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1.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-319106

ABSTRACT

Background: Purposefully designed and validated screening, triage, and severity scoring tools are needed to reduce mortality of COVID-19 in low-resource settings (LRS). This review aimed to identify currently proposed and/or implemented methods of screening, triaging, and severity scoring suspected COVID-19 patients upon initial presentation to the healthcare system, and to evaluate the utility of these tools in LRS. Methods: A scoping review was conducted to identify studies describing screening, triage, and severity scoring of suspected COVID-19 patients published between December 12, 2019 and September 01, 2020. Extracted information included clinical features, use of laboratory and imaging studies, and relevant tool validation data. Findings: The initial search strategy yielded 14,350 articles. A total of 93 manuscripts met inclusion criteria. Most studies were from China (n=37, 39.8%) or the United States (n=15, 16·1%). In total, 51 screening, 39 severity scoring tools, and 20 triage tools were described;13 of these – nine for screening, two for triage, and two for severity scoring – were identified as feasible in LRS and were being used in such settings. A total of 31 studies provided validation data: four prospective and 27 retrospective, with none from low-income and lower-middle-income countries. Interpretation: This study identified a wide range of screening, triage, and severity scoring tools implemented and proposed for suspected COVID-19 patients. No tools were designed and validated in LRS. A tool specific to resource limited context is crucial to reducing mortality in the current pandemic. Funding: No funding was received for this study.Declaration of Interests: The authors declare no competing interests.

2.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-319105

ABSTRACT

Background: In low-resource settings (LRS), a COVID-19 severity scoring tool could ensure timely access to appropriate care and guide use of critically limited resources. We systematically evaluated existing literature for associations between COVID-19 illness severity, and historical characteristics, clinical presentations, and investigations measurable in LRS. Methods: A systematic review of four databases from December 01, 2019 to June 01, 2020 identified all studies assessing potential associations between clinical characteristics and investigations, and illness severity. Data for all variables that were statistically analysed in relation to COVID-19 disease severity were extracted. A meta-analysis was conducted to generate pooled estimates of odds ratios (pORs). This review was registered with PROSPERO (CRD42020178098). Findings: Of 8402 relevant articles, 79 were eligible for inclusion, analysing 27713 patients with laboratory-confirmed COVID-19. A total of 202 features were analysed in relation to COVID-19 severity. Of these, 81 were deemed feasible for assessment in LRS: appropriate data were available for meta-analysis of 44 (54·3%). Meta-analysis identified 19 significant predictors of severe COVID-19, including: stroke (pOR: 3.08 (95% CI [1.95, 4.88])), shortness of breath (pOR: 2·78 (95% CI [2·24-3·46])), and chronic kidney disease (pOR: 2.55 (95% CI [1.52-4.29])). I 2 testing suggested substantial heterogeneity across samples. Interpretation: We identified multiple variables predictive of severe COVID-19. Due to the novelty of the disease, there is currently no prognostication tool purpose-designed and validated for LRS. Findings may inform such a tool that can offer guidance on clinical treatment and disposition, ultimately reducing morbidity and mortality due to the pandemic. Funding: No funding was received for this study.Declaration of Interests: The authors declare no competing interests.

3.
PLoS One ; 17(1): e0262020, 2022.
Article in English | MEDLINE | ID: covidwho-1643252

ABSTRACT

BACKGROUND: Informed consent is an essential prerequisite for enrolling patients into a study. Obtaining informed consent in an emergency is complex and often impossible. Delayed consent has been suggested for emergency care research. This study aims to determine the acceptability of prehospital emergency care research with delayed consent in the Western Cape community of South Africa. METHODS: This study was an online survey of a stratified, representative sample of community members in the Western Cape province of South Africa. We calculated a powered sample size to be 385, and a stratified sampling method was employed. The survey was based on similar studies and piloted. Data were analysed descriptively. RESULTS: A total of 807 surveys were returned. Most respondents felt that enrolment into prehospital research would be acceptable if it offered direct benefit to them (n = 455; 68%) or if their condition was life-threatening and the research would identify improved treatment for future patients with a similar condition (n = 474; 70%). Similar results were appreciable when asked about the participation of their family member (n = 445; 66%) or their child (n = 422; 62%) regarding direct prospects of benefit. Overwhelmingly, respondents indicated that they would prefer to be informed of their own (n = 590; 85%), their family member's (n = 593; 84%) or their child's (n = 587; 86%) participation in a study immediately or as soon as possible. Only 35% (n = 283) agreed to retention data of deceased patients without the next of kin's consent. CONCLUSION: We report majority agreement of respondents for emergency care research with delayed consent if the interventions offered direct benefit to the research participant, if the participant's condition was life-threatening and the work held the prospect of benefit for future patients, and if the protocol for delayed consent was approved by a human research ethics committee. These results should be explored using qualitative methods.


