomatic patients had a more gradual rate of increase and lower peak titers, while critical patients had the fastest rate of rise and the highest peak titers. Of the 21 patients with samples > 30 days after symptom onset (range 31–67 days), there was no evidence for decrease in anti-RBD IgG.

Kinetics of IgG to SARS-CoV-2 receptor binding domain by clinical severity

Conclusion

Following infection with SARS-CoV-2, disease severity correlates with both the rate of increase and peak in antibody titers. Anti-RBD IgG titers did not decrease over the observation period.

Disclosures

All Authors: No reported disclosures
519. Immune responses and COVID-19 severity
Authors: salvatore mirella , Vorkas Charles K , Sing Harjot , Morales Ayana , Soave Rosemary , Kapatia Shashi , Ellsworth Grant , Saito Kotha , Brown Christopher D , Hsu Jing-Mei , Casano Joseph , Inghirami Giorgio
Published: January 2021

Background

The coronavirus-19-disease (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread to >200 countries and surpassed 7 million cases. There is a broad range of COVID-19 illness, ranging from milder disease to a rapidly progressive respiratory disease and ARDS. The causes of this different clinical course and the drivers for severe disease are currently unknown. A fulminant increase of pro-inflammatory cytokines is thought to play a role in causing a rapid disease evolution, however the immune correlates of severe COVID-19 remain unclear.

Methods

To gain insight into relationship between immune responses and disease severity we built a longitudinal cohort of 40 adult patients with known COVID-19. Samples were collected at diagnosis and every 7 days until hospital discharge or death. As controls we also included a group of convalescent patients, and subjects who tested negative for COVID-19 by PCR. Clinical and laboratory data and were also collected. Multicolor flow cytometry was used to determine the presence and phenotype of B, T and natural killer (NK) cells. We also identified specific sub-populations (Tfh, activated/cytotoxic CD8 and NK) and assessed lymphoid exhaustion of different cell types such as naïve, memory T cells, or NK over time. Anti-Sars-CoV2 IgG and IgM antibody were detected using lateral flow method.

Results

We found that the absolute number of lymphocytes and monocytes was decreased starting at diagnosis and correlated with disease severity. Disease severity correlated with decreased NK and T cell. In severe COVID-19 cases, NK cell populations were strongly decreased over time in intubated patients while they recovered in patients who improved and were discharged. CD8+ were also decreased at disease onset and seemed to correlate with disease severity. A high percentage of CD4+ and CD8+ T cells showed an exhausted phenotype. All patients tested at admission had IgM antibody responses irrespective of the course of the disease. Further analyses are ongoing.

Conclusion

The characterization and role of the immune responses in COVID-19 evolution is still under investigation. Further characterization of viral and immune factors will help in identifying subjects at high risk of severe disease and targets for intervention.

Disclosures

All Authors: No reported disclosures
522. The Simple and Novel SAS Score to Predict Mortality at Presentation in 2541 Hospitalized COVID-19 Patients
Authors: Acosta Tommy J Parraga , Vahia Amit T , Chaudhry Zohra S , Gudipati Smitha , Arshad Samia , Ramesh Mayur , Zervos Marcus , Alangaden George J
Published: January 2021

Background

The clinical spectrum of the novel corona virus disease 2019 (COVID-19) ranges from mild to severe disease and death. We aim to construct a simple and novel scoring model that will predict mortality events in hospitalized COVID-19 patients.

Methods

We established a retrospective cohort of 2541 patients admitted with COVID-19 from February 19, 2020 to April 28, 2020 to Henry Ford Health System, MI. Sociodemographic data, comorbidities, and clinical data were collected. Our novel SAS score was constructed using 3 easily available parameters, namely Sex, Age, and Oxygen Saturation at presentation (Table 1 and 2). Primary endpoint was mortality. Multivariate analysis with logistic regression was done and the model was assessed using receiver operating characteristic (ROC) with area under ROC (AUROC) to determine the optimal cutoff for sensitivity, specificity, and positive and negative predictive values.

