Fever Clinic Research Articles

“Lymphocyte * Neutrophil” count decreased in SARS‐CoV‐2 Omicron patients in Shanghai with no significant change in CRP and SAA

BackgroundAt present, there is a new variant Omicron BA.2 of SARS‐CoV‐2. In some previous studies, it was found that CBC, NLR, CRP, SAA, etc. in patients with SARS‐CoV‐2 had a series of changes, which were significantly correlated with the diagnosis and prognosis of patients. Therefore, in order to find specific diagnostic indicators, we explore the changes in these blood indicators and inflammatory indicators in patients with the SARS‐CoV‐2 Omicron.MethodsA total of 127 Omicron confirmed patients who had visited fever clinic was selected as the positive group, and 75 Omicron excluded patients were selected as the negative group. We collected and analyzed the CBC, CRP, SAA test data, and clinical data of all subjects for analysis and statistics.ResultsWBC, NEU, LYM, EOS, PLT, PCT, LYM * NEU count compared with the negative group were significantly lower (p < 0.05); on the contrary, CNR were significantly higher (p < 0.05); The levels of CRP and SAA were not significantly different from those of the negative group (p > 0.05); the AUC of 0.781 for the diagnosis of LYM * NEU with an optimal cutoff value of 5.79, with a sensitivity and specificity of 68% and 73%, respectively, Youden index of 0.41, giving the best diagnostic performance.ConclusionThe decreased LYM * NEU count can be used as the early, rapid, and accurate diagnostic indicator for Omicron. While due to the attenuated toxicity of BA.2 sublineage, CRP and SAA had no significance in the differential diagnosis of confirmed patients.

Case Report: Recognition of Devastating Primary Amoebic Meningoencephalitis (PAM) Caused by Naegleria fowleri: Another Case in South China Detected via Metagenomics Next-Generation Sequencing Combined With Microscopy and a Review

IntroductionPrimary amoebic meningoencephalitis (PAM) caused by Naegleria fowleri is seldom reported in mainland China.MethodsOne case from South China was presented, and the clinical features of the PAM, especially the early CT features, were compared to those in the literatures from PubMed/Web of Science/China National Knowledge internet (CNKI).Case Presentation and ResultsA 47-year-old man with a high fever came to the fever clinic. Twelve hours later, the man lost consciousness and exhibited generalized tonic-clonic seizures and needed ventilator-controlled ventilation. Then, he was admitted to the neurology intensive care unit (NICU). The opening pressure of his cerebrospinal fluid (CSF) was over 500 mm H2O with highly increased leukocyte/protein levels and very low glucose levels. Three days after admission, high copy numbers of Naegleria fowleri amoebae were detected by metagenomics next-generation sequencing (mNGS) and cysts were visible with wet mount microscopy. Four days after admission, the patient experienced brain death. However, the relatives of the patient did not want to give up, and he received amphotericin B (AmB). During hospitalization, he suffered from severe damage to the liver and kidneys and electrolyte disorders that required continuous renal replacement therapy (CRRT).ReviewAll 20 included PAM patients suffered from fever. Seventeen of them had headache and neck stiffness. Ten of them showed generalized brain edema. To date, 7 cases of PAM have been reported in China. Only one patient survived. Most of the patients showed generalized brain edema. Only the surviving patient showed focal edema. He died three months later.ConclusionRapidly progressive meningoencephalitis in which the CSF results are similar to those suffered from a bacterial infection should be considered a possible case of PAM. It can be rapidly detected with microscopy in CSF wet mounts but needs further molecular investigation for confirmation, and mNGS should be a new method used for rapid and precise identification. Moreover, CRRT may prolong the survival time of PAM patients with multiple organ failure.

Preferences for Attributes of Initial COVID-19 Diagnosis in the United States and China During the Pandemic: Discrete Choice Experiment With Propensity Score Matching.

