Special Issue "COVID-19 Pandemic: Challenges Facing the Health System"

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Coronaviruses (CoV) and COVID-19 Pandemic".

Deadline for manuscript submissions: closed (30 June 2021).

Special Issue Editors

Prof. Christopher R. Cogle
E-Mail Website
Guest Editor
Division of Hematology and Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
Interests: health policy; epidemiology; health services research; oncology; leukemia; myelodysplastic syndromes
Special Issues and Collections in MDPI journals
Dr. Amar H. Kelkar
E-Mail Website
Guest Editor
Division of Hematology and Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
Interests: health policy; epidemiology;health services research; oncology; hematology

Special Issue Information

Dear Colleagues,

Miranda in Katherine Anne Porter’s Pale Horse, Pale Rider walks out of a hospital after a fevered and dream-like month of hospitalization for a pneumonia due to the 1918–1919 influenza. Her first senses are, “No more war, no more plague, only the dazed silence that follows the ceasing of the heavy guns …” As she looks around, Miranda sees “… noiseless houses with the shades drawn, empty streets, the dead cold light of tomorrow.”

A century later, we are in a similar fight against a different RNA virus, SARS-CoV-2. Currently, its human disease, COVID-19, challenges all aspects of healthcare in all countries in every locale.

Medicine in the early 21st century is very different from that in Miranda’s early 20th century. Within weeks, our pathogen’s RNA sequence was fully decoded and published, and its origin speculated (PMID 32015507). Six years prior to the outbreak, our pandemic virus was predicted (PMID 24172901)—theoretically, plenty of time for preparation. Its genetic evolution is also being captured in near-real-time and published rapidly (PMID 32092483, 32321524). Within months of the outbreak, the first in-human vaccines were in testing (https://www.sciencemag.org/news/2020/03/record-setting-speed-vaccine-makers-take-their-first-shots-new-coronavirus). Pharmaceutical companies are simultaneously testing vaccines in clinical trials and scaling up vaccine manufacture for mass production, with or without regulatory approvals, to hasten the process of immunizing the general public.

Our pandemic also confronts another major difference than a century ago: our health system (or system of systems). Stressed before the pandemic, our health systems are certainly straining now. Healthcare disparities that were present even before the pandemic have been brought into sharp relief by COVID-19. Heterogeneous standards of healthcare before the pandemic are now even more disparate under varieties of quarantines, stay-in-place orders, and prohibitions of non-essential healthcare (however that is defined).

This Special Issue of Healthcare seeks commentaries, original research, short reports, and reviews on challenges in health systems created or exacerbated by the COVID-19 pandemic. This Special Issue aims to inform needed changes in health policies, systems, and environments. Some of these changes, such as increasing access to care, may have lasting effects in non-crisis times. It is envisioned that health policy specialists, policymakers, and elected officials will use this Special Issue as a resource for writing intelligent and progressive healthcare policies.

Upon seeing a once-bustling street now quieted by quarantine and finally accepting the death of her new friend Adam by the 1918–1919 influenza virus, Miranda concludes that “Now there would be time for everything.”

Prof. Christopher R. Cogle
Dr. Amar H. Kelkar
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Health policy
  • Public health
  • Medical ethics
  • Health care delivery
  • Global health
  • Medical practice, training, and education
  • Health services research
  • COVID-19
  • Coronavirus
  • Viral infections
  • Pandemic
  • Epidemic
  • Emergency medicine
  • Pulmonary/critical care

Published Papers (53 papers)

