bluuebunny/crossref_metadata_2025_split huggingface dataset:
407. Minimum Manufacturing Costs, National Prices and Estimated Global Availability of New Repurposed Therapies for COVID-19
Authors: Wang Junzheng , Levi Jacob , Ellis Leah , Hill Andrew 
Published: December 2021

Abstract

Background
Currently, only dexamethasone, tocilizumab and sarilumab have conclusively been shown to reduce mortality of COVID-19. No drug for prevention or treatment in earlier stages of COVID-19 are yet found, with previously promising drugs such as hydroxychloroquine and remdesivir have been shown to be ineffective. Several new candidates are now being studied in clinical trials. Safe and effective treatments will need to be both affordable and widely available. We therefore revised our original 2020 analysis to reflect recent developments. In this update we analysed the cost of production, current national list prices, and API availability for oral and IV dexamethasone, ivermectin, colchicine, dutasteride, budesonide, baricitinib and monoclonal antibodies tocilizumab and sarilumab.

Methods
Costs of production for new and potential COVID-19 drugs (dexamethasone, ivermectin, dutasteride, budesonide, baricitinib, tocilizumab, sarilumab and colchicine) were estimated using an established and published methodology based on costs of active pharmaceutical ingredients (API), extracted from the global shipping records database Panjiva. This was compared with national pricing data from low, medium, and high-income countries. Annual API export volumes from India were used to estimate the current availability of each drug.

Results
Repurposed therapies can be generically manufactured at very low per-course costs: ranging from &2.58 for IV dexamethasone (or &0.19 orally) to &0.12 for ivermectin. No export price data was available for baricitinib, tocilizumab or sarilumab. When compared against international list prices, we found wide variations between countries. Drug API availability was generally good, with colchicine being the most available with sufficient annual API exported for 59.8 million treatment courses. A summary is shown in Table 1.
Table 1. Summary of list prices, estimated production costs, and current availability of potential COVID-19 drugs selected for analysis. OD = Once daily, BD = twice per day, EUA = Emergency Use Authorisation (only to be given with remdesivir) *In most recent 12-month period.

Conclusion
Successful management of COVID-19 will require equitable access to treatment for all, not just those able to pay. Repurposed drugs can be manufactured at very low costs if shown to be clinically effective, and offers an affordable, widely available option for patients at all stages of the disease from pre-exposure prophylaxis to asymptotic and mild infections, through to critical care until vaccination coverage is expanded.

Disclosures
All Authors: No reported disclosures
409. High Engagement in Social Distancing and Mask Wearing and Associations with Reduced COVID-19 Infection Among California College Students
Authors: Walicek Lindsey , Regan Annette , L’Engle Kelly , Couture Marie-Claude 
Published: December 2021

Abstract

Background
Engaging in preventive behaviors, including face mask wearing and social distancing, has been widely recommended, and in some cases mandated, to limit the spread of the COVID-19 disease. Despite wide-scale use, there is little data available on engagement of mask wearing and social distancing in college students and associated COVID-19 infection.

Methods
A school-wide online survey was conducted (2021) among university students (n=2,132) in California. Frequency of mask-wearing and social distancing (indoors or public settings) and diagnosis with COVID-19 infection were measured. Multiple logistic regression models assessed associations between i) mask-wearing and ii) social distancing and COVID-19 infection, controlling for race, age, gender, and living with people who have high-risk health conditions.

Results
Fourteen percent (14.06%) reported previous COVID-19 infection. Most students reported wearing masks in public settings (77.9%) and indoors (58%). About half (49.9%) reported social distancing in public settings and 44.9% indoors. In multiple logistic regression models, wearing a mask indoors was associated with 30% lower odds of COVID-19 infection (OR= 0.70; 95% CI: 0.54,0.91) but no statistically significant association was observed for wearing a mask outdoors (OR= 0.80; 95% CI: 0.59,1.08). Social distancing indoors and outdoors was associated with a 34% (OR= 0.66; 95% CI: 0.50,0.86) and 32% (OR= 0.68; 95% CI: 0.52,0.88) decrease in the odds of infection, respectively. COVID-19 infection declined as the number of preventive behaviors a student engaged in increased. Compared to those who engaged in no preventive behavior, the odds of infection were 0.71 (95% CI: 0.46,1.11) among students engaging in one behavior, 0.70 (95% CI: 0.46,1.07) in two behaviors, 0.42 (95% CI: 0.25,0.70) in three behaviors, and 0.48 (95% CI: 0.31,0.74) among those who engaged in all four behaviors.

