LETTER TO EDITOR
Year : 2020 | Volume
: 4 | Issue : 3 | Page : 152--154
Qatar's center of communicable disease control (CDC) first triage experience and management strategy during novel coronavirus 2019 (COVID 19) pandemic
Phool Iqbal1, Theresa Paul1, Adeel Ahmad Khan1, Safna Farsana Akkam Veettil1, Rasha Mohamed Abdul Rahman1, -Mohd Abdullah Juma Abu Khattab2, Muna A. Rahman S. Al. Maslamani3,
1 Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
2 Department of Infectious Disease, Communicable Disease Center, Doha, Qatar
3 Department of Internal Medicine, Hamad General Hospital; Department of Infectious Disease, Communicable Disease Center; Department of Clinical Medicine, Weill Cornell Medical College Doha, Qatar
Correspondence Address:
Dr. Phool Iqbal
Hamad General Hospital, P. O. Box: 3050, Doha
Qatar
How to cite this article:
Iqbal P, Paul T, Khan AA, Akkam Veettil SF, Abdul Rahman RM, Abu Khattab -A, S. Al. Maslamani MA. Qatar's center of communicable disease control (CDC) first triage experience and management strategy during novel coronavirus 2019 (COVID 19) pandemic.Libyan J Med Sci 2020;4:152-154
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How to cite this URL:
Iqbal P, Paul T, Khan AA, Akkam Veettil SF, Abdul Rahman RM, Abu Khattab -A, S. Al. Maslamani MA. Qatar's center of communicable disease control (CDC) first triage experience and management strategy during novel coronavirus 2019 (COVID 19) pandemic. Libyan J Med Sci [serial online] 2020 [cited 2023 Mar 28 ];4:152-154
Available from: https://www.ljmsonline.com/text.asp?2020/4/3/152/295612 |
Full Text
Dear Editor,
The COVID-19 pandemic has shaken the whole world. It has massively affected the health-care system and economy. Affected countries were met with sheer unpreparedness and limited health-care resources. It has been declared as a worldwide pandemic by the World Health Organization (WHO) on March 11th, 2020, while the first case was detected in Wuhan, China, on December 31, 2019.[1]
Countries applied lockdown strategies to cope with the spread of the virus. There were massive travel restrictions; social distancing; and shutting down of restaurants, hotels, shopping malls, and various recreational areas, while the daily needs were met by keeping the grocery stores and pharmacies open for a limited time duration to break the chain of virus spread.[2]
Consumption of health-care resources due to the ongoing pandemic creates a need for an effective plan to avoid overutilization with early detection of the infected patients. In such situations, an efficient triage system can play a vital role in the characterization of cases according to disease severity with further implementation of a treatment strategy to fight against the COVID-19 pandemic.[3] Here, we, as health-care personnel, want to share Qatar's Center of Communicable Disease Control (CDC) first experience of triaging patients with a brief overview of further management during the COVID-19 pandemic.
Introduction to Qatar's Health-Care System
The State of Qatar is playing its crucial role in fighting against the novel coronavirus pandemic together with other nations of the world. The total population of Qatar is 2.8 million, and Hamad Medical Corporation (HMC), Doha, is the primary health-care provider of the state. HMC has been structured according to the Joint Commission International and the Accreditation Council for Graduate Medical Education International standards. It is a well-established training institute for the provision of community health.[4]
Covid-19 Screening
HMC's CDC established an effective triage system to circumvent the depletion of its health-care resources while maintaining its medical care standards in the COVID-19 pandemic. The first case was reported on February 29, 2020, in Qatar, and screening was performed rigorously since the start of the COVID-19 pandemic. It has screened >152,700 cases till May 16, 2020, based on the polymerase chain reaction technique of detecting the virus in a nasopharyngeal and oropharyngeal swab. Out of those, 30,972 were diagnosed with COVID-19, with 27,169 active cases under treatment, 1308 under acute hospital care, 158 under intensive care unit (ICU) management, 3788 recovered from the illness, and unfortunately 15 died.[5]
We want to share our experience of the triage system in CDC where we effectively categorized patients for further intervention based on a well-formulated system of the local pathway, and further management strategies as well while dealing with the community cases. The triage pathway was modified now and then according to the disease pattern in our community.
Categorization
Patients were categorized into a high- or low-risk group. High-risk group had a recent trip to endemic countries such as China, Hong Kong, Iran, Egypt, Italy, Japan, Macau, Malaysia, the Republic of Korea, Singapore, Taiwan, and Thailand or a positive contact history with a COVID-19-infected patient. We defined close contacts based on the WHO criteria as any person who had contact within 1 m with a confirmed COVID-19 case during his/her symptomatic period, including 4 days before symptom onset.[6] The elderly population of age >65 years or those with comorbid conditions such as diabetes mellitus, hypertension, bronchial asthma, malignancy, and other immunocompromised states if symptomatic were also considered as high risk. Health-care personnel who were dealing with COVID-19 patients and became symptomatic while performing their duty were also kept in this category.
