Adapting for the COVID-19 pandemic in Ecuador, a characterization of hospital strategies and patients.

The World Health Organization (WHO) declared coronavirus disease-2019 (COVID-19) a global pandemic on 11 March 2020. In Ecuador, the first case of COVID-19 was recorded on 29 February 2020. Despite efforts to control its spread, SARS-CoV-2 overran the Ecuadorian public health system, which became one of the most affected in Latin America on 24 April 2020. The Hospital General del Sur de Quito (HGSQ) had to transition from a general to a specific COVID-19 health center in a short period of time to fulfill the health demand from patients with respiratory afflictions. Here, we summarized the implementations applied in the HGSQ to become a COVID-19 exclusive hospital, including the rearrangement of hospital rooms and a triage strategy based on a severity score calculated through an artificial intelligence (AI)-assisted chest computed tomography (CT). Moreover, we present clinical, epidemiological, and laboratory data from 75 laboratory tested COVID-19 patients, which represent the first outbreak of Quito city. The majority of patients were male with a median age of 50 years. We found differences in laboratory parameters between intensive care unit (ICU) and non-ICU cases considering C-reactive protein, lactate dehydrogenase, and lymphocytes. Sensitivity and specificity of the AI-assisted chest CT were 21.4% and 66.7%, respectively, when considering a score >70%; regardless, this system became a cornerstone of hospital triage due to the lack of RT-PCR testing and timely results. If health workers act as vectors of SARS-CoV-2 at their domiciles, they can seed outbreaks that might put 1,879,047 people at risk of infection within 15 km around the hospital. Despite our limited sample size, the information presented can be used as a local example that might aid future responses in low and middle-income countries facing respiratory transmitted epidemics.

Prevention of SARS-CoV-2 transmission from international arrivals: Xiaotangshan Designated Hospital, China.

A surge in the number of international arrivals awaiting coronavirus disease 2019 (COVID-19) screening overwhelmed health-care workers and depleted medical resources in designated hospitals in Beijing, China in March 2020. The People's Government of Beijing Municipality therefore issued a policy which required the mandatory transfer of all asymptomatic passengers arriving from a foreign country to designated quarantine hotels, and the transfer of passengers with fever or respiratory symptoms to designated hospitals. Xiaotangshan Designated Hospital, a severe acute respiratory syndrome hospital in 2003, was rapidly renovated and put into operation with the main tasks of screening and isolating symptomatic international arrivals at Beijing Capital International Airport, providing basic medical care for mild to moderate COVID-19-positive cases, and rapidly referring severe to critical COVID-19-positive cases to higher-level hospitals. During the month-long period of its operation, 2171 passengers were screened and 53 were confirmed as having COVID-19 (six severe to critical). We describe how the use of Xiaotangshan Designated Hospital in this way enabled the efficient grouping and assessment of passengers arriving from a foreign country, the provision of optimal patient care without compromising public safety and the prioritization of critically ill patients requiring life-saving treatment. The designated hospital is a successful example of the World Health Organization's recommendation to renovate existing medical infrastructures to improve the COVID-19 response capacity. The flexible design of Xiaotangshan Designated Hospital means that it can be repurposed and reopened at any time to respond to the changing pandemic conditions.

En mars 2020, la brusque hausse du nombre d'arrivées internationales en attente de dépistage de la maladie à coronavirus 2019 (COVID-19) a submergé les professionnels de la santé et épuisé les ressources médicales dans les hôpitaux de référence à Beijing, en Chine. Le gouvernement populaire de la municipalité de Beijing a réagi en ordonnant que tous les passagers asymptomatiques en provenance d'un pays étranger soient transférés vers des hôtels reconvertis en centres de quarantaine, et que ceux manifestant de la fièvre ou des symptômes respiratoires soient envoyés dans des hôpitaux de référence. L'hôpital de référence Xiaotangshan, construit en 2003 pour lutter contre le syndrome respiratoire aigu sévère, a rapidement été rénové et mis en service. Ses tâches principales: dépister et isoler les passagers internationaux symptomatiques débarquant au Beijing Capital International Airport, prodiguer les soins médicaux de base aux cas positifs de COVID-19 souffrant d'une forme légère à modérée, et adresser dès que possible les cas positifs de COVID-19 dans un état grave ou critique aux hôpitaux spécialisés. En l'espace d'un mois, 2171 passagers ont été testés et 53 se sont révélés positifs à la COVID-19 (6 étant dans un état grave ou critique). Nous décrivons la façon dont l'hôpital de référence Xiaotangshan a ainsi permis de regrouper et d'évaluer efficacement les arrivées en provenance de l'étranger, d'offrir une prise en charge optimale des patients sans compromettre la sécurité publique, et d'établir des priorités afin que les malades gravement atteints puissent bénéficier d'un traitement dans les plus brefs délais. Cet hôpital de référence est un exemple réussi de la mise en œuvre de la recommandation formulée par l'Organisation mondiale de la Santé: rénover les infrastructures médicales existantes afin d'améliorer les capacités de lutte contre la COVID-19. Grâce à sa conception flexible, l'hôpital Xiaotangshan peut être réutilisé et rouvert à n'importe quel moment pour réagir à un contexte pandémique en perpétuelle évolution.