Results

The mean age of survivors was 61 compared to 75 years for non-survivors (standard deviation 16 vs 13.8, p< 0.0001), and 1298 (51.1%) were men. Multivariate analysis of the SAS score adjusted for modified SOFA [Sequential organ failure assessment] score (mSOFA) showed that age (odds ratio [OR] 2.4, 95% confidence interval {CI} 2.04–2.72, p< 0.0001) and oxygen saturation (OR 1.6, 95% CI 1.27–1.98) were the most significant predictors of mortality in the model. The SAS score had an AUROC of 0.78 (95% CI 0.77–0.81) (Figure 1). A cutoff score of 3 offered the most sensitivity for predicting mortality while maintaining a negative predictive value of 95% (Table 3). Comparison of AUROC shows that SAS score adjusted to mSOFA has better diagnostic information compared to either SAS score or mSOFA alone (Figure 2).

Conclusion

The easy to use SAS score at time of presentation identified hospitalized COVID-19 patients at high risk for mortality. Application of the SAS score in the emergency department may help triage patients to inpatient versus outpatient care.

Disclosures

Marcus Zervos, MD, Melinta Therapeutics (Grant/Research Support)
524. COVID 19 Infection in Pregnant Women and Newborn Infants at a Single U.S. Center: What Disparities, Testing and Isolation Practices can Teach Us
Authors: Camelo ingrid Y , Figueira Marisol , Sabharwal Vishakha
Published: January 2021

Background

COVID-19 transmission from mother to infant suggests that vertical and horizontal transmission of COVID-19 are possible. Here we describe the demographic and clinical characteristics and outcomes of SARS-CoV-2 positive pregnant women and their newborns.

Summarized Characteristics of 19 COVID-19 Positive Mothers that Delivered 3/31/20–6/17/20 at Boston Medical Center

Methods

We collected data from the electronic medical records of pregnant women. Data composed of maternal demographics and morbidities, and symptoms of COVID-19. Descriptive statistics were used to analyze data. Women had positive polymerase chain reaction (PCR) testing done by nasopharyngeal swabs.

Each newborn was tested for SARS_CoV-2 by RT_PCR with a nasopharyngeal swab at 24 hours, 48 hours, and day 5 of life.

Results

36 women met criteria to be included in this study. 22% had chronic hypertension, 8% had asthma, one had chronic HIV and hepatitis C, 30% had pregnancy-related morbidities including pregnancy-induced hypertension (19%), cholestasis of pregnancy (8%) and gestational diabetes(3%) (Table1) Of the 32 deliveries to date, 17 (53% delivered vaginally and 15 (47%) via C-section. Of the 15 C-sections, 6 (40%) were due to complications related to COVID-19. 38% (14/36) women developed hypoxia.

Five newborns (15%) born to SARS-CoV-2 positive mothers had positive PCR testing for SARS-CoV-2. 2 of them were born prematurely and by C section secondary to COVID 19 infection respiratory deterioration. One premature infant tested positive for RT-PCR for SARS-CoV-2 on days 1, 2, and 5. The other one was positive on day 2. The two full-term newborns who tested positive by PCR for COVID 19 after delivery, were not delivered secondary to COVID 19 complications. One infant who was separated from his mother was negative by PCR at days 1,2 and 5 but tested positive later after being in contact with his mother.

Conclusion

Our population of pregnant mothers had a high incidence of cesarean section secondary to COVID 19 infection complications. They also had a high frequency of chronic health conditions.

Infants born to mothers with COVID-19 can have positive PCR tests for SARS-CoV-2 suggesting that both, vertical and horizontal mother to infant transmission is possible. Infants had negative tests before positive tests, suggesting false negative testing may have occurred.

Disclosures

All Authors: No reported disclosures
527. Corona Virus Disease-19 (COVID-19) in a Veterans Affairs Hospital at Suffolk County, Long Island, New York
Authors: Psevdos George , Papamanoli Aikaterini , Lobo Zeena
Published: January 2021

Background

The area of New York was hit hard by the COVID 19 pandemic with Suffolk county in Long Island numbering >40 thousand cases and 1900 deaths by the end of May 2020. The Veterans Affairs Medical Center (VAMC) at Northport NY serves over 30000 Veterans. We report our institution’s experience during the COVID 19 outbreak

Methods

Retrospective chart review of hospitalized Veterans (VETS) with COVID-19 from March 1st to May 31st 2020 at Northport VAMC

