#Clinical Characteristics of 54 #medical #staff with #COVID19: A retrospective study in a single center in #Wuhan, #China (J Med Virol., abstract)

[Source: Journal of Medical Virology, full page: (LINK). Abstract, edited.]

Clinical Characteristics of 54 medical staff with COVID‐19: A retrospective study in a single center in Wuhan, China

Jiaojiao Chu,  Nan Yang,  Yanqiu Wei,  Huihui Yue,  Fengqin Zhang,  Jianping Zhao,  Li He, Gaohong Sheng,  Peng Chen,  Gang Li,  Sisi Wu,  Bo Zhang,  Shu Zhang,  Congyi Wang, Xiaoping Miao,  Juan Li,  Wenhua Liu,  Huilan Zhang

First published: 29 March 2020 | DOI:  https://doi.org/10.1002/jmv.25793

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/jmv.25793

 

Abstract

Background

In December 2019, an outbreak of the SARS‐Cov‐2 infection occurred in Wuhan, and rapidly spread to worldwide, which has attracted many people’s concerns about the patients. However, studies on the infection status of medical personnels is still lacking.

Methods

54 cases of SARS‐Cov‐2 infected medical staff from Tongji Hospital between January 7th to February 11th of 2020 were analyzed in this retrospective study. Clinical and epidemiological characteristics were compared between different groups by statistical method.

Results

From January 7 to February 11, 2020, 54 medical staff of Tongji Hospital were hospitalized due to COVID‐19. Most of them were from other clinical departments (72.2%) rather than emergency department (3.7%) or medical technology departments (18.5%). Among the 54 COVID‐19 patients, the distribution of age had a significant difference between non‐severe type and severe/critical cases (median age: 47 years vs. 38 years, p=0.0015). However, there was no statistical difference in terms of gender distribution and the first symptoms between theses two groups. Furthermore, we observed that the lesion regions in SARS‐Cov‐2 infected lungs with severe‐/critical‐type of medical staff were more likely to exhibit lesions in the right upper lobe (31.7% vs. 0%, P=0.028) and right lung (61% vs. 18.2%, P=0.012).

Conclusions

Based on our findings with medical staff infection data, we suggest training for all hospital staff to prevent infection and preparation of sufficient protection and disinfection materials.

This article is protected by copyright. All rights reserved.

Keywords: SARS-CoV-2; COVID-19; HCWs; Nosocomial Outbreaks; Hubei; China.

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#Epidemiology of #Covid19 in a Long-Term Care Facility in King County, #Washington (N Engl J Med., abstract)

[Source: The New England Journal of Medicine, full page: (LINK). Abstract, edited.]

Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington

Temet M. McMichael, Ph.D., Dustin W. Currie, Ph.D., Shauna Clark, R.N., Sargis Pogosjans, M.P.H., Meagan Kay, D.V.M., Noah G. Schwartz, M.D., James Lewis, M.D., Atar Baer, Ph.D., Vance Kawakami, D.V.M., Margaret D. Lukoff, M.D., Jessica Ferro, M.P.H., Claire Brostrom-Smith, M.S.N., et al., for the Public Health–Seattle and King County, EvergreenHealth, and CDC COVID-19 Investigation Team*

 

Abstract

BACKGROUND

Long-term care facilities are high-risk settings for severe outcomes from outbreaks of Covid-19, owing to both the advanced age and frequent chronic underlying health conditions of the residents and the movement of health care personnel among facilities in a region.

METHODS

After identification on February 28, 2020, of a confirmed case of Covid-19 in a skilled nursing facility in King County, Washington, Public Health–Seattle and King County, aided by the Centers for Disease Control and Prevention, launched a case investigation, contact tracing, quarantine of exposed persons, isolation of confirmed and suspected cases, and on-site enhancement of infection prevention and control.

