Faculty of Health, Dalhousie University, Halifax, NS, Canada.
Maritime SPOR SUPPORT Unit, Halifax, NS, Canada.
BMC Health Serv Res. 2022 Apr 23;22(1):544. doi: 10.1186/s12913-022-07847-0.
As of November 25th 2021, four SARS-CoV - 2 variants of concern (VOC: Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), and Delta (B.1.617.2)) have been detected. Variable degrees of increased transmissibility of the VOC have been documented, with potential implications for hospital and health system capacity and control measures. This rapid review aimed to provide a synthesis of evidence related to health system responses to the emergence of VOC worldwide.
Seven databases were searched up to September 27, 2021, for terms related to VOC. Titles, abstracts, and full-text documents were screened independently by two reviewers. Data were extracted independently by two reviewers using a standardized form. Studies were included if they reported on at least one of the VOC and health system outcomes.
Of the 4877 articles retrieved, 59 studies were included, which used a wide range of designs and methods. Most of the studies reported on Alpha, and all except two reported on impacts for capacity planning related to hospitalization, intensive care admissions, and mortality. Most studies (73.4%) observed an increase in hospitalization, but findings on increased admission to intensive care units were mixed (50%). Most studies (63.4%) that reported mortality data found an increased risk of death due to VOC, although health system capacity may influence this. No studies reported on screening staff and visitors or cohorting patients based on VOC.
While the findings should be interpreted with caution as most of the sources identified were preprints, evidence is trending towards an increased risk of hospitalization and, potentially, mortality due to VOC compared to wild-type SARS-CoV - 2. There is little evidence on the need for, and the effect of, changes to health system arrangements in response to VOC transmission.
截至 2021 年 11 月 25 日，已检测到四种关注的 SARS-CoV-2 变异株（VOC：Alpha（B.1.1.7）、Beta（B.1.351）、Gamma（P.1）和 Delta（B.1.617.2））。已经记录到 VOC 的传播能力有不同程度的提高，这可能对医院和卫生系统的能力和控制措施产生影响。本快速审查旨在综合全球范围内与 VOC 出现相关的卫生系统应对措施的证据。
2021 年 9 月 27 日之前，在七个数据库中搜索与 VOC 相关的术语。两名审查员独立筛选标题、摘要和全文文件。两名审查员使用标准化表格独立提取数据。如果研究报告了至少一种 VOC 和卫生系统结果，则纳入研究。
在检索到的 4877 篇文章中，纳入了 59 项研究，这些研究采用了广泛的设计和方法。大多数研究报告了 Alpha 的情况，除了两项研究外，所有研究都报告了与住院、重症监护入院和死亡率相关的容量规划的影响。大多数研究（73.4%）观察到住院人数增加，但对重症监护病房入院人数增加的研究结果存在差异（50%）。大多数报告死亡率数据的研究（63.4%）发现，由于 VOC，死亡风险增加，尽管卫生系统的能力可能会影响这一点。没有研究报告基于 VOC 对员工和访客进行筛查或对患者进行分组。
虽然由于确定的来源大多是预印本，因此应谨慎解释这些发现，但与野生型 SARS-CoV-2 相比，证据表明 VOC 导致住院和潜在死亡率增加的风险增加。关于应对 VOC 传播需要改变卫生系统安排以及改变效果的证据很少。
