Addressing Uncertainty: An Evidence-Based, Data-Driven, Decision Matrix for Healthcare Operations During The COVID-19 Pandemic

Background. Uncertainty and continuously changing guidance for COVID-19 response has taken a toll on the mental health of all individuals. Growing uncertainty within a healthcare system can create stress and confusion, ultimately affecting patient care. We designed an evidence-based, data-driven, decision matrix for healthcare operations that adapts COVID-19 mitigation measures in a predictable fashion according to the CDC community risk level and wastewater positivity data. Methods. A multidisciplinary team reviewed mitigation measures, published and internal data on the value and yield of these measures, and different operational aspects of a major healthcare system that are affected by COVID-19. The team also reviewed publicly available community risk metrics to then a create a decision matrix that adjusts mitigation measures and operational aspects in a predictable fashion according to COVID-19 risk in the community. Results. When COVID-19 rates were low during the pandemic the yield of temperature and symptom screening was 0.19% people screening out and the yield of preprocedure testing was 0.17% patients testing positive. Taking that into account, as well as published literature and public health guidance, we built the COVID-19 decision matrix shown in the figure, with adaptations for in-patient, out-patient, long-term care sites. The decision matrix was then posted online with a qualification that the enterprise COVID-19 status would only change with sustained changes ( > 2 weeks) in CDC Community risk level or wastewater positivity. The enterprise COVID-19 status is inserted in all enterprise communications for operational awareness. The response to the COVID-19 decision matrix has been overwhelmingly positive by staff and visitors, with no safety or operational problems in the first month of implementation. Conclusion. An evidence-based, data-driven, decision matrix provides predictable mitigation measures and operational responses to changes in the COVID-19 community risk levels and alleviates workforce uncertainty.

Equine Arteritis Virus (EAV) Outbreak in a Show Stallion Population.

(1) Background: Equine arteritis virus (EAV) infection causes reproductive losses and systemic vasculitis in susceptible equidae. The intact male becomes the virus' reservoir upon EAV infection, as it causes a chronic-persistent infection of the accessory sex glands. Infected semen is the main source of virus transmission. (2) Here, we describe acute EAV infection and spread in a stallion population after introduction of new members to the group. (3) Conclusions: acute clinical signs, acute phase detection of antigen via (PCR) nasal swabs or (EDTA) blood, and seroconversion support the idea of transmission via seminal fluids into the respiratory tract(s) of others. This outbreak highlights EAV's horizontal transmission via the respiratory tract. This route should be considered in a chronic-persistently infected herd, when seronegative animals are added to the group.

COVID-19 Pandemic: What Have We Learned and What to Expect in the Future?

The COVID-19 pandemic resulted in an unprecedented and unexpected challenge for societies and healthcare systems, including nuclear medicine providers. This article summarizes the major events imposed on nuclear medicine by COVID-19 from a global perspective, focuses on the major lessons learned regarding attitude, medical procedures, organizational implications and strategical considerations, and then discusses what to expect (and how to prepare) for the future. While the look back to what has happened is clearly evidence based, the look ahead and the conclusions drawn require the disclaimer of only representing the personal opinion and prediction of the authors. The COVID-19 pandemic relentlessly revealed deficiencies on an organizational, systematic and leadership level in nuclear medicine and beyond. Crisis gives us the opportunity to learn and furthermore perpare for the future. The authors' take home messages include the recommendation to focus on developing a culture of responsibility and ownership as opposed to blame, strengthening teams and communication, adapting existing structures based on the lessons learned during COVID-19, as well as establishing an environment of active decision making, prioritizing proposal of solutions rather than simply stating problems, incentivizing support and collaboration, not opposition.

Changes in the global impact of COVID-19 on nuclear medicine departments during 2020: an international follow-up survey.

