bluuebunny/crossref_metadata_2025_split huggingface dataset:
1894. Sensitivity of Symptom-Based Screening for COVID-19 in Active Duty Service Members
Authors: Matthews Zachary , Cybulski Daniel , Frankel Dianne , Kieffer John , Casey Theresa , Osuna Angela , Marcus Joseph E 
Published: December 2022

Abstract

Background
Symptomatic COVID-19 screening has been a cornerstone of case identification during the pandemic. Despite the myriad of COVID-19 symptoms, screens have focused on fever, cough, and dyspnea. It is unknown how well these symptoms identify cases in a healthy military population. This study aims to evaluate the utility of symptom-based screening in identifying COVID-19 through different COVID-19 waves.

Methods
A convenience sample of 600 active-duty service members who arrived at JBSA in 2021 and 2022 was included in this study. We compared 200 symptomatic service members who tested positive for COVID-19 in each of FEB-APR 2021 (prior to the emergence of the Delta variant), JUN-AUG 2021 (Delta variant was predominant), and JAN 2022 (Omicron variant was predominant). Collected data included test date, reported symptoms, and vaccination status. Comparisons were conducted via Chi-Square or Fisher’s Exact test.

Results
Of the 600 symptomatic active-duty service members who tested positive for COVID-19, the most common symptoms were sore throat (n=385, 64%), headache (n=334, 56%), and cough (n=314, 52%). While sore throat was the most prominent symptom during Delta (n=140, 70%) and Omicron (n=153, 77%), headache was the most common prior to Delta (n=93, 47%). There were significant differences in symptoms by vaccination status (Table 2). Overall, screening for fever, cough, and dyspnea had a 65.1% sensitivity in this cohort (Table 3) with its lowest sensitivity in the pre-Delta cohort (53.5%) and highest sensitivity in the fully vaccinated Omicron cohort (78.3%).

Conclusion
In this descriptive cross-sectional study evaluating symptomatic military members with COVID-19, symptom prevalence varied based on the predominant COVID-19 variant as well as patients’ vaccination status. As screening strategies evolve with the pandemic, changing symptom prevalence should be considered.

Disclosures
All Authors: No reported disclosures.
1898. The Impact of Polymerase Chain Reaction Versus Antigen Based COVID-19 Testing on Subsequent Infections in Military Trainees
Authors: Cybulski Daniel , Matthews Zachary , Kieffer John , Casey Theresa , Osuna Angela , Kasper Korey , Frankel Dianne , Yun Heather , Marcus Joseph E 
Published: December 2022

Abstract

Background
Screening large groups of individuals entering a congregate setting has been a challenge during the COVID-19 pandemic. Current Infectious Disease Society of America guidelines recommend polymerase chain reaction (PCR)-based screening in symptomatic and at-risk individuals over antigen based testing due to higher sensitivity. However, there are limited real-world data describing secondary COVID-19 cases after different arrival testing strategies.

Methods
Between January 1 - August 31, 2021 all trainees attending United States Air Force Basic Military Training underwent arrival testing for COVID-19. Trainees who arrived January 1, 2021 - May 21, 2021 were tested via PCR and those from May 24, 2021 - August 31, 2021 via antigen test. All trained in groups of 30-50 and slept in communal quarters. Symptomatic secondary cases within the first two weeks of training were identified by individual as well as training group and compared based on method of arrival testing. For this study, a case cluster was defined as &gt; 5 cases.

Results
A total of 24,601 trainees arrived during the study period with 406 (1.6%) trainees testing positive on arrival, of which 134 (33%) were symptomatic. Initial positivity rate was greater for PCR testing as compared to antigen testing (2.5% vs 0.4%, RR: 5.4, 95% CI: 4.0-7.3, p&lt; 0.001). With PCR testing, training groups were significantly more likely to have a positive case on arrival (57% vs 11%, RR: 5.3, 95% CI: 3.7-7.7, p&lt; 0.001). However, PCR testing was not associated with a difference in training groups with a secondary case (20% vs 22%, RR: 0.9, 95% CI: 0.66-1.2, p=0.53), number of training groups with a case cluster (4% vs 6.7%, RR: 0.61, 95% CI: 0.3-1.2, p=0.16), or number of days after arrival until development of symptomatic secondary case (median 8 vs 6.5 days, p=0.37) as compared to antigen testing.

