LitCovid-sentences  

PMC:7675688 / 1851-21240 JSONTXT 3 Projects

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Id Subject Object Predicate Lexical cue
T22 0-10 Sentence denotes The U.S.S.
T23 11-199 Sentence denotes Theodore Roosevelt was conducting operations in the western Pacific Ocean when an outbreak of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred on board.
T24 200-264 Sentence denotes On identification of the outbreak, the ship was diverted to U.S.
T25 265-281 Sentence denotes Naval Base Guam.
T26 282-409 Sentence denotes The base hospital, a 42-bed inpatient facility, provides medical care for U.S. military beneficiaries and others in the region.
T27 410-566 Sentence denotes Although the initial response was handled by the medical staffs of the ship and Naval Hospital Guam, it was quickly augmented by a joint medical task force.
T28 567-614 Sentence denotes This report provides key findings from the U.S.
T29 615-677 Sentence denotes Navy response and epidemiologic investigation of the outbreak.
T30 678-749 Sentence denotes Over the course of the response, every member of the crew of the U.S.S.
T31 750-885 Sentence denotes Theodore Roosevelt was evaluated, tested, placed in isolation or quarantine, and monitored on a daily basis to ensure their well-being.
T32 886-1044 Sentence denotes Our findings offer insights into the epidemiology and outcomes of SARS-CoV-2 infection in healthy, fit, military-aged adults who are housed in close quarters.
T33 1046-1053 Sentence denotes Methods
T34 1055-1101 Sentence denotes Initial Response to the Outbreak and Follow-Up
T35 1102-1263 Sentence denotes The ship had been at sea for 13 days when three crew members presented to the medical department with symptoms suggestive of coronavirus disease 2019 (Covid-19).
T36 1264-1408 Sentence denotes All three underwent testing by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) and were found to be positive for SARS-CoV-2.
T37 1409-1541 Sentence denotes Over the next 24 hours, additional symptomatic crew members and approximately 400 close contacts were identified by contact tracing.
T38 1542-1636 Sentence denotes Four days after the first positive test result was reported, the ship reached Naval Base Guam.
T39 1637-1751 Sentence denotes Crew members with confirmed cases of Covid-19 were placed in isolation on Naval Base Guam or in the base hospital.
T40 1752-1875 Sentence denotes Persons with one or more negative Covid-19 tests and no symptoms were quarantined in hotels off base or on Naval Base Guam.
T41 1876-1960 Sentence denotes In addition, essential personnel who were uninfected stayed aboard the ship in port.
T42 1961-2063 Sentence denotes All members of the crew underwent screening for signs and symptoms of Covid-19 and testing by rRT-PCR.
T43 2064-2203 Sentence denotes Those who tested positive for SARS-CoV-2 were placed in isolation and received twice-daily symptom, temperature, and pulse oximetry checks.
T44 2204-2256 Sentence denotes Those who tested negative were placed in quarantine.
T45 2257-2371 Sentence denotes Ultimately, 4079 SARS-CoV-2–negative crew members who did not have symptoms were quarantined in 11 hotels in Guam.
T46 2372-2414 Sentence denotes All were placed in single-occupancy rooms.
T47 2415-2495 Sentence denotes A surveillance model was implemented that relied on in-person health screenings.
T48 2496-2620 Sentence denotes These screenings were supplemented by self-reporting with the use of a symptom checker developed by Defense Digital Service.
T49 2621-2748 Sentence denotes Health screenings and symptom-checker data were collated and analyzed each morning by 9 a.m. and again in the evening by 9 p.m.
T50 2749-2928 Sentence denotes Crew members who had progressive symptoms or were deemed to have conditions potentially placing them at higher risk for poorer outcomes were followed up with additional screening.
T51 2929-3084 Sentence denotes Any crew members who were determined by on-site medical providers to need closer observation or treatment were transported to Naval Hospital Guam for care.
T52 3085-3256 Sentence denotes In addition to Covid-19–related health surveillance, crew members received primary care, pharmacy, and psychiatric services to ensure a complete scope of medical coverage.
T53 3257-3385 Sentence denotes On completion of prespecified periods of isolation or quarantine, all personnel were required to undergo repeat rRT-PCR testing.
T54 3386-3499 Sentence denotes To be eligible for exit testing, a crew member had to remain in isolation or quarantine for a minimum of 14 days.
T55 3500-3588 Sentence denotes Those in isolation were also required to be symptom-free for 3 days before exit testing.
