Healthcare impact of COVID-19 epidemic in India: A stochastic mathematical model

BackgroundIn India, the SARS-CoV-2 COVID-19 epidemic has grown to 1251 cases and 32 deaths as on 30 Mar 2020. The healthcare impact of the epidemic in India was studied using a stochastic mathematical model.MethodsA compartmental SEIR model was developed, in which the flow of individuals through compartments is modeled using a set of differential equations. Different scenarios were modeled with 1000 runs of Monte Carlo simulation each using MATLAB. Hospitalization, intensive care unit (ICU) requirements, and deaths were modeled on SimVoi software. The impact of nonpharmacological interventions (NPIs) including social distancing and lockdown on checking the epidemic was estimated.ResultsUninterrupted epidemic in India would have resulted in more than 364 million cases and 1.56 million deaths with peak by mid-July. As per the model, at current growth rate of 1.15, India is likely to reach approximately 3 million cases by 25 May, implying 125,455 (±18,034) hospitalizations, 26,130 (±3298) ICU admissions, and 13,447 (±1819) deaths. This would overwhelm India's healthcare system. The model shows that with immediate institution of NPIs, the epidemic might still be checked by mid-April 2020. It would then result in 241,974 (±33,735) total infections, 10,214 (±1649) hospitalizations, 2121 (±334) ICU admissions, and 1081 (±169) deaths.ConclusionAt the current growth rate of epidemic, India's healthcare resources will be overwhelmed by the end of May. With the immediate institution of NPIs, total cases, hospitalizations, ICU requirements, and deaths can be reduced by almost 90%.     

Risk factors for hospital admission among COVID-19 patients with diabetes: A study from Saudi Arabia

Objectives:To elucidate the risk factors for hospital admission among COVID-19 patients with type 2 diabetes mellitus (T2DM).Methods:This retrospective study was conducted at the Prince Sultan Military Medical City, Riyadh, Saudi Arabia between May 2020 and July 2020. Out of 7,260 COVID-19 patients, 920 were identified as T2DM. After the exclusion process, 806 patients with T2DM were included in this analysis. Patients’ data were extracted from electronic medical records. A logistic regression model was performed to estimate the risk factors of hospital admission.Results:Of the total of 806 COVID-19 patients with T2DM, 48% were admitted in the hospital, 52% were placed under home isolation. Older age between 70-79 years (OR [odd ratio] 2.56; p=0.017), ≥80 years (OR 6.48; p=0.001) were significantly more likely to be hospitalized compared to <40 years. Similarly, patients with higher HbA1c level of ≥9% compared to <7%; (OR 1.58; p=0.047); patients with comorbidities such as, hypertension (OR 1.43; p=0.048), cardiovascular disease (OR 1.56; p=0.033), cerebrovascular disease (OR 2.38; p=0.016), chronic pulmonary disease (OR 1.51; p=0.018), malignancy (OR 2.45; p=0.025), chronic kidney disease (CKD) IIIa, IIIb, IV (OR 2.37; p=0.008), CKD V (OR 5.07; p=0.007) were significantly more likely to be hospitalized. Likewise, insulin-treated (OR 1.46; p=0.03) were more likely to require hospital admission compared to non-insulin treated patients.Conclusion:Among COVID-19 patients with diabetes, higher age, high HbA1c level, and presence of other comorbidities were found to be significant risk factors for the hospital admission.     