BackgroundChina and the United States play critical leading roles in the global effort to contain the COVID-19 virus. Therefore, their population’s preferences for initial diagnosis were compared to provide policy and clinical insights.ObjectiveWe aim to quantify and compare the public’s preferences for medical management of fever and the attributes of initial diagnosis in the case of presenting symptoms during the COVID-19 pandemic in China and the United States.MethodsWe conducted a cross-sectional study from January to March 2021 in China and the United States using an online discrete choice experiment (DCE) questionnaire distributed through Amazon Mechanical Turk (MTurk; in the United States) and recruited volunteers (in China). Propensity score matching (PSM) was used to match the 2 groups of respondents from China and the United States to minimize confounding effects. In addition, the respondents’ preferences for different diagnosis options were evaluated using a mixed logit model (MXL) and latent class models (LCMs). Moreover, demographic data were collected and compared using the chi-square test, Fisher test, and Mann-Whitney U test.ResultsA total of 9112 respondents (5411, 59.4%, from China and 3701, 40.6%, from the United States) who completed our survey were included in our analysis. After PSM, 1240 (22.9%) respondents from China and 1240 (33.5%) from the United States were matched for sex, age, educational level, occupation, and annual salary levels. The segmented sizes of 3 classes of respondents from China were 870 (70.2%), 270 (21.8%), and 100 (8.0%), respectively. Meanwhile, the US respondents’ segmented sizes were 269 (21.7%), 139 (11.2%), and 832 (67.1%), respectively. Respondents from China attached the greatest importance to the type of medical institution (weighted importance=40.0%), while those from the United States valued the waiting time (weighted importance=31.5%) the most. Respondents from China preferred the emergency department (coefficient=0.973, reference level: online consultation) and fever clinic (a special clinic for the treatment of fever patients for the prevention and control of acute infectious diseases in China; coefficient=0.974, reference level: online consultation), while those from the United States preferred private clinics (general practices; coefficient=0.543, reference level: online consultation). Additionally, shorter waiting times, COVID-19 nucleic acid testing arrangements, higher reimbursement rates, and lower costs were always preferred.ConclusionsImprovements in the availability of COVID-19 testing and medical professional skills and increased designated health care facilities may help boost potential health care seeking during COVID-19 and prevent unrecognized community spreading of SARS-CoV-2 in China and the United States. Moreover, to better prevent future waves of pandemics, identify undiagnosed patients, and encourage those undiagnosed to seek health care services to curb the pandemic, the hierarchical diagnosis and treatment system needs improvement in China, and the United States should focus on reducing diagnosis costs and raising the reimbursement rate of medical insurance.

Designing Mobile Epidemic Prevention Medical Stations for the COVID-19 Pandemic and International Medical Aid.

The demand for mobile epidemic prevention medical stations originated from the rapid spread of the COVID-19 pandemic. In order to reduce the infection risk of medical practitioners and provide flexible medical facilities in response to the variable needs of the pandemic, this research aimed to design mobile medical stations for COVID-19 epidemic prevention, the emergence of which began in February 2020. The mobile medical stations include a negative pressure isolation ward, a positive pressure swabbing station, a fever clinic and a laboratory. In Taiwan, many medical institutions used the mobile swabbing station design of this study to practice COVID-19 screening pre-tests. Internationally, this study assisted Palau in setting up medical stations to provide anti-epidemic goods and materials. The design of this study not only provides a highly flexible and safe medical environment but the benefits of screening can also be used as resources for medical research, forming an economic circulation for operation sustainability. In addition, the design of this study can also be used during the non-epidemic period as a healthcare station for rural areas or as a long-term community medical station.

Intervention Study on Pass-forward Management on Nursing Staff in Fever Clinic

Intervention Study on Pass-forward Management on Nursing Staff in Fever Clinic

Accessibility calculation and equality evaluation of medical facilities for COVID-19 pandemic treatment: A case study of the Wuhan metropolitan development zone.

