Task 5 - What has been published about medical care?

Resources to support skilled nursing facilities

The goal of the training and examination group was to ensure qualified skills of nurses working at frontline . The training and examination group included a leader who was the deputy director of the Nursing Department , 8 head nurses and 8 education nurses as members . Through step - by - step training [ 3 ] , professional and competent echelons of nurses for front - line and back - up personnel were prepared . Through online courses , the hospital - wide nursing staff are trained in diagnosis and treatment protocol , prevention and control protocol , infection control process , and protection grade standards [ 1 , [ 4 ] [ 5 ] . For nurses of ICU , nursing skills training of patient with ventilation in the prone position , extracorporeal membrane oxygenation support , invasive hemodynamic monitoring , etc were strengthened .

At the national level there should be an IC programme , which would provide healthcare facilities with appropriate direction , guidance and support in preventing the spread of infection in healthcare facilities . This will ensure consistency of approach . 49 In those areas without existing legislation to make IC and prevention interventions mandatory , public health officials should promote meetings with policy makers to lobby for legislation to mandate that each hospital should have an IC committee ( ICC ) with a specified core membership and an appropriate IC infrastructure , including resources . Functions of the hospital ICC should include outbreak investigation , surveillance , reviewing local epidemiological data , educating staff , patients and visitors , developing and promoting local guidelines and estimating resource needs . The ICC should be multidisciplinary and include nursing , medical , laboratory , public health , pharmacy , occupational health , hospital management and engineering representatives .

However , other studies report similar findings [ 13 , 16 , 21 ] . In the case of an outbreak , confidence in safety , early training , and confidence in professional skills are all factors that promote medical staff ' s willingness to actively participate in anti - epidemic work [ 29 ] . Physical and mental rewards to nurses from work units are also important supporting factors [ 11 ] . Our participants generally believed that positive emotions were related to the multi - dimensional support of patients , family members , team members , government , social groups etc . Therefore , social support is critical for nurses in the fight against epidemics [ 14 , 16 , 21 ] . The calmness and ease of most nurses in this study after starting the anti - epidemic tasks is rarely mentioned in other studies and may be related to nurses ' gradual adaptation , acceptance , positive response , and personal growth [ 14 , 26 ] . Studies have shown that positive emotions play an important role in the recovery and adjustment of psychological trauma [ 30 ] .

Abstract Objective To introduce the emergency management of nursing human resources and material resources of a large general hospitals when facing the outbreak of the coronavirus disease 2019 ( COVID - 19 ) . Method The Nursing Department of the hospital fully executed its functional authority to establish a three - level echelon of sustainable support , allocate human recourses dynamically , organize pre - service training , supervise the key working steps , formulate positive incentive methods , and deploy medical supplies scientifically . Result By taking these strategies , the hospital effectively improved the coping capacity of the nursing team and played a positive role in the prevention and treatment of COVID - 19 . Conclusion The emergency management of nursing human resources and material resources for COVID - 19 of the hospital is successful . But several deficiencies were identified as well , which indicated that the hospital needs to establish an efficient emergency management system , and pay attention to the practice of nursing emergency plans to enhance coping capacities in public health emergencies .

In terms of the content of interest , namely , psychological care , medical and nursing staff with subthreshold disturbances most wanted to obtain skills to help alleviate others ' psychological distress , whereas other medical and nursing staff most wanted to obtain self - help skills . Medical and nursing staff with higher levels of mental health problems were more interested in skills for self - rescue and showed more urgent desires to seek help from psychotherapists and psychiatrists . Medical and nursing staff differed in terms of how they wanted to obtain services based on their levels of mental health problems . Medical and nursing staff with subthreshold and mild disturbances preferred to obtain such services from media sources , while staff with heavier burdens wanted to seek services directly from professionals . Apart from medical and nursing staff with subthreshold disturbances who did not think they needed help from others , the other workers saw a greater need to obtain help from professionals than from close family and friends . The results are shown in Table 7 .

Resources to support long term care facilities

As part of the intensive response , at least 100 long - term care facilities in King County were contacted by email on March 6 , 2020 , through a REDCap survey that was used to obtain information on residents or staff known to have Covid - 19 or on clusters of influenza - like illness among residents and staff . Nonresponders were sent up to five reminders to complete the survey . 15 In addition , countywide databases that capture all emergency medical service transfers from long - term care facilities to acute care facilities were reviewed on a daily basis for evidence of cases or clusters of influenza - like illness . Finally , routine passive surveillance for influenza - like illness clusters in long - term care facilities was used to identify possible Covid - 19 ; reporting is mandated for a confirmed case of influenza or for two or more cases of influenza - like illness in a 72 - hour period . All long - term care facilities with evidence of a cluster of respiratory illness were contacted by telephone for additional information , including information on infection - control strategies that were in place and on personal protective equipment ( PPE ) supplies . On the basis of this information , the long - term care facilities were prioritized according to risk of Covid - 19 introduction , and the highest - priority facilities were visited by response personnel to perform diagnostic testing of those with influenza - like illness and to implement infection - control assessment , training , and support .

The Infection Prevention & Control of the World Health Organization ( WHO ) Health Emergency Programme presented a query on preventing and managing COVID - 19 in older adults aged 60 years and above living in long - term care facilities including privately paid for and publicly paid for settings with a 5 - business day timeline . According to the WHO , " long - term care covers those activities undertaken by others to ensure that people with , or at risk of , a significant ongoing loss of intrinsic capacity can maintain a level of functional ability consistent with their basic rights , fundamental freedoms and human dignity " ( https : / / www . who . int / ageing / long - term - care / WHO - LTC - series - subsaharan - africa . pdf ? ua = 1 ) . Examples of long - term care include nursing homes , charitable homes , municipal homes , long - term care hospitals , long - term care facilities , skilled nursing facilities , convalescent homes , and assisted living facilities ( https : / / www . canada . ca / en / health - canada / services / home - continuing - care / long - term - facilitiesbased - care . html ) .

The vulnerability of long - term care facilities to respiratory disease outbreaks , including influenza and other commonly circulating human coronaviruses such as the common cold , is well recognized . 16 , 17 As this report shows , the spread of Covid - 19 reflected the same vulnerability in at least one long - term care facility . In total , 167 confirmed cases of Covid - 19 had been identified among residents , personnel , and visitors as of March 18 , and 30 skilled nursing and assisted living facilities in King County had identified at least one confirmed case of Covid - 19 . Staff working in multiple facilities while ill and transfers of patients from one facility to another potentially introduced Covid - 19 into some of these facilities . The transmission within Facility A and to other facilities in the area posed a serious threat to the medically vulnerable population residing within long - term care facilities and strained the local acute care hospitals . Although the use of vaccine and antiviral medications can be effective in reducing the spread of influenza in long - term care facilities , such interventions are not currently available for Covid - 19 . 18 Residents and health care personnel at long - term care facilities are at risk for Covid - 19 transmission and severe outcomes , particularly for residents who are predominantly at advanced ages and have underlying medical conditions . Publicly available information on staffing and quality measures shows no indication that baseline practices at Facility A placed residents at greater risk than residents at other similar facilities .

MOHLTC , 2018 ; Country : Canada Sponsor : Ontario Ministry of Health and Long - term Care Scope : assist long - term care facilities and public health units with prevention , detection and management of respiratory infection outbreaks 3 . 1 Outbreak Management

Sustained transmission of SARS - CoV - 2 in the community will result in a surge of patients , both with and without COVID - 19 . Efforts should be made to provide adequate care for both groups of patients . Multiple media reports from Wuhan and Hubei province tell the story of sick people unable to access medical care . Overflow of healthcare system will unequivocally lead to suboptimal outcome in all patients regardless of their diagnosis . Surge capacities should be prepared , in terms of infrastructures , human and material resources , procedures , and organizations . Healthcare facilities should secure extra beds and instruments ( e . g . , ventilators ) for surge capacity . Patients who could be cared at home or at long - term care facilities should be discharged , and elective medical care could be postponed . Resources for care of patients with COVID - 19 needs to be checked and stocked . While their effects are yet to be proven by clinical trials , agents such as lopinavir / ritonavir , interferon , chloroquine , and remdesivir have been used for treatment [ 89 ] . Antibiotics are expected to be administered to many patients , thus their stocks and contingency supply plan must be reviewed . Medical surge operation cannot be executed effectively by individual facilities alone . Public health authorities should coordinate joint operations to utilize limited resources in the most effective way . Designating hospitals for COVID - 19 care would be more beneficial for the efficient use of limited resources and could maintain essential healthcare for patients requiring emergent or intensive management for other diseases .

Mobilization of surge medical staff to address shortages in overwhelmed communities

A hospital - specific protocol for screening and management is necessary if an epidemic outbreak occurs . In the situation of an unanticipated surge of patients combined with a relative shortage of medical resources ( beds , staff and PPE ) , the establishment of screening and diagnostic protocol for suspected patients can focus medical resources on patients who need them and may help reduce missed cases .

Working for long hours , disturbed daily routines including eating and sleeping schedules and fear of being infected are key factors that increase the risks of stress and anxiety for doctors and nurses , and may lead to their working less efficiently in terms of providing better treatment and care to patients . Under these pressures , some medical staff have experienced an emotional breakdown at the frontline [ 4 ] . The situation worsened for medical staff after the death of Dr Liang Wudong , who contracted 2019n - CoV . The increasing number of suspected individuals every day and the shortage of laboratory staff could increase the workload and may delay routine clinical tests for infected or suspected individuals . Furthermore , the shortage of protective coverings further increases the chances of getting the infection [ 5 ] . Staff have been asked to use substandard masks , putting them at greater risk [ 4 ] . The healthcare authorities have stepped up efforts to overcome the problems and have sent thousands of medical personnel including army medical staff to Wuhan . To cope with further shortages , the designated hospitals have transferred medical and clinical testing staff to frontline departments from other departments such as oncology , orthopaedics and medicines . In addition , healthcare workers from several undesignated healthcare units have been transferred to designated hospitals for coronavirus - infected patients . In order to increase the space and availability of sickbeds , regular hospital patients ( not infected with 2019n - CoV ) are being moved out of hospitals , and admissions for new regular patients are being delayed . Several hospitals are setting up online medical consultations for these patients to discuss their conditions and seek help . Furthermore , some companies are working to make diagnostic kits available on a large scale , but it may take some time . However , the increasing number of patients every day and the expected peak in the coming days [ 6 ] may cause a further shortage of medical staff and health and logistic issues for the frontline healthcare provider .

The COVID - 19 epidemic became a serious challenge for the healthcare authorities , scientific community , and the infections controlling agencies across China , in terms of spread , treatment , and prevention . Pneumonia appears to be the most frequent manifestation of infection , characterized primarily by fever , cough , dyspnea , and bilateral infiltrates on chest imaging [ 5 ] . The overall case fatality rate is uncertain but appears to be around 3 percent . Most of the fatal cases have occurred in patients with underlying medical comorbidities . Nonetheless , the COVID - 19 outbreak is harming not only the physical health but also mental health , however , the healthcare authorities are mainly focusing on physical health . Thus , it is necessary to identify and properly address mental health abnormalities in individuals who are at higher risk . In the current scenario of the outbreak in Wuhan , healthcare workers are at the highest risk of contracting an infection . According to Danmeng and Jia ( 2020 ) , the total number of health workers infected are twice ( more than 3000 ) as reported by the Chinese Government . This indicates that a large number of medical staffs is suspected to have contracted the infection and their confirmation may create an alarming situation for healthcare authorities . According to the report of the Organization for Economic Cooperation and Development , there are 1 . 8 practicing doctors for 1000 citizens in China which is too low . Therefore , the increasing numbers of infected and suspected doctors and nurses are creating an additional significant shortage of working medical staff , thus , increasing an additional working and mental pressure on the normal health workers [ 6 ] . In such circumstances , the working efficiency of medical staff may critically decrease , that may increase the risk of viral spread and further increase the fatality rate among the infected individuals .

