Uncertainty Quantification for Epidemic Risk Management: Case of SARS-CoV-2 in Morocco.

In this paper, we propose a new method for epidemic risk modelling and prediction, based on uncertainty quantification (UQ) approaches. In UQ, we consider the state variables as members of a convenient separable Hilbert space, and we look for their representation in finite dimensional subspaces generated by truncations of a suitable Hilbert basis. The coefficients of the finite expansion can be determined by approaches established in the literature, adapted to the determination of the probability distribution of epidemic risk variables. Here, we consider two approaches: collocation (COL) and moment matching (MM). Both are applied to the case of SARS-CoV-2 in Morocco, as an epidemic risk example. For all the epidemic risk indicators computed in this study (number of detections, number of deaths, number of new cases, predictions and human impact probabilities), the proposed models were able to estimate the values of the state variables with precision, i.e., with very low root mean square errors (RMSE) between predicted values and observed ones. Finally, the proposed approaches are used to generate a decision-making tool for future epidemic risk management, or, more generally, a quantitative disaster management approach in the humanitarian supply chain.

Withholding and withdrawing life-sustaining therapy in a Moroccan Emergency Department: an observational study.

BACKGROUND: Withdrawing and withholding life-support therapy (WH/WD) are undeniably integrated parts of medical activity. However, Emergency Department (ED) might not be the most appropriate place to give end-of life (EOL) care; the legal aspects and practices of the EOL care in emergency rooms are rarely mentioned in the medical literature and should be studied. The aims of this study were to assess frequency of situations where life-support therapies were withheld or withdrawn and modalities for implement of these decisions. METHOD: A survey of patients who died in a Moroccan ED was performed. Confounding variables examined were: Age, gender, chronic underlying diseases, acute medical disorders, APACHE II score, Charlson Comorbidities Index, and Length of stay. If a decision of WH/WD was taken, additional data were collected: Type of decision; reasons supporting the decision, modalities of WH/WD, moment, time from ED admission to decision, and time from processing to withhold or withdrawal life-sustaining treatment to death. Individuals who initiated (single emergency physician, medical staff), and were involved in the decision (nursing staff, patients, and families), and documentation of the decision in the medical record. RESULTS: 177 patients who died in ED between November 2009 and March 2010 were included. Withholding and withdrawing life-sustaining treatment was applied to 30.5% of all patients who died. Therapies were withheld in 24.2% and were withdrawn in 6.2%. The most reasons for making these decisions were; absence of improvement following a period of active treatment (61.1%), and expected irreversibility of acute disorder in the first 24 h (42.6%). The most common modalities withheld or withdrawn life-support therapy were mechanical ventilation (17%), vasopressor and inotrops infusion (15.8%). Factors associated with WH/WD decisions were older age (OR = 1.1; 95%IC = 1.01-1.07; P = 0.001), neurological acute medical disorders (OR = 4.1; 95%IC = 1.48-11.68; P = 0.007), malignancy (OR = 7.7; 95%IC = 1.38-8.54; P = 0.002) and cardiovascular (OR = 3.4;95%IC = 2.06-28.5;P = 0.008) chronic underlying diseases. CONCLUSION: Life-sustaining treatment were frequently withheld or withdrawn from elderly patients with underlying chronic cardiovascular disease or metastatic cancer or patients with acute neurological medical disorders in a Moroccan ED. Religious beliefs and the lack of guidelines and official Moroccan laws could explain the ethical limitations of the decision-making process recorded in this study.