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Carter BG, Harcourt E, Harris A, Zampetti M, Duke T, Tingay D. Making respiratory care safe for neonatal and paediatric intensive care unit staff: mitigation strategies and use of filters. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2024; 60:13-27. [PMID: 38384335 PMCID: PMC10881236 DOI: 10.29390/001c.91262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/11/2023] [Indexed: 02/23/2024]
Abstract
Background Many medical devices in pediatric and newborn intensive care units can potentially expose healthcare workers (HCWs) and others to transmission of respiratory and other viruses and bacteria. Such fomites include ventilators, nebulizers, and monitoring equipment. Approach We report the general, novel approach we have taken to identify and mitigate these risks and to protect HCWs, visitors and patients from exposure while maintaining the optimal performance of such respiratory equipment. Findings The approach combined a high level of personal protective equipment (PPE), strict hand hygiene, air filtration and air conditioning and other relevant viral risk mitigation guidelines. This report describes the experiences from the SARS-CoV-2 pandemic to provide a reference framework that can be applied generally. The steps we took consisted of auditing our equipment and processes to identify risk through sources of potentially contaminated gas that may contain aerosolized virus, seeking advice and liaising with suppliers/manufacturers, devising mitigation strategies using indirect and direct approaches (largely filtering), performing tests on equipment to verify proper function and the absence of negative impacts and the development and implementation of relevant procedures and practices. We had a multidisciplinary team to guide the process. We monitored daily for hospital-acquired infections among staff caring for SARS-CoV-2 patients. Conclusion Our approach was successful as we have continued to offer optimal intensive care to our patients, and we did not find any healthcare worker who was infected through the course of caring for patients at the bedside. The lessons learnt will be of benefit to future local outbreaks or pandemics.
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Affiliation(s)
- Bradley G Carter
- Neonatal and Paediatric Intensive Care UnitsThe Royal Children’s Hospital Melbourne
| | - Edward Harcourt
- Neonatal and Paediatric Intensive Care UnitsThe Royal Children’s Hospital Melbourne
| | | | - Michael Zampetti
- Neonatal and Paediatric Intensive Care UnitsThe Royal Children’s Hospital Melbourne
| | - Trevor Duke
- Paediatric Intensive Care UnitThe Royal Children’s Hospital
- Department of PediatricsThe University of Melbourne
| | - David Tingay
- Department of PediatricsUniversity of Melbourne
- Neonatal ResearchMurdoch Children’s Research Institute
- Department of NeonatologyThe Royal Children’s Hospital
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Wang XT, Meng H, Pan DF, Zheng XY, Lu WW, Chen C, Su M, Su XY, Liu Z, Ma XJ, Liang PF. Multidrug-resistant organisms may be associated with bed allocation and utilization efficiency in healthcare institutions, based on national monitoring data from China (2014-2020). Sci Rep 2023; 13:22055. [PMID: 38087043 PMCID: PMC10716176 DOI: 10.1038/s41598-023-49548-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 12/09/2023] [Indexed: 12/18/2023] Open
Abstract
Analyzing the influence of the bed allocation and utilization efficiency in healthcare institutions on the isolation proportion of Multidrug-resistant organisms (MDROs) to provide data to support prevention and control of MDROs. In this study, the provincial panel data from 2014 to 2020 in China on health resource indicators, including the number of beds per 1,000 population, hospital bed utilization rate, and average hospital stay from 2014 to 2020 in China were used to analyze the relationship between bed allocation or utilization efficiency and MDROs by the panel data quantile regression model. It was shown that the number of beds per 1,000 population had a negative effect on the isolation proportion of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecalis, vancomycin-resistant Enterococcus faecium, penicillin-resistant Streptococcus pneumoniae, methicillin-resistant coagulase-negative Staphylococcus, and cefotaxime or ceftriaxone resistant Escherichia coli (regression coefficient < 0, P < 0.05). The utilization rate of hospital bed had a positive effect on the isolation proportion of methicillin-resistant Staphylococcus aureus, methicillin-resistant coagulase-negative Staphylococcus, vancomycin-resistant Enterococcus faecium, penicillin-resistant Streptococcus pneumoniae, cefotaxime or ceftriaxone resistant Escherichia coli, carbapenem-resistant Escherichia coli, cefotaxime or ceftriaxone resistant Klebsiella pneumoniae, carbapenem-resistant Klebsiella pneumoniae, carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Acinetobacter baumannii (regression coefficient > 0, P < 0.05). The average hospital stay had a positive effect on the isolation proportion for several antibiotic-resistant organisms, including methicillin-resistant Staphylococcus aureus, methicillin-resistant coagulase-negative Staphylococcus, vancomycin-resistant Enterococcus faecalis, vancomycin-resistant Enterococcus faecium, penicillin-resistant Streptococcus pneumoniae, cefotaxime or ceftriaxone resistant Escherichia coli, carbapenem-resistant Escherichia coli, quinolone-resistant Escherichia coli, cefotaxime or ceftriaxone resistant Klebsiella pneumoniae, carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Acinetobacter baumannii (regression coefficient > 0, P < 0.05). Bed allocation and utilization efficiency in healthcare institutions may affect the isolation proportion of MDROs in varying degrees.
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Affiliation(s)
- Xing-Tian Wang
- Department of Medicine Statistics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750002, Ningxia Hui Autonomous Region, China
| | - Hua Meng
- School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Dong-Feng Pan
- Department of Emergency Medicine, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750002, Ningxia Hui Autonomous Region, China
| | - Xiao-Yu Zheng
- Ningxia Chinese Medicine Research Center, Yinchuan, 750021, Ningxia Hui Autonomous Region, China
| | - Wen-Wen Lu
- School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Chen Chen
- Department of Medicine Statistics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750002, Ningxia Hui Autonomous Region, China
| | - Ming Su
- Yinchuan Stomatology Hospital, Yinchuan, 750002, Ningxia Hui Autonomous Region, China
| | - Xin-Ya Su
- School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Zhuo Liu
- School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Xiao-Juan Ma
- School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Pei-Feng Liang
- Department of Medicine Statistics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750002, Ningxia Hui Autonomous Region, China.
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3
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Humphreys H. Infection prevention and control considerations regarding ventilation in acute hospitals. Infect Prev Pract 2022; 3:100180. [PMID: 34988422 PMCID: PMC8696268 DOI: 10.1016/j.infpip.2021.100180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/13/2021] [Indexed: 12/31/2022] Open
Abstract
Infection prevention and control team members (IPCTM) are often intimidated by aspects of ventilation as they relate to healthcare, because they consider them technical and outside their area of comfort and expertise. However, engineers, estates departments and planners need IPCTM input to ensure appropriate design and use. The main areas of importance centre on the operating theatre, the provision of air-controlled ventilated isolation rooms, and how to respond to major outbreaks/pandemics. Concentrating on basic principles of infection prevention and control, developing relationships with key departments and individuals, and applying best practice to these and other areas as they arise, are of great value. Some background, information and suggestions are provided for IPCTM with a view to providing simple practical advice in these areas.
