Asymptomatic RT-PCR positive COVID-19 patients in orthopaedic pre-operative evaluation during the peak of the second wave

SARS-CoV-2 variants rapid emergence has posed critical challenge of higher transmission and immune escape causing serious threats to control the pandemic. The present study was carried out in confirmed cases of SARS-CoV-2 patients to elucidate the prevalence of SARS-CoV-2 variant strain. We performed RT-PCR using extracted RNA from the nasopharyngeal swabs of suspected Covid-19 patients. Confirmed positive cases with CT<25 were subjected to whole-genome sequencing to track the prevalence of the virus in the Malwa region of Punjab. The presence of B.1, B.1.1.7, B.1.351, B.1.617.1, B.1.617.2, AY.1 and other unidentified variants of SARS-CoV-2 was found in the studied population. Among all the variants, B.1.1.7 (UK variant) and B.1.617.2 (delta-Indian variant) was found to be the most dominant variant in the population and was found majorly in Patiala followed by Ludhiana, SBS Nagar, Mansa and Sangrur. In addition to this, sequencing results also observed that the dominant trait was more prevalent in male population and age group 21-40 years. The B.1.1.7 and B.1.617.2 variant of SARS-CoV-2 is replacing the wild type (Wuhan Strain) and emerging as the dominant variant in Punjab.

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Dynamics of seroconversion of anti-SARS-CoV-2 IgG antibodies in the Czech unvaccinated population: nationwide prospective seroconversion (PROSECO) study

10.1101/2021.08.15.21262007 ◽

2021 ◽

Author(s):

Pavel Piler ◽

Vojtěch Thon ◽

Lenka Andrýsková ◽

Kamil Doležel ◽

David Kostka ◽

...

Keyword(s):

Czech Republic ◽

Population Based ◽

Igg Antibodies ◽

Rt Pcr ◽

The Czech Republic ◽

Global Pandemic ◽

Government Data ◽

Low Incidence ◽

Study Participants ◽

Second Wave

AbstractBackgroundAlthough the Czech Republic weathered the first wave of the COVID-19 epidemic with relatively low incidence, the second wave of the global pandemic saw it rank among countries bearing the greatest COVID-19 burden, both in Europe and on a worldwide scale. The aim of the nationwide prospective seroconversion (PROSECO) study was to investigate the dynamics of seroconversion of anti-SARS-CoV-2 IgG antibodies in the Czech population.MethodsAll clients of the second largest health insurance company in the Czech Republic were sent a written invitation to participate in this longitudinal study. The study includes the first 30,054 persons who provided a blood sample between October 2020 and March 2021. Seroprevalence was compared between calendar periods of blood sample collection, RT-PCR test results, sociodemographic factors, and other characteristics.FindingsThe data show a dramatic increase in seropositivity over time, from 28% in October/November 2020 to 43% in December 2020/January 2021 to 51% in February/March 2021. These trends were consistent with government data on cumulative viral antigenic prevalence in the population captured by PCR testing – although the seroprevalence rates established in this study were considerably higher than those listed in government data. Data pooled across the entire study period exhibited minor differences in seropositivity between sexes, age groups and body mass index categories; results were similar between test providing laboratories. Seropositivity was substantially higher among symptomatic vs. asymptomatic persons (76% vs. 34%). At least one third of all seropositive participants were asymptomatic, and 28% participants who developed antibodies against SARS-CoV-2 never underwent PCR testing.InterpretationAntibody response provides a better marker of past SARS-CoV-2 infection than PCR testing data. Our data on seroconversion confirm the rapidly increasing prevalence in the Czech population during the dramatically rising pandemic wave prior to the beginning of massive vaccination. The planned second and third assessment of the study participants (April 2021 – September 2021, October 2021 – March 2022) will provide valuable evidence on the seroprevalence changes following vaccination and persistence of antibodies resulting from natural infection and vaccination.Research in contextEvidence before this studySimilarly to most European countries, the first COVID-19 epidemic wave in the Czech Republic produced a relatively low incidence (86.9 confirmed cases per 100,000 persons over three months). At the peaks of the second wave, however, over 100 confirmed cases per 100,000 persons were diagnosed daily and the Czech Republic ranked among the countries with the greatest burden of COVID-19 in Europe and in the world. Only a few nationwide population-based studies have been published covering the second wave of the epidemic in Europe, and none of them from the Central and Eastern European region.Added value of this studyThe PROSECO study will provide key data from the heavily affected Central European region and contribute to the epidemiological and serological characteristics of the SARS-CoV-2 infection. All 30,054 study participants were recruited between October 2020 and March 2021, thus covering all three epidemic peaks (November 2020, January and March 2021) of the second COVID-19 epidemic wave. This allows us to follow the dynamics of seroconversion of anti-SARS-CoV-2 IgG antibodies in the immunologically naive and unvaccinated population during the COVID-19 pandemic. The study participants will be re-assessed in the second (April 2021 – September 2021) and third (October 2021 – March 2022) PROSECO phases to further study the post-infection/post-vaccination dynamics of seroconversion in/after a period of massive vaccination.Implications of all the available evidenceData from the first phase of the PROSECO study indicate that the percentage of the population that has been exposed to the SARS-CoV-2 may be substantially higher than estimates based on official data on cumulative viral positivity incidence as at least one third of seropositive participants were asymptomatic, and 28% of participants who developed antibodies against SARS-CoV-2 never underwent PCR testing. Regional seroprevalence data provide key information to inform, in combination with other surveillance data, public health policies and will be instrumental for the successful management of the subsequent phases of the global pandemic.The number of seropositive participants who never underwent RT-PCR testing demonstrates the importance of serological population-based studies describing the spread and exposure to the virus in the population over time.

