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Kacerik E, Bottega F, Andreassi A, Sechi G, Zoli A, Botteri M, Signorelli C, Fagoni N. Italy's Post-COVID-19 Stroke Network: Has It Returned to Pre-Pandemic Standards? EPIDEMIOLOGIA 2024; 5:353-361. [PMID: 39051205 PMCID: PMC11270169 DOI: 10.3390/epidemiologia5030025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/10/2024] [Accepted: 07/03/2024] [Indexed: 07/27/2024] Open
Abstract
The COVID-19 pandemic strongly transformed the healthcare system in the Lombardy region (Italy), forcing a rapid reorganization of hospital structures. The emergency medical service (EMS) system and emergency departments (EDs) were among the most affected departments. Several studies have shown a change in the epidemiology of time-dependent pathologies, such as stroke, during the pandemic's peak. However, there is little scientific evidence regarding the interpandemic phase. The regional register for ED accesses (EUOL) was analyzed, taking into consideration all accesses for stroke and stroke-like syndromes during the years 2019, 2020, and 2021. The analysis shows a significant difference in the average number of diagnoses per month [2092 vs. 1815 vs. 2015, respectively (p < 0.05)] and an increase in the percentage of transports carried out by EMS vehicles to EDs [17% vs. 25% vs. 22%, respectively (p < 0.05)]. The length of stay (LOS) increased for both discharged patients (9.0 vs. 10.1 vs. 11.2 h, respectively; p < 0.005) and hospitalized patients (7.5 vs. 9.7 vs. 10.6 h, respectively; p < 0.005). During the COVID-19 pandemic, the overall number of stroke diagnoses decreased, while the percentage of patients transported to EDs by EMS vehicles increased. Furthermore, an increased processing time in EDs was highlighted.
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Affiliation(s)
- Erika Kacerik
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milano, Italy
| | - Francesca Bottega
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milano, Italy
| | - Aida Andreassi
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Via Campanini 6, 20124 Milano, Italy
| | - Giuseppe Sechi
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Via Campanini 6, 20124 Milano, Italy
| | - Alberto Zoli
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Via Campanini 6, 20124 Milano, Italy
| | - Marco Botteri
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Via Campanini 6, 20124 Milano, Italy
| | - Carlo Signorelli
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milano, Italy
| | - Nazzareno Fagoni
- Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
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Fagoni N, Bellini L, Bonora R, Botteri M, Migliari M, Pagliosa A, Sechi GM, Signorelli C, Zoli A, Stirparo G. Changing the stroke network during pandemic scenarios does not affect the management of patients with a positive Cincinnati prehospital stroke scale. Neurol Sci 2024; 45:655-662. [PMID: 37672177 PMCID: PMC10791942 DOI: 10.1007/s10072-023-07046-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION Time plays a crucial role in the management of stroke, and changing the prehospital emergency network, altering the HUB and spoke relationship in pandemic scenarios, might have an impact on time to fibrinolysis or thrombectomy. The aim of this study was to evaluate the time-dependent stroke emergency network in Lombardy region (Italy) by comparing 2019 with 2020 and early 2021. Three parameters were investigated: (i) time of arrival of the first vehicle at the scene, (ii) overall duration of missions, and (iii) number of patients transported by emergency vehicles. METHODS Data analysis process conducted using the SAS-AREU portal (SAS Institute, USA). RESULTS The number of patients with a positive CPSS was similar among the different pandemic waves. Mission duration increased from a mean time (SD) of 52.9 (16.1) min in 2019 to 64.1 (19.7) in 2020 and 55.0 (16.8) in 2021. Time to first vehicle on scene increased to 15.7 (8.4) min in 2020 and 16.0 (7.0) in 2021 compared to 2019, 13.6 (7.2) (P < 0.05). The number of hospital with available stroke units decreased from 46 in 2019 to 10 during the first pandemic wave. CONCLUSIONS The pandemic forced changes in the clinical mission of many hospitals by reducing the number of stroke units. Despite this, the organization of the emergency system allowed to identify strategic hospitals and thus avoid excessive transport time. The result was an adequate time for fibrinolysis/thrombectomy, in agreement with the guidelines. Coordinated management in emergency situations makes it possible to maintain service quality standards, despite the unfavorable scenario.
