Critical Care 1950 to 2022: Evolution of Medicine, Nursing, Technology, and Design.

Critical care units-designed for concentrated and specialized care-came from multiple parallel advances in medical, surgical, and nursing techniques and training taking advantage of new therapeutic technologies. Regulatory requirements and government policy impacted design and practice. After WWII, medical practice and education promoted further specialization. Hospitals offered newer, more extreme, and specialized surgeries and anesthesia enabled more complex procedures. ICUs developed in the 1950s, providing a recovery room's level of observation and specialized nursing to serve the critically ill, whether medical or surgical.

Longitudinal Assessment of Point-of-Care LumiraDx Antigen and Antibody Test Performance During Acute SARS-CoV-2 Infection and Recovery

Background. Rapid COVID-19 tests can offer significant advantages and reduce health disparities. The LumiraDx SARS-CoV-2 platform can perform microfluidic fluorescence assays for the rapid detection of SARS-CoV-2 antigen (Ag) and antibodies (Ab). We evaluated both tests in a longitudinal cohort to evaluate performance during acute SARS-CoV-2 infection and recovery. Methods. We collected nasal samples from 71 unique participants at four clinic visits spanning 0-21 days since symptom onset (DSSO);blood samples were collected from the same participants over six visits spanning 0-87 DSSO. For Ag testing, 232 anterior nasal swabs were assayed by: 1) the LumiraDx Ag test, 2) a laboratory-based electrochemiluminescence immunoassay for N Ag, 3) RT-PCR (Hologic Panther Fusion), and 4) culture (growth in VeroE6AT cells). For Ab testing, 308 serum samples were assayed by: 1) the LumiraDx Ab test and 2) Roche Elecsys Anti-S SARS-CoV-2 total Ab test. Measures of concordance [positive predictive agreement (PPA), negative predictive agreement (NPA), and Cohen's Kappa (K)] were estimated for qualitative results of the LumiraDx tests versus corresponding lab reference tests. Confidence intervals were estimated via bootstrapping. Results. LumiraDx Ag results had strong agreement with lab N-Ag results (K > 0.80) across all samples. Between 0-5 days, agreement was perfect, except for one sample resulting positive by LumiraDx Ag and negative by lab Ag. Agreement with PCR results was moderate overall (K=0.60), though substantial (K > 0.6) for both 0-5 DSSO (PPA=0.96/NPA=0.80) and 6-10 DSSO (PPA=0.96/NPA=0.59). Agreement with culture results was moderate overall (K=0.46): substantial (K=0.6) between 0-5 DSSO (PPA=0.96/NPA=0.60) and fair (K=0.29) between 6-10 DSSO (PPA=1.0/NPA=0.32). LumiraDx Ab results showed almost perfect agreement with lab Ab results across all samples (K=0.88), with substantial agreement (K > 0.7) for samples collected 0-10 DSSO (PPA=0.93/NPA=0.89) and 11-28 DSSO (PPA=0.99/NPA=0.69). Longitudinal agreement of LumiraDx antigen test result and culture positivity, by PCR Ct value. Nasal samples grouped by participant (lines) and agreement of results between LumiraDx antigen test result and culture positivity (proxy for infectiousness). Conclusion. LumiraDx rapid tests perform well compared to more costly and time-consuming lab methods of Ag and Ab detection. The rapid Ag test may be helpful in identifying patients infectious between 0-5 DSSO, given the substantial concordance of the rapid Ag test and culture positivity.

Diagnostic Test Kinetics, Infectivity, and Immunological Responses Among Unvaccinated Adults During Acute SARS-CoV-2 Infection

