Nosocomial COVID-19 Infection Research Articles

COVID-19 Outbreak During Inpatient Rehabilitation: Impact on Settings and Clinical Course of Neuromusculoskeletal Rehabilitation Patients.

The COVID-19 pandemic affects a large number of patients. The impact on feasibility and outcome of rehabilitation during COVID-19 actually remains unclear. Nosocomial infection of healthcare workers or hospitalized patients is common, and prevention of nosocomial infections during rehabilitation is challenging. Therefore, we analyzed a cohort of nosocomial infected COVID-19 patients in a single-center inpatient rehabilitation clinic and described performance and outcome. The cohort (N = 27) describes patients with nosocomial SARS-CoV-2 infection while participating in neuromusculoskeletal rehabilitation. Infection was caused by an initially unidentified so-called superspreader. We compared this cohort with all neuromusculoskeletal rehabilitation inpatients of 2019 (comparison group). Normally distributed continuous variables were presented as mean with standard deviation and the t test was used for comparison between groups. Linear regression was used to assess the impact of COVID-19 on Functional Independence Measure at discharge. COVID-19 patients were mostly male (66.7%) with an age of 71.5 ± 12.3 yrs. Age, sex, and cumulated comorbidities of the comparison group (n = 786) were not different from the COVID-19 group. A total of 92.6% of COVID-19 patients had a mild or moderate course, two patients had to be referred to acute hospital because of respiratory failure, and one of these patients died in the acute hospital. After implementation of a strict hygiene concept, no further nosocomial COVID-19 infections were detected. The rehabilitation duration was significantly longer in the COVID-19 group (54.2 ± 23.6 days vs. 32.1 ± 17.7 days, P < 0.001). Daily therapy duration was 132.3 ± 44 mins before SARS-CoV-2 infection and reduced to 81.9 ± 27.3 mins during COVID-19 (P < 0.001). After discontinuation of isolation measures, therapy duration increased significantly (99.3 ± 70.2 mins, P < 0.05).The baseline Functional Independence Measure score was higher in the COVID-19 group (91.93 ± 25.64 points vs. 82.98 ± 22.73 points) and Functional Independence Measure improvements were lower in COVID-19 patients than in the 2019 comparison group (6.96 ± 8.96 points vs. 20.3 ± 15.98 points, P < 0.001). COVID-19 infection itself had a strong negative impact on Functional Independence Measure change as identified by regression analysis. Linear regression analysis showed that COVID-19 reduced the Functional Independence Measure at discharge by 8.9 points (95% CI = -14.725 to -3.097, P = 0.003) after correction for Functional Independence Measure at admission, age, sex, and morbidity index at admission. COVID-19 had a strong negative impact on rehabilitation benefits as assessed by Functional Independence Measure. Neuromusculoskeletal rehabilitation could be continued, but all patients received less therapy minutes during isolation. After implementation of a strict COVID-19-specific hygiene concept, no further infections were detected.

Robotic HPB surgery and impact of COVID-19 in a community hospital setting

Presenter: Imran Siddiqui MD ;Hartford Healthcare St.Vincent's Medical Center Background: Complex hepatopancreaticobiliary (HPB) surgery is associated with high morbidity even in high volume tertiary care centers. Minimally invasive robotic HPB surgeries including robotic whipple and major hepatectomies are resource intense. The COVID-19 pandemic has brought about new challenges in terms of resources and patient safety. We evaluate outcomes of patients undergoing Robotic HPB oncology surgery at high volume community center during COVID-19 pandemic Methods: All patients undergoing robotic HPB and foregut surgery for malignancies from March 2020 to January 2021 were included. Non-malignant indications were excluded. Mortality, morbidity, length of stay and oncologic outcomes were evaluated. Nosocomial COVID-19 infection and mortality and morbidity associated with it were evaluated separately Results: 33 patients were included out of which 22 of which were robotic and others included laparoscopy and hybrid approaches Surgeries included robotic whipple, robotic major hepatectomies, robotic gastrectomies, robotic duodenal resection, robotic biliary and gastric bypass surgery. Clavien III/IV morbidity was 6.5%. There was no post-operative respiratory failure or 30-day mortality. No patients were diagnosed with COVID 19 in the postoperative setting and none developed symptoms in the 30-day post-operative period. All patients were cared for in dedicated non COVID units and were discharged home or COVID free rehab centers. All patients who needed adjuvant treatment received it in a timely setting. Conclusion: Although COVID-19 pandemic has had a significant impact on the mortality and morbidity in the general setting and data has demonstrated worse outcomes for patients with COVID-19 in the post-operative period, we describe in this case series that with COVID safety protocols and preoperative testing, even complex and resource intense surgeries like robotic HPB surgeries can be performed safely in a community hospital setting with significant resource limitations.

