COVID-19: Learning rapidly from an overwhelmed healthcare system in Bergamo, Italy

A very sobering piece published in NEJM Catalyst Innovations in Care Delivery (a new digital journal in the NEJM group) describes a catastrophic situation in a hospital in Bergamo, Italy, which has been overrun by COVID-19. We all have much to learn from this experience: about pandemic preparedness, response, and the key role of IPC at all stages of this pandemic.

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COVID-19 and Q-fever: random observation or something to evaluate?

“The course of an epidemic is defined by a series of key factors, some of which are poorly understood at present for COVID-19” (Roy Anderson Lancet, March 9th)

While several of the factors are obvious and come to mind immediately, others, might at this point be speculation or indiscriminate observations that need further scientific evaluation.

One of the latter category, might be the observation I would like to share in this post. One of the regions of the Netherlands that presently has one of the highest COVID-19 rates, is a region in the South of the country. To our knowledge there is only one thing unusual about that region; About ten years ago, the region was in the midst of the Dutch Q-fever epidemic. Could one of those key factors that we don’t understand and that may lead to area’s with exceptional high rates of COVID-19 be previous infectious diseases such as Q-fever, or more general a higher prevalence of previous long damage, due to infectious diseases? 

Have a look at the graphs and please share your thoughts.

With thanks to my colleague Bert Mulder, Nijmegen

COVID-19 and a lack of PPEs

Schermafbeelding 2020-03-20 om 15.27.13.png

By Andreas Voss, Jan Kluytmans and Alexander Friedrich

As the surge of COVID-19 cases is hitting some of the Dutch hospitals hard, healthcare, in the areas being overwhelmed with cases, experience a shortage of PPEs and especially masks. In other Dutch regions with no or only a few cases, colleagues still believe that life is normal and PPEs can be ordered with a click on the computer. They look with awe at what colleagues in the midst of battling COVID-19 and shortages are facing. In addition, all healthcare-settings that do not usually use a lot of PPE’s (e.g. nursing homes and GPs), will be heavily understocked.

Still, infection control advice seems to be based on standard, safety-maximized procedures, thereby wasting valuable resources. As a consequence, HCWs in the Netherlands are still following these recommendations, by using FFP masks routinely, in low risk situations, while they should be saved for the high-risk procedures.

We believe that it is time to rethink our protocols, based on the fact that we still assume that COVID-19, in general, is based on droplet and contact transmission.

  1. Restricted and risk-based use of FFP masks
  2. Use of surgical masks for normal care of COVID patients
  3. Efficient and extended use of FFP masks and other PPEs
  4. Re-use of FFP masks

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Update on COVID-19: part 14, the changing picture

Where the world is gradually (or instantaneously) facing the COVID-19 reality, China claims victory. Yet, it ain’t over till it’s over, and many fear a rebound once daily life has returned to its normal practices and contact patterns. In the meantime our Chinese colleagues keep on producing very impressive epidemiological studies. Such as this one, published today. Continue reading

Update on COVID-19: part 13, it giet oan?

In February many in my country just want to hear three words: “it giet oan”. This means that the famous eleven city ice-skating race will actually happen. Since 1909 this occurred 15 times (last time in 1997), as it needs about three weeks of continuous frost. No chance for that this year, but the words must have crossed many clinical microbiologists’ mind this weekend when the news on SARS-CoV-2 from Italy unfolded. Continue reading

Update on 2019-nCoV: part 11 – where will it end?

I’m sure we’ve all been following the emerging story of the 2019-nCoV outbreak closely, with the third cases reported in the UK yesterday (pleased to see this is where you’d expect the UK to be based on Marc’s post earlier)! There’s been a small explosion of publications in the peer reviewed literature. I’ve chosen one slightly randomly to discuss today: a short modelling study providing some insight on the likely volume of unreported cases (very much the ice berg and not the tip!) and some sense of where this outbreak will end (it depends on how we respond, globally).

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Update on 2019-nCoV: part 10

The 2019_CoV outbreak remains as interesting as the House of Cards once was (until it was bypassed by reality). After the gold rush for R_0, last week was devoted to the question on silent transmission; yes or no. Tuesdays’ story had an unexpected follow-up today, but the true clifhanger is a new study published yesterday. Continue reading