Preparedness and impact of COVID 19 infection at tertiary care neurology centers in Pakistan

Abstract

Objective We aimed to assess the response and impact of response to pandemic at tertiary care centers in Pakistan especially pertaining to neurological care, facilities and training. Methods A pre-tested survey form was sent to 40 neurology tertiary care centers in all the provinces in the country in the first week of July 2020. 33 filled forms were received, out of which 18 were public (government) and 15 were private hospitals. Results Estimated 1300 HCW (faculty, medical officers, trainees and nurses) work at these 33 participating centers. There were 17 deaths among HCW (1.3%) at ten centers. Sufficient personal protective equipment (PPE) were provided to 158 HCW (12%). 129 (10%)HCW tested positive for COVID 19 at 31 centers including trainees/medical officers (39), consultants (29) and nursing and other staff (61). Due to low neurology admissions, 23/33 hospitals (70%) posted neurology trainees in COVID 19 units to contribute to covid care. Less than 50% hospitals did covid screening PCR before admission to neurology wards. Only 10% hospitals provide training and regular update to HCW. Neurology tele-health services were started for clinically stable patients at 15 (45%) centers. Only 60% neurology training programs were able to start online training. Ongoing research studies and trials focusing neurological manifestations of COVID-19 were done at 10 (30%) centers. Modification of facilities for COVID patients showed that 24(72%) hospitals strictly reduced the number of attendants accompanying patients. Only 10 (30%) centers had neurophysiological tests being conducted on COVID-19 patients. Mental health support services to HCW were provided at 12 (36%) centers. Conclusions Among HCW 10% tested positive for covid and 1.3% died. Mental health support services offered for HCW were available in 36% institutions. Neurology training was substantially affected due to low admissions, limited ward rounds and limited availability of online training.

Neurological Consequences of COVID-19: A Systematic Review of the Pandemic’s Impact on Neurology Training

“…Of the 95,460 studies identified through database searching, 95,418 records were excluded because the abstract or the title did not fulfil the inclusion criteria for this review (i.e., were not studies about neurology residents’/trainees’ perspectives on the impact of COVID-19 on their residency or quantitative analysis of these findings). Forty-two full papers were assessed for eligibility, and, eventually, only 12 studies met the aforementioned full criteria and underwent data extraction ( Figure 1 ) [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. Information related to year of publication, study design, sample size, study population, time and country of assessment is reported in Table 1 .…”

“…Encouragingly, 21% of those surveyed reported no reduction (0–20%) in supervision at work during the pandemic [ 23 ]. In a study evaluating the impact of COVID-19 in tertiary care neurology centers in Pakistan, it was found that 69.7% of neurology trainees were assigned to work in COVID-19 isolation units, and 66.7% of residents/interns had their daily duty schedules converted to on-call schedules only [ 24 ].…”

“…Interestingly, a very small proportion of participants (1%) stated that their classes were not suspended at all during the pandemic [ 23 ]. As in other countries, also in Pakistan; it was observed that 60.6% of regular teaching sessions designed for neurology trainees transitioned to digital platforms [ 24 ]. In a US study of a single stroke center, a survey showed that 45% of trainees agreed that digital consultations did not hinder learning or education in the field of stroke services.…”

Lessons learned in stroke care during COVID-19 pandemic and preparing for future pandemics in the MENA+ region: A consensus statement from the MENA+-SINO

“…A multi-center study was conducted in Pakistan evaluating preparedness and the impact of COVID-19 of the neurological / stroke care and training of residents and fellows [ 45 ]. Both societies organized many public awareness and media awareness activities related to COVID-19 neurological manifestations and stroke care in COVID-19 patients.…”

“…An unexpected halting effect of these programs was due to the fear of contracting the COVID-19 infection. Simultaneously there was a significant decline in emergency presentations of patients with potentially serious diseases (for example, acute coronary syndrome and stroke) [ [45] , [46] , [47] ]. While there is no clear evidence that this decrease in hospital admissions of patients with acute vascular syndromes may have resulted in serious effects, the realization that patients may not come to the hospital requires active public efforts to promote the safety of care in such situations.…”