bluuebunny/crossref_metadata_2025_split huggingface dataset:
438. Characteristics and Epidemiology of a Native American Community with a High Prevalence of COVID-19
Authors: Bratsch Nicole A , Campbell Natalie , McAuley James , Close Ryan M 
Published: January 2021

Abstract

Background
COVID research and reporting has focused on large urban populations. However, limited data suggests that rural Native American (NA) populations are disparately impacted. We serve a well-defined NA population of ≈18,000 that is relatively geographically isolated in the White Mountains of eastern Arizona. Our first case SARS-CoV-2 was confirmed April 1st. We have since confirmed an attack rate significantly higher than most of the United States. We provide testing and case trends in addition to characteristics of the first 800 cases.

Methods
We sequentially reviewed the charts of all laboratory-confirmed COVID-19 patients from April 1 to June 3, 2020. In addition to calculating prevalence and rates, we provided summary statistics that were used to describe testing breakdown, demographics, symptoms, and co-morbidities.

Results
From April 1 to June 3, we tested 2,662 persons, of which 884 (33.2%) were positive. The estimated prevalence of the time of writing is 4.9% and the rate of 4,911 per 100,000 persons. Data compiled from the first 800 laboratory-confirmed patients is summarized in table 1. Median age for confirmed cases was 40.6 (IQR 28–54). 555 cases (72.1%) were symptomatic. The most common symptoms were cough (67.7%), subjective fever (39.5%), and muscle aches (36.8%). 30.6% of confirmed cases were asymptomatic at the time of testing. The majority of cases were among persons aged 30–39 years (22.9%). Some of the most common comorbidities in confirmed cases included cardiovascular disease (30.4%), substance abuse (30.1%), and diabetes (25.0%). There were 18 (2.04%) deaths.
Clinical findings among symptomatic patients

Conclusion
We observed a significantly higher prevalence (10-times) and attack rate of (17-times) COVID-19 in a well-defined NA population, when compared to the general Arizona population. We provide characteristics of these cases and report that nearly a third were asymptomatic at the time of testing. More research is needed to understand the rapid spread of COVID-19 in vulnerable rural communities.

Disclosures
All Authors: No reported disclosures
441. Clinical Characteristics of Pediatric SARS-CoV-2 Infection and Coronavirus Disease 2019 (COVID-19) in Kuwait
Authors: Alsharrah Danah Y , Al-Haddad Fatemah , Aljamaan Sarah , Al-Yaseen Muneera , Al-Mutairi Nahar , Ayed Mariam , Papenburg Jesse , Alghounaim Mohammad 
Published: January 2021

Abstract

Background
Clinical presentation of coronavirus disease-2019 (COVID-19) ranges from asymptomatic to severe and life threatening. National-level registries found that children, generally, have less severe disease when compared to adults. However, most asymptomatically infected children will not present to hospital and may be missed. We aimed to describe the clinical characteristics in pediatric COVID-19 patients in Kuwait, and to estimate the potential duration of viral shedding.

Methods
A retrospective cohort study was performed in Jaber Alahmad Hospital (JAH) from Feb. 29th to Apr. 30th, 2020. During the study period and as part of the public health measures to contain COVID-19, all SARS-CoV-2 infected patients 1 month-18 years old, regardless of symptoms, were hospitalized at JAH, and were included. Demographics, clinical data, and laboratory results were collected. Polymerase chain reaction (PCR) negativity was defined as having two consecutive negative PCR results from a respiratory specimen. Descriptive statistics and multivariable regression analyses were performed.

Results
A total of 134 pediatric SARS-CoV-2 infections were identified. Of those, 91 patients (67.9%) were asymptomatic, the remaining cases had mild COVID-19 illness and mild pneumonia. The median age was 8.8 years (IQR: 4.7–12.4), 55.2% were males, and 89.5% were healthy. Cough and fever were the most commonly reported symptoms. The median duration to PCR negativity was 15 days (IQR: 13–19) for symptomatic patients and 15.5 days (IQR: 14–21) for asymptomatic patients. Predictors for symptoms included abnormal procalcitonin (aOR 6.6; 95% CI 1.48 -29.3), C-reactive protein (aOR 9.10; 95% CI 1.29–32.13), and X-ray finding of pneumonia (aOR 6.44; 95% CI 1.29–32.13).