Conclusion
Wearing face masks and social distancing were both associated with lower odds of COVID-19 infection. The more preventive behaviors students engaged in the less frequently they reported COVID-19 infection. Our findings support existing guidelines promoting mask wearing and social distancing to limit the spread of COVID-19 disease.

Disclosures
All Authors: No reported disclosures
410. The Importance of Personal Protective Equipment Education Opportunities and Messages of Encouragement at the Workplace to Reduce Burnout: Cross-sectional Survey After the First Wave of the COVID-19 Pandemic in Japan
Authors: Matsuo Takahiro , Taki Fumika , Kobayashi Daiki , Jinta Torahiko , Suzuki Chiharu , Ayabe Akiko , Sakamoto Fumie , Kitaoka Kazuyo , Uehara Yuki , Mori Nobuyoshi , Fukui Tsuguya 
Published: December 2021

Abstract

Background
The rapid spread of the COVID-19 pandemic has taken a considerable mental strain on frontline healthcare workers (HCWs). Although a number of studies have reported on burnout during the peak of the pandemic, few studies have analyzed it after the pandemic temporally subsided. This study aimed to identify which intervention or support was helpful to reduce the physical and mental burden during the pandemic.

Methods
An online cross-sectional survey of HCWs from June 15 to July 6, 2020, was conducted at a tertiary hospital in Tokyo, Japan. Demographic characteristics, results of the Japanese version of the Maslach Burnout Inventory-General Survey, types of anxiety and stress, changes in life and work after the peak of the pandemic, and types of support aimed at reducing the physical or mental burden, were determined.

Results
Out of 672 HCWs, 149 (22.6%) met the overall burnout criteria. Figure 1 showed the comparison of what helped reduce their physical and mental burden between the burnout group and the non-burnout group. After adjusted by the potential covariates, burnout was more prevalent in women (OR, 3.11; 95% CI, 1.45–6.67; p = .003), and had heightened anxiety due to unfamiliarity with PPE (OR, 1.98; 95% CI, 1.20–3.27; p=.007). Conversely, participants who reported that PPE education opportunities (OR, .484; 95% CI, .236–.993; p = .048) and messages of encouragement at the workplace (OR, .584; 95% CI, .352–.969; p = .037) helped reduce their physical and mental burden had less burnout.
Figure 1. What factors helped reduce the physical or mental burden

Conclusion
The educational interventions for PPE and messages of encouragement at the workplace may be needed to reduce the mental burden for HCWs.

Disclosures
All Authors: No reported disclosures
411. Significance of a Known Epidemiological Link to a COVID-19 Index Case and Severity of COVID-19 Infection
Authors: Kandel Christopher , McGeer Allison , Friedland Joshua , Shigayeva Altynay , Mubareka Samira 
Published: December 2021

Abstract

Background
Several factors have been associated with severity of COVID-19 disease, but there remains a paucity of data surrounding whether the nature of exposure is impactful. Evidence demonstrating the correlation between initial viral exposure dose and disease severity exists for many viral infections. Observational studies have suggested that the exposure context, which can be considered a proxy for magnitude of viral inoculum, may influence severity of COVID-19 infection. We aimed to assess whether having a known exposure, as a proxy for higher inoculum dose to COVID-19, was associated with more severe outcomes for individuals hospitalized with COVID-19.

Methods
We created a retrospective cohort of community-dwelling adults hospitalized for COVID-19 in south-central Ontario from April 1, 2020 - January 14, 2021. Individuals or next of kin were contacted to ascertain exposure history. The primary outcome was death, intensive care unit (ICU) admission, or mechanical ventilation (MV) within 30 days of admission. A multivariable logistic regression model was used to determine whether a known exposure was associated with worse outcomes.

