International Observational Survey of the Effectiveness of Personal Protective Equipment during Endoscopic Procedures Performed in Patients with COVID-19

Kinetics of SARS-CoV-2 Serum Antibodies Through the Alpha, Delta, and Omicron Surges Among Vaccinated Health Care Workers at a Boston Hospital

Background

Longitudinal serology studies can assist in analyzing the kinetics of antibodies to SARS-CoV-2, helping to inform public health decision making. Our study aims to characterize circulating antibody trends over 18 months in vaccinated participants with and without evidence of COVID-19 infection.

Methods

A cohort of health care workers employed at Boston Medical Center was followed to collect serum samples and survey data over 6 time points from July 2020 through December 2021 (N = 527). History of SARS-CoV-2 infection, vaccination, and booster status were confirmed, where possible, through electronic medical records. Serum was assessed for the qualitative and semiquantitative detection of IgG antibody levels (anti-nucleoprotein [anti-N] and anti-spike [anti-S], respectively). Piecewise regression models were utilized to characterize antibody kinetics over time.

Results

Anti-S IgG titers remained above the positivity threshold following infection and/or vaccination throughout the 18-month follow-up. Among participants with no evidence of COVID-19 infection, titers declined significantly faster in the initial 90 days after full vaccination (β = -0.056) from December 2020 to March 2021 as compared with the decline observed following booster dose uptake (β = -0.023, P < 0.001). Additionally, COVID-19 infection prior to vaccination significantly attenuated the decline of anti-S IgG when compared with no infection following vaccine uptake (P < 0.001). Lastly, fewer participants contracted Omicron when boosted (12.7%) compared to fully vaccinated (17.6%). Regardless of vaccination status, participants who were Omicron positive had lower anti-S IgG titers than those who did not test positive, but this difference was not significant.

Conclusions

These findings provide novel 18-month kinetics of anti-S IgG antibodies and highlight the durability of hybrid immunity, underlining the strong humoral response stimulated by combined infection and vaccination.

The use of Endo barrier for prevention of COVID-19 infection enables upper gastrointestinal endoscopy with high patient satisfaction in private clinic

OBJECTIVES

In the midst of the coronavirus disease 2019 (COVID-19) infection pandemic, practitioners who perform endoscopic examinations need to prevent infections through procedures, along with routine medical care. By using continuous suction, Endo barrier is thought to be effective in preventing the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) droplets and aerosols. The study aimed to evaluate patient discomfort and satisfaction with the use of the Endo barrier during esophagogastroduodenoscopy (EGD). The study evaluated the system's effectiveness as well as the system's preparation time and the amount of burden on the medical staff.

METHODS

EGD was performed on 788 consecutive cases using the Endo barrier. A questionnaire was used to survey patients after the procedure on four points: discomfort (feeling of pressure, breathlessness) and good points (feeling of relief and satisfaction) using a visual analog scale. In addition, patients were divided into two groups according to sedation status: with sedation (69.7%) and without sedation (30.3%), and their scores were compared. Additionally, the preparation time of the Endo barrier was measured.

RESULTS

Patient discomfort was reported as minimal, resulting in a high level of satisfaction using this system. Although the overall results were better in the sedation group, the overall evaluation of the non-sedated group was also favorable. Furthermore, preparation time (30 s) was less burdensome for medical staff.

CONCLUSION

The Endo barrier is an easy-to-implement tool to prevent COVID-19 infection in private clinics, and both patients and staff were highly satisfied with the device with or without the use of sedation during EGD.

Alpha-Fetoprotein-Producing Gastric Cancer With Delayed Diagnosis Caused by COVID-19: A Case Report

A 70-year-old man was diagnosed with coronavirus disease 2019 (COVID-19). The patient had suspected upper gastrointestinal bleeding during the course of the COVID-19 infection. Urgent esophagogastroduodenoscopy (EGD) was performed. However, because of mobility restrictions imposed as a COVID-19 countermeasure, EGD was done in a small hospital room. Hemostatic treatment was successful, but no sufficient close examination could be done. The patient, who was diagnosed as having alpha-fetoprotein-producing gastric cancer, died about three months later.