Clinical Outcome in Patients with Nosocomial COVID-19 Infection After Thoracic Surgery.

In the present study, we retrospectively evaluated outcomes in 8 patients (mean age 67±7, range 55-77years; male/female 7/1) who acquired nosocomial COVID-19 infection postoperatively out of the 39 adults who underwent elective thoracic surgery in November 2020. All patients were tested negative for COVID-19 on admission. The mortality rate in the eight patients was 25%. The surviving six patients were discharged in a good clinical condition. Fatal outcomes were due to the development of severe and unrelenting acute respiratory distress syndrome (ARDS) and were associated with preoperatively reduced serum albumin (<3g/dL), an open surgical approach, oxygen saturation <90% at the time of COVID-19 diagnosis, and the real-time PCR cycle threshold (Ct) value <20. A high mortality rate indicates a need for systematic and frequent COVID-19 screening in patients scheduled for elective thoracic surgery and the use of minimally invasive procedures whenever feasible.

1. Incidence of Nosocomial COVID-19 in Patients Hospitalized at a Large U.S. Academic Medical Center

BackgroundMany patients are avoiding essential care for fear of contracting Covid-19 in healthcare settings. However, the incidence of nosocomial Covid-19 infection in U.S. acute care hospitals is unknown.MethodsWe conducted an observational study of all patients admitted to Brigham and Women’s Hospital in Boston, Massachusetts between March 7 (when the first Covid-19 patient was admitted) and May 30, 2020. During this period, a comprehensive infection control program was implemented including dedicated Covid-19 units with airborne infection isolation rooms, personal protective equipment (PPE) in accordance with CDC recommendations, PPE donning and doffing monitors, universal masking, restriction of visitors, and liberal RT-PCR testing of symptomatic and asymptomatic patients. We reviewed the medical records of all patients who tested positive for SARS-CoV-2 by RT-PCR on hospital day 3 or later or within 14 days of hospital discharge to determine whether infection was community or hospital-acquired based on timing of RT-PCR tests, clinical course, and exposures.ResultsOver the 12-week period, 9,149 patients were admitted, in whom 7,394 SARS-CoV-2 RT-PCR tests were performed and 697 Covid-19 cases were confirmed, translating into a total 8,656 days of Covid-19-related care (Figure). The inpatient Covid-19 census peaked at 171 on April 21. Twelve of the 697 Covid-19 patients (1.7%) were first diagnosed by RT-PCR on hospital day 3 or later (median 4 days, range 3–15 days). Of these, only one was deemed hospital-acquired and was most likely acquired from his pre-symptomatic spouse who was visiting daily and diagnosed with Covid-19 before visitor restrictions were implemented. Amongst 8,370 non-Covid-19 patients discharged through June 17, 11 (0.1%) subsequently tested positive within 14 days (median time to diagnosis 6 days, range 1–14). Only one was deemed likely to have been hospital-acquired, albeit with no known exposures.Figure. Timeline of implementation of major infection control policies and cumulative number of hospitalized COVID-19 cases (total and hospital-onset) ConclusionNosocomial Covid-19 infection was exceedingly rare during the height of the pandemic in a hospital with rigorous infection control measures. Our findings may inform practices in other institutions and provide reassurance to patients regarding the safety of receiving care in acute care hospitals.Disclosures All Authors: No reported disclosures

Safety and Operational Efficiency of Restructuring and Redeploying a Transcatheter Aortic Valve Replacement Service During the COVID-19 Pandemic: The Oxford Experience

