key: cord-0895639-vn18823m authors: Sagy, Iftach; Rosenberg, Elli; Barski, Leonid title: Converting a standard internal medicine ward into an isolation unit during the COVID‐19 outbreak date: 2021-01-09 journal: Int J Clin Pract DOI: 10.1111/ijcp.13979 sha: 553f76c939cff0a413e9d60aba0f19b715ac1a69 doc_id: 895639 cord_uid: vn18823m nan The ongoing COVID-19 pandemic has a substantial impact on the delivery of health care throughout the world. It also has a profound influence on financial, social and physiological aspects with implications that are yet to be fully recognised. Although the COVID-19 outbreak emerged in China at the end of December 2019, the first patient was identified in Israel on February 21st. This two-monthlong gap enabled the Israeli universal health-care system to implement logistic preparations at both national and institutional levels. In this letter, we summarise our experience and outline the guidelines for the organisational aspects of managing COVID-19 patients in an isolated internal medicine ward of a tertiary medical centre. During March-May 2020, our COVID-19 ward treated 91 positive Polymerase Chain Reaction SARS-COV-2 patients. The mean age of the patients was 56.9 years (±23.6); 46.8% of the patients were females. The median length of hospitalisation was 6.0 (interquartile range 2.0-9.0) days. Eight patients (8.8%) were transferred to ICU and six (6.5%) underwent mechanical intubation. The overall mortality rate was 8.8%. The isolation-ward medical and nursing staff are essential resources yet are continuously at risk of contracting SARS-COV-2. Therefore, a major concern is maximising staff safety through minimising exposure to the pathogen. Minimal exposure is facilitated using the following methods: 1. The medical staff enter the isolation ward the least as possible -usually once for morning rounds and later only for new admissions or to tend to deteriorate patients. We operate a situation room (SR) manned around-the-clock by a physician or a nurse. The SR is physically situated outside of the isolation unit and the staff manning it does not require the use of personal protective equipment (PPE). Patients' vital signs and medical follow-up are transmitted from the isolation ward to the SR through multiple telecommunication channels and are continuously recorded using dedicated hardware and software. In addition, the SR is wired to other relevant units both inside and outside of the hospital for further assistance if needed. We initiated several small-scale studies in our isolated COVID-19 ward. Extensive clinical data of the admitted COVID-19 patients have been collected to evaluate possible associations with demographical and clinical characteristics. We also evaluated several compounds with minimal adverse effects which were recently reported to have possible positive effects on disease prognosis, such as zinc, vitamin C and N-acetyl-cysteine. 6, 7 In conclusion, treating COVID-19 patients creates unique clinical, organisational and logistic challenges. These challenges can be managed with minimal exposure of the medical staff to COVID-19 patients without losing the therapeutic continuum by utilising various technologies. Notwithstanding, the basic concepts of internal medicine remain the same: high quality and compassionate treatment all the while minimising risk for the patients. More studies are needed to investigate the operation of isolation COVID-19 wards at a larger scale, as well as the preparedness of regional and national health-care systems for this pandemic. https://orcid.org/0000-0002-2720-9934 Critical care crisis and some recommendations during the COVID-19 epidemic in China COVID-19 infection epidemic: the medical management strategies in Heilongjiang Province Findings of lung ultrasonography of novel corona virus pneumonia during the 2019-2020 epidemic Tabletop exercise to prepare institutions of higher education for an outbreak of COVID-19 The emotional impact of coronavirus 2019-nCoV (new coronavirus disease) Treatment for severe acute respiratory distress syndrome from COVID-19 COVID-19 Pandemic. Can Maintaining Optimal Zinc Balance Enhance Host Resistance?