A Study of Trauma Patients in the Emergency Department of a Tertiary Care Hospital in Nepal during Lockdown in COVID-19 Pandemic

Background The nationwide lockdown was imposed upon by the Government of Nepal with regards to the COVID-19 pandemic. Even during times of limited mobility and travel, trauma cases were presenting to the hospital. Objective To asses trauma patterns among patients presented to the Emergency department in Dhulikhel hospital during the lockdown period. The assessment of the burden of trauma during the pandemic could aid in planning allocation of resources and improving trauma care. Method A retrospective cross-sectional study design was used to assess all patients with a history of trauma during the period of lockdown announced by the Government of Nepal for COVID-19 from March 24 to June 14, 2020. Result Among 2097 patients that visited the emergency department, 23% were trauma cases. In comparison to the corresponding time-period in 2019, trauma cases reduced by more than half (54.5%). The majority of patients utilized ambulances as a means of transportation;a few patients utilized Dhulikhel emergency medical services. The most common mechanism of injury was fall injury, followed by motor vehicle accident and physical assault. Traumatic brain injury occurred in 30% of patients. Of all patients, 71% were discharged after initial treatment, 26% were admitted to different wards and 3% were referred to other health centres. Conclusion Fall injury is a crucial public health concern followed by motor vehicle accident among trauma patients even during the pandemic condition. Thus, emergency rooms should aid in planning for preparedness, mitigation of trauma during situations like these, in planning the allocation of resources and improving trauma care. Copyright © 2022, Kathmandu University. All rights reserved.

Isolation and Intensive Care (ICU) Service, Surge Capacity and Pandemic Training in Government Designated COVID-19 Clinics and Hospitals of Nepal

Background The coronavirus pandemic preparedness and response activities began in Nepal after the detection of the first case on 24 January 2020. Highest daily case record in June 2020 was 671, but it reached above 5,000 in October 2020. Objective This study assessed preparedness and response status of government designated COVID-19 clinics and various level hospitals. Method A web-based survey was conducted among government designated COVID-19 clinics and Level hospitals in June 2020. The Medical Operations Division of the COVID-19 Crisis Management Center (CCMC) retained contact list of focal person in each facility for regular updates. Forty-nine out of 125 clinics and all level hospitals (five Level-1, 12 Level-2, three Level-3) provided responses. Result There were 25 or less isolation beds in the majority of COVID-19 clinics (83.7%) and Level-1 hospitals (60%), whereas the majority of Level-2 (92%) and Level-3 hospitals (67%) had arranged >25 beds. Only five clinics, one Level-1 hospital, six Level-2 and two Level-3 hospitals had a surge capacity of additional 20 or more isolation beds. Only one-fourth of the designated health facilities had arranged separate isolation facility for vulnerable population. Majority of the designated clinics and Level-1 hospitals had five or less functional ICU beds and functional ventilators. Very few Level-2 hospitals had > 10 ICU beds and > 10 ventilators. Healthcare workers in the majority of facilities were trained on donning/doffing, hand washing, swab collection, and healthcare waste management, but, a very few received formal training on patient transport, dead body management, epidemic drill, and critical care. Conclusion This study revealed insufficient preparation in COVID-19 facilities during the initial phase of pandemic. The findings were utilized by the government stakeholders at central, provincial and local levels for scaling up surge capacity and improving health services at the time of case surge. As the pandemic itself is a dynamic process, periodic assessments are needed to gauze preparedness and response during different phases of disease outbreak. Copyright © 2022, Kathmandu University. All rights reserved.

