Potential pandemic pathogens series: MERS virus

In the last two years we have experienced the effects of the COVID-19 pandemic in our lives and hospitals. Pandemics are part of the history of humanity and we can be certain that in the future new pandemics will appear. In fact, due to the growth in the human population, increased travel and global warming, it is to be expected that new pandemic pathogens will arise more frequently than before. Additionally, decreased barriers between animals and humans will give rise to spillover events, which will result in the introduction of new zoonotic pathogens in humans. In each of the parts of this series we will, in a short format, highlight a potential pandemic pathogen and describe its characteristics, history and potential for global pandemics. This part of the series focusses on MERS-CoV infection which, up until now, has been fairly contained in a small part of the world but definitely has traits that make it a pathogen to watch. As in previous parts of this series, we will highlight its clinical picture and explain why it should not be underestimated.

Potential pandemic pathogens series: Crimean-Congo haemorrhagic fever

In the last two years we have experienced the effects of the COVID-19 pandemic in our lives and hospitals. Pandemics are part of the history of humanity and we can be certain that in the future new pandemics will appear. In fact, due to the growth in the human population, increased travel and global warming, it is to be expected that new pandemic pathogens will arise more frequently than before. Additionally, decreased barriers between animals and humans will give rise to spillover events, which will result in the introduction of new zoonotic pathogens in humans. In each of the parts of this series we will, in a short format, highlight a potential pandemic pathogen and describe its characteristics, history and potential for global pandemics. This part of the series focusses on the Crimean-Congo haemorrhagic fever virus. Crimean-Congo haemorrhagic fever is a tick-borne disease, which is generally found in workers at farms and slaughterhouses and sometimes causes small outbreaks in families or hospital personal, as it can be spread by body fluids. Symptoms are unspecific, including myalgia, headache and fever. The disease course is often mild, but in patients who develop a haemorrhagic phase, the fatality rate is high. Treatment is primarily supportive but antiviral therapy including favipiravir and ribavirin are under investigation.

Potential pandemic pathogens series: Nipah virus

In the last two years we have experienced the effects of the COVID-19 pandemic in our lives and hospitals. Pandemics are part of the history of humanity and we can be certain that in the future new pandemics will appear. In fact, due to the growth in the human population, increased travel and global warming, it is to be expected that new pandemic pathogens will arise more frequently than before. Additionally, decreased barriers between animals and humans will give rise to spillover events which may result in the introduction of new zoonotic pathogens in humans. In each of the parts of this series we will, in a short format, highlight a potential pandemic pathogen and describe its characteristics, history and potential for global pandemics. In this part of the series we focus on the Nipah virus. Nipah virus is currently on the WHO’s list of global priority pathogens as it possesses pandemic properties, is highly infectious and potentially fatal. Here we explore the past, present and future of Nipah virus.

Potential pandemic pathogens series: Zika virus

In the last two years we have experienced the effects of the COVID-19 pandemic in our lives and hospitals. Pandemics are part of the history of humanity and we can be certain that in the future new pandemics will appear. In fact, due to the growth in the human population, increased travel and global warming, it is to be expected that new pandemic pathogens will arise more frequently than before. Additionally, decreased barriers between animals and humans which will give rise to spillover events which will result in the introduction of new zoonotic pathogens in humans. In each of the parts of this series we will, in a short format, highlight a potential pandemic pathogen and describe its characteristics, history and potential for global pandemics. This part of the series is devoted to the Zika virus (ZIKV). We describe the history of ZIKV, the clinical picture and finally, we conclude with a discussion about the pandemic risk of ZIKV infection.

