Convalescent plasma transfusion in severe COVID-19 patients: Clinical and laboratory outcomes.

INTRODUCTION: The objective of this study was to investigate the effect of convalescent plasma (CP) transfusion on clinical and serial laboratory parameters in severe COVID-19 patients. The Coronavirus Disease 2019 (COVID-19) pandemic presents a challenge to the healthcare system worldwide due to the limited treatment options available. The body of evidence reported that CP containing anti- COVID-19 antibodies could be effective against the infection. MATERIALS AND METHODS: This was a cross-sectional study that involved retrospective data collection of severe COVID-19 adult patients who received CP transfusion along with the best-of-care (CP group, n: 53) and best-of-care only (control group, n: 53). An age, gender, and comorbidity were manually matched approximately at a 1:1 ratio. RESULTS: The prevalence of adverse transfusion reactions was 5.7%. A shorter duration of oxygen support (median: 12 days vs 14 days, P=0.030) and a shorter duration of mechanical ventilation (median: 6 days vs 10 days, P=0.048) were found in the CP group. The laboratory parameters were also improved. However, there was no significant difference in the mechanical ventilation rate, length of hospital stay, length of intensive care unit (ICU) stay, and mortality rate across both groups (P = 0.492, 0.614, 0.793, 0.374). CONCLUSION: CP transfusion is safe and effective in the treatment of severe COVID-19 patients. However, a revision of our approaches such as early CP transfusion and use of a high-titre anti-COVID-19 neutralising antibody (nAb) unit is necessary to unlock the full potential benefits of CP transfusion among COVID-19 patients.

Outcomes of a "hospital at home” programme for the supervised home recovery of COVID-19 patients in Singapore

Background: The Singapore General Hospital COVID-19 Virtual Ward is a "hospital at home” (HaH) programme for the supervised home recovery of higher-acuity COVID-19 patients from the hospital and the community. Objective: To describe how an existing HaH programme was redesigned so that COVID-19 patients could be remotely monitored at home and report the outcomes of the first 100 patients in this Virtual Ward. Methods: Patients received an admission package comprising instructions and equipment for home monitoring, and uploaded their parameters into a clinical dashboard via a secure messaging app. Medical staff conducted video or telephone consultations daily. Patients were discharged according to time-based criteria, although some required SARS-CoV-2 PCR testing, which were conducted at home by a third-party medical provider. De-identified data of the first 100 patients were analysed by demographic details, indication for enrolment into the Virtual Ward, and the need for subsequent inpatient readmission. Results: Of the first 100 patients admitted into the Virtual Ward, 58 were female, mean age was 63.1 years old (23–95 years), and 76 were fully vaccinated. There were 77 hospital referrals and 23 community referrals. The number of days of inpatient hospitalisation avoided was 717 days (average of 7.9 days per patient). Three hospital referrals (3.9%) were readmitted, while seven community referrals (30.4%) required subsequent hospitalisation. Conclusion: The Virtual Ward programme demonstrates that selected COVID-19 patient can safely recover at home with remote medical support and monitoring, thereby expanding hospital capacity.

Health systems response when COVID-19 hits Malaysia: Public perspective of border control during early phase of infectious disease threat

Introduction: In the early phase of the pandemic, confirmed COVID-19 cases spread globally from Wuhan, China. Similarly, Malaysia's first three cases were Chinese nationality travelers entering from Singapore to Johor. As the coronavirus spread rapidly across borders, World Health Organisation (WHO) declared the outbreak a Public Health Emergency of International Concern on 30th January 2020. One of the measures imposed to curb the spread was travelling restrictions between countries. Objective(s): This study aimed to explore the public's perspective on Malaysia's border control or point of entry during the early phase of COVID-19 pandemic. Material(s) and Method(s): WHO's Strategic Preparedness and Response Plan (SPRP) pillars were adopted to develop an online survey. The online survey was distributed to public respondents and identified healthcare experts from March to April 2020 via social media and email invitation. The survey includes open-ended questions where respondents gave their opinions with regards to eight pillars of SPRP strategies taken during the early phase of COVID-19. The fourth pillar emphasizes on country's point of entry. A qualitative content analysis approach was performed using NVIVO-12 software. Result(s) and Conclusion(s): Four domains were identified namely Entry/Exit Control, Screening Measures, Quarantine Policy and Information. Issues on the timeliness for border closure, quarantine policy and dissemination of information regarding disease management as well as Standard Operation Procedure were highlighted by the respondents. Respondents felt that the screening mechanism at points of entry was lacking in stringency and inconsistent. Respondents raised concerns regarding the competency of frontliners in implementing the screening process. Respondents believed that clear quarantine instructions and traveler tracking system are necessary upon entering the country. Containment of infectious diseases like COVID-19 during the initial phase of the pandemic were critical to slow down the spread of the disease. Country's authorities were expected to make judicious decisions on travel restrictions, border controls, travelers quarantine and point of entry screening to reduce imported cases.

