Simple Symptom-Based Prediction of COVID-19: A Single-Center Study of Outpatient Fever Clinic in Japan.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) symptoms are not fully understood in non-hospitalized individuals in Japan, and COVID-19 differentiation by symptoms alone remained challenging. Therefore, this study aimed to examine COVID-19 prediction from symptoms using real-world data in an outpatient fever clinic. METHODS: We compared the symptoms of COVID-19-positive and negative patients who visited the outpatient fever clinic at Imabari City Medical Association General Hospital and tested for COVID-19 from April 2021 to May 2022. This retrospective single-center study enrolled 2,693 consecutive patients. RESULTS: COVID-19-positive patients had a higher frequency of close contact with COVID-19-infected patients compared with COVID-19-negative patients. Moreover, patients with COVID-19 had high-grade fever at the clinic compared with patients without COVID-19. Additionally, the most common symptom in patients with COVID-19 was sore throat (67.3%), followed by cough (62.0%), which was approximately twice as common in patients without COVID-19. COVID-19 was more frequently identified in patients having a fever (≥37.5℃) with a sore throat, a cough, or both. The positive COVID-19 rate reached approximately half (45%) when three symptoms were present. CONCLUSION: These results suggested that COVID-19 prediction by combinations of simple symptoms and close contact with COVID-19-infected patients might be useful and lead to recommendations for testing of COVID-19 in symptomatic individuals.

Effect Analysis of Different Environmental Disinfection Methods on Reducing Contamination of Surfaces by the Omicron BA.2.2 Variant of SARS-CoV-2 and the Characteristics of Fomite Contamination in the Fever Clinic in the Out-Broken of Shanghai.

This study aimed to investigate the effect of different environmental disinfection methods on reducing contaminated surfaces (CSs) by the Omicron BA.2.2 variant of SARS-CoV-2 in the fever clinic between March 20 and May 30, 2022, and to analyze the influences and related factors of CSs. This study includes survey data from 389 positive patients (SPPs) and 204 CSs in the fever clinic, including the CS type, disinfection method, length of time spent in the clinic, cycle threshold (CT) value, name, age, weight, mask type, mask-wearing compliance, hand-mouth touch frequency and sex. Associations between study variables and specified outcomes were explored using univariate regression analyses. Mask-wearing compliance had a significant negative correlation with CSs (r = - 0.446, P = 0.037). Among the 389 SPPs, 22 SPPs (CRP, 5.66%) caused CSs in the separate isolation room. A total of 219 SPPs (56.30%) were male. The mean age of SPPs was 4.34 ± 3.92 years old, and the mean CT value was 12.44 ± 5.11. In total, 9952 samples with exposure history were taken, including 204 (2.05%) CSs. Among the CSs, the positive rate of flat surfaces was the highest in public areas (2.52%) and separate isolation rooms (4.75%). Disinfection methods of ultraviolet radiation + chemical irradiation significantly reduced the CSs in both the public area (0% vs. 4.56%) and the separate isolation room (0.76% vs. 2.64%) compared with the chemical method alone (P < 0.05). Compared with ordinary SPPs, CRPs were older (6.04 year vs. 4.23 year), and the male proportion was higher (72.73% vs. 55.31%). In particular, it was found that SPPs contaminated their surroundings and therefore imposed risks on other people. Environmental disinfection with ultraviolet radiation + chemical treatment should be emphasized. The findings may be useful to guide infection control practices for the Omicron BA.2.2 variant of SARS-CoV-2.

Stress response and influencing factors among fever outpatients and children's families during normalisation of the COVID-19 epidemic: A cross-sectional study.