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Affiliation(s)
- Nazzareno Fagoni
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
- AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU), ASST Spedali Civili Di Brescia, Brescia, Italy.
| | - Lorenzo Bellini
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Milan, Italy
| | - Rodolfo Bonora
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Marco Botteri
- AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU), ASST Spedali Civili Di Brescia, Brescia, Italy
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Maurizio Migliari
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Andrea Pagliosa
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Giuseppe Maria Sechi
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Carlo Signorelli
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Milan, Italy
| | - Alberto Zoli
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Giuseppe Stirparo
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Milan, Italy
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
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Reges O, Abu Ahmad W, Battat E, Saliba W, Wolff Sagy Y, Danon A, Lavie G. Trends in the Incidence of Cardiovascular Diagnoses and Procedures over the Years 2012-2021 in Israel: The Impact of the COVID-19 Pandemic. J Clin Med 2024; 13:476. [PMID: 38256610 PMCID: PMC10816154 DOI: 10.3390/jcm13020476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Prior studies found reduced incidences of cardiovascular diagnoses and treatments in the initial phase of the COVID-19 pandemic. However, these studies included a limited number of outcomes and did not consider pre-pandemic trends. This study aimed to describe trends in the incidence of cardiovascular diagnoses and treatments over the years 2012-2021 in Israel and to compare the two years of the COVID-19 period with the preceding 8 years. In this retrospective, population-based study, carried out within Clalit Health Services, the incidence rates of cardiovascular outcomes were calculated for individuals aged ≥ 25 (~2.7 million adults per year) during the first (Y1, 3/2020-2/2021) and second (Y2, 3/2021-2/2022) years of COVID-19 and the 8 years prior (3/2012-2/2020). Declines were observed in Y1 compared to 2019 in all diagnoses and treatments: STEMI (-16.3%; 95% CI: -16.6, -16.1), non-STEMI (-16.4%; -16.6, -16.2), AF (-14.1%; -14.2, -14.0), CHF (-7.8%; -7.9, -7.7), CVA (-5.0%; -5.0, -4.9), catheterization (-64.7%; -65.2, -64.2), CABG (-77.7%; -79.2, -76.2), ablation (-21.2%; -22.0, -20.4), pacemaker implantation (-39.3%; -40.7, -37.9), and defibrillator insertion (-12.5%; -13.1, -12.0). Compared with expected rates based on pre-pandemic trends, observed rates were within expected ranges (CHF, CVA, and ablation), less than expected (STEMI, non-STEMI, AF, catheterization, CABG, and pacemaker insertion), or more than expected (defibrillator insertion). In Y2, STEMI, catheterization, and CABG returned to expected rates; non-STEMI and AF were lower than expected; and CHF, CVA, ablation, and pacemaker and defibrillator implantations were higher than expected. Several cardiovascular diagnoses and treatment trends were interrupted by COVID-19. The long-term consequences of these changes should be considered by health policymakers.
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Affiliation(s)
- Orna Reges
- Department of Health Systems Management, School of Health Sciences, Ariel University, Ariel 4077625, Israel
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv 6209804, Israel; (W.A.A.); (E.B.); (Y.W.S.); (G.L.)
| | - Wiessam Abu Ahmad
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv 6209804, Israel; (W.A.A.); (E.B.); (Y.W.S.); (G.L.)
