bluuebunny/crossref_metadata_2025 huggingface dataset:
437. Asymptomatic Healthcare Worker COVID-19 Testing Program
Authors: Horton Lucy E , Taplitz Randy , Torriani Francesca J , Abeles Shira R , Ikeda Lydia , Ikeda Tyson
Published: January 2021

Background

The SARS-CoV-2 pandemic remains a major threat worldwide. Healthcare workers (HCWs) are particularly impacted by the COVID-19 pandemic with high infection rates reported from HCWs in hard-hit regions2,3, raising concerns about nosocomial infections and the effectiveness of personal protective equipment in protecting HCWs. Asymptomatic infection is estimated 17.9% to 33.3%4 and is a common source of transmission5.

We designed a HCW testing program to address patient and employee concerns about exposures in the healthcare setting at our 808-bed health system. During the time of employee testing, the mean (range) number of inpatients with a diagnosis of COVID was 30 (22–38) of a mean (range) daily census of 560 (492–602) (approximately 5.4%).

Methods

This opt-in program offered SARS-CoV-2 testing of asymptomatic HCWs with paired nasopharyngeal or mid-turbinate swab for PCR (Roche) and serum IgG antibody testing (Diazyme). While initially designed as a pilot project in the Emergency Departments and COVID-19 units, it was quickly expanded to a health system-wide initiative.

Results

From April 22 to June 2, PCR testing was performed on 5826 asymptomatic HCWs with four PCR tests resulting positive (0.09%). Of 5589 serologic tests (anti-SARS-CoV-2 IgG) performed, 57 tested positive (1.02 %). All HCW with a positive IgG had a concurrent negative PCR.

Conclusion

In this cross-sectional evaluation, the point prevalence of SARS-CoV-2 IgG in asymptomatic HCWs at UC San Diego was less than 1%, supporting modeling estimations at the San Diego County level of very low levels of community exposure at the time of this testing.

Further analyses of incidence rates and potential risk factors such as employee roles within the healthcare system, community and healthcare exposures, and home zip code are underway.

Asymptomatic HCW testing is a strategy that can provide the perception of additional safety to both the workforce and patients as the health system reopens, while potentially reduce transmission from asymptomatic persons through active case finding and isolation.

Disclosures

Randy Taplitz, MD, Merck (Advisor or Review Panel member)
440. Clinical Characteristics of Early Noncritical Hospitalized Patients with Coronavirus Disease 2019 (COVID-19): A Single-Center Retrospective Study in New York City
Authors: Lee Michelle , Fayad Mona , Mabud Tarub , de Lara Paulino Tallon , Hernandez Adiac Espinosa , Anez Gustavo A Contreras , Freites Christian Olivo , Kholi Maanit , Chadha Nikhil , Jean Raymonde
Published: January 2021

Background

COVID-19 first originated in Wuhan, China, in December 2019. As of April 9, 2020, New York State had become the single largest global epicenter of COVID-19.

Methods

This is a retrospective chart review of the first 33 patients with RT-PCR-confirmed COVID-19 admitted from the emergency department to a general medicine unit in a single academic hospital in New York City between March 11th to March 27th, 2020. Patient’s demographic, clinical, laboratory, radiographic investigations, treatments and clinical outcomes were retrospectively extracted from the electronic medical record and followed until April 10th, 2020. Patients were divided into severe and nonsevere sub-cohorts. Statistics were descriptive in nature.

Results

The study cohort (median age 68 yr, 67% male) presented with subjective fevers (82%), cough (88%), and dyspnea (76%). The median incubation period was 3 days. Most cases met SIRS criteria upon admission (76%). Patients had elevated inflammatory markers. Patients were treated with antimicrobials, corticosteroids, hydroxychloroquine, and varying levels of supplemental oxygen. Mortality was 15% and 18% of the cohort required intensive care services.

Conclusion

Patient age, presenting clinical symptoms, comorbidity profile, laboratory biomarkers, and radiographic features are consistent with findings published from China. Severe patients had peaks in inflammatory biomarkers later in the hospitalization, which may be useful to trend. Further studies are necessary to create guidelines to better risk-stratify COVID-19 patients based on clinical severity.

Disclosures

All Authors: No reported disclosures
449. Disproportionate of COVID-19 Mortality across NYC: Experience from the Bronx Hospital during the First Wave of Pandemic Crisis
Authors: Suwanwongse Kulachanya , Shabarek Nehad
Published: January 2021

Background

The Bronx (BX) is an urban city with the most poverty, least educated population and poorest health outcomes among 62 counties in New York State. Unsurprisingly, BX has the highest rates of COVID-19 diagnoses across New York City (NYC). Lincoln Medical Center (LMC) is part of the NYC health and hospital system (NYC H+H) and has the highest COVID-19 admissions in BX and the second-highest across NYC. Herein we report our preliminary data on mortality rate (MR) of hospitalized COVID-19 patients and discuss the disproportionate of MR across NYC.

Methods

On 26 April 2020, we acquired the total number of hospitalized COVID-19 and deaths and mechanically ventilated (MV) COVID-19 and death from LMC and all other NYC H+H. Scheffe test was used to determine MR differences. The P-value (p) < 0.005 was set as a statistically significant threshold.

Results

MR of our hospitalized COVID-19 patients was 31%, which is higher than that of Man (24%, p 0.001). However, LMC has a high proportion of MV COVID-19 (local and transferred cases). Sub-group analysis of non-MV COVID-19 showed LMC MR (6%) is lower than Brooklyn (BL) (17%, p 0.00) and Queens (Qu) (17%, p 0.00) and didn’t differ from Man NYC H+H centers (8%, p 0.68). Analysis of MR among MV patients between LMC and other NYC H+H centers across four boroughs did not discover any differences.

