Perception of healthcare workers towards ethical aspects of responsiveness of COVID 19 outbreak: A cross-sectional study.

Introduction: COVID-19 has spread all over the world and most of the countries are still grappled with the Pandemic. Health-care-workers (HCWs) being the frontlines during such pandemics have different beliefs and faiths with regards to ethical aspects of preparations. Methodology: In order to study the perception of HCW about ethical aspects of COVID-19, a cross-sectional study was done in a tertiary-care-teaching hospital. A pretested questionnaire was circulated among the participants on a digital platform. Results: The HCWs were divided over many statements, like if COVID-19 was more hype than reality (45.77% disagreed and 43.25% agreed). 57.44% of participants either agreed or strongly agreed that the treatment of non-COVID-19 cases suffered due to arrangements made for COVID-19 cases. When the responses received against individual statements were compared with various other socio-demographic variables as a denominator, various interesting results were revealed. There was a significant difference of opinion among the participating HCWs (P < 0.05). Conclusion: Differences of the opinions had their relationships to demographic characteristics of the subjects as well as related to perceived knowledge of COVID-19.

COVID-19 vaccine-induced immune thrombotic thrombocytopenia: A review.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly transmissible and pathogenic coronavirus responsible for the pandemic coronavirus disease 19 (COVID-19). It has significant impact on human health and public safety along with negative social and economic consequences. Vaccination against SARS-CoV-2 is likely the most effective approach to sustainably control the global COVID-19 pandemic. Vaccination is highly effective in reducing the risk of severe COVID-19 disease. Mass-scale vaccination will help us in attaining herd immunity and will lessen the negative impact of the disease on public health, social and economic conditions. The present pandemic stimulated the development of several effective vaccines based on different platforms. Although the vaccine is safe and efficacious, rare cases of thrombosis and thrombocytopenia following the use of vaccination with the ChAdOx1 CoV-19 vaccine (AstraZeneca, University of Oxford, and Serum Institute of India) or the Ad26.COV2.S vaccine (Janssen/Johnson & Johnson) have been reported globally. This review focussed on the definition, epidemiology, pathogenesis, clinical features, diagnosis, and management of vaccine associated thrombosis.

COVID-19 and coagulopathy.

The SARS-CoV-2 is a new coronavirus responsible for the COVID-19 disease and has caused the pandemic worldwide. A large number of cases have overwhelmed the healthcare system worldwide. The COVID-19 infection has been associated with a heightened risk of thromboembolic complications. Various mechanisms are leading to the high thrombotic risk in COVID-19 patients such as inflammation, endotheliitis, hyperviscosity, and hypercoagulability. We searched PubMed, EMBASE, and CINAHL from January 2020 to December 2020. We used the following search terms: COVID-19, coagulopathy, and thrombosis. We reviewed the epidemiology, clinical features, mechanisms, and treatment of COVID-19-associated coagulopathy.

Assessment of knowledge of COVID-19 among health care workers-a questionnaire-based cross-sectional study in a tertiary care hospital of India.

BACKGROUND: Health Care Workers (HCW) are among the primary stakeholders and front liners in the fight against COVID-19. They are in direct contact with the patients as primary caregivers and, therefore, are at a higher risk of infection. This Pandemic offers a unique opportunity to explore the level of knowledge among ground-level HCWs during this global health crisis. OBJECTIVE: We conducted this study to assess the knowledge and awareness among HCW regarding the COVID-19 Pandemic in a tertiary care hospital. METHODS: It was a cross-sectional study done on HCW comprising faculty, senior residents, junior residents, demonstrators, and nursing staff of various specialties directly involved in the care of suspected/confirmed COVID-19 patients. A pretested questionnaire consisting of 20 questions was used as a study tool and was circulated through the digital platform. RESULTS: There were a total of 437 respondents. In the subgroup analysis, the respondents in the age group of 55-64 years had a higher mean knowledge score, followed by the respondents in the age group of 18-24 years. For years of experience, the mean knowledge score varied from 13.89 (10-20 years of experience) to 13.83 (5-10 years of experience). The mean knowledge score was the highest for consultants (14.10), followed by Resident Doctors (13.96). CONCLUSIONS: This study has shed some critical clues for further research and interventions. Firstly, as health care workers are probably learning about COVID-19 from their practical exposure rather than formal teaching, it is pertinent to address this issue through well-planned formal sessions of training workshops and lectures.

