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Hogan DB, Maxwell CJ, Dampf H, McGrail K, Estabrooks CA, Poss JW, Bakal JA, Hoben M. Excess Deaths in Assisted Living and Nursing Homes during the COVID-19 Pandemic in Alberta, Canada. J Am Med Dir Assoc 2024; 25:105032. [PMID: 38782041 DOI: 10.1016/j.jamda.2024.105032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Assisted living (AL) is a significant and growing congregate care option for vulnerable older adults designed to reduce the use of nursing homes (NHs). However, work on excess mortality in congregate care during the COVID-19 pandemic has primarily focused on NHs with only a few US studies examining AL. The objective of this study was to assess excess mortality among AL and NH residents with and without dementia or significant cognitive impairment in Alberta, Canada, during the first 2 years of the COVID-19 pandemic, relative to the 3 years before. DESIGN Population-based, retrospective cohort study. SETTING AND PARTICIPANTS Residents who lived in an AL or NH facility operated or contracted by the Provincial health care system to provide publicly funded care in Alberta between January 1, 2017, and December 31, 2021. METHODS We used administrative health care data, including Resident Assessment Instrument - Home Care (RAI-HC, AL) and Minimum Data Set 2.0 (RAI-MDS 2.0, NHs) records, linked with data on residents' vital statistics, COVID-19 testing, emergency room registrations, and hospital stays. The outcome was excess deaths during COVID-19 (ie, the number of deaths beyond that expected based on pre-pandemic data), estimated, using overdispersed Poisson generalized linear models. RESULTS Overall, the risk of excess mortality [adjusted incidence rate ratio (95% confidence interval)] was higher in ALs than in NHs [1.20 (1.14-1.26) vs 1.10 (1.07-1.13)]. Weekly peaks in excess deaths coincided with COVID-19 pandemic waves and were higher among those with diagnosed dementia or significant cognitive impairment in both, AL and NHs. CONCLUSIONS AND IMPLICATIONS Finding excess mortality within both AL and NH facilities should lead to greater focus on infection prevention and control measures across all forms of congregate housing for vulnerable older adults. The specific needs of residents with dementia in particular will have to be addressed.
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Affiliation(s)
- David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Colleen J Maxwell
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Hana Dampf
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey W Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Jeffrey A Bakal
- Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada; Alberta Strategy for Patient Oriented Research Support Unit, Edmonton, Alberta, Canada
| | - Matthias Hoben
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada; School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada.
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Hulscher N, Alexander PE, Amerling R, Gessling H, Hodkinson R, Makis W, Risch HA, Trozzi M, McCullough PA. Withdrawn: A systematic review of autopsy findings in deaths after COVID-19 vaccination. Forensic Sci Int 2024:112115. [PMID: 39120477 DOI: 10.1016/j.forsciint.2024.112115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/17/2024] [Accepted: 06/17/2024] [Indexed: 08/10/2024]
Abstract
This Article-in-Press has been withdrawn at the request of the Editors-in-Chief. Members of the scientific community raised concerns about this Article-in-Press following its posting online. The concerns encompassed. • Inappropriate citation of references. • Inappropriate design of methodology. • Errors, misrepresentation, and lack of factual support for the conclusions. • Failure to recognise and cite disconfirming evidence. The concerns were shared with the authors, who prepared a response and submitted a revised manuscript for consideration by the journal. In consideration of the extent of the concerns raised and the responses from the authors, the journal sent the revised manuscript to two independent peer-reviewers. The peer-reviewers concluded that the revised manuscript did not sufficiently address the concerns raised by the community and that it was not suitable for publication in the journal. The authors disagree with this withdrawal and dispute the grounds for it. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal.
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Affiliation(s)
- Nicolas Hulscher
- University of Michigan School of Public Health, Ann Arbor, MI, United States.
