Organ support in Ebola virus disease: Utility of point-of-care blood tests

Optimizing Public Health Preparedness for Highly Infectious Diseases in Central Vietnam

Our primary objectives were (a) to determine the need for and the availability of point-of-care testing (POCT) for infectious diseases and (b) to recommend point-of-care testing strategies and Spatial Care Paths^TM (SCPs) that enhance public health preparedness in the regional districts of Thua Thien Hue Province (TTHP), Central Vietnam, where we conducted field surveys. Medical professionals in seven community health centers (CHCs), seven district hospitals (DHs) and one provincial hospital (PH) participated. Survey questions (English and Vietnamese) determined the status of diagnostic testing capabilities for infectious diseases and other acute medical challenges in TTHP. Infectious disease testing was limited: six of seven CHCs (86%) lacked infectious disease tests. One CHC (14%, 1/7) had two forms of diagnostic tests available for the detection of malaria. All CHCs lacked adequate microbiology laboratories. District hospitals had few diagnostic tests for infectious diseases (tuberculosis and syphilis), blood culture (29%, 2/7), and pathogen culture (57%, 4/7) available. The PH had broader diagnostic testing capabilities but lacked preparedness for highly infectious disease threats (e.g., Ebola, MERS-CoV, SARS, Zika, and monkeypox). All sites reported having COVID-19 rapid antigen tests; COVID-19 RT-PCR tests were limited to higher-tier hospitals. We conclude that infectious disease diagnostic testing should be improved and POC tests must be supplied near patients’ homes and in primary care settings for the early detection of infected individuals and the mitigation of the spread of new COVID-19 variants and other highly infectious diseases.

Long-Term, Gridded Standardized Precipitation Index for Hawai‘i

Spatially explicit, wall-to-wall rainfall data provide foundational climatic information but alone are inadequate for characterizing meteorological, hydrological, agricultural, or ecological drought. The Standardized Precipitation Index (SPI) is one of the most widely used indicators of drought and defines localized conditions of both drought and excess rainfall based on period-specific (e.g., 1-month, 6-month, 12-month) accumulated precipitation relative to multi-year averages. A 93-year (1920–2012), high-resolution (250 m) gridded dataset of monthly rainfall available for the State of Hawai‘i was used to derive gridded, monthly SPI values for 1-, 3-, 6-, 9-, 12-, 24-, 36-, 48-, and 60-month intervals. Gridded SPI data were validated against independent, station-based calculations of SPI provided by the National Weather Service. The gridded SPI product was also compared with the U.S. Drought Monitor during the overlapping period. This SPI product provides several advantages over currently available drought indices for Hawai‘i in that it has statewide coverage over a long historical period at high spatial resolution to capture fine-scale climatic gradients and monitor changes in local drought severity.

Clinical Chemistry of Patients With Ebola in Monrovia, Liberia

The development of point-of-care clinical chemistry analyzers has enabled the implementation of these ancillary tests in field laboratories in resource-limited outbreak areas. The Eternal Love Winning Africa (ELWA) outbreak diagnostic laboratory, established in Monrovia, Liberia, to provide Ebola virus and Plasmodium spp. diagnostics during the Ebola epidemic, implemented clinical chemistry analyzers in December 2014. Clinical chemistry testing was performed for 68 patients in triage, including 12 patients infected with Ebola virus and 18 infected with Plasmodium spp. The main distinguishing feature in clinical chemistry of Ebola virus-infected patients was the elevation in alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and γ-glutamyltransferase levels and the decrease in calcium. The implementation of clinical chemistry is probably most helpful when the medical supportive care implemented at the Ebola treatment unit allows for correction of biochemistry derangements and on-site clinical chemistry analyzers can be used to monitor electrolyte balance.