AIM: To examine the demographic characteristics associated with stress response of fever outpatients and children's families during normalisation of the COVID-19 epidemic and to examine the relationship between stress response, coping style and resilience. DESIGN: Online cross-sectional study. METHODS: A total of 541 fever clinic participants from Yiwu, China, were recruited via WeChat from February to November 2021. Online self-administered questionnaires were used to collect data. Data were analysed using t-tests, one-way analyses of variance, Pearson's correlation analyses and multiple linear regression analyses. RESULTS: There were apparent physical and emotional responses among the fever outpatients, especially the adult patients. The main coping style was negative coping, and the degree of psychological resilience was low. Income, comorbidities, religious beliefs, tenacity, negative coping and positive coping were independent predictors of stress response.

Optimizing national border reopening policies in the COVID-19 pandemic: A modeling study.

Objective: After emergence of the COVID-19 pandemic and subsequent restrictions, countries worldwide have sought to reopen as quickly as possible. However, reopening involves the risk of epidemic rebound. In this study, we investigated the effective policy combination to ensure safe reopen. Methods: On the basis of the classical SEIR epidemic model, we constructed a COVID-19 system dynamics model, incorporating vaccination, border screening, and fever clinic unit monitoring policies. The case of China was used to validate the model and then to test policy combinations for safe reopening. Findings: Vaccination was found to be crucial for safe reopening. When the vaccination rate reached 60%, the daily number of newly confirmed COVID-19 cases began to drop significantly and stabilized around 1,400 [1/1,000,000]. The border screening policy alone only delayed epidemic spread for 8 days but did not reduce the number of infections. Fever clinic unit monitoring alone could reduce the peak of new confirmed cases by 44% when the case identification rate rose from 20 to 80%. When combining polices, once the vaccination rate reached 70%, daily new confirmed cases stabilized at 90 [0.64/1,000,000] with an 80% case identification rate at fever clinic units and border screening. For new variants, newly confirmed cases did not stabilize until the vaccination rate reached 90%. Conclusion: High vaccination rate is the base for reopening. Vaccination passport is less effective compared with a strong primary care monitoring system for early detection and isolation of the infected cases.

A Phenomenological Study of Nurses' Experiences in a Pediatric Fever Clinic During the COVID-19 Epidemic.

BACKGROUND AND PURPOSE: In the initial COVID-19 outbreak, nursing staff reportedly experienced high levels of psychological stress. The purpose of this study was to explore the real experience of the first cohort of pediatric fever clinic nurses during the COVID-19 epidemic. METHODS: Semi-structured interviews were conducted with eight nurses who worked in a fever clinic at a children's hospital in China. The interviews were conducted by an experienced and trained interviewer. Qualitative content analysis was used to describe the experiences of the nurses. RESULTS: Three themes were distilled from the interviews: 1) complex psychological experiences including positive experiences (increased sense of responsibility and honor, gaining the respect and recognition of parents, having a sense of achievement in personal growth) and negative experiences (panic and compulsion, guilt towards their family, antipathy, and dissatisfaction); 2) extreme physical discomfort; and 3) a lack of relevant knowledge. IMPLICATIONS FOR PRACTICE: The nurses in the pediatric fever clinic experienced various psychological impacts and physiological discomfort. Nursing managers should improve the management of hospital emergency nursing, strengthen the psychological guidance and logistics support of frontline nurses, and provide nurses with the relevant knowledge and skills training. These improvements would support frontline nurses in their work to provide effective patient treatment during the COVID-19 epidemic.

Clinical characteristics of fever clinic visits during the coronavirus disease 2019 pandemic: a retrospective case-control study.

