All That Coughs Is Not COVID.

We report the case of a woman from the Bronx, New York, who presented to the emergency department (ED) in June 2020 with a febrile respiratory illness resembling coronavirus disease 2019 (COVID-19) but was ultimately diagnosed with Legionnaires' disease (LD). New York City (NYC) rapidly became an epicenter of the global COVID-19 pandemic in 2020. In the years since the pandemic started, variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have recurred in multiple waves and remain an important cause of viral respiratory illness. The bacteria Legionella pneumophila is often under-recognized as a cause of community-acquired pneumonia, yet it recurs each year in clusters, outbreaks, or as sporadic infections. Pneumonia caused by SARS-CoV-2 and Legionella can present similarly and may not be readily distinguished in the absence of diagnostic testing.

BSG cross-sectional survey on impact of COVID-19 recovery on workforce, workload and well-being.

Objective: The aim of this survey was to understand the impact of the COVID-19 pandemic and recovery phase on workload, well-being and workforce attrition in UK gastroenterology and hepatology. Design/method: A cross-sectional survey of British Society of Gastroenterology physician and trainee members was conducted between August and October 2021. Multivariable binary logistic regression and qualitative analyses were performed. Results: The response rate was 28.8% (180/624 of opened email invites). 38.2% (n=21/55) of those who contracted COVID-19 felt pressured to return to work before they felt ready. 43.8% (71/162) had a regular increase in out-of-hours working. This disproportionately affected newly appointed consultants (OR 5.8), those working full-time (OR 11.6), those who developed COVID-19 (OR 4.1) and those planning early retirement (OR 4.0). 92% (150/164) believe the workforce is inadequate to manage the service backlog with new consultants expressing the highest levels of anxiety over this. 49.1% (80/163) felt isolated due to remote working and 65.9% (108/164) felt reduced face-to-face patient contact made their job less fulfilling. 34.0% (55/162) planned to work more flexibly and 54.3% (75/138) of consultants planned to retire early in the aftermath of the pandemic. Early retirement was independently associated with male gender (OR 2.5), feeling isolated from the department (OR 2.3) and increased anxiety over service backlog (OR 1.02). Conclusion: The pandemic has placed an additional burden on work-life balance, well-being and workforce retention within gastroenterology and hepatology. Increased aspirations for early retirement and flexible working need to be explicitly addressed in future workforce planning.

All That Coughs Is Not COVID

We report the case of a woman from the Bronx, New York, who presented to the emergency department (ED) in June 2020 with a febrile respiratory illness resembling coronavirus disease 2019 (COVID-19) but was ultimately diagnosed with Legionnaires' disease (LD). New York City (NYC) rapidly became an epicenter of the global COVID-19 pandemic in 2020. In the years since the pandemic started, variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have recurred in multiple waves and remain an important cause of viral respiratory illness. The bacteria Legionella pneumophila is often under-recognized as a cause of community-acquired pneumonia, yet it recurs each year in clusters, outbreaks, or as sporadic infections. Pneumonia caused by SARS-CoV-2 and Legionella can present similarly and may not be readily distinguished in the absence of diagnostic testing.

ABO Blood Type and Outcomes in a Diverse COVID-19 Infected Population

Introduction:There is conflicting data on the association of blood type with COVID-19 infection. Recent studies have shown an association of blood type in acquisition of COVID-19 infection (Zhao et al., medRxiv 2020), but no association in terms of disease mortality (Latz, Ann Hematol 2020). Prior studies are limited due to lack of diversity. One of the largest studies conducted in China found blood type A conferred highest risk of acquiring COVID-19 infection (Zhao et al., medRxiv 2020). Similar results were found in which the odds of COVID-19 positive infection compared to negative test results were increased in blood group A and decreased in blood group O (Zietz et al., medRxiv 2020). There was no significant association between blood group and intubation or death. Neither of these studies addressed the association of blood groups with thromboembolism. This study aimed to evaluate the impact of blood types on outcomes of COVID-19 infection in a multiracial population.Methods:This is a retrospective electronic chart review of all patients admitted to New York-Presbyterian Brooklyn Methodist Hospital in Brooklyn, NY. All patients admitted from March 2020 to April 2020 who tested positive for SARS-CoV-2 nasopharyngeal swab were analyzed. Baseline patient characteristics and outcomes were entered manually by medical professionals via chart review using the electronic medical record (EMR). Baseline characteristics include blood group type, rhesus antigen status, age, gender, race, comorbid conditions, median initial and peak D-dimer. The primary endpoint was inpatient mortality. The secondary endpoints included thromboembolism (pulmonary embolism, deep venous thrombosis, arterial thrombosis), myocardial infarction, bleeding event, length of stay, intensive care unit admission, and intubation. Chi-square test for categorical variables was used to calculate statistical significance defined as p value ≤ .05 when comparing ABO blood group and rhesus antigen with mortality and development of thromboembolism.Results:Our study consisted of 249 patients that were COVID-19 positive with a documented blood group. Our population consisted of 51% of patients that identified as black, 35.7% that identified as white, and 17.7% that identified as Hispanic. Blood type B had the highest rate of patients that identified as black at 58.1% and blood type O had the highest rate that identified as Hispanic at 23.6%. When comparing blood groups A, AB, B and O to the rate of mortality the result was 46%, 44.4%, 41.9% and 50.9% respectively which was found to be not statistically significant (p=0.759). Rh positive patients had a 47.2% mortality rate while Rh negative patients had a 46.9% mortality rate however this was also found to be not statistically significant (p=0.954). Next, we compared development of thromboembolism during hospital stay in the A, AB, B, and O blood type groups and the rate was 8%, 11.1%, 9.3%, and 10.9% respectively with the results not being statistically significant when accounted for blood type (p=0.991). Rate of development of thromboembolism in Rh positive and negative patients was 9.3% and 9.4% respectively which was found to not be statistically significant as well (p=0.998). When looking at comorbidities, 70.2% of our patient population had hypertension and the second prevalent comorbidity was diabetes at 38.2% (Table 1).Discussion:In a diverse population, no association between ABO blood group, Rh status, and mortality was found which is similar to the conclusion found in prior studies done by Zhao et al. and Latz et al. in which the majority of the population was either Caucasian or Asian. Additionally, there is no association found between ABO blood group, Rh status and development of thromboembolism. Our patient population consisted mostly of minority groups.Prior studies have shown that blood type A has the highest risk of positive SARS-CoV-2 test whereas type O has the lowest risk of positive SARS-CoV-2 test. Our study further supplements this discovery by the conclusion that while blood type A confer ed highest risk of acquiring COVID-19 infection, blood type had no significant association with mortality. Investigation on a larger scale is necessary to address the susceptibility of ABO blood group and COVID-19 infection severity in a multiracial population to address racial disparities.

Optimizing preoperative antibiotics in patients with ß-lactam allergies: A role for pharmacy.

PURPOSE: Patients with a reported ß-lactam allergy (BLA) are often given alternative perioperative antibiotic prophylaxis, increasing risk of surgical site infections (SSIs), acute kidney injury (AKI), and Clostridioides difficile infection (CDI). The purpose of this study was to implement and evaluate a pharmacist-led BLA clarification interview service in the preoperative setting. METHODS: A pharmacist performed BLA clarification telephone interviews before elective procedures from November 2018 to March 2019. On the basis of allergy history and a decision algorithm, first-line preoperative antibiotics, alternative antibiotics, or allergy testing referral was recommended. The pharmacist intervention (PI) group was compared to a standard of care (SOC) group who underwent surgery from November 2017 to March 2018. RESULTS: Eighty-seven patients were included, with 50 (57%) and 37 (43%) in the SOC and PI groups, respectively. The most common surgeries included orthopedic surgery in 41 patients (47%) and neurosurgery in 17 patients (20%). In the PI group, all BLA labels were updated after interview. Twenty-three patients were referred for allergy testing, 12 of the 23 (52%) completed BLA testing, and penicillin allergies were removed for 9 of the 12 patients. Overall, 28 of the 37 (76%) pharmacy antibiotic recommendations were accepted. Cefazolin use significantly increased from 28% to 65% after the intervention (P = 0.001). SSI occurred in 5 (10%) patients in the SOC group and no patients in the PI group (P = 0.051). All of these SSIs were associated with alternative antibiotics. Incidence of AKI and CDI was similar between the groups. No allergic reactions occurred in either group. CONCLUSION: Implementation of a pharmacy-driven BLA reconciliation significantly increased ß-lactam preoperative use without negative safety outcomes.

Grass-roots junior doctor communication network in response to the COVID-19 pandemic: a service evaluation.

