bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1968. Mask fatigue, compliance, and illness among healthcare workers during the COVID-19 pandemic
Authors: Patel Ria , Jayaram Aparna , Ali Mirza , Mena Lora Alfredo J 
Published: January 2025

Abstract

Background
During the COVID-19 pandemic, healthcare facilities frequently adopted mandatory masking to protect patients and healthcare workers (HCWs). Although effective in preventing virus spread, prolonged masking can induce discomfort and fatigue among HCWs. As the pandemic progressed, the prolonged use of masks became a source of growing discomfort and presented increasing challenges with masking policy compliance. There is a paucity of data on masking fatigue among HCWs.
Mask use in HCWs with mask fatigue

Methods
We performed an anonymous survey of at two hospitals in Chicago. An anomyous survey was sent via hospital list-servs to all HCWs. The survey was sent on May 23, 2023 and collected the clinical roles of participants, masking habits during the pandemic, masking fatigue, and self-reported influenza-like illness (ILI). Data was tabulated and descriptive statistics used.
Differences in sickness frequency as a correlate of mask fatigue

Results
A total of 90 HCWs provided responses, with 66% experiencing mask fatigue throughout the study period. In 2020, among HCWs who reported mask fatigue, 46% of always wore their masks, while 3% never wore masks (Figure 1). In 2021, HCWs who always wore their masks decreased to 6%, while the percentage of HCWs who never wore their masks increased to 26% (p=0.0075). An statistically significant increase (p=0.0312) in reported ILI was seen among HCWs with mask fatigue in 2021 (Figure 2).

Conclusion
Masking fatigue was common during the pandemic and increased with time. Reduced masking due to this fatigue may have led to increased ILI in HCWs. Fatigue and non-compliance can contribute to HCW absenteeism and transmission to vulnerable patients. Finding strategies to mitigate mask fatigue and ensure consistent adherence to masking policies is critical during respiratory virus season or future respiratory pandemics.

Disclosures
All Authors: No reported disclosures
P-1982. SARS-CoV-2 Rebound during Acute Infection is Associated with Long COVID
Authors: Ramdeep Nisha , Herbert Carly , Antar Annukka A R , Soni Apurv , Manabe Yukari C 
Published: January 2025

Abstract

Background
SARS-CoV-2 rebound, defined as recurrence of a positive SARS-CoV-2 test after testing negative during an acute infection, has received attention in patients treated with nirmatrelvir/ritonavir. We examined the association between SARS-CoV-2 rebound in untreated patients with delayed viral clearance and subsequent self-reported long COVID.

Methods
From October 2021 to February 2022, the Test Us at Home (TUAH) study enrolled 7361 participants to self-collect anterior nasal specimens for SARS-CoV-2 RT-PCR testing every 24-48 hours for 10-14 days. In August 2023, 244 participants with ≥ 1 positive test during the original study period were surveyed about long COVID symptoms, defined as new symptoms persisting for 3+ months post-infection. Viral rebound was defined as testing positive, negative, and subsequently positive again during the 10-14 day study period. Only participants with ≥ 3 molecular (RT-PCR) tests were included (Figure 1). The associations between rebound (outcome) and presence of long COVID (exposure 1) as well as different symptoms of long COVID (exposure 2) were examined using separate multivariable logistic regression models that adjusted for participant-level confounding variables.

Results
Data from 215 eligible participants were analyzed; 77 (35.8%) had long COVID. 75 of 215 (34.9%) experienced rebound. Long COVID was associated with 13-fold higher odds of experiencing viral rebound during acute infection (OR: 13.1, 95% CI: [6.79, 26.2]). When adjusting for other symptoms and covariates, there was an association between viral rebound and 1) post-acute fatigue (OR: 2.93, 95% CI: [1.04, 8.48]) and 2) taste or smell changes (OR: 4.96, 95% CI [1.76, 15.7]). There were no notable associations in demographics or pre-existing conditions with viral rebound.

Conclusion
Acutely infected COVID-19 participants who experienced viral RNA rebound in the first 14 days after symptom onset were significantly more likely to have long COVID with fatigue or changes in taste or smell.

