Infectious Disease Commons^™

High Prevalence Of Pre-Existing Serological Cross-Reactivity Against Severe Acute Respiratory Syndrome Coronavirus-2 (Sars-Cov-2) In Sub-Saharan Africa, For Yue Tso, Salum J. Lidenge, Phoebe B. Peña, Ashley A. Clegg, John R. Ngowi, Julius Mwaiselage, Owen Ngalamika, Peter Julius, John T. West, Charles Wood

Nebraska Center for Virology: Faculty Publications

Objective: Significant morbidity and mortality have occurred in the USA, Europe, and Asia due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), whereas the numbers of infections and deaths in sub-Saharan Africa (SSA) have remained comparatively low. It has been hypothesized that exposure of the population in SSA to other coronaviruses prior to the COVID-19 pandemic resulted in some degree of cross-protection against SARS-CoV-2 infection and pathogenesis. We evaluated this hypothesis by comparing SARS-CoV-2 cross-reactive antibodies in pre-pandemic plasma samples collected from SSA and the USA.

Method: Pre-COVID-19 pandemic plasma samples from SSA and the USA were collected and tested by …

A Midwestern Academic Hiv Clinic Operation During The Covid-19 Pandemic: Implementation Strategy And Preliminary Outcomes, Nada Fadul, Nichole Regan, Layan Kaddoura, Susan Swindells

Journal Articles: Infectious Diseases

During the COVID-19 pandemic, HIV clinics had to transform care delivery for people with HIV (PWH). We developed a multifaceted telehealth implementation strategy and monitored number of out of care patients (OOC), medical visit frequency (MVF), gap in care (GiC) and viral suppression (VS), and compared measures to baseline data. Between April and October 2020, 1559 visits were scheduled; 328 (21%) were missed, and 63 (4%) were new to care. Of the remaining 1168 follow-up visits, 412 (35%) were telehealth visits. As of October 2020, there were 53 patients OOC, MVF was 55% and GiC was 24% compared to 34, …

High Prevalence Of Pre-Existing Serological Cross-Reactivity Against Severe Acute Respiratory Syndrome Coronavirus-2 (Sars- Cov-2) In Sub-Saharan Africa, For Yue Tso, Salum Lidenge, Phoebe B. Peña, Ashley A. Clegg, John R. Ngowi, Julius Mwaiselage, Owen Ngalamika, Peter Julius, John T. West, Charles Wood

Nebraska Center for Virology: Faculty Publications

Objective: Significant morbidity and mortality have occurred in the USA, Europe, and Asia due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), whereas the numbers of infections and deaths in sub-Saharan Africa (SSA) have remained comparatively low. It has been hypothesized that exposure of the population in SSA to other coronaviruses prior to the COVID-19 pandemic resulted in some degree of cross-protection against SARS-CoV-2 infection and pathogenesis. We evaluated this hypothesis by comparing SARS-CoV-2 cross-reactive antibodies in pre-pandemic plasma samples collected from SSA and the USA.

Method: Pre-COVID-19 pandemic plasma samples from SSA and the USA were collected and tested by …

Epidemiology Of Covid-19 And Predictors Of Outcome In Nigeria: A Single-Center Study., Olayinka Rasheed Ibrahim, Bello Muhammed Suleiman, Suleiman Bello Abdullahi, Taofeek Oloyede, Abdallah Sanda, Maruf Sanusi Gbadamosi, Bashir Olajide Yusuf, Rabilu Yandoma Iliyasu, Lawal Magaji Ibrahim, Adamu Danladi Dawud, Sulaiman Saidu Bashir, Nwawueze Efam Okonta, Wasinda Francis Umar, Abiodun Gbenga Tekobo, Muhammadu Sani Abubakar, Bashir Taiye Aminu, Shuaibu Onoruoyiza Ibrahim, Rasaq Olaosebikan, Olugbenga Ayodeji Mokuolu

Department of Pharmacology and Experimental Therapeutics Faculty Papers

There is a paucity of information regarding the epidemiology and outcome of COVID-19 from low/middle-income countries, including from Nigeria. This single-center study described the clinical features, laboratory findings, and predictors of in-hospital mortality of COVID-19 patients. Patients admitted between April 10, 2020 and June 10, 2020 were included. Forty-five patients with a mean age of 43 (16) years, predominantly male (87%), presented with fever (38%), cough (29%), or dyspnea (24%). In-hospital mortality was 16%. The independent predictors of mortality were hypoxemia (adjusted odds ratio [aOR]: 2.5; 95% CI: 1.3-5.1) and creatinine > 1.5 mg/dL (aOR: 4.3; 95% CI: 1.9-9.8).

