Using Lung Base Covid-19 Findings to Predict Future Disease Trends and New Variant Outbreaks: Study of First New York City (NYC) Outbreak

Published:September 30, 2021DOI:https://doi.org/10.1016/j.acra.2021.09.023

      Rationale and Objectives

      Asymptomatic COVID-19 carriers and insufficient testing make containment of the virus difficult. The purpose of this study was to determine if unexpected lung base findings on abdominopelvic CTs concerning for COVID-19 infection could serve as a surrogate for the diagnosis of COVID-19 in the community.

      Materials and Methods

      A database search of abdominopelvic CT reports from March 1,2020 to May 2,2020 was performed for keywords suggesting COVID-19 infection by lung base findings. COVID-19 status, respiratory symptoms, laboratory parameters and patient outcomes (hospitalization, ICU admission and/or intubation, and death) were recorded. The trend in cases of unexpected concerning lung base findings on abdominopelvic CT at our institution was compared to the total number of confirmed new cases in NYC over the same time period.

      Results

      The trend in abnormal lung base findings on abdominopelvic CT at our institution correlated with the citywide number of confirmed new cases, including rise and subsequent fall in total cases. The trend was not mediated by COVID-19 testing status or number of tests performed. Patients with respiratory symptoms had significantly higher ferritin (median = 995ng/ml vs 500ng/ml, p = 0.027) and death rate (8/24, 33% vs 4/54, 9%, p = 0.018) compared to those without.

      Conclusion

      The rise and fall of unexpected lung base findings suggestive of COVID-19 infection on abdominopelvic CT in patients without COVID-19 symptoms correlated with the number of confirmed new cases throughout NYC from the same time period. A model using abdominopelvic CT lung base findings can serve as a surrogate for future COVID-19 outbreaks.
      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Zhou F
        • Yu T
        • Du R
        • et al.
        Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.
        Lancet (London, England). 2020; 395: 1054-1062
      1. COVID-19 coronavirus pandemic. Worldometer Website. Available at: www.worldometers.info/coronavirus 2021

