Remote surveillance and detection of SARS-CoV-2 transmission among household members in King County, Washington

BACKGROUND

Early during the COVID-19 pandemic, it was important to better understand transmission dynamics of SARS-CoV-2, the virus that causes COVID-19. Household contacts of infected individuals are particularly at risk for infection, but delays in contact tracing, delays in testing contacts, and isolation and quarantine posed challenges to accurately capturing secondary household cases.

METHODS

In this study, 346 households in the Seattle region were provided with respiratory specimen collection kits and remotely monitored using web-based surveys for respiratory illness symptoms weekly between October 1, 2020, and June 20, 2021. Symptomatic participants collected respiratory specimens at symptom onset and mailed specimens to the central laboratory in Seattle. Specimens were tested for SARS-CoV-2 using RT-PCR with whole genome sequencing attempted when positive. SARS-CoV-2-infected individuals were notified, and their household contacts submitted specimens every 2 days for 14 days.

RESULTS

In total, 1371 participants collected 2029 specimens that were tested; 16 individuals (1.2%) within 6 households tested positive for SARS-CoV-2 during the study period. Full genome sequences were generated from 11 individuals within 4 households. Very little genetic variation was found among SARS-CoV-2 viruses sequenced from different individuals in the same household, supporting transmission within the household.

CONCLUSIONS

This study indicates web-based surveillance of respiratory symptoms, combined with rapid and longitudinal specimen collection and remote contact tracing, provides a viable strategy to monitor households and detect household transmission of SARS-CoV-2.

TRIAL REGISTRATION IDENTIFIER

NCT04141930, Date of registration 28/10/2019.

Utilizing a university testing program to estimate relative effectiveness of monovalent COVID-19 mRNA booster vaccine versus two-dose primary series against symptomatic SARS-CoV-2 infection

Vaccine effectiveness (VE) studies utilizing the test-negative design are typically conducted in clinical settings, rather than community populations, leading to bias in VE estimates against mild disease and limited information on VE in healthy young adults. In a community-based university population, we utilized data from a large SARS-CoV-2 testing program to estimate relative VE of COVID-19 mRNA vaccine primary series and monovalent booster dose versus primary series only against symptomatic SARS-CoV-2 infection from September 2021 to July 2022. We used the test-negative design and logistic regression implemented via generalized estimating equations adjusted for age, calendar time, prior SARS-CoV-2 infection, and testing frequency (proxy for test-seeking behavior) to estimate relative VE. Analyses included 2,218 test-positive cases (59 % received monovalent booster dose) and 9,615 test-negative controls (62 %) from 9,066 individuals, with median age of 21 years, mostly students (71 %), White (56 %) or Asian (28 %), and with few comorbidities (3 %). More cases (23 %) than controls (6 %) had COVID-19-like illness. Estimated adjusted relative VE of primary series and monovalent booster dose versus primary series only against symptomatic SARS-CoV-2 infection was 40 % (95 % CI: 33-47 %) during the overall analysis period and 46 % (39-52 %) during the period of Omicron circulation. Relative VE was greater for those without versus those with prior SARS-CoV-2 infection (41 %, 34-48 % versus 33 %, 9 %-52 %, P < 0.001). Relative VE was also greater in the six months after receiving a booster dose (41 %, 33-47 %) compared to more than six months (27 %, 8-42 %), but this difference was not statistically significant (P = 0.06). In this relatively young and healthy adult population, an mRNA monovalent booster dose provided increased protection against symptomatic SARS-CoV-2 infection, overall and with the Omicron variant. University testing programs may be utilized for estimating VE in healthy young adults, a population that is not well-represented by routine VE studies.

