Saturday 29 August 2020

The 24th WACEM-ACAIM Special Global Web Conference on COVID-19


24th in the series of WACEM-ACAIM Joint Working Group Meetings

ED & COVID-19: Where are the patients gone? presented by Dr. Lateef 

Talks for this week kicked off with Dr. Lateef's insightful talk about the trends of ED attendance during the pandemic. Hospitals across Singapore, and more widely, across the world, saw a significant reductions in hospital attendances at the beginning of the pandemic. A qualitative analysis showed multiple reasons as to why this phenomenon occurred, ranging from altered health-seeking behavior to cultural influences, from attempts at self-management to lack of manpower. The concept of Behavioral Immune Responses (BIR) was also introduced, which refers to the psychological processes that infer infection risk based on perceptual clues through activation of various behavioral, emotive and cognitive responses that motivate pathogen-avoidance behaviors. 

Blind Spots, presented by Dr. Stawicki

The topic of discussion by Dr. Stawicki alludes to the concept so regularly repeated in medicine, 'The eyes see what the mind knows'. Rather, the corollary, what the mind doesn't know, goes unseen. There are multiple areas in and outside of health care which led to the less than efficient handling of the crisis and learning from these instances will help us, not just with the ongoing pandemic, but future outbreaks. The paper is still in production. 

HCW in COVID, presented by Dr. Sahu

Dr. Sahu presented results of his meta-analysis about healthcare workers infected by COVID-19. (Link: ). The study concludes a significant risk of contracting COVID-19 among healthcare workers, but low incidence of severe morbidity and mortality. 

Other papers co-authored by Dr. Sahu: 

Evolution of Medical COVItrature, presented by Dr. Tiwari

Dr. Tiwari's paper and presentation highlighted the patterns and trends of literature during this pandemic, of which there were admittedly many. The difference in publications about clinical discussions and education and training for instance, among other examples, showed the trends in publication, or indeed, readership. 

Clinical Update, presented by Dr. Downing 

Dr. Downing's presentation of New York data confirmed obesity as being a significant indicator common between adults and children with COVID-19. The other notable point was the discrepancy in infection incidence and severity based upon latitudinal variations which led to the idea of a link between vitamin D deficiency and COVID-19. 

Goals of Care in COVID, presented by Dr. Garg 

Dr. Garg talked about topic that many a clinician has struggled with. The introduction of discussions regarding advanced directives - always difficult in the acute setting, and even more in the presence of a pandemic. Particularly one where there is already some healthcare paranoia, and specifically in the case of a disease with such high numbers of morbidity and mortality. Dr. Garg shared her hospital's introduction of a protocol nudging clinicians to have appropriately timed difficult conversations, which unfortunately remain vital in our communications with patients and their relatives. 

More to follow next week...

The 23rd WACEM-ACAIM- Special Global Web Conference on COVID Crisis

The 23rd  in the series of WACEM-ACAIM Joint Group Meeting



The COVID Central Academic Information System:





COVID-19 and governmental response of quarantine has impacted men, women and children across the globe. It is unknown whether the United States experience will be unique.

The volume, demographics and presentations of emergency psychiatric patients have been evolving during the COVID-19 pandemic with initial volumes significantly lower than 2019 levels. Cited concerns include wait times, lack of PPE and risk of COVID-19 infection but levels may rise once local levels of COVID-19 decrease. Associated lockdown/quarantine visit statistics may be different from pre-pandemic stats.

Our psychiatric colleagues have noted an increased utilization of non-ED care options including telehealth for those with established psychiatric issues and care providers with some clinics reporting an almost 100% visit show rate.

We have seen an uptick in those seeking care in the ED with addiction.

We have also seen the number of pediatric psychiatric visits and referrals decrease. However, whether this is drop in peds volume is because the stress on children and adolescents from bullying has been reduced/removed with the closure of schools or whether it is because of the failure of our schools as a safety net to identify and report signs of abuse or psychiatric distress remains unknown at this time.


The SUNY Story of NYC & COVID19

Dr. Bonnie Arquilla, DO, FAIM

SUNY Downstate Medical Center took a large brunt of the COVID19 Pandemic. Data was presented which covered each in every health services aspects of the pandemic and the gaps and challenges faced to counter the huge volume of infected patients.

Lessons learnt were:

     Having a team that you trust is vital

       Senior administration does not have the same goals as Clinicians

Plan and remember it will get worse

Keep track of the wins and losses

The clinical picture changes "it's not just the flu"

Infection control does work but you have to practice it

Plan for deaths 

Have a follow-up clinic organized asap

Spend money on people, not stuff likes tents except PPE!

Make sure everyone has the same mission the specialist must step up and take care of patients


Jefferson-WACEM Sepsis Summit 2020

In September 2020 WACEM along with Jefferson University will host the World Wide Web Summit on Sepsis 2020. It was announced that all WACEM Members could attend the summit and participate as speakers. Dr. David Gaieski is the Leader of this Summit.