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Key Words
- ACH, air changes per hour
- ACV, air controlled ventilated
- Air sampling
- Air-controlled ventilation
- ED, emergency department
- IPC, infection prevention and control
- IPCTM, infection prevention and control team members
- Isolation facilities
- MIS, minimally invasive surgery
- NIPPV, non-invasive positive pressure ventilation
- Operating theatres
- PJA, prosthetic joint arthroplasty
- Pandemic preparedness
- SSI, surgical site infection
- UDAF, unidirectional air flow
- Upgrades/refurbishments
- cfu, colony forming units
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Affiliation(s)
- Hilary Humphreys
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
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Shashikumar SP, Wardi G, Paul P, Carlile M, Brenner LN, Hibbert KA, North CM, Mukerji SS, Robbins GK, Shao YP, Westover MB, Nemati S, Malhotra A. Development and Prospective Validation of a Deep Learning Algorithm for Predicting Need for Mechanical Ventilation. Chest 2021; 159:2264-2273. [PMID: 33345948 PMCID: PMC8027289 DOI: 10.1016/j.chest.2020.12.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/19/2020] [Accepted: 12/04/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Objective and early identification of hospitalized patients, and particularly those with novel coronavirus disease 2019 (COVID-19), who may require mechanical ventilation (MV) may aid in delivering timely treatment. RESEARCH QUESTION Can a transparent deep learning (DL) model predict the need for MV in hospitalized patients and those with COVID-19 up to 24 h in advance? STUDY DESIGN AND METHODS We trained and externally validated a transparent DL algorithm to predict the future need for MV in hospitalized patients, including those with COVID-19, using commonly available data in electronic health records. Additionally, commonly used clinical criteria (heart rate, oxygen saturation, respiratory rate, Fio2, and pH) were used to assess future need for MV. Performance of the algorithm was evaluated using the area under receiver operating characteristic curve (AUC), sensitivity, specificity, and positive predictive value. RESULTS We obtained data from more than 30,000 ICU patients (including more than 700 patients with COVID-19) from two academic medical centers. The performance of the model with a 24-h prediction horizon at the development and validation sites was comparable (AUC, 0.895 vs 0.882, respectively), providing significant improvement over traditional clinical criteria (P < .001). Prospective validation of the algorithm among patients with COVID-19 yielded AUCs in the range of 0.918 to 0.943. INTERPRETATION A transparent deep learning algorithm improves on traditional clinical criteria to predict the need for MV in hospitalized patients, including in those with COVID-19. Such an algorithm may help clinicians to optimize timing of tracheal intubation, to allocate resources and staff better, and to improve patient care.
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Affiliation(s)
| | - Gabriel Wardi
- Department of Emergency Medicine, University of California, San Diego, La Jolla, CA; Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, La Jolla, CA
| | - Paulina Paul
- Department of Biomedical Informatics, University of California, San Diego, La Jolla, CA
| | - Morgan Carlile
- Department of Emergency Medicine, University of California, San Diego, La Jolla, CA
| | - Laura N Brenner
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA
| | - Kathryn A Hibbert
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA
| | - Crystal M North
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Gregory K Robbins
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
| | - Yu-Ping Shao
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | | | - Shamim Nemati
- Department of Biomedical Informatics, University of California, San Diego, La Jolla, CA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, La Jolla, CA.
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5
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Li H, Burm SW, Hong SH, Ghayda RA, Kronbichler A, Smith L, Koyanagi A, Jacob L, Lee KH, Shin JI. A Comprehensive Review of Coronavirus Disease 2019: Epidemiology, Transmission, Risk Factors, and International Responses. Yonsei Med J 2021; 62:1-11. [PMID: 33381929 PMCID: PMC7820451 DOI: 10.3349/ymj.2021.62.1.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/02/2020] [Accepted: 11/24/2020] [Indexed: 12/23/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a worldwide pandemic. The first reports of patients with COVID-19 were provided to World Health Organization on December 21, 2019 and were presumably associated with seafood markets in Wuhan, China. As of October 25, 2020, more than 42 million cases have been confirmed worldwide, with more than 1.1 million deaths. Asymptomatic transmission contributes significantly to transmission, and clinical features are non-specific to the disease. Thus, the diagnosis of COVID-19 requires specific viral RNA testing. The disease demonstrates extensive human-to-human transmissibility and has infected healthcare workers at high rates. Clinical awareness of the epidemiology and the risk factors for nosocomial transmission of COVID-19 is essential to preventing infection. Moreover, effective control measures should be further identified by comprehensive evaluation of hospital and community responses. In this review, we provide a comprehensive update on the epidemiology, presentation, transmission, risk factors, and public health measures associated with COVID-19. We also review past insights from previous coronavirus epidemics [i.e., severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS)] to suggest measures to reduce transmission.
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Affiliation(s)
- Han Li
- University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Sung Hwi Hong
- Yonsei University College of Medicine, Seoul, Korea
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ramy Abou Ghayda
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Urology Institute, University Hospitals System, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Science, Anglia Ruskin University, Cambridge, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain
- ICREA, Pg. Lluis Companys 23, Barcelona, Spain
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
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6
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Pfenninger EG, Kaisers UX. [Provisioning of personal protective equipment in hospitals in preparation for a pandemic]. Anaesthesist 2020; 69:909-918. [PMID: 32936348 PMCID: PMC7493059 DOI: 10.1007/s00101-020-00843-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND At the beginning of the SARS-CoV‑2 outbreak, personal protective equipment (PPE) was scarce worldwide, leading to the treatment of patients partially without sufficient protection for the medical personnel. In order to be prepared for a new epidemic or pandemic or a "second wave" of COVID-19 outbreak and to meet a renewed deficiency of PPE, considerations were made on how personnel and patients can be better protected by appropriate provisioning. OBJECTIVE The aim of this study was to develop a tool to predict the necessary amount of PPE to be in stock at a transregional university hospital for a certain period of time during a pandemic. MATERIAL AND METHODS The consumption of PPE needed for every patient was calculated based on the following data of the Ulm University Hospital: the total consumption of healthcare workers' PPE for April 2020 recorded by the materials management department and the number of patients suffering from COVID-19 and their treatment days. From the amount of PPE necessary for every patient in the intensive care unit (ICU) or in an infection ward, a PPE calculator was created in which the estimated amount of PPE can be calculated with the input variables "patients in intensive care unit", "patients in infection ward" and "treatment days". To validate the PPE calculator, the actual consumption of PPE for May 2020 at the Ulm University hospital was compared to the theoretically calculated demand by the PPE calculator. RESULTS In April 2020 PPE consisting of 18 different items were kept in stock at Ulm University Hospital and in total 1,995,500 individual items were used. 22 intensive care patients with 257 nursing days and in the infection ward 39 patients with 357 nursing days were treated for COVID-19 disease, leading to a total of 603.2 man-days. A total of 34,550 KN95 masks, 1,558,780 gloves and 1100 goggles or protective visors were used, with a daily average of 49 NK95 masks and 2216 gloves required per ICU patient. In May 2020, 6 ICU patients and 19 patients in infection wards were treated for COVID-19 with 34 nursing days in intensive care and 201 nursing days in infection wards. The use of PPE material was 39% lower than in the previous month but in absolute terms 82% and on average 39% higher than calculated. CONCLUSION The developed tool allows our hospital to estimate the necessary amount of PPE to be kept in stock for future pandemics. By taking local conditions into account this tool can also be helpful for other hospitals.
