Triage protocol for allocation of critical health resources during Covid-19 pandemic and public health emergencies. A narrative review.

BACKGROUND AND AIM OF THE WORK: Triage during the Covid-19 pandemic can impose difficult allocation decisions when demand for mechanical ventilation or intensive care beds greatly exceeds available resources. Triage criteria should be objective, ethical, transparent, applied equitably and publically disclosed. The aim of this review is to describe the triage tools and process for critical care resources in a pandemic health emergency. METHODS: A narrative review was conducted of the literature on five electronic databases, namely PubMed, CINHAL, Web of Science, Cochrane and Embase, searching for studies published from 2006 to June 2020. RESULTS: The results describe different triage tools. A gold standard of triage does not exist for the adult or paediatric population. Using probability of short-term survival as the sole allocation principle is problematic. In general, each triage protocol should be applied with a specific ethical justification, including transparency, duty to care, duty to steward resources, duty to plan, and distributive justice. CONCLUSIONS: Clinical triage decisions based on clinical judgment alone are prone to inconsistent application by triage officers in a pandemic. An ethical framework can inform decision-making and improve accountability. It remains difficult to connect clinical criteria and ethical criteria, because of the models on offer for health services.

Face Mask Use in the Community for Reducing the Spread of COVID-19: A Systematic Review.

Background: Evidence is needed on the effectiveness of wearing face masks in the community to prevent SARS-CoV-2 transmission. Methods: Systematic review and meta-analysis to investigate the efficacy and effectiveness of face mask use in a community setting and to predict the effectiveness of wearing a mask. We searched MEDLINE, EMBASE, SCISEARCH, The Cochrane Library, and pre-prints from inception to 22 April 2020 without restriction by language. We rated the certainty of evidence according to Cochrane and GRADE approach. Findings: Our search identified 35 studies, including three randomized controlled trials (RCTs) (4,017 patients), 10 comparative studies (18,984 patients), 13 predictive models, nine laboratory experimental studies. For reducing infection rates, the estimates of cluster-RCTs were in favor of wearing face masks vs. no mask, but not at statistically significant levels (adjusted OR 0.90, 95% CI 0.78-1.05). Similar findings were reported in observational studies. Mathematical models indicated an important decrease in mortality when the population mask coverage is near-universal, regardless of mask efficacy. In the best-case scenario, when the mask efficacy is at 95%, the R0 can fall to 0.99 from an initial value of 16.90. Levels of mask filtration efficiency were heterogeneous, depending on the materials used (surgical mask: 45-97%). One laboratory study suggested a viral load reduction of 0.25 (95% CI 0.09-0.67) in favor of mask vs. no mask. Interpretation: The findings of this systematic review and meta-analysis support the use of face masks in a community setting. Robust randomized trials on face mask effectiveness are needed to inform evidence-based policies. PROSPERO registration: CRD42020184963.

Strategies to exiting the COVID-19 lockdown for workplace and school: A scoping review.

In an attempt to curb the COVID-19 pandemic, several countries have implemented various social restrictions, such as closing schools and asking people to work from home. Nevertheless, after months of strict quarantine, a reopening of society is required. Many countries are planning exit strategies to progressively lift the lockdown without leading to an increase in the number of COVID-19 cases. Identifying exit strategies for a safe reopening of schools and places of work is critical in informing decision-makers on the management of the COVID-19 health crisis. This scoping review describes multiple population-wide strategies, including social distancing, testing, and contact tracing. It highlights how each strategy needs to be based on both the epidemiological situation and contextualize at local circumstances to anticipate the possibility of COVID-19 resurgence. However, the retrieved evidence lacks operational solutions and are mainly based on mathematical models and derived from grey literature. There is a need to report the impact of the implementation of country-tailored strategies and assess their effectiveness through high-quality experimental studies.