bluuebunny/crossref_metadata_2025_split huggingface dataset:
495. Effectiveness of Personal Protective Equipment in Preventing Transmission of COVID-19 in Healthcare Workers
Authors: Li Aldon , Rieg Gunter , Maldonado Ana Miranda , Concepcion June 
Published: January 2021

Abstract

Background
Human-to-human transmission of the SARS-CoV-2 occurs during exposure to infectious respiratory particles generated by humans with COVID-19. Global personal protective equipment (PPE) shortages necessitate further studies looking at the correlation between PPE use and transmission of COVID-19 to healthcare workers (HCW). This study aims to provide data on test positivity rates of HCW wearing different PPE.

Methods
Retrospective Case Series. During the study period from Mar-Apr 2020, HCW were tested for SARS-CoV-2 if they 1) were exposed to COVID-19 case OR 2) had symptoms of potential COVID-19 disease per CDC criteria. Respirator masks defined as N95 or higher were used in high risk departments (Emergency and Urgent Care (ERUC), Medical/Surgical (MSU), and Intensive Care (ICU) units). Medical masks defined as surgical or procedural masks were used in low risk, outpatient departments. All departments used gowns, gloves, eye protection, and appropriate masks.

Results
In low risk departments, 124/1578 (7.9%) of HCW tested positive, compared to 118/1499 (7.9%) of HCW who worked in high risk departments (p=0.9886). In high risk departments, 55/626 of HCW who worked in MSU, 37/459 of HCW who worked in ERUC, and 26/414 who worked in ICU tested positive. In a logistic regression model comparing tested individuals in high risk departments to those in ambulatory settings, a slightly lower risk of a positive test among ICU employees (OR=0.786, CI=0.508–1.217) was found, and a similar risk among ERUC employees (OR=1.028, CI=0.701–1.508) and MSU employees (OR=1.129, CI=0.810–1.574) was found, but the differences were not statistically significant (p=0.5364).

Conclusion
HCW in ambulatory settings who used medical masks did not test positive at a higher rate than providers in high risk departments using respirators. The slightly lower positive rate in ICU providers may suggest respirator masks are beneficial in settings with higher risk of aerosolizing generating procedures, or it maybe related to training and familiarity with infection control procedures. The level of mask used was equally appropriate across all risk level care settings, providing evidence for local strategies to optimize PPE stewardship based on department assignments while protecting HCW during the COVID-19 pandemic.

Disclosures
All Authors: No reported disclosures
499. Infection with Coronavirus Disease 19 (COVID-19) in Healthcare Personnel with Exposure to COVID-19
Authors: Kang Minji , Granda Christopher , Torriani Francesca J , Taplitz Randy , Myers Frank , Isakari Marcia , Abeles Shira 
Published: January 2021

Abstract

Background
As of June 2, 2020, 67,113 cases and 321 deaths due to Coronavirus Disease 19 (COVID-19) have been reported in healthcare personnel (HCP) in the United States. Given the close contact of HCP with individuals with COVID-19, it is important to quantify the risk of acquiring COVID-19 in the healthcare setting.

Methods
We conducted a retrospective cohort study of HCP exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at our academic medical center from March 15, 2020 to May 16, 2020. Exposure during the study period was defined as having contact with patients or other HCP with COVID-19 within 6 feet of distance for at least 90 seconds when HCP’s eyes, nose, or mouth were not covered. HCP with exposures were monitored for symptoms consistent with COVID-19 for 14 days from last exposure and those who developed symptoms were tested for SARS-CoV-2 using RT-PCR.

Results
We identified 33 exposure events; 19 of which were patient-to-HCP exposures and 14 of which were HCP-to-HCP exposures. These 33 events resulted in 959 exposed HCP among whom 238 (25%) developed one or more symptoms of COVID-19 and required SARS-CoV-2 RT-PCR testing. Testing was performed at 7.1 ± 5.0 (mean ± SD) days from exposure. Of the 238 HCP who were tested, 82% were female and 49% were registered nurses (Table 1). Five HCP tested positive for SARS-CoV-2 by RT-PCR, but one was presumed to have acquired the disease from a household member with confirmed COVID-19. Among the four HCP who were infected due to occupational exposure, three were nurses while one was an environmental service worker (Table 1).