Tiny swabs: nasal swabs integrated into tube caps facilitate large-scale self-collected SARS-CoV-2 testing

The COVID-19 pandemic spurred the development of innovative solutions for specimen collection and molecular detection for large-scale community testing. Among these developments is the RHINOstic nasal swab, a plastic anterior nares swab built into the cap of a standard matrix tube that facilitates automated processing of up to 96 specimens at a time. In a study of unsupervised self-collection utilizing these swabs, we demonstrate comparable analytic performance and shipping stability compared to traditional anterior nares swabs, as well as significant improvements in laboratory processing efficiency. The use of these swabs may allow laboratories to accommodate large numbers of sample collections during periods of high testing demand. Automation-friendly nasal swabs are an important tool for high-throughput processing of samples that may be adopted in response to future respiratory viral pandemics.

Streptococcus pneumoniae nasal carriage patterns with and without common respiratory virus detections in households in Seattle, WA, USA before and during the COVID-19 pandemic

Background

Respiratory viruses might influence Streptococcus pneumoniae nasal carriage and subsequent disease risk. We estimated the association between common respiratory viruses and semiquantitative S. pneumoniae nasal carriage density in a household setting before and during the COVID-19 pandemic.

Methods

From November 2019-June 2021, we enrolled participants in a remote household surveillance study of respiratory pathogens. Participants submitted weekly reports of acute respiratory illness (ARI) symptoms. Mid-turbinate or anterior nasal swabs were self-collected at enrollment, when ARI occurred, and, in the second year of the study only, from household contacts after SARS-CoV-2 was detected in a household member. Specimens were tested using multiplex reverse-transcription PCR for respiratory pathogens, including S. pneumoniae, rhinovirus, adenovirus, common human coronavirus, influenza A/B virus, respiratory syncytial virus (RSV) A/B, human metapneumovirus, enterovirus, and human parainfluenza virus. We estimated differences in semiquantitative S. pneumoniae nasal carriage density, estimated by the inverse of S. pneumoniae relative cycle threshold (Crt) values, with and without viral detection for any virus and for specific respiratory viruses using linear generalized estimating equations of S. pneumoniae Crt values on virus detection adjusted for age and swab type and accounting for clustering of swabs within households.

Results

We collected 346 swabs from 239 individuals in 151 households that tested positive for S. pneumoniae (n = 157 with and 189 without ≥1 viruses co-detected). Difficulty breathing, cough, and runny nose were more commonly reported among individuals with specimens with viral co-detection compared to without (15%, 80% and 93% vs. 8%, 57%, and 51%, respectively) and ear pain and headache were less commonly reported (3% and 26% vs. 16% and 41%, respectively). For specific viruses among all ages, semiquantitative S. pneumoniae nasal carriage density was greater with viral co-detection for enterovirus, RSV A/B, adenovirus, rhinovirus, and common human coronavirus (P < 0.01 for each). When stratified by age, semiquantitative S. pneumoniae nasal carriage density was significantly greater with viral co-detection among children aged <5 (P = 0.002) and 5-17 years (P = 0.005), but not among adults aged 18-64 years (P = 0.29).

Conclusion

Detection of common respiratory viruses was associated with greater concurrent S. pneumoniae semiquantitative nasal carriage density in a household setting among children, but not adults.

1087 Establishing Guidelines for VTE Prophylaxis for Acute ENT Admissions

Aim

VTE prophylaxis is a vital aspect of patient safety. The decision whether to offer pharmacological thromboprophylaxis is a balance of risk versus benefit. There is a low incidence of VTE in ENT patients, admissions are often short and active bleeding on admission is not uncommon (epistaxis patients, already on anticoagulation are particularly difficult to manage}. There are no clear, specialty specific guidelines to assist in these frequently encountered endeavours.

Method

The number of emergency ENT admissions who had a documented VTE during admission or in the 28 days following was used to calculate the incidence of VTE in acute admissions. An audit of VTE prophylaxis and documentation was also conducted using 20 admissions over 24 hours.

Results

Incidence was 0.12%. 75% had a documented VTE risk assessment. Only 50% patients were prescribed chemical and mechanical thromboprophylaxis. 0% had appropriately documented that the patient did not require thromboprophylaxis on the drug chart (as per trust guidelines).