Despite the increased attention towards protecting medical staff from infection , information regarding the epidemiology and clinical features of medical staff confirmed with COVID - 19 is scarce . This single - centered , retrospective study aimed to describe epidemiological , clinical , laboratory and radiographic features , treatment , and prognosis of a group of medical staff confirmed with COVID - 19 who were admitted to Union Hospital , Wuhan . We hope the findings in the present study will provide an insight into the prevention and treatment of this novel coronavirus for the global community .

In NICUs , a virus outbreak will bring psychological stress to the patient ' s parents and other family members ; therefore , social workers and psychologists should be involved . Medical service providers will also be under tremendous psychological pressure due to overwork , shortage of medical resources , patients ' poor outcomes , or other detrimental experiences . Medical staff should be provided with adequate psychological support , as their physical and mental health is crucial in the context of a virus outbreak .

Age-adjusted mortality data for Acute Respiratory Distress Syndrome (ARDS)

Age-adjusted mortality data for Acute Respiratory Distress Syndrome (ARDS) for viral etiologies

What are the outcomes of Extracorporeal membrane oxygenation (ECMO) of COVID-19 patients?

The novel 2019 coronavirus - induced disease ( COVID - 19 ) has recently started spreading in Japan . According to the initial report from Wuhan in China , 4 of 138 hospitalized patients ( 2 . 8 % ) required extracorporeal membranous oxygenation ( ECMO ) [ 1 ] . As treatment for severe respiratory failure with ECMO requires specialized knowledge and training , the number of patients who present to a hospital for ECMO annually is positively associated with the survival rate of the patients [ 2 ] . It is also known that hospitalization at a center where health care professionals are well - trained on respiratory care results in improved outcomes [ 3 ] .

Compared with H1N1 , patients with COVID - 19 induced ARDS had lower severity of illness scores at presentation and lower SOFA - score adjusted mortality . ECMO , extracorporeal membrane oxygenation ; PaO 2 , partial pressure of oxygen ; PaCO 2 , partial pressure of carbon dioxide ; FiO 2 , fractional inspired oxygen .

The novel coronavirus disease 2019 ( COVID - 19 ) can induce acute respiratory distress syndrome ( ARDS ) , which can progress to refractory pulmonary failure . In such cases , extracorporeal membrane oxygenation ( ECMO ) may be considered as a rescue therapy . In a study of ECMO for ARDS in patients with Middle East Respiratory Syndrome Coronavirus ( MERS - CoV ) , a similar coronavirus disease emerged in 2012 , a significant decrease of inhospital mortality rate and length of intensive care unit ( ICU ) stay was found in patients treated with ECMO compared to those managed with conventional therapy [ 1 ] . However , with COVID - 19 , concerns have been raised about high mortality rate observed in an early report which included data on ECMO in infected patients [ 2 ] . It has been suggested that the compounded immunologic insult by both infection and extracorporeal circuit may counterbalance or even offset survival benefits [ 2 ] . In this article , we aimed to evaluate ECMO mortality as reported in early COVID - 19 epidemiological studies .

Based on our findings , we suggested that the early interventions of host immune system and gut microbiota are necessary for COVID - 2019 patients with refractory hypoxia . For these critical patients , extracorporeal membrane oxygenation ( ECMO ) therapy also should be supported early to ameliorate the symptom of refractory hypoxia .

Given the lack of effective antiviral therapy against COVID - 19 , current treatments mainly focused on symptomatic and respiratory support according to the Diagnosis and Treatment of Pneumonia Caused by COVID - 19 ( updated to version 6 ) issued by National Health Commission of the People ’ s Republic of China [ 71 ] . Nearly all patients accepted oxygen therapy , and WHO recommended extracorporeal membrane oxygenation ( ECMO ) to patients with refractory hypoxemia [ 72 ] . Rescue treatment with convalescent plasma and immunoglobulin G [ 73 ] are delivered to some critical cases according to their conditions .

What are the outcomes for COVID-19 after mechanical ventilation adjusted for age?

The current COVID - 19 pandemic [ 1 ] is causing a rapidly increasing number of SARS - CoV - 2 [ 2 ] pathologies all across the world . A common outcome of SARS - CoV - 2 is severe pneumonia [ 3 ] . Effective medical intervention in this pathology involves the use of mechanical ventilation [ 3 ] [ 4 ] [ 5 ] . In order to meet the needs of the increasingly large number of patients in the COVID - 19 pandemic , the rapid deployment of a large number of new mechanical ventilators [ 6 ] will be required .

Our review included studies that reported adult patients , aged 18 years or older . There was no restriction with respect to gender , race / ethnicity , and comorbidities . The primary outcome of interest was severe COVID - 19 defined by any of the following : all - cause mortality , ICU admission , ARDS , or the need for mechanical ventilation . We included studies reporting at least 10 cases of severe COVID - 19 . To obtain reliable estimates with enough number of outcomes and considering clinical cascade ( e . g . , death as the final outcome ) , when one study reported results for multiple outcomes , we prioritized any composite outcome followed by ICU admission , ARDS , the need of mechanical ventilation , and mortality .

Background : Coronavirus disease 2019 ( COVID - 19 ) , caused by the virus SARS - CoV - 2 , is spreading rapidly across the globe , with no proven effective therapy . Fever is seen in most cases of COVID - 19 , at least at the initial stages of illness . Although fever is typically treated ( with antipyretics or directly with ice or other mechanical means ) , increasing data suggest that fever is a protective adaptive response that facilitates recovery from infectious illness . Objective : To describe a randomized controlled pilot study of core warming patients with COVID - 19 undergoing mechanical ventilation . Methods : This prospective single - site randomized controlled pilot study will enroll 20 patients undergoing mechanical ventilation for respiratory failure due to COVID - 19 . Patients will be randomized 1 : 1 to standard - of - care or to receive core warming via an esophageal heat exchanger commonly utilized in critical care and surgical patients . The primary outcome is the severity of acute respiratory distress syndrome ( as measured by PaO2 / FiO2 ratio ) 24 hours after initiation of treatment . Secondary outcomes include hospital and intensive care unit length of stay , duration of mechanical ventilation , amount of viral shedding , and 30 - day mortality . Results : Resulting data will provide effect size estimates to guide a definitive multi - center randomized clinical trial . ClinicalTrials . gov registration number : pending . Conclusions : With growing data to support clinical benefits of elevated temperature in infectious illness , this study will provide data to guide further understanding of the role of active temperature management in COVID - 19 treatment and provide effect size estimates to power larger studies .

Background : Since December 2019 , when coronavirus disease 2019 ( COVID 19 ) emerged in Wuhan and rapidly spread throughout the world , critically ill patients have a high mortality rate . We aimed to assess the effect of continuous renal replacement therapy ( CRRT ) on all cause mortality in patients with COVID 19 undergoing invasive mechanical ventilation . Methods : In this retrospective cohort study , we included all patients with COVID 19 undergoing invasive mechanical ventilation at Optical Valley Branch of Tongji Hospital Affiliated with Tongji Medical College , Huazhong University of Science and Technology , Wuhan from February 12th to March 2nd , 2020 . Demographic , clinical , laboratory , and treatment data were collected and analyzed . All patients were followed until death or end of follow up ( March 9th ) , and all survivors were followed for at least one week . Findings : Of 36 hospitalized COVID - 19 patients with invasive mechanical ventilation , the mean age was 69 . 4 ( SD 1 . 8 ) years and 30 ( 83 . 3 % ) were men . 22 ( 61 . 1 % ) patients received CRRT ( CRRT group ) and 14 cases ( 38 . 9 % ) were managed in conventional strategy ( non CRRT group ) . There was no difference in age , sex , comorbidities , complications , treatments and most of the laboratory findings , except for patients in the CRRT group with higher levels of aspartate aminotransferase and serum creatinine . During the average follow - up period of 10 . 4 days , 12 of 22 ( 54 . 5 % ) patients in CRRT group and 11 of 14 ( 78 . 6 % ) patients in non CRRT group died . Kaplan Meier analysis demonstrated a prolonged survival in patients in CRRT group than non CRRT group ( P = 0 . 032 ) . The association between CRRT treatment and a reduced risk of mortality remained significant after adjusting for confounding factors in seven different models , with an adjusted hazard ratio ( aHR ) varying between 0 . 283 and 0 . 424 . Older age , higher levels of IL1b , IL2 receptor , hs cTnI and NT proBNP were independently associated with increased risk of mortality in patients with CRRT treatment . Interpretation : CRRT may be beneficial for the treatment of COVID 19 patients with invasive mechanical ventilation . Further prospective multicenter studies with larger sample sizes are required .

BACKGROUND : Since December 2019 , novel coronavirus ( SARS - CoV - 2 ) - infected pneumonia ( COVID - 19 ) occurred in Wuhan , and rapidly spread throughout China . This study aimed to clarify the characteristics of patients with refractory COVID - 19 . METHODS : In this retrospective single - center study , we included 155 consecutive patients with confirmed COVID - 19 in Zhongnan Hospital of Wuhan University from January 1st to February 5th . The cases were divided into general and refractory COVID - 19 groups according to the clinical efficacy after hospitalization , and the difference between groups were compared . RESULTS : Compared with general COVID - 19 patients ( 45 . 2 % ) , refractory patients had an older age , male sex , more underlying comorbidities , lower incidence of fever , higher levels of maximum temperature among fever cases , higher incidence of breath shortness and anorexia , severer disease assessment on admission , high levels of neutrophil , aspartate aminotransferase ( AST ) , lactate dehydrogenase ( LDH ) and C - reactive protein , lower levels of platelets and albumin , and higher incidence of bilateral pneumonia and pleural effusion ( P < 0 . 05 ) . Refractory COVID - 19 patients were more likely to receive oxygen , mechanical ventilation , expectorant , and adjunctive treatment including corticosteroid , antiviral drugs and immune enhancer ( P < 0 . 05 ) . After adjustment , those with refractory COVID - 19 were also more likely to have a male sex and manifestations of anorexia and fever on admission , and receive oxygen , expectorant and adjunctive agents ( P < 0 . 05 ) when considering the factors of disease severity on admission , mechanical ventilation , and ICU transfer . CONCLUSION : Nearly 50 % COVID - 19 patients could not reach obvious clinical and radiological remission within 10 days after hospitalization . The patients with male sex , anorexia and no fever on admission predicted poor efficacy .

What is known of the frequency, manifestations, and course of extrapulmonary manifestations of COVID-19?

Abstract : Pneumonia appears to be the most manifestation of COVID 19 , but some extrapulmonary involvement such as gastrointestinal , cardiac and renal has been reported . According to limited clinical data about the virus behavior up to now , specially extra - pulmonary symptoms , we should be aware on possibility of initial cerebrovascular manifestations of COVID19 .

