COVID-19 (Omicron strain) hospital admissions from a virtual ward - who required further care?

BACKGROUND: The COVID-19 virtual ward was created to provide care for people at home with COVID-19. Given this was a new model of care, little was known about the clinical characteristics and outcomes of patients requiring admission to hospital from the virtual ward platform. The aims were to characterise hospital admission volume, patient epidemiology, clinical characteristics, and outcome from a virtual ward in the setting of an Omicron (BA.1, BA.2) outbreak. METHODS: A retrospective observational study was performed for all virtual ward patients admitted from 1st January 2022 to 25th March 2022 (over 16 years old). Epidemiological, clinical and laboratory data was reviewed on all patients who required hospital admission. RESULTS: A total of 7021 patients were cared for on the virtual ward over the study period with 473 referred to hospital for assessment. Twenty-six (0.4%) patients were admitted to hospital during their care on the ward. Twenty-two (84.6%) admissions were COVID-19 related. Fifty three percent of the hospitalised patients were fully vaccinated and 11 had received prior therapeutics for COVID-19. Shortness of breath was the most common reason for escalation to hospital. Chest pain was the second most common reason and the most common diagnosis after investigation was non-cardiac chest pain. CONCLUSIONS: Few patients required admission from the virtual ward in the setting of the Omicron variant (BA.1, BA.2) as a direct result of COVID-19 disease and virtual ward care. Shortness of breath and chest pain were the most common symptoms driving further clinical care.

Infection control behaviours, intra-household transmission and quarantine duration: a retrospective cohort analysis of COVID-19 cases.

OBJECTIVES: To study COVID-19 (Delta Variant) cases and close contacts co-located within households. Focusing on epidemiology of transmission of COVID-19, quarantine duration and utilisation of infection control behaviours under a telehealth model of care in an elimination setting. METHODS: A retrospective cohort analysis examined household spread of infection, duration of quarantine and change in PCR CT value during illness. A survey explored infection control behaviours used by household members during isolation and quarantine. RESULTS: The cohort was 141 individuals in 35 households. Thirty-seven were index cases, and 48 became positive during quarantine, most within 10 days. Whole-household infection occurred in 12 households with multiple members. Behaviours focused on fomite transmission reduction rather than preventing aerosol transmission. The median duration of close contact household quarantine was 25 days. The majority of COVID-19 cases were de-isolated after 14 days with no evidence of further community transmission. CONCLUSION: Intrahousehold transmission was not universal and, if it occurred, usually occurred quickly. Behaviours utilised focused on fomites, suggesting a need for improved education regarding the potential utilisation of strategies to prevention the transmission of aerosols. Households experienced long durations of home-based quarantine. IMPLICATIONS FOR PUBLIC HEALTH: The impact of long quarantine durations must be considered, particularly where most community benefit from quarantine is achieved within 10 days from exposure in the setting of the Delta Variant. Education of households regarding aerosol risk reduction is a potential strategy in the household setting of individuals at risk of disease progression.

Vertebral artery dissection presenting as isolated vertigo.

In this report a central cause of isolated vertigo in a 24-year-old woman is presented: brainstem infarct secondary to vertebral artery dissection.

Hypoglycaemia related to ingestion of a herbal remedy.

We present the case of a 78-year-old diabetic man who was brought to the emergency department because of an episode of hypoglycaemia after taking a herbal remedy for benign prostatic hypertrophy. Patients with multiple comorbidities may well take nonprescribed medication, including herbal remedies, with deleterious effects. If physicians do not specifically ask patients about alternative and complementary medicines, they may be missed.

Vertigo: clinical assessment and diagnosis.

Dizziness is a common presenting complaint to emergency departments and medical admission units; the key is to differentiate between central and peripheral causes of vertigo. This review focuses on bedside assessment of vertigo and, by looking at patterns of symptoms and signs, provides guidance as to when to suspect a central cause.

The need for chest radiography before initiating non-invasive ventilation: a case report.

Severe, acute exacerbations of chronic obstructive pulmonary disease are a common presentation to emergency departments in the UK. In this group of patients, clinical examination can be unreliable in excluding a pneumothorax. With the increasing role of non-invasive positive pressure ventilation in these cases, we present a case report that highlights the need for an urgent chest X-ray prior to commencement of non-invasive positive pressure ventilation.

Best evidence topic report. Transthoracic ultrasonography to diagnose pneumothorax in trauma.

A short cut review was carried out to establish whether transthoracic ultrasound can be used to diagnose pneumothoraces in trauma patients. A total of 46 papers were found using the reported search, of which four represented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.