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1.
Clin Infect Dis ; 2022.
Artigo em Inglês | Web of Science | ID: covidwho-2160988

RESUMO

BACKGROUND: Aerosol inhalation is recognized as the dominant mode of SARS-CoV-2 transmission. Three highly transmissible lineages evolved during the pandemic. One hypothesis to explain increased transmissibility is that natural selection favors variants with higher rates of viral aerosol shedding. However, the extent of aerosol shedding of successive SARS-CoV-2 variants is unknown. We aimed to measure the infectivity and rate of SARS-CoV-2 shedding into exhaled breath aerosol (EBA) by individuals during the Delta and Omicron waves and compared those rates with those of prior SARS-CoV-2 variants from our previously published work. METHODS: COVID-19 cases (n = 93, 32 vaccinated and 20 boosted) were recruited to give samples, including 30-minute breath samples into a Gesundheit-II exhaled breath aerosol sampler. Samples were quantified for viral RNA using RT-PCR and cultured for virus. RESULTS: Alpha (n = 4), Delta (n = 3), and Omicron (n = 29) cases shed significantly more viral RNA copies into exhaled breath aerosols than cases infected with ancestral strains and variants not associated with increased transmissibility (n = 57). All Delta and Omicron cases were fully vaccinated and most Omicron cases were boosted. We cultured virus from the EBA of one boosted and three fully vaccinated cases. CONCLUSIONS: Alpha, Delta, and Omicron independently evolved high viral aerosol shedding phenotypes, demonstrating convergent evolution. Vaccinated and boosted cases can shed infectious SARS-CoV-2 via EBA. These findings support a dominant role of infectious aerosols in transmission of SARS-CoV-2. Monitoring aerosol shedding from new variants and emerging pathogens can be an important component of future threat assessments and guide interventions to prevent transmission.

2.
Clin Infect Dis ; 2022 Oct 26.
Artigo em Inglês | MEDLINE | ID: covidwho-2087752

RESUMO

BACKGROUND: Aerosol inhalation is recognized as the dominant mode of SARS-CoV-2 transmission. Three highly transmissible lineages evolved during the pandemic. One hypothesis to explain increased transmissibility is that natural selection favors variants with higher rates of viral aerosol shedding. However, the extent of aerosol shedding of successive SARS-CoV-2 variants is unknown. We aimed to measure the infectivity and rate of SARS-CoV-2 shedding into exhaled breath aerosol (EBA) by individuals during the Delta and Omicron waves and compared those rates with those of prior SARS-CoV-2 variants from our previously published work. METHODS: COVID-19 cases (n = 93, 32 vaccinated and 20 boosted) were recruited to give samples, including 30-minute breath samples into a Gesundheit-II exhaled breath aerosol sampler. Samples were quantified for viral RNA using RT-PCR and cultured for virus. RESULTS: Alpha (n = 4), Delta (n = 3), and Omicron (n = 29) cases shed significantly more viral RNA copies into exhaled breath aerosols than cases infected with ancestral strains and variants not associated with increased transmissibility (n = 57). All Delta and Omicron cases were fully vaccinated and most Omicron cases were boosted. We cultured virus from the EBA of one boosted and three fully vaccinated cases. CONCLUSIONS: Alpha, Delta, and Omicron independently evolved high viral aerosol shedding phenotypes, demonstrating convergent evolution. Vaccinated and boosted cases can shed infectious SARS-CoV-2 via EBA. These findings support a dominant role of infectious aerosols in transmission of SARS-CoV-2. Monitoring aerosol shedding from new variants and emerging pathogens can be an important component of future threat assessments and guide interventions to prevent transmission.