Medical facility equality is a critical metric for determining equal access to medical care. Their spatial distribution is important for effective pandemic treatment and daily prevention in cities. This paper used the Kernel Density Two-Step Floating Catchment Area (KD2SFCA) and shortest distance methods to calculate the accessibility of designated COVID-19 Fangcang hospitals and fever clinics in the Wuhan Metropolitan Development Zone. Their equality was evaluated by the Gini coefficient and Lorentz curve. Several results were obtained: (1) The facilities’ accessibility declines radial from the central to peripheral areas. (2) Most of the demand points in the study area can reach the medical facilities for COVID-19 pandemic treatment within 60 minutes. (3) For the spatial distribution of these facilities, the equality evaluated for different time thresholds differed significantly, with long time thresholds having better equality than for short time thresholds. (4) While the distances distribution of fever clinics is balanced, the equality gap in various areas remains enormous when considering population distribution. Suggestions for optimizing the spatial distribution of pandemic treatment medical facilities in Wuhan are proposed, and which will serve as references for the planning of Wuhan’s pandemic medical facilities in the future.

COVID-19: Evaluation of Fever Clinic and Fever Sentinel Configuration—A Case Study of Harbin, China

The COVID-19 pandemic has placed the inequalities in health services in countries around the world under severe pressure. As crucial pillars in the prevention and control of COVID-19, fever clinics and fever sentinels are important sites for the screening, diagnosis, and isolation of patients. This study comprehensively evaluated the spatial-layout characteristics, configuration quantity, and service capacity of 42 fever clinics and 418 fever sentinels in Harbin from the perspective of supply by using GIS spatial-analysis methods such as kernel density analysis. From the perspective of demand, we evaluated the accessibility of fever clinics with the modified two-step floating catchment area (2SFCA) method; the OD cost matrix method and Voronoi diagram method were used to evaluate the accessibility and service pressure of fever sentinels. This study found that a monocentric clustering characterizes the spatial layout of fever clinics, and the design of fever clinics in new urban areas and marginal rural areas is relatively lacking. The spatial layout of fever sentinels includes blank areas, and the service pressure in the central city area is relatively high. Combined with the assessment results, the study discussed optimization strategies and implementation paths for improving the public health and epidemic prevention system for COVID-19 in terms of four aspects: the transformation of governance practice, the spatial-planning response, the digital infrastructure response, and guarantees of policies and regulations.

Model-Based Evaluation of Transmissibility and Intervention Measures for a COVID-19 Outbreak in Xiamen City, China.

BackgroundIn September 2021, there was an outbreak of coronavirus disease 2019 (COVID-19) in Xiamen, China. Various non-pharmacological interventions (NPIs) and pharmacological interventions (PIs) have been implemented to prevent and control the spread of the disease. This study aimed to evaluate the effectiveness of various interventions and to identify priorities for the implementation of prevention and control measures.MethodsThe data of patients with COVID-19 were collected from 8 to 30 September 2021. A Susceptible-Exposed-Infectious-Recovered (SEIR) dynamics model was developed to fit the data and simulate the effectiveness of interventions (medical treatment, isolation, social distancing, masking, and vaccination) under different scenarios. The effective reproductive number (Reff) was used to assess the transmissibility and transmission risk.ResultsA total of 236 cases of COVID-19 were reported in Xiamen. The epidemic curve was divided into three phases (Reff = 6.8, 1.5, and 0). Notably, the cumulative number of cases was reduced by 99.67% due to the preventive and control measures implemented by the local government. In the effective containment stage, the number of cases could be reduced to 115 by intensifying the implementation of interventions. The total number of cases (TN) could be reduced by 29.66–95.34% when patients voluntarily visit fever clinics. When only two or three of these measures are implemented, the simulated TN may be greater than the actual number. As four measures were taken simultaneously, the TN may be <100, which is 57.63% less than the actual number. The simultaneous implementation of five interventions could rapidly control the transmission and reduce the number of cases to fewer than 25.ConclusionWith the joint efforts of the government and the public, the outbreak was controlled quickly and effectively. Authorities could promptly cut the transmission chain and control the spread of the disease when patients with fever voluntarily went to the hospital. The ultimate effect of controlling the outbreak through only one intervention was not obvious. The combined community control and mask wearing, along with other interventions, could lead to rapid control of the outbreak and ultimately lower the total number of cases. More importantly, this would mitigate the impact of the outbreak on society and socioeconomics.