Conclusion
This study describes two strategies of arrival testing for COVID-19 in a congregate setting at high risk for disease transmission. In this study, PCR-based testing was associated with more arrival cases. However, there was no difference in the number of training groups having a secondary case or a case cluster. This study supports the utility of antigen-based arrival testing for congregate settings.

Disclosures
All Authors: No reported disclosures.
1900. Time to appropriate care-seeking for Covid – 19 symptoms.
Authors: Ekat Martin Herbas , Doukaga Tatia Adoua , Ibara Bienvenu Rolland Ossibi 
Published: December 2022

Abstract

Background
in sub-Saharan Africa, the symptoms of covid-19 are similar to those of several pathologies frequently encountered in this region, which can confuse the diagnosis both for the patient and for health structures with limited resources. We studied self-reported time to care-seeking from the onset of covid-19 symptoms.

Methods
This was a cross-sectional study. Patient’files who attended the medical emergencies Unit of Brazzaville University Hospital, for symptoms suggestive of Covid - 19 between May 2020 and February 2022, were collected. The diagnosis of Covid-19 was confirmed by RT-PCR or antigen test. Delay, between the rise of Covid- 19 symptoms and the attendance at the medical emergencies Unit, was recovered from the history of the disease reported by the patients themselves. When the patient had reported a duration of 'about one week' in the delay we noted '7 days' and 'about 2 weeks' corresponded to '14 days' taking this into account we used the Weibull regression model accelerated failure-time metric to identify potential risk factors which were subsequently presented as a time ratio (TR).

Results
102 patients were included, 57 (55.88%) were women, the median age was 64 years (Interquartile Range (IQR): 56 – 71), history of hypertension and diabetes was found respectively in 51 (50%) and 27 (26.47%) patients. 13 (12.75%) were vaccinated against Covid – 19. The median time to care-seeking was 7 days (IIQ: 5 – 7). Being vaccinated (adjusted Time Ratio (aTR): 1.69 (95% CI: 1.09 – 2.6) p=0.02) and having a cough (aTR: 1.74 (95% CI: 1.2 – 2.52) p=0.03) was associated with a longer time to care-seeking. On the other hand, being Hypertensive (aTR: 0.68 (95% CI: 0.51 – 0.9) p= 0.006), asthenic (aTR: 0.46 (95% CI: 0.23 – 0.91) p= 0.03) and having respiratory distress (aTR: 0.48 (95% CI: 0.26 – 0.89) p=0.03) were associated with a faster time to care-seeking.

Conclusion
the vaccine increases time for care-seeking, especially when it is associated with the classic signs of COVID-19 such as cough. To limit the under-notification of cases in sub-Saharan Africa, Covid 19 testing must be generalized.

Disclosures
All Authors: No reported disclosures.
1905. High food insecurity during the COVID-19 pandemic among secondary school teachers - Tajikistan, 2021
Authors: Akhmedov Davron , Horth Roberta , Nabirova Dilyara 
Published: December 2022

Abstract

Background
The COVID-19 pandemic’s global disruptions resulted in food insecurity and negative consequences beyond direct health impact. Increased understanding of these consequences can protect critical infrastructure workers, including teachers, in future pandemics and COVID-19 waves.

Methods
We conducted a descriptive cross-sectional study from September through October 2021 in Kulyab, Tajikistan. Teachers, systematically recruited from 54 secondary schools, responded to an online structured questionnaire on food security and negative consequences. We defined food insecurity as (1) being very worried about not having food, (2) having run out of food a lot more than before the pandemic, or (3) having to skip meals often because of insufficient money, and high food insecurity if all applied. Multivariable logistic regressions were conducted to identify variables associated with high food insecurity.