- Hadassah Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Erez Battat
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv 6209804, Israel; (W.A.A.); (E.B.); (Y.W.S.); (G.L.)
| | - Walid Saliba
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa 3436212, Israel;
- Ruth and Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3200003, Israel;
| | - Yael Wolff Sagy
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv 6209804, Israel; (W.A.A.); (E.B.); (Y.W.S.); (G.L.)
| | - Asaf Danon
- Ruth and Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3200003, Israel;
- Department of Cardiology, Carmel Medical Center, Haifa 3436212, Israel
| | - Gil Lavie
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv 6209804, Israel; (W.A.A.); (E.B.); (Y.W.S.); (G.L.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3200003, Israel;
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Ramadani RV, Svensson M, Hassler S, Hidayat B, Ng N. Effects of the COVID-19 pandemic on healthcare utilization among older adults with cardiovascular diseases and multimorbidity in Indonesia: an interrupted time-series analysis. BMC Public Health 2024; 24:71. [PMID: 38166721 PMCID: PMC10763491 DOI: 10.1186/s12889-023-17568-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has disrupted healthcare utilization globally, but little is known about the effects among patients with cardiovascular diseases (CVDs) and other multimorbidities. This study analyzed the impacts of COVID-19 on healthcare utilization for patients aged 30 years and older with cardiovascular diseases (CVDs) with or without other chronic disease comorbidities in Indonesia. METHODS We designed a retrospective cohort study based on the Indonesian National Health Insurance (NHI) sample data from 2016-2020. We defined healthcare utilization as monthly outpatient and inpatient visits related to chronic diseases at the hospital and primary healthcare levels per 10,000 NHI members. We used interrupted time series analysis to evaluate how the healthcare utilization patterns had changed due to the COVID-19 pandemic. RESULTS Overall, hospital outpatient visits decreased by 39% when the pandemic occurred (95% Confidence Interval (CI): 0.48,0.76), inpatient visits by 28% (95% CI: 0.62,0.83), and primary healthcare visits by 34% (95% CI:0.55, 0.81). For patients with CVDs and multimorbidity, hospital outpatient and inpatient visit rates were reduced by 36% and 38%, respectively and primary healthcare visits by 32%. Some insignificant differences in the reduction of out-and inpatient visits were observed across diagnosis groups and regions. CONCLUSION Healthcare utilization among patients with chronic diseases decreased significantly during COVID-19 and consistently across different chronic diseases and regions. To cope with the unmet needs of healthcare utilization in the context of the pandemic, the healthcare system needs to be strengthened to cater to the needs of the population-at-risk, especially for patients with CVDs and multimorbidity.
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Affiliation(s)
- Royasia Viki Ramadani
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Center for Health Economics and Policy Studies, Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia.
| | - Mikael Svensson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, USA
| | - Sven Hassler
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | - Budi Hidayat
- Center for Health Economics and Policy Studies, Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia
| | - Nawi Ng
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Morales C, Bruckner TA, Du S, Young A, Ro A. Changes in Acute ED Visits by Race/Ethnicity During the Early COVID-19 Pandemic. J Immigr Minor Health 2023; 25:1286-1294. [PMID: 37269403 PMCID: PMC10239213 DOI: 10.1007/s10903-023-01499-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/05/2023]
Abstract
Emergency department (ED) visits for conditions unrelated to the Coronavirus Disease 2019 (COVID-19) pandemic decreased during the early pandemic, raising concerns about critically ill patients forgoing care and increasing their risk of adverse outcomes. It is unclear if Hispanic and Black adults, who have a high prevalence of chronic conditions, sought medical assistance for acute emergencies during this time. This study used 2018-2020 ED visit data from the largest safety net hospital in Los Angeles County to estimate ED visit differences for cardiac emergencies, diabetic complications, and strokes, during the first societal lockdown among Black and Hispanic patients using time series analyses. Emergency department visits were lower than the expected levels during the first societal lockdown. However, after the lockdown ended, Black patients experienced a rebound in ED visits while visits for Hispanics remained depressed. Future research could identify barriers Hispanics experienced that contributed to prolonged ED avoidance.
