Coronavirus disease 2019 (COVID-19, caused by severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) is a historic pandemic severely impacting health care. This study examines its early effect on a busy academic emergency department.

A retrospective analysis of patients from an academic tertiary care Level I trauma, cardiac and stroke center’s emergency department seeing an average of 54,000 adults and 21,000 pediatric patients per year. Total visits, reasons for patient visits, demographics, disposition, and length of stay were analyzed from January through July 2020 and compared with the same time period in the previous 2 y.

From March through July 2020 there were statistically significant decreases in the total number of patient visits (-47%) especially among pediatric (-73%) and elderly (-43%) patients and those with cardiovascular (-39%), neurological (-63%) complaints, headaches (-60%), back pain (-64%), abdominal pain (-51%), and minor trauma (-71%). There was, however, a significant increase in pulmonary complaints (+54%), as well as admissions (+32%), and length of stay (+40%).

There was a significant drop in overall patients and select groups early in the pandemic, while admissions and emergency department length of stay both increased. This has implications for future pandemic planning.

To assess ability of National Early Warning Score 2 (NEWS2), systemic inflammatory response syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA), and CRB-65 calculated at the time of intensive care unit (ICU) admission for predicting ICU mortality in patients of laboratory confirmed coronavirus disease 2019 (COVID-19) infection.

This prospective data analysis was based on chart reviews for laboratory confirmed COVID-19 patients admitted to ICUs over a 1-mo period. The NEWS2, CRB-65, qSOFA, and SIRS were calculated from the first recorded vital signs upon admission to ICU and assessed for predicting mortality.

Total of 140 patients aged between 18 and 95 y were included in the analysis of whom majority were >60 y (47.8%), with evidence of pre-existing comorbidities (67.1%). The most common symptom at presentation was dyspnea (86.4%). Based upon the receiver operating characteristics area under the curve (AUC), the best discriminatory power to predict ICU mortality was for the CRB-65 (AUC: 0.720 [95% confidence interval [CI]: 0.630-0.811]) followed closely by NEWS2 (AUC: 0.712 [95% CI: 0.622-0.803]). Additionally, a multivariate Cox regression model showed Glasgow Coma Scale score at time of admission (P < 0.001; adjusted hazard ratio = 0.808 [95% CI: 0.715-0.911]) to be the only significant predictor of ICU mortality.

CRB-65 and NEWS2 scores assessed at the time of ICU admission offer only a fair discriminatory value for predicting mortality. Further evaluation after adding laboratory markers such as C-reactive protein and D-dimer may yield a more useful prediction model. Much of the earlier data is from developed countries and uses scoring at time of hospital admission. This study was from a developing country, with the scores assessed at time of ICU admission, rather than the emergency department as with existing data from developed countries, for patients with moderate/severe COVID-19 disease. Because the scores showed some utility for predicting ICU mortality even when measured at time of ICU admission, their use in allocation of limited ICU resources in a developing country merits further research.

Assess the knowledge, confidence, and attitudes of residents toward disaster medicine education in the coronavirus disease 2019 (COVID-19) era.

Survey distributed to pediatric residents at a tertiary care center, assessing confidence in disaster medicine knowledge and skills, and preferred educational methods. Based on residents’ responses, virtual and in-person educational session implemented with a postsurvey to analyze effectiveness of education.

Distributed to 120 residents with a 51.6% response rate. Almost half (46.8%) of residents had less than 1 h of disaster training, with only 9.7% having experience with a prior disaster event. However, most residents were motivated to increase their knowledge of disaster medicine due to COVID-19 and other recent disasters, with 96.8% interested in this education as a curriculum standard. Simulation and peer learning were the most preferred method of teaching. Subsequent virtual and in-person educational session demonstrated improvement in confidence scores. However, 66.7% of the virtual subset conveyed they would have preferred in-person learning.

COVID-19 has highlighted to trainees that disasters can affect all specialties, and pediatric residents are enthusiastic to close the educational gap of disaster medicine. However, residents stressed that, although virtual education can provide a foundation, in-person simulation is preferred for effective training.

