Challenges of implementing the Paediatric Surviving Sepsis Campaign International Guidelines 2020 in resource-limited settings: A real-world view beyond the academia

Las Guías Internacionales de la Campaña Sobreviviendo a la Sepsis para el Manejo del Shock Séptico y la Disfunción de Órganos Asociada a la Sepsis en Niños, fueron publicadas en 2020 y están desti- nadas a ser utilizadas en todos los lugares que atienden a niños. Sin embargo, los profesionales que atienden a los niños con sepsis en entornos con recursos limitados se enfrentan a una serie de desafíos y perfiles de enfermedad distintos a los que se encuentran en entornos ricos en recursos. Basándonos en nuestra experiencia colectiva en entornos con recursos limitados, nos propusimos reflexionar so- bre las dificultades de aplicar las directrices internacionales. Creemos que hay una necesidad urgente de más evidencia de entornos con recursos limitados en enfoques factibles y eficaces para el trata- miento de la sepsis y el shock séptico que podrían incluirse en las futuras directrices para situaciones y contextos específicos.

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Impact of National and Regional Lockdowns on Growth of COVID-19 Cases in COVID-Hotspot City of Pune in Western India: A Real-World Data Analysis

10.1101/2021.05.05.21254694 ◽

2021 ◽

Author(s):

Vidya Mave ◽

Arsh Shaikh ◽

Joy Merwin Monteiro ◽

Prasad Bogam ◽

Bhalchandra S Pujari ◽

...

Keyword(s):

Real World ◽

Urban Region ◽

Western India ◽

Real World Data ◽

Resource Limited Settings ◽

World Data ◽

Resource Limited ◽

Incident Cases ◽

The Impact ◽

Geospatial Mapping

Background Real-world data assessing the impact of lockdowns on COVID-19 cases remain limited from resource-limited settings. We examined growth of incident confirmed COVID-19 cases before, during and after lockdowns in Pune, a city in western India with 3.1 million population that reported the largest COVID-19 burden at the peak of the pandemic. Methods Using anonymized individual-level data captured by Pune`s public health surveillance program between February 1st and September 15th 2020, we assessed weekly incident COVID-19 cases, infection rates, and epidemic curves by lockdown status (overall and by sex, age, and population density) and modelled the natural epidemic using the 9-compartmental model INDSCI-SIM. Effect of lockdown on incident cases was assessed using multilevel Poisson regression. We used geospatial mapping to characterize regional spread. Findings Of 241,629 persons tested for SARS-CoV-2, the COVID-19 disease rate was 267.0 (95% CI 265.3,268.8) per 1000 persons. Epidemic curves and geospatial mapping showed delayed peak of the cases by approximately 8 weeks during the lockdowns as compared to modelled natural epidemic. Compared to a subsequent unlocking period, incident COVID-19 cases 43% lower (IRR 0.57, 95% CI 0.53, 0.62) during India`s nationwide lockdown and 22% (IRR 0.78, 95% CI 0.73, 0.84) during Pune`s regional lockdown and was uniform across age groups and population densities. Conclusion Lockdowns slowed the growth of COVID-19 cases in population dense, urban region in India. Additional analysis from rural and semi-rural regions of India and other resource-limited settings are needed.

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