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Open Access Publications from the University of California

Scholarly Works (17 results)

  • Article
  • Peer Reviewed
UC San Diego Previously Published Works (2018)
Actinotignum schaalii is an underappreciated cause of urinary tract infections (UTIs) in older adults. The diagnosis may be missed due to difficulty isolating and identifying the organism. Complications can result because the organism is intrinsically resistant to 2 commonly used drugs to treat UTI, as illustrated by this case.
    Cover page: Actinotignum schaalii Infection: A Clandestine Cause of Sterile Pyuria?
    • Article
    • Peer Reviewed
    UC San Diego Previously Published Works (2021)
    Background: The County of San Diego Health and Human Services (SDHHSA) established a goal to vaccinate 1.9 million residents as quickly as possible to attain vaccine induced herd immunity. This strategy would minimize the emergence of more transmissible variants, to which some vaccines may be less effective. With this strategy in mind, UC San Diego Health (UCSDH) collaborated with the local health authorities and the San Diego Padres to build a superstation in downtown San Diego in the parking lot of a baseball stadium. Methods: Building on the experience of rapidly vaccinating the UCSDH workforce in mid-December 2020, UCSDH and SDHHSA partnered to more efficiently distribute SARS-CoV-2 vaccine in San Diego County by building a vaccine superstation. The San Diego Padres offered their parking lot as the site; it was centrally located, easily accessible, quick to set up, and semipermanent. They also provided infrastructure support, event coordination, and internet capability. Occupying a space of ~6.5 acres, the superstation included 12 lanes serving 12 cars each, with ~3 cycles every hour, as well as a pedestrian walk-up station. Altogether, the site had the capacity for >5,000 vaccinations daily. This effort required coordination among administration, healthcare providers, IT specialists, and support staff—a daily workforce of >300 persons. The workforce needs were met using a multipronged approach, including flexible staffing, coordination of volunteers, and recruitment of previously retired providers. The private–public partnership enabled the superstation to be up and running in 5 days. Results: The operation was quickly ramped up to provide >6,000 vaccines daily. Initially only open to healthcare workers, on January 17 the superstation was expanded to persons aged >75 years, with further expansion to those aged ≥65 years on January 23. From January 11 to February 5, >100,000 individuals received their first dose of vaccine at the superstation, corresponding to ~31% of all San Diego county vaccinations. Conclusions: Vaccination of as many people as quickly as possible is essential to controlling the pandemic. Unchecked replication of SARS-CoV-2 allows increases the chance that the virus may develop mutations that render vaccines and therapeutics less effective. Our model vaccine superstation was replicated at 3 more sites around the county, the limited allocation of vaccine has been the only barrier to further expansion. A force of 10 superstations could administer a first dose to the remaining 1.6 million county residents within 32 days.Funding: NoDisclosures: None
      Cover page: COVID-19 Vaccine Superstations as a Model to Rapidly Achieve Herd ImmunityCreative Commons 'BY-NC-ND' version 4.0 license
      • Article
      • Peer Reviewed
      UC San Diego Previously Published Works (2020)
      Abstract

      Background

      The SARS-CoV-2 pandemic remains a major threat worldwide. Healthcare workers (HCWs) are particularly impacted by the COVID-19 pandemic with high infection rates reported from HCWs in hard-hit regions2,3, raising concerns about nosocomial infections and the effectiveness of personal protective equipment in protecting HCWs. Asymptomatic infection is estimated 17.9% to 33.3%4 and is a common source of transmission5. We designed a HCW testing program to address patient and employee concerns about exposures in the healthcare setting at our 808-bed health system. During the time of employee testing, the mean (range) number of inpatients with a diagnosis of COVID was 30 (22–38) of a mean (range) daily census of 560 (492–602) (approximately 5.4%).

      Methods

      This opt-in program offered SARS-CoV-2 testing of asymptomatic HCWs with paired nasopharyngeal or mid-turbinate swab for PCR (Roche) and serum IgG antibody testing (Diazyme). While initially designed as a pilot project in the Emergency Departments and COVID-19 units, it was quickly expanded to a health system-wide initiative.

