June 20, 2024

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COVID: Pre-exposure Period/Transmission/Testing

Comparison of Two Methods for Sterilization of Filtering Facepiece Respirators Worn for Extended Periods During the COVID-19 Pandemic: An Experimental Laboratory Study
Here these investigators looked at Filtering Facepiece Respirators (FFRs) that were collected in three hospitals after extended use (up to 15 or 30 days). They assessed the physical characteristics and filtration levels of worn FFRs, before sterilization. Respirators that achieved at least 94% filtration of aerosol particles, nasal clip still attached, had no tears, had preserved elastic bands and had no dirt were randomized to receive or not receive cleaning before being submitted to hydrogen peroxide plasma gas sterilization. A total of 1,055 FFRs were collected. Over 85% of them exhibited secured nose clips, preserved strap elasticity, and no tears. However, more than 78% of samples contained dirt, leaving only 101 (19.6%) eligible to undergo sterilization. After sterilization, none of the FFRs in either group achieved minimum filtration, although 72% without cleaning and 80% with cleaning had filtration between 90.0 and 93.9%.

COVID: Early Viral Phase

Real-world Effectiveness of Sotrovimab for the Treatment of SARS-CoV-2 Infection during Omicron BA.2 and BA.5 Subvariant Predominance: A Systematic Literature Review
The authors identified 14 studies that were heterogeneous in terms of study design, population, endpoints and definitions. They included > 1.7 million high-risk patients with COVID-19, of whom approximately 41,000 received sotrovimab during BA.2 and BA.5 predominance. Four studies compared the effectiveness of sotrovimab with untreated or no monoclonal antibody treatment controls, two compared sotrovimab with other treatments, and three single-arm studies compared outcomes during BA.2 and/or BA.5 versus BA.1. Five studies descriptively reported rates of clinical outcomes in patients treated with sotrovimab. During BA.2, a lower risk of all-cause hospitalization or mortality was reported across studies with sotrovimab versus untreated cohorts. Compared with other treatments, sotrovimab was associated with a lower (molnupiravir) or similar (nirmatrelvir/ritonavir) risk of COVID-19-related hospitalization or mortality during BA.2 and BA.5. There was no significant difference in outcomes between the BA.1, BA.2 and BA.5 periods.
Hospital Nurse Staffing Variation and COVID-19 Deaths: A Cross-sectional Study
Here these investigators performed a cross-sectional study of 87,936 Medicare beneficiaries (65–99 years old) hospitalized with COVID-19 and discharged (or died) between April 1 and December 31, 2020, in 237 general acute care hospitals in New York and Illinois. Here measures of hospital nursing resources (i.e. patient-to-RN staffing ratios, proportion of bachelors-qualified RNs, nurse work environments, Magnet recognition) in pre-pandemic period (December 2019 to February 2020) and during (April to June 2021) were used to predict in-hospital and 30-day mortality. The mean age of patients was 78 years (8.6 SD); 51 % were male (n = 44,998). 23 % of patients admitted to the hospital with COVID-19 died during the hospitalization. In this study
they found that patients admitted with COVID-19 to hospitals with better nursing resources pre-pandemic and during the pandemic were significantly less likely to die. For example, each additional patient in the average nurses' workload pre-pandemic was associated with 20 % higher odds of in-hospital mortality (OR 1.20, 95 % CI [1.12–1.28], p < 0.001) and 15 % higher odds of 30-day mortality (OR 1.15, 95 % CI [1.09–1.21], p < 0.001). Hospitals with greater proportions of BSN-qualified RNs, better quality nurse work environments, and Magnet recognition offered similar protective benefits to patients during the pandemic. If all hospitals in the study had superior nursing resources prior to or during the pandemic, models estimate many thousands of deaths among patients hospitalized with COVID-19 could have been avoided.