Conclusion
Despite exposures among HCP, the risk of acquiring symptomatic COVID-19 in the healthcare setting was low with less than 1% of HCP with occupational exposure subsequently diagnosed with COVID-19. With the definition of exposure now changed to at least 15 minutes of close contact without personal protective equipment, we anticipate fewer exposures at our healthcare facility and that much of COVID-19 transmission affecting HCP are due to community exposures.

Disclosures
All Authors: No reported disclosures
500. Novel Use of a Targeted Ultraviolet Light Device for the Decontamination of a Single-Use Filtering Facepiece Respirator
Authors: Truitt Christopher L , Goldwater Wesley 
Published: January 2021

Abstract

Background
The use of disposable or single-use filtering facepiece respirators (FFRs), like N95s, are an important component of personal protective equipment for healthcare personnel in treating patients with a respiratory virus and not approved for reuse. The current pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in the limited availability of respirators. As a result, the decontamination of FFRs is a potential solution for reuse in order to conserve supplies. However, the efficacy of disinfection for a contaminated FFR needs to be evaluated. This experiment examined the effectiveness of a targeted ultraviolet C (UVC) device for the decontamination of a single-use respirator.

Methods
To mimic an aerosolized droplet contaminating a cellulose based respirator, a 6 mm cotton disk was inoculated with a 10 μL aliquot of Bacillus subtilis endospores. The disks were placed directly under the UVC light with 6 inches between the bulb and disk. The samples were then exposed for 90 seconds, 3 minutes, 5 minutes, and 10 minutes, respectively. After specified exposure time, the disks were turned over, and the other side was exposed for the same time interval as the previous side. Disks were placed in a 10 mL nutrient broth and incubated at 30°C for 48 hours. Lastly, the serially diluted specimens were plated onto nutrient agar, incubated for 48 hours, and the log10 colony forming units (CFU) reductions were enumerated by comparing disks after decontamination versus untreated controls.

Results
The log10 CFU reduction of B. subtilis spores over all time intervals were significant when compared to controls. The mean reduction of spores on the cotton disks were 2.5 log after 90 seconds, 4 log after 3 minutes, and &gt;6 log for both 5 and 10 minutes with no measurable recovery of spores for the last two exposures.

Conclusion
The use of targeted UVC was very successful in reducing the B. subtilis spores from a cotton disk within 90 seconds, and the 100% elimination of the spores after 5 minutes. Even though a pandemic virus was not used, the sporicidal efficacy suggests this device could be effective at inactivating SARS-CoV-2. Based upon these findings, a targeted UVC device could be utilized for the decontamination of a single-use respirator needed during times of shortages.

Disclosures
All Authors: No reported disclosures
503. The Misappropriation of COVID-19 Related TV Ad Expenditures
Authors: Vyas Kartavya J 
Published: January 2021

Abstract

Background
With nearly three-fourths of the U.S. population isolated in their homes between early March and the end of May, almost all of whom regularly watch television (TV), it was no surprise that companies began to purchase airtime on major television networks to advertise (ad) their brands and showcase their empathy with the populace. But how would the coronavirus disease 2019 (COVID-19) epidemic curve have changed had these same dollars been allocated to proven preventive interventions?

Methods
Performance and activity metrics on all COVID-19 related TV ads that have aired in the U.S. between February 26th and June 7th, 2020, were provided by iSpot.tv, Inc., including expenditures. COVID-19 incidence and mortality data were collected from the Centers for Disease Control and Prevention (CDC). Descriptive statistics were performed to calculate total TV ad expenditures and other performance metrics across industry categories. Leveraging a previously published stochastic agent-based model that was used to assess the cost-effectiveness of non-pharmaceutical interventions to control COVID-19, the number of cases that would have been prevented had these same dollars been used for preventive interventions was calculated using cost-effectiveness ratios (CERs), the cost divided by cases prevented.

Results
A total of 1,513 companies purchased TV airtime during the study period, totaling approximately 1.1 million airings, 215.5 billion impressions, and $2.7 billion in expenditures; most of the expenditures were spent by the restaurant (15.9%), electronics and communications (15.4%), and vehicle (13.7%) industries. The CERs for PPE and social distancing measures were $13,856 and $29,552, respectively; therefore, had all of these TV ad dollars instead been allocated to PPE or social distancing measures, approximately 194,908 and 91,386 cases of COVID-19 may have been prevented by the end of the study period, respectively.

