COVID-19 Treatment Center Research Articles

The Impact of COVID-19 on Hospital Attendance and Perceived Stigmatization Towards Individuals with COVID-19 Like Symptoms in Buea Municipality, Cameroon

Objectives: The outbreak of COVID-19 has brought about fear and uncertainty resulting to stigmatization and discrimination towards those with COVID-19 like symptoms as well as influence the patient influx to health facilities and the health-seeking behaviour of the population. This study assessed the health-seeking behaviour, hospital attendance, and the level of stigmatization of the population towards individuals with COVID-19 like symptoms. Methods: This was a cross-sectional community and hospital-based study carried out to assess hospital attendance, perceived stigmatization and population health-seeking behaviour during the COVID-19 pandemic in the Buea Municipality. The trend in the patients' influx in the COVID-19 treatment centre and other health facilities was assessed from March to June 2020 and compared with corresponding months in 2019. The stigmatization data was collected using a modified 12-items stigma scale. The data was analyzed with SPSS version 26. Results: The hospital attendance decreased in the COVID-19 treatment centre from April to June 2020 by -38.3% and increased in non-COVID-19 treatment health facilities by over 70%. Of the 570 participants for the community survey, 322 (56.5%) reported to go for auto medication if they developed COVID-19 symptoms. Individuals with COVID-19 like symptoms experienced moderate (59.1%) to severe (33.9%) perceived stigmatization. Perceived stigmatization was significantly higher (²=14.56, p=0.001) in participants who reported not willing to go to the hospital during the pandemic. Conclusion: The hospital turnout experienced a drop in the COVID-19 treatment centre and an increase in other health facilities. There was high perceived stigmatization towards people with COVID-19 like symptoms, which probably accounted for the population refusal to seek treatment in the COVID-19 treatment center and to resort to auto medication.

Perspectives of nurses on preparedness for combating COVID-19 crisis in Ghana: A qualitative inquiry

BackgroundCOVID-19 has impacted negatively on people physically, psychologically, spiritually, and socioeconomically worldwide. Nurses’ ability to prepare towards case management is imperative because the potential of one coming across the virus at the hospital is inevitable. This study intended to explore and describe nurses’ perspectives on preparation towards fighting COVID 19 in Ghana. MethodsA qualitative exploratory descriptive design was adopted. Nine major health facilities designated for COVID-19 treatment centres in four regions in Ghana were involved in the study. A semi structured interview guide was used to interview twenty-nine nurses via telephone based on data saturation. Ethics approval was obtained from the Ethics Review Committee of the Nursing and Midwifery Council of Ghana. Resultdata yielded two major themes and four subthemes. The two main themes were 1. Health facilities’ preparation of nurses towards COVID-19, with its subthemes; targeted training, and selection of experienced staff. 2. Nurses’ individual preparedness towards COVID-19 with the subthemes; information sourcing and sharing. Nurses in Ghana prepared for combating COVID-19 by going through training on infection prevention and control, and case management using demonstrations and simulations. Experienced nurses in Ghana volunteered to be at the frontline managing cases. Continuous updates on the virus and its management through information tracking sharing played a key role. ConclusionNurses in Ghana need to have more specialty training targeted at diseases of public health importance. Key words: Nurse; preparedness; covid-19.

Care of the Covid-19 Patients: Experiences of Health Workers in Rivers State Nigeria

Background: Frontline health workers are faced with the overwhelming responsibility of caring for patients infected with the Coronavirus and this has seriously affected their physical and mental health status due to the rapid spread of the disease globally and the unprepared state of health workers who were recruited with little or no skills in infectious disease care. This study describes the experiences of healthcare workers involved in the management of COVID-19 patients.
 Methods: A qualitative study design was employed, using a phenomenological approach. In-depth interviews were conducted by telephone on health workers selected purposively from the four COVID-19 treatment centers. The health workers consisted of seven doctors, three nurses, and two hygienists.
 Results: Data collected were transcribed and content analysis was done using Atlas. Ti. Some major highlights identified include; the bravery and commitment of health workers despite their proximity to patients, the anxiety and fear of becoming infected, the inconveniencing nature of the PPEs and its effect on their work efficiency, the patients mental and health status on admission (denial, fear, co-morbidities, need for special attention), and other challenges (boredom, shortage of personal protective equipment and medications, the need for special diet and privacy by some patients). Suggestions that emerged were; training, government action, and installing security cameras in patients’ wards. 
 Conclusion: Findings indicate the need for training health workers to enhance preparedness for future pandemics, provision of psycho-social support for health workers and patients, and government commitment.

Clinical Profile and Treatment of COVID-19 Patients: Experiences from an Ethiopian Treatment Center.