BackgroundThe risk of nosocomial COVID-19 infection for vulnerable aortic stenosis patients and intensive care resource utilization has led to cardiac surgery deferral. Untreated severe symptomatic aortic stenosis has a dismal prognosis. TAVR offers an attractive alternative to surgery as it is not reliant on intensive care resources. We set out to explore the safety and operational efficiency of restructuring a TAVR service and redeploying it to a new non-surgical site during the COVID-19 pandemic. MethodsThe institutional prospective service database was retrospectively interrogated for the first 50 consecutive elective TAVR cases prior to and after our institution's operational adaptations for the COVID-19 pandemic. Our endpoints were VARC-2 defined procedural complications, 30-day mortality or re-admission and service efficiency metrics. ResultsThe profile of patients undergoing TAVR during the pandemic was similar to patients undergoing TAVR prior to the pandemic with the exception of a lower mean age (79 vs 82 years, p < 0.01) and median EuroScore II (3.1% vs 4.6%, p = 0.01). The service restructuring and redeployment contributed to the pandemic-mandated operational efficiency with a reduction in the distribution of pre-admission hospital visits (3 vs 3 visits, p < 0.001) and the time taken from TAVR clinic to procedure (26 vs 77 days, p < 0.0001) when compared to the pre-COVID-19 service. No statistically significant difference was noted in peri-procedural complications and 30-day outcomes, while post-operative length of stay was significantly reduced (2 vs 3 days, p < 0.0001) when compared to pre-COVID-19 practice. ConclusionsTAVR service restructuring and redeployment to align with pandemic-mandated healthcare resource rationalization is safe and feasible.

Should Deep Brain Stimulation Programs Be Halted During the COVID-19 Pandemic? Balancing the Risk of COVID-19 Infection Against the Survival Benefits of DBS

To the Editor: The COVID-19 pandemic has rapidly spread over the world. Numerous infections and fatalities have been reported in almost all countries. Facing the challenge of steadily increasing patients, limited amount of protection equipment and ventilators, resources have been relocated towards emergency departments and intensive care units. Nonemergency elective procedures such as deep brain stimulation (DBS) for patients with Parkinson’s disease have been postponed. It has been discussed that most functional neurosurgery patients are vulnerable to the COVID-19 pandemic and at a higher risk for becoming critically ill infected. Therefore, most centers have halted their DBS programs. Undisputed is that hardware infections and battery replacements require urgent action to prevent sepsis, neuroinfections or akinetic crisis and death, eventually (1.Miocinovic S Ostrem JL Okun MS Bullinger KL Riva-Posse P Gross RE Buetefisch CM. Recommendations for deep brain stimulation device management during a pandemic.J Parkinsons Dis. 2020; 10 (https://doi.org/10.3233/JPD-202072.): 903-910Crossref PubMed Scopus (34) Google Scholar,2.Gross RE et al.Letter: evaluation and surgical treatment of functional neurosurgery patients with implanted deep brain stimulation and vagus nerve stimulation pulse generators during the COVID-19 pandemic.Neurosurgery. 2020; 87: E222-E226Crossref PubMed Scopus (8) Google Scholar). We would like to highlight the fact that Parkinson’s disease (PD) itself is a condition with high mortality rate and complement the rationale that for any functional neurosurgery procedure, and DBS for PD in particular, we should always weigh the imminent risk of a COVID-19 infection against the long term clinical benefits of the procedure. As it remains unclear how long the pandemic will last, and if there will be a second peak, this becomes crucially important. Despite progress in medical management of PD, it does not appear to have altered the mortality rate nor significantly delayed the onset of nonmotor symptoms. Life expectancy remains decreased with the main cause of death being respiratory failure from aspiration pneumonia caused by dysphagia due to brady- or dyskinesia and rigidity of the muscles involved in the act of swallowing. Other causes of death include the deterioration of general condition, cardiovascular disease, traumatic injuries due to postural instability and sepsis. Co-evolving depression and dementia as well as the need for admittance to residential care facilities are associated with higher mortality and increased risk of suicide. All in all, 11 years is the median duration from the onset of PD until death (3.Duarte J García Olmos LM Mendoza A Clavería LE. The natural history of Parkinson’s disease in the province of Segovia: mortality in a longitudinal study (20-year follow-up).Acta Neurol. Scand. 2013; 127 (https://doi.org/10.1111/ane.12003.): 295-300Crossref PubMed Scopus (27) Google Scholar). DBS of the subthalamic nucleus has become an established pillar of the therapy continuum of patients with beginning motor fluctuations and suboptimal medical management, mainly improving motor symptoms (4.Deuschl G Schade-Brittinger C Agid Y EARLYSTIM Study GroupNeurostimulation for Parkinson’s disease with early motor complications.N Engl J Med. 2013; 368: 2038Google Scholar). Moreover, it has shown to improve survival rates in PD patients. A prospective, open-labeled, nonrandomized study by Ngoga et al. followed 147 patients who were offered a DBS procedure by a joint medical/surgical movement disorders clinic over the course of a 10 years period; 106 patients underwent DBS procedure whilst 41 patients prefered medical management. The mortality rate of patients who underwent DBS was significantly lower (17%) compared to patients who received medical management (41.5%), so was admittance to residential nursing care (5.7% vs. 36.6%) (5.Ngoga D Mitchell R Kausar J Hodson J Harries A Pall H. Deep brain stimulation improves survival in severe Parkinson’s disease.J Neurol Neurosurg Psychiatry. 2014; 85 (https://doi.org/10.1136/jnnp-2012-304715.): 17-22Crossref PubMed Scopus (69) Google Scholar). It has been widely discussed whether improvement of survival is related to ameliorated mobility and axial motor functions, perceived improvement in swallowing ability or reduction in dopaminergic medication and drug-related side effects. DBS could prevent the development of motor complications at a much earlier time-point and before long-term sequelae occur, such as psychosocial limitations and deterioration of quality of life. Given all these factors, we strongly believe that PD patients with motor fluctuations should not be treated as nonurgent but interdisciplinary teams of neurologists and neurosurgeons should carefully balance the risk of nosocomial COVID-19 infection against the long-term survival benefits. Conflict of Interest: None for all authors. Dr. Bara developed the idea and wrote the manuscript. Prof. Maciaczyk supervised the work and performed the revisions. Both authors approved the final manuscript.