Background: Little is known about the change in characteristics of fever-clinic visits during the coronavirus disease 2019 (COVID-19) pandemic. We sought to examine the changes in the volume, characteristics, and outcomes of patients presenting at a fever clinic duringclinic during the first-level response to COVID-19. Methods: We conducted a single tertiary-center retrospective case-control study. We included consecutive patients aged 14 years or older who visited the fever clinic of a tertiary hospital during the period of the first-level response to the COVID-19 pandemic in Fuzhou, China (from 24 January to 26 February 2020). We also analyzed the data of patients in the same period of 2019 as a control. We compared a number of outcome measures, including the fever clinic volumes, consultation length, proportion of patients with pneumonia, hospital admission rate, and in-hospital mortality, using the fever-clinic visit data during the two periods. Results: We included 1,013 participants [median age: 35; interquartile range (IQR): 27-50, 48.7% male] in this retrospective study, including 707 in 2020 and 306 in 2019. The median daily number of participants who presented at the fever clinic in 2020 was significantly higher than that in 2019 [18 (IQR: 15-22) vs. 13 (IQR: 8-17), P=0.001]. Participants in 2020 had a longer consultation length than those in 2019 [127 (IQR: 51-204) vs. 20 (IQR: 1-60) min, P<0.001]. Participants in 2020 were also more likely to be diagnosed with acute pneumonia than those in 2019 [168 (23.8%) vs. 40 (13.1%), P<0.001]. The hospital admission rate in 2020 was higher than in 2019 [73 (10.3%) vs. 13 (4.2%), P=0.001]. No significant difference was found in terms of the in-hospital mortality of participants in 2020 and 2019 [8 (1.1%) vs. 0, P=0.114]. Conclusions: Our findings suggest a higher visits volume, proportion of acute pneumonia, and hospital admission rate among patients presenting at fever clinic during the COVID-19 pandemic. Improved measures need to be implemented.

An agent-based study on the airborne transmission risk of infectious disease in a fever clinic during COVID-19 pandemic.

Prevention of nosocomial infections is particularly important for the control of COVID-19 pandemic. We conducted a field study and performed extensive numerical simulations of infection transmission in a fever clinic during pandemic through an agent-based model with pedestrian dynamic and an infection transmission model. Furthermore, we evaluated the cross-infection risk of the patients influenced by the patient inject flow, medical service capability and plane layout. The service capability of fever clinic is determined by the least efficient medical session. When patient inject flow exceeded the service capability, the average dwell time, contact time, exposure dose, and risk of infection of patients all increased dramatically. With the patient inject flow exceeding the service capability, the growth rate of the contact time between patients and the cross-infection risk increased by 11.5-fold and 29.5-fold, respectively. The plane layout of the fever clinic affected the exposure dose and risk of infection. The waiting areas in the fever clinic had the highest risk, where the cumulative exposure dose of virus occupied up to 66.5% of the total. Our research will help to evaluate the biosafety of hospital buildings used for the diagnosis and treatment of infectious diseases.

The Physician Scheduling of Fever Clinic in the COVID-19 Pandemic

This article addresses a weekly physician scheduling problem in Covid-19. This problem has arisen in fever clinics in two collaborative hospitals located in Shanghai, China. Because of the coronavirus pandemic, the hospitals must consider some specific constraints in the scheduling problem. For example, due to social distance limitation, the patient queue lengths are much longer in the coronavirus pandemic, even with the same waiting patients. Thus, the hospitals must consider the maximum queue length in the physician scheduling problem. Moreover, the fever clinic’s scheduling rules are different from those in the common clinic, and some specific regulatory constraints have to be considered in the epidemic. We first build a mathematical model for this problem, in which a pointwise stationary fluid flow approximation method is used to compute the queue length. Some linearization techniques are designed to make the problem can be solved by commercial solvers, such as Gurobi. We find that solving this model from practical applications of the hospital within an acceptable computation time is challenging. Consequently, we develop an efficient two-phase approach to solve the problem. A staffing model and a branch-and-price algorithm are proposed in this approach. The performances of our models and approaches are discussed. The effectiveness of the proposed algorithms for real-life data from collaborative hospitals is validated. Note to Practitioners—This article is motivated by our collaborations with two hospitals in Shanghai, China. Covid-19 has swept the world since 2019 and is still raging in many regions, posing an unprecedented challenge to healthcare systems in countries worldwide. The hospitals are the frontlines of healthcare service, and the physicians are the most critical resource in the battles to coronavirus pandemic. In China, many large-scale hospitals establish fever clinics to serve fever patients. The physician scheduling for such clinics is different and complicated in the Covid-19 due to many specific constraints. We find that the managers are tough to give high-quality schedules to physicians. Thus, we propose a set of algorithms to solve this problem. Especially, a two-phase approach that consists of a staffing standard and a branch-and-price algorithm is designed. Based on hospitals’ real-life data, we show that the methods presented in this article can be used to help hospital managers obtain more reasonable scheduling solutions that can improve the service quality without increasing the workloads of physicians. [ FROM AUTHOR] Copyright of IEEE Transactions on Automation Science & Engineering is the property of IEEE and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Herd Behavior in Medicine: Examples From COVID-19.