.COVID-19 is not well studied in Africa. Understanding the clinical profile and management of COVID-19 will help to plan better prevention and treatment strategies taking the local context into consideration. In this study, we described the clinical profile, treatment used, and outcomes of COVID-19 patients in one of the COVID-19 treatment centers of Ethiopia, Boru Meda Hospital. An institution-based retrospective cross-sectional study was carried out using medical records of COVID-19 patients who were admitted to Boru Meda Hospital with a positive reverse transcription (RT)-PCR result from May 9, 2020 to September 20, 2020. All patients with a positive RT-PCR were admitted to the hospital, regardless of symptom and severity status. A total of 279 COVID-19 patients were included in the final analysis. The median age of patients was 28 years (interquartile range 23–40). The majority (69.5%) were male. Around a quarter (n = 73; 26.2%) of the patients were symptomatic, of which cough (n = 49; 67.1%) and fever (n = 32; 43.8%) were common symptoms. Among symptomatic patients, 48 (65.8%) were mild, four (5.5%) moderate, 12 (16.4%) severe, and nine (12.3%) were critical. The case fatality rate was 2.1%. Hypertension, age older than 25 years, and HIV/AIDS were significantly associated with symptomatic infection. In this study, most of the COVID-19 patients were asymptomatic. However, the proportion of severe and critical patients among those with symptoms was high. More studies are needed to assess the effect of HIV/AIDS on the severity and mortality of COVID-19.

The Role of Sex in Malaria-COVID19 Coinfection and Some Associated Factors in Rivers State, Nigeria.

Objectives Data on the coinfection of malaria and COVID-19 is highly limited especially in Africa due to the novel nature of the pandemic COVID-19. Malaria and COVID-19 share striking similarities in their symptoms. A cross-sectional randomized study was conducted to investigate the role of sex in the coinfection of malaria and COVID-19 as well as some associated factors in Rivers State, Nigeria. Methods Ethical approval was obtained from the Rivers State Health and Ethics Committee before the commencement of this study, and the study was conducted at the COVID-19 Treatment Center Medical Laboratory, Rivers State, Nigeria. Intravenous blood samples from three hundred randomly selected consenting study participants were examined for Plasmodium species using Giemsa microscopy, while pretested questionnaires were used to obtain data on sex, risk factors, and symptoms. All data generated were analyzed statistically using the Chi-square test with a P < 0.05 value considered significant. Results All study participants had Plasmodium species (100% prevalence) with varying parasite loads, and P. falciparum was the only species observed. Study participants (irrespective of sex) with low and high parasitaemia had the highest and least prevalence, respectively (P > 0.05). Male study participants experienced more symptoms than females (P > 0.05) except for sore throat which had an equal value among males and females. Travel history was the only risk factor that showed significant association with sex, and males had a higher value than females (P < 0.05). Conclusion Malaria and COVID-19 are major public health issues in Nigeria; more researches on these diseases especially in epidemiology, pathology, diagnosis, treatment, and vaccine production are vital.

Clinical features of COVID-19 in Ghana: symptomatology, illness severity and comorbid non-communicable diseases.

This analysis described the clinical features of COVID-19 in the early phase of the pandemic in Ghana. Data were extracted from two national COVID-19 treatment centers in Ghana for over 11 weeks(from March to May 2020). Descriptive and inferential statistics were performed. Modified Ordered Logistic and Negative Binomial Regression analysis were applied to establish factors associated with illness severity and Non-communicable Disease (NCDs) counts respectively. All analysis was conducted at the 95% confidence level (p-value ≤ 0.05) using Stata 16. Among the 275 patients, the average age was 40.7±16.4, with a preponderance of males (54.5%). The three commonest symptoms presented were cough (21.3%), headache (15.7%), and sore throat (11.7%). Only 7.6% of the patients had a history of fever. Most patients were asymptomatic (51.65). Approximately 38.9% have an underlying co-morbid NCDs, with Hypertension (32.1%), Diabetes (9.9%), and Asthma (5.2%) being the three commonest. The odds of Moderate/severe (MoS) was significantly higher for those with unknown exposures to similar illness [aOR(95%CI) = 4.27(1.12-10.2)] compared with non-exposure to similar illness. An increased unit of NCD's count significantly increased the odds of COVID-19 MoS illness by 26%[cOR(95%CI) =1.26(1.09-1.84)] and 67% (adjusting for age) [aOR(95%CI)=1.67(1.13-2.49)]. The presence of cardiovascular co-morbidities dictated the frequency of reported symptoms and severity of COVID-19 infection in this sample of Ghanaians. Physicians should be aware of the presence of co-morbid NCDs and prepare to manage effectively among COVID-19 patients. None declared.

Clinical characteristics of COVID-19 patients admitted at the Korle-Bu Teaching Hospital, Accra, Ghana.