Coronavirus disease 2019 (COVID-19) screening stations set up by Iranian Red Crescent Society have been available for 17 d with the aim of identifying and treating people with coronavirus, reducing road trips, and sensitizing people to the problem. This study aims to investigate the challenges of the procedure.

A qualitative study was used to find the challenges of the COVID-19 screening centers. Volunteers, branch managers, and headquarter managers of the Iranian Red Crescent Society participated in this study applying snowball sampling. Data were collected by means of in-depth semi-structured telephone interviews in April 2020 after completion of the fever screening plan. All interviews were recorded and transcribed verbatim, always with prior permission of interviewees.

The interviews with 20 participants in the plan indicated 6 relevant challenges, including logistics, lack of planning, lack of coordination, legal challenges, mental health, and ethical challenges.

The results indicated that, although establishing fever detection centers in Iran was a rapid response to COVID-19, it had significant flaws in the structure and adversely affected volunteers’ and staff’s health and financial resources. Therefore, well-structured protocols are required for similar responses in the future.

Countries are trying several policy options for decreasing the incidence and burden of the coronavirus disease 2019 (COVID-19). One of these strategies is a lockdown, complete closure, to reduce the risk of distributing disease by means of social interactions. This study aimed to analyze the effect of a 3-week lockdown on the mortality and morbidity of COVID-19 in Iran.

Official daily data on COVID-19 incidence and death reported by the World Health Organization (WHO) were extracted from September 1, 2020, to January 14, 2021. Data were analyzed using interrupted time series analysis by means of STATA 14 software.

Lockdown resulted in a significant reduction in the daily death from COVID-19 in the short-term (β = −139; P < 0.01) and in the long-term (β = −12; P < 0.01). Moreover, lockdown in the short-term insignificantly (β = −21.58; P = 0.969), and in the long-term significantly (β = −317.31; P < 0.01) reduced the COVID-19 daily incidence.

The results showed that the lockdown has a significant effect on incidence and death numbers. Therefore, it could be a suitable short-term strategy for controlling the COVID-19 outbreak. On the other hand, its negative effects on households and businesses should be considered.

The recent Covid-19 pandemic has burdened the healthcare facilities, especially in the presence of limited infrastructure. We aimed at applying a queuing model to the Covid-19 screening area so as to optimize the screening services and ensuring that no patient is refused the service.

The mean arrival time of patients, number of physicians, mean screening time and queue characteristics were observed and entered in the M/M/c/K queuing model using R programming to optimize the number of physicians required in the screening area.

Considering the mean arrival of 7 patients in 10 minutes and screening of 3 patients in 10 minutes by 1 physician, 2 physicians were assigned. At this capacity, the probability of saturation of the system was 15% with patient loss rate of 1.05 per 10 minutes. Queuing simulation with 3 physicians reduced the patient loss rate to 0.013 per 10 minutes and a saturation probability of 0.2%. However, an increase of arrival rate from 10 to 20 led to an early saturation of the system.

Queuing models offer an opportunity for the healthcare providers and hospital administrators to optimize patient care services, especially in critical areas with an ever-changing situation such as the current pandemic.

With the intention to try to contain the spread of the viral disease, several measures were taken in Argentina for long periods of time.

The lack of labor activity, social constraints, and a strong sense of helplessness, combined with a complex economic scenario with recession, inflation, and devaluation, led to the emergence of a dense climate of discontent.

After a second wave hit the country, several measures were reinstalled. The Argentine society, polarized in many aspects, was further divided between those who supported the re-establishment of strict measures to help prevent further infections and those who desperately claimed for the urgent need to return to work to sustain their livings.

The preexisting problems to which developing countries are usually exposed have been sharpened over the last year, determining a very complex scenario where every decision is important for the country’s future. An updated report of the current situation and its management in different countries is of vital importance regarding global health issues and may serve for feedback and decision-making.

Current standard practice for disaster response training is insufficient to prepare future responders. Interdisciplinary immersive education is necessary for disaster responders to react quickly to the devastating destruction, dangerous situations, and ethical dilemmas, while caring for survivors, families, and communities with limited resources. This study tests the effects of immersive emergency preparedness education on interdisciplinary college students.

