bluuebunny/crossref_metadata_2025_split huggingface dataset:
471. The Rochester Regional COVID-19 Registry: One Small Step toward a Unified National Action Plan
Authors: Hanna John J , Chen Tara , Newhart Donna , Schantz Katherine , Rozzi Kathleen , Bress Jonathan , Lesho Emil P 
Published: January 2021

Abstract

Background
On June 19, 2020, the Academies of Sciences, Engineering, and Medicine hosted a public meeting on “Data Needs to Monitor the Evolution of SARS-CoV-2”. The Office of the Assistant Secretary for Preparedness and Response (ASPR/HHS) and other agencies are seeking to track and correlate viral genome sequences with clinical and epidemiological (CE) data. A crucial part of that framework is obtaining detailed CE data from frontline facilities. In response, we sought to contribute by creating a registry of detailed CE data from SARS-COV -2 infected patients at five hospitals, spanning eleven counties in Western New York.

Methods
In addition to the usual demographics, comorbidities, and categories of outpatient prescriptions, the registry has 75 laboratory, 2 imaging, 19 therapeutic, and 4 outcome-related parameters. Mann-Whitney U Test for continuous variables and Chi-squared and Fisher Exact Test for categorical variables were performed in R and Minitab.

Results
The registry currently includes data from 399 patients: 236 ambulatory and 163 inpatient. Several comorbidities were associated with requirement for admission compared to ambulatory status, including obesity and kidney, liver, and cardiovascular disease (all p &lt; /= 0.01) (Table 1). Use of angiotensin inhibitors and receptor blockers, statins, and acid suppressants was higher in admitted vs. ambulatory patients (all p &lt; /=0.001) (Table 1 and Figure). Diabetes mellitus and statin use were more common in patients who required intensive care, p=0.04 and 0.01 respectively (Table 2).
Table 1

Figure

Table 2

Conclusion
The registry captures detailed clinical information from SARS-COV-2 infections, providing a valuable resource for researchers, planners, and policy makers. It also provides a framework for surge planning, predictive modeling, and linking CE data to whole genome sequencing data for precision epidemiology. As SARS-COV-2 reports from China, Italy, and New York City may not be fully generalizable to other regions, especially those not as severely affected or those in suburban and rural settings, reports from other areas are needed. To our knowledge, this is one of the largest U.S. case series outside of New York City.

Disclosures
All Authors: No reported disclosures
472. The Utility of Infectious Diseases E-consults in the Era of COVID-19
Authors: Saad Hala , Yagnik Kruti , King Helen , Bedimo Roger , Medford Richard J 
Published: January 2021

Abstract

Background
During the COVID-19 pandemic, rapid Infectious Diseases (ID) consultation has been required to answer novel questions regarding SARS-CoV-2 testing and infection prevention. We sought to evaluate the utility of e-consults to triage and provide rapid ID recommendations to providers.

Methods
We performed a retrospective study reviewing ID e-consults in three institutions in the North Texas region: Clements University Hospital (CUH), Parkland Hospital and Health System (PHHS), and the VA North Texas Health Care System (VA) from March 1, 2020 to May 15, 2020. Variables collected include age, sex, ethnicity, comorbidities, time to completion, reason for consult and outcome of consult (initiation or removal of personal protective equipment (PPE) and recommendation to test or retest for COVID-19).

Results
We performed all analysis using R studio (Version 1.3.959). Characteristics of 198 patients included: 112(57%) male, 86(43%) female, 86(43%) Caucasian, 71(36%) Hispanic, 42(21%) African American, 6(3%) Asian and mean(sd) age of 55.1(15.9). Patient comorbidities included: 89(45%) with a heart condition, 77(39%) diabetes, 30(15%) asthma and 14(7%) liver disease.
Median time to completion for all hospitals was 4 hours(h); ((CUH (4h) vs PHHS (2h), p&lt; 0.05; VA (5.5h) vs PHHS (2h) p&lt; 0.05)). Most common reasons for e-consult included: (63)32% regarding re-testing ((CUH 14(21%) vs PHHS 43(50%), p&lt; 0.05; CUH vs VA 14(27%), p&lt; 0.05; PHHS vs VA, p&lt; 0.05)), (61)31% testing ((CUH 25(37%) vs PHHS 39(45%), p&lt; 0.05; CUH vs VA 7(16%), p&lt; 0.05; PHHS vs VA, p&lt; 0.05)) and 61(31%) infection prevention (IP). Based on the e-consult recommendation, 53(27%) of patients were tested ((CUH 31(45%) vs PHHS 11(13%), p&lt; 0.05, CUH vs VA 11(25%), PHHS vs VA, p&lt; 0.05)), 45(23%) were re-tested, 44(22%) of patients had PPE started on and 19% had PPE removed ((CUH 0(0%) vs PHHS 16(19%), p&lt; 0.05; CUH vs VA 21(48%), p&lt; 0.05; PHHS vs VA, p&lt; 0.05)).
Reason for Consult