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Article
The Chinese Government’s Response to the Pandemic: Measures, Dynamic Changes, and Main Patterns
Healthcare 2021, 9(8), 1020; https://doi.org/10.3390/healthcare9081020 - 08 Aug 2021
Viewed by 477
Abstract
(1) Background: The governance measures that governments deploy vary substantially across countries and even within countries; there is, however, limited knowledge of the responses of local governments or from different areas in the same country. (2) Methods: By using grounded theory and an [...] Read more.
(1) Background: The governance measures that governments deploy vary substantially across countries and even within countries; there is, however, limited knowledge of the responses of local governments or from different areas in the same country. (2) Methods: By using grounded theory and an automatic text processing method, this study analyses the pandemic governance measures, the pandemic governance pattern, and possible factors across 28 provinces in mainland China based on the text of 28 official provincial government Sina microblogs dating from 20 January to 1 July 2020. (3) Results and discussion: The provincial pandemic governance patterns in China are divided into a pathogen-control pattern, a diagnosis and treatment consolidation pattern, a balanced promotion pattern, a quick-adjustment response pattern, and a recovery-oriented pattern. The pandemic severity, economic development, public health service, and population structure may all have an impact on pandemic governance measures. (4) Conclusions: The conclusions of this study may help us to reconstruct governance systems related to global public health emergencies from the perspective of normalisation, as well as providing important clarification for management and a reference for countries seeking to curb the global spread of a pandemic. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Article
Infection Spread, Recovery, and Fatality from Coronavirus in Different Provinces of Saudi Arabia
Healthcare 2021, 9(8), 931; https://doi.org/10.3390/healthcare9080931 - 24 Jul 2021
Viewed by 387
Abstract
The World Health Organization (WHO) announced COVID-19, a novel coronavirus outbreak, as a pandemic in 2020. In the month of February 2020, the disease began to spread through the Middle East. The first case of COVID-19 in the Kingdom of Saudi Arabia was [...] Read more.
The World Health Organization (WHO) announced COVID-19, a novel coronavirus outbreak, as a pandemic in 2020. In the month of February 2020, the disease began to spread through the Middle East. The first case of COVID-19 in the Kingdom of Saudi Arabia was identified in March 2020, and it is now one of the region’s most affected countries. Analyzing the disease’s propagation pattern may aid in the development of pandemic-fighting strategies. This study aims to analyze the trend of COVID-19’s spread, its recovery, and mortality in the Kingdom of Saudi Arabia (KSA). Two to three major cities from the 13 provinces of the country were chosen, and the rate of infection recovery was recorded from the first month until the number of confirmed cases showed a decline. The data published on the official Ministry of Health website were recorded on an Excel sheet, graphically represented as figures to indicate the pattern of spread. According to the study’s findings, COVID-19 positive cases were discovered in the majority of provinces as early as March 2020. The province of Makkah had the largest number of COVID-19 positive cases (30.7%), followed by Riyadh (23%). The province of Al Jowf had the lowest number of COVID-19 cases (0.3%). Tabuk province had the highest rate of recovery (97.8%), followed by the Northern Border Province (96.7%). Makkah province had the highest mortality rate (2.6%), followed by Al Jawf province (2.4%). The peak case–fatality ratio was recorded in August and September. The highest number of tests to detect the COVID-19 was performed in the month of July, and the highest percentage of positive cases was detected in June (19.55%). All the provinces from the month of September 2020 showed a progressive decline in the number of confirmed COVID-19 cases. According to this study, COVID-19 infection was found in the majority of Saudi Arabian provinces in March 2020, with a peak in June–July 2020. Considering the climatic and demographic characteristics of the region, specific modalities need to be adopted in collaboration with international guidelines to defeat the COVID-19 pandemic. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Article
Organizational Support Experiences of Care Home and Home Care Staff in Sweden, Italy, Germany and the United Kingdom during the COVID-19 Pandemic
Healthcare 2021, 9(6), 767; https://doi.org/10.3390/healthcare9060767 - 19 Jun 2021
Viewed by 845
Abstract
The COVID-19 pandemic has affected care workers all over the globe, as older and more vulnerable people face a high risk of developing severe symptoms and dying from the virus infection. The aim of this study was to compare staff experiences of stress [...] Read more.
The COVID-19 pandemic has affected care workers all over the globe, as older and more vulnerable people face a high risk of developing severe symptoms and dying from the virus infection. The aim of this study was to compare staff experiences of stress and anxiety as well as internal and external organizational support in Sweden, Italy, Germany, and the United Kingdom (UK) in order to determine how care staff were affected by the pandemic. A 29-item online questionnaire was used to collect data from care staff respondents: management (n = 136), nurses (n = 132), nursing assistants (n = 195), and other healthcare staff working in these organizations (n = 132). Stress and anxiety levels were highest in the UK and Germany, with Swedish staff showing the least stress. Internal and external support only partially explain the outcomes. Striking discrepancies between different staff groups’ assessment of organizational support as well as a lack of staff voice in the UK and Germany could be key factors in understanding staff’s stress levels during the pandemic. Structural, political, cultural, and economic factors play a significant role, not only factors within the care organization or in the immediate context. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Article
Assessment of Knowledge, Practice and Attitude about Biomedical Waste Management among Healthcare Professionals during COVID-19 Crises in Al-Ahsa
Healthcare 2021, 9(6), 747; https://doi.org/10.3390/healthcare9060747 - 18 Jun 2021
Viewed by 619
Abstract
Biomedical waste (BMW) management is an essential practice of healthcare professionals (HCPs) for preventing health and also environmental hazards. Coronavirus disease (COVID-19) has become a global pandemic, posing significant challenges for healthcare sectors. A cross-sectional study was performed to assess the knowledge, practice, [...] Read more.
Biomedical waste (BMW) management is an essential practice of healthcare professionals (HCPs) for preventing health and also environmental hazards. Coronavirus disease (COVID-19) has become a global pandemic, posing significant challenges for healthcare sectors. A cross-sectional study was performed to assess the knowledge, practice, and attitude on BMW management among HCPs when taking care of patients with COVID-19 and associated with demographic variables. From Al-Ahsa healthcare sectors, 256 HCPs were selected randomly, of which 105 (41%) had excellent knowledge, 87 (34%) had good knowledge, and 64 (25%) had poor knowledge with a mean score of 13.1 ± 3.6. A higher mean score was (14.4 ± 3.2) obtained by physicians, and (13.6 ± 3.8) nurses than the other HCPs. Regarding practice, 72 (28.1%) HCPs used and discarded PPE while handling biomedical wastes. Additionally, 88 (34.4%) followed proper hand hygiene before and after each procedure and whenever needed. Physicians, nurses, and respiratory therapists had a more favorable attitude than other HCPs. There was a statistically significant association found among knowledge level and educational qualification (p < 0.0001), gender (p < 0.001), and work experience (p < 0.05). Emphasis is needed to train all HCPs regarding proper BMW management during this pandemic to prevent infection transmission. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Article
Professional Quality of Life, Engagement, and Self-Care in Healthcare Professionals in Ecuador during the COVID-19 Pandemic
Healthcare 2021, 9(5), 515; https://doi.org/10.3390/healthcare9050515 - 29 Apr 2021
Viewed by 810
Abstract
The COVID-19 pandemic has highlighted the importance of healthcare workers and their professional quality of life. This quantitative cross-sectional study aims at exploring the professional quality of life, work engagement, and self-care of healthcare workers during the COVID-19 pandemic in Ecuador. A convenience [...] Read more.
The COVID-19 pandemic has highlighted the importance of healthcare workers and their professional quality of life. This quantitative cross-sectional study aims at exploring the professional quality of life, work engagement, and self-care of healthcare workers during the COVID-19 pandemic in Ecuador. A convenience sample of 117 participants completed an online voluntary and anonymous survey between April and July 2020. It contained a sociodemographic section, the Professional Quality of Life questionnaire V, the work engagement scale, and the scale of self-care behaviors for clinical psychologists. Results show that healthcare workers have an average quality of life with high levels of compassion satisfaction and average levels of compassion fatigue and burnout. Data also indicate that the sample frequently engaged in self-care practices and had high levels of work engagement. The regression analyses reveal that gender, the number of patients per week, the perceived fairness of the salary, among other variables are possible predictors of professional quality of life, frequency of self-care practices, and engagement. This study contributes to the understanding of these variables among healthcare professionals in Ecuador. These results should be considered when planning policies and prevention intervention efforts to promote professionals’ wellbeing. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
Article
Relationships among the Degree of Participation in Physical Activity, Self-Concept Clarity, and COVID-19 Stress in Adolescents
Healthcare 2021, 9(4), 482; https://doi.org/10.3390/healthcare9040482 - 19 Apr 2021
Viewed by 681
Abstract
The COVID-19 pandemic situation threatens the health of people globally, especially adolescents facing mental problems such as depression, anxiety, and obsessive-compulsive disorder due to constant COVID-19 stress. The present study aimed to provide basic data highlighting the need to alleviate COVID-19 stress among [...] Read more.
The COVID-19 pandemic situation threatens the health of people globally, especially adolescents facing mental problems such as depression, anxiety, and obsessive-compulsive disorder due to constant COVID-19 stress. The present study aimed to provide basic data highlighting the need to alleviate COVID-19 stress among adolescents by promoting physical activity participation and strengthening self-concept clarity (SCC). To examine the relationships among participation in physical activity, SCC, and COVID-19 stress in pandemic-like conditions, the study was conducted on middle and high school students aged 14 to 19 and an online survey was conducted on 1046 Korean adolescents (521 male and 525 female students in the preliminary survey and main survey). Frequency, reliability, confirmatory factor, descriptive, and path analyses were performed using SPSS and AMOS 18.0. Participation in physical activity exerted a positive effect on SCC (p < 0.001) as well as a negative effect on COVID-19 stress (p = 0.031). Our findings also indicated that SCC exerted a negative effect on COVID-19 stress (p < 0.001). Regular participation in physical activity and strong SCC are also fundamental elements for alleviating COVID-19 stress. Given these results, state and local governments and educational institutions should encourage youth to participate in sports by suggesting policies, providing guidelines, and offering education. Such information may allow adolescents to endure and overcome COVID-19 stress during this critical period of life. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Article
Evaluating the Practice of Preventive Behaviors and the Fear of COVID-19 among Dentists in Oradea Metropolitan Area after the First Wave of Pandemic; a Cross-Sectional Study
Healthcare 2021, 9(4), 443; https://doi.org/10.3390/healthcare9040443 - 09 Apr 2021
Cited by 2 | Viewed by 661
Abstract
Dental clinics were suspected to be a hotspot for nosocomial transmission of COVID-19 due to the easy spread of the virus. The study investigated the preventive behaviors applied in dentistry settings and the level of fear of COVID-19 infection among dentists. A total [...] Read more.
Dental clinics were suspected to be a hotspot for nosocomial transmission of COVID-19 due to the easy spread of the virus. The study investigated the preventive behaviors applied in dentistry settings and the level of fear of COVID-19 infection among dentists. A total of 83 respondents (34.94% male and 63.86% female) were included in the research. Sociodemographic data were collected, together with new institutional and personal rules regarding preventive behaviors. Fear of COVID-19 Scale was used to measure the fear of infection. Data was analyzed using SPSS (v.25, SPSS Inc., Chicago, IL, USA). During the first seven months of confinement, 3.9% of dentists were confirmed with COVID-19 and one fourth treated confirmed positive patients. A quarter of the doctors declared that they had periods when they lived away from home being afraid of transmitting the disease to their family members, and significant data were found in doctors being parents. The closure of dental offices had a negative impact on the financial situation of dentists, especially on those working in rural area offices. Many doctors encountered difficulties in purchasing protective suits and medical supplies, and more than half of the respondents (65.1%, N = 54) focused on the quality of protective suits when purchasing them. More than half of the dentists were trained how to use them. The score for fear of COVID 19 was similar to dentists from other countries. Respondents with chronic diseases were more prone to show higher level of anxiety when following the news and stories related to COVID-19 on TV, media, or social networks. One third of dentists mentioned that they had treated exclusively specific urgent dental problems since the onset of the pandemic and more than 13.3% declared that they refused to provide medical assistance to some specific pathologies because of the fear of infection. The results reflect new challenges and rules adopted by dentists in order to diminish the risk of infection and the impact of pandemic considering their psychological, familial, and financial context. Policymakers and professional associations around may benefit from these findings while formulating guidelines to support dentists during COVID-19 or any future pandemics. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Article
Vaccine Enthusiasm and Hesitancy in Cancer Patients and the Impact of a Webinar
Healthcare 2021, 9(3), 351; https://doi.org/10.3390/healthcare9030351 - 19 Mar 2021
Cited by 4 | Viewed by 1467
Abstract
(1) Background: Vaccine hesitancy and rejection are major threats to controlling coronavirus disease 2019 (COVID-19). There is a paucity of information about the attitudes of cancer patients towards vaccinations and the role of clinical oncologists in influencing vaccination acceptance. (2) Methods: Cancer patients [...] Read more.
(1) Background: Vaccine hesitancy and rejection are major threats to controlling coronavirus disease 2019 (COVID-19). There is a paucity of information about the attitudes of cancer patients towards vaccinations and the role of clinical oncologists in influencing vaccination acceptance. (2) Methods: Cancer patients and caregivers were invited to participate in a webinar and two surveys (pre- and post-webinar) assessing intention and thought processes associated with receiving COVID-19 vaccines. (3) Results: Two hundred and sixty-four participants participated in the webinar and registered to take at least one survey. Participants reported receiving most of their COVID-19 vaccine information from their doctor, clinic, or hospital. Before the webinar, 71% of participants reported the intention to receive a COVID-19 vaccine, 24% were unsure, and 5% had no intention of receiving a vaccine. The strongest predictors of vaccine enthusiasm were (a) planning to encourage the vaccination of family, friends, co-workers, and community, and (b) physician recommendation. The chief reason for vaccine hesitancy was a fear of side effects. After the webinar, 82.5% reported the intention to receive a vaccine, 15.4% were still unsure, and 2% stated that they had no intention of receiving a vaccine. The webinar shifted the attitude towards vaccine enthusiasm, despite an already vaccine-enthusiastic population. Communicating about vaccines using positive framing is associated with greater vaccine enthusiasm. (4) Conclusions: Patient education programs co-hosted by multiple stakeholders and delivered by oncologists can increase cancer patient enthusiasm for COVID-19 vaccination. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Article