Thirty-four college students attended a 3-day immersive disaster training event. Interdisciplinary teams were given 6 challenges to adapt and overcome: mass casualty; field hospital triage, treatment, and transportation; water rescue; high building rescue; search and rescue; and a water treatment. A pretest and posttest survey, Emergency Preparedness Information Questionnaire (EPIQ), was administered to all participants.

Statistically significant improvements in triage, biological agent detection, assessing critical resources, incident command, psychological issues, clinical decision making, and communication (range of P = 0.000–0.003). Improvement in clinical significance resulted in a change from limited knowledge to familiarity with the subject in all cases except isolation, quarantine, and decontamination.

Preparation and training of health care professionals need to include immersive disaster scenarios that create the experience of fatigue, psychological challenges, and physical stresses.

India, a developing country, was hit hard by the coronavirus disease 2019 pandemic, having reached the second position in the ranking of countries with the highest number of cases.

After reaching the peak of the pandemic in September 2020, the daily number of new cases due to the disease inexplicably began to decrease, despite the relaxation and non-compliance with the restriction measures. However, since March 2021, there has been a steady increase in the number of cases reported, signaling a very devastating second wave.

The collapse of the Administration, collapsing of the health-care system, and insufficient vaccinations are the major causes of this condition. Understanding the factors involved and the sequence of events that led to the flattening of the contagion curve in India during the ending of 2020 is also essential, since it can helped guide the next steps in the fight against the virus.

Contributing a greater percentage of gross domestic product toward health care seems to be the way to go as the ultimate strategy for curtailing the second wave. The advantages India has over the first wave, vaccines and a year of experience with the disease, should not be overlooked and used to its maximum in fighting against this pandemic.

During the COVID-19 pandemic, a total lockdown was enforced all over Italy starting on March 9, 2020. This resulted in the shrinking of economic activities. In addition, all formal occupational security-training courses were halted, among them the 81/08 law lectures and Basic Life Support-Defibrillation (BLS-D) laypersons training courses. The aim of this study was to evaluate the impact of the pandemic on BLS-D laypersons training courses in the Lombardy region.

BLS-D training courses records for the Lombardy region were analyzed. The analysis was conducted from 2016 to 2020 as part of the Hippo project.

In the period between 2017 and 2019, BLS-D trained laypersons kept increasing, moving from 53500 trained individuals up to 74700. In 2020, a stark reduction was observed with only 22160 individuals trained. Formal courses were not halted completely during 2020. Still, in the months available for training, the number of individuals enrolled showed a sharp 50% reduction.

Laypersons training courses for emergency management are a fundamental component of primary prevention practice. The 81/08 and 158/12 Italian laws have decreed this practice mandatory in the workplace. Following the enforcement of the lockdown and the subsequent interruption of emergency management courses, efforts will be necessary to re-establish and guarantee the high quality training of the pre-pandemic period.

This study aimed to explore how deployed healthcare workers (HCWs) perceived personal preparedness for response, and their main avenues for coping to maintain resilience during the prolonged COVID-19 (SARS-CoV-2) pandemic.

Semi-structured interviews were conducted with 25 HCWs deployed to the frontline for an extended period to provide acute COVID-19 related care. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically.

HCWs demonstrated heightened self-confidence and readiness to deal with public health emergencies owing to the ramped-up efforts in infrastructure for outbreak management and pre-emptive infectious disease training. Despite overall confidence, deployed HCWs had to adopt various coping mechanisms to sustain resilience during the prolonged pandemic. Main themes on coping centred around the value of team leaders and support from family members as an effective buffer for work-induced stress while institution-based counseling services and welfare were viewed as important for fostering the internal locus of control and wellbeing.

Our findings suggest that strategies such as on-the-job training, continuous education and improved communication would be essential to maintain resilience of deployed HCWs. Considerations should be also given to the swift implementation of blended wellness support comprising digital and in-person counseling to sustain wellbeing and prepare for endemic COVID-19.

The aim of this study was to develop and evaluate a pre-deployment sequestration (PDS) protocol to prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases on board the USS Ronald Reagan (CVN-76).