A Narrative Review On The Basic And Clinical Aspects Of The Novel Sars-Cov-2, The Etiologic Agent Of Covid-19., Joseph Hokello, Adhikarimayum Lakhikumar Sharma, Girish C. Shukla, Mudit Tyagi

Center for Translational Medicine Faculty Papers

The novel SARS-CoV-2 is responsible for causing the ongoing outbreak of coronavirus disease 19 (COVID-19), a systemic infection in humans. Ever since it was first detected in December 2019, the number of confirmed cases has continued to increase. Within a short period, this disease has become a global issue, and therefore it is characterized as a pandemic. The current understanding and explanations are based on epidemiological, clinical and physiological observations. Besides, it remains a great challenge, as much remains to be understood about this new disease-causing virus. Therefore, we seek to provide an overview of SARS-CoV-2, including its classification, origin, …

Innovative Conservation Of Inhaled Medication Devices During The Covid-19 Pandemic Through A Canister Reassignment Process, Mandelin K. Cooper, L. Hayley Burgess, Karla Miller, Theresa Baltz, Julia Moody, Elizabeth Wiggins, Jeffrey Guy

HCA Healthcare Journal of Medicine

Background: The ideal practice for patients requiring metered-dose inhalers (MDI) with coronavirus disease 2019 (COVID-19) is to use patient specific MDIs. However, this practice may not be possible during a time of increased usage throughout the country and limited availability of the medication. Nebulized medications are a concern due to the potential for aerosolized virus and increased exposure for health care workers. An alternative program of canister reassignment is proposed to address concerns for infection prevention, cross-contamination of MDI canisters and the shortage of MDI’s due to the COVID-19 pandemic.

Methods: A comprehensive MDI canister reassignment process was developed for …

Acute Ischemic Stroke As The Presenting Feature Of Covid-19 In The Young And Pregnant, Nermila A. Ballmick, Jiri F. Kubac, Hossein Akhondi

HCA Healthcare Journal of Medicine

Introduction: Coronavirus disease (COVID-19) is an emerging and rapidly evolving public health issue that has become globally widespread and an overwhelming pandemic. Clinical manifestations of the disease include asymptomatic carrier states, acute respiratory distress syndrome, and even multiorgan dysfunction. Here, we present a unique and rare case of an acute ischemic stroke (AIS) in an asymptomatic pregnant woman with no predisposing medical illnesses.

Discussion: An 18-year-old G2P1 African American woman at 7 weeks gestational age with no significant medical or family history presenting to the Emergency Department during the initial phases of the pandemic with complaints of new onset left …

New Normal For Medical Practice Post Covid-19?, David B. Nash

College of Population Health Faculty Papers

No abstract provided.

Population Health And The Pandemic: Emerging Stronger Next Time., David B. Nash

College of Population Health Faculty Papers

No abstract provided.

Implications Of Covid-19 In High Burden Countries For Hiv/Tb: A Systematic Review Of Evidence, Jacques L. Tamuzi, Birhanu T. Ayele, Constance Shumba, Olatunji O. Adetokunboh, Jeannine Uwimana-Nicol, Zelalem T. Haile, Joseph Inugu, Peter S. Nyasulu

School of Nursing & Midwifery, East Africa

Background: The triple burden of COVID-19, tuberculosis and human immunodeficiency virus is one of the major global health challenges of the twenty-first century. In high burden HIV/TB countries, the spread of COVID-19 among people living with HIV is a well-founded concern. A thorough understanding of HIV/TB and COVID-19 pandemics is important as the three diseases interact. This may clarify HIV/TB/COVID-19 as a newly related field. However, several gaps remain in the knowledge of the burden of COVID-19 on patients with TB and HIV. This study was conducted to review different studies on SARS-CoV, MERS-CoV or COVID-19 associated with HIV/TB co-infection …

Case Report: Tocilizumab For The Treatment Of Sars-Cov-2 Infection In A Patient With Aplastic Anemia, Gina Keiffer, Zach French, Lindsay Wilde, Joanne Filicko-O'Hara, Usama Gergis, Adam Binder

