COVID-19 vaccination in nursing homes: considerations on freedom to make decisions and legal protection measures

In the most vulnerable people, especially among the elderly, the COVID-19 pandemic has brought to light complex ethical issues such as consent to receive health care, the relationship between risks and benefits of therapies, the choices to be made during the most serious phases of the disease and family relationships have been made ex-treme and heavily emphasized by the pandemic. The article analyzes the ethical and legal aspects of the problem of reconciling respect for the individual’s right to make their own decisions and the need to protect the most vulnerable and fragile sections of the population (the dilemma between the principle of charity and respect for autonomy), with all the related communication, procedural and legal problems relating to Informed Consent. The exceptional circumstances of the pandemic have prompted law-makers to tackle the complex and long-neglected issue of the consent of vulnerable, generally elderly, individuals. In many contexts, from home to hospital to nursing home, patient in-volvement in decision making, the role of the family, and procedures for defining competencies above and beyond diagnostic categories, continue to be largely left behind. part in the hands of the health care workers or team. The methods chosen to obtain consent to vaccina-tion, together with the provisions of the Law of 22 December 2017 on the role of the trustee, pave the way for more appropriate operating methods for daily clinical practice in the field. © by Società Italiana di Gerontologia e Geriatria (SIGG).

Resource scarcity and allocation criteria during the Covid-19 pandemic: Ethical issues

The increase in cases of patients needing to be admitted to intensive care, due to Covid-19 infection, has led to a strong imbalance between available resources and healthcare requirements. Therefore, the determination of further criteria, in addition to those of clinical appropriateness and proportionality of care, to define the allocation of the limited resources available was necessary. For these reasons, in March 2020, the SIAARTI (Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care) published a document containing the "Clinical Ethics Recommendations for the Allocation of Intensive Care Treatments, in exceptional, resource-limited circumstances," to relieve clinicians from a part of the responsibility in the decision-making process, which can be emotionally burdensome, carried out in individual cases and to make the allocation criteria for healthcare resources explicit in a condition of their own extraordinary scarcity.

Monitoring Social Distancing With Single Image Depth Estimation

The recent pandemic emergency raised many challenges regarding the countermeasures aimed at containing the virus spread, and constraining the minimum distance between people resulted in one of the most effective strategies. Thus, the implementation of autonomous systems capable of monitoring the so-called social distance gained much interest. In this paper, we aim to address this task leveraging a single RGB frame without additional depth sensors. In contrast to existing single-image alternatives failing when ground localization is not available, we rely on single image depth estimation to perceive the 3D structure of the observed scene and estimate the distance between people. During the setup phase, a straightforward calibration procedure, leveraging a scale-aware SLAM algorithm available even on consumer smartphones, allows us to address the scale ambiguity affecting single image depth estimation. We validate our approach through indoor and outdoor images employing a calibrated LiDAR + RGB camera asset. Experimental results highlight that our proposal enables sufficiently reliable estimation of the inter-personal distance to monitor social distancing effectively. This fact confirms that despite its intrinsic ambiguity, if appropriately driven single image depth estimation can be a viable alternative to other depth perception techniques, more expensive and not always feasible in practical applications. Our evaluation also highlights that our framework can run reasonably fast and comparably to competitors, even on pure CPU systems. Moreover, its practical deployment on low-power systems is around the corner.

High incidence of COVID-19 at nursing homes in Madrid, Spain, despite preventive measures.

OBJECTIVE: To assess the impact of COVID-19 at nine nursing homes in Madrid, Spain, during the first wave of COVID-19 infection and lockdown period when preventive measures were taken to avoid transmission among residents. METHODS: Nine hundred forty-two residents and 846 staff members from nine nursing homes participated in the study (April 18 to June 20, 2020). All participants were tested for SARS-CoV-2 in the nasopharynx by PCR and for IgG antibodies detection. Microbiological status at sampling was defined as active infection (positive PCR ± presence of antibodies), past infection (negative PCR + presence of antibodies), or naïve participants (negative PCR + absence of antibodies). RESULTS: Laboratory results helped classify the residents as having active infection (n=224; 23.8%), past infection (n=462; 49.1%), or being naïve (n=256; 27.1%); staff members were actively infected (n=127; 15.1%), had had a past infection (n=290; 34.2%), or were naïve (n=429; 50.7%). Overall, the percentage of participants with COVID-19 was significantly higher in residents than in staff members (72.8% vs 49.2%; P=0.001). The clinical situation of residents vs staff at sampling was as follows: acute manifestations compatible with COVID-19 (7.3% vs 3.9%; P<0.01) and no manifestations of infection (92.7% vs 96.0%; P<0.01). A large proportion of both asymptomatic and symptomatic residents (69.4% vs 86.6%; P=0.015) had positive PCR results (mostly alongside positive IgG determinations). CONCLUSIONS: COVID-19 affects 75% of the residents in nursing homes in Madrid. The high impact in these settings, despite the strict restrictions adopted during the lockdown, demonstrates the ability of SARS-CoV-2 to cause outbreaks.

