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      Are doctors protected enough during COVID-19 in South Asia?

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          Abstract

          Background

          The highly contagious nature of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) places physicians in South Asia at high risk of contracting the infection. Accordingly, we conducted this study to provide an updated account of physician deaths in South Asia during the COVID-19 pandemic and to analyze and compare the different characteristics associated with physician mortality amongst the countries of the region.

          Methods

          We performed a cross-sectional study by using published news reports on the websites of news agencies from 9 selected countries in South Asia. Our study included only those physicians and doctors who died after contracting COVID-19 from their respective workplaces. All available data about the country of origin, type of, sex, age, medical or surgical specialty, and date of death were included.

          Results

          The total number of physician deaths reported due to COVID-19 in our study was 170, with half (87/170, 51%) of the deaths reported from Iran. Male physician deaths were reported to be 145 (145/170 = 85%). Internal Medicine (58.43%) was the most severely affected sub-specialty. The highest physician mortality rate in the general population recorded in Afghanistan (27/1000 deaths). General physicians from India [OR = 11.00(95% CI = 1.06–114.08), p = 0.045] and public sector medical practitioners from Pakistan [aOR = 4.52 (95% CI = 1.18–17.33), p = 0.028] were showing significant mortality when compared with other regions in multivariate logistic regression.

          Conclusion

          An increased number of physician deaths, owing to COVID-19, has been shown in South Asia. This could be due to decreased personal protective equipment and the poor health care management systems of the countries in the region to combat the pandemic. Future studies should provide detailed information of characteristics associated with physician mortalities along with the main complications arising due to the virus.

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          Most cited references15

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          The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

          Much of biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalizability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September 2004, with methodologists, researchers, and journal editors to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE Statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. Eighteen items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies. A detailed Explanation and Elaboration document is published separately and is freely available on the web sites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE Statement will contribute to improving the quality of reporting of observational studies.
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            COVID-19 battle during the toughest sanctions against Iran

            Coronavirus disease 2019 (COVID-19) has spread rapidly throughout the world. WHO declared the outbreak a global pandemic on March 11, 2020. 1 In Iran, the first official announcement of deaths from COVID-19 was made on Feb 19, 2020. As of March 16, 2020, 14 991 people have been infected with severe acute respiratory syndrome coronavirus 2, and 853 people have died from COVID-19. 4996 people have recovered. 2 The economic loss caused by the spread of COVID-19 in Iran coincides with the ever-highest politically induced sanctions against the country. Although various sanctions have been in place for the past four decades, since May, 2019, the unilateral sanctions imposed by the USA against Iran have increased dramatically to an almost total economic lockdown, which includes severe penalties for non-US companies conducting business with Iran. The Iranian health sector, although among the most resilient in the region, 3 has been affected as a consequence. 4 All aspects of prevention, diagnosis, and treatment are directly and indirectly hampered, and the country is falling short in combating the crisis. 5 Lack of medical, pharmaceutical, and laboratory equipment such as protective gowns and necessary medication has been scaling up the burden of the epidemic and the number of casualties. Despite WHO and other international humanitarian organisations dispatching supplies and medical necessities, 6 the speed of the outbreak and the detrimental effects of sanctions have resulted reduced access to life-saving medicines and equipment, adding to the health sector's pre-existing requirements for other difficult health conditions. 7 It is shameful that besides the lives lost to this deadly virus, extreme sanctions limit access to necessary materials and therefore kill even more Iranian people. Although sanctions do not seem to be physical warfare weapons, they are just as deadly, if not more so. Jeopardising the health of populations for political ends is not only illegal but also barbaric. We should not let history repeat itself; more than half a million Iraqi children and nearly 40 000 Venezuelans were killed as a result of UN Security Council and US sanctions in 1994 and 2017–18, respectively. 8 The global health community should regard these sanctions as war crimes and seek accountability for those who impose them. Given the COVID-19 pandemic and its alarming outcomes in Iran, 9 the international community must be obliged to stand against the sanctions that are hurting millions of Iranians. It is essential for the UN Security Council and the USA to ease, albeit temporarily, the barriers to providing lifesaving medical supplies to Iran. In the future, the global community must anticipate possible impacts of sanctions on humanitarian aid and move to prevent further disasters from happening. 4 Viruses do not discriminate, nor should humankind. © 2020 Bloomberg/Contributor/Getty Images 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
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              Healthcare impact of COVID-19 epidemic in India: A stochastic mathematical model