T56 3589-3712 Sentence denotes Any crew member in quarantine in whom symptoms developed was tested and moved to isolation for at least 14 additional days.
T57 3713-3810 Sentence denotes All crew members were followed up for a minimum of 10 weeks, regardless of their Covid-19 status.
T58 3812-3830 Sentence denotes Laboratory Testing
T59 3831-3953 Sentence denotes Nasopharyngeal swab specimens were obtained from all members of the crew with the use of viral transport medium swab kits.
T60 3954-4115 Sentence denotes The presence of SARS-CoV-2 infection was determined by rRT-PCR testing with the Thermo Fisher ABI 7500 or the Bio-Rad CFX96 Touch Real-Time PCR Detection System.
T61 4116-4520 Sentence denotes Samples were processed with either the Qiagen QIAamp Viral RNA Mini Kit or the Roche MagNA Pure 96 instrument for automated nucleic acid extraction, and testing was performed with the Seegene Allplex 2019-nCOV assay test kit or the Centers for Disease Control and Prevention (CDC) emergency-use-authorization assay.1 These assays included the detection of two targets in the nucleocapsid gene, N1 and N2.
T62 4521-4620 Sentence denotes Surveillance testing for influenza-like illness was conducted with the Biofire Respiratory 2 Panel.
T63 4622-4649 Sentence denotes Collection of Outbreak Data
T64 4650-4854 Sentence denotes The Navy and Marine Corps Public Health Center was tasked with providing public health support for the outbreak investigation and conducting data analysis in alignment with its core public health mission.
T65 4855-5133 Sentence denotes Data were collected as part of a coordinated public health outbreak investigation conducted by the Navy to bring the outbreak under control, ensure the well-being of the crew, assess the spread and effects of SARS-CoV-2, and implement measures to return the crew to work safely.
T66 5134-5363 Sentence denotes Under Navy public health support criteria, the intent of the outbreak investigation was to mitigate spread, inform decision making, gather information for use in other outbreaks, and decrease the effect on the health of the crew.
T67 5364-5573 Sentence denotes This project was deemed to be nonresearch with respect to the use of human subject information and was exempt from review by the institutional review board as an emergency public health outbreak investigation.
T68 5574-5838 Sentence denotes A roster of Electronic Data Interchange Personal Identifiers for the shipboard population was matched to Defense Manpower Data Center personnel rosters from February 2020 to identify demographic information for each crew member and to confirm personal identifiers.
T69 5839-6006 Sentence denotes Civilian personnel and anyone with an Electronic Data Interchange Personal Identifier that did not match with Defense Manpower Data Center were excluded from analysis.
T70 6007-6123 Sentence denotes The Defense Enrollment Eligibility Reporting System was used to identify race and ethnic group for all crew members.
T71 6124-6225 Sentence denotes Ages of crew members at time of the outbreak were calculated from the date of birth to March 3, 2020.
T72 6226-6489 Sentence denotes Medical surveillance data collected by the ship medical department, Naval Hospital Guam, and the joint medical task force were collated with the roster to create a data set that included dates of symptom onset, daily clinical signs and symptoms, and test results.
T73 6490-6610 Sentence denotes Data from the Defense Digital Service MySymptoms symptom-tracker application were also collated into the final data set.
T74 6611-6757 Sentence denotes For the purpose of this analysis, fever is defined as subjective fever reported by the crew member or a measured temperature of 100.0°F or higher.
T75 6758-6811 Sentence denotes All other symptoms were reported by the crew members.
T76 6812-7034 Sentence denotes Data on health-related factors were obtained from a number of existing clinical Military Health System data sources, including the Armed Forces Health Longitudinal Technology Application and Military Health System Genesis.
T77 7035-7162 Sentence denotes A confirmed case of Covid-19 was defined as one in which a nasopharyngeal swab specimen was positive for SARS-CoV-2 by rRT-PCR.
T78 7163-7331 Sentence denotes A suspected case of Covid-19 was defined as one that met Council of State and Territorial Epidemiologists clinical criteria for Covid-19 without a positive test result.
T79 7332-7617 Sentence denotes Confirmed cases were further classified as symptomatic (with symptom onset before the first positive laboratory test), presymptomatic (with the first positive laboratory test before subsequent symptom onset), and asymptomatic (positive laboratory test but clinical criteria never met).
T80 7618-7786 Sentence denotes Patients with confirmed or suspected infection were classified as having been hospitalized for Covid-19 if the admission diagnosis suggested a Covid-19–related illness.