新型冠状病毒肺炎流行期间医护人员心理健康与应对方式相关性研究

目的 调查新型冠状病毒肺炎(COVID-19)流行期间六安市区三家三级医院医护人员心理健康的现状,分析医护人员心理健康水平与应对方式的关系。方法 于2020年2月7日～2月15日,使用问卷星形式,采用焦虑自评量表、抑郁自评量表及简易应对方式问卷调查COVID-19流行期间六安市区三家三级医院360名医护人员心理状况,分析医护人员焦虑、抑郁水平及其与应对水平的相关性。结果 COVID-19流行期间六安市区三家三级医院医护人员焦虑粗分(32.82±7.80)分,抑郁粗分(37.90±8.30)分,均高于中国常模,差异有统计学意义(P<0.05)。焦虑阳性者(总粗分≥40分)68例(18.9%),抑郁阳性者(总粗分≥41 分)138例(38.4%);医护人员应对方式总分9～60分,平均为(36.61±8.55)分。积极应对6～36分,平均为(24.49±6.14)分。消极应对1～24分,平均为(12.12±4.19)分;偏相关分析显示,医护人员焦虑得分与积极应对呈负相关(r=-0.315,P<0.05),与消极应对呈正相关(r=0.147,P<0.05)。抑郁得分与积极应对呈负相关(r=-0.374,P<0.05),与消极应对呈正相关(r=0.207,P<0.05)。结论 COVID-19流行期间医护人员存在不同程度的焦虑和抑郁,疫情期间医护人员的心理健康与积极应对方式呈正相关,与消极应对方式呈负相关。     

重型新型冠状病毒肺炎患者临床特征及诊治分析

目的 总结重型新型冠状病毒肺炎(COVID-19)患者临床特征及诊治经验。方法 回顾性分析2020 年1 月27 日至2020 年3 月10 日在我院诊治的重症COVID-19 患者资料。结果 5 例重症COVID-19 患者中,男性2例,女性3 例,年龄47~65 岁,3 例合并基础疾病,主要临床表现为发热、咳嗽、咳痰、胸闷、乏力及腹泻等。外周血淋巴细胞绝对值与嗜酸性粒细胞均出现显著降低。胸部CT 表现为外周分布、双肺多发斑片状阴影。5 例重症患者均予抗病毒治疗,康复者血浆治疗1 例,托珠单抗治疗1 例。患者均治愈出院。结论 5 例重症COVID-19 患者以呼吸道症状及消化道症状为主要表现,外周血淋巴细胞及嗜酸性粒细胞显著减少,影像学特点以外周分布的两肺多发斑片状阴影为主,经积极治疗预后良好。     

Malaria in school‐age children in Africa: an increasingly important challenge

School‐age children have attracted relatively little attention as a group in need of special measures to protect them against malaria. However, increasing success in lowering the level of malaria transmission in many previously highly endemic areas will result in children acquiring immunity to malaria later in life than has been the case in the past. Thus, it can be anticipated that in the coming years there will be an increase in the incidence of both uncomplicated and severe malaria in school‐age children in many previously highly endemic areas. In this review, which focuses primarily on Africa, recent data on the prevalence of malaria parasitaemia and on the incidence of clinical malaria in African school‐age children are presented and evidence that malaria adversely effects school performance is reviewed. Long‐lasting insecticide treated bednets (LLIN) are an effective method of malaria control but several studies have shown that school‐age children use LLINs less frequently than other population groups. Antimalarial drugs are being used in different ways to control malaria in school‐age children including screening and treatment and intermittent preventive treatment. Some studies of chemoprevention in school‐age children have shown reductions in anaemia and improved school performance but this has not been the case in all trials and more research is needed to identify the situations in which chemoprevention is likely to be most effective and, in these situations, which type of intervention should be used. In the longer term, malaria vaccines may have an important role in protecting this important section of the community from malaria. Regardless of the control approach selected, it is important this is incorporated into the overall programme of measures being undertaken to enhance the health of African school‐age children.     

COVID-19期间贵州省STEMI患者救治特征分析

目的 分析贵州省2020年1月21日—2月24日新冠疫情期间贵州省STEMI患者的救治特征,为疫情的防控、诊断、治疗及决策提供详实的数据基础与参考。方法：选取2020年1月21日—2月24日贵州省内的13所三级甲等教学医院心内科收治的STEMI患者作为实验组,这13所医院2019年同期收治的STEMI患者为研究对象作为对照组。记录所选13家医院的医院等级、胸痛中心及胸痛联盟认证情况,记录是否分属教学医院。记录所选对象的性别、年龄及慢性合并症情况。记录两组对象在各家医院的就诊数量、救治方式及并发症情况。记录患者的总缺血时间、发病-首次医疗接触、首次医疗接触-导丝通过及入门-导丝通过时间。结果:2020年1月21日—2月24日选取贵州省13所三甲医院,其中12所为胸痛中心标准版认证单位,13所均分属当地胸痛中心联盟、为教学医院。两组患者的性别、年龄、吸烟史及慢性病情况均无统计学差异。实验组溶栓患者数较对照组明显降低(P＜0.01),溶栓成功患者、急诊PCI患者,心衰与死亡患者数目两组均无差异。实验组总缺血时间、发病-首次医疗接触时间、首次医疗接触-导丝通过时间及入门-导丝通过时间均长于对照组(均P＜0.01)。结论: ,新冠疫情使贵州省STEMI患者的发病就诊时间明显延长,表现为总缺血时间、发病-首次医疗接触、首次医疗接触-导丝通过及入门-导丝通过时间的延长,错过溶栓时间窗患者比例增加;对总体溶栓成功、心衰、死亡患者数目没有明显影响。     