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Affiliation(s)
- E G Pfenninger
- Stabsstelle Katastrophenschutz, Klinikum der Universität Ulm, Albert-Einstein-Allee 29, 89081, Ulm, Deutschland.
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7
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LoSavio PS, Eggerstedt M, Tajudeen BA, Papagiannopoulos P, Revenaugh PC, Batra PS, Husain I. Rapid implementation of COVID-19 tracheostomy simulation training to increase surgeon safety and confidence. Am J Otolaryngol 2020; 41:102574. [PMID: 32505992 PMCID: PMC7837027 DOI: 10.1016/j.amjoto.2020.102574] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/25/2020] [Indexed: 01/10/2023]
Abstract
Objective To determine if rapid implementation of simulation training for anticipated COVID-19 tracheostomy procedures can increase physician confidence regarding procedure competency and use of enhanced personal protective equipment (PPE). Methods A brief simulation training exercise was designed in conjunction with the development of a COVID-19 Tracheostomy Protocol. The simulation training focused primarily on provider safety, pre and post-surgical steps and the proper use of enhanced PPE. Simulation training was performed in the simulation lab at the institution over 2 days. Pre and post self-evaluations were measured using standardized clinical competency questionnaires on a 5-point Likert Scale ranging from “No knowledge, unable to perform” up to “Highly knowledgeable and confident, independent.” Results Physicians self-reported a significant increase in knowledge and competency immediately after completing the training exercise. Resident physicians increased from a mean score of 3.00 to 4.67, p-value 0.0041, mean increase 1.67 (CI 95% 0.81 to 2.52). Attending physicians increased from a mean score of 2.89 to 4.67, p-value 0.0002, mean increase 1.78 (CI 95% 1.14 to 2.42). Overall, all participants increased from a mean score of 3.06 to 4.71, p-value 0.0001, mean increase 1.65 (CI 95% 1.24 to 2.05). Discussion Implementation of this simulation training at our institution resulted in a significant increase in physician confidence regarding the safe performance of tracheostomy surgery in COVID-19 patients. Implications for practice Adoption of standardized COVID-19 tracheostomy simulation training at centers treating COVID-19 patients may result in improved physician safety and enhanced confidence in anticipation of performing these procedures in real-life scenarios. Rapid implementation of a COVID-19 mobile tracheostomy team is feasible in hospitals as the COVID-19 pandemic progresses. Continuing training of a groups of core providers promotes vigilance in pandemic situations. Simulation prior to pandemic peak is critical to ensure successful rollout. Training should focus on proper PPE donning and doffing, given the high risk of virus aerosolization during tracheostomy.
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Hu T, Liu Y, Zhao M, Zhuang Q, Xu L, He Q. A comparison of COVID-19, SARS and MERS. PeerJ 2020; 8:e9725. [PMID: 32879801 PMCID: PMC7443081 DOI: 10.7717/peerj.9725] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/24/2020] [Indexed: 12/19/2022] Open
Abstract
In mid-December 2019, a novel atypical pneumonia broke out in Wuhan, Hubei Province, China and was caused by a newly identified coronavirus, initially termed 2019 Novel Coronavirus and subsequently severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As of 19 May 2020, a total of 4,731,458 individuals were reported as infected with SARS-CoV-2 among 213 countries, areas or territories with recorded cases, and the overall case-fatality rate was 6.6% (316,169 deaths among 4,731,458 recorded cases), according to the World Health Organization. Studies have shown that SARS-CoV-2 is notably similar to (severe acute respiratory syndrome coronavirus) SARS-CoV that emerged in 2002–2003 and Middle East respiratory syndrome coronavirus (MERS-CoV) that spread during 2012, and these viruses all contributed to global pandemics. The ability of SARS-CoV-2 to rapidly spread a pneumonia-like disease from Hubei Province, China, throughout the world has provoked widespread concern. The main symptoms of coronavirus disease 2019 (COVID-19) include fever, cough, myalgia, fatigue and lower respiratory signs. At present, nucleic acid tests are widely recommended as the optimal method for detecting SARS-CoV-2. However, obstacles remain, including the global shortage of testing kits and the presentation of false negatives. Experts suggest that almost everyone in China is susceptible to SARS-CoV-2 infection, and to date, there are no effective treatments. In light of the references published, this review demonstrates the biological features, spread, diagnosis and treatment of SARS-CoV-2 as a whole and aims to analyse the similarities and differences among SARS-CoV-2, SARS-CoV and MERS-CoV to provide new ideas and suggestions for prevention, diagnosis and clinical treatment.
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Affiliation(s)
- Tingting Hu
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Ying Liu
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Mingyi Zhao
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Quan Zhuang
- Transplantation Center, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Linyong Xu
- Department of Biomedical Informatics, School of Life Sciences, Central South University, Changsha, China
| | - Qingnan He
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, China
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Hirota K. Air contamination with SARS-CoV-2 in the operating room. J Anesth 2020; 35:333-336. [PMID: 32562137 PMCID: PMC7303274 DOI: 10.1007/s00540-020-02814-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/06/2020] [Indexed: 12/14/2022]
Abstract
Angiotensin converting enzyme 2 (ACE2) is a target cell receptor for internalization and proliferation of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). When ACE2-highly expressed tissues are manipulated, SARS-CoV-2 containing aerosols may be generated. Normal breathing and speaking are capable of producing aerosols so mask ventilation, suction of airway tract and bucking during tracheal intubation and extubation are clinical procedures capable of significant aerosol production. Whilst no data have been reported on the distribution of SARS-CoV-2 in the operating room (OR), contamination in the OR can be estimated from the intensive care unit (ICU) data. ICU data showed that SARS-CoV-2 was detected on all types of surface and in air within about 4 m from coronavirus disease 2019 (COVID-19) patients. High concentrations of SARS-CoV-2 was detected in the personal protective equipment (PPE) removal room and medical staff office. Submicron virus-laden aerosols could result from resuspension of particles containing SARS-CoV-2 sticking the PPE surface; removal could produce the initial velocity. Supermicron virus-laden aerosol could come from floor deposited SARS-CoV-2, which were carried across different areas by medical staff (e.g., shoe). Knowledge of aerosol generation and distribution in the OR will aid the design of strategies to reduce transmission risk.