Cognitive Diversity as the Quality of Leadership in Crisis: Team Performance in Health Service during the COVID-19 Pandemic
Healthcare 2021, 9(3), 313; https://doi.org/10.3390/healthcare9030313 - 11 Mar 2021
Viewed by 846
Abstract
The level of leadership skills of healthcare team leaders has long been the subject of interest and many discussions. Several studies have pointed to their inadequacy, which is becoming a serious problem during the global crisis due to the Covid-19 pandemic. There is [...] Read more.
The level of leadership skills of healthcare team leaders has long been the subject of interest and many discussions. Several studies have pointed to their inadequacy, which is becoming a serious problem during the global crisis due to the Covid-19 pandemic. There is a direct link between the leadership in the healthcare system and its performance, conditioned by the level of decisions of leaders of medical teams. It is they who determine the performance of healthcare delivery. The study published in this article contains the results from the examination of the dependence between crisis leadership and team performance in healthcare providers. The subject of the research is the impact of cognitive diversity and the quality of crisis-leadership decision-making on the performance of medical teams in the acute crisis phase. The study was conducted on a research sample of 216 healthcare providers after the outbreak of the COVID-19 pandemic in Slovakia (April 2020). The respondents to the research sample involved team leaders in healthcare providers, who have been involved in managing the crisis. The study has justified the positive association between crisis leadership and team performance, which is mediated by cognitive diversity, supporting the quality of decision-making in crisis leadership. The results of the research have proven that the performance of the medical team in the acute crisis phase can be positively influenced through qualified decision-making in crisis leadership amplified by the usage of cognitive diversity. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Article
The Impact of COVID-19 on Essential Medicines and Personal Protective Equipment Availability and Prices in Saudi Arabia
Healthcare 2021, 9(3), 290; https://doi.org/10.3390/healthcare9030290 - 07 Mar 2021
Cited by 1 | Viewed by 1272
Abstract
This was a questionnaire-based cross-sectional study that explored the impact of the COVID-19 pandemic on the availability of essential medicine and personal protective equipment (PPE) in Saudi Arabia. Purposive sampling technique was used to recruit individuals working in the supply chain departments in [...] Read more.
This was a questionnaire-based cross-sectional study that explored the impact of the COVID-19 pandemic on the availability of essential medicine and personal protective equipment (PPE) in Saudi Arabia. Purposive sampling technique was used to recruit individuals working in the supply chain departments in different healthcare sectors in Saudi Arabia. One hundred and three pharmaceutical and medical supply chain employees participated in the study. Most of the participants (58.3%) were aged ≥35 years, male (65%), and pharmacists (92.2%). The majority of participants had at least two years of experience in supply chain (77.6%), worked in public hospitals (95.15%), and were mostly working at healthcare institutions located in Riyadh province (59.2%). Approximately 51% of the participants reported shortages of 10 or more essential drugs. Tocilizumab, hydroxychloroquine, lopinavir/ritonavir, ribavirin, dexamethasone, enoxaparin, interferon beta-1b, cisatracurium besylate, prednisolone, hydrocortisone, methimazole, and methylprednisolone were reported to be in shortage by at least 8% of the participants. Almost 70% of the participants reported that the pandemic did not significantly impact the prices of prescription drugs in shortage (e.g., ≥25%). Moreover, about 70% of the participants reported direct purchasing or procurement of drugs in shortage. Surgical masks, face shields, medical gowns, and N95 respirators were reported to be in short supply by 33% or more of the participants. Approximately 53% of the participants reported the prices of PPE in shortage had seen an increase by at least 25% during the pandemic. Although the COVID-19 pandemic has caused a significant disruption in the global pharmaceutical supply chain, its impact was largely manageable in Saudi healthcare institutions. This can be attributable to multiple reasons such as the effective exchange programs between hospitals and the drastic increase in public healthcare spending to ameliorate the negative impact of the pandemic on the healthcare sector. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Article
Work Engagement in Nurses during the Covid-19 Pandemic: A Cross-Sectional Study
Healthcare 2021, 9(3), 253; https://doi.org/10.3390/healthcare9030253 - 01 Mar 2021
Cited by 1 | Viewed by 969
Abstract
In some areas of Spain, health services and professionals working in the front line against the Sars-Cov-2 virus have been widely overwhelmed at all levels. Therefore, the objective of this study was to assess the level of work engagement of Spanish nurses during [...] Read more.
In some areas of Spain, health services and professionals working in the front line against the Sars-Cov-2 virus have been widely overwhelmed at all levels. Therefore, the objective of this study was to assess the level of work engagement of Spanish nurses during the COVID-19 pandemic. A cross-sectional study was carried out. The sample consisted of 510 active nurses from all over Spain, without age exclusion, who voluntarily accepted to participate in the study. Work engagement was assessed with the 9-item Utrecht Work Engagement Scale (UWES) questionnaire, through an online questionnaire and non-probabilistic snowball sampling. The results showed a mean age of 45.9 years (SD = 10.7 years), most of them women (78.1%), and 58.5% were in primary care. The mean score for the UWES-9 questionnaire was 4.6 points (SD = 1.35). The categorical regression analysis performed revealed an R2 value of 0.75 and a significance of p < 0.01 in the sex, type of unit, and training variables. The Spanish nurses in the sample present high levels of work engagement in all dimensions in general, although the lowest mean scores are found in the vigor dimension, among men, and nurses working in hospital and critical units. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
Article
First Experiences with Online Last Aid Courses for Public Palliative Care Education during the COVID-19 Pandemic
Healthcare 2021, 9(2), 172; https://doi.org/10.3390/healthcare9020172 - 05 Feb 2021
Cited by 3 | Viewed by 655
Abstract
The Last Aid course aims to teach public palliative care by increasing public awareness and empowering people about the role of the individual in the death of loved ones. The Covid-19 pandemic, however, has altered educational methods prohibiting classroom settings. Therefore, an online [...] Read more.
The Last Aid course aims to teach public palliative care by increasing public awareness and empowering people about the role of the individual in the death of loved ones. The Covid-19 pandemic, however, has altered educational methods prohibiting classroom settings. Therefore, an online course was created to enable continued and safe public palliative care education. A mixed-methods study was performed to examine the feasibility of delivering the Last Aid course online. Data collection included participant questionnaires with qualitative and quantitative data, observations and a focus group discussion. Data were analyzed using descriptive analysis and qualitative description. In total, 15 online Last Aid courses were held, 174 participants took part in the study and 92 completed questionnaires were included. Findings revealed overall course satisfaction for the online courses in line with previous findings for classroom teaching. The online platform enabled course participation from people previously unable or unwilling to attend, namely caregivers to dying relatives and younger people. Instructors displayed an ability to teach online. However, some instructors expressed frustration over reduced interaction and technical challenges, which was echoed by participant ratings showing that many lacked social networking with fellow participants. Nonetheless, this pilot study demonstrates the feasibility of the online Last Aid course. Attention must be given to increasing both participant-to-participant and instructor-to-participant interaction. More research on the long-term effects of Last Aid courses is needed. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Article
Perceptions of Romanian Physicians on Lockdowns for COVID-19 Prevention
Healthcare 2021, 9(1), 95; https://doi.org/10.3390/healthcare9010095 - 18 Jan 2021
Cited by 2 | Viewed by 1088
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) was declared a pandemic in March 2020, triggering important changes for the entire society and healthcare systems, as well as significant lockdown measures aimed to limit the disease spread. We herein intended to [...] Read more.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) was declared a pandemic in March 2020, triggering important changes for the entire society and healthcare systems, as well as significant lockdown measures aimed to limit the disease spread. We herein intended to catch the dynamic of Romanian physicians’ perceptions of COVID-19 impact. For this purpose, after a literature review, a 30-item questionnaire was designed. The questionnaire was twice distributed online, about 1 month apart, during which partial relaxation measures were decreed in Romania. The questionnaire was voluntarily filled in by Romanian physicians who were willing to participate in the study. A total of 214 physicians answered the questionnaire upon its first release, and 199 respondents were registered upon its second release, most of whom (94.9%) were involved in clinical work, with one-third working in units dedicated to COVID-19 patients. In parallel with the relaxation of lockdown measures, along with increased confidence in the efficiency of protective measures (46.7% vs. 31.3%), separation from household members decreased from 36.9% to 22.1%. Nevertheless, the feeling of rejection felt by doctors remained similar (22.4% vs. 24.6%). Furthermore, answers regarding the clinical picture, diagnostic approach, and treatment options are discussed. Most of therapeutic options considered for SARS-CoV-2 treatment (e.g., lopinavir/ritonavir, oseltamivir, hydroxychloroquine, azithromycin, tocilizumab, and convalescent plasma) failed to confirm significant efficiency. On the contrary, vaccines for widescale use are already available despite the initial skepticism. In the beginning of the pandemic, 25.2% (18.2% vs. 32.2%) considered that there will not be an effective COVID-19 vaccine, while 41.6% (43.0% vs. 40.2%) thought that a vaccine would be available after at least 12 months. In conclusion, initially, following only a 1 month period, Romanian physicians’ intention to consider treatments such as hydroxychloroquine or lopinavir/ritonavir for COVID-19 decreased significantly. Moreover, confidence in the efficiency of available protective measures increased, and the rates of separation from household members decreased. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
Article
Burnout Prevalence and Its Associated Factors among Malaysian Healthcare Workers during COVID-19 Pandemic: An Embedded Mixed-Method Study
Healthcare 2021, 9(1), 90; https://doi.org/10.3390/healthcare9010090 - 17 Jan 2021
Cited by 5 | Viewed by 4217
Abstract
Coronavirus disease 2019 (COVID-19) has become a global health threat and has placed an extraordinary demand on healthcare workers around the world. In this study, we aim to examine the prevalence of burnout and its associated factors and experience among Malaysian healthcare workers [...] Read more.
Coronavirus disease 2019 (COVID-19) has become a global health threat and has placed an extraordinary demand on healthcare workers around the world. In this study, we aim to examine the prevalence of burnout and its associated factors and experience among Malaysian healthcare workers during the COVID-19 pandemic through an embedded mixed-method study design. We found that more than half of Malaysian healthcare workers in this sample experienced burnout. Direct involvement in COVID-19 screening or treatment, having a medical condition, and less psychological support in the workplace emerged to be the significant factors in personal-, work-, and patient-related burnout. Participants described their workloads, uncertainties caused by the pandemic, challenging work–family balance, and stretched workplace relationships as the sources of burnout. Exhaustion appeared to be the major symptom, and many participants utilized problem-focused coping to deal with the adversities experienced during the pandemic. Participants reported physical-, occupational-, psychological-, and social-related negative impacts resulting from burnout. As the pandemic trajectory is yet unknown, these findings provide early insight and guidance for possible interventions. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
Article
Nurses’ Workplace Conditions Impacting Their Mental Health during COVID-19: A Cross-Sectional Survey Study
Healthcare 2021, 9(1), 84; https://doi.org/10.3390/healthcare9010084 - 16 Jan 2021
Cited by 8 | Viewed by 2976
Abstract
Among health workers, nurses are at the greatest risk of COVID-19 exposure and mortality due to their workplace conditions, including shortages of personal protective equipment (PPE), insufficient staffing, and inadequate safety precautions. The purpose of this study was to examine the impact of [...] Read more.
Among health workers, nurses are at the greatest risk of COVID-19 exposure and mortality due to their workplace conditions, including shortages of personal protective equipment (PPE), insufficient staffing, and inadequate safety precautions. The purpose of this study was to examine the impact of COVID-19 workplace conditions on nurses’ mental health outcomes. A cross-sectional correlational design was used. An electronic survey was emailed to nurses in one Canadian province between June and July of 2020. A total of 3676 responses were included in this study. We found concerning prevalence rates for post-traumatic stress disorder (47%), anxiety (38%), depression (41%), and high emotional exhaustion (60%). Negative ratings of workplace relations, organizational support, organizational preparedness, workplace safety, and access to supplies and resources were associated with higher scores on all of the adverse mental health outcomes included in this study. Better workplace policies and practices are urgently required to prevent and mitigate nurses’ suboptimal work conditions, given their concerning mental health self-reports during the COVID-19 pandemic. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Religious Coping, Depression and Anxiety among Healthcare Workers during the COVID-19 Pandemic: A Malaysian Perspective
Healthcare 2021, 9(1), 79; https://doi.org/10.3390/healthcare9010079 - 15 Jan 2021
Cited by 7 | Viewed by 2025
Abstract
Anxiety and depression have been prevalent among Healthcare Workers (HCWs) amidst the COVID-19 pandemic. This study aims to evaluate the prevalence of anxiety and depression among HCWs amid the pandemic and their association with religious coping. A cross-sectional study design was applied. The [...] Read more.
Anxiety and depression have been prevalent among Healthcare Workers (HCWs) amidst the COVID-19 pandemic. This study aims to evaluate the prevalence of anxiety and depression among HCWs amid the pandemic and their association with religious coping. A cross-sectional study design was applied. The scales utilized were Malay versions of the Brief Religious Coping Scale (Brief RCOPE M) and Hospital Anxiety and Depression Scale (HADS M). In total, 200 HCWs were recruited. HCWs scored higher in positive religious coping (mean: 21.33) than negative religious coping (mean: 10.52). The prevalence of anxiety and depression was 36.5% and 29.5%. Both positive and negative religious coping were significantly associated with anxiety (p < 0.01) and depression (p < 0.05, p < 0.01). Positive coping predicted reduction in anxiety (adjusted b = −0.15, p = 0.001) and log-transformed depression score (adjusted b = −0.019, p = 0.025). Negative coping predicted increment of anxiety (adjusted b = 0.289, p < 0.001) and log-transformed depression score (adjusted b = 0.052, p < 0.001). Positive religious coping is vital in reducing anxiety and depression among HCWs amid the pandemic. Strategies which increase positive religious coping and reduce negative religious coping must be emphasized to boost mental health among HCWs. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
