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1.
S Afr Med J ; 110(7): 621-624, 2020 06 17.
Article in English | MEDLINE | ID: covidwho-743568

ABSTRACT

Infectious diseases pandemics have devastating health, social and economic consequences, especially in developing countries such as South Africa. Scarce medical resources must often be rationed effectively to contain the disease outbreak. In the case of COVID-19, even the best-resourced countries will have inadequate intensive care facilities for the large number of patients needing admission and ventilation. The scarcity of medical resources creates the need for national governments to establish admission criteria that are evidence-based and fair. Questions have been raised whether infection with HIV or tuberculosis (TB) may amplify the risk of adverse COVID-19 outcomes and therefore whether these conditions should be factored in when deciding on the rationing of intensive care facilities. In light of these questions, clinical evidence regarding inclusion of these infections as comorbidities relevant to intensive care unit admission triage criteria is investigated in the first of a two-part series of articles. There is currently no evidence to indicate that HIV or TB infection on their own predispose to an increased risk of infection with SARS-CoV-2 or worse outcomes for COVID-19. It is recommended that, as for other medical conditions, validated scoring systems for poor prognostic factors should be applied. A subsequent article examines the ethicolegal implications of limiting intensive care access of persons living with HIV or TB.


Subject(s)
Coronavirus Infections , HIV Infections/epidemiology , Health Care Rationing/methods , Intensive Care Units , Pandemics , Pneumonia, Viral , Triage/organization & administration , Tuberculosis/epidemiology , Betacoronavirus/isolation & purification , Coinfection , Coronavirus Infections/economics , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Health Services Needs and Demand/organization & administration , Humans , Intensive Care Units/economics , Intensive Care Units/standards , Pandemics/economics , Patient Selection , Pneumonia, Viral/economics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Prognosis , Risk Assessment , South Africa/epidemiology
3.
BMJ Health Care Inform ; 27(3)2020 Aug.
Article in English | MEDLINE | ID: covidwho-729406

ABSTRACT

INTRODUCTION: We present the integration of telemedicine into the healthcare system of West China Hospital of Sichuan University (WCH), one of the largest hospitals in the world with 4300 inpatient beds, as a means for maximising the efficiency of healthcare delivery during the COVID-19 pandemic. METHODS: Implemented on 22 January 2020, the telemedicine technology allowed WCH providers to conduct teleconsultations, telerounds, teleradiology and tele-intensive care unit, which in culmination provided screening, triage and treatment for COVID-19 and other illnesses. To encourage its adoption, the government and the hospital publicised the platform on social media and waived fees. DISCUSSION: From 1 February to 1 April 2020, 10557 online COVID-19 consultations were conducted for 6662 individuals; meanwhile, 32676 patients without COVID completed virtual follow-ups. We discuss that high-quality, secure, affordable and user-friendly telemedical platforms should be integrated into global healthcare systems to help decrease the transmission of the virus and protect healthcare providers from infection.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Telemedicine/organization & administration , Betacoronavirus , China , Cooperative Behavior , Delivery of Health Care/organization & administration , Efficiency, Organizational , Humans , Intensive Care Units , Marketing of Health Services/organization & administration , Mobile Applications , Pandemics , Quality of Health Care , Triage/organization & administration
5.
Int J Environ Res Public Health ; 17(16)2020 Aug 10.
Article in English | MEDLINE | ID: covidwho-704729

ABSTRACT

BACKGROUND: Since the beginning of SARS-CoV-2 outbreak, a large number of infections have been reported among healthcare workers (HCWs). The aim of this study was to investigate the occurrence of SARS-CoV-2 infection among HCWs involved in the first management of infected patients and to describe the measures adopted to prevent the transmission in the hospital. METHODS: This prospective observational study was conducted between February 21 and April 16, 2020, in the Padua University Hospital (north-east Italy). The infection control policy adopted consisted of the following: the creation of the "Advanced Triage" area for the evaluation of SARS-CoV-2 cases, and the implementation of an integrated infection control surveillance system directed to all the healthcare personnel involved in the Advance Triage area. HCWs were regularly tested with nasopharyngeal swabs for SARS-CoV-2; body temperature and suggestive symptoms were evaluated at each duty. Demographic and clinical data of both patients and HCWs were collected and analyzed; HCWs' personal protective equipment (PPE) consumption was also recorded. The efficiency of the control strategy among HCWs was evaluated identifying symptomatic infection (primary endpoint) and asymptomatic infection (secondary endpoint) with confirmed detection of SARS-CoV-2. RESULTS: 7595 patients were evaluated in the Advanced Triage area: 5.2% resulted positive and 72.4% was symptomatic. The HCW team was composed of 60 members. A total of 361 nasopharyngeal swabs were performed on HCWs. All the swabs resulted negative and none of the HCWs reached the primary or the secondary endpoint. CONCLUSIONS: An integrated hospital infection control strategy, consisting of dedicated areas for infected patients, strict measures for PPE use and mass surveillance, is successful to prevent infection among HCWs.