Herd behavior is a commonly used term to describe the conduct of different individuals in a group acting without using an individual thought process. The term was first coined by British surgeon Wilfred Trotter in 1914. This editorial will elaborate on how herd behavior has affected the healthcare industry and will include examples from the coronavirus disease 2019 (COVID-19) pandemic. Many interventions were introduced during the initial period of the pandemic, some of them later proved to be either incorrect or only beneficial to a selected group of patients. The nonmedical intervention included personal protective equipment (PPE), the establishment of fever clinics, and telemedicine. Some of these interventions were beneficial and will likely continue after the pandemic. The aim of this editorial is to highlight observed herd behavior in medical practice during pandemics and endorses the need for evaluation of evidence rigorously.

Comparative Study of Shanghai's Fever Alertness Clinics and Singapore's PHPCs

Background: Among the regions in China, Shanghai has took the lead in proposing the establishment of fever alertness clinics in community health centers. As a component of the epidemic control and prevention system, fever alertness clinics assume the role of containing an epidemic at the primary level. The Public Health Preparedness Clinic(PHPC) is a branch of Singapore's sound public health system. Objective: To compare fever alertness clinics of Shanghai and Singapore's PHPCs, then put forward suggestions to improve the construction of Shanghai's fever alertness clinics. Methods: This study was carried out from December 2020 to April 2021. For studying Shanghai's fever alertness clinics, policy documents analysis, literature review and field survey were used. Besides, interviews were also used, which were conducted in two rounds, separately for managers and healthcare workers who were selected from a random sample of three fever alertness clinics(one in the central urban area, one in the outer suburb and one in the urban fringe) of Shanghai. Guided by different outlines, the interviews for the two groups were aimed to collect their perspectives of the organizational structure, setting, operation, and management of fever alertness clinics. For studying Singapore's PHPCs and relevant practice, literature review was used. Results: The number and density of PHPC in Singapore are higher than those in Shanghai fever alertness clinic. Shanghai has higher standards for setting up fever alertness clinic, but PHPCs in Singapore has a higher entry threshold. Shanghai fever alertness clinic have more specific treatment procedures and standardization. Singapore's PHPC system is more prominent in terms of subsidies for epidemic prevention and protection of medical staff. Conclusion: The construction of Singapore's PHPCs needs longer preparation time, and the government is responsible for setting standards, admittance approval, planning and layout using the top-down approach, so the development of PHPCs shows higher homogeneity and meticulousness. In contrast, the construction of fever alertness clinics in Shanghai started late, showing higher personalized and localized characteristics. Copyright © 2021 by the Chinese General Practice.

Survey Research on the Setting and Utilization of the Fever Clinic at Primary Healthcare Institutions