Department of Medicine Faculty Papers

While cytokine storm develops in a minority of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, novel treatment approaches are desperately needed for those in whom it does. Tocilizumab, an interleukin-6 receptor antibody, has been utilized for the treatment of cytokine storm in a number of severe inflammatory conditions, including in patients with severe coronavirus disease 2019 (COVID-19). Here, we present the first published case utilizing this therapy in a patient with underlying immunodeficiency. Our patient with aplastic anemia developed cytokine storm due to COVID-19 manifested by fever, severe hypoxia, pulmonary infiltrates, and elevated inflammatory markers. Following treatment …

Convalescent Plasma In Covid-19, Ranjit S. Banwait, Joshua K. Salabei, Troy J. Fishman, Uma G. Iyer

HCA Healthcare Journal of Medicine

The recent pandemic of SARS-CoV-2, which causes novel coronavirus disease 2019 (Covid-19), has had devastating impact on a global and national scale. In order to overcome this outbreak it is imperative we find treatments that are safe and effective. To date, no definitive treatment is available that can curtail the spread of this viral syndrome. Convalescent plasma (CP) is one such option that has repeatedly served as an important tool in treatment of various bacterial and viral infections, especially in the setting of no specific antimicrobial or vaccination against an infectious disease. Herein, we review the history of CP, prior …

A Comparison Efficacy Study Of Commercial Nasopharyngeal Swabs Versus A Novel 3d Printed Swab For The Detection Of Sars-Cov-2, Forest W. Arnold, Gerald Grant, Phillip F. Bressoud, Stephen P. Furmanek, Donghoon Chung, Nadine Sbaih, Dipan Karmali, Meredith Cahill, George Pantalos

The University of Louisville Journal of Respiratory Infections

Introduction: The large volume of diagnostic tests required by the response to the COVID-19 pandemic resulted in a shortage of commercial nasopharyngeal swabs. In an effort to alleviate the shortage, swabs created by 3D printing may be a solution.

Methods: We designed and produced 3D printed swabs and sought to compare their ability to detect SARS-CoV-2 in patients admitted for COVID-19 or who were suspected of having COVID-19.

Results: A total of 30 patients were swabbed with a commercial and a 3D printed swab. Results matched in 27 of 30 patients (90%). Two patients were discordant with a positive commercial …

Calculating Life And Death In A Time Of Covid, Larry Hirschhorn, Phd

School of Continuing and Professional Studies Coronavirus Papers

The current pandemic makes us feel helpless. We can respond to its predation pragmatically but its silent march through the population promotes dread. Our helplessness undermines our belief in our culture as the source of our self-esteem and felt significance. One response to our experience of helplessness is the omnipotent stance, the idea that we can master the virus, stop it in its tracks, command one another to comply with injunctions and wreak a path of destruction by devastating the economy. Omnipotence promotes magical thinking. In the service of defeating death, we ignore actual suffering; deaths of despair and deaths …

Intoxication With Endogenous Angiotensin Ii: A Covid-19 Hypothesis, Adonis Sfera, Carolina Osorio, Nyla Jafri, Eddie Lee Diaz, Jose Campo Maldonado

School of Medicine Publications

Severe acute respiratory syndrome coronavirus 2 has spread rapidly around the globe. However, despite its high pathogenicity and transmissibility, the severity of the associated disease, COVID-19, varies widely. While the prognosis is favorable in most patients, critical illness, manifested by respiratory distress, thromboembolism, shock, and multi-organ failure, has been reported in about 5% of cases. Several studies have associated poor COVID-19 outcomes with the exhaustion of natural killer cells and cytotoxic T cells, lymphopenia, and elevated serum levels of D-dimer. In this article, we propose a common pathophysiological denominator for these negative prognostic markers, endogenous, angiotensin II toxicity. We hypothesize …

Covid-19 Student Telehealth Support Initiative, Yash Varma, Mary White, Alexandra Leto

Health Equity and Quality Improvement (HEQI) Summit

SKMC students partnered with numerous TJUH departments and developed a telehealth support initiative to:

• Help TJUH patients navigate the telehealth system
• Reduce system-wide appointment delays experienced by patients
• Provide direction to COVID-19 resources

A Volunteer Script was prepared to help patients troubleshoot common issues with accessing the telehealth system and provide up to date recommendations from the CDC to remain safe.