Subject(s)
Emergency Medical Services , Informed Consent , Cross-Sectional Studies , Family , Female , Humans , Male , South Africa , Surveys and Questionnaires
4.
Afr J Prim Health Care Fam Med ; 13(1): e1-e9, 2021 Dec 09.
Article in English | MEDLINE | ID: covidwho-1580227

ABSTRACT

BACKGROUND: The coronavirus pandemic has put extreme pressure on health care services in South Africa. AIM: To describe the design, patients and outcomes of a field hospital during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. SETTING: The Cape Town International Convention Centre was the first location in Cape Town to be commissioned as a field hospital that would serve as an intermediate care bed facility. METHODS: This was a retrospective descriptive study of patients admitted to this facility between 8th June 2020 and 14th August 2020 using deidentified data extracted from patient records. RESULTS: There were 1502 patients admitted, 56.4% female, with a mean age of 58.6 years (standard deviation [s.d.]: 14.2). The majority of patients (82.9%) had at least one comorbidity, whilst 15.4% had three or more. Nearly 80.0% (79.8%) of patients required oxygen and 63.5% received steroids, and only 5.7% of patients were required to be transferred for escalation of care. The mean length of stay was 6 days (s.d.: 4.8) with an overall mortality of 5.7%. CONCLUSION: This study highlights the role of a field hospital in providing surge capacity. Its use halved the predicted duration of stay at acute care hospitals, allowing them the capacity to manage more unstable and critical patients. Adaptability and responsivity as well as adequate referral platforms proved to be crucial. Daily communication with the whole health care service platform was a critical success factor. This study provides information to assist future health planning and strategy development in the current pandemic and future disease outbreaks.


Subject(s)
COVID-19 , Female , Humans , Male , Middle Aged , Mobile Health Units , Retrospective Studies , SARS-CoV-2 , South Africa/epidemiology , United States
5.
2021.
Preprint in English | Other preprints | ID: ppcovidwho-295925

ABSTRACT

Background Globally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients are often overlooked in health systems. Essential Emergency and Critical Care (EECC) has been devised as the care that should be provided to all critically ill patients in all hospitals in the world. EECC includes the effective care of low cost and low complexity for the identification and timely treatment of critically ill patients across all medical specialities. This study aimed to specify the content of EECC and additionally, given the surge of critical illness in the ongoing pandemic, the essential diagnosis-specific care for critically ill patients with COVID-19. Methods A Delphi process was conducted to seek consensus (>90% agreement) in a diverse panel of global clinical experts. The panel was asked to iteratively rate proposed treatments and actions based on previous guidelines and the WHO/ICRC’s Basic Emergency Care. The output from the Delphi was adapted iteratively with specialist reviewers into a coherent and feasible EECC package of clinical processes plus a list of hospital resource requirements. Results The 269 experts in the Delphi panel had clinical experience in different acute medical specialties from 59 countries and from all resource settings. The agreed EECC package contains 40 clinical processes and 67 hospital readiness requirements. The essential diagnosis-specific care of critically ill COVID-19 patients has an additional 7 clinical processes and 9 hospital readiness requirements. Conclusion The study has specified the content of the essential emergency and critical care that should be provided to all critically ill patients. Implementation of EECC could be an effective strategy to reduce preventable deaths worldwide. As critically ill patients have high mortality rates, especially where trained staff or resources are limited, even small improvements would have a large impact on survival. EECC has a vital role in the effective scale-up of oxygen and other care for critically ill patients in the COVID-19 pandemic. Policy makers should prioritise EECC, increase its coverage in hospitals, and include EECC as a component of universal health coverage.

