Hospitalized COVID-19 Patients Research Articles

The effect of early remdesivir administration in COVID-19 disease progression in hospitalised patients.

Antiviral drugs have become crucial in managing COVID-19, reducing complications and mortality. Remdesivir has emerged as an effective therapeutic drug for hospitalized patients at risk of disease progression, especially when alternative treatments are infeasible. While the recommended treatment duration of remdesivir extends up to 7days post-symptom onset, this study examines how early remdesivir administration impacts clinical outcomes. We conducted aretrospective analysis using clinical data from consecutively PCR confirmed SARS-CoV‑2 adult patients (≥ 18years) who received remdesivir during their hospitalization at the department of infectious diseases, Klinik Favoriten in Vienna. The data covered the period from July1, 2021, to April31, 2022. Patients were divided into two groups based on the timing of remdesivir administration: an early group (0-3days since symptom onset) and alate group (≥ 4days since symptom onset). The primary outcome was in-hospital disease progression, assessed using the WHO COVID-19 Clinical Progression Scale (≥ 1point increase). Multivariable logistic regression, adjusted for age, sex, SARS-CoV‑2 variant, and COVID-19 vaccination status, was used to assess clinical outcomes. In total 219 patients were included of whom 148 (67.6%) were in the early group and 71(32.4%) were in the late group. The average age was 66.5 (SD: 18.0) years, 68.9% of the patients were vaccinated, and 72.6% had the Omicron virus variant. Late remdesivir administration was associated with asignificantly higher probability of needing high-flow oxygen therapy (OR 2.52, 95% CI 1.40-4.52, p = 0.002) and ICU admission (OR 4.34, 95% CI 1.38-13.67, p = 0.012) after adjusting for confounders. In the late group there was atrend towards ahigher risk of clinical worsening (OR 2.13, 95% CI 0.98-4.64, p = 0.056) and need for any oxygen therapy (OR 1.85, 95% CI 0.94-3.64, p = 0.074). Compared to patients who received remdesivir within the first 3days after symptom onset, administering remdesivir after day3 in hospitalized COVID-19 patients is associated with higher risk for complications, such as the need for high-flow oxygen therapy and ICU admission.

Parameters for Early Detection of Critical Illness in Hospitalized COVID-19 Patients

Parameters for Early Detection of Critical Illness in Hospitalized COVID-19 Patients

CO79 In-Hospital Mortality Among Hospitalized COVID-19 Patients in the United States: How Did It Change in 2022 and 2023?

CO79 In-Hospital Mortality Among Hospitalized COVID-19 Patients in the United States: How Did It Change in 2022 and 2023?

Vitamin K2 Supplementation in Hospitalised COVID-19 Patients: A Randomised Controlled Trial.

Background: In observational studies, high levels of desphospho-uncarboxylated matrix gla protein (dp-ucMGP) that result from vitamin K deficiency were consistently associated with poor clinical outcomes during COVID-19. Vitamin K-activated matrix gla protein (MGP) is required to protect against elastic fibre degradation, and a deficiency may contribute to pathology. However, intervention trials assessing the effects of vitamin K supplementation in COVID-19 are lacking. Methods: This is a single-centre, phase 2, double-blind, randomised, placebo-controlled trial investigating the effects of vitamin K2 supplementation in 40 hospitalised COVID-19 patients requiring supplemental oxygen. Individuals were randomly assigned in a 1:1 ratio to receive 999 mcg of vitamin K2-menaquinone-7 (MK-7)-or a placebo daily until discharge or for a maximum of 14 days. Dp-ucMGP, the rate of elastic fibre degradation quantified by desmosine, and hepatic vitamin K status quantified by PIVKA-II were measured. Grade 3 and 4 adverse events were collected daily. As an exploratory objective, circulating vitamin K2 levels were measured. Results: Vitamin K2 was well tolerated and did not increase the number of adverse events. A linear mixed model analysis showed that dp-ucMGP and PIVKA-II decreased significantly in subjects that received supplementation compared to the controls (p = 0.008 and p = 0.0017, respectively), reflecting improved vitamin K status. The decrease in dp-ucMGP correlated with higher plasma MK-7 levels (p = 0.015). No significant effect on desmosine was found (p = 0.545). Conclusions: These results demonstrate that vitamin K2 supplementation during COVID-19 is safe and decreases dp-ucMGP. However, the current dose of vitamin K2 failed to show a protective effect against elastic fibre degradation.