RESULTS

As of March 18, a total of 167 confirmed cases of Covid-19 affecting 101 residents, 50 health care personnel, and 16 visitors were found to be epidemiologically linked to the facility. Most cases among residents included respiratory illness consistent with Covid-19; however, in 7 residents no symptoms were documented. Hospitalization rates for facility residents, visitors, and staff were 54.5%, 50.0%, and 6.0%, respectively. The case fatality rate for residents was 33.7% (34 of 101). As of March 18, a total of 30 long-term care facilities with at least one confirmed case of Covid-19 had been identified in King County.

CONCLUSIONS

In the context of rapidly escalating Covid-19 outbreaks, proactive steps by long-term care facilities to identify and exclude potentially infected staff and visitors, actively monitor for potentially infected patients, and implement appropriate infection prevention and control measures are needed to prevent the introduction of Covid-19.

Keywords: SARS-CoV-2; COVID-19; USA; Nosocomial outbreaks.

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#Asymptomatic and #Presymptomatic #SARS-CoV-2 #Infections in Residents of a Long-Term Care Skilled #Nursing #Facility — King County, #Washington, March 2020 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020

Early Release / March 27, 2020 / 69

Anne Kimball, MD1,2; Kelly M. Hatfield, MSPH1; Melissa Arons, MSc1,2; Allison James, PhD1,2; Joanne Taylor, PhD1,2; Kevin Spicer, MD1; Ana C. Bardossy, MD1,2; Lisa P. Oakley, PhD1,2; Sukarma Tanwar, MMed1,2; Zeshan Chisty, MPH1; Jeneita M. Bell, MD1; Mark Methner, PhD1; Josh Harney, MS1; Jesica R. Jacobs, PhD1,3; Christina M. Carlson, PhD1,3; Heather P. McLaughlin, PhD1; Nimalie Stone, MD1; Shauna Clark4; Claire Brostrom-Smith, MSN4; Libby C. Page, MPH4; Meagan Kay, DVM4; James Lewis, MD4; Denny Russell5; Brian Hiatt5; Jessica Gant, MS5; Jeffrey S. Duchin, MD4; Thomas A. Clark, MD1; Margaret A. Honein, PhD1; Sujan C. Reddy, MD1; John A. Jernigan, MD1; Public Health – Seattle & King County; CDC COVID-19 Investigation Team

Corresponding author: Anne Kimball, opu7@cdc.gov, 770-488-7100.

1 CDC COVID-19 Investigation Team; 2 Epidemic Intelligence Service, CDC; 3 Laboratory Leadership Service, CDC; 4 Public Health – Seattle & King County; 5 Washington State Public Health Laboratory.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Suggested citation for this article: Kimball A, Hatfield KM, Arons M, et al. Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020. MMWR Morb Mortal Wkly Rep. ePub: 27 March 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6913e1external icon.

 

Summary

  • What is already known about this topic?
    • Once SARS-CoV-2 is introduced in a long-term care skilled nursing facility (SNF), rapid transmission can occur.
  • What is added by this report?
    • Following identification of a case of coronavirus disease 2019 (COVID-19) in a health care worker, 76 of 82 residents of an SNF were tested for SARS-CoV-2; 23 (30.3%) had positive test results, approximately half of whom were asymptomatic or presymptomatic on the day of testing.
  • What are the implications for public health practice?
    • Symptom-based screening of SNF residents might fail to identify all SARS-CoV-2 infections. Asymptomatic and presymptomatic SNF residents might contribute to SARS-CoV-2 transmission. Once a facility has confirmed a COVID-19 case, all residents should be cared for using CDC-recommended personal protective equipment (PPE), with considerations for extended use or reuse of PPE as needed.

 

