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Alshamrani MM, El-Saed A, Alalmai A, Almanna MA, Alqahtani SMD, Asiri MS, Almasoud SS, Othman F. Clinical characteristics and outcomes of COVID-19 cases admitted to adult intensive care units during the pandemic: A single center experience. J Infect Public Health 2024; 17:102475. [PMID: 39024896 DOI: 10.1016/j.jiph.2024.102475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/20/2024] [Accepted: 06/06/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND COVID-19 is the largest recorded pandemic in history. It causes several complications such as shock, pneumonia, acute respiratory distress syndrome, and organ failure. The objective was to determine COVID-19 outcomes and risk factors in the intensive care (ICU) setting. METHODS A retrospective review of prospectively collected data was conducted. Adult patients with a positive RT-PCR test for COVID-19 admitted to ICUs of a tertiary care hospital between 2020 and 2022 were included. Patients who had severe complex trauma were excluded. The outcomes examined included ventilation use and duration, length of stay (LOS), and mortality. RESULTS A total of 964 patients were included. The mean ( ± standard deviation, SD) age was 63.7 ± 16.9 years. The majority of the patients were males (59.0 %) and Saudi (75.7 %). Ventilation use was documented in 443 (57.1 %) patients, with a mean ( ± SD) ventilation duration of 9.7 ± 8.4 days. Death occurred in 361 (37.4 %) patients after a mean ( ± SD) of 33.3 ± 44.5 days from infection. The mean ( ± SD) LOS was 30.6 ± 54.1 days in hospital and 5.2 ± 5.4 days in ICU. Ventilation use was associated with older age, males, longer ICU LOS, mortality, and admission to medical-surgical ICU. Crude mortality use was associated with older age, longer ICU LOS, use of ventilator, shorter ventilation duration, and admission to medical-surgical or respiratory ICUs. CONCLUSIONS COVID-19 patients admitted to adult ICUs are at high risk of death and mechanical ventilation. The crude risks of both outcomes are higher in older age and longer ICU LOS and are very variable by ICU type.
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Affiliation(s)
- Majid M Alshamrani
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Aiman El-Saed
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Community Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Abdulrahman Alalmai
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia.
| | | | | | - Mohammed Saad Asiri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia.
| | | | - Fatmah Othman
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
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Dempsey W. ADDRESSING SELECTION BIAS AND MEASUREMENT ERROR IN COVID-19 CASE COUNT DATA USING AUXILIARY INFORMATION. Ann Appl Stat 2023; 17:2903-2923. [PMID: 38939875 PMCID: PMC11210953 DOI: 10.1214/23-aoas1744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Coronavirus case-count data has influenced government policies and drives most epidemiological forecasts. Limited testing is cited as the key driver behind minimal information on the COVID-19 pandemic. While expanded testing is laudable, measurement error and selection bias are the two greatest problems limiting our understanding of the COVID-19 pandemic; neither can be fully addressed by increased testing capacity. In this paper, we demonstrate their impact on estimation of point prevalence and the effective reproduction number. We show that estimates based on the millions of molecular tests in the US has the same mean square error as a small simple random sample. To address this, a procedure is presented that combines case-count data and random samples over time to estimate selection propensities based on key covariate information. We then combine these selection propensities with epidemiological forecast models to construct a doubly robust estimation method that accounts for both measurement-error and selection bias. This method is then applied to estimate Indiana's active infection prevalence using case-count, hospitalization, and death data with demographic information, a statewide random molecular sample collected from April 25-29th, and Delphi's COVID-19 Trends and Impact Survey. We end with a series of recommendations based on the proposed methodology.
