Reflections on the Cluster Epidemic of COVID-19; Lessons Learned from Wuhan's Experience: A Brief Review.

At present, new coronavirus pneumonia (COVID-19) is circulating worldwide. The pathogen of this coronavirus pneumonia is named SARS-CoV-2. The virus has a long incubation period and is highly contagious. There is currently no specific targeted drug treatment. The focus of anti-epidemic work should be more on prevention and control while cutting off the virus transmission route while treating infected patients, and protecting healthy people. In order to protect the safety and health of the Chinese citizens and to maintain the safety of world public health, the Chinese government and people have made unprecedented efforts to control the epidemic. Many people in the international community have joined in limiting the spread of COVID-19. This article combines the development of COVID-19 epidemic situation in Wuhan, the relevant prevention and control measures of the Wuhan government and local health authorities to share Wuhan's experience on control the cluster epidemic and provide new suggestions and ideas for epidemic prevention and control.

How to rapidly convert general wards to ICUs during the COVID-19 epidemic: Experience from Wuhan, China.

BACKGROUND: Critically ill patients with coronavirus disease 2019 (COVID-19) were surging and far outnumbered existing beds. AIMS: To describe how to rapidly convert general wards to intensive care units for critically ill patients with COVID-19. MATERIALS AND METHODS: Comprehensive assessment and analysis of available resources and standard requirements. RESULTS: The ICUs were successfully assembled in 4 days. The conversion included environment reconstruction, configuration and management of equipment, information system construction and human resource allocation. A total of 172 critically ill patients had been admitted to the contemporary ICUs and none medical staff was infected. DISCUSSION: The epidemic situation of COVID-19 poses a great challenge to various management departments of the hospital, especially for critically ill patients with a high mortality rate. To save more critically ill patients, the conversion of a general ward to a quarantine ICU ward must be completed in a short time, and the optimal allocation of resources must be appropriate to ensure that the medical team works effectively and is of high quality. In face of the overloaded medical system, the ideal non-negative pressure ward is hard to achieve. However, we have demonstrated with evidence that our conversions are effective in both providing care to critical patients and protecting the safety of our staff. CONCLUSION: The conversion is successful and the running experience would be a reference for hospitals in other areas nationally or globally.

Clinical characteristics of diarrhea in 90 cases with COVID-19: A descriptive study.

BACKGROUND: The novel coronavirus disease (COVID-19) has spread worldwide. Herein, we aimed to clarify the epidemiological and clinical characteristics of patients presenting with diarrhea. METHODS: A descriptive design was adopted from Jan 10 to Feb 17, 2020. All the cases included were diagnosed with COVID-19 under the interim guidance of the WHO. RESULTS: 912 patients with COVID-19 were admitted to hospital, in which, 90 cases (9.87%) presented with diarrhea. Among the 90 cases, 8 cases (9%) presented with diarrhea as the initial symptom, and 24%, 17%, and 24% of the patients complained of nausea, vomiting, and poor appetite, respectively. The most common fecal characteristics on admission were watery stool (64%) and mushy stool (28%). For the defecation frequency, 37% of the cases defecated over three times a day. The median time from illness onset to diarrhea was 3.0 days (IQR 0.0-5.0) and the median duration of diarrhea was 5.0 days (IQR 2.0-9.3). CONCLUSION: Clinicians are required to promptly identify the patients with initial diarrhea symptoms and pay adequate attention to the nutrient requirements of the patients with diarrhea during hospitalization. Standardized management is also recommended for the discharge of the patients to avoid potential fecal-oral transmission.

Monitoring and Management of Home-Quarantined Patients With COVID-19 Using a WeChat-Based Telemedicine System: Retrospective Cohort Study.