How medical students in a COVID-19 command centre improve communication and decrease physician workload

Last year the global community was confronted with COVID-19, a rapidly spreading pandemic disease. Hospitals had to cope with an increasing number of infectious patients, at times overwhelming their capacity. To prevent further transmission of the coronavirus, several protective measures had to be taken, such as the setup of large quarantine admission cohorts in hospitals, including in intensive care units (ICUs), and the use of personal protective equipment (PPE). The shear load of patients as well as these protective measures brought along certain difficulties for the staff working on the ICUs. Healthcare workers experienced problems in communication due to the mandatory strict use of PPE precluding easy access to cell phones and computers. Also, the increased workload restricted time for individual patient care. Hence, a different approach to the way we delivered our care was required. In this short report we describe the implementation of a student-managed command centre at Leiden University Medical Centre, which was designed to reduce the workload of our clinical staff and to increase the quality and ease of communication.

Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis.

INTRODUCTION: We recently reported a high cumulative incidence of thrombotic complications in critically ill patients with COVID-19 admitted to the intensive care units (ICUs) of three Dutch hospitals. In answering questions raised regarding our study, we updated our database and repeated all analyses. METHODS: We re-evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE), deep-vein thrombosis, ischemic stroke, myocardial infarction and/or systemic arterial embolism in all COVID-19 patients admitted to the ICUs of 2 Dutch university hospitals and 1 Dutch teaching hospital from ICU admission to death, ICU discharge or April 22nd 2020, whichever came first. RESULTS: We studied the same 184 ICU patients as reported on previously, of whom a total of 41 died (22%) and 78 were discharged alive (43%). The median follow-up duration increased from 7 to 14 days. All patients received pharmacological thromboprophylaxis. The cumulative incidence of the composite outcome, adjusted for competing risk of death, was 49% (95% confidence interval [CI] 41-57%). The majority of thrombotic events were PE (65/75; 87%). In the competing risk model, chronic anticoagulation therapy at admission was associated with a lower risk of the composite outcome (Hazard Ratio [HR] 0.29, 95%CI 0.091-0.92). Patients diagnosed with thrombotic complications were at higher risk of all-cause death (HR 5.4; 95%CI 2.4-12). Use of therapeutic anticoagulation was not associated with all-cause death (HR 0.79, 95%CI 0.35-1.8). CONCLUSION: In this updated analysis, we confirm the very high cumulative incidence of thrombotic complications in critically ill patients with COVID-19 pneumonia.

Incidence of thrombotic complications in critically ill ICU patients with COVID-19.

INTRODUCTION: COVID-19 may predispose to both venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilisation and diffuse intravascular coagulation. Reports on the incidence of thrombotic complications are however not available. METHODS: We evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE), deep-vein thrombosis, ischemic stroke, myocardial infarction or systemic arterial embolism in all COVID-19 patients admitted to the ICU of 2 Dutch university hospitals and 1 Dutch teaching hospital. RESULTS: We studied 184 ICU patients with proven COVID-19 pneumonia of whom 23 died (13%), 22 were discharged alive (12%) and 139 (76%) were still on the ICU on April 5th 2020. All patients received at least standard doses thromboprophylaxis. The cumulative incidence of the composite outcome was 31% (95%CI 20-41), of which CTPA and/or ultrasonography confirmed VTE in 27% (95%CI 17-37%) and arterial thrombotic events in 3.7% (95%CI 0-8.2%). PE was the most frequent thrombotic complication (n = 25, 81%). Age (adjusted hazard ratio (aHR) 1.05/per year, 95%CI 1.004-1.01) and coagulopathy, defined as spontaneous prolongation of the prothrombin time > 3 s or activated partial thromboplastin time > 5 s (aHR 4.1, 95%CI 1.9-9.1), were independent predictors of thrombotic complications. CONCLUSION: The 31% incidence of thrombotic complications in ICU patients with COVID-19 infections is remarkably high. Our findings reinforce the recommendation to strictly apply pharmacological thrombosis prophylaxis in all COVID-19 patients admitted to the ICU, and are strongly suggestive of increasing the prophylaxis towards high-prophylactic doses, even in the absence of randomized evidence.