Conclusion
Asymptomatic SARS-CoV-2 infection is very common in children. Among symptomatic patients, the disease seems to be mild. Children exhibit substantial duration of viral shedding, as measured by PCR positivity, regardless of symptoms.

Disclosures
Jesse Papenburg, MD, AbbVie (Consultant, Scientific Research Study Investigator, Research Grant or Support, Speaker’s Bureau)BD Diagnostics (Research Grant or Support)Cepheid (Speaker’s Bureau)MedImmune (Scientific Research Study Investigator)Sanofi Pasteur (Scientific Research Study Investigator)Seegene (Research Grant or Support, Speaker’s Bureau)
444. Coronavirus Disease 2019 (COVID-19) Among Healthcare Workers in Southeast Michigan
Authors: Vahia Amit T , Chaudhry Zohra Sarfraz , Weinmann Allison J , Samuel Linoj , Tibbetts Robert , Alangaden George J , Suleyman Geehan 
Published: January 2021

Abstract

Background
Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has significantly impacted Michigan, with over 60,000 cases and 5,700 deaths to date. During the surge, Metropolitan Detroit was the epicenter of the outbreak, accounting for 80% of cases and 86% of deaths statewide. Healthcare workers (HCW) are particularly at risk; however, rates of infection based on job category has not been described previously in the United States. We describe the impact of the outbreak on our workforce.
Background Michigan COVID

Figure 1

Methods
This was a retrospective review of employees with COVID-19 at Henry Ford Health System (HFHS), a comprehensive, integrated, health care organization in Southeast Michigan includes 5 hospitals and 9 emergency departments from 3/10/2020–6/10/2020. Employees exhibiting symptoms and/or signs consistent with COVID-19 infection were referred to employee health and tested for SARS-CoV-2. All employees with positive polymerase chain reaction (PCR) of upper respiratory tract were included. Data were obtained from a dedicated analytics dashboard that tracked all testing and results for employees. Rate (number positives/total tested) of infection for each job category was determined.

Results
A total 5352 (16%) of 33538 employees were tested, of whom 1036 (19%) tested positive. The number of infected workers represents approximately 3.1 % of the workforce. The sharp increase of COVID-19 admissions correlated with the rise in HCW COVID-19 positivity (Figure 1). The number of HCW tested largely correlated with the disease burden at each hospital (Figure2). Table 1 shows total population of symptomatic HCW tested and demonstrates volume of testing and positivity were higher among HCW with close patient contact. The positivity rates in specific clinical support staff are shown in Table 2. Notably, there were high rates of positivity among non-clinical business and management employees tested suggesting community-transmission.
Table 1

Table 2

Figure 2

Conclusion
COVID-19 risk is highest among HCW in high volume settings with close patient contact. Community exposure may be an important factor that contributes to this risk. Strategies to minimize transmission in healthcare settings should be combined with HCW education emphasizing measures to avoid exposure within the community.

Disclosures
All Authors: No reported disclosures
445. Correlative Factors for State to State Differences in the Prevalence and Case Fatality Rates of SARS-CoV-2, COVID-19 Infections in the United States of America
Authors: Kamar Amanda J , Doniparthi Meghana , Nhan Nhan , Zhou Ying , Colton James A , Ehrenpreis Eli D 
Published: January 2021

Abstract

Background
Individual States of the USA have ethnic, economic, community health and education differences that influence the prevalence and outcomes of COVID-19 infection. We hypothesized that Statewide differences in the prevalence and fatality rates of COVID-19 infections are dependent on factors that may be determined by mathematical modeling.

Methods
Two separate statistical regression models were developed using COVID-19 case prevalence and case fatality rates functioning as dependent variables. We obtained data from the prevalence and deaths from COVID-19 cases for each state in the USA that was posted at 4 PM Central Standard Time on April 29, 2020 from the Worldometer website. Publicly available databases were utilized to obtain data for the independent variables in the model.