Study design was a retrospective single-center review of hospital data. The study was conducted at the COVID-19 Treatment Center of the Department of Medicine and Therapeutics of the Korle-Bu Teaching hospital in Accra, Ghana. A total of fifty patients with laboratory (rRT-PCR) confirmed COVID-19 infection were involved in the study. A chart review of the medical records of the patients was conducted and the data obtained was documented using a data extraction form. The median age was 53 years and most (36% (18/50)) of the patients were at least 60 years of age. Eighty percent (40/50) of the patients were symptomatic, with cough and difficulty in breathing being the commonest presenting symptoms. The mean duration of hospitalization was 12.3 ± 7.3 days. Hypertension and Diabetes Mellitus were the commonest co-morbidities occurring in 52% (26/50) and 42% (21/50) of patients respectively. Fifty percent of patients developed COVID-19 pneumonia as a complication. The mortality rate was 12% (6/50). In this study, SARS-CoV2 infection affected older adults with hypertension and diabetes mellitus being the common comorbidities. Patients with these comorbid conditions should be counselled by their clinicians to strictly observe the COVID-19 prevention protocols to reduce their risk of acquiring the infection. There is a need to pay critical and prompt attention to the management of patients with COVID-19 pneumonia particularly among people with diabetes to improve outcomes. None declared.

Managing patient flows in radiation oncology during the COVID-19 pandemic

PurposeThe described work aimed to avoid cancellations of indispensable treatments by implementing active patient flow management practices and optimizing infrastructure utilization in the radiation oncology department of a large university hospital and regional COVID-19 treatment center close to the first German SARS-CoV‑2 hotspot region Heinsberg in order to prevent nosocomial infections in patients and personnel during the pandemic.Patients and methodsThe study comprised year-to-date intervention analyses of in- and outpatient key procedures, machine occupancy, and no-show rates in calendar weeks 12 to 19 of 2019 and 2020 to evaluate effects of active patient flow management while monitoring nosocomial COVID-19 infections.ResultsActive patient flow management helped to maintain first-visit appointment compliance above 85.5%. A slight appointment reduction of 10.3% daily (p = 0.004) could still significantly increase downstream planning CT scheduling (p = 0.00001) and performance (p = 0.0001), resulting in an absolute 20.1% (p = 0.009) increment of CT performance while avoiding overbooking practices. Daily treatment start was significantly increased by an absolute value of 18.5% (p = 0.026). Hypofractionation and acceleration were significantly increased (p = 0.0043). Integrating strict testing guidelines, a distancing regimen for staff and patients, hygiene regulations, and precise appointment scheduling, no SARS-CoV‑2 infection in 164 tested radiation oncology service inpatients was observed.ConclusionIn times of reduced medical infrastructure capacities and resources, controlling infrastructural time per patient as well as optimizing facility utilization and personnel workload during treatment evaluation, planning, and irradiation can help to improve appointment compliance and quality management. Avoiding recurrent and preventable exposure to healthcare infrastructure has potential health benefits and might avert cross infections during the pandemic. Active patient flow management in high-risk COVID-19 regions can help Radiation Oncologists to continue and initiate treatments safely, instead of cancelling and deferring indicated therapies.

Presenting Symptoms and Predictors of Poor Outcomes Among 2,184 Patients with COVID-19 in Lagos State, Nigeria

IntroductionLagos state remains the epicentre of COVID-19 in Nigeria. We describe the symptoms and signs of the first 2,184 PCR-confirmed COVID-19 patients admitted at COVID-19 treatment centers in Lagos State. We also assessed the relationship between patients’ presenting symptoms, sociodemographic and clinical characteristics and COVID-19 deaths.. MethodsMedical records of PCR-confirmed COVID-19 patients were extracted and analyzed for their symptoms, symptom severity, presence of comorbidities and outcome. ResultsThe ages of the patients ranged from 4 days to 98 years with a mean of 43.0(16.0) years. Of the patients who presented with symptoms, cough (19.3%) was the most common presenting symptom. This was followed by fever (13.7%) and difficulty in breathing, (10.9%). The most significant clinical predictor of death was the severity of symptoms and signs at presentation. Difficulty in breathing was the most significant symptom predictor of COVID-19 death (OR:19.26 95% CI 10.95-33.88). The case fatality rate was 4.3%. ConclusionPrimary care physicians and COVID-19 frontline workers should maintain a high index of suspicion and prioritize the care of patients presenting with these symptoms. Community members should be educated on such predictors and ensure that patients with these symptoms seek care early to reduce the risk of deaths associated with COVID-19.

Rapid Deployment of Critical Care Nurse Education During the COVID-19 Pandemic

This study evaluated nurses’ perceptions of a rapidly deployed critical care education program conducted to prepare a community hospital for its transformation to a COVID-19 treatment center. The education included a traditional didactic approach and incorporated experienced nursing support staff at the bedside. Nurses were interviewed about the strengths and weaknesses of the program, and for their perceptions of the additional clinical support. A distributed learning model with small groups attending multiple trainings could have improved the didactic session. However, there was positive feedback about the use of a “buddy” system and critical care education specialist in the intensive care unit setting.

