key: cord-0921724-448xcleq
authors: Martinez Garcia, Maria Fernanda; Benitez Hidalgo, Olga; Alvarez Martinez, Eva; Juarez Gimenez, Juan‐Carlos; Fernandez Sarmiento, Carmen; Suito Alcantara, Milagros; Soto Bonet, Nuria; Cardona Lopez, Raquel; Iacoboni Garcia‐Calvo, Gloria; Gironella Mesa, Mercedes
title: Organization of a reference haemophilia unit and its change of activity during the COVID‐19 pandemic
date: 2020-09-30
journal: Haemophilia
DOI: 10.1111/hae.14160
sha: bd2cae0daf798a42a0b7ff8a99c3ecd273aae9b3
doc_id: 921724
cord_uid: 448xcleq

nan

Dear Editor, In January 2020, with the increase in COVID-19-infected cases affecting more than 170 countries, the WHO declared this outbreak a public health emergency of international concern; on March 11, it was declared a pandemic. 1, 2 The first case in Spain was diagnosed in 1 February 2020 and in Catalonia in 25 February 2020 3, 4 Since then, different protocols were issued to prevent exposure to the new virus and to improve management strategies.

The first national guidelines for the prevention of occupational hazard against the novel coronavirus were issued by the Ministry of Health on March 5, establishing a series of preventive measures which included reducing face-to-face visits and on-site staff, limiting exposure at workplaces such as hospitals. 5 At Vall d´Hebron Hospital in Barcelona, the first protocol regarding COVID-19 was issued on March 11, the same day that schools and other educational centres were closed down in the city. On

March 15, a national lockdown was established after declaring the state of emergency. 6 The Haemophilia Unit (HU) at Vall d' Hebron Hospital provides comprehensive and dedicated care to patients with bleeding disorders. It has a multidisciplinary team lead by haematologists, 2 on weekdays and 1 on call for nights and weekends. The nursing staff is divided in 3 shifts to guarantee 24/7 attention, having 2 nurses during weekday mornings to guarantee better coverage during the busiest shift. The HU also includes orthopaedic trauma surgeons, a physical rehabilitation specialist, a hepatologist, an infectious disease specialist and a dentist who visit the patients at the HU once or twice a week.

The hospital's pharmacy department supplies the haemostatic treatment to the patients and guarantees a proper supply and traceability of the clotting factor concentrates. To do so, patients need to book an appointment with the hospital´s pharmacy, in order to pick up their monthly medication prescribed by the haematology team.

With the COVID-19 outbreak, the Unit searched for a new system to continue providing the same medical attention without putting the patients or staff at risk. The weekly analysis (Figure 2) showed that the highest volume of visits occurred during the first 2 weeks of the pandemic (31.2% of the entire medical activity of this 2020 period) because patients needed more information regarding the virus and the care required.

After those first weeks, we observed a global reduction of activity (reduction of 81%-95%) that coincided with the Spanish home-confinement period, as well as the fact that our bleeding disorder population was already informed about the pandemic and the changes regarding the medical attention at the HU. The reduction in on-site visits was mainly due to the remote follow-up but it is also possible that the lockdown caused a reduction of physical activity and less bleeding events in our patients. Haemoassist ® App which we have been using in our unit for many years now) and store-and-forward technologies that collect images and data to be transmitted at a later time. 8, 9 In our centre, before and during the pandemic, the telemedicine tools available were only phone calls and e-diaries. Now, video consults are available and face-to-face visits are still restricted to patients who need a physical examination or additional tests. 

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