scholarly journals Transmission dynamics of the COVID-19 epidemic in India and modelling optimal lockdown exit strategies

2020 ◽  
Author(s):  
Mohak Gupta ◽  
Saptarshi Soham Mohanta ◽  
Aditi Rao ◽  
Giridara Gopal Parameswaran ◽  
Mudit Agarwal ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Reproduction Number ◽  
Control Strategies ◽  
Tertiary Care ◽  
Time Lag ◽  
Control Measures ◽  
Surveillance Systems ◽  
Care Hospital ◽  
Incidence Data ◽  
Second Wave

Background: The coronavirus disease 2019 (COVID-19) has caused over 3 200 000 cases and 230 000 deaths as on 2 May 2020, and has quickly become an unprecedented global health threat. India, with its unique challenges in fighting this pandemic, imposed one of the worlds strictest and largest population-wide lockdown on 25 March 2020. Here, we estimated key epidemiological parameters and evaluated the effect of control measures on the COVID-19 epidemic in India. Through a modelling approach, we explored various strategies to exit the lockdown. Methods: We obtained data from 140 confirmed COVID-19 patients at a tertiary care hospital in India to estimate the delay from symptom onset to confirmation and the proportion of cases without symptoms. We estimated the basic reproduction number (R0) and time-varying effective reproduction number (Rt) after adjusting for imported cases and reporting lag, using incidence data from 4 March to 25 April 2020 for India. We built upon the SEIR model to account for underreporting, reporting delays, and varying asymptomatic proportion and infectivity. Using this model, we simulated lockdown relaxation under various scenarios to evaluate its effect on the second wave, and also modelled increased detection through testing. We hypothesised that increased testing after lockdown relaxation will decrease the epidemic growth enough to allow for a greater resumption of normal social mixing thus minimising the social and economic fallout. Findings: The median delay from symptom onset to confirmation (reporting lag) was estimated to be 2·68 days (95% CI 2·00−3·00) with an IQR of 2·03 days (95% CI 1·00−3·00). 60·7% of confirmed COVID-19 cases (n=140) were found to be asymptomatic. The R0 for India was estimated to be 2·083 (95% CI 2·044−2·122 ; R2 = 0·972), while the Rt gradually down trended from 1·665 (95%CI 1·539−1·789) on 30 March to 1·159 (95% CI 1·128−1·189) on 22 April. In the modelling, we observed that the time lag from date of lockdown relaxation to start of second wave increases as lockdown is extended farther after the first wave peak. This benefit was greater for a gradual relaxation as compared to a sudden lifting of lockdown. We found that increased detection through testing decreases the number of total infections and symptomatic cases, and the benefit of detecting each extra case was higher when prevailing transmission rates were higher (as when restrictions are relaxed). Lower levels of social restrictions when coupled with increased testing, could achieve similar outcomes as an aggressive social distancing regime where testing was not increased. Interpretation: The aggressive control measures in India since 25 March have produced measurable reductions in transmission, although suppression needs to be maintained to achieve sub-threshold Rt. Additional benefits for mitigating the second wave can be achieved if lockdown can be feasibly extended farther after the peak of active cases has passed. Aggressive measures like lockdowns may inherently be enough to suppress the epidemic, however other measures need to be scaled up as lockdowns are relaxed. Expanded testing is expected to play a pivotal role in the lockdown exit strategy and will determine the degree of return to normalcy that will be possible. Increased testing coverage will also ensure rapid feedback from surveillance systems regarding any resurgence in cases, so that geo-temporally targeted measures can be instituted at the earliest. Considering that asymptomatics play an undeniable role in transmission of COVID-19, it may be prudent to reduce the dependence on presence of symptoms for implementing control strategies, behavioral changes and testing.

Prevalence, risk factors and antimicrobial susceptibility pattern of extended spectrum β-lactamase-producing bacteria in a tertiary care hospital

2016 ◽  
Vol 27 (2) ◽  
Author(s):  
Dilip Chandrasekhar ◽  
Jaffer Chalilparambil ◽  
Sajitha Mukriyan Kallungal ◽  
Danisha Pattani ◽  
Abin Chandrakumar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antimicrobial Susceptibility ◽  
Control Strategies ◽  
Tertiary Care ◽  
Control Measures ◽  
Care Hospital ◽  
Susceptibility Pattern ◽  
Antimicrobial Susceptibility Pattern ◽  
Development Of Resistance ◽  
Extended Spectrum