      Results

      From April 22 to June 2, PCR testing was performed on 5826 asymptomatic HCWs with four PCR tests resulting positive (0.09%). Of 5589 serologic tests (anti-SARS-CoV-2 IgG) performed, 57 tested positive (1.02 %). All HCW with a positive IgG had a concurrent negative PCR.

      Conclusion

      In this cross-sectional evaluation, the point prevalence of SARS-CoV-2 IgG in asymptomatic HCWs at UC San Diego was less than 1%, supporting modeling estimations at the San Diego County level of very low levels of community exposure at the time of this testing. Further analyses of incidence rates and potential risk factors such as employee roles within the healthcare system, community and healthcare exposures, and home zip code are underway. Asymptomatic HCW testing is a strategy that can provide the perception of additional safety to both the workforce and patients as the health system reopens, while potentially reduce transmission from asymptomatic persons through active case finding and isolation.

      Disclosures

      Randy Taplitz, MD, Merck (Advisor or Review Panel member)
        Cover page: 437. Asymptomatic Healthcare Worker COVID-19 Testing Program
        • Article
        • Peer Reviewed
        UC San Diego Previously Published Works (2023)
        BACKGROUND: Pre-exposure prophylaxis for COVID-19 with tixagevimab/cilgavimab (T/C) received Emergency Use Authorization (EUA) based on results of a clinical trial conducted prior to the emergence of the Omicron variant. The clinical effectiveness of T/C has not been well described in the Omicron era. We examined the incidence of symptomatic illness and hospitalizations among T/C recipients when Omicron accounted for virtually all local cases. METHODS: Through retrospective electronic medical record chart review, we identified patients who received T/C between January 1 -July 31, 2022 within our quaternary referral health system. We determined the incidence of symptomatic COVID-19 infections and hospitalizations due to or presumed to be caused by early Omicron variants before and after receiving T/C (pre-T/C and post-T/C). Chi square and Mann-Whitney Wilcoxon two-sample tests were used to examine differences between the characteristics of those who got COVID-19 before or after T/C prophylaxis, and rate ratios (RR) and 95% confidence intervals (CI) were calculated to assess differences in hospitalization rates for the two groups. RESULTS: Of 1295 T/C recipients, 105 (8.1%) developed symptomatic COVID-19 infection before receiving T/C, and 102 (7.9%) developed symptomatic disease after receiving it. Of the 105 patients who developed symptomatic infection pre-T/C, 26 (24.8%) were hospitalized, compared with six of the 102 patients (5.9%) who were diagnosed with COVID-19 post-T/C (RR = 0.24; 95% CI = 0.10-0.55; p = 0.0002). Seven of the 105 (6.7%) patients infected pre-T/C, but none of the 102 infected post-T/C required ICU care. No COVID-related deaths occurred in either group. The majority of COVID-19 cases among those infected pre-T/C treatment occurred during the Omicron BA.1 surge, while the majority of post-T/C cases occurred when Omicron BA.5 was predominant. In both groups, having at least one dose of vaccine strongly protected against hospitalization (pre-T/C group RR = 0.31, 95% CI = 0.17-0.57, p = 0.02; post-T/C group RR = 0.15; 95% CI = 0.03-0.94; p = 0.04). CONCLUSION: We identified COVID-19 infections after T/C prophylaxis. Among patients who received T/C at our institution, COVID-19 Omicron cases occurring after T/C were one-fourth as likely to require hospitalization compared to those with Omicron prior to T/C. However, due to the presence of changing vaccine coverage, multiple therapies, and changing variants, the effectiveness of T/C in the Omicron era remains difficult to assess.
          Cover page: Real world effectiveness of tixagevimab/cilgavimab (Evusheld) in the Omicron era.
          • Multimedia
          Symposium 2022 (2022)

          Background

          Many patients who have been infected with SARS-CoV-2 continue to experience a constellation of symptoms for months following the initial phase of the infection, often referred to as “Long COVID.” Symptoms include fatigue, shortness of breath and cognitive dysfunction, which may impact daily functioning. The true incidence and comprehensive characteristics of Long COVID symptoms are currently unknown. This is the first population-based outreach study of Long COVID symptoms in patients within an entire health system, conducted to determine operational needs of the health system to care for patients with Long COVID at our multidisciplinary Post-COVID Care Clinic and in the primary care setting.   

