Where are all the patients? Addressing Covid-19 fear to encourage sick patients to seek emergency care

‘Emergency department volume is down nearly 50% as the United States struggles with the Covid-19 epidemic. There is increasing evidence that patients with medical emergencies are avoiding the emergency department because of fear of contracting Covid-19, leading to increased morbidity and mortality.

‘Here, the authors describe efforts taken in a community hospital to understand and combat this public health concern by using human-centered design. They share interview themes, the brainstorming process, and implementation of prototypes, as well as challenges faced in the early stages of implementation. They show that addressing patient fears by dividing the emergency department into respiratory and non-respiratory pods and through targeted messaging can result in increased visits to the emergency room. Time will tell if this results in improved health outcomes for community members.’

Read here (New England Journal of Medicine Catalyst, May 14, 2020)

National action plan for expanding and adapting the healthcare system for the duration of the Covid pandemic

This 24-page report by the Johns Hopkins Center for Health Security offers answers and recommendations related to the following problems, for which there are tractable solutions:

• How can we improve infection prevention in hospitals and maintain a robust supply chain for personal protective equipment (PPE)?
• What approach should we take to restarting deferred healthcare services?
• What financial support is needed for hospitals and healthcare providers?
• How should the healthcare workforce be sustained and augmented?
• How can we provide mental health support for healthcare workers in this crisis?
• How can we provide medical care and sick leave for all people in the United States?
• How can we make telemedicine a new normal?
• How can we reduce the number of undiagnosed infectious diseases in our hospitals?
• How can we better protect emergency medical services (EMS) personnel from infectious diseases?
• How can we better coordinate the healthcare response to COVID and the next pandemic?

Read and download here (Johns Hopkins Center for Health Security, May 5, 2020)

Historic financial decline hits doctors, dentists and hospitals — despite covid-19 — threatening overall economy

‘Most elective surgeries nationwide were postponed beginning in mid-March. Dentists offices were closed. Physicians stopped seeing all but the sickest patients in their offices. Stay-at-home orders didn’t just prevent people from dining in restaurants — they led people to avoid medical services, too, amid concerns about the disease the virus causes, covid-19. More than 200 hospitals, including Children’s National Hospital in Washington, have furloughed workers, according to a tally by Becker’s Hospital Review.’

Read here (Washington Post, May 4, 2020)

Transmission of Covid-19 to health care personnel during exposures to a hospitalised patient

What is already known about this topic? ‘Health care personnel (HCP) are at heightened risk of acquiring COVID-19 infection, but limited information exists about transmission in health care settings.’

What is added by this report? ‘Among 121 HCP exposed to a patient with unrecognised COVID-19, 43 became symptomatic and were tested for SARS-CoV-2, of whom three had positive test results; all three had unprotected patient contact. Exposures while performing physical examinations or during nebuliser treatments were more common among HCP with COVID-19.’

What are the implications for public health practice? ‘Unprotected, prolonged patient contact, as well as certain exposures, including some aerosol-generating procedures, were associated with SARS-CoV-2 infection in HCP. Early recognition and isolation of patients with possible infection and recommended PPE use can help minimise unprotected, high-risk HCP exposures and protect the health care workforce.’

Read here (US CDC, April 17, 2020)

Ensuring safe environment for primary healthcare settings — Dr Amar-Singh HSS, Dr Lee Chee Wan, Dr Paranthaman and Dr Timothy William

‘This guideline is written to offer ideas to general practitioners (GP) and those working in out-patient clinic settings (OPD) on what precautionary measures to take to curb the spread of Covid-19 disease and protect themselves when the relevant government authorities ease our lockdown.

‘It may also be useful for other clinic settings like speciality clinics, antenatal clinics, dental clinics, etc. We are sharing it to the general public as it may be useful for patients and the community to think though some of these issues.’

Read here (The Malay Mail, April 15, 2020)

Intermittent social distancing may be needed through 2022 to manage Covid-19

‘On-and-off periods of social distancing will likely be needed into 2022 to ensure that hospitals have enough capacity for future Covid-19 patients in need of critical care, according to a new modeling study from researchers at Harvard TH Chan School of Public Health.

‘The research, published April 14, 2020 in the journal Science, predicted several scenarios for how the coronavirus might spread over the next five years, taking into account factors such as whether or not the virus will exhibit seasonality, whether people who are infected go on to develop short-term or long-term immunity, and whether people would get any cross-protective immunity from having been infected with other types of coronaviruses that cause common colds.’

Read here (Harvard School of Public Health, April 14, 2020)