Conclusion
E-consult services can provide prompt ID input during the COVID-19 pandemic, minimizing the risk of infection to the patient and health care workers while preserving PPE and testing supplies.

Disclosures
Roger Bedimo, MD, MS, Gilead Sciences (Consultant)Merck & Co. (Advisor or Review Panel member)ViiV Healthcare (Advisor or Review Panel member, Research Grant or Support)
473. Using Serosurveillance for SARS-CoV-2 to Conserve PCR Tests in a Resource Constrained Combat Environment
Authors: White Brian K , Sachdeva Mohit , Bova Jacob , Nichols Shawnn , Stuart Rory P , Rutherford Ashley E , Comes Ryan , Cybulski Daniel , Case Alex M 
Published: January 2021

Abstract

Background
In March 2020, COVID-19 threatened combat operations in Afghanistan. At that time, the NATO Resolute Support mission involved nearly 17,000 troops from 38 partner nations, plus civilians who support the mission, scattered throughout Afghanistan. While Afghanistan did not initially report many confirmed cases, large numbers of cases were reported from neighboring countries with known migration across the borders (sometimes thousands/day). Military medical leaders advised commanders regarding the potential health risks to the force, balancing with risks to the mission. Quarantine and isolation protocols were established. Public health interventions of social distancing, cloth mask wear, enhanced environmental cleaning, active case finding, and emphasis on hand hygiene and cough etiquette were enforced. However, many base locations were unable to alleviate close living quarters. Testing was identified as a means to assess risk to the population. Testing capabilities were limited, particularly PCR. When this testing strategy was established, the utilization and interpretation of antibody tests was quite controversial. With rapid antibody kits, the time to detection of both IgM and IgG are similar; detection of either cannot identify the time since exposure.

Methods
A novel surveillance plan was established whereby subpopulations at highest risk for exposure to the virus were screened with antibody tests from 17 Apr-1 Jun, 2020. High risk populations included: those leaving quarantine, base defense guards, isolation unit guards, medical personnel, dining facility workers, and those who interact with local populations. Individuals with detectable antibody (either IgM or IgG) were further evaluated with PCR tests.

Results
In the first six weeks of this testing strategy, 1957 antibody tests were utilized. A total of 37 specimens were identified antibody positives with seroprevalence of 2% (Figure 1). Thirteen were identified to have positive IgG, 22 with IgM, and 2 with both. PCR was performed on those with detectable antibody, 13 (35%) had positive PCR.

Conclusion
Serosurveillance of populations at high risk for exposure to the virus is a logical way to conserve testing resources in a constrained combat environment.

Disclosures
Alex M. Case, n/a, United States Air Force (Employee)
474. Using telemedicine to provide virtual care for COVID-19 patients at home
Authors: Horton Lucy E , Jenks Jeffrey D , Bharti Ajay , Ritter Michele L , Bordeaux Kathleen 
Published: January 2021

Abstract

Background
In response to the COVID-19 pandemic in San Diego, California, the Infectious Disease Division at the University of California San Diego established a COVID-19 Clinic dedicated solely to managing patients safely in their homes. This strategy was developed in response to: i) concerns regarding transmission of infection in the healthcare setting, ii) avoiding overwhelming the healthcare system with COVID-19 patients, iii) providing patients with expedited access to specialists, and iv) reducing the burden on the emergency department and urgent care.