| | | | | | | | | | - William Makis
- Cross Cancer Institute, Alberta Health Services, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Harvey A Risch
- Professor Emeritus, Yale University School of Public Health, New Haven, CT, United States
| | | | - Peter A McCullough
- The Wellness Company, Boca Raton, FL, United States; Truth for Health Foundation, Tucson, AZ, United States
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Cooper IR, Schmaus A, Whitten TA, Bakal JA, Kurji F, Watt D, Lang E. Descriptive analysis and evaluation of Health Link referrals to the emergency department before and during the COVID-19 pandemic. Intern Emerg Med 2024; 19:1129-1137. [PMID: 38386095 DOI: 10.1007/s11739-023-03527-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/27/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND In Alberta, Health Link (HL) provides a 24-h, nurse-staffed, phone resource to the public for health-care advice. HL directs callers to either seek care in the emergency department (ED), with a primary care provider or provide self-care at home. This work aims to describe HL ED referrals prior to and during the COVID-19 pandemic. METHODS Data from January 1, 2018-December 31, 2019, and July 1, 2020-June 30, 2022, were selected. HL calls were categorized as likely appropriate if the patient was referred and presented to the ED within 24 h and had a Canadian Triage and Acuity Scale (CTAS) of 1-3; or a CTAS of 4-5 and the patient was admitted, specialist consulted, or diagnostic imaging or laboratory tests were completed. The primary outcome was the percentage of likely appropriate referrals among all HL ED referrals. RESULTS In the 2018-2019 and 2020-2022 samples, respectively, there were 845,372 and 832,730 calls. Of the 211,723 and 213,486 ED referrals, only 140,614 (66.4%) and 143,322 (67.1%) presented to an ED. Of these, 84.3 and 86.7 per 100 patient visits were categorized as likely appropriate referrals. Health Link referrals account for 3.2% and 3.8% of all ED visits. IMPACT HL referrals to the ED represent only a small percentage of all ED visits. Based on our definition, most referrals by HL are likely appropriate. The COVID-19 pandemic does not appear to have altered the rates of calls to HL, the number of HL calls referred to the ED, nor the likely appropriateness of those referrals.
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Affiliation(s)
- Ian R Cooper
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
| | - Andrew Schmaus
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Tara A Whitten
- Alberta Health Services, Edmonton, AB, Canada
- Alberta Strategy for Patient Oriented Research Support Unit Data Platform, Calgary, AB, Canada
- Provincial Research Data Services, Calgary, AB, Canada
| | - Jeffery A Bakal
- Alberta Health Services, Edmonton, AB, Canada
- Alberta Strategy for Patient Oriented Research Support Unit Data Platform, Calgary, AB, Canada
- Provincial Research Data Services, Calgary, AB, Canada
| | - Fayaz Kurji
- Alberta Health Services, Edmonton, AB, Canada
| | - Denise Watt
- Alberta Health Services, Edmonton, AB, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Eddy Lang
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
- Alberta Health Services, Edmonton, AB, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
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Natalia YA, Molenberghs G, Faes C, Neyens T. Geospatial patterns of excess mortality in Belgium: Insights from the first year of the COVID-19 pandemic. Spat Spatiotemporal Epidemiol 2024; 49:100660. [PMID: 38876554 DOI: 10.1016/j.sste.2024.100660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/21/2024] [Accepted: 05/14/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES Belgium experienced multiple COVID-19 waves that hit various groups in the population, which changed the mortality pattern compared to periods before the pandemic. In this study, we investigated the geographical excess mortality trend in Belgium during the first year of the COVID-19 pandemic. METHODS We retrieved the number of deaths and population data in 2020 based on gender, age, and municipality of residence, and we made a comparison with the mortality data in 2017-2019 using a spatially discrete model. RESULTS Excess mortality was significantly associated with age, gender, and COVID-19 incidence, with larger effects in the second half of 2020. Most municipalities had higher risks of mortality with a number of exceptions in the northeastern part of Belgium. Some discrepancies in excess mortality were observed between the north and south regions. CONCLUSIONS This study offers useful insight into excess mortality and will aid local and regional authorities in monitoring mortality trends.