Figure 2. COVID-19 cases prevented had TV ad expenditures been reallocated for interventions.

Conclusion
Americans were inundated with COVID-19 related TV ads during the early months of the pandemic and companies are now showing some signs to relent. In times of disaster, however, it is paramount that the private sector go beyond showcasing their empathy and truly become socially responsible by allocating their funds to proven prevention and control measures.

Disclosures
All Authors: No reported disclosures
504. Transmission of SARS-CoV-2 to Household Members of COVID Positive Healthcare Workers
Authors: Arshad Mehreen , Otero Sebastian , Mithal Leena B 
Published: January 2021

Abstract

Background
Healthcare workers (HCW) are at increased risk of SARS-CoV-2 infection. Infection prevention and control methods to prevent HCWs from bringing the virus home are lacking. We aimed to describe the various isolation practices of COVID positive (+) physicians and advanced practice providers to mitigate transmission risk to family members (FM) and understand HCW stress during this pandemic.

Methods
Survey responses were collected from 5/19/2020 - 6/12/2020 using a convenience sampling of HCW. Solicitations were done through email, listservs, institutional websites, and Facebook groups without geographic restriction. We collected data on demographics, details about HCW illness, health of FM, preventive measures taken, and HCW stress.

Results
The survey has so far been completed by 51 COVID+ respondents with FM in the home (Table 1). Half (55%) work in outpatient, 31% inpatient, and 8% in ER setting. Most HCW (83%) were diagnosed by PCR test; others were presumptive positive due to symptoms and exposure (14%). 64% had mild disease and 33% had moderate disease. Most common preventive measures were immediate showering after reaching home (59%) and changing clothes prior to going home (35%); 22% took no precautions. About 55% of FM developed symptoms of COVID. There were no significant differences between preventive measures taken by HCW whose FM remained asymptomatic. However, we noted that HCW whose FM remained symptom-free were more likely to sleep in a separate room (17% vs. 7%), refrain from physical contact with FM (22% vs.14%) and intimate contact with partners (22% vs. 11%). Over 88% reported increased stress level, many identifying health concerns and safety (26%) and impact on FM (28%) as the greatest source of stress. There was no difference in reported stress level between HCW whose FM became infected and those who were not. HCW with symptom-free FM were more concerned about transmission to their partner (p = 0.02).
Table 1

Table 2

Conclusion
This is the first survey of its kind which, although limited by total respondents, indicates that HCW are taking a variety of approaches to prevent transmission of SARS-CoV-2 to their FM. We did not find a significant impact of individual preventive measures on the risk of transmission. Regardless of the FM illness, most HCW have increased stress due to impact of COVID.

Disclosures
All Authors: No reported disclosures
508. Biomarker elevation during COVID-19: Differences between ambulatory and hospitalized individuals
Authors: Blair Paul W , Lanteri Charlotte , Striegel Deborah , Agan Brian , Maves Ryan C , Chenoweth Josh , Larson Derek , Mende Katrin , Colombo Rhonda , Lindholm David , Ganesan Anuradha , Richard Stephanie , Colombo Chris , Madar Cristian , Huprikar Nikhil , Tribble David , Dumler John S , Burgess Timothy , Burgess Timothy , Clark Danielle 
Published: January 2021

Abstract

Background
While the majority of illness due to COVID-19 does not require hospitalization, little has been described about the host inflammatory response in the ambulatory setting. Differences in the levels of inflammatory signaling proteins between outpatient and hospitalized populations could identify key maladaptive immune responses during COVID-19.