Methods
The COVID-19 clinic staff is comprised of a dedicated nurse, administrative assistant, and four infectious diseases (ID) physicians who aim to see patients within 24 hours of referral via virtual clinics 5 days a week. An ID physician initially assesses each patient in a direct telemedicine visit and answers their questions, assesses disease severity, provides both symptom management and emotional support, and education about self-isolation and transmission-based precautions. The patients are then triaged to daily nursing phone calls and follow up visits as needed.

Results
Over a period of 12 weeks (March 27 to June 16, 2020), the clinic has seen 179 patients. To assess the impact of the clinic, patients are asked to complete a 6-point verbal patients satisfaction survey after their visit. Of the 133 patients who have completed the survey to date, the vast majority reported high satisfaction with their encounters with the COVID-19 physician, with a mean score of 4.8 or higher on all six questions (on a scale of 1 to 5). When asked “Did you feel comfortable talking to your COVID-19 ID physician?” on a scale of 1 to 5, the average score was 4.9. When asked “Did the physician do a good job answering your questions?” the average was 4.9. Patients reported feeling safer after talking with their physician (mean score 4.8), and felt better educated on how to self-quarantine at home (mean score 4.85) and when to seek care from an emergency room, urgent care or hospital (mean score 4.83).

Conclusion
The UCSD COVID-19 Clinic demonstrates how telemedicine can be utilized in response to a public health crisis by creating a virtual clinic to provide ID care for patients in their homes.

Disclosures
All Authors: No reported disclosures
478. Psychological Distress among Infectious Disease Physicians during the Response to the COVID-19 Outbreak in the Republic of Korea
Authors: Park Se Yoon , Kim Bongyoung , Jung Dong Sik , Jung Sook In , Oh Won Sup , kim Shin-Woo , Peck Kyong Ran , Chang Hyun-Ha 
Published: January 2021

Abstract

Background
This study aimed to investigate psychological distress among infectious disease (ID) physicians during the coronavirus disease (COVID-19) outbreak in the Republic of Korea.

Methods
Using an online-based survey link sent via text message and email, we conducted a survey from April 21 to 25, 2020, targeting all ID physicians currently working in ID (n = 265). The questionnaire was based on the Maslach Burnout Inventory-Human Services Survey and the Depression, Anxiety, and Stress Scales, and information was collected on factors protecting against psychological distress and difficulties in relation to COVID-19.

Results
Of 265 ID physicians, 115 (43.3%) responded, showing burnout (97, 90.4%), depression (20, 17.4%), anxiety (23, 20.0%), and stress (5, 4.3%). There were no differences in terms of distress between ID physicians who were directly involved in the care of patients with COVID-19 or not (Table 1). Greater than 50% of physicians valued their work and felt recognized by others, whereas &lt; 10% indicated that sufficient human and financial support and private time had been provided during the outbreak. The most challenging issues concerned a lack of human resources for COVID-19 treatment or infection control, a shortage of personal protective equipment or airborne infection isolation rooms, pressure for research, and lack of guidelines for COVID-19 management (Figure 1).
Table 1.

Figure 1. Difficulties in response to the COVID-19 outbreak. Abbreviations: COVID-19, coronavirus disease 19; HCWs, healthcare workers; ICPs, infection control practitioners; IRB, Institutional Review Board; PPE, personal protective equipment

Conclusion
During the COVID-19 outbreak in the ROK, most respondents reported psychological distress. Preparing strategies for infectious disease outbreaks that support ID physicians is essential.

Disclosures
All Authors: No reported disclosures
483. OPAT Delivery during COVID-19
Authors: Swartwood Michael J , Boerneke Renae A , Kinlaw Alan C , Mavrogiorgos Nikolaos , Marx Ashley , Ciccone Emily J , Schranz Asher J , Bowman Mary C , Farel Claire E 
Published: January 2021

Abstract

Background
In 2020, COVID-19 spurred unprecedented change in the delivery of routine clinical care. The UNC OPAT program staff, previously accustomed to in-person collaboration in the hospital, became geographically distant amid North Carolina’s partial shutdown starting in March 2020. Team members relied on teleworking and many OPAT clinic visits shifted to phone and video telehealth. We assessed how COVID-19 impacted our care of OPAT patients including follow-up visits and readmissions.

