Showing papers by "Carrie A. Redlich published in 2020"

Occupational lung diseases in the 21st century: the changing landscape and future challenges.

Abstract: Purpose of review Occupational exposures remain an underrecognized and preventable cause of lung disease in high-income countries. The present review highlights the emergence of cleaning-related respiratory disease and the re-emergence of silicosis as examples of trends in occupational lung diseases in the 21st century. Recent findings Employment trends, such as the shift from large-scale manufacturing to a service economy, the growth of the healthcare sector, and changing consumer products have changed the spectrum of work-related lung diseases. Following decades of progress in reducing traditional hazards such as silica in U.S. workplaces, cases of advanced silicosis have recently re-emerged with the production of engineered stone countertops. With growth in the healthcare and service sectors in the United States, cleaning products have become an important cause of work-related asthma and have recently been associated with an increased risk of chronic obstructive pulmonary disease (COPD) in women. However, these occupational lung diseases largely go unrecognized by practicing clinicians. Summary The present article highlights how changes in the economy and work structure can lead to new patterns of inhalational workplace hazards and respiratory disease, including cleaning-related respiratory disease and silicosis. Pulmonary clinicians need to be able to recognize and diagnose these occupational lung diseases, which requires a high index of suspicion and a careful occupational history.

Performance of Abbott Architect, Ortho Vitros, and Euroimmun Assays in Detecting Prior SARS-CoV-2 Infection [preprint]

Abstract: Background Several serological assays have been developed to detect anti-SARS-CoV-2 IgG antibodies, but evidence about their comparative performance is limited. We sought to assess the sensitivity of four anti-SARS-CoV-2 IgG enzyme-linked immunosorbent assays (ELISA) in individuals with evidence of prior SARS-CoV-2 infection. Methods We obtained sera from 36 individuals with PCR-confirmed SARS-CoV-2 infection between March and May 2020. We evaluated samples collected at around 21 days (±14 days) after their initial PCR test using 3 commercially available ELISA assays, two anti-spike (Ortho- Clinical Diagnostics Vitros, and Euroimmun) and one anti-nucleocapsid (Abbott Architect), and a Yale-developed anti-spike ELISA test. We determined the sensitivity of the tests and compared their results. The Euroimmun and Yale ELISA had an equivocal and indeterminate category, which were considered as both negative and positive. Results Among the 36 individuals with SARS-CoV-2 infection, mean age was 43 (±13) years and 19 (53%) were female. The sensitivities of the tests were not significantly different (Abbott Architect, Ortho Vitros, Euroimmmun, and Yale assays: 86% (95% confidence interval [CI], 71– 95), 94% (95% CI, 81–99), 86% (95% CI, 71–95), and 94% (95% CI, 81–99), respectively; p- value=0.464). The sensitivities of the Euroimmun and Yale ELISA tests increased when the equivocal/indeterminate results were considered positive (97% [95% CI, 85–100] and 100% [95% CI, 90–100], respectively), but were not significantly different from other tests (p=0.082). The cross-correlation coefficient ranged from 0.85–0.98 between three anti-spike protein assays (Ortho Vitros, Euroimmun, Yale) and was 0.58–0.71 between the three anti-spike protein assays and the anti-nucleocapsid assay (Abbott). Conclusion The sensitivities of four anti-SARS-CoV-2 protein assays did not significantly differ, although the sample size was small. Sensitivity also depended on the interpretation of equivocal and indeterminate results. The strongest correlations were present for the three anti- spike proteins assays. These findings suggest that individual test characteristics and the correlation between different tests should be considered when comparing or aggregating data across different populations studies for serologic surveillance of past SARS-CoV-2 infection.

Injury, Illness, and Mental Health Risks in United States Domestic Mariners.

Abstract: Objective Describe health conditions and injury and illness rates in a population of United States mariners, an understudied workforce vital to economic security. Methods In this survey study, mariner health data was collected and analyzed to provide injury and illness rates (including mental health conditions) and associated risk factors. Results In this mariner population of highly tenured vessel masters and pilots, hypertension, obesity, sleep disorders, smoking, alcohol consumption, and symptoms of depression and anxiety were common. BMI ≥35 was associated with increased likelihood of work injury (OR 5.7; 95%CI 1.01, 32.59). Conclusions The mariners were in poor overall health, raising public health and safety concerns in this population of essential transportation workers. Follow-up studies including a wider distribution of domestic mariners (deck hands, engineers) would further characterize occupational risks.

Analysis of Lung Gene Expression Reveals a Role for Cl - Channels in Diisocyanate-induced Airway Eosinophilia in a Mouse Model of Asthma Pathology.