Hospitalized COVID-19 MR from all NYC H+H centers in BX (28%) did not differ from Man (24%, p 0.7) and Qu (28%, p 0.99). Interestingly, we found that MR is the highest in BL (33%). Moreover, MR of non-MV COVID-19 was higher in BL (17%) and Qu (17%) than BX (10%) and Man (8%) NYC H+H centers. We hypothesize this may result partly from the tense and shortage of health care resources in these two boroughs, especially, at the beginning of pandemic so some critical patients may not receive adequate care such as delaying intubation. Further research investigating reasons for this disproportion will help in developing the best available care plan for the ongoing crisis.

Percentage of COVID-19 Mortality in each group

Multiple comparison by Scheffe Test of MR of hospitalized patients with COVID-19 at LMC and across 4 NYC boroughs

Multiple comparison by Scheffe Test of MR of non-MV patients with COVID-19 at LMC and across 4 NYC boroughs

Conclusion

Despite the high COVID-19 incidence and poor epidemiologic health risks of the population in BX, MR of hospitalized COVID-19 seemed to be the same as Man and Qu, and surprisingly lower than BL. MR of non-MV COVID-19 in BX is lower than BL and Qu. The studies determining the reasons underlying this disproportionate would be worthwhile.

Disclosures

All Authors: No reported disclosures
450. Evaluating First Responders for SARS-CoV-2 Infection in Broward County, Florida
Authors: Eckardt Paula , Goldman Jennifer M , Claramunt Jose A Rodriguez , Niu Jianli , Edwards Courtney
Published: January 2021

Background

First responders (e.g., emergency medical technicians, firefighters and police) may be at higher risk of SARS-CoV-2 infection and potentially spreading it than the general population due to frequent and close exposure to others. Prevention of first responder infections is important for reducing secondary transmission and maintaining health system capacity. We aimed to evaluate the burden of SARS-CoV-2 infection on first responders, identify risk factors for infection, and to provide health services to help control the current outbreak.

Methods

Memorial Healthcare System (MHS), a public healthcare system serving the South Broward Hospital District, together with the National Guard and Florida state governor, opened up a drive-through testing center for SARS-CoV-2 at C.B. Smith Park in Broward County, Florida. All first responders in Broward County, symptomatic or asymptomatic, were being tested. SARS-CoV-2 infection was made as a positive result of real time polymerase chain reaction (PCR) testing on at least one nasal or nasopharyngeal swab. All first responders who test positive for SARS-CoV-2 were informed by test site staff and self-quarantined to limit the spread of the disease.

Results

A total of 3,375 individuals was tested during the period from April 1 to April 29, 2020. The median age was 42 years (IQR 33–52) and 1,464 (43%) were men. 473 (14%) were symptomatic and 2,902 (86%) were asymptomatic. 289 (8.5%) of 3,375 first responders were positive for SARS-CoV-2 infection. These included 54 of 473 symptomatic (11%) and 235 of 2,902 asymptomatic (8.1%) cases. The rates of SARS-CoV-2 infection were comparable in male vs female (8.1% vs 8.9%, p = 0.429) and in symptomatic vs asymptomatic (p = 0.173). There is no sex-, age-based differences in susceptibility to SARS-CoV-2 infection among the first responders tested (Figure 1).

Laboratory confirmed SARS-CoV-2 among first responders between April 1 and April 30, 2020 in Broward County.

Conclusion

First responders carry a significant burden from SARS-CoV-2 infection, with an infection rate of 8.5%, which was comparable in symptomatic and asymptomatic individuals. There is no sex-, age-based differences in susceptibility to SARS-CoV-2 infection in first responders. High priority testing for SARS-CoV-2 must expand to include first responders, particularly asymptomatic individuals.

Disclosures

All Authors: No reported disclosures
453. Frequency of Symptoms and Asymptomatic SARS-CoV-2 Infection in New Orleans, Louisiana
Authors: Feehan Amy K , Fort Daniel , Diaz Julia Garcia , Price-Haywood Eboni , Velasco Cruz , Sapp Eric , Pevey Dawn , Seoane Leonardo
Published: January 2021

Background

Individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who do not report symptoms throughout the course of infection (asymptomatic) or those who are asymptomatic when they first contract the virus (presymptomatic) are a major public health concern. However, few prevalence studies to date have targeted the question of asymptomatic frequency within a community.

Methods

A stratified, random sample of subjects were sent to testing sites to complete a verbal consent, survey, nasopharyngeal swab, and blood draw. Swabs were tested for active viral shedding (PCR) and blood was tested for immunoglobulin G (IgG) specific to SARS-CoV-2.

Disease progression and IgG antibody response

Results

Of the 2,640 subjects, 24 (0·9%) were PCR-positive alone, 30 (1·1%) were PCR-positive and IgG-positive, and 129 (4·9%) were IgG-positive alone. Subjects who reported anosmia were 17 times more likely to test positive. Thirty-eight percent of subjects never experienced symptoms despite developing antibodies to the virus, and 75% did not experience symptoms in the early stage of infection. Rates of reported asymptomatic infection and comorbidities statistically significantly increased with age.

Conclusion

This is the first randomized study that pairs PCR and IgG serology that addresses asymptomatic SARS-CoV-2 infection, showing a high frequency of asymptomatic disease. More research is needed to clarify differences between symptomatic and asymptomatic disease. Prevalence and outcomes studies of SARS-CoV-2 should include this group.

