When open source design is vital: critical making of DIY healthcare equipment during the COVID-19 pandemic

Shortages of personal protective equipment (PPE) and medical devices needed during the COVID-19 pandemic were widely reported in early 2020. In response, civic DIY volunteers explored how they could produce the required equipment. Members of communities such as hacker- and makerspaces employed their skills and tools to manufacture, for example, face shields and masks. The article discusses these civic innovation practices and their broader social implications by relating them to critical making theory. Methodologically, it is based on a digital ethnography approach, focusing on hacker and maker communities in the UK. Communities' DIY initiatives display characteristics of critical making and 'craftivism', as they assessed and counteracted politicised healthcare supply shortages. It is argued that their manufacturing activities during the COVID pandemic relate to UK austerity politics' effects on healthcare and government failure to ensure medical crisis supplies. Facilitated by open source design, communities' innovation enabled healthcare emergency equipment. At the same time, their DIY manufacturing raises practical as well as ethical issues concerning, among other things, efficacy and safety of use.

COVID-19 pandemic and lacrimal practice: Multipronged resumption strategies and getting back on our feet

The aim of this review was to propose multi-pronged resumption strategies for lacrimal practice in an effort to plan a sustainable recommencement of elective surgeries after we emerge from the peak of COVID-19 pandemic. The strategies for lacrimal practice were classified into 7 subtypes, and each of the blueprints were reassessed based on existing information on resumption strategies of elective surgeries from other specialties in COVID-19 era. The specific needs of lacrimal practice were then added to construct algorithms summarizing the resumption strategies. The basic principle of 'primum non nocere' needs to be followed. The overall proposed plan advocates the transition to a more sustainable health care reality in a world where we would still co-exist with COVID-19. A comprehensive effort involving screening, laboratory testing, appropriate triage, effective personal protection and specific precautionary measures for lacrimal clinics and operating room are needed to be able to safely resume elective surgery when the pandemic peak declines. To predict the timing of the resumption of elective surgeries is quite complex and influenced by several geographic, political and economic factors. It is equally important to remember that COVID-19 crisis is a dynamic situation and constantly evolving, hence the strategies provided are subject to change. Strict adherence to standard COVID-19 guidelines combined with effective testing and personal protection strategies can ensure slow yet smooth and safe return to full lacrimal practice after the COVID-19 pandemic calms down. The local government directives, individual and institutional discretion are advised.

COVID-19: Results of a national survey of United Kingdom healthcare professionals' perceptions of current management strategy - A cross-sectional questionnaire study

OBJECTIVE

COVID-19 has caused a global healthcare crisis with increasing number of people getting infected and dying each day. Different countries have tried to control its spread by applying the basic principles of social distancing and testing. Healthcare professionals have been the frontline workers globally with different opinions regarding the preparation and management of this pandemic. We aim to get the opinion of healthcare professionals in United Kingdom regarding their perceptions of preparedness in their workplace and general views of current pandemic management strategy.

METHOD

A questionnaire survey, drafted using Google Forms, was distributed among healthcare professionals working in the National Health Service (NHS) across the United Kingdom. The study was kept open for the first 2 weeks of April 2020.

RESULTS

A total of 1007 responses were obtained with majority of the responses from England (n = 850, 84.40%). There were 670 (66.53%) responses from doctors and 204 (20.26%) from nurses. Most of the respondents (95.23%) had direct patient contact in day to day activity. Only one third of the respondents agreed that they felt supported at their trust and half of the respondents reported that adequate training was provided to the frontline staff. Two-thirds of the respondents were of the view that there was not enough Personal Protective Equipment available while 80% thought that this pandemic has improved their hand washing practice. Most of the respondents were in the favour of an earlier lockdown (90%) and testing all the NHS frontline staff (94%).

CONCLUSION

Despite current efforts, it would seem this is not translating to a sense of security amongst the UK NHS workforce in terms of how they feel trained and protected. It is vital that healthcare professionals have adequate support and protection at their workplace and that these aspects be actively monitored.