326P Management of diffuse large B cell lymphomas in the COVID-19 era

Patients with haematologic malignancies, including diffuse large B cell lymphoma (DLBCL), have the highest COVID-19 severity and mortality. It is thus important to balance minimising nosocomial COVID-19 transmission with treatment of aggressive DLBCL. At the National Cancer Centre Singapore (NCCS), we implemented these changes: 1. Reduce outpatient visits for patients on surveillance through telemedicine consultations 2. Low threshold for prophylactic granulocyte stimulating factors (GCSF) to reduce febrile neutropenia 3. Low threshold for antimicrobial prophylaxis 4. Subcutaneous instead of intravenous rituximab to reduce “chair time” in suitable patients 5. Outpatient chemotherapy where possible (including for rituximab with dose-adjusted etoposide, prednisone, vincristine, doxorubicin and cyclophosphamide; DA R-EPOCH for double/triple hit lymphomas) 6. Central Nervous System International Prognostic Index (CNS-IPI) to determine high risk patients requiring CNS prophylaxis; delay CNS prophylaxis with intravenous methotrexate (MTX) to later cycles We then reviewed the data to see if these outcomes had been achieved. Data from DLBCL patients between 1 March to 30 April 2019 and the same period in 2020 were reviewed retrospectively and compared. Statistical analysis was performed using the chi-square test (Stata version 16.0, StataCorp, Texas, USA). There was no nosocomial COVID-19 infection. Inpatient admissions and outpatient visits showed numerical decrease, with significant reduction in surveillance visits (p<0.001). Patients still received appropriate curative treatment. CNS prophylaxis was given when indicated; MTX was given intrathecally during staging lumbar puncture and intravenously later. Most on treatment received GCSF as primary prophylaxis. All who received R-EPOCH also received antimicrobial prophylaxis. There was no difference in number of patients receiving radiation or palliative care. In- and outpatient visits were successfully reduced with no compromise to treatment and supportive care, with no nosocomial transmission of COVID-19. With no end from the pandemic in sight, this strategy for the management of DLBCL is useful in the “new normal” and for future pandemics of similar nature.

