ABSTRACT
The COVID-19 pandemic has challenged nations states across the world. They have implemented lockdown and social distancing and with the development of vaccines have gone to great lengths to build herd immunity for their populations. As place managers, local government has played a variety of roles supporting central government edicts related to social distancing and supporting local businesses impacted by lockdowns. The research reported here comparing the role local government has played in Australia, Canada, Italy, and New Zealand shows that they have at different times and for different issues been policy takers from central government, policy shapers, and policy makers adapting national strategies. Local government plays an important complementary role with central governments in both unitary and federal systems of government. The paper contributes to the literature on multi-level governance, place-based decision-making, and disaster and emergency management by offering a framework for analysing municipal roles in crises management both in their relationship with higher layers of government and in their acting as locally placed organisations. Points for practitioners: Cross-national study: Australia, Canada, Italy, and New Zealand. Examination of local government responses to COVID-19 pandemic as policy makers, takers, or shapers. Comparison of federal and unitary states. © 2023 The Authors. Australian Journal of Public Administration published by John Wiley & Sons Australia, Ltd on behalf of Institute of Public Administration Australia.
ABSTRACT
Older people are at a higher risk of serious illness and death from the COVID-19 disease due to physiological changes of ageing and potential underlying health conditions. In the last years, there has been an increase in the elderly population admitted to the intensive care unit (ICU) and the proportion of the very old (85 years or over) critically ill patients is very high especially during the COVID-19 crisis. The care of older patients often determines ethical and practical challenges both before and during admission to intensive care. Therefore a decision-making process of selection in the clinical pathway is necessary. This decision-making process requires some skills like remarkable knowledge of ageing and its consequences on the normal function of organs, competence in comprehensive geriatric assessment and good communication ability with the family and other caregivers. For these reasons, an approach based on comprehensive geriatric assessment (CGA) and the identification of levels of "frailty" becomes essential in the decision-making process to guarantee the most appropriate levels of care both in a critical area and in the long-term or palliative care in accordance, when it is possible, with the wishes and individual needs of the older patient. The mission of Geriatrics is to identify and to treat older patients maximally benefiting of goal-oriented, tailored, multidisciplinary interventions and to identify patients at risk of poor outcomes such as the "very frail" elderly to guarantee the best possible quality of life and avoid unnecessary treatment. When no benefit of treatments can be obtained, palliative care should be considered. © Springer Nature Switzerland AG 2020.
ABSTRACT
Even though COVID infection-19 mainly affected older adults (average age of 80 years according to data from the ISS-National Institute of Health), most of them were managed outside the hospital setting within services of Primary Care Department of Health Authority and Services of Modena and through the activation of specific care models. In this chapter, we discuss the possibility of care for older patients with COVID-19 in primary care settings such as Community Hospital, Nursing Home or Long-Term Care Facility (including special care unit for people with dementia) and home care through the experiences of the Special Continuity of Care Unit (USCA). Many people with COVID-19 who do not require hospitalisation may need home care, and those who are hospitalised with the virus will need home care post-discharge. Some older adults, less willing to move into nursing homes given many deaths in these settings, may opt for home care. The experience described with the care pathway for COVID-19 in a nursing home has allowed us, after the first even more severe cases which causes deaths, also not only to contain the spread of infection (in our network only n° 16 out of a total of n° 52 Nursing Homes has cases of COVID-19) but also to be able to treat and monitor the older people within these services. © Springer Nature Switzerland AG 2020.
ABSTRACT
BACKGROUND: Blood coagulation alterations are frequent in patients with Coronavirus disease 2019 (COVID-19), particularly in those with severe forms. We investigated the association between standard parameters of coagulation and in-hospital mortality in COVID-19. METHODS: Demographic, clinical and laboratory data at hospital admission, including prothrombin time (PT), international normalized rate (INR), activated thromboplastin time (aPTT), and D-dimer were retrospectively collected in a consecutive series of 309 COVID-19 hospitalized patients. The associations between parameters of coagulation and in-hospital mortality were investigated with receiver operating characteristics (ROC), multiple regression and Kaplan- Meyer analyses. RESULTS: In the overall population, 220 (71.2%) patients were discharged alive, whereas the remaining 89 (28.8%) died. Non-survivors had significantly higher INR (median: 1.20;IQR: 1.03-1.32 vs. 1.06;IQR: 1.02-1.11, P<0.001), PT (median: 12.0 sec;IQR: 11.1-14.0 vs. 11.4 sec;IQR: 11.0-11.9, P<0.001), aPTT (median: 25.1 sec;IQR: 22.7-29.6 vs. 23.4 sec;IQR: 21.4-25.1, P<0.001) and D-dimer (median: 1.36 μg/mL;IQR: 0.87-4.11 vs. 0.77 μg/mL;IQR: 0.43-1.58, P<0.001). In multivariate Cox regression analysis, both the INR (HR=1.8459;95% CI: 1.0713-3.1806, P=0.027) and PT (HR=1.071;95% CI: 1.0132-1.1303, P=0.015), but not the aPTT and D-dimer, remained independently associated with survival. CONCLUSIONS: Both the PTand INRare independently associated with in-hospital mortality in COVID-19. The clinical utility of these parameters for risk stratification warrants further investigations.