bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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

Abstract

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

Abstract

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

Abstract

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&lt; 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

Abstract

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 &lt; .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

Abstract

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

Abstract

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

Abstract

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

Abstract

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