Results
Of 1,575 teachers surveyed, 44% had food insecurity, and 14% had high food insecurity. Negative consequences experienced included, 40% income loss, 7% having to move households, 67% depression/anxiety, and 44% fear of leaving home due to violence. Food insecurity was independently greater among teachers with school age children (15% vs. 9%), that had to quarantine or isolate (18% vs. 9%), and who had COVID-19 (21% vs. 13%). Odds of high food insecurity were higher among teachers with significant income loss (Adjusted odds ratio (AOR): 3.3, 95% CI: 1.9-5.7), depression/anxiety (AOR 1.8, 95% CI: 1.2-3.0), fear of leaving home due to violence (AOR 2.6, 95% CI: 1.7-4.1), and teleworking vs in-person (AOR 1.6, 95% CI: 1.1-2.3). Odds were lower among teachers who practiced physical distancing (AOR 0.5, 95% CI: 0.3-0.7) and with household members &gt; 60 years old (AOR 0.4, 95% CI: 0.1-0.8).

Conclusion
During the COVID-19 pandemic teachers in our study experienced high food insecurity, income loss, and anxiety or depression. Safety nets could be strengthened and focused for health threats affecting populations access to food.

Disclosures
All Authors: No reported disclosures.
1911. A Pilot Study to Evaluate the Effectiveness of Nasal and Oral Povidone Iodine in Reducing the Burden of Severe Acute Respiratory Syndrome 2 RNA in Patients with COVID-19
Authors: Redmond Sarah , Jones Lucas D , Nguyen Alexandria , Ghaddara Hussein , Cadnum Jennifer , Donskey Curtis 
Published: December 2022

Abstract

Background
Nasal and oral application of topical antiseptics such as povidone iodine could potentially reduce the risk for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, limited information is available on the efficacy of such agents in reducing the burden of SARS-CoV-2.

Methods
We conducted a pilot non-blinded, randomized trial to compare the effectiveness of 3 doses of povidone iodine (each dose with 10% intranasal and 1% gargle) administered every 8 hours versus the control with phosphate-buffered saline in reducing the burden of SARS-CoV-2 RNA in the nares and oropharynx of patients with COVID-19. Swabs were used to collect anterior nares and oropharynx samples before the first and second doses and 8 hours after the final dose (24 hours after the initial dose). Real-time polymerase-chain reaction (RT-PCR) was used to assess the burden of viral RNA. Analysis of variance was used to compare cycle threshold values for povidone iodine versus control patients. Subjects were surveyed about adverse reactions to treatment.

Results
As shown in the figure, SARS-CoV-2 cycle thresholds were similar in the povidone iodine (N=10 subjects) and control (N=8 subjects) groups prior to treatment. After initiation of treatment, there was no significant difference in cycle thresholds for the povidone iodine versus control subjects (P &gt;0.05). No adverse effects of treatment were reported.
Effect of intranasal and oral application of povidone iodine versus phosphate-buffered saline on nasal and oropharyngeal SARS-CoV-2 RNA. Error bars show standard error.

Conclusion
Our findings suggest that that nasal and oral application of povidone iodine have limited effectiveness in reducing the burden of SARS-CoV-2. Future studies are needed to assess for effectiveness of more frequent dosing intervals and to determine if povidone iodine reduces recovery of viable virus by culture.

Disclosures
All Authors: No reported disclosures.
1913. Baltimore City Health Department COVID-19 Community-based Testing Results
Authors: Dye Shamola , Agnes Isabella , Phelan-Emrick Darcy , Greenbaum Adena 
Published: December 2022

Abstract

Background
The Baltimore City Health Department (BCHD) began community-based COVID-19 testing in response to the pandemic on April 21, 2020. The purpose was to provide access to COVID-19 testing to underserved communities. BCHD designed the program to accommodate transportation limitations, limited-access to internet and phones, and non-English speakers. BCHD has continued hosting up to five community-based testing sites per week. This analysis examines the test results of BCHD’s COVID-19 community-based testing program to date.

Methods
Patients completed an intake form, which included demographic information, at the testing event, prior to providing their specimen for COVID-19 testing. For this analysis, patient demographics and test results were analyzed using REDCap software.