BACKGROUND: Most patients with coronavirus disease (COVID-19) who show mild symptoms are sent home by physicians to recover. However, the condition of some of these patients becomes severe or critical as the disease progresses. OBJECTIVE: The aim of this study was to evaluate a telemedicine model that was developed to address the challenges of treating patients with progressive COVID-19 who are home-quarantined and shortages in the medical workforce. METHODS: A telemedicine system was developed to continuously monitor the progression of home-quarantined patients with COVID-19. The system was built based on a popular social media smartphone app called WeChat; the app was used to establish two-way communication between a multidisciplinary team consisting of 7 medical workers and 188 home-quarantined individuals (including 74 confirmed patients with COVID-19). The system helped patients self-assess their conditions and update the multidisciplinary team through a telemedicine form stored on a cloud service, based on which the multidisciplinary team made treatment decisions. We evaluated this telemedicine system via a single-center retrospective study conducted at Tongji Hospital in Wuhan, China, in January 2020. RESULTS: Among 188 individuals using the telemedicine system, 114 (60.6%) were not infected with COVID-19 and were dismissed. Of the 74 confirmed patients with COVID-19, 26 (35%) recovered during the study period and voluntarily stopped using the system. The remaining 48/76 confirmed patients with COVID-19 (63%) used the system until the end of the study, including 6 patients whose conditions progressed to severe or critical. These 6 patients were admitted to hospital and were stabilized (one received extracorporeal membrane oxygenation support for 17 days). All 74 patients with COVID-19 eventually recovered. Through a comparison of the monitored symptoms between hospitalized and nonhospitalized patients, we found prolonged persistence and deterioration of fever, dyspnea, lack of strength, and muscle soreness to be diagnostic of need for hospitalization. CONCLUSIONS: By continuously monitoring the changes in several key symptoms, the telemedicine system reduces the risks of delayed hospitalization due to disease progression for patients with COVID-19 quarantined at home. The system uses a set of scales for quarantine management assessment that enables patients to self-assess their conditions. The results are useful for medical staff to identify disease progression and, hence, make appropriate and timely treatment decisions. The system requires few staff to manage a large cohort of patients. In addition, the system can solicit help from recovered but self-quarantined medical workers to alleviate shortages in the medical workforce and free healthy medical workers to fight COVID-19 on the front line. Thus, it optimizes the usage of local medical resources and prevents cross-infections among medical workers and patients.

Evaluating a Nurse Training Program in the Emergency Surgery Department Based on the Kirkpatrick's Model and Clinical Demand During the COVID-19 Pandemic.

Objective:To analyze the application of Kirkpatrick's model in the nurse training program among the emergency surgery department based on clinical demand during the COVID-19 (coronavirus disease-2019). To provide reference for the training of emergency surgical nurses during the outbreak of COVID-19.Design:Guided by Kirkpatrick's model, 35 nurses in the emergency surgery department were trained according to a program that resulted from the clinical demand during the pandemic. The trainees were observed in terms of their performance at reaction level and learning level.Results:At reaction level, the degree of satisfaction scored by nurses was relatively high, with its total score achieving (18.77 ± 3.09). At learning level, the differences between theoretical and operational scores of tested nurses before and after training proved to be statistically significant (p < 0.001).Conclusion:The application of Kirkpatrick's model based on clinical demand during the COVID-19 confirms to be effective for the training program of nurses in the emergency surgery department. It is also beneficial to improve nurses' knowledge and skills during the pandemic, which serves as a positive influence for clinical reference.

The Distance Teaching Practice of Combined Mode of Massive Open Online Course Micro-Video for Interns in Emergency Department During the COVID-19 Epidemic Period.

Objective:To observe and analyze the application effect of the combined mode of Massive Open Online Course (MOOC) micro-video during the COVID-19 epidemic period in the distance teaching practice of interns in the emergency department.Materials and Methods:The subjects of this study were 60 trainee nurses who conducted emergency nursing practice in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 1 to February 29, 2020. At the time of the COVID-19 outbreak in Wuhan, they were divided into two groups: (1) the experimental group (combined mode of MOOC micro-video) and (2) the control group (traditional theory teaching combined with clinical practice teaching). The differences of theoretical and practical examination scores and teaching satisfaction between the two groups were compared.Results:There was no significant difference in theoretical, practical, and total examination scores between the two groups, but in terms of teaching satisfaction, the overall satisfaction, the degree of easy understanding, the evaluation of teachers and learning results in the experimental group were higher than those in the control group, with statistical difference (p < 0.05).Conclusion:Compared with the traditional teaching methods, the effect of combined mode of MOOC micro-video in emergency nursing practice is the same as that of traditional teaching methods, but the satisfaction is higher, so it is more suitable to be used in nursing practice during the COVID-19 epidemic period, so as to effectively reduce the cross-infection between doctors, nurses, and teaching staff.

Implications for Online Management: Two Cases with COVID-19.

Satisfactory outcome was observed in one mild case and one severe case of COVID-19 pneumonia after the use of the online/offline multidisciplinary quarantine observation form, online monitoring, and classified diagnosis and treatment, as well as strict compliance with quarantine measures. Conditions of both patients were improved, and cross-infection and disease onset clustering were not observed. The multidisciplinary self-quarantine model provides early judgment, identification, and treatment of disease, improves compliance with early rehabilitation, increases confidence in recovery, and enhances self-management capabilities. This model is applicable to the current novel coronavirus pneumonia epidemic and can actively promote the management of suspected or confirmed mild cases, monitoring of critical cases, and self-management of discharged patients. The application of this new management model is worthy of being promoted in our specialized treatment facilities and in countries with severe epidemics.