A Citywide Analysis of DWI Events in Association with Bar Reopening and Increased Restaurant Capacity.

BACKGROUND: During the COVID-19 pandemic many bars closed. Simultaneously, many persons experienced stay at home orders linked to an increase in alcohol use. The net impact of these restrictions on the incidence of driving while intoxicated (DWI) events is unclear. METHODS AND MATERIAL: We conducted a retrospective observational analysis using publicly reported data regarding police traffic encounters. We analyzed changes in DWI encounters in the San Antonio, TX metropolitan area before (1-14 October 2020) versus after (15-28 October 2020) bars reopened during the COVID-19 pandemic. We made these comparisons by comparing medians and through regression modelling to control for potential confounders. RESULTS: During the study period, 16,609 police traffic encounters met inclusion criteria. Of these, 353 were DWI encounters, 594 were officer traffic stop encounters, 14,565 were traffic related encounters, 113 were wrong way driver encounters, and 984 were other traffic violations. In the before and after analysis, there was no difference in the daily median numbers of DWI encounters (12 versus 10, p=0.461), wrong way driver incidents (3 versus 2, p=0.328), or other traffic violations (34 versus 35, p=0.854). The multivariable regression model similarly identified no change in the daily incidence of DWI encounters (p=0.281). CONCLUSIONS: We detected no change in the incidence of DWI encounters immediately following the reopening of bars in the San Antonio metropolitan area.

A Descriptive Analysis of the Execution of the Expert Field Medical Badge Competition with Mitigation Measures during the COVID-19 Pandemic.

OBJECTIVE: Introduction: In September 2020, the 2nd Stryker Brigade Combat Team of the 4th Infantry Division at Fort Carson, CO, executed an Expert Field Medical Badge (EFMB) event, unique in its implementation of Coronavirus Disease 2019 (COVID-19) mitigation measures. We conducted a descriptive analysis of our experience to inform future EFMB events. METHODS: We planned and resourced the EFMB competition in accordance with the Army Medical Department Center and School Pamphlet 350-10. We additionally defined adjustments to each event based upon the installation's COVID-19 Health Protection Condition (B, B+, or C) to set conditions for us to execute training regardless of shifts in the public health posture. We further implemented mitigation measures to include a 72-hour restriction of movement for all candidates and cadre prior to competition start, strict use of face coverings, and two daily temperature and symptom screenings. We recorded numbers of candidates and cadre withdrawing from the competition each day and the reasons for withdrawal. RESULTS: Of the 66 evaluators, 179 support personnel, and 113 candidates, 2 personnel withdrew for reasons related to COVID-19 mitigation measures. A single cadre member entered a quarantine for the development of a sore throat during the competition. One candidate withdrew after disclosing failure to comply with the 72-hour restriction of movement prior to competition start. Another candidate withdrew prior to start due to an injury sustained during land navigation. Of the remaining 111 candidates, 22 (20%) earned the EFMB. Most failures occurred due to the Army Physical Fitness Test (APFT, 33) and land navigation (44). DISCUSSION: Our competition provides proof in principle that large-scale events to train individual skills such as EFMB are feasible in conjunction with COVID-19 public health measures. Our experience highlights the imperative of prior preparation of candidates in particular for the APFT and land navigation.

Task Force Contain: A Descriptive Analysis of Brigade Combat Team COVID-19 Operations.