Clinical features of SARS and MERS . Patients with SARS or MERS present with various clinical features , ranging from asymptomatic or mild respiratory illness to fulminant severe acute respiratory disease with extrapulmonary manifestations8 , 9 . Both diseases have predominantly respiratory manifestations , but extrapulmonary features may occur in severe cases56 ( see Supplementary information S2 ( table ) ) . Notably , early treatment is especially important for patients with severe MERS because this disease progresses to respiratory distress , renal failure and death much more rapidly than SARS does . The three - to four - fold higher case - fatality rate of MERS relative to SARS may be related to the higher median age and prevalence of comorbidities in patients with MERS as well as the different pathogenesis of the two diseases9 , 58 , 59 , 60 , 61 . Comorbidities associated with severe MERS include obesity , diabetes mellitus , systemic immunocompromising conditions and chronic cardiac and pulmonary diseases9 , 60 , 62 , 63 . Although the rate of secondary transmission among household contacts of index MERS patients ( which is approximately 4 % ) and the estimated pandemic potential of MERS - CoV are lower than those of SARS - CoV , the rapidly progressive clinical course and high fatality of MERS continues to pose a major threat to at - risk populations64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ( see Supplementary information S2 ( table ) ) .

Clinical characteristics . Beside CT examination results , initial symptoms were helpful in screening . For clinical manifestation , fever , dyspnea , chest tightness , cough , sputum , weakness , vomiting , diarrhea , etc . were observed in the patients with COVID - 19 infection . 5 , 7 Of these clinical characteristics , fever and cough were the most frequency percentage of initial symptoms , and the other manifestations should be taken consideration .

The mean incubation period of SARS is 6 . 4 days ( 2 to 10 days ) , and the clinical features are summarized in Table 1 . The key feature is the occurrence of rapidly progressive pneumonia , sometimes with dramatic overnight progression from a mild to bilateral pneumonia and then acute respiratory distress syndrome . The occurrence of upper respiratory tract symptoms is unusual . Patients with diarrhea could potentially be highly infectious . Physical signs are scarce in the first few days but become more prominent as patients develop extensive lung consolidation . Although SARS is predominantly a respiratory illness , extrapulmonary manifestations are not infrequently encountered ( Table 2 ) .

What is known of the frequency, manifestations, and course of cardiomyopathy?

What is known of the frequency, manifestations, and course of cardiac arrest?

Application of regulatory standards (e.g., EUA, CLIA)

Ability to adapt care to crisis standards of care level

The atypical presentation and lack of communication in this case led to unnecessary HCW ' s exposures and risk . As community spread becomes more prevalent and PPE shortages continue , it is up to the health care team to assess the level of risk [ 2 , 8 ] . However , it is the authors ' opinion that given the of risk of COVID - 19 to HCW ' s and continued atypical presentations that PPE to include a face mask should be considered for every patient depending on the incidence of COVID - 19 within their community . As we continue in this health crisis it is critical that communication continues to be of the utmost importance [ 9 ] . In this case , communication could have protected dozens of patients and HCW ' s . It should be noted that this case was at the beginning of the United States outbreak when national and institutional standards were in their infancy , and new adaptations to these standards are being made daily . We present this case as a lesson learned from the front lines and to bring awareness of atypical COVID - 19 cases as they continue to present .

Provision of care with an egalitarian approach in the face of crisis where circumstances are swiftly changing can be arduous . Prioritization and rapid adaptation within mental health services with available resources may be required with increasing demands of mentally ill persons .

Principles of the crisis standard of care should be used in disaster response when health care needs overwhelm available resources . 12 At the highest response levels , plans for the advancement of senior residents and fellows to attending status may be required . Given the increased need for critical care expertise at this highest level , emergency general surgery ( EGS ) and trauma coverage should be transitioned to general surgery trained elective surgeons to allow deployment of any surgical critical care ( SCC ) trained physicians solely to the intensive care setting . We recommend a tiered reallocation of Acute Care Surgeons ( ACS ) faculty as appropriate for each respective facility . At severe manpower shortage levels , non - ACS familiar with high - acuity priorities and hemorrhage control , like vascular , transplant , and hepatobiliary surgeons may be required to take trauma call . Additionally , when supra - maximum patient capacity , with decreasing providers in Critical Care and Internal Medicine , subspecialized surgeons will likely be called to become general physicians to treat the non - critical patients with COVID - 19 . However , every nurse , therapists , ancillary staff , and physician regardless of specialty should have some basic training of ventilator management given the possibility of provider depletion and expansion of ICU ' s .

In crisis care , there are inadequate resources available to provide equivalent care and care is provided to the highest level possible , acknowledging that there will likely be increased mortality and morbidity as a result of scarce resources , but striving to provide this care in the highest quality and most ethical way possible . We used this framework to guide the development of a palliative care strategy in response to the COVID - 19 pandemic .

A surge in workload will likely be seen in the NHS and across the world at a time when staffing is well below optimal levels . Pragmatic choices will need to be made about achievable and acceptable levels of care with national guidance and local adaptation . It will need to be emphasised that chest imaging should be undertaken as clinically indicated in pregnant women .

Approaches for encouraging and facilitating the production of elastomeric respirators, which can save thousands of N95 masks

Which are the best telemedicine practices?

The rapid spread of Coronavirus disease 2019 ( COVID - 19 ) presents China with a critical challenge . As normal capacity of the Chinese hospitals is exceeded , healthcare professionals struggling to manage this unprecedented crisis face the difficult question of how best to coordinate the medical resources used in highly separated locations . Responding rapidly to this crisis , the National Telemedicine Center of China ( NTCC ) , located in Zhengzhou , Henan Province , has established the Emergency Telemedicine Consultation System ( ETCS ) , a telemedicine - enabled outbreak alert and response network . ETCS is built upon a doctor - to - doctor ( D2D ) approach , in which health services can be accessed remotely through terminals across hospitals . The system architecture of ETCS comprises three major architectural layers : ( 1 ) telemedicine service platform layer , ( 2 ) telemedicine cloud layer , and ( 3 ) telemedicine service application layer . Our ETCS has demonstrated substantial benefits in terms of the effectiveness of consultations and remote patient monitoring , multidisciplinary care , and prevention education and training .

ABSTRACT Within weeks , COVID - 19 has transformed our practice of palliative care and clinical medicine as we know it . Telemedicine has emerged as a critical technology to bring medical care to patients while attempting to reduce the transmission of COVID - 19 among patients , families , and clinicians . It is also increasingly necessary to preserve scarce resources like personal protective equipment . In this article , we share just - in - time tips to support palliative care clinicians and program leaders in providing the best care possible by telemedicine . These quick , practical tips cover telemedicine set - up , patient considerations , and clinician considerations . Next steps include ensuring equitable access to affordable telemedicine technology for vulnerable populations through creative solutions and financing , and dedicated attention to telemedicine evaluation and quality improvement .

Within weeks , COVID - 19 has transformed our practice of palliative care and clinical medicine as we know it . Telemedicine has emerged as a critical technology to bring medical care to patients while attempting to reduce the transmission of COVID - 19 among patients , families , and clinicians . It is also increasingly necessary to preserve scarce resources like personal protective equipment . In this article , we share just - in - time tips to support palliative care clinicians and program leaders in providing the best care possible by telemedicine . These quick , practical tips cover telemedicine set - up , patient considerations , and clinician considerations . Next steps include ensuring equitable access to affordable telemedicine technology for vulnerable populations through creative solutions and financing , and dedicated attention to telemedicine evaluation and quality improvement .

Telemedicine is a proven modality for delivering palliative care value to the most vulnerable people . Care of people with serious illness and their families now requires impeccable social distancing for their protection and for all healthcare professionals so critically needed in response to COVID - 19 . Preparation , patience , and practice will help ensure effective implementation of telemedicine . The quick tips offered above are an excellent starting point , but additional support and innovation can help eliminate barriers and stimulate rapid mastery . First , we must find creative ways to ensure that all patients have equitable access to this valuable resource . We must reach individuals with poor social networks , poor technological literacy , and who lack access to technology . Soliciting the help of volunteers , philanthropy , and tech companies who can create plug - and - play telemedicine devices at low - cost can help shore up potential gaps in access . Second , reimbursement for telephone visits , particularly to those in whom video visits are not possible , will incentivize the use of this important modality when it is needed . Third , we must capitalize on this unprecedented time in which telemedicine will become a critical part of healthcare delivery to study processes and outcomes through programmatic evaluation and research to guide best practices in the future .

ETCS is built upon a doctor - to - doctor ( D2D ) approach , in which health services can be accessed remotely through terminals across hospitals . The system architecture of ETCS comprises three major architectural layers : ( 1 ) telemedicine service platform layer , ( 2 ) telemedicine cloud layer , and ( 3 ) telemedicine service application layer , as depicted in Figure 1 . The telemedicine service platform layer enables a specialist treatment team of provincial specialists to conquer distance and provide access to clinicians working in the regional hospitals . It provides clinicians and patients with immediate diagnosis and consultations regarding COVID - 19 , wireless remote patient monitoring , remote multiple disciplinary care , and telehealth for education and training , utilizing interactive live video conferencing . The specialist treatment team members work closely with the NCPPCH and Health Commission of Henan Province to prevent and control the spread of COVID - 19 . The telemedicine cloud layer allows clinicians to capture , store and process patient medical records , and to achieve real - time data exchange . In addition , prevention and treatment guidelines , and guidance on drug use and management of coronavirus patients can be accessed via the telemedicine cloud . The telemedicine service application layer involves 2 provincial - level hospitals , 18 municipal hospitals and 106 county - level hospitals , which can obtain consultations from the specialist treatment team . This logical structure supports a system of telemedicine clinical management to combat the COVID - 19 outbreak . the author / funder , who has granted medRxiv a license to display the preprint in perpetuity .

Which are the facilitators to expand the telemedicine practices?

As we look to the future of epidemic prevention and control , we believe that telemedicine systems have the potential to play a role in addressing emergencies and large - scale outbreaks in high uncertainty settings . As telemedicine has inevitably altered the traditional working relationships within the healthcare network , how to ensure high - quality communication among healthcare practitioners poses a significant challenge . As such , frequent , timely , accurate , and problem - solving focused communication among clinical staffs from hospitals at different levels in the healthcare system is essential to minimize the risk incurred in handling patients with possible COVID - 19 infection 3 . However , we have found that high quality of communication is not always maintained during the telemedicine coordination . Therefore , a learning telemedicine system platform for coronavirus care was developed across connected hospitals , serving as the overarching authoritative source for diagnostic decision making and knowledge sharing for treatment . The platform could aggregate COVID - 19 patient records across 126 connected hospitals and rapidly expand to enable open collaborations with key stakeholders such as government authorities , research institutions and laboratories . The lessons learned from this crisis can provide insights to guide public health institutions as they implement telemedicine to increase resilience to future epidemic outbreaks .

On the other hand , this can be viewed as an educational opportunity . We will be forced to become acquainted with the practice of telemedicine , something in which we would otherwise have lacked experience . Even when normalcy returns , telemedicine might gain an increasing role in medical practice . Our experience may allow us to incorporate new skills into future situations that warrant telemedicine visits , such as patients who lack adequate transportation . Additionally , this gives an opportunity to develop competency to triage between those who need in - person office and virtual visits . The solutions that have arisen out of this current crisis may continue to play an integral part in the outreach of difficult - to - reach patient populations .