The Onset of Antinuclear Antibodies (ANAs) as a Potential Risk Factor for Mortality and Morbidity in COVID-19 Patients: A Single-Center Retrospective Study.

The immune system's amplified response to SARS-CoV-2 may lead to the production of autoantibodies, but their specific impact on disease severity and outcome remains unclear. This study aims to assess if hospitalized COVID-19 patients face a worse prognosis based on ANA presence, even without autoimmune diseases. We performed a retrospective, single-center, observational cohort study, enrolling 638 COVID-19 patients hospitalized from April 2020 to March 2021 at Hospital "Policlinico Riuniti" of Foggia (Italy). COVID-19 patients with a positive ANA test exhibited a significantly lower 30-day survival rate (64.4% vs. 83.0%) and a higher likelihood of severe respiratory complications during hospitalization than those with negative ANA screening (35.4% vs. 17.0%) (p < 0.001). The association between poor prognosis and ANA status was identified by calculating the HALP score (Hemoglobin-Albumin-Lymphocyte-Platelet), which was lower in COVID-19 patients with a positive ANA test compared to ANA-negative patients (108.1 ± 7.4 vs. 218.6 ± 11.2 AU; p < 0.011). In detail, COVID-19 patients with a low HALP showed a lower 30-day survival rate (99.1% vs. 83.6% vs. 55.2% for high, medium, and low HALP, respectively; p < 0.001) and a higher incidence of adverse respiratory events compared to those with high and medium HALP (13.1% vs. 35.2% vs. 64.6% for high, medium, and low HALP, respectively; p < 0.001). In summary, ANA positivity in COVID-19 patients appears to be linked to a more aggressive disease phenotype with a reduced survival rate. Furthermore, we propose that the HALP score could serve as a valuable parameter to assess prognosis for COVID-19 patients.

The Evolving Challenge of Appropriate Antibiotics Use in Hospitalized COVID-19 Patients: A Systematic Literature Review.

The issue of bacterial infections in COVID-19 patients has received increasing attention. Scant data are available on the impact of bacterial superinfection and antibiotic administration on the outcome of hospitalized COVID-19 patients. We conducted a literature review from 1 January 2022 to 31 March 2024 to assess the current burden of bacterial infection and the evidence for antibiotic use in hospitalized COVID-19 patients. Published articles providing data on antibiotic use in COVID-19 patients were identified through computerized literature searches with the search terms [(antibiotic) AND (COVID-19)] or [(antibiotic treatment) AND (COVID-19)]. PubMed and SCOPUS databases were searched from 1 January 2022 to 31 March 2024. No attempt was made to obtain information about unpublished studies. English language restriction was applied. The quality of the included studies was evaluated by the tool recommended by the Joanna Briggs Institute. Both quantitative and qualitative information were summarized by means of textual descriptions. Five hundred fifty-one studies were identified, and twenty-nine studies were included in this systematic review. Of the 29 included studies, 18 studies were on the prevalence of bacterial infection and antibiotic use in hospitalized COVID-19 patients; 4 studies reported on the efficacy of early antibiotic use in COVID-19; 4 studies were on the use of sepsis biomarkers to improve antibiotic use; 3 studies were on the efficacy of antimicrobial stewardship programs and predictive models among COVID-19-hospitalized patients. The quality of included studies was high in 35% and medium in 62%. High rates of hospital-acquired infections were reported among COVID-19 patients, ranging between 7.5 and 37.7%. A high antibiotic resistance rate was reported among COVID-19 patients developing hospital-acquired infections, with a high in-hospital mortality rate. The studies evaluating multi-faceted antimicrobial stewardship interventions reported efficacy in decreasing antibiotic consumption and lower in-hospital mortality.