Colorectal Surgery in the COVID-19 Pandemic Era

The novel coronavirus disease 2019 (COVID-19) caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread at a very fast rate, overwhelming and disrupting healthcare systems around the world since its outbreak in December 2019 in China. As of October 2021, the total number of COVID-19 cases exceeds 240,000,000, and the total number of deaths is close to 5,000,000. In the situation of widespread SARS-CoV-2 infection, restrictions on the medical system due to shifts in medical care to accommodate the pandemic will occur, and its impact on surgical and endoscopic treatment for colorectal cancer is inevitable. Therefore, it is necessary to satisfy all of the following requirements: patient safety, prevention of exposure of healthcare workers including surgeons, prevention of nosocomial infection, and a decision on how to treat the primary disease. Surgical triage is also required, based on comprehensive consideration of the patient's condition, the severity of the disease, the SARS-CoV-2 infection situation in the region, and the medical supply system at each facility, including medical resources, human resources, and the availability of medical equipment. Understanding the diagnostic and treatment environment that the COVID-19 pandemic has dramatically changed is important in providing appropriate surgical care to patients who require surgery while taking utmost care to prevent the spread of COVID-19.

The use of personal protective equipment in endoscopy: what should the endoscopist wear during a pandemic?

Endoscopists are at high risk of exposure and nosocomial transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus) when performing endoscopic procedures due to the highly aerosol generating nature of these procedures. At present, there is still no consensus among endoscopists with regards to the type of protective equipment to be worn by healthcare workers, when performing endoscopy during the coronavirus 2019 (COVID-19) pandemic. This review encompasses a summary of currently published guidelines related to the use of personal protective equipment (PPE) when performing endoscopic procedures during the COVID-19 pandemic. With increasing calls to rationalize the use of PPE due to shortages in global supply chains, the review offers a concise summary on the most appropriate and adequate use of PPE when performing endoscopy during the pandemic. It is expected that these adaptations in the use of PPE during the pandemic will help to improve standards of care and safety of healthcare workers.

A Questionnaire-Based Survey on the Impact of the COVID-19 Pandemic on Gastrointestinal Endoscopy in Asia

INTRODUCTION

The COVID-19 outbreak abruptly restricted gastrointestinal (GI) endoscopy services during the first wave of the pandemic. We aimed to assess the impact of COVID-19 on the practice of GI endoscopy in Asian countries.

METHODS

This was an International Questionnaire-based Internet Survey conducted at multiple facilities by the International Gastrointestinal Consensus Symposium. A total of 166 respondents in Japan, China, Hong Kong, South Korea, Philippines, Thailand, Indonesia, and Singapore participated in this study.

RESULTS

The volume of endoscopic screening or follow-up endoscopies and therapeutic endoscopies were markedly reduced during the first wave of the pandemic, which was mainly attributed to the decreased number of outpatients, cancellations by patients, and adherence to the guidelines of academic societies. The most common indications for GI endoscopy during the first wave were GI bleeding, cholangitis or obstructive jaundice, and a highly suspicious case of neoplasia. The most common GI symptoms of COVID-19 patients during the infected period included diarrhea, nausea, and vomiting. The pandemic exacerbated some GI diseases, such as functional dyspepsia and irritable bowel syndrome. There were cases with delayed diagnosis of cancers due to postponed endoscopic procedures, and the prescription of proton pump inhibitors/potassium-competitive acid blockers, steroids, immunosuppressive agents, and biologics was delayed or canceled. The personal protective equipment used during endoscopic procedures for high-risk patients were disposable gloves, disposable gowns, N95 or equivalent masks, and face shields. However, the devices on the patient side during endoscopic procedures included modified surgical masks, mouthpieces with filters, and disposable vinyl boxes or aerosol boxes covering the head. Furthermore, the time for education, basic research, clinical research, and daily clinical practice decreased during the first wave.

CONCLUSION

This study demonstrated that the COVID-19 pandemic profoundly affected the method of performing GI endoscopy and medical treatment for patients with GI diseases in Asian countries.