Conclusions

The results showed that both documentation and prescribing related to VTE prevention were poor. By highlighting the low incidence amongst this patient group, we were able to establish clearer guidance for VTE prophylaxis in acute ENT admissions and a protocol to standardise the management of anticoagulation in actively bleeding epistaxis patients.

1326 Otorhinolaryngology Education and Training Innovation: A Literature Review of the Academic Year 2019-2020

Aim

We aimed to summarise the literature on educational research and training in otorhinolaryngology during the academic year of 2019-2020.

Method

A literature search was conducted on Medline, Embase and Cochrane in accordance with PRISMA guidelines for ““(ENT or otorhino* or otolaryngo* or (ear, nose, and throat)) and (educat* or train or training or teach*)””. The search was conducted independently on 13/09/20 by two authors (JOH, JM), any discrepancy was further reviewed by a third author (JC). All original research papers published between 2019-2020 were included.

Results

68 papers were included in our study. Educational research this year shifted focus on how to combat the negative impact of COVID-19 on otorhinolaryngology teaching. Although many of the interventions created for postgraduate and undergraduate education have not been formally assessed, virtual electives for medical students were found to increase interest and knowledge in the specialty. Surgical simulation represented the most common teaching method reported aside from COVID-19. 3D models were used for emergency training with an aim to increase trainee exposure to an anterior neck abscess, retrobulbar haematoma and paediatric tracheostomy. 3D models were positively rated for face and content validity and gave statistically significant improvements in confidence for trainees.

Conclusions

The otorhinolaryngology training in 2019-2020 has changed massively due to the pandemic. Improving on virtual learning and adapting simulation training are the key to maintain a positive learning environment for medical students and doctors in the short term. Research on the effect of COVID-19 on otorhinolaryngology education and training will be the focus in 2021.

A remote household-based approach to influenza self-testing and antiviral treatment

Background

Households represent important settings for transmission of influenza and other respiratory viruses. Current influenza diagnosis and treatment relies upon patient visits to healthcare facilities, which may lead to under‐diagnosis and treatment delays. This study aimed to assess the feasibility of an at‐home approach to influenza diagnosis and treatment via home testing, telehealth care, and rapid antiviral home delivery.

Methods

We conducted a pilot interventional study of remote influenza diagnosis and treatment in Seattle‐area households with children during the 2019‐2020 influenza season using pre‐positioned nasal swabs and home influenza tests. Home monitoring for respiratory symptoms occurred weekly; if symptoms were reported within 48 hours of onset, participants collected mid‐nasal swabs and used a rapid home‐based influenza immunoassay. An additional home‐collected swab was returned to a laboratory for confirmatory influenza RT‐PCR testing. Baloxavir antiviral treatment was prescribed and delivered to symptomatic and age‐eligible participants, following a telehealth encounter.

Results

124 households comprising 481 individuals self‐monitored for respiratory symptoms, with 58 home tests administered. 12 home tests were positive for influenza, of which eight were true positives confirmed by RT‐PCR. The sensitivity and specificity of the home influenza test were 72.7% and 96.2%, respectively. There were eight home deliveries of baloxavir, with 7 (87.5%) occurring within 3 hours of prescription and all within 48 hours of symptom onset.

Conclusions

We demonstrate the feasibility of self‐testing combined with rapid home delivery of influenza antiviral treatment. This approach may be an important control strategy for influenza epidemics and pandemics.

Patterns of praying mantid population density following cyclone disturbance in far north Queensland, Australia

In 2006, Cyclone Larry passed over a large area of far north Queensland, Australia. Before the cyclone, data had been collected on the population density of two species of praying mantids. Follow-up surveys found that one species, Ciulfina klassi (Mantodea: Liturgusidae), decreased in density following Cyclone Larry whereas the congeneric C. rentzi appeared resilient to cyclone disturbance. The differing responses of these two species are most likely attributable to their respective habitats being affected differently by cyclone disturbance. Whereas dense rainforest may have buffered C. rentzi from the damaging effects of cyclones, C. klassi may have been more vulnerable as it inhabits more sparsely vegetated woodlands.

