The Barts Health NHS Trust COVID-19 cohort: characteristics, outcomes and risk scoring of patients in East London

2021 ◽  
Vol 25 (5) ◽  
pp. 358-366
Author(s):  
T. Crocker-Buque ◽  
S. Williams ◽  
A. R. Brentnall ◽  
R. Gabe ◽  
S. Duffy ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Test Results ◽  
High Respiratory Rate ◽  
Minority Ethnic Groups ◽  
National Health Service Trust ◽  
Risk Scoring ◽  
Polymerase Chain ◽  
Respiratory Coronavirus ◽  
Strength Of Association ◽  
Minority Ethnic

BACKGROUND: Barts Health National Health Service Trust (BHNHST) serves a diverse population of 2.5 million people in London, UK. We undertook a health services assessment of factors used to evaluate the risk of severe acute respiratory coronavirus 2 (SARS‐CoV‐2) infection.METHODS: Patients with confirmed polymerase chain reaction (PCR) test results admitted between 1 March and 1 August 2020 were included, alongwith clinician‐diagnosed suspected cases. Prognostic factors from the 4C Mortality score and 4C Deterioration scores were extracted from electronic health records and logistic regression was used to quantify the strength of association with 28‐day mortality and clinical deterioration using national death registry linkage.RESULTS: Of 2783 patients, 1621 had a confirmed diagnosis, of whom 61% were male and 54% were from Black and Minority Ethnic groups; 26% died within 28 days of admission. Mortality was strongly associated with older age. The 4C mortality score had good stratification of risk with a calibration slope of 1.14 (95% CI 1.01–1.27). It may have under‐estimated mortality risk in those with a high respiratory rate or requiring oxygen.CONCLUSION: Patients in this diverse patient cohort had similar mortality associated with prognostic factors to the 4C score derivation sample, but survival might be poorer in those with respiratory failure.

scholarly journals Clinical Features and Follow-Up of SARS-Cov-2 Asymptomatic Carriers

2020 ◽  
Vol 5 (3) ◽  
Author(s):  
Liu L ◽  
Yuan MJ ◽  
Hong XQ ◽  
Yu Y ◽  
Su X ◽  
...  
Keyword(s):  
Clinical Features ◽  
Clinical Characteristics ◽  
Test Results ◽  
Laboratory Findings ◽  
Asymptomatic Carriers ◽  
Reverse Transcription Pcr ◽  
Laboratory Test Results ◽  
Polymerase Chain ◽  
Respiratory Coronavirus

In the current global coronavirus disease (COVID-19) pandemic, asymptomatic transmission of the causative agent, severe acute respiratory coronavirus-2 (SARS-CoV-2), poses a considerable challenge for disease control. Furthermore, information on the clinical characteristics of asymptomatic carriers is limited. Here, we aimed to clarify the clinical features and obtain follow-up data of asymptomatic carriers to assist in the clinical management of carriers. This retrospective study included all asymptomatic SARS-CoV-2 carriers diagnosed at the First People’s Hospital of Yueyang (Hunan, China) and Hunan Provincial People’s Hospital (Changsha, China) between January 22 and March 26, 2020. Data including the epidemiology, clinical characteristics, laboratory test results, and chest computed tomography status were collected, with a follow-up of these cases. A total of 24 asymptomatic carriers were enrolled at the First People’s Hospital of Yueyang and Hunan Provincial People’s Hospital between 22 January 2020 and 26 March 2020. All patients had previously been exposed to SARS-CoV-2. Over the monitored time, patients experienced no symptoms and most laboratory findings were normal. The median time from contact to diagnosis was 9.6 days (range: 1-38 days), while that from diagnosis to discharge was 14.4 days (range: 6-24 days). Following discharge, all patients remained asymptomatic. However, five patients (20.83%) were re-admitted because a polymerase chain reaction (PCR)-based re-test of their specimens (4 throat swabs and 1 feces) showed that they were positive for SARS-CoV-2. The time to re-testing positively varied from 23 to 53 days post-diagnosis. The time to re-testing negative for SARS-CoV-2 by real-time reverse transcription PCR after re-testing positive was 3 to 11 days. In conclusion, although asymptomatic carriers have favorable outcomes, they should be closely monitored. Also, clear guidelines need to be formulated and close surveillance is required for the management of asymptomatic carriers.

scholarly journals Is it enough for COVID-19 screening test? Limitation of swab test and general characteristics of mild symptom patients