Article
Increased Emergency Calls during the COVID-19 Pandemic in Saudi Arabia: A National Retrospective Study
Healthcare 2021, 9(1), 14; https://doi.org/10.3390/healthcare9010014 - 24 Dec 2020
Cited by 3 | Viewed by 1934
Abstract
The coronavirus 2019 (COVID-19) pandemic has a direct and indirect effect on the different healthcare systems around the world. In this study, we aim to describe the impact on the utilization of emergency medical services (EMS) in Saudi Arabia during the COVID-19 pandemic. [...] Read more.
The coronavirus 2019 (COVID-19) pandemic has a direct and indirect effect on the different healthcare systems around the world. In this study, we aim to describe the impact on the utilization of emergency medical services (EMS) in Saudi Arabia during the COVID-19 pandemic. We studied cumulative data from emergency calls collected from the SRCA. Data were separated into three periods: before COVID-19 (1 January–29 February 2020), during COVID-19 (1 March–23 April 2020), and during the Holy Month of Ramadan (24 April–23 May 2020). A marked increase of cases was handled during the COVID-19 period compared to the number before pandemic. Increases in all types of cases, except for those related to trauma, occurred during COVID-19, with all regions experiencing increased call volumes during COVID-19 compared with before pandemic. Demand for EMS significantly increased throughout Saudi Arabia during the pandemic period. Use of the mobile application ASAFNY to request an ambulance almost doubled during the pandemic but remained a small fraction of total calls. Altered weekly call patterns and increased call volume during the pandemic indicated not only a need for increased staff but an alteration in staffing patterns. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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The Use of Medical and Non-Medical Services by the Elderly during the SARS-CoV-2 Pandemic Differs between General and Specialist Practice: A One-Center Study in Poland
Healthcare 2021, 9(1), 8; https://doi.org/10.3390/healthcare9010008 - 23 Dec 2020
Cited by 2 | Viewed by 738
Abstract
In Poland, there is a lack of documented data on the use of medical and non-medical services by the elderly during the SARS-CoV-2 pandemic. The FIMA questionnaire assesses the use of medical and non-medical services by the elderly. The authors compared the demand [...] Read more.
In Poland, there is a lack of documented data on the use of medical and non-medical services by the elderly during the SARS-CoV-2 pandemic. The FIMA questionnaire assesses the use of medical and non-medical services by the elderly. The authors compared the demand for these services during the ongoing pandemic with similar months in 2017. It was confirmed that in the group of 61 surveyed elderly people, the number of individuals who had a medical visit decreased significantly in the three-month period. In the analyzed pandemic period, patients had significantly fewer visits to their general practitioner only. The pandemic had no significant impact on the use of other medical and non-medical services analyzed by FIMA. The limitations may include the small number of respondents, the relatively short period from the beginning of the pandemic covered by the survey, and the nature of the studied patients’ diseases. Further observation of elderly patients’ access to the abovementioned services can improve the efforts of governments and caregivers in this field, which is of particular importance in the group of chronically ill elderly patients. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
Article
Development of Case Numbers during the COVID-19 Pandemic in a Center of Maximum-Care for Traumatology and Orthopedic Oncology
Healthcare 2021, 9(1), 3; https://doi.org/10.3390/healthcare9010003 - 22 Dec 2020
Cited by 1 | Viewed by 823
Abstract
(1) Background: The COVID-19 pandemic has led to a significant change in the utilization of trauma surgery and tumor orthopedic hospital facilities. (2) Methods: In a monocentric retrospective analysis, the weekly numbers of cases requiring intra-clinical treatment in the first four months of [...] Read more.
(1) Background: The COVID-19 pandemic has led to a significant change in the utilization of trauma surgery and tumor orthopedic hospital facilities. (2) Methods: In a monocentric retrospective analysis, the weekly numbers of cases requiring intra-clinical treatment in the first four months of 2020 were compared with those of 2019. Patients’ visits to the emergency department and shock room, consultation hours, work-related accidents, case numbers in the normal and intensive care units, ventilation hours, the “Simplified Acute Physiology Score/ Therapeutic Intervention Scoring System” (SAPS/TISS), the average length of stay in hospital, the number of operations and their degree of urgency, as well as deaths, were analyzed in a study based on the data from 7606 outpatient consultations in 2019 and 6755 in 2020, as well as 993 inpatient cases in 2019 and 950 in 2020. (3) Results: There was a significant reduction in the number of treatments per week in the emergency department (261 ± 29 vs. 165 ± 25; p < 0.001) with the same number of shock room treatments and fewer consultation hour contacts (226 ± 29 vs. 119 ± 65; p = 0.012). There were fewer inpatient cases (66 ± 7 vs. 42 ± 11; p = 0.001), resulting in a fall in the days of hospitalization (492 ± 63 vs. 308 ± 78; p < 0.001) and number of operations (73 ± 7 vs. 55 ± 10; p = 0.012), especially elective procedures (20 ± 3 vs. 7 ± 7; p = 0.008). The SAPS/TISS score was lower (1351 ± 1213 vs. 399 ± 281; p = 0.023). Fewer fracture treatments and septic surgeries were performed, while the number of procedures to treat orthopedic malignancies remained constant. (4) Conclusions: During the first phase of the COVID-19 pandemic, we observed a significant reduction in the number of cases treated in orthopedics. While the number of multiple-injured patients was unchanged, fewer patients presented for primary and regular care. Treatment of acute injuries and malignant tumor diseases was not at risk. There was no effect on in-house mortality. We see a potential for the recruitment of medical staff from the outpatient department, operating room, and the ward. In the event of a future second wave, our results may allow for early planning, particularly of the all-important human resources. Reorganization by hospitals and decreased patient numbers in trauma surgery can enable the reallocation of medical staff, equipment, and beds to increase capacity for COVID-19 patients. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Frontline Healthcare Workers’ Knowledge and Perception of COVID-19, and Willingness to Work during the Pandemic in Nepal
Healthcare 2020, 8(4), 554; https://doi.org/10.3390/healthcare8040554 - 11 Dec 2020
Cited by 5 | Viewed by 2178
Abstract
This study investigated the contextual factors associated with the knowledge, perceptions, and the willingness of frontline healthcare workers (FHWs) to work during the COVID-19 pandemic in Nepal among a total of 1051 FHWs. Multivariable logistic regression analysis was applied to identify independent associations [...] Read more.
This study investigated the contextual factors associated with the knowledge, perceptions, and the willingness of frontline healthcare workers (FHWs) to work during the COVID-19 pandemic in Nepal among a total of 1051 FHWs. Multivariable logistic regression analysis was applied to identify independent associations between predictors and outcome variables. Of the total study subjects, 17.2% reported inadequate knowledge on COVID-19, 63.6% reported that they perceived the government response as unsatisfactory, and 35.9% showed an unwillingness to work during the pandemic. Our analyses demonstrated that FHWs at local public health facilities, pharmacists, Ayurvedic health workers (HWs), and those with chronic diseases were less likely, and male FHWs were more likely, to have adequate knowledge of COVID-19. Likewise, nurses/midwives, public health workers, FHWs from Karnali and Far-West provinces, and those who had adequate knowledge of COVID-19 were more likely to have satisfactory perceptions towards the government response. Further, FHWs—paramedics, nurse/midwives, public health workers, laboratory workers—FHWs from Karnali Province and Far-West Province, and those with satisfactory perceptions of government responses to COVID-19 were predictors of willingness to work during the COVID-19 pandemic. These results suggest that prompt actions are required to improve FHWs’ knowledge of COVID-19, address negative perceptions of government responses, and motivate them through specific measures to provide healthcare services during the pandemic. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
Article
Risk Perception and Worries among Health Care Workers in the COVID-19 Pandemic: Findings from an Italian Survey
Healthcare 2020, 8(4), 535; https://doi.org/10.3390/healthcare8040535 - 03 Dec 2020
Cited by 12 | Viewed by 1346
Abstract
The ongoing pandemic scenario, due to the coronavirus disease 2019 (COVID-19), has had a considerable impact on public health all over the world. Italy was one of the most affected countries, as the first European full-blown outbreak occurred there. The exposure of the [...] Read more.
The ongoing pandemic scenario, due to the coronavirus disease 2019 (COVID-19), has had a considerable impact on public health all over the world. Italy was one of the most affected countries, as the first European full-blown outbreak occurred there. The exposure of the Italian health care workers to COVID-19 may be an important risk factor for psychological distress. The aim of this cross-sectional study was to describe worries and risk perception of being infected among Italian Health Care Workers (HCWs) during the first wave of the pandemic. In total, 2078 HCWs participated in a web survey (78.8% were females). The highest percentage of respondents were physicians (40.75%) and nurses (32.15%), followed by medical (18.00%), health care support (4.50%) and administrative (4.60%) staff. In a score range between 0 (not worried) and 4 (very worried), our results showed that participants declared that they were worried about the Coronavirus infection with a median score of 3 (IQR 2-3) and for 59.19% the risk perception of being infected was very high. In addition, HCWs reported they suffered from sleep disturbances (63.43%). From the analysis of the psychological aspect, a possible divergence emerged between the perceived need for psychological support (83.85%) and the relative lack of this service among health care providers emerged (9.38%). Our findings highlight the importance of psychological and psychiatric support services not only during the COVID-19 pandemic, but also in other emerging infectious diseases (EIDs) scenarios. These services may be useful for health authorities and policymakers to ensure the psychological well-being of health care professionals and to promote precautionary behaviors among them. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
Article
Institutional Diversity in Response to the COVID-19 Emergency
Healthcare 2020, 8(4), 515; https://doi.org/10.3390/healthcare8040515 - 27 Nov 2020
Cited by 1 | Viewed by 618
Abstract
Four-quadrant modeling may offer some constructive insights into the institutional diversity of the emergency responses to COVID-19. This study utilized a typological method to investigate institutional arrangements and the emergency management of epidemic responses in China. The task environment for emergencies was divided [...] Read more.
Four-quadrant modeling may offer some constructive insights into the institutional diversity of the emergency responses to COVID-19. This study utilized a typological method to investigate institutional arrangements and the emergency management of epidemic responses in China. The task environment for emergencies was divided into four categories. Targeted policies were assigned to explicit task environments by placing them in one of the four quadrants: public health procedures, medical operation standards, supervisory and regulatory measures, and norms and instructions. Institutional diversity resulted when the very loci of decision-making carried a dominant or subordinate role, providing a hierarchical system for relating the institutional processes needed to address the challenges of institutional fragments. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Article
Professional Quality of Life and Perceived Stress in Health Professionals before COVID-19 in Spain: Primary and Hospital Care
Healthcare 2020, 8(4), 484; https://doi.org/10.3390/healthcare8040484 - 13 Nov 2020
Cited by 4 | Viewed by 1751
Abstract
This study aimed to analyze the professional quality of life and the perceived stress of health professionals before COVID-19 in Spain, in primary and hospital care professionals. A cross-sectional observational study on health professionals working in health centers during the health crisis caused [...] Read more.
This study aimed to analyze the professional quality of life and the perceived stress of health professionals before COVID-19 in Spain, in primary and hospital care professionals. A cross-sectional observational study on health professionals working in health centers during the health crisis caused by COVID-19 was conducted. Professional Quality of Life (ProQoL) and Perceived Stress (PSS-14) were measured, along with socio-demographic and labor variables through an online questionnaire. A descriptive and correlation analysis was performed. A total of 537 professionals participated, both in hospital care (54.7%) and in primary care (45.3%). There was a predominance of medium Compassion Satisfaction, high Compassion Fatigue and medium Burnout. Mean scores for compassion fatigue and compassion satisfaction were slightly higher in primary care, while burnout was higher in hospital care. When primary care participants were grouped by profession, significant differences were found in relation to perceived stress and to the three subscales of professional quality of life. In hospital care, the differences were observed when comparing compassion fatigue and perceived stress by gender. In addition, with respect to Burnout it was carried out by type of contract and shift and in relation to perceived stress grouped by sex, contract and profession. The COVID-19 health crisis has had an impact on mental health and the quality of professional life of health professionals. There is a need to implement long-term contingency programs aimed at improving the emotional well-being of health service professionals. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Article
The Demand for Elective Neurosurgery at a German University Hospital during the First Wave of COVID-19
Healthcare 2020, 8(4), 483; https://doi.org/10.3390/healthcare8040483 - 13 Nov 2020
Cited by 1 | Viewed by 700
Abstract
Background: Patients’ fear of the coronavirus disease 2019 (COVID-19) may delay inevitable treatment, putting potential benefits at risk. This single-center retrospective study aims to analyze temporal relationships of the first wave of the COVID-19 pandemic in Germany with the number of patients who [...] Read more.