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COVID-19: Epidemiology, Pathology, Diagnosis, Treatment, and Impact

Current Pharmaceutical Design ◽

10.2174/1381612827666210224142446 ◽

2021 ◽

Vol 27 ◽

Author(s):

Saimon Shahriar ◽

Md. Sohel Rana ◽

Md. Sabbir Hossain ◽

Ariful Karim ◽

Tasneem Nayla Mredula ◽

...

Keyword(s):

Drug Targets ◽

Face Mask ◽

Rt Pcr ◽

Comprehensive Overview ◽

Infected People ◽

Respiratory Problems ◽

Wide Range ◽

Critical Patients ◽

Physical And Chemical ◽

Second Wave

: The pandemic, well-known as COVID-19, has been brought about by the coronavirus SARS-CoV-2 and it has distinct characteristics from other coronavirus-related epidemics. This pandemic has been ravaging the whole world for more than a year now and no drugs or vaccines have been found to eliminate this virus from the infected people effectively; only physical measures like social distancing, hand washing and face-mask wearing have been taken to reduce its spreading and very recently Veklury (remdesivir) has been permitted by the USFDA to manage the critical patients. This disease can be asymptomatic but when it is symptomatic, it presents with respiratory problems and cold- or flu-like symptoms which can be diagnosed with a chest CT and confirmed with RT-PCR tests. In this review, the taxonomy and structure of SARS-CoV-2 and history, transmission, epidemiology, pathology, clinical features and impacts of the COVID-19 have been discussed. A summary of possible drug targets, attempted physical and chemical measures, as well as vaccine candidates, have also been provided. How this coronavirus is different from other coronaviruses, the obstacles in managing this disease and the possibility of a second wave have also been reviewed. This review represents a wide range of information regarding COVID-19 and intends to be used as a comprehensive overview in this regard.

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Assessment of health system preparedness to deal with the second wave of COVID-19 in a remote tribal district Surguja, Chhattisgarh, India-April 2021

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20213552 ◽

2021 ◽

Vol 8 (9) ◽

pp. 4456

Author(s):

Amitabha Dan ◽

Pushpendra Ram ◽

Khyati Aroskar ◽

Pragati B. Gaikwad ◽

Achhelal R. Pasi

Keyword(s):