Twilighter Role To Support Primary Team Patient Care, Workflow Efficiency, And Physician Wellbeing, Jesse Edwards, René Daniel, Catriona Harrop

Health Equity and Quality Improvement (HEQI) Summit

Objective

Enhance patient care, process efficiency, and physician wellbeing by decompressing primary team workload and reducing the multitasking demands during critical hours of the daily workflow

Ventilator Decision And Allocation Pathway For Surge Conditions, Bridget Gekas, Jerin Juby, Monica Purcell, John Smith, Laura Fantazzi, Raymond Malloy

Health Equity and Quality Improvement (HEQI) Summit

We created a deployment plan of the available ventilator fleet to be deployed during surge conditions. The plan includes appropriate allocation of acute care ventilators to manage complex respiratory patients, while a percentage of stable respiratory patients can be safely managed using a back-up ventilator.

Organizing A System-Wide Effort On Ventilator Supply Management During Covid-19, Jerin Juby, Raymond Malloy, Bridget Gekas, Laura Fantazzi, Monica Purcell, John Smith, Kathryn Sebastian, Lauren Diduch, Melissa Brancolassi, Megan Hennessy, James Fields

Health Equity and Quality Improvement (HEQI) Summit

We developed a concise definition of ventilators to accurately represent them in all reports across the enterprise, and a ventilator deployment plan.

Use Of Mobility And Exercise Videos During Covid-19 To Minimize Deconditioning, Nethra Ankam, Md, Tulasi Gude, Md, Courtney Back, Pt, Monina Florendo, Pt, Elizabeth Hearn, Pt, Morgan Miller, Pt, Kristen Stout, Pt

Health Equity and Quality Improvement (HEQI) Summit

COVID19 patients are at risk for becoming quickly deconditioned, especially in the hospital setting given the nature of the virus and those that get admitted. The concern for deconditioning stems from patients being confined to their room, the need to minimize exposure amongst healthcare providers and the need to conserve PPE.

We wanted to find ways to optimize opportunities for patient mobility, maintain patient and provider safety, all while conserving PPE. We reviewed the Chinese Association of Rehabilitation Medicine guidelines to help develop the exercise program.

Repairing A Damaged Powered Air-Purifying Respirator (Papr) Battery Component Component With 3-D Printing, Robert Ries, Dante Varotsis, Michelle Ho, Kathryn Linder, Jordan Kurzum, Bon Ku, Md, Mpp, Matt Fields, Md, Robert Pugliese, Pharmd, Morgan Hutchinson, Md

Health Equity and Quality Improvement (HEQI) Summit

• A team from the Thomas Jefferson University Health Design Lab worked with local engineers at FKB to create a 3-D replacement model for the faulty component
• A new component was designed to function with existing battery components
• The new component was created using a desktop fused deposition modeling (FDM) 3-D printer with polylactic acid (PLA) filament

Safer Ambu-Bag Manual Ventilation Through Addition Of A Second High Efficiency Particulate Air (Hepa) Filter, Robert Ries, Morgan Hutchinson, Md, Robert Pugliese, Pharmd, Bon Ku, Md, Mpp, Matt Fields, Md

Health Equity and Quality Improvement (HEQI) Summit

• Experts from the Thomas Jefferson University Health Design Lab met with Emergency Medicine and Anesthesia physicians and local engineers
• A design was envisioned in which 3-D printed connectors could be created to add an additional HEPA Filter as shown in Figure 1
• STL Files for the adapters were created based on standard HEPA filter diameters and 3-D printed
• The second HEPA filter was easily assembled by novice users using the adapters
• Ventilation adequacy using the double HEPA filter ambu-bag was similar to single HEPA filtered ambu-bag ventilation based on observed inflation of a test lung

Meeting The Critical Need For Ventilators In Treatment Of Covid-19 Patients, Alessandro Naopli, Nicholas Satterthwaite, Lawrence Husick, Dietrich Gravenstein, Jerin Juby, Monica Purcell, Bridget Gekas, Zvi Grunwald, Mae West, Bon Ku, Chip Malloy, Michael Mahla, Mijail Serruya

Health Equity and Quality Improvement (HEQI) Summit

We have designed and built a microprocessor-controlled valve manifold having a single air input supplied from a standard ventilator, three air outlets (one per patient), and a digital control panel for setting the pressure supplied to each patient as well as the desired respiration rate. The manifold features multiple pressure sensors for system monitoring. Each inspiration limb of the manifold will be fitted with a viral filter. Each expiration limb will have a passive HME in line with a viral filter to prevent patient cross-contamination and spread of virions.

Each patient will receive one epoch of inspiration pressure followed by …

Increasing Polst Documentation For Patient Transfers From Long Term Care Facilities, Jennifer White, Md, Mari Siegel, Chris Haines, Chris Pitsch, Heather Peiritsch, Erica Westlake

Health Equity and Quality Improvement (HEQI) Summit

With an increase in patients from long term care facilities being admitted to the hospital, a lack of goals of care documentation became evident and presented the providers with many unknowns regarding patient care.