Disclosures
Yukari C. Manabe, MD, Cepheid: Research materials to JHU|Chembio: Research materials to JHU|Hologic: Research grant to JHU|Roche: Research materials to JHU
P-1983. A Longitudinal Study of COVID-19 Sequelae and Immunity: Effects of SARS-CoV-2 Reinfection
Authors: Bravver Paula M , Higgins Bryan , Sneller Michael 
Published: January 2025

Abstract

Background
Post-acute sequelae of SARS-CoV-2 (PASC) affects approximately 10-30% of COVID-19 patients. Previous research suggests that reinfection with SARS-CoV-2 is associated with worsening PASC regardless of patients’ vaccination status and that reinfection contributes additional risks of pulmonary and other sequelae. The aims of this analysis are to describe rates of SARS-CoV-2 reinfection among patients followed on a longitudinal post-COVID-19 study with different vaccination statuses and compare the effect of reinfection on pulmonary symptoms and function and other PASC symptoms.

Methods
A sub-analysis of a NIAID clinical longitudinal study of COVID-19 was used with a convenience sample of 284 patients infected with SARS-CoV-2. Data was collected at enrollment and at six-month follow-up visits. Reinfection was documented by clinicians during follow-up visits and data on vaccination status was collected at baseline and follow-up visits. Pulmonary function tests including forced vital capacity (FVC), forced expiratory volume (FEV), FEV1/FVC ratio, and diffusing capacity of carbon monoxide (DLCO) were performed annually.

Results
Participants with SARS-CoV-2 reinfection, and those without reinfection, had similar vaccination rates. Among reinfected patients, nearly two thirds of participants reported an improvement in severity or resolution of their PASC symptoms following reinfection. Additionally, no patient without a history of PASC at enrollment developed PASC symptoms after their reinfection. In examining pulmonary function, there was no significant difference in FVC, FEV1, FEV1/FVC, and DLCO changes when comparing patients who were reinfected with SARS-CoV-2 to those who were not.

Conclusion
SARS-CoV-2 reinfection was not observed to be related with vaccine status, was not associated with new or worsening PASC symptoms, and there was no observed decline in pulmonary function when comparing reinfected and not reinfected patients. Continued longitudinal follow-up of this NIAID cohort will help clarify the effect of SARS-CoV-2 reinfection on the natural history of PASC and can inform overall clinical care when treating COVID-recovered patients.

Disclosures
All Authors: No reported disclosures
P-1984. AB2CO: a mortality risk score for COVID-19 patients admitted to intensive care units
Authors: Reis Gomes Virginia Mara , Pires Magda Carvalho , Delfino-Pereira Polianna , Nobre Vandack , Marcolino Milena S 
Published: January 2025

Abstract

Background
During the COVID-19 pandemic, several scoring systems have been developed and tested to stratify patients according to their risk levels, enabling the proper allocation of resources and increasing the likelihood of successful outcomes. However, there remains a gap in the availability of an effective tool for predicting in-hospital mortality among COVID-19 patients admitted to the intensive care unit (ICU). Most of the studies are bounded my methodological flaws which may lead to different bias, and uses data before the emergence of new variants and the broad use of vaccionation, that my impact scores' performance. We aimed to address this gap by developing a novel risk score and comparing it with other existing scores using more recent data.
Area under the ROC curve of the AB2CO risk score

Methods
This multicenter observational study included adult (≥18 years) patients with laboratory-confirmed COVID-19 who were admitted to 18 ICUs from 9 Brazilian cities, from September/2021 to July/2022. A total of 558 patients were included in the analysis, median age was 69 years (interquartile range 58-78), 56.3% were men, 19.7% required invasive mechanical ventilation (IMV), and 44.8% died during hospitalization. Potential predictors were selected based on a thorough literature review. Generalized Additive Models were used to assess outcomes and predictors, while LASSO regression was employed to develop the mortality score. Risk groups stratification were divided based on the predicted death probability as intermediate, high, and very high risk.
Calibration plot of the AB2CO risk score

Results
The final model, named AB2CO, comprised 6 variables: age, pO2/FiO2, respiratory function (respiratory rate or indication of IMV), COPD, and obesity. The AB2CO model showed an area under the Receiver Operating Characteristic curve of 0.781 (95% CI 0.744 to 0.819), good overall performance and an excellent calibration. Furthermore, on a complete case analysis the score achieved a discrimination ability of 0.783 (CI 95% 0.743-0.822), and it was compared with other existing scores and exhibited better performance than all of them.

