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1.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-309776

ABSTRACT

Background: COVID-19 infection is characterized by its heterogeneity in clinical presentation. Hospital admission, intensive care unit (ICU) admission and mortality rates have shown wide variations throughout the months. Colombia experienced a high rate of COVID-19 infection, leading to significant morbidity and mortality. To date, there are only a few studies reporting peak variations. Therefore, we aimed to explore the potential reasons for epidemiological changes in COVID-19 with time. Methods This study was conducted at a tertiary referral center in Cartagena, Colombia, between March 7, 2020, and February 28, 2021. We included patients aged > 18 years with suspected or confirmed COVID-19. A diagnosis was made using the reverse-transcriptase polymerase chain reaction (RT-PCR) test. We extracted information from the Colombian National Surveillance System (SIVIGILA). We collected demographic data, such as age, sex, RT-PCR test results, and information on close contacts (awareness of the disease). We categorized the study period into two according to the two peaks defined in Colombia: the first period included weeks 10–35 (March 7–August 30, 2020), and the second period included weeks 36–60 (September 1, 2020-February 28, 2021). We adjusted the weekly overall mortality by covariates to identify potential changes during the pandemic. Results In total, 2761 COVID-19 patients were hospitalized at our institution. The most significant number of cases occurred in the first and second periods during week 21 (peak 1 : 121 patients) and week 50 (peak 2 : 128 patients), respectively.

2.
Graefes Arch Clin Exp Ophthalmol ; 259(3): 567-574, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1060218

ABSTRACT

PURPOSE: Following the first wave of the COVID-19 pandemic in early 2020, the easing of strict measures to reduce its spread has led to a resurgence of cases in many countries at both the national and local level. This article addresses how guidance for ophthalmologists on managing patients with retinal disease receiving intravitreal injections of anti-vascular endothelial growth factor (VEGF) during the pandemic should be adapted to the local epidemic pressure, with more or less stringent measures implemented according to the ebb and flow of the pandemic. METHODS: The Vision Academy's membership of international retinal disease experts analyzed guidance for anti-VEGF intravitreal injections during the COVID-19 pandemic and graded the recommendations according to three levels of increasing epidemic pressure. The revised recommendations were discussed, refined, and voted on by the 14-member Vision Academy Steering Committee for consensus. RESULTS: Protocols to minimize the exposure of patients and healthcare staff to COVID-19, including use of personal protective equipment, physical distancing, and hygiene measures, should be routinely implemented and intensified according to local infection rates and pressure on the hospital/clinic or healthcare system. In areas with many COVID-19-positive clusters, additional measures including pre-screening of patients, postponement of non-urgent appointments, and simplification of complex intravitreal anti-VEGF regimens should be considered. Treatment prioritization for those at greatest risk of irreversible vision loss should be implemented in areas where COVID-19 cases are increasing exponentially and healthcare resources are strained. CONCLUSION: Consistency in monitoring of local infection rates and adjustment of clinical practice accordingly will be required as we move forward through the COVID-19 era. Ophthalmologists must continue to carefully weigh the risk-benefits to minimize the exposure of patients and healthcare staff to COVID-19, ensure that patients receive sight-saving treatment, and avoid the potential long-term impact of prolonged treatment postponement.


Subject(s)
Angiogenesis Inhibitors/administration & dosage , COVID-19/epidemiology , SARS-CoV-2 , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Disease Transmission, Infectious/prevention & control , Humans , Intravitreal Injections , Personal Protective Equipment , Practice Guidelines as Topic , Retinal Diseases/drug therapy
3.
Graefes Arch Clin Exp Ophthalmol ; 258(6): 1149-1156, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-121183

ABSTRACT

PURPOSE: There is an urgent need to address how to best provide ophthalmic care for patients with retinal disease receiving intravitreal injections with anti-vascular endothelial growth factor agents during the ongoing global COVID-19 pandemic. This article provides guidance for ophthalmologists on how to deliver the best possible care for patients while minimizing the risk of infection. METHODS: The Vision Academy's Steering Committee of international retinal disease experts convened to discuss key considerations for managing patients with retinal disease during the COVID-19 pandemic. After reviewing the existing literature on the issue, members put forward recommendations that were systematically refined and voted on to develop this guidance. RESULTS: The considerations focus on the implementation of steps to minimize the exposure of patients and healthcare staff to COVID-19. These include the use of personal protective equipment, adherence to scrupulous hygiene and disinfection protocols, pre-screening to identify symptomatic patients, and reducing the number of people in waiting rooms. Other important measures include triaging of patients to identify those at the greatest risk of irreversible vision loss and prioritization of treatment visits over monitoring visits where possible. In order to limit patient exposure, ophthalmologists should refrain from using treatment regimens that require frequent monitoring. CONCLUSION: Management of patients with retinal disease receiving intravitreal injections during the COVID-19 pandemic will require adjustment to regular clinical practice to minimize the risk of exposure of patients and healthcare staff, and to prioritize those with the greatest medical need. The safety of patients and healthcare staff should be of paramount importance in all decision-making.


Subject(s)
Coronavirus Infections/prevention & control , Intravitreal Injections , Ophthalmology/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Retinal Diseases/drug therapy , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Betacoronavirus , COVID-19 , Disinfection , Humans , Personal Protective Equipment , SARS-CoV-2
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