Which Matters More in Fighting COVID-19-Government Policy or Community Participation?

ObjectiveAs a heavily populated megacity, Shanghai faces major epidemic risks. However, Shanghai's control of COVID-19 has been successful owing to both the strict government policy and wide community participation. Here, we investigated the impact of these stakeholders and examined who played a major role across different epidemic stages.DesignWe extended the classic susceptible-exposed-infectious-recovered (SEIR) model considering the heterogeneous contact structure in four social sceneries, i.e., school, workplace, public entertainment venues, and neighborhood community, which could reflect the impact of lockdown policy and wide participation of residents happened at the community level.ResultThe simulation results showed that without lockdown policy and only with community participation, the daily new confirmed cases would gradually increase to more than 7,000 [292/1,000,000] at the end of Sep. However, without community participation and only with a lockdown policy, the daily new confirmed cases sharply decreased to 30 [1.2/1,000,000] at the end of the 1st month and remained low for several months. However, when a lockdown policy was gradually lifted, the new confirmed cases increased exponentially, eventually reaching more than 17,000 [708/1,000,000]. Therefore, a government lockdown policy was necessary for the rapid control of COVID-19 during the outbreak stage while community participation is more important in keeping the number of new confirmed cases low during the reopening stage.ConclusionGovernment lockdown policy and community participation play different roles in the control of COVID-19 at different stages of the epidemic: although the government played a leading role in setting up policies, the broader participation of community fever clinics (CFCs) and the general public were especially crucial in winning the battle against COVID-19 in the long run.

Application of Risk Management in Nurse Work of Fever Clinic

Application of Risk Management in Nurse Work of Fever Clinic

Analysis of Human Reliability in Fever Clinics during the Epidemic Based on the DEMATEL Method

Objective. To explore the method and process of human reliability analysis in epidemic prevention and control system in the complex environment of fever clinics. Methods. Based on the actual situation in the fever clinic of a level A tertiary hospital in Wenzhou, factors that affect clinical safety are sorted out. The Delphi method is used when evaluating the interrelationship among the contributing factors, and then, the DEMATEL method is used to further sort it out to build an impact model. Finally, the data of the experimental model are analyzed, and the impact of factors on human reliability is summarized. Results. Through the data analysis of 23 factors in the fever clinic of the hospital, the impact, prominence, and relation of each factor are confirmed. It is concluded that layout design, disinfection, and isolation setting and on-the-job training are the core factors impacting the operation of the fever clinic. Conclusion. Conducting a human factor reliability analysis with the help of the DEMATEL method can quantitatively describe the influence and interrelationship of human factors in epidemic prevention and control system and effectively promote the safety enhancement of fever clinics.

The Sleep Quality of the Frontline Healthcare Workers and the Improving Effect of Tai Chi.

BackgroundA number of studies have documented that coronavirus disease 2019 (COVID-19) brought more negative impact on the physical and psychological functioning of frontline healthcare workers. Especially, sleep quality was focused. This study aimed to investigate the sleep quality of frontline healthcare workers, risk factors for sleep quality, and the effect of Tai Chi training.MethodsA total of 98 frontline healthcare workers were recruited, coming from the infection department, fever clinic, laboratory, and medical imaging department in a COVID-19-designated hospital in Shanghai. Of them, 50 participated in a 2-week intervention and were randomized to receive a Tai Chi training or relaxation training. Participants were assessed at baseline, 7 and 14 days after participation. Demographic information, sleep quality, and anxiety were measured by using the demographic questionnaire, Pittsburgh Sleep Quality Index (PSQI) and Beck Anxiety Inventory (BAI).Results13.3% participants were above the cut-off score (>10) for the PSQI. Regression analysis showed gender, age, working years, and job category had effect on sleep quality. Compared to the control group, participants in the Tai Chi training group had lower scores on both PSQI (p < 0.05) and BAI (p < 0.01) after the 2-week intervention.ConclusionIt was demonstrated that poor sleep quality existed in the frontline healthcare workers, which was related to gender, age, working years, and job category. Tai Chi training can dramatically improve their sleep quality and reduce anxiety symptoms.