Background: Patients’ fear of the coronavirus disease 2019 (COVID-19) may delay inevitable treatment, putting potential benefits at risk. This single-center retrospective study aims to analyze temporal relationships of the first wave of the COVID-19 pandemic in Germany with the number of patients who sought and received elective neurosurgical treatment at a German university hospital. Methods: Daily outpatient numbers (ON) and elective procedures (EP) were recorded at our department between 1 January 2020 and 30 June 2020 (baseline: between 1 January 2019 and 30 June 2019). In patients who received EP, we recorded indication, outcome, and length of stay (LOS). Moving averages of ON (MAON) and of EP were calculated. Data on governmental action taken in response to the pandemic and on coronavirus-positive cases in Germany (CPCG) were superimposed. Exponential and arc tangent curves (ATC) were fitted to the absolute numbers of CPCG. Phase shifts were estimated, and Spearman’s rank correlation coefficient, rho, was calculated between the 2020 MAON and the derivative function of the fitted ATC (DFATC). Wilcoxon rank sum served as statistical test. Significance was assumed with p values of less than 0.05. Results: ON were significantly decreased in April 2020 as compared to April 2019 (p = 0.010). A phase shift between the German lockdown, the DFATC, and the decrease in MAON was not detected, while a phase shift of 10 days between the DFATC and the subsequent increase in MAON was detected. The DFATC was significantly negatively correlated (rho = −0.92, p < 0.0001) to the MAON until 31 March 2020, and, when shifted by 10 days, the DFATC was significantly negatively correlated (rho = −0.87, p < 0.0001) to the MAON from 01 April 2020. EP (p = 0.023), including the subset of non-oncological EP (p = 0.032), were significantly less performed in the first half of 2020 as compared to the first half of 2019. In March and April 2020, we conducted significantly more EP due to motor deficits (p = 0.0267, and less), visual disturbances (p = 0.0488), and spinal instability (p = 0.0012), and significantly less EP due to radicular pain (p = 0.0489), as compared to March and April 2019. LOS ranked significantly higher in patients who received cranial or spinal EP in March and April 2020 as compared to March and April 2019 (p = 0.0497). Significant differences in outcome were not observed. Conclusion: The beginning of the COVID-19 pandemic was correlated to an immediate and significant decrease in ON, and to a significant decrease in the number of EP performed. The subsequent increase in ON was delayed. Adequate measures to promote timely discharge of patients may become increasingly relevant as the pandemic proceeds. Although we observed a shift in the range of indications towards significantly more EP in patients with neurological deficiencies, care should be taken to avoid potentially deleterious delays of necessary elective treatment in future pandemic situations. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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A Drive-through Simulation Tool for Mass Vaccination during COVID-19 Pandemic
Healthcare 2020, 8(4), 469; https://doi.org/10.3390/healthcare8040469 - 09 Nov 2020
Cited by 8 | Viewed by 3427
Abstract
Several research and development teams around the world are working towards COVID-19 vaccines. As vaccines are expected to be developed and produced, preparedness and planning for mass vaccination and immunization will become an important aspect of the pandemic management. Mass vaccination has been [...] Read more.
Several research and development teams around the world are working towards COVID-19 vaccines. As vaccines are expected to be developed and produced, preparedness and planning for mass vaccination and immunization will become an important aspect of the pandemic management. Mass vaccination has been used by public health agencies in the past and is being proposed as a viable option for COVID-19 immunization. To be able to rapidly and safely immunize a large number of people against SARS-CoV-2, different mass vaccination options are available. Drive-through facilities have been successfully used in the past for immunization against other diseases and for testing during COVID-19. In this paper we introduce a drive-through vaccination simulation tool that can be used to enhance the planning, design, operation, and feasibility and effectiveness assessment of such facilities. The simulation tool is a hybrid model that integrates discrete event and agent-based modeling techniques. The simulation outputs visually and numerically show the average processing and waiting times and the number of cars and people that can be served (throughput values) under different numbers of staff, service lanes, screening, registration, immunization, and recovery times. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Article
Analysis and Evaluation of COVID-19 Web Applications for Health Professionals: Challenges and Opportunities
Healthcare 2020, 8(4), 466; https://doi.org/10.3390/healthcare8040466 - 07 Nov 2020
Cited by 1 | Viewed by 1321
Abstract
The multidisciplinary nature of the work required for research in the COVID-19 pandemic has created new challenges for health professionals in the battle against the virus. They need to be equipped with novel tools, applications, and resources—that have emerged during the pandemic—to gain [...] Read more.
The multidisciplinary nature of the work required for research in the COVID-19 pandemic has created new challenges for health professionals in the battle against the virus. They need to be equipped with novel tools, applications, and resources—that have emerged during the pandemic—to gain access to breakthrough findings; know the latest developments; and to address their specific needs for rapid data acquisition, analysis, evaluation, and reporting. Because of the complex nature of the virus, healthcare systems worldwide are severely impacted as the treatment and the vaccine for COVID-19 disease are not yet discovered. This leads to frequent changes in regulations and policies by governments and international organizations. Our analysis suggests that given the abundance of information sources, finding the most suitable application for analysis, evaluation, or reporting, is one of such challenges. However, health professionals and policy-makers need access to the most relevant, reliable, trusted, and latest information and applications that can be used in their day-to-day tasks of COVID-19 research and analysis. In this article, we present our analysis of various novel and important web-based applications that have been specifically developed during the COVID-19 pandemic and that can be used by the health professionals community to help in advancing their analysis and research. These applications comprise search portals and their associated information repositories for literature and clinical trials, data sources, tracking dashboards, and forecasting models. We present a list of the minimally essential online, web-based applications to serve a multitude of purposes, from hundreds of those developed since the beginning of the pandemic. A critical analysis is provided for the selected applications based on 17 features that can be useful for researchers and analysts for their evaluations. These features make up our evaluation framework and have not been used previously for analysis and evaluation. Therefore, knowledge of these applications will not only increase productivity but will also allow us to explore new dimensions for using existing applications with more control, better management, and greater outcome of their research. In addition, the features used in our framework can be applied for future evaluations of similar applications and health professionals can adapt them for evaluation of other applications not covered in this analysis. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Article
Prediction and Potential Spatially Explicit Spread of COVID-19 in Mexico’s Megacity North Periphery
Healthcare 2020, 8(4), 453; https://doi.org/10.3390/healthcare8040453 - 02 Nov 2020
Viewed by 965
Abstract
The novel COVID-19, detected in Wuhan, China, has reached almost every city across the globe, and researchers from many countries have used several epidemiologic models to describe the epidemic trends. In this context, it is also important to know the geographic extent of [...] Read more.
The novel COVID-19, detected in Wuhan, China, has reached almost every city across the globe, and researchers from many countries have used several epidemiologic models to describe the epidemic trends. In this context, it is also important to know the geographic extent of the infected population. Following this approach, a Gumpertz model was adapted with official data from the state of Hidalgo, Mexico, in order to estimate the people infected during this COVID-19 pandemic. We found, based on the adjusted data, the highest value in infected people according to official and theoretical data. Furthermore, using a geographical analysis based on geostatistical measures related to density of demographic and economic data, traffic level and geolocation, raster files were generated to estimate probability of coronavirus cases occurrence using the areas where the contagion may occur. We also distributed the maximum contagion obtained by the epidemic model, using these raster files, and a regression model to weight factors according their importance. Based on this estimated distribution, we found that most of the infected people were located in the southern border, a trend related to the economic strip in the southern part of Hidalgo State, associated with its vicinity to the Megacity of Mexico. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Article
Online University Counselling Services and Psychological Problems among Italian Students in Lockdown Due to Covid-19
Healthcare 2020, 8(4), 440; https://doi.org/10.3390/healthcare8040440 - 29 Oct 2020
Cited by 4 | Viewed by 1589
Abstract
Introduction: With the advent of Covid-19, Italian university students were overwhelmed by fear of the pandemic and the social restrictions of the lockdown phase, with all didactic activity provided online. These stress factors caused people to experience psychological problems and/or the aggravation of [...] Read more.
Introduction: With the advent of Covid-19, Italian university students were overwhelmed by fear of the pandemic and the social restrictions of the lockdown phase, with all didactic activity provided online. These stress factors caused people to experience psychological problems and/or the aggravation of pre-existing mental symptomatology. Psychological support is, therefore, important for the university-student population. Aims: (1) Analyzing the psychological difficulties and mental problems relative to lockdown from Covid-19 of students who asked for help from the Center of Psychological Counseling of the University of Salerno. (2) Describing the online services of the university’s psychological counseling treatment. Participants: 266 university students, but only 49 were undergoing psychological treatment during the Covid-19 lockdown at the center. Methods: (1) Semistructured interview; (2) Questionnaire consisting of sociodemographic information and ad hoc questions; and (3) Scl-90-r test. Results and Conclusions: Aim 1: The main results highlight high levels of anxiety and stress, concentration disorders, and psychosomatization. In several cases, there was a reactivation of previous traumas and sleep was found qualitatively compromised. Aim 2: Counseling services included telephone listening activities, online psychological interviews, psychoeducational groups for interventions of anxiety management, and workshops on study methods conducted in small groups. The online counseling intervention, in times of emergency, increased the resilience and identified any psychological problems in order to implement timely management. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
Article
Assessment of the Anxiety Level of Andalusian Podiatrists during the COVID-19 Pandemic: The Increase Phase
Healthcare 2020, 8(4), 432; https://doi.org/10.3390/healthcare8040432 - 26 Oct 2020
Viewed by 769
Abstract
Coronavirus disease (COVID-19) is caused by SARS-CoV-2 and represents the causative agent of a potentially fatal disease that is of great global public health concern. COVID-19 is a respiratory disease produced by the coronavirus family. The World Health Organization declared the disease a [...] Read more.
Coronavirus disease (COVID-19) is caused by SARS-CoV-2 and represents the causative agent of a potentially fatal disease that is of great global public health concern. COVID-19 is a respiratory disease produced by the coronavirus family. The World Health Organization declared the disease a pandemic on 11 March 2020. Podiatrists are in a peculiar situation regarding the COVID-19 pandemic: that of a health professional aspect and the singularity that most of them practise as self-employed workers. The aim of the study is to evaluate in a group of podiatrists, working at a national level, their knowledge, perception and degree of anxiety related to the COVID-19 pandemic via the use of a questionnaire specifically developed to this end in the initial phase of the pandemic. We employed a transversal descriptive study with 302 participants, with a purposive sampling technique. The degree of perception and knowledge of the podiatrists about COVID-19 was analysed as well as the cognitive impact of the situation of confinement. The results showed that the podiatrists perceive this situation as serious at the economic and health level, that they have a thorough knowledge of the disease and that they are in a moderate to severe percentile of anxiety. Additionally, 76.2% cancelled their usual work. The COVID-19 pandemic is negatively perceived by this group of podiatrists at the personal, professional, health and economic level, with even a state of anxiety being produced. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
Article
Med-Tech Industry Entry Strategy Analysis under COVID-19 Impact
Healthcare 2020, 8(4), 431; https://doi.org/10.3390/healthcare8040431 - 25 Oct 2020
Cited by 1 | Viewed by 952
Abstract
COVID-19 has been impacting the Med-Tech industry dramatically since the beginning of 2020. Along with the pandemic continuously growing, the demand for major global medical products such as masks and protective clothing has surged. The Med-Tech industry is facing the huge challenge of [...] Read more.
COVID-19 has been impacting the Med-Tech industry dramatically since the beginning of 2020. Along with the pandemic continuously growing, the demand for major global medical products such as masks and protective clothing has surged. The Med-Tech industry is facing the huge challenge of a lack of production capacity, including raw material, production equipment, production line, professional human resources, and more. It would require not only the operators in the Med-Tech industry to enlarge their productivity, but also new investors from outside. This study focused on the entry strategy analysis of the Med-Tech industry, developing five driving factors, and conducting an opinion survey from three different aspects, including vendors, channels, and end-users, under COVID-19 impact. A total of 99 valid questionnaires were collected. After that, the Importance Accessibility Analysis-Network Relation Map (IAA-NRM) approach was used to verify the importance and implementation priority of the entry strategies. Then, the Decision Making Trial and Evaluation Laboratory (DEMATEL) technique is used to construct the NRM method. The research results showed that there is a common strategic path, from the regulatory system to operation resources and then marketing promotion. In addition, in these three viewpoints, vendors and end-users have similar priorities in terms of industry attributes and barriers to entry. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Study on the Spatial Differentiation of Public Health Service Capabilities of European Union under the Background of the COVID-19 Crisis
Healthcare 2020, 8(4), 358; https://doi.org/10.3390/healthcare8040358 - 24 Sep 2020
Cited by 3 | Viewed by 970
Abstract
Access to public health services is a cause that benefits the people and concerns the vital interests of the people. Everyone has access to basic health care services. The continuous improvement in people’s health is an important indicator of the improvement in people’s [...] Read more.
Access to public health services is a cause that benefits the people and concerns the vital interests of the people. Everyone has access to basic health care services. The continuous improvement in people’s health is an important indicator of the improvement in people’s quality of life. This paper selects data from the European Union (EU) on aspects of public health expenditure, medical care resources, and government emergency coordination capacity from the period 2008 to 2017. Principal component analysis and factor analysis are used to measure their public health service capacity scores and conduct a comparative analysis. On this basis, the TOBIT model is adopted to explore the driving factors that lead to the spatial differentiation of public health service capabilities, and to combine it with the data of the COVID-19 epidemic as of 8 August 2020 from the official announcements of the World Health Organization and governments for further thinking. The results indicate that the public health service capacity of countries in the EU is showing a gradual increase. The capacity in Western Europe is, in turn, higher than that of Northern Europe, Southern Europe and Eastern Europe. In addition, the overall capacity in Western Europe is relatively high, but it is not balanced and stable, while Northern Europe has remained stable and balanced at a high level. Population density, degree of opening up, education level, economic development level, technological innovation level, and degree of aging have a positive effect on public health service capabilities. The level of urbanization has a negative effect on it. However, in countries with strong public health service capabilities, the epidemic of COVID-19 is more severe. The emergence of this paradox may be related to the detection capabilities of countries, the high probability of spreading thCOVID-19 epidemic, the inefficient implementation of government policy, the integrated system of the EU and the adverse selection of youth. This paper aims to improve the ability of the EU to respond to public health emergencies, improve the utilization of medical and health resources, and better protect people’s health from the perspective of public health service capacity. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Article