AbstractThe widespread misuse of antibiotics over the past several decades has been regarded as the contributing factor in the development of resistance toward them. Extended spectrum β-lactamases (ESBLs) are enzymes produced by certain bacteria that can make them resistant to certain antibiotics. Early detection of ESBL strains and judicious use of antibiotics and proper implementation of infection control strategies are essential to prevent the spread of this threat in the community. The study aimed at appraising the prevalence, risk factors and antimicrobial susceptibility pattern of ESBL-producing microorganisms.A prospective observational study was carried out in a tertiary care referral hospital located in Malappuram district of Kerala among inpatients with infection by ESBL-producing bacteria in order to estimate the prevalence, risk factors and their antibiotic susceptibility pattern.Out of the total 1156 patients studied, 118 had confirmed diagnosis on the presence of ESBL-producing microorganisms. Overall, 9.79% of all samples growingHigh prevalence of ESBL-producing organisms is evident in the study setting implicating the necessity to report the ESBL production along with the routine sensitivity reports supplemented with control measures which can assist a clinician in prescribing appropriate antibiotics.

Epidemiology and clinical outcome of ventilator-associated events at a tertiary care hospital from North India

2020 ◽  
pp. 004947552098245
Author(s):  
Pooja Kumari ◽  
Priya Datta ◽  
Satinder Gombar ◽  
Deepak Sharma ◽  
Jagdish Chander
Keyword(s):  
Mechanical Ventilation ◽  
Tertiary Care Hospital ◽  
Late Onset ◽  
Tertiary Care ◽  
Control Measures ◽  
North India ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Infection Control Measures ◽  
Utilisation Rate

The aim of our study was to determine the incidence, microbiological profile, risk factors and outcomes of patients diagnosed with ventilator-associated events in our tertiary care hospital. In this prospective study, intensive care patients put on mechanical ventilation for >48 h were enrolled and monitored daily for ventilator-associated event according to Disease Centre Control guidelines. A ventilator-associated event developed in 33/250 (13.2%); its incidence was 3.5/100 mechanical ventilation days. The device utilisation rate was 0.86, 36.4% of patients had early and 63.6% late-onset ventilator-associated pneumonia whose most common causative pathogen was Acinetobacter sp. (63.6%). Various factors were significantly associated with a ventilator-associated event: male gender, COPD, smoking, >2 underlying diseases, chronic kidney disease and elevated acute physiological and chronic health evaluation II scores. Therefore, stringent implementation of infection control measures is necessary to control ventilator-associated pneumonia in critical care units.

scholarly journals Lessons from the frontlines: a junior doctor’s experience of the first wave of the COVID-19 pandemic in a resource-limited setting

2021 ◽  
pp. medhum-2020-012109
Author(s):  
Brabaharan Subhani ◽  
Dilushi Wijayaratne ◽  
Saroj Jayasinghe
Keyword(s):  
Structural Changes ◽  
Tertiary Care ◽  
Medical Officer ◽  
Healthcare Services ◽  
Care Hospital ◽  
Generic Skills ◽  
Quality Healthcare ◽  
Resource Limited ◽  
Uncertain Future ◽  
Second Wave

COVID-19 has stressed healthcare systems across the globe. We present the experience of an intern medical officer working in a tertiary care hospital during the first wave of the pandemic in Sri Lanka. Her narrative describes how the stress of the pandemic brought into sharp focus the strengths and weaknesses in the health system. We suggest some strategies to improve our health services as the world faces the second wave and an uncertain future. These include structural changes in healthcare services at institutional and national levels, focused educational programmes for healthcare professionals to impart generic skills of disaster management, and the development of telehealth services and computerisation of health systems. We believe that we must maintain this focus to ensure that our patients can be guaranteed quality healthcare in the future.

scholarly journals Molecular and Epidemiological Characterization of IMP-Type Metallo-β-Lactamase-Producing Enterobacter cloacae in a Large Tertiary Care Hospital in Japan

2014 ◽  
Vol 58 (6) ◽  
pp. 3441-3450 ◽  
Author(s):  
Kayoko Hayakawa ◽  
Tohru Miyoshi-Akiyama ◽  
Teruo Kirikae ◽  
Maki Nagamatsu ◽  
Kayo Shimada ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Tertiary Care ◽  
Enterobacter Cloacae ◽  
Control Measures ◽  
Care Hospital ◽  
Invasive Procedures ◽  
Content Type ◽  
Infection Control Measures ◽  
Large Tertiary Care ◽  
Close Relationship