SARS-CoV-2 Virulence: Interplay of Floating Virus-Laden Particles, Climate, and Humans

With the emergence of COVID-19, it is important to address the possible scenarios of SARS-CoV-2 virulence. Although several researchers have addressed the possible mechanisms of enveloped virus transfection, for example, influenza, here, the relationship between exhaled virus laden-particles, the climate, and transfection probability is discussed by interpreting the findings of prior studies. Importantly, the higher probability of viral transfection in cold and dry public spaces such as near cold shelves of groceries is illustrated. Thus, additional protective measures in such spaces are recommended.

The Novel Coronavirus - Latest Findings

What was initially a lung infection epidemic in the metropolitan area of Wuhan followed by a now contained extension to mainland China has now spread to all continents as a major pandemic with current hotspots in Europe and the USA. This minireview is an update of an earlier report on this novel coronavirus infection (Brüssow, 2020, Microb Biotech 13, 607). I am now summarizing the research literature published between end of February to mid-April 2020.

The Rapid Response to the COVID-19 Pandemic by the Arthroplasty Divisions at Two Academic Referral Centers

The COVID-19 pandemic has created widespread changes across all of health care. As a result, the impacts on the delivery of orthopedic services have been challenged. To ensure and provide adequate health care resources in terms of hospital capacity and personnel and personal protective equipment, service lines such as adult reconstruction and lower limb arthroplasty have stopped or substantially limited elective surgeries and have been forced to re-engineer care processes for a high volume of patients. Herein, we summarize the similar approaches by two arthroplasty divisions in high-volume academic referral centers in (1) the cessation of elective surgeries, (2) workforce restructuring, (3) phased delivery of outpatient and inpatient care, and (4) educational restructuring.

Doing Our Part to Conserve Resources: Determining Whether All Personal Protective Equipment Is Mandatory for Closed Reduction and Percutaneous Pinning of Supracondylar Humeral Fractures

BACKGROUND

Closed reduction and percutaneous pinning (CRPP) of supracondylar humeral fractures is one of the most common procedures performed in pediatric orthopaedics. The use of full, standard preparation and draping with standard personal protective equipment (PPE) may not be necessary during this procedure. This is of particular interest in the current climate as we face unprecedented PPE shortages due to the current COVID-19 pandemic.

METHODS

This is a retrospective chart review of 1,270 patients treated with CRPP of a supracondylar humeral fracture at 2 metropolitan pediatric centers by 10 fellowship-trained pediatric orthopaedic surgeons. One surgeon in the group did not wear a mask when performing CRPP of supracondylar humeral fractures, and multiple surgeons in the group utilized a semisterile preparation technique (no sterile gown or drapes). Infectious outcomes were compared between 2 groups: full sterile preparation and semisterile preparation. We additionally analyzed a subgroup of patients who had semisterile preparation without surgeon mask use. Hospital cost data were used to estimate annual cost savings with the adoption of the semisterile technique.

RESULTS

In this study, 1,270 patients who underwent CRPP of a supracondylar humeral fracture and met inclusion criteria were identified. There were 3 deep infections (0.24%). These infections all occurred in the group using full sterile preparation and surgical masks. No clinically relevant pin-track infections were noted. There were no known surgeon occupational exposures to bodily fluid. It is estimated that national adoption of this technique in the United States could save between 18,612 and 22,162 gowns and masks with costs savings of $3.7 million to $4.4 million annually.

