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1.
Elife ; 102021 07 27.
Article in English | MEDLINE | ID: covidwho-1328262

ABSTRACT

Since the start of the COVID-19 pandemic, two mainstream guidelines for defining when to end the isolation of SARS-CoV-2-infected individuals have been in use: the one-size-fits-all approach (i.e. patients are isolated for a fixed number of days) and the personalized approach (i.e. based on repeated testing of isolated patients). We use a mathematical framework to model within-host viral dynamics and test different criteria for ending isolation. By considering a fixed time of 10 days since symptom onset as the criterion for ending isolation, we estimated that the risk of releasing an individual who is still infectious is low (0-6.6%). However, this policy entails lengthy unnecessary isolations (4.8-8.3 days). In contrast, by using a personalized strategy, similar low risks can be reached with shorter prolonged isolations. The obtained findings provide a scientific rationale for policies on ending the isolation of SARS-CoV-2-infected individuals.


Subject(s)
COVID-19/epidemiology , COVID-19/virology , Patient Isolation , Practice Guidelines as Topic , Quarantine , SARS-CoV-2 , COVID-19/diagnosis , COVID-19/transmission , Humans , Models, Theoretical , Molecular Diagnostic Techniques , Pandemics , Patient Isolation/methods , Patient Isolation/standards , Precision Medicine/methods , Quarantine/methods , Quarantine/standards , SARS-CoV-2/physiology , Viral Load
2.
J Microbiol Immunol Infect ; 54(5): 987-991, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1293987

ABSTRACT

We described a strategy for preventing virus transmission within hospitals through screening and advanced isolation during the coronavirus pandemic. Patients were screened and admitted to the adult advanced isolation unit from February to April 2020. Our process minimized exposure without delaying proper treatment and prevented virus transmission within the hospital.


Subject(s)
COVID-19/prevention & control , Cross Infection/prevention & control , Infection Control/methods , Pandemics/prevention & control , Patient Isolation/methods , Aged , Aged, 80 and over , Female , Health Personnel , Hospitalization , Hospitals , Humans , Male , Middle Aged , Patient Isolation/standards , Patient Safety , Retrospective Studies , SARS-CoV-2
3.
S Afr Med J ; 111(2): 100-105, 2021 01 20.
Article in English | MEDLINE | ID: covidwho-1168064

ABSTRACT

The COVID-19 pandemic has resulted in many hospitals severely limiting or denying parents access to their hospitalised children. This article provides guidance for hospital managers, healthcare staff, district-level managers and provincial managers on parental access to hospitalised children during a pandemic such as COVID-19. It: (i) summarises legal and ethical issues around parental visitation rights; (ii) highlights four guiding principles; (iii) provides 10 practical recommendations to facilitate safe parental access to hospitalised children; (iv) highlights additional considerations if the mother is COVID-19-positive; and (v) provides considerations for fathers. In summary, it is a child's right to have access to his or her parents during hospitalisation, and parents should have access to their hospitalised children; during an infectious disease pandemic such as COVID-19, there is a responsibility to ensure that parental visitation is implemented in a reasonable and safe manner. Separation should only occur in exceptional circumstances, e.g. if adequate in-hospital facilities do not exist to jointly accommodate the parent/caregiver and the newborn/infant/child. Both parents should be allowed access to hospitalised children, under strict infection prevention and control (IPC) measures and with implementation of non-pharmaceutical interventions (NPIs), including handwashing/sanitisation, face masks and physical distancing. Newborns/infants and their parents/caregivers have a reasonably high likelihood of having similar COVID-19 status, and should be managed as a dyad rather than as individuals. Every hospital should provide lodger/boarder facilities for mothers who are COVID-19-positive, COVID-19-negative or persons under investigation (PUI), separately, with stringent IPC measures and NPIs. If facilities are limited, breastfeeding mothers should be prioritised, in the following order: (i) COVID-19-negative; (ii) COVID-19 PUI; and (iii) COVID-19-positive. Breastfeeding, or breastmilk feeding, should be promoted, supported and protected, and skin-to-skin care of newborns with the mother/caregiver (with IPC measures) should be discussed and practised as far as possible. Surgical masks should be provided to all parents/caregivers and replaced daily throughout the hospital stay. Parents should be referred to social services and local community resources to ensure that multidisciplinary support is provided. Hospitals should develop individual-level policies and share these with staff and parents. Additionally, hospitals should ideally track the effect of parental visitation rights on hospital-based COVID-19 outbreaks, the mental health of hospitalised children, and their rate of recovery.