ABSTRACTIMP-type metallo-β-lactamase enzymes have been reported in different geographical areas and in various Gram-negative bacteria. However, the risk factors and epidemiology pertaining to IMP-type metallo-β-lactamase-producingEnterobacter cloacae(IMP-producingE. cloacae) have not been systematically evaluated. We conducted a retrospective, matched case-control study of patients from whom IMP-producingE. cloacaeisolates were obtained, in addition to performing thorough molecular analyses of the clinically obtained IMP-producingE. cloacaeisolates. Unique cases with IMP-producingE. cloacaeisolation were included. Patients with IMP-producingE. cloacaewere matched to uninfected controls at a ratio of 1 to 3. Fifteen IMP-producingE. cloacaecases were identified, with five of the isolates being obtained from blood, and they were matched to 45 uninfected controls. All (100%) patients from whom IMP-producingE. cloacaeisolates were obtained had indwelling devices at the time of isolation, compared with one (2.2%) uninfected control. Independent predictors for isolation of IMP-producingE. cloacaewere identified as cephalosporin exposure and invasive procedures within 3 months. Although in-hospital mortality rates were similar between cases and controls (14.3% versus 13.3%), the in-hospital mortality of patients with IMP-producingE. cloacae-caused bacteremia was significantly higher (40%) than the rate in controls. IMP-producingE. cloacaeisolates were frequently positive for other resistance determinants. The MICs of meropenem and imipenem were not elevated; 10 (67%) and 12 (80%) of the 15 IMP-producingE. cloacaeisolates had a MIC of ≤1 μg/ml. A phylogenetic tree showed a close relationship among the IMP-producingE. cloacaesamples. Indwelling devices, exposure to cephalosporin, and a history of invasive procedures were associated with isolation of IMP-producingE. cloacae. Screening for carbapenemase production is important in order to apply appropriate clinical management and infection control measures.

A RETROSPECTIVE STUDY OF BLOOD TRANSFUSION PRACTICES IN A TERTIARY CARE HOSPITAL OF NORTH INDIA.

2021 ◽  
pp. 25-29
Author(s):  
Rakesh Kumar Sharma ◽  
Shahid Anjum Awan ◽  
Vijay Sawhney
Keyword(s):  
Blood Transfusion ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Transfusion Practice ◽  
Blood Bank ◽  
Control Measures ◽  
North India ◽  
Care Hospital ◽  
Important Concern ◽  
Life Saving

INTRODUCTION: Blood transfusion is an important concern for the society, as it is life saving for patients with bleeding disorders, accidents, surgeries, inherited/acquired hematological diseases and malignancies. Generally, donors are classied into the following categories: voluntary, family replacement, remunerated or paid donors, and autologous donor. AIMS & OBJECTIVES:To understand the importance of Blood & its safe Transfusion practice in a Teaching Hospital. METHODOLOGY: An Observational study was conducted over a period of 12 months from January 2019 to December 2019 in a 750 –bedded Tertiary Care Hospital of Jammu(UT). OBSERVATIONS: In addition to providing Blood-Transfusion Services to the patients admitted in SMGS Hospital Jammu & Other Associated Hospitals of GMC Jammu, the Blood-Bank is also catering to the needs of Registered Private Nursing Homes & Hospitals of Jammu(UT).This Blood-Bank has exceptionally maintained a record of consuming the whole stock of Blood without wasting even a single pint of blood. DISCUSSION: The Aim of Blood Transfusion Services is to supply good Quality of Blood & its Components to the Patients & avoid any risk to the Donors as well as Recepients. Hence it is extremely essential to institute strict Quality Control Measures RECOMMENDATIONS: Recommended that Upgradation of Blood-Bank is essential to cater with the needs of Additional bed-strength that SMGS Hospital is going to acquire in the coming future.

First and second wave of COVID-19: A comparative study of tertiary care hospitalized patients in Jalgaon, Maharashtra

2021 ◽  
Vol 19 (3) ◽  
pp. 23-29
Author(s):  
Yogita G Bavaskar ◽  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical History ◽  
Care Hospital ◽  
Age Group ◽  
Number Of Patients ◽  
The Mean ◽  
Collection Form ◽  
Time Of Admission ◽  
Second Wave

