No studies directly evaluated the association between level of surge capacity and quality of care indicators for COVID-19 patients. However, in more broad studies, the findings suggest that mortality and other adverse events increase when the strain on the intensive care capacity increases.
A tiered staffing strategy is recommended to meet surge capacity needs in the ICU: High critical care nurse to patient ratios (1:1 or 1:2) are recommended to provide high quality patient care.
There is a lack of high-quality evidence to support ICU triage protocols tailored for patients with COVID-19. Nevertheless, the protocols must be flexible, adaptable according to the availability of local resources, and effective for inter-hospital patient transfer.
While the Crisis Standards of Care (CSC) guidelines (e.g., Saskatchewan’s Critical Care Resource Allocation Framework, published on September 2020) can be used to triage newly admitted COVID-19 patients requiring critical care, there is contradicting evidence about using the Sequential Organ Failure Assessment (SOFA) score for ICU triage of patients with COVID-19.
The literature suggests the use of mathematical modeling to support capacity planning (e.g., very low, low, medium, and high intensity patient surge response)
To relieve pressure from ICUs, other types of units (e.g., Step Down Unit [SDU] or Surge Clinic) can be implemented.
Azizian, A; Valiani, S; Groot, G; Badea, A; Miller, L; Howell-Spooner, B. At what level of surge capacity do quality of care indicators suffer? 2020 Dec 10; Document no.: CC120301 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 17 p. (CEST rapid review report)
Azizian, A; Valiani, S; Groot, G; Badea, A; Miller, L; Howell-Spooner, B. At what level of surge capacity do quality of care indicators suffer? 2020 Dec 10; Document no.: CC120301 RR Table. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 17 p. (CEST table)
Miller, L; Howell-Spooner, B. At what level of surge capacity do quality of care indicators suffer? 2020 Dec 4; Document no.: CC120301-01 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 50 p. (CEST evidence search report)
· There is little literature on the performance of triage frameworks. However, critiques of frameworks can help to inform the development of future protocols.
· It is ethically problematic to include age as a triage factor rather than the more nuanced factors of frailty and chronic comorbidities.
· The public should be included when creating triage protocols to create transparency and trust in the health system.
· Healthcare providers should be familiar with the ethical decisions that have been made in establishing the protocols. However, using a triage team to make decisions about resource allocation would alleviate moral burden from clinicians.
· Regular review of current guidelines, such as the use of SOFA scores, is recommended as knowledge about COVID-19 changes.
Rapid Review Report: CC120401 RR (Version 1: December 17, 2020 11:45) 2
· Patients should be regularly reassessed to allow for timely redistribution of critical resources.
Fick, F; Valiani, S; Miller, L; Howell-Spooner, B. Does data exist on the performance of triage or resource allocation frameworks for COVID-19 and other pandemics? 2020 Dec 17; Document no.: CC120401 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 91 p. (CEST rapid review report)
Miller, L; Howell-Spooner, B. Does data exist on the performance of triage or resource allocation frameworks for COVID-19 and other pandemics? 2020 Dec 8; Document no.: CC120401-01 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 20 p. (CEST evidence search report)
Howell-Spooner, B; Miller, L. How are Hutterite colonies responding to and coping with COVID-19 prevention and outbreaks? 2020 Jun 12; Document no.: PH061201-01 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 10 p. (CEST evidence search report)
The Hutterian Safety Council has established a COVID-19 taskforce to provide guidance for communities to best prevent and cope with COVID-19
Only one published study has investigated the prevalence of coronaviruses in relation to influenza vaccination/infection in Hutterite populations. This study found that coronaviruses are much less prevalent than influenza, entero/rhinoviruses and pediatric RSV and that it occurred in all age groups.
This study also found a high degree of co-circulation of other respiratory viruses along with influenza, which invites the questioning of signs/symptoms falsely attributed to influenza and therefore influencing empiric use of antivirals
Most studies available focus on influenza, polio and other common vaccine-preventable childhood communicable disease
One study assessing influenza in Hutterite populations found that the immunization of children and adolescents led to a protective effect among the community over multiple years of seasonal influenza and provided ~60% herd protection
Okpalauwaekwe, U; Reeder, B; Howell-Spooner, B; Miller, L. How are Hutterite colonies responding to and coping with COVID-19 prevention and outbreaks? 2020 Jun 12; Document no.: PH061201 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 16 p. (CEST rapid review report)
Mueller, M.; Young, C. How safe are the Pfizer and Moderna vaccinations? 2021 Jan 21; Document no.: EOC011901-01 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 31 p. (CEST evidence search report).
Initial findings from RCTs of the two authorized COVID-19 vaccines (Pfizer-BioNTech and Moderna) reported that the vaccines are safe. However, subsequent reports show that the adverse and severe allergic reactions to these vaccines are higher than the general rates for vaccines.
Various regulatory agencies identify the risk for serious allergic reactions as low for the authorized vaccines, and they continue to monitor the vaccines’ safety closely.
Further investigations to make causal relationships with reported severe allergic reactions or deaths are needed.
Risks and benefits of receiving the vaccines should be discussed individually in vulnerable populations including pregnant or breast-feeding women, immunocompromised people, or frail elderly people.
Azizian, A; Groot, G; Mueller, M; Young, C. How safe are the Pfizer and Moderna vaccinations? 2021 Jan 24; Document no.: EOC011901 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 30 p. (CEST rapid review report)
