Below please find a summary and link(s) of new coronavirus-related content published today in Annals of Internal Medicine. The summary below is not intended to substitute for the full article as a source of information. A collection of coronavirus-related content is free to the public at http://go.annals.org/coronavirus.
1. Study finds mortality rates decreased over time among critically ill COVID-19 patients
A study of critically ill patients admitted to the University of Pennsylvania Health System (Penn Medicine) intensive care unit with COVID-19 found that mortality decreased over time during the pandemic despite stable patient-level characteristics. The authors suggest that further studies are necessary to confirm this result and to identify contributing factors. Findings from a retrospective cohort study are published in Annals of Internal Medicine.
Using patient health records, Penn Medicine researchers sought to determine all-cause 28-day in-hospital mortality for 468 patients with COVID-19-related critical illness during the initial days of the pandemic. They also looked at all-cause death at any time, receipt of mechanical ventilation, and readmissions. The data showed that 68% of patients were treated with mechanical ventilation and 25.9% with vasopressors. The 28-day in-hospital mortality rate was 29% and all-cause 30-day readmission rate was 10.8%. The researchers noted that mortality decreased over time, from 43.5% to 19.2% between the first and last 15-day periods in the core adjusted model, whereas patient acuity and other factors did not change. While more research is needed to determine why survival rates increased, the authors suggest that better adherence to evidence-based standard-of-care therapies for critical illness, such as using high-flow nasal cannula to avert intubation and prone positioning of patients, may have contributed.
Read the full text:
https://www.acpjournals.org/doi/10.7326/M20-5327.
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A PDF for this article is not yet available. Please click the link to read the full text. The corresponding author, George L. Anesi, MD, MSCE, MBE, can be reached through Alex Gardner at Alex.Gardner@Pennmedicine.upenn.edu.
2. Top NIAID docs: Health care professionals should use data to encourage vaccine uptake
According to Anthony Fauci, MD, and colleagues from the National Institute of Allergy and Infectious Disease (NIAID), acknowledging that there is still much to learn while strongly encouraging vaccination is arguably one of the most critical challenges facing health care providers today. They say having a clear understanding of the data supporting the use of these new vaccines is critical to addressing that challenge.
As SARS-CoV-2 vaccines begin to be authorized and distributed, many questions remain regarding who should receive these vaccines and the immediate, intermediate, and long-term impact of the vaccination program on the pandemic. In a new commentary published in Annals of Internal Medicine, experts from NIAID provide a perspective on the vaccines furthest along in development in the United States and highlight some of the important issues frontline health care professionals will need to be prepared to discuss with their patients. These issues include potential side effects of the vaccines (both short and long-term), safety and efficacy of the vaccines in "special" populations, such as children, pregnant, women, and individuals with underlying illnesses, and the duration of protection patients can expect from vaccination.
Read the full text:
https://www.acpjournals.org/doi/10.7326/M21-0111.
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A PDF for this article is not yet available. Please click the link to read the full text. To schedule an interview with the authors, please contact the NIAID Office of Communications at (301) 402-1663 or NIAIDNews@niaid.nih.gov.
3. Essay describes hospital cyber attack during pandemic
An essay from George Washington University School of Medicine and Health Sciences published today in Annals of Internal Medicine describes a Ransomware attack on Universal Health Services during the COVID-19 pandemic. The attack disabled access to electronic health records and left frontline health care professionals to rely on old-fashioned pen and paper, teamwork, and compassion to push through the crisis and deliver necessary care to their patients.
According to the author, it was hard to ignore the poetic similarity between malware entering a computer network and the coronavirus. Both the malware and the virus crossed continents easily and were the subject of repeated warnings from security experts. Both exposed the slow-motion crises of a fraying infrastructure and a workforce already on the edge of burnout, and both can kill directly and cause unmeasured damage through delayed and omitted treatment, medical error, and the moral injury of providing inadequate care.
Read the full text:
https://www.acpjournals.org/doi/10.7326/M20-7191.
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A PDF for this article is not yet available. Please click the link to read the full text. The corresponding author, Hana Akselrod, MD, MPH, can be reached directly at hakselrod@gwu.edu.
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Journal
Annals of Internal Medicine