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Item COVID-19 disparity among racial and ethnic minorities in the US: A cross sectional analysis(Elsevier, 2020-11) Tirupathi, Raghavendra; Muradova, Valeriia; Shekhar, Raj; Salim, Sohail Abdul; Al-Tawfiq, Jaffar A.; Palabindala, Venkataraman; Medicine, School of MedicineAim To analyze racial disparities in Coronavirus disease (COVID-19) cases in the United States of America and discuss possible reasons behind this inequality. Subject and methods We obtained estimated case counts of African-American, Caucasian, Native American, Asian and Hispanic individuals with coronavirus disease (COVID-19)infection through May 5, 2020, from publicly available data on state departments of health websites. We calculated race-specific fractions as the percentage of the total population and analyzed the reasons behind this disparity. Results The incident rates of COVID-19 were higher among African Americans and among Latinos disproportionately higher than their representation in 14 states and 9 states, respectively. A similar observation was also reported for New York city. The percentage of deaths reported among African Americans was disproportionately higher than their represented share in the population in 23 out of 35 states. It was reported that 22.4% of COVID-19 deaths in the USA were African American, even though black people make up 13.4% of the USA population. Conclusions The analysis shows the disparity of coronavirus disease outcomes by ethnicity and race. Additional research is needed to determine the factors behind this inequality.Item Diagnosis and Management of COVID-19 Disease(American Thoracic Society, 2020) Jamil, Shazia; Mark, Nick; Carlos, Graham; Dela Cruz, Charles S.; Gross, Jane E.; Pasnick, Susan; Medicine, School of MedicineSARS-CoV-2 is a novel coronavirus that was identified in late 2019 as the causative agent of COVID-19 (aka coronavirus disease 2019). On March 11, 2020, the World Health Organization (WHO) declared the world-wide outbreak of COVID-19 a pandemic. This document summarizes the most recent knowledge regarding the biology, epidemiology, diagnosis, and management of COVID-19.Item Drivers of MERS-CoV transmission: what do we know?(Taylor & Francis, 2016) Al-Tawfiq, Jaffar A.; Memish, Ziad A.; Medicine, School of MedicineMiddle East Respiratory Syndrome coronavirus (MERS-CoV) emerged in 2012 has since resulted in sporadic cases, intra-familial transmission and major outbreaks in healthcare settings. The clinical picture of MERS-CoV includes asymptomatic infections, mild or moderately symptomatic cases and fatal disease. Transmissions of MERS-CoV within healthcare settings are facilitated by overcrowding, poor compliance with basic infection control measures, unrecognized infections, the superspreaders phenomenon and poor triage systems. The actual contributing factors to the spread of MERS-CoV are yet to be systematically studied, but data to date suggest viral, host and environmental factors play a major role. Here, we summarize the known factors for the diverse transmission of MERS-CoV.Item Droplet Exposure Risk to Providers From In-Office Flexible Laryngoscopy: A COVID-19 Simulation(Sage, 2021-01) Ye, Michael J.; Sharma, Dhruv; Rubel, Kolin E.; Lebo, Nicole L.; Burgin, Sarah J.; Illing, Elisa A.; Ting, Jonathan Y.; Moore, Michael G.; Yesensky, Jessica A.; Mantravadi, Avinash V.; Sim, Michael W.; Otolaryngology -- Head and Neck Surgery, School of MedicineTo provide data on risk of respiratory droplets from common otolaryngologic procedures during the COVID-19 pandemic, a novel simulation of droplet exposure from flexible laryngoscopy was performed. After completion of a nasal symptom questionnaire, topical fluorescein spray was administered into the nasal and oropharynx of 10 healthy volunteers, who then underwent flexible laryngoscopy under 2 conditions: routine without provoked response and with prompted sneeze/cough. After each, droplets on the proceduralist and participant were counted under ultraviolet A light. Droplets were observed on 1 of 10 volunteers after routine laryngoscopy and 4 of 10 during laryngoscopy with sneeze/cough. A nasal symptom score based on congestion and rhinorrhea was significantly elevated among droplet producers after sneeze/cough (P = .0164). No droplets were observed on the provider. Overall, with adequate personal protective equipment, flexible laryngoscopy poses minimal droplet risk to providers. Nasal symptoms can identify patients more likely to produce droplets after sneeze/cough.Item Dynamics of scientific publications on the MERS-CoV outbreaks in Saudi Arabia(Elsevier, 2017-11) Rabaan, Ali A.; Al-Ahmed, Shamsah H.; Bazzi, Ali M.; Al-Tawfiq, Jaffar A.; Medicine, School