We would like to help our GICS members during the current pandemic COVID-19 crisis by offering some resources.  Please email us if you find errors or if you know of other helpful information to add to this page.  If you work in a low-resource setting and have found successful strategies, please let us know so we can share those with others.  We are very eager to help our LMIC colleagues, so please let us know what we can do to help.

Click below to learn more about the following topics:

     

     Diagnosis and epidemiology

     Infrastructure

     COVID-19 in LMICs and low-resource settings

     Treatment

     Surgery and anesthesia during the pandemic

     Care of the health care provider

     Links to helpful websites

     Research | References | Donation

 

GICS Webinars

Nearly 150 people joined us on 4 June for an interesting discussion about what issues are facing our colleagues worldwide, and what GICS might do to mitigate the impact of COVID-19 on children’s surgery.  Click here to download the slide deck.  Click here to watch a video of the session.

On 2 July we gathered again to discuss specific interventions in the areas of educational resources, guidelines, backlog of patients, and research.  Click here to download the slide deck, and click here to view a video of the session.

Finally, on 10 September, the Nurses Working Group gathered providers to discuss the challenges facing nurses in LMICs during the pandemic.

We are working hard to address points raised in the discussions to meet the needs of our LMIC colleagues as they address implications of the pandemic.

Diagnosis and Epidemiology

 

One-page summary of COVID-19 from a Seattle intensivist, Dr Nick Mark (Download pdf)

Detailed Fact Sheet, with epidemiology, virology, lessons learned, discrete patient populations, including children, by Dr Al Giwa on EBMedicine website (Download pdf)

Testing

  •      Excellent summary about various diagnostic tests, including timing of positivity for each (Download pdf)

Epidemiology and clinical presentation of COVID-19 in children

  •      Putting risk of COVID-19 and transmission by children in context, Children’s Health Queensland Hospital and Health Service (Download pdf)
  •      Presentation in children, CDC (Download pdf)
  •      Pediatric presentation, AAP (Download pdf)
  •      Clinical and epidemiological features of 36 children with COVID-19 in China (Download pdf)
  •      Epidemiological characteristics of 2143 pediatric COVID-19 patients in China, Pediatrics (Download pdf)
  •      Clinical features and outcomes in 7 obstetric and neonatal patients in Wuhan, Lancet Infect Dis (Download pdf)
  •      Clinical features of COVID-19 in children, including diarrhea and emesis, NEJM (Download pdf)
  •      Newborn infection in newborns of COVID-19 positive mothers, JAMA Pediatrics (Download pdf)
  •      Rare inflammatory response to COVID-19 in children, Paediatric Intensive Care Society (Download pdf)
  •      Presentation in children in Asia, Europe, and North America, JPS (Download pdf)
  •      Clinical and CT findings in 20 children in Wuhan (Download pdf)
  •      Atypical presentation including neurological symptoms in 5 infants in France (Download pdf)
  •      Pediatric Multi-System Inflammatory Syndrome associated with COVID-19 (Download pdf)
  •      Pediatric patients presenting with GI symptoms are younger:  Fecal-oral route of transmission? (Download pdf)

Gastrointestinal presentation in 19% of people with COVID-19 in China, AJG (Download pdf)

Possible BCG protection against mortality in COVID-19, not peer reviewed (Download pdf)

Maps of COVID-19 spread

 

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Infrastructure

 

Good practice for surgeons and surgical teams, with guidelines for triage, rotas and working outside of one’s scope of practice, RCS (Download pdf)

Pyramidal method of managing multiple ICU ventilated patients, optimizing manpower available, Columbia University (Download pdf)

Global guidance for surgical care during the COVID-19 pandemic, COVIDSurg Collaborative (Download pdf)

Cancelling elective surgery to preserve PPE

Non-operative management of appendicitis protocol, adapted for COVID-19, APSA Quality and Safety Committee (Download pdf)

Guidance on when to resume elective surgery, ACS (Download pdf)