Methods
UNC’s OPAT database contains clinical and demographic information on all patients on OPAT for at least 14 days who received specialized monitoring program led by an infectious diseases (ID) pharmacist, after evaluation by an ID physician. For all OPAT courses that ended between 3/1/20 and 5/20/20 (last available data cut), we assessed the length of OPAT treatment course, readmissions, adverse events, follow-up ID clinic visits, and the method of follow up visit utilized. We compared these measurements to historical baseline data from 3/1/19 to 5/20/19.

Results
During the 2020 period, 73 patients completed OPAT, with median OPAT enrollment lasting 36 days, which was similar to 2019 data (70 patients; median OPAT enrollment of 35 days). During the 2019 period, 93% of patients attended a follow up visit with an infectious diseases clinician, all of which took place in person. During the 2020 (COVID-19) period, 85% of patients attended an ID follow up visit; contrary to 2019, 42% of these visits took place in person, 45% were by phone and 13% were via a telemedicine video service. Readmission rates were similar across the two time periods (16% during COVID-19 vs 14% during 2019 comparison time period, P=0.72).

Conclusion
UNC OPAT continued through the emergence of COVID-19 as an essential service for a high patient volume by adapting its care delivery and follow-up visit protocols to include virtual care options. Readmission rates for OPAT patients during COVID-19 were comparable to historical baseline data.

Disclosures
All Authors: No reported disclosures
484. The Impact of SARS-CoV-2 on Reproduction Rates of Seasonal Influenza and RSV
Authors: Sherman Amy C , Babiker Ahmed , Sieben Andrew , Pyden Alexander , Steinberg James P , Colleen Kraft , Koelle Katia , Kanjilal Sanjat 
Published: January 2021

Abstract

Background
The COVID-19 pandemic caused by SARS-CoV-2 has precipitated a global health crisis. In an effort to decrease person-to-person transmission, societal-level non-pharmacologic interventions (NPIs) to maintain social distancing have been enacted. As SARS-CoV-2 shares similar routes of transmission with other respiratory viruses, implementation of these NPIs may have decreased transmission for multiple viral pathogens. We compared influenza and respiratory syncytial (RSV) rates in prior seasons to rates during the 2019 - 2020 season at two large academic centers in Atlanta and Boston.

Methods
The clinical records were queried for adults with respiratory virus testing conducted at the Emory Healthcare system and associated clinics in Atlanta and the Mass General Brigham (MGB) Healthcare System in Boston. Total cases for influenza A and B, RSV and SARS-CoV-2 were analyzed for each week of the past 5 seasons (07/01/2015-05/30/2020) for the Atlanta and Boston sites. Systematic changes in viral infection rates were calculated using viral reproduction rates, R(t), between consecutive weeks. R(t) is the ratio of the number of positive cases in one week to the number of positive cases in the previous week. We used statistical bootstrapping to determine whether R(t) for influenza and RSV were lower in 2019–2020 following the introduction of SARS-CoV-2. Analyses were conducted using R (v 4.0.0).
Absolute respiratory virus activity by season, Boston (panel A) v. Atlanta (panel B)

Results
For the 2019–2020 Atlanta season, R(t) &lt; 1 (which reflects steady decline in infection rates) occurred at week 28 for influenza A, week 33 for influenza B, and week 35 for RSV, which corresponded with the increase of SARS-Cov-2 cases. The R(t) of these viruses stayed at or near 1 during weeks 33–35 in prior seasons, and R(t) was greater than 1 up to week 47. Data from MGB sites showed similar trends with a sudden decline in R(t) to &lt; 1 at the start of the SARS-CoV-2 pandemic.

Conclusion
We note decreased transmission of influenza and RSV during a time window where widespread movement restrictions and social distancing were imposed to control COVID-19. This trend was most pronounced for influenza A in Atlanta and influenza B in Boston. These data suggest that NPIs can have important effects across multiple pathogens.