Methods
Samples were collected from 76 participants (41% female, mean 46.8 years of age) enrolled at five military treatment facilities between March 20, 2020 and June 17, 2020 in an ongoing prospective COVID-19 cohort. This analysis was restricted to those with positive SARS-CoV-2 (severe acute respiratory syndrome–coronavirus 2) RT-PCR testing and included hospitalized (N=29; 10 requiring an ICU stay) and non-hospitalized (N=43) participants. Severity markers (IL6, D-dimer, procalcitonin, ferritin, ICAM-1, IL5, lipocalin, RAGE, TNFR, VEGFA, IFNγ, IL1β) were measured in plasma (mg/dL) using the Ella immunoassay and natural log transformed. Univariate negative binomial regression was performed to determine relative risk of hospitalization. Using the full marker panel, we performed a Principal Component Analysis (PCA) to determine directions of maximal variance in the data. Pearson’s correlation coefficient was determined between analytes and each axis.

Results
Participants requiring ambulatory-, hospital-, and ICU-level care had samples collected at 44.0 (IQR: 35.0–51.0), 40.0 (13.0–51.0), and 47.5 (21.0–54.0) days, respectively. Higher unadjusted levels of IL6, D-dimer, procalcitonin, or ferritin were each associated with hospitalization (Table 1). The PCA showed a separation along axes between level of care and duration of symptoms (Fig 1). While significant correlations were noted with a number of biomarkers, PC1 most correlated with TNFR1 (r=0.88) and PC2 most correlated with IL6Ra (r=0.95). PC1 axis variation accounted for 36.5% of variance and the PC2 axis accounted for 20.0% of variance.
Figure 1. Principal Component Analysis (PCA) of biomarkers by level of care and symptom duration.

Conclusion
TNFR1 and IL6Ra levels correlated with differences in the proinflammatory states between hospitalized and non-hospitalized individuals including time points late in the course of illness. Further analysis of these preliminary findings is needed to evaluate for differences by stages of illness.

Disclosures
All Authors: No reported disclosures
511. Hospitalized COVID-19 Patients with Elevated Cardiac Troponin I Have Increased Length Of Stay But Similar Ventilation Time
Authors: Johnson Andre , Hanna George , Biswas Mimi , Kubomoto Scott 
Published: January 2021

Abstract

Background
Coronavirus disease 2019 (COVID-19) causes increased mortality and morbidity in patients with underlying cardiovascular disease. Elevated cardiac troponin I (cTnI) can suggest either a co-concurrent myocarditis or acute myocardial infarction. Understanding how laboratory values predict disease severity is important for clinicians to guide therapy and triage patients.

Methods
A cross sectional study was performed utilizing the 184 hospital United States database of HCA. Patients were selected based on inpatient visits to HCA facilities from February 2020 to May 2020 with a COVID-19 diagnosis and at least one cTnI lab test. Patients were divided according to an elevated or normal cTnI value based on the 99th percentile reference range of the test. Outcomes, such as length of stay, disposition, and time on the ventilator, were compared.

Results
3968 patients hospitalized with COVID-19 were identified. Of those, 3158 patients had at least one cTnI test throughout their hospitalization. 829 (26%) had at least one positive cTnI during their hospitalization. Patients with at least one positive cTnI were hospitalized on average for 8.7 days, whereas patients without positive cTnI were hospitalized on average for 6.3 days (p&lt; 0.0001). 1499 patients without positive cTnI were sent home without health care, but only 196 with positive cTnI were discharged home without requiring home health (p &lt; 0.0001). Need for mechanical ventilation was also higher in the elevated cTnI group. If intubated, patients in both groups required on average the same amount of ventilator time, 7 days (p = 0.7263).
Ventilation time between COVID-19 patients with and without elevated Troponins

Length of hospitalization stay between COVID-19 patient with and without elevated Troponins

Differences in discharge between COVID-19 patients with and without elevated Troponins

Conclusion
Patients with at least one positive cTnI during their hospitalization had increased length of stay and decreased likelihood of being discharged home without home health. Using a large nationwide database we confirmed previously published findings in smaller patient populations associating cardiovascular disease with COVID-19 severity. Once patients were intubated, both subsets of patients with and without elevated cTnI had similar days on the ventilator, suggesting the COVID-19 acute respiratory distress syndrome (ARDS) has a more complicated relationship to troponin levels. These findings suggest that patients with an increased cTnI should be triaged to receive aggressive management.