Disclosures

All Authors: No reported disclosures
456. Implementing an At-Home Smell Test for Early Assessment of COVID-19 in High-Risk Healthcare Workers
Authors: Weiss Julian J , Attuquayefio Tuki , White Elizabeth B , Geng Bertie , Handoko Ryan , Herz Rachel S , White Theresa L , Iwasaki Akiko , Grubaugh Nathan D , Datta Rupak , Campbell Melissa , Martinello Richard A , Ko Albert I , Small Dana M , Farhadian Shelli F
Published: January 2021

Background

Smell loss has been recognized as an important, and potentially early, sign of COVID-19. However, to date smell loss has only been assessed in retrospective, COVID+ cohorts, and largely through self-report. The objective of this study was to implement a daily standardized behavioral test of smell sensitivity in healthcare workers (HCW) to capture changes in smell sensitivity over time and to assess whether these changes occur prior to positive COVID test.

Methods

The study enrolled 500 high-risk COVID-negative HCW during the COVID-19 epidemic in Connecticut, beginning March 28, 2020 (80% F, mean age 38, 58% nurses). Initially, HCW received a daily symptom questionnaire with parosmia screening questions. On April 23 we introduced the “Jiffy”, a daily at-home psychophysical test of smell sensitivity, where olfactory stimuli are sampled and rated for perceived intensity. SARS-CoV-2 infection was tested every three days by PCR of nasopharyngeal swabs or saliva.

Screening Questionnaire for Parosmia

The “Jiffy” Survey and Test

Results

Of the first 500 enrolled HCW, 376 HCW (75%) completed the Jiffy 4528 times (mean 12 times/HCW). 17/500 HCW (3.4%) had a COVID+ test, of which 9/17 (53%) reported smell loss through the Jiffy or the daily symptom survey. 6/9 (67%) reported smell loss that preceded or was concurrent with a COVID+ test. 8/17 COVID+ HCW completed the Jiffy, with 5/8 (63%) reporting reductions in smell versus 42/368 (11%) COVID- HCW (OR=13, 95% CI: 2.4–85, p=.001). COVID+ HCW rated their greatest reduction in smell sensitivity as slight (40%) and severe (60%), versus slight (88%) and moderate (12%) in COVID- HCW. 16/17 COVID+ HCW completed a daily symptom survey (mean 14 times/HCW), with 8/16 (50%) ever reporting parosmia versus 90/466 (19%) of COVID- HCW (OR=4.2, 95% CI: 1.3–13, p=.007). Overall, parosmia was the first reported symptom in 3/13 (23%) COVID+ HCW who reported symptoms.

Smell Changes in COVID+ and COVID- HCW Reported in the “Jiffy” Test

Smell Changes in COVID+ and COVID- HCW Reported in Daily Symptom Questionnaire

Smell Changes among COVID+ HCW by Day, Relative to Day of Positive PCR Test

Conclusion

We conducted a prospective study of smell testing in a population at high risk for COVID-19 using two parallel approaches. Our results demonstrate the feasibility of at-home smell testing for assessing parosmia during COVID-19, in some cases even prior to a positive PCR result. Given the urgent need for widespread, low-cost, non-invasive testing for COVID-19, we are now developing an easy-to-use app to distribute this survey more widely to high-risk populations.

Disclosures

Julian J. Weiss, BA, Nothing to disclose
459. Outcomes and Factors Associated with a SARS-CoV-2 Positive Test in Asymptomatic and Symptomatic Healthcare Workers of a Mexican Hospital Converted to Treat COVID-19 Patients
Authors: Rajme-López Sandra , Leal-Morán Patricia E , Gonzalez-Lara Fernanda , Vargas-Fernández Abril T , Ochoa-Hein Eric , Alberto-Hernández Fernanda , Valverde-Ramos Lirio N , Bustos-Román Daniel E , De León-Garduño Alfredo Ponce , Galindo-Fraga Arturo , Sifuentes-Osornio Jose
Published: January 2021

Background

Starting on 03/16/2020, the hospital was converted to attend only patients with COVID-19. A surveillance program for healthcare workers (HCWs) that included free in-site medical consultation and RT-PCR for detection of SARS-CoV-2 was initiated. On 04/28/2020, screening of HCWs was started to detect asymptomatic carriers. We report the results of such programs updated to 05/21/2020.

Methods

Sex, worker category, working area, use of personal protective equipment, date of screening, date of onset of symptoms and home address were retrieved from electronic databases. Logistic regression was done to identify factors associated with being a COVID-19 case or carrier, with p< 0.05 being significant. Odds ratios and incidence densities were calculated.

Results

Of 2566 HCWs in the hospital, 976 (38.0%) underwent screening and 41 (4.2%) were positive for SARS-CoV-2 (7.4 carriers x 10,000 person-days; median follow-up of 55.5 days); none of the latter were diagnosed with COVID-19 after completing a 14-day follow-up. Of HCWs with negative screen results, 6 (0.6%) ultimately developed COVID-19 after a median of 10 days (1.1 cases x 10,000 person-days). Of 232 symptomatic HCWs that did not undergo basal screening, 131 (56.5%) were diagnosed with COVID-19 (8.8 cases x 10,000 person-days). Ten COVID-19 cases (7.6%) were hospitalized and all were discharged without complications after a median hospital stay of 9 days. Factors associated with COVID-19 were working in a non-clinical area (OR=9.3, 95% CI=1.1–78.6) and being a nurse (OR=1.9, 95% CI=1.1–3.4). Factors associated with being a carrier were living in the State of Mexico (OR=3.7, 95% CI=1.8–8.0) and being a hospital cook (OR=3.7, 95% CI=1.7–8.5). Being a physician was associated with not being a carrier (OR=0.07, 95% CI=0.01–0.5). Wearing a face mask at all times tended to be associated with not being a carrier. Hospital epidemic curves closely ressembled those of the community (Mexico City).

