| Title:
|
Considerations for planning COVID-19 treatment services in humanitarian responses |
| Abstract:
|
The COVID-19 pandemic has the potential to cause high morbidity and mortality in crisis-affected populations. Delivering COVID-19 treatment services in crisis settings will likely entail complex trade-offs between offering services of clinical benefit and minimising risks of nosocomial infection while allocating resources appropriately and safeguarding other essential services. This paper outlines considerations for humanitarian actors planning COVID-19 treatment services where vaccination is not yet widely available. We suggest key decision-making considerations: allocation of resources to COVID-19 treatment services and the design of clinical services should be based on community preferences likely opportunity costs and a clearly articulated package of care across different health system levels. Moreover appropriate service planning requires information on the expected COVID-19 burden and the resilience of the health system. We explore COVID-19 treatment service options at the patient level (diagnosis management location and level of treatment) and measures to reduce nosocomial transmission (cohorting patients protecting healthcare workers). Lastly we propose key indicators for monitoring COVID-19 health services. |
| Published:
|
2020-11-25 |
| Journal:
|
Confl Health |
| DOI:
|
10.1186/s13031-020-00325-6 |
| DOI_URL:
|
http://doi.org/10.1186/s13031-020-00325-6 |
| Author Name:
|
Garry Sylvia |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/garry_sylvia |
| Author Name:
|
Abdelmagid Nada |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/abdelmagid_nada |
| Author Name:
|
Baxter Louisa |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/baxter_louisa |
| Author Name:
|
Roberts Natalie |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/roberts_natalie |
| Author Name:
|
le Polain de Waroux Olivier |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/le_polain_de_waroux_olivier |
| Author Name:
|
Ismail Sharif |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/ismail_sharif |
| Author Name:
|
Ratnayake Ruwan |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/ratnayake_ruwan |
| Author Name:
|
Favas Caroline |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/favas_caroline |
| Author Name:
|
Lewis Elizabeth |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/lewis_elizabeth |
| Author Name:
|
Checchi Francesco |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/checchi_francesco |
| sha:
|
d6b6909d4eeb1f74ceda3b8d8d46b9a9f8eb74f5 |
| license:
|
cc-by |
| license_url:
|
https://creativecommons.org/licenses/by/4.0/ |
| source_x:
|
Medline; PMC |
| source_x_url:
|
https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/ |
| pubmed_id:
|
33250932 |
| pubmed_id_url:
|
https://www.ncbi.nlm.nih.gov/pubmed/33250932 |
| pmcid:
|
PMC7686825 |
| pmcid_url:
|
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686825 |
| url:
|
https://doi.org/10.1186/s13031-020-00325-6
https://www.ncbi.nlm.nih.gov/pubmed/33250932/ |
| has_full_text:
|
TRUE |
| Keywords Extracted from Text Content:
|
patients
COVID-19
patient
home-versus facility-based
▪
women
Safeguard
pregnant women
cardiovascular
children
PPE
COVID-19 health services
COVID-19
people
volunteers
lockdown
Ensure
Prioritise SARS-CoV-2
Patients
COVID-19 patients
renal
COVID-19 risk factors
patients
UK
COVID-19 care
airway
COVID-19 patient
human
intravenous fluids
SARS-CoV-2
Red Cross / Red Crescent
IPC
non-COVID-19
patient
water
persons
oxygen
PPE [28]
NA and
FC |
| Extracted Text Content in Record:
|
First 5000 Characters:The COVID-19 pandemic has the potential to cause high morbidity and mortality in crisis-affected populations. Delivering COVID-19 treatment services in crisis settings will likely entail complex trade-offs between offering services of clinical benefit and minimising risks of nosocomial infection, while allocating resources appropriately and safeguarding other essential services. This paper outlines considerations for humanitarian actors planning COVID-19 treatment services where vaccination is not yet widely available. We suggest key decision-making considerations: allocation of resources to COVID-19 treatment services and the design of clinical services should be based on community preferences, likely opportunity costs, and a clearly articulated package of care across different health system levels. Moreover, appropriate service planning requires information on the expected COVID-19 burden and the resilience of the health system. We explore COVID-19 treatment service options at the patient level (diagnosis, management, location and level of treatment) and measures to reduce nosocomial transmission (cohorting patients, protecting healthcare workers). Lastly, we propose key indicators for monitoring COVID-19 health services.