Disclosures
All Authors: No reported disclosures
513. Viral kinetics of SARS-CoV-2 in patients with COVID-19
Authors: Kim Da Young , Lee Ju-Hyung , Oh Hyeon Jeong , Seo Jun-won , Yun Na Ra , Kim Choon-Mee , Kim Dong-Min 
Published: January 2021

Abstract

Background
As only few studies have analyzed viral kinetics between the incubation and symptomatic periods of COVID-19 patients, we investigated the viral kinetics and compared viral loads between patients with mild and severe COVID-19.

Methods
We determined the viral kinetics of 10 patients diagnosed with COVID-19 at Chosun University Hospital. Six patients were classified into the “mild” group and 4 into the “severe” group according to supplemental oxygen use during admission. Samples were collected via nasopharyngeal swabs and sputum specimens. SARS-CoV-2 was detected using real-time reverse transcription-polymerase chain reaction (RT-PCR). Chest radiograph scores during hospitalization were obtained

Results
Ct values of the upper respiratory tract specimens were low during the early stages after symptom onset but gradually increased over time in both groups. The severe group had lower Ct values than the mild group. The Ct values of the RdRP and E genes on day 6 after symptom onset were significantly lower in the severe group than in the mild group (p &lt; 0.05). Three of 6 patients had positive results on RT-PCR even before symptom onset; 2 of them had the lowest Ct values. The chest radiograph scores were higher in the severe group than in the mild group, and the score in the severe group was the highest at approximately 3 weeks after symptom onset.
Ct values when the RdRP gene and E gene were targeted to detect SARS-CoV-2 on the basis of the days after symptom onset in all the patients

Conclusion
Viral load and chest radiograph scores were significantly different between the severe and mild groups of COVID-19 patients.

Disclosures
All Authors: No reported disclosures
514. Clinical features and outcomes of 112 patients with SARS-CoV-2 infections requiring intensive care in a public healthcare system in South Florida
Authors: Niu Jianli , Sareli Candice , Sareli Aharon 
Published: January 2021

Abstract

Background
SARS-CoV-2 infections may result in intensive care unit (ICU) admission and mortality. We characterized patients with SARS-CoV-2 infections that required intensive care in a public healthcare system in South Florida.

Methods
Consecutive patients with SARS-CoV-2 infections, admitted to the ICUs of Memorial Healthcare System (MHS) in South Florida, from March 7 to May 14, 2020 were retrospectively reviewed. The primary outcome was the rate of in-ICU death. A Cox proportional hazards regression model was used to determine the independent risk factors for death during ICU stay.

Results
Of 702 patients with SARS-CoV-2 infections admitted to MHS from March 7 to May 14, 2020, 112 (16%) patients required ICU admission. The median age was 67 years (IQR 58–75) and 68 (61%) were men. The most common comorbidities were hypertension (88; 79%) and diabetes (43; 38%). All patients received hydroxychloroquine therapy, 42 (38%) received convalescent plasma transfusion, 39 (35%) received Tociluzimab, and 14 (13%) received Remdesivir. 90 (80%) patients required invasive mechanical ventilation for an average of 18 days (median = 14 days). 47 (42%) received vasopressors, and 34 (30%) received renal replacement therapy. As of May 14, 2020, 40 (36%) patients had died, 64 (57%) discharged alive, and 8 (7%) remained in the ICU. The ICU length of stay was comparable between discharged patients and those that died. An increased duration of mechanical ventilation was observed in discharged patients (Figure 1). Of 64 discharged patients, 9 (14%) were readmitted to ICU, with a median time to readmission of 4 days (IQR, 1.5–6.5). By multivariable Cox regression analysis, chronic pulmonary disease was one independent risk factor associated with in-ICU mortality, whereas renal replacement therapy, convalescent plasma transfusion, and tocilizumab administration were negatively associated with in-ICU mortality (Figure 2).
Figure 1. Clinical outcomes of critically ill COVID-19 patients required intensive care.

Figure 2. Forest plots for adjusted hazard ratio of in-ICU mortality in critically ill COVID-19 patients required intensive care.

Conclusion
In a public healthcare system in South Florida, patients with SARS-CoV-2 infection that required intensive care had 36% mortality. Mortality was associated with chronic pulmonary disease and inversely associated with renal replacement therapy, convalescent plasma transfusion, and tocilizumab administration.

Disclosures
All Authors: No reported disclosures