Clinical characteristics of fever clinic visits during the coronavirus disease 2019 pandemic: a retrospective case-control study.

BackgroundLittle is known about the change in characteristics of fever-clinic visits during the coronavirus disease 2019 (COVID-19) pandemic. We sought to examine the changes in the volume, characteristics, and outcomes of patients presenting at a fever clinic duringclinic during the first-level response to COVID-19.MethodsWe conducted a single tertiary-center retrospective case-control study. We included consecutive patients aged 14 years or older who visited the fever clinic of a tertiary hospital during the period of the first-level response to the COVID-19 pandemic in Fuzhou, China (from 24 January to 26 February 2020). We also analyzed the data of patients in the same period of 2019 as a control. We compared a number of outcome measures, including the fever clinic volumes, consultation length, proportion of patients with pneumonia, hospital admission rate, and in-hospital mortality, using the fever-clinic visit data during the two periods.ResultsWe included 1,013 participants [median age: 35; interquartile range (IQR): 27–50, 48.7% male] in this retrospective study, including 707 in 2020 and 306 in 2019. The median daily number of participants who presented at the fever clinic in 2020 was significantly higher than that in 2019 [18 (IQR: 15–22) vs. 13 (IQR: 8–17), P=0.001]. Participants in 2020 had a longer consultation length than those in 2019 [127 (IQR: 51–204) vs. 20 (IQR: 1–60) min, P<0.001]. Participants in 2020 were also more likely to be diagnosed with acute pneumonia than those in 2019 [168 (23.8%) vs. 40 (13.1%), P<0.001]. The hospital admission rate in 2020 was higher than in 2019 [73 (10.3%) vs. 13 (4.2%), P=0.001]. No significant difference was found in terms of the in-hospital mortality of participants in 2020 and 2019 [8 (1.1%) vs. 0, P=0.114].ConclusionsOur findings suggest a higher visits volume, proportion of acute pneumonia, and hospital admission rate among patients presenting at fever clinic during the COVID-19 pandemic. Improved measures need to be implemented.

Mass screening is a key component to fight against SARS-CoV-2 and return to normalcy.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had highly transmissible and pathogenic, which caused serious economic loss and hazard to public health. Different countries have developed strategies to deal with the COVID-19 pandemic that fit their epidemiological situations, capacities, and values. Mass screening combined with control measures rapidly reduced the transmission of the SARS-CoV-2 infection. The COVID-19 pandemic has dramatically highlighted the essential role of diagnostics capacity in the control of communicable diseases. Mass screening has been increasingly used to detect suspected COVID-19 cases and their close contacts, asymptomatic case, patients attending fever clinics, high-risk populations, employees, even all population to identify infectious individuals. Mass screening is a key component to fight against SARS-CoV-2 and return to normalcy. Here we describe the history of mass screening, define the scope of mass screening, describe its application scenarios, and discuss the impact and challenges of using this approach to control COVID-19. We conclude that through a comprehension screening program and strong testing capabilities, mass screening could help us return to normalcy more quickly.

A study of clinical profile and outcome of COVID-19 in children

Background: COVID-19 has become a major public health crisis around the world. This study aimed at identifying the different clinical presentations of children who were tested positive for SARS-COV-2.Methods: Descriptive and prospective study of the children who were seen over the fever clinic and were admitted to the Sapthagiri institute of medical science and research centre over a period of 4 months from November 2021 to February 2022.Results: Among the 251 children admitted to the hospital majority of them were males 52.5% and the age group of 1-5 years were highest affected 46.2%. The most common symptoms noted were fever 60.5%, followed by pain abdomen 45.8%, vomiting 43.8%, running nose 39%, cough 38%, diarrhoea 30.6%, decreased appetite 26.7% and the least common symptom was skin rash 0.3%. Children with comorbidites had higher risk of ICU admission. No deaths were noted during the study period.Conclusions: The study concludes that males and children of age group 1-5 years were more affected. Children with co morbidities were more severely affected. children who were positive presented with other system involvement like gastrointestinal system. Household contact were the make cause of infection among children.