Abstract

Older adults are susceptible to severe coronavirus disease 2019 (COVID-19) outcomes as a consequence of their age and, in some cases, underlying health conditions (1). A COVID-19 outbreak in a long-term care skilled nursing facility (SNF) in King County, Washington that was first identified on February 28, 2020, highlighted the potential for rapid spread among residents of these types of facilities (2). On March 1, a health care provider at a second long-term care skilled nursing facility (facility A) in King County, Washington, had a positive test result for SARS-CoV-2, the novel coronavirus that causes COVID-19, after working while symptomatic on February 26 and 28. By March 6, seven residents of this second facility were symptomatic and had positive test results for SARS-CoV-2. On March 13, CDC performed symptom assessments and SARS-CoV-2 testing for 76 (93%) of the 82 facility A residents to evaluate the utility of symptom screening for identification of COVID-19 in SNF residents. Residents were categorized as asymptomatic or symptomatic at the time of testing, based on the absence or presence of fever, cough, shortness of breath, or other symptoms on the day of testing or during the preceding 14 days. Among 23 (30%) residents with positive test results, 10 (43%) had symptoms on the date of testing, and 13 (57%) were asymptomatic. Seven days after testing, 10 of these 13 previously asymptomatic residents had developed symptoms and were recategorized as presymptomatic at the time of testing. The reverse transcription–polymerase chain reaction (RT-PCR) testing cycle threshold (Ct) values indicated large quantities of viral RNA in asymptomatic, presymptomatic, and symptomatic residents, suggesting the potential for transmission regardless of symptoms. Symptom-based screening in SNFs could fail to identify approximately half of residents with COVID-19. Long-term care facilities should take proactive steps to prevent introduction of SARS-CoV-2 (3). Once a confirmed case is identified in an SNF, all residents should be placed on isolation precautions if possible (3), with considerations for extended use or reuse of personal protective equipment (PPE) as needed (4).

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Keywords: SARS-CoV-2; COVID-19; USA; Nosocomial Outbreaks.

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Rapid #assessment of #regional #SARS-CoV-2 #community #transmission through a convenience sample of healthcare workers, the #Netherlands, March 2020 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Rapid assessment of regional SARS-CoV-2 community transmission through a convenience sample of healthcare workers, the Netherlands, March 2020

Chantal B Reusken1,2,7, Anton Buiting3, Chantal Bleeker-Rovers4, Bram Diederen5, Mariëtte Hooiveld6, Ingrid Friesema1, Marion Koopmans7, Titia Kortbeek1, Suzanne PM Lutgens8, Adam Meijer1, Jean-Luc Murk3, Ilse Overdevest9, Thera Trienekens10, Aura Timen1, Wouter Van den Bijllaardt11, Jaap Van Dissel1, Arianne Van Gageldonk-Lafeber1, Dewi Van der Vegt12, Peter C Wever13, Wim Van der Hoek1,2, Jan Kluytmans11

Affiliations: 1 Centre for Infectious Disease Control-National Institute for Public Health and the Environment, Bilthoven, the Netherlands; 2 These authors contributed equally to this work; 3 Elisabeth-Tweesteden hospital, Tilburg and Waalwijk, the Netherlands; 4 Radboudumc, Nijmegen, the Netherlands; 5 Bravis hospital, Roosendaal and Bergen-op-Zoom, the Netherlands. 6 Nivel, Netherlands institute for health services research, Utrecht, the Netherlands; 7 Erasmus MC, Rotterdam, the Netherlands; 8 Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; 9 Catharina hospital, Eindhoven, the Netherlands; 10 VieCuri hospital, Venlo, the Netherlands; 11 Amphia hospital, Breda, the Netherlands; 12 Elkerliek hospital, Helmond, the Netherlands; 13 Bernhoven hospital, Uden, the Netherlands

Correspondence:  Chantal Reusken

Citation style for this article: Reusken Chantal B, Buiting Anton, Bleeker-Rovers Chantal, Diederen Bram, Hooiveld Mariëtte, Friesema Ingrid, Koopmans Marion, Kortbeek Titia, Lutgens Suzanne PM, Meijer Adam, Murk Jean-Luc, Overdevest Ilse, Trienekens Thera, Timen Aura, Van den Bijllaardt Wouter, Van Dissel Jaap, Van Gageldonk-Lafeber Arianne, Van der Vegt Dewi, Wever Peter C, Van der Hoek Wim, Kluytmans Jan. Rapid assessment of regional SARS-CoV-2 community transmission through a convenience sample of healthcare workers, the Netherlands, March 2020. Euro Surveill. 2020;25(12):pii=2000334. https://doi.org/10.2807/1560-7917.ES.2020.25.12.2000334

Received: 16 Mar 2020;   Accepted: 25 Mar 2020

 

Abstract

To rapidly assess possible community transmission in Noord-Brabant, the Netherlands, healthcare workers (HCW) with mild respiratory complaints and without epidemiological link (contact with confirmed case or visited areas with active circulation) were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Within 2 days, 1,097 HCW in nine hospitals were tested; 45 (4.1%) were positive. Of six hospitals with positive HCW, two accounted for 38 positive HCW. The results informed local and national risk management.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: SARS-CoV-2; COVID-19; HCWs; Nosocomial Outbreaks; Netherlands.