Results
1097 individuals with community acquired COVID-19 required hospitalization; of these, 942 (86%) had available exposure data. In this group, the median age was 65, 44% were women, 84% lived in a private residence, 59% had a frailty score (FS) of 1 – 3 while 40% had a FS of 4 – 9, and 28% had a known exposure. Overall, the primary outcome occurred in 368/942 (39%) patients. Having a known exposure was not associated with worse outcome (OR 1.14, 95% CI 0.84–1.54, p = 0.41). Male gender (OR 1.41, 95% CI 1.06–1.89; p = 0.018), age (OR 1.01/year, 95% CI 1.00–1.03, p = 0.03), frailty (OR 1.22/point, 95% CI 1.09–1.36, p = 0.001) and living with at least one other person (OR 1.57, 95% CI 1.09–2.28, p = 0.017) were all associated with death, ICU admission, or MV within 30 days of admission.

Conclusion
While having a known exposure to a person with COVID-19 was not associated with worse outcome, the identified increased severity of illness associated with cohabitation suggests context of exposure may have a role in disease severity. This data and future studies can be used to guide public health recommendations to not only minimize transmission, but severity of COVID-19 infection.

Disclosures
All Authors: No reported disclosures
412. Estimating the Impact of School Classroom Sizes on the Probability of Severe Acute Respiratory Syndrome Coronavirus-2 Infectivity or Exposure
Authors: Thomas Sanya J , Young Rebecca R , Akinboyo Ibukunoluwa , Smith Michael J , Buckley Tara , Lewis Sarah S 
Published: December 2021

Abstract

Background
Despite schools reopening across the United States in communities with low and high Coronavirus disease 2019 (COVID-19) prevalence, data remain scarce about the effect of classroom size on the transmission of severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) within schools. This study estimates the effect of classroom size on the risk of COVID-19 infection in a closed classroom cohort for varying age groups locally in Durham, North Carolina. Total number of Coronavirus Disease 2019 (COVID-19) infections over a 28-day follow-up period for varying classroom reproduction number (R0) and varying classroom cohort sizes of 15 students, 30 students and 100 students in Durham County, North Carolina.

Methods
Using publicly available population and COVID-19 case count data from Durham County, we calculated a weekly average number of new confirmed COVID-19 cases per week between May 3, 2020 and August 22, 2020 according to age categories: &lt; 5 years, 5-9 years, 10-14 years, and 15-19 years. We collated average classroom cohort sizes and enrollment data for each age group by grade level of education for the first month of the 2019-2020 academic school year. Then, using a SEIR compartmental model, we calculated the number of susceptible (S), exposed (E), infectious (I) and recovered (R) students in a cohort size of 15, 30 and 100 students, modelling for classroom reproduction number (R0) of 0.5, 1.5 and 2.5 within a closed classroom cohort over a 14-day and 28-day follow-up period using age group-specific COVID-19 prevalence rates.

Results
The SEIR model estimated that the increase in cohort size resulted in up to 5 new COVID-19 infections per 10,000 students whereas the classroom R0 had a stronger effect, with up to 88 new infections per 10,000 students in a closed classroom cohort over time. When comparing different follow-up periods in a closed cohort with R0 of 0.5, we estimated 12 more infected students per 10,000 students over 28 days as compared to 14 days irrespective of cohort size. With a R0 of 2.5, there were 49 more infected students per 10,000 students over 28 days as compared to 14 days.

Conclusion
Classroom R0 had a stronger impact in reducing school-based COVID-19 transmission events as compared to cohort size. Additionally, earlier isolation of newly infected students in a closed cohort resulted in fewer new COVID-19 infections within that group. Mitigation strategies should target promoting safe practices within the school setting including early quarantine of newly identified contacts and minimizing COVID-19 community prevalence.

Disclosures
Michael J. Smith, MD, M.S.C.E, Merck (Grant/Research Support)Pfizer (Grant/Research Support)
416. Diagnostic Yield of Serial COVID-19 Testing in Hospitalized Patients
Authors: Li Jeremy , Frenette Charles , Loo Vivian 
Published: December 2021

Abstract

Background
Accurate and rapid diagnosis of SARS-CoV-2 infection is essential to prevent nosocomial transmission. Patients with negative COVID-19 tests at admission may still be in the incubation phase during hospitalisation. False negative results can occur when patients are tested too early. The incidence of COVID-19 infections in Montréal, Canada started to increase in December 2020. Because of this rise, on January 4th, 2021, the Infection Control Service of the McGill University Health Centre (MUHC) recommended serial COVID-19 testing for all admitted patients on days 5 and 10 after admission. The aim of this study is to examine the diagnostic yield of serial COVID-19 testing.

