COVID Clinic Research Articles

IMPACT OF COVID-19 PANDEMIC ON POSTGRADUATE TRAINEES: WAY FORWARD FOR ACADEMIC ACTIVITIES

Mankind has always been facing challenges in form of pandemics which take a lot of lives and spread fear as well [1]. The year 2019 introduced human race with COVID 19 which started from China and in no time spread around the globe [2]. Millions of people got affected and a lot of them had either life threatening complications or lost their lives [2]. Health professionals especially administrators have been under tremendous pressure to meet the needs arising in these unusual circumstances and every department has been getting affected including medical education. Tertiary care teaching hospitals not only cater for the management of patients but also serve the purpose of medical education of various undergraduate and post graduate trainees. When changes made in hospitals specific to pandemic last long they may affect the teaching activities of trainees in number of ways [3].
 Most departments in hospitals in developing countries had cut down their manpower and resources to equip the health system in fight against this pandemic especially during the peak time. These measures though inevitable in these difficult times, had an impact on clinical and teaching activities of other departments. Studies done even in developed countries revealed that there was 40 to 80% reduction in training activates of post graduate residents of various departments of hospital [4]. Reason may be temporary attachment to COVID wards, clinics and intensive care units and reduction or cessation of routine outpatients, elective surgeries and teaching activities.
 COVID 19 had its peak in May-June 2019 in Pakistan and now we may be having a second wave. Hospitals, ICUs, quarantine and isolation centers were full during the first wave and doctors from all the specialties either directly or indirectly got affected by this pandemic [5]. Limited resources forced the hospital administration to attach doctors and health professionals from all the specialties to get attached to covid-19 units in one way or other. Halt in academic and clinical activities of own unit and attachment to a unit in which health professionals have not been trained to may bring a lot of concerns in their minds and may affect their functioning in this difficult time.
 Due to closure of outpatient departments and diversion of most of the manpower toward COVID-19 patients screening and management; direct and indirect training activities of all the specialty doctors have been affected. Adjusting to this pandemic is need of the hour. At this moment we have to create a nice balance between precautions required to control the pandemic and measures needed to continue medical education for making health professionals more equipped. Smart learning may be a valuable strategy for maintaining the learning curve of residents. Wellness activities centered on increased communication also seem a good option in these difficult times. Teaching programs across the globe had begun to use video-conferencing and the majority planned to continue using this in coming times [6]. It is now high time for academicians to consider utilizing other modes of facilitating learning such as live tele-teaching video conference platforms whereby student’s engagement and interactivity can be preserved, whilst observing appropriate COVID-19 social distancing measures.

The effectiveness of early anticoagulant treatment in Covid-19 patients.

Coronavirus disease 2019 (Covid-19) is an emerging, fast-spreading and worldwide infectious disease that would be deteriorated with the precipitation of systemic or local thrombosis. The aim of current study was evaluating the effects of early anticoagulant treatment in hospitalized Covid-19 patients. The present retrospective and comparative cohort study investigated 413 hospitalized Covid-19 patients treated with or without Low Molecular Weight Heparin (LMWH) (n = 187 and 226, respectively) in the Covid Clinics of Gulhane Education and Research Hospital in Ankara, Turkey, between March 18 and May 03, 2020. The treatment groups were consisted of the patients evaluated before and after The Covid-19 Treatment Guide update on April 12, 2020 that included the anticoagulant treatment thereafter. The mean age of all 413 patients (204 male and 209 female) at disease onset was 50.6 ± 16.7 years. The LMWH-treated patients had significantly higher coagulation markers such as d-dimer and platelet count than LMWH-untreated patients (p values < 0.05). The inflammatory markers, ferritin, interleukin-6 and procalcitonin were significantly increased in LMWH-untreated patients (p values < 0.05). The presence of any comorbidity was significantly more common in LMWH-treated patients compared to LMWH-untreated group (39.6% vs 19.9%, respectively; p < 0.001). Hypertension and diabetes mellitus were the most frequent comorbidities in both groups. The number of intensive care unit (ICU) transfer and longer length of hospital stay were more commonly observed in LMWH-untreated patients (p values <0.05). Early anticoagulant treatment with relatively higher doses of LMWH may improve the clinical outcome of Covid-19 patients and shorten the length of hospital stay.

