Introduction. The COVID-19 pandemic has not only resulted in a public health crisis but has also strained hospital services. The provision of surgical care should therefore also be guided by ethical, and whenever applicable, also legal, principles. Methods. An integrative approach that covers clinical and ethical dimensions, as well as spans the spectrum of surgical care, is therefore necessary. This action research involved three key steps: 1) identification of ethical dilemmas related to the provision of surgical care during the COVID-19 pandemic; 2) preparation of clinical scenarios that highlight these dilemmas; and 3) determination of the appropriate options for the said scenarios, based on the best available evidence as well as most applicable ethical principles. Results. Ethical theories included utilitarianism, human rights, and communitarianism. Ethical principles included non-maleficence, justice, autonomy, and beneficence. Values considered were duty, reciprocity, human life, efficiency, fairness, fidelity, ownership, social value, and fair innings. Also incorporated were informed consent, allocation principles, resource allocation, and triage. In terms of operational issues and surgical technical concerns, the following were considered: phased standards of care, categorization of interventions, prioritization, surgical approaches, infection control, diagnostics, patient welfare, staff welfare, operations protocols, surgical training, and communication. Key points derived from the ethical and technical considerations of surgical care delivery during the COVID-19 pandemic are presented. Conclusion. This action research involving a review of the literature and stakeholder engagement has provided a concise ethical and technical resource for surgical administrators, practitioners, and trainees.
COVID-19 ; Pandemics

Background: Community pharmacists play a strategic and indispensable role as healthcare professionals with direct patient access during the COVID-19 pandemic. Nevertheless, there had been no studies that document the challenges, adaptive measures, and opportunities of community pharmacy practice in the country during such period. Objectives: This study aimed to describe the challenges encountered and adaptive measures implemented by community pharmacies, and to explore opportunities of community pharmacy practice brought about by the COVID-19 pandemic in the Philippines. Methods: The study employed a qualitative, cross-sectional study design. Convenience sampling was conducted representative of chain and independent drug stores, online and other stores with service variations, and pharmacy organizations. Recruitment was pursued until data saturation with a total of 16 participants. Interviews were transcribed and analyzed through thematic analysis using NVivo 12. The study received ethical clearance for implementation from the UP Manila Research Ethics Board. Results: Results showed there were various challenges that affected both the supply- and demand- side of pharmacy operations in the community pharmacy practice during the pandemic. Due to the adaptive role of the pharmacy profession during the pandemic, there has been an increased relevance of pharmacists in public health. Furthermore, the pandemic has exhibited the need to shift to the use of e-prescriptions. However, there are limitations to its current use, such as ensuring the validity of the prescription when presented in a pharmacy. Conclusion There are several challenges encountered by community pharmacists during the pandemic. These challenges led to several adaptive measures being implemented that also became an opportunity to emphasize the vital role community pharmacists play in the healthcare system.
COVID-19 ; pandemics

Introduction: COVID-19 emerged as a new disease during the early period of 2020. Given that our institution is a cardiac specialty center and our patients have numerous co-morbidities compared to the general population, we wanted to determine the clinical profiles and in-hospital short-term outcomes of suspect, probable and confirmed adult COVID-19 patients seen at our institution. Methodology: We prospectively enrolled 323 adult (115 health care workers) suspect, probable and confirmed COVID- 19 patients admitted from March to June 2020. We described and analyzed their clinical presentation, and in-hospital outcomes. Results: There were 117 (36.22%) RT-PCR positive patients with 36.53% confirmed, 13.00% probable and 50.46% suspect patients. For probable and confirmed patients, 25%, 21.25%, 23.13% 16.25% had no, mild, moderate, and severe symptoms, respectively with 14.28% critical cases. Over-all mortality rate for probable and confirmed cases was 25.54% with 91.3% mortality rate for critical cases. Co-morbidities with statistically significant association with severity of disease were as follows: hypertension, heart disease, cerebrovascular disease, diabetes mellitus and COPD. Conclusion During the early period of the COVID-19 pandemic, only 36.53% of cases admitted at our institution were COVID-19 confirmed by RT-PCR. One-third of the cases were severe and critical, with more clinical instability, increased inflammatory markers, and higher in-hospital morbidity and mortality.
COVID-19 ; Pandemics ; Philippines