Results

A total of 141 VETS had laboratory confirmed SARS-CoV-2 infection, 67 got hospitalized, and 20/67 died. The median age of the hospitalized cohort was 73 years (33 to 94). Figure 1 shows the dates of tests, Tables 1 &2 summarize the demographic characteristics, medical history and laboratory findings. No co-infection with influenza or other respiratory viruses were identified. The deceased group was older 77.5 vs 71 years P 0.007, had lower oxygen saturation and higher respiratory rate on presentation, had longer length of stay P 0.091, more likely to be in ICU and intubated, had lower bicarbonate levels, higher SAPS P < 0.001, higher lactate dehydrogenase, blood urea nitrogen, potassium levels, and higher peak procalcitonin, CRP, ferritin, ESR levels. There was no difference between recovered and deceased in terms of comorbidities except atrial fibrillation. Also, no difference in use of ACE inhibitors, statins, famotidine, hydroxychloroquine (HCQ), azithromycin, doxycycline, steroids. Beta lactam antibiotics and tocilizumab were given more in the deceased group. HCQ was stopped in 1 patient due to QTc prolongation. No bacteremia identified in the recovered group contrary to two occasions in the deceased, E. faecalis and S. mitis. Six pneumonias in intubated deceased patients were identified (3 had received steroids and one tocilizumab) and 4 in recovered (2 intubated/steroids and 1 tocilizumab). 12 recovered patients had persistent positive nasopharyngeal PCR for SARS-CoV-2 for average 29 days (14 to 79 days), and 4 of them were checked and had detectable IgG antibody

Dates of Tests for Hospitalized Veterans with COVID-19

Comparison of Demographic Data and Comorbidities in Recovered vs Diseased Hospitalized Veterans with COVID - 19

Comparison of Laboratory Data in Recovered vs Diseased Hospitalized Veterans with COVID - 19

Conclusion

The inpatient mortality of hospitalized VETS with COVID-19 in our institution was 30%. Mortality was associated with older age. Ongoing monitoring of outcomes in hospitalized patients will be important to understand the evolving epidemiology of COVID-19 among US VETS.

Disclosures

All Authors: No reported disclosures
529. COVID-19 Antibody Responses in Solid Organ Transplant Recipients
Authors: Zervou Fainareti , Ali Nicole , Neumann Henry J , Madan Rebecca Pellett , Mehta Sapna A
Published: January 2021

Background

Studies to date indicate that most adults develop IgG antibody to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) within 6 weeks of COVID-19 symptom onset. The seroconversion rate of solid organ transplant recipients (SOTR) following COVID-19 is unknown. Elucidation of humoral immune responses following COVID-19 in SOTR may inform risk of reinfection and the development of safe and effective vaccines for immunocompromised hosts.

Methods

We assessed the frequency of SARS-CoV-2 IgG detection among adult SOTR diagnosed with COVID-19 by nasopharyngeal PCR assays between 3/1/2020 and 6/5/2020. SARS-CoV-2 IgG was detected in serum using the Abbott IgG assay at the manufacturer’s recommended cut-off. Our primary objective was the frequency of SARS-CoV-2 IgG seropositivity after COVID-19. A secondary objective was to identify clinical factors associated with seroconversion. The mean age and nadir absolute lymphocyte count (ALC) were calculated between seropositive and negative SOTR and compared by Student’s t-test.

Results

Among 93 SOTR diagnosed with COVID-19, 19 died before SARS-CoV-2 IgG testing could be performed, and 18 had testing pending as of abstract submission. 56 SOTR (44 kidney, 5 heart, 4 liver, 1 lung, and 1 heart-kidney recipients) completed testing and were included in the analysis. Median age was 58 years (IQR 49.5–67), and all received maintenance immunosuppression at the time of COVID-19 diagnosis with median nadir ALC during illness of 400 (IQR 200–600). SARS-CoV-2 IgG testing was performed at a median of 60 days (IQR 50–70) from symptom onset, the shortest interval being 16 days. 47 out of 56 SOTR tested positive for SARS-CoV-2 IgG. The likelihood of seroconversion was not different between those who were tested at < or ≥ 60 days from symptom onset (p=0.26), nor did it vary significantly by age (p =0.59), gender (p=0.53) or nadir ALC (p =0.28).

