COVID-19 Resources by Topic

The COVID-19 pandemic is a major health crisis straining the healthcare system and affecting us all. The IARS is committed to supporting our members who are addressing this illness on the front lines in any way we can.

IARS has assembled a content base with the latest peer-reviewed articles on COVID-19 from leading medical journals, sorted by topic and chronologically. In the COVID-19 Resource Newsletter healthcare professionals on the frontlines are given access to global peer experiences and education from publications hand-selected and reviewed by the IARS COVID-19 Scientific Advisory Board. All of these articles are openly available without login.

Click on a phrase below to see resources on that topic. To search by keyword, select Ctrl + F on a PC and Command + F on a Mac. Then, enter keyword and Enter.

V. Logistics / Resource Allocation (Current / Future)

March 29, 2021

  • Hospital load and increased COVID-19 related mortality in Israel. 3/26/21. Rossman H. Nature.
    An analysis of all 22,636 Israeli COVID-19 inpatients from mid-July 2020 – mid-January 2021 determined that in-hospital mortality increased significantly when >62.5% of the national capacity for severely ill patients (800 beds) was occupied. A validated model using Monte-Carlo methods and a set of Cox regressions was used to predict mortality. Two high-occupancy periods had 22% (SE 3.1%) and 27% (SE 3.3%) greater mortality. Authors postulate that excess mortality during periods of high caseload was most likely due to “an insufficiency of health-care resources.”

February 1, 2021

January 8, 2021

October 26, 2020

  • Sensible Medicine—Balancing Intervention and Inaction during the COVID-19 Pandemic. 10/15/20. Seymour CW. JAMA.
    This article, which contains a discussion relevant for all practitioners engaged in clinical care cautions against abandoning clinical experience and consultation for early adoption of unproven and potentially harmful therapies. The authors urge that practitioners use sensible medicine, a blend between doing nothing and going all in. Their argument is well illustrated and supports the current therapeutic state in which good clinical care in well-managed ICUs following established protocols appears to be effective management strategy. No therapeutic agent has demonstrated significant mortality benefit with the exception of dexamethasone administered appropriately. The discussion supports the decision to steer a middle course with elegance and logic and is refreshing, timely and relevant.

September 9, 2020

May 29, 2020

May 16, 2020

  • Organ procurement and transplantation during the COVID-19 pandemic. May 11. Loupy. Lancet.
    The authors conclude that the COVID-19 pandemic has caused a dramatic loss of organs all across the world. Deceased organs denied means more preventable death likely in coming months. The overall reduction in deceased donor transplantations since the COVID-19 outbreak was 90.6% in France and 51.1% in the USA, respectively. In both France and the USA, this reduction was mostly driven by kidney transplantation, but a substantial effect was also seen for heart, lung, and liver transplants, all of which provide meaningful improvement in survival probability. Leaders of medical institutions will make difficult decisions about how best to deploy limited medical resources. The authors state that the data from public record suggests the only option is living related organ transplant.