Background: During the prevention and control of the COVID-19, the setting of fever clinic in primary healthcare institutions is an important experience summary and pilot practice. At present, the pilot sentinel surveillance has been carried out for more than one year, and it is necessary to analyze its operation situation. Objective: To investigate the setting and utilization of fever clinic in primary healthcare institutions, summarize experience and put forward corresponding suggestions. Methods: From 2021-02-22 to 2021-03-02, a multi-stage sampling method was adopted to select primary healthcare institutions(community healthcare centers/township health centers) who participated in the prevention and control of the COVID-19 epidemic to conduct a questionnaire survey(including fever sentinel surveillance clinics set up during epidemic prevention and fever clinics set up before epidemic prevention), cumulative use time, cumulative number of visits, cumulative referral rate, and cumulative number of diagnoses. Results: 718 valid responses from 408 primary healthcare institutions were totally obtained. Among them, 208 institutions(51.0%) set up fever sentinel surveillance clinic during the prevention and control of the COVID-19 epidemic, 91 institutions(22.3%) had set up before the prevention and control of the COVID-19 epidemic, and 109 institutions(26.7%) had not set up. 271 subjects participated in the work of the fever sentinel surveillance clinic. According to the 271 questionnaires: as the end of January 2021, the median cumulative use time of the fever sentinel surveillance clinic is 12(10) months;188 cases(69.4%) of the respondents indicated that the cumulative number of visits was <300, and 45 cases(16.6%) indicated that the cumulative number of visits was >1 000;184(67.9%) respondents indicated that the cumulative referral rate was <3%, and 35(12.9%) respondents indicated that the cumulative referral rate was >70%;238(87.8%) of the respondents indicated that the number of patients who were finally diagnosed with novel coronavirus pneumonia was 0 out of all the patients admitted. The test results of χ2 showed that the cumulative number of visits between the setting of the fever clinic during the prevention and control of the novel coronavirus pneumonia epidemic and the setting of the fever clinic before the epidemic prevention and control is statistically significant(P<0.05);However, there is no statistically significant difference in the cumulative number of visits, the cumulative referral rate, and the cumulative number of diagnoses in fever clinic in different regions(including economic zone, geographical location within the city, and the highest risk level during the epidemic period of the region). The results of Spearman rank correlation analysis showed that the setting time of fever clinics was significantly positively correlated with cumulative use time and cumulative visits(rs values were 0.37, 0.18, P<0.05), and the region(east, central, and western) was significantly positively correlated with cumulative diagnoses(rs=0.13, P<0.05). Conclusion: According to the survey, more than two thirds of primary healthcare institutions in China have set up fever sentinel surveillance clinics/fever clinics, and of which no difference were indicated in the cumulative visit number of febrile patients, cumulative referral rate and cumulative number of confirmed COVID-19 infections based on the different economic zones, geographical locations and regions with different highest risk level. The higher cumulative number of visits to fever clinics than fever sentinel surveillance clinics demonstrated the potential capacity of managing patients with fever during the pandemic of infectious diseases. Copyright © 2021 by the Chinese General Practice.

Knowledge, Attitude, and Practice Regarding COVID-19 Among Healthcare Workers in Primary Healthcare Centers in Dubai: A Cross-Sectional Survey, 2020.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic continues to challenge healthcare services worldwide. Healthcare workers (HCWs) are key to the continued effort to overcome the pandemic. This study aims to evaluate the knowledge, attitude, and practices of HCWs toward COVID-19 in primary health centers in Dubai. Methods: This cross-sectional study was conducted at four primary health centers in Dubai, including two fever clinics, from July 5th to July 11th, 2020. A self-administered online questionnaire was distributed to nurses and physicians working in these centers, which evaluated their knowledge, attitude, and practices regarding COVID-19 and their associations with the participants' demographic factors. A total score of 80% and above constituted a level of sufficiency in each section. Additionally, Mann-Whitney U test and multivariable logistic regression were used to analyze the variables. Results: A total of 176 HCWs completed the questionnaire, with a 91.2% (176/193) response rate. They were predominantly female (158/176, 90.0%), nurses (128/176, 72.7%), and non-Emiratis (150/176, 85.2%). While official health organizations were the primary source of information for 91.5% (161/176) of participants, only 38.1% (67/176) reported using scientific journals as one of their sources. Overall, 57.4% (101/176) of participants had a sufficient overall level of knowledge. Moreover, knowledge regarding signs, symptoms, and at-risk groups was generally satisfactory. However, knowledge about the virus, testing, transmission, and the isolation of contacts with positive cases was identified correctly by less than two-thirds of the participants. Half of the participants (89/176, 50.6%) expressed their concern about personally acquiring the infection, 112/176 (63.6%) worried about their relatives acquiring it, and 72/176 (40.9%) expressed some hesitancy to take the COVID-19 vaccine once available. Overall, only 58/176 (33.0%) HCWs had a sufficient overall positive attitude score. Nurses, compared to physicians, and non-Emiratis compared to Emiratis' HCWs, had statistically higher mean scores for attitude (U = 2,212, p < 0.01; and U = 1164.5, p < 0.01, respectively). The majority of participants (156/176, 88.6%) reported acceptable infection control practices. Conclusion: Given the gaps identified in the knowledge and attitude, we recommend further training to improve the skills of primary HCWs, with encouragement to practice evidence-based medicine. Additionally, further exploration regarding vaccine hesitancy is warranted.

