Covid-19 tests imported from South Korea were ‘flawed’: WPost

Coronavirus tests imported from South Korea by the governor of the US state of Maryland were flawed and ended up not being used, The Washington Post reported on Friday.

The newspaper said Maryland Governor Larry Hogan spent $9.46 million in April to import 500,000 coronavirus tests from South Korea.

But the tests turned out to be flawed and the state “quietly” paid the same South Korean company an additional $2.5 million for 500,000 replacement tests, the Post said.

It said a University of Maryland laboratory abandoned its use of the replacement tests after a spate of suspected false positives but a private lab continues to use them.

Around 370,000 of the replacement tests have been used by the private lab, the Post said.

Hogan, a frequent critic of President Donald Trump, trumpeted the arrival of the South Korea tests in April and praised the assistance of his South Korean-born wife in obtaining them.

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Rural hospitals are under siege from COVID-19 – here’s what doctors are facing, in their own words

It’s difficult to put into words how hard COVID-19 is hitting rural America’s hospitals. North Dakota has so many cases, it’s allowing asymptomatic COVID-19-positive nurses to continue caring for patients to keep the hospitals staffed. Iowa and South Dakota have teetered on the edge of running out of hospital capacity.

Yet in many communities, the initial cooperation and goodwill seen early in the pandemic have given way to COVID-19 fatigue and anger, making it hard to implement and enforce public health measures, like wearing face masks, that can reduce the disease’s spread.

Rural health care systems entered the pandemic in already precarious financial positions. Over the years, shifting demographics, declining revenue and increasing operating expenses have made it harder for rural hospitals to stay in business. The pandemic has made it even more difficult. In mid-March, most rural hospitals halted elective procedures to slow the spread of the virus, cutting their revenue further, and many have faced price gouging for supplies given extreme shortages.

I work with rural doctors and hospital administrators across the country as a researcher, and I see the stress they’re under from the pandemic. Here is what two of them—Konnie Martin, chief executive officer at San Luis Valley Health in Alamosa, Colorado, and Dr. Jennifer Bacani McKenney, who practices family medicine in Fredonia, Kansas—are facing. Their experiences reflect what others are going through and how rural communities are innovating under extraordinary pressure.

I’ll let them explain in their own words.

Konnie Martin, Alamosa, Colorado

COVID-19 fatigue is real. It’s wearing on people. Everyone wishes we were past this. I read the other day about health care workers being the “keeper of fears.” During COVID-19, patients have disproportionately placed their fears on clinicians, many of whom experience the same fears themselves. I focus on building resilience, but it’s hard.

My hospital currently has seven patients with COVID-19 and can make room for as many as 12. Back in the spring, we converted a visiting specialist center into a temporary respiratory clinic to keep potentially infectious patients separate and reduce pressure on our emergency department.

It’s all about making sure we have enough staff and hospital capacity.

There isn’t any hospital that isn’t under siege, which means that getting patients to the right level of care can be a challenge. In the past few days, we have accepted three transfers from facilities that are on the front range. We’ve never had to do this before. With six ICU beds and 10 ventilators, we are trying to help others.

Influenza hasn’t arrived yet in our community, and I worry about when it comes. We have nearly 40 staff out right now on isolation or quarantine, a staggering number for a small facility. We are having to shift staffing coverage in half-day increments to keep up.

We are not at a point where we are even contemplating bringing COVID-19-positive staff back to work, like the governor of North Dakota suggested. I hope we never get there. We are, however, considering high-risk versus low-risk exposures. If a clinician is exposed to COVID-19 during an aerosolizing medical procedure, that’s high risk. If a clinician is exposed in a classroom of 50 people who were all socially distanced and wearing masks, that’s low risk. If we face critical workforce needs, we may bring back health care workers that have had low-risk exposures.

We have gained a lot of knowledge this year, and we all feel wiser now, but definitely older, too.

Dr. Jennifer Bacani McKenney, Fredonia, Kansas

We chose to live in a rural community because we look out for one another. Our one grocery store will deliver to your home. Our sheriff’s department will drive medications outside of city limits. If we could return to our rural values of caring for and protecting one another we would be in a better position. Somewhere along the way, these values took a back seat to politics and fear.