Incidence of proteinuria and microscopic hematuria in hospitalised COVID-19 infected patients: A single centre experience

Introduction: The outbreak of COVID-19 has rapidly evolved to global pandemic since December 2019. Kidney injury is commonly associated with COVID-19 infection. The majority of reports strongly support that acute tubular injury is the primary lesion driving AKI in COVID-19. Our objective of this study is to identify the incidence of proteinuria and microscopic hematuria in COVID-19 patients admitted to Hospital Sultanah Bahiyah, Alor Setar. Material(s) and Method(s): This is a single centred, retrospective cross-sectional study examining the records of patients infected with COVID-19 admitted to Hospital Sultanah Bahiyah from September 13 till December 28, 2020. We excluded patients with pre-existing medical illnesses. These patients had urine dipstick tests done upon admission. Result(s): A total of 160 patients were included in this study. The mean age was 34.6 years, 43.8% were male and 56.2% were female patients. The median serum creatinine level was 68 mumol/L. Patients were categorised into different severity of COVID-19 infection on admission, 46% category 1, 22% category 2, 18% category 3, 13 % category 4, 1% category 5. The incidence of proteinuria and microscopic hematuria were 20.3% and 14.4% respectively on admission. The incidence of combined proteinuria and microscopic hematuria was 5.0%. Conclusion(s): In our study, proteinuria and microscopic hematuria were relatively common in different categories of COVID-19 infection even without preexisting chronic illnesses.The incidence of proteinuria and microscopic hematuria in our study are comparable to other studies. More data is needed to distinguish patients who had preexisting proteinuria and microscopic hematuria prior to presentation from those developed denovo in hospital.

Convalescent plasma as an adjunctive therapy for COVID-19: A single centre experience in Malaysia

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic posed a significant and urgent threat to global health and economy. Currently, there is no effective treatment known to alter the course of COVID-19. Convalescent plasma (CP) has been used previously to treat several types of infections during pandemics. The aim of our study is to evaluate the efficacy of CP in the treatment of severe COVID-19 infections at Hospital Sultanah Bahiyah, Kedah, Malaysia. MATERIALS AND METHODS: A retrospective cross-sectional study of all severe COVID-19 patients who received CP treatment from 1st August 2020 until 31st December 2020 was conducted. Clinical outcomes were compared before and after CP transfusion. RESULTS: Thirty-four patients were enrolled and received CP transfusion during the study period. The most common presenting complaints were fever (64.7%) and cough (58.8%). Fourteen patients showed improvement in oxygen support after CP transfusion. Several laboratory parameters also improved such as increased lymphocyte count (1.48 vs 1.98, p=0.008) and decreased C-reactive protein levels (28.1 vs 10.6, p=0.004), and these were statistically significant. Median time from symptoms onset to CP transfusion was 6 days (range 1-11) while median time from PCR diagnosis to CP transfusion was 5 days (range 1-11). One patient developed urticaria after CP transfusion and no severe adverse events were observed. Two of our patients passed away due to secondary causes. CONCLUSION: This study showed CP treatment was well tolerated and could potentially prevent progression of COVID-19 to a severe disease if administered early during the viraemic phase. Further evaluation with randomized control trial should be conducted to help ascertain the optimal dose and effectiveness of CP treatment, in correlation with the IgG titer of the donated CP.

Emergency Laparotomy in a COVID-19 patient with acute abdomen

We describe here the first laparotomy involving a COVID-19 patient in Malaysia. A 60-year-old man screened positive for SARS-CoV-2 in March 2020 and developed acute abdomen in the ward in Hospital Sultanah Bahiyah, Kedah. He underwent laparotomy and cholecystectomy for gangrenous cholecystitis. All personnel adhered to infectious control precautions, donning full personal protective equipment (PPE) throughout the surgery. Post-operatively, due to raised septic parameters, he was carefully diagnosed with and treated empirically for superimposed bacterial sepsis instead of cytokine release syndrome, with confirmed blood culture of Klebsiella pneumoniae. Patient was discharged well later. None of the staff involved in his care developed COVID-19 infection.

Collaboration between a tertiary pain centre and community teams during the pandemic.

People with chronic pain faced potential treatment disruption during the COVID-19 pandemic in Singapore, as the focus of healthcare shifted. A model of rapid integration of a pain centre with community healthcare teams was implemented to care for vulnerable older patients with chronic pain and multiple comorbidities. Telemedicine and home visits by community nurses were used, with risk-mitigation measures, ensuring comprehensive assessment and treatment compliance. Medications from pain physicians were delivered at home through a hospital pharmacy. A secure national electronic health records system used by all teams ensured seamless access and documentation. Potential emergency department visits, admissions and delayed discharges were thus avoided. Integration of community teams with chronic pain management services can be recommended to ensure pandemic preparedness.