The mechanics of setting up a COVID-19 response: Experiences of the COVID-19 epidemic from Groote Schuur Hospital, Cape Town, South Africa.

The SARS-CoV-2 pandemic has challenged the provision of healthcare in ways that are unprecedented in our lifetime. Planning for the sheer numbers expected during the surge has required public hospitals to de-escalate all non-essential clinical services to focus on COVID-19. Western Cape Province was the initial epicentre of the COVID-19 epidemic in South Africa (SA), and the Cape Town metro was its hardest-hit geographical region. We describe how we constructed our COVID-19 hospital-wide clinical service at Groote Schuur Hospital, the University of Cape Town's tertiary-level teaching hospital. By describing the barriers and enablers, we hope to provide guidance rather than a blueprint for hospitals elsewhere in SA and in low-resource countries that face similar challenges now or during subsequent waves.

Key Characteristics of a Fragile Healthcare Supply Chain: Learning from a Pandemic.

The COVID-19 pandemic has highlighted the many challenges that provincial health systems have experienced while scaling health services to protect Canadians from viral transmission and support care for those who get infected. Supply chain capacity makes it possible for health systems to deliver care and implement public health initiatives safely. In this paper, we present emerging findings from a national research study that documents the key features of the fragility of the health supply chain evident across the seven Canadian provinces. Results suggest that the fragility of the health supply chain contributes to substantive challenges across health systems, thus limiting or precluding proactive and comprehensive responses to pandemic management. These findings inform strategies to strengthen supply chain capacity and performance in order to enable health systems to effectively respond to pandemic events.

Logistics of an advanced therapy medicinal product during COVID-19 pandemic in Italy: successful delivery of mesenchymal stromal cells in dry ice.

BACKGROUND: During the coronavirus disease-2019 (COVID-19) pandemic, Italian hospitals faced the most daunting challenges of their recent history, and only essential therapeutic interventions were feasible. From March to April 2020, the Laboratory of Advanced Cellular Therapies (Vicenza, Italy) received requests to treat a patient with severe COVID-19 and a patient with acute graft-versus-host disease with umbilical cord-derived mesenchymal stromal cells (UC-MSCs). Access to clinics was restricted due to the risk of contagion. Transport of UC-MSCs in liquid nitrogen was unmanageable, leaving shipment in dry ice as the only option. METHODS: We assessed effects of the transition from liquid nitrogen to dry ice on cell viability; apoptosis; phenotype; proliferation; immunomodulation; and clonogenesis; and validated dry ice-based transport of UC-MSCs to clinics. RESULTS: Our results showed no differences in cell functionality related to the two storage conditions, and demonstrated the preservation of immunomodulatory and clonogenic potentials in dry ice. UC-MSCs were successfully delivered to points-of-care, enabling favourable clinical outcomes. CONCLUSIONS: This experience underscores the flexibility of a public cell factory in its adaptation of the logistics of an advanced therapy medicinal product during a public health crisis. Alternative supply chains should be evaluated for other cell products to guarantee delivery during catastrophes.

The role of the critical care pharmacist during the COVID-19 pandemic.

On January 4 2020, the World Health Organization (WHO) reported the emergence of a cluster of pneumonia cases in Wuhan, China due to a new coronavirus, the SARS-CoV-2. A few weeks later, hospitals had to put in place a series of drastic measures to deal with the massive influx of suspected COVID-19 (COronaroVIrus Disease) patients while securing regular patient care, in particular in the intensive care units (ICU). Since March 12th, 77 of the 685 COVID-19 patients admitted to our hospital required hospitalization in the ICU. What are the roles and the added-value of the critical care pharmacist during this period? His missions have evolved although they have remained focused on providing health services for the patients. Indeed, integrated into a steering committee created to organize the crisis in the intensive care units, the role of the clinical pharmacist was focused on the organization and coordination between ICU and the pharmacy, the implementation of actions to secure practices, to train new professionals and the adaptation of therapeutic strategies. He participated to literature monitoring and increased his involvement in the clinical research team. He provided a link between the ICU and the pharmacy thanks to his knowledges of practices and needs.

Intermittent demand forecasting for medical consumables with short life cycle using a dynamic neural network during the COVID-19 epidemic.

Accurate demand forecasting is always critical to supply chain management. However, many uncertain factors in the market make this issue a huge challenge. Especially during the current COVID-19 outbreak, the shortage of certain types of medical consumables has become a global problem. The intermittent demand forecast of medical consumables with a short life cycle brings some new challenges, such as the demand occurring randomly in many time periods with zero demand. In this research, a seasonal adjustment method is introduced to deal with seasonal influences, and a dynamic neural network model with optimized model selection procedure and an appropriate model selection criterion are introduced as the main forecasting models. In addition, in order to reduce the impact of zero demand, it adds some input nodes to the neural network by preprocessing the original input data. Lastly, a modified error measurement method is proposed for performance evaluation. Experimental results show that the proposed forecasting framework is superior to other intermittent demand models.

Resource husbandry in challenging times.

Coronavirus disease 2019 (COVID-19) pandemic has put a huge pressure on healthcare systems across the globe, more so in developing countries. Not only patients of acute febrile illness and respiratory problems but also patients with other acute and chronic diseases are facing challenges while seeking healthcare, getting laboratory investigations done and obtaining medications. Healthcare workers have their challenges including limited resources, lack of personal protective equipments, and fear of contracting COVID-19. Resource husbandry, which refers to the judicious use of available stocks, is a vital concept that needs to be promoted during such challenging times to combat the shortage of medical resources while simultaneously providing effective treatment to the patients. Some easily implementable concepts of resource husbandry can have a significant impact and result in minimising trouble for many patients during a challenging time.