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Abstract
The COVID-19 pandemic has stretched health care resources to a point of crisis throughout
the world. To answer the call for care, health care workers in a diverse range of
specialties are being retasked to care for patients with COVID-19. Consequently, specialty
services have had to adapt to decreased staff available for coverage coupled with
a need to remain available for specialty-specific emergencies, which now require a
dynamic definition. In this Invited Commentary, the authors describe their experiences
and share lessons learned regarding triage of patients, staff safety, workforce management,
and the psychological impact as they have adapted to a new reality in the Department
of Neurosurgery at Montefiore Medical Center, a COVID-19 hot spot in New York City.
Background: A novel human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in China in December 2019. There is limited support for many of its key epidemiologic features, including the incubation period for clinical disease (coronavirus disease 2019 [COVID-19]), which has important implications for surveillance and control activities. Objective: To estimate the length of the incubation period of COVID-19 and describe its public health implications. Design: Pooled analysis of confirmed COVID-19 cases reported between 4 January 2020 and 24 February 2020. Setting: News reports and press releases from 50 provinces, regions, and countries outside Wuhan, Hubei province, China. Participants: Persons with confirmed SARS-CoV-2 infection outside Hubei province, China. Measurements: Patient demographic characteristics and dates and times of possible exposure, symptom onset, fever onset, and hospitalization. Results: There were 181 confirmed cases with identifiable exposure and symptom onset windows to estimate the incubation period of COVID-19. The median incubation period was estimated to be 5.1 days (95% CI, 4.5 to 5.8 days), and 97.5% of those who develop symptoms will do so within 11.5 days (CI, 8.2 to 15.6 days) of infection. These estimates imply that, under conservative assumptions, 101 out of every 10 000 cases (99th percentile, 482) will develop symptoms after 14 days of active monitoring or quarantine. Limitation: Publicly reported cases may overrepresent severe cases, the incubation period for which may differ from that of mild cases. Conclusion: This work provides additional evidence for a median incubation period for COVID-19 of approximately 5 days, similar to SARS. Our results support current proposals for the length of quarantine or active monitoring of persons potentially exposed to SARS-CoV-2, although longer monitoring periods might be justified in extreme cases. Primary Funding Source: U.S. Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases, National Institute of General Medical Sciences, and Alexander von Humboldt Foundation.
Delayed or inappropriate treatment of spinal epidural abscess (SEA) can lead to serious morbidity or death. It is a rare event with significant variation in its causes, anatomical locations, and rate of progression. Traditionally the treatment of choice has involved emergency surgical evacuation and a prolonged course of antibiotics tailored to the offending pathogen. Recent publications have advocated antibiotic treatment without surgical decompression in select patient populations. Clearly defining those patients who can be safely treated in this manner remains in evolution. The authors review the current literature concerning the treatment and outcome of SEA to make recommendations concerning what population can be safely triaged to nonoperative management and the optimal timing of surgery.
Background Disasters are becoming more prevalent across the world and people are frequently exposed to them as part of their occupational groups. It is important for organisations to understand how best to support employees who have experienced a trauma such as a disaster. The purpose of this study was to explore employees’ perceptions of workplace support and help-seeking in the context of a disaster. Methods Forty employees in England took part in semi-structured interviews. Thematic analysis was used to extract recurring themes from the data. Results Participants reported both positive and negative psychological outcomes of experiencing a disaster or emergency at work. Most had little training in how to prepare for, and cope with, the psychological impact. They perceived stigma around mental health and treatment for psychological issues which often made them reluctant to seek help. Many reported that the psychological support available in the workplace was insufficient and tended to be reactive rather than proactive. Interpersonal relationships at work were viewed as being important sources of support, particularly support from managers. Participants suggested that psychosocial training in the workplace could be beneficial in providing education about mental health, encouraging supportive workplace relationships, and developing listening skills and empathy. Conclusions Organisations can take steps to reduce the psychological impact of disasters on employees. This could be done through provision of training workshops incorporating mental health education to reduce stigma, and team-building exercises to encourage supportive workplace relationships.
[1
]A. Ammar is a fifth-year resident, Department of Neurosurgery, Montefiore Medical Center,
Bronx, New York.
[2
]A.D. Stock is a first-year resident, Department of Neurosurgery, Montefiore Medical Center,
Bronx, New York.
[3
]R. Holland is a third-year resident, Department of Neurosurgery, Montefiore Medical Center,
Bronx, New York.
[4
]Y. Gelfand is chief resident, Department of Neurosurgery, Montefiore Medical Center, Bronx,
New York.
[5
]D. Altschul is attending neurosurgeon, Department of Neurosurgery, Montefiore Medical Center,
Bronx, New York.
Author notes
Correspondence should be addressed to Adam Ammar, Montefiore Medical Center, 3316
Rochambeau Ave., Bronx, NY 10467; telephone: (718) 920-7400; email:
AAmmar@
123456montefiore.org
.
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