ABSTRACT
RATIONALE: Mass casualty events (MCE) are situations that overwhelm local capacity and lead to morbidity and mortality. The SARS-CoV-2 pandemic (COVID-19) can be considered a nationwide sustained MCE that affected multiple aspects of healthcare. We hypothesized that the surge of patients and lack of preparation for MCEs resulted in increased patient length of stay (LOS), complications, mortality, and costs associated with care for critically ill patients. METHODS: A multicenter, retrospective cohort study compared patients admitted to an intensive care unit (ICU) in 2019 to 2020. The timeframe was March to August. In 2020, this was the first six months of the nationwide response to COVID-19. 2019 was the historical control. Data were collected from the Vizient Clinical Data Base/Resource Manager™ (CDB/RM) (Irving, TX), a national database of patient outcomes and cost-data from over 700 tertiary/quaternary and community hospitals. Data is reported with an associated severity of illness score. The total number of ICU admissions, complication percentage, ICU LOS, observed and expected LOS, LOS index (ratio of observed-to-expected LOS), observed and expected mortality rate, mortality index (ratio of observed-to-expected mortality), total cost of admission, observed and expected direct cost of admission, and direct cost index (ratio of observed-to-expected direct cost) were collected. Inclusion criteria were all medical centers with complete datasets for the timeframe. All major geographic regions of the United States were included. IBM SPSS Statistics for Windows, version 27.0 (Armonk, NY) was used to summarize data with mean and standard deviation. Independent sample two-sided t-tests were used to compare subgroup means. All cost data were adjusted for inflation using the consumer price index. RESULTS: Twenty health systems and 42,397 patients were included in the study. There was a significant increase from 2019 to 2020 in patient outcomes and cost-of-care (table 1). In 2020, ICU LOS was longer compared to 2019;this was highest at tertiary centers [1.5 days longer] and metropolitan hospitals [1.2 days longer]. There was 1.4% increase in complication rates;this was highest in community hospitals [1.8%] and hospitals in urban regions [1.8%]. On average, the total cost of admission per ICU patient was $5,522 more in 2020. This was highest for tertiary academic centers [$6,870] followed by metropolitan hospitals [$6,469], community hospitals [$4,945] and rural hospitals [$4,102]. CONCLUSION: The MCE caused by the SARS-CoV-2 virus resulted in increased adverse outcomes and cost-of-care for patients admitted to an ICU during the first six months of disaster response.
ABSTRACT
Background/Case Studies: In the absence of definitive treatment, plasma from convalescent donors is an investigational therapeutic option for COVID-19, caused by the virus SARS-CoV-2. We investigated total (Immunoglobulins A, M, and G), Immunoglobulin G and in vitro neutralizing anti-SARS-CoV-2 antibody titers in COVID-19 Convalescent Plasma (CCP) Donors. Study Design/Methods: We recruited donors who had laboratory evidence of past COVID-19 infection and recovery from COVID-19 for ≥ 28 days. Female donors were tested for HLA antibodies. All donor samples were tested for Anti-SARS-CoV-2 antibodies using the Ortho- Clinical Diagnostics VITROS Total and IgG COVID-19 Antibody Test, a qualitative (semi-quantitative) chemiluminescent CLIA immunoassay (EUA) targeting SARSCoV- 2 antigen subunit 1 [S1] of the spike protein and an in-house plaque reduction neutralizing test (PRNT). Results/Findings: We tested samples from 117 donors, mean age 46.9 ± 14.3 years, F:M=1.25:1;most (92.3%) had mild symptoms of COVID-19. ABO blood groups were O (34.2%), A (35.9%), B (12.8%), and AB (6.8%);30.7% of females had HLA antibodies. At initial presentation, total Anti-SARS-CoV-2 Ab, IgG Ab alone and presence of neutralizing activity were detected in 98.3%, 90.6%, and 82.9% of donors respectively. Neutralizing antibodies were detected in 84.9% (90/106) of IgG Ab positive donors. IgG Ab levels (S/Co) were positively correlated with Total Ab levels (R2=0.66, p <0.0001). IgG Ab levels showed a high degree of correlation with the neutralizing Ab titers (one-way ANOVA p <0.0001). Twentyeight (23.9%) donors presented for repeat donation, after a median interval of 37 days (range 21-72). On repeat presentation, total Ab level increased in 81.5% and IgG Ab decreased in 74.1% of donors;neutralizing Ab titers decreased in 44.4% and remained unchanged in 33.3% of repeat donors. There was no correlation observed between total Ab levels and number of days postsymptom onset (R2 = 0.09). Total Ab and IgG Ab levels were significantly different based on degree of symptomseverity (p = 0.019 and 0.022, respectively), with statistically significant differences between asymptomatic and severe cases (p = 0.041 and 0.030, respectively). There was no correlation between Total Ab, IgG Ab, or neutralizing Ab titers with age, sex, ABO blood group or HLA antibody status. Conclusions: 98% of CCP donors had detectable anti- SARS-CoV-2 antibody, and 83% had neutralizing antibodies. IgG Ab correlated strongly with neutralizing Ab titers. On repeat presentation, neutralizing Ab titers decreased in 44.4%, and remained unchanged in 33%.