4.
Oncology Research and Treatment ; 44(SUPPL 2):290, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-1623593

RESUMO

Introduction: In October 2020, with increasing infection counts during the COVID-19 pandemic, a Covid ward with focus on care for hematological and oncological patients was established within our hospital. One of the primary goals was to optimize treatment for Covid patients with preexisting hematological, oncological or immunological risk factors associated with increased mortality. In a meta-analysis including 3377 Covid patients (Vijenthira et al. Blood 2020), a mortality of 34% is described in cases with a previous hematological disease. Methods: Retrospective analysis of hematological cases with COVID- 19. Data was collected to compare available epidemiological figures with those of a hematologically specialized Covid ward. Results: From October 12, 2020 to April 30, 2021, a total of 151 men and 130 women with PCR-proven SARS-CoV2 infection were admitted. The median age was 69 years. Out of 281 admissions, there were 46 deaths (16.3%), 81 (28.8%) had a mild course, 131 (46.6%) had a moderate course and 70 (24.9%) had a severe course of COVID-19. A malignant diagnosis was evident in 86 patients, of which 67 were under ongoing oncological therapy. Of 45 hematologically ill patients undergoing therapy, 12 developed an uncomplicated course (26.7%), 23 (51.1%) a moderate course, and 10 (22.2%) a severe course. Odds ratio for a severe course/death was 0.85/1.00 for malignant hematological diseases, compared to 2.45/3.23 for pulmonary comorbidities and 3.26/5.00 for cardiomyopathy. The average length of stay was 12.0 versus 8.4 days with or without malignant disease, and 13.4 versus 8.5 days with or without hematological disease. Observed hospital mortality associated with COVID-19 was 14.4% in patients without malignant preconditions, 27.0% in cases with non-hematological malignancies and 16.3% for hematologically ill patients. Conclusions: As described above, protracted COVID-19 courses can be seen within a hematologically comorbid patient collective. However, outcomes based on preliminary data do not appear to be significantly aggravated dependent on hematological underlying disease in comparison to other COVID-19 courses. Analyzed data may indicate a potential to optimize COVID-19 survival for vulnerable patient groups through treatment in a specialized department. Updated data will be presented at the congress.

5.
Circulation ; 143(SUPPL 1), 2021.
Artigo em Inglês | EMBASE | ID: covidwho-1325202

RESUMO

Introduction: In response to the COVID-19 pandemic, medical practices have expanded utilization of telehealth. Little is known about the operational impacts of transitioning from in-person to video visits in specialty clinics. In 2018, the Stanford South Asian Translational Heart Initiative (SSATHI), a preventive cardiology clinic focused on high-risk South Asian adults, introduced CardioClick, a program replacing in-person follow-up visits with video visits. Hypothesis: We hypothesized that implementation of video visits increased the efficiency of clinic operations. Methods: We extracted visit-level data from the EHR for 134 patients enrolled in CardioClick with video follow-up visits from June 14, 2018 to April 21, 2020 and a cohort of 276 patients enrolled in the in-person SSATHI prevention program with follow-up visits from September 11, 2014 to March 6, 2020. Results: Patients in CardioClick and the in-person cohort were similar in terms of age (mean 45 years), gender balance (23 vs 21% female), and cardiometabolic risk profiles. There were 181 video and 637 in-person follow-up visits. Video visits were shorter than in-person visits, both in terms of total clinic time [median 22 min (IQR 16, 29) vs 67 min (48, 100)] and provider time required [median22 min (IQR 16, 29) vs 30 min (12, 58)]. Video visits were more likely to end on time (71 vs 11%,p<0.001). The median video visit ended on time while the median in-person visit ended 32 min late(13, 70) (see Figure). Providers were also more likely to complete video visit documentation thesame day (56 vs 42%, p=0.001). Conclusions: In a preventive cardiology clinic, video follow-up visits required less clinic and provider time than in-person visits, were more likely to end on time, and were associated with increased same-day provider documentation completion. In conclusion, video visits offer benefitsbeyond their convenience and may increase the operational efficiency of specialty care practicesfocused on disease prevention, improving value in care delivery.

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