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Infect Dis Clin North Am ; 36(2): 365-377, 2022 06.
Article in English | MEDLINE | ID: covidwho-1977336


The COVID-19 pandemic has led to significant mortality in the United States with more than 800,000 deaths in 2020 and 2021. The proportion of patients with COVID-19 who develop severe disease varies but is decreasing over time with growing population immunity and improved therapeutic options. Patients who are 65 years and older represent the largest proportion of deaths from COVID-19. Additional risk factors include immunosuppression and chronic medical conditions. Vaccination dramatically reduces the risk of severe COVID-19. Although critical illness from COVID-19 is mostly driven by respiratory disease, critical illness can manifest in several ways and affect several organ systems.

COVID-19 , Critical Illness , Critical Illness/therapy , Humans , Pandemics/prevention & control , Risk Factors , United States , Vaccination
JAMA Netw Open ; 4(3): e214619, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1251878
Telemed J E Health ; 27(1): 102-106, 2021 01.
Article in English | MEDLINE | ID: covidwho-1066235


Purpose: The vulnerability of postacute and long-term care (PA/LTC) facility residents to COVID-19 has manifested across the world with increasing facility outbreaks associated with high hospitalization and mortality rates. Systematic protocols to guide telehealth-centered interventions in response to COVID-19 outbreaks have yet to be delineated. This article is intended to inform PA/LTC facilities and neighboring health care partners how to collaboratively utilize telehealth-centered strategies to improve outcomes in facility outbreaks. Methods: The University of Virginia rapidly developed a multidisciplinary telehealth-centered COVID-19 facility outbreak strategy in response to a LTC facility outbreak in which 41 (out of 48) facility residents and 7 staff members tested positive. This strategy focused on supporting the facility team remotely using rapidly deployed technologic solutions. Goals included (1) early identification of patients who need their care escalated, (2) monitoring and treating patients deemed safe to remain in the facility, (3) care coordination to facilitate bidirectional transfers between the skilled nursing facility (SNF) and hospital, and (4) daily facility needs assessment related to technology, infection control, and staff well-being. To achieve these goals, a standardized approach centered on daily multidisciplinary virtual rounds and telemedicine consultation was provided. Results: Over a month since the outbreak began, 18 out of 48 (38%) facility residents required hospitalization and 6 (12.5%) died. Eleven facility residents have since returned back to the SNF after recovering from their hospitalization. No staff required hospitalization. Conclusions: Interventions that reduce hospitalizations and mortality are a critical need during the COVID-19 pandemic. The mortality and hospitalization rates seen in this PA/LTC facility outbreak are significantly lower than has been documented in other facility outbreaks. Our multidisciplinary approach centered on telemedicine should be considered as other PA/LTC facilities partner with neighboring health care systems in responding to COVID-19 outbreaks. We have begun replicating these services to additional PA/LTC facilities facing COVID-19 outbreaks.

COVID-19/epidemiology , Remote Consultation/organization & administration , Residential Facilities/organization & administration , Subacute Care/organization & administration , Continuity of Patient Care , Humans , Infection Control/organization & administration , Needs Assessment/organization & administration , Pandemics , SARS-CoV-2 , Time Factors