key: cord-0757503-22pgr4hi authors: Alves, Adelaide; Aguiar, Ana; Migliori, Giovanni Battista; Duarte, Raquel title: COVID-19 related hospital re-organization and trends in tuberculosis diagnosis and admissions: reflections from Portugal date: 2021-09-25 journal: Arch Bronconeumol DOI: 10.1016/j.arbres.2021.09.005 sha: aeec4b671f282cf83fd7ffc493178b797ef270c1 doc_id: 757503 cord_uid: 22pgr4hi nan methodology. Ana Aguiar contributed to refining the research and study methodology. GB Migliori critically revised the content and drafted some parts of the manuscript. Adelaide Alves was responsible for data analysis. All authors were involved in data interpretation. Adelaide Alves wrote the first draft of the paper. Ana Aguiar and Raquel Duarte reviewed the document. All authors provided inputs on and approved the final version of the manuscript. The authors declare to have no conflict of interest directly or indirectly related to the manuscript contents. Dear Editor, The acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease pandemic is imposing an unprecedented global burden on Health Systems.(1) , (2) The active participation of Pulmonology specialists in the first-line response against COVID-19 forced a rapid reorganization of hospital departments to manage a high number of contagious patients with variable levels of respiratory failure or other medical COVIDrelated complications. Scientific communities raised concern regarding the impact of COVID-19 on the global control of the tuberculosis (TB) epidemic because of the weakening of TB programmes and the potential interactions between these two infections.(3) , (4) , (5) , (6) As the fight against the pandemic continued, Pulmonology Departments continued to manage non-COVID-19 patients, including those with TB implementing some necessary organizational re-structuring. (7) We aimed to describe the re-organization of a major Pulmonology Department under the COVID-19 emergency and the main productivity outputs with special focus on diagnosis and admission of TB patients. The study, retrospective and descriptive, was conducted at the Pulmonology Department of Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E) (Portugal). The study is part of a larger international initiative of the Global Tuberculosis Network (GTN).(7) , (8) CHVNG/E is a central hospital providing healthcare to a catchment area of 334.000 inhabitants. According to its referral networks, CHVNG/E has assigned a larger influence area of 700.000 inhabitants.(9) CHVNG/E is a reference center for several diseases, including TB, and works in a close relationship with the TB outpatient center (TBOC) of Vila Nova de Gaia/Espinho, which is responsible for the diagnosis, treatment, screening and prevention of all TB cases in the area. Most TB cases are managed on an outpatient basis and only few (severe or drug-resistant) patients are hospitalized. We collected data from the Hospital Statistics Service and the Clinical Pathology Department on the re-organization procedures and on health services provided (including the total number of clinical appointments at the TBOC and of laboratory TB diagnosis). We conducted an analytical study comparing outpatient activity, overall hospitalizations, The CHVNG/E Pulmonology Department offers hospitalization (23 beds in the general ward and 4 beds to patients with acute respiratory failure under noninvasive ventilation) and day hospital services. It includes the following units: outpatient clinic; bronchology; respiratory function laboratory; obstructive lung disease; noninvasive ventilation; respiratory rehabilitation; allergic asthma; thoracic oncology; smoking cessation; sleep respiratory disorder; interstitial lung diseases; lung transplantation and pulmonary hypertension. As the pandemic intensified, CHVNG/E created many isolation wards exclusively dedicated to inpatients with confirmed COVID-19. Teams devoted to COVID-19 included physicians from almost all medical and surgical specialities available in the hospital. The first wave of COVID-19 forced many organizational changes in the Pulmonology Department (Table 1) , reinforced during the second and, especially, the third wave. Over the first semesters of 2019 and 2020, we found a predictable decrease in all sectors of activity (Table 2) 7 the trends in TB diagnosis and hospitalizations in three homologous periods corresponding to before, during and after the onset of the pandemic. One limitation of this study lies in the reduced number of TB patients throughout the three periods, which might be explained by the fact that only the first six months of each year were analyzed because of methodological reasons. In conclusion, health resources were allocated to the COVID-19 needs with an effect on the clinical response to other diseases. Our data reveals the effect of the pandemic on the overall clinical activity and the effort to recover in 2021. Although hospitalization for problems other than COVID-19 decreased, tuberculosis was an exception, despite the observed reduction of new diagnoses (likely related to increased severity as the prevalence of drug resistance did not increase). Reduction of the allocation time of physicians to the activities of Pulmonology Department in order to integrate medical teams in COVID-19 wards; Medical attendance during the night of all COVID-19 patients hospitalized in level 1 and 2 wards (third wave); Assignment of a pulmonologist as a team leader in a level 2 ward created to the management of COVID-19 patients with respiratory failure under noninvasive respiratory support (third wave). Allocation of pulmonology 27-bed ward to hospitalization of COVID-19 patients (third wave); Restriction of inpatients visits. Cancelling all non-urgent presential medical outpatient clinic consultations, limiting face-to-face consultations to almost only patients under diagnostic work-up of malignancy, oncologic patients under anti-cancer active treatment and patients with interstitial lung disease under antifibrotics or immunosuppression; Implementation of tele-consultation in the remaining situations; Implementation of a follow-up consultation for pos-COVID-19 patients, according to a referencing protocol 1 . Cancelling of all non-urgent bronchoscopy procedures, limiting activity to diagnostic suspicion of malignancy and emergency procedures. Temporary cancelling of all activity in the respiratory function laboratory. Temporary cancelling of pulmonary rehabilitation programmes. Temporary cancelling of all sleep studies. Pulmonology continued to ensure emergency services for respiratory patients (with or without COVID-19), 12 hours during the day, seven days a week. Cancelling the internships of residents and their allocation mainly to outpatient clinic activity and non-COVID-19 hospitalization; Cancelling the internships of residents of other Departments or Hospitals. Telework, as a measured applied in three cases during the first wave (due to pregnancy or significant heart disease); Reinforcement of preventive measures against infections transmission such as handwashing and personal protective equipment, including the use of medical uniforms and surgical masks in the contact with patients without COVID-19 and use of FFP2 or N95 masks, disposable coveralls, face shields, gloves, head and shoe protective covers when contacting with patients with presumptive or confirmed COVID-19, according to the instructions of the Portuguese General Health Direction. (12) The impact of the COVID-19 pandemic on health services utilization in China: Time-series analyses for 2016-2020 Tuberculosis and COVID-19, the new cursed duet: What differs between Brazil and Europe? Tuberculosis and COVID-19 interaction: A review of biological, clinical and public health effects Worldwide Effects of Coronavirus Disease Pandemic on Tuberculosis Services Gauging the impact of the COVID-19 pandemic on tuberculosis services: a global study TB and COVID-19 co-infection: rationale and aims of a global study The respiratory rehabilitation Maugeri network service reconfiguration after 1 year of COVID-19 COVID-19 and hospital admission: Consensus on pros and cons based on a review of the evidence Prevenção e Controlo de Infeção por SARS-CoV-2 (COVID-19): Equipamentos de Proteção Individual (EPI) Non-COVID-19 emergencies: where have all the patients gone ? Inpatient Hospitalizations during the First Wave of COVID-19 in Portugal Impact of COVID-19 on Tuberculosis Control Impacto de la COVID-19 en el control de la tuberculosis Dear Increase in tuberculosis diagnostic delay during first wave of the covid-19 pandemic: Data from an Italian infectious disease referral hospital