COVID-19 contingency plan strategies and risk management / Gestão de risco e as estratégias do plano de contingência para COVID-19 / Gestión de riesgos y estratégias del plan de contingencia para COVID-19

Objetivo: analisar o plano de contingência para infecção humana pelo Covid-19 e apresentar um modelo conceitual de gestão de risco para o Covid-19. Método: estudo de avaliação executiva, com análise seguindo os passos: Descrição da política; diagnóstico do problema; desenho da política; implementação; governança; resultados e impactos; que permitiu estabelecer o panorama geral acerca do Plano de Contingência Nacional para Infecção Humana pelo novo Coronavírus. Resultados: foram utilizados os passos metodológicos para apontar pontos positivos e fragilidades do plano de contingência e a construção de um modelo conceitual sobre a gestão de risco para o COVID-19. Conclusão: o cenário nacional enriquecido de condições socioambientais desfavoráveis, expõe o quão é vulnerável a nossa população e o sistema de saúde. Além disso, o estudo apontou para déficits de pessoal, materiais e preparação prévia para situações de risco como fatores a serem tratados dentro do processo de mitigação dos riscos.

Objective: to examine the contingency plan for human infection by Covid-19 and present a conceptual model of risk management for Covid-19. Method: in this executive evaluation study, the analysis followed the steps: policy description; problem diagnosis; policy design; implementation; governance; results and impacts; to establish an overall panorama of the National Human Infection Contingency Plan for the new Coronavirus. Results: the methodological steps were used to highlight the strengths and weaknesses of the contingency plan, and to construct a conceptual model of risk management for COVID-19. Conclusion: the scenario in Brazil, enhanced by unfavorable socio-environmental conditions, exposed how vulnerable its population and the health system are. The study also indicated that deficits in personnel, material and prior preparation for risk situations were factors to be addressed in the risk mitigation process.

Objetivo: examinar el plan de contingencia para la infección humana por Covid-19 y presentar un modelo conceptual de gestión de riesgos para Covid-19. Método: en este estudio de evaluación ejecutiva, el análisis siguió los pasos: descripción de la política; diagnóstico de problemas; diseño de políticas; implementación; gobernancia; resultados e impactos; Establecer un panorama general del Plan Nacional de Contingencia de Infección Humana por el nuevo Coronavirus. Resultados: los pasos metodológicos se utilizaron para resaltar las fortalezas y debilidades del plan de contingencia y para construir un modelo conceptual de gestión de riesgos para COVID-19. Conclusión: el escenario en Brasil, potenciado por condiciones socioambientales desfavorables, expuso la vulnerabilidad de su población y el sistema de salud. El estudio también indicó que los déficits en personal, material y preparación previa para situaciones de riesgo fueron factores a ser abordados en el proceso de mitigación de riesgos.

Extended use or reuse of single-use surgical masks and filtering face-piece respirators during the coronavirus disease 2019 (COVID-19) pandemic: A rapid systematic review.

BACKGROUND: Shortages of personal protective equipment during the coronavirus disease 2019 (COVID-19) pandemic have led to the extended use or reuse of single-use respirators and surgical masks by frontline healthcare workers. The evidence base underpinning such practices warrants examination. OBJECTIVES: To synthesize current guidance and systematic review evidence on extended use, reuse, or reprocessing of single-use surgical masks or filtering face-piece respirators. DATA SOURCES: We used the World Health Organization, the European Centre for Disease Prevention and Control, the US Centers for Disease Control and Prevention, and Public Health England websites to identify guidance. We used Medline, PubMed, Epistemonikos, Cochrane Database, and preprint servers for systematic reviews. METHODS: Two reviewers conducted screening and data extraction. The quality of included systematic reviews was appraised using AMSTAR-2. Findings were narratively synthesized. RESULTS: In total, 6 guidance documents were identified. Levels of detail and consistency across documents varied. They included 4 high-quality systematic reviews: 3 focused on reprocessing (decontamination) of N95 respirators and 1 focused on reprocessing of surgical masks. Vaporized hydrogen peroxide and ultraviolet germicidal irradiation were highlighted as the most promising reprocessing methods, but evidence on the relative efficacy and safety of different methods was limited. We found no well-established methods for reprocessing respirators at scale. CONCLUSIONS: Evidence on the impact of extended use and reuse of surgical masks and respirators is limited, and gaps and inconsistencies exist in current guidance. Where extended use or reuse is being practiced, healthcare organizations should ensure that policies and systems are in place to ensure these practices are carried out safely and in line with available guidance.

Healthcare risk management during the SARS-CoV-2 virus pandemic in the European Union: The guaranteed access to medicines.

