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:

https://emaindia.net/home/covid_central

 

 CRAZY DURING COVID-19: 

PSYCHIATRIC EMERGENCIES

VERONICA TUCCI, MD, JD, FAAEM, FACEP

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.

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

https://calladoctor.in/ , 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. 

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. 

See: https://noccarc.com/ and

Dr. Prachee Sathe's excellent blog explaining the journey and clinical background: https://dr-prachee-sathe.blogspot.com/

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. 

Masks

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

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

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

 The COVID Central Academic Information System:

https://emaindia.net/home/covid_central

 

 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. 

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

The 19^th  in the series of WACEM-ACAIM Joint Group Meeting

The COVID Central Academic Information System:

https://emaindia.net/home/covid_central

Key Note Speaker

Dr. Ibrahem

HMC Qatar

ECMO Data:

Dr. Ibrahem presented the HMC Data on ECMO in COBID 19

      Indications for ECMO

Monitoring of ECMO                           
De-Escalation of ECMO

Detail Discussion about Quality Patient Care Improvisation in Qatar took place. These improvisations are the foundation of Quality Benchmark Development in Post COVID Era.

Telemedicine:

Dr. Manish Garg discussed about the progress of the Telemedicine Systems document.

VigyanCentral:

The VCentral Platform for Global Education and BIG Data was presented.

Plant Based Immunotherapy

The Multi-Center Study Protocol was presented for Plant Based Intervention for COVID Inflammatory Control. The Clinical Trials Team will be invited next week for review.

BioSecurity in COVIFLU

Oxygen Supply Chain and Various Factors related to health Biosecurity were presented we moved ahead in preparing the blue print for the supply chain applications in the new era of COVIFLU.

Triple Cocktail for Early COVID

Dr. Downing discussed mulling of the ECOSANOID Storm by Colchicine, Aspirin and Motelucast.

Chronic COVID

Chronic Inflammation, Fibrosis and Cancer are the potential complications of persistent viral infections. This could be a possibility of COVID Stays on !

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 can attend the summit and participate as speakers. Dr. David Gaieski is the Leader of this Summit. 

The 18th WACEM-ACAIM- Special Global Web Conference on Combating COVIFLU

18th in the series of  WACEM-ACAIM Joint Working Group Meeting

Mumbai Model

In today's meeting we were joined by Dr. Sunil Khaparde, Advisor Public Health Mumbai who presented the strategies adopted by the Brihanmumbai Municipal Corporation (BMC) to successfully curb the incidence of COVID-19 in Mumbai hot-spots. 

The Dharavi model saw the forging of public and private partnerships with involvement of local societal organizations, local medical services, and various foundations. Ambulances staffed with trained medical personnel carry out door-to-door screening in order to check for individuals with fever and other COVID-19 symptoms, comorbidities, and collect swabs. They have an aggressive approach towards chasing the virus by using the 4 Ts model (Tracing, tracking, testing and treating). Read more at:

https://www.thehindu.com/news/national/other-states/steep-decline-of-daily-covid-19-cases-in-dharavi-says-union-health-ministry/article31883369.ece

Eicosanoid storm

We touched upon cytokine release syndrome and cytokine storm in previous discussions. With the evolving knowledge and science surrounding COVID-19, we now take a look at the eicosanoid storm. Eicosanoids such as prostaglandins, thromboxane, leukotrienes are pro-inflammatory chemokines that are mediators of processes such as fever, inflammation, pain etc. The cytokine and chemokine responses are closely associated. Note that not all eicosanoids are pro-inflammatory, and in fact, are also metabolized into anti-inflammatory mediators. Regulation of eicosanoids is an approach to be considered in COVID-19 therapeutics.

Simulation

As COVID-19 has brought with it the need for remote monitoring, telemedicine, and social distancing, it brought an obstacle into academic medicine unseen by the general public. Bedside teaching and learning has long been a classic method of medical education. In the last decade or so, the medical fraternity has seen an enthusiastic use of simulation based teaching. With evolving science, technology and educational techniques, simulation based learning is being adopted by many centers across the world. This pandemic has been a reason to further our enthusiasm. Simulation based learning using realistic scenarios, with interdepartmental team approach is both a helpful learning tool as well as a useful tool to find gaps and failures in the delivery of medical care (e.g. difficulty communicating whilst wearing PPE, difficulty identifying members of the team, inadequate knowledge of storage of equipment/medications, equipment failure, poor communication, etc.) We suggest standardization of simulation based learning and involvement of various in-hospital teams in the betterment of COVID-19 management, and beyond.

Sepsis Summit 2020

The World Wide Web Summit on Sepsis 2020, is planned for September 2020 hosted by WACEM and Jefferson University, led by Dr. David Gaieski, is open to WACEM members,

The 17th WACEM-ACAIM- Special Global Web Conference on Celebrating 100 Days of Web Conferencing on COVID Crisis

The 17^th  in the series of WACEM-ACAIM Joint Group Meeting

The COVID Central Academic Information System:

https://emaindia.net/home/covid_central

Key Note Speaker:

Dr. Sean Downing

Sarasota Concierge Physician

Sarasota Florida

Dr. Downing various interventions done in his Special Patient Population incorporating TELEMEDICINE

1.     ASA

2.     Colchicine

3.     Montelucast

He discussed about the Role of Telehealth in one case where he used a combination preventive treatment to curb the surge of cytokines.

Global Data:

Dr. Sinha presented Mumbai Data:

·       ICU Definition and Capabilities were a major factor in mortality

·       Oxygen Supply Chain has failed and need immediate attention

·       Overstock of Ventilators without trained Nurses or Doctors

Plant Based Immunotherapy

The Multi-Center Study Protocol was presented for Plant Based Intervention for COVID Inflammatory Control. A New agent X was added to the protocol to have direct comparison with other candidates in a multi-arm study.

Oxygen Supply Chain

 Various Factors related to health Oxygen Biosecurity were presented we moved ahead in preparing the blue print for the Oxygen supply chain applications in the new era of COVIFLU.

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 can attend the summit and participate as speakers. Dr. David Gaieski is the Leader of this Summit.