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Affiliation(s)
| | - Geert Molenberghs
- I-BioStat, Data Science Institute, Hasselt University, 3500 Hasselt, Belgium; I-BioStat, Leuven Biostatistics and Statistical Bioinformatics Centre, KU Leuven, 3000 Leuven, Belgium
| | - Christel Faes
- I-BioStat, Data Science Institute, Hasselt University, 3500 Hasselt, Belgium
| | - Thomas Neyens
- I-BioStat, Data Science Institute, Hasselt University, 3500 Hasselt, Belgium; I-BioStat, Leuven Biostatistics and Statistical Bioinformatics Centre, KU Leuven, 3000 Leuven, Belgium
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Chen X, Norris C, Whitten T, Ho C, Mann B, Bakal J. Symptomology following COVID-19 among adults in Alberta, Canada: an observational survey study. BMJ Open 2024; 14:e078119. [PMID: 38458800 DOI: 10.1136/bmjopen-2023-078119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVE Fatigue, headache, problems sleeping and numerous other symptoms have been reported to be associated with long COVID. However, many of these symptoms coincide with symptoms reported by the general population, possibly exacerbated by restrictions/precautions experienced during the COVID-19 pandemic. This study examines the symptoms reported by individuals who tested positive for COVID-19 compared with those who tested negative. DESIGN Observational study. SETTING The study was conducted on adult residents in Alberta, Canada, from October 2021 to February 2023. PARTICIPANTS We evaluated self-reported symptoms in 7623 adults with positive COVID-19 tests and 1520 adults who tested negative, using surveys adapted from the internationally standardised International Severe Acute Respiratory and emerging Infection Consortium (ISARIC)-developed COVID-19 long-term follow-up tools. These individuals had an index COVID-19 test date between 1 March 2020 and 31 December 2022 and were over 28 days post-COVID-19 testing. PRIMARY OUTCOME MEASURES The primary outcomes were to identify the symptoms associated with COVID-19 positivity and risk factors for reporting symptoms. RESULTS Fatigue was the top reported symptom (42%) among COVID-19-positive respondents, while headache was the top reported symptom (32%) in respondents who tested negative. Compared with those who tested negative, COVID-19-positive individuals reported 1.5 times more symptoms and had higher odds of experiencing 31 out of the 40 listed symptoms during the postinfectious period. These symptoms included olfactory dysfunction, menstruation changes, cardiopulmonary and neurological symptoms. Female sex, middle age (41-55 years), Indigeneity, unemployment, hospital/intensive care unit (ICU) admission at the time of testing and pre-existing health conditions independently predicted a greater number and variety of symptoms. CONCLUSIONS Our results provide evidence that COVID-19 survivors continue to experience a significant number and variety of symptoms. These findings can help inform targeted strategies for the unequally affected population. It is important to offer appropriate management for symptom relief to those who have survived the acute COVID-19 illness.
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Affiliation(s)
- Xueyi Chen
- Alberta Strategy for Patient-Oriented Research Support Unit Data Platform, Edmonton, Alberta, Canada
- Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Colleen Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Tara Whitten
- Alberta Strategy for Patient-Oriented Research Support Unit Data Platform, Edmonton, Alberta, Canada
- Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Chester Ho
- Alberta Health Services, Edmonton, Alberta, Canada
- University of Alberta, Edmonton, Alberta, Canada
| | - Balraj Mann
- Alberta Health Services, Edmonton, Alberta, Canada
| | - Jeffrey Bakal
- Alberta Strategy for Patient-Oriented Research Support Unit Data Platform, Edmonton, Alberta, Canada
- Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
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Artna E, Abi-Jaoudé A, Sockalingam S, Perry C, Johnson A, Wun C, Kozloff N, Henderson J, Levinson A, Buchman DZ. Understanding attitudes and beliefs regarding COVID-19 vaccines among transitional-aged youth with mental health concerns: a youth-led qualitative study. BMJ Open 2024; 14:e080707. [PMID: 38238177 PMCID: PMC10806589 DOI: 10.1136/bmjopen-2023-080707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Transitional-aged youth (16-29 years) with mental health concerns have experienced a disproportionate burden of the COVID-19 pandemic. Vaccination is limited in this population; however, determinants of its vaccine hesitancy are not yet thoroughly characterised. OBJECTIVES This study aimed to answer the following research question: What are the beliefs and attitudes of youth with mental illness about COVID-19 vaccines, and how do these perspectives affect vaccine acceptance? The study aims to generate findings to inform the development of vaccine resources specific to youth with mental health concerns. METHODS A qualitative methodology with a youth engagement focus was used to conduct in-depth semistructured interviews with transitional-aged youth aged 16-29 years with one or more self-reported mental health diagnoses or concerns. Mental health concerns encompassed a wide range of symptoms and diagnoses, including mood disorders, anxiety disorders, neurodevelopmental disorders and personality disorders. Participants were recruited from seven main mental health clinical and support networks across Canada. Transcripts from 46 youth and 6 family member interviews were analysed using thematic analysis. RESULTS Two major themes were generated: (1) factors affecting trust in COVID-19 vaccines and (2) mental health influences and safety considerations in vaccine decision-making. Subthemes included trust in vaccines, trust in healthcare providers, trust in government and mistreatment towards racialised populations, and direct and indirect influences of mental health. CONCLUSIONS Our analysis suggests how lived experiences of mental illness affected vaccine decision-making and related factors that can be targeted to increase vaccine uptake. Our findings provide new insights into vaccine attitudes among youth with mental health concerns, which is highly relevant to ongoing vaccination efforts for new COVID-19 strains as well as other transmissible diseases and future pandemics. Next steps include cocreating youth-specific public health and clinical resources to encourage vaccination in this population.
