RESUMO
The SARS-CoV-2 pandemic has challenged the provision of healthcare in ways that are unprecedented in our lifetime. Planning for the sheer numbers expected during the surge has required public hospitals to de-escalate all non-essential clinical services to focus on COVID-19. Western Cape Province was the initial epicentre of the COVID-19 epidemic in South Africa (SA), and the Cape Town metro was its hardest-hit geographical region. We describe how we constructed our COVID-19 hospital-wide clinical service at Groote Schuur Hospital, the University of Cape Town's tertiary-level teaching hospital. By describing the barriers and enablers, we hope to provide guidance rather than a blueprint for hospitals elsewhere in SA and in low-resource countries that face similar challenges now or during subsequent waves.
Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Hospitais Universitários/organização & administração , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Centros de Atenção Terciária/organização & administração , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Registros Eletrônicos de Saúde/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Humanos , Unidades de Terapia Intensiva/organização & administração , Administração de Materiais no Hospital , Pandemias , Equipe de Assistência ao Paciente , Pneumonia Viral/epidemiologia , SARS-CoV-2 , Centros de Cuidados de Saúde Secundários , África do Sul/epidemiologiaRESUMO
The SARS-CoV-2 pandemic has presented clinicians with an enormous challenge in managing a respiratory virus that is not only capable of causing severe pneumonia and acute respiratory distress syndrome, but also multisystem disease. The extraordinary pace of clinical research, and particularly the surge in adaptive trials of new and repurposed treatments, have provided rapid answers to questions of whether such treatments work, and has resulted in corticosteroids taking centre stage in the management of hospitalised patients requiring oxygen support. Some treatment modalities, such as the role of anticoagulation to prevent and treat potential thromboembolic complications, remain controversial, as does the use of high-level oxygen support, outside of an intensive care unit setting. In this paper, we describe the clinical management of COVID-19 patients admitted to Groote Schuur Hospital, a major tertiary level hospital at the epicentre of South Africa's SARS-CoV-2 epidemic during its first 4 months.
Assuntos
Infecções por Coronavirus/terapia , Hospitais Universitários/organização & administração , Pneumonia Viral/terapia , Centros de Atenção Terciária/organização & administração , Corticosteroides/uso terapêutico , Anticoagulantes/uso terapêutico , Gestão de Antimicrobianos , Betacoronavirus , COVID-19 , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/psicologia , Cuidados Críticos/organização & administração , Complicações do Diabetes , Humanos , Intubação Intratraqueal , Corpo Clínico Hospitalar/psicologia , Oxigenoterapia , Cuidados Paliativos , Pandemias , Equipe de Assistência ao Paciente , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/psicologia , Respiração Artificial , Fatores de Risco , SARS-CoV-2 , Apoio Social , África do Sul/epidemiologiaRESUMO
The COVID-19 pandemic has challenged the provision of healthcare in ways that are unprecedented in our lifetime. Planning for the sheer numbers expected during the surge has required public hospitals to de-escalate all non-essential clinical services to focus on COVID-19. Western Cape Province was the initial epicentre of the COVID-19 epidemic in South Africa (SA), and the Cape Town metro was its hardest-hit geographical region. We describe how we constructed our COVID-19 hospital-wide clinical service at Groote Schuur Hospital, the University of Cape Town's tertiary-level teaching hospital. By describing the barriers and enablers, we hope to provide guidance rather than a blueprint for hospitals elsewhere in SA and in low-resource countries that face similar challenges now or during subsequent waves