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Affiliation(s)
- Kazuyoshi Hirota
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, 036-8562, Japan.
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10
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Favier V, Kimmoun A, Gatin A, Gallet P. Percutaneous tracheostomy simulation training for ENT physicians in the treatment of COVID-19-positive patients. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:333-338. [PMID: 32624392 PMCID: PMC7284274 DOI: 10.1016/j.anorl.2020.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Tracheostomy in COVID-19-related severe acute respiratory syndrome is at high risk of viral dissemination. The percutaneous dilatation technique could reduce this risk, being performed at the bedside and minimising airway opening. In the COVID-19 context, however, with precarious respiratory status, it requires specific preparation. We designed a 3-hour training module, and here provide a step-by-step schedule, including video analysis, a demonstration of the kit, the recommended precautions related to COVID-19, and several simulation scenarios of increasing difficulty, using a high-tech mannequin. A low-tech procedural simulator was also developed for practicing the steps of the procedure. Our experience (3 sessions with 14 participants) highlighted the difficult points of the procedure in the COVID-19 context, and defined a checklist for clinical practice and an assessment grid. This type of simulation helps to prepare teams for a potentially delicate technical act.
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Affiliation(s)
- V Favier
- Département d'ORL et chirurgie maxillofaciale, CHU de Montpellier, Montpellier, France; Aide à la décision médicale personnalisée, EA 2415, institut universitaire de recherche clinique, université de Montpellier, Montpellier, France
| | - A Kimmoun
- Département de réanimation médicale, CHRU de Nancy, INSERM U1116, université de Lorraine, 54511, Vandœuvre-Lès-Nancy, Nancy, France
| | - A Gatin
- Service des urgences pédiatriques, CHRU de Nancy, université de Lorraine, 54511, Vandœuvre-Lès-Nancy, Nancy, France; Centre universitaire d'enseignement par simulation, CUESim, hôpital virtuel de Lorraine HVL, université de Lorraine, Nancy, France
| | - P Gallet
- Centre universitaire d'enseignement par simulation, CUESim, hôpital virtuel de Lorraine HVL, université de Lorraine, Nancy, France; Département d'ORL et chirurgie cervico-faciale, CHRU de Nancy, université de Lorraine, 54511, Vandœuvre-Lès-Nancy, Nancy, France.
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11
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Tom J. Infection Control in Dental Anesthesiology: A Time for Preliminary Reconsideration of Current Practices. Anesth Prog 2020; 67:109-120. [PMID: 32633770 PMCID: PMC7342805 DOI: 10.2344/anpr-67-02-12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/03/2020] [Indexed: 07/25/2023] Open
Abstract
Relegated to clinical afterthought, the topic of infection control has never taken center stage in our modern dental sedation and anesthesiology practices. Surgical and procedural masks, gloves, gowns, protective eyewear, and appropriate surgical attire have remained de rigueur in both fashion and custom for decades. However, the emergence of certain seminal events throughout health care history has driven mandated changes when practitioners, staff, patients, and the surrounding communities were exposed or put at risk of exposure to infectious disease. Hepatitis, human immunodeficiency virus, and now the global COVID-19 pandemic involving the novel coronavirus SARS-CoV-2, have forced us into rethinking our current practices. This review article will contextualize previous epidemics and their influence on infection control in dental settings, and it will explore the rapid evolution of current modifications to personal protective equipment and infection mitigation practices specific to sedation and anesthesia in dentistry.
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Affiliation(s)
- James Tom
- Associate Clinical Professor, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California
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Jheon S, Ahmed ADB, Fang VWT, Jung W, Khan AZ, Lee JM, Nakajima J, Sihoe ADL, Thongcharoen P, Tsuboi M, Turna A. General thoracic surgery services across Asia during the 2020 COVID-19 pandemic. Asian Cardiovasc Thorac Ann 2020; 28:243-249. [PMID: 32396384 PMCID: PMC7218355 DOI: 10.1177/0218492320926886] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The COVID-19 pandemic of 2020 posed an historic challenge to healthcare systems around the world. Besides mounting a massive response to the viral outbreak, healthcare systems needed to consider provision of clinical services to other patients in need. Surgical services for patients with thoracic disease were maintained to different degrees across various regions of Asia, ranging from significant reductions to near-normal service. Key determinants of robust thoracic surgery service provision included: preexisting plans for an epidemic response, aggressive early action to "flatten the curve", ability to dedicate resources separately to COVID-19 and routine clinical services, prioritization of thoracic surgery, and the volume of COVID-19 cases in that region. The lessons learned can apply to other regions during this pandemic, and to the world, in preparation for the next one.
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Affiliation(s)
- Sanghoon Jheon
- Department of Cardiothoracic Surgery, Seoul National University Bundang Hospital, Bundang, South Korea
| | - Aneez DB Ahmed
- Division of Thoracic Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Vincent WT Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
| | - Woohyun Jung
- Department of Cardiothoracic Surgery, Seoul National University Bundang Hospital, Bundang, South Korea
| | - Ali Zamir Khan
- Department of Minimally Invasive & Robotic Thoracic Surgery, Medanta Hospital, Gurgaon, India
| | - Jang-Ming Lee
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, Taipei
| | - Jun Nakajima
- Department of Thoracic Surgery, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Alan DL Sihoe
- Department of Surgery, Gleneagles Hong Kong Hospital, Hong Kong SAR, China
| | | | - Masahiro Tsuboi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Akif Turna
- Department of Cardiothoracic Surgery, Seoul National University Bundang Hospital, Bundang, South Korea
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13
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Mayo-Yánez M, Calvo-Henríquez C, Lechien JR, Fakhry N, Ayad T, Chiesa-Estomba CM. Is the ultrasonic scalpel recommended in head and neck surgery during the COVID-19 pandemic? State-of-the-art review. Head Neck 2020; 42:1657-1663. [PMID: 32441394 PMCID: PMC7280627 DOI: 10.1002/hed.26278] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 12/15/2022] Open
Abstract
Background Guidelines for ultrasonic devices use are imperative because infectious aerosols arising from airway procedures were a key etiologic factor in prior coronavirus outbreaks. This manuscript aims to summarize the available recommendations and the most relevant concepts about the use of ultrasonic scalpel during the SARS‐CoV‐2 pandemic. Methods Literature review of manuscripts with patients, animal models, or in vitro studies where the ultrasonic scalpel was used and the plume produced was analyzed in a quantitative and/ or qualitative way. Discussion Activated devices with tissue produce a biphasic bioaerosol composed (size 68.3‐994 nm) of tissue particles, blood, intact and no viable cells, and carcinogenic or irritant hydrocarbons (benzene, ethylbenzene, styrene, toluene, heptene, and methylpropene). Conclusion It is imperative to use an active smoke evacuator, to avoid ultrasonic scalpel use in COVID‐19 positive patients and in upper airway surgery, as well as to follow the protection recommendations of the guidelines for management this type of patients.