Wilson County, where I practice in Southeast Kansas, didn’t see its first COVID-19 case until April 15. By August, you could still count the number of cases on two hands. But by mid-November, the total was over 215 cases in a county with a population of about 8,500—meaning about one out of every 40 residents has been infected.

Our 25-bed critical-access hospital doesn’t have dedicated ICU beds, and it has only two ventilators. Emergency department calls are split among the five physicians in Fredonia. In addition to dealing with COVID-19 cases, we’re managing every other illness and injury that walks through the door, including strokes, heart attacks, traumatic injuries and rattlesnake bites.

We have sectioned off a hallway of rooms for suspected COVID-19 cases. Without an ICU, however, we have to rely on other hospitals. Recently, my partner had to transfer a patient who had a gastrointestinal bleed. She had to call 11 different hospitals to find one that could take the patient.

I feel lucky to have on-site testing in the hospital lab. But like many of my rural peers, getting enough face masks and other personal protective equipment early on was tough.

The community is tired, frustrated and stubborn. Politicians talk about relying on personal responsibility to end the pandemic, but I don’t see a majority of people wearing masks in public spaces despite pleas from health professionals. Some people are scared. Others act as if COVID-19 doesn’t exist.

Politics is making things harder. I have been Wilson County’s health officer for the past eight years. This year, county commissioners gained more control over COVID-19 health decisions.

When I proposed a mask mandate early in the pandemic, one county commissioner argued it would violate his rights. Another commissioner balked at one of my reports, saying I had no right to tell schools how to evaluate kids before they can return to sports, despite the health risks.

I recently proposed a new mask mandate given our rising numbers. I explained that masks would not only save lives, they would help businesses stay open and keep employees at work. The commissioners voted it down 3-0.

Preparing for the next pandemic

We live in an interconnected world where commerce and people cross state and national borders, and with that comes the risk of new diseases. America will face another pandemic in the future.

Rural health care delivery systems can leverage lessons from COVID-19 to prepare. Among other things, their emergency preparedness “tabletop exercises” can include planning for infectious disease outbreaks, in addition to fire and floods; mass casualty incidents; and chemical spills.

They can permanently diversify supply chain options from other industries, such as construction and agriculture, to help ensure access to needed supplies. To avoid staff and supply shortages, they can create regional rural health care networks for swapping staff, conducting testing and acquiring supplies.

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Antipsychotic Use Declined in Young Children From 2009 to 2017

FRIDAY, Nov. 13, 2020 — Among privately insured young children, antipsychotic use declined from 2009 to 2017, according to a study published online Oct. 19 in the Journal of the American Academy of Child & Adolescent Psychiatry.

Greta A. Bushnell, Ph.D., from Rutgers University in New Brunswick, New Jersey, and colleagues used data from a nationwide commercial claims database (2007 to 2017) to examine trends in annual antipsychotic medication use by privately insured U.S. young children (ages 2 to 7 years).

The researchers found that annual antipsychotic use in young children was 0.27 percent in 2007, peaked at 0.29 percent in 2009, and significantly declined to 0.17 percent by 2017 (linear trend: −0.017 percent per year). Boys had higher antipsychotic use than girls. More antipsychotic users received a mental disorder diagnosis in 2017 (89 percent) than 2009 (86 percent), with the most common clinical diagnoses being pervasive developmental disorder (2009: 27 percent; 2017: 38 percent), conduct or disruptive behavior disorder (2009: 15 percent; 2017: 21 percent), and attention-deficit/hyperactivity disorder (2009: 24 percent; 2017: 18 percent). In 2017, 32 percent of antipsychotic users had four or more psychotherapy claims, 43 percent had a psychiatrist visit, and the majority used another psychotropic medication, most commonly a stimulant (boys: 57 percent; girls: 50 percent).

“Despite continued prescribing, there is limited evidence for the efficacy of antipsychotics for conduct or disruptive behavior disorders in very young children and the long-term outcomes remain poorly understood,” Bushnell said in a statement.

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Iran passes grim milestone of 40,000 deaths from coronavirus

Iran on Thursday passed the grim milestone of 40,000 coronavirus deaths, with the latest 10,000 added in less than a month, as the country struggles to contain its most widespread wave of infection yet.

