Health care workers (HCW) are at the frontline response to the new coronavirus disease 2019 (COVID-19), being at a higher risk of acquiring the disease, and subsequently, exposing patients and colleagues. Searches in eight bibliographic databases were performed to systematically review the evidence on the prevalence, risk factors, clinical characteristics, and prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among HCW. Ninety-seven studies (All published in 2020), including 230,398 HCW, met the inclusion criteria. From the screened HCW using RT-PCR and the presence of antibodies, the estimated prevalence of SARS-CoV-2 infection was 11% (95%CI; 7%-15%) and 7% (95% CI; 4%-11%), respectively. The most frequently affected personnel were the nurses (48%. 95%CI; 41%-56%), while most of the COVID-19 positive medical personnel were working in hospitalization/non-emergency wards during the screening (43%, 95%CI;28%-59%). Anosmia, fever and myalgia were identified as the only symptoms associated with HCW SARS-CoV-2 positivity. Among RT-PCR positive HCW, 40% (95%CI;17%-65%) did not show symptoms at the time of diagnosis. Finally, 5% (95%CI;3%-8%) of the COVID-19 positive HCW developed severe clinical complications, and 0.5% (95% CI; 0.02%-1.3%) died. HCW suffer a significant burden from COVID-19, with HCW working in hospitalization/non-emergency wards and nurses being the most infected personnel.

COVID-19 in Health-Care Workers: A Living Systematic Review and Meta-Analysis of Prevalence, Risk Factors, Clinical Characteristics, and Outcomes

Psychological Impact of the COVID-19 Pandemic on Health Care Workers in Singapore Background: In response to the coronavirus disease 2019 (COVID-19) pandemic, Singapore raised its Disease Outbreak Response System Condition alert to “orange,” the second highest level. Between 19 February and 13 March 2020, confirmed cases rose from 84 to 200 (34.2 per 1 000 000 population), with an increase in patients in critical condition from 4 to 11 (5.5%) and no reported deaths in Singapore (1). Understanding the psychological impact of the COVID-19 outbreak among health care workers is crucial in guiding policies and interventions to maintain their psychological well-being. Objective: To examine the psychological distress, depression, anxiety, and stress experienced by health care workers in Singapore in the midst of the outbreak, and to compare these between medically and non–medically trained hospital personnel. Methods and Findings: From 19 February to 13 March 2020, health care workers from 2 major tertiary institutions in Singapore who were caring for patients with COVID-19 were invited to participate with a self-administered questionnaire. LETTERS

Psychological Impact of the COVID-19 Pandemic on Health Care Workers in Singapore

The Clavien-Dindo Classification of Surgical Complications

PURPOSE: The COVID-19 pandemic has many potential impacts on people with mental health conditions and on mental health care, including direct consequences of infection, effects of infection control measures and subsequent societal changes. We aimed to map early impacts of the pandemic on people with pre-existing mental health conditions and services they use, and to identify individual and service-level strategies adopted to manage these. METHODS: We searched for relevant material in the public domain published before 30 April 2020, including papers in scientific and professional journals, published first person accounts, media articles, and publications by governments, charities and professional associations. Search languages were English, French, German, Italian, Spanish, and Mandarin Chinese. Relevant content was retrieved and summarised via a rapid qualitative framework synthesis approach. RESULTS: We found 872 eligible sources from 28 countries. Most documented observations and experiences rather than reporting research data. We found many reports of deteriorations in symptoms, and of impacts of loneliness and social isolation and of lack of access to services and resources, but sometimes also of resilience, effective self-management and peer support. Immediate service challenges related to controlling infection, especially in inpatient and residential settings, and establishing remote working, especially in the community. We summarise reports of swiftly implemented adaptations and innovations, but also of pressing ethical challenges and concerns for the future. CONCLUSION: Our analysis captures the range of stakeholder perspectives and experiences publicly reported in the early stages of the COVID-19 pandemic in several countries. We identify potential foci for service planning and research.