Conclusion

83% of evaluated SOTR with COVID-19 disease had detectable SARS-CoV-2 IgG in serum at a median of 60 days after symptom onset. Studies are ongoing to identify variables associated with poor antibody response among the nearly 20% of SOTR in this cohort who failed to seroconvert. The significance of seroconversion on risk of reinfection and vaccine immunogenicity remains to be determined.

Disclosures

All Authors: No reported disclosures
531. COVID-19 infection outcome in African American Renal Transplant recipients: Detroit Medical Center experience
Authors: Cruz Angela Beatriz V , Tejada Claudia Jarrin , Zachariah Mareena , Hussein Shakir , Wilpula Elizabeth , Meeks Nicole , Wolff Jeffrey A , Chandrasekar Pranatharthi
Published: January 2021

Background

Transplant recipients are more vulnerable to infections including COVID-19, given their co-morbidities and chronic immunosuppression. Most preliminary care series report rapid clinical progression and higher mortality compared to the general population.

Methods

Retrospective study at Harper University Hospital - Detroit Medical Center. Twenty-five renal transplant recipients (RTR) presenting consecutively with COVID-19 symptoms and positive NP swab PCR for SARS-CoV2 between 03/01/2020 - 05/01/2020 were included. Data on demographics, clinical presentation, laboratory findings, management and outcomes were collected.

Results

All 25 patients were hospitalized. Patients had a median age of 56, all African American and deceased donor transplant recipients. Most had hypertension (96%), about half (52%) had diabetes, 64% had pulmonary disease including obstructive sleep apnea, COPD and pulmonary hypertension. Most common presenting symptom was dyspnea (64%), followed by fever and cough (56%) and diarrhea (56%). One-half of patients had multifocal opacities on initial chest x-ray (52%). Immunosuppression with tacrolimus and low dose prednisone was continued, while mycophenolate mofetil was held on admission. Following institution guidelines, hydroxychloroquine was given to 32%, while 48% received both hydroxychloroquine and steroids. Prophylactic anticoagulation was given to 80% of patients and therapeutic coagulation to 8%. Oxygen supplementation given to 60% of patients and one patient required intubation. Three patients (12%) required transfer to the intensive care unit, one expired. At follow-up, treatment with mycophenolate was reintroduced based on resolution of symptoms and laboratory parameters.

Conclusion

COVID-19 infected RTR in this small cohort had lower mortality of 4% (n=1) compared to State-wide mortality of 10%. Despite multiple co-morbidities and chronic immunosuppression, our patient cohort had excellent prognosis and lower mortality compared to other series. Exact reasons for this optimal outcome are explored.

Disclosures

All Authors: No reported disclosures
532. COVID-19 Pneumonia in Patients with Hematologic Malignancies – A Report from the US Epicenter
Authors: Plate Markus , Kodiyanplakkal Rosy Priya , Satlin Michael J , Soave Rosemary , Drelick Alexander Christian , Orfali Nina , Helfgott David , Niesvizky Ruben , Roboz Gail J , Shore Tsiporah B , Van Besien Koen , Small Catherine B , Walsh Thomas J
Published: January 2021

Background

Limited data are available for risk assessment and outcome of COVID-19 in patients with hematologic malignancies (HM). We present a single center study of COVID-19 pneumonia in a cohort of 31 patients with HM.

Methods

Data were abstracted from electronic medical records for patients admitted to NYPH between 3/5/20 and 4/17/20 and entered into a REDCap database.