Background: Most of the countries including India have witnessed two or more waves of Covid 19 pandemic. The present study was conducted to compare the differences in clinico-demographic characteristics and outcomes of Covid 19 patients admitted in first and second wave of Covid 19 pandemic in a tertiary care hospital at Jalgaon, Maharashtra. Methods: A retrospective observational study was conducted at a tertiary care Dedicated Covid hospital for Covid 19 at Jalgaon, Maharashtra. All microbiologically proven corona positive patients were included in the study. The demographic records and clinical history was extracted from the case history sheets of the patients from first as well as second wave using standardized data collection form. Clinical outcome of the patients, i.e., development of complications, death or discharge was also recorded for each enrolled subject. Results: 3845 patients of Covid-19 admitted in the hospital during the first wave of epidemic and 2956 patients during second wave of the epidemic were included in the study. The mean age of patients admitted in the second wave was significantly lower as compared to first [48.77(15.31) years vs 50.23 (14.33) years, P<0.005]. There is increase in proportion of patients in the age group of < 15 years in second wave as compared to first wave (74/2956, 2.5% vs 52/3845, 1.3%). The number of patients requiring admission in ICU at the time of admission increased by 13% in second wave as compared to first wave. [827/2956 (28%) vs 577/3845(15%), P<0.0001]. More than half of the patients who got admitted for Covid 19 in first as well as second wave were having one or more comorbidities.But the proportion of the patients with previous co-morbities was significantly higher in second wave (1684/2956, 57% vs 1960/ 3845, 51%, P= 0.0004). The mortality was also higher in second wave (533/2956, 18.03% vs 541/3845, 14%, P=0.0004). Conclusions: The demographic, clinical characteristics and outcome of Covid 19 patients was different in first and second wave of pandemic with involvement of younger patients, increased rates of admission to ICU and more mortality in the second wave as compared to first wave of the pandemic.

scholarly journals Phenotypic and Genotypic Detection of Methicillin Resistant Staphylococcus aureus in Health Care Workers and Its Containment in a Tertiary Care Hospital, in South India

2021 ◽  
Author(s):  
Shamim Rahman ◽  
Ragini Ananth Kashid
Keyword(s):  
Staphylococcus Aureus ◽  
Tertiary Care ◽  
Meca Gene ◽  
Control Measures ◽  
Care Hospital ◽  
Beta Lactam ◽  
Accurate Identification ◽  
Mortality And Morbidity ◽  
Sensitivity Pattern ◽  
Hospital Infection Control

MRSA causes nosocomial and community based infections. It is associated with significant mortality and morbidity. Resistance in MRSA is encoded by mecA gene. Anterior nares are the ecological niche of Staphylococcus aureus. HCWs who are colonized with MRSA, act as agents of cross contamination of hospital and community acquired MRSA. Treating MRSA infections is a therapeutic challenge as it is resistant to beta lactam group of drugs. Therefore, there is a need for rapid and accurate detection of MRSA carriage in HCWs and to understand its antibiotic susceptibility pattern.The objective of the present study is to estimate the occurrence of MRSA in HCWs, using phenotypic and genotypic methods. A prospective study for six months was conducted after obtaining Institutional Ethical Committee clearance. Anterior nasal swabs of those HCWs who gave informed consent were taken processed for culture and sensitivity as per standard protocol. To detect MIC for oxacillin, E-strip method was used. mecA gene detection was done by PCR. A total of 300 HCWs were sampled.14.66% (44/300) of the isolates were identified as Staphylococcus aureus, of which 10 isolates were detected as MRSA. The overall isolation rate of MRSA is 3.33 %(10/300). MRSA carriage was high amongst nurses (5/59, 8.47%), followed by doctors (4/105, 3.80%).Antibiotic sensitivity pattern showed that highest resistance was to penicillin (75%) followed by amoxiclav (70.45 %).9 MRSA isolates were detected as mecA gene positive by PCR. MRSA carriers were decontaminated successfully with 2% mupirocin ointment and 2% chlorhexidine shampoo. This study reiterates the need for rapid and accurate identification of HCWs who have nasal colonization with MRSA, for reinforcing hospital infection control measures and decontamination protocol. This will help prevent the spread of MRSA in our community.

scholarly journals Quantifying the relationship between lockdowns, mobility, and effective reproduction number (Rt) during the COVID-19 pandemic in the Greater Toronto Area

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christopher Dainton ◽  
Alexander Hay
Keyword(s):  
Public Health ◽  
Secular Trend ◽  
Reproduction Number ◽  
Time Lag ◽  
Correlation Coefficients ◽  
Greater Toronto Area ◽  
Global Mobility ◽  
The Relationship ◽  
Second Wave ◽  
Over Time