Methods
We retrospectively analyzed SARS-CoV-2 test results for patients admitted to the MUHC between January 4, 2021, and April 30, 2021. Nasopharyngeal swabs were collected from patients for SARS-CoV-2 PCR testing. Multiple testing platforms were used (Roche Cobas 6800, Thermo ScientificTM King Fisher and Cepheid GeneXpert) because of the high volume of samples. Tests were classified as admission, day 5, and day 10 tests if they were done on days 0 to 2, 3 to 7, and 8 to 12 respectively. Patients positive for SARS-CoV-2 on admission were excluded from the analyses. The diagnostic yield of serial testing for patients admitted during each month was calculated by dividing the number of patients testing positive on day 5 or day 10 by the total number of patients who underwent serial testing during that month.

Results
There were 2945 admissions of 5 days or more and 1777 admissions of 10 days or more. Of these, 1509 patients and 841 patients respectively were serially tested for SARS-CoV-2 as recommended for a compliance rate of 51% at day 5 and 47% at day 10. Ten (0.7%) and 12 (1.4%) patients tested positive on days 5 and 10 respectively. The diagnostic yield of serial testing was highest for patients admitted in January 2021 at 2.2%, when the average daily incidence of COVID-19 was highest in Montréal (see Figure).

The diagnostic yield of serial testing for each month, compared to the average daily COVID-19 incidence rate in Montréal, Québec, Canada.

Conclusion
The diagnostic yield of serial SARS-CoV-2 testing in hospitalized patients is low when the overall community incidence is low. However, diagnostic yield of serial testing increases when community incidence of COVID-19 is higher and should be considered in this situation.

Disclosures
All Authors: No reported disclosures
417. COVID-19 Aerostudy: Evaluation of SARS-CoV-2 Virus in the Air of Patients Hospitalized with COVID-19
Authors: Hamza Hamed , Seitsema Margaret , Conroy Lorraine , Mena Lora Alfredo J , Wenzler Eric , Borgetti Scott , Ladner Benjamin , Cable Tracy , Dahlquist ashley , Ismail Nahed , Fisher Steven , Ali Taha , Sweeney Dagmar , Bleasdale Susan C 
Published: December 2021

Abstract

Background
At the onset of the COVID-19 pandemic, hospitals implemented infection control measures with limited data on predictors of nosocomial SARS-CoV-2 transmission. We aimed to quantify SARS-CoV-2 presence in an inpatient setting to understand nosocomial risk.

Methods
Patients admitted with confirmed SARS-CoV-2 infection at an urban academic hospital were enrolled. Demographic/clinical characteristics, a PCR nasal swab(NS), and air samples on filter media in the near- (&lt; 6ft) and far-field ( &gt;6ft) of each patient for 3.5 hours were collected. PCR was used to detect SARS-CoV-2 on filter media. Associations between clinical characteristics and presence of SARS-CoV-2 in air samples used Fisher’s exact and Wilcoxon rank sum tests.

Results
Of 52 subjects, 46% had no detectable virus by nasal swab on the day of sampling. Of 104 room air samples, 16% had detectable virus from 25% of rooms, including 10 near and 7 far field samples. Subjects with a positive room air sample had fewer days from symptom-onset compared with those with a negative air sample (median 6 vs. 8, p=0.24). Being on room air and having a nasal swab positive increased the odds of detecting virus in air samples but were not statistically significant.

Conclusion
A small number of air samples with detectable SARS-CoV-2 may suggest lower nosocomial risk than previously anticipated. Multiple subject and environmental factors may have contributed to this finding including patient source control masking, anti-viral therapies and HEPA filtration. The decreased association of virus in the air of those with more days of symptoms but with the need for supplemental oxygen may be related to what is now known about the COVID-19 inflammatory response after the infectious period.

Disclosures
All Authors: No reported disclosures
418. Low Frequency of Healthcare Worker Infections Following Occupational Exposures to COVID-19
Authors: Seidelman Jessica , Akinboyo Ibukunoluwa , Rinehart Maya , Stiegel Matthew , Moehring Rebekah W , Anderson Deverick J , Said Kristen , Epling Carol A , Lewis Sarah S , Smith Becky 
Published: December 2021

Abstract

Background
Data on occupational acquisition of COVID-19 in healthcare settings are limited. Contact tracing efforts are high resource investments.