T81 7788-7808 Sentence denotes Statistical Analysis
T82 7809-7910 Sentence denotes Data collation and analysis were performed with the use of SAS software, version 9.4 (SAS Institute).
T83 7911-8123 Sentence denotes Baseline characteristics among crew members who were infected and those who were not infected were compared and univariate odds ratios with 95% confidence intervals were calculated with OpenEpi (www.openepi.com).
T84 8124-8190 Sentence denotes For denominators of less than 20, odds ratios were not calculated.
T85 8191-8258 Sentence denotes All reported odds ratios are not adjusted for multiple comparisons.
T86 8260-8267 Sentence denotes Results
T87 8269-8293 Sentence denotes Timeline of the Outbreak
T88 8294-8409 Sentence denotes Between March 23 and May 18, 2020, a total of 1271 crew members (26.6% of the crew) tested positive for SARS-CoV-2.
T89 8410-8474 Sentence denotes An additional 60 crew members had suspected Covid-19 (Figure 1).
T90 8475-8751 Sentence denotes Of the 1271 crew members with laboratory-confirmed Covid-19, 572 (43.0%) remained asymptomatic throughout the outbreak, 293 (22.0%) were symptomatic at the time that they tested positive, and an additional 406 (30.5%) were presymptomatic at the time that they tested positive.
T91 8752-8969 Sentence denotes In all, 978 (76.9%) of the 1271 crew members with laboratory-confirmed Covid-19 did not have symptoms at the time that they tested positive, and 699 (55.0%) had symptoms develop at any time during the clinical course.
T92 8970-9102 Sentence denotes Testing for influenza-like illnesses had been conducted on a limited number of specimens before and after the start of the outbreak.
T93 9103-9361 Sentence denotes Testing of specimens obtained from 5 crew members during the week before the outbreak identified 3 crew members who were positive for human rhinovirus or enterovirus, 1 who was positive for respiratory syncytial virus (RSV), and 1 with no pathogens detected.
T94 9362-9452 Sentence denotes After the outbreak was identified on March 23, specimens from 16 crew members were tested:
T95 9453-9672 Sentence denotes 10 crew members had no pathogens detected, 3 were positive for human rhinovirus or enterovirus, 2 were positive for coronavirus OC43 (not SARS-CoV-2), and 1 was positive for both human rhinovirus or enterovirus and RSV.
T96 9673-9722 Sentence denotes The outbreak epidemic curve is shown in Figure 2.
T97 9723-9913 Sentence denotes In retrospect, crew members with symptomatic confirmed or suspected Covid-19 had symptoms as early as March 11, 2020, and continued to receive diagnoses up to the end of the analysis period.
T98 9914-10009 Sentence denotes Epidemic curves according to sex and crew type show parallel infection rates for men and women.
T99 10010-10120 Sentence denotes Although the ship docked in Guam on March 27, 2020, the outbreak continued for at least an additional 6 weeks.
T100 10122-10157 Sentence denotes Characteristics of the Crew Members
T101 10158-10269 Sentence denotes The crew was predominantly young (mean age, 27 years) and male (78.3%) and was racially and ethnically diverse.
T102 10270-10358 Sentence denotes At the time of deployment, all crew members were in general good health and met the U.S.
T103 10359-10387 Sentence denotes Navy standards for sea duty.
T104 10388-10503 Sentence denotes Ultimately, Covid-19 cases were evenly distributed across sexes, races and ethnic groups, and crew types (Table 1).
T105 10504-10632 Sentence denotes Enlisted personnel (90% of the shipboard population) appeared more likely than officers to have confirmed or suspected Covid-19.
T106 10633-10688 Sentence denotes Data were analyzed to identify higher-risk work spaces.
T107 10689-10942 Sentence denotes Those working in tighter spaces (e.g., reactor, engineering, supply, and weapons departments) appeared more likely to have confirmed or suspected Covid-19 than those working in a combination of open-air and confined conditions (e.g., air and deck crew).
T108 10943-11236 Sentence denotes Members of the medical department, who wore personal protective equipment when evaluating crew members, had a somewhat lower attack rate (16.7% [8 cases among 48 personnel) than the overall crew, despite being at highest risk as a result of exposure to patients with Covid-19 in a small space.
