Ensuring safety from COVID-19 in arthroscopic surgery

In the current time of coronavirus disease-2019 (COVID-19) pandemic, orthopedic procedures have been shelved and guidelines to establish the safety of medical professionals and patients are still evolving. Although sports injuries are not life threatening, a spectrum of these injuries requires urgent intervention. To ensure the safety of medical professionals and patients of sports injuries in COVID times, the following guidelines are suggested. Such surgery needs to be performed only in COVID-free facility (green zone). Patients from red zone and containment zone should be avoided. Young, fit individuals without medical comorbidities should be considered. Wherever possible, regional anesthesia should be used. As COVID virus is present in all body fluids, aerosol generation (coughing, sneezing, intubation, use of power instruments, and cautery) should be minimized. Operation theater (OT) should be fumigated on the prior night and ideally between the cases. The number of cases per OT should be kept under three to get adequate time in-between for sterilization. The ventilation setup of OT should be negative pressure in addition to positive pressure. If there are hindrances in setting up negative pressure, a simple exhaust can be added to the existing setup. The ventilation system should ideally provide more than 20 air changes per hour. During surgery, movement of doors of OT and OT personnel should be minimal so as to minimize the air turbulence and eddy current. This will reduce the risk of infection. Surgical team should wear personal protective equipment (PPE) and helmet hood to reduce the chances of respiratory droplet infection. The doffing of helmet and PPE should be done with utmost care and should be discarded in a chloro-derivate solution. The motorized drill used for surgical procedure should be used at low revolution per minute (RPM). Usage of sterile transparent polythene hood while irrigating during drilling and sequential drilling will help in minimizing aerosol generation. Spillage of arthroscopic fluid should be avoided at all times. These basic norms will minimize the chance of accidental spread of COVID.

The Role of the Private Sector in the COVID-19 Pandemic: Experiences From Four Health Systems.

As societies urbanize, their populations have become increasingly dependent on the private sector for essential services. The way the private sector responds to health emergencies such as the COVID-19 pandemic can determine the health and economic wellbeing of urban populations, an effect amplified for poorer communities. Here we present a qualitative document analysis of media reports and policy documents in four low resource settings-Bangladesh, Ghana, Nepal, Nigeria-between January and September 2020. The review focuses on two questions: (i) Who are the private sector actors who have engaged in the COVID-19 first wave response and what was their role?; and (ii) How have national and sub-national governments engaged in, and with, the private sector response and what have been the effects of these engagements? Three main roles of the private sector were identified in the review. (1) Providing resources to support the public health response. (2) Mitigating the financial impact of the pandemic on individuals and businesses. (3) Adjustment of services delivered by the private sector, within and beyond the health sector, to respond to pandemic-related business challenges and opportunities. The findings suggest that a combination of public-private partnerships, contracting, and regulation have been used by governments to influence private sector involvement. Government strategies to engage the private sector developed quickly, reflecting the importance of private services to populations. However, implementation of regulatory responses, especially in the health sector, has often been weak reflecting the difficulty governments have in ensuring affordable, quality private services. Lessons for future pandemics and other health emergencies include the need to ensure that essential non-pandemic health services in the government and non-government sector can continue despite elevated risks, surge capacity to minimize shortages of vital public health supplies is available, and plans are in place to ensure private workplaces remain safe and livelihoods protected.

A region-specific clustering approach to investigate risk-factors in mortality rate during COVID-19: comprehensive statistical analysis from 208 countries.

Since the outbreak of the novel coronavirus, COVID-19 has continuously spread across the globe briskly. However, since its existence, the symptoms of the disease have been varying widely; thus, developing an urgent need to stratify high-risk categories of people who show more propensity to be affected by this deadly virus will be beneficial for health care. Using the open-access data and machine learning algorithms, this paper aims to cluster countries in groups with similar profiles with respect to the country level pre COVID-19 pandemic parameters. The purpose of performing the data analysis is to measure the extent to which these major risk factors determine the mortality rate due to the coronavirus disease 2019. An unsupervised machine learning model (k-means) was employed for two hundred and eight countries to define data-driven clusters based on thirteen country-level parameters. After performing the one-way ANOVA for comparing the clusters in terms of total cases, total deaths, total cases per population, total deaths per population, and death rate, the paradigm with four and seven clusters showed the best ability to stratify the countries according to total cases per population and death rate with p-values of less than 0.05 and 0.001, respectively. However, the model could not stratify countries in total deaths/cases and total deaths per population.

Reduced survival after upper gastrointestinal bleed endoscopy in the COVID-19 era is a secondary effect of the response to the global pandemic: a retrospective cohort study.

OBJECTIVE: The COVID-19 pandemic has placed increased strain on healthcare systems worldwide with enormous reorganisation undertaken to support 'COVID-centric' services. Non-COVID-19 admissions reduced secondary to public health measures to halt viral transmission. We aimed to understand the impact of the response to COVID-19 on the outcomes of upper gastrointestinal (UGI) bleeds. DESIGN/METHODS: A retrospective observational multicentre study comparing outcomes following endoscopy for UGI bleeds from 24 March 2020 to 20 April 2020 to the corresponding dates in 2019. The primary outcome was in-hospital survival at 30 days with secondary outcomes of major rebleeding within 30 days postprocedure and intervention at the time of endoscopy. RESULTS: 224 endoscopies for 203 patients with UGI bleeds were included within this study. 19 patients were diagnosed with COVID-19. There was a 44.4% reduction in the number of procedures performed between 2019 and 2020. Endoscopies performed for UGI bleeds in the COVID-19 era were associated with an adjusted reduced 30-day survival (OR 0.25, 95% CI 0.08-0.67). There was no increased risk of major rebleeding or interventions during this era. Patients with COVID-19 did not have reduced survival or increased complication rates. CONCLUSION: Endoscopy for UGI bleeds in the COVID-19 era is associated with reduced survival. No clear cause has been identified but we suspect that this is a secondary effect of the response to the COVID-19 pandemic. Urgent work is required to encourage the public to seek medical help if required and to optimise patient pathways to ensure that the best possible care is provided.