Safety of urologic elective surgery in a covid-hospital

Introduction: To demonstrate safety of a new internal protocol for patients and health workers adopted for elective urologic surgical activity during COVID-19 pandemic. Materials and methods: We have retrospectively evaluated 86 patients who underwent elective surgery in the urology department of IRCCS Policlinico San Donato, from March 9th to May 8th, 2020. Our institution became a first line hospital for COVID-19 patients since March 2020. We identified non-deferrable patients that needed to be treated within one month. All patients included have followed a dedicated pathway from the day-hospital till the discharge. Clinical data, as nasopharyngeal swabs, chest X-ray, type of anesthesia, type of surgical procedure and days of hospitalization were collected. Moreover, individual risk factors for COVID-19 pneumonia, as advanced age, ongoing malignancy, high blood pressure and coronary artery disease, were analyzed. All patients were interviewed after a minimum post discharge time of 14 days to find out if any of them had developed general and Covid-related complications. Results: The study population included 66 (76.75%) men and 20 (23.25%) women, aged between 17 and 90 years old. We have performed eighty-eight (88) preoperative screenings and two (2) patients were excluded, due to exclusion criteria. Overall, 63 (71.60%) patients underwent oncological procedures while only 23 (28.40%) patients underwent non-oncological surgery. The average number of hospitalization days was 2.39 ± 2.21. After at least 14 days after discharge (25.00 ± 10.35 days), we phone interviewed all patients to check their conditions. No patients included in the study showed symptoms related to COVID-19, except for 2 (2.32%) who manifested coryza, 28 and 35 days after discharge respectively. We also analyzed clinical characteristics of the study participants in relation to develop SARS CoV-2. None of patient developed Covid-19 postoperatively and in addition, none of hospital workers that were part of this pathway got the Covid-19 infection. Conclusions: The duration of pandemic period is undefined;therefore, our protocol could be considered a good model for every type of surgery and its application could ensure a continuous treatment for non-deferrable conditions, even during healthcare emergencies in a safe way for both the patients and health workers.

Dermatologists and SARS-CoV-2: the impact of the pandemic on daily practice.

Since the first case of 'pneumonia of unknown aetiology' was diagnosed at the Wuhan Jinyintan Hospital in China on 30 December 2019, what was recognized thereafter as 'severe acute respiratory syndrome coronavirus 2' (SARS-CoV-2) has spread over the four continents, causing the respiratory manifestations of coronavirus disease-19 (COVID-19) and satisfying the epidemiological criteria for a label of 'pandemic'. The ongoing SARS-CoV-2 pandemic is having a huge impact on dermatological practice including the marked reduction of face-to-face consultations in favour of teledermatology, the uncertainties concerning the outcome of COVID-19 infection in patients with common inflammatory disorders such as psoriasis or atopic dermatitis receiving immunosuppressive/immunomodulating systemic therapies; the direct involvement of dermatologists in COVID-19 care for patient assistance and new research needs to be addressed. It is not known yet if skin lesions and derangement of the skin barrier could make it easier for SARS-CoV-2 to transmit via indirect contact; it remains to be defined if specific mucosal or skin lesions are associated with SARS-CoV-2 infection, although some unpublished observations indicate the occurrence of a transient varicelliform exanthema during the early phase of the infection. SARS-CoV-2 is a new pathogen for humans that is highly contagious, can spread quickly, and is capable of causing enormous health, economic and societal impacts in any setting. The consequences may continue long after the pandemic resolves, and new management modalities for dermatology may originate from the COVID-19 disaster. Learning from experience may help to cope with future major societal changes.