Results
Models are represented as follows:
Statewide COVID-19 Prevalence Model
Log (Statewide COVID_19 case prevalence) = 1.847* (100–250 individuals/mile2) +3.0025*(250+ individuals/mile2) + 1.021* (% African American population) +1.029* (% Hispanic American population +2.164 *(% adults aged 85+)
Model results are shown in Table 1.
Statewide COVID-19 Case Fatality Rate Model
Log (Statewide COVID_19 case fatality rate) =2.194* (100–250 individuals/mile2) +2.758* (250+ individuals/mile2) +1.031* (% African American population) + 1.032* (% Hispanic American population) + 0.942 (% Native American population)+ 1.108 (% Asian American population) + 2.275 (% adults aged 85+)
Model results are shown in Table 2.
Table 1: COVID-19 Statewide Prevalence Model

Table 2: COVID-19 Statewide Case Fatality Model

Conclusion
Higher State population density (See Figure 1 and Figure 2) and higher State populations of elderly persons correspond to increased prevalence and case-fatality rates of COVID-19 infections. Statewide data also shows health disparities for COVID-19 infections in Hispanic Americans, African Americans, and Asian Americans. Paradoxically, States with larger populations of Native Americans who have known poor outcomes from COVID-19 infection demonstrate a decrease in case-fatality rates, suggesting a large effect of healthcare inequality in this population.
Figure 1: ANOVA one-way analysis of the association between COVID-19 prevalence and population density

Figure 2: ANOVA one-way analysis of the association between COVID-19 death prevalence and population density

Disclosures
Eli D. Ehrenpreis, MD, FACG, AGAF, E2Bio Consultants (Board Member, Chief Executive Officer)E2Bio Life Sciences (Shareholder, Chief Executive Officer)Level Ex, Inc. (Consultant)
448. Disproportionate Burden of COVID-19 on Latinx Residents among Hospitalized Patients at San Francisco’s Public Health Hospital
Authors: Jain Vivek , Brown Lillian B , Marquez Carina , Rubio Luis , Spottiswoode Natasha , Churnet Bethlehem , Brooks Katherine , Zhou Mengyu , Muldoon Timothy , Hendrickson Carolyn , Cattamanchi Adithya , Gomez Antonio , Haas Brian , Charlebois Edwin , Luetkemeyer Annie , Luetkemeyer Annie , Gandhi Monica , Havlir Diane , Ranji Sumant , Winston Lisa Gail 
Published: January 2021

Abstract

Background
San Francisco implemented one of the earliest shelter-in-place public health mandates in the U.S., with flattened curves of diagnoses and deaths. We describe demographics, clinical features and outcomes of COVID-19 patients admitted to a public health hospital in a high population-density city with an early containment response.

Methods
We analyzed inpatients with COVID-19 admitted to San Francisco General Hospital (SFGH) from 3/5/2020–5/11/2020. SFGH serves a network of &gt;63,000 patients (32% Latinx/24% Asian/19% African American/19% Caucasian). Demographic and clinical data through 5/18/2020 were abstracted from hospital records, along with ICU and ventilator utilization, lengths of stay, and in-hospital deaths.

Results
Of 157 admitted patients, 105/157 (67%) were male, median age was 49 (range 19-96y), and 127/157 (81%) of patients with COVID-19 were Latinx. Crowded living conditions were common: 60/157 (38%) lived in multi-family shared housing, 12/1578 (8%) with multigenerational families, and 8/157 (5%) were homeless living in shelters. Of 102 patients with ascertained occupations, most had frontline essential jobs: 23% food service, 14% construction/home maintenance, and 10% cleaning. Overall, 86/157 (55%) of patients lived in neighborhoods home to majority Latinx and African-American populations. Overall, 45/157 (29%) of patients needed ICU care, and 26/157 (17%) required mechanical ventilation; 20/26 (77%) of ventilated patients were successfully extubated, and 137/157 (87%) were discharged home. Median hospitalization duration was 4 days (IQR, 2–10), and only 6/157 (4%) patients died in hospital.

Conclusion
In San Francisco, where early COVID-19 mitigation was enacted, we report a stark, disproportionate COVID-19 burden on Latinx patients, who accounted for 81% of hospitalizations despite making up only 32% of the patient base and 15% of San Francisco’s total population. Latinx inpatients frequently lived in high-density settings, increasing household risk, and frequently worked essential jobs, potentially limiting the opportunity to effectively distance from others. We also report here favorable clinical outcomes and low overall mortality. However, an effective COVID-19 response must urgently address racial and ethnic disparities.