25th Week Commendations of Weekly WACEM-ACAIM Summit are on 29th August, 5th September and 12th September 2020


Saturday 15 August 2020

The 22nd WACEM-ACAIM Special Global Web Conference on COVID-19


22nd in the series of the ACAIM-WACEM Joint Group Meetings

Blind Spots Paper

The team is working on our next publication - the blind spots paper refers to phenomenon, events, or incidents that people may not recognize or realize because it falls within their "blind spot" while the are preoccupied with different issues. 

Calladoctor , the WACEM telemedicine platform is now live.

Singaporean Successes

From an excellent presentation by Dr. Fatima Lateef, we learned that hospitals in Singapore worked diligently to maintain staff well being and morale. They achieved this through daily COVID briefing emails, daily visits to the shop floor by the departmental lead, and generally supporting each other. Each department or unit had a wellbeing lead. They had simulations and training, with PPE donning-doffing procedures and ensured there was an adequate supply of PPE at all times. Their focus on self-care resulted in less medical leave than typical. They had posters, training, apps for practicing mindfulness, sleep hygiene, stress management. This is an inspiration for all departments around the world. 

Saturday 8 August 2020

The 21st WACEM-ACAIM Special Global Web Conference on COVID Crisis


21st in the series of the WACEM-ACAIM Joint Group Meetings

Plant based therapeutics

We have made further progress in refining the study design for trials with plant based therapeutics. 

Mumbai report

Maharashtra remains a hotspot for COVID-19 in India, and unfortunately has 40% of the deaths. Of the Maharashtrian burden, Mumbai houses 50%. 

India is now seeing a rural wave, with extension of the disease from urban and semi urban areas. Due to the restricted and limited access to primary care, the patients do not have access or have delayed access to simple clinical management measures (e.g. oxygen administration) and presentation to healthcare centers late in the disease process. 

We also have seen the practice of desperation medicine. Patients are being prescribed new medications as soon as they are on the market, with little or no evidence base by clinicians relatively unfamiliar with the drug profiles. 

To add insult to injury, the August deluge has sent Mumbai underwater. Due to heavy rains and floods, there will be a domino effect on healthcare with delayed access to care, supply chain issues, infrastructure problems, and vector-borne disease endemics that happen annually, now on the back of the present pandemic. 

Indigenous ventilator

Developed by a multifaceted team including, importantly, intensivists who actually use the machines, these ventilators are a much needed technological and medical innovation. 
Dr. Prachee Sathe's excellent blog explaining the journey and clinical background:

With technical specifications as recommended by the Ministry of Health and Family Welfare and the ICMR, and practical improvisations by the clinical teams managing patients, these ventilators were developed in a short time for use in ICUs. They were tested for endurance, battery time, different modes, parameters and displays, noise levels, and precision in delivery of FiO2, with volunteer based trials. One of the unique value of this NOCCARC v310 ventilator is the capability of high flow nasal cannula delivery of oxygen in addition to invasive ventilation and NIV modes. 

Ecuadorial hypothesis

We were joined by Dr. Ricardo Izurieta who shared some statistics of COVID-19 in Ecuador. 

There has been some consideration of association between geography/climate/environment with the COVID-19 illness, with reports looking into lower mortality rates in highland areas with some explanations offered e.g. ACE-2 receptor concentration, vitamin D3 levels etc. 

Dr. Izurieta also presented some interesting research into historical medicine, looking at cross-reactivity of yellow fever and dengue fever, which provided some food for thought about amnestic responses potentially in COVID. 

Calladoctor telemedicine platform

Being launched as a novel concept for kicking off telemedicine use in India. 


We had a presentation reminding us of various masks used during (and beyond) this COVID-19 pandemic, and the latest WHO recommendations. 

Sunday 2 August 2020

The 20th WACEM-ACAIM- Special Global Web Conference on COVID Crisis

The 20th  in the series of WACEM-ACAIM Joint Group Meeting

 The COVID Central Academic Information System:


 The Plant Base Discovery Trial

Discussion was done with the Multi-Central Clinical Trial Team on the Progress on the Plant Based Interventional Study. The Regulatory framework and the approval process as well as the design was discussed.

 E-Epidemiology of COVID Research

Prof. Raina presented the PubMed Differential statistics of Published COVID Research and pointed out that CHINA was the major producer of research when it concerned COVID19.


Analysis of Demographic and Social Determinants in Mortality

Prof. Chauhan highlighted the major factors correlating them with open source data assessing mortality from COVID19 in the US.

Triple Cocktail Trials for Early COVID

Dr. Downing discussed the FDA approved individual studies using Colchicine, and Motelucast for COVID19.


Chronic COVID

ECOSANOID Storm was discussed in detail and its contributions to Chronic Inflammation, Fibrosis and Cancer was also highlighted.


Stock Market Impact of COVID19

Dr. Tiwari and Prof. Venkat discussed the impacts of COVID19 on US-INDIA stocks and concluded that overall health care and pharma stocks did well when the whole economy suffered.


Jefferson-WACEM Sepsis Summit 2020

In September 2020 WACEM along with Jefferson University will host the World Wide Web Summit on Sepsis 2020. It was announced that all WACEM Members could attend the summit and participate as speakers. Dr. David Gaieski is the Leader of this Summit.