The Need for Early Management in Patients With COVID-19

Abstract In March 2020, the IHU Méditerranée Infection set up a screening and treatment center for patients with COVID-19, a system that has been ultimately recommended by French public health authorities. The recent publication of the profiles of patients hospitalized in France published by the Directorate for Research, Studies, Evaluation and Statistics gives us the opportunity to measure the impact of this multidisciplinary early management system coupled with screening on mortality at 90 days. Analysis of the data shows that the system established at IHU-MI was associated with lower mortality, taking age and sex into account. Regarding the age-standardized mortality rate, mortality rates were lower than national data regardless of the period of the epidemic. Early management seems to have significantly decreased the mortality rate in the under-60 age group, suggesting the importance of early management, regardless of age. In addition, these patients had pejorative clinical criteria (high NEWS-2 score, ICU visits, oxygen saturation below 95%) requiring hospitalization, and co-morbidities that are now known to be aggravating factors [7]. This reinforces the need to care for all individuals, regardless of age. Early medical care, as part of a system integrating a screening center and a day hospital, may explain the lower mortality rates.

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Trends in the nontuberculous mycobacterial disease mortality rate in Japan: A nationwide observational study, 1997-2016

Clinical Infectious Diseases ◽

10.1093/cid/ciaa810 ◽

2020 ◽

Cited By ~ 1

Author(s):

Ko Harada ◽

Hideharu Hagiya ◽

Tomoko Funahashi ◽

Toshihiro Koyama ◽

Mitsunobu R Kano ◽

...

Keyword(s):

Mortality Rate ◽

The Elderly ◽

Mortality Rates ◽

Vital Statistics ◽

Female Population ◽

Health Authorities ◽

Disease Mortality ◽

Crude Mortality ◽

Public Health Authorities ◽

Nationwide Observational Study

Abstract Background The incidence of nontuberculous mycobacterial (NTM) infections has been increasing worldwide, becoming a significant healthcare burden especially among elderly people. This study aimed to evaluate the trends in NTM-associated mortality in Japan. Methods This study used vital statistics data and data on all NTM-associated deaths (N=18,814) among individuals aged ≥40 years in Japan from 1997 to 2016. We calculated the crude and age-adjusted mortality rates by age and sex and used joinpoint regression to analyze trends and estimate the average annual percentage change (AAPC). We compared crude NTM- and tuberculosis (TB)-associated mortality rates by sex. Results The overall crude annual mortality rate increased from 0.63/100,000/year in 1997 to 1.93/100,000/year in 2016 and was the highest among individuals aged 80–84 years. The AAPC of the crude mortality rates among males of all ages and females aged 40–59 years were stable but increased among females aged 60–79 years (3.5%, 95% confidence interval [CI]: 2.8–4.3%) and ≥80 years (4.3%, 95% CI: 3.7–4.9%). Among males, the age-adjusted mortality rates did not show a significant trend, while among females, the rates increased over the study period (AAPC: 4.6%, 95% CI: 2.7–6.6%). In females, the crude NTM-associated mortality rate exceeded the TB mortality rate in 2014, 2015, and 2016. Conclusions NTM mortality increased in Japan between 1997 and 2016, especially among the elderly female population. Given the increasing NTM-associated mortality and susceptible aging population, public health authorities in Japan should pay greater attention to NTM infections.

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XarxaSalut, network of municipalities for health, Valencia Region (Spain): policy process evaluation

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.235 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

R Peiró Pérez ◽

E Pérez Sanz ◽

E Legaz Sanchez ◽

J Quiles Izquierdo ◽

Grupo XarxaSalut

Keyword(s):