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Early impacts of the COVID-19 pandemic on mental health care and on people with mental health conditions: framework synthesis of international experiences and responses.

Background The coronavirus pandemic appeared as the worst global health disaster of the century. Since the advent of the Second world war-2, humankind has experienced the most challenging health emergencies. The novel respiratory disease (SARS-CoV-2) emerged in Wuhan at the end of December 2019. Aim The study focuses on providing education through the educational system with a mode of delivery using digital solutions with a new paradigm method. Method This research incorporates the statistical data related to the Pakistani Ministry of Health's coronavirus epidemic to draw the results. Results WHO reported more than 51.949 million confirmed COVID-19 patients in more than 200 territories and countries. This epidemic caused more than 1.282 million deaths; however, more than 36.49 million people have recovered from the infection of the deadly disease COVID-19, as of November 11, 2020. The COVID-19 has put forward unique challenges in personal and social life spheres. The precautionary measures, including social distancing, called for abrupt closure of educational institutions, leaving the digital solutions as the primary mean of continuity in educational activities. Conclusion The current review looks into the dynamics of embracing the change in the educational system, ranging from delivery mode to shifting to a new paradigm moving to digital solutions. This study looks into the challenges, issues, barriers, and success parameters of Pakistan's online learning management system. From the preparedness phase to the actual implementation of the learning system at higher education, the level is noteworthy. The private sector has provided higher, secondary, and primary levels; the private sector came forward to maintain learning continuity. The review suggests a way forward ahead for the educational system's continuity and sustainability in the coronavirus pandemic and educational institutions' crises.

The paradigm shift for educational system continuance in the advent of COVID-19 pandemic: Mental health challenges and reflections

COVID-19: Results of a national survey of United Kingdom healthcare professionals' perceptions of current management strategy - A cross-sectional questionnaire study.

Background The coronavirus disease 2019 (COVID-19) pandemic led to a need to introduce video telemedicine for outpatients as an emergency measure without widespread stakeholder consultation. The patient and clinician experience of video outpatient consultation during the peak of the pandemic was studied for acceptability and to gather recommendations to improve the service during continuing infection control measures. Methods Outpatient video telemedicine was introduced over a 14-day period including the provision of equipment, systems integration and stakeholder communication. Patient and clinician experience were measured between 15 April 2020 and 5 May 2020. Results A total of 43 patients and 79 clinicians provided feedback. Of the patients, 86% were above the age of 30 years, with the largest patient group aged 51-70 years. Patient experience was positive. All (100%) patients found joining the video consultation easy; 93% of them recommended to use it for future consultations. Clinician satisfaction was >90% with sound and video quality. Patients were less satisfied than clinicians in that they had communicated everything they wanted to (86% versus 95%). All (100%) patients thought that the video telemedicine solution met their needs, but 25% of clinicians believed that the patient experience of a video consultation was worse than a face-to-face clinic appointment. The three significant factors identified for introducing video consultations were successful IT, improved patient experience and digital healthcare records. Conclusions In the COVID-19 crisis, video telemedicine played a central role in outpatient consultations with excellent levels of success. With some differences in satisfaction level, clinicians significantly underestimate the level of patient satisfaction with outpatient video consultation.

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Agile Application of Video Telemedicine During the COVID-19 Pandemic.