Impact of COVID-19 on Outcomes and Productivity in a Gynecologic Oncology and Minimally Invasive Surgery Practice

Study ObjectiveTo determine the impact of COVID-19 on patients undergoing surgery.DesignRetrospective review.SettingCommunity hospital and ambulatory practice in New York near the epicenter of the COVID-19 pandemic.Patients or ParticipantsSurgical volumes were reviewed for years 2019-2020.InterventionsSeventy-three charts were assessed for COVID-19 related outcomes during a 14-week period, beginning February 17th, 2020.Measurements and Main ResultsDuring the study period, gynecologic oncology and minimally invasive surgery activity decreased by 50%. This resulted in economic and clinical disruption. Other surgical divisions showed similar case decreases (34 – 64%) except for otolaryngology which increased by 48%.Seventy-one surgeries were completed in our practice during the study period. Elective cases were restricted on March 7th. Afterward, indications for surgery were malignancy (43.2%), rule out malignancy (27.0%), heavy bleeding (21.6%), and pain (8.1%). All patients were asymptomatic for COVID-19 associated symptoms during preoperative evaluations.Mandatory day-of-surgery COVID-19 PCR testing commenced on April 6th. Prior to this, 49 surgeries were completed. Afterward, 4 of the remaining 21 cases (18%) were cancelled due to positive testing. Of these, 3 tested positive on day of surgery, 1 self-tested positive due to community exposure. All 4 patients remained asymptomatic.Of the 71 patients, 83% were discharged on the same day or on postoperative day one (POD). Postoperatively, 6 patients reported mild COVID-19 symptoms (cough, fever, shortness of breath). Of these, 1 patient tested negative and 5 were not tested. Additionally, 1 patient tested positive remote from surgery (POD #30). Surgeons tested negative for COVID-19 antibodies, and all office staff were asymptomatic.ConclusionAsymptomatic COVID-19 patients were encountered in the preoperative setting. No symptomatic cases of nosocomial COVID-19 infection were identified. Clinical care and surgery appear safe provided there is appropriate utilization of personal protective equipment (PPE). Gynecologic surgical services may be safely performed during a pandemic with appropriate PPE and safety measures.

Secure Health Care Workers' Health and Safety Methodically During COVID-19 Epidemic in Taiwan.

The aim of this article is to assess the effectiveness of 3 measures of COVID-19 (coronavirus disease) containment for securing health care workers' (HCWs) safety and health at 5 medical university-affiliated hospitals in Taiwan. Three measures were to enforce the reporting of HCWs with unknown fever, acute respiratory illness, and other symptoms; to conduct ongoing surveillance to obtain early warning of potential contagion exposure; and to perform epidemiological investigation and outbreak management. A 17-week surveillance data were collected, 374 (6.17%) HCWs with unknown fever or acute respiratory infection symptoms detected by online body temperature surveillance system were reported, there were no cases of nosocomial infection of COVID-19 among HCWs. Via contact tracing and reporting system, 133 (2.19%) HCWs reported footprints in different epidemic events, but no HCWs were infected. No onward transmission to HCWs occurred after containment measures were formulated. Integrated measures of surveillance, managing epidemic transmission chain, and encouraging individual responsibility have been effective approaches among HCWs in the ongoing COVID-19 epidemic. Despite the absence of ongoing local transmission, vigilance and compliance must be maintained to prevent spread of health care-associated infections in all areas and in social mingling among HCWs outside hospitals. These 3 methodical measures secured HCWs' health and safety successfully and preserved health care delivery continuously.

Risk factors of SARS-CoV-2 infection in healthcare workers: a retrospective study of a nosocomial outbreak

BackgroundHealthcare workers (HCWs) are at the forefront of fighting against the COVID-19 pandemic. However, they are at high risk of acquiring the pathogen from infected patients and transmitting to other HCWs. We aimed to investigate risk factors for nosocomial COVID-19 infection among HCWs in a non-COVID-19 hospital yard. MethodsRetrospective data collection on demographics, lifestyles, contact status with infected subjects for 118 HCWs (including 12 COVID-19 HCWs) at Union Hospital of Wuhan, China. Sleep quality and working pressure were evaluated by the Pittsburgh Sleep Quality Index (PSQI) and The Nurse Stress Index (NSI), respectively. The follow-up duration was from Dec 25, 2019, to Feb 15, 2020. ResultsA high proportion of COVID-19 HCWs had engaged in night shift-work (75.0% vs. 40.6%) and felt working under pressure (66.7% vs. 32.1%) than uninfected HCWs. SARS-CoV-2 infected HCWs had significantly higher scores of PSQI and NSI than uninfected HCWs (P < 0.001). Specifically, scores of 5 factors (sleep quality, sleep time, sleep efficiency, sleep disorder, and daytime dysfunction) in PSQI were higher among infected HCWs. For NSI, its 5 subscales (nursing profession and work, workload and time allocation, working environment and resources, patient care, management and interpersonal relations) were all higher in infected than uninfected nurse. Furthermore, total scores of PSQI (HR = 2.97, 95%CI = 1.86−4.76; P <0.001) and NSI (HR = 4.67, 95%CI = 1.42−15.45; P = 0.011) were both positively associated with the risk of SARS-CoV-2 infection. ConclusionOur analysis shows that poor sleep quality and higher working pressure may increase the risk of nosocomial SARS-CoV-2 infection among HCWs.

