TABLE 1.

The challenges and changes facing healthcare staff and patients during the coronavirus disease 2019 (COVID-19) epidemic

Challenge	Changes/unwanted consequences	Affected parties
Lockdown	Loss of work, loss of income Increase in mental health issues, domestic violence and suicide Limited options for transportation to healthcare facilities Aggression and racism towards minorities Cancellation of appointments and elective surgery Reduced or no access to hospital to visit loved ones Reduced or no access to funerals and religious ceremonies Less attention/reduced priority for comorbidities and other diseases (i.e. avoiding accessing healthcare facilities due to fear, even in the presence of severe symptoms) Personal drug procurement: reduced access to pharmacies, especially hospital pharmacies and public dispensaries Drug distribution irregularities Nursery and school closures Cancellation of exams, lost school years Cancellation of holidays	Everyone
Social distancing	Reduction in support from peers, social workers, relatives, friends Increased isolation and deprivation Travel challenges: disruption to public transport, fewer seats available, booking necessary (even for short-to-medium distances) Long queues for shopping essentials Increase in mental health issues, domestic violence and suicide	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 comorbidities (at least during COVID-19 peaks) Delayed diagnosis Underestimation of the clinical impact of concomitant comorbidities (respiratory or not) Challenges in diagnosis of COVID-19 versus TB sequelae	Patients HCWs
Avoiding transmission of SARS-CoV-2 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. Postponing appointments (at least during COVID-19 peaks) Temporary discontinuation of rehabilitation activities (at least during COVID-19 peaks) Limiting outpatient activities to urgent issues (at least during COVID-19 peaks) Replacement of face-to-face activities with phone/remote web-based interactions (including psychological support, adherence support initiatives, etc.) Lack of protective equipment (at least during COVID peaks) Increased cost of healthcare services	Patients HCWs
Peaks of epidemic	Shift of resources (financial, staff, protective equipment, laboratory, other diagnostics, etc.) from existing programmes to COVID-19 Paralysis of emergency departments (at least during COVID-19 peaks) Shift of HCWs to COVID-19 wards High transmission of SARS-CoV-2 to HCWs: sick leave, HCW hospitalisations, HCW deaths Health staff for contact tracing activities shifted to COVID-19 Rapid exhaustion of protective equipment (at least during COVID-19 peaks) Lack of drugs, oxygen, consumables Lack of invasive and noninvasive ventilators	Patients HCWs

HCWs: healthcare workers; TB: tuberculosis; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.