Ethical issues with limited resources

  •      Who Should be Saved First?  Ethical dilemmas when faced with scarcity of resources, New York Times (Download pdf)
  •      What do I need to know about rationing in the ICU? David Kaufman (Download pdf)
  •      Fair allocation of scarce medical resources in the time of COVID-19, NEJM (Download pdf)
  •      Ethical framework for allocation of resources in the event of shortages, ACS (Download pdf)
  •      Critical care triage, ICM (Download pdf)
  •      NY State Ventilator Allocation Guidelines:  Fascinating document, addressing ethics, triage scores, and guidelines for adults, pediatrics (p 82) and newborns (p 157) at assessment and at intervals while ventilated (Download pdf)
  •      Practical approach to running a Scarce Resource Allocation Team (SRAT) (Download pdf)
  •      Guidelines for institutional ethics services responding to COVID-19, Hastings Center (Download pdf)

Care of the deceased (Download pdf)

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COVID-19 in LMICs and low-resource settings

 

COVID-19:  Operational guidance for maintaining essential services, WHO (Download pdf)

Frontline Health Workers Coalition Recommendations on COVID-19, with suggestions applicable to countries yet to face the pandemic (Download pdf)

Access to COVID-19 Tools Accelerator:  A Global Collaboration (Download pdf)

Vulnerable populations

  •      Scaling up COVID-19 outbreak readiness and response in humanitarian situations, including camps, IASC (Download pdf)
  •      Prevention of COVID-19 infections in camps (Download pdf)
  •      Applying humanitarian standards to fight COVID-19, Sphere (Download pdf)
  •      Refugees and migrants editorial, The Lancet (Download pdf )
  •      Redefining vulnerability in COVID-19 editorial, The Lancet (Download pdf)


Implications of COVID-19 pandemic in LMICs

  •      Devastating implications of COVID-19 in West Africa, Lancet (Download pdf)
  •      How COVID-19 will hit India (Lessons about mass migration from crowded cities perhaps applicable to other LMICs), New Yorker (Download pdf)
  •      WHO concerned as COVID-19 cases accelerate in Africa, The Citizen 3 April 2020
  •      Learning from Experience, including consequences in LMICs, Lancet (Download pdf)
  •      Only 1 ventilator per 1,200,000 people in Nigeria vs 1 ventilator per 10,000 people in the US (Download pdf)
  •      Potential effects of COVID-19 pandemic on malaria control in endemic regions (Download pdf)
  •      Fragility, resilience, and inequality in Zimbabwe, with 16 ventilators in the entire country (Download pdf)
  •      Africa has a COVID-19 time bomb to diffuse, World Economic Forum (Download pdf)
  •      Africa could be next epicentre, BBC news (Download pdf)
  •      ICU capacity in LICs, 2004 (Download pdf)
  •      Possible protective effect of BCG vaccination (Download pdf)
  •      Livelihoods threatened by lockdowns in South Africa (Download pdf)
  •      Poor infrastructure, but young population might help in Africa, Reuters (Download pdf)
  •      Rich nations leave little resources for the poor, NY Times (Download pdf)
  •      Indirect effect of COVID-19 on neonatal and maternal health in LMICs (Download pdf)
  •      Pandemic in West Africa (Download pdf)
  •      Politics in Brazil hindering response (Download pdf)
  •      Health systems in LICs will struggle to protect health workers from COVID-19, Center for Global Development (Download pdf)


Strategies and recommendations in LMICs

  •      Leveraging US Global Health Assets (Download pdf)
  •      Realistic alternatives for COVID-19 response in LICs (Download pdf)
  •      COVID-19 in LIC and displaced populations:  What can realistically be done?  (Download pdf)
  •      COVID-19 in LICs, FIGO (Download pdf)
  •      Limiting the spread of COVID-19 in Africa:  One size does not fit all, Lancet Glob Health (Download pdf)
  •      Responding to COVID-19 in Africa:  Impact and effectiveness of public health and social measures, Partnership for Evidence-Based Response to COVID-19 (Download pdf)
  •      Recommendations for COVID-19 preparedness within the surgical, obstetric, and anesthetic ecosystem in Sub-Saharan Africa, Lifebox (Download summary table pdf)