BACKGROUND: The disease caused by the novel coronavirus SARS-CoV-2 has rapidly spread escalating the situation to an international pandemic. The absence of a vaccine or an efficient treatment with enough scientific evidence against the virus has generated a healthcare crisis of great magnitude. The precautionary principle justifies the selection of the recommended medicines, whose demand has increased dramatically. METHODS: we carried out an analysis of the healthcare risk management and the main measures taken by the state healthcare authorities to a possible shortage of medicines in the most affected countries of the European Union: Spain, France, Italy and Germany. RESULTS: the healthcare risk management in the European Union countries is carried out based on the precautionary principle, as we do not have enough scientific evidence to recommend a specific treatment against the new virus. Some measures aimed to guarantee the access to medicines for the population has been adopted in the most affected countries by the novel coronavirus. CONCLUSIONS: in Spain, Italy and Germany, some rules based on the precautionary principle were pronounced in order to guarantee the supply of medicines, while in France, besides that, the competences of pharmacists in pharmacy offices have been extended to guarantee the access to medicines for the population.

The effects of the COVID-19 pandemic on risk management practice: A report from the epicenter of the epicenter in New York City.

Health care organizations have had to respond to the Coronavirus disease 2019 (COVID-19) pandemic in unprecedented ways. In the United States, where health risk management is an established profession, health care risk managers (HRMs) contributed to the response by supporting organizations and frontline workers. HRMs advised administrative and clinical leadership on decisions and policies aimed at addressing the medico legal, ethical, and operational dilemmas raised by this public health emergency. This article describes these challenges from the perspective of a New York City (NYC) public hospital located in the "epicenter within the epicenter" of the pandemic and aims to provide practical guidance for HRMs on the front lines of this crisis.

Cross-continental comparison of safety and protection measures amongst urologists during COVID-19.

OBJECTIVES: To determine the well-being of urologists worldwide during the coronavirus disease 2019 pandemic, and whether they have adequate personal protective equipment knowledge and supplies appropriate to their clinical setting. METHODS: Urologists worldwide completed a Société Internationale d'Urologie online survey from 16 April 2020 until 1 May 2020. Analysis was carried out to evaluate their knowledge about protecting themselves and others in the workplace, including their confidence in their ability to remain safe at work, and any regional differences. RESULTS: There were 3488 respondents from 109 countries. Urologists who stated they were moderately comfortable that their work environment offers good protection against coronavirus disease 2019 showed a total mean satisfaction level of 5.99 (on a "0 = not at all" to "10 = very" scale). A large majority (86.33%) were confident about protecting themselves from coronavirus disease 2019 at work. However, only about one-third reported their institution provided the required personal protective equipment (35.78%), and nearly half indicated their hospital has or had limited personal protective equipment availability (48.08%). Worldwide, a large majority of respondents answered affirmatively for testing the healthcare team (83.09%). Approximately half of the respondents (52.85%) across all regions indicated that all surgical team members face an equal risk of contracting coronavirus disease 2019 (52.85%). Nearly one-third of respondents reported that they had experienced social avoidance (28.97%). CONCLUSIONS: Our results show that urologists lack up-to-date knowledge of preferred protocols for personal protective equipment selection and use, social distancing, and coronavirus disease 2019 testing. These data can provide insights into functional domains from which other specialties could also benefit.

The crisis standard of care: Considerations for risk management.

Many writers and organizations have postulated that health care facilities and providers may need to implement a "crisis standard of care" to deal with the exigent circumstances associated with the massive influx of patients infected with the novel coronavirus and suffering from COVID-19. There is a relative scarcity of critical resources, such as intensive care unit beds, emergency department beds, ventilators, personal protective equipment, and medications. Facilities can become overwhelmed. A crisis standard of care can act as a guidepost for rationing supplies and care, should that become necessary. However, that is not without danger. Health care facilities and providers should plan carefully and then act with due deliberation in implementing a crisis standard of care to mitigate or prevent future liability.

Mitigating the Twin Threats of Climate-Driven Atlantic Hurricanes and COVID-19 Transmission.

The co-occurrence of the 2020 Atlantic hurricane season and the ongoing coronavirus disease 2019 (COVID-19) pandemic creates complex dilemmas for protecting populations from these intersecting threats. Climate change is likely contributing to stronger, wetter, slower-moving, and more dangerous hurricanes. Climate-driven hazards underscore the imperative for timely warning, evacuation, and sheltering of storm-threatened populations - proven life-saving protective measures that gather evacuees together inside durable, enclosed spaces when a hurricane approaches. Meanwhile, the rapid acquisition of scientific knowledge regarding how COVID-19 spreads has guided mass anti-contagion strategies, including lockdowns, sheltering at home, physical distancing, donning personal protective equipment, conscientious handwashing, and hygiene practices. These life-saving strategies, credited with preventing millions of COVID-19 cases, separate and move people apart. Enforcement coupled with fear of contracting COVID-19 have motivated high levels of adherence to these stringent regulations. How will populations react when warned to shelter from an oncoming Atlantic hurricane while COVID-19 is actively circulating in the community? Emergency managers, health care providers, and public health preparedness professionals must create viable solutions to confront these potential scenarios: elevated rates of hurricane-related injury and mortality among persons who refuse to evacuate due to fear of COVID-19, and the resurgence of COVID-19 cases among hurricane evacuees who shelter together.

