Burn patients' management during the COVID-19 pandemic: An institutional report from the Mohammed Vth Teaching Armed Forces Hospital in Morocco.

Since the early outbreak of the pandemic in Morocco by March 2nd 2020, Moroccan officials have taken several drastic measures, both at the individual and community levels, to contain the pandemic and limit the spread of the disease.

The Health care system had also to adapt to this unpreceded situation by designating special hubs for COVID-19 patients testing, admission and care.

In response to the COVID-19 emergency plan, the Mohammed V Teaching Armed Forces Hospital in Rabat has been taking part of the national medical workforce. Therefore, a complete reorganization took place to efficiently manage the expected massive flow of COVID-19 patients while allowing for a continuous medical service at the same time. An hybrid organization has been implemented mimicking similar infrastructures from other countries [1].

We would like through this letter to share and summarize our experience in managing burn patients during the COVID-19 pandemic at the National Reference Burn Center of Mohammed Vth Military Hospital in Rabat.

General Organization:

As part of the general organization of the Hospital, three separate pathways were created for patients’ admission: Non COVID, COVID positive and suspected cases circuit.

The burn department, located in the Non-COVID building, was therefore assigned to provide continuous care while strictly complying with the Hospital policies and directives during this pandemic.

Burn Patients pathway:

Before admission to the department, patients undergo a fever testing along with a questionnaire, and stratified according to a specific scoring system as part of the risk assessment process of patients [2].

Highly suspected burn patients, are to be transferred to the infectious disease department, part of the COVID positive pathway.

Patients requiring immediate surgery for a life-threatening condition (severe face burn for example) were considered as COVID positive cases and managed within negative pressure operating theatre with maximal airborne precautions and PPE (personal protective equipment) [1].

Burn Admission profile:

Patients were separated into three categories: Major, intermediate and minor burn cases.

While all elective cases were postponed and rescheduled, major and intermediate burn patients were admitted to the department. Minor burn patients were examined, given primary care and instructed to self-dressing procedures and then followed over phone calls and on an ambulatory basis twice a week.

Admitted patients undergo systematic blood screening including: Blood cell count, Troponin level, LDH, D-Dimers, Procalcitonin, C reactive protein, Urea and creatinine. Additional thoracic CT-Scan and rt-PCR Swab screening are performed for patients presenting respiratory or general symptoms (fever) during the course of the hospitalization.

Individual patient room and nursing equipment were also respected during this period.

Visitors were limited to one per-patient per-day, and all undergo the triage and fever screening step.

Epidemiology of burns:

We analyzed the data regarding patients’ admission and burn profile during the 3-months lockdown period (march 16th to June 10th), and compared it to the same period of year 2019 (Fig. 1 ). Overall, the number of admissions decreased by 50% between the two periods (34 vs 70 patients), and because of the lockdown and the consequent decrease in industrial activity, only one professional burn case was admitted (4%); the 33 remaining cases (96%) occurred from domestic burns.

Fig. 1

Comparative profile and epidemiology of burn patients during the COVID-19 pandemic (March to June2020) and 2019 (same period).

Thermic injury remained the main cause of burns in admitted patients (97% in 2020 vs 85% in 2019), while a significant decrease in chemical and electric burn was observed.

Regarding the severity of burns, only one patient (4%) was considered as having a major burn and 33 patients (96%) as intermediate, while in the same period of 2019, 10 (15%) cases were major burns and 60 (85%) as intermediate.

Although being prepared for a massive surge during the lockdown period, no ICU care was required for admitted burn patients.

Similar findings were collected in many centers as part of the direct consequences of the extensive lockdown measures taken worldwide [3,4]. However, this low rate of admitted burn patients may also reflect an inadequate access to care, as patient may fear to go to the hospital to avoid contamination, and rather use self-medication. Among patients admitted to our department, two cases suffered from neglected intermediate burns leading to advanced clinical condition. Burn centers should therefore expect a backlog of patients who experienced an abnormal course of burn healing and/or with intermediate to major late burn effects.

Declarations of interest

None.

Acknowledgments of contribution

Fatima Ezzahra Fouadi, author, conception study design and drafting; Karim Ababou, Co-author, acquisition of data; Ahmed Belkouch, co-author, drafting and data analysis; Karim El Khatib, reviewer; Samir Siah, reviewer.