ABSTRACT
Purpose: It has been proposed that patients with intestinal failure (IF) and intestine transplant (IT) are at higher risk of severe complications of COVID-19 due to weakened immunity and comorbidities. Multidisciplinary teams had to adapt their clinical approaches in order to keep these patients as safe as possible during the pandemic. Data is lacking. Method(s): Retrospective, observational, multicenter study performed with 3 surveys to assess COVID-19 practice changes in IF and IT patients. Result(s): 17 centers were included in the analysis;six had a 3 (+/- 4) months moratorium on performing transplant. Nine delayed their routine follow up including "protocol" biopsies. Nine reported decrease in new referrals. Sixteen incorporated telemedicine. Two reported rehabilitation services (home health, PN deliveries) being affected. In the first survey, 10 centers (59%) reported having IF and IT patients with COVID-19. In the other 2 surveys, a total of 25 IF and IT patients were reported positive for COVID-19. Of the 11 IF patients, 8 were male;7 were adults, with a mean age of 60 (+/- 8) years. Nine of them were symptomatic at presentation, with the most prevalent symptoms being fever/chills, cough and sore throat;hospitalization was required in 45.5%, all patients survived. A total of 14 IT patients were positive;8 were female;all of them were adults, mean age: 47 (+/- 16) years. All of them were symptomatic at presentation, with the most prevalent symptoms being fever/chills, dyspnea and cough. Hospitalization was required in 50%. Immunosuppression was discontinued in 1 patient, decreased in 5 (all on tacrolimus), and left unchanged in 8 cases;3 patients (21%) died. Conclusion(s): Many aspects of healthcare have been impacted by the COVID-19 pandemic. Centers adapted to new paradigms in patient care. Despite the availability of telemedicine, hospitals that treat IF and IT patients have found difficulties to sustain an appropriate home care regimen and referrals. IF patients did not have increased mortality, but IT recipients did, with similar results to those reported for other solid organs.
ABSTRACT
Global outbreak of the corona virus disease 2019 (COVID19) has not only challenged the existing healthcare systems but is also a threat to the world economy and stability. In the recent times the world has seen the best healthcare systems collapsing due to the overwhelming burden. Thus, it shows that there have been major lacunae in the pandemic preparedness across the globe. Hence, there is an urgent need to identify the problems, learn from failures and to prepare for future pandemics to reduce the loss of lives and livelihood. In the modern era, blend of public healthcare systems, medical sciences and technology can be put to use to provide solutions. In this article, the authors propose a developmental model of international integrated database software which would connect all the players involved in the management of a pandemic. Better networking and warning system is a key to successful containment of a new viral outbreak.