Hospital Epidemic Curve, 03/16/2020 - 05/21/2020

Conclusion

This study suggests that factors present inside and outside of the hospital are associated with COVID-19 and asymptomatic carriage in HCWs. This information is of utmost importance for infection prevention and control policies. Additionally, a lower percentage of severe cases and no deaths were observed in this cohort as compared to others.

Disclosures

All Authors: No reported disclosures
461. Presentation and Demographics of Veterans Tested for COVID-19 Infection
Authors: Sciarra Braden , Kennedy Patrick , Sherman Katherine , Held Nicole M , Gundacker Nathan
Published: January 2021

Background

COVID-19, caused by the Severe Acute Respiratory Syndrome-Related Coronavirus 2 (SARS-CoV-2), has been a major cause of morbidity and mortality in the United States since its emergence in Wuhan, China. As of June 2020, there are over 20,000 confirmed cases and nearly 700 deaths due to COVID-19 in Wisconsin, with the majority of COVID-19 related deaths occurring within Milwaukee County. COVID-19 infections are disproportionately affecting minority communities across the United States. Presentation and outcomes vary, with the elderly and those with underlying diseases having poorer outcomes.

Methods

This retrospective chart review of patients tested for COVID-19 infection from March 2020-May 2020 at the Zablocki VA Medical Center, Milwaukee, WI evaluated demographics, comorbidities, presenting symptoms, and duration of symptoms. The primary outcomes analyzed were whether there were significant differences in demographic data, comorbidities, and presentation between patients testing positive or not positive for COVID-19.

Results

A total of 173 patients tested for COVID-19 were included during the study period, 82 positive and 91 otherwise. Univariate analysis of patient demographics and presenting symptoms are summarized in Table 1. A multivariable logistic regression using stepwise selection (AUC=0.7188) determined patients that tested positive for COVID-19, when controlling for demographics and comorbidities, were more likely to be African-American than White (OR 3.455, CI 1.733–6.887), and more likely to have a diagnosis of diabetes (OR 2.698, CI 1.36–5.353). However, race and diabetes were not informative when symptoms were included in a subsequent model (AUC=0.8458); patients testing positive for COVID-19 were more likely to present with diarrhea (OR 6.926, CI 1.760–6.926) and a higher temperature (OR 2.651, CI 1.533–4.584), but less likely to present with vomiting (OR 0.007, CI < .001-0.161) when compared to patients testing otherwise for COVID-19.

Table 1: Univariate Analysis of Variables Associated with Testing Positive for COVID-19 at Zablocki VA Medical Center 3/2020–5/2020

Conclusion

Patients testing positive in Milwaukee County are more likely to be African-American and/or diabetic; further highlighting racial disparities in COVID-19. Symptomology at presentation is more related to positive COVID-19 test results than demographics and comorbidities.

Disclosures

All Authors: No reported disclosures
480. Outbreak of COVID-19 Among School Auction Attendees: Was it a “Silent Auction” or “Silent Transmission”?
Authors: Rankin Danielle A , Howard Leigh , Fernandez Kailee N , Talj Rana , Haddadin Zaid , Spieker Andrew J , Halasa Natasha B
Published: January 2021

Background

One day after the pandemic was announced, Tennessee declared a state of emergency on March 12, 2020 with implementation of a stay-at-home order on March 23, 2020. Data regarding the routes and patterns of community transmission of SARS-CoV-2 are limited. We initiated an investigation after clusters of confirmed COVID-19 cases attended a large social gathering.

Methods

We were notified of clinical providers who attended a “Silent School Auction” on March 7, 2020, of which several confirmed-cases were identified as targeted participants. To derive a standardized REDCap web-survey, we conducted a hypothesis-generating interview with three confirmed attendees to collect event details. Once finalized, enrollment included collecting sociodemographic, epidemiologic, and clinical data. Attendees were classified as: 1) confirmed if they had a positive SARS-CoV-2 test; 2) suspected if they developed symptoms 21-days before or after the auction; and 3) asymptomatic if no symptoms were noted.

Results

From March 20-June 16, 100/166 (60%) of attendees were enrolled, with a median age of 41 years, 54% female, and 99% white. Of those, 34 and 32 were confirmed- and suspect-cases, respectively. Table 1 compares sociodemographic behaviors of all attendees, with the majority of confirmed-cases eating late in the evening. From March 6 to March 8, 58 participants reported attending other social events, of which three (i.e., church service, women’s retreat, and a birthday party) were common among 43 attendees and five individuals reported onset of mild respiratory symptoms prior to the event (Figure 1). Confirmed-cases were more likely to report having shortness of breath, chest tightness, loss of taste, loss of smell, and fever compared to suspect-cases (Figure 2) and no one required hospitalization. Dining tables from the school auction depicted a clustering of cases occurring at each table, with some individuals visiting more than one table during the event (Figure 3).

Conclusion

We identified several COVID-19 cases from a single event that occurred prior to social mitigation strategies. Our investigation highlights the importance of staying home when sick and the significance of social distancing to halt transmission of COVID-19.