Leveraging the Power of a Healthcare System to Fulfill the COVID Convalescent Plasma Needs Early in the COVID-19 Pandemic

INTRODUCTIONConvalescent plasma for the treatment of emerging infectious disease has shown to reduce mortality during the 1918 influenza, 2003 SARS, and 2009 influenza H1N1 pandemics. The overall cumulative COVID-19 hospitalization rate is 130 per 100,000, with up to 50% mortality in critically ill patients. In response to the COVID-19 pandemic, the US Food and Drug Administration (FDA) collaborated with the Mayo Clinic to develop a national Expanded Access Program (EAP) for COVID convalescent plasma (CCP). In the early days of the COVID-19 pandemic, when CCP was scarce, the MedStar Health system leveraged a large number of recovered patients enrolled in a donor protocol to ensure adequate CCP and meet the demand across the hospital network, including our community hospitals.AIMTo work as a hospital system to enroll donors and obtain convalescent plasma across a hospital network of eight hospitals in the Maryland and Washington DC area, including our smaller community hospitals to ensure all patients with COVID -19 infection had access to this resource. Additionally, we worked to treat patients uniformly and track metrics to measure outcomes.METHODSDue to the unavailability of CCP at the beginning of the pandemic, a working group from MedStar Washington Hospital Center, the largest hospital in the healthcare system, designed a protocol to systematically screen and send eligible donors to our local blood collection centers.As each donor can donate two to three units of plasma, we were able to distribute CCP units obtained to all hospitals across our hospital network, which included our smaller community hospitals.The donor screening protocol was utilized from April 9, 2020, until June 1, 2020, when the CCP became more available from our local blood collector. Dedicated nurse practitioners screened all potential donors that called a dedicated donor line. At the beginning of the pandemic, we worked with our COVID clinic to screen potential donors for PCR negativity and obtain blood types; when deemed eligible, we sent them to AABB accredited local donation centers. All CCP units obtained were returned to our hospital network to be directed by the working group to in-system hospitals. Regular system-wide calls were utilized to monitor COVID admission rates and project demand in our health system.For the treatment arm, we included patients over 18 years old with laboratory-confirmed SARS-CoV-2 enrolled between April 13, 2020, to June 1, 2020. As a healthcare system, we attempted to treat patients early in their disease course, especially within 14 days of symptoms. When resources were scarce, we aimed to treat patients that appeared to have tangentially worsening symptoms as judged by continued/increasing oxygen requirements and worsening inflammatory markers.RESULTSWe screened 159 potential donors, and 143 (89.9%) were sent to our local blood collectors to provide between 2 and 4 units of CCP per donation. We started our screening protocol five days before our first CCP transfusion and were able to meet the demand for convalescent plasma until the American Red Cross (ARC) could provide enough CCP for our needs, end of May 2020.A total of 324 patients were enrolled in the Mayo Expanded Access Program, and 116 patients were excluded: 4 (3%) were transferred to outside hospitals, 27 (23%) died before CCP transfusion (when resources were scarce), 5 (4%) had more than 14 days of symptoms onset, 64 (55%) were discharged before CCP infusion, and 36 patients were waiting for plasma transfusion. 172 patients received convalescent plasma, including 12 patients (6.9%) that received two units of CCP. 114 (66%) discharged. The adjusted 28 day-mortality rate was 23%.CONCLUSIONThe MedStar Health System was able to leverage many potential donors to match the demand for CCP early in the pandemic and provide this scarce resource to the maximum number of patients treated in our network. By designing a donor protocol to obtain the ideal amount of CCP units, we were able to meet demand across a hospital system and treat patients at community hospitals in the network who may not have otherwise had access to this resource.DisclosuresNo relevant conflicts of interest to declare.