Conclusion
The AB2CO score is a simple and easy tool, based on only six varibles routinely available in ICU. It may provide guidance for clinical decisions.
Discrimination ability for each risk score applied in the Brazilian database of COVID-19 patients admitted to the intensive care unit, and comparison of the derived and other existing scores.

Disclosures
All Authors: No reported disclosures
P-1986. COVID-19 Surveillance in Infants, Minnesota, October 2023–January 2024
Authors: Ruhland Abbey J , Meyer Stephanie , Como-Sabetti Kathryn , Fell Ashley , Talsma Elle , O’Toole Siobhan , Lynfield Ruth 
Published: January 2025

Abstract

Background
The impact of COVID-19 in infants is incompletely understood. We conducted active surveillance, including interviews of parents of infants with COVID-19.

Methods
We attempted phone interviews of parents of infants aged &lt; 12 months with lab-confirmed COVID-19 reported to the Minnesota Department of Health from 10/1/2023–1/31/2024 using a standardized form. Analyses were performed using SAS 9.4.

Results
Parents of 1161 (35%) infants were interviewed. There were no differences among those interviewed vs. not by white/non-white, urban/rural residence, or age. Median age was 6 months (IQR 3–8 months), 65% white, non-Hispanic, 53% male, 46% received federal assistance (WIC), and 38% attended childcare. 25% had an ill household member prior to, and 55% after, infant illness.
95% reported symptoms with fever (84%) and coryza (82%) most common. Co-pathogen detections were reported in 16% (68% RSV).
70% reported emergency (ED) or urgent care (UC) visits; 8% were hospitalized. Having a codetection (OR=4.14, p&lt; 0.01) or underlying condition (OR=2.12, p=0.03) was associated with hospitalization.
16% of illnesses were considered severe by parents. Codetections (OR=2.46, p&lt; 0.01), being non-white (OR=2.46, p&lt; 0.01), receiving WIC (OR=1.99, p&lt; 0.01), or having household income &lt; $30,000 (OR=2.28, p&lt; 0.01) were associated with severe illness. 80% of households had ≥ 1 adult vaccinated, but only 29% were vaccinated &lt; 6 months prior to infant infection; 34% of households with other children had ≥ 1 child vaccinated.
10% of cases remained unrecovered at 30 days after positive test. Factors linked to non-recovery included codetections (OR=2.30, p&lt; 0.01), prematurity (OR=2.19, p&lt; 0.01), being non-white (OR=1.62, p=0.02), receiving WIC (OR=1.56, p=0.03), and low household income (OR=2.09, p&lt; 0.01).

Conclusion
Among MN infants reported with COVID-19 with interview data, most visited ED/UC, and 16% were considered severely ill by parents. We found medical conditions, race, socioeconomic disparities, and codetections associated with severe and/or longer lasting illness. Improved understanding of the role of codetections and other risk factors, and encouraging up to date vaccination in households, may help mitigate the impact of severe COVID-19 in infants.

Disclosures
All Authors: No reported disclosures
P-1991. Unique Demographic Characteristics of Patients Experiencing Long COVID
Authors: Kricorian Christopher 
Published: January 2025

Abstract

Background
As the COVID-19 pandemic retreats, health care providers now treat many patients experiencing lingering symptoms long after their initial infection, also known as Long COVID (LC). Given that the population of those affected by LC has been generally cumulative, understanding the current demographics of this population is critical to public health planning.

Methods
The US Census Bureau Household Pulse Survey data was used in this analysis. The survey data was collected January 9 - February 5, 2024. Respondents were asked about a variety of demographic factors, as well as their self-reported COVID-19 experiences. The survey was conducted online; N=68,544 respondents were included in the analysis. Demographic factors were compared between those reporting LC, COVID-19 infection that had resolved (Short COVID, or SC), and those who had not experienced COVID (No COVID, or NC). Data were analyzed using X2, between group contrast analysis, and non-parametric tests.

