This cross-sectional study evaluates the proportion of patients tested for coronavirus disease 2019 (COVID-19) and the proportion of positive cases, using language as a surrogate for immigrant status.

Background Healthcare workers (HCW) serving on the front lines of the coronavirus disease 2019 (COVID-19) pandemic have been at increased risk for infection due to SARS-CoV-2 in some settings. Healthcare-acquired infection has been reported in similar epidemics, but there are limited data on the prevalence of COVID-19 among HCWs and their associated clinical outcomes in the United States. Methods We established two high-throughput employee testing centers in Seattle, Washington with drive-through and walk-through options for symptomatic employees in the University of Washington Medicine system and its affiliated organizations. Using data from these testing centers, we report the prevalence of SARS-CoV-2 infection among symptomatic employees and describe the clinical characteristics and outcomes among employees with COVID-19. Results Between March 12 and April 23, a total of 3,477 symptomatic employees were tested for COVID-19 at two employee testing centers; 185 (5.3%) employees tested positive for COVID-19. The prevalence of SARS-CoV-2 was similar when comparing frontline HCWs (5.2%) to non-frontline staff (5.5%). Among 174 positive employees reached for follow-up at least 14 days after diagnosis, 6 reported COVID-related hospitalization; all recovered. Conclusions During the study period, we observed that the prevalence of positive SARS-CoV-2 tests among symptomatic HCWs was comparable to that of symptomatic non-frontline staff. Reliable and rapid access to testing for employees is essential to preserve the health, safety, and availability of the healthcare workforce during this pandemic and to facilitate the rapid return of SARS-CoV-2 negative employees to work.

Background Patients with reported beta lactam antibiotic allergies (BLA) are more likely to receive broad-spectrum antibiotics and experience adverse outcomes. Data describing antibiotic allergies among solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients are limited. Methods We reviewed records of adult SOT or allogeneic HCT recipients from 1/1/2013-12/31/2017 to characterize reported antibiotic allergies at time of transplant. Inpatient antibiotic use was examined for 100 days post-transplant. Incidence rate ratios (IRR) comparing antibiotic use in BLA and non-BLA groups were calculated using multivariable negative binomial models for two metrics: days of therapy (DOT)/1000 inpatient days and percentage of antibiotic exposure days. Results Among 2153 SOT (65%) and HCT (35%) recipients, 634 (29%) reported any antibiotic allergy and 347 (16%) reported BLA. Inpatient antibiotics were administered to 2020 (94%) patients during the first 100 days post-transplant; average antibiotic exposure was 41% of inpatient days (Interquartile range (IQR) 16.7%, 62.5%). BLA patients had significantly higher DOT for vancomycin (IRR 1.4; 95% confidence interval (CI) [1.2, 1.7]; p<0.001), clindamycin (IRR 7.6; 95% CI [2.2, 32.4]; p=0.001), aztreonam in HCT (IRR 9.7; 95% CI [3.3, 35.0]; p<0.001), and fluoroquinolones in SOT (IRR 2.9; 95% CI [2.1, 4.0]; p<0.001); these findings were consistent when using percentage of antibiotic exposure days. Conclusions Transplant recipients are frequently exposed to antibiotics and have a high prevalence of reported antibiotic allergies. Reported BLA was associated with greater use of beta lactam antibiotic alternatives. Pre-transplant antibiotic allergy evaluation may optimize antibiotic use in this population.

Background In response to the SARS-CoV-2 pandemic, clinicians in outpatient HIV practices began to routinely offer telemedicine (video and/or phone visits) to replace in-person appointments. Video visits are preferred over phone visits but determinants of video visit uptake in HIV care settings have not been well described. Methods Trends in type of encounter (face-to-face, video, and phone) before and during the pandemic were reviewed for persons with HIV (PWH) at an urban, academic, outpatient HIV clinic in Seattle, WA. Logistic regression was used to assess factors associated with video visit use including sociodemographic characteristics (age, race, ethnicity, language, insurance status, housing status) and electronic patient portal login. Results After an initial increase in video visits to 30% of all completed encounters, the proportion declined and plateaued at approximately 10%. A substantial proportion of face-to-face visits were replaced by phone visits (approximately 50% of all visits were by phone early in the pandemic, now stable at 10 to 20%). Logistic regression demonstrated that older age (&gt;50 or &gt;65 years old compared to 18 to 35 years old), Black, Asian, or Pacific Islander race (compared to White race), and Medicaid insurance (compared to private insurance) were significantly associated with never completing a video visit, whereas history of patient portal login was significantly associated with completing a video visit. Conclusions Since the pandemic began, an unexpectedly high proportion of telemedicine visits have been by phone instead of video. Several social determinants of health and patient portal usage are associated with video visit uptake.

Studies of infective endocarditis (IE) have relied on International Classification of Disease (ICD) codes to identify cases, a method vulnerable to misclassification. Clinical narrative data could offer greater accuracy and richness to cohort identification. We evaluated two algorithms: a standard query of ICD-9/10 billing codes, with or without procedure codes for echocardiogram and a text query of discharge summaries (DS) that selected on the term “endocarditis” in fields headed by “Discharge Diagnosis” or “Admission Diagnosis” or similar. Further coding extracted valve involved and organism responsible if present. All cases were chart reviewed using pre-specified criteria. Positive predictive value (PPV), sensitivity and specificity were calculated. The ICD-based query identified 612 individuals from July 2015 to July 2019 who had a hospital billing code for infective endocarditis; of these, 534 had an echocardiogram. The DS query identified 387 cases. PPV for the DS query was 84.5% (95% CI 80.6%, 87.8%) compared with 72.4% (95% CI 68.7%, 75.8%) for ICD only ( P < .001) and 75.8% (95% CI 72.0%, 79.3%) for ICD + echo queries ( P = .002). Sensitivity was 75.9% for DS query and 86.8% to 93.4% for ICD queries ( P < .02 for these comparisons). Specificity was high for all queries >94%. The DS query also yielded valve data (prosthetic, tricuspid, aortic, etc) in 60% and microbiologic agent in 73% of identified cases with an accuracy of 94% and 90%, respectively when assessed by chart review. Compared with ICD-based queries, text-based queries of discharge summaries have the potential to improve precision of IE case ascertainment and extract key clinical variables.