Subject(s)
Child Health/standards , Child, Hospitalized/statistics & numerical data , Hospitals/standards , Infection Control/standards , Patient Isolation/standards , Visitors to Patients/statistics & numerical data , COVID-19 , Child , Female , Humans , Infant, Newborn , South Africa
4.
Eur Rev Med Pharmacol Sci ; 24(23): 12579-12588, 2020 12.
Article in English | MEDLINE | ID: covidwho-995018

ABSTRACT

Management of SARS-CoV-2 requires safe decision-making to minimize contamination. Healthcare workers and professionals in confined areas are affected by the risk of the activity and the environment. Isolation of contaminated workers and healthcare professionals requires clinical and diagnostic criteria. On the other hand, interrupting the isolation of healthcare employees and professionals is critical because diagnostic tests do not support clinical decisions. In addition to defining the best test in view of its accuracy, it is necessary to consider aspects such as the stage of the disease or cure, the viral load and the individual's own immunity. Uncertainty about natural and herd immunity to the disease leads to the development of appropriate antivirals, diagnostic tests and vaccines.


Subject(s)
COVID-19 Nucleic Acid Testing , COVID-19 Serological Testing , COVID-19/transmission , Patient Isolation/standards , Adaptive Immunity/immunology , Antibodies, Viral/immunology , Antigens, Viral/immunology , Bronchoalveolar Lavage Fluid/chemistry , Bronchoalveolar Lavage Fluid/virology , COVID-19/diagnosis , COVID-19/immunology , COVID-19/prevention & control , COVID-19 Testing , Clinical Decision-Making , Feces/chemistry , Feces/virology , Health Personnel , Humans , Immunoglobulin G/immunology , Immunoglobulin M/immunology , Nasopharynx/chemistry , Nasopharynx/virology , Patient Isolation/methods , RNA, Viral/analysis , SARS-CoV-2 , Sputum/chemistry , Sputum/virology , Viral Load
5.
HERD ; 14(2): 38-48, 2021 04.
Article in English | MEDLINE | ID: covidwho-975844

ABSTRACT

OBJECTIVES, PURPOSES, OR AIM: To identify design strategies utilized in airborne infection isolation and biocontainment patient rooms that improve infection control potential in an alternative care environment. BACKGROUND: As SARS-CoV-2 spreads and health care facilities near or exceed capacity, facilities may implement alternative care sites (ACSs). With COVID-19 surges predicted, developing additional capacity in alternative facilities, including hotels and convention centers, into patient care environments requires early careful consideration of the existing space constraints, infrastructure, and modifications needed for patient care and infection control. Design-based strategies utilizing engineering solutions have the greatest impact, followed by medical and operational strategies. METHODS: This article evaluates infection control and environmental strategies in inpatient units and proposes system modifications to ACS surge facilities to reduce infection risk and improve care environments. RESULTS: Although adequate for an acute infectious disease outbreak, existing capacity in U.S. biocontainment units and airborne infection isolation rooms is not sufficient for widespread infection control and isolation during a pandemic. To improve patients' outcomes and decrease infection transmission risk in the alternative care facility, hospital planners, administrators, and clinicians can take cues from evidence-based strategies implemented in biocontainment units and standard inpatient rooms. CONCLUSIONS: Innovative technologies, including optimized air-handling systems with ultraviolet and particle filters, can be an essential part of an infection control strategy. For flexible surge capacity in future ACS and hospital projects, interdisciplinary design and management teams should apply strategies optimizing the treatment of both infectious patients and minimizing the risk to health care workers.


Subject(s)
Built Environment/organization & administration , COVID-19/epidemiology , COVID-19/prevention & control , Infection Control/organization & administration , Patients' Rooms/organization & administration , Built Environment/standards , Humans , Infection Control/standards , Pandemics , Patient Isolation/standards , Patients' Rooms/standards , SARS-CoV-2 , Ventilation/standards
6.
Rev Esp Anestesiol Reanim (Engl Ed) ; 67(8): 438-445, 2020 Oct.
Article in English, Spanish | MEDLINE | ID: covidwho-724561

ABSTRACT

COVID-19 infection also affects obstetric patients. Regular obstetric care has continued despite the pandemic. Case series of obstetric patients have been published. Neuroaxial techniques appear to be safe and it is important to obtain the highest possible rate of success of the blocks before a cesarean section. For this reason, it is recommended that the blocks be carried out by senior anesthesiologists. The protection and safety of professionals is a key point and in case of general anesthesia, so it is also recommended to call to the most expert anesthesiologist. Seriously ill patients should be recognized quickly and early, in order to provide them with the appropriate treatment as soon as possible. Susceptibility to thrombosis makes prophylactic anticoagulation a priority.


