Resilience in Heath Care workers during Disaster situation-Experience from tertiary care hospital during Covid 19 and future lessons

Aims and objective: To present a series of 5 cases of Stress Related Disorders in HCWs during the covid second wave where they bounced back and recovered fully, returned to work Methodology: Reporting 5 different cases of psychological trauma in healthcare workers working in the peak of covid pandemic as frontline workers -02 doctors, 02 Nurses, and 01 health assistant who reported symptoms of vague nature arising out of stress during handling of Covid 19 pts. All of them had clear cut psychological symptoms arising in close temporal relation to experiencing the trauma of handling covid patients and the agony and disaster that befell us during the covid second wave from April to Aug 2021. None of them had any past history of psychiatric illness or genetic loading of significance. None of them had any other significant live stressor in personal life or h/o drug abuse. Thus underlying the life threatening nature of Covid exposure as a healthcare worker and it's psychological implications. All of them were referred for vague symptoms like irritable mood, not able to function as before, physical symptoms of headache, marital discord etc. The exposure ranged from personal handling of serious covid patients to handling dead bodies in the mortuary to managing relatives of dying patients. No preventive distressing mechanism was available to them, the need of which is the learning from this study. Also, the remarkable recovery and resumption of functioning and return to duty shown by these frontline healthcare covid warriors with minimal support from the environment is a lesson in bouncing back from psychological trauma, a concept recognized as resilience. The Resilient HCWs ascribed their bouncing back to peer and organizational support during crisis, a sense of duty to care and psychoeducation as their driving force to early recovery, among other things Results: High index of suspicion, early intervention, empathetic handling, psycho education, behavioral modifications and cognitive counseling with a short course of anxiolytics and antitidepressants in few, helped all of them improve completely with return to almost normal functioning. Conclusion(s): The Covid experience has been a life threatening experience for HCWs involved in treatment of serious covid patients during covid pandemic esp the second wave. It has been a never before experienced reality, completely overwhelming and traumatogenic enough to cause psychological decompensation in some of them. For the few diagnosed, there would be many undiagnosed HCWs. The focus should be on high index of suspicion for stress related psychological trauma in HCWs and it's mitigation through early detection and support for complete recovery. The importance of systemic, family and peer support is emphasized.

New networks in improving mortality surveillance beyond COVID-19, 2021

Introduction/ Background: Excess mortality reports suggest underreporting of COVID-19 related deaths, as routine surveillance utilizes mainly in-facility data. SARS-CoV-2 postmortem testing (PMT) for home deaths from natural causes has been implemented in South Africa. We provide information to highlight the critical role of morticians in improving mortality surveillance in South Africa. Methods: Sentinel surveillance was implemented in three Districts to support SARS-CoV-2 PMT and reporting in two provinces of South Africa. A repository of out of-facility natural deaths was compiled using mortuary registers from public and private sectors, with multiple stakeholder involvement. Deaths were linked to cumulative COVID-19 laboratory test data and case linelists. Data from August 2020 to October 2021 were analyzed to assess the contribution of community COVID-19 related deaths to the overall reported mortality. Results: A total of 8,254 COVID-19 related deaths were reported, comprising of 70% (n=5,751) hospital and 30% (n=2,503) community deaths. Most of the deaths were females (57.5%;n=4,742) and 60 years and older (61.5%;n=5,079). Of the 2,503 community deaths, 47% (n=1,184) were tested prior to death and 53% (n=1,319) post-mortem. Overall, reporting of COVID-19 related deaths markedly improved by 16% (1,319/8,254) with engagement and additional reporting of data from post-mortem testing. Impact: Morticians play a critical role in COVID-19 mortality surveillance, providing the much-needed sociodemographic information and vital to the handling and transport of corpses to health facilities for specimen collection. Conclusion: The number of reported COVID-19 related deaths was enhanced by linking mortuary registers with laboratory test data and case line lists. Expansion of this model to all mortuaries, across the districts in South Africa, could be a vital component of efforts to improve community-based surveillance.

Sudden Death with Dual Organ Pathologies–An Autopsy-based Case Report

Sudden death due to cardiac cause is considered as a major health problem worldwide accounting for 15–20% of all deaths and cardiomyopathies account for 10–15% of the cases.According to the 2016 WHO classification, angiomatous meningioma is a rare subtype of meningioma classified as Grade I. It is an aggressive variety with a fair prognosis, with typical symptoms including headache and seizures. We present a case of a 60-year-old man brought to the morgue for autopsy with a history of progressive left-sided weakness and headache for several months with no prior diagnosis or treatment for the same because of current pandemic of COVID-19.On conducting medicolegal autopsy significant pathologies in heart and brain were found which could have contributed to the cause of death.

