Low mortality from COVID-19 at a nursing facility in France following a combined preventive and active treatment protocol.

BACKGROUND: The aim of this study was to retrospectively describe the evolution of symptoms, infections, and mortality at a nursing facility in France that had implemented a protocol for the prevention and treatment of COVID-19. METHODS: A database was created on 21 March 2020 to store all information related to residents, including co-morbidities, as well as COVID-19 symptoms, incidence, and mortality. Residents followed a COVID-19 protocol, consisting of preventive (administering vitamins and zinc, social distancing, and temperature checks) and active (antibiotics, anticoagulants, and corticosteroids) measures. RT-PCR and serology testing were performed on residents. A new coefficient, named the Zemgor coefficient, was calculated as the haemoglobin-to-albumin ratio at 2 time points 15 days apart, to monitor hypoxemia. RESULTS: In January 2020, the nursing facility housed 192 residents, 75 men and 117 women, aged 80±11. One or more co-morbidities were present in 94% of residents, with the most common being dementia. The COVID-19 protocol provided 61% of residents with anticoagulants, 51%with antibiotics, 21% with oxygen therapy, and 3% with corticosteroids. The COVID-19 incidence was 51% based on presence of COVID-19 symptoms, 35% based on positive RT-PCR (amongst residents tested for RT-PCR) and 41% based on positive serology (amongst residents tested for serology), and the COVID-19 mortality rate was 8%. The Zemgor coefficient was 0.049±0.053 for patients with hypoxemia compared to 0.011±0.041 for patients without hypoxemia (P=0.001). CONCLUSIONS: The protocol for the prevention and treatment of COVID-19 implemented at this nursing facility resulted in a COVID-19 incidence and mortality at the lower end of that reported by other nursing facilities.

Turning a crisis into an opportunity for general practice teams in NI

The emergence of COVID-19 saw a seismic change in General Practice with significant clinical, operational and educational challenges across the whole of the primary care team. Information and guidance from multiple different sources emerged at an overwhelming pace for practitioners. There was no robust way of cascading critical information to individuals. Shielded, remote and sessional health care professionals in particular lacked access to sensitive Health and Social Care Board (HSCB) information.It was evident that there was a need for a centralised information platform for professionals. This would provide easily accessible, accurate and up to date information on service changes, operational and clinical guidance as well as legislative changesAn MDT working group, with representatives from all professions including trainees was formed to design a central knowledge repository for the whole primary care team. This ensured all practitioners had access to the latest information, equipping them to deliver high quality care during the pandemic.From concept to website launch took just three weeks, with a live web-based educational programme starting just one week later and acting as a catalyst for enhanced primary and secondary care understanding and communication.There are over 150 attendees at weekly live ZOOM educational events, with the programme reflecting learning needs across the whole primary care teamWebsite analytics confirm ‘Pageviews’ >100,000 and ‘users’ >7,500 and rising with a global audience.A crisis can bring exciting opportunities and a highly effective team can be created from conception in less than 4 weeks with a shared vision, enthusiasm and determination to make it work.Collaborative learning between GPs, fledgling MDTs, and across the primary-secondary care interface has united colleagues around a shared purpose, starting solution-focused conversations.