Acute myocardial injury is common in patients with COVID-19 and impairs their prognosis

ObjectiveWe sought to explore the prevalence and immediate clinical implications of acute myocardial injury in a cohort of patients with COVID-19 in a region of China where medical resources are...

Facility-Level Approaches for COVID-19 When Caseload Surpasses Surge Capacity

.As COVID-19 cases continue to increase globally, fragile health systems already facing challenges with health system infrastructure, SARS-CoV-2 diagnostic capacity, and patient isolation capabilities may be left with few options to effectively care for acutely ill patients. Haiti—with only two laboratories that can perform reverse transcriptase PCR for SARS-CoV-2, a paucity of hospital beds, and an exponential increase in cases—provides an example that underpins the need for immediate infrastructure solutions for the crisis. We present two COVID-19 treatment center designs that leverage lessons learned from previous outbreaks of communicable infectious diseases and provide potential solutions when caseload exceeds existing capacity, with and without access to SARS-CoV-2 testing. These designs are intended for settings in which health facilities and testing resources for COVID-19 are surpassed during the pandemic, are adaptable to local conditions and constraints, and mitigate the likelihood of nosocomial transmission while offering an option to care for hospitalized patients.

Clinical characteristics and outcomes of COVID-19 infection in nine pregnant women: a report from a sub-Saharan African country, Senegal.

IntroductionTo investigate the clinical characteristics of COVID-19 in pregnancy in Senegal.MethodsThis was a cross-sectional and descriptive study of all cases of COVID-19 including nine pregnant women who were admitted in COVID-19 treatment centers in Senegal from March 2 to May 15, 2020. SARS-COV-2 infection was confirmed by PCR. Patients’ characteristics, clinical features, treatment and outcome were obtained with a customized data collection form.ResultsThe frequency of the association COVID-19 and pregnancy was 0.5%. The age range of the patients was 18-42 years with an average 28 years, and the range of gestational weeks at admission was 7 weeks to 32 weeks. None of the patients had underlying diseases. All the patients presented with a headache and only four of them had fever. Other symptoms were also observed: two patients had a cough, two had rhinorrhea, and two patients reported poor appetite. The median time to recovery was 13.6 days, corresponding to the number of days in hospital. None of the nine pregnant women developed severe COVID-19 pneumonia or died.ConclusionPregnant women appear to have the same contamination predispositions and clinical features of SARS-COV-2 infection as the general population. This study shows no evidence that pregnant women are more susceptible to infection with coronavirus.

Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial

ObjectiveTo assess the efficacy and safety of hydroxychloroquine plus standard of care compared with standard of care alone in adults with coronavirus disease 2019 (covid-19).DesignMulticentre, open label, randomised controlled trial.Setting16...

Healthcare Workers Exposure Risk Assessment: A Survey among Frontline Workers in Designated COVID-19 Treatment Centers in Ghana.

Background:Healthcare workers (HCWs) are faced with an elevated risk of exposure to SARS-COV-2 due to the clinical procedures they perform on COVID-19 patients. However, data for frontline HCWs level of exposure and risk of COVID-19 virus infection are limited.Objective:We investigated the level of exposure and risk of COVID-19 virus infection among HCWs in COVID-19 treatment centers in Ghana.Methods:A cross-sectional study was utilized in this study and HCWs were invited by convenience to participate in the study, 408 HCWs in 4 COVID-19 treatment centers participated in the study. Adherence to infection prevention and control (IPC) measures were used to categorized HCWs as low or high risk of COVID-19 virus infection. The WHO COVID-19 risk assessment tool was used to collect quantitative data from the study participants.Results:There was a high (N = 328, 80.4%) level of occupational exposure to the COVID-19 virus. However, only 14.0% of the exposed HCWs were at high risk of COVID-19 virus infection. Healthcare workers who performed or were present during any aerosol-generating procedures (AGP) were 23.8 times more likely to be exposed compared to HCWs who did not perform or were absent during any AGP (AOR 23.83; 95% CI: 18.45, 39.20). High risk of COVID-19 virus infection was less likely among registered nurses (AOR = 0.09; 95% CI: 0.02, 0.60), HCWs who performed or were present during any AGP (AOR = 0.05; 95% CI: 0.01, 0.50) and HCWs with a master’s degree qualification (AOR 0.06; 95% CI: 0.01, 0.63).Conclusion:Despite the high level of exposure to the COVID-19 virus among HCWs in the treatment centers, only 14.0% were at high risk of COVID-19 virus infection. To protect this group of HCWs, treatment centers and HCWs should continue to adhere to WHO and national IPC protocols in managing of COVID-19 cases.