Perceptions, experiences, expectations, and challenges of Indian public health programs

The COVID-19 pandemic has served as a wake-up call for India’s public health system. Public health if aided by strong political will, academic reforms, and awareness among youth (as a career choice)–will get a boost. Skilled public health professionals would be expected to play a key role in strengthening public health systems. Thus, to bring deep structural health reforms, it is imperative to analyse the perceptions of key public health stakeholders. In this study, we explored stakeholders’ perspectives about public health, and their views regarding the current state of public health education. Thirty-nine semi-structured in-depth interviews were conducted during 2017–2018 across India among stakeholders that included students of public health programs, public health professionals (PHPs), faculty of public health institutions, employers of public health graduates, and policymakers. Thematic analysis of the data was undertaken focusing on 10 themes emanating around the focus areas of the study. Public health stakeholders suggested that for building a competent public health workforce there is a need to match supply and demand of PHPs, create job opportunities, institutionalising a large body of guidance such as a separate Ministry or Council of public health (for educational institutions, quality assurance of curriculum etc.). Within India, the public health profession & education remains under-researched. This study is the first from a lower middle income country (LMIC) & from Asia to offer insight about public health programs–from policy, education, and professional perspective.

Learnings from COVID-19 Forced Lockdown on Regional Air Quality and Mitigation Potential for South Asia

South Asia is a hotspot of air pollution with limited resilience and hence, understanding the mitigation potential of different sources is critically important. In this context the country lockdown initiated to combat the COVID-19 pandemic (during March and April 2020 that is the pre-monsoon season) provides an unique opportunity for studying the relative impacts of different emission sources in the region. Here, we analyze changes in levels of air quality species across the region during selected lockdown periods using satellite and in-situ datasets. This analysis compares air quality levels during the lockdown against pre-lockdown conditions as well as against regional long-term mean. Satellite derived AOD, NO2, and CO data indicates an increase of 9.5%, 2%, and 2.6%, respectively, during the 2020 lockdown period compared to pre-lockdown over the South Asia domain. However, individual country statistics, urban site data, and industrial grid analysis within the region indicate a more varied picture. Cities with high traffic loads reported a reduction of 12–39% in columnar NO2 during lockdown, in-situ PM2.5 measurements indicate a 23–56% percent reduction over the country capitals and columnar SO2 has an approximate reduction of 50% over industrial areas. In contrast, pollutant emissions from natural sources e.g., from biomass burning were observed to be adversely affecting the air quality in this period potentially masking expected lockdown related air quality improvements. This study demonstrates the need for a more nuanced and situation specific understanding of sources of air pollutants (anthropogenic and natural) and for these sources to be better understood from the local to the regional scale. Without this deeper understanding, mitigation strategies cannot be effectively targeted, wasting limited resources as well as risking unintended consequences both for the atmosphere and how mitigation action is perceived by the wider public. © The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are cited.

Cancer clinical trial access during the COVID-19 pandemic

Introduction: Cancer clinical trial conduction during the COVID-19 pandemic required a rapid move to virtual engagement to support participant and research team safety. We were faced with the challenge of translating our approach from in-person to virtual engagement for recruitment, enrollment, and delivery of the study intervention. We present our strategies to conduct cancer clinical trials focused on cancer risk reduction during the COVID-19 pandemic. Subject Recruitment: Our multimodal approach utilized online platforms and established approaches like posters, flyers, and collaborating with community health workers to recruit participants. Our virtual engagement strategies include direct outreach to potential participants via email, the electronic medical record (EMR), and social media. Contact via email and the EMR was guided by study-defined eligibility criteria. Social media outreach was through institutional Twitter, Facebook, and video channel accounts. Twitter posts and chats were employed. Enrollment: e-consenting and remote consenting processes were instituted via REDCAP. Delivery of the Educational Risk Reduction Intervention: We also conducted the intervention using the Zoom platform and through a recorded video of the educational risk reduction intervention, which is shared with the participant via REDCAP. Challenges: As documented by others, the greatest challenge to virtual engagement is lack of internet access and lack of digital literacy. These factors have a greater impact on underserved populations, including the elderly, those with low socioeconomic status, those located farther from the cancer center, and racially/ethnically diverse populations. Conclusion: By translating study outreach and processes to virtual engagement, we were able to facilitate clinical trial access across diverse community subgroups and support subject participation in clinical trials during the COVID-19 pandemic.