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Initiation of a new #infection #control #system for the #COVID19 #outbreak (Lancet Infect Dis., summary)

[Source: The Lancet Infectious Diseases, full page: (LINK). Summary, edited.]

Initiation of a new infection control system for the COVID-19 outbreak

Xuejiao Chen, Junzhang Tian, Guanming Li, Guowei Li

Published: February 18, 2020 / DOI: https://doi.org/10.1016/S1473-3099(20)30110-9

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In December, 2019, a group of patients with pneumonia of unknown origin, most of whom had been exposed to the Huanan seafood wholesale market in Wuhan, China, was first reported.1 Using deep sequencing analysis, Chinese authorities identified a new betacoronavirus (severe acute respiratory syndrome coronavirus 2; SARS-CoV-2) as the cause of the outbreak, and found that SARS-CoV-2 belongs to a clade within the subgenus sarbecovirus, orthocoronavirinae subfamily.2 As of Feb 10, 2020, the ongoing outbreak of coronavirus disease 2019 (COVID-19) originating in Wuhan had caused 42 638 confirmed cases and 1016 deaths, with 32 provinces and regions of China affected.3

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We declare no competing interests.

Keywords: COVID19; SARS-CoV; Nosocomial Outbreaks; HCWs; PPE; Guangdong; China.

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#Clinical Characteristics of 30 #Medical #Workers Infected With New #Coronavirus #Pneumonia (Zhonghua Jie He He Hu Xi Za Zhi, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Zhonghua Jie He He Hu Xi Za Zhi, 43 (0), E016 2020 Feb 17 [Online ahead of print]

[Clinical Characteristics of 30 Medical Workers Infected With New Coronavirus Pneumonia]

[Article in Chinese]

M Liu 1, P He 2, H G Liu 3, X J Wang 1, F J Li 1, S Chen 1, J Lin 4, P Chen 4, J H Liu 4, C H Li 1

PMID: 32062957 DOI: 10.3760/cma.j.issn.1001-0939.2020.0016

 

Abstract in English , Chinese

Objective:

To investigate the clinical characteristics of medical staff with novel coronavirus pneumonia(NCP).

Methods:

30 patients infected with novel coronavirus referred to jianghan university hospital between January 11, 2020 and January 3, 2020 were studied. The data reviewed included those of clinical manifestations, laboratory investigation and Radiographic features.

Results:

The patients consisted of 10 men and 20 women, including 22 doctors and 8 nurses,aged 21~59 years(mean 35±8 years).They were divided to 26 common type and 4 severe cases, all of whom had close(within 1m) contact with patients infected of novel coronavirus pneumonia. The average contact times were 12 (7,16) and the average cumulative contact time was 2 (1.5,2.7) h.Clinical symptoms of these patients were fever in 23 patients (76.67%) , headache in 16 petients (53.33%) , fatigue or myalgia in 21 patients (70%) , nausea, vomiting or diarrhea in 9 petients (30%) , cough in 25 petients (83.33%) , and dyspnea in 14 petients (46.67%) . Routine blood test revealed WBC <4.0×10(9)/L in 8 petients (26.67%) , (4-10) ×10(9)/L in 22 petients (73.33%) , and WBC>4.0×10(9)/L in 4 petients (13.33%) during the disease. Lymphocyte count <1.0×10(9)/L occurred in 12 petients (40%), abnormal liver function in 7 petients (23.33%) , myocardial damage in 5 petients(16.67%), elevated D-dimer (>0.5mg/l) in 5 patients (16.67%). Compared with normal patients, the average exposure times, cumulative exposure time, BMI, Fever time, white blood cell count, liver enzyme, LDH, myoenzyme and D-dimer were significantly increased in severe patients, while the lymphocyte count and albumin levels in peripheral blood were significantly decreased. Chest CT mainly showed patchy shadows and interstitial changes.According to imaging examination, 11 patients (36.67%) showed Unilateral pneumonia and 19 patients (63.33%) showed bilateral pneumonia,4 patients (13.33%) showed bilateral multiple mottling and ground-glass opacity. Compared with the patients infected in the protected period, the proportion of severe infection and bilateral pneumonia were both increased in the patients infected in unprotected period.

