Answering the Call: Inpatient Vaccination for SARS-CoV2 Infection in an Academic Hospital

Background. While the available SARS-CoV2 vaccines are up to 94% effective at preventing COVID-19-related death or invasive mechanical ventilation, only 76% of the United States population aged >=18 years have received a primary series and 49% have received a booster. Vaccine administration has been complicated by changing schedule recommendations, packaging in multi-dose vials, and federal reporting requirements that may have limited the locations offering vaccines. We therefore implemented a pharmacy-based initiative to provide SARS-CoV2 vaccination to patients admitted to an academic health center, in order to encourage vaccination when patients had presented for other care. Methods. A pharmacy committee developed a protocol for administering the three authorized SARS-CoV2 vaccines to interested inpatients while minimizing vaccine waste, monitoring for safety events, and providing next dose education. Associated training included multidisciplinary education on requirements related to vaccine Emergency Use Authorization (EUA) status. While developing the protocol, the vaccine committee utilized a temporary procedure to administer vaccines once weekly through review by antimicrobial stewardship pharmacists during August 2021. The protocol went live in September 2021 for inpatient and emergency department sites, with subsequent tracking of the number of doses ordered (stratified by vaccine type and dose number) and number administered. Results. From August 3 2021 to March 25 2022, a total of 389 vaccine orders were placed with 302 doses (78%) administered, including 126 Moderna (48 first, 20 second, 15 third, 42 booster, and 1 undesignated), 165 Pfizer/BioNTech (80 first, 24 second, 41 third, 14 booster, and 6 undesignated), and 11 Janssen COVID-19 vaccine doses. Only 18 vaccine orders were placed on patients in the ED, with 14 (78%) of those doses administered. Of the 87 vaccine orders not administered, 6 were placed but not given, and 81 were placed and then discontinued. Conclusion. With multidisciplinary collaboration, SARS-CoV2 vaccination can be performed in inpatient and ED settings. However, orders should be monitored for protocol compliance and order discontinuation, as these may increase potential for waste.

Evaluation of Outcomes in Critically-ill Patients with COVID-19 Disease Receiving Short Versus Long Courses of Methylprednisolone

Introduction: Determination of an optimal dosing regimen incorporating an effective agent, dose, and duration of corticosteroids in patients presenting with severe acute respiratory syndrome coronavirus-2 leading to coronavirus disease of 2019 (COVID-19) is pivotal in order to balance the benefits and risks of corticosteroid use in this high-risk patient population. Research Question or Hypothesis: How do outcomes differ with use of short versus long course methylprednisolone therapy in patients with confirmed COVID-19 disease? Study Design: multi-center, retrospective, chart review Methods: Patients were stratified into two intervention groups comparing short course (<14 days) versus long course (>15 days) methylprednisolone therapy. The primary outcome evaluated was time to sustained oxygenation improvement. Safety outcomes included incidence of serious secondary infections, hyperglycemia leading to a new insulin requirement, and new corticosteroid prescription at discharge. Result(s): A total of 142 patients were included in this study with 95 patients in the short course cohort and 47 patients in the long course cohort. Baseline characteristics had a few notable differences in female sex (p=0.037), intubation rates (p<0.001), and certain lab values. The composite time to sustained oxygenation improvement was significantly shorter in the short course cohort with 8.1 days (IQR 3.4-12.1) on supplemental oxygen in comparison to 13.4 days (IQR 13.4-37.5) for the long course cohort (p<0.001). In-hospital mortality was significantly lower in the short course cohort when compared to the long course cohort (30.5% versus 55.3%;p=0.004). This study found that the long course cohort had higher rates of serious secondary infections (p<0.001) and increased rates of hyperglycemia with additional insulin requirements (p=0.014). Conclusion(s): Shorter courses of methylprednisolone in patients with COVID-19 were associated with decreased time to oxygenation improvement as well as with decreased rates of secondary infections and hyperglycemia. Due to the limitations of this study, further prospective studies are needed to evaluate the impact of corticosteroid duration on patient outcomes.

EVALUATION OF THE CONSEQUENCES ON THE MENTAL HEALTH OF ELDERLY ADULTS DUE TO SOCIAL ISOLATION DURING COVID-19

The theme of the correlated consequences Covid’s pandemic a problems of a lot of present time for the scientific international community are 19. For the severe consequences that you have left him the human being, he is for it that investigation aimed at designing a methodology from a pedagogic perspective for the evaluation of the consequences in the mental health caused by the social isolation in covid’s pandemic 19 in the adult elders of the group Santa Teresita of the Niño Jesús of Julio Andrade’s Parish Church. I eat the one that necessary methods of empiric type like the observation and theoreticians were for where it the inductive deductive, analytical systemic;sane thai thai constituted the development of investigation. The utilized methodology was the mixed quantitative cuali, affirmed under the fact-finding ty-pes descriptive of transverse type, utilizing like instrument of information the opinion poll;That way than himself I evidence than 80 % of the investigated people no physical activity, according to the bibliography, does not accomplish the exercise you obey a fundamental role in the quality of life of the older adult it enables the continuity of force and the mobility, provide a dream without interruptions (allowing to leave sleeping pills without difficulty), improve the state of mind, the stress diminishes, you prevent some diseases and generate recreational environments, the risk of mortality for diseases lessens host cardiovasculares.En to it you developed a proposal based in the pedagogic perspective of the evaluation with the purpose to diminish, the effects in the mental health once 19 were caused by the isolation of the pandemic of the Covid. © 2022, University of Cienfuegos, Carlos Rafael Rodriguez. All rights reserved.

Teleworking in the Public Administration: An Analysis Based on Spanish Civil Servants' Perspectives During the Pandemic

COVID-19 has inflicted unprecedented damage on the entire concept of work and has prompted a paradigm shift in workplace relations. Many work environments have faced a context in which on-site work has been restricted and telework has been the only viable option. In countries like Spain, the pandemic has forced the Public Administration to opt for this way of working in order to continue operating. Therefore, this study aims to determine the catalysts and blockers for Spanish civil servants wanting to telework. To achieve the study's objectives, descriptive statistics were obtained using the multiple linear regression technique, with a model building system known as backward stepwise. The identification of these catalysts and blockers will help to facilitate human resource management based on teleworking in the public sector. This study's findings could help to recommend possible actions to improve the employees' teleworking experience at the Spanish Administracion General del Estado. These actions include investing in equipment, providing training in information and communication technologies, and defining human resources policy to promote the work-life balance.

Covid 19 care, ECMO usage and outcomes in a time of crisis at a major medical center

Objective: Outline the impact of COVID 19 and use of ECMO at INOVA Fairfax Medical Center, a full service, 1000 bed facility. Methods: Review of the EMR and use of descriptive statistics. Results: Between March 2020-February 13, 2021, 3220 COVID admissions occurred, of which 23% required ICU care and 10% mechanical ventilation (MV). Average hospital stay was 8 days and ICU 13 days. 51% of ICU patients (pts) received MV and 13% of vented pts (7% of ICU admissions) received ECMO. Data on 48 ECMO pts in 2020 is presented. Eligibility for ECMO included: Age < 60 yrs, failed lung protective ventilation (TV< 6cc/kg, Pplat < 30 cm H2O) or acidosis (pH< 7.20, pCO2>65), trial of neuromuscular blockade and prone positioning, p/f< 100 torr. Up to 12 ECMO patients supported simultaneously (prior ECMO census cap of 4-7).Age range 15-68yrs. By quarters of 2020 ECMO: Q1, 7 pts, duration 6-27 days, 100% survival;Q2, 30 patients, duration 3-95 days, 60% survival. 95 d pt decannulated but expired later;Q3 6 pts, duration 5-66 d, 50% survival, no survivor past 26 d;Q4 9 pts, 67% surv, duration 2-27d, survivor at 27d. Overall ECMO survival (n=48): 67% to discharge. Conclusions: 1. Initially, elective admissions were cancelled to allow care for over 200-300 COVID pts per day. Critical illness required expansion of ECMO services outside the usual site (CVICU), requiring emergent training of nursing and medical staff by core ECMO physicians and ECMO specialist staff. 2. Prone positioning helpful (before or during ECMO);3. higher levels of anticoagulation (heparin or bivalirudin) required due to acute/persistent thrombus;4. Bronchoscopy/tracheostomy performed without complications;5. Resumption of elective and non- COVID critically ill admissions in Q3 and Q4 resulted in inability to accept ECMO referrals in the second wave of pandemic, highlighting need for more experienced ECMO beds.