Subject(s)
Coronavirus Infections/prevention & control , Health Personnel/organization & administration , Infection Control/organization & administration , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Adult , Asymptomatic Infections/epidemiology , Betacoronavirus , Body Temperature , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Disease Outbreaks , Female , Health Personnel/standards , Humans , Infection Control/standards , Italy/epidemiology , Male , Patient Care Team/organization & administration , Personal Protective Equipment/statistics & numerical data , Personal Protective Equipment/supply & distribution , Prospective Studies , Triage/organization & administration
8.
Chest ; 158(2): 603-607, 2020 08.
Article in English | MEDLINE | ID: covidwho-683267

ABSTRACT

Health systems confronting the coronavirus disease 2019 (COVID-19) pandemic must plan for surges in ICU demand and equitably distribute resources to maximize benefit for critically ill patients and the public during periods of resource scarcity. For example, morbidity and mortality could be mitigated by a proactive regional plan for the triage of mechanical ventilators. Extracorporeal membrane oxygenation (ECMO), a resource-intensive and potentially life-saving modality in severe respiratory failure, has generally not been included in proactive disaster preparedness until recently. This paper explores underlying assumptions and triage principles that could guide the integration of ECMO resources into existing disaster planning. Drawing from a collaborative framework developed by one US metropolitan area with multiple adult and pediatric extracorporeal life support centers, this paper aims to inform decision-making around ECMO use during a pandemic such as COVID-19. It also addresses the ethical and practical aspects of not continuing to offer ECMO during a disaster.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Critical Illness/therapy , Extracorporeal Membrane Oxygenation/statistics & numerical data , Pandemics , Pneumonia, Viral/therapy , Triage/organization & administration , Ventilators, Mechanical/supply & distribution , Global Health , Humans
9.
Heart Rhythm ; 17(9): e233-e241, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-656387

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a global pandemic that is wreaking havoc on the health and economy of much of human civilization. Electrophysiologists have been impacted personally and professionally by this global catastrophe. In this joint article from representatives of the Heart Rhythm Society, the American College of Cardiology, and the American Heart Association, we identify the potential risks of exposure to patients, allied healthcare staff, industry representatives, and hospital administrators. We also describe the impact of COVID-19 on cardiac arrhythmias and methods of triage based on acuity and patient comorbidities. We provide guidance for managing invasive and noninvasive electrophysiology procedures, clinic visits, and cardiac device interrogations. In addition, we discuss resource conservation and the role of telemedicine in remote patient care along with management strategies for affected patients.


Subject(s)
Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/therapy , Betacoronavirus , Coronavirus Infections/prevention & control , Electrocardiography , Electrophysiologic Techniques, Cardiac , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Arrhythmias, Cardiac/etiology , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Humans , Infection Control/organization & administration , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Telemedicine/organization & administration , Triage/organization & administration
10.
J Card Surg ; 35(8): 1761-1764, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-644752

ABSTRACT

On 11 March 2020, the World Health Organization declared the SARS-CoV-2 outbreak a pandemic. At the time of writing, 24 May 2020 more than 5 million individuals have been tested positive and the death toll was over 330 000 deaths worldwide. The initial data pointed out the tight bond between cardiovascular diseases and worse health outcomes in COVID19-patients. Epidemiologically speaking, there is an overlap between the age-groups more affected by COVID-related death and the age-groups in which Cardiac Surgery has its usual base of patients. The Cardiac Surgery Departments have to think to a new normal: since the virus will remain endemic in the society, dedicated pathways or even dedicated Teams are pivotal to treat safely the patients, in respect of the safety of the health care workers. Moreover, we need a keen eye on deciding which pathologies have to be treated with priority: Coronary artery Disease showed a higher mortality rate in patients affected by COVID19, but it is, however, reasonable to think that all the cardiac pathologies affecting the lung circulation-such as symptomatic severe mitral diseases or aortic stenosis-might deserve a priority access to treatment, to increase the survival rate in case of an acquired-Coronavirus infection later on.