AIM: As a follow-up to the international survey conducted by the International Atomic Energy Agency (IAEA) in April 2020, this survey aims to provide a situational snapshot of the COVID-19 impact on nuclear medicine services worldwide, 1 year later. The survey was designed to determine the impact of the pandemic at two specific time points: June and October 2020, and compare them to the previously collected data. MATERIALS AND METHODS: A web-based questionnaire, in the same format as the April 2020 survey was disseminated to nuclear medicine facilities worldwide. Survey data was collected using a secure software platform hosted by the IAEA; it was made available for 6 weeks, from November 23 to December 31, 2020. RESULTS: From 505 replies received from 96 countries, data was extracted from 355 questionnaires (of which 338 were fully completed). The responses came from centres across varying regions of the world and with heterogeneous income distributions. Regional differences and challenges across the world were identified and analysed. Globally, the volume of nuclear medicine procedures decreased by 73.3% in June 2020 and 56.9% in October 2020. Among the nuclear medicine procedures, oncological PET studies showed less of a decline in utilization compared to conventional nuclear medicine, particularly nuclear cardiology. The negative impact was also significantly less pronounced in high-income countries. A trend towards a gradual return to the pre-COVID-19 situation of the supply chains of radioisotopes, generators, and other essential materials was evident. CONCLUSION: The year 2020 has a significant decrease in nuclear medicine diagnostic and therapeutic procedures as a result of the pandemic-related challenges. In June, the global decline recorded in the survey was greater than in October when the situation began to show improvement. However, the total number of procedures remained below those recorded in April 2020 and fell to less than half of the volumes normally carried out pre-pandemic.

One Year Later: Global Impact of COVID-19 on Nuclear Medicine Departments; an International Follow-up Survey (preprint)

Aim: As a follow-up to the international survey conducted in April 2020, this survey aims to provide a situational snapshot of the COVID-19 impact on nuclear medicine services worldwide, one year later. The survey was designed to determine the impact of the pandemic at two specific time-points: June and October 2020 and compare them to the previously collected data.Materials and Methods: A web-based questionnaire, in the same format as the April 2020 survey was disseminated to nuclear medicine facilities worldwide. Survey data was collected using a secure software platform hosted by the International Atomic Energy Agency (IAEA); it was made available for 6 weeks, from November 23 to December 31, 2020.Results: From 505 replies from 96 countries, data was extracted from 355 questionnaires (of which 338 were fully completed). The responses came from centres evenly distributed in different regions of the world and with different income status. Regional differences and challenges across the world were identified and analysed. Globally, the volume of nuclear medicine procedures decreased by 73.3% in June 2020 and 56.9% in October 2020. Among the nuclear medicine procedures, oncological PET studies showed less of a decline in utilization compared to conventional nuclear medicine and particularly nuclear cardiology. The impact was also significantly less in high-income countries. A trend towards a return to the pre-COVID-19 situation of the supply chains of radioisotopes, generators, and other essential materials was evident.Conclusion: The impact of the COVID-19 pandemic was associated with a significant reduction in nuclear medicine diagnostic and therapeutic procedures throughout 2020. In June, the global decline recorded in the survey was greater than in October when there was a slight improvement. However, the total number of procedures continued below that recorded in April 2020, and less than half of the volumes normally carried out before the pandemic

[Impact of COVID-19 on Nuclear Medicine Procedures in Germany 2020 - Results of a National Survey]. / Auswirkungen von COVID-19 auf nuklearmedizinische Untersuchungen und Therapien im Verlauf von 2020 ­ Ergebnisse einer nationalen Umfrage.

INTRODUCTION: The COVID-19 pandemic imposed an unimaginable challenge to the healthcare systems worldwide. This online survey captured the impact of the COVID-19 pandemic on nuclear medicine services in Germany comparing 2020 to 2019. MATERIALS AND METHODS: A web-based questionnaire was developed to record the 2020 numbers of nuclear medicine procedures and, in particular, the change compared with 2019. The changes in nuclear medicine diagnostics and therapy were queried, as well as the extent to which "Coronavirus SARS-CoV-2" recommendations provided by the DGN were implemented. RESULTS: 91 complete responses were recorded and evaluated. This corresponds to about 20 % of all German nuclear medicine facilities. Nuclear medicine diagnostic tests showed a decrease in scintigraphies for thyroid (15.9 %), bone (8.8 %), lung (7.6 %), sentinel lymph nodes (5.5 %), and myocardium (1.4 %) with small increases in PET/CT examinations (1.2 %) compared with 2019. Among nuclear medicine therapies, reductions were highest for benign indications (benign thyroid 13.3 %, RSO 7.7 %), while changes from 2019 were less pronounced for malignant indications (PRRT: + 2.2 %, PSMA: + 7.4 %, SIRT: -5.9 %, and RJT for thyroid carcinoma -2.4 %). The DGN recommendations for action were fully or partially applied in 90 %. CONCLUSIONS: The initial significant reduction in nuclear medicine procedures in the first three weeks of the COVID-19 pandemic did not continue, but there was no compensation of the previously not performed services. The decrease in diagnostics and therapy procedures of benign diseases was particularly severe.

