First Reported Death of a Postpartum Woman Due to Coronavirus Disease 2019 in Nepal: A Lesson Learnt

Bhushal, N.; Tamrakar, Dipesh; Adhikari, Prabha; Shrestha, Prabha; Shrestha, Archana; Karmacharya, B.; Basnet, Sijan; Tamrakar, Suman Raj; Shrestha, Raju

doi:10.3126/kumj.v18i2.33074

Cited by 8 publications

(10 citation statements)

References 5 publications

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“…The COVID-19 pandemic is presenting a global challenge not just in terms of infectious disease but also for mental health. The pandemic rapidly disseminated across the world with the first reported case in Nepal on January 25, 2020 and the first reported death on May 14, 2020 [ 1 ]. Nepal responded with a nationwide lockdown from March 24, 2020.…”

Section: Introductionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on suicide and self-harm among patients presenting to the emergency department of a teaching hospital in Nepal

et al. 2021

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The COVID-19 pandemic is a global challenge that is not just limited to the physical consequences but also a significant degree of a mental health crisis. Self-harm and suicide are its extreme effects. We aim to explore the impact of this pandemic on suicide and self-harm in our Emergency Department. A cross-sectional study was conducted including all fatal and nonfatal self-harm patients presenting to the emergency department during the lockdown period (March 24-June 23, 2020; Period1), matching periods in the previous year (March 24-June 23,2019; Period 2) and 3 months period prior (December 24 2019-March 23, 2020; Period 3) were included through the electronic medical record system. The prevalence and the clinical profile were compared between these three periods. A total of 125 (periods 1 = 55, 2 = 38, and 3 = 32) suicide and self-harm cases were analyzed. Suicide and self-harm had increased by 44% and 71.9% during the lockdown in comparison to periods 2 and 3. Organophosphate poisoning was the most common mode. Females were predominant in all three periods with a mean age of 32 (95%CI: 29.3–34.7). There was a significant delay in arrival of the patients in period 1 (p = 0.045) with increased hospital admission (p = 0.003) and in-hospital mortality (18.2% vs 2.6% and 3.1%) (p<0.001). Our study showed an increase in suicide and self-harm cases in the emergency department during the initial phase of the COVID-19 pandemic which may reflect the increased mental health crisis in the community in low resource settings like Nepal. This study highlights the importance of priming all mental health care stakeholders to initiate mental health screening and intervention for the vulnerable population during this period of crisis.

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Section: Introductionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on suicide and self-harm among patients presenting to the emergency department of a teaching hospital in Nepal

et al. 2021

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“…The pandemic rapidly disseminated across the world with the first reported case in Nepal on January 25, 2020 and the first reported death on May 14, 2020. [1] Nepal responded with a nationwide lockdown from March 24, 2020. The increasing number of infections and uncertainty induced a substantial fear and concern leading to stress and anxiety which was superimposed by lockdown restrictions, financial breakdown, lack of physical contact with other family members and friends.…”

Section: Introductionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on Suicide and Self Harm among Patients Presenting to the Emergency Department of a Teaching Hospital in Nepal

Shrestha

Siwakoti

Singh

et al. 2020

Preprint

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Background: The COVID-19 pandemic is a global challenge that is not just limited to the physical consequences but also a significant degree of a mental health crisis. Self-harm (SH) and suicide are its extreme effects. The aim of this study was to provide an overview of the impact of the COVID-19 pandemic on the occurrence and clinical profile of suicide and SH in our ED. Methods: This is a cross-sectional observational study conducted in the ED of a tertiary care center. Records of all fatal and nonfatal SH patients presenting to the ED during the lockdown period (March 24-June 23, 2020; Period1), matching periods in the previous year (March 24-June 23,2019; Period 2) and 3 months period prior (December 24 2019-March 23, 2020; Period 3) was included by searching the electronic medical record (EMR) system. The prevalence and the clinical profile of the patients were compared between these three periods. Results: A total of 125 (periods 1=55, 2=38, and 3=32) suicide and SH cases were analyzed. The cases of suicide/SH had increased by 44% and 71.9% during the lockdown period in comparison to the period 2 and 3. Organophosphate poisoning was the most common mode. Females were predominant in all three periods with a mean age of 32 (95%CI: 29.3-34.7). There was a significant delay in arrival of the patients in period 1 (p-value=0.045) with increased hospital admission (p-value =0.009) and in-hospital mortality (18.2% vs 2.6 % and 3.1%) (p-value=.001). Conclusion: We found an increase in patients presenting with suicide and SH in our ED during the pandemic which is likely to reflect an increased prevalence of mental illness in the community. We hope that the result will prime all mental health care stakeholders to initiate mental health screening and intervention for the vulnerable population during this period of crisis.