Establishing quality evaluation system of nursing management in fever clinics: A Delphi method.

AIM: The aim of this study is to construct a quality evaluation system for fever clinic nursing management. BACKGROUND: Fever clinic is the first line of defence against the epidemic during COVID-19 in China. METHODS: Our study combines the Delphi method and the analytic hierarchy process. Delphi method was used to carry out two rounds of consultation for 18 experts, to select and revise indicators at all levels. Analytic hierarchy process was used to calculate the weight of indicators at all levels. RESULTS: A quality evaluation system of nursing management for fever clinics is built using Delphi method. It includes five first-level indexes, 14 second-level indexes and 82 third-level indexes. A two-round expert consultation is used to build the indicators. The recovery rates of expert questionnaires in the two rounds were, respectively, 100% and 94%, and expert authority coefficients were 0.925. The Kendall coefficients in the two rounds were, respectively, 0.205 and 0.162 (P < .001). The weight analysis shows that health management of nursing staff (0.2803) and disinfection isolation and treatment of medical waste (0.2803) are most important, followed by nursing post management and personnel training (0.1889), configuration and management of equipment (0.1427) and patient consultation management and nursing (0.1078). CONCLUSION: The quality evaluation system of nursing management in the constructed fever clinic is used to put forward a specific, objective and quantifiable evaluation criteria of nursing quality for fever clinic management, which can better meet the needs of epidemic prevention and control, and has a certain application and promotion value. IMPLICATIONS FOR NURSING MANAGEMENT: The establishment and improvement of a quality system for fever clinic care management will help to respond to outbreaks such as COVID-19.

Development and application of quality checklist for the prevention and control of COVID-19 in fever clinic and isolation ward of the general hospital.

To develop a quality control checklist for the prevention and control of coronavirus disease 2019 （COVID-19） in fever clinic and isolation ward of the general hospital and to assess its application. Based on the relevant prevention and control plans and technical guidelines for COVID-19，Delphi method was used to identity items for evaluation，and a quality control checklist for the prevention and control of COVID-19 in the fever clinic and isolation ward was developed in Sir Run Run Shaw Hospital. The checklists included 8 dimensions and 32 items for fever clinic，7 dimensions and 27 items for the isolation ward. The appointed inspectors conducted daily quality control for each shift with this checklist. The expert authority coefficient was 0.88，the mean of the importance of each index in the quality control table was not less than 4.8，and the coefficient of variation was not more than 0.07. During the entire February 2020，8 problems were found and rectified on-the-spot with the application of the checklist. Quality inspection rate was 100% in both isolation wards and fever clinic. The compliance rate and accuracy rate of hand hygiene were 100%; the correct rate of wearing and removing protective equipment increased from 96% to 100%. During the same period，a total of 1915 patients were admitted to the fever clinic，including 191 suspected patients （all were isolated in the hospital，3 were confirmed）. There were no medical staff infected with COVID-19，no cross infection of patients and their families in the hospital. A quality control checklist for the prevention and control of COVID-19 has been developed and applied in the isolation wards and fever clinic，which plays an important role in preventing nosocomial infection.