The USS Ronald Reagan includes a crew of approximately 3000 Sailors and an embarked Air Wing of 2000 personnel. The PDS was conducted in 3 waves of 14-day strict quarantines during the months of April and May 2020. Sailors were cleared to board the ship with 2 negative reverse transcriptase polymerase chain reaction (rtPCR) tests at days 14 and 16. The ship was sanitized before Wave 1 boarding.

From March 1, 2020, through May 31, 2020, a total of 51 SARS-CoV-2 positive cases were detected. During the 3 waves of PDS, 28 Sailors were found to be positive on exit testing (14, 11, and 3, respectively); no cases were found among the Air Wing. During the first 90 days at sea, no SARS-CoV-2 cases were detected among any of the embarked personnel.

Although resource-intensive, the PDS protocol implemented for USS Ronald Reagan resulted in a coronavirus disease 2019 (COVID-19)-free ship during a global pandemic with unprecedented scope. Elements of this pandemic PDS protocol may be useful in other highly risk-averse environments with no tolerance for COVID-19 infections.

A well-organized emergency medical system with adequate prehospital care can save lives and prevent disability. In Yemen, there are no data available about its prehospital care system. This qualitative, cross-sectional study aims to assess the status of prehospital care or emergency medical services in Yemen.

Data were collected from January to February 2019 through interviews and a questionnaire obtained from the Prehospital Trauma Care Systems Guideline published by the World Health Organization (WHO). Respondents were key representatives of the Ministry of Public Health and Population (MoPHP), Civil Defense/Police departments, and Yemeni Red Crescent Association (YRCA).

Overall, based on 153 responses, it was found that, despite the availability of some formal services, the prehospital care system in Yemen is uncoordinated, fragmented, and insufficient.

Given the importance of regulation, legislation, and funding support in the establishment of an effective prehospital care system, these areas merit the greatest attention and efforts. Future policies and strategies should also strive to improve communication and coordination between existing prehospital care providers, to establish a lead agency, and to increase accessibility to training.

The surge in critically ill patients has pressured hospitals to expand their intensive care unit capacities and critical care staff. This was difficult given the country’s shortage of intensivists. This paper describes the implementation of a multidisciplinary central line placement team and its impact in reducing the vascular access workload of ICU physicians during the height of the COVID-19 pandemic.

Vascular surgeons, interventionalists, and anesthesiologists, were redeployed to the ICU Access team to place central and arterial lines. Nurses with expertise in vascular access were recruited to the team to streamline consultation and assist with line placement.

While 51 central and arterial lines were placed per 100 ICU patients in 2019, there were 87 central and arterial lines placed per 100 COVID-19 ICU patients in the sole month of April, 2020. The ICU Access Team placed 107 of the 226 vascular access devices in April 2020, reducing the procedure-related workload of ICU treating teams by 46%.

The ICU Access Team was able to complete a large proportion of vascular access insertions without reported complications. Given another mass casualty event, this ICU Access Team could be reassembled to rapidly meet the increased vascular access needs of patients.

In late 2019, a novel coronavirus was detected in Wuhan, China, that caused a pandemic by September 2021, resulting in 224,180,411 cases and more than 4,600,000 deaths worldwide. In response to the pandemic, the Autonomous Kurdistan Regional Government of Iraq (KRG) imposed strict infection control measures at its borders for all travelers from neighboring countries, wherein each traveler was subjected to a mandatory reverse transcription polymerase chain reaction (RT-PCR) test on arrival to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected travelers. The aim of this study is to determine the rate of infection with SARS-CoV-2 among the travelers entering Kurdistan region through Ibrahim Al-Khalil crossing point with Turkey as a predictor for the upcoming infection waves.

The data of RT-PCR tests to detect SARS-CoV-2 in all travelers arriving at the Ibrahim Al-Khalil Border Crossing between Iraq and the Republic of Turkey were reviewed from August 21, 2020 to August 21, 2021.

It was found that there were 9873 cases of SARS-CoV-2 infections among 1,082,074 travelers during the study period.

This study shows the importance of mass testing of travelers at border crossings to control the spread of SARS-CoV-2 infection.

This study aimed to describe the impact of the coronavirus disease (COVID-19) pandemic on emergency department (ED) admissions for urgent diagnoses.

