COVID disrupts healthcare in low- and middle-income countries
The COVID-19 pandemic has negatively affected healthcare programs in low- and middle-income countries (LMICs) that work to protect populations against HIV, tuberculosis (TB), and malaria, according to a new report by the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
The fund found that, from April to September 2020, HIV testing fell 41%, TB referrals declined 59%, and malaria diagnoses fell 31% among 502 health facilities in 32 LMICs in Africa and Asia.
According to 85% of the surveyed facilities, COVID-19 was the main reason patients no longer sought healthcare, with most reporting fear of transmission (28%), disruption to public transit (20%), lockdown or stay-at-home orders (20%), and general delayed care-seeking behaviors (15%). For instance, antenatal care visits fell 43%, and in seven Asian countries, they fell 66% while consultations for children under 5 dropped 74%.
During the pandemic, 45% of health facilities reported having sufficient personal protective equipment, and across 24 countries in Africa, only a minority of facilities could conduct COVID-19 antigen rapid diagnostic tests (11%) and polymerase chain reaction tests (8%).
Staffing was also a problem, and 67% of African facilities and 69% of facilities in seven Asian countries said that 10% of staff were not working during this period. Looking ahead to COVID-19 vaccinations, the researchers found that 7% of African facilities had no working refrigerators or adequate equipment to store traditional vaccines and that 23% did not have the minimum quantity of needles or syringes.
Some healthcare facilities, however, have been able to more easily adapt to the pandemic. The most common practices were reassigning staff to different units (70%), transferring staff to different facilities as needed (34%), extending drug prescription fills (71%), prioritizing patient consultations by risk (64%), and providing care for multiple conditions in one visit (39%).
“To regain the ground lost on the three epidemics in 2020 and to step up the fight against COVID-19, we have to massively scale up adaptation programs, increase access to COVID-19 tools, and shore up systems for health so they don’t collapse,” Peter Sands, MPA, Global Fund executive director, said in a press release.
Apr 13 The Global Fund report and press release
Commission Planning Group aims to integrate COVID lessons
More than two dozen of the nation's leading scientists, sponsored by Schmidt Futures, the Skoll Foundations, the Rockefeller Foundation, and Stand Together, are creating the Covid Commission Planning Group (CPG), the University of Virginia's Miller Center of Public Affairs announced today in a news release emailed to journalists.
The goal of the commission is, according to the press release, to "seize this once-in-a-century opportunity to help America—and the world—begin to heal and safeguard our common future from new existential threats." Already, the team has debriefed nearly 100 experts and defined nine task forces in areas such as COVID-19's origins and the prevention of future pandemics, national readiness and initial responses, communities at risk, care for the sick (including COVID-19 long-haulers), data solutions, and diagnostics, therapeutics, and vaccines.
The CPG will be directed by Philip Zelikow, JD, PhD, MA, former executive director of the 9/11 Commission and the earlier Carter-Ford Commission on Federal Election Reform. Other members include former Food and Drug Administration Commissioner Margaret Hamburg, MD; former Centers for Disease Control and Prevention Director Julie Gerberding, MD, MPH; Center for Infectious Disease Research and Policy Director Michael Osterholm, PhD, MPH; and other experts in vaccine development, biodefense, patient care, and more.
"A nonpartisan National Covid Commission could unite Americans to call upon their knowledge and practical skills across and beyond political parties," the release said. "Although it cannot provide the last word, a commission can build a healthier foundation for common understanding and future work, including on issues of equity and the way the seismic shock of this pandemic has exposed so many fault lines in our society." It added that the commission will offer its work to the federal government if Congress and the Biden administration establish a government commission.
Apr 13 University of Virginia press release
Covid CPG website
ECMO may improve survival in severely ill COVID-19 patients
Extracorporeal membrane oxygenation (ECMO) treatment for COVID-19 resulted in a 45.9% in-hospital mortality rate for those hospitalized with COVID-19 and acute respiratory distress syndrome (ARDS)—roughly half the rate reported in previous publications—according to a study late last week in the Annals of Surgery.
The researchers looked at 11,182 US patients hospitalized with COVID-19 and ARDS between April and September 2020. The average length of stay was 36.8 days, including 29.1 days in the intensive care unit. Most patients (57.9%) were younger than 50 years, while roughly 37% were 51 to 64, and about 5% were 65 and older.
In-hospital mortality increased with age, from 25.2% for those 30 and younger to 73.7% for those 65 and older. In a subset analysis of those 18 to 64 years, 1,113 patients with ECMO had a 44.6% in-hospital mortality rate, versus 37.9% of 16,343 patients who did not receive ECMO.
"Although ECMO therapy appears to show a benefit, it is a costly and resources intensive therapy including long length of hospitalization that is not readily available at most medical centers," said Ninh T. Nguyen, MD, in a Wolters Kluwer Health press release. "In the setting of a pandemic when the number of severely ill patients outpaced the availability of limited resources, then this therapy will require appropriate selection of patients that would be most likely to benefit."