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1.
IJID Regions ; 2022.
Article in English | ScienceDirect | ID: covidwho-1768189

ABSTRACT

Background The second wave of COVID-19 in South Africa was caused by the Beta variant of SARS-CoV-2. This study aimed to explore clinical and biochemical parameters that could predict COVID-19 patients’ outcome. Methods We conducted a prospective study between 05 November 2020 and 30 April 2021 among confirmed COVID-19 patients admitted to the intensive care unit (ICU) of a tertiary hospital. We used cox proportional hazards model in Stata 16 to assess the risk factors associated with discharge or death. Those factors with p< 0.05 were considered statistically significant. Results We found a significantly ‘low median pH (p<0.001)’, ‘increased median arterial partial pressure of carbon dioxide (p<0.001)’, ‘elevated “D-dimer (p=0.003)’, ‘‘elevated ‘Troponin T (p=0.003)’, ‘N-terminal (NT)-prohormone BNP (p=0.010)’, and ‘C-reactive protein (p = 0.013)’” among COVID-19 patients who died as opposed to those who were discharged. An increased HCO3std was associated with a lower risk of death (HR 0.96, 95%CI: 0.93-0.99). Conclusions The mortality of COVID-19 patients admitted to ICU was associated with elevated D-dimer and TropT, low HCO3std. In addition, patients who died had a shorter duration of ICU stay. Large studies are warranted to increase identification of patient at risk of poor prognosis and improve clinical approach.

2.
Health Syst Reform ; 8(1): e2019571, 2022 Jan 01.
Article in English | MEDLINE | ID: covidwho-1642261

ABSTRACT

Coronavirus disease 2019 (COVID-19) knows no borders and no single approach may produce a successful impact in controlling the pandemic in any country. In Southern Africa, where migration between countries is high mainly from countries within the Southern African Development Community (SADC) countries to South Africa, there is limited understanding of how the COVID-19 crisis is affecting the social and economic life of migrants and migrant communities. In this article, we share reflections on the impact of COVID-19 on people on the move within Southern Africa land border communities, examine policy, practice, and challenges affecting both the cross-border migrants and host communities. This calls for the need to assess whether the current response has been inclusive enough and does not perpetuate discriminatory responses. The lockdown and travel restrictions imposed during the various waves of the COVID-19 pandemic in SADC countries, more so in South Africa where the migrant population is high, denote that most migrants living with other comorbidities especially HIV/TB and who were enrolled in chronic care in their countries of origin were exposed to challenges of access to continued care. Further, migrants as vulnerable groups have low access to COVID-19 vaccines. This made them more vulnerable to deterioration of preexisting comorbidities and increased the risk of migrants becoming infected with COVID-19. It is unfortunate that certain disease outbreaks have been racialized, creating potential xenophobic environments and fear among migrant populations as well as gender inequalities in access to health care and livelihood. Therefore, a successful COVID-19 response and any future pandemics require a "whole system" approach as well as a regional coordinated humanitarian response approach if the devastating impacts on people on the move are to be lessened and effective control of the pandemic ensured.


Subject(s)
COVID-19 , Transients and Migrants , Africa, Southern , COVID-19 Vaccines , Communicable Disease Control , Humans , Pandemics , Policy , SARS-CoV-2
3.
IJID Regions ; 2022.
Article in English | ScienceDirect | ID: covidwho-1639444

ABSTRACT

Background Data on biochemical markers and their association with mortality rates observed in patients with severe COVID-19 disease admitted to Intensive Care Units (ICUs) in sub-Saharan Africa are scanty. We performed an evaluation of baseline routine biochemical parameters as prognostic biomarkers in COVID-19 patients admitted to ICU. Methods Demographic, clinical, and laboratory data were collected prospectively on patients with PCR-confirmed COVID-19 admitted to the adult ICU in a tertiary hospital in Cape Town, South Africa, between October 2020 and February 2021. Robust Poisson regression methods and receiver operating characteristic (ROC) curve were used to explore the association of biochemical parameters with severity and mortality. Results A total of 82 patients [(median age 53.8 years (IQR: 46.4-59.7)] were enrolled, of whom 27 (33%) were male. The median duration of ICU stay was 10 days (IQR: 5-14);54/82 (66% CFR) patients died. Baseline lactate dehydrogenase (LDH) (aRR: 1.002, 95%CI: 1.0004-1.004;P = 0.016) and N-terminal pro B-type natriuretic peptide (NTProBNP) (aRR: 1.0004, 95%CI: 1.0001-1.0007;P = 0.014) were both independent risk factors of a poor prognosis with optimal cut-off values of 449.5 U/L (sensitivity: 1;specificity: 0.43) and 551 pg/mL (sensitivity: 0.49;specificity: 0.86), respectively. Conclusion LDH and NTProBNP appear to be promising predictors of COVID-19 poor prognosis in the ICU. Larger sample size studies are required to confirm the validity of this combination of biomarkers.

