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We evaluated adverse drug events (ADE) by chart review in a random national sample of 428 Veterans with COVID-19 who received tocilizumab (n=173/428). ADEs (median time=5 days) occurred in 51/173 (29%) and included hepatoxicity (n=29) and infection (n=13). Concomitant medication discontinuation occurred in 22% of ADE patients; mortality was 39%.
Personal Protective Equipment (PPE) is a critical aspect of preventing transmission of SARS-CoV-2 in healthcare settings. We aimed to identify factors related to lapses in PPE usage that may influence transmission of SARS-CoV-2 from patients to healthcare personnel (HCP).
Retrospective cohort study
Tertiary care medical center in Minnesota
A total of 345 HCP that sustained a significant occupational exposure to a patient with Coronavirus Disease 2019 (COVID-19) from May 13th, 2020 through November 30th, 2020 were evaluated.
Eight HCP (2.3%) were found to have SARS-CoV-2 infection during their 14-day post-exposure quarantine. A lack of eye protection during the care of a patient with COVID-19 was associated with HCP testing positive for SARS-CoV-2 by RT-PCR during the post-exposure quarantine (RR 10.25 (95% Confidence Interval (CI) 1.28-82.39), p=.009). Overall, the most common reason for a significant exposure was the usage of a surgical facemask instead of a respirator during an aerosolizing generating procedure (AGP) (55.9%). However, this was not associated with HCP testing positive for SARS-CoV-2 during the post-exposure quarantine (RR 0.99 (95% CI 0.96-1), p=1). Notably, transmission primarily occurred in units that did not regularly care for patients with COVID-19.
The use of universal eye protection is a critical aspect of PPE to prevent patient to HCP transmission of SARS-CoV-2.
Coronavirus disease 2019 (COVID-19), has caused mild illness in children, until the emergence of the novel hyperinflammatory condition PIMS-TS: Paediatric Inflammatory Multisystem Syndrome Temporally associated with Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). PIMS-TS is thought to be a post- SARS-CoV-2 immune dysregulation with excessive inflammatory cytokine release. We studied 25 hydroxyvitamin D (25OHD) concentrations in children with PIMS-TS, admitted to a tertiary paediatric hospital in the United Kingdom (U.K), due to its postulated role in cytokine regulation and immune response. Eighteen children [median (range) age 8.9 (0.3 to 14.6) years, male=10] met the case definition. Majority were of Black, Asian and Minority Ethnic (BAME) origin [89%, 16/18]. Positive SARS-CoV-2 IgG antibodies were present in 94% (17/18) and RNA by PCR in 6% (1/18). 72% of the cohort were vitamin D deficient (<30nmol/L). The mean 25OHD concentration was significantly lower when compared to the population mean from the 2015/16 National Diet and Nutrition Survey (children aged 4-10 years) [24 vs 54nmol/L (95% CI: −38.6, −19.7); p<0.001]. The PICU group had lower mean 25OHD concentrations compared to the non-PICU group, but this was not statistically significant [19.5 vs 31.9 nmol/L; p=0.11]. The higher susceptibility of BAME children to PIMS-TS and also vitamin D deficiency merits contemplation. Whilst any link between vitamin D deficiency and the severity of COVID-19 and related conditions including PIMS-TS requires further evidence, public health measures to improve vitamin D status of the U.K BAME population has been long overdue.
To assess the potential for contamination of personnel, patients and the environment during use of contaminated N95 respirators and to compare the effectiveness of interventions to reduce contamination.
Simulation study of patient care interactions using N95 respirators contaminated with a higher and lower inoculum of the benign virus bacteriophage MS2.
Twelve healthcare personnel performed 3 standardized examinations of mannequins including: 1) Control with suboptimal respirator handling technique; 2) Improved technique with glove change after each N95 contact; and 3) Control with 1-minute ultraviolet-C light (UV-C) treatment prior to donning. The order of the examinations was randomized within subject. The frequencies of contamination were compared among groups. Observations and simulations with fluorescent lotion were used to assess routes of transfer leading to contamination.