Case Fatality ◽

P Value ◽

High Risk Population ◽

Rt Pcr ◽

Cross Sectional ◽

Primary Health Centres ◽

Care Workers ◽

Urban Rural ◽

Test Of Significance ◽

Second Wave

Background: Present study was conducted to assess the preparedness of the Surguja district to curtail COVID-19.Methods: We conducted a cross-sectional observational study from May 2020 to March 2021 through records of 2 primary health centres areas selected by convenient sampling (farthest and nearest to district headquarters). Data on existing facilities and logistics was from district headquarters. Preparedness was assessed through checklist. Observations were presented as rates, ratios and proportions. Standard error of difference between two proportions was used as test of significance and p value≤0.05 was considered significant.Results: For Surguja district population of 925938 (65% rural), overall attack rate was 1.15%, case fatality rate was 0.96% (102/10636); there was 1 DCH, 9 DCHC, 6 CHCs, 25 PHCs, 3 upgraded PHCs, 197 subcentres, 12 CCC, 01 RT-PCR laboratory and 228 COVID vaccination centres. There were 1151 isolation beds; 300 with oxygen support (26%); ICU beds 134 (11.60%) with 34 ventilators. Cumulative 258229 tests; antigen 67.90%, test positivity rate 4.10% (urban 8.2%, rural 1.7%). This urban-rural difference in test positivity rate was statistically significant (p<0.001). Health care workers, 94.81% (12722/13418) had received one dose of vaccine with 53.36% (6789/13418) both doses. Above 45 years eligible population; 66.68% (154254/231331) received one dose of vaccine.Conclusions: Surveillance and management of COVID-19 were as per GOI guidelines issued. However, to enhance response we recommended strict implementation of appropriate behaviour in community, establishment of containment zones/facilities for high risk population in urban area blocks and increasing laboratories with RT-PCR testing in appropriate proportions.

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Evaluation of chest computed tomography features in COVID-19: a single-center retrospective study

Journal of Ideas in Health ◽

10.47108/jidhealth.vol4.iss4.172 ◽

2021 ◽

Vol 4 (4) ◽

pp. 588-594

Author(s):

Akshat Sanjay Shukla ◽

Sanjay Rajendraprasad Shukla ◽

Feral Ravi Daruwala

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

False Negative ◽

Chest Ct ◽

Single Center ◽

Rt Pcr ◽

Pulmonary Vessel ◽

Ct Findings ◽

Diagnostic Center ◽

Second Wave

Background: Even though Real-Time Polymerase Chain Reaction (RT-PCR) is a gold standard for confirming COVID-19, it continues to be plagued by a lack of RT-PCR kits and the potential of false-negative results. Hence, during the second wave of COVID-19 in India, Computed Tomography (CT) scan is an emerging diagnostic tool in evaluating the severity of illness in COVID-19 pneumonia. The present study endeavored to assess chest CT features of COVID-19 pneumonia in Indian population. Methods: This was a single-center, retrospective, observational study conducted in 300 consecutive adults RT-PCR confirmed COVID-19 patients from 1, Jan 2021 to 31, March 2021 at a private radio diagnostic center. Data regarding baseline demographics, clinical and laboratory characteristics, extent, pattern, and type of abnormal CT findings were noted. Results: The study population (204 males and 108 females) had mean age of 43.18 ± 8.27 years. Our study's most common clinical presentation was cough (48.1%) and fever (47.1%), respectively. Lung parenchymal abnormalities were found in 294 (94.2%) patients. Abnormal CT findings revealed the involvement of bilateral (45.6%) and multilobar (42.9%) with a predominant peripheral (92.3%) and posterior (80.8%) distribution. According to the type of opacity, Ground Glass Opacity (GGO) was the dominant abnormality found in 270 (91.8%) patients, in which pure GGO (36.7%), GGO with crazy paving pattern (39.8%), and GGO mixed with consolidation (52.0 %) were noted. Peri-lesional or intralesional segmental or subsegmental pulmonary vessel enlargement was found in 192 (65.3 %) patients. Conclusion: During the second wave of COVID-19, a chest CT scan is a modality of choice in diagnosing COVID-19 pneumonia and related lung parenchymal changes.

