Participatory Approach to Develop Evidence-Based Clinical Ethics Guidelines for the Care of COVID-19 Patients: A Mixed Method Study From Nepal.

During health emergencies such as the COVID-19 pandemic, healthcare workers face numerous ethical challenges while catering to the needs of patients in healthcare settings. Although the data recapitulating high-income countries ethics frameworks are available, the challenges faced by clinicians in resource-limited settings of low- and middle-income countries are not discussed widely due to a lack of baseline data or evidence. The Nepali healthcare system, which is chronically understaffed and underequipped, was severely affected by the COVID-19 pandemic in its capacity to manage health services and resources for needy patients, leading to ethical dilemmas and challenges during clinical practice. This study aimed to develop a standard guideline that would address syndemic ethical dilemmas during clinical care of COVID-19 patients who are unable to afford standard-of-care. A mixed method study was conducted between February and June of 2021 in 12 government designated COVID-19 treatment hospitals in central Nepal. The draft guideline was discussed among the key stakeholders in the pandemic response in Nepal. The major ethical dilemmas confronted by the study participants (50 healthcare professionals providing patient care at COVID-19 treatment hospitals) could be grouped into five major pillars of ethical clinical practice: rational allocation of medical resources, updated treatment protocols that guide clinical decisions, standard-of-care regardless of patient's economic status, effective communication among stakeholders for prompt patient care, and external factors such as political and bureaucratic interference affecting ethical practice. This living clinical ethics guideline, which has been developed based on the local evidence and case stories of frontline responders, is expected to inform the policymakers as well as the decision-makers positioned at the concerned government units. These ethics guidelines could be endorsed with revisions by the concerned regulatory authorities for the use during consequent waves of COVID-19 and other epidemics that may occur in the future. Other countries affected by the pandemic could conduct similar studies to explore ethical practices in the local clinical and public health context.

A Nepalese bipolar case amidst risk and protective factors during COVID-19 pandemic.

Bipolar disorder is a chronic and recurring psychiatric illness. Emphasis on enhancing key protective factors like social support systems and promoting this to minimize risk factors like non-compliance is one of the key strategies tied to enhance overall psychological, intellectual, and emotional health for symptoms remission and relapse prevention even during adverse situations like the COVID-19 crisis. We intend here to point out implication of the dynamics of the protective and risk factors for bipolar mood through a 23-year patient from eastern Nepal, which is largely harmonious in its multi-ethnic, multilingual and multicultural social composition. This attribute of social cohesiveness and compassion is evident in this case report. When disturbed and ill, neighbors from native semi-urban Nepalese society did support even in the times of crisis of COVID-19 pandemic. The support of other people including neighbors is a key factor for the short-term and long-term management of bipolar mood.

COVID-19 Pandemic and BPKIHS: our Situation, Endeavors and Future Direction

Rapid spread of COVID-19 infection reached Nepal in about 1 month of its first appearance in China in December 2019 and affected all spheres of life and society including health and education, like in other countries. We are unprepared for this new menace with many unknown facts and uncertainties when well developed set ups with advanced science and technology also seemed drowned. We attempt here to appraise our situation (condition, trend) and reflect on to the lessons (observations, and messages) that we draw in various major areas of the activities of B. P. Koirala Institute of Health Sciences. We become acutely aware about the adverse effects of this pandemic in its academic, service and research activities along with all other aspects. Amidst the challenges, we were forced to take steps in scattered and trial and error pattern. This pandemic has brought our deficiencies in health system into surface and is offering opportunity to review, revise and reform them. We all the stakeholders, i.e. students, patients, clients, teachers, faculties, staff and authorities are in the same boat;all need to be in healthy, balanced and functional state for fruitful travel. We have certain weaknesses, drawbacks, deficits;and some strengths that we now should realize to move ahead in this COVID era.

COVID-19 across Countries: Situation and Lessons for Pandemic control

In the context of rapid worldwide spread of COVID-19 pandemic, many facts and issues are coming up. Some are general across borders while some others specific to particular context. We intend to review situation (condition, trend) and lessons (observations, and messages) from 9 different countries across the continents (in brief as contributed by respective authors). We have, here, the accounts and observations from Nepal, India, Japan (Asia);Norway and United Kingdom (Europe);United States of America (North America), Ecuador (South America), Australia and South Africa. General fact is that all need to maintain social distancing, adequate testing, aggressive contact tracing and treatment along with strategies to limit movements and crowds (e.g. lockdown). This pandemic has again shown that there is no border for disaster and pestilence. Borders are artificial. We all human being and whole world is a single unit. We have certain weaknesses, drawbacks and deficits as well as strengths that we need to understand and positively stand together in the battle against this pandemic.

COVID-19 testing: Essential for tracking infection and helping authority to overcome the challenges of spread

COVID-19 is mainly transmitted through droplet infection and spread very fast compared to SARS-CoV and MERS-CoV. For the countries, it is important to know at what stage the COVID-19 epidem­ic is? So, as to take appropriate steps to contain the epidemic. This will only be known by testing the suspects and contacts of confirmed cases. If there is poor testing, then most of the infected people may remain undetected, however they could spread the virus to hundreds of other people and potential contacts, which could not be known and quarantined in time continuing the spread. If there is quality assured, highly sensitive and specific testing along with adequate isolation and quarantine, then the spread will be limited. There are two types of tests available for COVID-19: the tests directly detecting the viral ribonucleic acid (RNA) collected in nasopharyngeal or throat swabs, and tests detecting antibodies from the blood sample. At this point in time, the polymerase chain reaction (PCR) tests are used for confirmation of the disease while antibodies tests may provide information regarding the prevalence of infection. World Health Organization advices the countries to increase the testing and get to know the level of epidemic and act accordingly for containment of infection.

Impact of COVID-19 Pandemic on Medical Education: Challenges and Opportunities for Medical educators in South Asia

Corona virus disease-19 (COVID-19) is an acute highly infectious disease primarily involving the respiratory system. The World Health Organization (WHO) declared COVID-19 a global pandemic on March 11, 2020. No proven efficacious drug and no vaccine are available so far for treatment or prophylaxis of COVID-19. Social distancing has been one of the major measures adopted to prevent spread of the disease. Educational institutions have been shut down all over the world for the safety of both students and communities. Social distancing measures hamper students from assembling in learning labs, lecture halls, or small-group rooms and interacting in person. The major response to the pandemic has been to try to move both teaching-learning and assessment online. Schools have also tried to move clinical learning and teaching communication skills online using standardized patients and facilitators. Online education and assessment are not without their challenges, more so in South Asia. Online teaching learning has been a challenge for both faculty members and students, in varying extent. With online learning environments, supervision and support by the teacher may be less and students should have well developed self-regulated learning skills. These challenges have also offered several opportunities, some general to educators, some relatively specific to medical educators, some global in perspective and some local ones. The pandemic offers both educators and students the insight into: how health problems particularly infectious diseases can affect human life and livelihood;and understanding how people respond to it. The pandemic has forced changes in education methods, modality and process, which though may demand extra effort initially, provides teacher, faculty and facilitator the impetus to keep pace with current trends InTechnology. It has offered an opportunity to move to online learning and interaction and use virtual platforms for e-conference, webinars, podcasts, e-class/ e-lectures etc. Pandemic has brought very rapid changes in educational approaches in South Asia, which otherwise would have taken 5-10 years under normal circumstances.