Tofacitinib Associated with Reduced Intubation Rates in the Management of Severe COVID-19 Pneumonia: A Preliminary Experience.

BACKGROUND: The second wave of COVID-19 pandemic was not only associated with a rapid and severe surge in the number of cases but also limited availability of recommended medicines. Baricitinib has been known to reduce recovery time in COVID-19 pneumonia in association with remdesivir. Tofacitinib, with limited evidence, was used in severe COVID-19 pneumonia based on its similarity of action with baricitinib. METHODS: Data of all patients admitted to the COVID-19 intensive care unit in the month of April were accessed and analyzed. Data of patients who were on other immunomodulators, invasive ventilation, or suffering from end-stage organ diseases were excluded from the analysis. RESULTS: Out of 73 patients, data of 50 were analyzed. Twenty-five received tofacitinib and the other 25 were managed with standard of care. Age, comorbidities, and gender distribution between the two groups were similar. On day 7 of admission, the change in SpO2/FiO2 ratio was 1.26 ± 1 and 0.72 ± 1 in the tofacitinib group and control group, respectively. Similarly, a higher number of subjects in the control group showed worsening in the World Health Organization (WHO) ordinal scale (36 vs 12%, p = 0.01). The clinical objective improvement was similar in the two groups. The intubation rates in the tofacitinib group were significantly lower than that in the control group (32% vs 8%, p = 0.034). CONCLUSION: Tofacitinib, in this retrospective single-center experience, was found to be associated with reduced intubation rates and reduced worsening in the WHO ordinal scale. There was no difference in mortality in the two groups. HOW TO CITE THIS ARTICLE: Singh PK, Lalwani LK, Govindagoudar MB, Aggarwal R, Chaudhry D, Kumar P, et al. Tofacitinib Associated with Reduced Intubation Rates in the Management of Severe COVID-19 Pneumonia: A Preliminary Experience. Indian J Crit Care Med 2021;25(10):1108-1112.

Assessment of pandemic (COVID-19) preparedness in a teaching hospital in northern India using available (CDC-Atlanta) checklist.

BACKGROUND: Hospitals are at the forefront of dealing infectious public health emergencies. Recently, COVID-19 has been declared as pandemic by the World Health Organization. Dealing with COVID-19 pandemic requires high intensity of administrative activity. OBJECTIVE: We conducted this study to assess and compare, objectively, hospital preparedness with available Centre of Disease Control and Prevention (CDC) standards. METHODS: CDC has issued checklist for the assessment of hospital preparedness for COVID-19 pandemic, globally. This list contains 10 elements with sub-sections. We objectified the same and scored the hospital preparations accordingly. Various financial efforts made by the hospital to procure COVID19-specified items was also recorded. RESULTS: As per the CDC checklist, the hospital scored 197 points (72.06%) out of 270 points with highest points in element two and eight. Element two is for the development for written COVID-19 plan. Element eight consists of addressing the occupational health of healthcare workers. Lowest scoring was in the element seven represented visitor access and movement within facility. During the study period, the hospital procured items of approximately 55 lakhs. In the study period, doctors, nursing staff, housekeeping staff, and security staff were channelized for doing COVID-19 duties. CONCLUSIONS: We obtained a score above 70% (good) which is quite encouraging, and we concluded that pandemic preparations in hospitals are necessary and it can be assessed objectively against prevailing standards. It is important in poor countries like India where spending on healthcare is minimal compared to other countries. Additionally, this assessment can be used to guide us further changes in policies and identifying the gaps in pandemic preparedness in hospitals which require special attention.

COVID-19: Winter is COMING!

Coronavirus disease-2019 (COVID-19) pandemic has battered the healthcare system of India recently. Though the mortality rate is low but the mortality itself is high. In this issue, dedicated to COVID-19, the authors have presented a concise and directed look at the pieces of evidence for COVID-19. Today, there is a plethora of information available on COVID-19 but the same does not translate into true knowledge. This issue serves as the one-point reference for pieces of evidence on various critical aspects of COVID-19. As winters are approaching and air pollution will again be bothering the healthcare system, these times are vital for preparing ourselves and resources for a long and exhaustive battle. How to cite this article: Chaudhry D, Kumar P, Singh PK, Govindagoudar MB. COVID-19: Winter is COMING! Indian J Crit Care Med 2020;24(Suppl 5):S223-S224.