ABSTRACT
The appearance and subsequent diffusion of COVID-19 forced many bars and restaurants across the United States to close their doors and discontinue normal business practices. This included over 8000 craft breweries. As a result of COVID-19 directives, craft breweries were restricted to curbside pick-up and home delivery of the beer they produced, forcing them to rethink and redesign an important part of their business model. The primary purpose of this chapter is to assess how craft breweries responded to the restrictions placed upon them. A historical review of how the 1918-19 influenza pandemic impacted the brewing industry in the United States is also provided. Similarities between how COVID-19 and the 1918-19 influenza pandemics impacted their period's respective brewing industries are identified. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
ABSTRACT
INTRODUCTION: The dysregulated inflammatory response to SARS-CoV-2 plays a crucial role in the pathogenesis of Coronavirus Disease 2019 (COVID-19). The National Institutes of Health (NIH) guidelines recommend adding a second immunomodulatory agent, tocilizumab (TCZ) or baricitinib (BARI), to dexamethasone in patients with rapidly increasing oxygen requirements and systemic inflammation. As of July 2022, these guidelines do not recommend one agent over the other. This study aims to compare the progression rates to mechanical ventilation and in-hospital mortality for TCZ vs. BARI in patients with moderate to severe COVID-19. METHOD(S): This was a single-center, retrospective, cohort study of patients treated with TCZ or BARI for COVID-19 between August 24, 2021, and December 31, 2021. The primary endpoint was a composite outcome of progression to mechanical ventilation or in-hospital mortality. Secondary endpoints included components of the composite outcome, progression to a higher level of care, duration of mechanical ventilation, hospital length of stay (LOS), and intensive care unit (ICU) LOS. Safety endpoints included the incidence of infection and thrombosis. RESULT(S): One-hundred-seventy-six patients were included, of which 61 (34.7%) received TCZ and 115 (65.3%) received BARI. The primary outcome was not significant between groups (52.5% TCZ vs. 44.3% BARI, p=0.305). There were no statistically significant differences noted between TCZ and BARI in regards to progression to mechanical ventilation (36.1% vs 28.7%, p=0.315), inhospital mortality (50.8% vs 41.7%, p=0.249), progression to higher level of care (18% vs 17.4%, p=0.926), duration of mechanical ventilation (median 9 days vs 6 days, p=0.311), hospital LOS (median 8 days vs 14 days, p=0.193), or ICU LOS (median 7 days vs 8 days, p=0.964). For safety outcomes, there was no difference in the infection rate (36.1% vs. 26.1%, p=0.167), but the rate of thrombosis was higher in the TCZ group (11.5% vs. 3.5%, p=0.042). CONCLUSION(S): There was no significant difference in the composite outcome of progression to mechanical ventilation or in-hospital mortality in patients who received TCZ of BARI for the treatment of COVID-19. However, this primary outcome occurred more frequently in the TCZ group, and a larger study may be able to detect this difference.
ABSTRACT
Purpose: Our goal was to review the incidence and outcomes of cholecystostomy tube placement during the COVID pandemic as compared to matched controls. Materials and Methods: Monthly interventional radiology (IR) case volume was evaluated during the COVID pandemic through July 30, 2020, and was compared to monthly IR case volume during the same time period in 2019. A retrospective review of 40 patients who received percutaneous cholecystostomy tubes between March 2020 and July 2020 (first COVID pandemic peak in Boston, MA) was compared in a propensity matched controlled study. 14 COVID-positive patients were matched to 26 control patients who received a cholecystostomy tube. Outcomes such as positive cholecystostomy tube microbiology, pre-procedural ICU status, and death were evaluated. Results: During March to July 30, 2020, cholecystostomy tube placement constituted 0.43%, average 6 (range 2-10) cases/month of 1389 (range 672-1777) cases/month, whereas in the year prior for the same period it constituted 0.28%, 5.8 (range 4-8) cases/month of 2103 (range 1998-2146) cases/month. We find the average age was 66.5 ± 17.7 (SD) for COVID-negative and 66.0 ± 17.7 (SD) years for COVID-positive patients. Pre-procedure 19% (5/26) of COVID-negative patients and 50% (7/14) of COVID-positive patients were intubated at the time of placement, P = 0.04. Post-procedure, 54% (14/26) of COVID-negative patients and 50% (7/14) of COVID-positive patients had positive cholecystostomy tube fluid microbiology cultures, P = 0.82. 38% (10/26) of COVID-negative patients and 57% (8/14) of COVID-positive patients were in the ICU at the time of placement, P = 0.26. 23% (6/26) of the COVID-negative patients and 36% (5/14) of COVID-positive patients died post-procedure, P = 0.41. 15.4% (4/26) COVID-negative and 14.3% (2/14) of COVID-positive patients had any complications reported, P = 0.93. Conclusions: During the COVID-19 pandemic, we observed a relative increase in the number of cholecystostomy tube referrals despite a drop in total IR case volume. There were no significant differences in post-procedure long-term outcomes and the microbial culture results in our matched control review. Our study suggests that this perceived increase in cholecystostomy tube placements is not secondary to unique COVID pathophysiology, but rather a persistent incidence of acalculous cholecystitis in the setting of chronic ICU stays seen during the COVID pandemic. With the continuation of the pandemic, cholecystostomy tube placement incidence may increase with continued COVID patient care and chronic ICU stays for these patients.