With the emergence of COVID - 19 , telemedicine has been catapulted into the role of a critically essential service for patients to help mitigate the spread of COVID - 19 and preserve valuable personal protective equipment . For example , the University of California , San Francisco ( UCSF ) has mandated telemedicine be used to care for palliative care and non - palliative care patients whenever possible in ambulatory settings . Similarly , many hospice agencies are currently offering most , if not all , social work and chaplaincy support by telemedicine . For hospitals , strict limitations on visitors has meant that some inpatient palliative care consult programs are performing family meetings and consults virtually . To support these changes , many telemedicine regulatory measures are being relaxed . As of this month in the United States , patients can receive telemedicine across state lines , Medicare will reimburse for telemedicine visits , and the Drug Enforcement Administration will allow prescription of controlled substances by telemedicine without a prior in - person evaluation ( 2 ) .

The decline in workforce capacity of physicians and nurses raise serious concerns about diminishing the quality of health care delivery system . This fact will emphasize another important aspect of using telemedicine which is the ability to reinforce those health care workers that have been quarantined at home after exposure to COVID - 19 and employ quarantined physicians to communicate with patients remotely via computer . It should be noted that telemedicine cannot replace in - person patient care , but could benefit other frontline physicians

J o u r n a l P r e - p r o o f Physicians can employ virtual communication with patients in the form of telemedicine . 4 Telemedicine allows interactions with patients while adhering to social distancing . Patients at risk , may benefit from staying at home , reducing exposure to others , while receiving medical care . Elderly populations have more medical conditions / comorbidities thus requiring increased doctor visits . With telemedicine , elderly patients can continue their care , lowering their nonemergent office visits . It is essential to employ all modes of reducing transmission and telemedicine allows this without compromising care .

Which are the specific actions to expand the telemedicine practices?

As we look to the future of epidemic prevention and control , we believe that telemedicine systems have the potential to play a role in addressing emergencies and large - scale outbreaks in high uncertainty settings . As telemedicine has inevitably altered the traditional working relationships within the healthcare network , how to ensure high - quality communication among healthcare practitioners poses a significant challenge . As such , frequent , timely , accurate , and problem - solving focused communication among clinical staffs from hospitals at different levels in the healthcare system is essential to minimize the risk incurred in handling patients with possible COVID - 19 infection 3 . However , we have found that high quality of communication is not always maintained during the telemedicine coordination . Therefore , a learning telemedicine system platform for coronavirus care was developed across connected hospitals , serving as the overarching authoritative source for diagnostic decision making and knowledge sharing for treatment . The platform could aggregate COVID - 19 patient records across 126 connected hospitals and rapidly expand to enable open collaborations with key stakeholders such as government authorities , research institutions and laboratories . The lessons learned from this crisis can provide insights to guide public health institutions as they implement telemedicine to increase resilience to future epidemic outbreaks .

Principle 3 : Care for patients and families . Serious illness affects both patients and their loved ones ; therefore , care of and communication with both is essential . Communication and family meetings are still critical but now must rely on technology and telemedicine . These approaches are by necessity expanding to implement best practices during the COVID - 19 pandemic . 4 Finding the right words to say about prognosis , grief , and loss can be difficult for clinicians , even under normal circumstances . The pandemic will only amplify this problem . PC clinicians and researchers have developed guides for communication during serious illness with tools such as VitalTalk , which recently added specific guidance for communication related to COVID - 19 . 5 For example , VitalTalk provides suggested language for conversations around poor prognosis or in the face of system - wide triage decisions that may make ICU beds or ventilators unavailable to some patients . Such communication tools can be used by non - palliative specialist clinicians to conduct difficult , yet critical conversations with patients and families during the COVID - 19 pandemic .

ETCS is built upon a doctor - to - doctor ( D2D ) approach , in which health services can be accessed remotely through terminals across hospitals . The system architecture of ETCS comprises three major architectural layers : ( 1 ) telemedicine service platform layer , ( 2 ) telemedicine cloud layer , and ( 3 ) telemedicine service application layer , as depicted in Figure 1 . The telemedicine service platform layer enables a specialist treatment team of provincial specialists to conquer distance and provide access to clinicians working in the regional hospitals . It provides clinicians and patients with immediate diagnosis and consultations regarding COVID - 19 , wireless remote patient monitoring , remote multiple disciplinary care , and telehealth for education and training , utilizing interactive live video conferencing . The specialist treatment team members work closely with the NCPPCH and Health Commission of Henan Province to prevent and control the spread of COVID - 19 . The telemedicine cloud layer allows clinicians to capture , store and process patient medical records , and to achieve real - time data exchange . In addition , prevention and treatment guidelines , and guidance on drug use and management of coronavirus patients can be accessed via the telemedicine cloud . The telemedicine service application layer involves 2 provincial - level hospitals , 18 municipal hospitals and 106 county - level hospitals , which can obtain consultations from the specialist treatment team . This logical structure supports a system of telemedicine clinical management to combat the COVID - 19 outbreak . the author / funder , who has granted medRxiv a license to display the preprint in perpetuity .

Scientific studies support the usage of telemedicine in patients of diabetes . A metaanalysis of 35 randomized controlled trials ( RCTs ) of telemedicine ( video , phone and email ) from China ( involving a pooled population ( n , 3514 ) given telemedicine over 3 - 60 months ) was done . This study showed a reduction in HbA1c by - 0 . 37 % ( p < 0 . 001 ) in telemedicine group when compared to controls . 11 In a Cochrane review done by Flodgren and colleagues 12 , 21 RCTs of patient with diabetes ( n , 2768 ) were analyzed . These patients had interactive telemedicine ( remote monitoring or real time video ) delivered in addition to , or as an alternative to , or partly substituted for standard care vs . standard care alone . This study showed that there was a reduction of HbA1c by - 0 . 31 % ( p < 0 . 001 ) in patients on telemedicine when compared with controls . In a recently published review of 46 studies , which included patients of type 2 diabetes mellitus ( T2DM , n , 24000 ) and type 1 diabetes mellitus ( T1DM n , 2052 ) , different modes of telemedicine were studied . There was overall mean reduction in HbA1c in telemedicine intervention group in both T1DM ( - 0 . 12 to - 0 . 86 % ) and T2DM ( - 0 . 01 % to - 1 . 13 % ) patients . 13 Research on telemedicine and diabetes in India is sparse . In a recently published article from our group , we have shown usage of customized mobile van with facility of telemedicine ( use of computer and Skype video app to transmit retinal images to ophthalmologist and to consult with diabetes foot specialist and diabetologist at a tertiary care center ) in underprivileged areas of Delhi . In this study , we showed success in screening and managing diabetes using telemedicine . 14

• The United States Department of Health and Human Services recently liberalized HIPAA compliance guidelines for the COVID - 19 pandemic . It is possible to use a variety of non - public facing video communication tools , many of which are free or low cost , including , Apple FaceTime , Facebook Messenger video chat , Google Hangouts video , and Skype . Consult with local leadership for specific institutional guidelines . • Patients need access to a smartphone , tablet , or a computer with audio and a camera as well as a data - plan or internet connection . • For patients who are new to telemedicine , identify one key contact ( preferably Englishspeaking ) who can serve as the " technological liaison " for the patient / family . • When resources allow , designate palliative care program administrative staff and / or volunteers to reach out to the " technological liaison " at least 1 - 2 days before the telemedicine visit to provide set - up instructions and perform a test run . Ensure the " technological liaison " is available during the scheduled visit to troubleshoot technological glitches in real - time . • For programs that have a patient portal as part of the electronic medical record , a " dot phrase " that includes instructions for patients / families on how to download the telemedicine platform and prepare for the visit can be helpful . Provide this information a few days prior to the visit .

Guidance on the simple things people can do at home to take care of sick people and manage disease

There are many things that health services are doing to manage and prepare for the COVID - 19 response . Physical preparations may include modifying the facility layout , bed allocations and people flow . Moving to telehealth services , reduced contact with women and reducing visitors to the hospital are also happening . Staff may also need to make preparations at home for the care of their own children and other relatives , and preparations for longer and irregular shifts . These health system changes and adaptations are critical at this time and are already occurring in countries affected by COVID - 19 .

be delivered . For example , mental health professionals , social workers , nursing home administrators , and volunteers should deliver mental health care for people living with dementia collaboratively . Within such a team , dementia experts could take the lead and support team members from other disciplines . Self - help guidance for reducing stress , such as relaxation or meditation exercise , could be delivered through electronic media . Service teams could support behavioural management through telephone hotlines . Psychological counsellors could provide online consultation for carers at home and in nursing homes . 11 In addition , we encourage people who have a parent with dementia to have more frequent contact or spend more time with their parent , or to take on some of the caregiving duties so as to give the carer some respite time .

( 2 ) Chronic disease management 16 During the COVID - 19 pandemic , pharmacists shall actively provide guidance to community patient population on chronic disease management to improve patients ' medication adherence and support their self - monitoring of the effectiveness and safety of current therapy . Pharmacists shall instruct patients to take home medications on time with the same dosage as usual , and emphasize the importance of adherence in chronic disease control and in avoiding unnecessary hospital visits during the pandemic . Patients shall make sure the medication is within the period of validity before taking . Do not take expired medications due to drug shortage or to avoid pharmacy visits . Inform patients on the availability of drug delivery or mail order services provided in the pharmacy and encourage patients to use such services during the pandemic if needed .

Millions of people are currently exposed to a high risk of contamination . Among them , adults taking care of family members who tested positive for SARS - CoV - 2 at home , and medical and paramedical staffs treating hospitalized patients with symptomatic COVID - 19 , are highly susceptible to infection and may represent a second wave of extreme importance in the next few weeks . If those people get sick , we ' ll face another significant problem . Those highly exposed people should be protected . In that case , J o u r n a l P r e - p r o o f social distancing measures do not apply . In the absence of a vaccine , post - exposure pharmacological protection is the only way to prevent caregivers from becoming symptomatic .

• Avoid touching your eyes , nose , and mouth with unwashed hands . • Avoid close contact with people who are sick . • If you feel unwell , stay at home , do not attend work or school . • Cover your cough or sneeze with a tissue , then throw the tissue in a bin . • Clean and disinfect frequently touched objects and surfaces in the home and work environment .

Which are the oral medications that might potentially work?

Public health emergencies have an impact on the public mental health . The outbreak of the novel coronavirus has affected the normal diagnosis and treatment services in oral medical institutions across the country . Delay of non - emergency dental service will have a potential impact on the experience , cognition , treatment and rehabilitation of patients with oral diseases . Through literature review , this paper reviewed the oral psychosomatic diseases closely related to patients ' psychological state , such as oral mucosal disease , temporomandibular joint disease , bruxism , periodontal disease and so on . It was believed that these patients might be more susceptible to the impact of stress events , and dental specialists should pay more attention to them . At the same time , this paper analyzes the possible psychological stress symptoms of patients with different oral diseases , and puts forward suggestions for remote consultation and emergency treatment of dentists . From the perspective of social role , dentists not only played the role of expert in dental home professional guidance , but also played the role of psychological counseling for patients .

is the ( which was not peer - reviewed ) The copyright holder for this preprint . https : / / doi . org / 10 . 1101 / 2020 . 03 . 22 . 20040964 doi : medRxiv preprint In conclusion , chloroquine and hydroxchloroquine might have the potential to be the best therapeutic medication for this rampant COVID - 19 in the present context . However the corroborating evidences from these undergoing clinical trials are definitely demanded to make the ultimate decision on COVID - 19 treatment .

