Challenge | Changes/unwanted consequences | Affected |
Lockdown | • Loss of work, loss of income • Increase in mental health issues, domestic violence and suicide • Limited possibilities of transportation to health care facilities • Aggression and racism against minorities • Cancellation of appointments and elective surgery • Reduced or negated access to hospital to visit love ones • Reduced or no access to funerals and religious cerimonies • Less attention/priority for co-morbidities or other diseases (i.e. avoiding to access health care facilities for fear even in the presence of severe symptoms) • Personal drug procurement: less access to pharmacies, especially to hospital pharmacies and public dispensaries • Drugs distribution irregularities • Nursery and school closures • Loss of exams, school years • Loss of holidays | • Patients • HCWs • Everyone |
Social distancing | • Reduction in support from peers, social workers, relatives, friends • Increased isolation and deprivation • Challenges in travelling: disruption of public transport, fewer seats available, booking necessity (even for short-medium distances) • Long queues for shopping of essentials • Increase in mental health issues, domestic violence and suicide | • Patients • Everyone |
Differential diagnosis | • Increase in number and type of diagnostic procedures and tests (to exclude or confirm concomitant COVID-19) • Reduction in spirometry, imaging and ultrasonography due to infection control concerns • Lack of reagents due to unprecendented global demand • Lack of laboratory capacity • Reduced medical workforce due to illness • Misdiagnosis, especially of respiratory co-morbidities (at least during COVID peaks) • Delayed diagnosis • Underestimation of clinical impact of concomitant co-morbidities (respiratory or not) • Challenges in diagnosis of COVID versus TB sequelae | • Patients • HCWs |
Avoiding transmission of SARSCoV2 in healthcare settings | • Reduction in number of patients evaluated per day (more time needed to assess patients) • Changes in flow for diagnosis and visits within health facilities • Slower procedures: triage pre-entry; disinfection after each visit/diagnostic procedure; personal distancing (from a patient to another or from patient to health staff), etc. • Postponement of appointments (at least during COVID peaks) • Temporary discontinuation of rehabilitation activities (at least during COVID peaks) • Limiting outpatients’ activities to urgent issues (at least during COVID peaks) • Replacement of face-to-face activities towards phone, remote web-based interactions (including psychological support; adherence support initiatives, etc) • Stockouts of protective equipment (at least during COVID peaks) • Increased cost of healthcare services | • Patients • HCWs |
Peaks of epidemics | • Shift of resources (financial, staff, protective equipment, laboratory, other diagnostics, etc.) from existing programmes to COVID • Paralysis of emergency departments (at least during COVID peaks) • Shift of HCWs to COVID wards • High transmission of SARSCoV2 to HCWs: sick leave, HCWs hospitalisations, HCWs deaths • Health staff for contact tracing activities shifted to COVID activities • Rapid exhaustion of protective equipment (at least during COVID peaks) • Lack of drugs, oxygen, consumables • Lack of invasive and non-invasive ventilators | • Patients • HCWs |
Legend: HCWs: health care workers; TB: tuberculosis.