344. Prevalence and Impact of Post-Acute Sequelae of COVID-19 Among People Experiencing Homelessness in King County, WA Between September 2020 - May 2021

Abstract Background Homeless shelters are high risk settings for SARS-CoV-2 transmission. People experiencing homelessness (PEH) have high rates of chronic illness, and have been disproportionately affected by COVID-19. The burden of post-acute sequelae of COVID-19 (PASC) in PEH has not been well-studied and PEH may be uniquely affected due to barriers to medical care and the potential exacerbation of existing threats to health, housing, employment, and self-care. Methods The Seattle Flu Study conducted community-based surveillance for SARS-CoV-2 in nine homeless shelters from September 1, 2020 and May 31, 2021. Individuals with and without respiratory symptoms were tested for SARS-CoV-2 infection using a PCR assay. We completed follow-up surveys with shelter residents age ≥18 years at days 5, 10, 30 and 60+ after positive or inconclusive diagnosis with SARS-CoV-2 infection. Individuals were asked about residual symptoms, impact on activities of daily living, access to medical care, and health-related quality of life. Results Of 51 eligible participants, 22 (43%) completed a follow-up survey, with six at day 5 or 10 survey, 11 at day 30, and 18 at day 60+. The median time from enrollment to last follow-up survey was 77 (range 49-138) days. Five (23%) participants reported at least one symptom at day 0, five (83%) at day 5 or 10, eight (73%) at day 30 and seven (39%) at day 60+ (Figure 1). Eight (36%) reported at least one symptom on a day 30 or 60+ follow up survey that interfered or prevented their daily activities. Nine (41%) received medical care at the quarantine facility. Of those with symptoms persisting beyond day 10, four (30%) received medical care outside of a medical provider at the quarantine facility. Prevalence of self-reported symptoms at Day 0 (enrollment), Day 5 or 10, Day 30, and Day 60+ in shelter residents who tested positive or inconclusive for SARS-CoV-2. Conclusion PEH reported a high prevalence of persistent COVID-19 symptoms 30+ days after their SARS-CoV-2 detection. Few participants accessed medical care for their persistent illness. The impact of COVID-19 extends beyond acute illness and PASC may exacerbate existing challenges PEH face in health and wellbeing. Disclosures Helen Y. Chu, MD MPH, Bill and Melinda Gates Foundation (Consultant)Cepheid (Research Grant or Support)Ellume (Consultant)Merck (Consultant)Pfizer (Consultant)Sanofi-Pasteur (Research Grant or Support)

Background. The impact of COVID-19 in rural communities has been well described. However, little is known regarding differences in coinfections among COVID-19 patients in rural vs. urban settings. Our primary objective is to evaluate community acquired coinfection (CACo) rates (< 72 hrs from admission) and healthcare-associated infection (HAI) rates ( > 72 hrs from admission) in these populations. Secondary objectives include use of empiric antibiotics, pathogen prevalence, and patient outcomes.
Methods. Retrospective analysis of the first 255 adult patients admitted to a tertiary medical center with symptomatic COVID-19 and confirmed by PCR. Rural and urban categories were determined using patient address and county census data. Isolated pathogens were individually evaluated and considered coinfections if the patient met predetermined criteria.
Predetermined Coinfection Criteria Results. The rates of CACo for rural (n = 90) and urban (n = 165) residents were 11.1% and 13.3%, respectively. Non-respiratory coinfections, such as bloodstream and urinary tract infections, were more common in urban residents; however, empiric antibiotics were started in 75.1% of all subjects. Methicillin susceptible staphylococcus aureus and Escherichia coli were the most common pathogens isolated on admission in both populations. HAI rates were 13.3% in the rural residents vs 13.9% in the urban residents with Methicillin resistant staphylococcus aureus as the most common respiratory pathogen, although Pseudomonas aeruginosa was the most prevalent overall pathogen. There was no significant difference in hospital length of stay or 30-day allcause mortality among both populations.

Patient Outcomes Among Rural and Urban Populations
Conclusion. There was no significant difference in the rate of CACo or HAI among rural or urban populations. Despite the high rate of antibiotic use to empirically cover community acquired respiratory infections at the start of the pandemic, only 1.9% of the subjects had a possible or proven respiratory coinfection on admission. Despite prior research showing worse outcomes for rural populations with COVID-19, our data demonstrates that coinfection rates and patient outcomes were similar among these populations when receiving medical care at an academic hospital.
Disclosures. All Authors: No reported disclosures S276 • OFID 2021:8 (Suppl 1) • Abstracts Methods. The Seattle Flu Study conducted community-based surveillance for SARS-CoV-2 in nine homeless shelters from September 1, 2020 and May 31, 2021. Individuals with and without respiratory symptoms were tested for SARS-CoV-2 infection using a PCR assay. We completed follow-up surveys with shelter residents age ≥18 years at days 5, 10, 30 and 60+ after positive or inconclusive diagnosis with SARS-CoV-2 infection. Individuals were asked about residual symptoms, impact on activities of daily living, access to medical care, and health-related quality of life.
Results. Of 51 eligible participants, 22 (43%) completed a follow-up survey, with six at day 5 or 10 survey, 11 at day 30, and 18 at day 60+. The median time from enrollment to last follow-up survey was 77 (range 49-138) days. Five (23%) participants reported at least one symptom at day 0, five (83%) at day 5 or 10, eight (73%) at day 30 and seven (39%) at day 60+ (Figure 1). Eight (36%) reported at least one symptom on a day 30 or 60+ follow up survey that interfered or prevented their daily activities. Nine (41%) received medical care at the quarantine facility. Of those with symptoms persisting beyond day 10, four (30%) received medical care outside of a medical provider at the quarantine facility.
Prevalence of self-reported symptoms at Day 0 (enrollment), Day 5 or 10, Day 30, and Day 60+ in shelter residents who tested positive or inconclusive for SARS-CoV-2.
Conclusion. PEH reported a high prevalence of persistent COVID-19 symptoms 30+ days after their SARS-CoV-2 detection. Few participants accessed medical care for their persistent illness. The impact of COVID-19 extends beyond acute illness and PASC may exacerbate existing challenges PEH face in health and wellbeing.
Results. 100 patients were entered into the study, with an average age of 49.4 years, 54% male. The general symptoms with the highest incidence were: fever, cough and dyspnea characteristic of SARS-CoV-2 infection, followed by chest pain, headache, anosmia and dysgeusia. The main alteration of the hemogram was lymphopenia, no leukopenia or plaquetopenia was demonstrated. 54% of those affected had mild pneumonia, the rest severe pneumonia. 75% progressed towards improvement and 25% died. Among the dermatological manifestations identified, all occurred in cases with severe pneumonia, the one with the highest incidence was the morbilliform viral exanthema in 18%, the presence of diffuse partial alopecia in 7% as well as manifestations of lividity and maceration in 1%. Regarding alopecia, in 6% it was reversible androgenetic alopecia, having manifested during the acute stage of pneumonia (all men), in 1% it presented alopecia areata (male) that has been persistent beyond the acute phase and in frank recovery Demographic and clinical variables

Clinical manifestations
Conclusion. The incidence of dermatological manifestations is low in this study population, the most frequent being the morbilliform viral exanthema expected in a virus, however they present manifestations of low incidence such as reversible androgenetic alopecia associated with severity of the disease, a finding that has been documented recently as a manifestation associated with COVID-19 Disclosures. All Authors: No reported disclosures