From January 1, 2019, until December 31, 2020, patients older than 18 years who attended the ED at University Hospital of Leuven (UZ Leuven, Belgium) were included. Urgent diagnoses selected in the First Hour Quintet were collected. The periods of the pandemic waves in 2020 were analyzed and compared with the same time period in 2019.

During the first wave of the pandemic, 16 075 patients attended the ED compared with 16 893 patients during the comparison period in 2019. The proportion of patients having one of the diagnoses of the First Hour Quintet was similar between the periods (4.4% vs 4.5%). During the second wave, 14 739 patients attended the ED compared with 18 704 patients during the same period in 2019; 5.6% of patients had a diagnosis of the First Hour Quintet compared with 4.3% of patients in the comparison period.

This study showed a decrease in the number of patients attending the ED during the COVID-19 pandemic. Further studies are needed to determine for which conditions patients visited the ED less.

This study aimed to investigate coronavirus disease (COVID-19) epidemiology in Alberta, British Columbia, and Ontario, Canada.

Using data through December 1, 2020, we estimated time-varying reproduction number, R t , using EpiEstim package in R, and calculated incidence rate ratios (IRR) across the 3 provinces.

In Ontario, 76% (92 745/121 745) of cases were in Toronto, Peel, York, Ottawa, and Durham; in Alberta, 82% (49 878/61 169) in Calgary and Edmonton; in British Columbia, 90% (31 142/34 699) in Fraser and Vancouver Coastal. Across 3 provinces, Rt dropped to ≤ 1 after April. In Ontario, Rt would remain < 1 in April if congregate-setting-associated cases were excluded. Over summer, Rt maintained < 1 in Ontario, ~1 in British Columbia, and ~1 in Alberta, except early July when Rt was > 1. In all 3 provinces, Rt was > 1, reflecting surges in case count from September through November. Compared with British Columbia (684.2 cases per 100 000), Alberta (IRR = 2.0; 1399.3 cases per 100 000) and Ontario (IRR = 1.2; 835.8 cases per 100 000) had a higher cumulative case count per 100 000 population.

Alberta and Ontario had a higher incidence rate than British Columbia, but Rt trajectories were similar across all 3 provinces.

The imposition of protective health protocols in public spaces to curb the spread of coronavirus disease (COVID-19) has confronted the ritual of congregational prayers in mosques for Muslims. This study examines the adoption of protective behaviors in the early stage of the COVID-19 outbreak and the influence of religion on risk perception by comparing precautionary behaviors in public and in mosques.

Data were collected through an online survey of 327 Muslim men across the Aceh Province, Indonesia, from April 21, 2020, to May 2, 2020. The Wilcoxon signed-rank test and the paired t-test were employed to compare the uptake of protective behaviors in public and mosques.

The adoption of protective behaviors was higher in public rather than in mosques. It further revealed that the understanding of Islamic teachings during the pandemic has influenced perceived risk and the way Muslim men comply with the protective guidelines. Those who have complete, incomplete, or no compliance of precautionary behaviors have their own interpretation of Islamic teachings that inform their individual actions to manage the risk.

This study suggests the significance of religious views for developing public health preparedness during the current and future pandemics in Aceh and other Muslim majority regions.

To assess the hospital beds and intensive care unit (ICU) beds with a ventilator surge capacity of the health system in Kingdom of Saudi Arabia (KSA) during the coronavirus disease (COVID-19) pandemic.

This study used relevant data from the National Health Emergency Operation Center to estimate general hospital and ICU bed surge capacity and tipping points under 3 distinct transmission scenarios.

The study results reveal that hospitals in the KSA need to be supplied with additional 4372 hospital beds to care for COVID-19 positive cases if the pandemic continues over a 6 months’ period. At the same time, it requires additional 2192 or 1461 hospital beds if the pandemic persists over a 12- or 18-month period, respectively, to manage hospitalized COVID-19 overloads. The health system surge capacity would suffer from a shortage of 1600, 797, and 540 ICU beds under the 3 transmission scenarios to absorb critical and intensive care COVID-19 cases.

Our findings highlight the urgent need for additional hospital and ICU beds in the face of critical COVID-19 cases in KSA. The study recommends further assessment measures to the health system surge capacity to keep the Saudi health system prepared during the COVID-19 pandemic.