Building Digital Resilience to Combat Pandemics: Comparison of South Korea, Sri Lanka and Rwanda

Use of digital technologies for management of COVID-19 pandemic was widely observed across the globe. However, building resilient digital systems to better manage the pandemic based on country contexts was a challenge. The objective of this study is to identify socio-technical determinants of building resilient digital technologies based on a comparative study or three countries. Case study method was utilized with qualitative data collection methods to identify thematic areas for comparison. The study revealed that resilient digital pandemic responses will rely on a plurality of technologies, and on agility, flexibility and capacity in producing these solutions. © 2022, IFIP International Federation for Information Processing.

THE EFFECT OF DIETARY PATTERN ON DURATION OF HOSPITAL STAYS IN PATIENTS WITH RESPIRATORY COVID ILLNESS

Background: The immune system defends the host against many harmful microorganisms. The immune system has developed to contain various specialized cell types, signaling molecules, and functional responses to deal with this wide range of threats. In Covid-19 infections immune system is the key component for prevention of the disease. Hospital admission and duration of stay due to covid 19 infection have a considerable physical, financial, and psychological burden for the individual, family, and country. Diet has been shown to have a vital role in boosting one's immunity. Non vegetarian diet is traditionally considered to be immunity boosting as it is rich in protein, vitamins, and micronutrients. Aims and objective: To study the effect of dietary pattern on duration of hospital stay in patients with respiratory Covid illness Material and Methods: This was a double blind retrospective cohort study comprising of 113 patients tested positive in RTPCR for SARS-CoV-2 and admitted at DCH located at super specialty hospital of Jayarogya Group of Hospitals, Gwalior, Madhya Pradesh, was studied retrospectively between July 2020 to October 2020. Patients were divided based on diet pattern into Group A (patients following a vegetarian diet;n=70) and Group B (patients following a non-vegetarian diet;n=43). The outcome was measured as the duration of hospital stay and comparison of diet type, age, and gender of patients. All these patients were discharge stable and case files of deaths were excluded. Non vegetarian diet was defined as inclusion of eggs, meet, fish in the routine diet whereas a vegetarian diet was exclusion of these items. Result: Out of 113 patients, most (61.94%) had a vegetarian diet, whereas 43 (38.06%) had a non-vegetarian diet. Duration of hospital stay was more in patients in Group A (10.71±5.5 days) than Group B (8.4± 4.7 days), p=0.0302. Hospital stay was longer (11.05 days) in older patients (>50 years) compared to younger patients (≤50 years) (9.2 days) (table 3). In Group A, hospital stay was longer in those with age >50 years (11.4 days) compared to those with age ≤50 (9.2 days). On the contrary, older patients had shorter hospital lengths (9.9 days) than younger patients (10.09 days) in Group B (p value =). Conclusion: A significantly shorter hospital stay was observed in patients of respiratory covid infection following a non-vegetarian diet with Covid-19 infection.

Development and validation of prognostic scoring system for COVID-19 severity in South India.

BACKGROUND: Development of a prediction model using baseline characteristics of COVID-19 patients at the time of diagnosis will aid us in early identification of the high-risk groups and devise pertinent strategies accordingly. Hence, we did this study to develop a prognostic-scoring system for predicting the COVID-19 severity in South India. METHODS: We undertook this retrospective cohort study among COVID-19 patients reporting to Hindu Mission Hospital, India. Multivariable logistic regression using the LASSO procedure was used to select variables for the model building, and the nomogram scoring system was developed with the final selected model. Model discrimination, calibration, and decision curve analysis (DCA) was performed. RESULTS: In total, 35.1% of the patients in the training set developed severe COVID-19 during their follow-up period. In the basic model, nine variables (age group, sex, education, chronic kidney disease, tobacco, cough, dyspnea, olfactory-gustatory dysfunction [OGD], and gastrointestinal symptoms) were selected and a nomogram was built using these variables. In the advanced model, in addition to these variables (except OGD), C-reactive protein, lactate dehydrogenase, ferritin, D-dimer, and CT severity score were selected. The discriminatory power (c-index) for basic model was 0.78 (95%CI: 0.74-0.82) and advanced model was 0.83 (95%CI: 0.79-0.87). DCA showed that both the models are beneficial at a threshold probability around 10-95% than treat-none or treat-all strategies. CONCLUSION: The present study has developed two separate prognostic-scoring systems to predict the COVID-19 severity. This scoring system could help the clinicians and policymakers to devise targeted interventions and in turn reduce the COVID-19 mortality in India.

G6PD deficiency and severity of COVID19 pneumonia and acute respiratory distress syndrome: Tip of the iceberg?

The severe pneumonia caused by the human Coronavirus (hCoV)-SARS-CoV-2 has inflicted heavy causalities, especially among the elderly and those with comorbid illnesses irrespective of their age. The high mortality in African-Americans and males, in general, raises the concern for a possible X-linked mediated process that could affect the viral pathogenesis and the immune system. We hypothesized that G6PD, the most common X linked enzyme deficiency associated with redox status, may have a role in severity of pneumonia. Retrospective chart review was performed in hospitalized patients with COVID19 pneumonia needing supplemental oxygen. A total of 17 patients were evaluated;six with G6PD deficiency, and 11 with normal levels. The two groups (Normal and G6PD def) were comparable in terms of age, sex and co-morbidities, and laboratory parameters-LDH, IL-6, CRP, and Ferritin, WHO ordinal scale respectively. Thirteen patients needed ventilatory support with 6 in the G6PD group (83% vs.72%). The main differences indicating increasing severity in G6PD def group included G6PD levels (12.2 vs. 5.6, P=0.0002), PaO2/FiO2 ratio (159 vs. 108, P=0.05), days before intubation (2.5 vs. 4.8 P= 0.03), days on mechanical ventilation (10.25 vs. 21 days P=0.04), hemoglobin level (10 vs. 8.1 P=0.03) and Hematocrit (32 vs. 26 P=0.015) and Mean WHO ordinal Scale at discharge (0.73 Vs 4.67 P=0.001). Only one patient with G6PD deficiency died;16 were discharged home. Our clinical series ascribes a possible biological role for G6PD deficiency in SARS-CoV2 viral proliferation. It is imperative that further studies are performed to understand the interplay between the viral and host factors in G6PD-deficiency that may lead to disparity in outcomes.

Building Agility in Health Information Systems to Respond to the COVID-19 Pandemic: The Sri Lankan Experience

Agile methods have been popular in the software industry particularly in relation to technical innovations. However, agility in terms of providing health information support within a crisis laden pandemic situation such as COVID-19 is less well understood. This paper focused on an ongoing response of design, development, and implementation of a COVID-19 surveillance system based on DHIS2 platform in Sri Lanka. Our analysis aims at understanding;and developing agility. An interpretive case study approach was adopted where qualitative data were gathered using multiple methods such as participant observation, document analysis, historical accounts, informal interviews and using secondary data. Thematic analysis technique was adopted where themes were identified collectively following multiple iterations of collaborative analysis. We argue that the flexibility of the software platform, good technical and medical capacity and new modes of collaboration on systems development across institutional borders have contributed to the agility shown in the Sri Lankan context and its success in meeting health information challenges posed by COVID-19. © 2020, IFIP International Federation for Information Processing.