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Affiliation(s)
- Miguel Mayo-Yánez
- Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Galicia, Spain.,Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Galicia, Spain
| | - Christian Calvo-Henríquez
- Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Galicia, Spain.,Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario Santiago de Compostela (CHUS), Santiago de Compostela, Galicia, Spain
| | - Jérôme R Lechien
- Human Anatomy & Experimental Oncology Department, Faculty of Medicine UMONS Research Institute for Health Sciences and Technology , University of Mons (UMons), Mons, Belgium.,Otorhinolaryngology and Head and Neck Surgery Department, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicolas Fakhry
- Otolaryngology-Head and Neck Surgery Department, Universitary Hospital of la Conception Marseille, France
| | - Tareck Ayad
- Division of Otolaryngology-Head & Neck Surgery , Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Carlos M Chiesa-Estomba
- Otorhinolaryngology-Head and Neck Surgery Department, Hospital Universitario Donostia, Donostia, Gipuzkoa, Spain
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14
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Levin M, Ansotegui IJ, Bernstein J, Chang YS, Chikhladze M, Ebisawa M, Fiocchi A, Heffler E, Martin B, Morais-Almeida M, Papadopoulos NG, Peden D, Wong GWK. Acute asthma management during SARS-CoV2-pandemic 2020. World Allergy Organ J 2020; 13:100125. [PMID: 32411315 PMCID: PMC7221365 DOI: 10.1016/j.waojou.2020.100125] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 12/14/2022] Open
Abstract
Background The current COVID-19 pandemic has changed many medical practices in order to provide additional protection to both our patients and healthcare providers. In many cases this includes seeing patients through electronic means such as telehealth or telephone rather than seeing them in person. Asthma exacerbations cannot always be treated in this way. Problem Current emergency unit asthma guidelines recommend bronchodilators be administered by metered dose inhaler (MDI) and spacer for mild-moderate asthma and include it as a choice even in severe asthma, but many emergency units continue to prefer nebulised therapy for patients who urgently require beta-agonists. The utilization of nebulised therapy potentially increases the risk of aerosolization of the coronavirus. Since nosocomial transmission of respiratory pathogens is a major threat in the context of the SARS-CoV-2 pandemic, use of nebulised therapy is of even greater concern due to the potential increased risk of infection spread to nearby patients and healthcare workers. Practical implications We propose a risk stratification plan that aims to avoid nebulised therapy, when possible, by providing an algorithm to help better delineate those who require nebulised therapy. Protocols that include strategies to allow flexibility in using MDIs rather than nebulisers in all but the most severe patients should help mitigate this risk of aerosolised infection transmission to patients and health care providers. Furthermore, expedient treatment of patients with high dose MDI therapy augmented with more rapid initiation of systemic therapy may help ensure patients are less likely to deteriorate to the stage where nebulisers are required.
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Affiliation(s)
| | | | | | - Yoon-Seok Chang
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | - Motohiro Ebisawa
- National Hospital Organization, Sagamihara National Hospital, Sagamihara, Kanagwa, Japan
| | | | | | | | | | | | - David Peden
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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15
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Frizzelli A, Tuttolomondo D, Aiello M, Majori M, Bertorelli G, Chetta A. What happens to people's lungs when they get coronavirus disease 2019? ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:146-149. [PMID: 32420938 PMCID: PMC7569635 DOI: 10.23750/abm.v91i2.9574] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 01/08/2023]
Abstract
The novel coronavirus SARS-CoV-2 was first identified in Wuhan in December 2019 as cause of the consequent novel coronavirus disease 2019 (COVID-19). The virus has since spread worldwide. The clinical presentation following human infection ranges from a mild upper respiratory tract infection to severe acute respiratory distress syndrome and sepsis. We reviewed literature using Pubmed to identify relevant English-language articles published until April 15, 2020. Search terms include novel coronavirus pneumonia, severe acute respiratory syndrome coronavirus 2, coronavirus and ventilation. We summarized what SARS-CoV-2 infection means for the lungs.
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Affiliation(s)
- Annalisa Frizzelli
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy..
| | - Domenico Tuttolomondo
- Department of Cardiology, Parma University-Hospital, Parma, Italy and Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy.
| | - Marina Aiello
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy..
| | - Maria Majori
- Department of Cardiothoracic and Vascular Diseases, Pneumology and Endothoracic Endoscopy Unit, University Hospital, Parma, Italy.
| | - Giuseppina Bertorelli
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy..
| | - Alfredo Chetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy.
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16
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Huang Z, Yan J, Jin T, Huang X, Zeng G, Adashek ML, Wang X, Li J, Zhou D, Wu Z. The challenges of urgent radical sigmoid colorectal cancer resection in a COVID-19 patient: A case report. Int J Surg Case Rep 2020; 71:147-150. [PMID: 32395420 PMCID: PMC7212967 DOI: 10.1016/j.ijscr.2020.04.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic presents a unique global health challenge further complicating surgical management of COVID-19 positive patients due to a lack of published literature. CASE Within we discuss a 48-year-old Chinese man, presenting with acute gastrointestinal obstruction due to sigmoid colonic mass. The patient was screened and tested positive for COVID 19 due to his employment in Wuhan, China at the COVID-19 pandemic epicenter. The patient was subsequently taken for open sigmoid colonic resection, however the case presented multiple challenges due to the patient's COVID-19 positive status. DISCUSSION The challenges of surgical management of COVID-19 positive patients exist are four-fold. First the unknown efficacy of pre-surgical risk stratification in COVID-19 positive patients, second the risk of aerosolized COVID-19 transmission during intubation for surgery, third the risk of fecal COVID-19 transmission to surgical staff during large bowel resection, and fourth the post-operative challenges of caring for COVID-19 positive patients. CONCLUSION Further research is needed into these topics, as well as the medical management of COVID-19 surgical patients.