BACKGROUND: In March 2020, a Fort Carson brigade combat team established Task Force (TF) Contain in response to the Coronavirus Disease 2019 (COVID-19) pandemic. We offer a descriptive analysis of the TF Contain execution. METHODS: This study comprises a descriptive analysis of the design and execution of COVID-19 response by an infantry brigade combat team. Specific analyses include patient flow and mitigation measures; task organization; and definition of commander decision points as associated with separate lines of effort. RESULTS: TF Contain defined separate teams to address each component of the COVID-19 response, each assigned to subordinate battalions. Team Trace augmented the installation medical activity tracing interviews and data collection. Team Isolation provided lodging and life support; whereas, Team Transportation provided movement assets for soldiers requiring restriction of movement related to COVID-19. Team Clean executed disinfection operations at geographic locations determined to be associated with transmission events. Team Oversight enforced standards of mask wear and social distancing throughout the installation. Team Overflow analyzed installation infrastructure for contingency planning in the event more facilities became necessary for soldiers in isolation or quarantine. Finally, Team Testing augmented medical department activity (MEDDAC) medical manpower to staff providers and medics for support testing operations. CONCLUSIONS: Few personnel assigned to this organization had pre-existing experience or training related to infectious disease prevention or epidemiology. Nevertheless, this organization demonstrated the capacity of the military decision-making and operations processes to build robust procedures in response to public health threats.

Analysis of the Effects of a Texas State-Wide Mask Mandate (Executive Order GA-29) on Case Load, Hospitalizations, and Mortality.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has resulted in unprecedented hospitalizations, ventilator use, and deaths. Because of concerns for resource utilization and surges in hospital capacity use, Texas Executive Order GA-29 required statewide mask wear beginning July 3, 2020. Our objective was to compare COVID-19 case load, hospital bed use, and deaths before and after implementation of this mask order. METHODS: This was a retrospective observational study using publicly reported statewide data to perform a mixed-methods interrupted time series analysis. We compared outcomes before and after the statewide mask wear mandate per Executive Order GA-29. The preorder period was from June 19 to July 2, 2020. The postorder period was July 17 to September 17, 2020. Outcomes included daily COVID-19 case load, hospitalizations, and mortality. RESULTS: The daily case load before the mask order per 100,000 individuals was 187.5 (95% confidence interval [CI] 157.0-217.0) versus 200.7 (95% CI 179.8-221.6) after GA-29. The number of daily hospitalized patients with COVID-19 was 171.4 (95% CI 143.8-199.0) before GA-29 versus 225.1 (95% CI 202.9-247.3) after. Daily mortality was 2.4 (95% CI 1.9-2.9) before GA-29 versus 5.2 (95% CI 4.6-5.8). There was no material impact on our results after controlling for economic activity. CONCLUSIONS: In both adjusted and unadjusted analyses, we were unable to detect a reduction in case load, hospitalization rates, or mortality associated with the implementation of an executive order requiring a statewide mask order. These results suggest that during a period of rapid virus spread, additional public health measures may be necessary to mitigate transmission at the population level.

A Retrospective Review of Emergency Department Visits That May Be Appropriate for Management in Non-Emergency Settings.

BACKGROUND: Emergency departments (EDs) continue to struggle with overcrowding, increasing wait times, and a surge in patients with non-urgent conditions. Patients frequently choose the ED for non-emergent medical issues or injuries that could readily be handled in a primary care setting. We analyzed encounters in the ED at the Brooke Army Medical Center-the largest hospital in the Department of Defense-to determine the percentage of visits that could potentially be managed in a lower cost, appointment-based setting. MATERIALS AND METHODS: We conducted a retrospective chart review of patients within our electronic medical record system from September 2019 to August 2020, which represented equidistance from the start of the COVID-19 pandemic, resulting in a shift in ED used based on previously published data. Our study also compared the number of ED visits pre-covid vs. post-covid. We defined visits to be primary care eligible if they were discharged home and received no computed tomography imaging, ultrasound, magnetic resonance imaging, intravenous medications, or intramuscular-controlled substances. RESULTS: During the 12 month period, we queried data on 75,205 patient charts. We categorized 56.7% (n = 42,647) of visits as primary care eligible within our chart review. Most primary-care-eligible visits were ESI level 4 (59.2%). The largest proportion of primary-care-eligible patients (28.3%) was seen in our fast-track area followed by our pediatric pod (21.9%). The total number of ED visits decreased from 7,477 pre-covid to 5,057 post-covid visits. However, the proportion of patient visits that qualified as primary care eligible was generally consistent. CONCLUSIONS: Over half of all ED visits in our dataset could be primary care eligible. Our findings suggest that our patient population may benefit from other on-demand and appointment-based healthcare delivery to decompress the ED.