Disclosures
All Authors: No reported disclosures
451. Evaluation of Exposure History in Healthcare Personnel with Coronavirus 2019 Disease
Authors: Silva Sandra , Mana Thriveen , Bhullar Davinder , Tabor Beatrice , Donskey Curtis 
Published: January 2021

Abstract

Background
During the Coronavirus Disease 2019 (COVID-19) pandemic, many healthcare personnel (HCP) have developed COVID-19. However, there is uncertainty regarding whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was acquired at work versus in the community.

Methods
We conducted a cohort study to examine exposure history of personnel with COVID-19 infection or asymptomatic carriage in a VA healthcare system. High-risk exposures were classified based Centers for Disease Control and Prevention criteria.

Results
Of 578 personnel tested, 49 (8%) had nasopharyngeal swabs with positive PCR results, including 45 (92%) with and 4 (8%) without COVID-19 symptoms. Of the 49 cases, 21 (43%) had a documented high-risk exposure at work, including 14 exposures to COVID-19 patients and 7 exposures to colonized or infected personnel. Exposures to infected patients most often were a result of delays in recognition of COVID-19 due to atypical presentations. Exposures to personnel with COVID-19 most often involved activities such as meals when facemasks were not worn. Most cases occurred among nurses (26, 53%) and administrative personnel (10, 20%); only 3 physicians developed COVID-19. No cases occurred in personnel working on COVID-19 wards. All personnel had mild or moderate disease.

Conclusion
Forty-three percent of healthcare personnel with COVID-19 had prior high-risk exposures at work. Improved detection of patients with atypical presentations and efforts to reduce high-risk contacts among personnel may reduce the risk for acquisition of SARS-CoV-2.

Disclosures
All Authors: No reported disclosures
452. Familial Cluster of COVID-19 Cases Associated with High Prevalence of Anosmia, Ageusia, and Gastrointestinal Symptoms
Authors: Ho Bethany E , Ho Andrea P , Ho Michaela A , Ho Elizabeth C 
Published: January 2021

Abstract

Background
Patients with COVID-19 most commonly report respiratory symptoms, with a minority reporting gastrointestinal (GI) symptoms in currently available reports. Additionally, little is known about the symptoms of anosmia/hyposmia, ageusia, and dysgeusia anecdotally seen in COVID-19 patients, which may be considered both GI and sensory/neurological manifestations of infection.

Methods
We interviewed 7 patients via oral inquiries and a questionnaire, collecting data on subject symptoms and their durations. Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to confirm 2 of these cases.

Results
We report a familial cluster of 7 COVID-19 cases, 5 of whom reported sensory symptoms of anosmia/hyposmia (5/7), ageusia/hypogeusia (5/7), and/or dysgeusia (3/7). All 7 cases reported GI involvement with one or more symptom of: nausea (5/7), diarrhea (4/7), abdominal pain (3/7), anorexia (3/7), and emesis (2/7).
Figure 1. Timeline of Symptoms and Exposure to Index Case in Familial COVID-19 Cluster

Conclusion
This frequency of GI symptoms is high relative to currently available epidemiological reports, which also infrequently report on sensory symptoms. The mechanistic underpinnings of GI and sensory symptoms in COVID-19 warrant close consideration and analysis, especially as it relates to reducing disease transmission. COVID-19 exhibits wide variation in duration, severity, and progression of symptoms, even within a familial cluster.

Disclosures
All Authors: No reported disclosures
455. Hepatic Laboratory Abnormalities Associated with Disease Severity in Patients with COVID-19: A Pooled Analysis of 6 Retrospective Cohort Studies Including 755 Patients
Authors: Cheng Ce , Lang Anqi , Finnigan Nancy 
Published: January 2021

Abstract

Background
Patients with COVID-19 are at high risks of developing significant pulmonary complications. However, its possible hepatic involvement has not been researched extensively. This study amis to analyze liver abnormality associated with disease severity in patients with COVID-19.