5.
Clin Infect Dis ; 73(10): 1913-1919, 2021 11 16.
Article in English | MEDLINE | ID: covidwho-1522140

ABSTRACT

Globally, there are prevailing knowledge gaps in the epidemiology, clinical manifestations, and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among children and adolescents; and these gaps are especially wide in African countries. The availability of robust age-disaggregated data is a critical first step in improving knowledge on disease burden and manifestations of coronavirus disease 2019 (COVID-19) among children. Furthermore, it is essential to improve understanding of SARS-CoV-2 interactions with comorbidities and coinfections such as human immunodeficiency virus (HIV), tuberculosis, malaria, sickle cell disease, and malnutrition, which are highly prevalent among children in sub-Saharan Africa. The African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents is conducting studies across Western, Central, Eastern, and Southern Africa to address existing knowledge gaps. This consortium is expected to generate key evidence to inform clinical practice and public health policy-making for COVID-19 while concurrently addressing other major diseases affecting children in African countries.


Subject(s)
COVID-19 , Coinfection , Tuberculosis , Adolescent , Africa South of the Sahara/epidemiology , Child , Humans , SARS-CoV-2
6.
JAMA Netw Open ; 4(7): e2120295, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1300327

ABSTRACT

Importance: The COVID-19 pandemic is the greatest global test of health leadership of our generation. There is an urgent need to provide guidance for leaders at all levels during the unprecedented preresolution recovery stage. Objective: To create an evidence- and expertise-informed framework of leadership imperatives to serve as a resource to guide health and public health leaders during the postemergency stage of the pandemic. Evidence Review: A literature search in PubMed, MEDLINE, and Embase revealed 10 910 articles published between 2000 and 2021 that included the terms leadership and variations of emergency, crisis, disaster, pandemic, COVID-19, or public health. Using the Standards for Quality Improvement Reporting Excellence reporting guideline for consensus statement development, this assessment adopted a 6-round modified Delphi approach involving 32 expert coauthors from 17 countries who participated in creating and validating a framework outlining essential leadership imperatives. Findings: The 10 imperatives in the framework are: (1) acknowledge staff and celebrate successes; (2) provide support for staff well-being; (3) develop a clear understanding of the current local and global context, along with informed projections; (4) prepare for future emergencies (personnel, resources, protocols, contingency plans, coalitions, and training); (5) reassess priorities explicitly and regularly and provide purpose, meaning, and direction; (6) maximize team, organizational, and system performance and discuss enhancements; (7) manage the backlog of paused services and consider improvements while avoiding burnout and moral distress; (8) sustain learning, innovations, and collaborations, and imagine future possibilities; (9) provide regular communication and engender trust; and (10) in consultation with public health and fellow leaders, provide safety information and recommendations to government, other organizations, staff, and the community to improve equitable and integrated care and emergency preparedness systemwide. Conclusions and Relevance: Leaders who most effectively implement these imperatives are ideally positioned to address urgent needs and inequalities in health systems and to cocreate with their organizations a future that best serves stakeholders and communities.


Subject(s)
COVID-19 , Health Personnel , Leadership , Pandemics , Consensus , Disaster Planning , Health Personnel/legislation & jurisprudence , Health Personnel/organization & administration , Humans , Models, Organizational , SARS-CoV-2
7.
Respiration ; 100(8): 811-815, 2021.
Article in English | MEDLINE | ID: covidwho-1247454

ABSTRACT

The radiological findings of COVID-19 are well-described, including its evolution. In an earlier report of admission chest radiographs of patients with COVID-19, we anecdotally noted relative sparing of the left upper zone (LUZ). We subsequently aimed to describe the main chest radiograph findings in another cohort, focusing on zonal predominance. The admission chest radiographs of 111 patients with CO-VID-19 pneumonia requiring intensive care admission were reviewed by 2 thoracic radiologists and categorized according to the predominant pattern into either ground-glass opacities (GGOs), alveolar infiltrates and/or consolidation, or reticular and/or nodular infiltrates or an equal combination of both, and the extent of disease involvement of each of the zones using a modified Radiologic Assessment of Lung Edema (RALE) score. Parenchymal changes were detected in all. In total, 106 radiographs showed GGOs, alveolar infiltrates, and/or consolidation, and 5 had a combination of reticular/nodular infiltrates as well as GGOs, alveolar infiltrates, and/or consolidation. The LUZ had a significant lower grading score than the right upper zone: 1 versus 2 (p < 0.001). Likewise, the upper zones had a significant lower score than the mid and lower zones (p < 0.001). Our findings confirmed the relative sparing of the LUZ in severe COVID-19 pneumonia.