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Affiliation(s)
- Celina Morales
- Department of Population Health and Disease Prevention, University of California Irvine, 653 E. Peltason Dr, Irvine, CA, 92697-3957, USA.
| | - Tim A Bruckner
- Department of Health, Society, and Behavior, University of California Irvine, Irvine, CA, USA
| | - Senxi Du
- Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andrew Young
- Harbor UCLA Medical Center, Los Angeles, CA, USA
| | - Annie Ro
- Department of Health, Society, and Behavior, University of California Irvine, Irvine, CA, USA
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Zhou Q, Yu M, Jin M, Zhang P, Qin G, Yao Y. Impact of free hypertension pharmacy program and social distancing policy on stroke: A longitudinal study. Front Public Health 2023; 11:1142299. [PMID: 37143973 PMCID: PMC10151749 DOI: 10.3389/fpubh.2023.1142299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/28/2023] [Indexed: 05/06/2023] Open
Abstract
Background The estimated lifetime risk of stroke was the highest in East Asia worldwide, especially in China. Antihypertensive therapy can significantly reduce stroke mortality. However, blood pressure control is poor. Medication adherence is a barrier as patients' out-of-pocket costs have risen. We aimed to take advantage of a free hypertension pharmacy intervention and quantified the impact on stroke mortality. Methods A free pharmaceutical intervention program was implemented in Deqing, Zhejiang province in April 2018. Another non-pharmaceutical intervention, social distancing due to the pandemic of Coronavirus disease 2019 (COVID-19), was also key to affecting stroke mortality. We retrospectively collected the routine surveillance data of stroke deaths from Huzhou Municipal Center for Disease Prevention and Control in 2013-2020 and obtained within-city mobility data from Baidu Migration in 2019-2020, then we quantified the effects of both pharmaceutical intervention and social distancing using Serfling regression model. Results Compared to the predicted number, the actual number of stroke deaths was significantly lower by 10% (95% CI, 6-15%; p < 0.001) from April 2018 to December 2020 in Deqing. Specifically, there was a reduction of 19% (95% CI, 10-28%; p < 0.001) in 2018. Moreover, we observed a 5% (95% CI, -4 - 14%; p = 0.28) increase in stroke mortality due to the adverse effect of COVID-19 but it wasn't statistically significant. Conclusion Free hypertension pharmacy program has great potential to prevent considerable stroke deaths. In the future, the free supply of low-cost, essential medications that target patients with hypertension at increased risk of stroke could be taken into account in formulating public health policies and guiding allocations of health care resources.
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Affiliation(s)
- Qi Zhou
- Department of Biostatistics, School of Public Health and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Meihua Yu
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang, China
| | - Meihua Jin
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang, China
- *Correspondence: Meihua Jin,
| | - Peng Zhang
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang, China
| | - Guoyou Qin
- Department of Biostatistics, School of Public Health and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Ye Yao
- Department of Biostatistics, School of Public Health and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Ye Yao,
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Changes to the Major Trauma Pre-Hospital Emergency Medical System Network before and during the 2019 COVID-19 Pandemic. J Clin Med 2022; 11:jcm11226748. [PMID: 36431225 PMCID: PMC9692576 DOI: 10.3390/jcm11226748] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/07/2022] [Accepted: 11/12/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: During the coronavirus disease 2019 pandemic, emergency medical services (EMSs) were among the most affected; in fact, there were delays in rescue and changes in time-dependent disease networks. The aim of the study is to understand the impact of COVID-19 on the time-dependent trauma network in the Lombardy region. Methods: A retrospective analysis on major trauma was performed by analysing all records saved in the EmMa database from 1 January 2019 to 31 December 2019 and from 1 January 2020 to 31 December 2020. Age, gender, time to first emergency vehicle on scene and mission duration were collected. Results: In 2020, compared to 2019, there was a reduction in major trauma diagnoses in March and April, during the first lockdown, OR 0.59 (95% CI 0.49−0.70; p < 0.0001), and a reduction in road accidents and accidents at work, while injuries related to falls from height and violent events increased. There was no significant increase in the number of deaths in the prehospital setting, OR 1.09 (95% CI 0.73−1.30; p = 0.325). Conclusions: The COVID-19 pandemic has changed the epidemiology of major trauma, but in the Lombardy region there was no significant change in mortality in the out-of-hospital setting.