2021 ◽  
Vol 104 (2) ◽  
pp. 003685042110261
Author(s):  
Sungwoo Choi ◽  
Hyo Jeong Choi ◽  
Ho Jung Kim
Keyword(s):  
Screening Test ◽  
Community Treatment ◽  
Upper Respiratory Tract ◽  
Test Results ◽  
Rt Pcr ◽  
Pcr Assay ◽  
Positive Rate ◽  
Upper Respiratory ◽  
Polymerase Chain ◽  
Discharge Criteria

The most common method for SARS-CoV-2 testing is throat or nasal swabbing by real-time reverse transcription polymerase chain reaction (RT-PCR) assay. In South Korea, drive-through swab test is used for screening system and community treatment centers (CTCs), which admit and treat confirmed COVID-19 patients with mild symptoms, are being used. This retrospective study was conducted on patients admitted to a CTC on March 6, 2020. A total of 313 patients were admitted. The nasal and throat swabs were collected from the upper respiratory tract, and a sputum test was performed to obtain lower respiratory samples. The positive rate of the first set of test, sputum test was higher than that of the swab test ( p = 0.011). In the second set of test, 1 week after the first ones, the rate of positive swab tests was relatively high ( p = 0.026). In the first set of test, 66 of 152 (43.4%) patients showed 24-h consecutive negative swab test results, when the sputum test results were considered together, that number fell to 29 patients (19.1%) ( p < 0.001). Also, in the second set of test, 63 of 164 (38.4%) patients met the discharge criteria only when the swab test was considered; that number fell to 30 (18.3%) when the sputum test results were also considered ( p < 0.001). Using the swab test alone is insufficient for screening test and discharge decision. Patients who may have positive result in the sputum test can be missed.

scholarly journals Seroprevalence of SARS-CoV-2 Antibodies Among Health Care Personnel at a Health Care System in Pakistan

2021 ◽  
pp. 101053952110110
Author(s):  
Salma Abbas ◽  
Aun Raza ◽  
Ayesha Iftikhar ◽  
Aamir Khan ◽  
Shahzaib Khan ◽  
...  
Keyword(s):  
Health Care ◽  
Control Measures ◽  
Health Care Personnel ◽  
Test Results ◽  
Antibody Testing ◽  
Chain Reaction ◽  
Past Infection ◽  
Infection Control Measures ◽  
History Of ◽  
Polymerase Chain

Health care personnel (HCP) are at high risk for coronavirus disease-2019 acquisition. Serum antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) indicate past infection. Our institution offered SARS-CoV-2 antibody testing to HCP. We surveyed HCP with positive test results to explore past exposure to SARS-CoV-2, details of symptoms during the preceding 6 months, and a history of SARS-CoV-2 polymerase chain reaction testing. A total of 2162 HCP underwent antibody testing. Eight hundred fifty-seven (39.6%) employees tested positive and, of these, 820 (95.7%) participated in the survey. When adjusted for age, males had higher odds of testing positive for SARS-CoV-2 antibodies compared with females (OR = 1.68; 95% CI = 1.37-2.05; P = .00) and clinical staff had higher odds of SARS-CoV-2 seropositivity compared with nonclinical staff (OR = 1.273; 95% CI = 1.06-1.53; P = .01). Implementation of effective infection control measures is essential to protect HCP from coronavirus disease-2019.

scholarly journals Unequal impact of the COVID-19 crisis on minority ethnic groups: a framework for understanding and addressing inequalities

2021 ◽  
pp. jech-2020-216061
Author(s):  
Srinivasa Vittal Katikireddi ◽  
Sham Lal ◽  
Enitan D Carrol ◽  
Claire L Niedzwiedz ◽  
Kamlesh Khunti ◽  
...  
Keyword(s):  
Ethnic Groups ◽  
Social Consequences ◽  
Control Measures ◽  
Current Evidence ◽  
Future Research ◽  
Complex Interplay ◽  
Structural Racism ◽  
Theoretical Understanding ◽  
Minority Ethnic Groups ◽  
Minority Ethnic