Disclosures
Kraft Colleen, MD, MSc, Rebiotix (Advisor or Review Panel member)
490. A Randomized Crossover Study to Evaluate Interventions to Reduce Contamination during Reuse of N95 Respirators
Authors: Li Daniel , Alhmidi Heba , Pearlmutter Basya , Cadnum Jennifer , Wilson Brigid , Donskey Curtis 
Published: January 2021

Abstract

Background
During the Coronavirus Disease 2019 pandemic, shortages of personal protective equipment (PPE) have forced many healthcare facilities to require personnel to reuse N95 respirators. We hypothesized that use of correct technique such as changing gloves after N95 contact or providing rapid decontamination between each use would reduce the risk for contamination.

Methods
We conducted a randomized crossover study using simulated patient care interactions to compare the effectiveness of interventions to reduce contamination of personnel and the environment with high-level N95 contamination (107 plaque-forming units [PFU] of bacteriophage MS2 applied to front of respirator). Ten healthcare personnel performed 4 randomly-assigned standardized examinations of mannequins including: 1) Control (PPE donning and doffing not including glove change after N95 contact); 2) Glove change after any N95 contact; 3) Control with 1-minute ultraviolet-C light (UV-C) treatment between simulations; 4) Control with 30-second steam treatment between simulations. A second trial was conducted with groups 1–3 using a lower inoculum (105 PFU). The frequencies of participant and environmental contamination were compared.

Results
As shown in Figure 1.A, use of a highly contaminated N95 respirator resulted in frequent MS2 contamination in the Control, Glove change, and UV-C groups, but was dramatically reduced with steam treatment of the N95. With the lower level of contamination, MS2 contamination occurred less frequently across all groups, and was significantly reduced in the UV group, compared to the Control (Figure 1.B).
Figure 1: Bacteriophage MS2 contamination during simulated patient care interactions with contaminated N95 respirators

Conclusion
Reuse of contaminated N95 respirators resulted in contamination of personnel and the environment even when correct technique was used. Rapid decontamination technologies can reduce the risk for transmission.

Disclosures
All Authors: No reported disclosures
491. Aerosol-Generating Medical Procedures: Transmission of SARS-CoV-2 and Emerging Viruses
Authors: Judson Seth D , Munster Vincent J 
Published: January 2021

Abstract

Background
During the pandemic of coronavirus disease 2019 (COVID-19), many questions arose regarding risks for hospital-acquired or nosocomial transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Aerosol generating medical procedures (AGMPs), techniques that can generate infectious, virus-laden aerosols, could potentially amplify transmission among healthcare workers (HCWs). Thus, it was widely recommended that HCWs use airborne precautions when performing AGMPs. However, in clinical settings it is often unclear what procedures constitute AGMPs and how the risk varies by procedure or pathogen. We set out to further define AGMPs and assess the risk for nosocomial transmission of SARS-CoV-2 and other high-risk viruses via AGMPs.

Methods
We identified potential AGMPs and emerging viruses that were high-risk for nosocomial transmission through reviewing experimental and clinical data. Potential AGMPs were those associated with previous virus transmission or mechanically capable of transmission. High-risk viruses were defined as those that cause severe disease in humans for which limited therapies or interventions exist, are infectious via aerosols in humans or non-human primates (NHPs), found in the respiratory tract of infected humans or NHPs, and had previous evidence of nosocomial transmission.

Results
We identified multiple potential AGMPs, which could be divided into those that generate aerosols or induce a patient to form aerosols, as well as eight families of high-risk viruses. All of the viruses were emerging zoonotic RNA viruses. In the family Coronaviridae, we identified potential evidence for SARS-CoV-1, MERS-CoV, and SARS-CoV-2 transmission via AGMPs. SARS-CoV-1 and SARS-CoV-2 were also found to be similarly stable when aerosolized.

Conclusion
Multiple emerging zoonotic viruses pose a high risk for nosocomial transmission through a variety of AGMPs. Given the similar stability of SARS-CoV-2 with SARS-CoV-1 when aerosolized and prior nosocomial transmission of SARS-CoV-1 via AGMPs, we suspect that certain AGMPs pose an increased risk for SARS-CoV-2 transmission. Additional experimental studies and on-site clinical sampling during AGMPs are necessary to further risk stratify AGMPs.

Disclosures
All Authors: No reported disclosures