Abstract Background The effectiveness of lockdowns in mitigating the spread of COVID-19 has been the subject of intense debate. Data on the relationship between public health restrictions, mobility, and pandemic growth has so far been conflicting. Objective We assessed the relationship between public health restriction tiers, mobility, and COVID-19 spread in five contiguous public health units (PHUs) in the Greater Toronto Area (GTA) in Ontario, Canada. Methods Weekly effective reproduction number (Rt) was calculated based on daily cases in each of the five GTA public health units between March 1, 2020, and March 19, 2021. A global mobility index (GMI) for each PHU was calculated using Google Mobility data. Segmented regressions were used to assess changes in the behaviour of Rt over time. We calculated Pearson correlation coefficients between GMI and Rt for each PHU and mobility regression coefficients for each mobility variable, accounting for time lag of 0, 7, and 14 days. Results In all PHUs except Toronto, the most rapid decline in Rt occurred in the first 2 weeks of the first province-wide lockdown, and this was followed by a slight trend to increased Rt as restrictions decreased. This trend reversed in all PHUs between September 6th and October 10th after which Rt decreased slightly over time without respect to public health restriction tier. GMI began to increase in the first wave even before restrictions were decreased. This secular trend to increased mobility continued into the summer, driven by increased mobility to recreational spaces. The decline in GMI as restrictions were reintroduced coincides with decreasing mobility to parks after September. During the first wave, the correlation coefficients between global mobility and Rt were significant (p < 0.01) in all PHUs 14 days after lockdown, indicating moderate to high correlation between decreased mobility and decreased viral reproduction rates, and reflecting that the incubation period brings in a time-lag effect of human mobility on Rt. In the second wave, this relationship was attenuated, and was only significant in Toronto and Durham at 14 days after lockdown. Conclusions The association between mobility and COVID-19 spread was stronger in the first wave than the second wave. Public health restriction tiers did not alter the existing secular trend toward decreasing Rt over time.

Vancomycin Control Measures at a Tertiary-Care Hospital: Impact of Interventions on Volume and Patterns of use

1998 ◽  
Vol 19 (4) ◽  
pp. 248-253 ◽  
Author(s):  
Mary V. Singer ◽  
Rachel Haft ◽  
Tamar Barlam ◽  
Mark Aronson ◽  
Amy Shafer ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Care Center ◽  
Tertiary Care ◽  
Hospital Information Systems ◽  
Control Measures ◽  
Prescribing Patterns ◽  
Care Hospital ◽  
Patterns Of Use ◽  
Before And After ◽  
Aggressive Interventions

ABSTRACTOBJECTIVE: Evaluate vancomycin prescribing patterns in a tertiary-care hospital before and after interventions to decrease vancomycin utilization.DESIGN: Before/after analysis of interventions to limit vancomycin use.SETTING: 420-bed academic tertiary-care center.INTERVENTIONS: Educational efforts began August 10, 1994, and involved lectures to medical house staff followed by mailings to all physicians and posting of guidelines for vancomycin use on hospital information systems. Active interventions began November 15, 1994, and included automatic stop orders for vancomycin at 72 hours, alerts attached to the medical record, and, for 2 weeks only, computer alerts to physicians following each vancomycin order. Parenteral vancomycin use was estimated from the hospital pharmacy database of all medication orders. Records of a random sample of 344 patients receiving van-comycin between May 1, 1994, and April 30, 1995, were reviewed for an indication meeting published guidelines.RESULTS: Vancomycin prescribing decreased by 22% following interventions, from 8.5 to 6.8 courses per 100 discharges (P<.05). The estimated proportion of van-comycin ordered for an indication meeting published guidelines was 36.6% overall, with no significant change following interventions. However, during the 2 weeks that computer alerts were in place, 60% of vancomycin use was for an approved indication.CONCLUSIONS: Parenteral vancomycin prescribing decreased significantly following interventions, but the majority of orders still were not for an indication meeting published guidelines. Further improvement in the appropriateness of vancomycin prescribing potentially could be accomplished by more aggressive interventions, such as computer alerts, or by targeting specific aspects of prescribing patterns.

First Outbreak of Colonization and Infection With Vancomycin-ResistantEnterococcus faeciumin a Tertiary Care Hospital in Singapore

2006 ◽  
Vol 27 (9) ◽  
pp. 991-993 ◽  
Author(s):  
Maciej Piotr Chlebicki ◽  
Moi Lin Ling ◽  
Tse Hsien Koh ◽  
Li Yang Hsu ◽  
Ban Hock Tan ◽  
...  
Keyword(s):  
Infection Control ◽  
Enterococcus Faecium ◽  
Public Hospital ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Control Measures ◽  
Care Hospital ◽  
Infection Control Measures ◽  
Vancomycin Resistant

We report the first outbreak of vancomycin-resistantEnterococcus faeciumcolonization and infection among inpatients in the hematology ward of an acute tertiary care public hospital in Singapore. Two cases of bacteremia and 4 cases of gastrointestinal carriage were uncovered before implementation of strict infection control measures resulted in control of the outbreak.

Sign in / Sign up

Export Citation Format

Share Document