Un aumento del número de llegadas de vuelos internacionales en espera de la detección del coronavirus 2019 (COVID-19) sobrecargó al personal sanitario y agotó los recursos médicos en los hospitales designados de Pekín (China) en marzo de 2020. Por lo tanto, la policía del Gobierno Popular del municipio de Pekín se tuvo que hacer cargo del traslado obligatorio de todos los pasajeros asintomáticos que llegaran de un país extranjero a los hoteles de cuarentena designados, y el traslado de los pasajeros con fiebre o síntomas respiratorios a los hospitales designados. El hospital designado de Xiaotangshan, un hospital especializado en el síndrome respiratorio agudo severo en 2003, se rehabilitó rápidamente y se puso en funcionamiento con las tareas principales de examinar y aislar a los sintomáticos que llegaban al Aeropuerto Internacional de Pekín, proporcionando atención médica básica a los casos positivos de COVID-19 de leves a moderados, y derivando rápidamente los casos positivos de COVID-19 de graves a críticos a hospitales de nivel superior. Durante el mes que duró su funcionamiento, se examinó a 2.171 pasajeros y se confirmó que 53 tenían la COVID-19 (6 de ellos con intensidad de grave a crítica). Describimos cómo el uso del hospital designado de Xiaotangshan permitió agrupar y evaluar eficazmente a los pasajeros que llegaban de un país extranjero, prestar una atención óptima a los pacientes sin comprometer la seguridad pública y priorizar a los pacientes en estado crítico que requerían tratamiento para salvar su vida. El hospital designado es un ejemplo de éxito de la recomendación de la Organización Mundial de la Salud de renovar las infraestructuras médicas existentes para mejorar la capacidad de respuesta ante la COVID-19. El diseño flexible del hospital designado de Xiaotangshan significa que puede utilizarse y volver a habilitarse en cualquier momento para responder a las condiciones cambiantes de la pandemia.

Establishing a COVID-19 treatment centre in Israel at the initial stage of the outbreak: challenges, responses and lessons learned.

Anticipating the need for a COVID-19 treatment centre in Israel, a designated facility was established at Sheba Medical Center-a quaternary referral centre. The goals were diagnosis and treatment of patients with COVID-19 while protecting patients and staff from infection and ensuring operational continuity and treatment of patients with non-COVID. Options considered included adaptation of existing wards, building a tented facility and converting a non-medical structure. The option chosen was a non-medical structure converted to a hospitalisation facility suited for COVID-19 with appropriate logistic and organisational adaptations. Operational principles included patient isolation, unidirectional workflow from clean to contaminated zones and minimising direct contact between patients and caregivers using personal protection equipment (PPE) and a multimodal telemedicine system. The ED was modified to enable triage and treatment of patients with COVID-19 while maintaining a COVID-19-free environment in the main campus. This system enabled treatment of patients with COVID-19 while maintaining staff safety and conserving the operational continuity and the ability to continue delivery of treatment to patients with non-COVID-19.

Practice in Information Technology Support for Fangcang Shelter Hospital during COVID-19 Epidemic in Wuhan, China.

In confronting the sudden epidemic of COVID-19, China and other countries have been under great deal of pressure to block virus transmission and reduce death cases. Fangcang shelter hospital, which is converted from large-scale public venue, is proposed and proven to be an effective way for administering medical care and social isolation. This paper presents the practice in information technology support for a Fangcang shelter hospital in Wuhan, China. The experiences include the deployment strategy of IT infrastructure, the redesign of function modules in the hospital information system (HIS), equipment maintenance and medical staff training. The deployment strategy and HIS modules have ensured smoothness and efficiency of clinical work. The team established a quick response mechanism and adhered to the principle of nosocomial infection control. Deployment of network and modification of HIS was finished in the 48 hours before patient admittance. A repair hotline and remote support for equipment and software were available whenever medical workers met with any questions. No engineer ever entered the contaminated areas and no one was infected by the coronavirus during the hospital operation. Up to now, Fangcang shelter hospital is adopted by many regions around the world facing the collapse of their medical systems. This valuable experience in informatization construction and service in Wuhan may help participators involving in Fangcang shelter hospital get better information technology support, and find more practical interventions to fight the epidemic.