What is being done


Commentaries

 

  •      Africa missing from coronavirus trials (Download pdf)
  •      COVID-19 pandemic:  Solidarity or neocolonialism? Dr Dominique Vervoort (Download pdf)
  •      Implications of social distancing in Africa:  Markets and money transfers (Download pdf)
  •      Lessons learned from Ebola in Guinea might help in COVID-19 pandemic (Download pdf)
  •      Spend what it takes to fight COVID-19 in poor countries, too (Download pdf)
  •      Ways to increase workforce in South Africa, opinion piece (Download pdf)
  •      Africa’s COVID-19 research must be tailored to its realities, The Guardian (Download pdf)
  •      LMICs unable to procure valuable resources to find COVID-19 as HICs empty stocks for their populations, The Lancet (Download pdf)

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Treatment

 

Clinical Guidance for Management of Patients with Confirmed COVID-19 (CDC)

Treatment guidelines of COVID-19, with reference to various populations including children, released 21 April 2020, National Institutes of Health

Clinical management of severe acute respiratory infection with COVID-19, WHO guidelines (Download pdf)

Infographic on managing COVID-19, SCCM (Download pdf)

Surviving sepsis campaign guidelines, with practice recommendations for COVID-19, Society of Critical Care Medicine and European Society of Intensive Medicine (Download pdf)

Intensive care management of COVID-19:  Challenges and recommendations, including nice summary of systems and experimental medications, Lancet Resp Med (Download pdf)

Mt Sinai Treatment Guidelines for COVID-19, table based on severity of disease (Download pdf)

Society of Critical Care Medicine Rapid Resource Center:  Several short instructional videos on a variety of topics

Practical tips on how to manage COVID-19 patients, from an ER doctor on the frontlines in New Orleans, USA (Download pdf)

Practical tips on critical care management of COVID-19 patients, from an ICU doctor in the UK (Download pdf)

Clinical management of COVID-19, Partners in Health:  More geared toward LMIC settings (Download pdf)

Handbook of COVID-19 Prevention and Treatment, Zhejuang University School of Medicine:  Includes sections with radiographic images and experience with ECMO (Download pdf)

Intubation of Confirmed or Suspected COVID-19 Patients, Legacy Emanuel Hospital (Download pdf)

Simulation training and intubation checklist, Vital Anaesthesia Simulation Training (Download pdf)

Treating hypoxemia

  •      COVID-19 patients with asymptomatic hypoxia, Science (Download pdf)
  •      Suggestion to rely less on ventilators for COVID-19 patients (Download pdf)
  •      Oxygen Therapy with Limited Resources in COVID-19 (Download pdf)

Proposed treatments for COVID-19

Coagulopathy and clotting in COVID-19

  •      Recognition and management of coagulopathy in COVID-19, ISTH (Download pdf)
  •      Practical guidance for prevention of thrombosis and management of DIC in COVID-19 patients (Download pdf)
  •      Unprecedented blood clotting in COVID-19 patients, CNN Health (Download pdf)


Treating children


Training for Non-ICU clinicians who might need to care for ventilated patients during the COVID-19 pandemic

Converting anesthesia machines for use as ICU ventilators in COVID-19


ECMO for patients with COVID-19


Using ventilators for multiple patients

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Surgery and anesthesia during the pandemic

 

Anesthesia concerns  

COVID-19 Surgical Patient Checklist:  Lifebox, SmileTrain, WFSA (Download pdf)

Infographic on guidelines for various types of general surgery, RCS (Download pdf)


