Challenges in pharmacy education with limited resources during COVID-19: ASEAN perspective

The rapidly emerging COVID-19 pandemic resulted in the need for rapid and extensive changes in the education programs of universities. This chapter reviews the changes in teaching and learning made by pharmaceutical faculties in six universities located in the Association of Southeast Asian Nations (ASEAN): Mahasarakham University (Thailand), Taylor's University (Malaysia), University of the Philippines-Manilla (Philippines), Hai Phong University of Medicine and Pharmacy (Vietnam), University of Health Sciences (Lao PDR), and Sanata Dharma University (Indonesia). The authors discuss adjustments that were made based on educational contexts, planning and infrastructure, educational processes, and products and outcomes. Each university provides a specific story concerning lessons learned in responding to the pandemic. The chapter concludes with changes that will be employed in future emergency situations, as well as those that will continue to be incorporated with the resumption of normal operations. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

ON THE FRACTIONAL-ORDER MODELING OF COVID-19 DYNAMICS IN A POPULATION WITH LIMITED RESOURCES

Resource availability plays a pivotal role in the fight against emerging infections such as COVID-19. In the event where there are limited resources the control of an epidemic disease tends to be slow and the disease spread faster in the human population. In this paper, we are motivated to formulate and investigate a mathematical model via the Caputo derivative which incorporates the impact of limited resources on COVID-19 transmission dynamics in the population. We analyze the fractional model by computing the equilibrium points, and basic reproduction number, (R0), and also used the Banach-fixed point theorem to prove the existence and uniqueness of the solution of the model. The impact of each parameter on the dynamical spread of COVID-19 was examined by the help of Sensitivity analysis. Results from mathematical analyses depict that the disease-free equilibrium is stable if R0 < 1 and unstable otherwise. Numerical simulations were carried out at different fractional order derivatives to understand the impact of several model parameters on the dynamics of the infection which can be used to establish the influential parameter driving the epidemic transmission path. Our numerical results show that an increase in the recovery rate of hospitalization increases the number of infected individuals. The results of this work can help policymakers to devise strategies to reduce the COVID-19 infection. © 2023, SCIK Publishing Corporation. All rights reserved.

Evaluation of pooling strategy of SARS-CoV-2 RT-PCR in limited resources setting in Egypt at low prevalence.

Sample pooling testing for SARS-COV-2 can be an effective tool in COVID-19 screening when resources are limited, yet it is important to assess the performance before implementation as pooling has its limitations. Our objective was to assess the efficacy of pooling samples for coronavirus 2019 (COVID-19) compared to an individual analysis by using commercial platforms for nucleic acid testing. A total of 2200 nasopharyngeal swabs for SARS-COV-2 were tested individually and in pools of 4, 8, and 10. The cycle threshold (Ct) values of the positive pooled samples were compared to their corresponding individual positive samples. In pool size 10 samples, an estimated increase of 3-Ct was obtained, which led to false negative results in low viral load positive samples. Pooling SARS COV-2 samples is an effective strategy of screening to increase laboratories' capacity and reduce costs without affecting diagnostic performance. A pool size of 8 is recommended.

Translational design for limited resource settings as demonstrated by Vent-Lock, a 3D-printed ventilator multiplexer.

BACKGROUND: Mechanical ventilators are essential to patients who become critically ill with acute respiratory distress syndrome (ARDS), and shortages have been reported due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We utilized 3D printing (3DP) technology to rapidly prototype and test critical components for a novel ventilator multiplexer system, Vent-Lock, to split one ventilator or anesthesia gas machine between two patients. FloRest, a novel 3DP flow restrictor, provides clinicians control of tidal volumes and positive end expiratory pressure (PEEP), using the 3DP manometer adaptor to monitor pressures. We tested the ventilator splitter circuit in simulation centers between artificial lungs and used an anesthesia gas machine to successfully ventilate two swine. RESULTS: As one of the first studies to demonstrate splitting one anesthesia gas machine between two swine, we present proof-of-concept of a de novo, closed, multiplexing system, with flow restriction for potential individualized patient therapy. CONCLUSIONS: While possible, due to the complexity, need for experienced operators, and associated risks, ventilator multiplexing should only be reserved for urgent situations with no other alternatives. Our report underscores the initial design and engineering considerations required for rapid medical device prototyping via 3D printing in limited resource environments, including considerations for design, material selection, production, and distribution. We note that optimization of engineering may minimize 3D printing production risks but may not address the inherent risks of the device or change its indications. Thus, our case report provides insights to inform future rapid prototyping of medical devices.