Results
Among those surveyed, 16.5% reported experiencing LC, 42.2% reported SC and 41.3% reported NC. Among those who reported LC, 64.3% identified as female (vs. 53.1% SC and 53.0% NC, comparisons to LC p&lt; .05). The median incomes by group were LC $54.6k, SC $75.4K, and NC $59.2K (all pairwise comparisons p&lt; .001). Median age for those with LC was 50 years old, SC was 52 years old, and NC was 60 years old (all pairwise comparisons p&lt; .001). LC individuals were 10.1% Hispanic of any race, compared to SC 8.0% and NC 7.6% (comparisons to LC p&lt; .05). Additionally, 6.3% of those with LC described themselves as Black or African American, vs. 5.7% of SC and 9.6% NC (comparisons to NC p&lt; .05).

Conclusion
Patients experiencing LC have a substantially different demographic profile than both those who experienced SC and NC. LC individuals are younger, poorer, more female, and more likely to be Hispanic. The reasons for these differences are unclear and merit further study, but the general finding that people with LC are more likely to belong to marginalized groups suggests they could have greater difficulty getting adequate care. Reportedly, LC patients may feel their illness is trivialized by others, and these findings underscore the importance for medical personnel to identify and validate LC patient experiences.

Disclosures
All Authors: No reported disclosures
P-1992. Significant Positive Correlation of PD-1 and PD-L1 Levels in Children with Post-acute Sequelae of SARS-CoV-2 Infection in Taiwan
Authors: Hsu Yu-Lung , Chen Pei-Chi , Wu Lawrence Shih-Hsin , Hsieh Kai-Sheng , Lai Huan-Cheng , Lin Hsiao-Chuan , Hwang Kao-Pin , Wang Jiu-Yao 
Published: January 2025

Abstract

Background
Post-acute sequelae of SARS-CoV-2 infection (PASC) is a condition that impacts certain children following recovery from COVID-19. Programmed death-1 (PD-1) and its ligands, PD-L1 and PD-L2, may play a critical role in the immune response in PASC. However, the specific functions of these components in PASC among pediatric patients remain unclear.

Methods
The study participants were recruited from the DISCOVER (Diagnosis and Support for COVID Children to Enhance Recovery) study, conducted at the China Medical University Children's Hospital in central Taiwan during the Omicron outbreak. Children aged 3-18 years, previously diagnosed with SARS-CoV-2 infection via polymerase chain reaction (RT-PCR) or antigen rapid tests and identified specifically for post-acute sequelae of SARS-CoV-2 infection (PASC) in the outpatient department, were enrolled from October 1, 2022, to August 15, 2023. The investigation assessed the clinical characteristics of children with PASC, including measuring serum levels of PD-1, PD-L1, and PD-L2 to examine their interrelationships and the influence of demographic factors.Figure 1.Correlation between PD-1 and PD-L1 levels in PASC children

Results
Baseline characteristics of the study cohort (N=108) indicated an average age of 9.59 years, with 55.6% being male. All children had confirmed infections via antigen rapid tests, with 70.4% vaccinated against COVID-19. Only a small proportion (5.6%) were hospitalized, and none required ICU care. Our analysis identified a significant positive correlation between PD-1 and PD-L1 concentrations (r=0.92, P&lt; 0.001) in children with PASC. In contrast, there was no significant relationship between PD-1 and PD-L2 (r=0.14, P=0.138). There were no significant differences in PD-1 concentrations across different age groups, genders, vaccination statuses, or various PASC symptoms.Figure 2.PD-1 level in PASC children with or without COVID-19 vaccination

Conclusion
The significant correlation between PD-1 and PD-L1 highlights a potentially enhanced immunosuppressive state in children after COVID-19, which might predispose them to PASC. Our findings suggest the need for further investigation into the PD-1/PD-L1 axis to fully understand its implications in this vulnerable population.

Disclosures
All Authors: No reported disclosures
P-2010. Association between Urbanicity and Up-to-date COVID-19 Vaccination Coverage among Healthcare Personnel and Residents of Nursing Homes - National Healthcare Safety Network, United States, March 3, 2024
Authors: Haas Lori , Oliver Darielle , Woods Austin , Reses Hannah E , Barbre Kira A , SOE M I N N M , Lu Meng , Edwards Jonathan R , Rowe Theresa , Bell Jeneita 
Published: January 2025

Abstract

Background
CDC recommends that residents and healthcare personnel (HCP) in nursing homes be up to date with COVID-19 vaccinations to protect residents, who are at increased risk for severe COVID-19. COVID-19 vaccination coverage is often lower in rural versus urban populations; it is unclear if this applies to residents and HCPs in nursing homes. We assessed the association of urbanicity with up-to-date COVID-19 vaccination of residents and HCP in U.S. nursing homes.