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Affiliation(s)
- Zhengbin Huang
- Department of General Surgery, Hanchuan People's Hospital, 1 Renmin Avenue, Hanchuan, Hubei 431600, China
| | - Jijun Yan
- Department of General Surgery, Hanchuan People's Hospital, 1 Renmin Avenue, Hanchuan, Hubei 431600, China
| | - Tian Jin
- Department of Pathology, Hanchuan People's Hospital, 1 Renmin Avenue, Hanchuan, Hubei 431600, China
| | - Xiufang Huang
- Department of General Surgery, Hanchuan People's Hospital, 1 Renmin Avenue, Hanchuan, Hubei 431600, China
| | - Guoxiang Zeng
- Department of General Surgery, Hanchuan People's Hospital, 1 Renmin Avenue, Hanchuan, Hubei 431600, China
| | - Michael L Adashek
- Department of Internal Medicine, Sinai Hospital, 2401 W. Belvedere Ave, Baltimore, MD 21215, USA
| | - Xinhai Wang
- Department of Pathology, Hanchuan People's Hospital, 1 Renmin Avenue, Hanchuan, Hubei 431600, China
| | - Jieping Li
- Department of Radiology, Hanchuan People's Hospital, 1 Renmin Avenue, Hanchuan, Hubei 431600, China
| | - Dan Zhou
- Department of Molecular Biology Laboratory, Hanchuan People's Hospital, 1 Renmin Avenue, Hanchuan, Hubei 431600, China
| | - Zhengqi Wu
- Department of Medicine, Winchester Medical Center, 1840 Amherst Street, Winchester, VA 22601, USA.
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17
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Whiteside T, Kane E, Aljohani B, Alsamman M, Pourmand A. Redesigning emergency department operations amidst a viral pandemic. Am J Emerg Med 2020; 38:1448-1453. [PMID: 32336583 PMCID: PMC7156950 DOI: 10.1016/j.ajem.2020.04.032] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 01/15/2023] Open
Abstract
As shown by the current COVID-19 pandemic, emergency departments (ED) are the front line for hospital-and-community-based care during viral respiratory disease outbreaks. As such, EDs must be able to reorganize and reformat operations to meet the changing needs and staggering patient volume. This paper addresses ways to adapt departmental operations to better manage in times of elevated disease burden, specifically identifying areas of intervention to help limit crowding and spread. Using experience from past outbreaks and the current COVID-19 pandemic, we advise strategies to increase surge capacity and limit patient inflow. Triage should identify and geographically cohort symptomatic patients within a designated unit to limit exposure early in an outbreak. Screening and PPE guidelines for both patient and staff should be followed closely, as determined by hospital administration and the CDC. Equipment needs are also greatly affected in an outbreak; we emphasis portable radiographic equipment to limit transport, and an upstocking of certain medications, respiratory supplies, and PPE.
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Affiliation(s)
- Tess Whiteside
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Erin Kane
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Bandar Aljohani
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, DC, United States; Emergency Medicine Department, King Abdullah Medical City, Mecca, Saudi Arabia
| | - Marya Alsamman
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Ali Pourmand
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
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18
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Zhou M, Zhang X, Qu J. Coronavirus disease 2019 (COVID-19): a clinical update. Front Med 2020; 14:126-135. [PMID: 32240462 PMCID: PMC7115348 DOI: 10.1007/s11684-020-0767-8] [Citation(s) in RCA: 229] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has posed a significant threat to global health. It caused a total of 80 868 confirmed cases and 3101 deaths in Chinese mainland until March 8, 2020. This novel virus spread mainly through respiratory droplets and close contact. As disease progressed, a series of complications tend to develop, especially in critically ill patients. Pathological findings showed representative features of acute respiratory distress syndrome and involvement of multiple organs. Apart from supportive care, no specific treatment has been established for COVID-19. The efficacy of some promising antivirals, convalescent plasma transfusion, and tocilizumab needs to be investigated by ongoing clinical trials.
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Affiliation(s)
- Min Zhou
- National Research Center for Translational Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xinxin Zhang
- National Research Center for Translational Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Research Laboratory of Clinical Virology, Ruijin Hospital and Ruijin Hospital North Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jieming Qu
- National Research Center for Translational Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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19
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Fischer D, Schlößer RL, Kempf VAJ, Wichelhaus TA, Klingebiel T, Philippi S, Falgenhauer L, Imirzalioglu C, Dahl U, Brandt C, Reinheimer C. Overcrowding in a neonatal intermediate care unit: impact on the incidence of multidrug-resistant gram-negative organisms. BMC Infect Dis 2019; 19:357. [PMID: 31035966 PMCID: PMC6489334 DOI: 10.1186/s12879-019-3981-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overcrowding, reduced nurse to patient ratio, limited distance between incubators and absence of microbiological surveillance have been shown to promote spread of multidrug-resistant gram-negative organisms (MDRGN) in patients with birthweight < 1500 g. Patients > 1500 g treated on an intermediate care unit are unrepresented in recent literature. We therefore intended to present data obtained from a short-term overcrowded neonatal intermediate care unit (NIMCU) at a level III (international categorization) perinatal center at University Hospital Frankfurt, Germany. METHODS During a 25 day overcrowding (OV) and 28 day post-overcrowding period (POST-OV) on NIMCU, epidemiological data obtained from continuously hold microbiological surveillance were investigated and compared to the last 12 months of ward-regular bed occupancy preceding OV (PRAE-OV). RESULTS During OV, the number of patients simultaneously treated at the NIMCU increased from 18 to 22, resulting in a reduced bed-to-bed space. Nurse: patient ratio was 4:22 during OV compared to 3:18 during PRAE-OV. Cumulative incidence of MDRGN was 4.7% in OV and 2.4% POST-OV compared to 4.8% to PRAE-OV, respectively, without any significant variations. During OV and POST-OV, septic episodes due to MDRGN were not observed. In one case, potential nosocomial transmission of Enterobacter cloacae resistant to Piperacillin and 3rd/4th generation cephalosporins was observed. CONCLUSIONS Prevention of nosocomial spread of MDRGN in an overcrowded NIMCU is based on staff's diligent training and adequate staffing. Concise microbiological surveillance should be guaranteed to escort through overcrowding periods. In our setting, impact of bed-to-bed distance on MDRGN transmission seemed to be less strong.