CONCLUSIONS

We currently face critical shortages of PPE due to the COVID-19 pandemic. Data from this large series suggest that a semisterile technique during CRPP of supracondylar humeral fractures is a safe practice. We anticipate that this could preserve approximately 20,000 gowns and masks in the United States over the next year. Physicians are encouraged to reevaluate their daily practice to identify safe opportunities for resource preservation.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Strategies for radiology departments in handling the COVID-19 pandemic

The world is facing an unprecedented global pandemic in the form of the coronavirus disease 2019 (COVID-19) which has ravaged all aspects of life, especially health systems. Radiology services, in particular, are under threat of being overwhelmed by the sheer number of patients affected, unless drastic efforts are taken to contain and mitigate the spread of the virus. Proactive measures, therefore, must be taken to ensure the continuation of diagnostic and interventional support to clinicians, while minimizing the risk of nosocomial transmission among staff and other patients. This article aims to highlight several strategies to improve preparedness, readiness and response towards this pandemic, specific to the radiology department.

The Attitudes and Professional Approaches of Dental Practitioners during the COVID-19 Outbreak in Poland: A Cross-Sectional Survey

The coronavirus infectious disease 2019 (COVID-19) pandemic has put enormous pressure on health care systems around the world. Dentistry has had to adjust to the new epidemic situation to not only bring relief to suffering patients but also to avoid becoming a source of SARS-CoV-2 transmission. Methods: A comprehensive, cross-sectional survey was conducted between April 6 and 16, 2020 among 875 Polish dental practitioners. The aim of the research was to assess dentists’ attitudes and professional approaches resulting from the COVID-19 pandemic. Results: 71.2% of dentists who responded to the questionnaire decided to suspend their clinical practice during that particular time. The main factors for this fact were the shortage of personal protective equipment (PPE), the respondents’ subjective perceptions of the risk of COVID-19 contraction and a general feeling of anxiety and uncertainty regarding the COVID-19 situation. The authors observed a significant decrease in the number of patients admitted weekly in April 2020 (12.06; SD, 11.55) in comparison to that in the time before the state of pandemic was declared on March 11, 2020 (49.21; SD, 24.97). Conclusions: Due to the unpreparedness of the dental sector, both in national health and private settings, most of the Polish dentists decided to voluntarily suspend their clinical practice in order to mitigate the spread of the disease. The COVID-19 outbreak has revealed numerous shortcomings in the dental care system, especially regarding the insufficient coordination of health services related to the pandemic and lack of advanced PPE. This has led to an overwhelming feeling of fear, confusion and anxiety among dental professionals in Poland and a sudden decrease in the number of performed dental procedures. Hopefully enriched with the recent experience and due to the implementation of proper strategic and long-term measures, dental practitioners will be better prepared and adapted to global health care disruptions in the future.

Testing PPE: Are DIY Masks a Viable Alternative to Address Shortages?

As the global pandemic caused by the COVID-19 virus continues to spread, researchers from across the world are harnessing their skills and opening their labs to contribute to solutions for managing and addressing the health crisis. One area identified by hospitals and medical providers as a critical need has been the shortage of personal protective equipment (PPE), which is required to keep health care providers safe from exposure to the virus as they care for patients. In response, manufacturers such as 3M have promised to increase production in order to fulfill the extensive orders. However, medical providers may not see the bulk of these outputs for weeks even as current supplies are running low.

Hospital Pharmacy Compounding against COVID-19 pandemic

As in other areas of the health system, COVID-19 has had a dramatic impact on  hospital compounding. This area has faced numerous challenges, including the  shortage of frequent-use products (hydroalcoholic solutions, lopinavir/ritonavir  suspension), the use of new preparations for SARS-CoV-2 (tocilizumab,  remdesivir), or requests from overwhelmed wards unable to assume the safe  preparation of a high volume of medications (intravenous solutions). The  demand for all types of preparations (topic and oral medications, intravenous  solutions) has increased dramatically. This increase has highlighted the shortage of resources allocated to this area, which has made it difficult to meet the high  demand for preparations. In addition, the pandemic has revealed the scarcity of  research on such basic aspects as agent stability and drug compatibility. One of  the most relevant conclusions drawn from the COVID-19 pandemic is that the  basic areas of hospital pharmacy, along with other, must be maintained and  reinforced, as these are the areas that make us essential.