The Iranian health ministry announced 457 new fatalities on Thursday, along with 117,517 new infections, pushing the total case count past 726,000, although officials have warned that’s a significant undercount.

The death toll has soared in recent weeks, shattering records in the nation that for months has suffered the worst outbreak in the Middle East.

Nearly half of Iran’s coronavirus deaths are recorded in the capital of Tehran, according to health officials, where medical workers have warned that the health system may soon be overwhelmed and demanded a strict month-long lockdown in all provincial capitals to slow the virus’ spread.

But the government has resisted shutting down the country, desperate to salvage an economy cratered by unprecedented American sanctions that effectively bar Iran from selling its oil internationally. The Trump administration reimposed sanctions in 2018 after withdrawing from Tehran’s nuclear deal with world powers.

Earlier this week, authorities ordered a month-long nightly business curfew in Tehran and 30 other major cities and towns, asking nonessential shops to keep their workers home. Still, enforcement in the sprawling metropolis remains a challenge.

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Cornea appears to resist infection from novel coronavirus

New findings from researchers at Washington University School of Medicine in St. Louis suggest the eye’s cornea can resist infection from the novel coronavirus. Although the herpes simplex virus can infect the cornea and spread to other parts of the body in patients with compromised immune systems, and Zika virus has been found in tears and corneal tissue, SARS-CoV-2, the virus that causes COVID-19, does not appear to replicate in the human cornea.

The researchers have yet to determine, however, whether other tissue in and around the cornea, such as the tear ducts and the conjunctiva, are vulnerable to the virus.

The new findings are published Nov. 3 in the journal Cell Reports.

“Our findings do not prove that all corneas are resistant,” said first author Jonathan J. Miner, MD, Ph.D. “But every donor cornea we tested was resistant to the novel coronavirus. It’s still possible a subset of people may have corneas that support growth of the virus, but none of the corneas we studied supported growth of SARS-CoV-2.”

Miner, an assistant professor of medicine, of molecular microbiology and of pathology and immunology, teamed up with ophthalmologist Rajendra S. Apte, MD, Ph.D., to study mouse and human corneas exposed to the herpes simplex, Zika and SARS-CoV-2 viruses.

“Some COVID-19 patients get eye symptoms, such as conjunctivitis (pinkeye), but it’s not clear that the viral infection itself causes that; it could be related to secondary inflammation,” said Apte, the Paul A. Cibis Distinguished Professor in the John F. Hardesty Department of Ophthalmology & Visual Sciences. “The cornea and conjunctiva are known to have receptors for the novel coronavirus, but in our studies, we found that the virus did not replicate in the cornea.”

Prior research in human and mouse corneal tissue had demonstrated that Zika virus could be shed in tears, and the researchers wanted to learn whether the cornea might serve as an entry point for SARS-CoV-2. Apte, Miner and their colleagues tested that by exposing the eye tissue to the different viruses and observing whether they could grow in and replicate. They also identified key substances in corneal tissue that can promote or inhibit viral growth.

One inhibitor they identified is called interferon lambda. They found that interferon lambda prevented efficient growth of Zika virus and herpes simplex virus in the cornea. But with SARS-CoV-2, levels of the substance had not effect on whether the virus could replicate. It simply could not gain a foothold whether interferon lambda was present or not.

That’s reassuring to Apte, also a professor of developmental biology and of medicine, who said it suggests COVID-19 probably cannot be transmitted through a cornea transplant or similar procedures in the eye.

“Our data suggest that the novel coronavirus does not seem to be able to penetrate the cornea,” Apte said.

Miner added, however, that because of unknowns involving the tear ducts and the conjunctiva, it’s too soon to dismiss the importance of eye protection.

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Ineffective regulation on discharge from hospital in England leaves patients at risk

Regulators have failed to properly address patient safety on discharge from hospital in England, leaving the physical wellbeing and dignity of patients continuously at risk at a time when they should be returning safely home, finds new research.

The research, “Leaving hospital: A step too far for risk-based regulation?” investigates the reasons for the lack of effective regulations from a legal standpoint. It was published in the journal, Medical Law Review and was funded by the National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre (GM PSTRC) which is a partnership between The University of Manchester and Salford Royal hospital.