T109 11238-11255 Sentence denotes Symptoms and Care
T110 11256-11547 Sentence denotes Among the crew members who had symptomatic Covid-19 (confirmed or suspected), headache was the most common symptom reported at any point during illness (occurring in 68.0%), followed by cough (59.5%), nasal or sinus congestion (43.8%), and altered sense of taste or smell (42.3%) (Figure 3).
T111 11548-11688 Sentence denotes The predominant symptoms reported at the onset of illness were cough (32.8%), headache (31.0%), and altered sense of taste or smell (24.1%).
T112 11689-11871 Sentence denotes Shortness of breath at any point during illness was reported by 20.3% of the crew members with symptomatic cases, and 7.0% noted shortness of breath as an initial presenting symptom.
T113 11872-12010 Sentence denotes In addition, 26.2% of the crew members with symptomatic Covid-19 reported chest pain or chest pressure at some point during their illness.
T114 12011-12178 Sentence denotes Fever was reported as an initial presenting symptom by 5.3% of the crew members with symptomatic Covid-19, and fever at any point during illness was reported by 13.2%.
T115 12179-12379 Sentence denotes Measured temperature readings showed that 2.8% of the crew members who had Covid-19 had a recorded temperature of 100.0°F or above, as compared with 0.3% of the crew members who did not have Covid-19.
T116 12380-12573 Sentence denotes Among the crew members with Covid-19 for whom pulse oximetry data were available, approximately 0.5% had readings below 95% while breathing ambient air, with 0.08% below 94% and none below 90%.
T117 12574-12750 Sentence denotes Of the 1271 crew members who tested positive for SARS-CoV-2 plus the 60 who had suspected Covid-19, 23 (1.7%) received hospital care, for a mean of 16 days after symptom onset.
T118 12751-12941 Sentence denotes Four crew members (0.3% of those with suspected or laboratory-confirmed Covid-19) were admitted to the intensive care unit, 1 of whom died from Covid-19–related cardiovascular complications.
T119 12942-13114 Sentence denotes Before hospitalization, crew members with Covid-19 who became hospitalized were more likely to report cough (68%), body aches (58%), and fever (32%) than those who did not.
T120 13115-13262 Sentence denotes One third of hospitalized patients reported fever before their hospitalization, as compared with 12% of nonhospitalized crew members with Covid-19.
T121 13263-13412 Sentence denotes During the outbreak, as a precautionary measure, admission criteria were revised to permit hospitalization of crew members with less severe symptoms.
T122 13414-13424 Sentence denotes Discussion
T123 13425-13569 Sentence denotes The epidemiology of SARS-CoV-2 infection in young, healthy populations has not been studied extensively.2 The outbreak of Covid-19 on the U.S.S.
T124 13570-13701 Sentence denotes Theodore Roosevelt provided an unusual opportunity to assess an outbreak in a predominantly young, healthy, working-age population.
T125 13702-13814 Sentence denotes Approximately 69% of crew members were younger than 30 years of age, and no crew member was older than 65 years.
T126 13815-13860 Sentence denotes All were up to date with their immunizations.
T127 13861-13932 Sentence denotes Over the course of the outbreak and the subsequent response by the U.S.
T128 13933-14002 Sentence denotes Navy, every crew member underwent evaluation, testing, and follow-up.
T129 14003-14105 Sentence denotes This level of controlled evaluation and documentation is difficult to achieve in civilian populations.
T130 14106-14594 Sentence denotes On ships at sea, respiratory viruses such as influenza and enteric pathogens such as norovirus can spread quickly.3,4 In the early weeks of the pandemic, several outbreaks of Covid-19 occurred on cruise ships, most notably on the Diamond Princess.5,6 The medical department of a ship can be overwhelmed quickly by a major outbreak of disease, as is similarly seen with health care facilities in civilian communities.7 The shipboard environment on naval vessels is generally more confined.
T131 14595-14794 Sentence denotes Typically, enlisted crew members sleep in open bays packed with dozens of tightly spaced bunks, work in densely populated areas, and congregate in gathering points such as the gyms and galleys (Figs.
T132 14795-14894 Sentence denotes S1 and S2 in the Supplementary Appendix, available with the full text of this article at NEJM.org).
T133 14895-15073 Sentence denotes These conditions probably facilitated the transmission of SARS-CoV-2, as evidenced by the higher likelihood of Covid-19 among enlisted crew members than among officers (Table 1).
T134 15074-15236 Sentence denotes Not surprisingly, crew members working in the engine room and other confined areas of the ship faced a higher risk of being infected than their shipmates on deck.