Disclosures

Danielle A. Rankin, MPH, CIC, Sanofi Pasteur (Grant/Research Support, Research Grant or Support) Zaid Haddadin, MD, CDC (Grant/Research Support, Research Grant or Support)Quidel Corporation (Grant/Research Support, Research Grant or Support)sanofi pasteur (Grant/Research Support, Research Grant or Support) Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Karius (Consultant)Moderna (Consultant)Quidel (Grant/Research Support, Research Grant or Support)Sanofi (Grant/Research Support, Research Grant or Support)
486. Understanding Public Perception of COVID-19 Social Distancing on Twitter
Authors: Saleh Sameh N , Lehmann Christoph , McDonald Samuel , Basit Mujeeb , Medford Richard J
Published: January 2021

Background

Managing and changing public opinion and behavior are vital for social distancing to successfully slow transmission of COVID-19, preserve hospital resources, and prevent overwhelming the healthcare system’s resources. We sought to leveraging organic, large-scale discussion on Twitter about social distancing to understand public’s beliefs and opinions on this policy.

Methods

Between March 27 and April 10, 2020, we sampled 574,903 English tweets that matched the two most trending social distancing hashtags at the time, #socialdistancing and #stayathome. We used natural language processing techniques to conduct a sentiment analysis that identifies tweet polarity and emotions. We also evaluated the subjectivity of tweets and estimated the frequency of discussion of social distancing rules. We then identified clusters of discussion using topic modeling and compared the sentiment by topic.

Results

There was net positive sentiment toward both #socialdistancing and #stayathome with mean sentiment scores of 0.150 (standard deviation [SD], 0.292) and 0.144 (SD, 0.287) respectively. Tweets were also more likely to be objective (median, 0.40; IQR, 0 to 0.6) with approximately 30% of all tweets labeled as completely objective. Approximately half (50.4%) of all tweets primarily expressed joy and one-fifth expressed fear and surprise each (Figure 1). These trends correlated well with topic clusters identified by frequency including leisure activities and community support (i.e., joy), concerns about food insecurity and effects of the quarantine (i.e., fear), and unpredictability of COVID and its unforeseen implications (i.e., surprise) (Table 1).

Table 1. Topic clusters identified by topic modeling. Words contributing to the model are shown in decreasing order of weighting. The topics are labeled manually based on these words. The number of tweets primarily with that topic, mean sentiment, mean subjectivity, and sample tweets are also included.

Figure 1. Emotion analysis for all tweets and stratified by tweets with the hashtag #socialdistancing and #stayathome. Comparison between the two hashtags is done using Chi-squared testing. Bonferroni correction was used to define statistical significance at a threshold of p = 0.008 (0.05/n, where n = 6 since 6 comparisons were completed).

Conclusion

The positive sentiment, preponderance of objective tweets, and topics supporting coping mechanisms led us to believe that Twitter users generally supported social distancing measures in the early stages of their implementation.

Disclosures

All Authors: No reported disclosures
487. Patient Outcomes of Contact Tracing for COVID-19 in a Pediatric Hospital
Authors: Smathers Sarah , Deming Regan , Goff Lauren Le , Lenar David , Gebeline-myers Cheryl , Trella Jeanette , Coffin Susan E , Coffin Susan E , Sammons Julia S
Published: January 2021

Background

Contact tracing is a critical component in controlling the spread of infectious diseases. During the COVID-19 pandemic, the demands for contract tracing far exceeded the resources available to infection prevention and control (IPC) programs. Leveraging our Poison Control Center, our organization established a Contact Tracing Center (CTC) with content expertise and oversight by IPC and Occupational Health. The CTC identifies exposed patients and employees, provides testing guidance and scheduling, and offers post-exposure recommendations for employees. We describe patient outcomes due to employee exposures in a pediatric healthcare system.

Methods

Exposure data about employee to patient exposures (EPE) were captured real-time by scripted telephone interviews by our CTC. Chart review was performed to determine outcomes of exposed patients. A concerning exposure from a direct patient care provider to a patient was defined as unprotected contact at less than 6 feet for greater than 5 minutes in the 24 hours prior to developing symptoms. Data were analyzed to determine COVID-19 conversion rates for children exposed to pre-symptomatic and symptomatic employees based upon exposure risk stratification, window of exposure, and employees who worked with symptoms.

Results

From March 2020 – present, we identified 38 EPE that involved 10 employees; 26 EPE were pre-symptomatic and 12 EPE symptomatic exposures. The average number of EPE per employee was 3.8 (SD 3.01). There were no secondary transmission events to patients from either pre-symptomatic or symptomatic employees. After instituting universal masking, the number of concerning exposures to patients were 3 compared to 35 prior to universal masking.

Conclusion

We describe the experience of a novel Contact Tracing Center, leveraging alternate staffing pools to track EPE resulting in no secondary transmission to patients either before or after universal masking. We credit sick policy adherence, high hand hygiene compliance, use of standard precautions, universal masking, robust contact tracing operations and a strong data collection system to identify process gaps.

Disclosures

All Authors: No reported disclosures
488. SARS-CoV-2 Preparedness among Community Hospitals in Southeastern United States
Authors: Advani Sonali D , Baker Esther , Cromer Andrea , Wood Brittain A , Crawford Kathryn , Crane Linda S , Adcock Linda , Roach Linda , Padgette Polly W , Anderson Deverick J , Sexton Daniel
Published: January 2021

Background

The SARS-CoV-2 pandemic has placed a tremendous strain on the U.S. healthcare system leading to personal protective equipment (PPE) and resource shortages. Hospitals have developed contingency and crisis capacity strategies to optimize the use of resources, but, to date, community hospital preparedness has not been described.

Methods

We performed a cross-sectional survey of infection preventionists in 60 community hospitals within the Duke Infection Control Outreach Network between April 22 and May 7, 2020 using Qualtrics. The survey included 13 questions related to resource availability, crisis capacity strategies and approaches to testing.

