ABSTRACT
The control of the risks associated with major hazard events is critical to the safe and continuous operation of the process industry. Over the last decades, the process industry has been successful at establishing and implementing robust Process Safety Management (PSM) systems to prevent and mitigate the consequences of such major hazard events. While there exist some industry guidelines developed relatively recently for events initiated by natural disasters and security-related threats, for initiating events like outbreaks of pathogens and pandemics, there is currently a clear lack of understanding of the impact of the restrictions and disruption caused by a pandemic on the ability of companies operating major hazard facilities to keep controlling the risks associated to their hazardous operations. Moreover, there is no industry guideline on how to account for such an impact in PSM systems for process safety hazards. The recent COVID-19 outbreak caused serious disruptions to normal operations that have challenged industry in their ability to control risks. The objective of this paper is to perform an analysis of the impact of a pandemic situation on the implementation of selected elements of PSM systems related to the identification and evaluation of the risks of a major hazard and their control. The approach chosen involves the analysis of the root causes of the failure of the selected PSM elements using a Fault Tree Analysis method. The findings provide the first steps in the establishment of recommendations for the upgrade of PSM systems to face events such as pandemics.
ABSTRACT
BACKGROUND: Coronavirus disease (COVID) is a new and highly contagious infectious disease caused by the coronavirus (COVID-19 or severe acute respiratory syndrome coronavirus 2). There is limited data regarding the incidence and management of COVID-19 in immunocompromised patients' post-transplantation. In the pre-COVID-19 era, these patients were already at an increased risk of developing opportunistic infections. These often manifested with atypical symptoms. CASE SUMMARY: We report another case of uneventful COVID-19 pneumonia in a 58-year old male who was 18 mo' post liver transplantation. He received tacrolimus monotherapy since July 2019. The clinical manifestations included only epigastric pain radiating to the right hypochondrium, nausea and vomiting. He had no fevers, cough, shortness of breath, anosmia or dysgeusia even if the chest computed tomography scan revealed an extension of the multiple patchy ground-glass density shadows to the upper lobe of the left lung too. He was hospitalised and received a course of oral chloroquine (200 mg × 3 per day) for a period of 10 d. Interestingly, the COVID 19 infection was uneventful though there were no modifications to his tacrolimus dosing. He was successfully discharged. We performed subsequent follow-up via telemedicine. CONCLUSION: In light of the current pandemic, it is even more important to identify how the liver recipient's patients present and are managed, especially for immunosuppression treatment.