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      Ethical conflicts associated with COVID‐19 pandemic, triage and frailty—unexpected positive disease progression in a 90‐year‐old patient: A case report

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          Key Clinical Message

          During the COVID 19 pandemic, advanced age, scoring systems, and a shortage of ICU beds were used as cut‐offs for ICU admission. This case report describes the epicrisis of an elderly patient who was almost mistakenly not treated in an ICU.

          Abstract

          Chest radiograph of a 90‐year‐old patient with bipulmonary infiltrates typical of COVID‐19, already covering 70% of the lung parenchyma. The unexpectedly positive disease course in this 90‐year‐old patient raises ethical conflicts related to the COVID‐19 pandemic, standard triage practice at the time, and the frailty score used for this purpose.

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          Most cited references23

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          Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

          Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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            A Novel Coronavirus from Patients with Pneumonia in China, 2019

            Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)
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              Fair Allocation of Scarce Medical Resources in the Time of Covid-19

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                Author and article information

                Contributors
                andreas.wehrfritz@uk-erlangen.de
                Journal
                Clin Case Rep
                Clin Case Rep
                10.1002/(ISSN)2050-0904
                CCR3
                Clinical Case Reports
                John Wiley and Sons Inc. (Hoboken )
                2050-0904
                18 July 2023
                July 2023
                : 11
                : 7 ( doiID: 10.1002/ccr3.v11.7 )
                : e7710
                Affiliations
                [ 1 ] Department of Anaesthesiology University hospital of Erlangen, Faculty of Medicine, Friedrich‐Alexander‐University Erlangen Erlangen Germany
                [ 2 ] Department of Anaesthesiology Klinikum Fuerth Fuerth Germany
                Author notes
                [*] [* ] Correspondence

                Andreas Wehrfritz, Department of Anaesthesiology, University hospital of Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany.

                Email: andreas.wehrfritz@ 123456uk-erlangen.de

                Author information
                https://orcid.org/0000-0002-0399-0535
                Article
                CCR37710 CCR3-2023-05-1061.R1
                10.1002/ccr3.7710
                10354352
                2ea2ce77-bd63-4f60-a6c3-04227b2af54f
                © 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 02 July 2023
                : 28 May 2023
                : 04 July 2023
                Page count
                Figures: 6, Tables: 0, Pages: 7, Words: 4556
                Funding
                Funded by: Deutsche Forschungsgemeinschaft , doi 10.13039/501100001659;
                Funded by: Friedrich‐Alexander‐Universität Erlangen‐Nürnberg
                Categories
                Geriatrics
                Ethics
                Critical Care Medicine
                Case Report
                Case Report
                Custom metadata
                2.0
                July 2023
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.2 mode:remove_FC converted:19.07.2023

                aged patient,covid‐19,ethical dilemma,triage and frailty,unexpectedly positive trend

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