May 15, 2020

  • COVID Activated Emergency Scaling of Anesthesiology Responsibilities (CAESAR) ICU
    May 7. Verdiner. Anesthesia & Analgesia.
    Opinion from SAB Member: Dr. Jagdip Shah
    Practitioners from the American Society of Anesthesiologists (ASA), the Society of Critical Care Anesthesiologists (SOCCA), the Society of Critical Care Medicine (SCCM), and the Anesthesia Patient Safety Foundation (APSF), representing more than a dozen universities in the USA, created the COVID Activated Emergency Scaling of Anesthesiology Responsibilities (CAESAR) ICU working group. The specific goal is to address the shortage of critical care medicine (CCM) MDs in this current COVID-19 pandemic when supply is mismatched with demand, by fast-tracking anesthesiologists with short notice. This long article is formatted as a knowledge-based guideline. It addresses all possible potential areas of weaknesses in anesthesiology knowledge as it pertains to practicing in the ICU on day #1. The authors have provided state of the art information about the pathophysiology of COVID-19, pertaining to all the disciplines (respiratory, cardiovascular, renal, inflammation cascades, central nervous system, infection control, endocrinology, coagulation dichotomy, etc.) in a dynamic fashion. The article is a well referenced and complete effort to inform non-ICU physicians in simple formats of an inner working of the ICU regarding: multi-specialty involvement, scoring systems for patients, the ABCDEF Bundle (Assess, prevent, and manage pain, Both spontaneous awakening trials and spontaneous breathing trials, Choice of analgesia and sedation, Delirium: assess, prevent, and manage, Early mobility and exercise, and Family engagement and empowerment), drug therapy / interactions, supply shortages and their implications, managing codes, interpretation of monitors, ventilator synchronizations, proning, CPR, ARDS, glucose control, ECHO, ECMO, CRRT/dialysis/ultrafiltration, ethical philosophy, the role of the triage committee, and role of palliative care and hospice. The authors explain clearly that COVID-19 is a very different disease regarding its transmissibility to the caregivers, and stresses the need for adaptability of the healthcare system for a huge surge of ICU demand while optimizing the patients for greater benefit and greater good without wasting time, effort and resources.

May 2, 2020

  • Return to normal—prioritizing elective surgeries with low resource utilization. Apr 29. Wilson. Anesthesia & Analgesia.
    In an effort to commence elective surgery without overburdening their ICU, a large hospital in NYC did a statistical analysis of pre-COVID-19 elective surgeries, looking at ICU admission and ventilator use. Cardiac, abdominal and spine surgeries in patients with a high co-morbidity burden were at greatest risk. Such an organized approach to determining how to open to elective surgery is commendable, and is likely to vary in different institutions. Ventilation and ICU care may not be the limiting resource to make such decisions.

April 29, 2020

  • Regional Planning for Extracorporeal Membrane Oxygenation Allocation During COVID-19
    Apr 20. Prekker. CHEST.
    Opinion from SAB Member: Dr. Lydia Cassorla
    This pre-proof review from the University of Minnesota and the Mayo Clinic provides a well thought out and succinctly described framework for regional ECMO resource planning and operational deployment. Their approach involves regional situation awareness, a high degree of coordination between centers with ECMO capability, clinical decision support tools, involvement of expert clinicians in decision making and triage of resources to those most likely to benefit. It also addresses the ethical and practical aspects of not continuing to offer ECMO during a disaster, a decision best based upon a pre-existing framework. Priority for ECMO, which is described as a “trial of support rather than an indefinite resource assignment”, is based upon probability of survival, expected duration of ECMO, illness severity and patient age. A table outlines their framework for prioritization. Acute respiratory failure due to infection including flu and corona viruses is expected to require a “long” duration of >5 days with anticipated survival >60% if all other organ systems are intact. The authors anticipate that when more data of sufficient quality is available for COVID-19 patients treated with ECMO, it may become clearer how to optimally leverage this limited resource.

