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1.
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
2.
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
4.
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
5.
Nat Med ; 26(7): 1005-1008, 2020 07.
Article in English | MEDLINE | ID: covidwho-595980
7.
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
8.
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
9.
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
11.
Euro Surveill ; 25(21)2020 05.
Article in English | MEDLINE | ID: covidwho-437617

ABSTRACT

The coronavirus disease (COVID-19) pandemic has caused tremendous pressure on hospital infrastructures such as emergency rooms (ER) and outpatient departments. To avoid malfunctioning of critical services because of large numbers of potentially infected patients seeking consultation, we established a COVID-19 rapid response infrastructure (CRRI), which instantly restored ER functionality. The CRRI was also used for testing of hospital personnel, provided epidemiological data and was a highly effective response to increasing numbers of suspected COVID-19 cases.


Subject(s)
Civil Defense/organization & administration , Coronavirus Infections/epidemiology , Coronavirus , Disease Outbreaks , Patient Care Management , Pneumonia, Viral/epidemiology , Adult , Betacoronavirus , Germany/epidemiology , Humans , Middle Aged , Pandemics , Risk Assessment , Tertiary Care Centers , Triage
12.
AAPS PharmSciTech ; 21(5): 153, 2020 May 24.
Article in English | MEDLINE | ID: covidwho-343702

ABSTRACT

The supply of affordable, high-quality pharmaceuticals to US patients has been on a critical path for decades. In and beyond the COVID-19 pandemic, this critical path has become tortuous. To regain reliability, reshoring of the pharmaceutical supply chain to the USA is now a vital national security need. Reshoring the pharmaceutical supply with old know-how and outdated technologies that cause inherent unpredictability and adverse environmental impact will neither provide the security we seek nor will it be competitive and affordable. The challenge at hand is complex akin to redesigning systems, including corporate and public research and development, manufacturing, regulatory, and education ones. The US academic community must be engaged in progressing solutions needed to counter emergencies in the COVID-19 pandemic and in building new methods to reshore the pharmaceutical supply chain beyond the pandemic.


Subject(s)
Antiviral Agents/supply & distribution , Betacoronavirus/drug effects , Civil Defense/organization & administration , Coronavirus Infections/therapy , Health Services Needs and Demand/organization & administration , Needs Assessment/organization & administration , Pandemics , Pneumonia, Viral/therapy , Viral Vaccines/supply & distribution , Antiviral Agents/economics , Betacoronavirus/pathogenicity , Civil Defense/economics , Coronavirus Infections/drug therapy , Coronavirus Infections/economics , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/virology , Drug Costs , Health Services Needs and Demand/economics , Humans , Needs Assessment/economics , Pandemics/economics , Pneumonia, Viral/economics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , United States , Viral Vaccines/economics
14.
Head Neck ; 42(7): 1477-1481, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-265904

ABSTRACT

The COVID-19 pandemic has had a dramatic impact on care delivery among health care institutions and providers in the United States. As a categorical cancer center, MD Anderson has prioritized care for our patients based on acuity of their disease. We continue to implement measures to protect patients and employees from acquiring the infection within our facilities, and to provide acute management of cancer patients with concomitant COVID-19 infections who are considered at high risk of death. The Division of Patient Experience, formerly established in October 2016, has played an integral role in the institution's pandemic response from its inception. The team actively supported programs and processes in anticipation of the pandemic's effect on our patients and employees. We will describe how the team continues to serve in the ever-dynamic environment as we approach the expected surge in COVID-19 cases among our patient population, our employees, and in our community.


Subject(s)
Cancer Care Facilities/organization & administration , Civil Defense/organization & administration , Coronavirus Infections/epidemiology , Neoplasms/epidemiology , Organization and Administration , Pneumonia, Viral/epidemiology , Surgical Oncology/organization & administration , Coronavirus Infections/prevention & control , Delivery of Health Care/organization & administration , Humans , Infection Control/methods , Interdisciplinary Communication , Neoplasms/surgery , Organizational Innovation , Outcome Assessment, Health Care , Pandemics/prevention & control , Pandemics/statistics & numerical data , Patient Care Team/organization & administration , Pneumonia, Viral/prevention & control , United States
16.
Eur Heart J Acute Cardiovasc Care ; 9(3): 222-228, 2020 Apr.
Article in English | MEDLINE | ID: covidwho-197585

ABSTRACT

Hospitals play a critical role in providing communities with essential medical care during all types of disaster. Depending on their scope and nature, disasters can lead to a rapidly increasing service demand that can overwhelm the functional capacity and safety of hospitals and the healthcare system at large. Planning during the community outbreak of coronavirus disease 2019 (Covid-19) is critical for maintaining healthcare services during our response. This paper describes, besides general measures in times of a pandemic, also the necessary changes in the invasive diagnosis and treatment of patients presenting with different entities of acute coronary syndromes including structural adaptations (networks, spokes and hub centres) and therapeutic adjustments.


Subject(s)
Acute Coronary Syndrome/epidemiology , Betacoronavirus/isolation & purification , Coronavirus Infections/complications , Emergency Service, Hospital/organization & administration , Pneumonia, Viral/complications , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/therapy , Civil Defense/organization & administration , Cross Infection/epidemiology , Cross Infection/prevention & control , Delivery of Health Care/organization & administration , Delivery of Health Care/statistics & numerical data , Disasters , Disease Outbreaks/statistics & numerical data , Emergencies/epidemiology , Emergency Service, Hospital/statistics & numerical data , Facilities and Services Utilization/statistics & numerical data , Facilities and Services Utilization/trends , Hospitals , Humans , Pandemics , Safety , Surge Capacity/statistics & numerical data
17.
Int J Cardiol ; 312: 24-26, 2020 08 01.
Article in English | MEDLINE | ID: covidwho-135706
18.
Am J Trop Med Hyg ; 102(6): 1181-1183, 2020 06.
Article in English | MEDLINE | ID: covidwho-108902

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
19.
J Am Coll Cardiol ; 76(1): 72-84, 2020 07 07.
Article in English | MEDLINE | ID: covidwho-92085

ABSTRACT

The COVID-19 pandemic has presented a major unanticipated stress on the workforce, organizational structure, systems of care, and critical resource supplies. To ensure provider safety, to maximize efficiency, and to optimize patient outcomes, health systems need to be agile. Critical care cardiologists may be uniquely positioned to treat the numerous respiratory and cardiovascular complications of the SARS-CoV-2 and support clinicians without critical care training who may be suddenly asked to care for critically ill patients. This review draws upon the experiences of colleagues from heavily impacted regions of the United States and Europe, as well as lessons learned from military mass casualty medicine. This review offers pragmatic suggestions on how to implement scalable models for critical care delivery, cultivate educational tools for team training, and embrace technologies (e.g., telemedicine) to enable effective collaboration despite social distancing imperatives.


Subject(s)
Cardiology Service, Hospital , Coronavirus Infections , Critical Care , Delivery of Health Care , Organizational Innovation , Pandemics/prevention & control , Pneumonia, Viral , Betacoronavirus/isolation & purification , Cardiology Service, Hospital/organization & administration , Cardiology Service, Hospital/trends , Civil Defense/methods , Civil Defense/organization & administration , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Critical Care/methods , Critical Care/organization & administration , Critical Care/trends , Delivery of Health Care/methods , Delivery of Health Care/organization & administration , Delivery of Health Care/trends , Humans , Organizational Objectives , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy
20.
Can J Cardiol ; 36(6): 956-960, 2020 06.
Article in English | MEDLINE | ID: covidwho-77140

ABSTRACT

The novel coronavirus 2019 disease (COVID-19) pandemic has placed intense pressure on health care organizations around the world. Among other concerns, there has been an increasing recognition of common and deleterious cardiovascular effects of COVID-19 based on preliminary studies. Furthermore, patients with preexisting cardiac disease are likely to experience a more severe disease course with COVID-19. As case numbers continue to increase exponentially, a surge in the number of patients with new or comorbid cardiovascular disease will translate into more frequent and, in some cases, prolonged rehabilitation needs after acute hospitalization. This report describes the current status of post-discharge cardiac care in Canada and provides suggestions regarding steps that policymakers and health care organizations can take to prepare for the COVID-19 pandemic.


Subject(s)
Aftercare , Cardiac Rehabilitation/methods , Cardiovascular Diseases , Civil Defense , Coronavirus Infections , Infection Control/organization & administration , Pandemics , Patient Discharge/standards , Pneumonia, Viral , Aftercare/methods , Aftercare/organization & administration , Canada , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/therapy , Civil Defense/methods , Civil Defense/organization & administration , Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Humans , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Risk Management
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