Monitored COVID-19 mRNA vaccine second doses for people with adverse reactions after the first dose

Background: After Emergency Use Authorization of the coronavirus disease 2019 (COVID-19) vaccines, guidance was provided by the Centers for Disease Control and Prevention that persons with an immediate allergic reaction to a messenger RNA (mRNA) COVID-19 vaccine should be evaluated by an allergist/immunologist before receipt of the second dose. Methods: In vaccinating health-care personnel, we referred those with significant reactions to allergy/immunology specialists so that they could safely receive the second dose. Results: We found that many reactions after the first dose were nonallergic but could be debilitating and a barrier to the second dose. We created a protocol of premedications to allow health-care personnel to safely receive their second mRNA COVID-19 vaccine dose. Conclusion: This protocol is adaptable and can be used in settings where allergy/immunology referral is not immediately available.

Clinical Presentation and course of SARS-CoV-2 infection in health care personnel working in dedicated Covid hospital during two pandemic waves in India

Introduction: Health care personnel (HCPs) are predisposed to infection during direct or indirect patient care as well as due to the community spread of the disease. Methods: We observed the clinical presentation and course of SARS-CoV-2 infection in HCPs working in a dedicated Covid care hospital during the first and the second wave. Results: A total of 100 and 223 HCPs were enrolled for the first wave and the second wave respectively. Cough, shortness of breath, sore throat, runny nose, and headache was seen in 40(40%) and 152 (68%) (p <0.01), 15(15%) and 64 (29%) (p = .006), 40 (40%) and 119 (53.3%) (p=0.03), 9 (9%) and 66 (30%) (p<0.01), 20 (20%) and 125 (56%) (p<0.01) respectively. Persistent symptoms at the time of joining back to work were seen in 31(31%) HCPs and 152(68%) HCPs respectively (p= <0.01). Reinfection was reported in 10 HCPs. Conclusions: Most of the HCPs had mild to moderate infections. Symptoms persist after joining back to work. Upgradation of home based care and tele consultation facilities for active disease and redressal of residual symptoms will be helpful.

Promoting health equity in the health-care system: How can we identify potentially vulnerable patients?

Background: There is documented social inequality in cancer. The health-care system may contribute to health equity by targeting interventions to potentially vulnerable patients who may be at risk of not receiving optimal treatment and care. Aim: This study aimed to develop and pilot test a tool to identify patients who may need additional support. Method: The study took place in a department of palliative medicine and in a team for head and neck cancer within an oncology department. The tool to identify potentially vulnerable patients was developed based on literature reviews and interviews with patients and health-care personnel. It was pilot tested in a six-month period, with subsequent interviews with health-care personnel. Results: In total, 212 consecutive patients referred to the departments were systematically screened with the tool by health-care personnel. Of these, 74 (35%) patients were considered potentially vulnerable. The most frequently reported sign of vulnerability was ‘few supportive relations’ (47% of the vulnerable patients). Most health-care personnel found it relevant to focus systematically on these patients. However, some were concerned that using the tool could prove to be stigmatising and were critical of attributing the vulnerability to the individual. Conclusions: Most patients were considered in need of additional support because they lacked a social network or had difficulties communicating with health-care personnel. Applying a tool to identify potentially vulnerable patients was feasible and increased attention to this group of patients. However, the screening procedure was also questioned.

Brucellosis with splenic abscess in a child initially suspected to have covid-19

COVID-19 can manifest with signs and symptoms related to many different systems. Therefore, in the examination of almost every patient, COVID-19 infection is excluded first This may cause other diseases to be missed, as almost occurred in the case of a 15-year old boy with brucellosis and a splenic abscess. Public and health care personnel fear of COVID-19 may cause more harm than the virus itself.

Bottom-Up Approach to Establish Coordination Mechanisms for Disaster Preparedness Among Largely Private Health-Care Providers in Central Tokyo

In Japan, despite its private-dominant and disjointed health-care system, national initiatives to coordinate various types of health-care facilities are lacking. Municipal governments manage this task with limited resources. This study describes a successful example of a bottom-up approach to create city-wide collaboration for disaster preparedness. In Minato City, located in central Tokyo, a group of physicians created a project involving a city-wide disaster medical care drill. The city Public Health Center, in charge of health-care systems including disaster medicine, helped the group to increase proponents of the project. The city-wide disaster drill started in November 2017; thereafter, the drills were held every year. Participation in drills by various health-care personnel helped establish a city-wide system for disaster medical care, coordination mechanisms among stakeholders, increased motivation among health-care personnel, and development of in-hospital systems. This approach is flexible and applicable to various forms of health-care systems in other areas.