Epistaxis and nasotracheal intubation--prevention with vasoconstrictor spray

Eighty patients having anaesthesia for oral surgery requiring nasal intubation were randomly allocated to be intubated with either a plain Magill red rubber or cuffed polyethylene endotracheal tube and in a double blind manner, to receive xylometazoline 0.1% vasoconstrictor nasal spray. The extent of any epistaxis occurring was assessed by an independent observer. With the Magill tube there was bleeding in one out of twenty patients in both the vasoconstrictor group and non vasoconstrictor group at intubation and no bleeding in either of the two groups at extubation. With the polyethylene tube sixteen out of twenty patients had bleeding in the non vasoconstrictor group. This improved to seven out of twenty with the administration of vasoconstrictor drops at intubation (chi square 10.2; p < 0.01) in the polyethylene tube group. At extubation ten out of twenty patients had bleeding in the non vasoconstrictor group improving to two out of twenty with the administration of the vasoconstrictor (chi square 9.6; p,0.01). The use of the vasoconstrictor xylometazoline helped to reduce epistaxis that occurred during nasal intubation and further study into the type of endotracheal tube is recommended.

When the system is the problem, don't blame the patient: problems inherent in the interdisciplinary inpatient team

Organizational theory used in conjunction with the transference/countertransference paradigm enables members of the interdisciplinary team to look at treatment problems from two perspectives and to intervene at the appropriate level. Common problems of the team are poorly defined accountability, a lack of leadership, communication breakdowns, and boundary violations. Suggested interventions are education of team members about organizational theory, open discussion of contentious issues, and reinforcement of boundaries. The dynamics of the team are important and a team can benefit from self-examination through organizational theory.

A comparison of characteristics in the families of patients with anorexia nervosa and normal controls

The present study compared families of patients with anorexia nervosa with families of non-anorexic adolescent daughters of a similar social class. All anorexics and adolescent comparison girls and their parents were studied using a variety of psychometric measures. Body size estimation and physical anhedonia were also measured. Family characteristics were assessed using the Family Assessment Measure (FAM). Contrary to the hypotheses, no abnormalities were found in terms of parental attitudes to weight control or dieting. The mothers of anorexics displayed no increase in psychopathology on any of the measures. The fathers scored very similarly to controls but with higher degrees of conscientiousness. Neither fathers nor mothers displayed abnormalities of their own body size estimates or body satisfaction. On the FAM the anorexic families reported an increased pathology on several sub-scales. It is not possible to say whether these disturbances are part of the pathogenesis or are sequelae to the illness.

Social networks, attachments and support in minor affective disorders: a replication

Significant deficiencies in personal social networks and social support in non-psychotic psychiatric out-patients have been reported by Henderson ad his colleagues. In a replication study, 50 non-psychotic psychiatric out-patients were compared with 50 matched controls. Patients reported spending less time in social interaction, but more time in unpleasant interaction during the previous week; they also had fewer attachment figures, close relatives and good friends and fewer social contacts than controls. However, the separate analysis of Neurotic and Retarded depressives (using the Present State Examination) failed to replicate all these findings in the Retarded depressives. It is concluded that these associations are confirmed in neurotic patients, but that the more severe depressive disorders require further investigation.

Sonar doppler discrimination and the effect of a visual alertness indicator upon detection of auditory sonar signals in a sonar watch

Research reported nearly 20 years ago concluded that the ability to make auditory pitch discriminations is impaired in some Ss by prolonged listening to sonar returns. As a special type of pitch discrimination, discrimination of doppler, is of importance in classifying sonar signals, an experiment was performed to determine whether or not listening to sonar returns for 90 minutes impairs the ability to discriminate doppler. No impairment was found. A second aim of this experiment was to evaluate the effectiveness of an alertness indicator when listening for sonar signals. With the indicator 16 per cent more signals were detected than without it.