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“…This study has provided us with a unique opportunity to aid in the preparedness of the emergency department in the COVID-19 pandemic. The COVID-19 related protocols on triage and protected intubation prepared the ED staff during the first recorded COVID-related mortality in Nepal 7 and subsequent cases which were managed by the ED team. The simulated cases were designed to assess and improve team preparedness for safe and effective care of a COVID-19 suspected patient from triage.…”

Section: Discussionmentioning

confidence: 99%

“… 3 , 4 Nepal had its first imported case of COVID-19 which was reported by WHO on January 25, 2020 5 and first reported death due to COVID-19 on May 14, 2020. 6 , 7 As of September 30, 2020, there are 20,891 active cases, 498 deaths and 56,428 recovered cases. 8 Nepal responded with a nationwide lockdown from March 24, 2020.…”

Section: Introductionmentioning

confidence: 99%

<p>COVID-19 Emergency Department Protocols: Experience of Protocol Implementation Through in-situ Simulation</p>

Shrestha¹,

Shrestha²,

Sonnenberg³

et al. 2020

OAEM

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Purpose: During the outbreak of Coronavirus disease of 2019 (COVID-19), the preparedness of emergency departments (EDs) for triaging of the patients and safety of staff is of utmost importance. The aim of our study was to develop and implement COVID-19 ED triage and protected intubation protocols for COVID-19 patients with in-situ simulation (ISS) training. The latent safety threats (LST) detection also served as a platform to test new system amendments and refine the protocols and workflows with infection control issues. We also explored the effectiveness of this approach based on Kirkpatrick's model of evaluating training outcomes. Participants and Methods: The protocols and simulation scenarios were developed and validated. A total of 22 triage and 13 intubation simulation sessions were conducted in the ED with multidisciplinary staff (physicians=18, nurses=20) during a period of four months. Each simulation was followed by a debriefing session to discuss the team performance. Preand post-simulation performances were compared. LSTs were identified and remediated. An online voluntary feedback was collected from the participants to explore the opinion about the ISS sessions and confidence level using a 5-point Likert scale. Results: There was a significant improvement in triage knowledge score after ISS [5.5/10 (IQR 4-6) versus 8.5/10 (IQR 8-9), p<0.001]. There was a desirable proportion of correct responses (>75%) following the ISS for triage case scenarios. A pre-designed checklist was used during protective intubation simulations. Some important LSTs were missing medications, lack of mechanism to deliver patient samples to lab and faulty airway maneuvers. The participants' feedback on ISS showed increased skills and confidence level on triaging and protected intubation (p<0.001). They found the protocols easy to follow and they recommended for more such modules in future. Conclusion: ISS is a quick and efficient tool to implement the ED protocols for preparation of outbreaks like COVID-19. It helps the ED staff to triage and manage the airway safely. We recommend such an approach to train the multidisciplinary staff and continue to improve ourselves through ISS addressing the changing nature of the pandemic.

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First Reported Death of a Postpartum Woman Due to Coronavirus Disease 2019 in Nepal: A Lesson Learnt

Cited by 8 publications

References 5 publications

Impact of the COVID-19 pandemic on suicide and self-harm among patients presenting to the emergency department of a teaching hospital in Nepal

Impact of the COVID-19 pandemic on suicide and self-harm among patients presenting to the emergency department of a teaching hospital in Nepal

Impact of the COVID-19 pandemic on Suicide and Self Harm among Patients Presenting to the Emergency Department of a Teaching Hospital in Nepal

<p>COVID-19 Emergency Department Protocols: Experience of Protocol Implementation Through in-situ Simulation</p>

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