Patan Academy of Health Sciences started preparedness for COVID-19 in response to increasing number of patient in neighboring country. Outbreak preparedness in resource limited setup is challenging. Despite this, preparedness was done in reference to WHO interim guidance utilizing best available resources. During this preparedness, one patient was isolated as suspected COVID-19. This paper presents level of preparedness achieved with the limited resources and the lesson learned while isolating the patient.Keywords: COVID-19; Disaster; hospital preparedness

Introduction: Intentional pesticide poisoning is a major clinical and public health problem in agricultural communities in low and middle income countries like Nepal. Bans of highly hazardous pesticides (HHP) reduce the number of suicides. We aimed to identify these pesticides by reviewing data from major hospitals across the country and from forensic toxicology laboratories. Methods: We retrospectively reviewed medical records of 10 hospitals for pesticide poisoned patients and two forensic laboratories of Nepal from April 2017 to February 2020. The poison was identified from the history, referral note, and clinical toxidrome in the hospitals and from gas chromatography analysis in the laboratories. Data on demographics, poison, and patient outcome were recorded on a data collection sheet. Simple descriptive analysis was performed. Results: Among hospital cases (n ¼ 4148), the commonest form of poisoning was self-poisoning (95.8%) while occupation poisoning was rare (0.03%). Case fatality was 5.3% (n ¼ 62). Aluminum phosphide (n ¼ 38/62, 61.3%) was the most commonly identified lethal pesticide for deaths. Forensic toxicology laboratories reported 2535 deaths positive for pesticides, with the compounds most commonly identified being organophosphorus (OP) insecticides (n ¼ 1463/2535; 57.7%), phosphine gas (n ¼ 653/ 2535; 25.7%; both aluminum [11.8%] and zinc [0.4%] phosphide) and organochlorine insecticides (n ¼ 241/2535; 9.5%). The OP insecticide most commonly identified was dichlorvos (n ¼ 273/ 450, 60.6%). Conclusion:The data held in the routine hospital medical records were incomplete but suggested that case fatality in hospitals was relatively low. The pesticides identified as causing most deaths were dichlorvos and aluminum phosphide. Since this study was completed, dichlorvos has been banned and the most toxic formulation of aluminum phosphide removed from sale. Improving the medical record system and working with forensic toxicology laboratories will allow problematic HHPs to be identified and the effects of the bans in reducing deaths monitored.

Introduction: Clinical presentation of the patient with COVID-19 in an emergency department is very important. The proper assessment of the symptom allows correct intervention. So, this study is conducted specifically to find out the clinical spectrum of the patient on presentation to the emergency department. Methods: This was a cross-sectional descriptive study. A retrospective analysis of patient records was done. There were 258 COVID-19 positive cases admission from 13th April to 13th August 2020. Out of these cases, 57 cases were excluded as they did not have respiratory symptoms but were admitted for other medical conditions. So, 201 symptomatic patients were analyzed in this study. Symptoms of all patients with the confirmed diagnosis of COVID-19 admitted from the emergency department were analyzed. Data entry was done in an excel sheet and presenting symptoms of COVID-19 positive patients were described along with their comorbid conditions. Results: Two hundred and one symptomatic patients were analyzed in this study. The mean age of study population was 37.9 years (median 37) with a minimum age of 2 months and a maximum age of 83 years. There were 114 (56.7%) male and 87 (43.3%) female; 109 (54.2%) patients were from outside the and 92 (45.8%) were from inside of Kathmandu Valley. The most common presenting symptom was fever 131 (65.2%) and cardiovascular condition including hypertension was the most common comorbid condition. Conclusions: Fever was the most common symptom of the patient presenting to the COVID19 emergency of our hospital. Moreover, fever needs to be analyzed carefully in terms of its onset total duration and associated cough, and underlying comorbid condition.

Introduction:Patan Hospital, located in Kathmandu Valley, Nepal is a 400-bed hospital that has a long history of responding to natural disasters. Hospital personnel have worked with the Ministry of Health (MOH) and the World Health Organization (WHO) to develop standardized disaster response plans that were implemented in multiple hospital systems after the earthquake of 2015. These plans focused primarily on traumatic events but did not account for epidemics despite the prevalence of infectious diseases in Nepal.Aim:To develop and test a robust epidemic/pandemic response plan at Patan Hospital in Kathmandu that would be generalizable to other hospitals nationwide.Methods:Using the existing disaster plan in conjunction with public health and disaster medicine experts,we developed an epidemic response plan focusing on communication and coordination (between the hospital and MOH, among hospital administration and staff), logistics and supplies including personal protective equipment (PPE), and personnel and hospital incident command (IC) training. After development, we tested the plan using a high-fidelity, real-time simulation across the entire hospital and the hospital IC using actors and in conjunction with the MOH and WHO. We adjusted the plan based on lessons learned from this exercise.Results:Lessons learned from the high-fidelity simulation included the following: uncovering patient flow issues to avoid contamination/infection; layout issues with the isolation area, specifically accounting for donning/doffing of PPE; more sustained duration of response compared to a natural disaster with implications for staffing and supplies; communication difficulties unique to epidemics; need for national and regional surveillance and inter-facility planning and communication. We adjusted our plan accordingly and created a generalizable plan that can be deployed at an inter-facility and national level.Discussion:We learned that this process is feasible in resource-poor hospital systems. Challenges discovered in this process can lead to better national and system-wide preparedness.

Introduction: Understanding clinical characteristics of patient is important to plan human resource and logistics. Moreover, this gives understanding of pattern of disease. This study aim to find the clinical characteristics observed in patients with suspected COVID-19 admitted at Patan Hospital. Method: This is cross sectional descriptive study conducted at Patan Hospital, Patan Academy of Health Sciences, Nepal, on April 2020. Suspected COVID-19 patient admitted from January 25 to April 20, 2020 is taken for the study. Record files were retrieved from record section and patient’s age, gender, place of residence, travel history, duration of symptom onset, symptoms on admission like fever, cough, rhinorrnoea, sore throat, myalgia and shortness of breath was recorded. Signs on admission like temperature, pulse, blood pressure, respiratory rate and oxygen saturation were also recorded. Data were descriptive analyzed. Ethical approval was obtained. Result: Total 40 suspected COVID-19 patients got admitted from 25 January to 20 April 2020. Of these admissions 25 (62.5%) were male, median age was 30 years, median days of return from abroad was 9 days, average duration of stay at hospital was 3.8 days. There were two COVID-19 positive patients who were asymptomatic. Conclusion: Travel history and history of travel to the community inside the country where COVID-19 has been detected is important to suspect COVID-19.