With suboptimal respirator handling technique, bacteriophage MS2 was frequently transferred to the participants, mannequin, and environmental surfaces and fomites. Improved technique resulted in significantly reduced transfer of MS2 in the higher inoculum simulations (P<0.01), whereas UV-C treatment reduced transfer in both the higher and lower inoculum simulations (P<0.01). Observations and simulations with fluorescent lotion demonstrated multiple potential routes of transfer to participants, mannequin, and surfaces, including both direct contact with the contaminated respirator and indirect contact via contaminated gloves.
Reuse of contaminated N95 respirators can result in contamination of personnel and the environment even when correct technique is used. Decontamination technologies such as UV-C could reduce the risk for transmission.
Early in the COVID-19 pandemic, CDC recommended collection of a lower respiratory tract (LRT) specimen for SARS-CoV-2 testing in addition to the routinely recommended upper respiratory tract (URT) testing in mechanically ventilated patients. Significant operational challenges were noted at our institution using this approach. In this report, we describe our experience with routine collection of paired URT and LRT sample testing. Our results revealed a high concordance between the two sources, and that all children tested for SARS-CoV-2 were appropriately diagnosed with URT testing alone. There was no added benefit to LRT testing. Based on these findings, our institutional approach was therefore adjusted to sample the URT alone for most patients, with LRT sampling reserved for patients with ongoing clinical suspicion for SARS-CoV-2 after a negative URT test.
To identify error-prone operational steps and key sites of self-contamination during donning and doffing of personal protective equipment (PPE).
A total of 56 health care workers including 37 nurses and 19 physicians, were recruited to don and doff the PPE recommended by the Chinese Center for Disease Control and Prevention. Operational errors and sites of self-contamination were recorded using UV-fluorescent labeling and video surveillance.
Three main errors during donning were identified: choosing a loose-fitting coverall that was difficult to handle; ignoring to inspect the seal of N95 respirator or gloves; and forgetting to pull up the zipper completely. Four main errors during doffing were identified: removing the N95 respirator in a wrong way; touching the scrubs with contaminated hands and elbows; touching contaminated external surfaces of the goggles; and performing insufficient hand hygiene. Key sites that were easily contaminated during the doffing of PPE included left hand and wrist, left lower leg, chest, and left abdomen.
Identifying the steps prone to errors and key sites of self-contamination in the process of PPE donning and doffing can facilitate the training of PPE use and provide detailed evidence for optimizing standardized protocols to reduce contamination.
This study aimed to investigate the impact of COVID-19 on time spent cooking and parental inclusion of children in cooking. A secondary aim was to investigate differences between those who frequently included their children in cooking activities during the COVID-19 pandemic and those that included their children less, on a number of factors such as working from home, parents’ diet quality and cooking skills confidence.
Cross-continental survey with Wilcoxon signed ranks, Independent t-tests, Mann Whitney-U, Chi2, and a binomial logistic regression used for assessment.
A convenience sample of parents over 18 years from the island of Ireland (N=180), Great Britain (N=312), United States of America (N=120), New Zealand (N=166)
In three regions, parents’ time spent cooking and inclusion of children in everyday cooking activities increased (p<0.001). Country (OR=3.6, 95% CI=1.7–7.6), education (OR=1.6, 95% CI =1.1–2.4), cooking skills confidence (OR=1.02, 95% CI=1.009-1.032) and a parental higher intake of vegetables (OR=1.3, 95% CI=1.1-1.5) were significant predictors of a more frequent inclusion of children in cooking activities.
While there a number of key benefits to including children in cooking for the children such as providing life skills and increases in diet quality, this study highlighted a higher intake of vegetables by parents who included children more frequently in cooking activities. With continued lockdowns due to COVID-19 and perhaps more flexibility in working from home in the future, including children in cooking activities should be a key public health message for both children and parents.