Managing COVID-19 in resource-limited settings: critical care considerations

Siow, Wen Ting; Liew, Mei Fong; Shrestha, Babu Raja; Muchtar, Faisal; See, Kay Choong

doi:10.1186/s13054-020-02890-x

Cited by 71 publications

(66 citation statements)

References 13 publications

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“…These results suggest that other regions of Mexico, and LMICs in general, may need to plan for and ameliorate sharply increasing rates of out-ofhospital mortality in order to prevent a large burden of potentially unmeasured death stemming from the COVID-19 pandemic. These findings echo a growing number of calls for health system strengthening in LMIC in the face of the COVID-19 pandemic [9][10][11][12][13] .…”

Section: Discussionsupporting

confidence: 61%

“…One recent report from the Lombardy region of Italy used EMS records to show an increase of 58% compared to prior year values, during the peak of the epidemic 8 . It is unclear, however, how this phenomenon would play out in LMICs with relatively weaker health systems [9][10][11][12][13] . In the context of COVID-19, an increase in out-of-hospital mortality could be expected, directly from COVID-19, or indirectly as patients delay care and health systems become overwhelmed [14][15][16] .…”

Section: Introductionmentioning

confidence: 99%

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Excess Out-Of-Hospital Mortality and Declining Oxygen Saturation: The Sentinel Role of EMS Data in the COVID-19 Crisis in Tijuana, Mexico

Friedman

Calderón-Villarreal

Bojorquez

et al. 2020

Preprint

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Objective: Emergency medical services (EMS) may serve as a key source of real-time data about the evolving health of COVID-19 affected populations, especially in low-and-middle-income countries (LMICs) with less rapid and reliable vital statistic registration systems. Although official COVID-19 statistics in Mexico report almost exclusively in-hospital mortality events, excess out-of-hospital mortality has been identified in other settings, including one EMS study in Italy that showed a 58% increase. EMS and hospital reports from several countries have suggested that silent hypoxemia-low oxygen saturation (SpO2) in the absence of dyspnea-is associated with COVID-19 outbreaks. It is unclear, however, how these phenomena can be generalized to LMICs. We assess how EMS data can be used in a sentinel capacity in Tijuana, a city on the Mexico-United States border with earlier exposure to COVID-19 than many LMIC settings. Methods:We calculated numbers of weekly out-of-hospital deaths and respiratory cases seen by EMS in Tijuana, and estimate the difference between peak-epidemic rates (during April 14 th -May 11 th ) and forecasted 2014-2019 trends. Results were compared with official COVID-19 statistics, stratified by neighborhood socioeconomic status (SES), and examined for changing demographic or clinical features, including mean (SpO2).Results: An estimated 194.7 (95%CI: 135.5-253.9) excess out-of-hospital deaths events occurred, representing an increase of 145% (70%-338%) compared to forecasted trends. During the same window, only 8 COVID-19-positive, out-of-hospital deaths were reported in official statistics. This corresponded with a rise in respiratory cases of 274% (119%-1142%), and a drop in mean SpO2 to 77.7%, from 90.2% at baseline. The highest out-of-hospital death rates were observed in low-SES areas, although respiratory cases were more concentrated in high-SES areas.Conclusions: EMS systems may play an important sentinel role in monitoring excess out-of-hospital mortality and other trends during the COVID-19 crisis in LMICs. Using EMS data, we observed increases in out-of-hospital deaths in Tijuana that were nearly threefold greater magnitude than increases reported using EMS data in Italy. Increased testing in out-of-hospital settings may be required to determine if excess mortality is being driven by COVID-19 infection, health system saturation, or patient avoidance of healthcare. We also found evidence of worsening rates of hypoxemia among respiratory patients seen by EMS, suggesting a rise in silent hypoxemia, which should be met with increased detection and clinical management efforts. Finally, we observed that social disparities in out-of-hospital death that warrant monitoring and amelioration.

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Section: Discussionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Excess Out-Of-Hospital Mortality and Declining Oxygen Saturation: The Sentinel Role of EMS Data in the COVID-19 Crisis in Tijuana, Mexico

Friedman

Calderón-Villarreal

Bojorquez

et al. 2020

Preprint

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“…To prevent human efforts of disease containment from being overwhelmed, we need tools that can streamline the diagnosis, surveillance, and treatment of COVID-19 [ 4 ]. This need is particularly pressing in relatively resource-scarce settings, such as low- or middle-income countries [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Artificial Intelligence for COVID-19: Rapid Review

Chen¹,

See²

2020

J Med Internet Res

Self Cite

123

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Background COVID-19 was first discovered in December 2019 and has since evolved into a pandemic. Objective To address this global health crisis, artificial intelligence (AI) has been deployed at various levels of the health care system. However, AI has both potential benefits and limitations. We therefore conducted a review of AI applications for COVID-19. Methods We performed an extensive search of the PubMed and EMBASE databases for COVID-19–related English-language studies published between December 1, 2019, and March 31, 2020. We supplemented the database search with reference list checks. A thematic analysis and narrative review of AI applications for COVID-19 was conducted. Results In total, 11 papers were included for review. AI was applied to COVID-19 in four areas: diagnosis, public health, clinical decision making, and therapeutics. We identified several limitations including insufficient data, omission of multimodal methods of AI-based assessment, delay in realization of benefits, poor internal/external validation, inability to be used by laypersons, inability to be used in resource-poor settings, presence of ethical pitfalls, and presence of legal barriers. AI could potentially be explored in four other areas: surveillance, combination with big data, operation of other core clinical services, and management of patients with COVID-19. Conclusions In view of the continuing increase in the number of cases, and given that multiple waves of infections may occur, there is a need for effective methods to help control the COVID-19 pandemic. Despite its shortcomings, AI holds the potential to greatly augment existing human efforts, which may otherwise be overwhelmed by high patient numbers.

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“…[ 19 ] Similar experiences and success stories have been reported with early proning of nonintubated patients. [ 4 20 ]…”

mentioning

confidence: 99%

State of the globe: The trials and tribulations of the COVID-19 pandemic: Separated but together, telemedicine revolution, frontline struggle against “Silent Hypoxia,” the relentless search for novel therapeutics and vaccines, and the daunting prospect of “COVIFLU”

Chauhan

Galwankar

Yellapu

et al. 2020

J Global Infect Dis

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Managing COVID-19 in resource-limited settings: critical care considerations

Cited by 71 publications

References 13 publications

Excess Out-Of-Hospital Mortality and Declining Oxygen Saturation: The Sentinel Role of EMS Data in the COVID-19 Crisis in Tijuana, Mexico

Excess Out-Of-Hospital Mortality and Declining Oxygen Saturation: The Sentinel Role of EMS Data in the COVID-19 Crisis in Tijuana, Mexico

Artificial Intelligence for COVID-19: Rapid Review

State of the globe: The trials and tribulations of the COVID-19 pandemic: Separated but together, telemedicine revolution, frontline struggle against “Silent Hypoxia,” the relentless search for novel therapeutics and vaccines, and the daunting prospect of “COVIFLU”

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