      2. NYC Health Database. Available at: https://www1.nyc.gov/site/doh/covid/covid-19-data.page

        • Farinholt T
        • Doddapaneni H
        • Qin X
        • et al.
        Transmission event of SARS-CoV-2 Delta variant reveals multiple vaccine breakthrough infections.
        Medrxiv: The Preprint Server for Health Sciences. 2021;
        • Lopez Bernal J
        • Andrews N
        • Gower C
        • et al.
        Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant.
        N Engl J Med. 2021; 385: 585-594
        • Planas D
        • Veyer D
        • Baidaliuk A
        • et al.
        Reduced sensitivity of SARS-CoV-2 variant Delta to antibody neutralization.
        Nature. 2021; 596: 276-280
        • Wilder-Smith A
        • Freedman DO.
        Isolation, quarantine, social distancing and community containment: pivotal role for old-style public health measures in the novel coronavirus (2019-nCoV) outbreak.
        J Travel Med. 2020; 27: 1-4
        • Aleem A
        • Akbar Samad AB
        • Slenker AK
        Emerging Variants of SARS-CoV-2 And Novel Therapeutics Against Coronavirus (COVID-19).
        StatPearls. StatPearls Publishing, Treasure IslandFL2021 (Copyright © 2021, StatPearls Publishing LLC)
        • Avula A
        • Nalleballe K
        • Narula N
        • et al.
        COVID-19 presenting as stroke.
        Brain Behav Immun. 2020; 87: 115-119
        • Dane B
        • Brusca-Augello G
        • Kim D
        • et al.
        Unexpected Findings of Coronavirus Disease (COVID-19) at the Lung Bases on Abdominopelvic CT.
        AJR Am J Roentgenol. 2020; 215: 603-606
        • Driggin E
        • Madhavan MV
        • Bikdeli B
        • et al.
        Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the Coronavirus Disease 2019 (COVID-19) Pandemic.
        J Am Coll Cardiol. 2020; 75: 2352-2371
        • King MJ
        • Lewis S
        • El Homsi M
        • et al.
        Lung base CT findings in COVID-19 adult patients presenting with acute abdominal complaints: case series from a major New York City health system.
        Eur Radiol. 2020; 30: 6685-6693
        • Capaccione KM
        • Yang H
        • West E
        • et al.
        Pathophysiology and Imaging Findings of COVID-19 Infection: An Organ-system Based Review.
        Acad Radiol. 2021; 28: 595-607
        • Qiu C
        • Deng Z
        • Xiao Q
        • et al.
        Transmission and clinical characteristics of coronavirus disease 2019 in 104 outside-Wuhan patients, China.
        J Med Virol. 2020; 92: 2027-2035
        • Sendi AA
        • Saggat DF
        • Alzahrani SJ.
        Incidental typical COVID-19 appearance on the lung bases, visualized at abdominal CT for a patient that presented with abdominal pain and nausea.
        Radiology Case Reports. 2020; 15: 1238-1241
        • Cohen JI
        • Burbelo PD
        Reinfection with SARS-CoV-2: Implications for Vaccines.
        Clin Infect Dis. 2020; 20: 1-6
        • Sharma R
        • Sardar S
        • Mohammad Arshad A
        • et al.
        A Patient with Asymptomatic SARS-CoV-2 Infection Who Presented 86 Days Later with COVID-19 Pneumonia Possibly Due to Reinfection with SARS-CoV-2.
        The American Journal of Case Reports. 2020; 21e927154
        • Chen N
        • Zhou M
        • Dong X
        • et al.
        Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study.
        Lancet (London, England). 2020; 395: 507-513
        • Xu G
        • Yang Y
        • Du Y
        • et al.
        Clinical Pathway for Early Diagnosis of COVID-19: Updates from Experience to Evidence-Based Practice.
        Clin Rev Allergy Immunol. 2020; 59: 89-100
        • Reiter PL
        • Pennell ML
        • Katz ML.
        Acceptability of a COVID-19 vaccine among adults in the United States: How many people would get vaccinated?.
        Vaccine. 2020; 38: 6500-6507
        • Thompson CN
        • Baumgartner J
        • Pichardo C
        • et al.
        COVID-19 Outbreak - New York City, February 29-June 1, 2020.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 1725-1729
        • Goldstein J
        • McKinley J.
        Coronavirus in NY: Manhattan woman is first confirmed case in state.
        The New York Times. 2020; (Available at:)
        • Zhao H
        • Lu X
        • Deng Y
        • et al.
        COVID-19: asymptomatic carrier transmission is an underestimated problem.
        Epidemiol Infect. 2020; 148: e116
        • Bai Y
        • Yao L
        • Wei T
        • et al.
        Presumed Asymptomatic Carrier Transmission of COVID-19.
        JAMA. 2020; 323: 1406-1407
        • Zou L
        • Ruan F
        • Huang M
        • et al.
        SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients.
        N Engl J Med. 2020; 382: 1177-1179
        • Al-Tawfiq JA.
        Asymptomatic coronavirus infection: MERS-CoV and SARS-CoV-2 (COVID-19).
        Travel Medicine and Infectious Disease. 2020; 35101608
        • R Core Team
        R: A language and environment for statistical computing.
        R Foundation for Statistical Computing, Vienna, Austria. 2020; (Available at:)
        • Argenziano MG
        • Bruce SL
        • Slater CL
        • et al.
        Characterization and clinical course of 1000 Patients with COVID-19 in New York: retrospective case series.
        Medrxiv: The Preprint Server for Health Sciences. 2020;
        • Wang R
        • Chen J
        • Gao K
        • et al.
        Vaccine-escape and fast-growing mutations in the United Kingdom, the United States, Singapore, Spain, India, and other COVID-19-devastated countries.
        Genomics. 2021; 113: 2158-2170
        • Zarei F
        • Jalli R
        • Iranpour P
        • et al.
        Differentiation of Chest CT Findings Between Influenza Pneumonia and COVID-19: Interobserver Agreement Between Radiologists.
        Acad Radiol. 2021; 28: 1331-1338
        • Delli Pizzi A
        • Chiarelli AM
        • Chiacchiaretta P
        • et al.
        Radiomics-based machine learning differentiates “ground-glass” opacities due to COVID-19 from acute non-COVID-19 lung disease.
        Sci Rep. 2021; 11: 17237
        • Lin Z
        • Long F
        • Yang Y
        • et al.
        Serum ferritin as an independent risk factor for severity in COVID-19 patients.
        J Infect. 2020; 81: 647-679
        • Gómez-Pastora J
        • Weigand M
        • Kim J
        • et al.
        Hyperferritinemia in critically ill COVID-19 patients - Is ferritin the product of inflammation or a pathogenic mediator?.
        Clin Chim Acta. 2020; 509: 249-251
        • Colafrancesco S
        • Alessandri C
        • Conti F
        • et al.
        COVID-19 gone bad: A new character in the spectrum of the hyperferritinemic syndrome?.
        Autoimmun Rev. 2020; 19102573
        • Zhou C
        • Chen Y
        • Ji Y
        • et al.
        Increased Serum Levels of Hepcidin and Ferritin Are Associated with Severity of COVID-19.
        Med Sci Monit. 2020; 26e926178
        • Olson DR
        • Huynh M
        • Fine A
        • et al.
        Preliminary Estimate of Excess Mortality During the COVID-19 Outbreak - New York City, March 11-May 2, 2020.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 603-605
        • Corman VM
        • Landt O
        • Kaiser M
        • et al.
        Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR.
        Euro Surveillance: Bulletin Europeen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin. 2020; 25
        • Xiao Y
        • Shi X
        • She Q
        • et al.
        Exploration of turn-positive RT-PCR results and factors related to treatment outcome in COVID-19: a retrospective cohort study.
        Virulence. 2020; 11: 1250-1256
        • Xie X
        • Zhong Z
        • Zhao W
        • et al.
        Chest CT for Typical Coronavirus Disease 2019 (COVID-19) Pneumonia: Relationship to Negative RT-PCR Testing.
        Radiology. 2020; 296: E41-e45