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Marron L, Burke S, Kavanagh P. Changes in the utilisation of acute hospital care in Ireland during the first wave of the COVID-19 pandemic in 2020. HRB Open Res 2022; 4:67. [PMID: 36204710 PMCID: PMC9513415 DOI: 10.12688/hrbopenres.13307.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Reduced and delayed presentations for non-COVID-19 illness during the COVID-19 pandemic have implications for population health and health systems. The aim of this study is to quantify and characterise changes in acute hospital healthcare utilisation in Ireland during the first wave of COVID-19 to inform healthcare system planning and recovery. METHODS A retrospective, population-based, observational study was conducted using two national datasets, Patient Experience Time (PET) and Hospital In-Patient Enquiry (HIPE). The study period was 6th January to 5th July 2020. RESULTS Comparison between time periods pre- and post-onset of the COVID-19 pandemic within 2020 showed there were 81,712 fewer Emergency Department (ED) presentations (-18.8%), 19,692 fewer admissions from ED (-17.4%) and 210,357 fewer non-COVID-19 hospital admissions (-35.0%) than expected based on pre-COVID-19 activity. Reductions were greatest at the peak of population-level restrictions, at extremes of age and for elective admissions. In the period immediately following the first wave, acute hospital healthcare utilisation remained below pre-COVID-19 levels, however, there were increases in emergency alcohol-related admissions (Rate Ratio 1.22, 95% CI 1.03, 1.43, p-value 0.016), admissions with self-harm (Rate Ratio 1.39, 95% CI 1.01, 1.91, p-value 0.043) and mental health admissions (Rate Ratio 1.28, 95% CI 1.03, 1.60, p-value 0.028). DISCUSSION While public health implications of delayed and lost care will only become fully apparent over time, recovery planning must begin immediately. In the short-term, backlogs in care need to be managed and population health impacts of COVID-19 and associated restrictions, particularly in relation to mental health and alcohol, need to be addressed through strong public health and health system responses. In the long-term, COVID-19 highlights health system weakness and is an opportunity to progress health system reform to deliver a universal, high-quality, sustainable and resilient health system, capable of meeting population health needs and responding to future pandemics.
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Affiliation(s)
- Louise Marron
- Department of Public Health HSE East, Dr Steevens’ Hospital, Dublin 8, Ireland
| | - Sara Burke
- Centre for Health Policy and Management, Trinity College Dublin, Dublin 2, Ireland
| | - Paul Kavanagh
- Health Intelligence Unit, Strategic Planning and Transformation, Jervis House, Jervis St, Dublin 1, Ireland
- Department of Epidemiology and Public Health, Royal College of Surgeons, Dublin 2, Ireland
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Stirparo G, Bellini L, Ristagno G, Bonora R, Pagliosa A, Migliari M, Andreassi A, Signorelli C, Sechi GM, Fagoni N. The Impact of COVID-19 on Lombardy Region ST-Elevation Myocardial Infarction Emergency Medical System Network-A Three-Year Study. J Clin Med 2022; 11:5718. [PMID: 36233584 PMCID: PMC9573454 DOI: 10.3390/jcm11195718] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/13/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: The COVID-19 pandemic had a significant impact on emergency medical systems (EMS). Regarding the ST-elevation myocardial infarction (STEMI) dependent time network, however, there is little evidence linked to the post-pandemic phase regarding this issue. Such information could prove to be of pivotal importance regarding STEMI clinical management, especially pre-hospital clinical protocols such as fibrinolysis. Methods: A retrospective observational cohort study of all STEMI rescues recorded in the Lombardy EMS registry from the 1st of January 2019 to the 30th of December 2021. Results: Regarding the number of STEMI diagnoses, March 2020 (first pandemic wave in Italy) saw a reduction compared to March 2019 (OR 0.76 [0.60-0.93], p = 0.011). The average time of the entire mission increased to 63.1 min in 2021, reaching 64.7 min in 2020, compared with 57.7 min in 2019. The number of HUBs for STEMI patients saw a reduction, falling from 52 HUBs in the pre-pandemic phase to 13 HUBs during the first wave. Conclusions: During the pandemic phase, there was an increase in the transportation times of STEMI patients from home to the hospital. Such changes did not alter the clinical approach in the out-of-hospital phase. Indeed, the implementation of fibrinolysis was not required.
