ABSTRACT
Introduction: Many reports have described a decrease in the numbers of patients seeking medical attention for typical emergencies during the COVID-19 pandemic. These reports primarily relate to urban areas with widespread community transmission. The impact of COVID-19 on non-urban areas with minimal community transmission is less well understood. Methods: Using a prospectively maintained pre-hospital quality improvement database, we reviewed our hospital EMS transports with a diagnosis of stroke from January to April 2019 (baseline) and January to April 2020 (pandemic). We compared the volume of patients, transport/presentation times, severity of presenting symptoms, and final diagnosis. Results: In January, February, March, and April 2019 10, 11, 17 and 19 patients, respectively were transported in comparison to 19, 14, 10 and 8 during the same months in 2020. From January through April 2019 there was a 53% increase in transports, compared to a 42% decrease during the same months in 2020. The slopes of these trend lines are significantly different (3.30;95%CI 0.48 - 6.12 versus -3.70;95%CI -5.76 - -1.64, P = 0.001). There were no significant differences in demographics, comorbidities, symptom severity, or stroke discharge diagnoses between the two time periods. However, the median interval from LKW to time of EMS dispatch was significantly longer in January to April 2020 (12 + 273 min) compared to the same time period of January through April in 2019 (7 + 115 min). Conclusion: Our data indicate not only a decrease in patient transport volumes but more alarmingly, significantly longer intervals to EMS activation for suspected stroke care. These results suggest that even in a non-urban location without widespread community transmission patientswere delaying or avoiding care for severe illness such as stroke.(Figure Presented).
ABSTRACT
With the rapidly expanding pandemic of SARS-CoV-2, there is concern that solid organ transplant recipients will be particularly vulnerable to infection and may experience a more severe clinical course. We report four cases of COVID-19 in solid organ transplant recipients including recipients of kidney, liver, lung, and heart transplants. We describe each patient's medical history including transplantation history, their clinical presentation and workup, and their course from diagnosis to either hospital discharge or to improvement in symptoms. These reports demonstrate a range of symptoms, clinical severity, and disease course in solid organ transplant recipients with COVID-19, including two hospitalized patients and two patients managed entirely in the outpatient setting.