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1.
Journal of Heart and Lung Transplantation ; 41(4):S527-S527, 2022.
Article in English | Web of Science | ID: covidwho-1848705
3.
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation ; 41(4):S526-S526, 2022.
Article in English | EuropePMC | ID: covidwho-1781962

ABSTRACT

Purpose The COVID-19 pandemic represents a major global health burden, and an important cause of morbidity and mortality nowadays. Data remains scarce on COVID-19 in lung transplant recipients (LTR). The purpose of this study was to understand impact of infection with COVID-19 in this population, to investigate different variables that contributed to the prognosis, and to assess the long-term clinical outcomes. This represents the largest cohort of continuously followed LTR with COVID-19 to date. Methods We conducted an observational retrospective cohort study of LTRs infected with COVID 19 at a major transplant center between June 2020 and April 2021. Infection was defined by having a positive diagnostic polymerase chain reaction (PCR) test. Patients’ characteristics, COVID severity and management were retrieved. Changes in individual patient's FEV1, imaging and trans-bronchial lung biopsies (TBLB) performed at 3, 6, and 12 month intervals after infection were compared to the baseline prior to infection. Results Fifty-three LTRs were identified as having COVID infection. Median age was 64 years, 31 (58.5%) were males, and 48 (90.5%) were double-LTR. Average BMI was 26.71 and 9 patients had diabetes. 38 (71.7%) patients were on three immunosuppression agents, and 4 (7.5%) patients had an augmented immunosuppression prior to COVID infection. 7 (13.2%) patients had at least one dose of mRNA COVID vaccine. 29 (54.7%) patients were treated as outpatient. Among admitted patients, 13 (24.5%) were treated in the ICU, and 7 (13.2%) required mechanical ventilation. Mortality rate was 15.1%. 26 patients had follow up on their FEV1 in 3 months, 33 in 6 months, and 7 up to 12 months. 14 (26.4%) patients had at least >10% drop in their FEV1, of which 10 patients had >20% drop. 18 patients had TBLB in 3 months, 19 in 6 months, and 4 in 12 months. Overall, 7 (13.2%) patients had acute cellular rejections (ACR). 23 patients had chest imaging at time of infection, with CT scan available for 10. Out of these, 6 showed pure ground glass opacities (GGO), and 4 showed mixed GGO and nodular opacities. Conclusion Out of our 53 LTR with COVID infection, 24.5% had severe disease. Mortality was high in our cohort at 15.1%. PFT decline was common, with 26.4% having an FEV1 drop of over 10% at follow up, suggesting persistent complications are common.

4.
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation ; 41(4):S73-S74, 2022.
Article in English | EuropePMC | ID: covidwho-1781909

ABSTRACT

Purpose The COVID19 pandemic has exacerbated the thoracic organ shortage. Safe donation from COVID19 infected donors would increase the donor pool. Methods We present our institutional protocol and early results for thoracic organ transplantation using COVID19 positive donors. Endpoints To date, we performed 10 thoracic organ transplants in 9 recipients using organs from COVID19 positive donors (9 hearts;1 pair of lungs). Patient and graft survival to date is 100%, 91%. Hearts were procured from donors testing positive for COVID19 on upper and/or lower respiratory tract specimens, provided severe COVID pneumonia or myocarditis was not the cause of death, and hypercoagulable complications were absent. Lungs were procured only if donors were first positive >20 days prior and were PCR-negative on bronchoalveolar lavage. Cycle threshold, duration of infectivity and urgency of recipient need were considered in addition to routine evaluations.8/10 donors were first detected positive during terminal illness, yet no heart recipients acquired COVID19 infection through transplant and no unexpected rejection occurred. 1 heart-liver recipient required a redo heart transplant due to massive hemorrhage followed by hypercoagulability and coronary thrombus. An RV biopsy from the donor heart demonstrated ischemic changes and SARS-CoV-2 immunohistochemical findings suspicious for myocyte infiltration. Urgent re-transplantation was successfully completed utilizing a heart from another COVID19+ donor with no recurrence of hypercoagulability. One patient received lungs from a donor with mild COVID19, first detected 38 days earlier, yet still COVID19 positive on nasopharyngeal swab but not on BAL. No procurement or care team members became infected with covid as a result of this protocol. While limited, our experience to date supports that use of hearts from COVID19 positive donors is safe and effective. Lung transplantation from COVID19 positive donors is unresolved but may be cautiously pursued under the restricted circumstances.