Victoria Moore, who led the research, is from the centre’s Safer Care Systems and Transitions theme, and said: “Being discharged from hospital can be a dangerous time for patients, but this is an area that regulators haven’t recognized as a group and as such haven’t paid much attention to. This leaves patients vulnerable. My research investigates why this is the case. The answer lies in the regulatory approach that dominates regulation within the NHS.”

Risk-based regulation is the regulatory approach underpinning health and social care regulations in England. To be successful, this approach requires the risk to patient safety to be appropriately identified, fully understood and prioritized by all regulators involved.

Victoria continued: “Within healthcare regulation in England there are a number of regulators, so it is virtually impossible for all of them to have a unified understanding of the risk posed by discharge. This has resulted in a lack of action by any one regulator.”

The research identifies that in hospital discharge, there are three main weaknesses in risk-based regulation and these have been created by the sheer number of regulators involved.

The first is when identifying risk, as regulators don’t possess a complete overview of all relevant information. This is because of the limited information-sharing mechanisms between the regulators. Therefore, judgements have to be made about what information to share and with which regulator. This is problematic given that successful risk-based regulation is heavily dependent upon the availability of sufficient information to identify risks and inform decision-making.

The number of statutory regulators and the limited nature of information-sharing leads to a second important weakness; it’s virtually impossible for all regulators to have a unified understanding of the risks posed by discharge from hospital. Risks will be understood based on the nature of information available, which will vary due to the number of regulators involved.

Finally, the research explains that successful risk-based regulation relies on being able to correctly prioritize risk. This can only happen if regulators have gathered enough information and all understand and agree the regulatory aims.

Victoria concludes, “The combination of the three weaknesses I’ve identified in my research means the risk posed to the safety of patients on discharge from hospital is neither uniformly recognized by the statutory regulators within the English NHS, nor sufficiently addressed. Professional regulators in particular appear to have a poor awareness of the risk and their role in addressing it. Until regulators can accurately identify this risk, build a unified understanding of its causes and consequences, and prioritize it appropriately, this unacceptable status quo will remain.”

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Now That's Crafty! How-to DIY Your Halloween, from Cupcakes to Costumes

This Halloween may look and feel a little different than years past, but that doesn’t mean it needs to be less fun! From decorating to baking to building your own costumes, there are lots of activities families can do together to help create fun and memorable bonding experiences. Best of all, there’s one simple solution to help mom and child alike learn the ropes together.  Meet Sawyer!

This interactive education platform provides a wide range of learning opportunities for children of all ages, with endless hours of guided instruction at your fingertips. From music and sewing lessons to art and science classes, Sawyer provides valuable resources designed to enrich childhood development, especially from the safety of one’s home.

Here are some of the fun ways Sawyer can help you build fun memories this Halloween.

Get Your Bake On:

What’s better than sweets on Halloween? Rather than relying on going house-to-house for candy, have your child trick-or-treat around your own house! Each room could be a new adventure full of yummy surprises. From Giant Jack O’Lantern Brownies  to Bloody Red Velvet Cupcakes to Day of the Dead Sugar Cookie Skulls, Sawyer has baking from home virtual classes designed to provide endless fun (and yums!) for the whole family.

Get Crafty:

From fun Halloween-themed bracelets to superhero wristbands that light up when you run (say what?!) Sawyer provides hands-on instruction for unleashing your child’s imagination. And what’s better than seeing their own creations come to life! Best of all, if you need materials, Sawyer will even ship them to you!

Get Messy:

What’s Halloween without painting a funny face on a jack-o’-lantern? Or drawing a spooky picture that can be hung around the house for decoration? Sawyer has a host of at-home DIY Halloween ideas that bring the fun, especially with your fingers!

Sawyer has plenty of fun for older kids too, from cooking lessons, to learning how to code (yes, code!), to music and dance. Perhaps even mom can learn a thing or two for her next TikTok video?

Sound incredible? It is!  There’s tons of FREE classes too, from Spanish lessons to making marbled paper! Visit hisawyer.com to get started on building your family fun today!