COVID-19 preparedness: Clinical pharmacy services remote staffing in a quaternary, level I trauma and comprehensive stroke center.

PURPOSE: The rapid spread of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has strained the resources of healthcare systems around the world. In accordance with recommendations from the World Health Organization, Centers for Disease Control and Prevention, and US Department of Defense, Intermountain Medical Center (IMED) in Murray, UT, has developed a plan to provide remote clinical pharmacy services to protect the health of pharmacy caregivers while maintaining appropriate clinical pharmacy coverage to optimally care for patients. SUMMARY: The utilization of telemedicine technology permits clinical pharmacists to readily communicate with nurses, physicians, other caregivers, and patients. We have identified strategies to allow clinical pharmacists to continue to participate in daily rounds, provide consultations under collaborative practice agreements, verify medication orders, collect medication histories, provide antimicrobial stewardship, and deliver medication education to patients from off-site locations. The pharmacy department at IMED proactively tested telemedicine technologies, defined the roles of clinical pharmacists, and identified communication strategies prior to a rapid rise in COVID-19 cases in the state of Utah. CONCLUSION: The proactive measures described can help ensure that pharmacy caregivers have appropriate remote access and are capable of confidently using the resources. These steps allow for optimal care of hospitalized patients and promote social distancing, which may have the added benefit of decreasing the spread of SARS-CoV-2 among patients and caregivers.

Lessons from a COVID-19 hospital, Republic of Korea.

OBJECTIVE: To document the experiences of converting a general hospital to a coronavirus disease 2019 (COVID-19) designated hospital during an outbreak in Daegu, Republic of Korea. METHODS: The hospital management formed an emergency task force team, whose role was to organize the COVID-19 hospital. The task force used different collaborative channels to redistribute resources and expertise to the hospital. Leading doctors from the departments of infectious diseases, critical care and pulmonology developed standardized guidelines for treatment coherence. Nurses from the infection control team provided regular training on donning and doffing of personal protective equipment and basic safety measures. FINDINGS: Keimyung University Daegu Dongsan hospital became a red zone hospital for COVID-19 patients on 21 February 2020. As of 29 June 2020, 1048 COVID-19 patients had been admitted to the hospital, of which 22 patients died and five patients were still being treated in the recovery ward. A total of 906 health-care personnel worked in the designated hospital, of whom 402 were regular hospital staff and 504 were dispatched health-care workers. Of these health-care workers, only one dispatched nurse acquired COVID-19. On June 15, the hospital management and Daegu city government decided to reconvert the main building to a general hospital for non-COVID-19 patients, while keeping the additional negative pressure rooms available, in case of resurgence of the disease. CONCLUSION: Centralized coordination in frontline hospital operation, staff management, and patient treatment and placement allowed for successful pooling and utilization of medical resources and manpower during the COVID-19 outbreak.

Management of COVID-19 patients in Fangcang shelter hospital: clinical practice and effectiveness analysis.

Fangcang shelter (Cabin) hospitals were set up in order to cope with the rapid growth of confirmed cases of coronavirus disease 2019 (COVID-19) in Wuhan, China at a time when there were insufficient beds in designated hospitals. This paper describes the layout and functioning of a typical Fangcang shelter hospital, Wuhan Dongxihu Fangcang shelter Hospital, where the author has worked, the working mechanism, experience and effectiveness. A set of patient management protocols was employed for daily practice, which included preset criteria and procedure for admission, examination, medication treatment, referral and discharge. WeChat platform with different groups was used for communication, ward round, test appointments and patient data communication. All these procedures and mechanisms of working enabled the effective management of a larger number of patients with relatively few doctors. As a result, 442 mild or moderate COVID-19 patients in Hall C were successfully managed by a team of 40 doctors, with 246 (56%) patients were cured and discharged from the Fangcang shelter hospital while the remaining 196 (44%) patients were referred on to designated hospitals for further treatment. The reasons for referral included poor resolution in computerized tomography (CT) scan (59%), persistently positive severe acute respiratory syndrome coronavirus 2 by PCR after 9 days of admission (16%), deterioration in CT image (4%), development of dyspnoea (1%) and other (4%) or unclear reasons (16%) due to no record of reasons for referral on the document. There were no deaths and no complaints from the patients in Hall C. In summary, the Fangcang shelter hospital could be run successfully with a set of patient management protocols under conditions of limited facilities and medical staff. It was effective and safe in isolating patients, providing basic medical care and early identification of potential severe cases. This experience may provide a successful example of a working mechanism for the prevention and control of the COVID-19 pandemic worldwide.

