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      Clinical and ethical challenges for emergency departments during communicable disease outbreaks: Can lessons from Ebola Virus Disease be applied to the COVID‐19 pandemic?

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          Abstract

          EDs fulfil a frontline function during public health emergencies (PHEs) and will play a pivotal role during the COVID‐19 pandemic. This perspective article draws on qualitative data from a longitudinal, ethnographic study of an Australian tertiary ED to illustrate the clinical and ethical challenges faced by EDs during PHEs. Interview data collected during the 2014 Ebola Virus Disease PHE of International Concern suggest that ED clinicians have a strong sense of professional responsibility, but this can be compromised by increased visibility of risk and sub‐optimal engagement from hospital managers and public health authorities. The study exposes the tension between a healthcare worker's right to protection and a duty to provide treatment. Given the narrow window of opportunity to prepare for a surge of COVID‐19 presentations, there is an immediate need to reflect and learn from previous experiences. To maintain the confidence of ED clinicians, and minimise the risk of moral injury, hospital and public health authorities must urgently develop processes to support ethical healthcare delivery and ensure adequate resourcing of EDs.

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          COVID-19 and Italy: what next?

          Summary The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has already taken on pandemic proportions, affecting over 100 countries in a matter of weeks. A global response to prepare health systems worldwide is imperative. Although containment measures in China have reduced new cases by more than 90%, this reduction is not the case elsewhere, and Italy has been particularly affected. There is now grave concern regarding the Italian national health system's capacity to effectively respond to the needs of patients who are infected and require intensive care for SARS-CoV-2 pneumonia. The percentage of patients in intensive care reported daily in Italy between March 1 and March 11, 2020, has consistently been between 9% and 11% of patients who are actively infected. The number of patients infected since Feb 21 in Italy closely follows an exponential trend. If this trend continues for 1 more week, there will be 30 000 infected patients. Intensive care units will then be at maximum capacity; up to 4000 hospital beds will be needed by mid-April, 2020. Our analysis might help political leaders and health authorities to allocate enough resources, including personnel, beds, and intensive care facilities, to manage the situation in the next few days and weeks. If the Italian outbreak follows a similar trend as in Hubei province, China, the number of newly infected patients could start to decrease within 3–4 days, departing from the exponential trend. However, this cannot currently be predicted because of differences between social distancing measures and the capacity to quickly build dedicated facilities in China.
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            [The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China].

            (2020)
            Objective: An outbreak of 2019 novel coronavirus diseases (COVID-19) in Wuhan, China has spread quickly nationwide. Here, we report results of a descriptive, exploratory analysis of all cases diagnosed as of February 11, 2020. Methods: All COVID-19 cases reported through February 11, 2020 were extracted from China's Infectious Disease Information System. Analyses included: 1) summary of patient characteristics; 2) examination of age distributions and sex ratios; 3) calculation of case fatality and mortality rates; 4) geo-temporal analysis of viral spread; 5) epidemiological curve construction; and 6) subgroup analysis. Results: A total of 72 314 patient records-44 672 (61.8%) confirmed cases, 16 186 (22.4%) suspected cases, 10567 (14.6%) clinical diagnosed cases (Hubei only), and 889 asymptomatic cases (1.2%)-contributed data for the analysis. Among confirmed cases, most were aged 30-79 years (86.6%), diagnosed in Hubei (74.7%), and considered mild (80.9%). A total of 1 023 deaths occurred among confirmed cases for an overall case-fatality rate of 2.3%. The COVID-19 spread outward from Hubei sometime after December 2019 and by February 11, 2020, 1 386 counties across all 31 provinces were affected. The epidemic curve of onset of symptoms peaked in January 23-26, then began to decline leading up to February 11. A total of 1 716 health workers have become infected and 5 have died (0.3%). Conclusions: The COVID-19 epidemic has spread very quickly. It only took 30 days to expand from Hubei to the rest of Mainland China. With many people returning from a long holiday, China needs to prepare for the possible rebound of the epidemic.
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              Too Many Patients…A Framework to Guide Statewide Allocation of Scarce Mechanical Ventilation During Disasters

              The threat of a catastrophic public health emergency causing life-threatening illness or injury on a massive scale has prompted extensive federal, state, and local preparedness efforts. Modeling studies suggest that an influenza pandemic similar to that of 1918 would require ICU and mechanical ventilation capacity that is significantly greater than what is available. Several groups have published recommendations for allocating life-support measures during a public health emergency. Because there are multiple ethically permissible approaches to allocating scarce life-sustaining resources and because the public will bear the consequences of these decisions, knowledge of public perspectives and moral points of reference on these issues is critical. Here we describe a critical care disaster resource allocation framework developed following a statewide community engagement process in Maryland. It is intended to assist hospitals and public health agencies in their independent and coordinated response to an officially declared catastrophic health emergency in which demand for mechanical ventilators exceeds the capabilities of all surge response efforts and in which there has been an executive order to implement scarce resource allocation procedures. The framework, built on a basic scoring system with modifications for specific considerations, also creates an opportunity for the legal community to review existing laws and liability protections in light of a specific disaster response process.
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                Author and article information

                Contributors
                ro.mitchell@alfred.org.au , mitchell.rob@me.com
                Journal
                Emerg Med Australas
                Emerg Med Australas
                10.1111/(ISSN)1742-6723
                EMM
                Emergency Medicine Australasia
                Wiley Publishing Asia Pty Ltd (Melbourne )
                1742-6731
                1742-6723
                05 May 2020
                June 2020
                : 32
                : 3 ( doiID: 10.1111/emm.v32.3 )
                : 520-524
                Affiliations
                [ 1 ] Emergency and Trauma Centre Royal Brisbane and Women's Hospital Brisbane Queensland Australia
                [ 2 ] Clinical Senate Queensland Health Brisbane Queensland Australia
                [ 3 ] School of Medicine The University of Queensland Brisbane Queensland Australia
                [ 4 ] Emergency and Trauma Centre Alfred Hospital Melbourne Victoria Australia
                [ 5 ] School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
                [ 6 ] Business School The University of Queensland Brisbane Queensland Australia
                Author notes
                [*] [* ]Correspondence: Dr Rob Mitchell, Emergency and Trauma Centre, Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia. Email: ro.mitchell@ 123456alfred.org.au
                Author information
                https://orcid.org/0000-0002-6422-3348
                Article
                EMM13514
                10.1111/1742-6723.13514
                7262026
                32275805
                a183fdc7-e3b1-4d34-840f-69fb65f8d55a
                © 2020 Australasian College for Emergency Medicine

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 17 March 2020
                : 02 April 2020
                Page count
                Figures: 0, Tables: 0, Pages: 5, Words: 3700
                Funding
                Funded by: Australian Research Council , open-funder-registry 10.13039/501100000923;
                Award ID: Linkage project grant LP0989662
                Categories
                Perspective
                Perspectives
                Custom metadata
                2.0
                June 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.3 mode:remove_FC converted:01.06.2020

                covid‐19,ebola,public health
                covid‐19, ebola, public health

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