6.
BMJ Glob Health ; 6(9)2021 09.
Article in English | MEDLINE | ID: covidwho-1435044

ABSTRACT

BACKGROUND: Globally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients are often overlooked in health systems. Essential Emergency and Critical Care (EECC) has been devised as the care that should be provided to all critically ill patients in all hospitals in the world. EECC includes the effective care of low cost and low complexity for the identification and treatment of critically ill patients across all medical specialties. This study aimed to specify the content of EECC and additionally, given the surge of critical illness in the ongoing pandemic, the essential diagnosis-specific care for critically ill patients with COVID-19. METHODS: In a Delphi process, consensus (>90% agreement) was sought from a diverse panel of global clinical experts. The panel iteratively rated proposed treatments and actions based on previous guidelines and the WHO/ICRC's Basic Emergency Care. The output from the Delphi was adapted iteratively with specialist reviewers into a coherent and feasible package of clinical processes plus a list of hospital readiness requirements. RESULTS: The 269 experts in the Delphi panel had clinical experience in different acute medical specialties from 59 countries and from all resource settings. The agreed EECC package contains 40 clinical processes and 67 requirements, plus additions specific for COVID-19. CONCLUSION: The study has specified the content of care that should be provided to all critically ill patients. Implementing EECC could be an effective strategy for policy makers to reduce preventable deaths worldwide.


Subject(s)
COVID-19 , Emergency Medical Services , Consensus , Critical Care , Humans , SARS-CoV-2
7.
BMJ Open ; 11(9): e046130, 2021 09 15.
Article in English | MEDLINE | ID: covidwho-1412601

ABSTRACT

OBJECTIVES: Purposefully designed and validated screening, triage, and severity scoring tools are needed to reduce mortality of COVID-19 in low-resource settings (LRS). This review aimed to identify currently proposed and/or implemented methods of screening, triaging, and severity scoring of patients with suspected COVID-19 on initial presentation to the healthcare system and to evaluate the utility of these tools in LRS. DESIGN: A scoping review was conducted to identify studies describing acute screening, triage, and severity scoring of patients with suspected COVID-19 published between 12 December 2019 and 1 April 2021. Extracted information included clinical features, use of laboratory and imaging studies, and relevant tool validation data. PARTICIPANT: The initial search strategy yielded 15 232 articles; 124 met inclusion criteria. RESULTS: Most studies were from China (n=41, 33.1%) or the United States (n=23, 18.5%). In total, 57 screening, 23 triage, and 54 severity scoring tools were described. A total of 51 tools-31 screening, 5 triage, and 15 severity scoring-were identified as feasible for use in LRS. A total of 37 studies provided validation data: 4 prospective and 33 retrospective, with none from low-income and lower middle-income countries. CONCLUSIONS: This study identified a number of screening, triage, and severity scoring tools implemented and proposed for patients with suspected COVID-19. No tools were specifically designed and validated in LRS. Tools specific to resource limited contexts is crucial to reducing mortality in the current pandemic.


Subject(s)
COVID-19 , Triage , Humans , Prospective Studies , Retrospective Studies , SARS-CoV-2
9.
PLoS One ; 15(10): e0240503, 2020.
Article in English | MEDLINE | ID: covidwho-840859

ABSTRACT

BACKGROUND: In this paper, we predict the health and economic consequences of immediate investment in personal protective equipment (PPE) for health care workers (HCWs) in low- and middle-income countries (LMICs). METHODS: To account for health consequences, we estimated mortality for HCWs and present a cost-effectiveness and return on investment (ROI) analysis using a decision-analytic model with Bayesian multivariate sensitivity analysis and Monte Carlo simulation. Data sources included inputs from the World Health Organization Essential Supplies Forecasting Tool and the Imperial College of London epidemiologic model. RESULTS: An investment of $9.6 billion USD would adequately protect HCWs in all LMICs. This intervention would save 2,299,543 lives across LMICs, costing $59 USD per HCW case averted and $4,309 USD per HCW life saved. The societal ROI would be $755.3 billion USD, the equivalent of a 7,932% return. Regional and national estimates are also presented. DISCUSSION: In scenarios where PPE remains scarce, 70-100% of HCWs will get infected, irrespective of nationwide social distancing policies. Maintaining HCW infection rates below 10% and mortality below 1% requires inclusion of a PPE scale-up strategy as part of the pandemic response. In conclusion, wide-scale procurement and distribution of PPE for LMICs is an essential strategy to prevent widespread HCW morbidity and mortality. It is cost-effective and yields a large downstream return on investment.


Subject(s)
Coronavirus Infections/pathology , Cost-Benefit Analysis , Health Workforce/economics , Personal Protective Equipment/economics , Pneumonia, Viral/pathology , Bayes Theorem , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/economics , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Developing Countries , Health Personnel/statistics & numerical data , Humans , Monte Carlo Method , Pandemics/economics , Personal Protective Equipment/supply & distribution , Pneumonia, Viral/economics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , SARS-CoV-2
10.
Afr J Emerg Med ; 10(2): 49, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-600069
12.
Afr J Emerg Med ; 2020 Apr 02.
Article in English | MEDLINE | ID: covidwho-27773
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