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Affiliation(s)
- Doris Fischer
- Department of Pediatrics, Division of Neonatology, University Hospital Frankfurt, St. Vincenz Hospital, Auf dem Schafsberg, 65549, Limburg, Germany.
| | - Rolf L Schlößer
- Department of Pediatrics, Division of Neonatology, University Hospital Frankfurt, St. Vincenz Hospital, Auf dem Schafsberg, 65549, Limburg, Germany
| | - Volkhard A J Kempf
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
| | - Thomas A Wichelhaus
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
| | - Thomas Klingebiel
- Department of Pediatrics, Division of Neonatology, University Hospital Frankfurt, St. Vincenz Hospital, Auf dem Schafsberg, 65549, Limburg, Germany
| | - Sabine Philippi
- Department of Pediatrics, Division of Neonatology, University Hospital Frankfurt, St. Vincenz Hospital, Auf dem Schafsberg, 65549, Limburg, Germany
| | - Linda Falgenhauer
- Justus Liebig University, Institute of Medical Microbiology, and German Center for Infection Research (DZIF), Partner site Giessen-Marburg-Langen, Giessen, Germany
| | - Can Imirzalioglu
- Justus Liebig University, Institute of Medical Microbiology, and German Center for Infection Research (DZIF), Partner site Giessen-Marburg-Langen, Giessen, Germany
| | - Udo Dahl
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
| | - Christian Brandt
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
| | - Claudia Reinheimer
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
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20
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O'Neil CA, Li J, Leavey A, Wang Y, Hink M, Wallace M, Biswas P, Burnham CAD, Babcock HM. Characterization of Aerosols Generated During Patient Care Activities. Clin Infect Dis 2018; 65:1335-1341. [PMID: 29017249 PMCID: PMC6248660 DOI: 10.1093/cid/cix535] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/16/2017] [Indexed: 12/16/2022] Open
Abstract
Background Questions remain about the degree to which aerosols are generated during routine patient care activities and whether such aerosols could transmit viable pathogens to healthcare personnel (HCP). The objective of this study was to measure aerosol production during multiple patient care activities and to examine the samples for bacterial pathogens. Methods Five aerosol characterization instruments were used to measure aerosols during 7 patient care activities: patient bathing, changing bed linens, pouring and flushing liquid waste, bronchoscopy, noninvasive ventilation, and nebulized medication administration (NMA). Each procedure was sampled 5 times. An SKC BioSampler was used for pathogen recovery. Bacterial cultures were performed on the sampling solution. Patients on contact precautions for drug-resistant organisms were selected for most activity sampling. Any patient undergoing bronchoscopy was eligible. Results Of 35 sampling episodes, only 2 procedures showed a significant increase in particle concentrations over baseline: NMA and bronchoscopy with NMA. Bronchoscopy without NMA and noninvasive ventilation did not generate significant aerosols. Of 78 cultures from the impinger samples, 6 of 28 baseline samples (21.4%) and 14 of 50 procedure samples (28.0%) were positive. Conclusions In this study, significant aerosol generation was only observed during NMA, both alone and during bronchoscopy. Minimal viable bacteria were recovered, mostly common environmental organisms. Although more research is needed, these data suggest that some of the procedures considered to be aerosol-generating may pose little infection risk to HCP.
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Affiliation(s)
- Caroline A O'Neil
- Infectious Diseases Division, Washington University School of Medicine, St Louis, MS
| | - Jiayu Li
- School of Engineering and Applied Science, Department of Energy, Environmental, and Chemical Engineering, Aerosol and Air Quality Research Laboratory, Washington University, St Louis, Missouri
| | - Anna Leavey
- School of Engineering and Applied Science, Department of Energy, Environmental, and Chemical Engineering, Aerosol and Air Quality Research Laboratory, Washington University, St Louis, Missouri
| | - Yang Wang
- School of Engineering and Applied Science, Department of Energy, Environmental, and Chemical Engineering, Aerosol and Air Quality Research Laboratory, Washington University, St Louis, Missouri
| | - Matthew Hink
- Infectious Diseases Division, Washington University School of Medicine, St Louis, MS
| | - Meghan Wallace
- School of Medicine, Department of Pathology and Immunology, Washington University, St Louis, Missouri
| | - Pratim Biswas
- School of Engineering and Applied Science, Department of Energy, Environmental, and Chemical Engineering, Aerosol and Air Quality Research Laboratory, Washington University, St Louis, Missouri
| | - Carey-Ann D Burnham
- School of Medicine, Department of Pathology and Immunology, Washington University, St Louis, Missouri
| | - Hilary M Babcock
- Infectious Diseases Division, Washington University School of Medicine, St Louis, MS
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Garraud O, Heshmati F, Pozzetto B, Lefrere F, Girot R, Saillol A, Laperche S. Plasma therapy against infectious pathogens, as of yesterday, today and tomorrow. Transfus Clin Biol 2016; 23:39-44. [PMID: 26775794 PMCID: PMC7110444 DOI: 10.1016/j.tracli.2015.12.003] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Indexed: 12/20/2022]
Abstract
Plasma therapy consists in bringing to a patient in need – in general suffering a severe, resistant to current therapy, and even lethal infection – plasma or specific, fractioned, antibodies, along with other immunoglobulins and possibly healing factors that can be obtained from immunized blood donors; donors (voluntary and benevolent) can be either actively immunized individuals or convalescent persons. Plasma therapy has been used since the Spanish flu in 1917–1918, and regularly then when viral epidemics threatened vulnerable populations, the last reported occurrence being the 2013–2015 Ebola virus outbreak in West Africa. The precise action mechanism of plasma therapy is not fully delineated as it may function beyond purified, neutralizing antibodies.
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Affiliation(s)
- O Garraud
- Faculté de médecine de Saint-Étienne, université de Lyon, 42023 Saint-Étienne, France; Institut national de la transfusion sanguine, 75015 Paris, France.
| | - F Heshmati
- Hôpital Cochin, Assistance publique des Hôpitaux de Paris, 75005 Paris, France
| | - B Pozzetto
- Faculté de médecine de Saint-Étienne, université de Lyon, 42023 Saint-Étienne, France; Laboratoire des agents infectieux et d'hygiène, CHU de Saint-Étienne, 42055 Saint-Étienne, France
| | - F Lefrere
- Groupe Necker-Enfants malades, Assistance publique des Hôpitaux de Paris, 75015, Paris, France
| | - R Girot
- Hôpital Tenon, Assistance publique des Hôpitaux de Paris, 75020 Paris, France; Université Pierre-et-Marie-Curie-Paris 6, 75005 Paris, France
| | - A Saillol
- Centre de transfusion sanguine des armées, 92140 Clamart, France
| | - S Laperche
- Institut national de la transfusion sanguine, 75015 Paris, France
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22
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Wiwanitkit V. Critical care medicine for emerging Middle East respiratory syndrome: Which point to be considered? Indian J Crit Care Med 2015; 19:528-30. [PMID: 26430339 PMCID: PMC4578197 DOI: 10.4103/0972-5229.164802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Middle East respiratory syndrome (MERS) is a new emerging respiratory tract infection. This coronavirus infection is firstly reported from the Middle East, and it becomes threat for the global public health at present due to its existence in a remote area such as USA and Korea. The concern on the management of the patients is very important. Since most of the patients can develop severe respiratory illness and critical care management is needed, the issue on critical care for MERS is the topic to be discussed in critical medicine.
