ABSTRACT
The COVID-19 pandemic has changed many dynamics in healthcare in the United States. This study explores an increase in patient experience (PE) scores in a pediatric emergency department. Visits were analyzed before and after March 8, 2020, corresponding with the first local case of COVID-19. Changes in the patient population and characteristics of survey responders were analyzed. Overall, the number of daily visits decreased (113 vs 36/day) and survey response rate decreased (3.7 vs 2.8%, p = 0.03), but PE scores increased (87.21 to 93.73, p = 0.002). Comparatively, an increase in patients with higher acuity levels by Emergency Severity Index (ESI), white/Caucasian race, and non-Hispanic ethnicity were observed in the population. Similarly, responders were comprised of higher ESI and a similar racial shift. No correlations, however, were identified between these factors and PE score. Overall, while the data suggest some changes in demographics and acuity, they do not adequately account for the increase in PE score. Further evaluation of the patient/provider relationship during a global pandemic is justified. © The Author(s), 2020.
ABSTRACT
Background: The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has demonstrated the need to share data and biospecimens broadly to optimize clinical outcomes for US military Veterans. Methods: In response, the Veterans Health Administration established VA SHIELD (Science and Health Initiative to Combat Infectious and Emerging Life-threatening Diseases), a comprehensive biorepository of specimens and clinical data from affected Veterans to advance research and public health surveillance and to improve diagnostic and therapeutic capabilities. Results: VA SHIELD now comprises 12 sites collecting de-identified biospecimens from US Veterans affected by SARS-CoV-2. In addition, 2 biorepository sites, a data processing center, and a coordinating center have been established under the direction of the Veterans Affairs Office of Research and Development. Phase 1 of VA SHIELD comprises 34 157 samples. Of these, 83.8% had positive tests for SARS-CoV-2, with the remainder serving as contemporaneous controls. The samples include nasopharyngeal swabs (57.9%), plasma (27.9%), and sera (12.5%). The associated clinical and demographic information available permits the evaluation of biological data in the context of patient demographics, clinical experience and management, vaccinations, and comorbidities. Conclusions: VA SHIELD is representative of US national diversity with a significant potential to impact national healthcare. VA SHIELD will support future projects designed to better understand SARS-CoV-2 and other emergent healthcare crises. To the extent possible, VA SHIELD will facilitate the discovery of diagnostics and therapeutics intended to diminish COVID-19 morbidity and mortality and to reduce the impact of new emerging threats to the health of US Veterans and populations worldwide.
ABSTRACT
Background: On March 13, 2020, the United States declared a national emergency to combat coronavirus disease 2019 (COVID-19). Many states and localities issued shelter-in-place or stay-at-home orders to reduce the spread of COVID-19, limiting movement outside the home to essential activities. Since that time the pandemic has been associated with documented disruptions in routine preventive and other nonemergency care. Screening for HIV infection as well as HIV-1 viral load monitoring for persons living with HIV have likely been affected by the pandemic. Laboratory data from the National Syndromic Surveillance Program provide one way to assess the impact of the COVID-19 pandemic on HIV screening, HIV diagnoses and HIV-1 viral load monitoring. Methods: Using data reported daily to CDC from a large commercial laboratory, we identified lab test reports for HIV screening or HIV-1 viral load testing. For reports with HIV screening test results, we assessed how often the final HIV test algorithm result was confirmed positive. We plotted daily counts of each of the three HIV test types and 7-day moving averages. We also calculated the difference in the number of each type of test performed between March 13, 2019 and September 30, 2019 from those performed during the same time period in 2020. Results: Compared with number of tests performed in 2019, there were 669,847 fewer HIV screening tests, 4,910 fewer confirmed HIV-1 diagnoses, and 67,694 fewer HIV-1 viral load tests performed during March 13 to September 30, 2020. The 7-day average number of HIV tests performed dropped dramatically after March 13, 2020 and did not recover to 2019 levels by September 30, 2020 (Figure). Conclusion: During the national COVID-19 emergency, routine screening for HIV and HIV-1 viral load monitoring may have been delayed or foregone by many patients and clinicians. Undiagnosed HIV infection and higher viral loads could have led to increased morbidity and transmission. Although the number of tests being performed has partially recovered from a nadir this spring, testing at this commercial lab has not yet rebounded to make up what was lost. Healthcare system adaptations including home testing, home sample collection, and telemedicine visits for HIV care can help to address this shortfall as the COVID-19 pandemic persists in the US.
ABSTRACT
INTRODUCTION: Bag mask ventilation (BMV) and tracheal intubation (TI) are aerosol generating procedures. The COVID-19 pandemic impacted North America since March 2020, possibly altering TI practice. We hypothesized that during COVID-19 there was more use of rapid sequence intubation (RSI) without BMV and more use of video laryngoscopy (VL) and apneic oxygenation (AO) as techniques to reduce patient to provider transmission of SARS CoV 2. METHODS: Prospective observational cohort of initial TIs from NEAR4KIDS database: two periods (April-June 2019: Pre-COVID and April-June 2020: COVID) were chosen. We evaluated the difference in patient, provider, and practice characteristics as well as the adverse TI associated events (TIAEs) and oxygen desaturation (SpO2<80%) between two periods. RESULTS: 749 primary TIs were reported from 38 centers during Pre-COVID, and 374 TIs from 30 centers during COVID. Patient median age was older in COVID-19 pandemic (Pre-COVID 1y (IQR 0-8), COVID 2yr (IQR 0-13), p=0.005). RSI without BMV was more frequently used during COVID-19 (4% Pre-COVID vs. 13% COVID, p<0.001). VL and AO were more commonly used during COVID-19 (VL: Pre-COVID 48% vs. COVID 68%, p<0.001;AO: Pre-COVID 30% vs. COVID 44%, p<0.001). The proportion of attending intubation increased during pandemic (Pre-COVID 20% vs. COVID 27%) and the resident and fellow intubations decreased (Pre-COVID 60% vs. COVID 48%). The adverse TIAEs were not significantly different (Pre-COVID 11% vs. COVID 12%, p=0.74), and desaturation (SpO2<80%) were not different (Pre-COVID 15% vs. COVID 17%, p=0.60). CONCLUSIONS: In this preliminary analysis, more senior providers served as a primary laryngoscopist, more rapid sequence intubation (RSI) without BMV was provided, and video laryngoscopy (VL) and apneic oxygenation (AO) were used more during the COVID-19 pandemic TIs. However, adverse TI associated events (TIAEs) and oxygen desaturation (SpO2<80%) were NOT more common during the COVID-19 era.