Challenges in pharmacy education with limited resources during COVID-19: ASEAN perspective

The rapidly emerging COVID-19 pandemic resulted in the need for rapid and extensive changes in the education programs of universities. This chapter reviews the changes in teaching and learning made by pharmaceutical faculties in six universities located in the Association of Southeast Asian Nations (ASEAN): Mahasarakham University (Thailand), Taylor's University (Malaysia), University of the Philippines-Manilla (Philippines), Hai Phong University of Medicine and Pharmacy (Vietnam), University of Health Sciences (Lao PDR), and Sanata Dharma University (Indonesia). The authors discuss adjustments that were made based on educational contexts, planning and infrastructure, educational processes, and products and outcomes. Each university provides a specific story concerning lessons learned in responding to the pandemic. The chapter concludes with changes that will be employed in future emergency situations, as well as those that will continue to be incorporated with the resumption of normal operations. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Canadian Journal of Bioethics Revue Canadienne de Bioethique

The COVID-19 pandemic brings to the forefront the ethical question of allocating scarce resources in terms of access to intensive care and ventilators. The ethical question is: on what ethical principles should we base the triage of patients who will have access to resources when they are insufficient to meet the needs of all? In order to discuss this issue, two historical references for triage are first presented;one is based on an egalitarian principle of meeting individual needs, the other on a principle of social utility. After defining the conditions of equity as procedural equality and adequate response to needs, two types of protocols are examined with a focus on the criteria of equity and utility they advocate. The types of protocols are then compared by presenting their strengths and limitations in responding to population and individual needs. Our analysis highlights the difficulty of reconciling population and clinical objectives in a pandemic situation, while showing that a protocol that uses the Sequential Organ Failure Assessment (SOFA) tool facilitates this reconciliation.

Models to assess imported cases on the rebound of COVID-19 and design a long-term border control strategy in Heilongjiang Province, China.

Since the outbreak of COVID-19 in Wuhan, China in December 2019, it has spread quickly and become a global pandemic. While the epidemic has been contained well in China due to unprecedented public health interventions, it is still raging or not yet been restrained in some neighboring countries. Chinese government adopted a strict policy of immigration diversion in major entry ports, and it makes Suifenhe port in Heilongjiang Province undertook more importing population. It is essential to understand how imported cases and other key factors of screening affect the epidemic rebound and its mitigation in Heilongjiang Province. Thus we proposed a time switching dynamical system to explore and mimic the disease transmission in three time stages considering importation and control. Cross validation of parameter estimations was carried out to improve the credibility of estimations by fitting the model with eight time series of cumulative numbers simultaneous. Simulation of the dynamics shows that illegal imported cases and imperfect protection in hospitals are the main reasons for the second epidemic wave, the actual border control intensities in the province are relatively effective in early stage. However, a long-term border closure may cause a paradox phenomenon such that it is much harder to restrain the epidemic. Hence it is essential to design an effective border reopening strategy for long-term border control by balancing the limited resources on hotel rooms for quarantine and hospital beds. Our results can be helpful for public health to design border control strategies to suppress COVID-19 transmission.

Variant-specific interventions to slow down replacement and prevent outbreaks.

Emergency and establishment of variants of concern (VOC) impose significant challenges for the COVID-19 pandemic control specially when a large portion of the population has not been fully vaccinated. Here we develop a mathematical model and utilize this model to examine the impact of non pharmaceutical interventions, including the COVID-test (PCR, antigen and antibody test) and whole genome sequencing (WGS) test capacity and contact tracing and quarantine strength, on the VOC-induced epidemic wave. We point out the undesirable and unexpected effect of lukewarm tracing and quarantine that can potentially increase the VOC-cases at the outbreak peak time, and we demonstrate the significance of strain-specific interventions to either prevent a VOC-induced outbreak, or to mitigate the epidemic wave when this outbreak is unavoidable.