COVID: The Late Phase/PASC/Long COVID

Endothelial Dysfunction and Persistent Inflammation in Severe Post-COVID-19 Patients: Implications for Gas Exchange
Investigators studied 88 survivors of COVID-19-associated severe ARDS six months post-intensive care unit (ICU) discharge. Assessments included clinical and functional evaluation as well as plasma biomarkers of endothelial dysfunction, inflammation, and viral response. Additionally, an in vitro model using human umbilical vein endothelial cells (HUVECs) explored the direct impact of post-COVID plasma on endothelial function. They found that post-COVID patients with impaired gas exchange demonstrated persistent endothelial inflammation marked by elevated ICAM-1, IL-8, CCL-2, and ET-1 plasma levels. Concurrently, systemic inflammation, evidenced by NLRP3 overexpression and elevated levels of IL-6, sCD40-L, and C-reactive protein, was associated with endothelial dysfunction biomarkers and increased in post-COVID patients in this group with impaired gas exchange. T-cell activation, reflected in CD69 expression, and persistently elevated levels of interferon-β (IFN-β) further contributed to sustained inflammation. An in vitro model confirmed that patient plasma, with altered levels of sCD40-L and IFN-β proteins, had the capacity to alter endothelial function. They conclude: “Six months post-ICU discharge, survivors of COVID-19-associated ARDS exhibited sustained elevation in endothelial dysfunction biomarkers, correlating with the severity of impaired gas exchange. NLRP3 inflammasome activity and persistent T-cell activation indicate on going inflammation contributing to persistent endothelial dysfunction, potentially intensified by sustained immune response.”
Prevalence and Risk Factors of Cytomegalovirus Reactivation in Critically Ill Patients with COVID-19 Pneumonia
These are the results of a retrospective cohort study conducted among adult patients who were admitted to ICU and screened for quantitative real-time PCR for CMV viral load in a tertiary-care hospital during the third wave of the COVID-19 outbreak in Thailand. A total of 185 patients were studied; 133 patients (71.9%) in the non-CMV group and 52 patients (28.1%) in the CMV group. Of all, the mean age was 64.7±13.3 years and (54.6%) were males. The CMV group had received a significantly higher median cumulative dose of corticosteroids than the non-CMV group (301 vs 177 mg of dexamethasone, p<0.001).
Other modalities of treatments for COVID-19 including anti-viral drugs, anti-cytokine drugs and hemoperfusion were not different between the two groups (p>0.05). The 90-day mortality rate for all patients was 29.1%, with a significant difference between the CMV group and the non-CMV group (42.3% vs. 24.1%, p = 0.014). Median length of stay was longer in the CMV group than non-CMV group (43 vs 24 days, p<0.001). The CMV group has detectable CMV DNA load with a median [IQR] of 4,977 [1,365–14,742] IU/mL and 24,570 [3,703–106,642] in plasma and bronchoalveolar fluid, respectively. In multivariate analysis, only a cumulative corticosteroids dose of dexamethasone ≥250 mg (HR = 2.042; 95%CI, 1.130–3.688; p = 0.018) was associated with developing CMV reactivation.
Epidemiologic Features of Recovery From SARS-CoV-2 Infection
Authors look at what variables might impact or predict a person’s time to recovery from an acute SARS-CoV-2 infection. They do a prospective look at a cohort of 4,708 participants and find that by 90 days post infection, there were significant differences in mean recovery time according to sociodemographic, clinical, and lifestyle characteristics, particularly by acute infection severity (outpatient vs critical hospitalization, 32.9 days [95% CI, 31.9-33.9 days] vs 57.6 days [95% CI, 51.9-63.3 days]; log-rank P < .001). Recovery by 90 days post infection was associated with vaccination prior to infection (hazard ratio [HR], 1.30; 95% CI, 1.11-1.51) and infection during the sixth (Omicron variant) vs first wave (HR, 1.25; 95% CI, 1.06-1.49). Recovery was unfavorably associated with female sex (HR, 0.85; 95% CI, 0.79-0.92) and prepandemic clinical cardiovascular disease (HR, 0.84; 95% CI, 0.71-0.99). No significant multivariable-adjusted associations were observed for age, educational attainment, smoking history, obesity, diabetes, chronic kidney disease, asthma, chronic obstructive pulmonary disease, or elevated depressive symptoms. Results were similar for reinfections.
Reduced olfactory bulb volume accompanies olfactory dysfunction after mild SARS-CoV-2 infection
In this study 233 participants underwent MRI and neuropsychological testing as well as a structured questionnaire for olfactory function. This study included 233 individuals recovered from mainly mild to moderate SARS-CoV-2 infections. They found that participants with post-acute self-reported olfactory dysfunction had a significantly lower olfactory bulb volume at baseline than normally smelling individuals. Olfactory bulb volume at baseline predicted olfactometric scores at follow-up.