Methods
Duke Health developed robust COVID-19 contact tracing methods as part of a comprehensive prevention program. We prospectively collected data on HCW exposures and monitored for development of symptomatic (SYX) and asymptomatic (ASYX) COVID-19 infection after documented high-, medium, and low-risk exposures. HCWs were required to self-report exposures or were identified through contact tracing as potentially exposed to COVID-19 positive HCWs, patients or visitors. Contact tracers interviewed exposed HCWs and assessed the risk of exposure as high-, medium-, or low-risk based on CDC guidance (Table 1). Testing was recommended at 6 days after high- or medium-risk exposures and was provided upon HCW request following low-risk exposures. Our vaccination campaign began in 12/2020.

Results
12,916 HCWs registered in the contact tracing database. From March 2020-May 2021, we identified 6,606 occupational exposures (0.51 exposures/HCW). The highest incidence of workplace exposures per number of HCWs in each job category was among respiratory therapists (RT) (0.95 exposures/RT), nursing assistants (NA) (0.79 exposures/NA), and physicians (0.64 exposures/physician). The most common exposure risk level was medium (51.4%), followed by low (35.5%), and then high (13.1%). A total of 260 (2%) HCW had positive tests/conversions; 28 (10.8%) were ASYX at the time of testing. High-risk exposures had a significantly greater number of post-exposure infections compared to medium- and low-risk exposures (12.5% vs. 4.2%, vs. 0.4%; p &lt; 0.001). The rate of SYX infection following exposure to a fellow HCW (179/3,198; 5.6%) was higher than that following exposure to a patient (81/3,408; 2.4%; p&lt; 0.001).

Conclusion
Conversion following exposure to COVID-19 in the healthcare setting with appropriate protective equipment was low. Incomplete testing of all exposed individuals was a limitation and our data may under-estimate the true conversion rate. Our findings support our local practice of not quarantining HCWs following non-household exposures. Limiting contact tracing to only high or medium risk exposures may best utilize limited personnel resources.

Disclosures
Rebekah W. Moehring, MD, MPH, UpToDate, Inc. (Other Financial or Material Support, Author Royalties)
420. Emergency Nurses’ Experiences over 1 Year of the COVID-19 Pandemic: A Qualitative Study
Authors: Lee Ki Rog , Kang JaHyun 
Published: December 2021

Abstract

Background
At the frontline of fighting against the coronavirus disease 2019 (COVID-19) pandemic, emergency room (ER) nurses are faced with various challenges throughout the provision of emergency care for incoming patients without knowing their COVID-19 status. However, little is known about their work burden, exhaustion, and psychological distress in the pandemic. Therefore, to provide basic data for effective counterstrategies against future emerging infectious diseases in the ER, this study aims to understand ER nurses’ COVID-19 work experiences in depth at one tertiary hospital over 1 year.
Table 1. Summary of Qualitative Responses Regarding Emergency Room Nurses’ COVID-19 Pandemic Experience

Methods
This study was conducted at a 2,715-bed tertiary hospital in Seoul, Korea. Using a purposeful sampling method, we recruited 20 nurses who have worked for more than 1 year in the ER and have capacity for independent care for COVID-19 patients. With institutional review board approval, one-on-one individual, in-depth interviews were completed using a semi-structured questionnaire from February 13 to March 25, 2021. After recording and transcribing interviews, the narrative data were analyzed using a thematic analysis method.

Results
The 20 participants were 29.9 years old on average with 69.2 months’ clinical experience. The overarching theme was derived as ‘COVID-19 highlighted the importance of ER’s infection control and ER nurses’ professional dedication’ covering 6 sub-themes and 16 concepts (Table 1). Sub-themes were ‘psychological burden of handling COVID-19 patients directly’, ‘unprecedented changes for ER’s response to the pandemic’, ‘revealing hospital’s lack of support for ER’, ‘withdrawal from social life as ER nurses’, ‘re-illuminating nurses’ calling for their occupation’, and ‘planning for the post COVID-19 era’.

Conclusion
ER nurses experienced challenges from their drastically changed tasks, received poor compensation from the hospital, and felt pressure from social expectations towards medical personnel. However, nurses showed enough dedication towards their jobs, considered pandemic experience as a valuable asset to their future career, and maintained a positive attitude towards difficulties in ER. Providing comprehensive support for ER nurses is necessary to improve ER infection control to respond to the pandemic.

Disclosures
All Authors: No reported disclosures