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4.
J Am Med Dir Assoc ; 21(7): 924-927, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-651432

ABSTRACT

OBJECTIVES: In the United States, home health agencies (HHAs) provide essential services for patients recovering from post-acute care and older adults who are aging in place. During the COVID-19 pandemic, HHAs may face additional challenges caring for these vulnerable patients. Our objective was to explore COVID-19 preparedness of US HHAs and compare results by urban/rural location. DESIGN: Cross-sectional study. SETTING/PARTICIPANTS: Using a stratified random sample of 978 HHAs, we conducted a 22-item online survey from April 10 to 17, 2020. METHODS: Summary statistics were computed; open-ended narrative responses were synthesized using qualitative methods. RESULTS: Similar to national data, most responding HHAs (n = 121, 12% response rate) were for-profit and located in the South. Most HHAs had infectious disease outbreaks included in their emergency preparedness plan (76%), a staff member in charge of outbreak/disaster preparedness (84%), and had provided their staff with COVID-19 education and training (97%). More urban HHAs had cared for confirmed and recovered COVID-19 patients than rural HHAs, but urban HHAs had less capacity to test for COVID-19 than rural HHAs (9% vs 21%). Most (69%) experienced patient census declines and had a current and/or anticipated supply shortage. Rural agencies were affected less than urban agencies. HHAs have already rationed (69%) or implemented extended use (55%) or limited reuse (61%) of personal protective equipment (PPE). Many HHAs reported accessing supplemental PPE from state/local resources, donations, and do-it-yourself efforts; more rural HHAs had accessed these additional resources compared with urban HHAs. CONCLUSIONS/IMPLICATIONS: This survey reveals challenges that HHAs are having in responding to the COVID-19 pandemic, particularly among urban agencies. Of greatest concern are the declines in patient census, which drastically affect agency revenue, and the shortages of PPE and disinfectants. Without proper protection, HHA clinicians are at risk of self-exposure and viral transmission to patients and vulnerable family members.


Subject(s)
Civil Defense/organization & administration , Coronavirus Infections/prevention & control , Disease Outbreaks/prevention & control , Home Care Agencies/organization & administration , Outcome Assessment, Health Care , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Aged , Aged, 80 and over , Coronavirus Infections/epidemiology , Cross-Sectional Studies , Female , Humans , Infection Control , Male , Pandemics/statistics & numerical data , Personal Protective Equipment/statistics & numerical data , Pneumonia, Viral/epidemiology , Risk Assessment , Rural Population , United States , Urban Population , Vulnerable Populations/statistics & numerical data
5.
J Perioper Pract ; 30(7-8): 210-220, 2020 07.
Article in English | MEDLINE | ID: covidwho-636523

ABSTRACT

This article aims to describe the early experience of a large major trauma operating theatres department in the East of England during the outbreak of the coronavirus disease 2019 (COVID-19) pandemic. To date and to our knowledge, a small amount of reports describing a surgical department's response to this unprecedented pandemic have been published, but a well-documented account from within the United Kingdom (UK) has not yet been reported in the literature. We describe our preparation and response, including: operating theatres management during the COVID-19 pandemic, operational aspects and communication, leadership and support. The process review of measures presented covers approximately the two-month period between March and May 2020 and emphasises the fluidity of procedures needed. We discuss how significant challenges were overcome to secure implementation and reliable oversight. The visible presence of clinical leads well sighted on every aspect of the response guaranteed standardisation of procedures, while sustaining a vital feedback loop. Finally, we conclude that an effective response requires rapid analysis of the complex problem that is of providing care for patients intraoperatively during the COVID-19 pandemic, and that retrospective sense-making is essential to maintain adaptability.


