Subject(s)
Adaptive Immunity/immunology , COVID-19 Vaccines , COVID-19 , Inflammatory Bowel Diseases , SARS-CoV-2 , Tumor Necrosis Factor Inhibitors , Adolescent , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/immunology , COVID-19/prevention & control , COVID-19 Serological Testing/methods , COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/immunology , Disease Transmission, Infectious/prevention & control , Female , Humans , Immunoglobulin G/blood , Inflammatory Bowel Diseases/drug therapy , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/immunology , Male , Retrospective Studies , SARS-CoV-2/immunology , SARS-CoV-2/isolation & purification , Seroconversion/drug effects , Tumor Necrosis Factor Inhibitors/immunology , Tumor Necrosis Factor Inhibitors/therapeutic use , United States/epidemiology , Young AdultABSTRACT
In April 2020, a study of The Mount Sinai Hospital in New York City was conducted to better understand the challenge of adapting idealized infection control design guides to site-specific conditions during a pandemic. The study aimed to capture quick interventions that are working, offer a new hypothesis and framework to guide future design interventions, and share lessons to assist other medical facilities as they pursue their own necessary spatial adaptations moving forward. Three units repurposed for COVID-19 were studied. Using action cameras and cloud-based videoconferencing, clinicians helped designers remotely peer in real time to active COVID-19 units, create ?heatmap? annotations of perceived risk by frontline clinicians, and conduct interviews with decision makers. The COVID-19 pandemic has challenged health care systems around the world to provide safe and effective care. Leveraging spatial design, architecture, and design hacks offers an untapped opportunity to support infection prevention and improved team dynamics, ultimately improving the safety and the effectiveness of the health care team by creating an environment that supports infection prevention and team function.
Subject(s)
Clinical Laboratory Techniques/standards , Coronavirus Infections/prevention & control , Endoscopy/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Preoperative Care/standards , Adolescent , Adult , Aged , Asymptomatic Infections/epidemiology , Betacoronavirus/genetics , Betacoronavirus/isolation & purification , COVID-19 , COVID-19 Testing , Child , Clinical Laboratory Techniques/methods , Clinical Laboratory Techniques/statistics & numerical data , Communicable Disease Control/methods , Communicable Disease Control/standards , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Female , Humans , Male , Middle Aged , New York City/epidemiology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Polymerase Chain Reaction/statistics & numerical data , RNA, Viral/isolation & purification , Retrospective Studies , SARS-CoV-2 , Tertiary Care Centers/statistics & numerical dataABSTRACT
Coronavirus disease 2019 (COVID-19) may lead to a severe inflammatory response referred to as a cytokine storm. We describe a case of severe COVID-19 infection in a recently diagnosed pediatric Crohn disease patient successfully treated with tumor necrosis factor-alpha (TNF-α) blockade. The patient presented with 5 days of fever, an erythematous maculopapular facial rash, and abdominal pain without respiratory symptoms. SARS-CoV-2 polymerase chain reaction was positive. Despite inpatient treatment for COVID-19 and a perianal abscess, the patient acutely decompensated, with worsening fever, tachycardia, fluid-refractory hypotension, elevation of liver enzymes, and transformation of the rash into purpura extending from the face to the trunk, upper and lower extremities, including the palmar and plantar surfaces of the hands and feet. Cytokine profile revealed rising levels of interleukin (IL)-6, IL-8, and TNF-α, higher than those described in either inflammatory bowel disease or severe COVID-19 alone. The patient was treated with infliximab for TNF-α blockade to address both moderately to severely active Crohn disease and multisystem inflammatory syndrome in children temporally related to COVID-19. Within hours of infliximab treatment, fever, tachycardia, and hypotension resolved. Cytokine profile improved with normalization of TNF-α, a decrease in IL-6, and IL-8 concentrations. This case supports a role for blockade of TNF-α in the treatment of COVID-19 inflammatory cascade. The role of anti-TNF agents in patients with multisystem inflammatory syndrome in children temporally related to COVID-19 requires further investigation.