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Affiliation(s)
- Walter Dempsey
- DEPARTMENT OF BIOSTATISTICS, UNIVERSITY OF MICHIGAN, ANN ARBOR, MI 48109
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Goldberg Y, Huppert A. To boost or not to boost: navigating post-pandemic COVID-19 vaccination. THE LANCET. RESPIRATORY MEDICINE 2023; 11:1039-1041. [PMID: 37898149 DOI: 10.1016/s2213-2600(23)00350-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 10/30/2023]
Affiliation(s)
- Yair Goldberg
- Technion - Israel Institute of Technology, Haifa, Israel.
| | - Amit Huppert
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel; The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kahn R, Schrag SJ, Verani JR, Lipsitch M. Identifying and Alleviating Bias Due to Differential Depletion of Susceptible People in Postmarketing Evaluations of COVID-19 Vaccines. Am J Epidemiol 2022; 191:800-811. [PMID: 35081612 PMCID: PMC8807238 DOI: 10.1093/aje/kwac015] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/09/2022] [Accepted: 01/24/2022] [Indexed: 01/06/2023] Open
Abstract
Recent studies have provided key information about SARS-CoV-2 vaccines' efficacy and effectiveness (VE). One important question that remains is whether the protection conferred by vaccines wanes over time. However, estimates over time are subject to bias from differential depletion of susceptible individuals between vaccinated and unvaccinated groups. We examined the extent to which biases occur under different scenarios and assessed whether serological testing has the potential to correct this bias. By identifying nonvaccine antibodies, these tests could identify individuals with prior infection. We found that in scenarios with high baseline VE, differential depletion of susceptible individuals created minimal bias in VE estimates, suggesting that any observed declines are likely not due to spurious waning alone. However, if baseline VE was lower, the bias for leaky vaccines (which reduce individual probability of infection given contact) was larger and should be corrected for by excluding individuals with past infection if the mechanism is known to be leaky. Conducting analyses both unadjusted and adjusted for past infection could give lower and upper bounds for the true VE. Studies of VE should therefore enroll individuals regardless of prior infection history but also collect information, ideally through serological testing, on this critical variable.
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Affiliation(s)
- Rebecca Kahn
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Stephanie J Schrag
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Jennifer R Verani
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
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5
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Comparative Evaluation of Rapid Isothermal Amplification and Antigen Assays for Screening Testing of SARS-CoV-2. Viruses 2022; 14:v14030468. [PMID: 35336875 PMCID: PMC8951466 DOI: 10.3390/v14030468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/17/2022] Open
Abstract
Human transmission of SARS-CoV-2 and emergent variants of concern continue to occur globally, despite mass vaccination campaigns. Public health strategies to reduce virus spread should therefore rely, in part, on frequent screening with rapid, inexpensive, and sensitive tests. We evaluated two digitally integrated rapid tests and assessed their performance using stored nasal swab specimens collected from individuals with or without COVID-19. An isothermal amplification assay combined with a lateral flow test had a limit of detection of 10 RNA copies per reaction, and a positive percent agreement (PPA)/negative percent agreement (NPA) during the asymptomatic and symptomatic phases of 100%/100% and 95.83/100%, respectively. Comparatively, an antigen-based lateral flow test had a limit of detection of 30,000 copies and a PPA/NPA during the asymptomatic and symptomatic phases of 82.86%/98.68% and 91.67/100%, respectively. Both the isothermal amplification and antigen-based lateral flow tests had optimized detection of SARS-CoV-2 during the peak period of transmission; however, the antigen-based test had reduced sensitivity in clinical samples with qPCR Ct values greater than 29.8. Low-cost, high-throughput screening enabled by isothermal amplification or antigen-based techniques have value for outbreak control.
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Ma KC, Menkir TF, Kissler S, Grad YH, Lipsitch M. Modeling the impact of racial and ethnic disparities on COVID-19 epidemic dynamics. eLife 2021; 10:e66601. [PMID: 34003112 PMCID: PMC8221808 DOI: 10.7554/elife.66601] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/17/2021] [Indexed: 12/29/2022] Open
Abstract
Background The impact of variable infection risk by race and ethnicity on the dynamics of SARS-CoV-2 spread is largely unknown. Methods Here, we fit structured compartmental models to seroprevalence data from New York State and analyze how herd immunity thresholds (HITs), final sizes, and epidemic risk change across groups. Results A simple model where interactions occur proportionally to contact rates reduced the HIT, but more realistic models of preferential mixing within groups increased the threshold toward the value observed in homogeneous populations. Across all models, the burden of infection fell disproportionately on minority populations: in a model fit to Long Island serosurvey and census data, 81% of Hispanics or Latinos were infected when the HIT was reached compared to 34% of non-Hispanic whites. Conclusions Our findings, which are meant to be illustrative and not best estimates, demonstrate how racial and ethnic disparities can impact epidemic trajectories and result in unequal distributions of SARS-CoV-2 infection. Funding K.C.M. was supported by National Science Foundation GRFP grant DGE1745303. Y.H.G. and M.L. were funded by the Morris-Singer Foundation. M.L. was supported by SeroNet cooperative agreement U01 CA261277.