Use of personal protective equipment against coronavirus disease 2019 by healthcare professionals in Wuhan, China: cross sectional study

OBJECTIVE

To examine the protective effects of appropriate personal protective equipment for frontline healthcare professionals who provided care for patients with coronavirus disease 2019 (covid-19).

DESIGN

Cross sectional study.

SETTING

Four hospitals in Wuhan, China.

PARTICIPANTS

420 healthcare professionals (116 doctors and 304 nurses) who were deployed to Wuhan by two affiliated hospitals of Sun Yat-sen University and Nanfang Hospital of Southern Medical University for 6-8 weeks from 24 January to 7 April 2020. These study participants were provided with appropriate personal protective equipment to deliver healthcare to patients admitted to hospital with covid-19 and were involved in aerosol generating procedures. 77 healthcare professionals with no exposure history to covid-19 and 80 patients who had recovered from covid-19 were recruited to verify the accuracy of antibody testing.

MAIN OUTCOME MEASURES

Covid-19 related symptoms (fever, cough, and dyspnoea) and evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, defined as a positive test for virus specific nucleic acids in nasopharyngeal swabs, or a positive test for IgM or IgG antibodies in the serum samples.

RESULTS

The average age of study participants was 35.8 years and 68.1% (286/420) were women. These study participants worked 4-6 hour shifts for an average of 5.4 days a week; they worked an average of 16.2 hours each week in intensive care units. All 420 study participants had direct contact with patients with covid-19 and performed at least one aerosol generating procedure. During the deployment period in Wuhan, none of the study participants reported covid-19 related symptoms. When the participants returned home, they all tested negative for SARS-CoV-2 specific nucleic acids and IgM or IgG antibodies (95% confidence interval 0.0 to 0.7%).

CONCLUSION

Before a safe and effective vaccine becomes available, healthcare professionals remain susceptible to covid-19. Despite being at high risk of exposure, study participants were appropriately protected and did not contract infection or develop protective immunity against SARS-CoV-2. Healthcare systems must give priority to the procurement and distribution of personal protective equipment, and provide adequate training to healthcare professionals in its use.

The structural vulnerability of healthcare workers during COVID-19: Observations on the social context of risk and the equitable distribution of resources

Healthcare workers have emerged as a vulnerable population group during COVID-19, and securing supply chains of personal protective equipment (PPE) has been identified as a critical issue to protect healthcare workers and to prevent health system overwhelm. While securing PPE is a complex logistical challenge facing many countries, it is vital to recognise the social and health systems issues that structure the differential degrees of risk faced by various subgroups of healthcare workers. As an illustrative case study, the author identifies two key social factors that are likely to face the degrees of risk faced by midwives in the Special Region of Yogyakarta, Indonesia, if and when COVID-19 takes hold in Indonesia. Healthcare workers in both high and low resource-settings globally are likely to face particular risks and vulnerabilities that are shaped by localized social and health systems factors. Qualitative social and health systems research can and should be utilized proactively in order to protect healthcare workers, to inform more equitable program design, and to create a foundation for health equity within the future of global health that emerges from the pandemic.

Public Health Emergency and Crisis Management: Case Study of SARS-CoV-2 Outbreak

The SARS-CoV-2 pandemic has caused an unparalleled public health crisis, delivering an immense shock to humanity. With the virus’s health consequences largely unknown, different health systems around the globe have pursued various avenues of crisis management. South Korea, troubled early by the virus, was once the second most affected nation in the world. Arrays of measures in South Korea, such as large-scale diagnostic testing and technology-based comprehensive contact tracing, have brought about debates among public health experts and medical professionals. This case study describes the major cluster transmissions in SARS-CoV-2 hotspots in South Korea (such as a religious sect, a call center, logistics facilities, and nightclubs) and offers early observations on how South Korean public health authorities acted in response to the initial outbreak of the virus and to the new waves prompted by re-opening economies. We then discuss the way in which South Korea’s experience can act as a reference for shaping other countries’ public health strategies in pandemic crisis management.