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ObjectivesThis study was conducted to explore the perspectives and opinions of Intensive Care Unit (ICU) nurses and doctors at a COVID-19 designated pandemic hospital concerning the preparedness and response to COVID-19 and to consolidate the lessons learnt for crisis/disaster management in the future. DesignA qualitative study using in-depth interviews (IDIs) and focus group discussions (FGDs). Purposeful sampling was conducted to identify participants. A semi-structured guide was utilised to facilitate in-depth interviews with individual participants. Two focus group discussions were conducted, one with the ICU doctors and another with the ICU nurses. Thematic analysis identified themes and subthemes informing about the level of preparedness, response measures, processes, and factors that were either facilitators or those that triggered challenges. SettingICU in a quaternary referral centre affiliated to a university teaching COVID-19 designated pandemic hospital, in Adelaide, South Australia. ParticipantsThe participants included eight ICU doctors and eight ICU nurses for the in-depth interviews. Another sixteen clinicians participated in focus group discussions. ResultsThe study identified six themes relevant to preparedness for, and responses to, COVID-19. The themes included: (1) Staff competence and planning, (2) Information transfer and communication, (3) Education and skills for the safe use of PPE, (4) Team dynamics and clinical practice, (5) leadership, and (6) Managing End-of life situations and expectations of caregivers. ConclusionFindings highlight that preparedness and response to the COVID-19 crisis were proportionate to the situations gravity. More enablers than barriers were identified. However, opportunities for improvement were recognised in the domains of planning, logistics, self-sufficiency with equipment, operational and strategic oversight, communication, and managing end-of-life care. ARTICLE SUMMARYO_ST_ABSStrengths and limitations of this studyC_ST_ABSO_LIThis is the first study that provided insights about clinicians perspectives and viewpoints to preparing and responding to COVID-19 in Australia. C_LIO_LIThe study used qualitative methodological framework allowing participants to provide in-depth accounts of processes and enabling factors and barriers. C_LIO_LIOur study provides information on issues that needs to be addressed from a critical care viewpoint and interventions that were effective and efficient C_LIO_LIThis is a single-center study in a developed country where experience is vastly different from other centers with higher demand and fewer resources C_LIO_LIWe acknowledge the potential for selection bias because of the qualitative design C_LI
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Increasing evidence suggests immune dysregulation in individuals recovering from SARS- CoV-2 infection. We have undertaken an integrated analysis of immune responses at a transcriptional, cellular, and serological level at 12, 16, and 24 weeks post-infection (wpi) in 69 individuals recovering from mild, moderate, severe, or critical COVID-19. Anti-Spike and anti-RBD IgG responses were largely stable up to 24wpi and correlated with disease severity. Deep immunophenotyping revealed significant differences in multiple innate (NK cells, LD neutrophils, CXCR3+ monocytes) and adaptive immune populations (T helper, T follicular helper and regulatory T cells) in COVID-19 convalescents compared to healthy controls, which were most strongly evident at 12 and 16wpi. RNA sequencing suggested ongoing immune and metabolic dysregulation in convalescents months after infection. Variation in the rate of recovery from infection at a cellular and transcriptional level may explain the persistence of symptoms associated with long COVID in some individuals.