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Affiliation(s)
- Kevin C Ma
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public HealthBostonUnited States
| | - Tigist F Menkir
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public HealthBostonUnited States
| | - Stephen Kissler
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public HealthBostonUnited States
| | - Yonatan H Grad
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public HealthBostonUnited States
- Division of Infectious Diseases, Brigham and Women’s Hospital and Harvard Medical SchoolBostonUnited States
| | - Marc Lipsitch
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public HealthBostonUnited States
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public HealthBostonUnited States
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Soriano JB, Ancochea J. Cabbage and COVID-19. Allergy 2021; 76:966-967. [PMID: 33675254 PMCID: PMC8251406 DOI: 10.1111/all.14654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Joan B. Soriano
- Department of Pneumology Hospital Universitario de la Princesa Madrid Spain
- School of Medicine Universidad Autónoma de Madrid Madrid Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) Instituto de Salud Carlos III (ISCIII) Madrid Spain
| | - Julio Ancochea
- Department of Pneumology Hospital Universitario de la Princesa Madrid Spain
- School of Medicine Universidad Autónoma de Madrid Madrid Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) Instituto de Salud Carlos III (ISCIII) Madrid Spain
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Accorsi EK, Qiu X, Rumpler E, Kennedy-Shaffer L, Kahn R, Joshi K, Goldstein E, Stensrud MJ, Niehus R, Cevik M, Lipsitch M. How to detect and reduce potential sources of biases in studies of SARS-CoV-2 and COVID-19. Eur J Epidemiol 2021; 36:179-196. [PMID: 33634345 PMCID: PMC7906244 DOI: 10.1007/s10654-021-00727-7] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/04/2021] [Indexed: 02/07/2023]
Abstract
In response to the coronavirus disease (COVID-19) pandemic, public health scientists have produced a large and rapidly expanding body of literature that aims to answer critical questions, such as the proportion of the population in a geographic area that has been infected; the transmissibility of the virus and factors associated with high infectiousness or susceptibility to infection; which groups are the most at risk of infection, morbidity and mortality; and the degree to which antibodies confer protection to re-infection. Observational studies are subject to a number of different biases, including confounding, selection bias, and measurement error, that may threaten their validity or influence the interpretation of their results. To assist in the critical evaluation of a vast body of literature and contribute to future study design, we outline and propose solutions to biases that can occur across different categories of observational studies of COVID-19. We consider potential biases that could occur in five categories of studies: (1) cross-sectional seroprevalence, (2) longitudinal seroprotection, (3) risk factor studies to inform interventions, (4) studies to estimate the secondary attack rate, and (5) studies that use secondary attack rates to make inferences about infectiousness and susceptibility.
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Affiliation(s)
- Emma K. Accorsi
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115 USA
| | - Xueting Qiu
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115 USA
| | - Eva Rumpler
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115 USA
| | - Lee Kennedy-Shaffer
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115 USA
- Department of Mathematics and Statistics, Vassar College, Poughkeepsie, NY 12604 USA
| | - Rebecca Kahn
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115 USA
| | - Keya Joshi
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115 USA
| | - Edward Goldstein
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115 USA
| | - Mats J. Stensrud
- Department of Mathematics, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Rene Niehus
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115 USA
| | - Muge Cevik
- Division of Infection and Global Health Research, School of Medicine, University of St Andrews, St Andrews, UK
- Specialist Virology Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK
- Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115 USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115 USA
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Othman F. Bias in early coronavirus disease 2019 research. SAUDI JOURNAL FOR HEALTH SCIENCES 2021. [DOI: 10.4103/sjhs.sjhs_104_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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