Minority ethnic groups have been disproportionately affected by the COVID-19 pandemic. While the exact reasons for this remain unclear, they are likely due to a complex interplay of factors rather than a single cause. Reducing these inequalities requires a greater understanding of the causes. Research to date, however, has been hampered by a lack of theoretical understanding of the meaning of ‘ethnicity’ (or race) and the potential pathways leading to inequalities. In particular, quantitative analyses have often adjusted away the pathways through which inequalities actually arise (ie, mediators for the effect of interest), leading to the effects of social processes, and particularly structural racism, becoming hidden. In this paper, we describe a framework for understanding the pathways that have generated ethnic (and racial) inequalities in COVID-19. We suggest that differences in health outcomes due to the pandemic could arise through six pathways: (1) differential exposure to the virus; (2) differential vulnerability to infection/disease; (3) differential health consequences of the disease; (4) differential social consequences of the disease; (5) differential effectiveness of pandemic control measures and (6) differential adverse consequences of control measures. Current research provides only a partial understanding of some of these pathways. Future research and action will require a clearer understanding of the multiple dimensions of ethnicity and an appreciation of the complex interplay of social and biological pathways through which ethnic inequalities arise. Our framework highlights the gaps in the current evidence and pathways that need further investigation in research that aims to address these inequalities.

scholarly journals COVID-19 and pregnancy – where are we now? A review

2020 ◽  
Vol 48 (5) ◽  
pp. 428-434 ◽  
Author(s):  
Aleksandra Rajewska ◽  
Wioletta Mikołajek-Bedner ◽  
Joanna Lebdowicz-Knul ◽  
Małgorzata Sokołowska ◽  
Sebastian Kwiatkowski ◽  
...  
Keyword(s):  
Case Fatality ◽  
Fetal Distress ◽  
Delivery Mode ◽  
Test Results ◽  
Rt Pcr ◽  
Third Trimester ◽  
The Third ◽  
Laboratory Test Results ◽  
Protective Antibodies ◽  
Polymerase Chain

AbstractThe new acute respiratory disease severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is highly contagious. It has caused many deaths, despite a relatively low general case fatality rate (CFR). The most common early manifestations of infection are fever, cough, fatigue and myalgia. The diagnosis is based on the exposure history, clinical manifestation, laboratory test results, chest computed tomography (CT) findings and a positive reverse transcription-polymerase chain reaction (RT-PCR) result for coronavirus disease 2019 (COVID-19). The effect of SARS-CoV-2 on pregnancy is not already clear. There is no evidence that pregnant women are more susceptible than the general population. In the third trimester, COVID-19 can cause premature rupture of membranes, premature labour and fetal distress. There are no data on complications of SARS-CoV-2 infection before the third trimester. COVID-19 infection is an indication for delivery if necessary to improve maternal oxygenation. Decision on delivery mode should be individualised. Vertical transmission of coronavirus from the pregnant woman to the fetus has not been proven. As the virus is absent in breast milk, the experts encourage breastfeeding for neonatal acquisition of protective antibodies.

scholarly journals Perceived major experiences of discrimination, ethnic group, and risk of psychosis in a six-country case−control study

2021 ◽  
pp. 1-9
Author(s):  
Supriya Misra ◽  
Bizu Gelaye ◽  
David R. Williams ◽  
Karestan C. Koenen ◽  
Christina P.C. Borba ◽  
...  
Keyword(s):  
Ethnic Groups ◽  
Psychotic Disorders ◽  
Case Control Study ◽  
Perceived Discrimination ◽  
Case Control ◽  
Excess Risk ◽  
Minority Ethnic Groups ◽  
Increased Risk ◽  
Minority Ethnic ◽  
Control Study

Abstract Background Perceived discrimination is associated with worse mental health. Few studies have assessed whether perceived discrimination (i) is associated with the risk of psychotic disorders and (ii) contributes to an increased risk among minority ethnic groups relative to the ethnic majority. Methods We used data from the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions Work Package 2, a population-based case−control study of incident psychotic disorders in 17 catchment sites across six countries. We calculated odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between perceived discrimination and psychosis using mixed-effects logistic regression models. We used stratified and mediation analyses to explore differences for minority ethnic groups. Results Reporting any perceived experience of major discrimination (e.g. unfair treatment by police, not getting hired) was higher in cases than controls (41.8% v. 34.2%). Pervasive experiences of discrimination (≥3 types) were also higher in cases than controls (11.3% v. 5.5%). In fully adjusted models, the odds of psychosis were 1.20 (95% CI 0.91–1.59) for any discrimination and 1.79 (95% CI 1.19–1.59) for pervasive discrimination compared with no discrimination. In stratified analyses, the magnitude of association for pervasive experiences of discrimination appeared stronger for minority ethnic groups (OR = 1.73, 95% CI 1.12–2.68) than the ethnic majority (OR = 1.42, 95% CI 0.65–3.10). In exploratory mediation analysis, pervasive discrimination minimally explained excess risk among minority ethnic groups (5.1%). Conclusions Pervasive experiences of discrimination are associated with slightly increased odds of psychotic disorders and may minimally help explain excess risk for minority ethnic groups.

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