Abstract The coronavirus ( CoV ) family consists of viruses that infects a variety of animals including humans with various levels of respiratory and fecal - oral transmission levels depending on the behavior of the viruses ' natural hosts and optimal viral fitness . A model to classify and predict the levels of respective respiratory and fecal - oral transmission potentials of the various viruses was built before the outbreak of MERS - CoV using AI and empirically - based molecular tools to predict the disorder level of proteins . Using the percentages of intrinsic disorder ( PID ) of the nucleocapsid ( N ) and membrane ( M ) proteins of CoV , the model easily clustered the viruses into three groups with the SARS - CoV ( M PID = 8 % , N PID = 50 % ) falling into Category B , in which viruses have intermediate levels of both respiratory and fecal - oral transmission potentials . Later , MERS - CoV ( M PID = 9 % , N PID = 44 % ) was found to be in Category C , which consists of viruses with lower respiratory transmission potential but with higher fecal - oral transmission capabilities . Based on the peculiarities of disorder distribution , the SARS - CoV - 2 ( M PID = 6 % , N PID = 48 % ) has to be placed in Category B . Our data show however , that the SARS - CoV - 2 is very strange with one of the hardest protective outer shell , ( M PID = 6 % ) among coronaviruses . This means that it might be expected to be highly resilient in saliva or other body fluids and outside the body . An infected body is likelier to shed greater numbers viral particles since the latter is more resistant to antimicrobial enzymes in body fluids . These particles are also likelier to remain active longer . These factors could account for the greater contagiousness of the SARS - CoV - 2 and have implications for efforts to prevent its spread .

We compared the medications on the first day of admission and during the hospitalization in patients with AKI and non - AKI . We found that patients with AKI were more likely to have higher proportion of glucocorticoid and lower proportion of antiviral drugs and renin - angiotensin - aldosterone system ( RAAS ) inhibitors treatment on admission . The difference in the use of glucocorticoid may be explained by the condition of patients with AKI that was more severe , thus physicians tended to use glucocorticoid in the most critically ill patients , even if there is a controversy on the use of glucocorticoid in COVID - 19 patients . 22 , 23 However , the oral antiviral drugs , including arbidol ( umifenovir ) , oseltamivir , lopinavir and ritonavir , were preferred in moderate patients on admission . Given that ACE2 is a functional receptor for SARS - CoV - 2 , the safety and potential effects of RAAS inhibitors in patients with COVID - 19 should be carefully considered . 24 Even though this study included a large number of patients from a tertiary teaching hospital in Wuhan , it has several limitations . First , an accurate baseline serum creatinine was not available , which may have led to an underestimation of AKI or erroneous associations . Second , although we attempted to adjust for many confounders , other unmeasured or unknown confounders might have played a role .

Use of artificial intelligence in real-time health care delivery to evaluate interventions

The strict control of cross - infection in medical institutions is also key to preventing the further spread of the epidemic . In addition , actively mobilizing the population to participate in epidemic prevention and control is critical , and this can be achieved by accurate information dissemination and ongoing updates . Real - time updating the information of the epidemic situation can help to alleviate panic and reduce societal anxiety . A strong public health surveillance system to guide the response to the outbreak is important in the face of a lack of effective therapeutics or vaccines . Big data and artificial intelligence systems are tools that can be used to fully integrate the information , conduct comprehensive research and analyze public health risks . Last but not least , use of the Internet and the media to conduct health education for the people , publicize the correct knowledge of prevention , and offer online consultation to guide patients to seek medical treatment correctly are additional strategies that can be implemented to achieve viral containment .

Artificial Intelligence ( AI ) has been shown to be an effective tool in predicting medical conditions and adverse events , and help caregivers with medical decision - making [ 9 ] - [ 13 ] . In this study , we proposed a data - driven predictive analytics algorithm based on Artificial Intelligence ( AI ) and machine learning to determine the health risk and predict the mortality risk of patients with COVID - 19 . The developed system can help hospitals and medical facilities decide who needs to get attention first , who has higher priority to be hospitalized , triage patients when the system is overwhelmed by overcrowding , and eliminate delays in providing the necessary care . The algorithm predicts the mortality risks based on patients ' physiological conditions , symptoms , and demographic information .

by mental health professionals in medical institutions , universities , and academic societies throughout all 31 provinces , municipalities , and autonomous regions in mainland China , which provide free 24 - h services on all days of the week . Online psychological self - help intervention systems , including online cognitive behavioural therapy for depression , anxiety , and insomnia ( eg , on WeChat ) , have also been developed . In addition , several artificial intelligence ( AI ) programmes have been put in use as interventions for psychological crises during the epidemic . For example , individuals at risk of suicide can be recognised by the AI programme Tree Holes Rescue , 5 by monitoring and analysing messages posted on Weibo , and alerting designated volunteers to act accordingly .

In the wake of COVID - 19 disease , caused by the SARS - CoV - 2 virus , we designed and developed a predictive model based on Artificial Intelligence ( AI ) and Machine Learning algorithms to determine the health risk and predict the mortality risk of patients with COVID - 19 . In this study , we used documented data of 117 , 000 patients world - wide with laboratory - confirmed COVID - 19 . This study proposes an AI model to help hospitals and medical facilities decide who needs to get attention first , who has higher priority to be hospitalized , triage patients when the system is overwhelmed by overcrowding , and eliminate delays in providing the necessary care . The results demonstrate 93 % overall accuracy in predicting the mortality rate . We used several machine learning algorithms including Support Vector Machine ( SVM ) , Artificial Neural Networks , Random Forest , Decision Tree , Logistic Regression , and K - Nearest Neighbor ( KNN ) to predict the mortality rate in patients with COVID - 19 . In this study , the most alarming symptoms and features were also identified . Finally , we used a separate dataset of COVID - 19 patients to evaluate our developed model accuracy , and used confusion matrix to make an in - depth analysis of our classifiers and calculate the sensitivity and specificity of our model .

In this research , we present our experience in developing and deploying an artificial intelligence ( AI ) based method to assist novel coronavirus pneumonia screening using CT imaging .

Use of artificial intelligence in real-time health care delivery to evaluate risk factors

Artificial Intelligence ( AI ) has been shown to be an effective tool in predicting medical conditions and adverse events , and help caregivers with medical decision - making [ 9 ] - [ 13 ] . In this study , we proposed a data - driven predictive analytics algorithm based on Artificial Intelligence ( AI ) and machine learning to determine the health risk and predict the mortality risk of patients with COVID - 19 . The developed system can help hospitals and medical facilities decide who needs to get attention first , who has higher priority to be hospitalized , triage patients when the system is overwhelmed by overcrowding , and eliminate delays in providing the necessary care . The algorithm predicts the mortality risks based on patients ' physiological conditions , symptoms , and demographic information .

The strict control of cross - infection in medical institutions is also key to preventing the further spread of the epidemic . In addition , actively mobilizing the population to participate in epidemic prevention and control is critical , and this can be achieved by accurate information dissemination and ongoing updates . Real - time updating the information of the epidemic situation can help to alleviate panic and reduce societal anxiety . A strong public health surveillance system to guide the response to the outbreak is important in the face of a lack of effective therapeutics or vaccines . Big data and artificial intelligence systems are tools that can be used to fully integrate the information , conduct comprehensive research and analyze public health risks . Last but not least , use of the Internet and the media to conduct health education for the people , publicize the correct knowledge of prevention , and offer online consultation to guide patients to seek medical treatment correctly are additional strategies that can be implemented to achieve viral containment .

In the wake of COVID - 19 disease , caused by the SARS - CoV - 2 virus , we designed and developed a predictive model based on Artificial Intelligence ( AI ) and Machine Learning algorithms to determine the health risk and predict the mortality risk of patients with COVID - 19 . In this study , we used documented data of 117 , 000 patients world - wide with laboratory - confirmed COVID - 19 . This study proposes an AI model to help hospitals and medical facilities decide who needs to get attention first , who has higher priority to be hospitalized , triage patients when the system is overwhelmed by overcrowding , and eliminate delays in providing the necessary care . The results demonstrate 93 % overall accuracy in predicting the mortality rate . We used several machine learning algorithms including Support Vector Machine ( SVM ) , Artificial Neural Networks , Random Forest , Decision Tree , Logistic Regression , and K - Nearest Neighbor ( KNN ) to predict the mortality rate in patients with COVID - 19 . In this study , the most alarming symptoms and features were also identified . Finally , we used a separate dataset of COVID - 19 patients to evaluate our developed model accuracy , and used confusion matrix to make an in - depth analysis of our classifiers and calculate the sensitivity and specificity of our model .

Artificial intelligence technology can play a key role in almost every aspect including traffic management , infection detection , logistics supply chain , etc . This is a very important feature of a modern data - driven smart city . If the status of each citizen is listed , all can be accurately tracked and any population can be accommodated . Therefore , the flow of population can be controlled in a more orderly manner . Artificial intelligence technologies can be used to employ smart devices to support diagnosis and treatment , and can be used in telecommunications , online training and intelligent manufacturing to ensure minimal disruption to people ' s lives . Some hospitals use smart systems . Train stations can install powerful thermal imagers to measure the body temperature of passengers . Overall , efficiency and speed are very important in the control process , and conflicting research needs to be conducted ( 9 - 11 ) .

Use of artificial intelligence in real-time health care delivery to evaluate outcomes

The strict control of cross - infection in medical institutions is also key to preventing the further spread of the epidemic . In addition , actively mobilizing the population to participate in epidemic prevention and control is critical , and this can be achieved by accurate information dissemination and ongoing updates . Real - time updating the information of the epidemic situation can help to alleviate panic and reduce societal anxiety . A strong public health surveillance system to guide the response to the outbreak is important in the face of a lack of effective therapeutics or vaccines . Big data and artificial intelligence systems are tools that can be used to fully integrate the information , conduct comprehensive research and analyze public health risks . Last but not least , use of the Internet and the media to conduct health education for the people , publicize the correct knowledge of prevention , and offer online consultation to guide patients to seek medical treatment correctly are additional strategies that can be implemented to achieve viral containment .

Artificial Intelligence ( AI ) has been shown to be an effective tool in predicting medical conditions and adverse events , and help caregivers with medical decision - making [ 9 ] - [ 13 ] . In this study , we proposed a data - driven predictive analytics algorithm based on Artificial Intelligence ( AI ) and machine learning to determine the health risk and predict the mortality risk of patients with COVID - 19 . The developed system can help hospitals and medical facilities decide who needs to get attention first , who has higher priority to be hospitalized , triage patients when the system is overwhelmed by overcrowding , and eliminate delays in providing the necessary care . The algorithm predicts the mortality risks based on patients ' physiological conditions , symptoms , and demographic information .

In the wake of COVID - 19 disease , caused by the SARS - CoV - 2 virus , we designed and developed a predictive model based on Artificial Intelligence ( AI ) and Machine Learning algorithms to determine the health risk and predict the mortality risk of patients with COVID - 19 . In this study , we used documented data of 117 , 000 patients world - wide with laboratory - confirmed COVID - 19 . This study proposes an AI model to help hospitals and medical facilities decide who needs to get attention first , who has higher priority to be hospitalized , triage patients when the system is overwhelmed by overcrowding , and eliminate delays in providing the necessary care . The results demonstrate 93 % overall accuracy in predicting the mortality rate . We used several machine learning algorithms including Support Vector Machine ( SVM ) , Artificial Neural Networks , Random Forest , Decision Tree , Logistic Regression , and K - Nearest Neighbor ( KNN ) to predict the mortality rate in patients with COVID - 19 . In this study , the most alarming symptoms and features were also identified . Finally , we used a separate dataset of COVID - 19 patients to evaluate our developed model accuracy , and used confusion matrix to make an in - depth analysis of our classifiers and calculate the sensitivity and specificity of our model .