April 25, 2020

April 20, 2020

  • A conceptual and adaptable approach to hospital preparedness for acute surge events due to emerging infectious diseases. Apr 20. Anesi. Crit Care Explor.
    This narrative review provides a framework for factors that must be incorporated into an effective response to an epidemic or pandemic. The focus is on bringing order to what might otherwise be a chaotic situation. Graphics and definitions are useful in conceptualizing the many stressors and optimal responses to a surcharged system. Causes of healthcare capacity strain are defined as increased volume, increased acuity, special care requirements and resource reduction (relative to demand), and the “4 Ss” of surge preparation discussed: Space, Staff, Stuff, Systems. Perhaps most useful for clinical leaders, policy experts and healthcare administrators.
  • Hospital Preparedness for COVID-19: A Practical Guide from a Critical Care Perspective. Apr 17. Griffin KM. Am J Respir Crit Care Med.
    This detailed report from Cornell outlines the adaptations implemented at a large university medical center in one of the epicenters of the SARS CoV2 pandemic. Topics include evolving indications for O2 therapy, intubation and ECMO, PPE, team models, physician staffing and expansion of duties, multidisciplinary care including infectious disease, critical care medicine (CCM), cardiology, anesthesiology, respiratory care, physical therapy, palliative care, and nursing. ICU care was standardized under supervision of CCM specialists regardless of patient location or provider background. Many adaptations in care were designed to limit opportunities for infection of workers, such as dedicated smart phones within ICU care rooms, monitors and care information outside rooms when feasible (compliant due to restricted visitors), bundled care, and dedicated or defined teams for many aspects of care such as invasive procedures and proning. Education, triage, and ethical considerations and wellness are also discussed.
  • The Utah Model: mental bandwidth and strategic risk generation in COVID-19 airway management. Apr 17. Runnels S. Anaesthesia.
    Correspondence regarding the Consensus guidelines for managing the airway in patients with COVID-19 by Cook et al.
    Two points are raised: “First, failure to minimise aggregate airway management risk poses a strategic threat to our medical systems, and two, it is critical to include the risk of mental bandwidth saturation as a risk for contamination.” They feel that protecting providers is the first principle of the current resource-constrained system. The authors provide a graph which shows that increasing aerosolization risk due to increasing airway management complexity correlates with increasing provider stress.

April 16, 2020

  • Balancing Supply and Demand for Blood during the COVID-19 Pandemic. Apr 13. Gehrie E. Anesthesiology.
    Thoughtful discussion on COVID-19 impact on disruption of normal sources to maintain national blood supply highlights decreased donations due to elimination of mobile blood drives at schools, universities and other public locations contrasting with continuing demand and overall decrease in donation which parallels other efforts to decrease demand over past decade. Further mitigation discussion recognizes cancellation of elective surgeries (living donor transplantation, etc.), “keeping the blood in the patient”, single unit transfusions in order to keep blood available for other needs. Recommendations: encourage healthy donors to go to donation centers and optimize currently available and practice recommended blood management techniques.

April 15, 2020

April 14, 2020

April 8, 2020

  • Ark of Life and Hope-Role of Cabin Hospital in Facing COVID-19. Apr 4. Shu. J Hosp Infect.
    Chinese government transformed public places into Cabin hospitals for the treatment of patients with mild and moderate COVID-19. Over one month, a total of 14 Cabin hospitals were opened in Wuhan, and more than 12,000 patients confirmed with COVID-19 were treated, most of whom were cured and discharged and only a few patients were transferred to designated hospitals for further treatment due to exacerbations. These played a crucial role in the prevention and treatment of COVID-19 patients, and quickly solved the problem of insufficient beds in a short period of time, which greatly accelerated the admission of patient, reducing the conversion rate from mild and moderate cases of COVID-19 to severe and critical cases.
  • Covid-19: Increased demand for steroid inhalers causes “distressing” shortages. Apr 5. Mahase. BMJ.
    Brief note regarding shortages of steroid inhalers with recommendation not the “stock pile.”
  • Essential care of critical illness must not be forgotten in the COVID-19 pandemic. Apr 5. Baker. Lancet.
    Lancet correspondence highlighting difficulties associated with CCM in low resourced environments and emphasizing excellent basic care as a fundamental requirement that may ameliorate disease progression and prevent complications from early disease. While important, states the obvious and is a future looking approach rather than an immediate aid, even in low income environments. Longer range awareness and planning should incorporate these principles which already are in effect in many such areas.
  • Fangcang shelter hospitals: a novel concept for responding to public health emergencies. Apr 6. Chen. Lancet.
    Defines criteria for creating temporary isolation hospitals designed to care for mild to moderate disease with provisions for triage to higher level care in traditional facilities if condition deteriorates. Hospital designed for basic care with important feature of isolating mild symptoms from community and home environment while providing appropriate medical and social care. A form of isolation that provides relief from traditional hospitals and supports home environment from contamination with infected family member. Different concept than current additional bed capacity construction in US. Cultural environment may make universal adoption problematic. The discussion is interesting and may prove useful in future epidemic/pandemic strategic planning.
  • Harnessing Our Humanity – How Washington’s Health Care Workers Have Risen to the Pandemic Challenge Apr 1. Rosenbaum. NEJM.
    COVID-19 SAB Opinion from: Dr. Philip Lumb
    Articulate discussion of challenges faced when balancing traditional medical treatment priorities with realities of equipment shortages (protective and therapeutic), patient isolation, loss of family support and healthcare worker tensions arising from the unknown challenges ahead. The discussion presents challenges across all areas including Trainees, Nursing staff, front line CCM and ED providers, Environmental Service Workers, Patients and their Families. Fundamental message is that clear direction and agile protocols are supportive and reassuring, but must be focused, adaptable and transparent.
  • Hospital surge capacity in a tertiary-emergency referral-centre during the COVID-19 outbreak in Italy. Apr 5. Carenzo. Anaesthesia.
    An Italian experience: the author reviews the steps of disaster preparedness: setting up a dedicated cohort COVID ICU with its own Command / Control & Coordination Center overseeing these several wings of an existing hospital. It was managing the dedicated: SPACE – each wing of building / supply constant monitoring demand / staff in shifts. Emphasizes the training of new recruits of qualified personnel from other specialties. Early importance of pre-Triage is mandatory and explains how this becomes more dynamic process with time. The hospital was broadly divided in Red/ yellow / green zone for patient & staff movement.
  • Monitoring behavioural insights related to COVID-19. Apr 6. Betsch. Lancet.
    Interesting insight into population management in times of crisis based on Weekly COVID Snapshot Monitoring (COSMO) initiated on March 3 in Germany. Contains links to COSMO and WHO Europe websites detailing data collection methodology and resources for information integration. Interesting insight and information.
  • Setup of a Dedicated Coronavirus Intensive Care Unit: Logistical Aspects Mar 30. Anesthesiology. Mojoli.
    COVID-19 SAB Opinion from: Dr. Jagdip Shah
    Short, informative article. There is a diagram about isolation ICU set up as a hospital is trying to increase “surge capacity” by 50%. The article explains exactly what/how to set up an isolation ICU.
  • Where Have All the Heart Attacks Gone? Apr 6. Krumholz. NY Times.
    Except for treating Covid-19, many hospitals seem to be eerily quiet.

April 7, 2020

April 2, 2020

April 1, 2020

March 30, 2020

March 28, 2020

March 27, 2020

March 25, 2020

March 24, 2020

March 23, 2020

March 20, 2020

March 19, 2020

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AAMSE Award
Disclaimer
The material on this website is provided for informational purposes and does not constitute medical advice. New knowledge is added daily and may change over time. Opinions expressed should not be construed as representing IARS policy or recommendations. References and links to third parties do not constitute an endorsement or warranty by IARS.

Thank you IARS COVID-19 Scientific Advisory Board and Content Reviewers!

The IARS would like to recognize the COVID-19 Scientific Advisory Board and the Content Reviewers for sharing their expertise and time to help curate and evaluate the most relevant information coming out about COVID-19 for our members. The COVID-19 SAB meet regularly to discuss articles, provide reviews and determine what information would be most valuable to those on the frontline. The Content Reviewers review a list of articles daily to determine their topic areas and relevance to the audience. We greatly appreciate the commitment they have made to help during this major health crisis!

Encourage, stimulate, and fund ongoing anesthesia-related research projects that will enhance and advance the specialty, and to disseminate current, state-of-the-art, basic and clinical research data in all areas of clinical anesthesia, including perioperative medicine, critical care, and pain management. The IARS is focused solely on the advancement and support of education and scientific research related to anesthesiology..

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