The impact of osteosarcopenia and its parameters on mortality of COVID-19 in-hospitalized older patients: the findings of BEH (Bushehr elderly health) program

The impact of osteosarcopenia and its parameters on mortality of COVID-19 in-hospitalized older patients: the findings of BEH (Bushehr elderly health) program

Alteration of circulating ACE2-network related microRNAs in patients with COVID-19

Angiotensin converting enzyme 2 (ACE2) serves as the primary receptor for the SARS-CoV-2 virus and has implications for the functioning of the cardiovascular system. Based on our previously published bioinformatic analysis, in this study we aimed to analyze the diagnostic and predictive utility of miRNAs (miR-10b-5p, miR-124-3p, miR-200b-3p, miR-26b-5p, miR-302c-5p) identified as top regulators of ACE2 network with potential to affect cardiomyocytes and cardiovascular system in patients with COVID-19. The expression of miRNAs was determined through qRT-PCR in a cohort of 79 hospitalized COVID-19 patients as well as 32 healthy volunteers. Blood samples and clinical data of COVID-19 patients were collected at admission, 7-days and 21-days after admission. We also performed SHAP analysis of clinical data and miRNAs target predictions and advanced enrichment analyses. Low expression of miR-200b-3p at the seventh day of admission is indicative of predictive value in determining the length of hospital stay and/or the likelihood of mortality, as shown in ROC curve analysis with an AUC of 0.730 and a p-value of 0.002. MiR-26b-5p expression levels in COVID-19 patients were lower at the baseline, 7 and 21-days of admission compared to the healthy controls (P < 0.0001). Similarly, miR-10b-5p expression levels were lower at the baseline and 21-days post admission (P = 0.001). The opposite situation was observed in miR-124-3p and miR-302c-5p. Enrichment analysis showed influence of analyzed miRNAs on IL-2 signaling pathway and multiple cardiovascular diseases through COVID-19-related targets. Moreover, the COVID-19-related genes regulated by miR-200b-3p were linked to T cell protein tyrosine phosphatase and the HIF-1 transcriptional activity in hypoxia. Analysis focused on COVID-19 associated genes showed that all analyzed miRNAs are strongly affecting disease pathways related to CVDs which could be explained by their strong interaction with the ACE2 network.

Impact of Laboratory Biomarkers on COVID-19 Severity: First Cross-sectional Study in a Remote Area of Pakistan

Objectives: The study aimed to evaluate the performance of rapid antigen test (RAT) and reverse transcription polymerase chain reaction (RT-PCR) in detecting COVID-19 and the impact of laboratory biomarkers on the severity of the disease. Material and Methods: A total of 150 nasopharyngeal swabs and blood samples were collected from symptomatic COVID-19 patients in Tehsil head-quarter Hospital, Dargai from August 2021 to March 2022. Results: RAT revealed a sensitivity of 86.67% and specificity of 100%, while RT-PCR revealed a sensitivity of 93.33% and specificity of 100%. The highest infection rate was found in males, and the average age of patients was 53.87 years. The most common symptoms were fever and sore throat. Patients were categorized into four groups based on cycle threshold values and blood biomarkers: mild, moderate, severe, and critical. White blood cell count, platelet count, and C-reactive protein were significantly different between the groups. Lactate dehydrogenase, D-dimer, and serum ferritin were significantly increased in critical patients. The receiver operating characteristic curve showed that inflammatory biomarkers had a comparative performance in predicting disease severity in COVID-19 patients. Conclusion: Blood biomarkers are associated with the disease severity in COVID-19 patients, and further studies, such as metabolomics, are recommended to explore the immunological mechanisms behind these biomarkers.

Preparing for future pandemics: frailty associates with mortality in hospitalised older people during the entire COVID-19 pandemic, a Dutch multicentre cohort study

Key summary pointsAimWe aim to investigate how associations of frailty with in-hospital mortality changed throughout the pandemic in older people hospitalised for COVID-19.FindingsOlder hospitalised COVID-19 patients with frailty had a higher in-hospital mortality risk over the entire course of the pandemic. Older hospitalised COVID-19 patients had a lower in-hospital mortality risk in each subsequent wave, which reflects the effects of improved prevention and treatment options.MessageFrailty is a relevant risk factor in all stages of a pandemic, which indicates that frailty is important to consider in prevention and treatment guidelines for future pandemics.

Mortality rates among vaccinated and unvaccinated covid19 patients in Duhok hospitals, Kurdistan Region, Iraq