To evaluate the effect of COVID-19 pandemic and national lockdown on patient care at a tertiary-care ophthalmology institute.

PURPOSE: To evaluate the effect of COVID-19 pandemic and national lockdown on patient care at a tertiary-care ophthalmology institute. METHODS: Records of all the patients who presented from March 25th to May 3rd, 2020 were scanned to evaluate the details regarding the presenting complaints, diagnosis, advised treatment and surgical interventions. RESULTS: The number of outpatient department visits, retinal laser procedures, intravitreal injections and cataract surgeries during this lockdown decreased by 96.5%, 96.5%, 98.7% and 99.7% respectively compared from the corresponding time last year. Around 38.8% patients could be triaged as non-emergency cases based on history alone while 59.5% patients could be triaged as non-emergency cases after examination. Only eighty-four patients opted for video-consultation from April 15th to May 3rd, 2020. Nine patients presented with perforated corneal ulcer, but could not undergo penetrating keratoplasty due to the lack to available donor corneal tissue. One of these patients had to undergo evisceration due to disease progression. Two patients with open globe injury presented late after trauma and had to undergo enucleation. Around 9% patients could not undergo the advised urgent procedure due to logistical issues related to the lockdown. CONCLUSION: A significant number of patients could not get adequate treatment during the lockdown period. Hospitals need to build capacity to cater to the expected patient surge post-COVID-19-era, especially those requiring immediate in-person attention. A large number of patients can be classified as non-emergency cases. These patients need to be encouraged to follow-up via video-consultation to carve adequate in-person time for the high-risk patients.

Transformation of a large multi-speciality hospital into a dedicated COVID-19 centre during the coronavirus pandemic.

INTRODUCTION: The article describes the process of converting a large multi-specialized hospital into one dedicated to COVID-19 patients, and present established standards of work organization in all the wards and training system of the medical and supporting staff. The several weeks pandemic of the COVID-19 disease has forced the healthcare systems of numerous countries to adjust their resources to the care of the growing number of COVID-19 patients. Managers were presented with the challenge of protecting the healthcare workers from transmission of the disease within medical institutions, and issues concerning the physical and psychological depletion of personnel. MATERIAL AND METHODS: Based on analyses of the structure and work processes in Central Clinical Hospital (CCH) reconstructive strategic plan was developed. It included: division of existing wards into observation and isolation wards; installing locks; weekly plan for supplying personal protection equipment (PPE); designating new access to the hospital and communication routes; training of medical and supporting staff. The plan was implemented from the first days of conversion of the hospital. RESULTS: The wards of the CCH were converted for observation and isolation, and each one was fitted with sanitary locks. There was a big improvement in the supply of PPE for the medical staff. Separation of the 'dirty' and 'clean' parts of the CCH were attained, and widespread intensive training not only protected personnel against infections, but also diminished unrest which was discernable at the beginning of conversion. CONCLUSIONS: The transformation efforts will ultimately be appraised at the end of the epidemic, but the data looks encouraging. Two weeks after conversion, the testing of hospital Staff was started and by the end of April, 459 tests were had been conducted, of which only 11 were positive.

The Greek Response to COVID-19: A True Success Story from an IBD Perspective.

