mteb/CovidQA huggingface dataset:
In addition to these methods, other smart city data sources include the application of terminal tracking systems that are mostly emphasized in Safe City concepts, where, at the point of entry or departure, relevant data is collected and analyzed. Li et al. [32] highlights that sensors installed in such locations have the potential to receive and distribute data in real-time to digital infrastructures within the network, and their interconnectedness in the network renders them extremely efficient in providing real-time updates on different issues. Urban areas are also known to be amassed with numerous Urban Health sensors, some of which are wearable. Though these are not specifically fashioned to track the present case of virus outbreak, they are able to track other related parameters like heartbeat, blood pressure, body temperature and others variables, that when analyzed can offer valuable insights. Loncar-Turukalo et al. [33] hail these devices for their role in transforming the
health care sector especially by allowing for Connected Health (CH) care, where data collected from them can be analyzed and provide insightful information on the health scenario in any given area. Vashist et al. [34] further highlight how emerging features such as spatiotemporal mapping, remote monitoring and management, and enhanced cloud computing capabilities can emanate from such endeavours, leading to better urban management potential.
While it is true that the basic source of medical data is generally sourced from general practitioners or medical laboratories-a fact that has also been affirmed in the case of the current epidemic-this paper explores how data sourced from an urban perspective can contribute to the medical narrative. The conviction to dwell on the urban realm in this manuscript is based on the fact that the current epidemic (COVID-19) is transmitted majorly through human-to-human contact, and in most cases, especially where the spread is reported in a different country, the first point of contact is an urban area, where large groups of people convene, like airports or subway stations. In most cases, such facilities, which are mostly based in urban areas, are observed to have installed surveillance technologies to ensure that anyone showing any symptoms of the disease are identified and quarantined. However, even in such cases, as underlined in the present manuscript, the need for anonymizing medical
data is emphasized to ensure that the use of current technologies does not breach data privacy and security requirements, across different geographies. In this case, novel technologies like Blockchain technologies and quantum cryptography can aid in the discussion and be made to integrate with data collecting technologies. This would render an increased wealth of data from both the medical field and smart city operators, while ensuring privacy and security; hence, aiding in providing relevant information for better informed decisions.
However, despite the indisputable roles that installed devices play in providing relevant health information, their data communication aspect needs to be reviewed. First, communications are seen to be geography-restricted (restricted to a given location), such that they seldom expand or communicate with their like, installed beyond their restricted areas. Secondly, these devices are usually sourced and installed by separate corporations that maintain unique and specific standards for data processing and sharing, and accordingly, tying cities to the sole usage of their product(s). Such strategies are adopted as private corporations try to maximize their economic gains, since the digital solution market is a lucrative one and is expected to continue growing and expanding [6, 7] .
For its current application, the standardization of protocols as elaborated in this manuscript need to be pursued to ensure that there is seamless sharing of information and data. By doing this, it is expected that issues like burdens of collecting data, accuracy and other complexity that are experienced (when systems are fragmented) are reduced or eliminated altogether. The standardization can be achieved by, for example, ensuring that all the devices and systems are linked into a single network, like was done in the U.S., where all the surveillance of healthcare were combined into the National Healthcare Safety Network (NHSH) [35] . The fact that cities are increasingly tuning on the concept of Smart Cities and boasting an increased adoption rate of technological and connected products, existing surveillance networks can be re-calibrated to make use of those new sets of databases. Appropriate protocols however have to be drafted to ensure effective actions while ensuring privacy and
security of data and people.
With scenarios like the present Coronavirus (COVID-19) outbreak, that not only impacts upon the economic status of cities, but also affects their social standing, it becomes imperative to emphasize the adoption of universal standards for data sharing. Such a move could have far reaching impact across cities and territories especially in positively combating outbreaks and disasters in a quicker, safer and standardized way, such that when the cure is discovered, the results can be replicated in various parts of the globe. With a collaborated data sharing protocol, it would be possible to have a larger dataset resulting in increased processing capabilities especially with technologies that are powered by artificial intelligence (AI) tools. Through this way, as noted by Jiang et al. [36] and Allam [37] , it would be possible to facilitate early detection, achieve better diagnosis and provide better urban management decisions for increased efficiency for virus containment.
An example of how beneficial collaboration and sharing of data can be occurred during the 2014 Ebola outbreak in West Africa where scientists, health workers and clinicians, amongst other stakeholders from around the world, openly worked together and were able to contain the spread of this pandemic [38] . On this front, Boué et al. [39] highlight that levels of trust and transparency need to be reviewed and enhanced to facilitate unfettered data generation and sharing. Such could lead to an even earlier detection scenario of future virus outbreaks, and in the better curative management of the same, without minimal compromise on urban functions and on an urban economy.