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Robust Protective Effect of COVID-19 Vaccination in India—Results of Survey in the Midst of Pandemic’s Second Wave

South Asian Journal of Cancer ◽

10.1055/s-0041-1733320 ◽

2021 ◽

Vol 10 (01) ◽

pp. 28-31

Author(s):

Purvish M. Parikh ◽

Udip Maheshwari ◽

V. M. Krishna ◽

S. Gupta ◽

T. Patil ◽

...

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Online Survey ◽

Normal Activity ◽

High Risk Group ◽

Fake News ◽

Rt Pcr ◽

Positivity Effect ◽

Polymerase Chain ◽

Second Wave

Abstract Introduction Our objective was to document the incidence of COVID-19 in vaccinated health care professionals and related personnel. Method We conducted an online survey to ascertain the incidence of COVID-19 symptoms, reverse transcriptase polymerase chain reaction (RT-PCR) positivity, effect on normal activity, need for anti-COVID-19 medication, hospitalization, and death among individuals who had completed both doses of COVID vaccination at least 2 weeks earlier. Results A total of 351 unique valid responses were received. Among the 340 people who had been vaccinated in India, 5% (17/340) had COVID-19 symptoms, 4.7% (16) became COVID-19 RT-PCR positive, 12 (3.5%) had sickness preventing normal daily activity, 2.65% (9) required anti-COVID-19 medication, and 1.18% (4) required hospitalization. Among family members living with the survey responders, the corresponding incidence was even lower. There was one death in this group. Discussion Being health care professionals, the responders would be at higher risk of daily exposure to COVID-19. Even in this high risk group, the vaccine efficacy is good. Vulture journalists should stop spreading fake news and misinformation that makes people hesitate taking the vaccine or be afflicted analysis paralysis. Every person who chooses to remain unvaccinated increases the risk for our entire community. We also need to follow universal precautions (wearing mask, physical distancing, handwashing) diligently without letting down our guard.

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COVID-19 epidemic trends from a Self-Assessment Web Application in France: Observational Study (Preprint)

10.2196/preprints.26182 ◽

2020 ◽

Author(s):

Fabrice Denis ◽

Arnaud Fontanet ◽

Yann-Mael Le Douarin ◽

Florian Le Goff ◽

Stephan Jeanneau ◽

...

Keyword(s):

Web Application ◽

Large Scale ◽

Correlation Coefficients ◽

Young Population ◽

Rt Pcr ◽

Self Assessment ◽

Emergency Visits ◽

Spatially Correlated ◽

Participatory Surveillance ◽

Second Wave

BACKGROUND We developed a self-assessment and participatory surveillance web-application for coronavirus disease (COVID-19), which was launched in France in March 2020. OBJECTIVE We compared daily large-scale RT-PCR tests results to daily connections to a self-triage application by anosmic users to assess dynamics of emergency visits, hospitalizations and ICU admissions for COVID-19 positive patients in France. METHODS Between 3/21/2020 and 11/18//2020, users of maladiecoronavirus.fr self-triage application were asked questions about COVID-19 symptoms. Data of daily hospitalizations, large-scale RT-PCR positive tests, emergency visits and ICU entrances for COVID-19 patients were compared to data of anosmic users of the applications. RESULTS As of November 18, 2020, 575,214 users reported recent anosmia on near 13 Million responders. Daily anosmia reported during the peak of connections to the application on September 16 were spatially correlated with daily COVID-19–related hospitalizations peak which occurred in November (spearman correlation coefficients=0.77, p<.001). Decrease of the connections of anosmic users after the main peaks of connections preceded the decrease of daily hospitalizations by 10 and 9 days during the first and the second outbreak waves respectively although the decrease of RT-PCR positive tests occurred only 2 days before daily hospitalizations during the second wave. CONCLUSIONS A peak of daily reported anosmia in young adults was observed 49 days before the peak of the hospitalizations corresponding to the first phase of a large-scale contamination of young population followed by older people leading to hospitalization’s peak in November. Data of anosmic users of a national widespread self-assessment application can be a relevant tool to anticipate outbreak surge, and hospitalizations and ICU decrease of COVID-19 patients. CLINICALTRIAL ClinicalTrials.gov NCT04331171

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Effectiveness of Preventive Measures in Keeping Low Prevalence of SARS-CoV-2 Infection in Health Care Workers in a Referral Children’s Hospital in Southern Italy