Assessment of Preparedness and Readiness of Government of Nepal Designated COVID Hospitals and Clinics to Respond COVID-19 Pandemic

Background: Preparedness, readiness and response status of any country is integral in identifying, managing and preventing COVID-19 pandemic. This study was designed to assess the current status of the Government of Nepal designated COVID hospitals and COVID clinics, find the gaps and align the practices and resources for better preparedness and readiness to respond against COVID-19. Methods: A cross sectional study was conducted with the focal persons of COVID hospitals and COVID clinics using a semi-structured questionnaire from April 26, 2020 to May 27, 2020. Data was collected from each respondent via face to face interview and telephonic interview with few unreachable health facilities. Findings: Government of Nepal designated COVID hospitals and COVID clinics demonstrated efforts in establishing preparedness plans and committees such as COVID management core team (96.7% and 86%), provision of coordination with the government authority (both 100%), preparedness response plan (93.3% and 84%), and infection prevention and control committee (63.3% and 65.6%) to respond to COVID-19 respectively. The respondents reported variations in training provided to their health care workers with maximum COVID hospitals (80%) providing training on use of personal protective equipment and least (43.3%) on handling dead bodies. Only half of the COVID clinics (49.5%) had provision of triage systems. Interpretation: Overall, COVID hospitals and COVID clinics in Nepal demonstrated different levels of COVID pandemic preparedness and readiness. In case of surge, Nepalese hospitals would struggle due to lack of trained workforce and infrastructure. Interdisciplinary, multi-sectoral collaboration with various focused strategies, including in-service training to staff, is paramount to increase preparedness and readiness.Funding Statement: None.Declaration of Interests: None.Ethics Approval Statement: Written informed consent was obtained from all the participants who had undergone face to face interviews. In case of telephonic interviews, electronic consent via email as well as verbal consent was obtained. Before the initiation of the study, ethical approval was obtained from the Ethical Review Board of NHRC (Registration number: 148/2020).

Emerging Stronger from the COVID-19 Crisis: Recover, Reposition, and Redesign.

This article analysed past Big Event disruptions such as the 1918-1919 and 1957-1958 influenza pandemics, economic shocks such as the Great Depression and global financial crisis of 2008, and the September 11, 2001 terrorist attacks By looking across these Big Events, the study found 3 key principles to follow Big Event disruptions provide a unique window of opportunity for leaders to take bold steps to ensure near-term resiliency and long-term sustainability The hospital in home model is emblematic of how health systems should consider big strategic moves to drive shifts toward systemness, consumer-centricity, and care transformation The study hopes that these principles serve as inspiration for leaders to drive growth and accelerate health care's transformation

Coronavirüs (COVİD-19) Salgınının Sağlık Çalışanlarının Sağlık Kaygıları Düzeylerine Etkileri

ABSTRACT&#x0D; Objective: We aimed to determine the effects of the COVID-19 outbreak on health workers' health concerns and life.&#x0D; Methods: The study included 293 healthcare professionals reached via e-mail. A questionnaire created by researchers and health anxiety inventory were applied online to all participants. The questionnaire questions investigated the sociodemographic characteristics of the participant, whether he received psychological support during the COVID-19 outbreak, whether he had a chronic disease, whether he had problems with the care of his children, whether he was actively involved in the COVID clinic / service, and how his social and work life was affected.&#x0D; Results: Participants consisted of 73 doctors, 145 nurses and 75 other healthcare professionals (OHP). It was determined that the COVID-19 test was performed to the healthcare personnel in the risk group at a very low rate (1.4%). The number of people receiving psychiatric support during the COVID-19 outbreak was 59 (20.1%). It was determined that the COVID-19 outbreak affected business life and social life of healthcare professionals very much and significantly (p

Sharing stories in our BVA Covid Clinics

Following on from our popular Sunday Covid webinars, we set up the BVA Covid Clinics to keep the conversations going. Sally Burnell, director of policy, media and strategy, reports on...