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Affiliation(s)
- Viroj Wiwanitkit
- Public Health Curriculum, Surin Rajabhat University, Surin, Thailand
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23
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Abstract
Purpose of review Hand hygiene and isolation are basic, but very effective, means of preventing the spread of pathogens in healthcare. Although the principle may be straightforward, this review highlights some of the controversies regarding the implementation and efficacy of these interventions. Recent findings Hand hygiene compliance is an accepted measure of quality and safety in many countries. The evidence for the efficacy of hand hygiene in directly reducing rates of hospital-acquired infections has strengthened in recent years, particularly in terms of reduced rates of staphylococcal sepsis. Defining the key components of effective implementation strategies and the ideal method(s) of assessing hand hygiene compliance are dependent on a range of factors associated with the healthcare system. Although patient isolation continues to be an important strategy, particularly in outbreaks, it also has some limitations and can be associated with negative effects. Recent detailed molecular epidemiology studies of key healthcare-acquired pathogens have questioned the true efficacy of isolation, alone as an effective method for the routine prevention of disease transmission. Summary Hand hygiene and isolation are key components of basic infection control. Recent insights into the benefits, limitations and even adverse effects of these interventions are important for their optimal implementation.
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Bennett B, Carney T. Planning for Pandemics: Lessons From the Past Decade. JOURNAL OF BIOETHICAL INQUIRY 2015; 12:419-28. [PMID: 25000924 PMCID: PMC7089178 DOI: 10.1007/s11673-014-9555-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 04/10/2014] [Indexed: 05/23/2023]
Abstract
It is now 10 years since the disease we now know as SARS--severe acute respiratory syndrome--caused more than 700 deaths around the world and made more than 8,000 people ill. More recently, in 2009 the global community experienced the first influenza pandemic of the 21st century--the 2009 H1N1 influenza pandemic. This paper analyses the major developments in international public health law relating to infectious diseases in the period since SARS and considers their implications for pandemic planning.
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Affiliation(s)
- Belinda Bennett
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Australia.
| | - Terry Carney
- University of Sydney, and Visiting Research Professor, University of Technology Sydney, Sydney, Australia.
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Torabi-Parizi P, Davey RT, Suffredini AF, Chertow DS. Ethical and practical considerations in providing critical care to patients with Ebola virus disease. Chest 2015; 147:1460-1466. [PMID: 25764372 PMCID: PMC4451704 DOI: 10.1378/chest.15-0278] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Infectious disease epidemics in the past have given rise to psychologic and emotional responses among health-care workers (HCWs), stemming from fear of infection during patient care. Early experiences in the AIDS epidemic provide an example where fear of contagion resulted in differential treatment of patients infected with HIV. However, with a deeper understanding of AIDS pathogenesis and treatment, fear and discrimination diminished. Parallels exist between early experiences with AIDS and the present outbreak of Ebola virus disease in West Africa, particularly regarding discussions of medical futility in seriously ill patients. We provide a historical perspective on HCWs' risk of infection during the provision of CPR, discuss physicians' duty to treat in the face of perceived or actual HCW risk, and, finally, present the protocols implemented at the National Institutes of Health to reduce HCW risk while providing lifesaving and life-sustaining care.
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Affiliation(s)
- Parizad Torabi-Parizi
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD.
| | - Richard T Davey
- Clinical Research Section, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Anthony F Suffredini
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Daniel S Chertow
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD
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Screening of an FDA-approved compound library identifies four small-molecule inhibitors of Middle East respiratory syndrome coronavirus replication in cell culture. Antimicrob Agents Chemother 2014; 58:4875-84. [PMID: 24841269 DOI: 10.1128/aac.03011-14] [Citation(s) in RCA: 527] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Coronaviruses can cause respiratory and enteric disease in a wide variety of human and animal hosts. The 2003 outbreak of severe acute respiratory syndrome (SARS) first demonstrated the potentially lethal consequences of zoonotic coronavirus infections in humans. In 2012, a similar previously unknown coronavirus emerged, Middle East respiratory syndrome coronavirus (MERS-CoV), thus far causing over 650 laboratory-confirmed infections, with an unexplained steep rise in the number of cases being recorded over recent months. The human MERS fatality rate of ∼ 30% is alarmingly high, even though many deaths were associated with underlying medical conditions. Registered therapeutics for the treatment of coronavirus infections are not available. Moreover, the pace of drug development and registration for human use is generally incompatible with strategies to combat emerging infectious diseases. Therefore, we have screened a library of 348 FDA-approved drugs for anti-MERS-CoV activity in cell culture. If such compounds proved sufficiently potent, their efficacy might be directly assessed in MERS patients. We identified four compounds (chloroquine, chlorpromazine, loperamide, and lopinavir) inhibiting MERS-CoV replication in the low-micromolar range (50% effective concentrations [EC(50)s], 3 to 8 μM). Moreover, these compounds also inhibit the replication of SARS coronavirus and human coronavirus 229E. Although their protective activity (alone or in combination) remains to be assessed in animal models, our findings may offer a starting point for treatment of patients infected with zoonotic coronaviruses like MERS-CoV. Although they may not necessarily reduce viral replication to very low levels, a moderate viral load reduction may create a window during which to mount a protective immune response.
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Chang C. Unmet needs in respiratory diseases : "You can't know where you are going until you know where you have been"--Anonymous. Clin Rev Allergy Immunol 2013; 45:303-13. [PMID: 24293395 PMCID: PMC7090922 DOI: 10.1007/s12016-013-8399-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The care of patients with respiratory diseases has improved vastly in the past 50 years. In spite of that, there are still massive challenges that have not been resolved. Although the incidence of tuberculosis has decreased in the developed world, it is still a significant public health problem in the rest of the world. There are still over 2 million deaths annually from tuberculosis, with most of these occurring in the developing world. Even with the development of new pharmaceuticals to treat tuberculosis, there is no indication that the disease will be eradicated. Respiratory syncytial virus, severe acute respiratory syndrome, and pertussis are other respiratory infectious diseases with special problems of their own, from vaccine development to vaccine coverage. Asthma, one of the most common chronic diseases in children, still accounts for significant mortality and morbidity, as well as high health care costs worldwide. Even in developed countries such as the USA, there are over 4,000 deaths per year. Severe asthma presents a special problem, but the question is whether there can be one treatment pathway for all patients with severe asthma. Severe asthma is a heterogeneous disease with many phenotypes and endotypes. The gene for cystic fibrosis was discovered over 24 years ago. The promise of gene therapy as a cure for the disease has fizzled out, and while new antimicrobials and other pharmaceuticals promise improved longevity and better quality of life, the average life span of a patient with cystic fibrosis is still at about 35 years. What are the prospects for gene therapy in the twenty-first century? Autoimmune diseases of the lung pose a different set of challenges, including the development of biomarkers to diagnose and monitor the disease and biological modulators to treat the disease.
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Affiliation(s)
- Christopher Chang
- Division of Allergy and Immunology, Thomas Jefferson University, 1600 Rockland Road, Wilmington, DE, 19803, USA,
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