Whereas the low-risk group comprised asymptomatic young and elderly patients, and also symptomatic healthy patients with no recent travel or close contact history. Individuals with symptoms of cough, headache, fever, diarrhea, loss of taste, or smell sensation even without any known positive contact or travel history were screened and admitted for further investigations and management.
the Strategy of Contact Tracing and Allocation of Quarantine Facilities and Hospitals for Covid-19 Cases
Asymptomatic COVID-19 patients were admitted to different quarantine facilities. Meanwhile, the Qatar's Ministry of Health started to put efforts into contact tracing of positive cases and screened them as well with further admission and management accordingly. It also utilized its resources to allocate and separate hospitals specifically for COVID-19 patients. The main aim was to break the chain of spread with the rapid creation of further inpatient care, acute care, intensive care unit (ICU) care, and quarantine facilities to admit the triaged patients concerning their category without any burden. Further, considering the need for health-care workers in those facilities, various departments of HMC including surgery, anesthesia, medicine, psychiatry, and ophthalmology selected doctors with appropriate training of personal protection while dealing with the patients.
Lockdown Plan Implementation With Social Awareness
International travel bans and lockdown plans including shutting down of shopping malls, cafes, restaurants, hotels, and other recreational spots were implemented. Grocery stores and pharmacies were allotted specific opening timings to address the daily needs of the community. Travel bans applied and social awareness videos about COVID 19, its symptoms, social distancing, hand hygiene measures, wearing masks, and community case updates were made available in different languages through the country's online application portal under the control of the Ministry of Health.
Telemedicine
Patients on regular follow-ups for comorbid conditions such as diabetes mellitus, hypertension, dyslipidemia, bronchial asthma, and stable heart disease. were addressed by telemedicine, and the medications were delivered to them at their residence.
Main Aim and Treatment Strategy
We aimed to identify and safely isolate high-risk and low-risk patients from the community. Precautionary measures of social distancing, wearing masks in the community, and maximally staying at home have shown effectiveness in flattening the curve by preventing the addition of cases worldwide.[7] This effectively reduced the burden on health-care facilities by decreasing exposure and creating more positive cases. Number of personal protective equipment, including the surgical and N95 masks, COVID-19 testing kits, available nursing staff and doctors, hospital beds, and ICU facilities may suffer shortage in any health-care system if overutilized, but an efficient triage system helps to deliver it smoothly considering the supply and demands. It further balances the need for acute inpatient admissions and ICU utilization. Qatar has managed to apply an effective triage in the initial stage of this COVID-19 pandemic in the country with further strategic plans as mentioned, which resulted in having the lowest mortality among the affected countries all over the world.[8]
Currently, there are no FDA-approved guidelines for treatment, and treatment strategy is being applied based on a few published articles that provide anecdotal management plans.
There is a need for proper treatment and vaccines to overcome this situation, which will only be possible with clinical trials.[9]
Overall, it is a joint effort of all worldwide countries, individual communities, governments, and health-care systems to overcome this pandemic situation by applying various strategies as needed with parallel efforts of science and research to find an ultimate solution in the form of standard medical treatment and vaccine.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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| 3 | Erika P, Andrea V, Cillis MG, Ioannilli E, Iannicelli T, Andrea M. Triage decision-making at the time of COVID-19 infection: the Piacenza strategy. Intern Emerg Med. 2020. |
| 4 | HMC Achieves ACGME-International Accreditation for an Additional Seven Residency Programs. (n.d.). Available from; https://www.hamad.qa: 443/EN/news/2015/May/Pages/HMC-achieves-ACGME-Int ernational-Accreditation-for-an-additional-seven-residency-programs.aspx. [Last retrieved on 2020 May 17]. |
| 5 | MOPH-Coronavirus Disease 2019 (COVID-19). (n.d.). Available from: https://www.moph.gov.qa/english/Pages/Coronavirus2019.aspx. [Last retrieved on 2020 May 17]. |
| 6 | The First Few X (FFX) Cases and contact investigation protocol for 2019-novel coronavirus (2019-nCoV) infection, version 2 [Internet] 2020. Available from: https://www.who.int/publications-detail-redirect/the- first-few-x-(ffx)-cases-and-contact-investigation-protocol-for-2019-novel-coronavirus-(2019-ncov)-infection [Last retrieved on 2020 May 17] |
| 7 | Akiyama MJ, Spaulding AC, Rich JD. Flattening the Curve for Incarcerated Populations - Covid-19 in Jails and Prisons. N Engl J Med 2020 28;382:2075–7. |
| 8 | Minister of Public Health Presents Qatar's Strategy to Contain the Spread of COVID-19 to WHO Officials. (n.d.). Available from: http://www.moph.gov.qa/english/mediacenter/News/Pages/NewsDetails.aspx?ItemId=166. [Last retrieved on 2020 May 19]. |
| 9 | Responding to COVID-19-”A Once-in-a-Century Pandemic? NEJM (n.d.). from https://www.nejm.org/doi/full/10.1056/NEJMp2003762. [Last retrieved on 2020 May 17]. |
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