Methods
This was a pooled analysis of 6 retrospective, cohorts studies including 755 Chinese adult patients (&gt; 18 years) diagnosed with COVID-19, admitted from January through February 2020. These patients were classified into two groups: non- severe and severe, based on interim guidelines of World Health Organization and the National Health Commission of China. Patients would be classified into severe group if one of three following criteria were met: respiratory rate &gt; 30 breaths/min, SpO2 &lt; 93% on room air, or PaO2/FiO2 ≤ 300mmHg. Results were analyzed with Student’s t- test, Pearson’s Chi-Squared test and Wilcoxon rank-sum test by SAS Enterprise Guide 7.1.
Table 1: Pooled Results

Results
755 Chinese adult patients (&gt;18 years) with COVID-19 were included. Gender of male (OR 1.95; 95% CI 1.26–3.0; P=0.0022), and Wuhan region (OR 2.17; 95% CI 1.4–3.34; P= 0.0004) were significantly associated with the severe group compared with the non-severe group. Also the severe group had a significant lower albumin (g/dL) (3.5±1.1 vs. 4.1±1.0, P= 0.001), higher AST (U/L) (34.1±24.8 vs. 22.3±17.9, P= 0.001), and higher CRP (mg/L) (54.1±122.2 vs. 9.3±59.0, P= 0.0135) compared with the non-severe group. Surprisingly, no significant difference of age between these two groups was identified. Furthermore, no significant difference of ALT, Total bilirubin, D-dimer or INR with disease severity were identified.
Table 2: Lab Results And Age With Disease Severity

Table 3: Age And Location With Disease Severity

Figure 1: Variables Comparison Severe vs. Non- Severe

Conclusion
This study demonstrated that male gender and of Wuhan origin were significantly higher in proportion in the severe group. Of Wuhan origin as a risk factor of severe COVID-19 could be explained by limited medical resources for overwhelming COVID-19 patients in Wuhan during the period of January and February 2020. It is unclear why male was the risk factor of severe COVID-19 based on our data. Also, there were significant lower Albumin, higher AST and CRP in severe COVID-19, but their values were not too impressive. However due to limited data and studies, future studies are needed to elucidate risks factors associated with severe COVID-19.
Figure 2: Locations of Patients by Cities

Locations of Severe COVID-19 by Cities

Disclosures
All Authors: No reported disclosures
457. Low Rates of COVID-19 in a Vulnerable Population: Learning from Early and Decisive Public Health Policies
Authors: Donaldson Mira , Edeer Nazde , Bhangu Gurjeet , Greiner Jesse , Murray Melanie 
Published: January 2021

Abstract

Background
Disasters, including pandemics, disproportionately affect vulnerable populations. The Downtown Eastside (DTES) neighborhood of Vancouver has high prevalence of mental illness, substance use, infectious disease and homelessness. While studies have described clinical characteristics of COVID-19 patients in other centres worldwide, data is lacking on marginalized groups. We describe the clinical characteristics and outcomes of COVID-19 patients seen at two urban hospitals who care for the vulnerable population in the DTES of Vancouver, British Columbia (BC), Canada.

Methods
A retrospective chart review was conducted on all COVID-19 patients ≥19 years seen at either centre from January 1 to June 10, 2020. Descriptive statistics assessed demographics, comorbidities, presenting symptoms, laboratory values and outcomes, and were compared between subjects managed as inpatients (died vs. discharged) and outpatients.

Results
Of 71 COVID-19 subjects, mean age was 57y (SD 20); 36 (51%) were male. Time to presentation, symptoms and laboratory values were similar to other reports. 58 (82%) presented from the community, 3 (4%) from long-term care/rehabilitation centres, and 8 (11%) had no fixed address (NFA) or lived in the DTES. 45 (64%) had a known exposure, 20 (28%) were healthcare workers, 85% involved in direct patient care; 0/20 were admitted to hospital. Of the 8 NFA/DTES subjects, mean age was 46y (SD 13), 50% were male, 5 (63%) were admitted to hospital and all survived.
Admitted subjects (n=34) were older (mean age 69 vs 46y, p&lt; 0.001), 62% were male, and had more comorbidities (mean [SD] 3 [3] vs. 1 [2], p&lt; 0.001). Eight (24%) died, 26 (76%) were discharged, 29% developed acute respiratory distress syndrome, 21% secondary infection, 18% renal failure, and 15% cardiac dysfunction. Of patients admitted to intensive care, 5/10 died.

Conclusion
Our results concur with other studies showing older age and comorbidities contribute to more severe COVID-19 disease. 64% of subjects had a known exposure, and only 11% had NFA/DTES residence. Given that there is no financial barrier to access healthcare in Canada and these hospitals serve our most vulnerable populations, our results may indicate that BC Public Health has done an effective job of tracking and limiting community spread of COVID-19.

Disclosures
All Authors: No reported disclosures