Telemedicine in Times of the Pandemic Produced by COVID-19: Implementation of a Teleconsultation Protocol in a Hospital Emergency Department
Healthcare 2020, 8(4), 357; https://doi.org/10.3390/healthcare8040357 - 23 Sep 2020
Cited by 2 | Viewed by 1167
Abstract
Since the first case of COVID-19 was reported in Spain, almost 22% of healthcare professionals have been infected. Among the main causes are exposure during the care of suspected patients and asymptomatic patients, which caused a greater lack of protection in some cases, [...] Read more.
Since the first case of COVID-19 was reported in Spain, almost 22% of healthcare professionals have been infected. Among the main causes are exposure during the care of suspected patients and asymptomatic patients, which caused a greater lack of protection in some cases, and to the global shortage of personal protective equipment due to the strong demand for it. The main objective of this study was to evaluate the effectiveness of a teleconsultation protocol with patients who had respiratory symptoms in the reduction of the consumption of personal protective equipment (PPE) in a hospital emergency service (HES) during the COVID-19 pandemic. This is a descriptive and retrospective study that analyzes the implementation of a teleconsultation protocol with patients with respiratory problems treated in the HES at the Hospital de Poniente (Almeria), between 18 March and 30 April 2020. In the selected study period, 5353 patients were treated in the HES of the Hospital de Poniente; of these, 15.43% showed respiratory symptoms and were referred to the Respiratory Circuit, of which 42.2% did so via teleconsultation. Sixty-six cases of COVID-19 were diagnosed, 57.6% were male, and the median age was 71 years old. The main disease related was pneumonia (89.4%), symptoms more frequent were cough (77.3%), fever (77.3%), and dyspnea (60.6%). Lastly, 56.1% of the patients that attended had one or more comorbidities, high blood pressure (53%), and diabetes (36.4%), which became the main risk factors. The results showed that the implementation of teleconsultation in the HES reduced the possibility of infection and allowed for a more efficient consumption of personal protective equipment. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Article
How Will COVID-19 Impact on the Governance of Global Health in the 2030 Agenda Framework? The Opinion of Experts
Healthcare 2020, 8(4), 356; https://doi.org/10.3390/healthcare8040356 - 23 Sep 2020
Cited by 1 | Viewed by 1696
Abstract
In 2015, the 2030 Agenda was formally adopted by the United Nations, establishing a set of 17 Sustainable Development Goals (SDGs). SDG 3 seeks to promote Global Health and the quality of public health systems in developing countries. The achievement of these goals [...] Read more.
In 2015, the 2030 Agenda was formally adopted by the United Nations, establishing a set of 17 Sustainable Development Goals (SDGs). SDG 3 seeks to promote Global Health and the quality of public health systems in developing countries. The achievement of these goals requires the commitment of all signing countries, but the COVID-19 crisis is changing the behavior of the main stakeholders in the international arena. What do the experts think about these changes? Could these changes threaten the 2030 Agenda and Global Health? To answer these questions, we conduct a content analysis of 152 documents written by experts from the 15 main think tanks on international development policy. The results point out that the new scenario brought about by the pandemic is hindering the necessary cooperation between countries to achieve global health goals and to guarantee public health coverage in developing countries. To deal with these challenges, more delegation of powers to international organizations and a reform of the international cooperation system are needed. With this analysis, we launch a warning about potential weaknesses of the institutional design of the 2030 Agenda in order for it to survive in a post-COVID-19 world and remain a valid instrument to promote health worldwide. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Communication
COVID-19 Pandemic: Perspective of an Italian Tertiary Care Pediatric Center
Healthcare 2020, 8(3), 311; https://doi.org/10.3390/healthcare8030311 - 01 Sep 2020
Cited by 3 | Viewed by 1086
Abstract
Since February 2020, Italy has been faced with the dramatic spread of novel Coronavirus SARS-CoV-2. This impetuous pandemic infection forced many hospitals to reorganize their healthcare systems. Predicting a rapid spread of the SARS-CoV-2 virus within our region, the Department for Women’s and [...] Read more.
Since February 2020, Italy has been faced with the dramatic spread of novel Coronavirus SARS-CoV-2. This impetuous pandemic infection forced many hospitals to reorganize their healthcare systems. Predicting a rapid spread of the SARS-CoV-2 virus within our region, the Department for Women’s and Children’s Health promptly decided (i) to revise the distribution of the clinical areas in order to create both designated COVID-19 and COVID-19-free areas with their own access, (ii) to reinforce infection prevention control (IPC) measures for all healthcare workers and administrative staff and (iii) to adopt the new “double-gate approach”: a phone call pre-triage and nasopharyngeal swab for SARS-CoV-2 detection before the admission of all patients and caregivers. Between 21 February 2020 till 04 May 2020, only seven physicians, two nurses and two of the administrative staff resulted positive, all during the first week of March. No other cases of intra-department infection were documented among the healthcare workers since all the preventive procedures described above were implemented. It is predicted that similar situations can happen again in the future, and thus, it is necessary to be more prepared to deal with them than we were at the beginning of this COVID-19 pandemic. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Article
Physicians’ Perspectives on COVID-19: An International Survey
Healthcare 2020, 8(3), 250; https://doi.org/10.3390/healthcare8030250 - 02 Aug 2020
Cited by 6 | Viewed by 1897
Abstract
Coronavirus disease 2019 (COVID-19) has put a tremendous pressure over health care systems worldwide. Physicians were faced to fight this novel, emerging disease, without evidence-based recommendations. Our aim was to investigate physicians’ point of view regarding the new coronavirus disease. We designed an [...] Read more.
Coronavirus disease 2019 (COVID-19) has put a tremendous pressure over health care systems worldwide. Physicians were faced to fight this novel, emerging disease, without evidence-based recommendations. Our aim was to investigate physicians’ point of view regarding the new coronavirus disease. We designed an on-line survey with 30 questions to assess physicians’ perception of personal impact as well as epidemiology, clinical features, management, and outcome in COVID-19. A total of 194 physicians from 43 countries, of which 42.3% were male, 45.4% had more than 5 years’ experience and 10.8% were heads of department/professors, filled-out the questionnaire. Although 47.4% of the physicians were currently treating patients, over 80% thought that they might get in contact with COVID-19 patients. A total of 36.6% physicians thought that they are not and 30.9% were not sure if they were being protected by the ongoing procedures. A total of 21.1% of the doctors felt that they are avoided by the persons with whom they usually interact in daily life and 24.7% were isolated from the household members they usually live with. A total of 72.7% of physicians considered that COVID-19-free patients are currently neglected. The results of the current survey raise awareness about the impact of COVID-19 on physicians’ practice. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
Article
Lessons from South Korea Regarding the Early Stage of the COVID-19 Outbreak
Healthcare 2020, 8(3), 229; https://doi.org/10.3390/healthcare8030229 - 24 Jul 2020
Cited by 8 | Viewed by 2133
Abstract
South Korea has experienced difficulty in controlling the spread of the novel coronavirus disease (COVID-19) during the early stages of the outbreak. South Korea remains passionately determined to protect Koreans against COVID-19 and through trial and error hopes to improve the strategies used [...] Read more.
South Korea has experienced difficulty in controlling the spread of the novel coronavirus disease (COVID-19) during the early stages of the outbreak. South Korea remains passionately determined to protect Koreans against COVID-19 and through trial and error hopes to improve the strategies used to limit the outbreak. Here, we review how COVID-19 spread and what prevention strategies were implemented during the early stages of the outbreak in South Korea. We investigated online newspapers published in South Korea from 21 January 2020 to 20 March 2020, and reviewed academic medical articles related to COVID-19. Additionally, we acquired data on COVID-19 cases through the official website for COVID-19 in South Korea. To date, numerous measures have been applied by the government and the medical community during the early stages of the COVID-19 outbreak including the reporting of methods for diagnostic testing, patient classification, the introduction of drive-through screening centers, COVID-19 preventive measures, implementation of government policies for the shortage of face masks, and entry restrictions. Here, we present data from the early stages of the COVID-19 outbreak and measures to prevent its spread in South Korea. We believe that sharing the experience of South Korea during the COVID-19 outbreak can help other countries to implement strategies to prevent its rapid transmission. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Article
Development of a Remote Psychological First Aid Protocol for Healthcare Workers Following the COVID-19 Pandemic in a University Teaching Hospital, Malaysia
Healthcare 2020, 8(3), 228; https://doi.org/10.3390/healthcare8030228 - 24 Jul 2020
Cited by 10 | Viewed by 3098
Abstract
The purpose of this article is to discuss the importance of addressing the psychological impact of coronavirus disease 2019 (COVID-19) on healthcare workers (HCWs) who are frontliners directly involved in mitigating the spread of the disease. This paper focuses on the utilization of [...] Read more.
The purpose of this article is to discuss the importance of addressing the psychological impact of coronavirus disease 2019 (COVID-19) on healthcare workers (HCWs) who are frontliners directly involved in mitigating the spread of the disease. This paper focuses on the utilization of a clinical practice protocol for identifying HCWs who are COVID-19-positive or under investigation and surveillance for suspected infection, in a tertiary, university teaching hospital of Malaysia. The protocol for Psychological First Aid (PFA), which is applied remotely via a mobile application and phone calls, outlines the work process in stages, with expected immediate, intermediate, and long-term goals within a “Specific, Measurable, Attainable, Relevant, and Realistic Timeframe” (SMART). This protocol is developed to provide a guideline for psychological crisis interventions that promote safety, calm, and hope in HCWs, allowing them to return to psychological functioning without being stigmatized. The unprecedented remote PFA protocol may serve as a platform for further research on the application of a goal-directed approach in a healthcare organization. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Communication
Quadrupling the N95 Supply during the COVID-19 Crisis with an Innovative 3D-Printed Mask Adaptor
Healthcare 2020, 8(3), 225; https://doi.org/10.3390/healthcare8030225 - 23 Jul 2020
Cited by 5 | Viewed by 1609
Abstract
The need for personal protective equipment during the COVID-19 pandemic is far outstripping our ability to manufacture and distribute these supplies to hospitals. In particular, the medical N95 mask shortage is resulting in healthcare providers reusing masks or utilizing masks with filtration properties [...] Read more.
The need for personal protective equipment during the COVID-19 pandemic is far outstripping our ability to manufacture and distribute these supplies to hospitals. In particular, the medical N95 mask shortage is resulting in healthcare providers reusing masks or utilizing masks with filtration properties that do not meet medical N95 standards. We developed a solution for immediate use: a mask adaptor, outfitted with a quarter section of an N95 respirator that maintains the N95 seal standard, thereby quadrupling the N95 supply. A variety of designs were 3D-printed and optimized based on the following criteria: seal efficacy, filter surface area and N95 respirator multiplicity. The final design is reusable and features a 3D-printed soft silicone base as well as a rigid 3D-printed cartridge to seal one-quarter of a 3M 1860 N95 mask. Our mask passed the computerized N95 fit test for six individuals. All files are publicly available with this publication. Our design can provide immediate support for healthcare professionals in dire need of medical N95 masks by extending the current supply by a factor of four. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Article
A Strategy for International Cooperation in the COVID-19 Pandemic Era: Focusing on National Scientific Funding Data
Healthcare 2020, 8(3), 204; https://doi.org/10.3390/healthcare8030204 - 09 Jul 2020
Cited by 4 | Viewed by 1950
Abstract
The coronavirus crisis may lead to a deeper understanding of international collaborations for developing antivirals and vaccines that are essential to protect us from current and future health security threats. Beyond technical solutions, the government of South Korea needs to establish a timely [...] Read more.
The coronavirus crisis may lead to a deeper understanding of international collaborations for developing antivirals and vaccines that are essential to protect us from current and future health security threats. Beyond technical solutions, the government of South Korea needs to establish a timely strategic investment in coronavirus-related research and development (R&D) in order to enhance the capabilities for managing this new uncertainty in regard to the domestic health crisis. Thus, this study aims to provide useful information about the status of global coronavirus-related research from the South Korean government’s perspective. National funded projects stemmed from leading nations such as the United States, countries of the European Union, and Japan between 2012 and 2018. Six research fields were derived by clustering analysis and an expert-based approach, and then matched to those of South Korea. The comparative analysis among them allowed for the identification of the nations’ strengths and weaknesses, thereby laying the groundwork for strategic international research collaborations. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Article
Strategies for the Prevention of the Intra-Hospital Transmission of COVID-19: A Retrospective Cohort Study
Healthcare 2020, 8(3), 195; https://doi.org/10.3390/healthcare8030195 - 03 Jul 2020
Cited by 5 | Viewed by 1635
Abstract
Coronavirus disease (COVID-19) has spread rapidly worldwide. We aimed to review the strategies used by our university hospital in Daegu (South Korea) to prevent the transmission of COVID-19 within our institution. We also investigated the actual situation at our hospital against the recommended [...] Read more.
Coronavirus disease (COVID-19) has spread rapidly worldwide. We aimed to review the strategies used by our university hospital in Daegu (South Korea) to prevent the transmission of COVID-19 within our institution. We also investigated the actual situation at our hospital against the recommended guidelines. We conducted a survey among patients and staff in our hospital. Additionally, patients’ electronic medical records were reviewed along with closed-circuit television (CCTV) recordings. Various strategies and guidelines developed by our hospital have been implemented. A total of 303 hospital staff and patients had exposure to 29 confirmed COVID-19 patients. Of them, three tested positive for COVID-19 without further transmission. The intra-hospital infection of the disease occurred when the recommended strategies and guidelines such as wearing a mask and isolating for 2 weeks were not followed. In conclusion, the implementation of robust guidelines for preventing the intra-hospital transmission of COVID-19 is essential. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Review