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Affiliation(s)
- Giuseppe Stirparo
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Via Olgettina 60, 20090 Milano, Italy
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Via Campanini 6, 20090 Milano, Italy
| | - Lorenzo Bellini
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Via Olgettina 60, 20090 Milano, Italy
| | - Giuseppe Ristagno
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti Via Festa del Perdono 7, 20122 Milano, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20090 Milano, Italy
| | - Rodolfo Bonora
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Via Campanini 6, 20090 Milano, Italy
| | - Andrea Pagliosa
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Via Campanini 6, 20090 Milano, Italy
| | - Maurizio Migliari
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Via Campanini 6, 20090 Milano, Italy
| | - Aida Andreassi
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Via Campanini 6, 20090 Milano, Italy
| | - Carlo Signorelli
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Via Olgettina 60, 20090 Milano, Italy
| | - Giuseppe M. Sechi
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Via Campanini 6, 20090 Milano, Italy
| | - Nazzareno Fagoni
- Dipartimento di Medicina Molecolare e Traslazionale, Università di Brescia, Piazza del Mercato, 15, 25121 Brescia, Italy
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Marron L, Burke S, Kavanagh P. Changes in the utilisation of acute hospital care in Ireland during the first wave of the COVID-19 pandemic in 2020. HRB Open Res 2022; 4:67. [PMID: 36204710 PMCID: PMC9513415 DOI: 10.12688/hrbopenres.13307.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Reduced and delayed presentations for non-COVID-19 illness during the COVID-19 pandemic have implications for population health and health systems. The aim of this study is to quantify and characterise changes in acute hospital healthcare utilisation in Ireland during the first wave of COVID-19 to inform healthcare system planning and recovery. METHODS A retrospective, population-based, observational study was conducted using two national datasets, Patient Experience Time (PET) and Hospital In-Patient Enquiry (HIPE). The study period was 6th January to 5th July 2020. RESULTS Comparison between time periods pre- and post-onset of the COVID-19 pandemic within 2020 showed there were 81,712 fewer Emergency Department (ED) presentations (-18.8%), 19,692 fewer admissions from ED (-17.4%) and 210,357 fewer non-COVID-19 hospital admissions (-35.0%) than expected based on pre-COVID-19 activity. Reductions were greatest at the peak of population-level restrictions, at extremes of age and for elective admissions. In the period immediately following the first wave, acute hospital healthcare utilisation remained below pre-COVID-19 levels, however, there were increases in emergency alcohol-related admissions (Rate Ratio 1.22, 95% CI 1.03, 1.43, p-value 0.016), admissions with self-harm (Rate Ratio 1.39, 95% CI 1.01, 1.91, p-value 0.043) and mental health admissions (Rate Ratio 1.28, 95% CI 1.03, 1.60, p-value 0.028). DISCUSSION While public health implications of delayed and lost care will only become fully apparent over time, recovery planning must begin immediately. In the short-term, backlogs in care need to be managed and population health impacts of COVID-19 and associated restrictions, particularly in relation to mental health and alcohol, need to be addressed through strong public health and health system responses. In the long-term, COVID-19 highlights health system weakness and is an opportunity to progress health system reform to deliver a universal, high-quality, sustainable and resilient health system, capable of meeting population health needs and responding to future pandemics.
