Emergency Department-based monoclonal antibody therapy for patients with mild to moderate COVID-19

Objectives: To describe the implementation of an ED-based program to offer monoclonal antibody therapy to patients with mild-moderate COVID-19 disease. Background(s): Monoclonal antibody therapy (MOAB) has recently emerged as a treatment for mild to moderate COVID-19, potentially preventing those with underlying conditions from progressing to severe illness and hospitalization. Further, as EDs are the primary point of health care access for many at-risk individuals, offering MOAB in the ED may increase availability of treatment options for patients from traditionally underserved communities. Method(s): A retrospective chart review was conducted of patients 12 years and above who received treatment in our urban, academic, community hospital. Patients 12 years and older were screened for eligibility during ED visits or during follow-up calls providing positive test results. Staff was trained on specific consent, infusion, monitoring, and documentation procedures adherent to MOAB administration under the Emergency Use Authorization. Patients were contacted following MOAB and queried regarding symptom resolution and healthcare utilization. Data regarding patient demographics, ED course, and 7-day unscheduled visits were collected. Result(s): In this ongoing quality improvement initiative, from December 2020 to March 2021, there were 26,229 patient encounters at the pilot ED site. 84 patients were provided MOAB, 87% Bamlanivimab and 13% Bamlanivimab/Etesevimab. Patients had a mean age of 52.3 years (SD 24.4);21% were 12-17 years of age and 37% were >65 years old. 52% were male. 33% self-reported as Caucasian, 19% Black, 18% Asian/Pacific Islander, 21% as other, and 9% were unknown. 17% identified as Latinx. 19% of patients were insured by Medicaid, 36% Medicare, 39% commercially insured, and 6% were uninsured. Patients had symptoms a median of 3 days prior to MOAB. After age (46%), the most commonly reported eligibility criteria was obesity (20%), followed by hypertension (11%) and immunocompromised state (11%). 74% of infusions were administered during nights and weekends. No infusion reactions occurred. 8% returned to an ED within 7 days of MOAB, 5% were hospitalized. No patients required ICU admission or died. Conclusion(s): ED-based MOAB has been safely implemented and may be an effective treatment for patients with mild to moderate COVID-19. Health-system wide expansion of this program may provide opportunities to offer this life-saving therapy to underserved populations with poor access to care.Copyright © 2023

Uncovering the effectual-causal resilience nexus in the era of Covid-19: A case of a food sector SME's resilience in the face of the global pandemic

This research explores the underlying roles of effectuation and causation logic as they impact upon firm resilience in Small and Medium Sized Enterprises (SMEs) in the unprecedented disruption caused by Covid-19. Because Covid-19 provides a unique and powerful discontinuance to internal and external environments, it requires firm adaptation in a wide variety of areas, as they seek to find a new “normal”. Our study contributes to the literature by applying effectuation to understand how an SME can experiment and learn in the face of disruption, and then subsequently causally adapt their resources and networks to achieve resilient outcomes. It adds to knowledge about the interaction between effectual and causal logic, leading to a more nuanced explanation of how and why an SME might apply each logic when responding to disruption caused by Covid-19.

Older Individuals and Digital Healthcare Platforms: Usage Motivations and the Impact of Age on Postadoption Usage Patterns

Digital healthcare platforms have enabled patients to receive healthcare in ways that were impossible previously—for example, by providing a “safer”way to meet, as underscored by the Covid-19 pandemic. This article investigates whether older and younger primary care users display behavioral differences on digital healthcare platforms. The article adopts a mixed-method approach in which one-way ANOVA analysis on a sample of 152 000 patient journeys was combined with qualitative interview data. The findings highlight significant differences in usage between elderly and younger patients. The elderly spends more time during use—for example, during anamnesis, onboarding, and in queues. We also outline how the key antecedent factors that are most central to platform usage, such as perceived usefulness, perceived ease of use, digital maturity, and trust, play out in the elderly user context. The study contributes to the nascent literature on digital healthcare platforms and the postadoption usage of information and communication technologies by the elderly. The article also outlines research implications in the area of DHPs and mHealth for elderly users, and it discusses the practical implications for both platform owners and healthcare professionals, where platform design and information management are particularly important for elderly users. Author

The Impact of COVID-19 Government Responses on Rhinoceroses in Kruger National Park

Global COVID-19 responses by governments restricted international travel, imposed national lockdowns, reduced economies, and influenced people's livelihoods. Travel restrictions and national lockdowns may constrain international illegal supply chains of high value wildlife products such as rhinoceros (rhino) horn. We evaluated whether the COVID-19 lockdown responses by South Africa induced a poaching pause on rhinos in Kruger National Park. We collated information on poaching incidences from 2017 and made predictions for expected incidences during 2020 using trends noted between 2017 and 2019. Rangers observed substantially fewer incidences of poaching during South Africa's hard lockdown. As restrictions eased, poaching incidences increased. Despite the COVID-19 poaching pause, both black and white rhinos continued to decline in Kruger National Park as recruitment could not offset poaching and natural deaths. © 2021 Southern African Wildlife Management Association. All rights reserved.

Emergency Department-Based Monoclonal Antibody Therapy for Patients With Mild to Moderate COVID-19

Study Objective: Monoclonal antibody therapy (MOAB) has recently emerged as a treatment for mild to moderate COVID-19, potentially preventing those with underlying conditions from progressing to severe illness and hospitalization. While MOAB administration has commonly been restricted to infusion centers or inpatient settings, the infection prevention needs of patients with acute COVID-19 and the ambulatory nature of the therapy make the emergency department (ED) a useful setting to offer this treatment. Further, as EDs are the primary point of health care access for many at-risk individuals, offering MOAB in the ED may increase availability of treatment options for patients from traditionally underserved communities. Methods: A retrospective chart review was conducted of patients 12 years and above who received treatment in our urban, academic, community hospital. A multidisciplinary group comprised of stakeholders in emergency medicine, pediatrics, infectious disease, nursing, informatics, and pharmacy developed a comprehensive ED-based MOAB program. Patients 12 years and older were screened for eligibility during ED visits or during follow-up calls providing positive test results. Staff was trained on specific consent, infusion, monitoring, and documentation procedures adherent to MOAB administration under the Emergency Use Authorization. Patients were contacted following MOAB and queried regarding symptom resolution and health care utilization. Data regarding patient demographics, ED course, and 7-day unscheduled visits were collected. Results: In this ongoing quality improvement initiative, from December 2020 to March 2021, there were 26,229 patient encounters at the pilot ED site. 84 patients were provided MOAB, 87% Bamlanivimab and 13% Bamlanivimab/Etesevimab. Patients had a mean age of 52.3 years (SD 24.4);21% were 12-17 years of age and 37% were >65 years old. 52% were male. 33% self-reported as Caucasian, 19% Black, 18% Asian/Pacific Islander, 21% as other, and 9% were unknown. 17% identified as Latinx. 19% of patients were insured by Medicaid, 36% Medicare, 39% commercially insured, and 6% were uninsured. Patients had symptoms a median of 3 days prior to MOAB. After age (46%), the most commonly reported eligibility criteria was obesity (20%), followed by hypertension (11%) and immunocompromised state (11%). 74% of infusions were administered during nights and weekends. No infusion reactions occurred. 8% returned to an ED within 7 days of MOAB, 5% were hospitalized. No patients required ICU admission or died. Conclusion: ED-based MOAB has been safely implemented and may be an effective treatment for patients with mild to moderate COVID-19. Health-system-wide expansion of this program may provide opportunities to offer this life-saving therapy to underserved populations with poor access to care.