Analysis of the Effects of COVID-19 Mask Mandates on Hospital Resource Consumption and Mortality at the County Level.

OBJECTIVES: Coronavirus disease 2019 (COVID-19) threatens vulnerable patient populations, resulting in immense pressures at the local, regional, national, and international levels to contain the virus. Laboratory-based studies demonstrate that masks may offer benefit in reducing the spread of droplet-based illnesses, but few data are available to assess mask effects via executive order on a population basis. We assess the effects of a county-wide mask order on per-population mortality, intensive care unit (ICU) utilization, and ventilator utilization in Bexar County, Texas. METHODS: We used publicly reported county-level data to perform a mixed-methods before-and-after analysis along with other sources of public data for analyses of covariance. We used a least-squares regression analysis to adjust for confounders. A Texas state-level mask order was issued on July 3, 2020, followed by a Bexar County-level order on July 15, 2020. We defined the control period as June 2 to July 2 and the postmask order period as July 8, 2020-August 12, 2020, with a 5-day gap to account for the median incubation period for cases; longer periods of 7 and 10 days were used for hospitalization and ICU admission/death, respectively. Data are reported on a per-100,000 population basis using respective US Census Bureau-reported populations. RESULTS: From June 2, 2020 through August 12, 2020, there were 40,771 reported cases of COVID-19 within Bexar County, with 470 total deaths. The average number of new cases per day within the county was 565.4 (95% confidence interval [CI] 394.6-736.2). The average number of positive hospitalized patients was 754.1 (95% CI 657.2-851.0), in the ICU was 273.1 (95% CI 238.2-308.0), and on a ventilator was 170.5 (95% CI 146.4-194.6). The average deaths per day was 6.5 (95% CI 4.4-8.6). All of the measured outcomes were higher on average in the postmask period as were covariables included in the adjusted model. When adjusting for traffic activity, total statewide caseload, public health complaints, and mean temperature, the daily caseload, hospital bed occupancy, ICU bed occupancy, ventilator occupancy, and daily mortality remained higher in the postmask period. CONCLUSIONS: There was no reduction in per-population daily mortality, hospital bed, ICU bed, or ventilator occupancy of COVID-19-positive patients attributable to the implementation of a mask-wearing mandate.

Changes in Emergency Department Volumes at the Largest U.S. Military Hospital During the COVID-19 Pandemic.

INTRODUCTION: The coronavirus-2019 (COVID-19) pandemic has significantly impacted global healthcare delivery. Brooke Army Medical Center (BAMC) is the DoD's largest hospital and a critical platform for maintaining a ready medical force. We compare temporal trends in patient volumes and characteristics in the BAMC emergency department (ED) before versus during the pandemic. MATERIALS AND METHODS: We abstracted data on patient visits from the BAMC ED electronic medical record system. Data included patient demographics, visit dates, emergency severity index triage level, and disposition. We visually compared the data from January 1, 2019 to November 30, 2019 versus January 1, 2020 to November 30, 2020 to assess the period with the most apparent differences. We then used descriptive statistics to characterize the pre-pandemic control period (1 March-November 30, 2019) versus the pandemic period (1 March-November 30, 2020). RESULTS: Overall, when comparing the pre-pandemic and pandemic periods, the median number of visits per day was 232 (Interquartile Range (IQR) 214-250, range 145-293) versus 165 (144-193, range 89-308, P < .0001). Specific to pediatric visits, we found the median number of visits per day was 39 (IQR 33-46, range 15-72) versus 18 (IQR 14-22, range 5-61, P < .001). When comparing the median number of visits by month, the volumes were lower during the pandemic for all months, all of which were strongly significant (P < .001 for all). CONCLUSIONS: The BAMC ED experienced a significant decrease in patient volume during the COVID-19 pandemic starting in March 2020. This may have significant implications for the capacity of this facility to maintain a medically ready force.