          Methods

          We conducted a survey of patients in our electronic health record (EHR) via email or SMS message who met these inclusion criteria: age 18 years or older, tested positive for COVID-19 at UCSDH between March 1, 2020 and July 1, 2021, and not deceased. Our survey identified patients experiencing symptoms consistent with Long COVID, and characterized the nature and severity of these symptoms and their impact on daily functioning. Rates of Long COVID symptoms were tabulated from patient responses and aligned with demographics from EHR.

          Results

          The survey was sent to 9,619 patients and achieved a 10.4% response rate. The average age of respondents was 51.5 years (range: 18 – 89 years), and 525 (53%) identified as White, 229 (23%) as Other Race or Mixed Race, 91 (9%) as Asian, 44 (4%) as Black or African American, five (0.5%) as American Indian or Alaska Native, 5 (0.5%) as Native Hawaiian or Other Pacific Islander, and 100 (10%) were unknown. Of the 999 respondents, almost half (46.3%) replied “yes” or “maybe” to currently having symptoms believed to be caused by having COVID-19. The breakdown of symptoms is depicted in Figure 1, with weakness/tiredness (77.8%), sleep disturbances (67.2%), and difficulty thinking/concentrating (“brain fog”) (64.3%) reported most frequently. Of those experiencing chronic symptoms, 343 (83.9%) had at least three symptoms, with a mean, median and mode of six symptoms (range: 0 – 16). 75/216 (34.7%) of patients reported absences from work/school due to symptoms, 143/216 (66.2%) reported disruption of daily activities, but only 123 reported seeking medical care. 130 (14.8%) reported being hospitalized due to COVID-19, and 74 (8.4%) reported being treated with monoclonal antibodies for COVID-19. 21.7% and 22.6% of respondents screened positive (score of 3+) on the PHQ-2 depression and GAD-2 anxiety screening tools.

          Conclusion

          To our knowledge, this represents the first population-based study of Long COVID symptoms in this spectrum of patients within a health system, particularly as most were not hospitalized for COVID-19 (>85% of respondents). The results demonstrate that patients experiencing Long COVID symptoms have a significant impact on their daily functioning and mental health, with about 1/3 reporting absenteeism and 2/3 reporting daily impact on functioning, and ¼ screening positive for depression and anxiety, which has major implications for population-based screening for post-COVID morbidity. Large population-based surveys like ours can be utilized across health systems to better triage patients with Long COVID who may need closer follow-up care.

          • 1 supplemental ZIP
          • Article
          • Peer Reviewed
          UC San Diego Previously Published Works (2022)
          The true incidence and comprehensive characteristics of Long Coronavirus Disease-19 (COVID-19) are currently unknown. This is the first population-based outreach study of Long COVID within an entire health system, conducted to determine operational needs to care for patients with Long COVID.
            Cover page: Population-Based Evaluation of Postacute Coronavirus Disease-2019 (COVID-19) Chronic Sequelae in Patients Who Tested Positive for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)
            • Article
            • Peer Reviewed
            UC San Diego Previously Published Works (2024)
            Many patients infected with the SARS-CoV-2 virus (COVID-19) continue to experience symptoms for weeks to years as sequelae of the initial infection, referred to as Long COVID. Although many studies have described the incidence and symptomatology of Long COVID, there are little data reporting the potential burden of Long COVID on surgical departments. A previously constructed database of survey respondents who tested positive for COVID-19 was queried, identifying patients reporting experiencing symptoms consistent with Long COVID. Additional chart review determined whether respondents had a surgical or non-routine invasive procedure on or following the date of survey completion. Outcomes from surgeries on patients reporting Long COVID symptoms were compared to those from asymptomatic patients. A total of 17.4% of respondents had surgery or a non-routine invasive procedure in the study period. A total of 48.8% of these patients reported experiencing symptoms consistent with Long COVID. No statistically significant differences in surgical outcomes were found between groups. The results of this analysis demonstrate that Long COVID does not appear to have created a significant burden of surgical disease processes on the healthcare system despite the wide range of chronic symptoms and increased healthcare utilization by this population. This knowledge can help guide surgical operational resource allocation as a result of the pandemic and its longer-term sequelae.
              Cover page: The Long Haul to Surgery: Long COVID Has Minimal Burden on Surgical Departments.
              • Article
              • Peer Reviewed
              UCLA Previously Published Works (2021)
                Cover page: SARS-CoV-2 Infection after Vaccination in Health Care Workers in CaliforniaCreative Commons 'BY-NC-ND' version 4.0 license
                • Article
                • Peer Reviewed
                UC San Diego Previously Published Works (2021)