Background. Appropriate diagnostic testing can be used to inform infection control measures and reduce SARS-CoV-2 transmission, yet the test kinetics, infectivity, and immunological responses during acute, non-severe SARS-CoV-2 infection need clarity. Methods. We conducted a prospective cohort study between Nov 2020-July 2021 in Seattle, Washington of 95 unvaccinated, immunocompetent adults with no prior SARS-CoV-2 infection. Nasal swabs (nasopharyngeal and anterior) and blood serum samples were serially collected at six visits over two months. Viral RNA, N and S antigen concentrations, and viral growth/infectivity were measured from nasal samples. Anti-S total antibody and IgG assays were performed on serum. We fit loess curves to quantitative data corresponding to each testing modality by days since symptom onset (DSSO) and compared qualitative test results across time points to demonstrate timedependent agreement of PCR, N antigen, and culture results. Generalized estimating equations were used to approximate relative risk of culture positivity (a proxy for infectiousness) for positive vs. negative test results (antigen and PCR), stratified by presence/ absence of symptoms and DSSO. Sampling Schema Nasal swabs and venous blood were collected at visits 1-4;venous blood only at visits 5-6. All participants were enrolled within 14 days of symptom onset (median: 6) and 7 days of a positive test (median: 4). Results. Infections in this cohort (median age: 29y) were mild (no hospitalization). Median (IQR) time to negative result was 11 (4), 13 (6), and 20 (7) DSSO for culture growth, N antigen, and PCR tests, respectively. Viral RNA quantities declined more slowly than antigen and culturable virus;antibody titers rose rapidly 5-15 DSSO and plateaued 20-30 DSSO. All culture-positive samples collected 0-5 DSSO were positive by PCR, but relative risk of culture positivity (infectiousness) for positive vs. negative PCR results declined 6-10 DSSO. Relative risk of culture positivity for positive vs. negative antigen results was consistently high 0-10 DSSO, with similar results when stratified by presence of symptoms. Diagnostic test kinetics and immunological responses Diagnostic test kinetics and immunological responses measured in adults with non-severe, symptomatic SARS-CoV-2 infection: loess trendlines and 95% confidence intervals are given for SARS-CoV-2 viral load (calculated from PCR Ct value using a calibration curve), TCID50 from viral culture, mean concentrations of nucleocapsid and spike antigen proteins, and anti-S total and IgG antibody concentrations. Conclusion. The results reinforce the importance of molecular PCR testing as a highly sensitive diagnostic tool but with limited utility as an indicator of viral culturability and likely infectiousness. N antigen testing may be a preferable diagnostic test within two weeks of symptom onset, especially 6-10 DSSO, because it more closely correlates with culture growth over the course of infection.

Long-term passive wastewater surveillance of SARS-CoV-2 for seven university dormitories in comparison to municipal surveillance.

Wastewater-based surveillance (WBS) has been an effective tool for monitoring and understanding potential SARS-CoV-2 transmission across small and large-scale communities. In this study at the University of Saskatchewan, the assessment of SARS-CoV-2 was done over eight months during the 2021-2022 academic year. Wastewater samples were collected using passive samplers that were deployed in domestic sewer lines near adjacent campus residences and extracted for viral RNA, followed by Reverse Transcription quantitative Polymerase Chain Reaction (RT-qPCR). The results showed similar trends for SARS-CoV-2 detection frequencies and viral loads across university residences, the whole campus, and from related WBS at Saskatoon Wastewater Treatment Plant. The maximum daily detection frequency for seven dormitories considered was about 75 %, while maximum daily case numbers for the residences and campus-wide were about 11 and 75 people, respectively. In addition, self-reported rates of infection on campus peaked during similar time frames as increases in viral load were detected at the Saskatoon wastewater treatment plant. These similarities indicate the usefulness and cost-effectiveness of monitoring the spread of COVID-19 in small-scale communities using WBS.

Novel Method of Engaging with Vulnerable, Settled Communities During COVID-19

Aims Ongoing high COVID-19 incidence rates within settled vulnerable populations in the Midlands of Ireland required a novel, non-discriminatory model of engagement. Methods A collaboration of HSE Midland’s Department of Public Health, Safetynet Primary Care and the HSE Midlands Traveller Health Unit trialled six pop-up COVID-19 testing sites throughout March/April 2021, targeting settled vulnerable communities with high local incidence rates. Public Health doctors provided information, reassurance and advice on-site, with members of the Traveller Health Unit and Primary Health Care Projects providing Infection Prevention and Control (IPC) supplies. Results 576 COVID-19 tests were performed, from which two positive cases identified, 42 members of vulnerable populations were identified, 221 health promotion videos were sent and 448 IPC packs were distributed. Conclusion While the effectiveness of the process to identify positive COVID-19 cases was limited, it offered a unique opportunity for Public Health Medicine to engage with settled vulnerable populations and build a relationship of trust. © 2021, Irish Medical Association. All rights reserved.

Teledentistry Implementation in a Private Pediatric Dental Practice During the COVID-19 Pandemic

Purpose: (1) Implementation of teledentistry in a private pediatric practice during COVID-19 pandemic, (2) Evaluate dental care that was assessed and managed during the COVID-19 pandemic. Methods: Urgent dental care provided during the recommended deferment of elective dentistry (3/16/20-5/17/20) was documented. Encounters were documented by type and management (conventional vs. teledentistry). Results were summarized using descriptive statistics. Associations were compared with Chi-squared or Fisher's exact test. Results: There were 137 emergency patient encounters during the study period. The types were: orthodontics (32 percent), caries (22 percent), eruption concerns (18 percent), trauma (16 percent), "other" (12 percent) (i.e., ankyloglossia, aphthous ulcers). Almost half (48 percent) were managed with teledentistry. The highest utilization of conventional dentistry was caries (70 percent), and for teledentistry was "Other" (75 percent) and eruption concerns (60 percent). Conclusion: Nearly half of emergency encounters in this sample were managed with teledentistry. Teledentistry was a necessary modality of care during the beginning of the COVID-19 pandemic and has uses and implications beyond the triage of acute dental emergencies.