Case Report of a Critically Ill Patient with COVID-19 in Early Outbreak

Introduction: Corona Virus Disease 2019 (COVID-19) has spread rapidly throughout the world. Many people died of this disease. We reported a case of critical illness with COVID-19 pneumonia that occurred in the early stage of viral spread in China and describe the identification, diagnosis, clinical course, and management of the case, including the patient’s symptoms throughout the course. Patient concerns: This article describes the whole diagnosis and treatment process of a critically ill patient in a case report. Diagnosis: The patient was a physician and presented to a fever clinic with a history of treating a suspected patient without special protection the day before. After 5 days, a nucleic acid test for COVID-19 was positive. Then, the patient was transferred to the intensive care unit (ICU) immediately because of severe dyspnea. He was diagnosed with COVID-19 based on a history of exposure, severe acute respiratory syndrome, positive COVID-19 test and chest computed tomography (CT). Interventions: Various therapies were used in this critically ill patient, including anti-infection drugs, hormones, immunoglobulins, herbal medicine, noninvasive ventilation, and special plasma. Outcomes: The patient recovered completely and was discharged after one month of hospitalization. COVID-19 was tested negative and a chest CT showed marked improvement prior to discharge after 4 weeks admission. Conclusion: This study highlights the complexity of treatment and recurrent positivity of the critically ill COVID-19 pneumonia patient and aims to provide useful reference and information for our knowledge of the clinical spectrum of disease.

An agent-based study on the airborne transmission risk of infectious disease in a fever clinic during COVID-19 pandemic

Prevention of nosocomial infections is particularly important for the control of COVID-19 pandemic. We conducted a field study and performed extensive numerical simulations of infection transmission in a fever clinic during pandemic through an agent-based model with pedestrian dynamic and an infection transmission model. Furthermore, we evaluated the cross-infection risk of the patients influenced by the patient inject flow, medical service capability and plane layout. The service capability of fever clinic is determined by the least efficient medical session. When patient inject flow exceeded the service capability, the average dwell time, contact time, exposure dose, and risk of infection of patients all increased dramatically. With the patient inject flow exceeding the service capability, the growth rate of the contact time between patients and the cross-infection risk increased by 11.5-fold and 29.5-fold, respectively. The plane layout of the fever clinic affected the exposure dose and risk of infection. The waiting areas in the fever clinic had the highest risk, where the cumulative exposure dose of virus occupied up to 66.5% of the total. Our research will help to evaluate the biosafety of hospital buildings used for the diagnosis and treatment of infectious diseases.

Antibody Responses Against Plasmodium falciparum MSP3 Protein During Natural Malaria Infection in Individuals Living in Malaria-Endemic Regions of India.

The humoral immune responses to blood-stage malaria proteins are requisite for the inhibition of parasite invasion. Plasmodium falciparum merozoite surface protein 3 (MSP3) is a secretory, expressed abundantly, merozoite surface protein that is important for the parasite invasion process. It has been shown to induce antibody responses during natural infections and is, therefore, considered to be the potential vaccine candidates against Plasmodium. Elucidating the immunogenicity and prevalence of anti-parasite antibodies is important in identifying potential targets as candidates for malarial diagnosis and anti‐malarial vaccine. The present study concerns the presence of antibodies against the MSP3 proteins of human malaria parasite- P. falciparum in infected individuals from endemic regions of India. Seventy-one anonymized P. falciparum infected serum samples were procured from the malaria fever clinic of ICMR-National Institute of Malaria Research (NIMR), New Delhi to detect the presence of antibodies against MSP3 protein by ELISA. The IgM antibody response against recombinant MSP3 was detected at significantly higher levels during acute malaria. The protein was found to be immunogenic and did not demonstrate any cross-reactivity with the serum of uninfected individuals or individuals infected with other Plasmodium species. The protein has hydrophilic regions in its N- and C-terminus which may contain immunogenic linear and conformational B-cell epitopes. The results from this study suggest that the MSP3 is immunogenic and likely a potential candidate for antibody-based diagnosis or vaccine development against the blood-stage of P. falciparum.Graphical abstract