Background and objectives: The corona virusvaccines are important in controlling the pandemic. In Kurdistan Region of Iraq three types of vaccines are available; Pfizer, AstraZeneca and SinoPharm. The objectiveof the study was to determine the effect of vaccine on severity and mortality rate among Covid-19 cases in Duhok, Iraq. Methods: In this Prospective study, 470 of hospitalized covid19 cases in Duhok, Iraqi Kurdistan between 1st june 2021 to 1st june 2022 were enrolled. Demographic parameters including age, sex, and past medical history of chronic diseases were taken. The severity of cases was assessed based on respiratory rate, oxygen saturation, and percentage of chest involvement by CT scan. The types and doses of vaccines received by patients were recorded. The patients were followed-up by the outcome (recovered and discharged from the hospital or dead). Results: The mean age of the patients was 64.98 years. The males were (51.49%, n=242) and females (48.51%, n=228). The majority of them did not receive any type of vaccines (81.49%, n=383). Most of the vaccinated patients received Pfizer vaccine. In term of Covid-19 severity, the study showed (65.75%, n=309) had mild-moderate disease and (34.26, n= 161) had severe disease. Moreover, the mortality rate was lower among vaccinated patients compared with unvaccinated patients 24.14% to 40.73% respectively. The study revealed that having the severe cases and being old were considered the main independent predictor of mortality among the patients (p value &lt;0.0001). Conclusions: Vaccinated patients had lower chance of severe chest involvement, oxygen requirement and death rate compared to unvaccinated patients in our study.

Safety and effectiveness of remdesivir in hospitalized patients with COVID-19 and severe renal impairment: experience at a large medical center

Background Literature on the safety of remdesivir in hospitalized COVID-19 patients with severe renal impairment is limited. We aimed to investigate the safety and effectiveness of remdesivir in this population. Methods We conducted a retrospective cohort study of adult hospitalized COVID-19 patients who received remdesivir between April 2022 and October 2022. Outcomes were compared between estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 and ≥30 mL/min/1.73 m2 groups. The primary safety outcomes were acute kidney injury (AKI) and bradycardia, while the primary effectiveness outcomes included mortality in COVID-19-dedicated wards and hospital mortality. Secondary outcomes included laboratory changes, disease progression, and recovery time. Results A total of 1,343 patients were recruited, with 307 (22.9%) in the eGFR <30 group and 1,036 (77.1%) in the eGFR ≥30 group. Patients with an eGFR <30 had higher risks of AKI (adjusted hazard ratio [aHR] 2.92, 95% CI 1.93–4.44) and hospital mortality (aHR 1.47, 95% CI 1.06–2.05) but had comparable risks of bradycardia (aHR 1.15, 95% CI 0.85–1.56) and mortality in dedicated wards (aHR 1.43, 95% CI 0.90–2.28) than patients with an eGFR ≥30. Risk of disease progression was higher in the eGFR <30 group (adjusted odds ratio 1.62, 95% CI 1.16–2.26). No difference between the two groups in laboratory changes and recovery time. Conclusions Hospitalized COVID-19 patients receiving remdesivir with severe renal impairment had an increased risk of AKI, hospital mortality, and COVID-19 disease progression compared to patients without severe renal impairment.

Evaluation of Healthcare Workers Attitudes Toward Handling and Treating COVID-19 Patients in Diyala Governorate, Iraq

Background: In 2019, the World Health Organization (WHO) declared a global state of emergency due to the spread of the COVID-19 pandemic. Objective: This study aimed to determine the attitudes of healthcare workers in various Iraqi health institutions towards treating patients with COVID-19. Additionally, it aimed to identify the most important reasons behind preventing them from doing their job. Methods: Between Nov. 2021 to Dec. 2022, we conducted a self-administered cross-sectional survey of 207 healthcare worker participants. The data were collected using a questionnaire that included three parts. The first part included sociodemographic data, the second part aimed to assess the participants’ information concerning how they dealt with this pandemic, and the third part was designed to identify the participants’ attitudes. The statistic data were analysed by using (SPSS), 25.0/ IBM Crop., Armonk, NY. The scientific content of the questionnaire items was taken from the online literature as well as updated information on the WHO website. Results: The results study revealed that 135 (65.22\%) of the participants were willing to receive and treat COVID-19 patients in hospitals and private clinics. While 72 (34.78\%) of the study participants showed their unwillingness to treat infected patients. The most crucial reasons behind their reluctance were the fear of transmission of infection and the lack of protective equipment. Conclusion: The study concluded that the participants' willingness was good. This was indicated by their positive attitudes toward carrying out their medical duties and commitment to providing health care and treatment for COVID-19 patients. There is an urgent need to reduce psychological and physical stress as well as the pressures that health workers suffer from because they are facing large numbers of daily infections. This reduction is achieved via training, continuous education and equipping hospitals with the latest protective supplies to confront epidemics and pandemics.

