Ministry of Health Ankara City Hospital, Bilkent, Ankara, Turkey.
Department of Electrical and Electronics Engineering, Bilkent University, Bilkent, Ankara, Turkey.
J Matern Fetal Neonatal Med. 2021 Nov;34(21):3591-3600. doi: 10.1080/14767058.2021.1875440. Epub 2021 Feb 28.
Compartmental models simplify the mathematical modeling of infectious diseases based on reported cases. In the absence of precautions, personal protective equipment, quarantine and social distancing, a Susceptible-Exposed-Infectious-Recovered (SuEIR) model with Unscented Kalman Filter for coronavirus disease-19 (COVID-19) Forecasts in Turkey has revealed 174 641 infected people on August 15, 2020, whilst the reported case was 12 216. Through numerical experiments, the effects of quarantine, social distancing, and COVID-19 testing on the dynamics of the outbreak varies. We herein present the documentation of the work in a perinatology clinic during COVID-19 pandemic to find the reflection in a pandemic hospital as even in the pandemic, pregnancy complications and fetal diagnosis/therapy are time-sensitive and cannot be delayed. During the prevention of the horizontal transmission to the health-care workers (HCWs), testing all pregnant women with nasopharyngeal/oropharyngeal swabs for severe acute respiratory syndrome coronavirus (SARS-COV-2) undergoing birth, ultrasound examinations, invasive procedures appear to be the gold standard so that appropriate precautions can be taken if the screen is positive. Though it is logical, it may be incompatible with a busy obstetric practise as a pending polymerase chain reaction (PCR) result should never delay any emergent procedure.
We aim to describe the development of COVID-19 disease of 408 HCW out of 1462 by the exposure to pregnant women while providing obstetric care in a single tertiary perinatology unit under strict clinical triage, recommended precautions and wearing personal protective equipment and compare the maternal and perinatal outcome with those of the preceding three months.
A prospective cohort study involving the pregnant women and the HCW with positive PCR for SARS-COV-2 were carried out to correlate with the horizontal transmission while documenting the perinatal work.
25 HCW, including nurses/midwives: 11, doctors: 7 and health technicians: 3 and support staff: 4 developed positive PCR for SARS-COV-2 while providing healthcare to 162 cases: mild-moderate ( = 146), severe ( = 12) and critical ( = 1) and asymptomatic ( = 3) in obstetric population. 22 out of 25 HCW were working in the perinatology unit. COVID-19 clinic was asymptomatic ( = 8), mild-moderate (13) or severe ( = 2) in HCW. However, "Exposed" group in the SuEIR model, both the pregnant women and the HCW that have already been infected and have not been tested, which have been also capable of infecting the "Susceptible" group could not be determined. Some of the HCW and the pregnant women in the "Exposed" group were tested and transferred to the "Infectious" group (which were reported to be PCR positive), while the rest of them who recovered, transitted to the so-called "Unreported Recovered" group. The ratio of the women with severe pre-eclampsia admitted to intensive care unit increased significantly during the lockdown ( = .01).
In a nonstop pandemic perinatology clinic, exposure to 162 PCR positive pregnant women may be correlated with a 5.4% (22/408) documented horizontal transmission in the frontline HCW despite clinical triage and personal protective equipment.
基于报告病例， compartmental 模型简化了传染病的数学建模。在没有采取预防措施、个人防护设备、隔离和社会疏远措施的情况下，针对冠状病毒病-19（COVID-19）在土耳其的预测，采用了具有无迹卡尔曼滤波器的易感-暴露-感染-恢复（SuEIR）模型，该模型预测 2020 年 8 月 15 日将有 174641 人感染，而报告病例数为 12216 例。通过数值实验发现，隔离、社会疏远和 COVID-19 检测对疫情动态的影响各不相同。本文介绍了在 COVID-19 大流行期间在围产医学诊所的工作记录，以在大流行医院中找到反映，因为即使在大流行期间，妊娠并发症和胎儿诊断/治疗也是时间敏感的，不能延迟。在预防向医护人员（HCW）横向传播的过程中，对所有接受分娩的、经鼻咽/口咽拭子检测严重急性呼吸综合征冠状病毒（SARS-COV-2）的孕妇、超声检查、有创性操作进行检测，似乎是金标准，以便在筛查呈阳性时采取适当的预防措施。虽然这是合乎逻辑的，但它可能与繁忙的产科实践不兼容，因为悬而未决的聚合酶链反应（PCR）结果绝不应该延迟任何紧急程序。
我们旨在描述在严格的临床分诊、推荐的预防措施和佩戴个人防护设备的情况下，在一个单一的三级围产医学单位为 1462 名孕妇提供产科护理的情况下，408 名 HCW 中 COVID-19 疾病的发展情况，并将其与前三个月的母婴和围产期结局进行比较。
进行了一项前瞻性队列研究，涉及接受 SARS-COV-2 聚合酶链反应阳性检测的孕妇和 HCW，以在记录围产期工作的同时，对水平传播进行相关性分析。
在为 162 例病例（轻度-中度：146 例，严重：12 例，危急：1 例，无症状：3 例）提供医疗保健时，包括护士/助产士：11 例、医生：7 例和卫生技术人员：3 例和支持人员：4 例 HCW 的 SARS-COV-2 聚合酶链反应呈阳性。25 名 HCW 中，22 名在围产医学单位工作。COVID-19 诊所中，HCW 为无症状（8 例）、轻度-中度（13 例）或严重（2 例）。然而，在 SuEIR 模型的“暴露”组中，已经感染但未接受检测的孕妇和 HCW，以及尚未感染的“易感”组，也有可能感染“暴露”组。一些 HCW 和“暴露”组的孕妇已经接受了检测，并转移到“感染”组（报告 PCR 阳性），而其余的已经康复，并转移到所谓的“未报告的康复”组。在封锁期间，重症子痫前期患者入住重症监护病房的比例显著增加（ = .01）。
在一个不停歇的大流行围产医学诊所中，尽管进行了临床分诊和个人防护设备，但是与 162 名 PCR 阳性孕妇接触可能与一线 HCW 中 5.4%（22/408）记录的水平传播相关。
