High mortality in coronavirus disease 2019 (COVID-19)–suspect unit: Lessons learned for patient safety

Abstract

To the Editor-The coronavirus disease 2019 (COVID-19) pandemic is a global healthcare emergency on a scale not seen in more than a century. With the emergence of new variants, COVID-19 is becoming potentially more contagious with transmission dynamics associated with intercontinental spread. 1-4 To limit transmission of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in the hospital in Thailand, most hospitals have created special COVID-19-suspected units to care for all patients suspected to have COVID-19. At Thammasat University Hospital (Pratum Thani, Thailand), a COVID-19-suspect unit was created on February 1, 2020. This unit admits non-critically ill medical patients with special protocols (eg, specific laboratory procurement and respiratory sample collection protocol and management of patients by assigned personal for COVID-19) assigned at the initial sites of evaluation (eg, emergency department, outpatient department, emerging infectious diseases clinic) for patients admitted to the COVID-19-suspect unit. From February 1, 2020, to June 30, 2020, higher mortality was detected among patients who were admitted to this unit compared to patients admitted to regular medicine units [10 of 78 (12.8%) vs 46 of 678 (6.7%); P = .04], despite the comparable severity index between those units. The mean Charlson comorbidity index score of COVID-19-suspect unit was 2.2 (±1.7) and this score in regular medicine units was 2.4 (±1.9) (P = .56). We performed a retrospective review of the patients who were admitted to a COVID-19-suspect unit from February through June 30, 2020, to evaluate potential reasons for the higher mortality in this unit. Data collected included patient demographics, underlying diseases, the initial evaluation site (eg, delay laboratory procurements, delay time to admission, and delay in critical medical measures such as intravenous fluid and antibiotic administration), final diagnoses, and causes of mortality. Analyses were performed using SPSS software, version 15 software (IBM, Armonk, NY). Categorical data were compared using the χ 2 test or the Fisher exact test, as appropriate. We used the Mann-Whitney U test to compare continuous variables. Logistic regression was performed to assess predictors for mortality. Adjusted odd ratios (aORs) and 95% confidence intervals (CIs) were computed; a significant statistical difference was defined as P < .05.

Feasibility and safety of discontinuation of isolation precaution policy for coronavirus disease 2019 (COVID-19) patients from COVID-19 units to general medical units in Thailand

“…This delay is frustrating for patients, consumes personal protective equipment, and compromises the safety of patients receiving care in COVID-19 units, due to the delays in laboratory collection and reporting, and critical care management. 2 These limitations have to be taken into consideration, along with the safety of HCP who may acquire SARS-CoV-2 from patients if they are prematurely released from isolation precautions. We report here the feasibility and safety of a discontinuation of isolation precautions policy implemented in a tertiary-care hospital in Thailand.…”

“…The median age of these HCP was 32 years (range, 22–49 years), and 59 (86%) of these 69 HCP had no underlying disease(s). For these 25 COVID-19 patients, the median age was 59 years (range, 24–79); 15 patients (60%) were female; their median body mass index was 28 kg/m 2 (range, 24–32), and 23 (92%) had underlying disease(s). Also, 15 patients (60%) received ICU care: 13 of these were classified as severely ill and 2 were immunocompromised.…”

“…Our data support the recommendation by the US Centers for Disease Control and Prevention to avoid test-based clearance, given that persistently PCR-positive patients are not contagious. [1][2][3][4] A limitation of our study is that we cannot exclude the possibility of asymptomatic infections in our HCP because routine SARS-CoV-2 testing was not performed. However, because we have no evidence of an outbreak of COVID-19 among our HCP, we believe that the time-based strategy of discontinuation of COVID-19 precautions was both effective and safe.…”