514例确诊COVID-19患者心电图特征分析

目的：研究新型冠状病毒肺炎住院患者心电图改变和心律失常类型及其与患者临床预后关系。方法：纳入某新冠肺炎专科医院在院患者入院心电图514份,分析其中心电图改变和心律失常类型、特征。结果：254例患者出现明显心电图改变和心律失常,其中窦性心动过速65例（22.2%）,QT间期延长60例（20.5%）,房颤45例（15.4%）,传导阻滞39例（13.3%）,房性早搏22例（7.5%）,室性早搏20例（6.8%）,窦性心律不齐20例（6.8%）,窦性心动过缓18例（6.1%）,预激综合征4例（1.4%）,心律失常发生组患者其在院死亡率显著高于无心律失常组（P＜0.05）。 结论：心律失常多见于老年及合并基础心血管疾病COVID-19患者,其发生与临床预后密切相关。     

Evaluation of lockdown effect on SARS-CoV-2 dynamics through viral genome quantification in waste water,Greater Paris,France, 5 March to 23 April 2020

IntroductionSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiological agent of coronavirus disease (COVID-19). People infected with SARS-CoV-2 may exhibit no or mild non-specific symptoms; thus, they may contribute to silent circulation of the virus among humans. Since SARS-CoV-2 RNA can be detected in stool samples, monitoring SARS-CoV-2 RNA in waste water (WW) has been proposed as a complementary tool to investigate virus circulation in human populations.AimTo test if the quantification of SARS-CoV-2 genomes in WW correlates with the number of symptomatic or non-symptomatic carriers.MethodWe performed a time-course quantitative analysis of SARS-CoV-2 by RT-qPCR in raw WW samples collected from several major WW treatment plants in Greater Paris. The study period was 5 March to 23 April 2020, including the lockdown period in France (from 17 March).ResultsWe showed that the increase of genome units in raw WW accurately followed the increase of human COVID-19 cases observed at the regional level. Of note, the viral genome could be detected before the epidemic grew massively (around 8 March). Equally importantly, a marked decrease in the quantities of genome units was observed concomitantly with the reduction in the number of new COVID-19 cases, 29 days following the lockdown.ConclusionThis work suggests that a quantitative monitoring of SARS-CoV-2 genomes in WW could generate important additional information for improved monitoring of SARS-CoV-2 circulation at local or regional levels and emphasises the role of WW-based epidemiology.     

The Impact of COVID-19 Pandemic on the Hospital Management of TAVI Patients: TAVI Team Thoughts and Recommendation

The COVID-19 Pandemic has put enormous pressure on the healthcare system globally, causing many healthcare organizations all over the world to cancel or stop elective procedures in their cardiac catheterization laboratoires. This delay in elective procedures with no doubt has led to a suspension of patient care primarily to those with severe aortic stenosis, which might place them at higher risk for cardiovascular complications like sudden death and heart failure.Health Care Worker are faced with the uncertainty of contracting infections while performing procedures in patients with a confirmed diagnosis of COVID-19 or suspected cases. This unprecedented situation is very challenging for the safety of Health Care Worker. Hence, in this article, we aim to summarize some of the current guidelines as to how to triage patients in need for Trans Catheter Aortic Valve Implantation (TAVI), during this ongoing pandemic, and will address some necessary considerations related to the preparation of catheterization laboratories and personal during the COVID-19 pandemic.