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Review
Role of Laboratory Medicine in SARS-CoV-2 Diagnostics. Lessons Learned from a Pandemic
Healthcare 2021, 9(7), 915; https://doi.org/10.3390/healthcare9070915 - 19 Jul 2021
Viewed by 801
Abstract
Since the 2019 novel coronavirus outbreak began in Wuhan, China, diagnostic methods in the field of molecular biology have been developing faster than ever under the vigilant eye of world’s research community. Unfortunately, the medical community was not prepared for testing such large [...] Read more.
Since the 2019 novel coronavirus outbreak began in Wuhan, China, diagnostic methods in the field of molecular biology have been developing faster than ever under the vigilant eye of world’s research community. Unfortunately, the medical community was not prepared for testing such large volumes or ranges of biological materials, whether blood samples for antibody immunological testing, or salivary/swab samples for real-time PCR. For this reason, many medical diagnostic laboratories have made the switch to working in the field of molecular biology, and research undertaken to speed up the flow of samples through laboratory. The aim of this narrative review is to evaluate the current literature on laboratory techniques for the diagnosis of SARS-CoV-2 infection available on pubmed.gov, Google Scholar, and according to the writers’ knowledge and experience of the laboratory medicine. It assesses the available information in the field of molecular biology by comparing real-time PCR, LAMP technique, RNA sequencing, and immunological diagnostics, and examines the newest techniques along with their limitations for use in SARS-CoV-2 diagnostics. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Review
Overview of the User Experience for Snorkeling Mask Designs during the COVID-19 Pandemic
Healthcare 2021, 9(2), 204; https://doi.org/10.3390/healthcare9020204 - 14 Feb 2021
Cited by 2 | Viewed by 1085 | Correction
Abstract
During the first wave of the COVID-19 pandemic, industries and academic institutes have collaborated to resolve the worldwide medical supply shortage issues. Innovative designs of 3D-printed items were proposed and developed by the maker community as a temporary solution to address the lack [...] Read more.
During the first wave of the COVID-19 pandemic, industries and academic institutes have collaborated to resolve the worldwide medical supply shortage issues. Innovative designs of 3D-printed items were proposed and developed by the maker community as a temporary solution to address the lack of personal protective equipment. An overview of global ongoing and past initiatives during the COVID-19 pandemic along with their challenges on retrofitting full-face snorkeling masks for healthcare applications such as splash-proof face shields, respirator masks and non-invasive ventilation systems are reported in this contribution. This study reviews these global initiatives and challenges. From our analysis, the present situation highlights the need to build solid networks between healthcare institutes and the different rapid prototyping initiatives. A clear feedback system needs to be implemented to facilitate effective collaboration between engineering (maker) and healthcare teams, to optimize the available human resources, and to achieve adequate product developments responding to the needs of healthcare workers. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Review
Multistakeholder Participation in Disaster Management—The Case of the COVID-19 Pandemic
Healthcare 2021, 9(2), 203; https://doi.org/10.3390/healthcare9020203 - 13 Feb 2021
Viewed by 1223
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is affecting society’s health, economy, environment and development. COVID-19 has claimed many lives across the globe and severely impacted the livelihood of a considerable section of the world’s population. We are still in the process of finding [...] Read more.
The coronavirus disease 2019 (COVID-19) pandemic is affecting society’s health, economy, environment and development. COVID-19 has claimed many lives across the globe and severely impacted the livelihood of a considerable section of the world’s population. We are still in the process of finding optimal and effective solutions to control the pandemic and minimise its negative impacts. In the process of developing effective strategies to combat COVID-19, different countries have adapted diverse policies, strategies and activities and yet there are no universal or comprehensive solutions to the problem. In this context, this paper brings out a conceptual model of multistakeholder participation governance as an effective model to fight against COVID-19. Accordingly, the current study conducted a scientific review by examining multi-stakeholder disaster response strategies, particularly in relation to COVID-19. The study then presents a conceptual framework for multistakeholder participation governance as one of the effective models to fight against COVID-19. Subsequently, the article offers strategies for rebuilding the economy and healthcare system through multi-stakeholder participation, and gives policy directions/decisions based on evidence to save lives and protect livelihoods. The current study also provides evidence about multidimensional approaches and multi-diplomatic mechanisms during the COVID-19 crisis, in order to examine dimensions of multi-stakeholder participation in disaster management and to document innovative, collaborative strategic directions across the globe. The current research findings highlight the need for global collaboration by working together to put an end to this pandemic situation through the application of a Multi-Stakeholder Spatial Decision Support System (MS-SDSS). Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Review
Pandemic Pause: Systematic Review of Cost Variables for Ambulatory Care Organizations Participating in Accountable Care Organizations
Healthcare 2021, 9(2), 198; https://doi.org/10.3390/healthcare9020198 - 12 Feb 2021
Cited by 1 | Viewed by 762
Abstract
Ambulatory health care provider organizations participating in Accountable Care Organizations (ACOs) organizations assume costs beyond typical practice operations that are directly associated with value-based care initiatives. Identifying these variables that influence such costs are essential to an organization’s financial viability. To enable the [...] Read more.
Ambulatory health care provider organizations participating in Accountable Care Organizations (ACOs) organizations assume costs beyond typical practice operations that are directly associated with value-based care initiatives. Identifying these variables that influence such costs are essential to an organization’s financial viability. To enable the U.S. healthcare system to respond to the COVID-19 pandemic CMS issued blanket waivers that permit enhanced flexibility, extension, and other emergency declaration changes to ACO reporting requirements through the unforeseen future. This relaxation and even pausing of reporting requirements encouraged the researchers to conduct a systematic review and identify variables that have influenced costs incurred by ambulatory care organizations participating in ACOs prior to the emergency declaration. The research findings identified ACO-ambulatory care variables (enhanced patient care management, health information technology improvements, and organizational ownership/reimbursement models) that helped to reduce costs to the ambulatory care organization. Additional variables (social determinants of health/environmental conditions, lack of integration/standardization, and misalignment of financial incentives) were also identified in the literature as having influenced costs for ambulatory care organizations while participating in an ACO initiative with CMS. Findings can assist ambulatory care organizations to focus on new and optimized strategies as they begin to prepare for the post-pandemic resumption of ACO quality reporting requirements once the emergency declaration is eventually lifted. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Review
Rapid Telehealth Implementation during the COVID-19 Global Pandemic: A Rapid Review
Healthcare 2020, 8(4), 517; https://doi.org/10.3390/healthcare8040517 - 29 Nov 2020
Cited by 6 | Viewed by 1515
Abstract
The implementation and continued expansion of telehealth services assists a variety of health care organizations in the delivery of care during the current COVID-19 global pandemic. However, limited research has been conducted on recent, rapid telehealth implementation and expansion initiatives regarding facilitators and [...] Read more.
The implementation and continued expansion of telehealth services assists a variety of health care organizations in the delivery of care during the current COVID-19 global pandemic. However, limited research has been conducted on recent, rapid telehealth implementation and expansion initiatives regarding facilitators and barriers surrounding the provision of quality patient care. Our rapid review evaluated the literature specific to rapid telehealth implementation during the current COVID-19 pandemic from three research databases between January 2020 and May 2020 and reported using preferred reporting items for systematic reviews and meta-analyses (PRISMA). The results indicate the rapid implementation and enhanced use of telehealth during the COVID-19 pandemic in the United States surrounding the facilitators and barriers to the provision of patient care, which are categorized into three identified themes: (1) descriptive process-oriented implementations, (2) the interpretation and infusion of the CARES Act of 2020 telehealth exemptions related to the relaxation of patient privacy and security (HIPAA) protocols, and (3) the standard of care protocols and experiences addressing organizational liability and the standard of care. While the study limitation of sample size exists (n = 21), an identification of rapid telehealth implementation advancements and challenges during the current pandemic may assist health care organizations in the delivery of ongoing quality care during the COVID-19 pandemic. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Other

