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Lessons learnt from the first wave of COVID-19 in Damascus, Syria: a multicentre retrospective cohort study

OBJECTIVES: The decade-long Syrian war led to fragile health infrastructures lacking in personal and physical resources. The public health of the Syrian population was, therefore, vulnerable to the COVID-19 pandemic, which devastated even well-resourced healthcare systems. Nevertheless, the official...

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Autores principales: Hanafi, Ibrahem, Alzamel, Lyana, Alnabelsi, Ola, Sallam, Sondos, Almousa, Samaher
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10360434/
https://www.ncbi.nlm.nih.gov/pubmed/37474170
http://dx.doi.org/10.1136/bmjopen-2022-065280
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author Hanafi, Ibrahem
Alzamel, Lyana
Alnabelsi, Ola
Sallam, Sondos
Almousa, Samaher
author_facet Hanafi, Ibrahem
Alzamel, Lyana
Alnabelsi, Ola
Sallam, Sondos
Almousa, Samaher
author_sort Hanafi, Ibrahem
collection PubMed
description OBJECTIVES: The decade-long Syrian war led to fragile health infrastructures lacking in personal and physical resources. The public health of the Syrian population was, therefore, vulnerable to the COVID-19 pandemic, which devastated even well-resourced healthcare systems. Nevertheless, the officially reported incidence and fatality rates were significantly lower than the forecasted numbers. DESIGN: A retrospective cohort study. SETTING: The four main responding hospitals in Damascus, which received most of the cases during the first pandemic wave in Syria (i.e., June–August 2020). PARTICIPANTS: One thousand one hundred eighty-four patients who were managed as inpatient COVID-19 cases. PRIMARY AND SECONDARY OUTCOME MEASURES: The records of hospitalised patients were screened for clinical history, vital signs, diagnosis modality, major interventions and status at discharge. RESULTS: The diagnostic and therapeutic preparedness for COVID-19 was significantly heterogeneous among the different centres and depleted rapidly after the arrival of the first wave. Only 32% of the patients were diagnosed based on positive reverse transcription-PCR tests. Five hundred twenty-six patients had an indication for intensive care unit admission, but only 82% of them received it. Two hundred fifty-seven patients needed mechanical ventilation, but ventilators were not available to 14% of them, all of whom died. Overall mortality during hospitalisation reached 46% and no significant difference was found in fatality between those who received and did not receive these care options. CONCLUSIONS: The Syrian healthcare system expressed minor resilience in facing the COVID-19 pandemic, as its assets vanished swiftly with a limited number of cases. This forced physicians to reserve resources (e.g., ventilators) for the most severe cases, which led to poor outcomes of in-hospital management and limited the admission capacity for milder cases. The overwhelmed system additionally suffered from constrained coordination, suboptimal allocation of the accessible resources and a severe inability to informatively report on the catastrophic pandemic course in Syria.
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spelling pubmed-103604342023-07-22 Lessons learnt from the first wave of COVID-19 in Damascus, Syria: a multicentre retrospective cohort study Hanafi, Ibrahem Alzamel, Lyana Alnabelsi, Ola Sallam, Sondos Almousa, Samaher BMJ Open Infectious Diseases OBJECTIVES: The decade-long Syrian war led to fragile health infrastructures lacking in personal and physical resources. The public health of the Syrian population was, therefore, vulnerable to the COVID-19 pandemic, which devastated even well-resourced healthcare systems. Nevertheless, the officially reported incidence and fatality rates were significantly lower than the forecasted numbers. DESIGN: A retrospective cohort study. SETTING: The four main responding hospitals in Damascus, which received most of the cases during the first pandemic wave in Syria (i.e., June–August 2020). PARTICIPANTS: One thousand one hundred eighty-four patients who were managed as inpatient COVID-19 cases. PRIMARY AND SECONDARY OUTCOME MEASURES: The records of hospitalised patients were screened for clinical history, vital signs, diagnosis modality, major interventions and status at discharge. RESULTS: The diagnostic and therapeutic preparedness for COVID-19 was significantly heterogeneous among the different centres and depleted rapidly after the arrival of the first wave. Only 32% of the patients were diagnosed based on positive reverse transcription-PCR tests. Five hundred twenty-six patients had an indication for intensive care unit admission, but only 82% of them received it. Two hundred fifty-seven patients needed mechanical ventilation, but ventilators were not available to 14% of them, all of whom died. Overall mortality during hospitalisation reached 46% and no significant difference was found in fatality between those who received and did not receive these care options. CONCLUSIONS: The Syrian healthcare system expressed minor resilience in facing the COVID-19 pandemic, as its assets vanished swiftly with a limited number of cases. This forced physicians to reserve resources (e.g., ventilators) for the most severe cases, which led to poor outcomes of in-hospital management and limited the admission capacity for milder cases. The overwhelmed system additionally suffered from constrained coordination, suboptimal allocation of the accessible resources and a severe inability to informatively report on the catastrophic pandemic course in Syria. BMJ Publishing Group 2023-07-20 /pmc/articles/PMC10360434/ /pubmed/37474170 http://dx.doi.org/10.1136/bmjopen-2022-065280 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Infectious Diseases
Hanafi, Ibrahem
Alzamel, Lyana
Alnabelsi, Ola
Sallam, Sondos
Almousa, Samaher
Lessons learnt from the first wave of COVID-19 in Damascus, Syria: a multicentre retrospective cohort study
title Lessons learnt from the first wave of COVID-19 in Damascus, Syria: a multicentre retrospective cohort study
title_full Lessons learnt from the first wave of COVID-19 in Damascus, Syria: a multicentre retrospective cohort study
title_fullStr Lessons learnt from the first wave of COVID-19 in Damascus, Syria: a multicentre retrospective cohort study
title_full_unstemmed Lessons learnt from the first wave of COVID-19 in Damascus, Syria: a multicentre retrospective cohort study
title_short Lessons learnt from the first wave of COVID-19 in Damascus, Syria: a multicentre retrospective cohort study
title_sort lessons learnt from the first wave of covid-19 in damascus, syria: a multicentre retrospective cohort study
topic Infectious Diseases
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10360434/
https://www.ncbi.nlm.nih.gov/pubmed/37474170
http://dx.doi.org/10.1136/bmjopen-2022-065280
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