Worldwide trends in COVID-19 related attacks against healthcare (preprint)

Background: During the COVID-19 pandemic, violence targeting healthcare reportedly increased. Attacks against healthcare have the potential to impair the public health response and threaten the availability of healthcare services. However, there is little systematic understanding of the extent and characteristics of healthcare attacks in the setting of a pandemic. This study aimed to investigate global trends regarding COVID-19 related attacks against healthcare from January 2020 until January 2023. Methodology: COVID-19 related incidents that occurred between January 2020 and January 2023 were extracted from the Safeguarding Health in Conflict Coalition database and screened for eligibility. Data collected per incident included temporal factors; country; setting; attack and weapon type; perpetrator; motive; number of healthcare workers (HCWs) and patients killed, injured or kidnapped; and whether the incident caused damage to a health facility. Results: This study identified 255 COVID-19 related attacks against healthcare. The attacks occurred globally and throughout the course of the pandemic. Incidents were heterogeneous with regards to motives, attack types and outcomes. At least 18 HCWs were killed, 147 HCWs were injured and 86 facilities were damaged or destroyed. There were two periods with a peak incidence of reports. The first peak occurred during the beginning of the pandemic, and predominantly concerned stigma-related attacks against healthcare. The second peak, in 2021, was mainly composed of conflict-related attacks in Myanmar, and attacks targeting the global vaccination campaign. Conclusion: COVID-19 related attacks against healthcare occurred globally and in a variety of settings throughout the course of the pandemic. The findings of this study can be used to prevent and mitigate healthcare attacks during the ongoing and future pandemics.

Individualized mechanical ventilation in a shared ventilator setting: limits, safety and technical details. (preprint)

Background- The COVID-19 pandemic has resulted in an increased need for ventilators. The potential to ventilate more than one patient with a single ventilator, a so-called split ventilator setup, provides an emergency solution. Our hypothesis is that ventilation can be individualized by adding a flow restrictor to limit tidal volumes, add PEEP, titrate FiO 2 and monitor ventilation. This way we could ensure optimization of patient safety and clinical applicability. We performed bench testing to test our hypothesis and identify limitations. Methods- We performed a bench testing in two lungs: 1) determine lung compliance 2) determine volume, plateau pressure and PEEP, 3) illustrate individualization of airway pressures and tidal volume with a flow restrictor, 4a) illustrate that PEEP can be applied and individualized 4b) create and measure intrinsic PEEP 4c-d) determine PEEP as a function of flow restriction, 5) individualization of FiO 2 . Results- The lung compliance varied between 13 and 27 mL/cmH 2 O. Set ventilator settings could be applied and measured. Extrinsic PEEP can be applied except for settings with a large expiratory time. Volume and pressure regulation is possible between 70-39% flow restrictor valve closure. Flow restriction in the tested circuit had no effect on the other circuit or on intrinsic PEEP. FiO 2 could be modulated individually between 0.21 and 0.8 by gradually adjusting the additional flow, and minimal affecting FiO 2 in the other circuit. Conclusions- Tidal volumes, PEEP and FiO2 can be individualized and monitored in a bench testing of a split ventilator. In vivo research is needed to further explore the clinical limitations and outcomes, making implementation possible as a last resort ventilation strategy.