BACKGROUND: COVID-19 was declared a worldwide pandemic on 11 March 2020. Imperial College Healthcare NHS Trust provides 1412 inpatient beds staffed by 1200 junior doctors and faced a large burden of COVID-19 admissions. LOCAL PROBLEM: A survey of doctors revealed only 20% felt confident that they would know to whom they could raise concerns and that most were getting information from a combination of informal work discussions, trust emails, social media and medical literature. METHODS: This quality improvement project was undertaken aligning with Standards for Quality Improvement Reporting Excellence 2.0 guidelines. Through an iterative process, a digital network (Imperial Covid cOmmunications Network; ICON) using existing smartphone technologies was developed. Concerns were collated from the junior body and conveyed to the leadership team (vertical-bottom-up using Google Form) and responses were conveyed from leadership to the junior body (vertical-top-down using WhatsApp and Zoom). Quantitative analysis on engagement with the network (members of the group and number of issues raised) and qualitative assessment (thematic analysis on issues) were undertaken. RESULTS: Membership of the ICON WhatsApp group peaked at 780 on 17 May 2020. 197 concerns were recorded via the Google Form system between 20 March and 14 June 2020. There were five overarching themes: organisational and logistics; clinical strategy concerns; staff safety and well-being; clinical (COVID-19) and patient care; and facilities. 94.4% of members agreed ICON was helpful in receiving updates and 88.9% agreed ICON improved collaboration. CONCLUSIONS: This work demonstrates that a coordinated network using existing smartphone technologies and a novel communications structure can improve collaboration between senior leadership and junior doctors. Such a network could play an important role during times of pressure in a healthcare system.

A Hybrid Model of Outpatient Memory Care in the COVID Era

Introduction The coronavirus pandemic has drastically affected day-to-day life, including the way healthcare is provided. An emphasis is placed on the need to transition to telemedicine to reduce exposure rates. The effects of the pandemic have been especially significant in the geriatric population, which is at increased risk of hospital mortality with infection: 35% mortality for patients aged 70 to 79 years and greater than 60% mortality for patients aged 80 to 89 years (Gómez-Belda et all., 2020, Wiersinga et al., 2020). Physicians, as well as patients, have had to quickly adapt to telemedicine for outpatient services to reduce rates of transmission and infection. However, the barriers to telemedicine are also higher in the geriatric population. The lack of smart devices with cameras, microphones, internet, and the lack of ability and comfort in using these are some of the barriers in which the older population face (Hawley, et al. 2020). With confounding factors of dementia limiting instrumental activities of daily living, learning new technology can also be an additional burden to this population. This can lead to unwillingness or hesitation in participation of telehealth visits by both the patient and the caretaker. An increase in caregiver burden has also been shown secondary to the coronavirus pandemic and the increased isolation (Alexopoulos et al., 2020). Methods At the Banner Alzheimer's Institute, the needs of this population led to the development of the Hybrid model of care, which allows some patients to be present in person at the office but distanced in a separate room from the providers. In a separate room, a screen with a camera is set up so the appointment can occur as a “remote” visit. When indicated, short direct contact is made to complete a physical exam. This reduced time of close contact is important for infection control, especially when as testing prior to visits is not widespread for outpatient services. Prolonged exposure is defined as within 6 feet of contact with infected persons for at least 15 minutes (Wiersinga et al., 2020). This hybrid model allows for decreased time of contact, and therefore decreases exposure risk while removing the initial barrier of access to and difficulty navigating technology in this population. With more hybrid visits, patients may even develop more comfort and confidence in technology use for fully remote visits. We analyzed data routinely collected by the department regarding patient and provider satisfaction. We analyzed ratings on front desk interactions, provider interactions, ease of care, office net promoter score (NPS), and provider NPS. We compared the ratings from June to October of 2020, when the hybrid model was in use, to the ratings from June to October of 2019 using a paired t-test. Results None of the measures analyzed showed any statistically significant difference between the scores. Conclusions To provide care to the high-risk geriatric population, we developed this hybrid model of treatment. A key concern was the potential for patient dissatisfaction with not being able to see the provider in person. However, this was not seen on the patient satisfaction survey results. One reason could be related to increased flexibility from patients considering the pandemic, the quality of video visits, and a perception of valuing safety over in person visits. In the evaluation of this model, using the typical measure of patient and provider satisfaction, we did not see significant differences between the previous and new models of care. This is an encouraging result and argues for the increased use of this hybrid model in the future to optimize infection prevention while maintaining patient satisfaction. With the use of the hybrid model, geriatric patients can be partially exposed to use of technology first in the office and be provided with in person tutorials on video use. This can normalize the use of video visits with time and practice and therefore lead to more confidence when applying the use of technology at home. The hybrid model can also mitigate concern over continuous exposure, and therefore address the wellbeing of physicians. Funding Not applicable