ICU beds increased a net 10% during early COVID-19

US intensive care unit (ICU) beds increased a net 10% amid the COVID-19 pandemic, from April to July 2020, over 2019 baselines, according to a study today in Infection Control & Hospital Epidemiology.

The researchers used the National Healthcare Safety Network to look at 3,867 hospitals (67.5% of eligible hospitals) that had data from 2019 and 2020. Early in the pandemic, 30,279 beds were added to the 84,631 ICU beds available in 2019 (a 35.8% increase), while 21,507 were removed (25.4% of baseline). This made for a net 10.4% increase; however, beds were added or taken away unequally across different hospitals.

For instance, about 61% of large hospitals (221 ICU beds or more) and 16% of small hospitals (25 or fewer ICU beds) increased capacity from April to July 2020. General acute care hospitals (ACHs) were the most likely type of hospital to see increases, with 48% of sites recording upticks, but long-term acute care hospitals (LTACHs) saw the largest surge, with a 156% increase in capacity. Surgical and orthopedic hospitals, on the other hand, decreased ICU beds by 53%.

Overall, 39.1% of hospitals reported a positive net percentage change in ICU beds in 2020, compared with 35.1% that experienced a negative net change.

Geographic region trends generally followed COVID-19 case trends. The highest peak was a 59% increase in the Upper Northeast region on May 8, and the greatest drop was 32% in the Northern Plains on Apr 15. The researchers note that later, on Jul 11, the latter region increased ICU bed capacity 11%.

"As large ACHs and LTACHs increased their ICU capacity, smaller hospitals and those that provide primarily elective services may have experienced declines in patient visits, resulting in the same or fewer ICU beds maintained by these hospitals," the researchers write. "These results can be used to inform future emergency planning initiatives and resource allocation."
Jun 3 Infect Control Hosp Epidemiol study

Five blood clotting events occurred in COVID vaccinees in South Africa

Five blood clotting events occurred among almost 290,000 healthcare workers vaccinated with the AstraZeneca/Oxford COVID vaccine in South Africa, according to interim safety data published yesterday in a New England Journal of Medicine letter.

The AstraZeneca/Oxford vaccine, which had its emergency use paused by the South Africa Health Products Regulatory Authority earlier in the year, is currently undergoing a phase 3b trial in what will be a 500,000-person cohort of South African healthcare workers. The interim data include 288,368 vaccinated persons between Feb 17 and Apr 12.

About 2% of all participants reported adverse events, 81% of which were mild-to-moderate reactogenicity. Fifty events were of serious or of special interest, such as getting infected with the coronavirus within 28 days post-vaccination (12), allergic reactions (12, one of which was anaphylaxis), and neurological conditions (6), including a 40-year-old man who was later diagnosed as having Guillain-Barré syndrome and a 53-year-old woman with Bell's palsy.

Five arterial, venous thrombotic, or embolic events occurred in five participants with known risk factors (1.7 events per 100,000 people; less than 0.002% of the cohort). All instances occurred in women 38 to 65 years. The only fatal clotting instance occurred 23 days post-vaccination in a 63-year-old woman who was overweight and had high blood pressure, diabetes, and a history of venous thrombosis.

While other patient comorbidities included HIV, rheumatic heart disease, chronic pulmonary emboli, and diabetes, one woman who experienced signs of a transient ischemic attack 8 days post-vaccination only had the noteworthy condition of giving birth to twins 9 months prior.

"The rate of adverse events with vaccination is low, and thromboembolic events have occurred mainly in persons with risk factors for thromboembolism," the researchers conclude. They add, "To date, no case of vaccine-induced immune thrombotic thrombocytopenia has been documented."
Jun 2 N Engl J Med study

CDC warns of Salmonella outbreak linked to frozen, breaded chicken

Yesterday the Centers for Disease Control and Prevention (CDC) announced a multistate Salmonella Enteritidis outbreak linked to breaded chicken products. So far 17 people in 6 states have been sickened, with illness onset dates ranging from Feb 21 to May 7.

No deaths have been reported, but 8 people required hospitalization, the CDC said. Of 12 people interviewed, 10 said they reported preparing and eating frozen breaded stuffed chicken products before getting sick.

"People reported buying many different brands of raw frozen breaded stuffed chicken products from multiple stores. When asked about how the products were prepared at home, seven people reported undercooking, microwaving, or air frying the product," said the CDC.

Illinois has the most cases with 6, followed by Minnesota (4) and Indiana (3). Arizona and Michigan each have reported a single case, and New York has two cases.

The CDC said to avoid Salmonella, people should cook raw chicken in the oven to 165°F. The CDC does not recommend using a microwave or air fryer to cook raw chicken.

According to a statement from the US Department of Agriculture Food Safety and Inspection Service (FSIS), the products linked to the outbreak may be labeled "chicken cordon bleu", chicken with “broccoli and cheese”, or "chicken Kiev. " The products may seem ready to eat, the FSIS warned, but are not fully cooked. As part of the investigation, Minnesota officials found the outbreak strain in product samples from retail stores, but the production lots haven't been linked to any of the known cases.
Jun 2 CDC outbreak notice
Jun 2 FSIS statement