Abstract: Diisocyanates are well-recognized causes of asthma. However, sensitized workers frequently lack diisocyanate-specific IgE, which complicates diagnosis and suggests the disease involves IgE-independ...

Seroprevalence of SARS-CoV-2-Specific IgG Antibodies Among Adults Living in Connecticut Between March 1 and June 1, 2020: Post-Infection Prevalence (PIP) Study [preprint]

Abstract: Importance: A seroprevalence study can estimate the percentage of people with SARS-CoV-2 antibodies in the general population. Most existing reports have used a convenience sample, which may bias their estimates. Objective: To estimate the seroprevalence of antibodies against SARS-CoV-2 based on a random sample of adults living in Connecticut between March 1 and June 1, 2020. Design: Cross-sectional. Setting: We sought a representative sample of Connecticut residents who completed a survey between June 4 and June 23, 2020 and underwent serology testing for SARS-CoV-2-specific IgG antibodies between June 10 and July 6, 2020. Participants: 505 respondents, aged ≥18 years, residing in non-congregate settings who completed both the survey and the serology test. Main outcomes and measures: We estimated the seroprevalence of SARS-CoV-2-specific IgG antibodies among the overall population and across pre-specified subgroups. We also assessed the prevalence of symptomatic illness, risk factors for virus exposure, and self-reported adherence to risk mitigation behaviors among this population. Results: Of the 505 respondents (mean age 50 [±17] years; 54% women; 76% non-Hispanic White individuals) included, 32% reported having at least 1 symptom suggestive of COVID-19 since March 1, 2020. Overall, 18 respondents had SARS-CoV-2-specific antibodies, resulting in the state-level weighted seroprevalence of 3.1 (90% CI 1.4-4.8). Individuals who were asymptomatic had significantly lower seroprevalence (0.6% [90% CI 0.0-1.5]) compared with the overall state estimate, while those who reported having had ≥1 and ≥2 symptoms had a seroprevalence of 8.0% (90% CI 3.1-12.9) and 13.0% (90% CI 3.5-22.5), respectively. All 9 of the respondents who reported previously having a positive coronavirus test were positive for SARS-CoV-2-specific IgG antibodies. Nearly two-third of respondents reported having avoided public places (74%) and small gatherings of family or friends (75%), and 97% reported wearing a mask outside their home, at least part of the time. Conclusions and relevance: These estimates indicate that most people in Connecticut do not have detectable levels of antibodies against SARS-CoV-2. There is a need for continued adherence to risk mitigation behaviors among Connecticut residents, to prevent resurgence of COVID-19 in this region.

SARS-CoV-2 Infection Hospitalization Rate and Infection Fatality Rate among the Non-Congregant Population in Connecticut

Abstract: Importance COVID-19 case fatality and hospitalization rates, calculated using the number of confirmed cases of COVID-19, have been described widely in the literature. However, the number of infections confirmed by testing underestimates the total infections as it is biased based on the availability of testing and because asymptomatic individuals may remain untested. The infection fatality rate (IFR) and infection hospitalization rate (IHR), calculated using the estimated total infections based on a representative sample of a population, is a better metric to assess the actual toll of the disease. Objective To determine the IHR and IFR for COVID-19 using the statewide SARS-CoV-2 seroprevalence estimates for the non-congregate population in Connecticut. Design Cross-sectional. Setting Adults residing in a non-congregate setting in Connecticut between March 1 and June 1, 2020. Participants Individuals aged 18 years or above. Exposure Estimated number of adults with SARS-CoV-2 antibodies. Main Outcome and Measures COVID-19-related hospitalizations and deaths among adults residing in a non-congregate setting in Connecticut between March 1 and June 1, 2020. Results Of the 2.8 million individuals residing in the non-congregate settings in Connecticut through June 2020, 113,515 (90% CI 56,758–170,273) individuals had SARS-CoV-2 antibodies. There were a total of 9425 COVID-19-related hospitalizations and 4071 COVID-19-related deaths in Connecticut between March 1 and June 1, 2020, of which 7792 hospitalizations and 1079 deaths occurred among the non-congregate population. The overall COVID-19 IHR and IFR was 6.86% (90% CI, 4.58%–13.72%) and 0.95% (90% CI, 0.63%–1.90%) among the non-congregate population. Older individuals, men, non-Hispanic Black individuals and those belonging to New Haven and Litchfield counties had a higher burden of hospitalization and deaths, compared with younger individuals, women, non-Hispanic White or Hispanic individuals, and those belonging to New London county, respectively. Conclusion and Relevance Using representative seroprevalence estimates, the overall COVID-19 IHR and IFR were estimated to be 6.86% and 0.95% among the non-congregate population in Connecticut. Accurate estimation of IHR and IFR among community residents is important to guide public health strategies during an infectious disease outbreak.