The American journal of tropical medicine and hygiene
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Am. J. Trop. Med. Hyg. · Aug 2021
Kumbh Mela Religious Gathering as a Massive Superspreading Event: Potential Culprit for the Exponential Surge of COVID-19 Cases in India.
The Kumbh Mela is a significant religious gathering of millions of Hindu devotees in India. It is celebrated on certain auspicious days in the Hindu calendar and attracts millions of pilgrims across the country. Despite the religious intention of millions of Hindu devotees, it raised public health concerns as it became a massive superspreading event for COVID-19. ⋯ Several cases of COVID-19 across India had been contact-traced to returnees from the event who acted as a nidus to help spread the infection. As a consequence, India's healthcare system was severely challenged as a result of the overwhelming hospitalizations and increasing fatalities resulting in an acute manpower shortage in healthcare along with the depletion of drugs and medical supplies despite being one of the largest pharmaceutical hubs globally. Leaders and governments around the world should learn from India's experience and thereby take preventive measures to manage potential superspreading events to curb the spike of COVID-19 cases.
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Am. J. Trop. Med. Hyg. · Mar 2021
Awake Proning as an Adjunctive Therapy for Refractory Hypoxemia in Non-Intubated Patients with COVID-19 Acute Respiratory Failure: Guidance from an International Group of Healthcare Workers.
Non-intubated patients with acute respiratory failure due to COVID-19 could benefit from awake proning. Awake proning is an attractive intervention in settings with limited resources, as it comes with no additional costs. However, awake proning remains poorly used probably because of unfamiliarity and uncertainties regarding potential benefits and practical application. ⋯ Pragmatic recommendations including indications and contraindications were formulated and adjusted for resource-limited settings. Awake proning, an adjunctive treatment for hypoxemia refractory to supplemental oxygen, seems safe in non-intubated patients with COVID-19 acute respiratory failure. We provide pragmatic recommendations including indications and contraindications for the use of awake proning in LMICs.
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Am. J. Trop. Med. Hyg. · Jan 2021
Critical Considerations for COVID-19 Vaccination of Refugees, Immigrants, and Migrants.
As COVID-19 vaccines are distributed across the United States, it is essential to address the pandemic's disproportionate impact on refugee, immigrant, and migrant (RIM) communities. Although the National Academies Press Framework for Equitable Allocation of COVID-19 Vaccine provides recommendations for an equitable vaccine campaign, implementation remains. ⋯ To overcome barriers, effective communication, convenience of care, and community engagement are essential. Taking these actions now can improve health among RIM communities.
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Am. J. Trop. Med. Hyg. · Jan 2021
Pragmatic Recommendations for the Management of Anticoagulation and Venous Thrombotic Disease for Hospitalized Patients with COVID-19 in Low- and Middle-Income Countries.
New studies of COVID-19 are constantly updating best practices in clinical care. Often, it is impractical to apply recommendations based on high-income country investigations to resource limited settings in low- and middle-income countries (LMICs). We present a set of pragmatic recommendations for the management of anticoagulation and thrombotic disease for hospitalized patients with COVID-19 in LMICs. ⋯ For hospitalized COVID-19 patients in LMICs receiving intravenous therapeutic UFH, we recommend serial monitoring of partial thromboplastin time or anti-factor Xa level, based on local laboratory capabilities. For hospitalized COVID-19 patients in LMICs receiving LMWH, we suggest against serial monitoring of anti-factor Xa level. We suggest serial monitoring of platelet counts in patients receiving therapeutic anticoagulation for VTE, to assess risk of bleeding or development of heparin induced thrombocytopenia.
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Am. J. Trop. Med. Hyg. · Jan 2021
Longitudinal Monitoring of Lactate in Hospitalized and Ambulatory COVID-19 Patients.
Hypoxemia is readily detectable by assessing SpO2 levels, and these are important in optimizing COVID-19 patient management. Hyperlactatemia is a marker of tissue hypoxia, particularly in patients with increased oxygen requirement and microvascular obstruction. ⋯ The blood lactate levels were significantly higher in hospitalized patients than ambulatory patients (day 1: hospitalized versus ambulatory patients P = 0.002; day 28: hospitalized versus ambulatory patients P = < 0.0001). Elevated lactate levels may be helpful in risk stratification, and serial monitoring of lactate may prove useful in the care of hospitalized COVID-19 patients.