Jump to: Research, Review

Correction
Correction: Profili et al. Overview of the User Experience for Snorkeling Mask Designs during the COVID-19 Pandemic. Healthcare 2021, 9, 204
Healthcare 2021, 9(7), 817; https://doi.org/10.3390/healthcare9070817 - 28 Jun 2021
Cited by 1 | Viewed by 337
Abstract
The authors would like to make the following corrections to the published paper [...] Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Viewpoint
COVID-19 in China: Responses, Challenges and Implications for the Health System
Healthcare 2021, 9(1), 82; https://doi.org/10.3390/healthcare9010082 - 16 Jan 2021
Cited by 6 | Viewed by 1293
Abstract
A public health crisis is a “touchstone” for testing the ability and capacity of a national health system. In the current era, public health crises are presenting new systematic and cross-border characteristics and uncertainty. The essence of a system for public health crisis [...] Read more.
A public health crisis is a “touchstone” for testing the ability and capacity of a national health system. In the current era, public health crises are presenting new systematic and cross-border characteristics and uncertainty. The essence of a system for public health crisis governance is the rules administering the stimulus–response chain. The health system generally emphasizes joint participation and communication between different subjects, which may lead to overlap and redundancy as well as a lack of auxiliary support for major public health crisis events. In the context of coronavirus disease 2019 (COVID-19) in China, we track the responses, challenges, and implications of the temporary disruption of the health system and its response to this major public health crisis. We examine local governance capacity, performance in pandemic control, and the coordinated responses to COVID-19. Accordingly, we identify the challenges to the health system, including the imbalance in attention given to medical care versus health care, insufficient grassroots public health efforts and control capacity, and untimely information disclosure. It is strongly suggested that the government improve its cognitive ability and focus more attention on building and strengthening the emergency health system. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
Commentary
What Can COVID-19 Teach Us about Using AI in Pandemics?
Healthcare 2020, 8(4), 527; https://doi.org/10.3390/healthcare8040527 - 01 Dec 2020
Cited by 2 | Viewed by 1376
Abstract
The COVID-19 pandemic put significant strain on societies and their resources, with the healthcare system and workers being particularly affected. Artificial Intelligence (AI) offers the unique possibility of improving the response to a pandemic as it emerges and evolves. Here, we utilize the [...] Read more.
The COVID-19 pandemic put significant strain on societies and their resources, with the healthcare system and workers being particularly affected. Artificial Intelligence (AI) offers the unique possibility of improving the response to a pandemic as it emerges and evolves. Here, we utilize the WHO framework of a pandemic evolution to analyze the various AI applications. Specifically, we analyzed AI from the perspective of all five domains of the WHO pandemic response. To effectively review the current scattered literature, we organized a sample of relevant literature from various professional and popular resources. The article concludes with a consideration of AI’s weaknesses as key factors affecting AI in future pandemic preparedness and response. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Perspective
Clinical Communication Skills Training in Dental Medical Education: The COVID-19 Pandemic Challenge
Healthcare 2020, 8(4), 429; https://doi.org/10.3390/healthcare8040429 - 25 Oct 2020
Cited by 4 | Viewed by 1249
Abstract
It is very important for healthcare professionals to have good clinical communication skills, especially dentists. Patient-centred care results in patient satisfaction, better outcomes, and less complaints from dental patients. Due to the onset of the COVID-19 pandemic, the clinical communications skills programme of [...] Read more.
It is very important for healthcare professionals to have good clinical communication skills, especially dentists. Patient-centred care results in patient satisfaction, better outcomes, and less complaints from dental patients. Due to the onset of the COVID-19 pandemic, the clinical communications skills programme of the pre-graduate course in dental medicine at the University of Porto had to be transformed to an online format. Based on their role as faculty, the authors aimed to recount their initial reflections and concerns within this perspective, and to share how they adapted to the new reality of teaching clinical communication skills online, as well as the conclusions of our experience, in the hope that this will help others who may have to go through a similar process. The authors acknowledged that the students achieved the pre-established goals of the clinical communications skills programme through the new online format. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
Commentary
Are Special Care Dentistry Services Prepared for a Global Disruption in Healthcare? A Call for a Wider Promotion of Dental Conscious Sedation Training
Healthcare 2020, 8(4), 419; https://doi.org/10.3390/healthcare8040419 - 22 Oct 2020
Cited by 2 | Viewed by 827
Abstract
Recently, calls for prompt and smart reform of dental education and postgraduate training have been made, reflecting the current global healthcare needs and addressing the most common problems faced by dental care providers. Objectives: Herewith, we propose the enhancement of multilevel dental training [...] Read more.
Recently, calls for prompt and smart reform of dental education and postgraduate training have been made, reflecting the current global healthcare needs and addressing the most common problems faced by dental care providers. Objectives: Herewith, we propose the enhancement of multilevel dental training in dental conscious sedation (DCS), in order to meet the increasing demands associated with current and post-pandemic times. The temporary suspension of general anaesthesia and hospital-based sedation provision in response to coronavirus disease 2019 (COVID-19) revealed the urgent need for more efficient utilization of a variety of forms of DCS. Whilst the global spread of Severe Acute Respiratory Syndrome novel coronavirus (SARS-CoV-2) has particularly challenged dental sedation teams in community services, the appropriate preparation for similar disruptions in future should be undertaken proactively. In response, dental schools and commissioners are obliged to implement innovations in teaching, with the development of new programs supporting trainer–trainee interactions and focusing on practical sedation skills. Conclusions: The joint efforts of educators, healthcare providers, and commissioners, as well as adequate and robust DCS training utilizing a variety of teaching methods, would allow our profession to face the growing demand for pain and anxiety control measures in light of the current situation, which may increase even further over time. Decision makers are urged to consider making training in DCS more accessible, meeting current healthcare demands, and equally providing essential support for the special dental care sector. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Commentary
COVID-19 and Mental Well-Being: Guidance on the Application of Behavioral and Positive Well-Being Strategies
Healthcare 2020, 8(3), 336; https://doi.org/10.3390/healthcare8030336 - 12 Sep 2020
Cited by 13 | Viewed by 4045
Abstract
The raging COVID-19 pandemic has been a great source of anxiety, distress, and stress among the population. Along with mandates for social distancing and infection control measures, the growing importance of managing and cultivating good mental well-being practices cannot be disregarded. The purpose [...] Read more.
The raging COVID-19 pandemic has been a great source of anxiety, distress, and stress among the population. Along with mandates for social distancing and infection control measures, the growing importance of managing and cultivating good mental well-being practices cannot be disregarded. The purpose of this commentary is to outline and discuss some research-proven positive well-being and stress reduction strategies to instill healthy coping mechanisms among individuals and community members. The authors anticipate that usage of these strategies at the individual and the community level should greatly benefit the mental well-being not only in the current COVID-19 pandemic but also in any future epidemics at the national level. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
Perspective
Cancer in the Time of Coronavirus: A Call for Crisis Oncology Standards of Care
Healthcare 2020, 8(3), 214; https://doi.org/10.3390/healthcare8030214 - 17 Jul 2020
Cited by 1 | Viewed by 1365
Abstract
Since the Coronavirus Disease 2019 (COVID-19) was identified as a global pandemic, health systems have been severely strained, particularly affecting vulnerable populations such as patients with cancer. In response to the COVID-19 pandemic, a variety of oncology specialty societies are making recommendations for [...] Read more.
Since the Coronavirus Disease 2019 (COVID-19) was identified as a global pandemic, health systems have been severely strained, particularly affecting vulnerable populations such as patients with cancer. In response to the COVID-19 pandemic, a variety of oncology specialty societies are making recommendations for standards of care. These diverse standards and gaps in standards can lead to inconsistent and heterogeneous care among governments, cancer centers, and even among oncologists within the same practice. These challenges highlight the need for a common nomenclature and crisis guidelines. For times of increased scarcity of resources, the National Academy of Medicine developed Crisis Standards of Care, defined as fairness, duty to care, duty to steward resources, transparency, consistency, proportionality, and accountability. However, we believe there is an urgent need to develop cancer-specific guidelines by convening a panel of experts from multiple specialties. These would be Crisis Oncology Standards of Care (COSCs) that are sensitive to both the individual cancer patient and to the broader health system in times of scarce resources, such as pandemic, natural disaster, or supply chain disruptions. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
Brief Report
How Medical Studies in Poland Prepare Future Healthcare Managers for Crises and Disasters: Results of a Pilot Study
Healthcare 2020, 8(3), 202; https://doi.org/10.3390/healthcare8030202 - 09 Jul 2020
Cited by 6 | Viewed by 3932
Abstract
In the event of a crisis, rapid and effective assistance for victims is essential, and in many cases, medical assistance is required. To manage the situation efficiently, it is necessary to have a proactive management system in place that ensures professional assistance to [...] Read more.
In the event of a crisis, rapid and effective assistance for victims is essential, and in many cases, medical assistance is required. To manage the situation efficiently, it is necessary to have a proactive management system in place that ensures professional assistance to victims and the safety of medical personnel. We evaluated the perceptions of students and graduates in public health studies at the Medical University of Lublin, Poland, concerning their preparation and management skills for crises such as the COVID-19 pandemic. This pilot study was conducted in March 2020; we employed an online survey with an anonymous questionnaire that was addressed to students and graduates with an educational focus in healthcare organization and management. The study involved 55 people, including 14 men and 41 women. Among the respondents, 41.8% currently worked in a healthcare facility and only 21.7% of them had participated in training related to preparation for emergencies and disasters in their current workplace. The respondents rated their workplaces’ preparedness for the COVID-19 pandemic at four points. A significant number of respondents stated that if they had to manage a public health emergency, they would not be able to manage the situation correctly and not be able to predict its development. Managers of healthcare organizations should have the knowledge and skills to manage crises. It would be advisable for them to have been formally educated in public health or healthcare administration. In every healthcare facility, it is essential that training and practice of performing medical procedures in full personal protective equipment (PPE) be provided. Healthcare facilities must implement regular training combined with practical live scenario exercises to prepare for future crises. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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