T135 15237-15348 Sentence denotes A study conducted by the Navy and Marine Corps Public Health Center and the CDC, involving 384 volunteer U.S.S.
T136 15349-15598 Sentence denotes Theodore Roosevelt crew members, showed similar results: those working in confined spaces had higher odds of contracting Covid-19.8 A majority of infected crew members did not note symptoms at the time that Covid-19 was diagnosed by rRT-PCR testing.
T137 15599-15980 Sentence denotes In addition, crew members with unusual or atypical symptoms may not have considered themselves to be infected with SARS-CoV-2.9 These observations suggest that nonsymptomatic or mildly symptomatic crew members played an important role in the rapid spread of the outbreak, much as young adults with asymptomatic infection appear to contribute to spread in civilian populations.10,11
T138 15981-16148 Sentence denotes Although cases of serious illness occur in younger persons, they are less frequent and typically less severe than those in older persons.9,11 In the case of the U.S.S.
T139 16149-16204 Sentence denotes Theodore Roosevelt, few crew members were hospitalized.
T140 16205-16562 Sentence denotes Certain coexisting conditions, such as hypertension, obesity, and diabetes, are associated with higher mortality.12-14 In our findings, we noted a number of coexisting conditions among hospitalized crew members, including uncomplicated, mild, and medically managed asthma, lung disease (e.g., bronchitis), hypertension, and liver disease–related conditions.
T141 16563-16757 Sentence denotes Although we were able to confirm the outcomes in all infected crew members, data collection was limited by the quality of records, particularly those generated in the early days of the outbreak.
T142 16758-16894 Sentence denotes Future studies involving longitudinal cohorts may provide greater insight into the epidemiology of SARS-CoV-2 infection in young adults.
T143 16895-16985 Sentence denotes Our observations within a military population may not be fully generalizable to civilians.
T144 16986-17187 Sentence denotes The CDC case definition for Covid-19, along with clinical criteria, changed over time (e.g., the outbreak began in March 2020, and the CDC-published case definition for Covid-19 changed in April 2020).
T145 17188-17303 Sentence denotes Multiplex testing by polymerase chain reaction identified other causes of influenza-like illness on board the ship.
T146 17304-17494 Sentence denotes Any effect that the case definition or other respiratory pathogens may have had on classifying a case of Covid-19 is limited, because the majority of cases were confirmed by rRT-PCR testing.
T147 17495-17526 Sentence denotes Finally, the crew of the U.S.S.
T148 17527-17626 Sentence denotes Theodore Roosevelt, like all members of the U.S. military forces, have equal access to health care.
T149 17627-17683 Sentence denotes This is not true for all civilians in the United States.
T150 17684-17722 Sentence denotes Since this outbreak occurred, the U.S.
T151 17723-17810 Sentence denotes Navy has incorporated lessons learned to enhance the safety and readiness of its crews.
T152 17811-18000 Sentence denotes To minimize the risk of deploying with asymptomatic carriers of SARS-CoV-2 on board, the Navy has initiated several procedures to create and sustain Covid-19–free environments on its ships.
T153 18001-18139 Sentence denotes Before deployment, all members of a ship’s crew are placed in “restriction of movement” and insulated from community exposure for 14 days.
T154 18140-18275 Sentence denotes To identify asymptomatic or presymptomatic carriers, the Navy added rRT-PCR testing at the end of the “restriction of movement” period.
T155 18276-18395 Sentence denotes Navy ships have sharply reduced shore leaves at foreign ports to prevent crew members from bringing the virus on board.
T156 18396-18687 Sentence denotes Since these policies (along with preventive measures of mask use, social distancing to the extent possible, small-group cohorting, strict hand hygiene, and regular cleaning of common spaces) were put in place, the Navy has deployed multiple ships without sustaining another serious outbreak.
T157 18688-18917 Sentence denotes The concept of creating virus-free “bubbles” is a strategy the Navy has used and has been mirrored by the National Basketball Association and Major League Soccer to enable competition while minimizing the risk of player exposure.
T158 18918-19096 Sentence denotes It is unlikely that this strategy is practical for all employers, much less the general population; however, creating bubbles or cohorts for select populations may be achievable.
T159 19097-19389 Sentence denotes Organizations seeking to safeguard their employees, customers, patients, or students may benefit from assuming that Covid-19 will be introduced into their populations and rigorously enforcing measures to minimize viral transmission by all, since persons may be unaware that they are infected.