Health System Dynamic & Resource Requirement in a South African COVID-19 Field Hospital

Study Overview
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Brief Summary
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The aim of this study is to describe the patient clinical profile, resource requirements, and health system dynamics in a field hospital during the second wave of the Coronavirus (COVID-19) pandemic, leading to the outbreak of viral severe acute respiratory syndrome (SARS-CoV-2 virus), in South Africa. By describing the field hospital in this unique setting, the investigators hope to provide an efficient guide to similar settings across low- and middle-income countries. This was a retrospective, single-center study. A total of 596 patients with confirmed COVID-19 were admitted to Mitchells Plain Hospital of Hope (MPHOH), Cape Town, South Africa, between January 1st and February 28th, 2021. Patient clinical characteristics, outcome, and resource allocation was collected. Daily hospital dynamics, including admissions, discharges, deaths and oxygen use was analyzed and compared to the local and national COVID-19 incidence rates.

Detailed Description
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The aim of the study is to amplify what is known about field hospitals in resource-constrained setting, so as to guide meaningfully the future COVID-19 public health response. Understanding not only the patient profile, but clinical resource requirements, and health system dynamic in a South African field hospital during the second wave of the COVID-19 pandemic can help in preparation for a future infection surge. This will shed light on the extent and timing of excess demand for intermediate care facilities for COVID-19 during peak infection periods in this region. Furthermore, lessons learnt here can guide efforts in similar settings across low-and middle-income countries. Data was collected on all patients admitted to MPHOH between January 1st and February 28th 2021 using notes from patient folders' and an electronic hospital records systems. Patient demographics, clinical profile, resource utilization; as well as the hospital dynamics were collected. COVID-19 incidence rates were collected from the National Institute for Infectious Diseases, South Africa A descriptive data analysis was performed to report the number, mean, median, and range of all relevant values. Hospital level data were summarized into weekly intervals, described and compared to COVID-19 incidence rates. Statistical data analysis was performed using R Statistical Computing program and Microsoft Excel.

Official Title
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Health System Dynamic & Resource Requirement in a South African COVID-19 Field

Conditions
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Field Hospitals, COVID-19 Pandemic, Health Systems, Global Health, Health Resources, Low-Income Population

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients admitted to the Mitchells Plain Hospital of Hope COVID-19 field hospital between 1st January 2021 and 29th February 2021. Patients admitted to the hospital must have been: over 18years of age, diagnosed with COVID-19 via polymerase chain reaction (PCR) test, transferred from a referring facility. Exclusion Criteria: No patients were excluded.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| COVID-19 Patients<br>Completed Sample of all patients admitted to the Mitchells Plain Hospital of Hope COVID-19 Field Hospital between January 1st and February 29th 2021. All patients were diagnosed with COVID-19 prior to admission to the hospital and were transferred directly from a referring hospital. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient Demographics | Patient age (in numbers) | January 1st to February 29th 2021 | 
| Patient Demographics | Patient sex (male or female) | January 1st to February 29th 2021 | 
| Patient Clinical Condition | Patient medical comorbidities on admission (categorical) | January 1st to February 29th 2021 | 
| Patient Clinical Condition | If patient diabetic, type of diabetic treatment received in hospital (oral vs insulin therapy) | January 1st to February 29th 2021 | 
| Patient Clinical Condition | If patient diabetic, glycated haemoglobin (HBA1C) level during admission (in numbers) | January 1st to February 29th 2021 | 
| Patient Clinical Condition | Patient clinical complications during hospital admission (categorical) | January 1st to February 29th 2021 | 
| Patient Clinical Condition | If patient received antibiotic treatment during admission, name of infection treated (categorical) | January 1st to February 29th 2021 | 
| Patient Clinical condition | Patient ICU priority triage score on admission (in numbers) | January 1st to February 29th 2021 | 
| Hospital Human Resources Utilized | Number of patients who utilized palliative care services (in numbers) | January 1st to February 29th 2021 | 
| Hospital Human Resources Utilized | Number of patients who utilized dietician services (in numbers) | January 1st to February 29th 2021 | 
| Hospital Human Resources Utilized | Number of patients who utilized physiotherapy services (in numbers) | January 1st to February 29th 2021 | 
| Hospital Physical Resources Utilized | Number of patients requiring oxygen therapy during admission (in numbers) | January 1st to February 29th 2021 | 
| Hospital Physical Resources Utilized | Type of oxygen therapy utilized by each patient (Categorical: nasal prong oxygen; face mask oxygen; or high flow oxygen) | January 1st to February 29th 2021 | 
| Hospital Physical Resources Utilized | Duration of oxygen therapy for each patient (in days) | January 1st to February 29th 2021 | 
| Hospital Physical Resources Utilized | Number of patients requiring antibiotic treatment (in numbers) | January 1st to February 29th 2021 | 
| Hospital Physical Resources Utilized | If patient required antibiotic therapy, name of antibiotic given (categorical) | January 1st to February 29th 2021 | 
| Hospital Physical resources Utilized | Patient duration of hospital stay (in days) | January 1st to February 29th 2021 | 
| Health System Dynamics | Daily number of patients admitted to hospital (in numbers/day) | January 1st to February 29th 2021 | 
| Health System Dynamics | Daily number of inpatients at hospital (in numbers/day) | January 1st to February 29th 2021 | 
| Health System Dynamics | Daily number of patients discharged from hospital (in numbers/day) | January 1st to February 29th 2021 | 
| Health System Dynamics | Daily number of patient deaths (in numbers/day) | January 1st to February 29th 2021 | 
| Health System Dynamics | Daily number of patients transferred out of hospital to another medical facility (in numbers/day) | January 1st to February 29th 2021 | 
| Health System Dynamics | Daily hospital bed capacity (in numbers/day) | January 1st to February 29th 2021 | 
| Health System Dynamics | Daily hospital oxygen consumption (in kg/day) | January 1st to February 29th 2021 | 
| Health System Dynamics | Name of hospital from which each patient was referred from (categorical) | January 1st to February 29th 2021 | 
| Local Incidence rates of COVID-19 infections | South African National COVID-19 incidence rates per week (in numbers/week) | December 1st 2020 to February 29th 2021 | 
| Local Incidence rates of COVID-19 infections | Western Cape Provincial COVID-19 incidence rates per week (in numbers/week) | December 1st 2020 to February 29th 2021 |