ABSTRACT
Introduction Treatment with dexamethasone reduces mortality in patients with coronavirus disease 2019 (COVID-19) pneumonia requiring supplemental oxygen, but the optimal dose has not been determined. Objective To determine whether weight-based dexamethasone of 0.2 mg/kg is superior to 6 mg daily in reducing 28-day mortality in patients with COVID-19 and hypoxemia. Materials and methods A multicenter, open-label, randomized clinical trial was conducted between March 2021 and December 2021 at seven hospitals within Northwell Health. A total of 142 patients with confirmed COVID-19 and hypoxemia were included. Participants were randomized in a 1:1 ratio to dexamethasone 0.2 mg/kg intravenously daily (n = 70) or 6 mg daily (n = 72) for up to 10 days. Results There was no statistically significant difference in the primary outcome of 28-day all-cause mortality with deaths in 12 of 70 patients (17.14%) in the intervention group and 15 of 72 patients (20.83%) in the control group (p = 0.58). There were no statistically significant differences among the secondary outcomes. Conclusion In patients with COVID-19 and hypoxemia, the use of weight-based dexamethasone dosing was not superior to dexamethasone 6 mg in reducing all-cause mortality at 28 days. Clinical trial registration This study was registered under ClinicalTrials.gov (identifier: NCT04834375).
ABSTRACT
BACKGROUND: The United States is experiencing a drug addiction and overdose crisis, made worse by the COVID-19 pandemic. Relative to other types of health services, addiction treatment and overdose prevention services are particularly vulnerable to disaster-related disruptions for multiple reasons including fragmentation from the general medical system and stigma, which may lead decisionmakers and providers to de-prioritize these services during disasters. In response to the COVID-19 pandemic, U.S. states implemented multiple policies designed to mitigate disruptions to addiction treatment and overdose prevention services, for example policies expanding access to addiction treatment delivered via telehealth and policies designed to support continuity of naloxone distribution programs. There is limited evidence on the effects of these policies on addiction treatment and overdose. This evidence is needed to inform state policy design in future disasters, as well as to inform decisions regarding whether to sustain these policies post-pandemic. METHODS: The overall study uses a concurrent-embedded design. Aims 1-2 use difference-in-differences analyses of large-scale observational databases to examine how state policies designed to mitigate the effects of the COVID-19 pandemic on health services delivery influenced addiction treatment delivery and overdose during the pandemic. Aim 3 uses a qualitative embedded multiple case study approach, in which we characterize local implementation of the state policies of interest; most public health disaster policies are enacted at the state level but implemented at the local level by healthcare systems and local public health authorities. DISCUSSION: Triangulation of results across methods will yield robust understanding of whether and how state disaster-response policies influenced drug addiction treatment and overdose during the COVID-19 pandemic. Results will inform policy enactment and implementation in future public health disasters. Results will also inform decisions about whether to sustain COVID-19 pandemic-related changes to policies governing delivery addiction and overdose prevention services long-term.
Subject(s)
COVID-19 , Delivery of Health Care/methods , Drug Overdose/drug therapy , Substance-Related Disorders/therapy , Disasters , Drug Overdose/mortality , Health Policy , Health Services , Humans , Outcome and Process Assessment, Health Care , United StatesABSTRACT
Local policies can have substantial spillovers both across geographies and markets. Little is known about the impact of public health regulations across administrative borders. We estimate U.S. county level direct and spillover effects of Stay-at-Home-Orders (SHOs) aimed at containing the spread of COVID-19 on mobility and social interaction measures. We propose a modified difference-in-difference regression design, based on contiguous-county triplets. This approach compares treated counties, which adopted the SHO, and neighbors, to the neighbor's neighbors, which we term hinterland, counties. We find that mobility in neighboring counties declined by a third to a half as much as in the treated locations. These spillover effects are concentrated in neighbors that share media markets with treated counties. Using directional mobility data, we decompose the spillover decline in mobility into reductions in external visits coming from the treated county and an even stronger voluntary decline in the neighbor county's own traffic. Together, our results provide strong evidence that SHOs operate through information sharing and illustrate the quantitative importance of voluntary social distancing. The finding that the estimated spillovers are in the same direction as the direct effects casts doubt on the prevailing narrative that a more nationally coordinated policy response would have accomplished a greater reduction in mobility and contacts.
ABSTRACT
Objetivo: La incertidumbre de una posible transmisión posnatal por SARS-CoV-2 genera un desafío entre aplicar o evitar los cuidados esenciales del recién nacido para prevenir la transmisión. La revisión sistemática tiene como objetivo describir el impacto de los cuidados esenciales del neonato en la transmisión posnatal del SARS-CoV-2. Métodos: Se realizó una revisión sistemática en bases de datos electrónicas, se incluyero studios observacionales, serie de casos y reporte de casos. Dos investigadores de forma independiente evaluaron los criterios de inclusión, la calidad metodológica y la extracción de datos. Resultados: Se tamizaron 208 estudios para una inclusión final de 9 artículos relevantes. El reporte de transmisión del virus SARS-CoV-2 está centrado en la posibilidad de transferencia por la leche materna y ausencia de información acerca de la transmisión por otros cuidados esenciales, sin embargo, se observa un bajo uso en la práctica clínica de los cuidados esenciales del recién nacido hijo de madre con COVID- 19. Conclusiones: La información es limitada sobre la posible transmisión del SARS-CoV-2 a través de los cuidados esenciales del recién nacido, sin embargo, la pandemia ha impactado de forma importante los mismos. Según los hallazgos en la literatura, es mayor el beneficio de estas intervenciones y las recomendaciones científicas promueven su aplicación empleando las medidas de protección personal para la madre y el personal de salud.Alternate :Objective: The uncertainty of a possible postnatal transmission by SARS-CoV-2 creates hallenge between applying or avoiding essential newborn care to prevent transmission. The objective of the systematic review is to describe the impact of essential neonate care o he postnatal transmission of SARS-CoV-2. Methods: A systematic review was carried out in electronic databases, observational studies, case series, and case reports. Two investigators independently assessed the inclusion criteria, methodological quality, and data extraction. Results: 208 studies were screened for a final inclusion of 9 relevant articles. The transmission report of the SARS-CoV-2 virus is focused on the possibility of transfer through breast milk and the absence of information about transmission by other essential care, however, a low use, in clinical practice, of essential care for the newborn child of a mother with COVID-19, is observed. Conclusions: Information is limited on the possible transmission of SARS-CoV-2 through essential newborn care;however, the pandemic has had a significant impact on them. According to the findings in the literature, the benefit of these interventions is greater, and the scientific recommendations promote their application, using personal protection measures for the mother and the healthcare personnel.