The Physician Scheduling of Fever Clinic in the COVID-19 Pandemic

This article addresses a weekly physician scheduling problem in Covid-19. This problem has arisen in fever clinics in two collaborative hospitals located in Shanghai, China. Because of the coronavirus pandemic, the hospitals must consider some specific constraints in the scheduling problem. For example, due to social distance limitation, the patient queue lengths are much longer in the coronavirus pandemic, even with the same waiting patients. Thus, the hospitals must consider the maximum queue length in the physician scheduling problem. Moreover, the fever clinic’s scheduling rules are different from those in the common clinic, and some specific regulatory constraints have to be considered in the epidemic. We first build a mathematical model for this problem, in which a pointwise stationary fluid flow approximation method is used to compute the queue length. Some linearization techniques are designed to make the problem can be solved by commercial solvers, such as Gurobi. We find that solving this model from practical applications of the hospital within an acceptable computation time is challenging. Consequently, we develop an efficient two-phase approach to solve the problem. A staffing model and a branch-and-price algorithm are proposed in this approach. The performances of our models and approaches are discussed. The effectiveness of the proposed algorithms for real-life data from collaborative hospitals is validated. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Note to Practitioners</i> —This article is motivated by our collaborations with two hospitals in Shanghai, China. Covid-19 has swept the world since 2019 and is still raging in many regions, posing an unprecedented challenge to healthcare systems in countries worldwide. The hospitals are the frontlines of healthcare service, and the physicians are the most critical resource in the battles to coronavirus pandemic. In China, many large-scale hospitals establish fever clinics to serve fever patients. The physician scheduling for such clinics is different and complicated in the Covid-19 due to many specific constraints. We find that the managers are tough to give high-quality schedules to physicians. Thus, we propose a set of algorithms to solve this problem. Especially, a two-phase approach that consists of a staffing standard and a branch-and-price algorithm is designed. Based on hospitals’ real-life data, we show that the methods presented in this article can be used to help hospital managers obtain more reasonable scheduling solutions that can improve the service quality without increasing the workloads of physicians.

COVID-19 Infection among Patients Attending the Fever Clinic of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

The COVID-19 is caused by a coronavirus. COVID-19 patients present with lymphopenia, thrombocytopenia, and elevated inflammatory markers. This study aims to find out the prevalence of COVID-19 infection among patients attending the fever clinic of a tertiary care centre. This was a descriptive cross-sectional study conducted from 15th July, 2020 to 15th January, 2021 in the Department of Pathology at a tertiary care centre. The ethical clearance was obtained from the Institutional Review Committee of a tertiary care centre (Reference number: 2007021388). The patients who attended the fever clinic during the study period were subjected to the COVID-19 reverse transcriptase polymerase chain reaction test. A total of 1431 samples were taken using the convenience sampling method. All data were filled into a predesigned proforma and entered into Microsoft Excel. The data were analyzed using Statistical Package for the Social Sciences version 24.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data and mean and standard deviation for continuous data. Among 1431 patients attending the fever clinic, the prevalence of COVID-19 was found in 277 (19.31%) (17.26-21.36 at 95% Confidence Interval). Most patients belonged to the age group of 20-29 years. There were 113 (40.79%) females and 164 (59.21%) males. The prevalence of COVID-19 infection in this study was higher than similar studies done in similar settings. Most cases had a low hematocrit with anemia. The total count, absolute neutrophil count, and absolute leukocyte count showed a wide range of variation. blood cell count; COVID-19; hematology; lymphocytes; neutrophils.