Introduction
Our hospital found itself at the epicentre of the Irish COVID-19 pandemic. We describe the organisational challenges faced in managing the surge and identified risk factors for mortality ...and ICU admission among hospitalised SARS-CoV-2-infected patients.
Methods
All hospitalised SARS-CoV-2 patients diagnosed between March 13 and May 1, 2020, were included. Demographic, referral, deprivation, ethnicity and clinical data were recorded. Multivariable regression, including age-adjusted hazard ratios (HR (95% CI), was used to explore risk factors associated with adverse outcomes.
Results
Of 257 inpatients, 174 were discharged (68%) and 39 died (15%) in hospital. Two hundred three (79%) patients presented from the community, 34 (13%) from care homes and 20 (8%) were existing inpatients. Forty-five percent of community patients were of a non-Irish White or Black, Asian or minority ethnic (BAME) population, including 34 Roma (13%) compared to 3% of care home and 5% of existing inpatients, (
p
< 0.001). Twenty-two patients were healthcare workers (9%). Of 31 patients (12%) requiring ICU admission, 18 were discharged (58%) and 7 died (23%). Being overweight/obese HR (95% CI) 3.09 (1.32, 7.23),
p
= 0.009; a care home resident 2.68 (1.24, 5.6),
p
= 0.012; socioeconomically deprived 1.05 (1.01, 1.09),
p
= 0.012; and older 1.04 (1.01, 1.06),
p
= 0.002 were significantly associated with death. Non-Irish White or BAME were not significantly associated with death 1.31 (0.28, 6.22),
p
= 0.63 but were significantly associated with ICU admission 4.38 (1.38, 14.2),
p
= 0.014 as was being overweight/obese 2.37 (1.37, 6.83),
p
= 0.01.
Conclusion
The COVID-19 pandemic posed unprecedented organisational issues for our hospital resulting in the greatest surge in ICU capacity above baseline of any Irish hospital. Being overweight/obese, a care home resident, socioeconomically deprived and older were significantly associated with death, while ethnicity and being overweight/obese were significantly associated with ICU admission.
In this study, we aim to describe the demographic, clinical and imaging characteristics, treatment course and subsequent outcomes of the first 116 cases presenting to a tertiary Dublin hospital with ...COVID-19 infection and to compare whether ethnic minority background was a risk factor for poorer disease outcomes in this cohort. Of 116 cases analysed, 100 (86%) patients presented from the community, 6 (5%) from care homes and 10 (9%) were existing inpatients. Fifty-four (46%) patients identified as being from an ethnic minority group. One hundred fourteen (98%) patients reported two or more symptoms at time of diagnosis with 81 (70%) patients having confirmed radiological findings of COVID-19 infection. Median duration of symptoms prior to hospital presentation was 6 days (IQR 3–10 days). The median age at presentation was 52 years (IQR 43–65). Co-morbidities recorded included hypertension, hyperlipidaemia, type 2 diabetes mellitus, underlying respiratory disease, previous or current malignancy and current smoker. Twenty-six patients (22%) required ICU admission, 20 (76.9%) of these were from all other ethnic groups combined and 6 (10%) from White Irish group. Adjusting for variables of age, ethnicity and gender, all other ethnic groups combined were five times more likely to require ICU admission than White Irish group (Table
5
). Patients from all other ethnic groups combined admitted to ICU were significantly younger than patients from White Irish group (OR 50.85 vs 62.83,
P
= 0.012). Our hospital’s catchment area serves a wide-ranging and diverse population with many ethnic minority groups represented. Our data demonstrated that there was a significant overrepresentation of a younger cohort of patients from ethnic minority groups admitted to ICU with COVID-19 infection with less co-morbidities than that of the White Irish group.
Abstract
Background
While the modes of transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are well studied, the risk of transmission in various group settings or activities ...is less clear. This living scoping review aims to summarize the risk factors of coronavirus disease 2019 (COVID-19) spread in common group activities (e.g. social gatherings) or settings (e.g. schools, hospitals, shared workplaces) to understand the drivers of transmission and to inform a risk assessment profile tool for use of rapid antigen detection tests.
Methods
We systematically searched electronic databases, MEDLINE and Embase, from January 2019 until February 2022. We included studies that evaluated the risk of SARS-CoV-2 transmission in activities and settings, deemed strategically important to government departments in Ireland, provided by the Department of Health (Ireland) Expert Advisory Group on Rapid Testing.
Results
After screening 14 052 records, data from 139 studies were narratively synthesized. The risk was consistently reported as ‘high’ for large social events (e.g. weddings) and indoor sports, working in healthcare settings and shared workplaces, working/living in residential settings and travelling via public transportation. Most studies were from healthcare settings, with common risk factors including close contact with COVID-19 cases, working in high-risk departments and inappropriate use of personal protective equipment. For other settings and activities, lack of infection prevention and control practices reportedly contributed to infection transmission.
Conclusion
The heterogeneity across studies and lack of direct information on dominant variants, preventive measures, vaccination coverage necessitates further research on transmission risk within group activities to inform infection prevention and control measures.
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NUK, OILJ, UL, UM, UPUK, VSZLJ
We describe the development of a risk assessment profile tool that incorporates data from multiple domains to help determine activities and events where rapid antigen detection tests (Ag-RDT) could ...be used to screen asymptomatic individuals to identify infectious cases as an additional mitigation measure to reduce transmission of SARS-CoV-2. The tool aims to stratify, in real time, the overall risk of SARS-CoV-2 transmission associated with common activities and events, and this can be matched to an appropriate Ag-RDT testing protocol.