We have seen the events of the pandemic unfold from our unique perspective as pathologists. Early on, we stood helpless as the virus ravaged our cities and towns with ferocity while we could hardly do anything. We were woefully unprepared to cope with the testing. Very few labs were capable of doing RT-PCR testing, exposing our unpreparedness in molecular pathology.
COVID-19 ; Research ; Pandemics

Objective: The purposes of this study were to (1) describe the perceptions and practices of telemedicine among ophthalmologists in a tertiary hospital; and (2) evaluate knowledge, satisfaction, and perceived patient outcomes in using telemedicine to provide eye care in a time of a global pandemic. Methods: This was a descriptive, cross-sectional study using a self-administered online survey. Thirty-two (32) ophthalmology consultants and residents-in-training in a single tertiary, private hospital who practiced telemedicine participated in this study. Descriptive statistics was used to summarize the data. Responses to open-ended questions were analyzed thematically Results: The respondents were somewhat knowledgeable (75%) and somewhat confident (72%) in using telemedicine. Respondents strongly conveyed their satisfaction with telemedicine outcomes (56%). Majority also believed that their patients were satisfied with teleconsults (69%). Majority agreed that telemedicine can be effective for select types of care [i.e., chronic condition management (66%), follow- up care (62%), and acute non-emergency care (53%)]. Telemedicine also proved to be a boon during a pandemic due to its convenience (59%) and efficiency (63%). However, it is limited by the imperative need for face-to-face consults (69%) and technological constraints (44%). Conclusions Telemedicine was perceived to be a valuable solution during the present pandemic due to its convenience, safety, and ability to provide remote diagnosis and management of urgent and non-urgent cases. Although the current practice of telemedicine still has plenty of room for improvements in the standardization of training, connectivity and technological constraints, and addressing liability concerns, it can serve as an adjunct to face-to face consultations to provide optimal care for patients.
Telemedicine ; COVID-19 ; Pandemics

Objective: This study aimed to determine the prevalence and severity of major depressive disorder, generalized anxiety disorder, and the level of perceived stress of the Physician Licensure Exam (PLE) takers during the COVID-19 pandemic. Method: We conducted a cross-sectional descriptive survey among the Physician Licensure Exam takers using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder (GAD-7), and Perceived Stress Scale (PSS). Results: Seven hundred thirty-two (732) Physician Licensure Exam takers participated in the survey, 423 (57.8%) were November takers and 309 (42.2%) were March takers who will be completing the exam on September 2020. The prevalence rates of major depression and generalized anxiety disorder among the PLE takers were 44.1% and 50.3%, respectively. November takers have a higher rate of depression (60.1%) and anxiety (52.7%) compared to the March takers (54.4% and 46.6%, respectively). The majority of the takers have moderate levels of depression (26.6%), anxiety (37.8%), and perceived stress (70.2%). There was a significant difference in the prevalence of major depression between the March and November takers (p-value <0.00001) but not with generalized anxiety disorder (p-value: 0.05155). There was also no significant difference in the severity of depression (p value=0.527878), anxiety (p-value=0.883558), and levels of perceived stress (p- value=0.2476) between the March and November takers. Conclusions There was a high prevalence of major depression and generalized anxiety disorder among the PLE takers during the COVID19 pandemic. Majority of the PLE takers experienced moderate levels of depression, anxiety, and perceived stress.
Covid-19 ; Pandemics

Introduction. The COVID-19 pandemic presented an extraordinary challenge to the operations of private hospitals involved in neurological residency training. Numerous adaptations were made to restructure the hospital, including the special units and diagnostic centers. Teaching and training activities were swiftly transitioned to online platforms and research activities were streamlined. Manpower allocation into teams with active duties followed by mandatory quarantine periods became the norm.

Objective. To evaluate the effect of the COVID-19 pandemic on the neurology training program by comparing two periods: pre-pandemic and pandemic periods.

Methods. We reviewed the changes implemented by the hospital in response to the pandemic. We also looked into our residency training program pre-pandemic and the subsequent changes instituted to adapt to the pandemic.

Results. Due to the community quarantine imposed by the government, there was a drastic drop by as much as 70.5% in the out-patient census, 38.4% in the in-patient census, and 46.9% in neurodiagnostic (electroencephalography and electrodiagnostic medicine). The residents were reorganized into three teams of 4 residents, further divided into COVID and non-COVID rotations for 5 days straight duty. Consultants were also stratified into high-risk (on-call for emergency referrals in a work-from-home scheme) and non-high-risk (COVID patient rounds). Teleconsultation was likewise utilized. Academic activities were shifted to blended online learning.