A Novel Non-contact Self-Injection-Locked Radar for Vital Sign Sensing and Body Movement Monitoring in COVID-19 Isolation Ward.

BackgroundThe outbreak of Coronavirus disease (COVID-19) pandemic has become the most serious global health issue. Isolation policy in hospitals is one of the most crucial protocols to prevent nosocomial infection of COVID-19. It is important to monitor and assess the physical conditions of the patients in isolation.MethodsOur institution has installed the novel non-contact wireless sensor for vital sign sensing and body movement monitoring for patients in COVID-19 isolation ward.ResultsWe have collected and compared data between the radar record with the nurse’s handover record of two patients, one recorded for 13 days and the other recorded for 5 days. The P value by Fisher’s exact test were 0.139 (temperature, P > 0.05) and 0.292 (heart beat rate, P > 0.05) respectively.ConclusionsThis is the first report about the application experience of this equipment. Therefore we attempted to share the experience and try to apply this equipment in COVID-19 patients in future to offer the more reliable and safe policy.Electronic supplementary materialThe online version of this article (10.1007/s10916-020-01637-z) contains supplementary material, which is available to authorized users.

Elective tracheostomy in COVID-19 patients: experience with a standardized interdisciplinary approach

Berichtet wird über die Erfahrungen mit einer interdisziplinären klinikinternen SOP (Standard Operation Procedure) zur Tracheostomie (TS) bei „Coronavirus-Disease“(COVID-19)-Patienten, unter Berücksichtigung der allgemeinen nationalen und internationalen Empfehlungen. Der interdisziplinär festgelegte operative Zeitpunkt der TS aufgrund einer prolongierten invasiven Beatmung und frustranen Weaning-Versuchen betraf Phasen sowohl hoher als auch niedriger Erkrankungsaktivität. Es wurden 5 TS bei Patienten mit einem Durchschnittsalter von 70,6 Jahren durchgeführt. Neben den Standard-COVID-19-Schutzmaßnahmen für das medizinische Personal zur Vermeidung einer nosokomialen COVID-19-Infektion führt die SOP-unterstützte Kommunikation während der TS zu einer periprozeduralen Sicherheit aller Beteiligten. COVID-19-Erkrankungen des medizinischen Personals der beteiligten Abteilungen sind bisher nicht bekannt.

Identifying the effects of an upgraded ‘fever clinic’ on COVID-19 control and the workload of emergency department: retrospective study in a tertiary hospital in China

ObjectiveCOVID-19 started spreading widely in China in January 2020. Outpatient fever clinics (FCs), instituted during the SARS epidemic in 2003, were upgraded to serve for COVID-19 screening and prevention of...

Nosocomial COVID-19 infection: examining the risk of mortality. The COPE-Nosocomial Study (COVID in Older PEople)

BackgroundHospital admissions for non-coronavirus disease 2019 (COVID-19) pathology have decreased significantly. It is believed that this may be due to public anxiety about acquiring COVID-19 infection in hospital and the subsequent risk of mortality.AimTo identify patients who acquire COVID-19 in hospital (nosocomial COVID-19 infection (NC)) and their risk of mortality compared to those with community-acquired COVID-19 (CAC) infection.MethodsThe COPE-Nosocomial Study was an observational cohort study. The primary outcome was the time to all-cause mortality (estimated with an adjusted hazard ratio (aHR)), and secondary outcomes were day 7 mortality and the time-to-discharge. A mixed-effects multivariable Cox's proportional hazards model was used, adjusted for demographics and comorbidities.FindingsThe study included 1564 patients from 10 hospital sites throughout the UK, and one in Italy, and collected outcomes on patients admitted up to April 28th, 2020. In all, 12.5% of COVID-19 infections were acquired in hospital; 425 (27.2%) patients with COVID died. The median survival time in NC patients was 14 days compared with 10 days in CAC patients. In the primary analysis, NC infection was associated with lower mortality rate (aHR: 0.71; 95% confidence interval (CI): 0.51–0.98). Secondary outcomes found no difference in day 7 mortality (adjusted odds ratio: 0.79; 95% CI: 0.47–1.31), but NC patients required longer time in hospital during convalescence (aHR: 0.49, 95% CI: 0.37–0.66).ConclusionThe minority of COVID-19 cases were the result of NC transmission. No COVID-19 infection comes without risk, but patients with NC had a lower risk of mortality compared to CAC infection; however, caution should be taken when interpreting this finding.