Results

We received 50 responses during the study period with a response rate of 83%. Community hospitals reported varying degrees of PPE shortages (Table 1); 80% of community hospitals were implementing strategies to extend and reuse N95 respirators, Powered Air-Purifying Respirators, face shields and face masks. Over 70% of facilities reported reprocessing N95 respirators (Figure 1). Almost all facilities reported universal masking at time of this survey with 90% performing daily employee screening at point of entry. Additionally, 8% of facilities restarted elective procedures at the time of this survey, but only 54% of facilities reported that they were performing preoperative testing for SARS-CoV-2. Thirty-seven percent of facilities performed one SARS-CoV-2 test before discharging an asymptomatic patient to skilled nursing facility, while 43% of facilities performed 2 tests.

Table 1- Supply of Personal Protective Equipment and other resources in 50 community hospitals in southeastern United States

Figure 1: Different methods of reprocessing N95 respirators by 50 community hospitals in southeastern United States

Conclusion

Our findings reveal differences in resource availability, crisis capacity strategies and testing approaches used by community hospitals in preparation for the SARS-COV-2 pandemic. Lack of harmonization in approaches may be in part due to differences in state guidelines and decentralized federal approach to SARS-CoV-2 preparedness.

Disclosures

All Authors: No reported disclosures
493. Clinical and Epidemiological Features of Healthcare Workers Detected with Coronavirus Disease
Authors: Campbell Melissa , Datta Rupak , Wyllie Anne , Casanovas-Massana Arnau , Handoko Ryan , Sewanan Lorenzo , Ko Albert I , Martinello Richard A
Published: January 2021

Background

Data early in the SARS-CoV-2 pandemic suggested frontline healthcare workers (HCW) may account for 10–20% of all infections. CDC estimated 600,000 infections in HCWs. Symptom screening is a strategy to prevent healthcare-associated transmission. This method may not identify asymptomatic or pre-symptomatic carriers.

Methods

We conducted a prospective cohort study in asymptomatic or minimally symptomatic healthcare workers in a 1541-bed academic medical center. Although recruitment began in designated COVID-19 units, we expanded to all HCWs providing care to hospitalized patients during the pandemic. Data was gathered on demographics, work area in the hospital and daily questionnaires were sent listing symptoms of SARS-CoV-2. Protocol included twice weekly self-collected nasopharyngeal swab and saliva for SARS-CoV-2 N1 and N2.Those with positive PCR result, underwent telephone survey to assess symptomatology and severity of illness.

Results

A total 525 HCWs began the study protocol and 16 were identified as PCR positive. Samples included concordant saliva and NP samples on 9 (56%), exclusively NP samples on 5 (31%) and 2 (12%) HCWs were positive by saliva PCR only. Majority were female, and all were nursing staff; with 19% reported not working in a designated COVID-19 unit. During the course of this active surveillance, universal masking was mandated in the institution. Rhinorrhea and headache were reported by 6 (38%), 5 (31%) reported cough and 3 (19%) developed myalgia. Changes in smell and taste preceded the positive PCR test in 2 (12%). One HCW reported developing a fever with acute illness. All were notified about their PCR positive status by institution’s occupational health department and self-isolated to monitor for symptoms.

Conclusion

The spectrum of disease in this HCW cohort is similar to mild disease in the community. Due to high incidence of asymptomatic or mildly symptomatic HCWs, active surveillance with routine testing proves be beneficial to prevent hospital transmission of SARS-CoV-2. Universal masking significantly decreased the HCW positive rate in our study, underscoring the need for universal efforts to mitigate healthcare-associated transmission with self-monitoring, face mask use, and other infection prevention behaviors like hand hygiene.

Disclosures

All Authors: No reported disclosures
494. COVID-19 Outbreak: A Tale of Two Psych Units
Authors: Corpuz Marilou , Jain Ruchika , Weston Gregory , Nori Priya , Nori Priya , Boland-Reardon Carmel , Bernard Evan , Graham Esther , Madaline Theresa
Published: January 2021

Background

COVID infections in inpatient psychiatry units present unique challenges during the pandemic, including behavioral characteristics of the patients, structural aspect of the unit, type of therapy for the patients. We present COVID outbreaks in psychiatry units in two hospitals in our medical center in Bronx, NY, and describe our mitigation strategies.

Methods

Hosp A: In the early period of the pandemic in NY, 2 patients in the inpatient psychiatry unit tested positive for SARS-CoV-2 PCR. The unit was temporarily closed to new admissions. Hosp B: On 4/1, one of the patients in a 22 bed Psych unit, admitted since 3/10/20, developed fever, cough and tested positive for COVID-19 PCR. Two of her close contacts tested positive for SARS-COV-2 PCR.

Results

Hospital A: In total, 5 of the 29 patients (17.2%) in the unit were SARS-CoV-2 positive, all of whom were asymptomatic. Hospital B: Testing of the remaining patients showed positive PCR in 10/14. PCR tests of healthcare workers (HCW) were positive in 13/46. Except for the index patient, all the patients were asymptomatic but 32/46 HCW reported symptoms. One negative patient subsequently turned positive.

Infection control and prevention strategies instituted in both hospitals were the same with subtle differences due to dissimilar burden of infection and structure of the units. Table 1 shows the timing of the outbreak and the rapid institution of preventive measures in each of the hospitals.

There was still difficulty with patients regarding adherence. Some of the patients refused to stay in isolation and would roam. Compliance with masking and hand hygiene was problematic.

