COVID-19/epidemiology* ; Child ; Humans ; Infectious Disease Transmission, Vertical ; SARS-CoV-2 ; Singapore/epidemiology* ; Systemic Inflammatory Response Syndrome/virology*

In this paper, we provide guidance to clinicians who care for infants born to mothers with suspected/confirmed COVID-19 during this current pandemic. We reviewed available literature and international guidelines based on the following themes: delivery room management; infection control and prevention strategies; neonatal severe acute respiratory syndrome coronavirus 2 testing; breastfeeding and breastmilk feeding; rooming-in of mother-infant; respiratory support precautions; visiting procedures; de-isolation and discharge of infant; outpatient clinic attendance; transport of infant; and training of healthcare staff. This guidance for clinical care was proposed and contextualised for the local setting via consensus by members of this workgroup and was based on evidence available as of 31 July 2020, and may change as new evidence emerges.
Infant, Newborn ; Pregnancy ; Female ; Humans ; Mothers ; COVID-19/epidemiology* ; Singapore/epidemiology* ; COVID-19 Testing ; Pandemics/prevention & control* ; Infectious Disease Transmission, Vertical/prevention & control* ; Pregnancy Complications, Infectious/prevention & control*

INTRODUCTION: Healthcare workers (HCWs) are a critical resource in the effort to control the COVID-19 pandemic. They are also a sentinel surveillance population whose clinical status reflects the effectiveness of the hospital's infection prevention measures in the pandemic. METHODS: This was a retrospective cohort study conducted in Singapore General Hospital (SGH), a 1,822-bed tertiary hospital. Participants were all HCWs working in SGH during the study period. HCW protection measures included clinical workflows and personal protective equipment developed and adapted to minimise the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. HCW monitoring comprised staff contact logs in high-risk locations, twice-daily temperature monitoring, assessment of HCWs with acute respiratory illnesses (ARIs) in the staff clinic and, in the event of an exposure, extensive contact tracing, detailed risk assessment and risk-based interventions. HCW surveillance utilised monitoring data and ARI presentations and outcomes. RESULTS: In the ten-week period between 6 January 2020 and 16 March 2020, 333 (17.1%) of 1,946 HCWs at risk of occupational COVID-19 presented with ARI. 32 (9.6%) screened negative for SARS-CoV-2 from throat swabs. Five other HCWs developed COVID-19 attributed to non-clinical exposures. From the nine COVID-19 exposure episodes investigated, 189 HCW contacts were identified, of whom 68 (36.2%) were placed on quarantine and remained well. CONCLUSION Early in an emerging infectious disease outbreak, close monitoring of frontline HCWs is essential in ascertaining the effectiveness of infection prevention measures. HCWs are at risk of community disease acquisition and should be monitored and managed to prevent onward transmission.
Humans ; COVID-19/epidemiology* ; Pandemics/prevention & control* ; SARS-CoV-2 ; Infectious Disease Transmission, Patient-to-Professional/prevention & control* ; Sentinel Surveillance ; Retrospective Studies ; Infection Control ; Health Personnel

INTRODUCTION: Oropharyngeal swabs for diagnosis of COVID-19 often induce violent coughing, which can disperse infectious droplets onto providers. Incorrectly doffing personal protective equipment (PPE) increases the risk of transmission. A cheap, single-use variation of the face shield invented by a Singaporean team, SG Shield, aims to reduce this risk. This manikin study aimed to study the efficacy of the SG Shield in combination with standard PPE. METHODS: A person attired in full PPE whose face and chest was lined with grid paper stood in front of an airway manikin in an enclosed room. A small latex balloon containing ultraviolet fluorescent dye was placed in the oral cavity of the manikin and inflated until explosion to simulate a cough. Three study groups were tested: (a) control (no shield), (b) face shield and (c) SG Shield. The primary outcome was droplet dispersion, determined quantitatively by calculating the proportion of grid paper wall squares stained with fluorescent dye. The secondary outcome was the severity of provider contamination. RESULTS: The SG Shield significantly reduced droplet dispersion to 0% compared to the controls (99.0%, P = 0.001). The face shield also significantly reduced droplet contamination but to a lesser extent (80.0%) compared to the control group (P = 0.001). Although the qualitative severity of droplet contamination was significantly lower in both groups compared to the controls, the face shield group had more contamination of the provider's head and neck. CONCLUSION The manikin study showed that the SG Shield significantly reduces droplet dispersion to the swab provider's face and chest.
Humans ; Infectious Disease Transmission, Patient-to-Professional/prevention & control* ; COVID-19 ; Fluorescent Dyes ; Personal Protective Equipment ; Cough

COVID-19/transmission* ; COVID-19 Testing ; Humans ; Infection Control ; Infectious Disease Transmission, Patient-to-Professional/prevention & control* ; Intraoperative Care ; Pandemics ; Personal Protective Equipment ; Postoperative Care ; Preoperative Care ; Tracheostomy/methods*

COVID-19/transmission* ; Cesarean Section ; Emergencies ; Female ; Humans ; Infectious Disease Transmission, Patient-to-Professional/prevention & control* ; Inservice Training ; Pregnancy ; Respiratory Protective Devices ; Time-to-Treatment

INTRODUCTION: Teleophthalmology may assist the healthcare sector in adapting to limitations imposed on clinical practice by a viral pandemic. A scoping review is performed in this study to assess the current applications of teleophthalmology for its suitability to diagnose, monitor or manage ophthalmological conditions with accuracy. METHODS: A search of PubMed was conducted for teleophthalmology-related articles published from 1 January 2018 to 4 May 2020. Only articles that focused on the use of teleophthalmology in terms of diagnosis and management, as well as its benefits and detriments, were included. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the included articles. RESULTS: A total of 38 articles were assessed at the full-text level. There were 2 qualitative studies and 1 quantitative randomised controlled trial, while the majority were either quantitative descriptive studies (19, 50.0%) or quantitative non-randomised studies (16, 42.1%). Overall, 8 studies described reducing manpower requirements, 4 described reducing direct patient-doctor contact, 17 described storage of medical imaging and clinical data, and 9 described real-time teleconferencing. The MMAT analysis revealed limitations in appropriate sampling strategy in both quantitative non-randomised studies (9 of 16, 56.3%) and quantitative descriptive studies (9 of 19, 47.4%). Cost-effectiveness of teleophthalmology was not performed in any included study. CONCLUSION This current review of the various aspects of teleophthalmology describes how it may potentially assist the healthcare sector to cope with the limitations imposed by a viral pandemic through technology. Further research is required to evaluate the cost-effectiveness of the various strategies.
COVID-19/transmission* ; Humans ; Ophthalmology/organization & administration* ; Telemedicine/organization & administration*

COVID-19/transmission* ; Communicable Disease Control/organization & administration* ; Humans ; Remote Consultation/organization & administration* ; Singapore/epidemiology* ; Videoconferencing/organization & administration*

COVID-19/transmission* ; Communicable Disease Control/organization & administration* ; Humans ; Thailand/epidemiology*

COVID-19/transmission* ; Communicable Disease Control/organization & administration* ; Education, Distance/organization & administration* ; Education, Medical/organization & administration* ; Humans ; Otolaryngology/organization & administration* ; Singapore/epidemiology* ; Telemedicine/organization & administration*