Conclusion:

Medical staffs are at higher risk of infection.Infection rates are associated with contact time, the amount of suction virus. Severe patients had BMI increased, heating time prolonged , white blood cell count, lymphocyte count, D-dimer and albumin level significantly changed and were prone to be complicated with liver damage and myocardial damage.Strict protection measures is important to prevent infection for medical workers.

Keywords: Medical workers; Novel coronavirus; Pneumonia.

Keywords: SARS-CoV-2; COVID-19; Nosocomial Outbreaks; HCWs; China.

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Low-temperature #laminar #flow #ward for the #treatment of #MDR #Acinetobacter baumannii #pneumonia (Eur J Clin Microbiol Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Eur J Clin Microbiol Infect Dis. 2020 Jan 2. doi: 10.1007/s10096-019-03790-x. [Epub ahead of print]

Low-temperature laminar flow ward for the treatment of multidrug resistance Acinetobacter baumannii pneumonia.

Gong Z1,2, Li J, Luo H1,2, Zhan D2,3, Liu X1,2, Gao C1,2, Huang J1,2, Qian Y1,2, Song Y1,2, Quan W1,2, An S1,2, Tian Y1,2, Hu Z4, Sun J1,2, Yuan H5,6, Jiang R7,8.

Author information: 1 Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China. 2 Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China. 3 Department of Pharmacy, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China. 4 Department of clinical laboratories, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China. 5 Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China. hengjieyuan@163.com. 6 Department of Pharmacy, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China. hengjieyuan@163.com. 7 Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China. jiang116216@163.com. 8 Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China. jiang116216@163.com.

 

Abstract

This study was designed to investigate the effect of low-temperature laminar flow ward (LTLFW) on the Acinetobacter baumannii pneumonia (MDR-ABP) in neurosurgical intensive care unit (NICU) patients. We evaluated whether patients in a LTLFW had significantly improved clinical outcomes as compared to those in nonconstant-temperature NICU (room temperature). The association of temperature with the prevalence of ABP and A. baumannii isolates (ABI) found in NICU patients was specifically investigated. In vitro microbiological experiments were conducted to measure the proliferation, antibiotic sensitivity, and genomic profiles of A. baumannii (AB) that grew in variable temperatures. MDR-ABP patients in LTLFW had significantly improved outcomes than those in the room temperature NICU. In addition, the numbers of ABI were positively associated with mean ambient outdoor temperatures (P = 0.002), with the incidence of ABP and average numbers of ABI among NICU patients being substantially lower in the winter as compared to other seasons. However, there were no significant seasonal variations in the other strains of the top five bacteria. Consistent with these clinical observations, AB growing at 20°C and 25°C had significantly reduced viability and antibiotic resistance compared to those growing at 35°C. The expression of genes related to AB survival ability, drug resistance, and virulence also differed between AB growing at 20°C and those at 35°C. LTLFW is effective in promoting the recovery of MDR-ABP patients because low temperatures reduced the density and virulence of AB and enhanced the efficacy of antibiotics, likely at the genetic level.

KEYWORDS: Acinetobacter baumannii; Pneumonia; Temperature; Treatment; Variation

PMID: 31898800 DOI: 10.1007/s10096-019-03790-x

Keywords: Antibiotics; Drugs Resistance; Acinetobacter baumannii; Nosocomial outbreaks; Pneumonia; Intensive care.

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