Clinical Characteristics and Patterns of Immune Responses in COVID-19 Patients From a Rural Community Hospital.

Background Although demographic and clinical factors such as age, certain comorbidities, and sex have been associated with COVID-19 outcomes, these studies were largely conducted in urban populations affiliated with large academic medical centers. There have been very few studies focusing on rural populations that also characterize broader changes in inflammatory cytokines and chemokines. Methodology A single-center study was conducted between June 2020 and March 2021 in Abilene, Texas, USA.Patients were included if they presented to the hospital for treatment of COVID-19, had extra biological materials from routine care available, and were between the ages of 0 to 110 years. There were no exclusion criteria. Patient characteristics, symptom presentation, and clinical laboratory results were extracted from electronic health records. Blood specimens were analyzed by protein microarray to quantitate 40 immunological biomarkers. Results A total of 122 patients were enrolled, of whom 81 (66%) were admitted to the general non-critical inpatient unit, 37 (30%) were admitted to the intensive or critical care units, and four (3.2%) were treated outpatient. Most hospitalized COVID-19 patients in this rural population were elderly, male, obese, and retired individuals. Predominant symptoms for non-critical patients were shortness of breath, fever, and fatigue. Ferritin levels for outpatient patients were lower on average than those in an inpatient setting and lactate dehydrogenase (LDH) levels were noted to be lower in non-critical and outpatient than those in the intensive care unit setting. Inflammatory biomarkers were positively correlated and consistent with inflammatory cascade. Interleukin (IL)-10 was positively correlated while platelet-derived growth factor was negatively correlated with inflammatory biomarkers. Patients ≥65 years had significantly higher levels of LDH and seven cytokines/chemokines (granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin IL-1b, IL-6, IL-10, IL-11, macrophage inflammatory protein (MIP)-1d, and IL-8) while levels of five other immune molecules (intercellular adhesion molecule 1 (ICAM-1), monocyte chemoattractant protein 1 (MCP-1), tissue inhibitor of metalloproteinase 2 (TIMP-2), IL-2, and IL-4) were significantly lower compared to those <65 years. Females had significantly higher levels of LDH and 10 cytokines/chemokines (GM-CSF, IL-1b, IL-6, IL-10, IL-11, IL-15, IL-16, MIP-1a, MIP-1d, and IL-8) while levels of TIMP-2 and IL-4 were significantly lower than male patients. Conclusions The clinical characteristics of this rural cohort of hospitalized patients differed somewhat from nationally reported data. The contributions of social, environmental, and healthcare access factors should be investigated. We identified age and sex-associated differences in immunological response markers that warrant further investigation to identify the underlying molecular mechanisms and impact on COVID-19 pathogenesis.

Safety outcomes of remdesivir for treatment of COVID-19 hospitalised patients in Indonesia

Background: Remdesivir has been granted emergency use authorisation for hospitalised COVID-19 patients. However, the available evidence in Indonesia is limited to related liver and kidney injuries. Objective: This study aims to assess the safety of remdesivir based on liver and kidney function and its association with comorbidity and disease severity. Method: This retrospective study evaluated remdesivir's efficacy in hospitalised COVID-19 patients of varying severity by collecting baseline and follow-up data on aspartate aminotransferase (AST), alanine aminotransferase (ALT), Glomerular filtration rate (GFR) and Blood urea nitrogen (BUN). Result: In this study, 189 patients with elevated transaminase enzyme levels were given hepatoprotection therapy. Patients who did not receive the treatment experienced a significant rise in ALT levels (p &lt; 0.001), while BUN levels increased significantly (p = 0.001) but within the normal range. There was no worsening of GFR value (p &lt; 0.001), and no significant association was found between AST and ALT levels with comorbidity and disease severity (p &lt; 0.001; OR 50.202). Conclusion: Remdesivir demonstrated good tolerability despite increased ALT and BUN without correlating to comorbidity or disease severity in COVID-19.

Making Drug Approval Decisions in the Face of Uncertainty: Cumulative Evidence versus Value of Information.