Alternatives for establishing a surgical airway during the COVID-19 pandemic. / Alternativas para o estabelecimento de via aérea cirúrgica durante a pandemia de COVID-19.

Currently doctors and health professionals are facing a challenging pandemic caused by a new strain called 2019 Novel Coronavirus (COVID-19). Human infection with COVID-19 does not yet have the clinical spectrum fully described, and the pattern of lethality, mortality, infectivity and transmissibility is not known with precision. There is no specific vaccine or medication available. Treatment is supportive and nonspecific. In Brazil, as in the rest of the world, the number of COVID-19 cases has grown alarmingly, leading to an increase in the number of hospitalizations as well as in mortality from the disease. Currently, the states with the highest number of cases are, respectively, São Paulo, Rio de Janeiro, Distrito Federal and Ceará. The objective of this work is to offer alternatives in order to guide surgeons regarding the surgical management of the airways in patients with suspicion and / or confirmation for COVID-19 infection.

Atualmente médicos e profissionais da saúde encontram-se frente a uma pandemia desafiadora causada por uma nova cepa denominada 2019 Novel Coronavírus (COVID-19). A infecção humana pelo COVID-19 ainda não tem o espectro clínico completamente descrito, bem como não se sabe com precisão o padrão de letalidade, mortalidade, infectividade e transmissibilidade. Não há vacina ou medicamento específico disponível. O tratamento é de suporte e inespecífico. No Brasil, assim como no restante do mundo o número de casos de COVID-19 tem crescido de maneira alarmante levando a um aumento do número de internações assim como da mortalidade pela doença. Atualmente os estados com maior número de casos são, respectivamente, São Paulo, Rio de Janeiro, Distrito Federal e Ceará. O objetivo deste trabalho é oferecer alternativas a fim de orientar cirurgiões quanto ao manejo cirúrgico das vias aéreas em pacientes com suspeita e/ou confirmação para infecção pelo COVID-19.

Clinical Trials for Inflammatory Bowel Disease: Global Guidance During the COVID-19 Pandemic.

The severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]-causing coronavirus disease [COVID]-19 pandemic poses major challenges for patients with inflammatory bowel disease [IBD] to be recruited and maintained in clinical trials. However, clinical trials offer patients who have failed multiple drugs access to study medications with alternative modes of action and the potential for relief from inflammation-mediated symptoms. Therefore, the continuation of clinical trials in IBD during the COVID-19 pandemic is important both for participants and for the community of IBD patients, due to the dire need for an expanded therapeutic armamentarium. As the safety of patients in clinical trials is the leading principle, we are providing ten specific rules to guide patients and principal investigators safely through the challenging time.

Short-Term Effects of Mitigation Measures for the Containment of the COVID-19 Outbreak: An Experience From Northern Italy.

We evaluated the short-term effects of mitigation measures imposed by the Italian government on the first 10 municipalities affected by Sars-Cov-2 spread. Our results suggest that the effects of containment measures can be appreciated in about approximately 2 wk.

ESGE and ESGENA Position Statement on gastrointestinal endoscopy and the COVID-19 pandemic.

We are currently living in the throes of the COVID-19 pandemic that imposes a significant stress on health care providers and facilities. Europe is severely affected with an exponential increase in incident infections and deaths. The clinical manifestations of COVID-19 can be subtle, encompassing a broad spectrum from asymptomatic mild disease to severe respiratory illness. Health care professionals in endoscopy units are at increased risk of infection from COVID-19. Infection prevention and control has been shown to be dramatically effective in assuring the safety of both health care professionals and patients. The European Society of Gastrointestinal Endoscopy (www.esge.com) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (www.esgena.org) are joining forces to provide guidance during this pandemic to help assure the highest level of endoscopy care and protection against COVID-19 for both patients and endoscopy unit personnel. This guidance is based upon the best available evidence regarding assessment of risk during the current status of the pandemic and a consensus on which procedures to perform and the priorities on resumption. We appreciate the gaps in knowledge and evidence, especially on the proper strategy(ies) for the resumption of normal endoscopy practice during the upcoming phases and end of the pandemic and therefore a list of potential research questions is presented. New evidence may result in an updated statement.