Subject(s)
Civil Defense/organization & administration , Coronavirus Infections/epidemiology , Infection Control/organization & administration , Operating Rooms/organization & administration , Pneumonia, Viral/epidemiology , Trauma Centers/organization & administration , Betacoronavirus/isolation & purification , Coronavirus Infections/prevention & control , Disease Outbreaks/prevention & control , Female , Humans , Male , Pandemics/prevention & control , Patient Care Team/organization & administration , Pneumonia, Viral/prevention & control , Safety Management , United Kingdom/epidemiology
6.
Wien Klin Wochenschr ; 132(13-14): 400-402, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-635183

ABSTRACT

Mankind has to prepare for a pandemic with respect to medical and practical aspects, but also with respect to ethical issues. There are various ethical guidelines for managing infectious disease outbreaks, but they do not apply to the specific aspects of the COVID-19 pandemic, since they were formulated after the different kinds of outbreaks of avian influenza and Ebola. Today we are confronted with completely new issues endangering our fundamental human rights. As COVID-19 is spreading all over the world, we are in a desperate situation to find treatment solutions; however, despite the urgency, scientific rules have to be applied as bad science is unethical since it might be harmful for patients. Fake news and alternative facts might not be easily recognized and are also threatening scientific values. Pandemics might be leading to a meltdown of the health system if no measures are being taken constraining fundamental human rights. Tracking of persons is violating human rights as well if not accepted on a voluntary basis. A failure to have safeguards for times of crisis leads to a scarcity of medicinal products and goods resulting in a nationalistic approach and ignorance of international solidarity. And last but not least selective measures and triage in intensive care have to be taught to young physicians and nursing staff in medical schools in order to be prepared in times of an infectious disease outbreak and scarcity of resources.


Subject(s)
Civil Defense , Coronavirus Infections , Human Rights , Pandemics/ethics , Pneumonia, Viral , Betacoronavirus , Civil Defense/ethics , Coronavirus Infections/epidemiology , Humans , Mass Media , Pneumonia, Viral/epidemiology , Resource Allocation/ethics , Truth Disclosure
9.
Eur J Orthop Surg Traumatol ; 30(6): 951-954, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-615373
12.
JNMA J Nepal Med Assoc ; 58(225): 355-359, 2020 May 30.
Article in English | MEDLINE | ID: covidwho-601567

ABSTRACT

The COVID-19 pandemic is unfolding at an unprecedented pace. The unprecedented threat provides an opportunity to emerge with robust health systems. Nepal has implemented several containment measures such as Rapid Response Team formulation; testing; isolation; quarantine; contact tracing;surveillance, establishment of COVID-19 Crisis Management Centre and designation of dedicated hospitals to gear up for the pandemic. The national public health emergency management mechanisms need further strengthening with the proactive engagement of relevant ministries; we need a strong, real-time national surveillance system and capacity building of a critical mass of health care workers; there is a need to further assess infection prevention and control capacity; expand the network of virus diagnostic laboratories in the private sector with adequate surge capacity;implement participatory community engagement interventions and plan for a phased lockdown exit strategy enabling sustainable suppression of transmission at low-level and enabling in resuming some parts of economic and social life.


Subject(s)
Civil Defense , Communicable Disease Control , Coronavirus Infections , Emergency Medical Services/organization & administration , Pandemics/prevention & control , Pneumonia, Viral , Betacoronavirus/isolation & purification , Civil Defense/legislation & jurisprudence , Civil Defense/methods , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Government Regulation , Humans , Nepal/epidemiology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Public Health/methods
13.
Emerg Microbes Infect ; 9(1): 1372-1378, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-598768

ABSTRACT

Background: According to the World Health Organization (WHO), the outbreak of coronavirus disease in 2019 (COVID-19) has been declared as pandemic and public health emergency that infected more than 5 million people worldwide at the time of writing this protocol. Strong evidence for the burden, admission, and outcome of COVID-19 has not been published in Africa. Therefore, this protocol will be served as a guideline to conduct a systematic review and meta-analysis of the burden, admission, and outcome of COVID-19 in Africa. Methods: Published and unpublished studies on the burden, admission, and outcome of COVID-19 in Africa and written in any language will be included. Databases (PubMed / MEDLINE, Google Scholar, Google, EMBASE, Web of Science, Microsoft Academic, WHO COVID-19 database, Cochran Library, Africa Wide Knowledge, and Africa Index Medicus) from December 2019 to May 2020 will be searched. Two independent reviewers will select, screen, extract data, and assess the risk of bias. The proportion will be measured using a random-effects model. Subgroup analysis will be conducted to manage hetrogeinity. The presence of publication bias will be assessed using Egger's test and visual inspection of the funnel plots. This systematic and meta-analysis review protocol will be reported per the PRISMA-P guidelines. Conclusion: This systematic review and meta-analysis protocol will be expected to quantify the burden, admission, and outcome of COVID-19 in Africa. Systematic review registration: This protocol was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) in March 2020 and accepted with the registration number: CRD42020179321(https://www.crd.york.ac.uk/PROSPERO).


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/epidemiology , Meta-Analysis as Topic , Pandemics , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Systematic Reviews as Topic , Africa/epidemiology , Betacoronavirus/isolation & purification , Civil Defense/economics , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Coronavirus Infections/economics , Coronavirus Infections/transmission , Developing Countries/economics , Humans , Incidence , Pandemics/economics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/economics , Pneumonia, Viral/transmission , World Health Organization
14.
Am J Trop Med Hyg ; 102(6): 1181-1183, 2020 06.
Article in English | MEDLINE | ID: covidwho-596857

ABSTRACT

Novel coronavirus disease (COVID-19), named a pandemic by the WHO, is the current global health crisis. National and international collaboration are indispensable for combating COVID-19 and other similar potential outbreaks. International efforts to tackle this complex problem have led to remarkable scientific advances. Yet, as a global society, we can and must take additional measures to fight this pandemic. Undoubtedly, our approach toward COVID-19 was not perfect, and testing has not been deployed fast enough to arrest the epidemic early on. It is critical that we revise our approaches to be more prepared for pandemics as a united body by promoting global cooperation and commitment.


Subject(s)
Betacoronavirus/pathogenicity , Civil Defense/organization & administration , Coronavirus Infections/epidemiology , International Cooperation/legislation & jurisprudence , Pandemics , Pneumonia, Viral/epidemiology , Antiviral Agents/chemical synthesis , Antiviral Agents/therapeutic use , Asia/epidemiology , Betacoronavirus/drug effects , Clinical Laboratory Techniques/standards , Clinical Laboratory Techniques/statistics & numerical data , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Coronavirus Infections/prevention & control , Europe/epidemiology , Humans , Middle East/epidemiology , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/drug therapy , Pneumonia, Viral/prevention & control , Viral Vaccines/biosynthesis , Viral Vaccines/therapeutic use
15.
Nat Med ; 26(7): 1005-1008, 2020 07.
Article in English | MEDLINE | ID: covidwho-595980
17.
J Am Med Dir Assoc ; 21(7): 924-927, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-526826

ABSTRACT

OBJECTIVES: In the United States, home health agencies (HHAs) provide essential services for patients recovering from post-acute care and older adults who are aging in place. During the COVID-19 pandemic, HHAs may face additional challenges caring for these vulnerable patients. Our objective was to explore COVID-19 preparedness of US HHAs and compare results by urban/rural location. DESIGN: Cross-sectional study. SETTING/PARTICIPANTS: Using a stratified random sample of 978 HHAs, we conducted a 22-item online survey from April 10 to 17, 2020. METHODS: Summary statistics were computed; open-ended narrative responses were synthesized using qualitative methods. RESULTS: Similar to national data, most responding HHAs (n = 121, 12% response rate) were for-profit and located in the South. Most HHAs had infectious disease outbreaks included in their emergency preparedness plan (76%), a staff member in charge of outbreak/disaster preparedness (84%), and had provided their staff with COVID-19 education and training (97%). More urban HHAs had cared for confirmed and recovered COVID-19 patients than rural HHAs, but urban HHAs had less capacity to test for COVID-19 than rural HHAs (9% vs 21%). Most (69%) experienced patient census declines and had a current and/or anticipated supply shortage. Rural agencies were affected less than urban agencies. HHAs have already rationed (69%) or implemented extended use (55%) or limited reuse (61%) of personal protective equipment (PPE). Many HHAs reported accessing supplemental PPE from state/local resources, donations, and do-it-yourself efforts; more rural HHAs had accessed these additional resources compared with urban HHAs. CONCLUSIONS/IMPLICATIONS: This survey reveals challenges that HHAs are having in responding to the COVID-19 pandemic, particularly among urban agencies. Of greatest concern are the declines in patient census, which drastically affect agency revenue, and the shortages of PPE and disinfectants. Without proper protection, HHA clinicians are at risk of self-exposure and viral transmission to patients and vulnerable family members.


Subject(s)
Civil Defense/organization & administration , Coronavirus Infections/prevention & control , Disease Outbreaks/prevention & control , Home Care Agencies/organization & administration , Outcome Assessment, Health Care , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Aged , Aged, 80 and over , Coronavirus Infections/epidemiology , Cross-Sectional Studies , Female , Humans , Infection Control , Male , Pandemics/statistics & numerical data , Personal Protective Equipment/statistics & numerical data , Pneumonia, Viral/epidemiology , Risk Assessment , Rural Population , United States , Urban Population , Vulnerable Populations/statistics & numerical data
18.
Inflamm Bowel Dis ; 26(8): 1149-1154, 2020 07 17.
Article in English | MEDLINE | ID: covidwho-526670

ABSTRACT

BACKGROUND: The outbreak of COVID-19 has rapidly evolved into a pandemic that has represented a challenge to health systems worldwide. Inflammatory bowel disease (IBD) units have been forced to change their practices to address the disease and to ensure the quality of care. METHODS: We conducted a national survey among IBD gastroenterologist members of the Spanish Working Group on Crohn's Disease and Colitis regarding changes of practice, IBD treatments, and diagnosis and treatment of COVID-19. RESULTS: We received 54 answers from Spanish hospitals. One hundred percent of the IBD units rescheduled onsite visits to telematic consultation, and elective endoscopic and surgical procedures were delayed. Protective measures were also taken in the infusion units (100% of health centers) and hospital pharmacies, with 40.7% sending subcutaneous medications to patients. No switching between intravenous and subcutaneous anti-tumor necrosis factor drugs were made. We also found that 96.1% of IBD units advised their patients to maintain treatment if they were asymptomatic for COVID-19. For patients with COVID-19 symptoms, 92.6% of IBD units referred them to primary care or the emergency department. In addition, 7.5% of IBD units made a COVID-19 diagnosis through polymerase chain reaction and/or chest x-ray.Modifications in IBD treatment and treatment recommended for COVID-19 are also discussed. CONCLUSIONS: We report a representative national survey of changes made in the structure, diagnosis of COVID-19, and modifications in IBD treatments within IBD units.


Subject(s)
Civil Defense/organization & administration , Coronavirus Infections/epidemiology , Delivery of Health Care/organization & administration , Organizational Innovation , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Disease Management , Disease Outbreaks/prevention & control , Female , Hospital Units/organization & administration , Humans , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/therapy , Interprofessional Relations , Male , Outcome Assessment, Health Care , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Spain/epidemiology , Surveys and Questionnaires
19.
Ann Glob Health ; 86(1): 51, 2020 05 18.
Article in English | MEDLINE | ID: covidwho-460242

ABSTRACT

The developed countries of the world were ill-prepared for the pandemic that they have suffered. When we compare developed to developing countries, the sophisticated parameters we use do not necessarily address the weaknesses in the healthcare systems of developed countries that make them susceptible to crises like the present pandemic. We strongly suggest that better preparation for such events is necessary for a country to be considered developed.


Subject(s)
Coronavirus Infections/epidemiology , Delivery of Health Care , Developed Countries/classification , International Health Regulations , Pandemics , Pneumonia, Viral/epidemiology , Public Health , Betacoronavirus/isolation & purification , Civil Defense/organization & administration , Civil Defense/standards , Delivery of Health Care/organization & administration , Delivery of Health Care/standards , Humans , International Health Regulations/organization & administration , International Health Regulations/standards , Public Health/standards
20.
Inflamm Bowel Dis ; 26(8): 1144-1148, 2020 07 17.
Article in English | MEDLINE | ID: covidwho-457571

ABSTRACT

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.


Subject(s)
Communicable Disease Control/organization & administration , Communicable Diseases, Emerging/prevention & control , Coronavirus Infections/epidemiology , Delivery of Health Care/organization & administration , Outcome Assessment, Health Care , Pneumonia, Viral/epidemiology , Severe Acute Respiratory Syndrome/epidemiology , Adult , Civil Defense , Coronavirus Infections/prevention & control , Female , Greece , Hospitals, Special/organization & administration , Humans , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/therapy , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Risk Assessment , Severe Acute Respiratory Syndrome/prevention & control , Urban Population
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