Pattern of dental problems among patients visiting a dental hospital during covid-19 pandemic

Background Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Nepal is a part of this worldwide corona virus disease. In this critical situation, the patients have a sense of insecurity visiting dental hospital. Objective To assess the pattern of dental problems in patients visiting a dental college during COVID-19. Method A descriptive cross-sectional study was conducted in Dental Hospital of Kathmandu Medical College and Teaching Hospital from May to August 2020. The patients visiting the Dental hospital were assessed for dental problems. Data were analyzed in Statistical Package of Social Sciences version 20. Frequency and percentage for pattern of dental problems were calculated. Result Most of the patients of age group of 14 to 31 years 530 (36.53%) had dental problems during the survey period. Out of total patients having dental emergency, 739 (50.93%) were males and 712 (49.07%) were females. Majority 545 (37.56%) visited the dental hospital for endodontic consultation followed by emergency consultation for oral surgical procedures 298 (20.54%). Least consulted dental emergency condition was prosthodontic consultation 18 (1.24%). Conclusion The study findings showed that the major dental problems in patients causing emergency visit to dental hospital during COVID-19 pandemic period were dental pain and swelling requiring endodontic consultation and the least need felt is prosthodontic consultation. © 2020, Kathmandu University. All rights reserved.

Knowledge, attitude, and practices related to COVID-19 among healthcare personnel in a tertiary care hospital in Nepal: A cross-sectional survey

Background COVID-19 is significantly affecting the healthcare system globally. As a result, healthcare workers need to be updated on the best practices for the proper management of the disease. Objective The purpose of this study was to assess the knowledge, attitude, and practices (KAP) related to COVID-19 among healthcare personnel. Method This was a cross-sectional study conducted among medical personnel at Dhulikhel Hospital Kathmandu University Hospital using a semi-structured questionnaire on KAP related to COVID-19 from May 8th to June 8th, 2020. We analyzed survey data by using descriptive statistics. Spearman rank correlation, chi-square test and binary logistic analysis were used to examine the association between sociodemographic characteristics with KAP related to COVID-19. Result Among 220 participants, the majority were nurses (60%) followed by doctors (27.7%), paramedics (10%) and technicians (2.3%). The results showed that 68.6% of healthcare personnel had a good knowledge with appropriate practices (98.5%) and negative attitude (59.3%). In the multivariate binary logistic analysis, the healthcare workers with the clinical experience level of one to five years (OR:.42, 95% CI:.19-.96) and more than 5 years (OR:.16, 95% CI:.04-.63) were significantly associated with negative attitude. The confidence score for managing COVID-19 (OR:1.16, 95% CI:1.02-1.34) was significantly associated with an optimistic attitude. Conclusion Healthcare workers are knowledgeable about COVID-19 and proactively practising to minimize the spread of infection but lack optimistic attitudes. Hence, the constantly updated educational programmes related to COVID-19 for targeted groups will contribute to improving healthcare workers’ attitude and practices.

Spatial variability in the risk of death from COVID-19 in Italy.

OBJECTIVES: Italy has been badly affected by the COVID-19 pandemic and has one of the highest death tolls. We analyzed the severity of COVID-19 across all 20 Italian regions.METHOD: We manually retrieved the daily cumulative numbers of laboratory-confirmed cases and deaths attributed to COVID-19 in each region, and estimated the crude case fatality ratio and time delay-adjusted case fatality ratio (aCFR). We then assessed the association between aCFR and sociodemographic, health care and transmission factors using multivariate regression analysis.RESULTS: The overall aCFR in Italy was estimated at 17.4%. Lombardia exhibited the highest aCFR (24.7%), followed by Marche (19.3%), Emilia Romagna (17.7%) and Liguria (17.6%). Our aCFR estimate was greater than 10% for 12 regions. Our aCFR estimates were statistically associated with population density and cumulative morbidity rate in a multivariate analysis.CONCLUSION: Our aCFR estimates for Italy as a whole and for seven out of the 20 regions exceeded those reported for the most badly affected region in China. These findings highlight the importance of social distancing to suppress transmission to avoid overwhelming the health care system and reduce the risk of death.