Results
Total test volume for year 2020 (4/21/2020 -12/30/2020) was 15,839, year 2021 (1/5/2021- 12/30/2021) was 13,087, and year 2022 (1/4/2022 - 4/1/2022) was 2,261. Average percent positivity for year 2020 was 9%, year 2021 was 7%, and year 2022 to date was 6%. Patient ethnicity was Non-Hispanic 85.5%, Hispanic 13.5%, and Did not respond/Don’t know 1.0%. Race was Black or African America 61.1%, White 25.0%, Asian 2.8%, American Indian/Alaska Native 0.1%, Native Hawaiian or Other Pacific Islander 0.1%, and Unknown 10.7%. Total positive COVID-19 results among Black/African Americans in 2020, 2021, and 2022 respectively were 1567 (12.8%), 1177 (15.1%), and 218 (22.1%). Total positive COVID-19 results among White in 2020, 2021, and 2022 respectively were 541 (10.1%), 441 (12.1%), and 60 (15.1%) respectively. Total positive COVID-19 results among Asians in 2020, 2021, and 2022 were 63 (20.9%), 47 (11.0%), and 4 (25.5%) respectively. Total positive COVID-19 results among Native Hawaiian or Other Pacific Islander in 2020, 2021, and 2022 respectively were 4 (16.7%), 4 (20.0%), and 2 (0.0%) respectively. Total positive COVID-19 results among American Indian/Alaskan in 2020, 2021, and 2022 were 3 (13.6%), 1 (7.1%), and 2 (66.7%) respectively.

Conclusion
BCHD’s community-based testing program has completed over 31,000 tests to date. COVID-19 percent positivity among patients showed a decline across the three years. This analysis demonstrates how a local health department can provide testing to the communities.

Disclosures
All Authors: No reported disclosures.
1925. Prevalence of SARS-CoV-2 Infection in Immunocompromised Patients Following Receipt of Tixagevimab/Cilgavimab
Authors: Lim Sarah , Morris Keeley , Fess Lydia J , Como-Sabetti Kathy , Lynfield Ruth 
Published: December 2022

Abstract

Background
Tixagevimab/cilgavimab (TC) was approved by the FDA in December 2021 for use as pre-exposure prophylaxis in patients with moderate to severe immune compromise. On February 24, FDA recommended a second dose for patients who received the original dosing because of decreased activity against Omicron subvariants. We were interested in reviewing TC experience in Minnesota.

Methods
Minnesota Department of Health established a voluntary TC patient registry in December 2021, including date of treatment, COVID-19 vaccination status and immunocompromising conditions. Patients were matched to state COVID-19 case data from December 1, 2021 to April 22, 2022, to examine occurrence of SARS-CoV-2 infection (a positive test by PCR or antigen) following receipt of TC.

Results
Data were available for 289 patients, representing 5-10% of all patients treated with TC in Minnesota. 53% were male with a median age of 62 (IQR 48-70). 13 patients (4.5%) had not received COVID-19 vaccine at the time of initial TC dose. 128 patients (44%) received 2 doses of TC. Immunocompromising conditions included: hematological malignancy (114, 39.4%), treatment with immunosuppressant medications (113, 39.1%), solid organ transplant (45, 15.6%), and stem cell transplant (13, 4.5%). 5 patients (1.7%) had a positive SARS-CoV-2 test (4 PCR, 1 antigen) following receipt of TC (Table 1); patients tested positive on days 7, 11, 13, 17 and 48/70. Three patients were on rituximab and 2 had hematological malignancy. All 5 had received 3 doses of COVID-19 vaccine prior to receipt of TC. Variant information was available for 2 patients: BA.1 and BA.1.1. 1 patient required hospitalization for COVID-19 and died 39 days after the positive test but had 3 subsequent negative tests before discharge; death was attributed to underlying malignancy. Table 1:Characteristics of patients with positive SARS-CoV-2 tests following treatment with tixagevimab/cilgavimab.

Conclusion
In a convenience sample of 289 patients who received TC, 5 patients had COVID-19, with 3 occurring within the SARS CoV-2 incubation period following receipt of TC. One of the other patients was positive after receiving 2 doses of TC. Following effectiveness of TC will be useful as SARS CoV-2 continues to evolve.

Disclosures
All Authors: No reported disclosures.
1929. A Qualitative Analysis of COVID-19 Vaccination Intent and Recommendations to Increase Uptake Among Residents and Staff in Six Seattle Homeless Shelters
Authors: Cox Sarah N , Thuo Nicholas , Rogers Julia H , Meehan Ashley A , Link Amy C , Lo Natalie K , Manns Brian , Ogokeh Constance E , Chow Eric J , Rolfes Melissa A , Mosites Emily , Achkar Morhaf Al , Chu Helen Y 
Published: December 2022

Abstract

Background
COVID-19 vaccines are important to mitigate severe disease in congregate settings, yet uptake remains lower among people experiencing homelessness (PEH) than in the general population. This study aimed to explain changes in COVID-19 vaccination intent over time and identify modifiable factors to improve vaccine acceptance among PEH.