The COVID-19 pandemic underscored the criticality and complexity of decision making for novel treatment approval and further research. Our study aims to assess potential decision-making methodologies, an evaluation vital for refining future public health crisis responses. We compared 4 decision-making approaches to drug approval and research: the Food and Drug Administration's policy decisions, cumulative meta-analysis, a prospective value-of-information (VOI) approach (using information available at the time of decision), and a reference standard (retrospective VOI analysis using information available in hindsight). Possible decisions were to reject, accept, provide emergency use authorization, or allow access to new therapies only in research settings. We used monoclonal antibodies provided to hospitalized COVID-19 patients as a case study, examining the evidence from September 2020 to December 2021 and focusing on each method's capacity to optimize health outcomes and resource allocation. Our findings indicate a notable discrepancy between policy decisions and the reference standard retrospective VOI approach with expected losses up to $269 billion USD, suggesting suboptimal resource use during the wait for emergency use authorization. Relying solely on cumulative meta-analysis for decision making results in the largest expected loss, while the policy approach showed a loss up to $16 billion and the prospective VOI approach presented the least loss (up to $2 billion). Our research suggests that incorporating VOI analysis may be particularly useful for research prioritization and treatment implementation decisions during pandemics. While the prospective VOI approach was favored in this case study, further studies should validate the ideal decision-making method across various contexts. This study's findings not only enhance our understanding of decision-making strategies during a health crisis but also provide a potential framework for future pandemic responses. This study reviews discrepancies between a reference standard (retrospective VOI, using hindsight information) and 3 conceivable real-time approaches to research-treatment decisions during a pandemic, suggesting suboptimal use of resources.Of all prospective decision-making approaches considered, VOI closely mirrored the reference standard, yielding the least expected value loss across our study timeline.This study illustrates the possible benefit of VOI results and the need for evidence accumulation accompanied by modeling in health technology assessment for emerging therapies.

Clinical characteristics and outcomes among hospitalised COVID-19 patients across epidemic waves in Spain: An unCoVer analysis

Background and objectivesThe COVID-19 pandemic had a significant impact in population health worldwide, and particularly in people with pre-existing chronic diseases. Early risk identification and stratification is essential to reduce the impact of future outbreaks of pandemic potential. This study aimed to comprehensively examine factors associated with COVID-19 mortality across the pandemic waves in Spain. MethodsA retrospective study analyzed the characteristics of 13,974 patients admitted to Spanish hospitals due to SARS-CoV-2 infection from 2020-01-28 to 2022-12-31. The demographic and clinical features of patients during hospitalization on each pandemic waves were analyzed. Main findingsThe findings highlight the heterogeneity of patient characteristics, comorbidities and outcomes, across the waves. The high prevalence of cardiometabolic diseases (53.9%) among COVID-19 patients emphasizes the importance of controlling these risk factors to prevent severe COVID-19 outcomes. ConclusionsIn summary, the study associate hospital mortality with factors such as advanced age and comorbidities. The decline in mortality after the 4th wave indicates potential influences like vaccination, viral adaptation, or improved treatments. Notably, dementia and cancer metastases emerge as critical factors linked to higher mortality, highlighting the importance of addressing these conditions in COVID-19 management and preparing for future challenges.

Incidence and Related Factors to Developing Dysphagia in Hospitalized COVID-19 Patients

Incidence and Related Factors to Developing Dysphagia in Hospitalized COVID-19 Patients

Evaluation of clinical characteristics in hospitalized COVID-19 patients across different waves

Evaluation of clinical characteristics in hospitalized COVID-19 patients across different waves

Legal Protection of Health Workers on the Installation of Mechanical Ventilation of Covid-19 Patients in Hospitals

Corona Virus Disease-2019 (Covid-19) is a disease that causes an epidemic with a high number of deaths and morbidity in Indonesia. Covid-19 sufferers often experience respiratory failure, so they need to receive mechanical ventilation assistance. This research aims to find out the rules for legal protection for health workers in the act of installing mechanical ventilation for Covid-19 patients in hospitals and to find out the implementation of legal protection. This type of research is normative juridical based on a legal approach. Data collection is based on literature study, taken from legislation, research results and literature books. The results of the research found that the provision of health services was carried out responsibly, safely, of good quality and evenly and non-discriminatory. The position faced by medical personnel or health workers is sometimes problematic because installing mechanical ventilators for Covid-19 patients from a criminal law perspective is a mistake if it is done outside of their authority, even though the medical personnel or health workers are dealing with the function and task of carrying out actions. for patient safety which is of course tied to the Hippocratic Oath as an ethical and moral basis. The suggestion in this research is that the government must provide legal protection to medical personnel whose rights are not fulfilled by policy organizers, even though their obligations have been fulfilled by health personnel.