Results

Twenty (64.5%) were male; median age was 71 years. There were 8 patients with Multiple Myeloma (MM), 8 with Chronic Lymphocytic Leukemia (CLL), 6 (19.4%) had AML, 5 (16.1%) NHL, 2 (3.2%) ALL; CML, MDS and Polycythemia Vera occurred in 1 patient each. Twenty-four (77.4%) had active HM; 6 (19.4%) were in remission; and 1 relapsed. Nineteen patients (61.3%) received recent chemotherapy and 11 (35.5%) immunosuppressive therapies. There were 7 (22.6%) hematopoietic stem cell transplant (HSCT) recipients (4 allogeneic and 3 autologous). Comorbidities were evenly distributed among all malignancies: 18 (58.1%) had hypertension, 9 (38.7%) obesity, 7 (22.6%) diabetes mellitus, and 11 (35.5%) were former smokers. The most common symptoms included cough (90.3%), fever (83.9%) and dyspnea (61.3%); 7 (22.6%) had nausea and vomiting; 7 (22.6%) had diarrhea. On presentation, hypoxia (O2 sat ≤94% on room air) occurred in 64.5%; median ALC was 330/ml; 23 (74.2%) had ALC< 1000/ml; median CRP was 15.9 mg/dl (2.5–40.4), ferritin 1162 ng/ml (264 - > 16500), and D-dimers 456 ng/ml (< 150–2418). Thirteen patients (41.9%) required ICU admission and were intubated; among those 9 (69.2%) had either MM or CLL. Co-infections were uncommon; two patients developed HSV1 pneumonitis and one of these also had CMV pneumonitis. Twenty-eight (90.3%) were treated with hydroxychloroquine, 5 (16.1%) remdesivir, 2 (6.5%) tocilizumab, 1 (3.2%) sarilumab, and 4 (12.9%) with methylprednisolone 0.5mg/kg Q12h. Seventeen patients (54.8%) recovered and were discharged, 12 (38.7%) died; 2 (6.5%) were still hospitalized but left the ICU.

Conclusion

In our cohort, there were predominantly more patients with MM and CLL and 56% of these were intubated; larger cohort studies will further define the risk and outcome for COVID-19 in patients with HM.

Disclosures

Michael J. Satlin, MD, MS, Achaogen (Consultant)Allergan (Grant/Research Support)Merck (Grant/Research Support)Shionogi Inc. (Consultant)
536. HIV Patients with COVID-19 in the Bronx: A Retrospective Cohort Study
Authors: Lee Philip J , Sirichand Surksha , Gutierrez Nataly Rios , Corro Luis Gonzalez , Cruz Carlos , Grossberg Robert , Bernardo Raffaele
Published: January 2021

Background

Since the start of the pandemic there has been limited data on mortality in people living with HIV (PLWH) who have Coronavirus Disease 2019 (COVID-19) in the United States (US). We conducted a retrospective review to investigate potential risk factors associated with survival and need for medical ventilation for PLWH and COVID-19.

Methods

This is a retrospective observational cohort from a large academic center across three campuses, conducted from January 1, 2020 to April 30, 2020. Thirty day readmissions were observed from January 1, 2020 to May 31, 2020. Our patients were identified by an ICD-10 code (B20) corresponding to HIV and positive SARS-CoV-2 PCR test. As a primary endpoint, we compared survivors vs. non-survivors. As a secondary endpoint, we compared patients who needed mechanical ventilator (MV) vs. those who did not need MV.

Results

Seventy two PLWH (28 female patients (39%), median [IQR] age was 62 [-/+16] years) had positive SARS-CoV-2 PCR tests during this retrospective review. Median CD4+ count was 235 cells/ul and 11 (15%) had an HIV viral load >200 copies/mL. The median length of stay was 5 days and 6 patients were directly discharged from the emergency department. Ten patients were readmitted within 30 days with SARS-CoV-2 – like symptoms and 2 are still inpatient. Twenty patients (27.8%) have expired. All non-survivors that expired had an undetectable HIV viral load (0%, p=0.02). The 11 patients with unsuppressed HIV viral loads at the start of the study period all survived, p=0.02. Non-survivors were more likely to have chronic kidney disease CKD (p< 0.01) acute kidney injury (p< 0.01), higher absolute neutrophils (p< 0.01), and elevated IL-6 levels (p< 0.01) compared to survivors. Fifteen patients (20.8%) required mechanical ventilation (MV), 3 (4.1%) of those patients survived. Patients that required MV were more likely to be male (p=0.01) obese (p< 0.01) and had higher absolute neutrophil counts (p=0.01) versus those that did not need MV. Patients with lower CD4 counts (< 200 cells/uL) did not require more mechanical ventilation (p=0.04).

Table 1: Demographics, Primary and Secondary Outcome Results

Conclusion

PLWH who had COVID-19 had a high mortality rate. Since all the patients who died had an undetectable HIV viral load across CD4 counts, our study suggests that patients with uncontrolled HIV are not at an increased risk of mortality.

Disclosures

All Authors: No reported disclosures