A tale of 2 years. The impact on Covid 19 on veno-venous ECMO support at a major medical center

Objective: To compare usage and outcomes of COVID and non-COVID venovenous ECMO patients. Methods: Database review and descriptive statistics Results: In 2019, a total of 29 patients received VV ECMO for respiratory failure not related to COVID 19. Age ranged from 6 months to 70 years. Overall survival was 62%. In 2020, 48 patients received VV ECMO for COVID respiratory failure, with overall survival of 67%. Despite the sudden increase in VV ECMO volume for an entity with no prior ECMO experience at our site, survival was similar to other ECMO patients. Conclusions: Experienced ECMO centers may achieve good survival with ECMO support of new patient diseases, even during stressful pandemic situations. Lessons learned during ECMO care of new illnesses such as COVID in large centers may provide data to improve care in smaller and less experienced sites. Collaborations such as the international COVID Consortium/ECMO Card group can assist with data sharing and development of best practice between a wide range of centers.

Extracorporeal membrane oxygenation (ECMO) in adolescent COVID-19: A tale of two families

Objective: The successful use of ECMO in adult patients with severe respiratory failure from COVID-19 has been reported, but there is little data in children or adolescents except those with cardiac manifestations. Thus, the utility of ECMO in pediatric patients with severe respiratory failure is not well established. Describe the clinical course and outcome of three pediatric patients with COVID-19 who progressed to Acute Respiratory Distress Syndrome (ARDS) requiring ECMO. Methods: Data related to demographics, clinical course, ECMO course and outcome from three consecutive pediatric patients who received venovenous (VV) ECMO due to COVID-19-associated respiratory failure were analyzed from electronic health records. IRB approval was given. Results: We describe three patients (see Figure 1) aged 14 to 16 who all had acute COVID-19 leading to the acute respiratory distress syndrome - one patient whose father died from COVID following ECMO and two brothers. The patients presented between days 4 and 10 of symptoms and rapidly required escalation of care including intubation, nitric oxide and VV ECMO. All three patients were treated with methylprednisolone, though with differing regimens;two received remdesivir through a clinical trial;and two required tracheostomy placement for respiratory support, with one having the tracheostomy tube removed prior to discharge. ECMO was continued for 9 to 24 days, with no episodes of recannulation, major bleeding events or other complications from the ECMO therapy. All three patients were eventually discharged;two were discharged home and one transferred to acute rehabilitation. Conclusions: These cases show the safe and effective use of VV ECMO in COVID-19-associated ARDS. Pediatric critical care physicians should be aware of the ability to use VV ECMO for pulmonary support in patients with COVID-19 illness and should consider early transfer to ECMO capable units to improve survival from ARDS related mortality.

Prevention of COVID-19 superspreader events in buses boarded by presymptomatic patients

Introduction: COVID-19 superspreader events have occurred when symptomatic individuals without wearing face masks boarded buses. Objective: To report the risk of superspreader events when presymptomatic individuals boarded buses together with unvaccinated passengers, but with non-pharmacological preventive interventions being maintained. Methods: Prospective study of health personnel transported in buses to a COVID-19 vaccination center for two weeks. Open windows, correct use of face masks and exclusion of symptomatic individuals were mandatory. Prospective surveillance identified workers with COVID-19 within 14 days after vaccination. Each asymptomatic passenger of buses where cases were identified was monitored for a similar time period. Voluntary screening results were available for workers who were tested in the month before or after vaccination. Results: 1,879 workers boarded 65 buses. On-board time ranged from three to eight hours. Twenty-nine cases of COVID-19 and four asymptomatic cases were identified among 613 passengers of 21 buses. Median time between vaccination and COVID-19 symptoms onset was six days. One case of suspected transmission on a bus was identified. Conclusions: Strict nonpharmacological preventive interventions substantially reduced the risk of COVID-19 superspreader events in buses boarded by presymptomatic individuals. © 2022 Academia Nacional de Medicina de México,.