The challenge of treating COVID-19 in humanitarian responses COVID-19 epidemics are resulting in high excess morbidity and mortality across high-income countries. The virus is expected to cause even more pernicious effects in crisis-affected populations, defined here as forcibly displaced people within or across national borders and non-displaced persons affected by armed conflict, exceptional food insecurity and/or natural disasters, and in need of humanitarian assistance. These populations may face higher COVID-19 attack rates due to large household sizes, inadequate hygiene and access to safe water and sanitation, and camp or urban overcrowding; they may also experience higher disease severity and poorer outcomes due to untreated co-morbidities and limited access to health services [1] .
COVID-19 treatment services may prove particularly challenging in settings with low baseline healthcare capacity, fragile supply chains and limited access to testing. Aside from the complexities of adapting clinical protocols to these conditions, humanitarian actors are likely to face complex trade-offs when deciding whether and which COVID-19 health services can be offered in a given setting. In this paper, we outline considerations and decision-making criteria for humanitarian and government actors to adapt routine health services and design COVID-19 health services. While the World Health Organization (WHO) has published clinical management guidelines [2, 3] and ethical guidance for supporting decision-making in outbreaks [4] , we focus here on supporting decision-makers in balancing resource allocation across the spectrum of population healthcare needs until vaccination is widely locally available.
We suggest that the following principles should underpin decision-making and planning for provision of COVID-19 health services:
▪ Beneficence: Care offered, particularly outside the home and in settings where patients are separated from their families, should offer an evidence-based clinical benefit where available (including documented, publicly-available clinical experience) to the type of patient for whom it is intendedfor example, critical cases, severe but non-critical cases, or non-severe with known risk factors [3] . Accordingly, COVID-19 inpatient facilities should admit patients whose severity profile they are equipped to mitigate, which will depend on resource availability and expertise / experience (see Table 1 ).
The most experienced clinicians available should make this assessment at triage; ▪ Non-maleficence: COVID-19 health services must keep to a minimum the risk of nosocomial SARS-CoV-2 infection for clinical and support staff. Proposed COVID-19 treatment services should not be pursued if this risk could (i) present staff with a dilemma between caring for patients and preserving their health, particularly when abstaining from care provision would result in loss of income or stigma [11] ; (ii) cause unacceptable absenteeism, mortality or long-term disability among healthcare workers, particularly where such losses would leave serious, long-term gaps in non-COVID-19 health service delivery [12, 13] ; and/or (iii) propagate transmission within healthcare settings (e.g. to non-COVID-19 patients) to an extent likely to negate the clinical benefits of treatment. ▪ Justiceefficiency: Against finite resources, COVID-19 treatment services must be carefully balanced to not excessively withdraw resources from potentially more cost-effective interventions [14] to mitigate both the direct effects of the epidemic (such as nonpharmaceutical prevention) and its indirect effects due to disruption of essential routine health services; ▪ Justiceequity of resource allocation: If COVID-19 treatment service |
| Keywords Extracted from PMC Text:
|
COVID-19 patient
people
patients
home-
lockdown
COVID-19 patients
interventions);Reduce COVID-19
IPC
persons
oxygen
COVID-19 care
patient
PPE
human
▪
Safeguard
UK
COVID-19
non-COVID-19
's
COVID-19 risk factors
children
PPE [28]
Patients
pregnant women
volunteers
2013–2016
water
SARS-CoV-2
Red Cross / Red Crescent |
| Extracted PMC Text Content in Record:
|
First 5000 Characters:COVID-19 epidemics are resulting in high excess morbidity and mortality across high-income countries. The virus is expected to cause even more pernicious effects in crisis-affected populations, defined here as forcibly displaced people within or across national borders and non-displaced persons affected by armed conflict, exceptional food insecurity and/or natural disasters, and in need of humanitarian assistance. These populations may face higher COVID-19 attack rates due to large household sizes, inadequate hygiene and access to safe water and sanitation, and camp or urban overcrowding; they may also experience higher disease severity and poorer outcomes due to untreated co-morbidities and limited access to health services [1].