Without documentation and sick with COVID, patients cannot always advocate for themselves. This problem is worsened by the ban on visitors, preventing surrogate decision makers from being in the room.

There is a need for providers at long term care facilities to have these goals of care discussions, for COVID specific circumstances and for long term care.

Creation Of A Dedicated Anesthesia Airway Cart For Use In High-Volume Covid-19 Airway Management, Anna Rabinowitz, Alexander M. Olson, Daniel Casey, Elaine Kilmartin

Health Equity and Quality Improvement (HEQI) Summit

The COVID-19-specific approach to intubation required a change in the team structure and workflow for emergent airway management.

1. New need for bulky PPE and the introduction of an aerosol barrier shield for emergent intubations
2. Higher volume of intubations and use of videolaryngoscopy requires additional equipment
3. Concern for Code Cart contamination and wastage of airway equipment
4. Desire for more efficient approach to selecting and customizing equipment

Telemedicine Certified Recovery Specialists For Patients With Opioid Use Disorders In The Emergency Department In Covid-19, Kory S. London, Md

Health Equity and Quality Improvement (HEQI) Summit

COVID-19 is a staggering tragedy in a number of manners, but the lack of available access points to healthcare services due to federal, state, local and institutional regulations and decisions creates higher levels of patient vulnerability.

Patients with opioid use disorders (OUD) are especially vulnerable given high levels of coexistent housing insecurity, food insecurity and lack of primary care at baseline. These patients frequently utilize the emergency department for both medical and non-medical concerns.

Existing pathways to assist these patients utilize in person certified (peer) recovery specialists (CRS) who are not employed by the enterprise. Given the need to limit …

Training New Providers Dobhoff Tube Insertion During Covid-19: Rapid Training And A Novel “Opt In” Approach To Learning, Michele Decastro, Msn, Crnp, Heather M. Etzl, Msn, Rn, Cbc, Jacqueline E. Crawford, Ms, Rn, Accns-P

Health Equity and Quality Improvement (HEQI) Summit

As increasing numbers of Covid-19 patients were admitted to the hospital and progressed thru their disease course, the Division of Hospital Medicine noted an increased need for enteral feeding access for their patients. At the same time, the Nutritional Support Clinical Nurse Specialists were seeing an increase in requests for assistance with use of Cortrak technology for insertion of Dobhoff tube (DHT) insertion for high risk patients diagnosed with Covid-19.

Progression Of Patient Cohorting In Response To Covid-19 At The Jefferson Methodist Emergency Department, Kory S. London, Md, Efrat Kean, Md

Health Equity and Quality Improvement (HEQI) Summit

While COVID-19 and it’s various complications are a source of a substantial number of Emergency Department (ED) visits, many patients still arrive to the ED for non-COVID-19 indications.

Due to pre-existing construction which was halted by the pandemic, external space for a tent configuration was unavailable.

In effort to decrease patient, staff and nurse exposure to COVID, a system of cohorting was created to assure uninterrupted service in a manner as safe as possible for all involved.

Given the uncertainty of patient volumes and the potential for a high burden of disease similar to our colleagues in New York and …

Jefferson Internal Medicine Associates (Jima) Patient Triage Initiative, Mary White, Alexandra Leto, Barry Ziring, Md

Health Equity and Quality Improvement (HEQI) Summit

HOW MIGHT WE:

1. Contact patients to triage them for in-person versus virtual visits and teach them to use telehealth quickly?
2. How might we screen patients who are coming to the office for COVID-19 symptoms and exposures?

Ensure Follow-Up For Functional Issues Post Covid-19, Nethra Ankam, Md, Tulasi Gude, Md, Kristofer Feeko, Do, Shannon Ames, Pt, Catherine Piersol, Ot, Tiffany Prince-Kandrakota, Pt, Erica Rao, Pt, Kristen Stout, Pt, Monina Florendo, Pt

Health Equity and Quality Improvement (HEQI) Summit

What's the Problem?

Patients post COVID-19 infection have functional limitations at home related to the multi-system effects of the infection, in addition to elevated risk for post-intensive care syndrome.

Our goals were to ensure patients had the resources they needed to safely mobilize at home, ensure referral to appropriate agencies for home care and therapies, and provide guidance on return to life activities in the setting of the stay-at-home order, need to self-quarantine, and limited outpatient therapy options.