Methods
We utilized the Health Belief Model and 3Cs Model of Vaccine Hesitancy to develop a conceptual framework to explore factors that may influence COVID-19 vaccination intent among PEH. Between July 27 - October 15, 2021, we conducted semi-structured interviews (SSIs) and focus group discussions (FGDs) across six homeless shelters in Seattle-King County, Washington. Residents and staff aged 18 years and older were recruited through purposive sampling for SSIs and convenience sampling for FGDs. We captured retrospective information about perceptions of and intent to receive COVID-19 vaccines between March 2020 - August 2021. Thematic analysis was conducted using Dedoose.

Results
We conducted 31 SSIs (25 residents and six staff) and eight FGDs with 43 residents. Participants reported that too much contradictory and changing information about COVID-19 vaccines led to confusion. Information deemed trustworthy (i.e., objective, honest, professional, and recommended by others) contributed to individual’s knowledge and in some cases changed their vaccination intent. Despite intention to vaccinate, participants reported barriers to COVID-19 vaccine access including availability, eligibility, appointments, and timeliness. While many intended to get vaccinated on their own, others were motivated by incentives and requirements. Participants presented recommendations to improve COVID-19 information content and dissemination, access, and incentives in shelter settings (Table 1). Table 1.Recommendations for Interventions to Increase COVID-19 Vaccine Uptake in Shelter Settings

Conclusion
COVID-19 vaccination strategies that are rooted in the voices and experiences of PEH are presented and can inform improved vaccine implementation among key stakeholders. Future research should test recommended strategies to determine feasibility and effectiveness in shelter settings.

Disclosures
Helen Y. Chu, MD, MPH, Cepheid: Reagents|Ellume: Advisor/Consultant|Gates Ventures: Grant/Research Support|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant.
1945. Effects of COVID-19 Vaccines on Outcomes Among Hospitalized COVID-19 Patients
Authors: Hoskins Serene , Restrepo Marcos I , Cadena Jose 
Published: December 2022

Abstract

Background
After COVID-19 vaccinations, breakthrough infections appear to be of public health concern. There is limited data regarding clinical effectiveness of COVID-19 vaccination. Our aim was to determine the differences in clinical outcomes among COVID-19 unvaccinated versus vaccinated patients who required hospitalization.

Methods
This was a retrospective cohort study of COVID-19 hospitalized patients between 7/25/21 and 9/6/2021. Previously infected COVID-19 patients were excluded. The patients were classified as fully vaccinated vs. unvaccinated (CDC guidelines). The primary outcome included the need for advance oxygen therapy (high flow nasal cannula, non-invasive ventilation, mechanical ventilation), ICU admission, or 28-day all-cause mortality. We performed a subgroup analysis according to the immunocompetent status and older age (≥65 years).

Results
We enrolled 207 patients, stratified as unvaccinated (n=147 [71%]) vs. fully vaccinated (n=60 [29%]). Unvaccinated patients were younger (median age 58 vs. 71 years old, p&lt; 0.001) and more likely to require oxygen (n=105[71%] vs. n=35[58%], p=0.07) compared to vaccinated patients.
Unvaccinated patients were more likely to reach the primary outcome (n=59 [40%] vs. n=16 [26%], p=0.08) when compared to vaccinated patients. The subgroup analyses revealed that unvaccinated patients had higher rates of the primary outcome when ≥65 years old ( n=27/46 [58.7%] vs. n=13/37 [35.1%], p=0.047), immunocompetent (n=57/139 [41%] vs. 13/53 [24.5%]) and both groups combined (n=22/39 [56%] vs. 11/38 [28.9%], p=0.021), respectively.

Conclusion
Unvaccinated patients represented the largest proportion of hospitalized patients. Unvaccinated patients were younger and required oxygen therapy. Unvaccinated immunocompetent patients aged ≥ 65 had worse outcomes compared to vaccinated patients. Further studies are needed to identify unmeasured characteristics that may be associated with poor clinical outcomes.

Disclosures
All Authors: No reported disclosures.