Pediatric Reports ◽

10.3390/pediatric13010017 ◽

2021 ◽

Vol 13 (1) ◽

pp. 118-124

Author(s):

Désirée Caselli ◽

Daniela Loconsole ◽

Rita Dario ◽

Maria Chironna ◽

Maurizio Aricò

Keyword(s):

Health Care ◽

Health Care Workers ◽

Southern Italy ◽

Hospital Setting ◽

Nasopharyngeal Swab ◽

Rt Pcr ◽

Children's Hospital ◽

Care Workers ◽

Children’S Hospital ◽

Second Wave

The coronavirus disease 2019 (COVID-19) pandemic now represents a major threat to public health. Health care workers (HCW) are exposed to biological risk. Little is currently known about the risk of HCW operating in pediatric wards for SARS-CoV-2 infection. The aim is to assess the prevalence of SARS-CoV-2 infection in HCW in a third-level children’s hospital in Southern Italy. An observational cohort study of all asymptomatic HCW (physician, technicians, nurses, and logistic and support operators) was conducted. HCW were screened, on a voluntary basis, for SARS-CoV-2 by RT-PCR on nasopharyngeal swab performed during the first wave of COVID-19. The study was then repeated, with the same modalities, at a 7-month interval, during the “second wave” of the COVID-19 pandemic. At the initial screening between 7 and 24 April 2020, 525 HCW were tested. None of them tested positive. At the repeated screening, conducted between 9 and 20 November 2020, 627 HCW were tested, including 61 additional ones resulting from COVID-emergency recruitment. At this second screening, eight subjects (1.3%) tested positive, thus being diagnosed as asymptomatic carriers of SARS-CoV-2. They were one physician, five nurses, and two HCW from the logistic/support services. They were employed in eight different wards/services. In all cases, the epidemiological investigation showed convincing evidence that the infection was acquired through social contacts. The study revealed a very low circulation of SARS-CoV-2 infection in HCW tested with RT-PCR. All the infections documented in the second wave of epidemic of SARS-CoV-2 were acquired outside of the workplace, confirming that in a pediatric hospital setting, HCW education, correct use of personal protective equipment, and separation of the COVID-patient pathway and staff flow may minimize the risk derived from occupational exposure.

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Molecular point-of-care testing for SARS-CoV-2 using the ID NOW(TM) System in Emergency Department: Prospective Evaluation and Implementation in the Care Process

10.1101/2021.09.09.21263266 ◽

2021 ◽

Author(s):

Stefan O. Kortuem ◽

Marina Krause ◽

Hans-Juergen Ott ◽

Lisa Kortuem ◽

Hans-Peter Schlaudt

Keyword(s):

Point Of Care ◽

Clinical Care ◽

Care Process ◽

Daily Routine ◽

Rt Pcr ◽

Essential Information ◽

Testing Procedures ◽

Patient Pathways ◽

The Impact ◽

Second Wave

Background. The increasing number of cases and hospital admissions due to COVID-19 created an urgent need for rapid, reliable testing procedures for SARS-CoV-2 in Emergency Departments (ED) in order to effectively manage hospital resources, allocate beds and prevent nosocomial spread of infection. The ID NOW(TM) COVID-19 assay is a simple, user-friendly, rapid molecular test run on an instrument with a small footprint enabling point-of-care diagnostics. Methods. In the first wave, outsourced RT-PCR testing regularly required 36-48 hours before results were available. This prospective study was conducted in the second wave (October 2020-April 2021) and evaluated the impact the implementation of the ID NOW(TM) COVID-19 test in the ED had on clinical care processes and patient pathways. 710 patients were recruited upon arrival at the ED which included those presenting clinical symptoms, asymptomatic individuals or persons fulfilling epidemiological criteria. The first anterior nasal swab was taken by trained nurses in the ambulance or a separate consultation room. The ID NOW(TM) COVID-19 test was performed in the ED in strict compliance with the manufacturer's instructions and positive or suspected cases were additionally tested with RT_PCR (cobas SARS-COV-2 RT-PCR, Roche) following collection of a second nasopharyngeal NP specimen. Results. Swabs directly tested with the ID NOW(TM) COVID-19 test showed a diagnostic concordance of 98 % (sensitivity 99.59 %, specificity 94.55 %, PPV 97.6 %, NPV 99.05 %) compared to RT-PCR as reference. The 488 patients that tested positive with the ID NOW(TM) COVID-19 had a Ct range in RT-PCR results between 7.94 to 37.42 (in 23.2 % > 30). Two false negative results (0.28%) were recorded from patients with Ct values > 30. 14 (1.69%) discordant results were reviewed case-by-case and usually associated with either very early or very advanced stages of infection. Furthermore, patients initially negative with the ID NOW(TM) COVID-19 test and admitted to the hospital were tested again on days 5 and 12: no patient became positive. Discussion. The ID NOW(TM) COVID-19 test for detection of SARS-CoV-2 demonstrated excellent diagnostic agreement with RT-PCR under the above-mentioned patients pathways implemented during the second wave. The main advantage of the system was the provision of reliable results within a few minutes. This not only allowed immediate initiative of appropriate therapy and care for COVID-19 (patient benefit) but provided essential information on isolation and thus available beds. This drastically helped the overall finances of the department and additionally allowed more patients to be admitted including those requiring immediate attention; this was not possible during the first wave since beds were blocked waiting for diagnostic confirmation. Our findings also show that when interpreting the results, the clinical condition and epidemiological history of the patient must be taken into account, as with any test procedure. Overall, the ID NOW(TM) COVID-19 test for SARS-CoV-2 provided a rapid and reliable alternative to laboratory-based RT-PCR in the real clinical setting which became an acceptable part of the daily routine within the ED and demonstrated that early patient management can mitigate the impact of the pandemic on the hospital.

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Maintenance of Elective Patient Care at Berlin University Children's Hospital During the COVID-19 Pandemic

Frontiers in Pediatrics ◽

10.3389/fped.2021.694963 ◽

2021 ◽

Vol 9 ◽

Author(s):

Nicolas Terliesner ◽

Alexander Rosen ◽

Angela M. Kaindl ◽

Uwe Reuter ◽

Kai Lippold ◽

...

Keyword(s):

Rt Pcr ◽

Admission Process ◽

Children's Hospital ◽

Pediatric Hospitals ◽

Increased Risk ◽

Elective Treatment ◽

Children’S Hospital ◽

Hospital Resources ◽

Second Wave ◽

Inpatient Case

Background: In Germany, so far the COVID-19 pandemic evolved in two distinct waves, the first beginning in February and the second in July, 2020. The Berlin University Children's Hospital at Charité (BCH) had to ensure treatment for children not infected and infected with SARS-CoV-2. Prevention of nosocomial SARS-CoV-2 infection of patients and staff was a paramount goal. Pediatric hospitals worldwide discontinued elective treatments and established a centralized admission process.Methods: The response of BCH to the pandemic adapted to emerging evidence. This resulted in centralized admission via one ward exclusively dedicated to children with unclear SARS-CoV-2 status and discontinuation of elective treatment during the first wave, but maintenance of elective care and decentralized admissions during the second wave. We report numbers of patients treated and of nosocomial SARS-CoV-2 infections during the two waves of the pandemic.Results: During the first wave, weekly numbers of inpatient and outpatient cases declined by 37% (p < 0.001) and 29% (p = 0.003), respectively. During the second wave, however, inpatient case numbers were 7% higher (p = 0.06) and outpatient case numbers only 6% lower (p = 0.25), compared to the previous year. Only a minority of inpatients were tested positive for SARS-CoV-2 by RT-PCR (0.47% during the first, 0.63% during the second wave). No nosocomial infection of pediatric patients by SARS-CoV-2 occurred.Conclusion: In contrast to centralized admission via a ward exclusively dedicated to children with unclear SARS-CoV-2 status and discontinuation of elective treatments, maintenance of elective care and decentralized admission allowed the almost normal use of hospital resources, yet without increased risk of nosocomial infections with SARS-CoV-2. By this approach unwanted sequelae of withheld specialized pediatric non-emergency treatment to child and adolescent health may be avoided.

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