The Role of Fever Clinics in the Strategic Triage of Suspected Cases of Imported COVID-19.

INTRODUCTION: Novel coronavirus pneumonia (COVID-19) is an acute respiratory infectious disease, which has the characteristic of human-to-human transmission and is extremely contagious. Correctly standardizing the process of early screening of infection or suspected cases in the fever clinic has become a key part of the fight against the pandemic. METHODS: A retrospective analysis of patients in the fever clinic of Shenyang Medical College Affiliated Central Hospital from January 23 to March 1, 2020, was conducted in the present study. RESULTS: It was found that 16 suspected cases of COVID-19 in the fever clinic were diagnosed with respiratory infections, accounting for 0.59%. CONCLUSION: In case of a negative result in the second nucleic acid test, strategic triage and typing might be more conducive for the following nucleic acid tests for suspected cases in order to prevent the spread of the epidemic caused by missed diagnosis.

Mobile isolation wards in a fever clinic: a novel operation model during the COVID-19 pandemic.

A fever clinic within a hospital plays a vital role in pandemic control because it serves as an outpost for pandemic discovery, monitoring and handling. As the outbreak of coronavirus disease 2019 (COVID-19) in Wuhan was gradually brought under control, the fever clinic in the West Campus of Wuhan Union Hospital introduced a new model for construction and management of temporary mobile isolation wards. A traditional battlefield hospital model was combined with pandemic control regulations, to build a complex of mobile isolation wards that used adaptive design and construction for medical operational, medical waste management and water drainage systems. The mobile isolation wards allowed for the sharing of medical resources with the fever clinic. This increased the capacity and efficiency of receiving, screening, triaging and isolation and observation of patients with fever. The innovative mobile isolation wards also controlled new sudden outbreaks of COVID-19. We document the adaptive design and construction model of the novel complex of mobile isolation wards and explain its characteristics, functions and use.

What patients "see" doctors in online fever clinics during COVID-19 in Wuhan?

OBJECTIVE: In December 2019, coronavirus disease 2019 (COVID-19) occurred in Wuhan, China. Online fever clinics were developed by hospitals, largely relieving the hospital's burden. Online fever clinics could help people stay out of crowded hospitals and prevent the risk of cross infections. The objective of our study was to describe the patient characteristics of an online fever clinic and explore the most important concerns and question of online patients. MATERIALS AND METHODS: Our study extracted data from fever clinic records in medical information systems from January 24 to February 18, 2020 in a tertiary hospital in Wuhan. We described the characteristics of patients in fever clinic, then we extracted and classified questions of patient consultations through the online fever clinic dataset. RESULTS: For the 64 487 patients who attended the online fever clinic, the average age was 30.4 years, and 37 665 (58.4%) were female patients. The current state of patients from online were home without isolation (52 360 [81.2%]), home isolated (11 152 [17.29%]), and outpatient observation (975 [1.51%]). From the 594 patient questions analyzed, confirming diagnosis and seeking medical treatment account for 60.61% and 38.05%, respectively, followed by treating (25.59%), preventing (4.38%), and relieving anxiety (1.68%). DISCUSSION: Online fever clinics can effectively relieve patients' mood of panic, and doctors can guide patients with suspected of COVID-19 to isolate and protect themselves through online fever clinic. Online fever clinics can also help to reduce the pressure of hospital fever clinics and prevent cross infection. CONCLUSIONS: This study indicated the importance of online fever clinics during the COVID-19 outbreak for prevention and control.

Nursing management at a Chinese fever clinic during the COVID-19 pandemic.