Process Evaluation ◽

Citizen Participation ◽

Policy Process ◽

Local Level ◽

Common Language ◽

Health Authorities ◽

Open Questions ◽

Economic Support ◽

Public Health Authorities ◽

The Impact

Abstract “XarxaSalut” started in 2017, with the municipalities that have taken the commitment to boost the Promotion of Health (HP) at the local level through community participation, intersectorality and equity perspective. The objective is to present a policy process evaluation (2'5 years) of the implementation of XarxaSalut. Different approaches have been used; a questionnaire addressed to the municipalities at the time of adhesion including data on intersectorality, participation, HP actions and open questions; description of instruments that Regional Public Health Authorities (RPHA) has mobilized and an analysis of barriers and strengths made by the coordination office. In 2017, 17 municipalities were joined, being 197 in February 2020 (70% of the population). 65% are in a process of an organizational change through the intersectoral, decision making and participative working group. 35% are doing analysis of determinants and /or health situation, assets maps and a prioritization of HP actions. The main barriers identified by municipalities are lack of economic and personal resources, and difficulties in achieve citizen participation. The main benefits were the optimization of resources, the exchange of experiences, training, or economic support from the RPHA. Some support instruments develop for RPHA are a collection of guides for community development, funds that the municipalities can apply to support actions related with training, HP action on vulnerable population, on asset maps, participation processes, vulnerable neighborhoods, etc.; Community actions have been included in the “Health Observatory” to give visibility and social support to XarxaSalut. Interdisciplinary training processes with health and municipal professionals have been made in order to develop a common language and strength the competences for HP. Lesson learned: The need to improve coordination and a common language between different types of participants and professionals Key messages The decision makers and professionals in the municipalities understand the impact in health of the policies developed at local level but needs guide and support to deal with it. The coordination between different administrations and primary health at local level and the misunderstandings about health and their determinants are the main aspect to reinforce.

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Endovascular Aortic Repair in Patients of Advanced Age

Journal of Endovascular Therapy ◽

10.1177/15266028211049342 ◽

2021 ◽

pp. 152660282110493

Author(s):

Mitri K. Khoury ◽

Micah A. Thornton ◽

Christopher A. Heid ◽

Jacqueline Babb ◽

Bala Ramanan ◽

...

Keyword(s):

Mortality Rate ◽

Survival Benefit ◽

Elective Surgery ◽

Endovascular Aneurysm Repair ◽

The Elderly ◽

Mortality Rates ◽

Current Data ◽

Aortic Aneurysms ◽

Advanced Age ◽

The Impact

Purpose: Treatment decisions for the elderly with abdominal aortic aneurysms (AAAs) are challenging. With advancing age, the risk of endovascular aneurysm repair (EVAR) increases while life expectancy decreases, which may nullify the benefit of EVAR. The purpose of this study was to quantify the impact of EVAR on 1-year mortality in patients of advanced age. Materials and Methods: The 2003–2020 Vascular Quality Initiative Database was utilized to identify patients who underwent EVAR for AAAs. Patients were included if they were 80 years of age or older. Exclusions included non-elective surgery or missing aortic diameter data. Predicted 1-year mortality of untreated AAAs was calculated based on a validated comorbidity score that predicts 1-year mortality (Gagne Index, excluding the component associated with AAAs) plus the 1-year aneurysm-related mortality without repair. The primary outcome for the study was 1-year mortality. Results: A total of 11 829 patients met study criteria. The median age was 84 years [81, 86] with 9014 (76.2%) being male. Maximal AAA diameters were apportioned as follows: 39.6% were <5.5 cm, 28.6% were 5.5–5.9 cm, 21.3% were 6.0–6.9 cm, and 10.6% were ≥7.0 cm. The predicted 1-year mortality rate without EVAR was 11.9%, which was significantly higher than the actual 1-year mortality rate with EVAR (8.2%; p<0.001). The overall rate of perioperative MACE was 4.4% (n = 516). Patients with an aneurysm diameter <5.5cm had worse actual 1-year mortality rates with EVAR compared to predicted 1-year mortality rates without EVAR. In contrast, those with larger aneurysms (≥5.5cm) had better actual 1-year mortality rates with EVAR. The benefit from EVAR for those with Gagne Indices 2–5 was largely restricted to those with AAAs ≥ 7.0cm; whereas those with Gagne Indices 0–1 experience a survival benefit for AAAs larger than 5.5 cm. Conclusion: The current data suggest that EVAR decreases 1-year mortality rates for patients of advanced age compared to non-operative management in the elderly. However, the survival benefit is largely limited to those with Gagne Indices 0–1 with AAAs ≥ 5.5 cm and Gagne Indices 2–5 with AAAs ≥ 7.0 cm. Those of advanced age may benefit from EVAR, but realizing this benefit requires careful patient selection.