Objective The COVID-19 pandemic caused a major strain on healthcare systems across the globe. As these systems got overwhelmed with the emergency care of the infected patients, widespread cancellations of elective surgery occurred. Our hospital utilised local private hospital as a dedicated cold site (CS) for urgent elective surgery during the peak of the COVID-19 pandemic. We aim to analyse the outcomes at this dedicated cold site. Method A retrospective review of a prospectively maintained database of all the cases operated at the CS during a 2-month period (30 March 2020 to 29 May 2020) was carried out. The primary outcome was 30-day COVID-19 related mortality. The secondary outcomes were 30-day non-COVID-19 related mortality, complications, readmission and development of COVID-19 symptoms. Results A total of 153 patients were operated at the CS over the study period with a median age of 57 years (Interquartile range, IQR 47–70). 62% were females and 82% had a Body Mass Index (BMI) less than 30. 73% of the operations were performed for cancer. 59% of the surgeries were graded as intermediate and 26% as major or complex. There was no mortality at 30 days from COVID-19 or non COVID-19 causes. There was only 1 (0.65%) readmission. 7 patients (4.57%) developed complications. 1 (0.65%) patient was diagnosed with COVID-19 in the postoperative period while 3 had COVID-19 symptoms but were tested negative. Conclusion Urgent elective surgery is safe and feasible during the COVID-19 pandemic if a dedicated cold site is available.

Single centre concept of 'cold site' elective surgery during the peak of COVID-19 pandemic: A cohort study.

Introduction COVID-19 pandemic has caused a healthcare crisis across the world. Low-economic countries like Pakistan lag behind in an adequate response including supply of Personal Protective Equipment (PPE), leading to panic among healthcare workers. We aim to evaluate hospital settings and state in Pakistan regarding availability of resources and views of healthcare workers on COVID-19. Method A questionnaire survey was carried out among healthcare workers in public and private sector hospitals across Pakistan for a period of one month. The primary measured outcomes were presence of local Standard Operating Procedures (SOPs), availability and training of PPE, specific isolation wards and staff wellbeing support by the hospital management. Results There were 337 participants, 307 (91.1%) doctors and 11 nurses (3.3%). About two-third of the participants (n = 199, 59%) reported non-availability of PPE and 40% (n = 136) denied availability of local Standard Operating Procedures. About a quarter of the participants (n = 94, 27.8%) had training in Donning and Doffing. Most of the participants (n = 277, 82.1%) felt that it was necessary to have testing available for frontline workers. Conclusion There is lack of PPE and adequate facilities in hospitals as COVID-19 continue to spread in Pakistan. Local medical governing bodies and societies should come forward with guidelines to ascertain wellbeing of the healthcare workers.

A cross-sectional survey on availability of facilities to healthcare workers in Pakistan during the COVID-19 pandemic

Background The coronavirus disease 2019 (COVID-19) pandemic has changed the dynamics of healthcare, and the elective surgical consent process has also evolved. The Royal College of Surgeons of England published guidance on consent during COVID-19. Through this study, we aimed to assess our local consent adherence to these guidelines on the resumption of elective activity after the first wave of COVID-19. Methods This prospective review of consecutive elective surgical consent forms was conducted from 20 July 2020 to 16 August 2020 at the Princess Alexandra Hospital NHS Trust, England. The primary outcome was evidence of COVID-19 risk documentation on the consent forms. Results A total of 116 patients' consent forms were reviewed. Most patients were American Society of Anaesthesiologists (ASA) grade 2 (n=70; 60.34%). Only 25 consent forms (21.55%) had COVID -19 and its associated risks documented, with registrars being the most compliant (19/46; 41.3%) followed by consultants (6/51; 11.7%). With regards to the surgical sub-specialities, general surgery, orthopaedics and ENT had the highest compliance with the guidance. Conclusions As the elective activity resumes, peri-operative risks of COVID-19 should be weighted in during the informed consent process, as mentioned in the latest international guidelines on consent to avoid litigation and negligence claims.

Muhammad Rafaih Iqbal

Papers

COVID-19: Results of a national survey of United Kingdom healthcare professionals' perceptions of current management strategy - A cross-sectional questionnaire study.

Agile Application of Video Telemedicine During the COVID-19 Pandemic.

Single centre concept of 'cold site' elective surgery during the peak of COVID-19 pandemic: A cohort study.

A cross-sectional survey on availability of facilities to healthcare workers in Pakistan during the COVID-19 pandemic

Informed Consent for Surgery at Resumption of Elective Activity After the First Wave of COVID-19.