Fit-testing of respiratory protective equipment in the UK during the initial response to the COVID-19 pandemic.

BACKGROUND: Public Health England guidance stipulates the use of filtering facepiece (FFP3) masks for healthcare workers engaged in aerosol-generating procedures. Mask fit-testing of respiratory protective equipment is essential to protect healthcare workers from aerosolized particles. AIM: To analyse the outcome of mask fit-testing across National Health Service (NHS) hospitals in the UK during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Using the Freedom of Information Act, 137 NHS hospitals were approached on May 26th, 2020 by an independent researcher to provide data on the outcome of fit-testing at each site. FINDINGS: Ninety-six hospitals responded to the request between May 26th, 2020 to October 29th, 2020. There was a total of 86 mask types used across 56 hospitals, 13 of which were used in at least 10% of these hospitals; the most frequently used was the FFP3M1863, used by 92.86% of hospitals. Overall fit-testing pass rates were provided by 32 hospitals with mean pass rate of 80.74%. The most successful masks, in terms of fit-test failure rates, were the Alpha Solway 3030V and the Alpha Solway S-3V (both reporting mean fit-test failures of 2%). Male- and female-specific pass and failure rates were provided by seven hospitals. Across the seven hospitals, 20.1% of men tested failed the fit-test for all masks used, whereas 19.9% of women tested failed the fit-test for all masks used. Failure rates were significantly higher in staff from Black, Asian, and Minority Ethnic (BAME) backgrounds 644/2507 (25.69%) across four hospitals. CONCLUSION: Twenty percent of healthcare workers tested during the first response to the pandemic failed fit-testing for masks. A small sample revealed that this was most prominent in staff from BAME backgrounds.

Systematic review: The effect of infection severe acuterespiratory syndrome coronavirus (SARS)-CoV-2 in pediatric patient

Background:The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus-2(SARS-CoV-2), originated in Wuhan, China in December 2019 and has spread globally.Signand other symptoms include fever, cough, fatigue, myalgia, dyspnea, and diarrhea. Although, few patients had conjunctivitis as the initial symptom.The first confirmed pediatric case of Severe AcuteRespiratory Syndrome (SARS)-CoV-2 infection wasreported in Shenzhen on January 20, and by January31, more than 20 pediatric cases were reported in China.Objective:To identify the effect of infection Severe AcuteRespiratory Syndrome Coronavirus (SARS)-CoV-2 in pediatric patient. Methods:The data was collected by searching the literature on article search sites, namely Google and Pubmed. The data search was carried out systematically using keywords coronavirus, coronavirus infection.Result:There are 214 articles found. After eliminating duplicated articles, the titles and abstracts of each article were analyzed across 87 articles excluding 127 articles. The full-text articles in the remaining 7 articles were analyzed again and 80 articles were excluded. Conclusion:Recent literature shows that the infection SARS-CoV-2 there are symptoms, suggesting the involvement of the gastrointestinal tract, heart, cardiovascular system, kidneys, and other organs. © 2021, Universitatea de Vest Vasile Goldis din Arad. All rights reserved.

Azithromycin may play a role in the Management of hospitalised patients with Suspected or PCR-proven covid-19

