Impact of the COVID-19 Vaccine on Asymptomatic Infection Among Patients Undergoing Pre-Procedural COVID-19 Molecular Screening

Abstract Background Several vaccines are now clinically available under emergency use authorization in the United States and have demonstrated efficacy against symptomatic COVID-19. The impact of vaccines on asymptomatic SARS-CoV-2 infection is largely unknown. Methods We conducted a retrospective cohort study of consecutive, asymptomatic adult patients (n = 39,156) within a large United States healthcare system who underwent 48,333 pre-procedural SARS-CoV-2 molecular screening tests between December 17, 2020 and February 8, 2021. The primary exposure of interest was vaccination with at least one dose of an mRNA COVID-19 vaccine. The primary outcome was relative risk of a positive SARS-CoV-2 molecular test among those asymptomatic persons who had received at least one dose of vaccine, as compared to persons who had not received vaccine during the same time period. Relative risk was adjusted for age, sex, race/ethnicity, patient residence relative to the hospital (local vs. non-local), healthcare system regions, and repeated screenings among patients using mixed effects log-binomial regression. Results Positive molecular tests in asymptomatic individuals were reported in 42 (1.4%) of 3,006 tests performed on vaccinated patients and 1,436 (3.2%) of 45,327 tests performed on unvaccinated patients (RR=0.44 95% CI: 0.33-0.60; p<.0001). Compared to unvaccinated patients, the risk of asymptomatic SARS-CoV-2 infection was lower among those >10 days after 1 st dose (RR=0.21; 95% CI: 0.12-0.37; p<.0001) and >0 days after 2 nd dose (RR=0.20; 95% CI: 0.09-0.44; p<.0001) in the adjusted analysis. Conclusions COVID-19 vaccination with an mRNA-based vaccine showed a significant association with a reduced risk of asymptomatic SARS-CoV-2 infection as measured during pre-procedural molecular screening. The results of this study demonstrate the impact of the vaccines on reduction in asymptomatic infections supplementing the randomized trial results on symptomatic patients.

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Impact of COVID-19 Second Wave on Healthcare Networks in the United States

10.1101/2020.07.11.20151217 ◽

2020 ◽

Author(s):

Emad M. Hassan ◽

Hussam Mahmoud

Keyword(s):

United States ◽

Healthcare System ◽

The United States ◽

Healthcare Systems ◽

Mitigation Strategies ◽

County Level ◽

Protective Measures ◽

The Impact ◽

Second Wave ◽

The U.S

The risk of overwhelming healthcare systems from a second wave of COVID-19 is yet to be quantified. Here, we investigate the impact of different reopening scenarios of states around the U.S. on COVID-19 hospitalized cases and the risk of overwhelming the healthcare system while considering resources at the county level. We show that the second wave might involve an unprecedented impact on the healthcare system if an increasing number of the population becomes susceptible and/or if the various protective measures are discontinued. Furthermore, we explore the ability of different mitigation strategies in providing considerable relief to the healthcare system. The results can aid healthcare planners, policymakers, and state officials in making decisions on additional resources required and on when to return to normalcy.

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Physician Wellness in Nephrology and Palliative Care

Palliative Care in Nephrology ◽

10.1093/med/9780190945527.003.0008 ◽

2020 ◽

pp. 76-84

Author(s):

Sarah Ramer ◽

Holly Koncicki

Keyword(s):

United States ◽

Palliative Care ◽

Healthcare System ◽

Symptom Management ◽

The United States ◽

Physician Wellness ◽

Communication Techniques ◽

Prevention And Treatment ◽

The Individual ◽

The Impact

Among many threats to physician wellness is burnout, which is associated with negative outcomes for patients and the healthcare system, in addition to the impact it has on physicians. Data on the prevalence, predictors, and consequences of burnout among nephrologists are very limited, but evidence from various sources suggests it might be a major issue. The prevalence of burnout among palliative care physicians is better-studied and appears to vary by country, with up to 60% of palliative care physicians in the United States suffering from burnout in a recent study. Various interventions for prevention and treatment of burnout have been tried, and some have been found to be effective. Controversy exists, however, over whether the individual or the system in which the individual works is more appropriately targeted for intervention. Learning palliative care skills, such as symptom management and advanced communication techniques, might lessen burnout and increase resilience in nephrologists.

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