COVID-19: An Experience from a Tertiary Care Hospital of Nowshera

Objective: To determine the frequency of COVID-19 and characteristics of patients presenting to the COVID-19 clinic at Qazi Hussain Ahmed Medical Complex (QHAMC) Nowshera.&#x0D; Methodology: This cross-sectional study was conducted from 21st Feb 2019 to April 8, 2020, in QHAMC Nowshera. Relevant information was collected on a pre-designed Performa prepared following the objectives of the study.&#x0D; Results: Out of 220 patients, 165(75%) were males, and 55(25%) females. 96(43.6%) of the patients were in the age range 18-30 years followed by 52(23.6%) in age range 31-45years and 17(7.7%) with age&gt;60 years etc. Out of total the nasopharyngeal swabs of 26(11.6%) strong suspects were sent for PCR testing. 208(94.5%) were sent home while 12(5.5%) were advised quarantine. Forty-seven (21.4%) had a travel history to an epidemic area in the last 14 days. 51(23.2%) had a positive history of contact. Eighty-five (38.6%) had a fever and sore throat followed by 27(12.3%) with (fever &amp; cough), 24(10.9%) with (cough and shortness of breath/dyspnea) and 14(6.4%) with a simple flue, etc. Out of 26 cases, 6(2.7%) were COVID-19 Positive, 12(5.5%) were negative and results of 8(3.6%) were still awaited. The PCR repeated the test for confirmed cases showed; 4(1.8%) negative, one died and one was refractory positive. A positive correlation (p=0.03, r=0.4) of an increase in age with the severity of the disease/outcome was recorded.&#x0D; Conclusion: The frequency of infectivity with COVID-19 was 2.6%. A higher number of patients with mild symptoms attend the COVID clinic. The rate of infection and mortality was higher in age&gt; 60 years.

COVID Care Clinic: A Unique Way for Family Medicine to Care for the Community During the SARS-CoV-2 (COVID-19) Pandemic.

The COVID-19 pandemic has presented new challenges in how Primary Care clinicians care for community patients. Our organization quickly allocated 1 of our community clinic sites into a dedicated COVID Clinic caring for the COVID positive or any patient with COVID like symptoms to minimize contact with the well patients. A prerequisite for all patients to be seen in the COVID Care Clinic was a virtual visit staffed with Advanced Practice Providers that would further determine if the patient needed to seek emergency medical care or be seen in the COVID Clinic. From March 23, 2020 through May 15, 2020, 852 patients with COVID symptoms were seen in this clinic rather than the emergency department. This article describes a collaborative effort to care for a community during the COVID-19 pandemic. This unique setting allowed us to focus an appropriate level of care to a high risk population in a safe and effective manner in the ongoing effort to flatten the epidemiological curve.

Analysis of the Patients Who Admitted To A Turkish Emergency Department During COVID-19 Pandemic

Background and aim:In this study, it was aimed to review patients who presented to a Turkish emergency department (ED) with fever and at least one symptom and finding of acute respiratory infection (cough, shortness of breath) in Sisli Hamidiye Etfal Education and Research Hospital Tertiary Medical Care Center during COVID-19 pandemic.Methods:This retrospective, descriptive, observational study included patients presented between March 10, 2020 and April 25, 2020. The patients were classified into two groups according to RT-PCR test result: RT-PCR (+) and RT-PCR (-). The demographic characteristics and clinical endpoint-related factors were analyzed in the patients.Results:The study included 840 patients; 461 men (54.9%) and 379 women (45.1%). RT-PCR test was positive in 345 patients (41.0%). The most common comorbidity was hypertension (HT) in 119 patients (34.5%); followed by diabetes mellitus (DM) in 61 patients (18.3%). At time of ED presentation, there was mild clinical manifestation in 72.2%, whereas moderate in 21.7% and severe in 6.1% of patients with positive RT-PCR testing. Of the patients with positive RT-PCR testing, 64 patients (18.6%) were discharged from ED while 255 patients (73.9%) were admitted to COVID clinic and 26 were admitted to COVID intensive care unit (ICU). Of the patients admitted, 299 patients (86.7%) were discharged while 46 patients (13.3%) died due to multi-organ failure (MOF) (50%), acute respiratory distress syndrome (ARDS) (32.6%), acute pulmonary embolism (APE) (10.9%) and acute coronary syndrome (ACS) (6.5%).Conclusions:The RT-PCR positivity rate seemed lower in our study when compared to literature. In addition, mortality rate was lower in our study when compared to other countries.