Artificial intelligence technology can play a key role in almost every aspect including traffic management , infection detection , logistics supply chain , etc . This is a very important feature of a modern data - driven smart city . If the status of each citizen is listed , all can be accurately tracked and any population can be accommodated . Therefore , the flow of population can be controlled in a more orderly manner . Artificial intelligence technologies can be used to employ smart devices to support diagnosis and treatment , and can be used in telecommunications , online training and intelligent manufacturing to ensure minimal disruption to people ' s lives . Some hospitals use smart systems . Train stations can install powerful thermal imagers to measure the body temperature of passengers . Overall , efficiency and speed are very important in the control process , and conflicting research needs to be conducted ( 9 - 11 ) .

Despite limitations in conducting randomized controlled trials , some fellows may find more time that can be allocated toward other types of research or learning new skills . Acquiring data through the combination of social media data and electronic health record data may be an innovative method to continue research endeavors . 3 Furthermore , crowd sourcing is another method that can be used . There has been success with the use of such tools in prior gastroenterology research . 4 Artificial intelligence is rapidly altering the endoscopy landscape , and much research can be done using existing image and video repositories , even in the current restrictive environment . Moreover , collaborative research projects may provide an opportunity to interact with peers in a stimulating academic environment while complying with social distancing .

Which are the challenges, solutions and technologies in hospital flow and organization?

Although telemedicine is a useful solution , it is not without its problems . Some institutions integrated it as part of their practice a long time ago . For others it is new technology , and its implementation will be complicated by the challenges of learning a new system . Technical issues may also arise , such as connection disruptions that can make establishing rapport difficult . Furthermore , because this is a new technology for some providers , it may be challenging to triage patients between in - person office and telemedicine visits . This ability is crucial because precluding patients from a necessary office visit may lead to increased emergency department visits .

To address the various issues of infection control , information flow , resuscitation training , advanced ICU services and psychological well - being of staff , we formulated several principles and solutions , which we hope can help other ICUs prepare for COVID - 19 ( see Table 1 ) .

Background The COVID - 19 pandemic presents a unique challenge to surgical residency programs . Due to the restrictions recommended by the Centers for Disease Control and Prevention and other organizations , the educational landscape for surgical residents is rapidly changing . In addition , the time course of these changes is undefined . Methods We attempt to define the scope of the problem of maintaining surgical resident education while maintaining the safety of residents , educators , and patients . Within the basic framework of limiting in - person gatherings , postponing or canceling elective operations in hospitals , and limiting rotations between sites , we propose innovative solutions to maintain rigorous education . Results We propose several innovative solutions including the flipped classroom model , online practice questions , teleconferencing in place of in - person lectures , involving residents in telemedicine clinics , procedural simulation , and the facilitated use of surgical videos . Although there is no substitute for hands - on learning through operative experience and direct patient care , these may be ways to mitigate the loss of learning exposure during this time . Conclusions These innovative solutions utilizing technology may help to bridge the educational gap for surgical residents during this unprecedented circumstance . The support of national organizations may be beneficial in maintaining rigorous surgical education .

In this study , we analyzed the spatial representation of the disease , material , population and social psychology at three scales : individual , JID : GEOSUS [ m5GeSdc ; March 28 , 2020 ; 14 : 39 ] group and regional . At the individual scale , the comparison between spatial epidemic tracking and the spatiotemporal trajectories of patients was carried out . At the group scale , the estimation of population flow and the spatial distribution was carried out . At the regional scale , the segmentation of spatial risk , the analysis of balance between the supply and demand of medical resources , and the spatial differentiation analysis of material transportation capacity and social sentiment were carried out . From the perspective of GIS technology , this study revolutionized the data acquisition methods through big data technology , which achieved rapid data acquisition and integration from traditional data to big data of various organizations . The analysis platform was quickly constructed through an innovative construction technology system , which provided the technical platform for timely epidemic analysis . The production of epidemic maps was quickly completed through multi - scale dynamic template technology , which allowed timely dissemination of epidemic dynamic information . From the perspective of spatial simulation and analysis , this study simulated the spatial transmission process of the epidemic scientifically by increasing detailed regional variables and changing the population flow and R 0 ( basic reproduction number ) according to the prevention and control measures . The calculation of the overlap between the spatial tracking of the virus and that of patient trajectories was realized based on the exposure index of fused spatial and text information via text spatialization technology . The estimation of population flow and spatial distribution was realized via the combination of big data and traditional geographic data , which identified the problems in the key risk areas and the spatial mismatching of medical resources in a timely manner , to bring about a rapid supply of information about the delimitation of prevention areas and resource deployment in epidemic control . The monitoring of social sentiment from social media was realized through the construction of a knowledge database on public opinion , which provided important foundational information on public opinion to guide the government .

Despite the advancement of diagnostic technologies targeting nucleic acids ( NA ) , there are still no rapid , handheld , low - cost , easy - to - use and integrated solutions for the testing of infectious diseases at the Point - of - Need ( PoN ) . This is unfortunately the case for pathogens infecting humans , animals or even plants . This large gap in the diagnostic workflow hampers attempts to contain infectious pathogens from spreading by rapid and early detection . This technological gap has become , once again , evident with the spread of COVID - 19 , the diagnosis of which continues to depend heavily on centralized laboratories with specialized personnel and facilities , which in turn slows down testing and delays treatment .

Which are the challenges, solutions and technologies in workforce protection?

Although telemedicine is a useful solution , it is not without its problems . Some institutions integrated it as part of their practice a long time ago . For others it is new technology , and its implementation will be complicated by the challenges of learning a new system . Technical issues may also arise , such as connection disruptions that can make establishing rapport difficult . Furthermore , because this is a new technology for some providers , it may be challenging to triage patients between in - person office and telemedicine visits . This ability is crucial because precluding patients from a necessary office visit may lead to increased emergency department visits .

Oncologists in Africa , in the absence of centralised and resource - appropriate COVID - 19 guidelines , are pragmatically safeguarding patients and the workforce while providing essential cancer care . This task is difficult considering the scarcity of cancer workforce and logistics to fight the pandemic as well as compounding health challenges .

Background The COVID - 19 pandemic presents a unique challenge to surgical residency programs . Due to the restrictions recommended by the Centers for Disease Control and Prevention and other organizations , the educational landscape for surgical residents is rapidly changing . In addition , the time course of these changes is undefined . Methods We attempt to define the scope of the problem of maintaining surgical resident education while maintaining the safety of residents , educators , and patients . Within the basic framework of limiting in - person gatherings , postponing or canceling elective operations in hospitals , and limiting rotations between sites , we propose innovative solutions to maintain rigorous education . Results We propose several innovative solutions including the flipped classroom model , online practice questions , teleconferencing in place of in - person lectures , involving residents in telemedicine clinics , procedural simulation , and the facilitated use of surgical videos . Although there is no substitute for hands - on learning through operative experience and direct patient care , these may be ways to mitigate the loss of learning exposure during this time . Conclusions These innovative solutions utilizing technology may help to bridge the educational gap for surgical residents during this unprecedented circumstance . The support of national organizations may be beneficial in maintaining rigorous surgical education .

Protection of healthcare workforce is of paramount relevance for the care of infected and non - infected patients in the setting of a pandemic such as coronavirus disease 2019 ( COVID - 19 ) . Healthcare workers are at increased risk to become infected because of contact to infected patients , infected co - workers and their community outside the hospital . The ideal organisational strategy to protect the healthcare workforce in a situation in which social distancing cannot be maintained at the workplace remains to be determined . In this study , we have mathematically modelled strategies for the employment of hospital workforce with the goal to simulate health and productivity of the workers . Therefore , deterministic models were extended to account for stochastic influences potentially occurring in rather small populations . The models were also designed to determine if desynchronization of medical teams by dichotomizing the workers may protect the workforce . Our studies model workforce productivity depending on the infection rate , the presence of reinfection and the efficiency of home office . As an application example , we apply our theory to the case of coronavirus disease 2019 ( COVID - 19 ) . The results of the models reveal that a desynchronization strategy in which two medical teams work alternating for 7 days reduces the infection rate of the healthcare workforce . In case of immunity to the infectious agent this affect is mainly relevant at early stages of the pandemic . This effect is independent on infection rates and increases the overall workforce productivity under certain situations .

School closures may be especially challenging for single parents . 14 . 7 % of nursing , psychiatric , and home health aides are single parents . Medical assistants ( 10 . 5 % ) and licensed practical and licensed vocational nurses ( 9 . 7 % ) are also more likely to be single parents than the healthcare average . Together this is 30 % of the healthcare workforce , and is the segment most likely to be providing infection control for the elderly in nursing homes and other facilities .

Which are the challenges, solutions and technologies in workforce allocation?

Although telemedicine is a useful solution , it is not without its problems . Some institutions integrated it as part of their practice a long time ago . For others it is new technology , and its implementation will be complicated by the challenges of learning a new system . Technical issues may also arise , such as connection disruptions that can make establishing rapport difficult . Furthermore , because this is a new technology for some providers , it may be challenging to triage patients between in - person office and telemedicine visits . This ability is crucial because precluding patients from a necessary office visit may lead to increased emergency department visits .

Oncologists in Africa , in the absence of centralised and resource - appropriate COVID - 19 guidelines , are pragmatically safeguarding patients and the workforce while providing essential cancer care . This task is difficult considering the scarcity of cancer workforce and logistics to fight the pandemic as well as compounding health challenges .

We conclude with a discussion of three possible solutions to this challenge : 1 ) establishing a global acquisition fund for EID vaccines , in which governments around the world collaborate ; 2 ) raising the price of portfolio vaccines by two orders of magnitude ; and 20 Mar 2020 © 2020 by Vu , Kaplan , Chaudhuri , Mansoura , Lo All Rights Reserved Page 4 of 19

Background The COVID - 19 pandemic presents a unique challenge to surgical residency programs . Due to the restrictions recommended by the Centers for Disease Control and Prevention and other organizations , the educational landscape for surgical residents is rapidly changing . In addition , the time course of these changes is undefined . Methods We attempt to define the scope of the problem of maintaining surgical resident education while maintaining the safety of residents , educators , and patients . Within the basic framework of limiting in - person gatherings , postponing or canceling elective operations in hospitals , and limiting rotations between sites , we propose innovative solutions to maintain rigorous education . Results We propose several innovative solutions including the flipped classroom model , online practice questions , teleconferencing in place of in - person lectures , involving residents in telemedicine clinics , procedural simulation , and the facilitated use of surgical videos . Although there is no substitute for hands - on learning through operative experience and direct patient care , these may be ways to mitigate the loss of learning exposure during this time . Conclusions These innovative solutions utilizing technology may help to bridge the educational gap for surgical residents during this unprecedented circumstance . The support of national organizations may be beneficial in maintaining rigorous surgical education .