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Laboratory-based surveillance for Cryptosporidium in France, 2006–2009

Eurosurveillance ◽

10.2807/ese.15.33.19642-en ◽

2010 ◽

Vol 15 (33) ◽

Cited By ~ 5

Author(s):

Collective The ANOFEL Cryptosporidium National Network

Keyword(s):

Seasonal Pattern ◽

Late Summer ◽

Epidemiological Data ◽

University Hospitals ◽

National Network ◽

Lack Of Information ◽

Health Authorities ◽

Public Health Authorities ◽

Set Up ◽

Voluntary Basis

In 2002, the French Food Safety Agency drew attention to the lack of information on the prevalence of human cryptosporidiosis in the country. Two years later, the ANOFEL Cryptosporidium National Network (ACNN) was set up to provide public health authorities with data on the incidence and epidemiology of human cryptosporidiosis in France. Constituted on a voluntary basis, ACNN includes 38 hospital parasitology laboratories (mainly in university hospitals). Each laboratory is engaged to notify new cases of confirmed human cryptosporidiosis, store specimens (e.g. stools, duodenal aspirates or biopsies) and related clinical and epidemiological data, using datasheet forms. From January 2006 to December 2009, 407 cryptosporidiosis cases were notified in France and 364 specimens were collected. Of the notified cases, 74 were children under four years of age, accounting for 18.2%. HIV-infected and immunocompetent patients represented 38.6% (n=157) and 28% (n=114) of cases, respectively. A marked seasonal pattern was observed each year, with increased number of cases in mid to late summer and the beginning of autumn. Genotyping of 345 isolates from 310 patients identified C. parvum in 168 (54.2%) cases, C. hominis in 113 (36.4%) and other species in 29 (9.4%), including C. felis (n=15), C. meleagridis (n=4), C. canis (n=4), Cryptosporidium chipmunk genotype (n=1), Cryptosporidium rabbit genotype (n=1) and new Cryptosporidium genotypes (n=4). These data represent the first multisite report of laboratory-confirmed cases of cryptosporidiosis in France.

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The Impact of Covid-19 Public Health Policies on Persons with Disability and their Caregivers in Malta

International Journal of Social Science Research and Review ◽

10.47814/ijssrr.v4i2.88 ◽

2021 ◽

Vol 4 (2) ◽

pp. 25-37

Author(s):

Andrew Camilleri ◽

Samantha Pace Gasan ◽

Andrew Azzopardi

Keyword(s):

Public Health ◽

World Health Organisation ◽

World Health ◽

Persons With Disabilities ◽

Health Authorities ◽

Essential Services ◽

Public Health Authorities ◽

Novel Coronavirus ◽

Restrictive Measures ◽

The Impact

On March 11, 2020, the World Health Organisation (WHO) declared a global health pandemic, due to the spread of a novel coronavirus, later named “Covid-19”. The spread of Covid-19 led to social isolation, distancing and a number of restrictive measures in Malta. The aim of this paper is to analyse the impact of Covid-19 and the subsequent restrictive measures on persons with disability and their caregivers and families in Malta. Using thematic analysis, the study found that a variety of impacts ranging from a sense of isolation, lack of essential services being provided, additional difficulties encountered at the place of work and education and measures that were not sufficiently tailored for persons with disability issued by public health authorities. Underlying the additional difficulties brought about by Covid-19, structural difficulties to access essential services as well as ignorance from policy makers and politicians and the added “vulnerable-ization” of persons with disabilities were found to be highly impacting factors that pervade the experience of persons with disabilities and their caregivers.

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Geospatial Analysis and Mapping Strategies for Fine Grained and Detailed COVID-19 Data With Geographic Information Systems

10.21203/rs.3.rs-273514/v1 ◽

2021 ◽

Author(s):

ÁNGEL MIRAMONTES CARBALLADA ◽

JOSE BALSA-BARREIRO

Keyword(s):