Rapid antigen detection tests (RADTs) for SARS-CoV-2 testing offer several advantages over molecular tests, but there is little evidence supporting an ideal testing algorithm. We aimed to examine the ...diagnostic test accuracy (DTA) and the effectiveness of different RADT SARS-CoV-2 testing strategies.
Following PRISMA DTA guidance, we carried out a living rapid review and meta-analysis. Searches were conducted in Ovid MEDLINE® ALL, Embase and Cochrane CENTRAL electronic databases until February 2022. Results were visualized using forest plots and included in random-effects univariate meta-analyses, where eligible.
After screening 8010 records, 18 studies were included. Only one study provided data on incidence outcomes. Seventeen studies were DTA reports with direct comparisons of RADT strategies, using RT-PCR as the reference standard. Testing settings varied, corresponding to original SARS-CoV-2 or early variants. Strategies included differences in serial testing, the individual collecting swabs and swab sample locations. Overall, specificity remained high (>98%) across strategies. Although results were heterogeneous, the sensitivity for healthcare worker-collected samples was greater than for self-collected samples. Nasal samples had comparable sensitivity when compared to paired RADTs with nasopharyngeal samples, but sensitivity was much lower for saliva samples. The limited evidence for serial testing suggested higher sensitivity if RADTs were administered every 3 days compared to less frequent testing.
Additional high-quality research is needed to confirm our findings; all studies were judged to be at risk of bias, with significant heterogeneity in sensitivity estimates. Evaluations of testing algorithms in real-world settings are recommended, especially for transmission and incidence outcomes.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
AimsThe Scottish Inpatient Diabetes Foot Audit conducted in 2013 revealed that 57% of inpatients had not had their feet checked on admission, 60% of those at risk did not have pressure relief in ...place and 2.4% developed a new foot lesion. In response, the Scottish Diabetes Foot Action Group launched the ‘CPR for Feet’ campaign. The aim of this project was to raise awareness of the ‘Check, Protect and Refer’ (CPR) campaign as well as improve the assessment and management of inpatients with diabetes.MethodsA quality improvement project underpinned by Plan-Do-Study-Act (PDSA) methodology was undertaken. The first and second cycles focused on staff education and the implementation of a ‘CPR for Feet’ assessment checklist using campaign guidelines, training manuals and modules. The third and fourth cycles focused on staff feedback and the implementation of a ‘CPR for Feet’ care bundle.ResultsBaseline measurements revealed 28% of patients had evidence of foot assessment. Medical and nursing staff reported to be largely unaware of the ‘CPR for Feet’ campaign (13%). Fifty-two per cent of inpatients with diabetes had their feet assessed and managed correctly following the second PDSA cycle. After completion of the third and fourth PDSA this number improved further to 72% and all staff reported to be aware of the campaign.ConclusionsThe introduction of a ‘CPR for Feet’ care bundle improved the assessment of inpatients with diabetes.
Non-invasive respiratory support (NRS) outside of the ICU has played an important role in the management of COVID-19 pneumonia. There is little data to guide selection of NRS modality. We present ...outcomes of NRS outside the ICU and discuss the effects of NRS on gas exchange with implications for management.
•Use of CPAP and HFNC may avoid intubation and allow time for recovery in COVID-19.•SpO2:FiO2 correlates well with P:F and can risk stratify without invasive testing.•Bedside assessment of respiratory rate and work of breathing outside ICU is important.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract
Background
During the advent of the COVID-19 pandemic, multiple cases were reported of the association between SARS-CoV-2 and invasive pulmonary aspergillosis. The diagnosis of Covid ...associated pulmonary aspergillosis (CAPA) remains difficult, especially in critically unwell patients. We describe those treated with VV ECMO and diagnosed with CAPA in the national centre for ECMO in Ireland during the COVID-19 pandemic, as well as their treatment course and outcomes.
Methods
We retrospectively collected data on all patients who received ECMO during the COVID-19 pandemic in Ireland’s national ECMO centre between May 2020 and January 2022. Data was collected from electronic health care records and cross referenced with positive microbiological samples. The 2020 ECMM/ ISCHAM consensus criteria was used to classify CAPA diagnoses.
Results
37 patients with diagnosed SARS-CoV-2 infection were treated using ECMO. The average age was 46 years (SD 9.3). 15 (41%) of those were female. The mean number of days spent in an intensive care unit (ICU) was 50 (IQR 45-67). 14 (38%) had diagnosed Hypertension, 10 (27%) had Diabetes Mellitus and 1 (2.7%) had known Chronic Kidney Disease requiring dialysis. CAPA was diagnosed in 7 (19%) cases. Using the criteria, no cases were proven as histology samples were not obtained. 1 (14%) case fitted the criteria for possible diagnosis while 6 (86%) cases fitted criteria for probable diagnosis based on biochemical, microbiological and radiological findings. Of these, all received steroids prior to diagnosis, while 3 (43%) also received tociluzumab. 6 (86%) patients received dual antifungal agents and 1 (14%) patient received voriconazole alone. In terms of outcome, 15 (41%) were discharged to another intensive care unit, 1 (3%) discharged to another acute hospital and 2 (5%) to a rehabilitation unit. 16 (43%) patients died while 3 (8%) were discharged home. Of the 7 patients diagnosed with CAPA, 5 (71%) patients died in ICU while 2 (29%) were transferred to other units with final outcome unknown.
Conclusion
Although 2020 guidelines available from ECMM/ISCHAM are used to define strict diagnostic criteria of CAPA, our study demonstrates the need for further research into how other factors may contribute to this diagnosis, including pre-determined risk factors or the use of ECMO.
Disclosures
All Authors: No reported disclosures
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