Subject(s)
Cardiac Surgical Procedures , Coronavirus Infections/prevention & control , Hospital Restructuring , Infection Control/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Triage/organization & administration , Betacoronavirus , Cardiovascular Diseases , Comorbidity , Coronavirus Infections/epidemiology , Hospital Units , Humans , Pneumonia, Viral/epidemiology
13.
J Vasc Surg Venous Lymphat Disord ; 8(5): 706-710, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-628665

ABSTRACT

The coronavirus disease 2019 (COVID-19) global pandemic has resulted in diversion of healthcare resources to the management of patients infected with SARS-CoV-2 virus. Elective interventions and surgical procedures in most countries have been postponed and operating room resources have been diverted to manage the pandemic. The Venous and Lymphatic Triage and Acuity Scale was developed to provide an international standard to rationalise and harmonise the management of patients with venous and lymphatic disorders or vascular anomalies. Triage urgency was determined based on clinical assessment of urgency with which a patient would require medical treatment or surgical intervention. Clinical conditions were classified into six categories of: (1) venous thromboembolism (VTE), (2) chronic venous disease, (3) vascular anomalies, (4) venous trauma, (5) venous compression and (6) lymphatic disease. Triage urgency was categorised into four groups and individual conditions were allocated to each class of triage. These included (1) medical emergencies (requiring immediate attendance), example massive pulmonary embolism; (2) urgent (to be seen as soon as possible), example deep vein thrombosis; (3) semiurgent (to be attended to within 30-90 days), example highly symptomatic chronic venous disease, and (4) discretionary/nonurgent- (to be seen within 6-12 months), example chronic lymphoedema. Venous and Lymphatic Triage and Acuity Scale aims to standardise the triage of patients with venous and lymphatic disease or vascular anomalies by providing an international consensus-based classification of clinical categories and triage urgency. The scale may be used during pandemics such as the current COVID-19 crisis but may also be used as a general framework to classify urgency of the listed conditions.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Lymphatic Diseases/therapy , Pneumonia, Viral/epidemiology , Triage/organization & administration , Vascular Diseases/therapy , Veins , Consensus , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Humans , International Cooperation , Lymphatic Diseases/diagnosis , Pandemics/prevention & control , Patient Selection , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Reproducibility of Results , Severity of Illness Index , Societies, Medical , Vascular Diseases/diagnosis , Vascular Surgical Procedures
19.
Hastings Cent Rep ; 50(3): 71-72, 2020 May.
Article in English | MEDLINE | ID: covidwho-619891

ABSTRACT

Ethicists and physicians all over the world have been working on triage protocols to plan for the possibility that the Covid-19 pandemic will result in shortages of intensive care unit beds, ventilators, blood products, or medications. In reflecting on those protocols, many health care workers have noticed that, outside the pandemic shortage situation, we routinely supply patients in the ICU with invasive and painful care that will not help the patients survive even their hospitalization. This is the kind of pointless care that even the most basic protocol would triage against. Perhaps this widespread reflection on triage standards will draw our attention to our ongoing custom of supplying burdensome and inefficacious care to those near the end of life-care that most health care providers would not want for themselves. This essay argues that reflecting on triage could help us improve end-of-life care.


Subject(s)
Coronavirus Infections/epidemiology , Health Care Rationing/ethics , Intensive Care Units/ethics , Pneumonia, Viral/epidemiology , Terminal Care/ethics , Triage/ethics , Betacoronavirus , Health Care Rationing/organization & administration , Humans , Intensive Care Units/organization & administration , Pandemics , Terminal Care/organization & administration , Triage/organization & administration
20.
J Card Surg ; 35(8): 1767-1768, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-619289

ABSTRACT

The authors share their experience of managing the cardiac surgery services across London during the challenging Covid-19 pandemic. The Pan London Emergency Cardiac Surgery Service model could serve as a blueprint to design policies applicable to other surgical specialities and parts of the UK and worldwide.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Surgery Department, Hospital/organization & administration , Thoracic Surgery/organization & administration , Triage/organization & administration , Betacoronavirus , Emergencies , Humans , London/epidemiology , Models, Organizational , Pandemics , Thoracic Surgical Procedures
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