Subject(s)
COVID-19/diagnostic imaging , Lung/diagnostic imaging , Cohort Studies , Female , Humans , Male , Middle Aged , Radiography, Thoracic
8.
Clin Infect Dis ; 73(10): 1913-1919, 2021 11 16.
Article in English | MEDLINE | ID: covidwho-1083754

ABSTRACT

Globally, there are prevailing knowledge gaps in the epidemiology, clinical manifestations, and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among children and adolescents; and these gaps are especially wide in African countries. The availability of robust age-disaggregated data is a critical first step in improving knowledge on disease burden and manifestations of coronavirus disease 2019 (COVID-19) among children. Furthermore, it is essential to improve understanding of SARS-CoV-2 interactions with comorbidities and coinfections such as human immunodeficiency virus (HIV), tuberculosis, malaria, sickle cell disease, and malnutrition, which are highly prevalent among children in sub-Saharan Africa. The African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents is conducting studies across Western, Central, Eastern, and Southern Africa to address existing knowledge gaps. This consortium is expected to generate key evidence to inform clinical practice and public health policy-making for COVID-19 while concurrently addressing other major diseases affecting children in African countries.


Subject(s)
COVID-19 , Coinfection , Tuberculosis , Adolescent , Africa South of the Sahara/epidemiology , Child , Humans , SARS-CoV-2
9.
BMC Infect Dis ; 20(1): 744, 2020 Oct 09.
Article in English | MEDLINE | ID: covidwho-841007

ABSTRACT

BACKGROUND: The triple burden of COVID-19, tuberculosis and human immunodeficiency virus is one of the major global health challenges of the twenty-first century. In high burden HIV/TB countries, the spread of COVID-19 among people living with HIV is a well-founded concern. A thorough understanding of HIV/TB and COVID-19 pandemics is important as the three diseases interact. This may clarify HIV/TB/COVID-19 as a newly related field. However, several gaps remain in the knowledge of the burden of COVID-19 on patients with TB and HIV. This study was conducted to review different studies on SARS-CoV, MERS-CoV or COVID-19 associated with HIV/TB co-infection or only TB, to understand the interactions between HIV, TB and COVID-19 and its implications on the burden of the COVID-19 among HIV/TB co-infected or TB patients, screening algorithm and clinical management. METHODS: We conducted an electronic search of potentially eligible studies published in English in the Cochrane Controlled Register of Trials, PubMed, Medrxiv, Google scholar and Clinical Trials Registry databases. We included case studies, case series and observational studies published between January, 2002 and July, 2020 in which SARS-CoV, MERS-CoV and COVID-19 co-infected to HIV/TB or TB in adults. We screened titles, abstracts and full articles for eligibility. Descriptive and meta-analysis were done and results have been presented in graphs and tables. RESULTS: After removing 95 duplicates, 58 out of 437 articles were assessed for eligibility, of which 14 studies were included for descriptive analysis and seven studies were included in the meta-analysis. Compared to the descriptive analysis, the meta-analysis showed strong evidence that current TB exposure was high-risk COVID-19 group (OR 1.67, 95% CI 1.06-2.65, P = 0.03). The pooled of COVID-19/TB severity rate increased from OR 4.50 (95% CI 1.12-18.10, P = 0.03), the recovery rate was high among COVID-19 compared to COVID-19/TB irrespective of HIV status (OR 2.23, 95% CI 1.83-2.74, P < 0.001) and the mortality was reduced among non-TB group (P < 0.001). CONCLUSION: In summary, TB was a risk factor for COVID-19 both in terms of severity and mortality irrespective of HIV status. Structured diagnostic algorithms and clinical management are suggested to improve COVID-19/HIV/TB or COVID-19/TB co-infections outcomes.


Subject(s)
Coinfection/epidemiology , Coronavirus Infections/epidemiology , Global Health/statistics & numerical data , HIV Infections/epidemiology , Pneumonia, Viral/epidemiology , Tuberculosis/epidemiology , Betacoronavirus , COVID-19 , Coronavirus Infections/mortality , Humans , Pandemics , Pneumonia, Viral/mortality , Prevalence , Registries , Risk Factors , SARS-CoV-2
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