5.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-329391

ABSTRACT

Background: Easily distributed oral antivirals are urgently needed to treat coronavirus disease-2019 (COVID-19), prevent progression to severe illness, and block transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report the results of a Phase 2a trial evaluating the safety, tolerability, and antiviral efficacy of molnupiravir in the treatment of COVID-19 ( ClinicalTrials.gov NCT04405570 ). Methods: Eligible participants included outpatients with confirmed SARS-CoV-2 infection and symptom onset within 7 days. Participants were randomized 1:1 to 200 mg molnupiravir or placebo, or 3:1 to molnupiravir (400 or 800 mg) or placebo, twice-daily for 5 days. Antiviral activity was assessed as time to undetectable levels of viral RNA by reverse transcriptase polymerase chain reaction and time to elimination of infectious virus isolation from nasopharyngeal swabs. Results: Among 202 treated participants, virus isolation was significantly lower in participants receiving 800 mg molnupiravir (1.9%) versus placebo (16.7%) at Day 3 (p = 0.02). At Day 5, virus was not isolated from any participants receiving 400 or 800 mg molnupiravir, versus 11.1% of those receiving placebo (p = 0.03). Time to viral RNA clearance was decreased and a greater proportion overall achieved clearance in participants administered 800 mg molnupiravir versus placebo (p = 0.01). Molnupiravir was generally well tolerated, with similar numbers of adverse events across all groups. Conclusions: Molnupiravir is the first oral, direct-acting antiviral shown to be highly effective at reducing nasopharyngeal SARS-CoV-2 infectious virus and viral RNA and has a favorable safety and tolerability profile.

6.
Journal of Applied Research in Memory and Cognition ; 10(4):527-531, 2021.
Article in English | Web of Science | ID: covidwho-1576107
7.
Morbidity and Mortality Weekly Report ; 69(46):1743-1747, 2020.
Article in English | GIM | ID: covidwho-1498667

ABSTRACT

SARS-CoV-2 can rapidly spread through university settings. Pooling specimens can enable large-scale testing while minimizing needed resources. In fall 2020, Duke University's COVID-19 prevention strategy included risk reduction behaviours, frequent testing using pooled SARS-CoV-2 polymerase chain reaction testing, and contact tracing. Among 10,265 students who received testing 68,913 times, 84 had positive results. One half of infections were asymptomatic, and some had high viral loads. SARS-CoV-2 transmission was limited in this congregate setting by integration of prevention strategies that included identification of asymptomatic infections through frequent testing. Pooled testing reduced the need for resources while allowing high throughput with high sensitivity and rapid turnaround of results.

8.
Morbidity and Mortality Weekly Report ; 70(1):7-11, 2021.
Article in English | CAB Abstracts | ID: covidwho-1395386

ABSTRACT

This study discusses the quarantine period for COVID-19 affected athletes during June to October 2020. To minimizse the spread of COVID-19, athletic programs implemented plans to implement measures designed to minimise the impact of the coronavirus disease. These include restricting outdoor activities and keeping athletes isolated from the rest of the team. Regional athletic conferences created policies that vary depending on the type of sport and conference. Stricter quarantine policies were also implemented in some countries to reduce the burden of compliance. Although most athletes reported experiencing COVID-19 exposure at social gatherings and from roommates, most of them had less than 2 weeks between their quarantine start and their first positive COVID-19 test result. 458 out of 1,830 athletes tested positive for the RT-PCR test during the 14-day quarantine. The rate of positive test results among those who did not receive a positive result decreased from 27% to 5% after day 10. The recommendations from the CDC support the use of different options to reduce quarantine for college athletes. These include reducing the duration of quarantine and improving compliance with mitigation measures. Twenty-four universities and colleges participated in the study of 2,257 quarantined athletes. Out of the 2,830 athletes, the most common sports they played were football, track and field, and soccer. Most of them reported being exposed to various activities while in quarantine. Only three universities and colleges contributed data on athletes who tested positive for SARS-CoV-2 during quarantine. Out of the 620 athletes, 159 remained quarantined. 436 (73.4%) of the athletes with an available exposure date tested positive for tuberculosis, and quarantine began a mean of 1.1 days after their reported exposure. Out of the 620 athletes with positive tests, 405 achieved positive results. The rate of positive tests decreased over the quarantine period. The median interval between when a positive specimen was collected and when quarantine was initiated was 2 days. Among the individuals whose test results remained unfavorable after day 5, 26.9% had a positive result. Among the 29 athletes who tested positive for Influenza A during the quarantine period, 26 percent did not have been tested previously. Although data support the CDC's recommendation that people with confirmed or suspected cases of SARS-CoV-2 should stay in quarantine for 14 days, this advice is not intended to reduce transmission among the general population. Adherence to quarantine can improve a population's adherence to isolation and mitigation strategies.

9.
Medical Decision Making ; 41(4):E106-E107, 2021.
Article in English | Web of Science | ID: covidwho-1250888
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