COVID-19 rapid response in a limited resource setting (notes from the field): Chinhoyi Provincial Hospital, Mashonaland West Province, Zimbabwe.

COVID-19 has impacted health systems globally with varying impacts across regions. In Zimbabwe, a country with perennial problems of shortage of healthcare workers and resources, the pandemic has caused substantial strain on the public health system. The ability to share experiences on what has worked and what has not can be valuable as scientists, policymakers, and others determine steps forward and reflect backward to determine lessons learned in the pandemic response. We describe the setup and function of a COVID-19 rapid response team in the context of a limited resource setting. The response had to be tailored to make maximal use of the resources available and manage the outbreak. In this article, we share notes from the field and discuss the process of setting up a rapid response protocol in a limited resource provincial hospital, the challenges encountered, improvised interventions and recommendations for managing a COVID-19 resurgence and future similar pandemics.

Clinical, Radiological Features and Outcome of COVID-19 patients in a Secondary Hospital in Jakarta, Indonesia.

INTRODUCTION: The numbers of people infected with SARS-CoV-2 in Indonesia especially in Jakarta as the epicenter continue to rise. Limited published clinical data, scarcity and long turn over time of diagnostic testing put clinician in dilemma to make diagnosis. METHODOLOGY: This is an observational case series study from confirmed COVID-19 patient in our hospital from first case admission on 17 March 30 April, 2020. We collected patient's demography, symptoms, comorbidities, therapy, laboratory, chest x-ray and ECG consecutively. RESULTS: Between 17 March 2020 and 30 April 2020, there were 30 confirmed COVID-19 cases, 16 (53.3%) were male. Clinical symptoms were dyspnea in 22 (73.3%) and dry cough 16 (53.3%). Comorbidities were diabetes in 14 (46.6%), hypertension 10 (33.3%) and Coronary Artery Disease (CAD) in 10 (33.3%) patients respectively. Laboratory findings showed lymphopenia in 21 (70%) patients, increased inflammation marker in Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP) and Lactate Dehydrogenase (LDH) 21 (70%), 23 (76.6%) and 12 (40%) patients respectively. Twenty-seven (90%) cases had abnormal Chest X-Ray (CXR) and mostly severe 18 (60%). Descriptive finding for images included consolidation 16 (53.3%) and Ground Glass Opacities (GGO) in 10 (33.3%) patients. CONCLUSIONS: Based on our findings, most cases of COVID-19 admitted in secondary referral hospital were already in moderate to severe stages. This is most likely due to late referral from primary care and unspecific clinical features resemblance of other infectious diseases. Inflammation marker and CXR are cost effective findings and can be used as marker to determine further referral.

Modeling the impact of mass influenza vaccination and public health interventions on COVID-19 epidemics with limited detection capability.

The emerging coronavirus SARS-CoV-2 has caused a COVID-19 pandemic. SARS-CoV-2 causes a generally mild, but sometimes severe and even life-threatening infection, known as COVID-19. Currently, there exist no effective vaccines or drugs and, as such, global public authorities have so far relied upon non pharmaceutical interventions (NPIs). Since COVID-19 symptoms are aspecific and may resemble a common cold, if it should come back with a seasonal pattern and coincide with the influenza season, this would be particularly challenging, overwhelming and straining the healthcare systems, particularly in resource-limited contexts, and would increase the likelihood of nosocomial transmission. In the present study, we devised a mathematical model focusing on the treatment of people complaining of influenza-like-illness (ILI) symptoms, potentially at risk of contracting COVID-19 or other emerging/re-emerging respiratory infectious agents during their admission at the health-care setting, who will occupy the detection kits causing a severe shortage of testing resources. The model is used to assess the effect of mass influenza vaccination on the spread of COVID-19 and other respiratory pathogens in the case of a coincidence of the outbreak with the influenza season. Here, we show that increasing influenza vaccine uptake or enhancing the public health interventions would facilitate the management of respiratory outbreaks coinciding with the peak flu season, especially, compensate the shortage of the detection resources. However, how to increase influenza vaccination coverage rate remains challenging. Public health decision- and policy-makers should adopt evidence-informed strategies to improve influenza vaccine uptake.