Geographic Location ◽

Social Contact ◽

Temporal Behaviour ◽

Fine Grained ◽

Health Authorities ◽

Public Health Authorities ◽

Spatio Temporal ◽

Media Reports ◽

Predictive Risk ◽

The Impact

Abstract The CoVID-19 pandemic is showing a dramatic impact across the world. To the tragedy of the loss of human lives, we must add the great uncertainty that the new coronavirus is causing to our lives. Governments and public health authorities must be able to respond this emergency by taking the appropriate decisions for minimizing the impact of the virus. In the absence of an immediate solution, governments have concentrated their efforts on adopting non-pharmaceutical interventions for restricting the mobility of people and reducing the social contact. Health authorities are publishing most of data for supporting their interventions and policies. The geographic location of the cases is a vital information with exceptional value for analysing the spatio-temporal behaviour of the virus, doing feasible to anticipate potential outbreaks and to elaborate predictive risk mapping. In fact, a great number of media reports, research papers, and web-browsers have presented the COVID-19 disease spreading by using maps. However, processing and visualization of this sort of data presents some aspects that must be carefully reviewed. Based on our experience with fine-grained and detailed data related to COVID-19 in a Spanish region, we present a bunch of mapping strategies and good practices using geospatial tools. The ultimate goal is create appropriate maps at any spatial scale while avoiding conflicts with data such as those related to patients’ privacy.

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Retrospective evaluation of healthcare utilisation and mortality of two post-discharge care programmes in Singapore

BMJ Open ◽

10.1136/bmjopen-2018-027220 ◽

2019 ◽

Vol 9 (5) ◽

pp. e027220 ◽

Cited By ~ 4

Author(s):

Ian Yi Han Ang ◽

Chuen Seng Tan ◽

Milawaty Nurjono ◽

Xin Quan Tan ◽

Gerald Choon-Huat Koh ◽

...

Keyword(s):

Emergency Department ◽

Mortality Rate ◽

Health System ◽

Emergency Admission ◽

Healthcare Utilisation ◽

Lower Mortality ◽

Post Discharge ◽

Discharge Care ◽

High Acuity ◽

The Impact

ObjectiveTo evaluate the impact on healthcare utilisation frequencies and charges, and mortality of a programme for frequent hospital utilisers and a programme for patients requiring high acuity post-discharge care as part of an integrated healthcare model.DesignA retrospective quasi-experimental study without randomisation where patients who received post-discharge care interventions were matched 1:1 with unenrolled patients as controls.SettingThe National University Health System (NUHS) Regional Health System (RHS), which was one of six RHS in Singapore, implemented the NUHS RHS Integrated Interventions and Care Extension (NICE) programme for frequent hospital utilisers and the NUHS Transitional Care Programme (NUHS TCP) for high acuity post-discharge care. The programmes were supported by the Ministry of Health in Singapore, which is a city-state nation located in Southeast Asia with a 5.6 million population.ParticipantsLinked healthcare administrative data, for the time period of January 2013 to December 2016, were extracted for patients enrolled in NICE (n=554) or NUHS TCP (n=270) from June 2014 to December 2015, and control patients.InterventionsFor both programmes, teams conducted follow-up home visits and phone calls to monitor and manage patients’ post-discharge.Primary outcome measuresOne-year pre- and post-enrolment healthcare utilisation frequencies and charges of all-cause inpatient admissions, emergency admissions, emergency department attendances, specialist outpatient clinic (SOC) attendances, total inpatient length of stay and mortality rates were compared.ResultsPatients in NICE had lower mortality rate, but higher all-cause inpatient admission, emergency admission and emergency department attendance charges. Patients in NUHS TCP did not have lower mortality rate, but had higher emergency admission and SOC attendance charges.ConclusionsBoth NICE and NUHS TCP had no improvements in 1 year healthcare utilisation across various setting and metrics. Singular interventions might not be as impactful in effecting utilisation without an overhauling transformation and restructuring of the hospital and healthcare system.

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SARS-CoV-2 and Coronavirus Disease 2019: What We Know So Far

Pathogens ◽

10.3390/pathogens9030231 ◽

2020 ◽

Vol 9 (3) ◽

pp. 231 ◽

Cited By ~ 125

Author(s):

Firas A. Rabi ◽

Mazhar S. Al Zoubi ◽

Ghena A. Kasasbeh ◽

Dunia M. Salameh ◽

Amjad D. Al-Nasser

Keyword(s):