Communication was of paramount importance. Multiple meetings were held between the Psychiatry staff, Infection Control and Prevention team, executive leadership of the hospital. Environmental Services and Engineering were also involved. Communications with the NY State Department of Health occurred frequently.

Conclusion

Strategies for management of COVID-19 patients in inpatient psychiatric units depends on the density of infected patients in the hospital and in the community. The implementation of practice change may need to be rapidly adjusted depending on the situation and available resources. Contingency plans should be formulated early on.

Disclosures

Gregory Weston, MD MSCR, Allergan (Grant/Research Support)
502. The Impact of Combating COVID-19 on Blood Culture Contamination and Central Line Associated Bloodstream Infection Rates
Authors: LeRose Jennifer , Sandhu Avnish , Polistico Jordan , Ellsworth Joseph , Baran Nancy , Cranis Mara , Jabbo Lavina , Cullen Lori , Moshos Judy , Chopra Teena
Published: January 2021

Background

Coronavirus disease (COVID-19) pandemic has presented challenges to every facet of the healthcare system. There is limited research evaluating the consequence of diverting resources from patient safety initiatives to COVID-19 crisis efforts. In an attempt to quantify the impact of COVID-19 on quality of patient care, we compared rates of blood culture contamination and central line associated bloodstream infections (CLABSIs) during COVID-19 to those before the pandemic.

Methods

A comparative retrospective cohort study was conducted to analyze blood culture contamination and CLABSI rate per 1,000 line days in a tertiary care hospital in Detroit within a “pre- COVID-19” timeframe, January - May 2019, and “COVID-19” timeframe, January - May 2020. The CLABSI rate data was obtained through Infection Control Surveillance System TheraDoc®. Blood culture contamination report was obtained through the Microbiology Department. Chi-square and t-test were used for statistical analysis.

Results

The blood culture contamination rate increased from 3.1% during pre COVID-19 timeframe to 4.0% during COVID-19 (p-value < 0.01) (Figure 1) with the highest rate in March and April 2020 correlating with the peak of COVID-19 (Figure 2). The CLABSI rate per 1,000 line days increased from 0.71 in pre-COVID-19 time frame to 2.70 during COVID-19 (p-value < 0.01) (Figure 1). Of the 33 CLABSIs identified during the COVID-19 time frame, 18 (54%) patients tested positive for COVID-19. When comparing COVID-19 positive and COVID-19 negative patients; average length of stay was 28.1 days shorter in the positive group (p-value < 0.01). COVID-19 positive patient had higher mortality (p-value < 0.01) (Table1). Refer to Table 1 for comparison of variables between pre COVID-19 and COVID-19 cohort and COVID-19 positive and negative cohort.

Figure 1. Rate of blood culture contamination (top) and CLABSI per 1,000 Line Days Rate (below) Between Two Study Period (Pre COVID-19 and COVID-19)

Figure 2. Unique COVID Positive results in a Tertiary Care Center, Detroit, January-May 2020

Table 1. Characteristics of Entire Cohort

Conclusion

A 29% increase in blood culture contamination and 280% increase in CLABSI rate represents an enormous burden on healthcare resources and decreased quality. Despite no increase in length of stay in COVID-19 positive patient, higher mortality and CLABSIs were noted in these patients. During a pandemic, healthcare systems should be allocated additional resources to accommodate the increased patient load without affecting quality of care.

Disclosures

Teena Chopra, MD, MPH, Spero Therapeutics (Consultant, Advisor or Review Panel member)
505. Use of CLABSI Prevention Bundle Audits to Decrease CLABSI Rates in COVID Positive ICU Patients in an Acute Care Hospital in New York City During the COVID-19 Epidemic
Authors: Moss Marie , Ehni Jordan , Herbison Ilka , Rabii Kristine B , Koepsell Caitlin , Devries Eileen , Fetman Rina , Latrace Maria , Mahoney Christine D , O’Neill Ann , Kranitzky Bethany , Barnett Barbara , Javaid Waleed
Published: January 2021

Background

Mount Sinai Beth Israel (MSBI) is a 220 bed acute care hospital located in the Manhattan borough of Manhattan in New York City. Prior to COVID-19, the hospital had one 16-bed Medical/Surgical ICU. When the COVID epidemic struck New York City, the MSBI ED was flooded with critically ill patients requiring ICU care. Seven other ICUs were opened, all of which were filled with COVID patients. The majority of these patients required central lines for the multiple antibiotics, steroids, and vasopressors they needed to survive. Agency RNs were brought in to care for ICU patients. In April, the MSBI Infection Prevention (IP) department received several CLABSI notifications through its data mining system. The IPs were alarmed at the number of CLABSIs occurring in ICU COVID patients with central lines.

ICU CLABSI Rates in an Acute Care Hospital During the COVID-19 Epidemic in New York City

Methods

A baseline assessment, using the central line maintenance bundle, was conducted on all COVID patients with central lines. This assessment revealed issues with central line maintenance, including: undated, bloody, and non-intact dressings, poorly placed CHG impregnated disks; blood in end-caps, and missing alcohol impregnated caps on ports. The decision was made to bring in infusion RNs from an outpatient system site to perform daily rounds on central lines. These RNs performed daily intensive maintenance bundle rounds for a month during the COVID epidemic. During their rounds, ICU nurses and managers were notified of central line dressing and cap issues and educated on how to correct them. These RNs also e-mailed daily reports of their findings to Nursing Leadership for their review.