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Affiliation(s)
- Louise Marron
- Department of Public Health HSE East, Dr Steevens’ Hospital, Dublin 8, Ireland
| | - Sara Burke
- Centre for Health Policy and Management, Trinity College Dublin, Dublin 2, Ireland
| | - Paul Kavanagh
- Health Intelligence Unit, Strategic Planning and Transformation, Jervis House, Jervis St, Dublin 1, Ireland
- Department of Epidemiology and Public Health, Royal College of Surgeons, Dublin 2, Ireland
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11
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Quiles LEP, Diamante PAB, Pascual JLV. Impact of the COVID-19 Pandemic in the Acute Stroke Admissions and Outcomes in a Philippine Tertiary Hospital. Cerebrovasc Dis Extra 2022; 12:76-84. [PMID: 35588704 PMCID: PMC9247441 DOI: 10.1159/000525057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/08/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE The coronavirus 2019 (COVID-19) pandemic has been continuing its global spread ever since it's onset and efforts to curb the infection in multiple reports have contrasting effects on stroke severity, admissions and outcomes. In the Philippines, where the COVID-19 pandemic shows no signs of slowing down and has been in the world's longest lockdown, we investigated the effect of the pandemic in the stroke admissions and outcomes in one of the largest tertiary hospitals in the Philippines. METHODS This is a retrospective, comparative study of all adult stroke patients admitted between Pre-COVID (February 2019-January 2020) and COVID period (February 2020-January 2021). The differences of stroke types, severity, classification, and discharge outcomes between pre-COVID and during COVID was analyzed in the study. RESULTS There is a decrease in total number of stroke admissions from 597 in the pre-COVID period to 487 during the pandemic. Stroke patients take significantly longer time to seek hospital consultation from onset of stroke symptoms and significantly higher proportion of patients have moderate and severe stroke. The discharge outcome showed significantly higher proportions of dependency upon discharge (13%) and higher proportion of death in stroke patients from 7% pre-COVID19 pandemic to 13% during the pandemic. CONCLUSIONS There was reduction in total stroke admissions, mild and transient stroke during the pandemic. There was significantly higher proportion of stroke patients having moderate and severe stroke. The discharge outcome of stroke patients is functionally poorer during the pandemic and more stroke patients have died compared to before COVID-19 pandemic.
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Affiliation(s)
- Liz Edenberg P. Quiles
- Department of Neurology, The Medical City, Pasig City, Philippines
- *Liz Edenberg P. Quiles,
| | | | - Jose Leonard V. Pascual
- Department of Neurology, The Medical City, Pasig City, Philippines
- Department of Neurosciences, University of the Philippines-College of Medicine, Manila, Philippines
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12
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Al Hashmi A, von Bandemer S, Shuaib A, Mansour OY, Wassy M, Ozdemir AO, Farhoudi M, Al Jehani H, Khan A, John S, Saqqur M. Lessons learned in stroke care during COVID-19 pandemic and preparing for future pandemics in the MENA+ region: A consensus statement from the MENA+-SINO. J Neurol Sci 2022; 432:120060. [PMID: 34864375 PMCID: PMC8626147 DOI: 10.1016/j.jns.2021.120060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 10/22/2021] [Accepted: 11/17/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND COVID-19 pandemic has negatively impacted stroke care services at multiple levels. There was a decline in acute stroke admissions. Fewer interventions have been performed. Increased "door-to-needle times and "door-to-groin puncture" during this pandemic. These factors combined have led to declining in the favoured outcomes of stroke patients' globally. Yet this pandemic permits an opportunity for higher preparedness for future pandemics. OBJECTIVES AND METHODS This paper aims to shed light on the main lessons learned in the field of stroke care during the first wave of COVID-19 pandemic. Here we are presenting proposals and initiatives for better preparedness in future similar emergencies. These proposals are based primarily on literature review of COVID-19 publications, as well as the first-hand experience gained during the first wave at the regional level. In addition to the consensus and collective ride of stroke experts in the Middle East North Africa Stroke and Interventional Neurotherapies Organization (MENA+-SINO) and interaction and collaboration with international stroke specialists from the Stroke World Organization (WSO), European Stroke Organization (ESO) and stroke and COVID-19 papers authors. CONCLUSION Stroke care is very complex, particularly in the initial hours after onset of symptoms. A successful outcome requires very close collaboration between clinical personnel from multiple specialties. Preparedness for future pandemics requires the improvement of care plans that allow for rapid assessment of stroke patients and ensuring that regular 'mock exercises' familiarize quintessential services that care for the stroke patients.
