Investigating the association between the COVID-19 vaccination and incident gastrointestinal symptomology: A comprehensive dataset.

The coronavirus disease of 2019 (COVID-19) pandemic created a variety of symptoms from mild to acute in the general population. Additional disease burden was experienced in high-risk populations, such as older adults, people with disabilities or overweight, those from racial and ethnic minority groups, and patients with cancer, chronic kidney, lung or liver disease, or diabetes. Although it is well-known that SARS-CoV-2 mostly affects the respiratory tract, studies have revealed the presence of gastrointestinal (GI) symptoms in those patients diagnosed with COVID-19. The best protection against infection is through receipt of the COVID-19 vaccine, which is associated with a low incidence of adverse events. However, there is limited research on the lesser-known side effects experienced following receipt of the COVID-19 vaccination, amongst healthy and special needs populations. This study investigated the association between the COVID-19 vaccination and, when it occurred, infection, and resulting gastrointestinal (GI) symptomology, focusing on both the general population and on those previously diagnosed with GI disorders, Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD). Through a short, anonymous survey, 215 participants were assessed for acute onset of GI issues and/or worsening of pre-existing GI issues following the receipt of one or more COVID-19 vaccine doses and following contraction of COVID-19 itself, when applicable. All analyses were performed using SAS version 9.4, and prior to study initiation, the study protocol was reviewed and approved as exempt by the Stamford Hospital's Institutional Review Board of record. Data analysis included reporting of demographic variables as well as descriptive statistics regarding side effects experienced after receipt of the COVID-19 vaccine, as well as after contracting COVID-19, if it occurred. To assess for statistically significant differences between the groups, ANOVA was conducted for each survey item. Reporting of results consisted of the mean and standard deviation within each of the groups, and an omnibus p-value less than 0.05 (p <0.05) was considered statistically significant. For the purposes of this report, a greater than 0.50 response difference between highest and lowest mean value will be presented. In the event of a statistically significant omnibus p-value, the Scheffe test was used as the post-hoc procedure. The database created through this research demonstrates the prevalence of post-COVID-19 vaccination side effects and can serve as preliminary data for gaining a better understanding of how both general and populations with a higher disease burden are being affected by the COVID-19 vaccine, booster doses, and incident COVID-19 infection in vaccinated individuals.

Augmentation of a Hospital Incident Command System to Support Continued Waves of the COVID-19 Pandemic.

Stamford Hospital (SH) is a 305 bed Level II Trauma center located in Fairfield County, the epicenter of the coronavirus disease 2019 (COVID-19) pandemic in Connecticut. The COVID-19 pandemic was a fast paced, rapidly evolving crisis, presenting our leadership team with unique challenges related to resource availability, patient care, and staff safety. The existing Hospital Incident Command System (HICS) was activated in March 2020 to coordinate our operational emergency management planning, response, and recovery capability for this unplanned event. Although HICS lays the groundwork for hospital preparations and protocol implementation, it is not designed to withstand prolonged crisis circumstances. Given the conditions that the COVID-19 pandemic presented, the possibility for future waves became an impending reality, prompting the need for a long-term solution. To establish guidelines that promoted balance between necessary preparations in the case of additional surges of the pandemic and concurrent resumption then maintenance of routine hospital operations, the SH COVID-19 Playbook was created. The Playbook, presented here, is arranged in accordance with the evidence-based 4 S's (Space, Staff, Systems, and Stuff) strategic critical care planning framework, to address surge capacity management within our hospital's four main patient care areas and additional supportive services. Through feedback from frontline caregivers and leaders within SH, the Playbook captures our experience, best practices, and insight acquired during the first wave of the pandemic. Established with the intentions of equipping leadership and staff globally, guidelines are presented to aid in the navigation of future pandemic surges and successfully care for COVID-19 patients, ensure staff safety, allow for normal services to operate, and provide optimal communication and support for the community, patients, and staff.

Effects of the COVID-19 Crisis on Resident Well-Being in a Community Teaching Hospital.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has been an unexpected crisis that continues to challenge the medical community at large. Healthcare environments have been forced to change dramatically, including for medical residents, who are vital members of the innovative emergency response teams. Articles have previously been published on the effects of crises on the well-being of healthcare practitioners; however, there is a paucity of literature targeting medical residents' experiences and general wellness during devastating events. The objective of our study aimed at understanding the emotional impact of the COVID-19 pandemic on residents' stress, academics, and support systems. METHODS: An anonymous, voluntary Likert scale questionnaire was sent via SurveyMonkey to Internal Medicine and Family Medicine residents in July 2020. Questions focused on residents' mood; stress levels; sense of support; and academics before, during, and immediately after the first surge of COVID-19 at our hospital between March 13 and June 15, 2020. RESULTS: Residents felt sad, stressed, and overworked during the first wave, as opposed to feelings of neutrality and happiness before and immediately after. Levels of concern for personal and loved ones' safety were significantly increased during and after our first wave. The impact on educational training was rated as neutral. Residents noted that institutional support could be improved by the provision of wellness activities and sponsored social events. CONCLUSIONS: This study provides insight on resident well-being during the initial months of the pandemic and identifies areas that could be improved. Our results demonstrated that the pandemic affected many aspects of residents' well-being and education, and the lessons learned can help guide healthcare institutions when implementing wellness activities for trainees during subsequent crises.

Compassionate Use of Remdesivir in Pregnant Women With Severe Coronavirus Disease 2019.

BACKGROUND: Remdesivir is efficacious for severe coronavirus disease 2019 (COVID-19) in adults, but data in pregnant women are limited. We describe outcomes in the first 86 pregnant women with severe COVID-19 who were treated with remdesivir. METHODS: The reported data span 21 March to 16 June 2020 for hospitalized pregnant women with polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus 2 infection and room air oxygen saturation ≤94% whose clinicians requested remdesivir through the compassionate use program. The intended remdesivir treatment course was 10 days (200 mg on day 1, followed by 100 mg for days 2-10, given intravenously). RESULTS: Nineteen of 86 women delivered before their first dose and were reclassified as immediate "postpartum" (median postpartum day 1 [range, 0-3]). At baseline, 40% of pregnant women (median gestational age, 28 weeks) required invasive ventilation, in contrast to 95% of postpartum women (median gestational age at delivery 30 weeks). By day 28 of follow-up, the level of oxygen requirement decreased in 96% and 89% of pregnant and postpartum women, respectively. Among pregnant women, 93% of those on mechanical ventilation were extubated, 93% recovered, and 90% were discharged. Among postpartum women, 89% were extubated, 89% recovered, and 84% were discharged. Remdesivir was well tolerated, with a low incidence of serious adverse events (AEs) (16%). Most AEs were related to pregnancy and underlying disease; most laboratory abnormalities were grade 1 or 2. There was 1 maternal death attributed to underlying disease and no neonatal deaths. CONCLUSIONS: Among 86 pregnant and postpartum women with severe COVID-19 who received compassionate-use remdesivir, recovery rates were high, with a low rate of serious AEs.