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Affiliation(s)
- Erin Artna
- University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Alexxa Abi-Jaoudé
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Claire Perry
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Andrew Johnson
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Charlotte Wun
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole Kozloff
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jo Henderson
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Andrea Levinson
- Health & Wellness Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Daniel Z Buchman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, and Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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Hulscher N, Hodkinson R, Makis W, McCullough PA. Autopsy findings in cases of fatal COVID-19 vaccine-induced myocarditis. ESC Heart Fail 2024. [PMID: 38221509 DOI: 10.1002/ehf2.14680] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024] Open
Abstract
COVID-19 vaccines have been linked to myocarditis, which, in some circumstances, can be fatal. This systematic review aims to investigate potential causal links between COVID-19 vaccines and death from myocarditis using post-mortem analysis. We performed a systematic review of all published autopsy reports involving COVID-19 vaccination-induced myocarditis through 3 July 2023. All autopsy studies that include COVID-19 vaccine-induced myocarditis as a possible cause of death were included. Causality in each case was assessed by three independent physicians with cardiac pathology experience and expertise. We initially identified 1691 studies and, after screening for our inclusion criteria, included 14 papers that contained 28 autopsy cases. The cardiovascular system was the only organ system affected in 26 cases. In two cases, myocarditis was characterized as a consequence from multisystem inflammatory syndrome. The mean age of death was 44.4 years old. The mean and median number of days from last COVID-19 vaccination until death were 6.2 and 3 days, respectively. We established that all 28 deaths were most likely causally linked to COVID-19 vaccination by independent review of the clinical information presented in each paper. The temporal relationship, internal and external consistency seen among cases in this review with known COVID-19 vaccine-induced myocarditis, its pathobiological mechanisms, and related excess death, complemented with autopsy confirmation, independent adjudication, and application of the Bradford Hill criteria to the overall epidemiology of vaccine myocarditis, suggests that there is a high likelihood of a causal link between COVID-19 vaccines and death from myocarditis.
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Affiliation(s)
- Nicolas Hulscher
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - William Makis
- The Wellness Company, Boca Raton, FL, USA
- Cross Cancer Institute, Alberta Health Services, Edmonton, Canada
| | - Peter A McCullough
- The Wellness Company, Boca Raton, FL, USA
- Truth for Health Foundation, Tucson, AZ, USA
- McCullough Foundation, Dallas, TX, USA
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Ibadin S, Brindle M, Wasylak T, Robert J, Litvinchuk S, Sauro KM. Delivery and Prioritization of Surgical Care in Canada During COVID-19: An Environmental Scan. Int J Health Policy Manag 2023; 12:8007. [PMID: 38618771 PMCID: PMC10843432 DOI: 10.34172/ijhpm.2023.8007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 11/20/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND During COVID-19 healthcare systems had to make concessions to make room for the surge of COVID-19 patients requiring hospital and intensive care. Postponing surgeries was a common strategy; however, it is unclear how surgical care was delivered during this time of constraint. The objective of this study was to understand how surgical care was delivered and prioritized during the COVID-19 pandemic response. METHODS This was an environmental scan following the Canadian Agency for Drugs and Technologies in Health methodology. This study was conducted in Canada; a universal, publicly funded healthcare system. Evidence sources on policies pertaining to the provision of surgical care between January 2020 and October 2022 were obtained from ministries of health, health services agencies and publicly funded hospitals across all 10 provinces and three territories. We synthesized the evidence sources using framework analysis. RESULTS We identified 205 evidence sources that described six themes about the provision of surgical care during the COVID-19 pandemic: the cycle of postponement and resumption; guidelines for triaging and prioritizing surgical cases; Infection Prevention and Control (IPAC), and safety measures for surgical care during COVID-19, patient-centred care, and looking forward (recovery planning, leadership, and decision-making). CONCLUSION This study provides a comprehensive understanding of how surgical care was disrupted and innovated during COVID-19 which can inform future strategies for providing effective and efficient surgical care during times of healthcare constraint.
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Affiliation(s)
- Seremi Ibadin
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mary Brindle
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Surgery Strategic Clinical Networks, Alberta Health Services, Calgary, AB, Canada
| | - Tracy Wasylak
- Surgery Strategic Clinical Networks, Alberta Health Services, Calgary, AB, Canada
| | - Jill Robert
- Surgery and Bone & Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary, AB, Canada
| | - Stacey Litvinchuk
- Surgery Strategic Clinical Networks, Alberta Health Services, Calgary, AB, Canada
| | - Khara M. Sauro
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Oncology and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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