Subject(s)
Anesthesiologists , Betacoronavirus , Cesarean Section/standards , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Pregnancy Complications, Infectious , Analgesia, Epidural/methods , Analgesia, Epidural/standards , Analgesia, Obstetrical/standards , Anesthesia, General , Anesthesia, Obstetrical/standards , COVID-19 , Cesarean Section/methods , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Cross Infection/prevention & control , Female , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Monitoring, Physiologic/methods , Monitoring, Physiologic/standards , Pandemics/prevention & control , Patient Isolation/standards , Personal Protective Equipment , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Postoperative Care/methods , Postoperative Care/standards , Pregnancy , SARS-CoV-2 , Severity of Illness Index
9.
J Gen Intern Med ; 35(9): 2738-2742, 2020 09.
Article in English | MEDLINE | ID: covidwho-649810

ABSTRACT

In the face of the continually worsening COVID-19 pandemic, jails and prisons have become the greatest vectors of community transmission and are a point of heightened crisis and fear within the global crisis. Critical public health tools to mitigate the spread of COVID-19 are medical isolation and quarantine, but use of these tools is complicated in prisons and jails where decades of overuse of punitive solitary confinement is the norm. This has resulted in advocates denouncing the use of any form of isolation and attorneys litigating to end its use. It is essential to clarify the critical differences between punitive solitary confinement and the ethical use of medical isolation and quarantine during a pandemic. By doing so, then all those invested in stopping the spread of COVID-19 in prisons can work together to integrate medically sound, humane forms of medical isolation and quarantine that follow community standards of care rather than punitive forms of solitary confinement to manage COVID-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Delivery of Health Care/methods , Patient Isolation/methods , Pneumonia, Viral/epidemiology , Prisons , Social Isolation , COVID-19 , Coronavirus Infections/prevention & control , Coronavirus Infections/psychology , Delivery of Health Care/standards , Humans , Pandemics/prevention & control , Patient Isolation/psychology , Patient Isolation/standards , Pneumonia, Viral/prevention & control , Pneumonia, Viral/psychology , Prisons/standards , Quarantine/methods , Quarantine/psychology , Quarantine/standards , SARS-CoV-2 , Social Isolation/psychology , United States/epidemiology
10.
Am J Infect Control ; 48(9): 1032-1036, 2020 09.
Article in English | MEDLINE | ID: covidwho-629903

ABSTRACT

OBJECTIVE: Add to available understanding of COVID-19 to help decrease further spread of SARS-CoV-2 by providing protocol providers can consider when giving patients recommendations to retest as well as length of time for self-isolation. METHODS: We retrospectively collected data from the electronic medical record of patients in the Mayo Clinic Florida's COVID Virtual Clinic. Hundred and eighteen patients with detectable results for the virus were followed. Data reviewed in this study included (1) length of time from detectable to undetectable results; (2) length of time from onset of symptoms to undetectable result; (3) length of time from resolution of fever to undetectable result. RESULTS: Fifty-three percent of studied patients eligible for discontinuation of self-isolation had detectable viral RNA, and therefore, underwent repeat testing. In these patients, the mean from the date of their first detectable result to attaining an undetectable result was 14.89 days. The mean time for onset of symptoms to undetectable testing was 21.5 days. CONCLUSIONS: Hundred and eighteen patients with detectable results for SARS-CoV-2 were followed in the Mayo Clinic Florida COVID Virtual Clinic; 53% of patients still showed detectable viral RNA despite meeting CDC guidelines for discontinuation of self-isolation, prompting us to propose following a more cautious guideline that other providers could consider as a strategy to discontinue self-isolation, including increasing length of days since symptom onset.


Subject(s)
Betacoronavirus , Clinical Laboratory Techniques/standards , Coronavirus Infections/transmission , Disease Transmission, Infectious/prevention & control , Patient Isolation/standards , Pneumonia, Viral/transmission , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19 , COVID-19 Testing , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Female , Florida , Humans , Male , Middle Aged , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Retrospective Studies , SARS-CoV-2 , Time Factors , Young Adult
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