Global Impact of COVID-19 on Nuclear Medicine Departments: An International Survey in April 2020.

The coronavirus disease 2019 (COVID-19) pandemic has placed significant challenges on health-care systems worldwide, whether in the preparation, response, or recovery phase of the pandemic. This has been primarily managed by dramatically reducing in- and outpatient services for other diseases and implementing infection prevention and control measures. The impact of the pandemic on nuclear medicine departments and their services has not yet been established. The aim of this online survey was to evaluate the impact of COVID-19 on nuclear medicine departments. Methods: A web-based questionnaire, made available from April 16 to May 3, 2020, was designed to determine the impact of the pandemic on in- and outpatient nuclear medicine departments, including the number of procedures, employee health, availability of radiotracers and other essential supplies, and availability of personal protective equipment. The survey also inquired about operational aspects and types of facilities as well as other challenges. Results: A total of 434 responses from 72 countries were registered and analyzed. Respondents reported an average decline of 54% in diagnostic procedures. PET/CT scans decreased by an average of 36%, whereas sentinel lymph-node procedures decreased by 45%, lung scans by 56%, bone scans by 60%, myocardial studies by 66%, and thyroid studies by 67%. Of all participating centers, 81% performed radionuclide therapies, and they reported a reduction of 45% on average in the last 4 wk, ranging from over 76% in Latin America and South East Asia to 16% in South Korea and Singapore. Survey results showed that 52% of participating sites limited their 99mTc/99Mo generator purchases, and 12% of them temporarily cancelled orders. Insufficient supplies of essential materials (radioisotopes, generators, and kits) were reported, especially for 99mTc/99Mo generators and 131I, particularly in Africa, Asia, and Latin America. Conclusion: Both diagnostic and therapeutic nuclear medicine procedures declined precipitously, with countries worldwide being affected by the pandemic to a similar degree. Countries that were in the postpeak phase of the pandemic when they responded to the survey, such as South Korea and Singapore, reported a less pronounced impact on nuclear medicine services; however, the overall results of the survey showed that nuclear medicine services worldwide had been significantly impacted. In relation to staff health, 15% of respondents experienced COVID-19 infections within their own departments.

Impact of COVID-19 on Nuclear Medicine in Germany, Austria and Switzerland: An International Survey in April 2020.

INTRODUCTION: Preparations of health systems to accommodate large number of severely ill COVID-19 patients in March/April 2020 has a significant impact on nuclear medicine departments. MATERIALS AND METHODS: A web-based questionnaire was designed to differentiate the impact of the pandemic on inpatient and outpatient nuclear medicine operations and on public versus private health systems, respectively. Questions were addressing the following issues: impact on nuclear medicine diagnostics and therapy, use of recommendations, personal protective equipment, and organizational adaptations. The survey was available for 6 days and closed on April 20, 2020. RESULTS: 113 complete responses were recorded. Nearly all participants (97 %) report a decline of nuclear medicine diagnostic procedures. The mean reduction in the last three weeks for PET/CT, scintigraphies of bone, myocardium, lung thyroid, sentinel lymph-node are -14.4 %, -47.2 %, -47.5 %, -40.7 %, -58.4 %, and -25.2 % respectively. Furthermore, 76 % of the participants report a reduction in therapies especially for benign thyroid disease (-41.8 %) and radiosynoviorthesis (-53.8 %) while tumor therapies remained mainly stable. 48 % of the participants report a shortage of personal protective equipment. CONCLUSIONS: Nuclear medicine services are notably reduced 3 weeks after the SARS-CoV-2 pandemic reached Germany, Austria and Switzerland on a large scale. We must be aware that the current crisis will also have a significant economic impact on the healthcare system. As the survey cannot adapt to daily dynamic changes in priorities, it serves as a first snapshot requiring follow-up studies and comparisons with other countries and regions.