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The objective of the study is to determine the prevalence of COVID-19 in the context of a secondary pneumonia surveillance program targeted at low-risk patients and to identify clinical characteristics associated with COVID-19. This study design is a retrospective cohort study. This study is conducted in Tan Tock Seng Hospital, a University affiliated 1600-bed public hospital in Singapore. Patients with pneumonia admitted under our Enhanced Pneumonia Surveillance (EPS) program from 7 February 2020 to 20 March 2020 were included. Relevant clinical variables were collated. Of 1295 patients admitted under our EPS program, 47 (3.6%) patients tested positive for COVID-19. The prevalence of a radiologist-reported normal chest X-ray (CXR) in the COVID-19–positive group was 62.8% compared with 6.2% in the COVID-19–negative group. In patients with a normal CXR, a low normal white blood cell (WBC) count and minimal C-reactive protein (CRP) elevation were associated with COVID-19. The pick-up rate of COVID-19 in low-risk patients with pneumonia is 3.6%. However, at least 7.9% of patients who were isolated had a normal CXR. For patients with pneumonia-like illness at presentation but a normal CXR, higher WBC and CRP values may guide early deisolation. Ultimately, this informs resource allocation for both COVID-19 and non–COVID-19 clinical services. • A secondary, pneumonia surveillance program can complement screening of suspect cases. • An unintended consequence of this program was capturing of patients with normal chest X-rays. • White blood cell count and C-reactive protein levels may guide early deisolation in this group of patients. • Results of a pneumonia surveillance system can inform future hospital resource management. [ABSTRACT FROM AUTHOR]

Introduction. During the early days of coronavirus disease 2019 (COVID-19) in Singapore, Tan Tock Seng Hospital implemented an enhanced pneumonia surveillance (EPS) programme enrolling all patients who were admitted from the Emergency Department (ED) with a diagnosis of pneumonia but not meeting the prevalent COVID-19 suspect case definition. Hypothesis/Gap Statement. There is a paucity of data supporting the implementation of such a programme. Aims. To compare and contrast our hospital-resource utilization of an EPS programme for COVID-19 infection detection with a suitable comparison group. Methodology. We enrolled all patients admitted under the EPS programme from TTSH's ED from 7 February 2020 (date of EPS implementation) to 20 March 2020 (date of study ethics application) inclusive. We designated a comparison cohort over a similar duration the preceding year. Relevant demographic and clinical data were extracted from the electronic medical records. Results. There was a 3.2 times higher incidence of patients with an admitting diagnosis of pneumonia from the ED in the EPS cohort compared to the comparison cohort ( P <0.001). However, there was no significant difference in the median length of stay of 7 days ( P =0.160). Within the EPS cohort, stroke and fluid overload occur more frequently as alternative primary diagnoses. Conclusions. Our study successfully evaluated our hospital-resource utilization demanded by our EPS programme in relation to an appropriate comparison group. This helps to inform strategic use of hospital resources to meet the needs of both COVID-19 related services and essential 'peace-time' healthcare services concurrently.

Background: Confluent and reticulate papillomatosis of Gougerot and Carteaud (CRP) is a rare dermatological condition, which has not been reported widely in Asian populations., Aim: To characterize the clinicopathological and diagnostic features of CRP in a South-East Asian population., Methods: The medical records of 29 patients accorded the diagnosis of CRP at the National Skin Centre, Singapore, from 1990 to 2011, were analyzed., Results: The male to female ratio was 2.6:1. Eight patients were Indians. The mean age at the onset of skin eruptions was 29.1 years (range 16-55 years), while the mean duration was 19.9 months (range 0.5-120 months). CRP itself was the most common preliminary diagnosis. Fungal smears were negative in all 22 instances. All 29 patients had received a trial of antifungal therapy before being seen at our center. Antifungal therapy was repeated in three subjects, and the response was uniformly poor. Conversely, the treatment response with tetracyclines was excellent, yielding more than a 50% response in all 14 patients. Four patients suffered recurrence of CRP. According to the diagnostic criteria set forth by Davis et al., 25/29 patients (86.2%) and 19/29 patients (65.6%) fulfilled at least three and four criteria, respectively., Conclusion: A predilection for male gender and Indian ethnicity were noted in our study. The diagnosis of CRP was often made clinically, and investigations were mainly ancillary. The treatment response was poor with antifungal agents but excellent with tetracyclines. The diagnostic criteria proposed by Davis et al. were found to be useful in our cohort of patients.