Protocols for testing and PPE use in the OR


Laparoscopy:  Concerns for aerosolized virus with desufflation

  •      Use of filtration device for CO2 release (SAGES)
  •      Desufflation filtration device and procedure, Columbia University (Download pdf)
  •      Low-cost smoke evacuation device, Annals of Surgery (Download pdf)
  •      Canadian Association of General Surgeons statement (Download pdf)
  •      MIS and the Coronavirus:  Lessons Learned in China and Italy (Download pdf)
  •      Sketch of easy-to-make filtration system for evacuating CO2, Paul Astudillo (Download pdf)
  •      Guidance for surgery in Queensland, more skeptical about laparoscopic risks but more wary of electrocautery, Prof David Cavallucci (Download pdf)

Easy-to-make suction device for electrocautery, Paul Astudillo (Download pdf)

Tracheostomy and Tracheostomy Change in COVID-19 patients (ENTUK)

Otolaryngology Recommendations, University of Cape Town (Download pdf)

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Care of the health care provider

 

CDC Recommendations for health care providers, with links (Download pdf)

Some strategies currently being used

  •      Consider excluding > 60-year-olds from call schedules and Surgeon-of-the-Week schedules
  •      Limit hours at the hospital to avoid burn-out
  •      Create 2 working teams and do not let them mingle in case one team needs to be quarantined
  •      Minimize staff working each day, encourage work from home
  •      Move all clinic visits to Telehealth or phone visits
  •      Hold virtual educational conferences
  •      Cohort all COVID-19 patients in one area or one building

Personal Protective Equipment (PPE)


When personal protective equipment is scarce


Practical ways to protect yourself from COVID-19

When to stay home from work during COVID-19


Wellness and Health

 

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Links to useful websites

 

American Academy of Pediatrics Red Book: COVI19 for Healthcare Personnel

American Association for the Surgery of Trauma:  COVID-19 resources

American College of Surgeons (ACS):  Resources for the Surgical Community

American Pediatric Surgical Association (APSA) NaT Covid-19 Resource Page:  Excellent resource, updated every 24-48 hours with pediatric-specific information

Alliance for Surgery and Anesthesia Presence (ASAP):  COVID-19 Resources aimed particularly at LMIC providers

British Association of Paediatric Surgeons:  COVID-19 information for paediatric surgeons

Center for Disease Control (CDC) COVID-19 webpage

COVID for HCP APP:  Detailed website with many resources, also available as an app for the phone

The Hendren Project list of resources:  Many resources and articles relevant to care of children with COVID-19

The Lancet Resource Centre

LifeBox:  COVID-19 Resources

Panamerican Trauma Society:  COVID-19 resources geared toward Latin America

Royal College of Surgeons: COVID-19 Guidance and Resources

Royal College of Surgeons in Ireland: Clinical guidance for surgeons

Society of Critical Care Medicine (SCCM):  Offers several online training modules for non-intensivists on managing ventilators and ICU patients

Students4COVID:  Resources and initiatives organized geographically

United Kingdom Government:  Guidance for health professionals

World Federation of Societies of Anaesthesiologists:  COVID-19 Resources

World Health Organization (WHO):  Country preparedness, learning modules for LMIC providers

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Research

 

Global research on COVID-19, WHO

COVIDSurg will study international data to determine 30-day mortality in patients with COVID-19 who undergo surgery

Corona Virus Global Surgical Collaborative (CVGSC)

COVID-19 Clinical Research Coalition accelerates research in resource-poor settings (Download pdf)

WHO SOLIDARITY Trial:  Compares 4 different drug regimens

 

References

 

Bibliography of recent studies from Wuhan, China (Download pdf)

Global Alliance for Surgical, Obstetric, Anesthesia, and Trauma Care (G4 Alliance):  List of online resources (Download pdf)

 

Donations

 

COVID-19 Solidarity Response Fund (WHO and UN Foundation):  Supports critical response efforts in countries most in need of help

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In the interest of getting information on the website as quickly as possible, we have listed some untested therapies (for instance, using one ventilator for more than one patient); please do not consider the information listed on this page to be supported or endorsed by GICS.  We are merely including the resources, but you must judge for yourself which protocols or measures are applicable in your own setting.