of MedicineMiddle East Respiratory Syndrome Coronavirus (MERS-CoV) is an emerging disease with a relatively high case fatality rate. Most cases have been reported from Saudi Arabia, and the disease epidemic potential is considered to be limited. However, human–human transmission has occurred, usually in the context of healthcare facility-associated outbreaks. The scientific and medical community depends on timely publication of epidemiological information on emerging diseases during outbreaks to appropriately target public health responses. In this review, we considered the academic response to four MERS CoV outbreaks that occurred in Al-Hasa in 2013, Jeddah in 2014 and Riyadh in 2014 and 2015. We analysed 68 relevant epidemiology articles. For articles for which submission dates were available, six articles were submitted during the course of an outbreak. One article was published within a month of the Al-Hasa outbreak, and one each was accepted during the Jeddah and Riyadh outbreaks. MERS-CoV epidemiology articles were cited more frequently than articles on other subjects in the same journal issues. Thus, most epidemiology articles on MERS-CoV were published with no preferential advantage over other articles. Collaboration of the research community and the scientific publishing industry is needed to facilitate timely publication of emerging infectious diseases.Item Fluid Resuscitation and Progression to Renal Replacement Therapy in Patients With COVID-19(Elsevier, 2022-02) Holt, Daniel B.; Lardaro, Thomas; Wang, Alfred Z.; Musey, Paul I.; Trigonis, Russell; Bucca, Antonino; Croft, Alexander; Glober, Nancy; Peterson, Kelli; Schaffer, Jason T.; Hunter, Benton R.; Medicine, School of MedicineBackground Coronavirus disease 2019 (COVID-19) is associated with respiratory symptoms and renal effects. Data regarding fluid resuscitation and kidney injury in COVID-19 are lacking, and understanding this relationship is critical. Objectives To determine if there is an association between fluid volume administered in 24 h and development of renal failure in COVID-19 patients. Methods Retrospective chart review; 14 hospitals in Indiana. Included patients were adults admitted between March 11, 2020 and April 13, 2020 with a positive test for severe acute respiratory syndrome coronavirus 2 within 3 days of admission. Patients requiring renal replacement therapy prior to admission were excluded. Volumes and types of resuscitative intravenous fluids in the first 24 h were obtained with demographics, medical history, and other objective data. The primary outcome was initiation of renal replacement therapy. Logistic regression modeling was utilized in creating multivariate models for determining factors associated with the primary outcome. Results The fluid volume received in the first 24 h after hospital admission was associated with initiation of renal replacement therapy in two different multivariate logistic regression models. An odds ratio of 1.42 (95% confidence interval 1.01–1.99) was observed when adjusting for age, heart failure, obesity, creatinine, bicarbonate, and total fluid volume. An odds ratio of 1.45 (95% confidence interval 1.02–2.05) was observed when variables significant in univariate analysis were adjusted for. Conclusions Each liter of intravenous fluid administered to patients with COVID-19 in the first 24 h of presentation was independently associated with an increased risk for initiation of renal replacement therapy, supporting judicious fluid administration in patients with this disease.Item Intranasal Antiviral Drug Delivery and Coronavirus Disease 2019 (COVID-19): A State of the Art Review(Sage, 2020-10) Higgins, Thomas S.; Wu, Arthur W.; Illing, Elisa A.; Sokoloski, Kevin J.; Weaver, Bree A.; Anthony, Benjamin P.; Hughes, Nathan; Ting, Jonathan Y.; Otolaryngology -- Head and Neck Surgery, School of MedicineObjective To provide a state of the art review of intranasal antiviral drug delivery and to discuss current applications, adverse reactions, and future considerations in the management of coronavirus disease 2019 (COVID-19). Data Sources PubMed, Embase, and Clinicaltrials.gov search engines. Review Methods A structured search of the current literature was performed of dates up to and including April 2020. Search terms were queried as related to topics of antiviral agents and intranasal applications. A series of video conferences was convened among experts in otolaryngology, infectious diseases, public health, pharmacology, and virology to review the literature and discuss relevant findings. Conclusions Intranasal drug delivery for antiviral agents has been studied for many years. Several agents have broad-spectrum antiviral activity, but they still