Abstract
The COVID-19 pandemic has revealed limitations in real-time surveillance needed for responsive health care action in low- and middle-income countries (LMICs). The Pakistan Registry for Intensive CarE (PRICE) was adapted to enable International Severe Acute Respiratory and emerging Infections Consortium (ISARIC)–compliant real-time reporting of severe acute respiratory infection (SARI). The cloud-based common data model and standardized nomenclature of the registry platform ensure interoperability of data and reporting between regional and global stakeholders. Inbuilt analytics enable stakeholders to visualize individual and aggregate epidemiological, clinical, and operational data in real time. The PRICE system operates in 5 of 7 administrative regions of Pakistan. The same platform supports acute and critical care registries in eleven countries in South Asia and sub-Saharan Africa. ISARIC-compliant SARI reporting was successfully implemented by leveraging the existing PRICE infrastructure in all 49 member intensive care units (ICUs), enabling clinicians, operational leads, and established stakeholders with responsibilities for coordinating the pandemic response to access real-time information on suspected and confirmed COVID-19 cases (N=592 as of May 2020) via secure registry portals. ICU occupancy rates, use of ICU resources, mechanical ventilation, renal replacement therapy, and ICU outcomes were reported through registry dashboards. This information has facilitated coordination of critical care resources, health care worker training, and discussions on treatment strategies. The PRICE network is now being recruited to international multicenter clinical trials regarding COVID-19 management, leveraging the registry platform. Systematic and standardized reporting of SARI is feasible in LMICs. Existing registry platforms can be adapted for pandemic research, surveillance, and resource planning.
Highlights
The COVID-19 pandemic has revealed limitations in capacity for real-time surveillance needed for responsive health care action in low- and middle-income countries (LMICs), where infrastructure and institutional partnerships to facilitate accurate and timely reporting of clinical and operational data are often absent [1,2]
In LMICs, critical care services are already limited outside the pandemic context, and technical and human resources are often already overburdened with existing endemic illness [6]
Pakistan Registry for Intensive CarE (PRICE)-collaborating intensive care unit (ICU) are being recruited to registry-embedded international multicenter research clinical trials—site recruitment to the Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP) COVID-19 trial is underway in three countries in the CRIT Care Collaboration for Research (Asia) network—with registry-enabled clinical and epidemiological data informing the selection of context-specific interventions and site enrollment
Summary
The COVID-19 pandemic has revealed limitations in capacity for real-time surveillance needed for responsive health care action in low- and middle-income countries (LMICs), where infrastructure and institutional partnerships to facilitate accurate and timely reporting of clinical and operational data are often absent [1,2]. Critical care; registry; informatics; COVID-19; severe acute respiratory infection; pandemic; surveillance; cloud-based; research; low-and-middle-income countries http://publichealth.jmir.org/2020/4/e21939/
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