              Background In India, the SARS-CoV2 COVID-19 epidemic has grown to 1,251 cases and 32 deaths as on 30 Mar 2020. The healthcare impact of the epidemic in India was studied with a stochastic mathematical model. Methods A compartmental SEIR model was developed, in which the flow of individuals through compartments is modeled using a set of differential equations. Different scenarios were modeled with 1000 runs of Monte Carlo simulation each using MATLAB. Hospitalization, ICU requirements and deaths were modeled on SimVoi software. The impact of Non-Pharmacological Interventions (NPI) including social distancing and lockdown on checking the epidemic was estimated. Results Uninterrupted epidemic in India would have resulted in over 364 million cases and 1.56 million deaths with peak by mid-July. As per the model, at growth rate of 1.15, India is likely to reach approximately 3 million cases by 25 May, implying 125,455 (±18,034) hospitalizations, 26,130 (±3,298) ICU admissions and 13,447 (±1,819) deaths. This would overwhelm India’s healthcare system. The model shows that with immediate institution of NPIs, the epidemic might still be checked by mid-April 2020. It would then result in 241,974 (±33,735) total infections, 10,214 (±1,649) hospitalizations, 2,121 (±334) ICU admissions and 1,081(±169) deaths. Conclusion At current growth rate of epidemic, India’s healthcare resources will be overwhelmed by end-May. With the immediate institution of NPIs, total cases, hospitalizations, ICU requirements and deaths can be reduced by almost 90%.
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                Author and article information

                Contributors
                nadia.jatoi64@gmail.com
                saniya.98@hotmail.com
                emad.sajid98@hotmail.com
                farahyasmin972@yahoo.com
                sohaib_asghar123@yahoo.com
                syed_ali11@hotmail.com
                b.zafarsayeed@gmail.com
                marufimariamm95@gmail.com
                kaneezfatima344@gmail.com
                faisal.mahmood@aku.edu
                Journal
                Glob Health Res Policy
                Glob Health Res Policy
                Global Health Research and Policy
                BioMed Central (London )
                2397-0642
                30 September 2021
                30 September 2021
                2021
                : 6
                : 36
                Affiliations
                [1 ]GRID grid.412080.f, ISNI 0000 0000 9363 9292, Department of Internal Medicine, Doctor Ruth K.M. Pfau Civil Hospital, , Dow University of Health Sciences, ; Baba-e-Urdu Road, Karachi, Sindh 74200 Pakistan
                [2 ]Department of Internal Medicine, Dow Ojha University Hospital, Suparco Road, KDA Scheme 33, Karachi, Sindh 75300 Pakistan
                [3 ]GRID grid.412080.f, ISNI 0000 0000 9363 9292, Department of Surgery, , Dow University of Health Sciences, ; Baba-e-Urdu Road, Karachi, Sindh 74200 Pakistan
                [4 ]Division of Infectious Disease, Department of Medicine, Agha Khan University Hospital, National Stadium Road, Karachi, Sindh 74800 Pakistan
                Author information
                http://orcid.org/0000-0003-0461-0060
                Article
                219
                10.1186/s41256-021-00219-x
                8481110
                34593053
                d7263f2f-d429-47c8-81c2-2fc2cb753e71
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 1 February 2021
                : 26 August 2021
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                © The Author(s) 2021

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