Characteristics, Treatment, and Outcomes of Patients With Severe or Life-threatening COVID-19 at a Military Treatment Facility—A Descriptive Cohort Study

Abstract

Introduction The treatment of severe and life-threatening COVID-19 is a rapidly evolving practice. The purpose of our study was to describe the characteristics and outcomes of patients with severe or life-threatening COVID-19 who present to a Military Treatment Facility (MTF) with an emphasis on addressing institutional adaptations to rapidly changing medical evidence. Materials and Methods A single-center retrospective study conducted on a prospectively maintained cohort. The MTF is a 52-bed hospital within an urban setting. Patients were included in the cohort if they had laboratory-confirmed severe or life-threatening COVID-19 with positive SARS-CoV-2 reverse transcription polymerase chain reaction. Severe disease was defined as dyspnea, respiratory frequency ≥30/min, blood oxygen saturation ≤93% on ambient air, partial pressure of arterial oxygen to fraction of inspired oxygen ratio <300, or lung infiltrates involving >50% of lung fields within 24-48 hours. Life-threatening COVID-19 was defined as respiratory failure, septic shock, or multiple organ dysfunction. The cohort included patients admitted from June 1 through November 13. Data were collected retrospectively via chart review by a resident physician. Results In total, our MTF saw 14 cases of severe or life-threatening COVID-19 from June 1 to November 13. Patients had a median age of 70.5 years, with 7% being active duty personnel, 21% dependents, and 71% retired military members. The median time to dexamethasone, remdesivir, and convalescent plasma administration was 4.7, 6.3, and 11.2 hours, respectively. The 28-day in-hospital mortality was 0%. Conclusions Patients who present to an MTF with severe or life-threatening COVID-19 are largely retirees, with only a small fraction comprising active duty personnel. The institution of order sets and early consultation can help facilitate prompt patient care for COVID-19.

SARS-CoV-2 Transmission in the Military during the Early Phase of the Pandemic—A Systematic Analysis

“…After accounting for potential overlap in cases, this study utilized 36 articles from 17 countries—the U.S. ( n = 17), Israel ( n = 2), Switzerland ( n = 2), and the United Kingdom ( n = 2) and one each from Belgium, Bolivia, Brazil, Canada, Djibouti, France, India, Italy, Norway, Philippines, South Korea, Sri Lanka, and Tunisia [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ]. The Israel-based study by Talmy et al was solely used for the meta-analysis of specific symptoms since it was the only Israeli study reporting symptoms breakdown [ 58 ].…”

“…The following supporting information can be downloaded at: . References [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ] are cited in the Supplementary Materials.…”

Freeze‐dried plasma: From damage control resuscitation to coronavirus disease 2019 therapy

“…This shelf-stable, fielddeployable therapeutic technology can also be beneficial as a first-line treatment against future pathogens, particularly under austere conditions or in congregate living settings, and may also provide passive immunity against a Biological Warfare Threat. 12 Clinical studies evaluating prophylactic and therapeutic use of CC-FDP in high-risk populations are warranted. 54 Taken together, our results suggest that FDP made from Canadian-sourced FFP or CC-FFP retains most of its hemostatic properties and closely resembled existing commercial FDP products FLYP and LyoPlas.…”

“…Current limitations include batch‐to‐batch antibody variability in single‐donor plasma units and cold‐chain preservation. Hence, there is a need to develop a stable COVID‐19 convalescent FDP (CC‐FDP) derived from multi‐donor units with high‐titer neutralizing antibodies for immediate treatment, production of hyperimmune globulins, and that may be stockpiled to support treatment in developing countries or austere military operational environments during future waves of the pandemic, where resources are likely to be lacking for vaccination and use of more expensive therapies 12,13 …”

“…Hence, there is a need to develop a stable COVID-19 convalescent FDP (CC-FDP) derived from multi-donor units with high-titer neutralizing antibodies for immediate treatment, production of hyperimmune globulins, and that may be stockpiled to support treatment in developing countries or austere military operational environments during future waves of the pandemic, where resources are likely to be lacking for vaccination and use of more expensive therapies. 12,13 In collaboration with Canadian Blood Services (CBS) and Defense Research and Development Canada, Canadian Forces Health Services is developing FDP from Canadian-sourced plasma. Hemostatic and immunological properties play important roles in the use of FDP for the treatment of severe trauma and COVID-19 patients who show changes in both functions despite different underlying mechanisms.…”