Conclusion. There was a need to reorganize resident staffing brought about by the hospital changes as well, to ensure safety during the pandemic. The pandemic has forced us to shift to alternative methods of teaching and examination, such as teleneurology. Regular assessments and adjustments to the training program will need to be done to adapt to an evolving situation.

Background: Being at the frontline, nurses working in hospital settings are vulnerable to a range of experiences that impact their wellbeing. Measures to protect their health and welfare during the COVID-19 pandemic have been the focus of discussion among policymakers and administrators. There is a need to collectively understand their personal experiences to inform relevant policy decisions. Objective: To synthesize and present the best available evidence describing the experiences of nurses working in hospital settings during the COVID-19 pandemic. Design: This is a rapid review using Tricco's seven stage process. Data sources: A structured search using PubMed, CINAHL, Scopus, and a local database Herdin was conducted. Review Methods: A rapid review of studies published from January to August 2020, describing nurses' experiences of working in hospital facilities during the COVID-19 pandemic were included regardless of methodology. Following data screening and extraction, a narrative synthesis of the findings was conducted. Results: Nineteen articles were included in the review. The experiences of nurses described in these articles generated a total of fifteen categories, based on similarities of meaning. Four synthesized findings were identified from the categories: (a) supportive nursing culture; (b) physical, emotional, and psychological impact of frontline work; (c) organizational responsiveness; (d) and maintaining standards of care. Conclusions Nurses' experiences working in hospital settings during the COVID-19 pandemic are diverse, profound, and dependent on the context of practice and prevailing healthcare system and organization. These experiences reflect personal encounters and shifts in healthcare delivery that ensure protection and safety while maintaining standards of care. Robust studies are needed to capture and explore the breadth of these experiences and heighten the discussions that advocate for nurses' welfare and safety during pandemics.
COVID-19 ; Pandemics

Background: The COVID-19 pandemic has put an immense strain on health systems worldwide. Nurses at the front line are prone to experience several staffing issues facing ever-increasing stresses to the health care system by a pandemic situation. The staffing experiences of nurses in this context can have a significant impact on current nursing practice and existing policies. Objective: To carry out a synthesis of the scientific evidence available on the staffing experiences of nurses during the SARS, MERS, and Ebola epidemics. Method: A narrative review was conducted. A literature search was carried out in PubMed, Scopus, and CINAHL databases. All studies describing nurses' experiences were included regardless of methodology. Atotal of 16 articles was included in the review. Results: Narrative synthesis revealed ten themes from the results of the articles: training, staffing ratios and models, shifting models, volunteer staffing, skill mix, planning staffing needs, hospital preparedness, communication, effects of workload, and structured workflow processes. Conclusions Nurses are pivotal to the healthcare response to infectious disease pandemics and epidemics. The results of this review should provide a basis for nurse managers and administrators on how they can actively engage in supporting the staffing concerns and issues of nurses during the COVID-19 pandemic.
COVID-19 ; Pandemics

Background: With the increasing number of COVID positive cases still being reported in the country, coupled with the possible vulnerability of pregnant patients to the disease, aggressive measures must be taken by all institutions to ensure safety of the patients. Objective: This study aimed to the determine the clinical profile and pregnancy outcome of patients who were admitted at a tertiary private hospital in Metro Manila from March 16, 2020 to June 15, 2020 in relation to the protocols that were implemented in response coronavirus disease 2019 pandemic. Methods: The protocols and guidelines implemented by the Department of Obstetrics and Gynecology of a private tertiary hospital in Metro Manila from March 16, 2020 to June 15, 2020 were retrieved. The case record of patients who were admitted and delivered during this period were retrieved and reviewed for pertinent data, which were recorded in a patient data collection form. Results: During the 3-month study period, COVID positive pregnant patients were effectively separated from COVID negative patients from admission to discharge based on a health declaration form and universal reverse transcriptase polymerized chain reaction (RT-PCR) testing. Discharge was facilitated after 12–48 h for uncomplicated deliveries and post partum follow-up was done via telemedicine. Conclusion The separation of COVID positive from COVID negative patients based on symptoms and RT-PCR results were effective in ensuring the safety of patients.
COVID‑19 ; Pandemics ; Quarantine