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Affiliation(s)
- Amal Al Hashmi
- Neuroscience Directorate, Khoula Hospital Ministry of Health of Oman, Muscat, Sultanate of Oman.
| | - Stephan von Bandemer
- Division of Health Service Research, Institute of Work and Technology, Gelsenkirchen, Germany.
| | - Ashfaq Shuaib
- Medicine and Neurology, Director Stroke Program, University of Alberta, Edmonton, AB, Canada.
| | - Ossama Yassin Mansour
- Alexandria Faculty of Medicine, Department of Neurology, Alexandria University, Egypt.
| | | | - Atilla Ozcan Ozdemir
- Interventional Neurology &Neurocritical Care Program, Eskisehir Osmangazi University, Turkey.
| | - Mehdi Farhoudi
- Neuroscience Research Center, Tabriz University, Islamic Republic of Iran.
| | - Hosam Al Jehani
- Department of Neurosurgery and Interventional Radiology, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Adnan Khan
- Department of Medicine, Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar.
| | - Seby John
- Neurology and Neurointerventional Surgery, Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates.
| | - Maher Saqqur
- University of Alberta Edmonton, Canada; Trillium Hospital, University of Toronto at Mississauga, Mississauga, ON. Canada.
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13
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Czap AL, Zha AM, Sebaugh J, Hassan AE, Shulman JG, Abdalkader M, Nguyen TN, Linfante I, Starosciak AK, Ortega-Gutierrez S, Farooqui M, Quispe-Orozco D, Vora NA, Rai V, Nogueira RG, Haussen DC, Jillella DV, Rana A, Yu S, Thon JM, Zaidat OO, Khandelwal P, Bach I, Sheth SA, Jadhav AP, Desai SM, Jovin TG, Liebeskind DS, Siegler JE. Endovascular thrombectomy time metrics in the era of COVID-19: observations from the Society of Vascular and Interventional Neurology Multicenter Collaboration. J Neurointerv Surg 2022; 14:neurintsurg-2020-017205. [PMID: 33558439 PMCID: PMC7871225 DOI: 10.1136/neurintsurg-2020-017205] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/23/2021] [Accepted: 01/25/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Unprecedented workflow shifts during the coronavirus disease 2019 (COVID-19) pandemic have contributed to delays in acute care delivery, but whether it adversely affected endovascular thrombectomy metrics in acute large vessel occlusion (LVO) is unknown. METHODS We performed a retrospective review of observational data from 14 comprehensive stroke centers in nine US states with acute LVO. EVT metrics were compared between March to July 2019 against March to July 2020 (primary analysis), and between state-specific pre-peak and peak COVID-19 months (secondary analysis), with multivariable adjustment. RESULTS Of the 1364 patients included in the primary analysis (51% female, median NIHSS 14 [IQR 7-21], and 74% of whom underwent EVT), there was no difference in the primary outcome of door-to-puncture (DTP) time between the 2019 control period and the COVID-19 period (median 71 vs 67 min, P=0.10). After adjustment for variables associated with faster DTP, and clustering by site, there remained a trend toward shorter DTP during the pandemic (βadj=-73.2, 95% CI -153.8-7.4, Pp=0.07). There was no difference in DTP times according to local COVID-19 peaks vs pre-peak months in unadjusted or adjusted multivariable regression (βadj=-3.85, 95% CI -36.9-29.2, P=0.80). In this final multivariable model (secondary analysis), faster DTP times were significantly associated with transfer from an outside institution (βadj=-46.44, 95% CI -62.8 to - -30.0, P<0.01) and higher NIHSS (βadj=-2.15, 95% CI -4.2to - -0.1, P=0.05). CONCLUSIONS In this multi-center study, there was no delay in EVT among patients treated for intracranial occlusion during the COVID-19 era compared with the pre-COVID era.
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Affiliation(s)
- Alexandra L Czap
- Neurology, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Alicia M Zha
- Neurology, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Jacob Sebaugh
- Neurology, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Ameer E Hassan
- Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA
- Clinical Neuroscience Research, Valley Baptist Medical Center, Harlingen, Texas, USA
| | - Julie G Shulman
- Neurology, