Management Measures Implemented at the West China Hospital may help Prevent and Contain COVID-19 and Similar Outbreaks.

This article presents management processes for dealing with the novel coronavirus disease 2019 (COVID-19) outbreak at the West China Hospital of Sichuan University. From January to March 2020, the West China Hospital of Sichuan University established response structures and protocols, as well as integrated out-of-hospital resources, to deal with the COVID-19 outbreak. A total of 8066 patients were screened, and 345 COVID-19 patients were isolated for treatment. Hospital command systems, emergency management protocols, as well as process, space, and personnel management, strengthening material reserves, and social responsibility strategies were implemented. Outbreak management aspects that required improvement included estimates of the anticipated number of cases, timely collection of patient information and feedback on the effect of outreach and online consultation methods.

Prevalence and risk factors of disability and anxiety in a retrospective cohort of 432 survivors of Coronavirus Disease-2019 (Covid-19) from China.

OBJECTIVE: To estimate the prevalence of disability and anxiety in Covid-19 survivors at discharge from hospital and analyze relative risk by exposures. DESIGN: Multi-center retrospective cohort study. SETTING: Twenty-eight hospitals located in eight provinces of China. METHODS: A total of 432 survivors with laboratory-confirmed SARS CoV-2 infection participated in this study. At discharge, we assessed instrumental activities of daily living (IADL) with Lawton's IADL scale, dependence in activities of daily living (ADL) with the Barthel Index, and anxiety with Zung's self-reported anxiety scale. Exposures included comorbidity, smoking, setting (Hubei vs. others), disease severity, symptoms, and length of hospital stay. Other risk factors considered were age, gender, and ethnicity (Han vs. Tibetan). RESULTS: Prevalence of at least one IADL problem was 36.81% (95% CI: 32.39-41.46). ADL dependence was present in 16.44% (95% CI: 13.23-20.23) and 28.70% (95% CI: 24.63-33.15) were screened positive for clinical anxiety. Adjusted risk ratio (RR) of IADL limitations (RR 2.48, 95% CI: 1.80-3.40), ADL dependence (RR 2.07, 95% CI 1.15-3.76), and probable clinical anxiety (RR 2.53, 95% CI 1.69-3.79) were consistently elevated in survivors with severe Covid-19. Age was an additional independent risk factor for IADL limitations and ADL dependence; and setting (Hubei) for IADL limitations and anxiety. Tibetan ethnicity was a protective factor for anxiety but a risk factor for IADL limitations. CONCLUSION: A significant proportion of Covid-19 survivors had disability and anxiety at discharge from hospital. Health systems need to be prepared for an additional burden resulting from rehabilitation needs of Covid-19 survivors.

Reconfigure rehabilitation services during the Covid-19 pandemic: best practices from Southwest China.

PURPOSE: The healthcare system and service capacity are overwhelmed by the Covid-19 pandemic. There is a substantial unmet need for rehabilitation service to all patients affected by Covid-19 directly or indirectly. This article aims to describe how to rapidly reconfigure and bring rehabilitation services back during the pandemic. METHOD: The Steer committee meeting was held for the development of a strategic preparedness plan and safety management based on principles and evidence of rehabilitation, which will lead to effective mitigation of consequences resulted from Covid-19. RESULTS: Five measures were taken in Southwest China during the pandemic, which includes the "First contact responsibility" and management system; the full-coverage system for nosocomial infection control; the "Closed-off management" system; the full-coverage system for body temperature monitoring; the adoption of 5G-based telerehabilitation. With the implementation of these measures, the capacity and capability were enhanced to safely reopen and operate rehabilitation facilities in Southwest China. CONCLUSION: Further measurement of quality of care and outcomes during and beyond the pandemic is needed in transforming the healthcare system and improving rehabilitation services. Hopefully, the positive message conveyed by this paper could encourage and support communities and the society of physical medicine and rehabilitation worldwide during this challenging time. IMPLICATIONS FOR REHABILITATION Rehabilitation services are essential and there is an unmet need posed by the Covid-19 pandemic. A feasible strategic plan and safety management measures are critical to reconfigure the capacity and capability of rehabilitation services suspended by Covid-19. The adoption of tele-rehabilitation technology has the potential to reshape public health emergency responses and the delivery of care. Measurement of quality and outcomes is of great importance to inform transformation and adaptation of rehabilitation services during and after the Covid-19 pandemic.

The residents' mental health status and community's role during the COVID-19 pandemic: a community-based cross-sectional study in China.

BACKGROUND: The related research of coronavirus disease 2019 (COVID-19) pandemic on the mental health of community residents is still lacking. Here we reported the mental health status of Chinese residents as well as the community's prevention and control during the pandemic period of COVID-19 and further explored the influencing factors of mental status. METHODS: In this cross-sectional study, convenience sampling and snowball sampling methods were adopted from February 16 to February 23, 2020, and Chinese community residents were included according to the inclusion and exclusion criteria. Three questionnaires, including General Anxiety Disorder 7 (GAD-7), Patient Health Questionnaire 9 (PHQ-9), and a self-designed "Community prevention and control questionnaire", were used. A multivariate linear regression analysis was conducted to analyze the impact factors of anxiety and depression. RESULTS: A total of 3,001 community residents were included in this study. In total, 85.6% and 83.7% of participants had minimal anxiety and depression, respectively. Among all the community residents, 16.6% of participants proved that the communities they lived in had confirmed cases. 95.3% of participants reported that the residents were screened for mobility and contact history. 97.8% of participants reported the entrance and exit of the community were managed in their communities. There were 97.5% and 99% of participants needed to take body temperature and wear masks in their communities. Ninety-two percent (92%) of communities have their public areas and facilities disinfected daily, and 95.4% of communities have conducted health education about COVID-19. Factors including gender, education level, chronic illness, the frequency of going out, achieving information about COVID-19 by community and newspaper, and confirmed cases in the community, show association with community residents' anxiety and depression. CONCLUSIONS: The vast majority of Chinese residents have little anxiety and depression, and most communities have adopted standardized control measures following the government's regulations and policy, which plays a vital role in the control of COVID-19 and improving residents' anxiety and depression.

Physical Therapist Management of COVID-19 in the Intensive Care Unit: The West China Hospital Experience.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) has dominated the attention of health care systems globally since January 2020. Various health disciplines, including physical therapists, are still exploring the best way to manage this new disease. The role and involvement of physical therapists in the management of COVID-19 are not yet well defined and are limited in many hospitals. This article reports a physical therapy service specially commissioned by the Health Commission of Sichuan Province to manage COVID-19 during patients' stay in the intensive care unit (ICU) at the Public Health Clinical Center of Chengdu in China. METHODS: Patients diagnosed with COVID-19 were classified into 4 categories under a directive from the National Health Commission of the People's Republic of China. Patients in the "severe" and "critical" categories were admitted to the ICU irrespective of mechanical ventilation was required. Between January 31, 2020, and March 8, 2020, a cohort of 16 patients was admitted to the ICU at the Public Health Clinical Center of Chengdu. The median (minimum to maximum) hospital and ICU stays for these patients were 27 (11-46) and 15 (6-38) days, respectively. Medical management included antiviral, immunoregulation, and supportive treatment of associated comorbidities. Physical therapist interventions included body positioning, airway clearance techniques, oscillatory positive end-expiratory pressure, inspiratory muscle training, and mobility exercises. All patients had at least 1 comorbidity. Three of the 16 patients required mechanical ventilation and were excluded for outcome measures that required understanding of verbal instructions. In the remaining 13 patients, respiratory outcomes-including the Borg Dyspnea Scale, peak expiratory flow rate, Pao2/Fio2 ratio, maximal inspiratory pressure, strength outcomes, Medical Research Council Sum Score, and functional outcomes (including the Physical Function in Intensive Care Test score, De Morton Mobility Index, and Modified Barthel Index)-were measured on the first day the patient received the physical therapist intervention and at discharge. RESULTS: At discharge from the ICU, while most outcome measures were near normal for the majority of the patients, 61% and 31% of these patients had peak expiratory flow rate and maximal inspiratory pressure, respectively, below 80% of the predicted value and 46% had De Morton Mobility Index values below the normative value. CONCLUSION: The respiratory and physical functions of some patients remained poor at ICU discharge, suggesting that long-term rehabilitation may be required for these patients. IMPACT: Our experience in the management of patients with COVID-19 has revealed that physical therapist intervention is safe and appears to be associated with an improvement in respiratory and physical function in patients with COVID-19 in the ICU.

Expert consensus on protocol of rehabilitation for COVID-19 patients using framework and approaches of WHO International Family Classifications.

Coronavirus disease 2019 (COVID-19) has widely spread all over the world and the numbers of patients and deaths are increasing. According to the epidemiology, virology, and clinical practice, there are varying degrees of changes in patients, involving the human body structure and function and the activity and participation. Based on the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) and its biopsychosocial model of functioning, we use the WHO Family of International Classifications (WHO-FICs) framework to form an expert consensus on the COVID-19 rehabilitation program, focusing on the diagnosis and evaluation of disease and functioning, and service delivery of rehabilitation, and to establish a standard rehabilitation framework, terminology system, and evaluation and intervention systems based the WHO-FICs.

Predictive performance of SOFA and qSOFA for in-hospital mortality in severe novel coronavirus disease.

OBJECTIVES: The assessment of illness severity at admission can contribute to decreased mortality in patients with the coronavirus disease (COVID-19). This study was conducted to evaluate the effectiveness of the Sequential Organ Failure Assessment (SOFA) and Quick Sequential Organ Failure Assessment (qSOFA) scoring systems at admission for the prediction of mortality risk in COVID-19 patients. METHODS: We included 140 critically ill COVID-19 patients. Data on demographics, clinical characteristics, and laboratory findings at admission were used to calculate SOFA and qSOFA against the in-hospital outcomes (survival or death) that were ascertained from the medical records. The predictive accuracy of both scoring systems was evaluated by the receiver operating characteristic (ROC) curve analysis. RESULTS: The area under the ROC curve for SOFA in predicting mortality was 0.890 (95% CI: 0.826-0.955), which was higher than that of qSOFA (0.742, 95% CI 0.657-0.816). An optimal cutoff of ≥3 for SOFA had sensitivity, specificity, positive predictive value, and negative predictive value of 90.00%, 83.18%, 50.00%, and 97.80%, respectively. CONCLUSIONS: This novel report indicates that SOFA could function as an effective adjunctive risk-stratification tool at admission for critical COVID-19 patients. The performance of qSOFA is accepted but inferior to that of SOFA.