Methods
We conducted a cross-sectional study of 14,304 nursing homes reporting to the CDC’s National Healthcare Safety Network (NHSN) for the week ending March 3, 2024. Up-to-date COVID-19 vaccination was receipt of an updated 2023-2024 COVID-19 vaccine. We used the 2006 NCHS urban-rural classification scheme for counties to group nursing homes as urban, suburban, and rural. We used logistic regression models to assess the association between urbanicity and up-to-date vaccination among residents and HCP. Facility size, social vulnerability index, and region were tested as potential confounders; facility size met the criteria for confounding (≥10% change in parameter estimates) and was included in the model.

Results
Among residents, vaccination was similar in rural (43.2%), suburban (41.3%), and urban (41.7%) nursing homes. Controlling for facility size, there was no association between urbanicity and odds of vaccination for residents (rural vs. urban: OR=1.0 [95% CI 1.0-1.1]; suburban vs. urban: OR = 1.0 [96% CI 0.9-1.0]); Table 1). Among HCP, urban nursing homes had the highest coverage at 9.1%; coverage at suburban and rural nursing homes was 6.9% and 5.7%, respectively. Controlling for facility size, compared to HCP in urban nursing homes, HCP in rural (OR= 0.7 [95% CI 0.5-0.6]) and suburban (OR= 0.7 [95% CI 0.7-0.8]) nursing homes had lower odds of vaccination (Table 2).

Conclusion
Up-to-date vaccination coverage among HCP and residents was low. HCP working in suburban and rural nursing homes were less likely to be up to date with COVID-19 vaccination than their urban counterparts. Coverage among residents did not vary by urbanicity. There is room to improve vaccination coverage among nursing home residents and HCP, especially among HCP working outside of urban areas.

Disclosures
All Authors: No reported disclosures
P-2037. Epidemiology, Clinical Features and Outcomes of COVID 19 Patients Post Evusheld Therapy Among Immunosuppressed Patients
Authors: Kale-Pradhan Pramodini , Channey Sarah , Sharma Mamta , Lebovic Daniel , Giuliano Christopher , Johnson Leonard B , Bhargava Ashish 
Published: January 2025

Abstract

Background
Evusheld® is a combination of two monoclonal antibodies, Tixagevimab and Cilgavimab. It was developed for the pre-exposure prophylaxis (PrEP) and treatment of COVID-19 illness for those who are immunocompromised. There is paucity of long-term real-world data on the use of Evusheld among the immunosuppressed patients against the SARS-CoV-2 Omicron variants.

Methods
A retrospective cohort chart review of patients 18 years and older who received the two dose Evusheld regimen from December 1, 2021 to January 31, 2023 at a community teaching institution was performed to evaluate the effectiveness of Evusheld as PrEP of COVID-19 patients. Evusheld as PrEP was indicated for patients with active solid tumor and hematologic malignancies or those receiving immunosuppressive treatment including CART therapy, biologic agents and high-dose corticosteroids (i.e., ≥ 20 mg prednisone or equivalent per day when administered for ≥ 2 weeks). The following data was collected: patient demographic, development of COVID19 after receiving Evusheld®, intensive care unit (ICU) length of stay (LOS), hospital LOS, ventilation requirement, duration of ventilation, and mortality among these patients within six months of receiving Evusheld therapy.

Results
Of the 663 patients screened, 459 were excluded primarily for duplicate patients. The mean age of the 204 included patients was 68.3 years and 97 (47.5%) were female. Eighteen (8.8%) patients had a positive COVID-19 test within 180 days of receiving Evusheld. None of the COVID positive patients were admitted to the hospital or required mechanical ventilation. All COVID positive patients survived.

Conclusion
Our study shows that Evusheld was effective in preventing COVID-19 among the immunocompromised patients during the six-month follow-up period. This study also showed that patients who developed COVID-19 after Evusheld did not develop severe disease or require hospitalization.

Disclosures
All Authors: No reported disclosures