                Background

                UC San Diego Health System (UCSDHS) is the largest academic medical center and integrated care network in US-Mexico border area of California contiguous to the Northern Baja region of Mexico. The COVID-19 pandemic compelled several UCSDHS and local communities to create awareness around best methods to promote regional health in this economically, socially, and politically important border area.

                Purpose

                To improve understanding of optimal strategies to execute critical care collaborative programs between academic and community health centers facing public health emergencies during the COVID-19 pandemic, based on the experience of UCSDHS and several community hospitals (one US, two Mexican) in the US-Mexico border region.

                Methods

                After taking several preparatory steps, we developed a two-phase program that included 1) in-person activities to perform needs assessments, hands-on training and education, and morale building and 2) creation of a telemedicine-based (Tele-ICU) service for direct patient management and/or educational coaching experiences.Findings.A clinical and educational program between academic and community border hospitals was feasible, effective, and well received.

                Conclusion

                We offer several policy-oriented recommendations steps for academic and community healthcare programs to build educational, collaborative partnerships to address COVID-19 and other cross-cultural, international public health emergencies.
                  Cover page: Designing a critical care solution using in-person and telemedicine approaches in the US-Mexico border area during COVID-19.
                  • Article
                  • Peer Reviewed
                  UC San Diego Previously Published Works (2022)
                  Long COVID is a chronic condition characterized by symptoms such as fatigue, dyspnea, and cognitive impairment that persist or relapse months after an acute infection with the SARS-CoV-2 virus. Many distinct symptoms have been attributed to Long COVID; however, little is known about the potential clustering of these symptoms and risk factors that may predispose patients to certain clusters. In this study, an electronic survey was sent to patients in the UC San Diego Health (UCSDH) system who tested positive for COVID-19, querying if patients were experiencing symptoms consistent with Long COVID. Based on survey results, along with patient demographics reported in the electronic health record (EHR), linear and logistic regression models were used to examine putative risk factors, and exploratory factor analysis was performed to determine symptom clusters. Among 999 survey respondents, increased odds of Long COVID (n = 421; 42%) and greater Long COVID symptom burden were associated with female sex (OR = 1.73, 99% CI: 1.16-2.58; β = 0.48, 0.22-0.75), COVID-19 hospitalization (OR = 4.51, 2.50-8.43; β = 0.48, 0.17-0.78), and poorer pre-COVID self-rated health (OR = 0.75, 0.57-0.97; β = -0.19, -0.32--0.07). Over one-fifth of Long COVID patients screened positive for depression and/or anxiety, the latter of which was associated with younger age (OR = 0.96, 0.94-0.99). Factor analysis of 16 self-reported symptoms suggested five symptom clusters-gastrointestinal (GI), musculoskeletal (MSK), neurocognitive (NC), airway (AW), and cardiopulmonary (CP), with older age (β = 0.21, 0.11-0.30) and mixed race (β = 0.27, 0.04-0.51) being associated with greater MSK symptom burden. Greater NC symptom burden was associated with increased odds of depression (OR = 5.86, 2.71-13.8) and anxiety (OR = 2.83, 1.36-6.14). These results can inform clinicians in identifying patients at increased risk for Long COVID-related medical issues, particularly neurocognitive symptoms and symptom clusters, as well as informing health systems to manage operational expectations on a population-health level.
                    Cover page: Deep Dive into the Long Haul: Analysis of Symptom Clusters and Risk Factors for Post-Acute Sequelae of COVID-19 to Inform Clinical Care
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