Protection of healthcare workforce is of paramount relevance for the care of infected and non - infected patients in the setting of a pandemic such as coronavirus disease 2019 ( COVID - 19 ) . Healthcare workers are at increased risk to become infected because of contact to infected patients , infected co - workers and their community outside the hospital . The ideal organisational strategy to protect the healthcare workforce in a situation in which social distancing cannot be maintained at the workplace remains to be determined . In this study , we have mathematically modelled strategies for the employment of hospital workforce with the goal to simulate health and productivity of the workers . Therefore , deterministic models were extended to account for stochastic influences potentially occurring in rather small populations . The models were also designed to determine if desynchronization of medical teams by dichotomizing the workers may protect the workforce . Our studies model workforce productivity depending on the infection rate , the presence of reinfection and the efficiency of home office . As an application example , we apply our theory to the case of coronavirus disease 2019 ( COVID - 19 ) . The results of the models reveal that a desynchronization strategy in which two medical teams work alternating for 7 days reduces the infection rate of the healthcare workforce . In case of immunity to the infectious agent this affect is mainly relevant at early stages of the pandemic . This effect is independent on infection rates and increases the overall workforce productivity under certain situations .

Which are the challenges, solutions and technologies in community-based support resources?

Although telemedicine is a useful solution , it is not without its problems . Some institutions integrated it as part of their practice a long time ago . For others it is new technology , and its implementation will be complicated by the challenges of learning a new system . Technical issues may also arise , such as connection disruptions that can make establishing rapport difficult . Furthermore , because this is a new technology for some providers , it may be challenging to triage patients between in - person office and telemedicine visits . This ability is crucial because precluding patients from a necessary office visit may lead to increased emergency department visits .

Two studies reported cessation of hospice volunteer services in response to pandemics . 3 , 8 An alternative role for volunteers may be in provision of psychological support for patients and carers which could occur by using digital technology or telephones . In light of the social distancing measures being widely employed in response to COVID - 19 , volunteers may have a wider role in supporting communities for example helping the most vulnerable with shopping for food and medicines .

Objective The research was aimed to discuss the role of science and technology research in the public health emergency response , and to provide theoretical support for building Healthy China , implementing the National Strategy of Innovation - Driven Development . Methods Take COVID - 19 as an example , to sum up the characteristics and the function of science and technology research in the public health emergency prevention and control system . Results In order to make the scientific and technological research as the supporting system in public health emergency , we need to strengthen the basic research , to improve the research and development for controlling product with the independent intellectual property , to optimize the training system and evaluating system in public health technology , to deepen the international collaboration and to popularize the basic scientific knowledge . Conclusions Through systematically arrangement for disease controlling and prevention , for the industrial supporting , for the health improvement , for the talent training system and for the cooperation and the communication , we need to fasten the technological innovation for better preparation and responding to public health emergencies .

Background The COVID - 19 pandemic presents a unique challenge to surgical residency programs . Due to the restrictions recommended by the Centers for Disease Control and Prevention and other organizations , the educational landscape for surgical residents is rapidly changing . In addition , the time course of these changes is undefined . Methods We attempt to define the scope of the problem of maintaining surgical resident education while maintaining the safety of residents , educators , and patients . Within the basic framework of limiting in - person gatherings , postponing or canceling elective operations in hospitals , and limiting rotations between sites , we propose innovative solutions to maintain rigorous education . Results We propose several innovative solutions including the flipped classroom model , online practice questions , teleconferencing in place of in - person lectures , involving residents in telemedicine clinics , procedural simulation , and the facilitated use of surgical videos . Although there is no substitute for hands - on learning through operative experience and direct patient care , these may be ways to mitigate the loss of learning exposure during this time . Conclusions These innovative solutions utilizing technology may help to bridge the educational gap for surgical residents during this unprecedented circumstance . The support of national organizations may be beneficial in maintaining rigorous surgical education .

This COVID - 19 outbreak also highlights the importance of rethinking of the basic design of social and economic resilience , in particular for disadvantaged poorer and rural communities , during such a disruptive event . How do we keep people connected and active when literal or corporeal mobility ceases . Virtual mobility is an obvious solution , using technologies to substitute literal mobility , connecting people through online sharingbut again , this solution is only available to those who either have jobs that can be done from a distance or who are able to afford and use such solution . Further , the reduction impact of such solutions in mobility is not always as apparent as shifting activity online sometimes only moves actors around . In e - shopping , for example , it creates more delivery people than shop workers , changing mobility patterns rather than eliminating them .

Which are the challenges, solutions and technologies in payment?

Although telemedicine is a useful solution , it is not without its problems . Some institutions integrated it as part of their practice a long time ago . For others it is new technology , and its implementation will be complicated by the challenges of learning a new system . Technical issues may also arise , such as connection disruptions that can make establishing rapport difficult . Furthermore , because this is a new technology for some providers , it may be challenging to triage patients between in - person office and telemedicine visits . This ability is crucial because precluding patients from a necessary office visit may lead to increased emergency department visits .

We conclude with a discussion of three possible solutions to this challenge : 1 ) establishing a global acquisition fund for EID vaccines , in which governments around the world collaborate ; 2 ) raising the price of portfolio vaccines by two orders of magnitude ; and 20 Mar 2020 © 2020 by Vu , Kaplan , Chaudhuri , Mansoura , Lo All Rights Reserved Page 4 of 19

Background The COVID - 19 pandemic presents a unique challenge to surgical residency programs . Due to the restrictions recommended by the Centers for Disease Control and Prevention and other organizations , the educational landscape for surgical residents is rapidly changing . In addition , the time course of these changes is undefined . Methods We attempt to define the scope of the problem of maintaining surgical resident education while maintaining the safety of residents , educators , and patients . Within the basic framework of limiting in - person gatherings , postponing or canceling elective operations in hospitals , and limiting rotations between sites , we propose innovative solutions to maintain rigorous education . Results We propose several innovative solutions including the flipped classroom model , online practice questions , teleconferencing in place of in - person lectures , involving residents in telemedicine clinics , procedural simulation , and the facilitated use of surgical videos . Although there is no substitute for hands - on learning through operative experience and direct patient care , these may be ways to mitigate the loss of learning exposure during this time . Conclusions These innovative solutions utilizing technology may help to bridge the educational gap for surgical residents during this unprecedented circumstance . The support of national organizations may be beneficial in maintaining rigorous surgical education .

It remains a highly challenging logistical exercise for medical professionals to practically and effectively screen suspected infectious cases from individual households . Such a massive undertaking is time - consuming and labor intensive and is constrained by the availability of testing technologies at this extremely critical time . However , an alternative method utilizing wastewater - based epidemiology ( WBE ) , may provide an effective approach to predict the potential spread of the infection by testing for infectious agents in wastewater , which has been approved as an effective way to trace illicit drugs , and obtain information on health , disease , and pathogens . 1

For patients who require CT scans , portable CT scanners can be a potential solution but many 69 institutions could face economic and logistical challenges ( i . e . space constraint ) during 70 implementation . As an alternative , our department designated a dedicated CT scanner with shortest 71 distance to isolation wards for case suspects to prevent contamination to other CT scanners .

Which are the challenges, solutions and technologies in supply chain management to enhance capacity, efficiency, and outcomes?

Considering that COVID - 19 has a strong infection capacity , there must be high alert to face this emergency . Policy - making should be based on resource integration , social mobilisation , funding input , medication supply , vaccine development , and international cooperation . Science and technology sources should be fully utilised . The complex emergencies of communicable diseases should be fully understood , and this is a process that needs continuous learning . A highly reactive , multifunctional and efficient emergency management system needs to be established , and the significance of information communication should be fully understood for the future .

The World Health Organization acknowledges the current global stockpile is insufficient , particularly for masks and respirators 2 , and supply of gowns and goggles is also expected to be insufficient . Coordinating the supply chain of PPE in the midst of an epidemic with many closed borders and reduced freight is challenging . Individual behaviour becomes a factor when people are scared or ill - informed 7 , theft of PPE can occur , and local supply chain issues mean that inappropriate use of PPE happens due to lack of supply , despite best - practice guidance on its use 2 . A call for ideas on conserving PPE was made through JAMA on 20 March 2020 8 . One recommendation was reusing PPE . Given the ability of this to rapidly increase supply issues close to the frontline avoiding many of the upstream disruption to the supply chain , this rapid evidence summary was prepared , aiming in particular at the re - utilization of the usually disposable N95 FFRs during the current epidemic . A whole - of - PPE solution has been developed within this protocol , which would be able to be rapidly set up in many healthcare settings .

The effort made to strengthening PICTs ' capacity to respond to COVID - 19 offers an opportunity to address underlying health system barriers that have inhibited PICTs ' ability to independently respond to public health emergencies . Hence , where possible , development support should be delivered within a health system strengthening frame [ 22 ] ; that is , actions that foster strong leadership within national and provincial health departments ; building systems and processes for the efficient collection , and evidence - based use of data ; building workforce skills in epidemiological and outbreak management and developing supply chain logistics .

Artificial intelligence technology can play a key role in almost every aspect including traffic management , infection detection , logistics supply chain , etc . This is a very important feature of a modern data - driven smart city . If the status of each citizen is listed , all can be accurately tracked and any population can be accommodated . Therefore , the flow of population can be controlled in a more orderly manner . Artificial intelligence technologies can be used to employ smart devices to support diagnosis and treatment , and can be used in telecommunications , online training and intelligent manufacturing to ensure minimal disruption to people ' s lives . Some hospitals use smart systems . Train stations can install powerful thermal imagers to measure the body temperature of passengers . Overall , efficiency and speed are very important in the control process , and conflicting research needs to be conducted ( 9 - 11 ) .

A stable and efficient national material supply and transportation system provides important support for successful epidemic prevention and control . We have integrated multiple datasets , such as provincial epidemic data , online consumption data and postal service data , to analyze the supply - demand situation and price changes in necessities and food , including vegetables and meat , for every province during the epidemic prevention period , as well as the changing volume and trends of postal and express delivery businesses in each region , to identify the area , type , and the transportation support capacity of the material short - age risks . Through this , we provided scientific data for the social management departments to obtain the material supply - demand dynamic information in real time . Meanwhile , by tracking the transportation of materials , we identified the highly sensitive nodes that may invoke virus transmission during the transportation process and provided advance warning and decision support for the prevention and control of the regional spread of the epidemic ( the national distribution of risk index is shown in Figure 9 ) . Due to the involvement of company business information in the data , there were many difficulties in the acquisition process , which revealed that knowledge of how businesses constrain data sharing will become an important research direction . At present , JID : GEOSUS [ m5GeSdc ; March 28 , 2020 ; 14 : 39 ] JD . COM , SF Express , and other large domestic online shopping and logistics companies have begun to establish GIS - based logistics monitoring systems . In the future , with the support of Internet of Things technology , a national classified material transportation monitoring system and national data integration and analysis platform will be gradually established , which will provide more accurate and timely information on the material supply and transportation capacity during emergency policymaking for the whole society .

Efforts to define the natural history of disease to inform clinical care, public health interventions, infection prevention control, transmission, and clinical trials

If COVID - 19 can be controlled by isolation and contact tracing , then public health efforts should be focused on this strategy ; however , if this is not enough to control outbreaks , then additional resources might be needed for additional interventions . Several key characteristics of the transmissibility and natural history of COVID - 19 are currently unknown — eg , whether transmission can occur before symptom onset . Therefore , we explored a range of epidemiological scenarios that represent potential transmission properties based on current information about COVID - 19 transmission . We assessed the ability of isolation and contact tracing to control disease outbreaks in areas without widespread transmission using a mathematical model . 6 , 15 , 16 , 17 By varying the efficacy of contact - tracing efforts , the size of the outbreak when detected , and the promptness of isolation after symptom onset , we show how viable it is for countries at risk of imported cases to use contact tracing and isolation as a containment strategy .

