Substantial differences in preparedness for emergency infection control measures among major hospitals in Japan: lessons from SARS

Impact of Japan's State of Emergency Due to the COVID-19 Pandemic on Trends in Diabetes Care: A Descriptive and Retrospective Study

OBJECTIVE

This study examined the impact of Japan's state of emergency on trends in diabetes care during the coronavirus disease 2019 (COVID-19) pandemic.

DESIGN

A descriptive and retrospective study.

SETTING

Showa University Hospital, Japan.

PARTICIPANTS

Patients with diabetes who received medical treatment from 2018 to 2020. Determinants of interest: Number of patients with diabetes visiting the hospital per week. To examine the impact of the Japan's state of emergency, the number of hospital visitations by patients with diabetes was summarized from 28 weeks of data for each year, from calendar week 8 to calender week 35.

RESULTS

Compared with the mean of 2018 and 2019, no significant difference was found between the three periods (before, during, and after the state of emergency). However, the numbers of patients from both inside and outside Tokyo increased at 7 weeks after the state of emergency was lifted.

CONCLUSIONS

A significant increase in the numbers of patients with diabetes was seen compared with the same period in 2018 and 2019, suggesting that the state of emergency may have hindered diabetes care. Therefore, patients with diabetes should receive continuous follow-up regarding their diabetes care, keeping a close eye on relvent measurements.

Impact of the state of emergency on trends in the care of three major diseases at Showa University Hospital, Japan: a retrospective and descriptive study

Introduction

This study aimed to examine the trends in patient consultations for three major diseases (cancer, heart disease, and stroke) at Showa University Hospital, Japan during the state of emergency for the Coronavirus 2019 (COVID-19) pandemic.

Methods

The present study was a retrospective and descriptive study of Showa University Hospital in Tokyo, Japan. Subjects were patients who had received medical treatment at Showa University Hospital and were diagnosed from 2017 to 2020. To examine the impact of the state of emergency, the number visits to hospital by the top three causes of death or other diseases were summarised from 21 weeks of data, from week 8 to week 28, for each year.

Results

Compared to the average of the previous 3 years, a comparison of the three periods before and after the state of emergency showed a V-shaped curve in 2020, with a large drop in the number of cancer patients during the state of emergency, both from within Tokyo and from outside the city.

Conclusions

This study showed a long-term decrease in cancer patient visits to Showa University Hospital since the beginning of the COVID-19 pandemic compared to the previous 3 years. It is also possible that medical care that would have been available may not have been provided due to the state of emergency, so it is necessary to follow up patients while keeping a close eye on measures other than infectious diseases.

Attitudes and Preparedness of Non-Frontline Physicians in Saudi Arabia Toward the COVID-19 Pandemic

OBJECTIVE

This study assesses the attitudes (willingness) and preparedness of non-frontline physicians across different specialties in the Kingdom of Saudi Arabia (KSA) toward the management of hospitalized coronavirus disease (COVID-19) patients.

METHODS

This cross-sectional study conducted between April 15, 2020, and May 5, 2020, included 6209 physicians working in KSA. An electronic questionnaire was designed and validated for the assessment of 3 categorical outcome variables, namely, attitudes, confidence, and knowledge levels. Pearson's chi-square test was used for comparing the distribution of the proportions of these 3 categorical variables.

RESULTS

Most participants (63.2%) were willing and prepared to treat COVID-19 patients. A significantly large proportion of participants specializing in anesthesiology (78.2%) had higher knowledge levels, followed by those from plastic surgery (71.1%), pediatrics (69.7%), and obstetrics and gynecology (69.1%) (P < 0.0001). Lower confidence levels were found for airway management skills (38.1%), particularly among dermatologists and radiologists.

CONCLUSION

Higher knowledge levels about personal protective equipment (PPE) use and confidence in airway management skills were proportionally related to the level of willingness to participate in COVID-19 patient management. There is an urgent need to train doctors from certain specialties on PPE use and airway management to enable their frontline support of severely ill COVID-19 patients.

Mapping infectious disease hospital surge threats to lessons learnt in Singapore: a systems analysis and development of a framework to inform how to DECIDE on planning and response strategies

Background

Hospital usage and service demand during an Infectious Disease (ID) outbreak can tax the health system in different ways. Herein we conceptualize hospital surge elements, and lessons learnt from such events, to help build appropriately matched responses to future ID surge threats.

Methods

We used the Interpretive Descriptive qualitative approach. Interviews (n = 35) were conducted with governance and public health specialists; hospital based staff; and General Practitioners. Key policy literature in tandem with the interview data were used to iteratively generate a Hospital ID Surge framework. We anchored our narrative account within this framework, which is used to structure our analysis.

Results

A spectrum of surge threats from combinations of capacity (for crowding) and capability (for treatment complexity) demands were identified. Starting with the Pyramid scenario, or an influx of high screening rates flooding Emergency Departments, alongside fewer and manageable admissions; the Reverse-Pyramid occurs when few cases are screened and admitted but those that are, are complex; during a ‘Black’ scenario, the system is overburdened by both crowding and complexity. The Singapore hospital system is highly adapted to crowding, functioning remarkably well at constant near-full capacity in Peacetime and resilient to Endemic surges. We catalogue 26 strategies from lessons learnt relating to staffing, space, supplies and systems, crystalizing institutional memory. The DECIDE model advocates linking these strategies to types of surge threats and offers a step-by-step guide for coordinating outbreak planning and response.

Conclusions

Lack of a shared definition and decision making of surge threats had rendered the procedures somewhat duplicative. This burden was paradoxically exacerbated by a health system that highly prizes planning and forward thinking, but worked largely in silo until an ID crisis hit. Many such lessons can be put into play to further strengthen our current hospital governance and adapted to more diverse settings.