'role of palliative care during a pandemic': Contribution for a pandemic plan

Aim or goal of the work: Italy was the first European country to experience COVID-19 emergency. This, in particular, in Lombardy and the northern regions. In anticipation of a second wave, in October 2020, the Italian Palliative Care Society (SICP) and the Palliative Care Federation (FCP) drew up the document: 'ROLE OF PALLIATIVE CARE DURING A PANDEMIC'. Design, methods and approach adopted: Scientific literature was analyzed to study the most effective items in a pandemic plan. The document considers both the specificities of the Italian Health System and the experiences that were carried out in the first months of the emergency. Additionally, in June 2020, FCP surveyed to measure the impact of the pandemic on Non-Profit Organizations. 22 questions about volunteering, fundraising, health workers and care, were submitted to 73 Organizations, 44 of whom managing Hospice or Home Care Units. Results: Following a model that classifies the activities in four areas, staff-stuff-space-systems, the document ends with some recommendations for the planning of a Pandemic Plan to ensure adequate responses to the palliative care needs in health emergency and, in particular, in the Sars-CoV-2 epidemic. Conclusion / Lessons Learned: Palliative care specialist teams were involved in counselling for COVID-19 in hospitals. Some Hospices converted for treating COVID patients, and Home Care Units adjusted to face the growing demand from COVID-19 and non-COVID-19 patients. In general, however, patients affected by COVID-19 could not access palliative care, that would have allowed the control of symptoms, the communication with family members, psychological support and the promotion of decision-making processes.

Integrated home and palliative care: Beyond COVID-19

Background: About 5-10% of patients who develop coronavirus disease need hospital care, even in the Intensive Care Unit, and also those who have passed the acute phase and may remain at home rather than hospitalized often continue to need home care, regardless of previous condition. Aim: The COVID-19 pandemic is upsetting the living conditions of everyone and especially of those affected by chronic and advanced diseases who have special health needs. We worked to assist patients who needs home care or social needs or palliative care or blood transfusions at home and are in a condition of isolation or quarantine. Methods: Our Associations have set up 4 dedicated palliative and home care teams in the Province of Ragusa involving: 2 Doctors, 5 Nurses and 6 Social Health Operators, provided with adequate Personal Protective Equipment (e.g. protective clothing, face shield and safety glasses, gloves, shoes, FFP2 / FFP3 masks);coordinated by 2 Operational Centers. Dedicated vans are used, with isolated areas for carrying out the dressing/ undressing procedures. Procedures for sanitation are used and the disposal of special waste is guaranteed. Results: From 17th November 2020 to 13th February 2021, the teams assisted 134 patients with 859 home interventions and took 748 hours excluding travel times and dressing/undressing procedures. Among the interventions were given: 378 pharmacological therapies;100 personal care hygiene interventions and 20 blood transfusions. Conclusion: The strengthening of palliative and home care services with these teams has allowed to ensure continuity of care for COVID-19 patients with urgent needs for home and palliative care and for whom hospitalization is no longer appropriate and thus freeing hospital resources. This experience also increased the synergy with General Practitioners (GPs) for the evaluation and clinical/care management of patients and support to family members for any shared care planning.

Chronic rhinosinusitis is associated with prolonged SARS-CoV-2 RNA shedding in upper respiratory tract samples: A case-control study.

BACKGROUND: SARS-CoV-2, the COVID-19 causative agent, has infected millions of people and killed over 1.6 million worldwide. A small percentage of cases persist with prolonged positive RT-PCR on nasopharyngeal swabs. The aim of this study was to determine risk factors for prolonged viral shedding amongst patient's basal clinical conditions. METHODS: We have evaluated all 513 patients attended in our hospital between 1 March and 1 July. We have selected all 18 patients with prolonged viral shedding and compared them with 36 sex-matched randomly selected controls. Demographic, treatment and clinical data were systematically collected. RESULTS: Global median duration of viral clearance was 25.5 days (n = 54; IQR, 22-39.3 days), 48.5 days in cases (IQR 38.7-54.9 days) and 23 days in controls (IQR 20.2-25.7), respectively. There were not observed differences in demographic, symptoms or treatment data between groups. Chronic rhinosinusitis and atopy were more common in patients with prolonged viral shedding (67%) compared with controls (11% and 25% respectively) (P < 0.001 and P = 0.003). The use of inhaled corticosteroids was also more frequent in case group (P = 0.007). Multivariate analysis indicated that CRS (odds ratio [OR], 18.78; 95% confidence interval [95%CI], 3.89-90.59; P < 0.001) was independently associated with prolonged SARS-CoV-2 RNA shedding in URT samples, after adjusting for initial PCR Ct values. CONCLUSION: We found that chronic rhinosinusitis and atopy might be associated with increased risk of prolonged viral shedding. If confirmed in prospective trials, this finding might have clinical implications for quarantine duration due to increased risk of pandemic spread.

Death trends based on autopsy data compared to the beginning of the coronavirus pandemic in Brazil

The novel Coronavirus disease (COVID-19) is responsible for thousands of deaths worldwide, especially in Brazil, currently one of the leading countries in number of infections and deaths. The beginning of the COVID-19 epidemic in Brazil is uncertain due to the low number of tests done in the country. The excess number of deaths can suggest the beginning of the pandemic in this context. In this article, we used an autoregressive integrated moving average (ARIMA) model to investigate possible excesses in the number of deaths processed by the São Paulo Autopsy Service according to different causes of deaths: all-cause, cardiovascular, and pulmonary causes. We calculated the expected number of deaths using data from 2019 to 2020 (n=17,011), and investigated different seasonal patterns using harmonic dynamic regression with Fourier terms with residuals modeled by an ARIMA method. We did not find any abnormalities in the predicted number of deaths and the real values in the first months of 2020. We found an increase in the number of deaths only by March 20, 2020, right after the first COVID-19 confirmed case in the city of São Paulo, which occurred on March 16, 2020.