COVID-19 treatment services may prove particularly challenging in settings with low baseline healthcare capacity, fragile supply chains and limited access to testing. Aside from the complexities of adapting clinical protocols to these conditions, humanitarian actors are likely to face complex trade-offs when deciding whether and which COVID-19 health services can be offered in a given setting. In this paper, we outline considerations and decision-making criteria for humanitarian and government actors to adapt routine health services and design COVID-19 health services. While the World Health Organization (WHO) has published clinical management guidelines [2, 3] and ethical guidance for supporting decision-making in outbreaks [4], we focus here on supporting decision-makers in balancing resource allocation across the spectrum of population healthcare needs until vaccination is widely locally available.
We suggest that the following principles should underpin decision-making and planning for provision of COVID-19 health services:
▪ Beneficence: Care offered, particularly outside the home and in settings where patients are separated from their families, should offer an evidence-based clinical benefit where available (including documented, publicly-available clinical experience) to the type of patient for whom it is intended – for example, critical cases, severe but non-critical cases, or non-severe with known risk factors [3]. Accordingly, COVID-19 inpatient facilities should admit patients whose severity profile they are equipped to mitigate, which will depend on resource availability and expertise / experience (see Table 1). The most experienced clinicians available should make this assessment at triage;▪ Non-maleficence: COVID-19 health services must keep to a minimum the risk of nosocomial SARS-CoV-2 infection for clinical and support staff. Proposed COVID-19 treatment services should not be pursued if this risk could (i) present staff with a dilemma between caring for patients and preserving their health, particularly when abstaining from care provision would result in loss of income or stigma [11]; (ii) cause unacceptable absenteeism, mortality or long-term disability among healthcare workers, particularly where such losses would leave serious, long-term gaps in non-COVID-19 health service delivery [12, 13]; and/or (iii) propagate transmission within healthcare settings (e.g. to non-COVID-19 patients) to an extent likely to negate the clinical benefits of treatment.▪ Justice – efficiency: Against finite resources, COVID-19 treatment services must be carefully balanced to not excessively withdraw resources from potentially more cost-effective interventions [14] to mitigate both the direct effects of the epidemic (such as non-pharmaceutical prevention) and its indirect effects due to disruption of essential routine health services;▪ Justice – equity of resource allocation: If COVID-19 treatment service capacity is not sufficient to meet demand, it should be offered equitably, with priority attributed to patients who would be most likely to benefit from treatment or palliation. Corresponding triage and admission criteria should be communicated and understandable to the community;▪ Justice – equity of access: COVID-19 health services should be designed to proactively
address barriers to accessing care by those most in need and should be accountable and acceptable to the catchment population, with an emphasis on dialogue and transparent communication.
In accordance with the above principles, we suggest that COVID-19 health services in humanitarian responses should be designed to achieve all of the following objectives:
Safeguard the delivery of essential non-COVID-19 health services;Protect frontline healthcare and support workers from infection;Allocate resources optimally and equitably, while minimising opportunity costs (e.g. diversion of resources from more cost-effective interventions);Reduce COVID-19 case-fatality and morbidity through safe, dignified and effective COVID-19 health services including palliative care where appropriate.
Decisions on which COVID-19 health services to offer should be accompanied by proactive, ongoing dialogue with legitimate community members repres |
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