NOVEL, SAFE, INDIGENOUS COST-EFFECTIVE INFECTION CONTAINMENT CHAMBER FOR HIGH-RISK AUTOPSIES: THE NEED OF THE HOUR

In view of the ongoing pandemic, healthcare workers are rightfully concerned about performing autopsies, due to the risk of infection. An autopsy surgeon and his/her team can inadvertently be exposed to infectious diseases. Use of appropriate personal protective equipment (PPE) and mortuaries equipped with negative pressure are essential to protect the autopsy team from exposure to potentially infected bodies, bodily fluids, tissues, and aerosolized particles. Unfortunately, in a developing country like India, due to a lack of funding most mortuaries have only the bare minimum facilities. Taking these issues into consideration, the authors have developed a prototype of a Low-Cost Infection Containment Chamber (LCICC) within which autopsies or sample collection from suspected or confirmed highly infectious cadaver can be performed. This innovation could provide infectious disease experts and pathologists a safer alternative to collect specimens to aid in the management outbreaks of highly infectious diseases.

Ergonomic exposures and control measures associated with mass fatality decedent handling in morgues and body collection points in a New York healthcare system during COVID-19: A case series.

INTRODUCTION: In April 2020, novel coronavirus SARS-CoV-2 (COVID-19) produced an ongoing mass fatality event in New York. This overwhelmed hospital morgues necessitating emergent expansion of capacity in the form of refrigerated trucks, trailers, and shipping containers referred to as body collection points (BCPs). The risks for musculoskeletal injury during routine and mass fatality mortuary operations and experiences of decedent handlers throughout the "first wave" of COVID-19 are presented along with mitigation strategies. METHODS: Awareness of the high rates of musculoskeletal injury among health care workers due to ergonomic exposures from patient handling, including heavy and repetitive manual lifting, prompted safety walkthroughs of mortuary operations at multiple hospitals within a health system in New York State by workforce safety specialists. Site visits sought to identify ergonomic exposures and ameliorate risk for injury associated with decedent handling by implementing engineering, work practice, and administrative controls. RESULTS: Musculoskeletal exposures included manual lifting of decedents to high and low surfaces, non-neutral postures, maneuvering of heavy equipment, and push/pull forces associated with the transport of decedents. DISCUSSION: Risk mitigation strategies through participatory ergonomics, education on body mechanics, development of novel handling techniques implementing friction-reducing aides, procurement of specialized equipment, optimizing BCP design, and facilitation of communication between hospital and system-wide departments are presented along with lessons learned. After-action review of health system workers' compensation data found over four thousand lost workdays due to decedent handling related incidents, which illuminates the magnitude of musculoskeletal injury risk to decedent handlers.

Practical application of Standard Operating Procedures (SOP) Guidelines for COVID-19 autopsies: an Italian experience

Introduction: SARS-CoV-2, responsible for severe human infection with high mortality rate, has been classified as HG3 pathogen. Despite the need to perform autopsy to clarify the pathogenesis of COVID, such procedures are at high risk of contagion due to the direct contact with aerosols and body fluids. To ensure the safety of the personnel against contagion, it is mandatory to follow the SOP for the management of autopsy environment and infected body. Several studies have shown that SARS-CoV-2 persists on inanimate surfaces for a long time and is also ubiquitously detected in many human tissues, even after long time after death. Material and Methods: Many international scientific societies have drowned up various guidelines on biosafety and exposure precautions, but none of these is uniquely adopted. So, in the daily practice our greatest difficulty was to identify SOP adherent to the guidelines but applicable to our reality. In our experience, COVID autopsies were performed accordingly to the following SOP: - COVID mortuary refrigerators - BSL3 autopsy facility - Autopsy saw with aspiration system - PPE: surgical scrub, rubber medical shoes, coverall, shoe leggings, FFP3 mask, waterproof gown or apron, eyes protection, two pairs of medical gloves and one of cut-resistant gloves - Sanitization of surgical tools in autoclave - Sanitization of the environments with VHP - Periodic nasopharyngeal swabs from personnel Results and Conclusions: Our work aims to share our experience and to demonstrate that adopting these measures is effective in reducing risk of infection. In fact, the periodic COVID swabs were negative in 100% of cases.