ABSTRACT
The author's collection of daily thoughts during the first weeks of the pandemic provide a roadmap for improving operations. SINCE FEBRUARY 2020, PHYSICIAN LEADERS have been faced with extraordinary challenges. Listen to your in-house and on-staff subject matter experts. * Provide all needed resources in an efficient manner, including personal protective equipment, medication, and staff members such as nursing, respiratory therapists and phlebotomists. * Provide a morale boost with food and rest areas for staff to help relieve stress and exhaustion. * Make sure all "action items" are assigned to a person (not a committee or team) with a clearly defined deadline. 2. Cash: Think about the future of the organization. * Focus on costs. * Inventory resources early and track accurately: people, including part-time;equipment, including records to track expenses;and supplies identified with secondary and tertiary vendors. * At daily meetings, ask all departments for input, including staffing/human resources, pharmacy, material management, lab, respiratory, emergency department, food, security, information technology, and epidemiologist/infection control. 8.
ABSTRACT
BACKGROUND: Bamlanivimab and casirivimab/imdevimab are recombinant neutralizing monoclonal antibodies that decrease viral load in patients with coronavirus disease 2019 (COVID-19) and can decrease hospitalizations. Few data exist comparing these two therapies. OBJECTIVE: Our aim was to compare the efficacy and safety of bamlanivimab and casirivimab/imdevimab in emergency department (ED) patients with COVID-19 who met criteria for monoclonal antibody therapy. METHODS: We performed a single-center, open-label, prospective study in adult ED patients with confirmed COVID-19 and high-risk features for hospitalization. Enrolled patients received bamlanivimab or casirivimab/imdevimab, depending on the day of the week that they arrived. We observed patients for post-infusion-related reactions and contacted them on days 5, 10, and 30. The primary outcome was the number of hospitalizations through day 30. In addition, we compared groups with regard to return visits to the ED, symptom improvement, antibody-induced adverse events, and deaths. RESULTS: Between December 17, 2020 and January 17, 2021, 321 patients completed the study. We found no statistically significant difference in the rate of subsequent hospitalization between groups (bamlanivimab: n = 18 of 201 [8.9%] and casirivimab/imdevimab: n = 13 of 120 [10.8%]; p = 0.57). In addition, we found no statistically significant differences between groups regarding return visits to the ED or symptom improvement. One patient had a possible adverse reaction to the treatment, and 1 patient died. Both of these events occurred in the bamlanivimab group. CONCLUSIONS: We found no statistically significant differences in rates of subsequent hospitalization or other outcomes for ED patients with COVID-19 when they received bamlanivimab as opposed to casirivimab/imdevimab. Adverse events were rare in both groups.