Ethical Issues in the COVID Era: Doing the Right Thing Depends on Location, Resources, and Disease Burden.

Ethical Issues in the COVID Era: Doing the Right Thing Depends on Location, Resources, and Disease Burden.

The impact of COVID-19 on trauma and orthopaedic surgery in the United Kingdom.

The coronavirus 2019 (COVID-19) global pandemic has had a significant impact on trauma and orthopaedic (T&O) departments worldwide. To manage the peak of the epidemic, orthopaedic staff were redeployed to frontline medical care; these roles included managing minor injury units, forming a “proning” team, and assisting in the intensive care unit (ICU). In addition, outpatient clinics were restructured to facilitate virtual consultations, elective procedures were cancelled, and inpatient hospital admissions minimized to reduce nosocomial COVID-19 infections. Urgent operations for fractures, infection and tumours went ahead but required strict planning to ensure patient safety. Orthopaedic training has also been significantly impacted during this period. This article discusses the impact of COVID-19 on T&O in the UK and highlights key lessons learned that may help to proactively prepare for the next global pandemic.Cite this article: Bone Joint Open 2020;1-7:420–423.

The impact of COVID-19 on trauma and orthopaedic surgery in the United Kingdom

The coronavirus 2019 (COVID-19) global pandemic has had a significant impact on trauma and orthopaedic (T&amp;O) departments worldwide. To manage the peak of the epidemic, orthopaedic staff were redeployed to frontline medical care; these roles included managing minor injury units, forming a “proning” team, and assisting in the intensive care unit (ICU). In addition, outpatient clinics were restructured to facilitate virtual consultations, elective procedures were cancelled, and inpatient hospital admissions minimized to reduce nosocomial COVID-19 infections. Urgent operations for fractures, infection and tumours went ahead but required strict planning to ensure patient safety. Orthopaedic training has also been significantly impacted during this period. This article discusses the impact of COVID-19 on T&amp;O in the UK and highlights key lessons learned that may help to proactively prepare for the next global pandemic. Cite this article: Bone Joint Open 2020;1-7:420–423.

Quantifying and Mitigating the Impact of the COVID-19 Pandemic on Outcomes in Colorectal Cancer

