A Comparative Analysis of Critical Limb Ischemia in the Intensive Care Unit since the COVID-19 Pandemic.

BACKGROUND: Emerging data and case reports have found coagulation abnormalities and thrombosis as sequelae of infection with SARS-CoV-2 (COVID-19). Case reports have reported thrombotic complications caused by COVID-19-related coagulopathy leading to limb loss. Alarmingly, many of these patients had no underlying vascular disease prior to being infected with COVID-19. Many of these case reports discuss patients developing gangrene in the intensive care unit (ICU). Our study compares the incidence of gangrene in the ICU in COVID-19 patients to baseline inpatient levels prior to the pandemic. METHODS: This retrospective analysis investigates two subsets of patients from a single institution. The first was from 2020 during the COVID-19 pandemic; the second subset was from 2019 before the pandemic. Demographic data and medication history were ascertained for both groups. Primary outcomes measures included extremity gangrene that developed in the ICU, mortality, and major amputation. RESULTS: There were 249 COVID-19 positive patients admitted to the ICU in 2020. In 2019, 1,846 admissions to the ICU took place, of which 249 patients were randomized to chart review. There were 13 cases of gangrene that developed in the ICU, 12 of which took place in 2020. In-hospital mortality was 11.6% in nonCOVID-19 patients in 2019 vs. 41.4% in 2021 (P < 0.001). Only 16.7% of the COVID-19 gangrene patients had previously known arterial disease. Also, patients in the COVID-19 group with gangrene were four times more likely to be smokers (P = 0.004). When the data were stratified to compare between gangrene development and no gangrene development, the combined total gangrene group had longer hospital stays, higher need for blood transfusions, required major amputations, and revascularization. A multivariate logistic regression from the total study similarly demonstrated that COVID-19 infection is associated with an 18.23 times increased risk of gangrene. CONCLUSIONS: COVID-19 has resulted in an incomprehensible societal impact that will linger for years to come. The last 2 years have reinforced that COVID-19 will be a part of our clinical practice indefinitely. This study emphasizes the importance of clinician awareness of COVID-19 induced critical limb ischemia in those without underlying arterial disease and few medical comorbidities. More research efforts toward preventing limb loss and COVID-19 coagulopathy must be performed expeditiously to achieve a better understanding.

A Comparative Analysis of Critical Limb Ischemia in the Intensive Care Unit since the COVID-19 Pandemic

Objective Emerging data and case reports have found coagulation abnormalities and thrombosis as sequelae of infection with SARS-CoV-2 (COVID-19). Case reports have reported thrombotic complications caused by COVID-19-related coagulopathy leading to limb loss. Alarmingly, many of these patients had no underlying vascular disease prior to being infected with COVID-19. Many of these case reports discuss patients developing gangrene in the intensive care unit (ICU). Our study compares the incidence of gangrene in the ICU in COVID-19 patients to baseline inpatient levels prior to the pandemic. Methods This retrospective analysis investigates two subsets of patients from a single institution. The first was from 2020 during the COVID-19 pandemic;the second subset was from 2019 before the pandemic. Demographic data and medication history were ascertained for both groups. Primary outcomes measures included extremity gangrene that developed in the ICU, mortality, and major amputation. Results There were 249 COVID-19 positive patients admitted to the ICU in 2020. In 2019, 1846 admissions to the ICU took place, of which 249 patients were randomized to chart review. There were 13 cases of gangrene that developed in the ICU, 12 of which took place in 2020. In hospital mortality was 11.6% in non-COVID patients in 2019 versus 41.4% in 2021 (p < 0.001). Only 16.7% of the COVID-19 gangrene patients had previously known arterial disease. Also, patients in the COVID-19 group with gangrene were four times more likely to be smokers (p=0.004). When the data was stratified to compare between gangrene development and no gangrene development, the combined total gangrene group had longer hospital stays, higher need for blood transfusions, required major amputations, and revascularization. A multivariate logistic regression from the total study same demonstrated COVID-19 infection is associated with an 18.23 times increased risk of gangrene. Conclusion COVID-19 has resulted in an incomprehensible societal impact that will linger for years to come. The last two years have reinforced that COVID-19 will be a part of our clinical practice indefinitely. This study emphasizes the importance of clinician awareness of COVID-19 induced critical limb ischemia in those without underlying arterial disease and few medical comorbidities. More research efforts toward preventing limb loss and COVID-19 coagulopathy must be performed expeditiously to achieve a better understanding.

Transportation During Coronavirus in New York City

The COVID-19 pandemic and the shutdown of non-essential business transformed mobility in, through and around New York City. This report provides a detailed analysis of the way in which the transportation systems in New York City and the surrounding region were affected by the pandemic and curtailed economic activity through May 31, 2020. Sections include: Trends in transportation: essential travel, trends in New York City, patterns of walking and micromobility, travel to New York City, and travel impact on the central business district;How New Yorkers adapted: essential workers, food and beverage delivery services, other creative solutions;Looking forward: challenges for public transit, returning demand;and Recommendations. Findings include: (1) Prior to the COVID-19 pandemic, New York City Transit carried 5.5 million subway riders on a typical weekday, or 2.5 times the total ridership of all other U.S. subway systems combined. On April 12th, 2020, subway ridership had dropped 96% to 213,424, its lowest point during the pandemic, and likely the lowest number in 100 years. (2) From the outset of the pandemic, essential workers, an estimated 25% of NYC’s workforce, depended on subways and personal vehicles, lacking sufficient access to rapid transit and micromobility options in their neighborhoods. On a normal day, essential workers account for 38% of transit commuters. (3) As vehicular trips on New York City streets fell by 84%, traffic speeds rose 27%. (4) Tourism from across the nation and globe declined precipitously as air travel was cut sharply: passenger counts across LaGuardia, Newark, and John F. Kennedy airports fell 98.4% below 2019 levels.