If 2019 - nCoV can be controlled by isolation and contact tracing , then public health efforts should be focussed on this strategy . However , if this is not enough to control outbreaks , then additional resources may be needed for additional interventions . There are currently key unknown characteristics of the transmissibility and natural history of 2019 - nCoV ; for example , whether transmission can occur before symptom onset . Therefore we explored a range of epidemiological scenarios that represent potential transmission properties based on current information about 2019 - nCoV transmission . We assessed the ability of isolation and contact tracing to control disease outbreaks using a mathematical model 6 , [ 15 ] [ 16 ] [ 17 ] [ 18 ] . By varying . CC - BY - ND 4 . 0 International license It is made available under a is the author / funder , who has granted medRxiv a license to display the preprint in perpetuity .

Following an outbreak of pneumonia caused by 2019 novel coronavirus ( 2019 - nCoV ) which has spread in China , the National Health Commission of China issued public health policies and implemented interventions for control and prevention of the epidemic . Given that the maternal - fetus vertical transmission caused by 2019 - nCoV is still unidentified , as a special population , neonates need a targeted clinical management . This detailed plan of care is proposed to provide better prevention and control of neonatal 2019 - nCoV infection .

COVID - 19 is an emerging infectious disease of global public health concern . Efforts to control the COVID - 19 epidemic are likely to require an evidence - based , multifactorial approach . First , there is a need to limit human - to - human transmission , including reducing secondary infections among close contacts and healthcare workers , preventing transmission amplification events , and preventing further international spread . Second , there is a need to rapidly identify , isolate , and provide optimised care for patients . Third , we need to identify and reduce transmission from the animal source or sources . Fourth , we need to address

Evidence - based public health programming depends on data - driven estimates of disease burden to develop interventions . As such , accurate estimate of the underlying burden of SARS - CoV - 2 infection within the US can provide critical information for hospital administrators , county - and state - level Departments of Health , and the US Centers for Disease Control and Prevention ( CDC ) to optimize and prioritize resource allocation .

What has been done to develop a core clinical outcome set to maximize usability of data across a range of trials?

The clinical efficacy and safety evaluation of medical interventions are usually based on the measurement and analysis of certain clinical outcomes . However , studies have found that the outcomes used in clinical research are frequently inconsistent , nonstandard , irrational , or inessential , weakening the scientific and practical nature of research results and leading to research waste [ 1 ] [ 2 ] [ 3 ] . In order to overcome these problems , experts in evidence - based medicine and clinical research methodology have put forward strategies to develop core outcome sets ( COSs ) . A COS refers to an agreed - upon standard set of outcomes that should be measured and reported , as a minimum , in all clinical trials in specific areas of health or healthcare [ 4 ] . A COS is helpful to regularize outcomes adopted in clinical trials , so as to improve the practicability , comparability , and transparency of the results [ 4 ] . In 2010 , the Core Outcome Measures in Effectiveness Trials ( COMET ) Initiative y was launched to promote research on COS by developing methodological guidelines . Thus far , a series of guidelines and handbooks have been published , including the COMET Handbook ( version 1 . 0 ) [ 5 ] , the COS - STAndards for Development ( COS - STAD ) [ 6 ] , the COS - STAndards for Reporting ( COS - STAR ) [ 7 ] , and the COS - STAndardised Protocol Items ( COS - STAP ) [ 8 ] .

Abstract Since its outbreak in December 2019 , a series of clinical trials on Coronavirus Disease 2019 ( COVID - 19 ) have been registered or carried out . However , the significant heterogeneity and less critical outcomes of such trials may be leading to a waste of research resources . This study aimed to develop a core outcome set ( COS ) for clinical trials on COVID - 19 in order to tackle the outcome issues . The study was conducted according to the Core Outcome Measures in Effectiveness Trials ( COMET ) handbook ( version 1 . 0 ) , a guideline for COS development . A research group was set up that included experts in respiratory and critical medicine , traditional Chinese medicine , evidence - based medicine , clinical pharmacology , and statistics , in addition to medical journal editors . Clinical trial registry websites ( chictr . org . cn and clinicaltrials . gov ) were searched to retrieve clinical trial protocols and outcomes in order to form an outcome pool . A total of 78 clinical trial protocols on COVID - 19 were included and 259 outcomes were collected . After standardization , 132 outcomes were identified within seven different categories , of which 58 were selected to develop a preliminary outcome list for further consensus . After two rounds of Delphi survey and one consensus meeting , the most important outcomes for the different clinical classifications of COVID - 19 were identified and determined to constitute the COS for clinical trials on COVID - 19 ( COS - COVID ) . The COS - COVID includes one outcome for the mild type ( time to 2019 - nCoV reverse transcription - polymerase chain reaction ( RT - PCR ) negativity ) , four outcomes for the ordinary type ( length of hospital stay , composite events , score of clinical symptoms , and time to 2019 - nCoV RT - PCR negativity ) , five outcomes for the severe type ( composite events , length of hospital stay , arterial oxygen partial pressure ( PaO2 ) / fraction of inspired oxygen ( FiO2 ) , duration of mechanical ventilation , and time to 2019 - nCoV RT - PCR negativity ) , one outcome for critical type ( all - cause mortality ) , and one outcome for rehabilitation period ( pulmonary function ) . The COS - COVID is currently the most valuable and practical clinical outcome set for the evaluation of intervention effect , and is useful for evidence assessment and decision - making . With a deepening understanding of COVID - 19 and application feedback , the COS - COVID should be continuously updated .

Many studies identified from the MERS and SARS systematic review were retrospective cohort studies and poor outcomes were assessed 21 - 30 days from symptom onset . In designing protocols for mortality or severe illness risk factors for COVID - 19 , case - control studies or prospective cohort studies should be used with an end - point at 90 days , so as not to miss late deaths . Whatever the optimal end - point for assessing outcome , standardising this outcome measure across studies will allow researchers to contribute to core data sets .

The copyright holder for this preprint . https : / / doi . org / 10 . 1101 / 2020 . 03 . 24 . 20041020 doi : medRxiv preprint should be specified for prognostic outcomes ( e . g . , 30 - day mortality ) . If study participants have neither recovered nor died within that time period , their data should not be excluded from analysis , as most reviewed studies have done . Instead , an appropriate time - to - event analysis should be considered to allow for administrative censoring . 16 It should be noted that censoring due to other reasons , for instance due to quick recovery and loss to follow - up of patients that are no longer at risk of death from COVID - 19 , may necessitate analysis in a competing risk framework . 42 Instead of developing and updating predictions in their local setting , Individual Participant Data ( IPD ) from multiple countries and healthcare systems may facilitate better understanding of the generalizability and implementation prediction models across different settings and populations , and may greatly improve their applicability and robustness in routine care . [ 43 ] [ 44 ] [ 45 ] [ 46 ] [ 47 ] The evidence base for the development and validation of prediction models related to COVID - 19 will quickly increase over the coming months . Together with the increasing evidence from predictor finding studies [ 48 ] [ 49 ] [ 50 ] [ 51 ] [ 52 ] [ 53 ] [ 54 ] and open peer review initiatives for COVID - 19 related publications , 55 data registries 56 - 60 are being set up . To maximize the new opportunities and to facilitate IPD meta - analyses , the WHO has recently released a new data platform to encourage sharing of anonymized COVID - 19 clinical data . 61 To leverage the full potential of these evolutions , international and interdisciplinary collaboration in terms of data acquisition and model building is crucial .

This study was conducted and reported following the COMET Handbook , COS - STAD , and COS - STAR . A research plan was publicized on the websites of COMET and the Chinese Clinical Trials Core Outcome Sets Research Center . àà

Can adjunctive or supportive intervention (e.g. steroids, high flow oxygen) improve the clinical outcomes of infected patients?

In ideal circumstances medications are intentionally designed , profiled and tested to combat initiators of pathophysiologic processes . However , when that is not available , there may be a need to consider treatment regimens from analogous disease patterns . Matching clinical dispositions can be considered in efforts to develop therapeutic interventions . Moreover , dire outcomes of illness may be overcome with adjunctive measures that do not necessarily cure underlying disease . Rather , supportive care as well as adjunctive countermeasures may assist patients in surviving viral illness .

The clinical outcomes of most patients in this study were not complicated . As of 17 February 2020 , no patient required supplemental oxygen therapy with mechanical ventilation nor any organ - supporting treatments in intensive care unit . A total of 10 cases have fully recovered from the infection and have been discharged from hospital . Of the 18 confirmed cases who are still in hospital , most are stable or improving .

Up to now , no antiviral treatment has been recommended for coronavirus treatment except supportive care and organ support [ 5 , 20 ] . In current clinical practice , arbidol was used as an antiviral treatment for SARS - CoV - 2 infected patients , but the efficacy remains to be proved . Other antiviral medications including remdesivir , lopinavir and traditional Chinese medicine are still being verified in clinical trials . Furthermore , application of intravenous immunoglobulin is recommended to enhance the ability of anti - infection for critically ill patients and steroids are recommended for patients with ARDS , for as short duration of treatment as possible [ 21 ] . In this study , 96 . 04 % patients received antiviral therapy , 98 . 02 % received antibacterial therapy . Application of glucocorticoid mainly depended on the severity of inflammatory response . In the early outbreak of COVID - 19 , all the non - survivors received oxygen inhalation therapy including high flow oxygen inhalation ( 77 . 23 % ) , but quite a low proportion of patients received machine ventilation partly due to limited medical resources against the steeply increasing number of patients at early outbreak . All rights reserved . No reuse allowed without permission . the author / funder , who has granted medRxiv a license to display the preprint in perpetuity .

Administration of corticosteroids to deteriorating SARS patients was associated with significant and sometimes dramatic radiographic and clinical recovery ( Figure 1 ) . Despite skepticism , immunomodulating drugs could be considered as rescue therapy . Patients who had pulse steroid therapy ( e . g . , methylprednisolone 250 - 500 mg daily for 3 - 5 days ) did not have higher cumulative steroid dosage or side effects , but had less oxygen requirement and better radiographic outcome , than their counterparts . Although a retrospective analysis showed a higher 30 - day mortality among patients who had pulse methylprednisolone , this could be due to the higher likelihood of using such therapy in more severe SARS cases . Corticosteroids are effective anti - inflammatory agents that significantly reduce interleukin - 8 , monocyte chemoattractant protein - 1 , and IFN - g inducible protein - 10 levels in SARS . The use of high - dose steroids was associated with sepsis , particularly ventilator - associated pneumonia , and even systemic fungal infection . Approximately 15 % of SARS patients had MRI - proven avascular necrosis ( AVN ) of the hips and knees ( Griffith et al . , 2005 ) , which could be steroid - induced , but this incidence seems much higher than that among recipients of organ transplants despite similar steroid dosages .

For example , a routine sequential respiratory support therapy for patients with SPO2 below 93 % is : intranasal catheterization of oxygen , oxygen supply through mask , high flow oxygen supply through nasal catheter , non - invasive ventilation support , invasive ventilation support , and ECMO . Predicting that for some patients this sequential oxygen therapy leads to unsatisfactory therapeutic effects could pre - empt physicians to pursuit different approaches .