For access to all our exclusive celebrity videos and interviews – Subscribe on YouTube!

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Study helps explain declines in death rates from COVID-19

Fewer New Yorkers are dying from the coronavirus than health experts had anticipated, a new study shows. Regional death rates have dropped from the highs seen at the start of the outbreak, partially due to a shift in the population contracting the disease toward those who are more resilient.

After New York became the epicenter for the pandemic in early March, with tens of thousands dying from COVID-19, experts had expected that the infection would remain as deadly in the following months.

Instead, a new investigation showed that by mid-August the death rate in those hospitalized with coronavirus-related illness had dropped from 27 percentage points to about 3 percentage points. Led by researchers at NYU Grossman School of Medicine, the study showed that a younger, healthier group of people were getting infected and were arriving at the hospital with less-severe symptoms than those infected in the spring.

However, the researchers’ analysis showed that these factors accounted for only part of the improvement in survival. The rest, they suspect, resulted from health care providers’ growing experience with the coronavirus. For example, physicians learned that resting COVID-19 patients on their stomachs rather than their backs and delaying the use of ventilators as long as possible were more effective practices, say the study authors. Drugs likely helped as well. In addition, other factors such as decreasing hospital volumes, less exposure to infection, and earlier testing and treatment, may have played a role.

“Our findings suggest that while COVID-19 remains a terrible disease, our efforts to improve treatment are probably working,” says study lead author Leora Horwitz, MD, an associate professor in the Department of Population Health at NYU Langone Health. “Even in the absence of a silver-bullet treatment or vaccine, we are protecting more of our patients through a host of small changes,” says Horwitz, who is also director of the Center for Healthcare Innovation and Delivery Science at NYU Langone.

New York was among the first states to grapple with a severe outbreak of COVID-19. By contrast, death rates in more recent waves in southern and western regions of the country, which also had younger, healthier coronavirus patients, have been lower, says Horwitz. However, it had remained unclear whether the virus was less deadly due to the different patient demographics or improved care.

Horwitz says the new study, publishing online next week in the Journal of Hospital Medicine, is the most detailed analysis to date of coronavirus death rates over time. By accounting for age, obesity, and other key factors, the researchers were able to eliminate some explanations from the analysis.

For the investigation, the research team analyzed 5,263 patient records of people treated for COVID-19 at NYU Langone hospitals in New York City and Long Island between March 1 and Aug. 8. Using a range of risk factors for the disease as well as indicators of the severity of the illness upon hospitalization, the study authors developed a model that predicted likelihood of death for each patient.

According to the findings, the likelihood of death was on average 22 percentage points lower in August than in March for most critically ill patients.

The average age of hospitalized COVID-19 patients also dropped from 63 to 47. In March, while 73 percent had chronic conditions like lung disease and diabetes, by mid-June only about 65 percent had such risk factors.

“Other pandemic hotspots should take hope from the lessons learned here in New York,” says study senior author Christopher Petrilli, MD, an assistant professor in the Department of Medicine at NYU Langone. “If we can do better at managing the disease, they can too.”

Still, he adds that the research team next plans to expand the investigation to hospitals outside of New York.

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Results from COMBINE (OCT-FFR) reported at TCT Connect

Data from COMBINE (OCT-FFR) found that the use of FFR combined with OCT imaging can help improve the accuracy of high-risk lesion identification in patients with diabetes.

Findings were reported today at TCT Connect, the 32nd annual scientific symposium of the Cardiovascular Research Foundation (CRF). TCT is the world’s premier educational meeting specializing in interventional cardiovascular medicine.

Fractional flow reserve (FFR) is widely used to guide the revascularization strategy in the catheterization lab. The FAME I and FAME II trials have shown that stable ischemic heart disease lesions with FFR >0.80 can be safely treated medically, while PCI of lesions with FFR<0.80 may benefit from revascularization.

However, recent evidence has shown that in some patient subgroups such as diabetes mellitus (DM) and/or acute coronary syndrome (ACS), lesions with FFR>0.80 can have worse outcomes than in patients without DM or ACS, most likely due to plaque instability or rapid progression of atherosclerotic plaque.

