The effect of COVID-19 pandemic on the length of stay and outcomes in the emergency department.

OBJECTIVE: This study aimed to evaluate the change in length of stay (LOS) in the emergency department (ED) and outcomes during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This is a single-center, retrospective observational study. We compared ED LOS and outcomes in patients aged ≥19 years who presented to the ED of Soonchunhyang University Bucheon Hospital, a single tertiary university hospital, between January and December in 2018, 2019, and 2020. We included patients who were diagnosed with fever, pneumonia, and sepsis in the ED, based on the International Statistical Classification of Diseases and Related Health Problems 10th Revision. We also compared the LOS and outcomes of overall ED patients in 2019 (before COVID-19) and in 2020 (after COVID-19). RESULTS: A total of 5,061 patients with fever, pneumonia, and sepsis were analyzed. The LOS in the ED in 2020 significantly increased compared with 2018 and 2019 (177.0±115.0 minutes in 2018, 154.0±85.0 minutes in 2019, and 208.0±239.0 minutes in 2020). The proportion of patients who were transferred to other hospitals in 2020 (2.1%) increased compared with 2018 (0.8%) and 2019 (0.7%). Intensive care unit admission significantly increased in 2020 (13.7%) compared with 2019 (10.3%). Among all ED patients, ED LOS in 2020 was longer than in 2019, particularly in patients who were admitted and then transferred to another hospital. Intensive care unit admission (4.4% vs. 5.0%), transfer rate (0.7% vs. 0.9%), and ED mortality (0.6% vs. 0.7%) also significantly increased. CONCLUSION: The ED LOS, time to intensive care unit admissions, time to transfer to other hospitals, and ED mortality significantly increased during the COVID-19 pandemic.

Overseas Air Medical Repatriation of National Soccer Players Infected With Coronavirus Disease 2019 and Contacted Staff From Austria to South Korea.

Korea rarely has a system to transport patients from abroad. However, single-patient transfers are steadily being performed, and there was an experience of transferring a large number of personnel regardless of whether they were confirmed or not due to coronavirus disease 2019. Recently, a national soccer game was held abroad, and a total of 8 players and staff were infected. A total of 15 people were transported through a charter fully equipped with quarantine equipment by a medical response team with experience in air transport.

Is it enough for COVID-19 screening test? Limitation of swab test and general characteristics of mild symptom patients.

The most common method for SARS-CoV-2 testing is throat or nasal swabbing by real-time reverse transcription polymerase chain reaction (RT-PCR) assay. In South Korea, drive-through swab test is used for screening system and community treatment centers (CTCs), which admit and treat confirmed COVID-19 patients with mild symptoms, are being used. This retrospective study was conducted on patients admitted to a CTC on March 6, 2020. A total of 313 patients were admitted. The nasal and throat swabs were collected from the upper respiratory tract, and a sputum test was performed to obtain lower respiratory samples. The positive rate of the first set of test, sputum test was higher than that of the swab test (p = 0.011). In the second set of test, 1 week after the first ones, the rate of positive swab tests was relatively high (p = 0.026). In the first set of test, 66 of 152 (43.4%) patients showed 24-h consecutive negative swab test results, when the sputum test results were considered together, that number fell to 29 patients (19.1%) (p < 0.001). Also, in the second set of test, 63 of 164 (38.4%) patients met the discharge criteria only when the swab test was considered; that number fell to 30 (18.3%) when the sputum test results were also considered (p < 0.001). Using the swab test alone is insufficient for screening test and discharge decision. Patients who may have positive result in the sputum test can be missed.