Furthermore, in cases of emergencies like the current outbreak of COVID-19 and any other, the need for observance of regulatory practices and international healthcare guidelines are paramount. This would ensure that both healthcare professionals and the general populace are informed, protected and remain within the prescribed rules and regulations. As noted by the WHO [40] , the healthcare guidelines and regulatory practices are advanced to also ensure that the health risk in question is reduced together with its consequences. In the current era of technological advancement, such regulations and guidelines are paramount as they have potential to lead to positive or negative outcomes. The position of this paper is to advance that it now possible to integrate technologies like the use of smart devices through IoT networks and wearable devices, data from mobile apps and others to help users to share information with accredited and certified health professionals, and in this case, improve
the outcomes for better cross disciplinary and more resilient protocols and policies.
The Battle Against Coronavirus Disease 2019 (COVID-19): Emergency Management
and Infection Control in a Radiology Department
https://www.jacr.org/article/S1546-1440(20)30285-4/pdf
Journal Pre-proof
Zixing Huang, Shuang Zhao, Zhenlin Li, Weixia Chen, Lihong Zhao, Lipeng Deng, Bin
Song
PII: S1546-1440(20)30285-4
DOI: https://doi.org/10.1016/j.jacr.2020.03.011
Reference: JACR 5139
To appear in: Journal of the American College of Radiology
Received Date: 24 February 2020
Revised Date: 13 March 2020
Accepted Date: 15 March 2020
Please cite this article as: Huang Z, Zhao S, Li Z, Chen W, Zhao L, Deng L, Song B, The Battle Against
Coronavirus Disease 2019 (COVID-19): Emergency Management and Infection Control in a Radiology
Department, Journal of the American College of Radiology (2020), doi: https://doi.org/10.1016/
j.jacr.2020.03.011.
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition
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© 2020 Published by Elsevier Inc. on behalf of American College of Radiology
The Battle Against Coronavirus Disease 2019 (COVID-19): Emergency Management
and Infection Control in a Radiology Department
Zixing Huang*, Shuang Zhao*, Zhenlin Li, Weixia Chen, Lihong Zhao, Lipeng Deng,
Bin Song
Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
*Zixing Huang and Shuang Zhao contributed equally to this work as co-first author.
Corresponding Author: Bin Song, MD
Address: Department of Radiology, West China Hospital, Sichuan University.
No. 37, GUOXUE Alley, Chengdu, 610041, China
Tel.: (+86)28 85423680, Fax: (+86)28 85582944
Email: songlab_radiology@163.com.
Authors’ contributions
ZXH: conceived the study and drafted the manuscript.
ZS: conceived the study and drafted the manuscript.
ZLL: The member of the emergency management and infection control team (EMICT)
and was involved in the formulation of the measures.
WXC: The member of the EMICT and was involved in the formulation of the
measures.
LHZ: The member of the EMICT and was involved in the formulation of the
measures.
LPD: The member of the EMICT and was involved in the formulation of the
measures.
BS: Leader of the EMICT, conceived the study and reviewed the manuscript.
All authors read and approved the final manuscript.
The authors declare no conflict of interest.
The authors declare that they had full access to all of the data in this study and the
authors take complete responsibility for the integrity of the data and the accuracy of
the data analysis
1
The Battle Against Novel Coronavirus Pneumonia (COVID-19): Emergency
Management and Infection Control in a Radiology Department
Abstract
Objective: To describe the strategy and the emergency management and infection control
procedure of our radiology department during the COVID-19 outbreak.
Methods: We set up emergency management and sensing control teams. The team formulated
various measures: reconfiguration of the radiology department, personal protection and training
of staff, examination procedures for patients suspected of or confirmed with COVID-19 as well
as patients without an exposure history or symptoms. Those with suspected or confirmed
COVID-19 infection were scanned in the designated fever-CT unit.
Results: From January 21, 2020 to March 9, 2020, 3,083 people suspected of or confirmed with
COVID-19 underwent fever-CT examinations. Including initial examinations and
reexaminations, the total number of fever-CT examinations numbered 3,340. As a result of our
precautions, none of the staff of the radiology department were infected with COVID-19.
Conclusion: Strategic planning and adequate protections can help protect patients and staff
against a highly infectious disease while maintaining function at a high volume capacity.
Keywords: Coronavirus, COVID-19, novel coronavirus pneumonia, infection control
2
Introduction
The whole world has been closely focusing on an outbreak of respiratory disease caused by a
novel coronavirus that was first reported in Wuhan, China, on December 31, 2019, and that
continues to spread. On February 11, 2020, the World Health Organization (WHO) named the
disease “coronavirus disease 2019” (COVID-19).
As of 24:00 on March 11, 2020, the National Health Commission (NHC) had received reports
of 80,793 confirmed cases and 3,169 deaths on the Chinese mainland. There remain 14,831
confirmed cases (including 4,257 in serious condition) and 253 suspected cases still
hospitalized. To date, 677,243 people have been identified as having had close contact with
infected patients of whom13,701 are under medical observation [1]. Outside China, 44,067
laboratory-confirmed cases and 1,440 deaths have occurred in 117 countries /territories/areas
according to the WHO [2]. COVID-19 poses significant threats to international health. Like the
flu, COVID-19 is thought to spread mainly from person-to-person between people who are in
close contact with one another through respiratory droplets produced when an infected person
coughs or sneezes. In light of the infectious nature of this disease, healthcare workers are at
high risk of infection of COVID-19. In China, healthcare workers account for 1,716 confirmed
cases of COVID-19, including six deaths [3].
 Computed tomography (CT) can play a role in both diagnosing and categorizing
COVID-19 on the basis of case definitions issued by the WHO and the treatment guidelines
from the NHC [4]. Suspected patients having the virus may undergo chest CT. Isolation and
barrier procedures are necessary to protect both the department staff and other patients in the
hospital. Note should be made that due to overlap of imaging findings with other respiratory
3
diseases, CT is not helpful as a screening tool. But it can help identify the degree of pulmonary
involvement and disease course.
Our hospital is a national regional medical center with 4,300 beds and a tertiary referral
center in Sichuan province. The initial response started on January 21, 2020, after transmission
of COVID-19 was confirmed to be human-to-human on January 20, 2020. The first suspected
case of COVID-19 in Sichuan province was reported on January 21, 2020. The Sichuan
provincial government immediately launched the first-level response to major public health
emergencies. On the same day, our hospital was designated to care for Sichuan province
patients with COVID-19.
This article describes the emergency management procedure of our radiology department
for situations involving severe infectious diseases, such as COVID-19, and the
infection-protection experience of the department staff.
Methods
The hospital provided personal protective equipment (medical protective clothing,
surgical cap, N95 mask, gloves, face shields, and goggles) to all its healthcare staff, erected
three medical tents (fever tents) for screening of fever cases in the parking lot of the emergency
department, planned an examination route and examination area for patients suspected of
harboring the virus, and placed confirmed patients in an isolation ward. “Fever” was the
colloquial term used to designate suspected COVID-19 based on symptoms such as a fever or
with an epidemiological history of a potential exposure as well as those with confirmed
COVID-19 referred for treatment. Further, during outbreak, emergency and outpatient patients
4
without fever were asked for information such as epidemiological history and sent to fever tents
as long as they met suspected criteria.
The radiology department has 65 diagnostic radiologists and 161 other staff members
(trained technologists, nurses, engineers, and support staff). The equipment of the radiology
department includes 12 magnetic resonance (MR) scanners, 14 CT scanners, 15 digital
subtraction angiography (DSA) systems, 32 sets of digital radiography (DR) systems
(including nine mobile bedside DR sets), and 130 imaging diagnostic workstations for picture
archiving and communication systems (PACS). Most of the equipment is distributed among
four buildings at the hospital main campus. 4 CT scanners, 4 MR scanners, 1 DR are located on
the first floor of the first inpatient building, and 9 DR and 8 DSA are located on the second
floor. 1 CT and 1 MR scanner are located in the third inpatient building. 1 CT and 1 MR scanner
are located in the sixth inpatient building. 2 CT scanners, 2 MR scanners and 7 DSA are located
in the technical building. The rest of the equipment is located in the seventh inpatient building
in the branch campus.
The first inpatient building, located next to the emergency department, was reconfigured to
handle cases of COVID-19. Fever tents were set up by the emergency department in the
emergency department parking lot to separate normal emergency patients from patients with
symptoms or exposure history suspicious of COVID-19. We established separate means of
access between fever tents and between the fever examination area of the radiology department
to avoid cross-contamination.
The emergency management and infection control measures, as described below and
implemented in the radiology department during the outbreak, have been approved by the
5
infection control committee of hospital. These measures are in accordance with relevant laws
and regulations, in order to protect patients as well as the staff.
Radiology Emergency Management and Infection Control Team (EMICT)
The radiology department director chaired the EMICT. Its members include the deputy
director, chief technologist, head nurse, equipment engineer supervisor, and infection control
nurse of the radiology department. Team responsibilities included (1) coordination between the
hospital’s management and planning of infection control and radiology departments; (2)
collection of the most up-to-date protection-related information to educate and train staff in the
department; (3) reallocation of staff according to the actual situation; (4) establishment of the
CT procedures for patients with COVID-19; and (5) establishment of an emergency
management plan for the radiology department to ensure that the department would run
normally.
Suspected patients
The suspected patients were identified according to the Diagnosis and Treatment Program of
the Novel Coronavirus Pneumonia of the NHC [5], mainly based on epidemiological history.
Reconfiguration of the radiology department
The radiology department was divided into four areas [6]: contaminated, semicontaminated,
buffer, and clean areas (Figure 1). The contaminated area is connected to the fever clinic and
includes the fever accessway, the CT examination room, and the DR examination room for
6
confirmed and suspected cases. One CT scanner and one DR system closest to the emergency
department are designated the fever-CT and fever-DR to examine patients with suspected and
confirmed COVID-19. There is a separate dedicated access between the contaminated area and
the fever screening tents. The semicontaminated area includes the fever-CT control room,
fever-DR control room, and other patient examination access areas. The buffer zone includes
access areas for medical personnel and a dressing area for technologists. The clean area
includes the administrative office and the diagnostic room.
The contaminated area was isolated from other areas using physical barricades.
Directional signs were newly installed to guide patients and staff.
Personal protection and training of staff
For providing care for patients with confirmed and suspected COVID-19, all hospital staff
are required to wear complete personal protective equipment [7]: medical protective clothing,
surgical cap, N95 mask, gloves, face shields, and goggles. Wearing and removing of the
equipment must be performed in accordance with the procedures and under the supervision of
the infection control nurse.
Because staff members working in the contaminated area are under much situational
pressure, periodically taking time off could lower their physical and mental stress levels. The
technologists on fever-CT duty shifts are provided a break once a week for four hours. In
addition, the health of staff in the contaminated area must be monitored closely for the
symptoms of COVID-19. Pregnant staff must be assigned to the clean area.
7
The EMICT formulates and continually updates guidelines and educates all staff for West
China Hospital of Sichuan University. The EMICT training for staff is mainly involves
documents regarding infection control and CT findings of COVID-19 and maintains an EMICT
WeChat group for West China Hospital of Sichuan University. WeChat is the most widely used
social media app in China. The EMICT releases the latest national and hospital-based
information regarding COVID-19, guidance documents, and other notices from the hospital
and radiology department in the WeChat group on a daily basis. Staff can also report to the
EMICT in the WeChat group any time. Protocols for each modality and infection control
instructions are posted on the walls in all examination rooms. The EMICT periodically reminds
staff to undertake personal measures to reduce infection, such as wearing masks at all instances
in the radiology department and N95 masks if working in the contaminated area; not touching
the mask and the eyes; practicing hand hygiene; facing away from colleagues when eating,
drinking, and talking; and not using personal cell phones while on duty.
 In addition, the chief thoracic radiologist provided lectures on all radiologists and
technologists on typical CT findings of COVID-19 infection using materials developed in
Wuhan, the epicenter of the outbreak in China.
CT examination procedures
There are two sets of procedures for CT examination: the fever-CT procedure and routine CT
procedure for those not suspected of COVID-19.
The fever-CT procedure for suspected or confirmed COVID-19 (Figure 2)
8
Before the fever-CT technologist operates the equipment, he or she should wear personal
protective equipment according to three-level protection standard [8]. Before the CT
examination of patients with suspected and confirmed COVID-19 begins, the fever tent or
isolation ward notifies the radiologist in advance. The fever-CT technologist checks the
equipment and prepares to disinfect the imaging equipment immediately after the examination.
The patient enters the fever-CT waiting area through the fever access area. If the patient
can get onto and off the examination table by themselves, the patient is allowed to do so. If the
patient cannot get onto or off the examination table independently, the person accompanying
the patient assists the patient, rather than the technologist. The technologist checks the patient
information and, using an intercom system in the examination room, asks the patient to remove
any metal ornaments on the neck and chest. Also, by intercom, the technologist trains the
patient to hold his or her breath during the examination.
The technologist uses a low-dose chest CT protocol to scan the patient. After scanning, the
original images are reconstructed as 1 mm-thick layers. The technologist browses the images to
ensure that their quality meets the diagnostic requirements and then guides the patient to leave
through the fever access area. The disposable sheets for patient examination are changed after
each patient. The equipment is disinfected according to the procedure below.
To protect themselves, the technologists assigned to the fever-CT wear N95 mask and
other personal protection as established by the EMICT.
The CT procedure for regular patients (figure.3)
9
Some patients with COVID-19 have no symptoms, and they may call at the general clinic for
other reasons. The following CT procedure is applicable under these circumstances:
When the patient makes an appointment for examination, the staff asks the patient about
their epidemiological history, symptoms, and signs. If suspected criteria are met, the patient
will be sent to the fever tent for further screening. When a patient presents to the radiology
department entrance, his/her temperature is measured. If the temperature is higher than 37.2 , ℃
the patient is sent to the fever tent for further investigation.
Those with no exposure history, suspicious symptoms or fever are screened in one of the
non-contaminated CT scanners. The technologists assigned to these scanners wear surgical
masks. All patients and the person accompanying them are required to wear surgical masks.