Background: The COVID-19 pandemic has caused disruption across cancer pathways for diagnosis and treatment. In England, 32% of colorectal cancer (CRC) is diagnosed via urgent symptomatic referral from primary care, the “2-week-wait” (2WW) pathway. Access to routine endoscopy is likely to be a critical bottleneck causing delays in CRC management due to chronic limitation in capacity, acute competition for physician time, and safety concerns. Methods: We used age-specific, stage-specific 10 year CRC survival for England 2007-2017 and 2WW CRC cases volumes. We used per-day hazard ratios of CRC survival generated from observational studies of CRC diagnosis-to-treatment interval to model the effect of different durations of per-patient delay. We utilised data from a large London observational study of faecal immunochemical testing (FIT) in symptomatic patients to model FIT-triage to mitigate delay to colonoscopy. Findings: Modest delays result in significant reduction in survival from CRC with a 4-month delay resulting across age groups in ≥20% reduction in survival in Stage 3 disease and in total over a year, 1,419 attributable deaths across the 11,266 CRC patients diagnosed via the 2WW pathway. FIT triage of >10 ug Hb/g would salvage 1,292/1,419 of the attributable deaths and reduce colonoscopy requirements by >80%. Diagnostic colonoscopy offers net survival in all age groups, providing nosocomial COVID-19 infection rates are kept low (<2·5%). Interpretation: To avoid significant numbers of avoidable deaths from CRC, normal diagnostic and surgical throughput must be maintained. An accrued backlog of cases will present to primary care following release of lockdown, supranormal endoscopy capacity will be required to manage this without undue delays. FIT-triage of symptomatic cases provides a rational approach by which to avoid patient delay and mitigate pressure on capacity in endoscopy. This would also reduce exposure to nosocomial COVID-19 infection, relevant in particular to older patient groups. Funding Statement: MEJ additionally received funding from Breast Cancer Now. B.T and A.G. are supported by Cancer Research UK award C61296/A27223. C.L. and C.T. receive support from the Movember foundation. R.S.H. is supported by Cancer Research UK (C1298/A8362) and Bobby Moore Fund for Cancer. GL is supported by a Cancer Research UK Advanced Clinician Scientist Fellowship Award [C18081/A18180] and is Associate Director of the multi-institutional CanTest Collaborative funded by Cancer Research UK [C8640/A23385]. Research UK). D.C.M is supported by Cancer Research UK (C57955/A24390. A.S. is in receipt of an Academic Clinical Lectureship from National Institute for Health Research (NIHR) and Biomedical Research Centre (BRC) post-doctoral support. This is a summary of independent research supported by the NIHR BRC at the Royal Marsden NHS Foundation Trust and Institute of Cancer Research. Declaration of Interests: The authors declare no competing interests.

Strategies suggested for emergency diagnosis and treatment of traumatic orthopedicsin the epidemic periodof Corona Virus Disease 2019

Objective To suggest strategies for emergency diagnosis and treatment of trauma orthopedics in the epidemic period of Corona Virus Disease 2019(COVID-19). Methods In the epidemic of COVID-19 from January 21 to February 15, 2020, 128 patients with orthopaedic trauma sought emergency treatment at Department of Orthopedic Surgery, The People’s Hospital of Wuhan University. They were 71 males and 57 females with an average age of 48.7 years (from 5 to 88 years).Of them, 107 cases were treated at the outpatient department and 21 hospitalized. Emergency operations were carried out for 4 cases and selective operationsfor 17 cases. COVID-19 infections were recorded in the patients and medical staff as well. Measures taken and experiences learned were summarized since the epidemicoutbreak of COVID-19. Results Of the 107 cases treated at the outpatient department, 3 had a definite diagnosis of COVID-19 and 3 a suspected diagnosis of COVID-19. Of the 4 cases undergoing emergency surgery, one was suspected of having COVID-19. Of the 17 cases undergoing selective surgery, one was diagnosed definitely as COVID-19and 2 were suspected of COVID-19. Two nurses were diagnosed definitely as having mildCOVID-19.One doctor and one nurse were suspected of COVID-19. Since the COVID-19 infections in medical staff occurred all before the preventive and control measures for COVID-19 had been implemented,is was not ruled out that their infections might have come from communities. Conclusions It is particularly important for medical institutions of all levels to maintain safe and effective routine services while doing well in COVID-19 prevention. In the epidemic of COVID-19, front-line medical staff in emergency traumatic orthopedics is faced with great challenges in the process of diagnosing and treating patients. High-quality and safe medical services can be provided as long as nosocomial COVID-19infection is effectively controlled by rigid screening of patientsnewly admitted, classified management of inpatients, optimal management of inpatient wards, standard preventive measures in perioperative period, a perfect system for medical protection, and medical education for patients and their carers. Key words: Corona Virus Disease 2019; Orthopaedics; Wound and injuries; Perioperative period; Prevention

Management strategy of prevention and control of nosocomial infection of COVID-19 in blood purification center

There are many patients in the blood purification center who need maintenance hemodialysis to maintain life. Those patients generally have low resistance and are easily exposed to coronavirus because they go back and forth the hospital and residence three times a week and closely contact with family, caregivers, community personnel, people in various means of transportation, medical staff, and other patients visiting hospital. Therefore, the blood purification center has become a high-risk environment for the spread of COVID-19 infection. In view of this, our center quickly responded to the formulation and implementation of infection prevention and control measures suitable for the characteristics of the blood purification center and continuous renal replacement therapy (CRRT) emergency plan for fever and suspected patients. According to these measures, we have a positive effect on preventing and controlling nosocomial infection in the blood purification center.