Vaccine Development ◽

Current Knowledge ◽

Treatment Options ◽

The Novel ◽

Clinical Criteria ◽

Health Authorities ◽

Close Relationship ◽

Public Health Authorities ◽

Molecular Information ◽

Novel Coronavirus

In December 2019, a cluster of fatal pneumonia cases presented in Wuhan, China. They were caused by a previously unknown coronavirus. All patients had been associated with the Wuhan Wholefood market, where seafood and live animals are sold. The virus spread rapidly and public health authorities in China initiated a containment effort. However, by that time, travelers had carried the virus to many countries, sparking memories of the previous coronavirus epidemics, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), and causing widespread media attention and panic. Based on clinical criteria and available serological and molecular information, the new disease was called coronavirus disease of 2019 (COVID-19), and the novel coronavirus was called SARS Coronavirus-2 (SARS-CoV-2), emphasizing its close relationship to the 2002 SARS virus (SARS-CoV). The scientific community raced to uncover the origin of the virus, understand the pathogenesis of the disease, develop treatment options, define the risk factors, and work on vaccine development. Here we present a summary of current knowledge regarding the novel coronavirus and the disease it causes.

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Withdrawal of Care in a Trauma Intensive Care Unit: The Impact on Mortality Rate

The American Surgeon ◽

10.1177/000313481408000824 ◽

2014 ◽

Vol 80 (8) ◽

pp. 764-767 ◽

Cited By ~ 2

Author(s):

Leonard J. Weireter ◽

Jay N. Collins ◽

Rebecca C. Britt ◽

T. J. Novosel ◽

L. D. Britt

Keyword(s):

Intensive Care Unit ◽

Decision Making ◽

Mortality Rate ◽

Trauma Center ◽

Mortality Rates ◽

Active Aging ◽

Neurologic Injury ◽

Trauma Service ◽

The Impact ◽

Overall Mortality

Withdrawal of care has increased in recent years as the population older than 65 years of age has increased. We sought to investigate the impact of this decision on our mortality rate. We retrospectively reviewed a prospectively collected database to determine the percentage of cases in which care was actively withdrawn. Neurologic injury as the cause for withdrawal, age of the patient, number of days to death, number of cases thought to be treatment failures, and the reason for failure were analyzed. Between January 2008 and December 2012, there were 536 trauma service deaths; 158 (29.5%) had care withdrawn. These patients were 67 (6 18.5) years old and neurologic injury was responsible in 63 per cent (6 5.29%). Fifty-two per cent of the patients died by Day 3; 65 per cent by Day 5; and 74 per cent Day 7. A total of 22.7 per cent (6 7.9%) could be considered a treatment failure. Accounting for cases in which care was withdrawn for futility would decrease the overall mortality rate by approximately 23 per cent. Trauma center mortality calculation does not account for care withdrawn. Treating an active, aging population, with advance directives, requires methodologies that account for such decision-making when determining mortality rates.

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Impact of data accuracy on the evaluation of COVID-19 mitigation policies

Data & Policy ◽

10.1017/dap.2021.25 ◽

2021 ◽

Vol 3 ◽

Author(s):

Michele Starnini ◽

Alberto Aleta ◽

Michele Tizzoni ◽

Yamir Moreno

Keyword(s):

Epidemiological Data ◽

Surveillance Data ◽

Inaccurate Data ◽

Health Authorities ◽

The Social ◽

Containment Measures ◽

Public Health Authorities ◽

Nonpharmaceutical Interventions ◽

The Impact ◽

Extreme Care

Abstract Evaluating the effectiveness of nonpharmaceutical interventions (NPIs) to mitigate the COVID-19 pandemic is crucial to maximize the epidemic containment while minimizing the social and economic impact of these measures. However, this endeavor crucially relies on surveillance data publicly released by health authorities that can hide several limitations. In this article, we quantify the impact of inaccurate data on the estimation of the time-varying reproduction number $ R(t) $ , a pivotal quantity to gauge the variation of the transmissibility originated by the implementation of different NPIs. We focus on Italy and Spain, two European countries among the most severely hit by the COVID-19 pandemic. For these two countries, we highlight several biases of case-based surveillance data and temporal and spatial limitations in the data regarding the implementation of NPIs. We also demonstrate that a nonbiased estimation of $ R(t) $ could have had direct consequences on the decisions taken by the Spanish and Italian governments during the first wave of the pandemic. Our study shows that extreme care should be taken when evaluating intervention policies through publicly available epidemiological data and call for an improvement in the process of COVID-19 data collection, management, storage, and release. Better data policies will allow a more precise evaluation of the effects of containment measures, empowering public health authorities to take more informed decisions.

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