Clinical medicine (London, England)
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There is disagreement between international guidelines on the level of personal protective equipment (PPE) required for chest compressions for patients with suspected COVID-19. This discrepancy centres on whether they are considered to be an aerosol-generating procedure (AGP), thus requiring airborne protection to prevent transmission to healthcare workers (HCWs). The need to don higher-level PPE has to be weighed against the resulting delay to emergency treatment. ⋯ One systematic review concluded that chest compressions were not an AGP. Two simulated studies (released as preprints) potentially demonstrate aerosol generation. Given that there is evidence for infection transmission during chest compressions, we conclude that a precautionary approach with appropriate PPE is necessary to protect HCW from contracting a potentially fatal infection.
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Widespread testing for the respiratory syndrome coronavirus-2 (SARS-CoV-2) will represent an important part of any strategy designed to safely reopen societies from lockdown. Healthcare settings have the potential to become reservoirs of infectivity, and therefore many hospital trusts are beginning to carry out routine screening of staff and patients. This could promote the effective cohorting of patients and reduce the rate of nosocomial infection. ⋯ Here we highlight this as an emergent ethicolegal issue which we expect to become increasingly relevant as testing becomes ubiquitous. We explore this position from an ethical and legal perspective, determining whether refusal of testing is acceptable under UK law. Individual patients refusing testing could undermine a hospital's testing strategy; therefore clinicians and policy makers must prospectively determine the best course of action if this were to occur.
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During the current SARS-CoV-2 pandemic the restructure of healthcare services to meet the huge increase in demand for hospital resource and capacity has led to the proposal that where necessary ST elevation myocardial infarction (STEMI) could be managed by intravenous thrombolysis in the first instance as a means of reducing the workforce requirements of a primary angioplasty service run at a heart attack centre. Our modelling, based on data from the UK, shows that contrary to reducing demand, the effect on both mortality and bed occupancy would be negative with 158 additional deaths per year for each 10% reduction in primary angioplasty and at a cost of ~8,000 additional bed days per year for the same reduction. Our analysis demonstrates that specialist services such as heart attack pathways should be protected during the COVID crisis to maximise the appropriate use of resource and prevent unnecessary mortality.
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We describe the details of a COVID-19 outbreak in a 25-bedded Birmingham neurology/stroke ward in the early phase of the pandemic (March to May 2020). Twenty-one of 133 admissions (16%) tested positive for COVID-19 and of those, 8 (6% of all admissions to the ward) were determined to be nosocomial. ⋯ Five of the 21 patients had negative swabs prior to receiving a positive test result. This study highlights the importance of appropriate use of personal protective equipment (PPE) with high-risk patients (including those with stroke and complex brain injury with tracheostomies) and the difficulties of COVID-19 management in a high-risk patient population.
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The SARS-CoV-2 pandemic is accompanied by an ever-rising death toll attributed to coronavirus disease 2019 (COVID-19), but questions have persisted regarding deaths formally attributed to COVID-19. We aimed to provide an independent review of clinical features of patients who died during hospitalisation with a positive PCR test for SARS-CoV-2 and relate these to the reported cause of death. ⋯ Review of the records revealed 138 (92%) patients had pulmonary infiltrates on chest radiography, and 146 (97%) required oxygen therapy. This retrospective review of cause of death has demonstrated that the overwhelming majority of hospitalised patients with positive SARS-CoV-2 PCR died as a direct consequence of COVID-19 infection.