Evaluation of health system resilience in 60 countries based on their responses to COVID-19 (preprint)

Introduction: In 2020, the COVID-19 epidemic swept the world, and many national health systems faced serious challenges. To improve future public health responses, it's necessary to evaluate the performance of each country's health system. Methods: We developed a resilience evaluation system for national health systems based on their responses to COVID-19 using four resilience dimensions: government governance and prevention, health financing, health service provision, and health workers. We determined the weight of each index by combining the three-scale and entropy-weight methods. Then, based on data from 2020, we used the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) method to rank the health system resilience of 60 countries, then used hierarchical clustering to classify countries into groups based on their resilience level. Finally, we analyzed the causes of differences among countries in their resilience based on the four resilience dimensions. Results: Switzerland, Japan, Germany, Australia, South Korea, Canada, New Zealand, Finland, the United States, and the United Kingdom had the highest health system resilience in 2020. Eritrea, Nigeria, Libya, Tanzania, Burundi, Mozambique, Republic of the Niger, Benin, Cote d'Ivoire, and Guinea had the lowest resilience. Government governance and prevention of COVID-19 will greatly affect a country's success in fighting future epidemics, which will depend on a government's emergency preparedness, stringency (a measure of the number and rigor of the measures taken), and testing capability. Given the lack of vaccines or specific drug treatments during the early stages of the 2020 epidemic, social distancing and wearing masks were the main defenses against COVID-19. Cuts in health financing had direct and difficult to reverse effects on health systems. In terms of health service provision, the number of hospitals and intensive care unit beds played a key role in COVID-19 clinical care. Conclusion: Resilient health systems were able to cope more effectively with the impact of COVID-19, provide stronger protection for citizens, and mitigate the impacts of COVID-19. Our evaluation based on data from 60 countries around the world showed that increasing health system resilience will improve responses to future public health emergencies.

Clinical findings in critical ill patients infected with SARS-Cov-2 in Guangdong Province, China: a multi-center, retrospective, observational study (preprint)

Abstract Background In December 2019, human infection with a novel coronavirus, known as SARS-CoV-2, was identified in Wuhan, China. The mortality of critical illness was high in Wuhan. Information about critically ill patients with SARS-CoV-2 infection outside of Wuhan is scarce. We aimed to provide the clinical features, treatment, and prognosis of the critically ill patients with SARS-CoV-2 infection in Guangdong Province. Methods In this multi-centered, retrospective, observational study, we enrolled critically ill patients with SARS-CoV-2 pneumonia who were admitted to the intensive care unit (ICU) in Guangdong Province. Demographic data, symptoms, laboratory findings, comorbidities, treatments, and prognosis were collected. Data were compared between patients with and without intubation. Results Forty-five critically ill patients with SARS-CoV-2 pneumonia were identified in 7 ICUs in Guangdong Province. The mean age was 56.7 years, and 29 patients (64.4%) were men. The most common symptoms at the onset of illness were high fever and cough. Majority of patients presented with lymphopenia and elevated lactate dehydrogenase. Treatment with antiviral drugs was initiated in all the patients. Thirty-seven patients (82.2%) had developed acute respiratory distress syndrome, and 13 (28.9%) septic shock. A total of 20 (44.4%) patients required intubation and 9 (20%) required extracorporeal membrane oxygenation. As of February 28th 2020, only one patient (2.2%) had died and half of them had discharged of ICU. Conclusions Infection with SARS-CoV-2 in critical illness is characterized by fever, lymphopenia, acute respiratory failure and multiple organ dysfunction. Compared with critically ill patients infected with SARS-CoV-2 in Wuhan, the mortality of critically ill patients in Guangdong Province was relatively low. These data provide some general understandings and experience for the critical patients with SARS-CoV-2 outside of Wuhan.