BACKGROUND: After the first case of infection with the novel coronavirus, SARS-CoV-2, in China, an outbreak rapidly spread, finally evolving into a global pandemic. The new disease was named coronavirus disease 2019 (COVID-19) and by May 10, 2020, it has affected more than 4 million people worldwide and caused more than 270,000 deaths. METHODS: We describe the Greek experience regarding the response to COVID-19, with particular focus on 2 COVID-19 reference hospitals in the metropolitan area of Athens, the capital of Greece. RESULTS: The first case of SARS-CoV-2 infection in Greece was reported on February 26, 2020, and prompted a decisive response from the Greek government. The primary focus was containment of virus spread, considering shortage of ICU beds. A general lockdown was implemented early on, and the national Health Care System underwent massive re-structuring. Our 2 gastrointestinal (GI) centers, which provide care for more than 1500 inflammatory bowel disease (IBD) patients, are located in hospitals that were transformed to COVID-19 reference centers. To maintain sufficient care for our patients, while also contributing to the fight against COVID-19, we undertook specific measures. These included provision of telemedicine services, electronic prescriptions and home delivery of medications, isolation of infusion units and IBD clinics in COVID-free zones of the hospitals, in addition to limiting endoscopies to emergencies only. Such practices allowed us to avoid interruption of appropriate therapies for IBD patients. In fact, within the SECURE-IBD database, there have been only 4 Greek IBD patients, to date, who have been reported as positive for SARS-CoV-2. CONCLUSION: Timely application of preventive measures and strict compliance to guidelines limited the spread of COVID-19 in Greece and minimally impacted our IBD community, without interfering with therapeutic management.

Acute Stroke Care Is at Risk in the Era of COVID-19: Experience at a Comprehensive Stroke Center in Barcelona.

BACKGROUND AND PURPOSE: The purpose of the study is to analyze how the coronavirus disease 2019 (COVID-19) pandemic affected acute stroke care in a Comprehensive Stroke Center. METHODS: On February 28, 2020, contingency plans were implemented at Hospital Clinic of Barcelona to contain the COVID-19 pandemic. Among them, the decision to refrain from reallocating the Stroke Team and Stroke Unit to the care of patients with COVID-19. From March 1 to March 31, 2020, we measured the number of emergency calls to the Emergency Medical System in Catalonia (7.5 million inhabitants), and the Stroke Codes dispatched to Hospital Clinic of Barcelona. We recorded all stroke admissions, and the adequacy of acute care measures, including the number of thrombectomies, workflow metrics, angiographic results, and clinical outcomes. Data were compared with March 2019 using parametric or nonparametric methods as appropriate. RESULTS: At Hospital Clinic of Barcelona, 1232 patients with COVID-19 were admitted in March 2020, demanding 60% of the hospital bed capacity. Relative to March 2019, the Emergency Medical System had a 330% mean increment in the number of calls (158 005 versus 679 569), but fewer Stroke Code activations (517 versus 426). Stroke admissions (108 versus 83) and the number of thrombectomies (21 versus 16) declined at Hospital Clinic of Barcelona, particularly after lockdown of the population. Younger age was found in stroke admissions during the pandemic (median [interquartile range] 69 [64-73] versus 75 [73-80] years, P=0.009). In-hospital, there were no differences in workflow metrics, angiographic results, complications, or outcomes at discharge. CONCLUSIONS: The COVID-19 pandemic reduced by a quarter the stroke admissions and thrombectomies performed at a Comprehensive Stroke Center but did not affect the quality of care metrics. During the lockdown, there was an overload of emergency calls but fewer Stroke Code activations, particularly in elderly patients. Hospital contingency plans, patient transport systems, and population-targeted alerts must act concertedly to better protect the chain of stroke care in times of pandemic.

Management of orthopaedic and traumatology patients during the Coronavirus disease (COVID-19) pandemic in northern Italy.

PURPOSE: This article aims to share northern Italy's experience in hospital re-organization and management of clinical pathways for traumatic and orthopaedic patients in the early stages of the COVID-19 pandemic. METHODS: Authors collected regional recommendations to re-organize the healthcare system during the initial weeks of the COVID-19 pandemic in March, 2020. The specific protocols implemented in an orthopaedic hospital, selected as a regional hub for minor trauma, are analyzed and described in this article. RESULTS: Two referral centres were identified as the hubs for minor trauma to reduce the risk of overload in general hospitals. These two centres have specific features: an emergency room, specialized orthopaedic surgeons for joint diseases and trauma surgeons on-call 24/7. Patients with trauma without the need for a multi-disciplinary approach or needing non-deferrable elective orthopaedic surgery were moved to these hospitals. Authors report the internal protocols of one of these centres. All elective surgery was stopped, outpatient clinics limited to emergencies and specific pathways, ward and operating theatre dedicated to COVID-19-positive patients were implemented. An oropharyngeal swab was performed in the emergency room for all patients needing to be admitted, and patients were moved to a specific ward with single rooms to wait for the results. Specific courses were organized to demonstrate the correct use of personal protection equipment (PPE). CONCLUSION: The structure of the orthopaedic hubs, and the internal protocols proposed, could help to improve the quality of assistance for patients with musculoskeletal disorders and reduce the risk of overload in general hospitals during the COVID-19 pandemic.