ABSTRACT
Introduction: Shab Teaching Hospital is a tertiary referral center for cardiology and cardio-thoracic surgery, located in Khartoum, the capital of Sudan. It provides emergency room (ER) services to cardiac patients as well as being a nationwide major referral center. Furthermore, it has a very active cardiac catheterization laboratory ( cath lab) performing coronary and valvular interventions as well as implanting cardiac devices. The COVID-19 pandemic had major impact on medical services in the country, and hospitals had to cope with unprecedented challenges. The first COVID-19 case was confirmed in Sudan on the 13th of March, 2020 and that was followed by major disruptions in the healthcare services especially for non-covid emergencies, a phenomenon seen worldwide. Objectives: To study the impact of COVID-19 on the emergency and cardiac catheterization services especially for acute MI ( acute myocardial infarction) Methods: This a retrospective hospital based study conducted at Shab Teaching Hospital. Data on total ER visits and MI admissions were collected for the months of April, May and June for the years 2019, 20202, and 2021. The volume of coronary angiographies and percutaneous coronary interventions for MI were also collected for the same periods. Results: The average monthly ER visits ( April, May and June) for the years 2019, 2020 and 2021 were 24,252, 25,548 and 31,889 per month respectively. Average monthly admissions for MI for 2019, 2020 and 2021 were 1603, 965 and 2,251 per month respectively . During the months of April , May and June of 2019, 2020 and 2021 the average number of diagnostic coronary angiograms, were 495, 186, and 408 per month respectively whereas average PCI volumes were 195,109, and 164 per month respectively . Conclusion: Cardiac emergency and interventional services at Shab Teaching hospital continued even at the height of the epidemic . Significant drop in emergency department visits was seen for MI in 2020 followed by a strong rebound and increase from pre-COVID 19 level in 2021. This may represent a delayed effect of patients avoiding ER visits during the peak of the epidemic. Regarding cardiac catheterization volumes and PCI for MI, there was also a significant drop in 2020 with partial rebound in 2021.
ABSTRACT
Disproportionately few clinical trials are undertaken on the African continent, in part due to lingering neocolonial attitudes in the Global North which keep research activity primarily in developing countries, while being skeptical of the abilities of those in the Global South to undertake organized clinical studies. In the era of the COVID-19 pandemic, applicable research and clinical trials should be undertaken in relevant populations in order to extrapolate to a population level. This is all the more important in Africa, which has a rich genetic diversity. We suggest that a lack of organized research ethics committees across the continent and a deficiency of appropriate training are responsible in part for the reluctance of clinical trial organizers in the developed countries of the Global North to engage with medical leadership in Africa. We consider ways of alleviating this problem, including suggesting a pan-continental surveillance of ethics committee agendas and of training, either through the auspices of the African Union or the World Health Organization. In addition, medical leadership in African nations must be encouraged to take ownership of their medical ethics agendas to facilitate decent international clinical trial participation for the good of the continent as a whole.