BACKGROUND: The rampant spread of the novel coronavirus disease (COVID-19) has assumed pandemic proportions across the world. Attempts to contain its spread have entailed varying early screening and triage strategies implemented in different countries and regions. AIM: To share the experience of scientific and standardized management of fever clinics in China, which provide the first effective checkpoint for the prevention and control of COVID-19. INTRODUCTION: A fever clinic was established at our hospital in Tianjin, China, for initially identifying suspected cases of COVID-19 and controlling the spread of the disease. METHODS: The management system covered the following aspects: spatial layout; partitioning of functional zones; a work management system and associated processes; management of personnel, materials and equipment; and patient education. RESULTS: Within two months of introducing these measures, there was a comprehensive reduction in the number of new COVID-19 cases in Tianjin, and zero infections occurred among medical staff at the fever clinic. DISCUSSION: The fever clinic plays an important role in the early detection, isolation and referral of patients presenting with fevers of unknown origin. Broad screening criteria, an adequate warning mechanism, manpower reserves and staff training at the clinic are essential for the early management of epidemics. CONCLUSION: The spread of COVID-19 has been effectively curbed through the establishment of the fever clinic, which merits widespread promotion and application. IMPLICATIONS FOR NURSING AND HEALTH POLICIES: Health managers should be made aware of the important role of fever clinics in the early detection, isolation and referral of patients, and in the treatment of infectious diseases to prevent and control their spread. In the early stage of an epidemic, fever clinics should be established in key areas with concentrated clusters of cases. Simultaneously, the health and safety of health professionals require attention.

Non-COVID-19 Patients with Life-threatening Diseases Who Visited a Fever Clinic: A Single-center, Observational Study in Tokyo, Japan.

Objective In fever clinics screening coronavirus disease (COVID-19), there could be patients with life-threatening diseases that physicians should not overlook. We exploratorily investigated the final diagnosis among non-COVID-19 hospitalized patients who visited the fever clinic. Methods This was a retrospective, observational, and single-centered study conducted in the National Center for Global Health and Medicine (NCGM), Tokyo, Japan. We conducted a retrospective chart review of patients who visited the fever clinic in the NCGM from 11 March 2020 to 24 April 2020. Patients Patients who met the following clinical criteria visited the fever clinic in the NCGM: (1) body temperature >37.5°C, (2) any symptoms consistent with COVID-19 or (3) referral from local healthcare facilities. In the fever clinic, all patients who met the above criteria had severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test with nasopharyngeal swab specimens. Patients with severe symptoms or an unstable condition were sent to an outpatient clinic for infectious diseases for further evaluation and treatment. Results Among 1,470 patients who visited the fever clinic, 84 patients were hospitalized, and 45 of them were diagnosed as having COVID-19. Among the remaining 39 non-COVID-19 patients, there were nine patients with life-threatening diseases. The life-threatening diseases included acute heart failure, septic shock, pneumocystis pneumonia, peritonsillar abscess, and necrotizing fasciitis. Conclusion Physicians should evaluate each patient carefully while considering other life-threatening conditions even in such a COVID-19 pandemic era.

Emergency management in fever clinic during the outbreak of COVID-19: an experience from Zhuhai.

Coronavirus disease 2019 (COVID-19) is a global health threat. A hospital in Zhuhai adopted several measures in Fever Clinic Management (FCM) to respond to the outbreak of COVID-19. FCM has been proved to be effective in preventing nosocomial cross infection. Faced with the emergency, the hospital undertook creative operational steps in relation to the control and spread of COVID-19, with special focuses on physical and administrative layout of buildings, staff training and preventative procedures. The first operational step was to set up triaging stations at all entrances and then complete a standard and qualified fever clinic, which was isolated from the other buildings within our hospital complex. Secondly, the hospital established its human resource reservation for emergency response and the allocation of human resources to ensure strict and standardised training methods through the hospital for all medical staff and ancillary employees. Thirdly, the hospital divided the fever clinic into partitioned areas and adapted a three-level triaging system. The experiences shared in this paper would be of practical help for the facilities that are encountering or will encounter the challenges of COVID-19, i.e. to prevent nosocomial cross infection among patients and physicians.