Central Line Audit Team: RNs Who Monitored Central Lines in COVID ICUs in An Acute Care Hospital in NYC

Central Line Audit Team: RNs Who Monitored Central Lines in COVID ICUs in An Acute Care Hospital in NYC

Results

Central line rounds performed after the intervention showed a great improvement in compliance with the central line maintenance bundle, from 13% during the first rounds performed in April, to 88% in May, less than a month after these rounds started. Since this intervention, the ICU CLABSI rate has decreased from a rate of 3.3 per 1,000 central line days in April and May to a current rate of 0.

Conclusion

The timely identification and root cause analysis of a problem must be followed by timely, intensive, and repeated interventions that are designed to attack the causes of problems at their source. After the crisis period is over, the interventions must be maintained to ensure that gains made can be sustained.

Disclosures

All Authors: No reported disclosures
516. SARS-CoV-2 Exhibits Clade-specific Differences in Nasopharyngeal Viral Loads
Authors: Nam Hannah , Lorenzo-Redondo Ramon , Roberts Scott C , Simons Lacy , Achenbach Chad , Hauser Alan R , Ison Michael G , Hultquist Judd F , Ozer Egon A
Published: January 2021

Background

The rapid spread of SARS-CoV-2, the causative agent of Coronavirus disease 2019 (COVID-19), has been accompanied by the emergence of distinct viral clades, although their clinical significance has yet to be fully elucidated. While whole genome sequencing efforts have identified viral diversity over time, less is known about the clinical significance of this diversity. This study assessed the nasopharyngeal viral loads within patients over time to determine if these changes affect clinical parameters.

Methods

Samples were collected from patients presenting to Northwestern Memorial Hospital in Chicago, IL with a positive SARS-CoV-2 RT-PCR from nasopharyngeal swabs. Cycle threshold (Ct) values less than 35 were considered positive, and whole genome sequencing was performed by reverse transcription, multiplex PCR, and Nanopore sequencing. Phylogenetic analysis was conducted on sequenced isolates and compared with publicly available global sequences. Sequence characteristics and viral loads were correlated with each clade.

Results

177 samples were analyzed from March 14, 2020, through May 1, 2020. Most of the sequences (92.6%) clustered in three main clades [Figure 1]. Clade IDs were ordered by relative abundance as Clades 1 (n=122, 68.9%), 2 (n=34, 19.2%), and 3 (n=8, 4.5%). Over this time, Clade 1 viruses have been increasing in incidence across the USA and globally while Clade 2 viruses were uniquely predominant in Illinois with limited global distribution. Ct values were compared across clades [Figure 2]. Significantly lower average Ct values (higher viral loads) were observed in Clade 1 relative to both Clade 2 (p=0.0002) and Clade 3 (p=0.0011). These findings were independent of time from symptom onset to specimen collection.

Phylogenetic Analysis of SARS-CoV-2 Isolates with Number of Clades and Clade Distribution

Associations Between Viral Clade and Ct Value

Conclusion

These data suggest that SARS-CoV-2 genotype may impact viral load in the upper airways. It remains to be determined whether this difference in clades may impact transmission potential and overall viral spread. Further longitudinal studies with more specimens and associated clinical data are needed.

Disclosures

Michael G. Ison, MD MS, AlloVir (Consultant)
520. Longitudinal Analysis of SARS-CoV-2 Viruses in Hospitalized Adults
Authors: Simons Lacy , Lorenzo-Redondo Ramon , Nam Hannah , Roberts Scott C , Ison Michael G , Achenbach Chad , Hauser Alan R , Ozer Egon A , Hultquist Judd F
Published: January 2021

Background

The rapid spread of SARS-CoV-2, the causative agent of Coronavirus disease 2019 (COVID-19), has been accompanied by the emergence of viral mutations, some of which may have distinct virological and clinical consequences. While whole genome sequencing efforts have worked to map this viral diversity at the population level, little is known about how SARS-CoV-2 may diversify within a host over time. This is particularly important for understanding the emergence of viral resistance to therapeutic interventions and immune pressure. The goal of this study was to assess the change in viral load and viral genome sequence within patients over time and determine if these changes correlate with clinical and/or demographic parameters.

Methods

Hospitalized patients admitted to Northwestern Memorial Hospital with a positive SARS-CoV-2 test were enrolled in a longitudinal study for the serial collection of nasopharyngeal specimens. Swabs were administered to patients by hospital staff every 4 ± 1 days for up to 32 days or until the patients were discharged. RNA was extracted from each specimen and viral loads were calculated by quantitative reverse transcriptase PCR (qRT-PCR). Specimens with qRT-PCR cycle threshold values less than or equal to 30 were subject to whole viral genome sequencing by reverse transcription, multiplex PCR, and deep sequencing. Variant populations sizes were estimated and subject to phylogenetic analysis relative to publicly available SARS-CoV-2 sequences. Sequence and viral load data were subsequently correlated to available demographic and clinical data.

Results

60 patients were enrolled from March 26th to June 20th, 2020. We observed an overall decrease in nasopharyngeal viral load over time across all patients. However, the temporal dynamics of viral load differed on a patient-by-patient basis. Several mutations were also observed to have emerged within patients over time.

Distribution of SARS-CoV-2 viral loads in serially collected nasopharyngeal swabs in hospitalized adults as determined by qRT-PCR. Samples were collected every 4 ± 1 days (T#1–8) and viral load is displayed by log(copy number).

Conclusion

These data indicate that SARS-CoV-2 viral loads in the nasopharynx decrease over time and that the virus can accumulate mutations during replication within individual patients. Future studies will examine if some of these mutations may provide fitness advantages in the presence of therapeutic and/or immune selective pressures.

Disclosures

Michael G. Ison, MD MS, AlloVir (Consultant)