ABSTRACT
Background Background: In March 2020, the WHO declared COVID-19 as a pandemic, and Tunisia implemented a containment and targeted screening strategy. The country's public health policy has since focused on managing hospital beds. Methods The study analyzed the bed occupancy rates in public hospitals in Tunisia during the pandemic. The evolution of daily cases and NPI actions undertaken by the Tunisian Government were also analyzed. The study used three indices to assess bed flexibility: Ramp Duration Until the Peak (RDUP), Ramp Growth Until the Peak (RGUP), and Ramp Rate Until the Peak (RRUP). The study also calculated the time shift at the start and peak of each wave to evaluate the government's response efficacy. Results The study found that the evolution of the epidemic in Tunisia had two phases. The first phase saw the pandemic being controlled due to strong NPI actions, while the second phase saw a relaxation of measures and an increase in wave intensity. ICU bed availability followed the demand for beds, but ICU bed occupancy remained high, with a maximum of 97%. The government's response in terms of bed distribution and reallocation was slow. The study found that the most deadly wave by ICU occupied bed was the third wave due to a historical variant, while the fifth wave due to the delta variant was the most deadly in terms of cumulative death. Conclusions The study concluded that decision-makers could use its findings to assess their response capabilities in the current pandemic and future ones. The study highlighted the importance of flexible and responsive healthcare systems in managing pandemics.
ABSTRACT
Introduction les objectifs de ce travail étaient de décrire le profil clinique et épidémiologique des décès COVID-19 en Tunisie notifié à l´ONMNE (Observatoire National des Maladies Nouvelles et Émergentes) entre le 02 mars 2020 et le 28 février 2021 et de comparer la mortalité COVID-19 enregistrée en Tunisie aux données internationales. Méthodes nous avons mené une étude nationale descriptive longitudinale prospective auprès des données colligées à travers le système national de surveillance de l´infection au SARS-CoV-2 de l´ONMNE, Ministère de la Santé. Tous les décès COVID-19 survenus en Tunisie entre mars 2020 et février 2021 ont été inclus dans cette étude. Les données ont été colligées auprès des structures hospitalières, des municipalités et des directions régionales de la santé. Les notifications des décès ont été collectées à travers différentes sources d´information (méthode de triangulation): les directions régionales de santé, Le ShocRoom (Strategic Health Operations Center ou Centre stratégique d´opérations sanitaires), les structures sanitaires publiques et privés, la Cellule de Crise de la Présidence du Gouvernement, La Direction d´Hygiène et de protection de l´Environnement, le Ministère des Affaires Locales et de l´Environnement, dans le cadre de suivi des cas confirmés par l´équipe de l´ONMNE, les résultats RT-PCR/TDR positifs en post mortem. Résultats durant la période de l´étude, 8051 décès ont été enregistrés soit une mortalité proportionnelle de 10,4%. L´âge médian était de 73 ans avec un intervalle interquartile de 17 ans. Le sex-ratio (M/F) était de 1,8. Le taux brut de mortalité était de 69,1/100 000 habitants et la létalité était de 3,5%. L´étude de la courbe épidémique a montré 2 pics de décès le 29 octobre 2020 et le 22 janvier 2021 avec respectivement 70 et 86 décès notifiés. La distribution spatiale des décès a montré que la région du Sud tunisien avait enregistré le taux de mortalité le plus élevé. Les patients âgés de 65 ans et plus étaient les plus concernés (73,7% des cas) avec un taux brut de mortalité de 570,9/100 000 habitants et une létalité de 13,7%. Conclusion la stratégie de prévention basée sur les mesures de santé publique doit être renforcées par le déploiement rapide de la vaccination anti-COVID-19 surtout pour les populations à risque de décès.
ABSTRACT
Introduction: the purpose of this study was to describe the clinical and epidemiological features of COVID-19-related deaths in Tunisia notified at the ONMNE (National Observatory of New and emerging Diseases) between 2nd March 2020 and 28th February 2021 and to compare COVID-19-related deaths recorded in Tunisia with the international data. Methods: we conducted a national prospective longitudinal descriptive study of data collected from the National Surveillance System of SARS-CoV-2 infection of the ONMNE, Ministry of Health. All COVID-19-related deaths that occurred in Tunisia between March 2020 and February 2021 were included in this study. Data were collected from hospitals, municipalities and regional health departments. Death notifications were collected from multiple data sources (triangulation): The Regional Directorate of Basic Health Care, the ShocRoom (Strategic Health Operations Center), public and private health facilities, the Crisis Unit of the Presidency of the Government, the Directorate for Hygiene and Environmental Protection, the Ministry of Local Affairs and the Environment, as part of the follow-up of confirmed cases by the ONMNE team, positive RT-PCR / TDR post mortem results. Results: during this study, 8051 deaths were recorded, corresponding to a proportional mortality of 10.4%. The median age was 73 years, with an interquartile range of 17 years. Sex-ratio (M/F) was 1.8. The crude death rate was 69.1/100 000 inhabitants and fatality rate was 3.5%. The analysis of the epidemic curve showed 2 peaks of deaths on 29th October 2020 and 22nd January 2021, with 70 and 86 deaths notified respectively. The spatial distribution of mortality showed that the southern Tunisian region had the highest mortality rate. Patients aged 65 and over were most affected (73.7% of cases) with a crude mortality rate of 570.9/100,000 inhabitants and a fatality rate of 13.7%. Conclusion: prevention strategy based on public health measures must be reinforced by the rapid deployment of anti-COVID-19 vaccination, especially for people at risk of death.
Subject(s)
COVID-19 , Humans , Adolescent , Tunisia/epidemiology , Prospective Studies , SARS-CoV-2 , Public HealthABSTRACT
In order to manage the urgent psychological need for support in response to the anticipated reaction of the population to the COVID-19 pandemic, we developed a new psychological crisis intervention model by implementing a centralised psychological support system for all of Tunisia. We set up a helpline which is accessible throughout the country, including those without access to Internet. This model integrates medical students, child and adolescent psychiatrists, psychiatrists, psychologists and social services to provide psychological intervention to the general population and medical staff. It will make a sound basis for developing a more effective psychological crisis intervention response system.