require human safety and efficacy trials prior to implementation. Intranasal drug delivery has potential relevance for future clinical trials in the settings of disease spread prevention and treatment of SARS-CoV-2 and other viral diseases.Item Middle East respiratory syndrome coronavirus in the last two years: Health care workers still at risk(Elsevier, 2019-10) Al-Tawfiq, Jaffar A.; Memish, Ziad A.; Medicine, School of MedicineBackground An important emerging respiratory virus is the Middle East respiratory syndrome coronavirus (MERS-CoV). MERS-CoV had been associated with a high case fatality rate especially among severe cases. Methods This is a retrospective analysis of reported MERS-CoV cases between December 2016 and January 2019, as retrieved from the World Health Organization. The aim of this study is to examine the epidemiology of reported cases and quantify the percentage of health care workers (HCWs) among reported cases. Results There were 403 reported cases with a majority being men (n = 300; 74.4%). These cases were reported from Lebanon, Malaysia, Oman, Qatar, Saudi Arabia, and United Arab Emirates. HCWs represented 26% and comorbidities were reported among 71% of non-HCWs and 1.9% among HCWs (P < .0001). Camel exposure and camel milk ingestion were reported in 64% each, and the majority (97.8%) of those with camel exposures had camel milk ingestion. There were 58% primary cases and 42% were secondary cases. The case fatality rate was 16% among HCWs compared with 34% among other patients (P = .001). The mean age ± SD was 47.65 ± 16.28 for HCWs versus 54.23 ± 17.34 for non-HCWs (P = .001). Conclusions MERS-CoV infection continues to have a high case fatality rate and a large proportion of patients were HCWs. Further understanding of the disease transmission and prevention mainly in health care settings are needed.Item The middle east respiratory syndrome coronavirus respiratory infection: an emerging infection from the arabian peninsula(Elsevier, 2016) Al-Tawfiq, J. A.; Memish, Ziad A.; Medicine, School of MedicineMiddle East Respiratory Syndrome coronavirus (MERS-CoV) was initially isolated from a patient who was admitted to a private hospital in the Western part of the Kingdom of Saudi Arabia in 2012. Subsequently, MERS-CoV resulted in many sporadic cases, multiple intrafamilial transmission, and major outbreaks in healthcare settings. Of all the cases reported within the Kingdom of Saudi Arabia, 38% of the cases were primary, 45% were healthcare-associated infection, and 14% were household infections. The clinical spectrum of the MERS-CoV infection ranges from asymptomatic infections, mild or moderately symptomatic cases, and severe disease requiring intensive care unit admissions and may result in death. Within healthcare settings, transmissions of MERS-CoV are facilitated by overcrowding, poor infection control measures, unrecognized infections, and superspreader phenomenon. Currently, there is no approved therapy for MERS-CoV and there are no vaccines.Item Multicenter Evaluation of the QIAstat-Dx Respiratory Panel for the Detection of Viruses and Bacteria in Nasopharyngeal Swab Specimens(ASM, 2020-05) Leber, Amy L.; Lisby, Jan Gorm; Hansen, Glen; Relich, Ryan F.; Schneider, Uffe Vest; Granato, Paul; Young, Stephen; Pareja, Josep; Hannet, Irene; Pathology and Laboratory Medicine, School of MedicineThe QIAstat-Dx Respiratory Panel (QIAstat-Dx RP) is a multiplex in vitro diagnostic test for the qualitative detection of 20 pathogens directly from nasopharyngeal swab (NPS) specimens. The assay is performed using a simple sample-to-answer platform with results available in approximately 69 min. The pathogens identified are adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus A and B, influenza A, influenza A H1, influenza A H3, influenza A H1N1/2009, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, rhinovirus/enterovirus, respiratory syncytial virus A and B, Bordetella pertussis, Chlamydophila pneumoniae, and Mycoplasma pneumoniae. This multicenter evaluation provides data obtained from 1,994 prospectively collected and 310 retrospectively collected (archived) NPS specimens with performance compared to that of the BioFire FilmArray Respiratory Panel, version 1.7. The overall percent agreement between QIAstat-Dx RP and the comparator testing was 99.5%. In the prospective cohort, the QIAstat-Dx RP demonstrated a positive percent agreement of 94.0% or greater for the detection of all but four analytes: coronaviruses 229E, NL63, and OC43 and rhinovirus/enterovirus. The test also demonstrated a negative percent agreement of ≥97.9% for all analytes. The QIAstat-Dx RP is a robust and accurate assay for rapid, comprehensive testing for respiratory pathogens.