Background Coronavirus infection (COVID-19) typically presents with mild symptoms;however, 15% of patients develop significant illness with up to 5% overall mortality. Hence, there is an urgent and unmet need for identifying definitive pharmacological interventions. Repurposing of Azithromycin presents encouraging early findings given its antiinflammatory properties and proven antiviral efficacy during the Ebola and Zika virus outbreaks. To date, studies are limited to using Azithromycin and Hydroxychloroquine in conjunction. Here, we present our findings on the isolated use of Azithromycin in the management of COVID-19. Methods We performed retrospective analysis of patients admitted between 1st March and 20th June 2020 to one of the most pressurised Greater London District General Hospitals during the early stages of the pandemic. Pearson's Chisquared test was utilised to compare mortality outcomes between two patient groups;those receiving Azithromycin (500 mg once daily, prescribed for five days) and those of a non-Azithromycin control group, comprising those with contraindication or allergy. Independent T-test analysed length of stay. Results Overall, 628 patients were analysed (mean age 71.6;41.9% female);448 (71.3%) were COVID-19 PCR swab positive, and an additional 70 (11.1%) had negative PCR but positive radiology. 394 (62.7%) received Azithromycin, whilst 234 (37.3%) constituted the non-Azithromycin control group. We observed notably improved mortality rates in Azithromycin patients (41.1%;162/394) compared to control patients (50.4%;118/234;p=0.14). Interestingly, length of stay was similar between Azithromycin administration (11.92±10.85) and control groups (10.82±12.30). Conclusion To our knowledge, this is the first large-scale analysis of Azithromycin as a stand-alone pharmacological treatment of COVID-19. The combination of Hydroxychloroquine and Azithromcyin has been widely discussed, however mortality data is adversely skewed by significant antagonistic cardiac side-effects which hinders interpretation of their individual therapeutic efficacy. Our preliminary results suggest, whilst just shy of statistical significance, a short course of Azithromycin in COVID-19 patients may reduce mortality, without negatively impacting length of stay. This highlights the need for prospective validation of this data with randomised control trials;preceding this, we advocate the use of Azithromycin in clinically selected patient populations until other licensed therapies become available.

The role of anticoagulation therapy in management of covid-19 patients

Introduction Hypoxemia, acute respiratory distress syndrome and coagulopathy are common issues experiences by pts with severe COVID-19 disease.1 The aim of this study was to evaluate the efficacy of anticoagulation therapy in COVID-19 patients. Methods This is a retrospective observational study for patients admitted to a busy district hospital during the peak period of the COVID-19 pandemic. All patients aged >18 with suspected or confirmed RT-PCR COVID-19 and raised D-Dimer were included in this study. Data including demographics, comorbidities, and effects of anticoagulation on mortality were examined. Results A total of 628 pts with more males (n = 365;58.1%), and 48.7% >75 years were included in the study. 27.9% were obese (BMI-30);and 25% were overweight (BMI 25-29.9). 448/628 (71.3%) had a positive swab for coronavirus and a further 70 patients (11.1%) had probable infection based on clinic-radiological suspicion. Nearly half (n = 311;49.5%) of the patients had hypertension and a quarter (n = 166;26.4%) had diabetes. A total of 226 (36%) pts died of which 85.8% (n = 194) had a positive swab compared to 12.8% (n = 29) with negative swab. This was statistically significant with a p-value of 0.001. Patients with a raised D-dimer 150/628 (23.8%) received therapeutic dose anticoagulation and 408/628 (64.9%) received prophylaxis or no anticoagulation. 53 patients (22.5%) of those who received treatment dose died compared to 183 (77.5%) who received prophylactic dose or no anticoagulation due to comorbidities. This was statistically significant (p value 0.02). Conclusion Therapeutic anticoagulation significantly reduces mortality in COVID-19 patients with a high D-dimer.

S99 The role of anticoagulation therapy in management of COVID-19 patients

S99 Table 1Association of swab PCR with Anticoagulants, D-Dimer in MortalityVariablesMortality with SWABp-valuePositive (n=236)Negative (n=41) n%n% AnticoagulantYes20687.33892.70.32No3012.737.3Treatment Dose AnticoagulantYes5322.51639.00.02*No18377.52561.0ConclusionTherapeutic anticoagulation significantly reduces mortality in COVID-19 patients with a high D-dimer.ReferenceKlok F, Kruip M, van der Meer N, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020 Apr 10. [Epub ahead of print]

Towards Emergency Systems Engineering: A Background

The emergency department (ED) setting within the healthcare system is quite complex, and it is necessity to perform mathematical modelling to examine the challenge of long waiting times and the ways in which it can influence EDs and patients experiencing and predict conditions that need to be urgently addressed. In addition, the ways in which certain mathematical models could help in assessing solutions to issues like waiting time and ensure that suitable care is offered to patients at all times based on decision matrix and related big data source is therefore analyzed. Various studies have been carried out in the last decade that examine the challenges faced by EDs to offer research evidence that can help in enhancing the ways in which health providers offer care to their patients and in today worlds with crisis and hazard mode like COVID-19, healthcare systems are barely able to tackle this pandemic. © 2021, The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG.