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2.
MMWR Morb Mortal Wkly Rep ; 71(11): 416-421, 2022 Mar 18.
Article in English | MEDLINE | ID: covidwho-1744554

ABSTRACT

The mRNA-1273 (Moderna) COVID-19 vaccine is a lipid nanoparticle-encapsulated, nucleoside-modified mRNA vaccine encoding the stabilized prefusion spike glycoprotein of SARS-CoV-2, the virus that causes COVID-19. During December 2020, the vaccine was granted Emergency Use Authorization (EUA) by the Food and Drug Administration (FDA), and the Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation for use among persons aged ≥18 years (1), which was adopted by CDC. During December 19, 2020-January 30, 2022, approximately 204 million doses of Moderna COVID-19 vaccine were administered in the United States (2) as a primary series of 2 intramuscular doses (100 µg [0.5 mL] each) 4 weeks apart. On January 31, 2022, FDA approved a Biologics License Application (BLA) for use of the Moderna COVID-19 vaccine (Spikevax, ModernaTX, Inc.) in persons aged ≥18 years (3). On February 4, 2022, the ACIP COVID-19 Vaccines Work Group conclusions regarding recommendations for the use of the Moderna COVID-19 vaccine were presented to ACIP at a public meeting. The Work Group's deliberations were based on the Evidence to Recommendation (EtR) Framework,* which incorporates the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach† to rank evidence quality. In addition to initial clinical trial data, ACIP considered new information gathered in the 12 months since issuance of the interim recommendations, including additional follow-up time in the clinical trial, real-world vaccine effectiveness studies, and postauthorization vaccine safety monitoring. ACIP also considered comparisons of mRNA vaccine effectiveness and safety in real-world settings when first doses were administered 8 weeks apart instead of the original intervals used in clinical trials (3 weeks for BNT162b2 [Pfizer-BioNTech] COVID-19 vaccine and 4 weeks for Moderna COVID-19 vaccine). Based on this evidence, CDC has provided guidance that an 8-week interval might be optimal for some adolescents and adults. The additional information gathered since the issuance of the interim recommendations increased certainty that the benefits of preventing symptomatic and asymptomatic SARS-CoV-2 infection, hospitalization, and death outweigh vaccine-associated risks of the Moderna COVID-19 vaccine. On February 4, 2022, ACIP modified its interim recommendation to a standard recommendation§ for use of the fully licensed Moderna COVID-19 vaccine in persons aged ≥18 years.


Subject(s)
/administration & dosage , Advisory Committees , Centers for Disease Control and Prevention, U.S. , Health Planning Guidelines , Immunization Schedule , Adult , Humans , Middle Aged , United States
3.
MMWR Morb Mortal Wkly Rep ; 71(8): 293-298, 2022 Feb 25.
Article in English | MEDLINE | ID: covidwho-1704437

ABSTRACT

Isolation is recommended during acute infection with SARS-CoV-2, the virus that causes COVID-19, but the duration of infectiousness varies among individual persons. Rapid antigen test results have been correlated with detection of viable virus (1-3) and might inform isolation guidance, but data are limited for the recently emerged SARS-CoV-2 B.1.1.529 (Omicron) variant. On January 5, 2022, the Yukon-Kuskokwim Health Corporation (YKHC) recommended that persons with SARS-CoV-2 infection isolate for 10 days after symptom onset (or, for asymptomatic persons, 10 days after a positive nucleic acid amplification or antigen test result). However, isolation could end after 5-9 days if symptoms were resolving or absent, fever was absent for ≥24 hours without fever-reducing medications, and an Abbott BinaxNOW COVID-19 Ag (BinaxNOW) rapid antigen test result was negative. Antigen test results and associated individual characteristics were analyzed among 3,502 infections reported to YKHC during January 1-February 9, 2022. After 5-9 days, 396 of 729 persons evaluated (54.3%) had a positive antigen test result, with a declining percentage positive over time. In a multivariable model, a positive antigen test result was more likely after 5 days compared with 9 days (adjusted odds ratio [aOR] = 6.39) or after symptomatic infection (aOR = 9.63), and less likely after previous infection (aOR = 0.30), receipt of a primary COVID-19 vaccination series (aOR = 0.60), or after both previous infection and receipt of a primary COVID-19 vaccination series (aOR = 0.17). Antigen tests might be a useful tool to guide recommendations for isolation after SARS-CoV-2 infection. During the 10 days after infection, persons might be infectious to others and are recommended to wear a well-fitting mask when around others, even if ending isolation after 5 days.


Subject(s)
COVID-19 Serological Testing , COVID-19/diagnosis , Quarantine , SARS-CoV-2 , Adolescent , Adult , Alaska/epidemiology , Alaskan Natives , COVID-19/prevention & control , COVID-19/transmission , Child , Child, Preschool , Female , Health Planning Guidelines , Humans , Infant , Male , Middle Aged , Young Adult
4.
PLoS Med ; 18(11): e1003867, 2021 11.
Article in English | MEDLINE | ID: covidwho-1599642

ABSTRACT

Zibusiso Ndlovu and Tom Ellman discuss the potential value of task sharing in provision of testing for HIV and other infectious diseases.


Subject(s)
Delivery of Health Care , HIV Infections/diagnosis , Health Personnel , Health Services , Point-of-Care Testing , Cost-Benefit Analysis , HIV Infections/economics , Health Planning Guidelines , Health Policy , Health Services/economics , Humans , Point-of-Care Testing/economics
5.
PLoS One ; 16(12): e0260762, 2021.
Article in English | MEDLINE | ID: covidwho-1566552

ABSTRACT

BACKGROUND: Prevention of coronavirus disease 2019 (COVID-19) transmission to newborns is one of the basic components of perinatal care in the era of the COVID-19 pandemic. As such, scientific evidence is compulsory for evidence-based practices. However, there was a scarcity of evidence on health care providers' awareness of breastfeeding practice recommendations during the COVID-19 pandemic in Ethiopia, particularly in the study setting. OBJECTIVE: The study aimed at assessing healthcare providers' awareness of breastfeeding practice recommendations during the COVID-19 pandemic and associated factors among healthcare providers in northwest Ethiopia, 2021. METHODS: A multicenter cross-sectional study was conducted among 405 healthcare providers working in hospitals of Gondar province from November 15, 2020, to March 10, 2021. A simple random sampling technique was employed to select the study subjects. Data were collected via a structured-self-administered questionnaire. EPI INFO version 7.1.2 and SPSS version 25 were used for data entry and analysis respectively. Binary logistic regression analyses were done to identify associated factors and the adjusted odds ratio (AOR) with its 95% confidence interval (CI) at a p-value of <0.05 was used to declare significant association. RESULTS: The healthcare providers' awareness of breastfeeding practice recommendations during the COVID-19 pandemic was 40.7% (95% CI: 35.9, 45.6). Working in a tertiary hospital (AOR = 3.69; 95% CI: 2.24, 6.08), using COVID-19 guideline updates (AOR = 3.34; 95% CI: 2.1, 5.3), being trained on COVID-19 (AOR = 2.78; 95% CI: 1.74, 4.47), owning a smartphone and/or a computer (AOR = 2.26; 95% CI: 1.39, 3.68), and perceiving that COVID-19 is dangerous (AOR = 1.78; 95% CI: 1.05, 3.01) were factors positively associated with healthcare providers' awareness of breastfeeding practice recommendations during the pandemic of COVID-19. CONCLUSION: Only two in five healthcare providers were aware of recommendations on breastfeeding practice during the COVID-19 pandemic and related to information of accessibility information on COVID-19. Therefore, expanding COVID-19 related information through the provision of COVID-19 training and guidelines to all levels of hospitals would improve health care providers' awareness of breastfeeding practice recommendations amid the COVID-19 pandemic.


Subject(s)
Breast Feeding , COVID-19/epidemiology , Health Knowledge, Attitudes, Practice , Health Personnel , Health Planning Guidelines , Pandemics , Adult , Ethiopia/epidemiology , Female , Humans , Logistic Models , Male , Workplace , World Health Organization
7.
Risk Anal ; 42(1): 97-104, 2022 01.
Article in English | MEDLINE | ID: covidwho-1430065

ABSTRACT

A striking feature of COVID-19 is many countries' low level of preparedness for it, despite pandemics being a known threat. This raises a question as to the reasons for this underpreparedness. While preparedness should have better reflected pandemics' long-run inevitability and potentially catastrophic impact, government-planning horizons are short term, and the attentiveness of policymakers is bounded and subject to multiple demands. Preparedness is therefore affected by the fundamental uncertainty surrounding the exact nature, timing, and impact of a pandemic. While a subjective probability is attributable to such an event's occurrence, just like it is any other, if founded on scant knowledge and perceived as being low it may inhibit preparedness. Under such circumstances, preparedness may be better served by a focus on plausibility. Moreover, any tendency for policymakers to disregard highly uncertain, low-probability, yet highly impactful events of this type is exacerbated by their "fat-tailed" distribution, which obscures their potential extremity. This article considers how plausibility-based scenario planning can increase preparedness for extreme events like a global pandemic, thereby reducing overconfidence in continued business-as-usual in their face, and emphasizing precaution in their wake. In so doing, the article contributes to what in this journal has recently been called "type B," "generic and fundamental" risk science, which is concerned with identifying better ways to present and communicate uncertainties. In focusing on plausibility-based scenario planning, the article highlights a method seldom previously discussed in relation to risk science, yet one that can contribute much to this type B component of it.


Subject(s)
COVID-19/epidemiology , Health Planning Guidelines , Influenza, Human/epidemiology , Pandemics , SARS-CoV-2 , Global Health , Humans , Incidence , Uncertainty
8.
Med Care ; 59(5): 371-378, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1254915

ABSTRACT

BACKGROUND: Planning for extreme surges in demand for hospital care of patients requiring urgent life-saving treatment for coronavirus disease 2019 (COVID-19), while retaining capacity for other emergency conditions, is one of the most challenging tasks faced by health care providers and policymakers during the pandemic. Health systems must be well-prepared to cope with large and sudden changes in demand by implementing interventions to ensure adequate access to care. We developed the first planning tool for the COVID-19 pandemic to account for how hospital provision interventions (such as cancelling elective surgery, setting up field hospitals, or hiring retired staff) will affect the capacity of hospitals to provide life-saving care. METHODS: We conducted a review of interventions implemented or considered in 12 European countries in March to April 2020, an evaluation of their impact on capacity, and a review of key parameters in the care of COVID-19 patients. This information was used to develop a planner capable of estimating the impact of specific interventions on doctors, nurses, beds, and respiratory support equipment. We applied this to a scenario-based case study of 1 intervention, the set-up of field hospitals in England, under varying levels of COVID-19 patients. RESULTS: The Abdul Latif Jameel Institute for Disease and Emergency Analytics pandemic planner is a hospital planning tool that allows hospital administrators, policymakers, and other decision-makers to calculate the amount of capacity in terms of beds, staff, and crucial medical equipment obtained by implementing the interventions. Flexible assumptions on baseline capacity, the number of hospitalizations, staff-to-beds ratios, and staff absences due to COVID-19 make the planner adaptable to multiple settings. The results of the case study show that while field hospitals alleviate the burden on the number of beds available, this intervention is futile unless the deficit of critical care nurses is addressed first. DISCUSSION: The tool supports decision-makers in delivering a fast and effective response to the pandemic. The unique contribution of the planner is that it allows users to compare the impact of interventions that change some or all inputs.


Subject(s)
COVID-19 , Health Planning Guidelines , Health Services Needs and Demand , Hospitals , Surge Capacity , Workforce , Critical Care Nursing , England , Equipment and Supplies, Hospital , Health Personnel , Hospital Bed Capacity , Humans
9.
Geriatr., Gerontol. Aging (Impr.) ; 14(4): 259-266, 31-12-2020. tab
Article in English, Portuguese | WHO COVID, LILACS (Americas) | ID: covidwho-1167980

ABSTRACT

INTRODUÇÃO: Pouco se sabe sobre o enfrentamento e a mitigação da COVID-19 em instituições de longa permanência para idosos (ILPIs) na América Latina. OBJETIVO: Descrever como os gestores de ILPIs de países hispano-americanos planejaram e adequaram suas rotinas de enfrentamento da COVID-19 e se foram capazes de cumprir as recomendações da Organização Mundial da Saúde (OMS). METODOLOGIA: Estudo transversal baseado na aplicação de uma pesquisa on-line dirigida aos gestores de ILPIs situadas em países hispano-americanos. Um questionário de 46 questões (adotando os princípios da OMS) foi enviado aos participantes. Estatística descritiva foi usada para resumir os dados. RESULTADOS: Vinte e três gestores responderam à pesquisa, totalizando 874 idosos (5 min - 270 máx); um questionário foi excluído por falta de respostas. Quatorze ILPIs (63,60%) eram privadas com fins lucrativos. A taxa de adesão às recomendações da OMS foi superior a 70% para a maioria das questões. Pouco mais da metade das instituições elaborou um plano estratégico de enfrentamento, ou identificou estratégias para lidar com óbitos de casos suspeitos. Dificuldade para a aquisição de equipamentos de proteção individual (EPIs) foi relatada por 59,10% das ILPIs investigadas. A capacidade de testagem para o SARS-Cov-2 foi reduzida (36,36% das instituições não dispunham de nenhum teste). CONCLUSÕES: A taxa de adesão às recomendações propostas pela OMS para o enfrentamento da COVID-19 foi superior a 70% para a maioria das ILPIs investigadas. Planos estratégicos de enfrentamento foram elaborados em pouco mais da metade das instituições. A disponibilidade de EPIs e a capacidade de testagem para o SARS-Cov-2 mostraram-se bastante insatisfatórias.


INTRODUCTION: Little is known about management and mitigation of COVID-19 in long-term care facilities (LTCF) for older adults in Latin America. OBJECTIVE: To describe how the management of LTCF in Hispanic American countries plan and adapt their routines for coping with COVID-19 and whether they have been able to fulfill recommendations published by the World Health Organization (WHO). METHODOLOGY: A cross-sectional study was conducted by online survey of managers of LTCF located in Hispanic American i countries. A 46-item questionnaire (adopting the WHO principles) was sent to participants. Descriptive statistics were used to summarize the data. RESULTS: Twenty-three care home managers replied, responsible for a total of 874 older people (range: 5 - 270). One questionnaire was excluded because of missing responses. Fourteen LTCF (63.60%) were private, for-profit facilities. The rate of compliance with WHO recommendations exceeded 70% for the majority of items. Just over half of the institutions had developed dû a strategic management plan, or had identified strategies for dealing with deaths of suspected cases. Difficulty acquiring personal protective equipment (PPE) was reported by 59.10% of the LTCF surveyed. The homes' capacity for SARS-Cov-2 testing was limited (36.36% of the institutions did not have any tests). CONCLUSIONS: The rate of compliance with recommendations published by the WHO for dealing with COVID-19 was greater than 70% at the majority of the LTCF surveyed. More than half of the institutions had strategic management plans. Availability of PPE and SARS-Cov-2 testing capacity were very unsatisfactory.


Subject(s)
Humans , Middle Aged , Aged , Aged, 80 and over , Health of Institutionalized Elderly , COVID-19/epidemiology , Health Services for the Aged/statistics & numerical data , Homes for the Aged/standards , Homes for the Aged/organization & administration , Pandemics/prevention & control , COVID-19/prevention & control , COVID-19/transmission , Health Planning Guidelines , Latin America/epidemiology
12.
Med Care ; 59(5): 371-378, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1041532

ABSTRACT

BACKGROUND: Planning for extreme surges in demand for hospital care of patients requiring urgent life-saving treatment for coronavirus disease 2019 (COVID-19), while retaining capacity for other emergency conditions, is one of the most challenging tasks faced by health care providers and policymakers during the pandemic. Health systems must be well-prepared to cope with large and sudden changes in demand by implementing interventions to ensure adequate access to care. We developed the first planning tool for the COVID-19 pandemic to account for how hospital provision interventions (such as cancelling elective surgery, setting up field hospitals, or hiring retired staff) will affect the capacity of hospitals to provide life-saving care. METHODS: We conducted a review of interventions implemented or considered in 12 European countries in March to April 2020, an evaluation of their impact on capacity, and a review of key parameters in the care of COVID-19 patients. This information was used to develop a planner capable of estimating the impact of specific interventions on doctors, nurses, beds, and respiratory support equipment. We applied this to a scenario-based case study of 1 intervention, the set-up of field hospitals in England, under varying levels of COVID-19 patients. RESULTS: The Abdul Latif Jameel Institute for Disease and Emergency Analytics pandemic planner is a hospital planning tool that allows hospital administrators, policymakers, and other decision-makers to calculate the amount of capacity in terms of beds, staff, and crucial medical equipment obtained by implementing the interventions. Flexible assumptions on baseline capacity, the number of hospitalizations, staff-to-beds ratios, and staff absences due to COVID-19 make the planner adaptable to multiple settings. The results of the case study show that while field hospitals alleviate the burden on the number of beds available, this intervention is futile unless the deficit of critical care nurses is addressed first. DISCUSSION: The tool supports decision-makers in delivering a fast and effective response to the pandemic. The unique contribution of the planner is that it allows users to compare the impact of interventions that change some or all inputs.


Subject(s)
COVID-19 , Health Planning Guidelines , Health Services Needs and Demand , Hospitals , Surge Capacity , Workforce , Critical Care Nursing , England , Equipment and Supplies, Hospital , Health Personnel , Hospital Bed Capacity , Humans
13.
Semin Perinatol ; 44(6): 151292, 2020 10.
Article in English | MEDLINE | ID: covidwho-935942

ABSTRACT

The rapid spread of COVID-19 across the globe quickly and drastically changed the way we practice medicine. In order to respond to its effects, careful planning and implementation of new guidelines and protocols was crucial to ensure the safety of both patients and staff. Given the limitations of space, staff, and resources in the community hospitals, a centralized command center, robust lines of communication within the department and between departments, and contingency and surge planning in this setting were critical. This chapter focuses on the unique challenges of practicing within a Level II hospital during a global pandemic.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Hospitals, Community/methods , Pandemics , SARS-CoV-2 , COVID-19/diagnosis , COVID-19 Testing , Clinical Protocols , Emergency Service, Hospital/organization & administration , Female , Health Plan Implementation , Health Planning Guidelines , Hospitals, Community/organization & administration , Humans , Information Dissemination , Interdepartmental Relations , New York City/epidemiology , Personal Protective Equipment/supply & distribution , Pregnancy , Surge Capacity
15.
Circ J ; 84(11): 2023-2026, 2020 10 23.
Article in English | MEDLINE | ID: covidwho-792535

ABSTRACT

BACKGROUND: The Japanese Circulation Society proposes recommendations for all healthcare professionals involved in cardiovascular medicine to protect them from infection and ensure that seriously ill patients requiring urgent care receive proper treatment.Methods and Results:Patients are divided into "Positive or suspected coronavirus disease 2019 (COVID-19)" and "All others". Furthermore, tests and treatments are divided into emergency or standby. For each category, we propose recommendations. CONCLUSIONS: To maintain the cardiovascular care system, The Japanese Circulation Society recommends completely preventing nosocomial COVID-19 infections, ensuring adequate PPE necessary for healthcare personnel, and learning and implementing standard precautions.


Subject(s)
Betacoronavirus/genetics , Cardiovascular Diseases/therapy , Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Health Planning Guidelines , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , COVID-19 , Coronavirus Infections/physiopathology , Coronavirus Infections/virology , Cross Infection/virology , Health Personnel , Humans , Infection Control/methods , Intubation, Intratracheal , Japan , Personal Protective Equipment , Pneumonia, Viral/physiopathology , Pneumonia, Viral/virology , Polymerase Chain Reaction , SARS-CoV-2 , Societies, Medical
16.
Sensors (Basel) ; 20(17)2020 Sep 02.
Article in English | MEDLINE | ID: covidwho-742835

ABSTRACT

COVID-19 has shown a relatively low case fatality rate in young healthy individuals, with the majority of this group being asymptomatic or having mild symptoms. However, the severity of the disease among the elderly as well as in individuals with underlying health conditions has caused significant mortality rates worldwide. Understanding this variance amongst different sectors of society and modelling this will enable the different levels of risk to be determined to enable strategies to be applied to different groups. Long-established compartmental epidemiological models like SIR and SEIR do not account for the variability encountered in the severity of the SARS-CoV-2 disease across different population groups. The objective of this study is to investigate how a reduction in the exposure of vulnerable individuals to COVID-19 can minimise the number of deaths caused by the disease, using the UK as a case study. To overcome the limitation of long-established compartmental epidemiological models, it is proposed that a modified model, namely SEIR-v, through which the population is separated into two groups regarding their vulnerability to SARS-CoV-2 is applied. This enables the analysis of the spread of the epidemic when different contention measures are applied to different groups in society regarding their vulnerability to the disease. A Monte Carlo simulation (100,000 runs) along the proposed SEIR-v model is used to study the number of deaths which could be avoided as a function of the decrease in the exposure of vulnerable individuals to the disease. The results indicate a large number of deaths could be avoided by a slight realistic decrease in the exposure of vulnerable groups to the disease. The mean values across the simulations indicate 3681 and 7460 lives could be saved when such exposure is reduced by 10% and 20% respectively. From the encouraging results of the modelling a number of mechanisms are proposed to limit the exposure of vulnerable individuals to the disease. One option could be the provision of a wristband to vulnerable people and those without a smartphone and contact-tracing app, filling the gap created by systems relying on smartphone apps only. By combining very dense contact tracing data from smartphone apps and wristband signals with information about infection status and symptoms, vulnerable people can be protected and kept safer.


Subject(s)
Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Disease Transmission, Infectious/statistics & numerical data , Models, Theoretical , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Public Health/methods , Quarantine/organization & administration , Vulnerable Populations , COVID-19 , Contact Tracing/methods , Coronavirus Infections/epidemiology , Disease Outbreaks/prevention & control , Health Planning Guidelines , Health Services Needs and Demand , Humans , Infection Control/methods , Infection Control/organization & administration , Infection Control/statistics & numerical data , Inventions/statistics & numerical data , Pneumonia, Viral/epidemiology , Preventive Health Services/methods , Preventive Health Services/organization & administration , Preventive Health Services/standards , Public Health/statistics & numerical data , Public Health Administration/methods , Quarantine/methods , Quarantine/statistics & numerical data , United Kingdom/epidemiology , Vulnerable Populations/statistics & numerical data
17.
Semin Perinatol ; 44(6): 151296, 2020 10.
Article in English | MEDLINE | ID: covidwho-665987

ABSTRACT

The goal of this chapter is to review the various considerations necessary to safely perform gynecologic surgery in the setting of a viral pandemic. The ability to triage surgical cases at a time of reduced resources is facilitated by both state and national societal guidelines in addition to various scoring systems. Concerns by health care personnel of viral transmission intra-operatively require appropriate use of PPE and pre-operative COVID-19 testing. Implementation of mitigation strategies around aerosol-generating procedures such as laparoscopy protects health care personnel involved in the surgical care of the patient.


Subject(s)
COVID-19/prevention & control , Gynecologic Surgical Procedures/methods , SARS-CoV-2 , Triage/methods , COVID-19/diagnosis , COVID-19/transmission , COVID-19 Testing , Female , Gynecologic Surgical Procedures/statistics & numerical data , Health Personnel , Health Planning Guidelines , Humans , Personal Protective Equipment , Preoperative Care/methods
18.
Int J Gynaecol Obstet ; 150(3): 368-378, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-596853

ABSTRACT

OBJECTIVE: To determine the acceptance rate of treatment alternatives for women with either preinvasive conditions or gynecologic cancers during the COVID-19 pandemic among Latin American gynecological cancer specialists. METHODS: Twelve experts in gynecological cancer designed an electronic survey, according to recommendations from international societies, using an online platform. The survey included 22 questions on five topics: consultation care, preinvasive cervical pathology, and cervical, ovarian, and endometrial cancer. The questionnaire was distributed to 1052 specialists in 14 Latin American countries. A descriptive analysis was carried out using statistical software. RESULTS: A total of 610 responses were received, for an overall response rate of 58.0%. Respondents favored offering teleconsultation as triage for post-cancer treatment follow-up (94.6%), neoadjuvant chemotherapy in advanced stage epithelial ovarian cancer (95.6%), and total hysterectomy with bilateral salpingo-oophorectomy and defining adjuvant treatment with histopathological features in early stage endometrial cancer (85.4%). Other questions showed agreement rates of over 64%, except for review of pathology results in person and use of upfront concurrent chemoradiation for early stage cervical cancer (disagreement 56.4% and 58.9%, respectively). CONCLUSION: Latin American specialists accepted some alternative management strategies for gynecological cancer care during the COVID-19 pandemic, which may reflect the region's particularities. The COVID-19 pandemic led Latin American specialists to accept alternative management strategies for gynecological cancer care, especially regarding surgical decisions.


Subject(s)
COVID-19/therapy , Genital Neoplasms, Female/therapy , Pregnancy Complications, Neoplastic/therapy , SARS-CoV-2 , Female , Health Planning Guidelines , Humans , Hysterectomy , Latin America , Neoadjuvant Therapy , Ovarian Neoplasms/therapy , Pregnancy , Salpingo-oophorectomy , Uterine Cervical Neoplasms/therapy
19.
J Gynecol Oncol ; 31(4): e68, 2020 07.
Article in English | MEDLINE | ID: covidwho-382022

ABSTRACT

The outbreak of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 has rapidly spread globally. Cancer patients are at a higher risk of being infected with the coronavirus and are more likely to develop severe complications, as compared to the general population. The increasing spread of COVID-19 presents challenges for the clinical care of patients with gynecological malignancies. Concerted efforts should be put into managing gynecological malignancies in an orderly manner by strictly implementing the measures that are specifically developed for controlling the spread of COVID-19. We have drafted Recommendations on Management of Gynecological Malignancies during the COVID-19 Pandemic based on our experience on controlling COVID-19 pandemic in China. We recommend that patients with gynecological malignancies should be managed in hierarchical and individualized manners in combination with local conditions related to COVID-19. Medical care decision should be balanced between controlling COVID-19 pandemic spread and timely diagnosis and treatment for gynecologic oncology patients.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Genital Neoplasms, Female/epidemiology , Pneumonia, Viral/epidemiology , COVID-19 , Disease Outbreaks/statistics & numerical data , Female , Guidelines as Topic , Gynecology/standards , Health Planning Guidelines , Humans , Oncologists/standards , Pandemics , SARS-CoV-2
20.
J Am Geriatr Soc ; 68(6): 1136-1142, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-186723

ABSTRACT

Coronavirus disease 2019 (COVID-19) continues to impact older adults disproportionately, from severe illness and hospitalization to increased mortality risk. Concurrently, concerns about potential shortages of healthcare professionals and health supplies to address these needs have focused attention on how resources are ultimately allocated and used. Some strategies misguidedly use age as an arbitrary criterion, inappropriately disfavoring older adults. This statement represents the official policy position of the American Geriatrics Society (AGS). It is intended to inform stakeholders including hospitals, health systems, and policymakers about ethical considerations to consider when developing strategies for allocating scarce resources during an emergency involving older adults. Members of the AGS Ethics Committee collaborated with interprofessional experts in ethics, law, nursing, and medicine (including geriatrics, palliative care, emergency medicine, and pulmonology/critical care) to conduct a structured literature review and examine relevant reports. The resulting recommendations defend a particular view of distributive justice that maximizes relevant clinical factors and deemphasizes or eliminates factors placing arbitrary, disproportionate weight on advanced age. The AGS positions include (1) avoiding age per se as a means for excluding anyone from care; (2) assessing comorbidities and considering the disparate impact of social determinants of health; (3) encouraging decision makers to focus primarily on potential short-term (not long-term) outcomes; (4) avoiding ancillary criteria such as "life-years saved" and "long-term predicted life expectancy" that might disadvantage older people; (5) forming and staffing triage committees tasked with allocating scarce resources; (6) developing institutional resource allocation strategies that are transparent and applied uniformly; and (7) facilitating appropriate advance care planning. The statement includes recommendations that should be immediately implemented to address resource allocation strategies during COVID-19, aligning with AGS positions. The statement also includes recommendations for post-pandemic review. Such review would support revised strategies to ensure that governments and institutions have equitable emergency resource allocation strategies, avoid future discriminatory language and practice, and have appropriate guidance to develop national frameworks for emergent resource allocation decisions. J Am Geriatr Soc 68:1136-1142, 2020.


Subject(s)
Betacoronavirus , Coronavirus Infections , Geriatrics/standards , Health Care Rationing/standards , Health Planning Guidelines , Pandemics , Pneumonia, Viral , Aged , Aged, 80 and over , COVID-19 , Female , Humans , Male , SARS-CoV-2 , United States/epidemiology
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