bluuebunny/crossref_metadata_2025_split huggingface dataset:
482. Impact of COVID-19 Pandemic on Psychosocial and Clinical Factors among people with and without HIV living in Miami
Authors: Uribe Patricia RaccamarichClaudia S , Zetina Ana S Salazar , Montgomerie Emily K , Salguero Douglas , Mantero Alejandro M , Barreto Irma S , Vazquez Andres , Martinez Paola , Morgan Kristiana , Yanes Nicolle L Rodriguez , Brophy Theodora , Maddalon Marissa , McGaugh Angela , Weiss Deborah Jones , Alcaide Maria L 
Published: January 2021

Abstract

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

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

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

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

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

Abstract

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

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

Results
Between April 24th-30th, 16 inmates were released from facility, seven were laboratory-confirmed positive. Secondary infections only occurred in households of positives. Of the seven households, four experienced secondary transmission of virus. There were 27 household contacts, six secondary infections (secondary attack rate of 30.0%). There were four hospitalizations and one death, though cause of death was not due to COVID-19 despite incidental finding. After opening of medical recovery site, all individuals with active infection (12 cases) agreed to isolation at site. This intervention resulted in no further epidemiologically linked cases from recently released incarcerated individuals to community.
Figure 1: Household Secondary Infections with Epidemiological Links to Previously Incarcerated Inmates Before and After Opening of Medical Recovery Site

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

Disclosures
All Authors: No reported disclosures
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

Abstract

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 &lt; 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

Abstract

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 &gt;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

Abstract

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 &lt; 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 &lt; 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 &lt; 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 &lt; 10 days of symptoms compared to patients with &gt;=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

Abstract

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

Abstract

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

Abstract

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

Abstract

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&lt; 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&lt; 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&lt; 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&lt; 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