Abstract
Even though the COVID-19 pandemic has affected every corner of the world, disparity exists among different regions in Asia. The World Health Organization (WHO) statistics showed that South East Asia and Western Pacific ranked third and fourth in terms of the number of cumulative cases as of 24th February 2022. 1 In parallel, Western Pacific region has the highest population vaccination rate with 81 persons fully vaccinated per 100 population. 1 Thanks to the prompt public health measures, emergency departments (EDs) in Hong Kong have seen relatively fewer COVID-19 patients compared with neighbouring regions. 2 The fear of contracting the infection has caused a significant drop in ED attendance during periods of high COVID-19 caseload. In a local survey, 25% of the citizens reported that they would avoid visiting hospital EDs during the pandemic. 3 COVID-19 has also caused health service disruptions to people in need of healthcare, including patients with chronic diseases. 4 At the time of writing, Hong Kong is currently faced with the largest community outbreak of COVID-19 since the pandemic began.
It is commonly agreed that ED staff safety and morale are the top priorities in well functioning EDs. During the pandemic, emergency healthcare workers, especially nurses, have a high rate of burnout. Zakaria et al. 5 found the frequent exposure to an angry public, increase in workload, long working hours, dynamic work conditions (including frequent change of guidelines and management approach), and perceived underpayment are factors leading to burnout during COVID-19 in Malaysia. A survey conducted by Wong et al. 6 in four public EDs in Hong Kong showed that ED healthcare professionals who had a higher level of self-reported resilience had better compassion satisfaction and lower levels of secondary traumatic stress and burnout, highlighting the importance of fostering resilience among ED staff. The pandemic is also known to impact on psychological health in our everyday lives. 7 Protecting and ensuring the wellbeing of ED staff are more important than ever.
Combating COVID-19 at the frontline, ED staff have to be vigilant in screening for potential cases, often with a limited battery of diagnostic tests especially early in the pandemic. Asymptomatic cases put additional pressure on the frontline staff. Screening criteria based on fever, travel history, occupation, contact history, and cluster of symptoms (FTOCC) remain the cornerstone in most EDs. Lin et al. 8 demonstrated that a travel history alert at the ED that linked up electronic health records and custom travel record databases had averted community spread of COVID-19 from an infected returned traveller in Taiwan. By isolating a family cluster of four members, Wang et al. 9 showed that prompt recognition of infection cluster is another important strategy to stop further spread of the virus in the hospital and community when travel history is not indicative.
Many EDs have revamped the patient flow and staff workflow and set up pre-triage screening and designated zone for patients with respiratory symptoms. Monti et al. 10 illustrated that such a revamp of patient flow could be implemented with success even in a rural ED, where none of the ED staff was infected. To further reduce the risk of healthcare workers, many ED staff improvised novel barrier or enclosure devices in addition to the standard personal protective equipment. An example is the COVID-19 swab shield built by Lin and Chong, 11 which serves to separate the healthcare worker and the patient during the swab test by placing a protective barrier in between them.
Accurate diagnosis is another key element of ED response. While reverse transcription polymerase chain reaction test remains the gold standard of diagnosis, Cengel et al. 12 showed that in high-prevalence areas, computed tomography of thorax had an acceptable accuracy of diagnosing COVID-19 infection and good inter-observer agreement between radiologists and clinicians. In an observational study conducted on 42 COVID-19 patients in the intensive care unit (ICU), Li et al. 13 demonstrated that point-of-care lung ultrasound had a superior diagnostic performance in detecting adult respiratory distress syndrome compared with chest X-ray, making it a useful bedside tool for physicians in the care of critically ill COVID-19 patients.
For the more critical cases, the risk of aerosol generation during resuscitation has generated additional demand for alternative methods to reduce the risk of aerosol transmission. To minimise frequent connection and disconnection of endotracheal tube for end-tidal CO2 measurement during patient transfer, Sun et al. 14 advocated the use of trans-tracheal ultrasound for confirmation of the endotracheal tube position. To reduce ventilator-associated pneumonia and mortality, Man et al. 15 found that critically ill COVID-19 with respiratory failure who received awake prone ventilation had a significant improvement in SpO2, FiO2, SpO2/FiO2, respiratory rate, and ROX index. Those who received prone ventilation also appeared to have a lower ICU and hospital mortality. 15
These are just some of the innovative solutions from Asia published in the recent issues of the Hong Kong Journal of Emergency Medicine. During the 11th Asian Conference on Emergency Medicine hosted in Hong Kong in December 2021, emergency physicians from 10 countries/regions gathered virtually to discuss Asian ED solutions to the COVID-19 crisis. Participants shared the situations of their EDs, the challenges they faced, and their coping strategies. The lessons learned from the COVID-19 response and the future, including the use of telemedicine in patient care and virtual reality in training, were also deliberated. At the time of writing, there was no end in sight to this global pandemic. This is our journal’s mission to continue to publish innovative solutions to improve the care of COVID-19 patients and to protect our fellow ED colleagues.