Previous studies have shown that lipid-rich plaques with a thin cap fibroatheroma (TCFA) have unfavorable clinical outcomes compared to non-TCFA lesions particularly in DM patients. Optical coherence tomography (OCT) can accurately identify lipid-rich and TCFA lesions. Whether OCT can identify lesions with future unfavorable clinical events despite lack of ischemia has not been studied previously.

The COMBINE (OCT-FFR) trial was a prospective international, natural history study. Patients with DM and with stable or acute coronary syndromes who had one or more non-culprit target lesion(s), with a 40-80% diameter stenosis, underwent FFR assessment. FFR-negative patients underwent OCT assessment and were further medically treated. Depending on the presence or absence of TCFA, patients were divided in two groups: TCFA negative (group A) and TCFA positive (group B). Patients with target lesions with FFR<0.80 were revascularized (group C).

The primary endpoint was the incidence of target lesion related MACE defined as cardiac death, target vessel myocardial infarction (MI), clinically-driven target lesion revascularization (TLR), or hospitalization due to unstable or progressive angina at 18 months in the medically treated patients with FFR>0.80 and TCFA patients (Group B) compared with medically treated patients with FFR>0.80 and no-TCFA (Group A). The secondary endpoint was the incidence of MACE between patients with FFR>0.80 and TCFA (Group B) vs. revascularized lesions that had FFR<0.80 (Group C).

The primary endpoint occurred in 13.3% of Group B compared with 3.1% of Group A [HR 4.7 95%CI (2.0-10.9) P=0.0004], suggesting that the presence of TCFA even in the absence of an abnormal FFR was predictive of future events. This rate of adverse events was even higher than the rate of events among the revascularized lesions with abnormal FFR at baseline (Group C) [HR 1.25 95%CI (0.28-5.59) P=0.77].

“In patients with diabetes, COMBINE (OCT-FFR) showed that the presence of a high-risk plaque (TCFA) is a strong predictor of future MACE, despite lack of ischemia,” said Elvin Kedhi, MD, Ph.D. Dr. Kedhi is Professor of Cardiology, working in ULB (Liberal University Brussel) Hopital Erasme and Silesian Medical University, Katowice, Poland

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Interim data from early US COVID-19 hotspot show mortality of disease were not associated with race/ethnicity

A study of interim data from two hospitals in an early US COVID-19 hotspot, to be presented at the ESCMID Conference on Coronavirus Disease (ECCVID, held online 23-25 September), shows that race and ethnicity were not significantly associated with higher in-hospital COVID-19 mortality, and that rates of moderate, severe, and critical forms of COVID-19 were similar between racial and ethnic groups.

The study, by Dr. Daniel Chastain (University Of Georgia College Of Pharmacy, Albany, GA, U.S.) and colleagues included data from adult patients hospitalised between March 10 and and May 22 with COVID-19, defined by laboratory-detected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, in Southwest Georgia.

The authors compared severity of illness categories on presentation to the hospital between patients from different racial and ethnic groups based on criteria from the US National Institutes of Health (NIH) COVID-19 treatment guidelines. They also studied outcomes including comorbidities, laboratory values, vital signs, and in-hospital mortality.

A total of 164 randomly selected non-consecutive patients were included with a median age of 61.5 years. These consisted of 119 African American patients, 36 Caucasian patients, and 9 Latinx patients. Thus the majority were African American (73%) and 51% were female. Rates of moderate, severe, and critical COVID-19 did not significantly differ between African American (9%, 56%, and 35%), Caucasian (0%, 69%, and 31%), and Latinx patients (0%, 56%, and 44%). In-hospital mortality was not statistically significantly different between groups but was highest among Caucasians (31%) followed by Latinx (22%) and African Americans (16%).

Caucasian patients had significantly higher Charlson comorbidity index scores (meaning more underlying conditions) (4.5) compared to African American (4) and Latinx (2) patients, while median BMI was significantly higher in African Americans (33.7 kg/m2) than in Caucasians (26.9) or Latinx patients (25.9).

Duration of time from symptom onset to admission was similar between groups, whereas median temperature on admission was significantly higher in African Americans (38.3C) than in Caucasians (37.9) or Latinx patients (37.8)

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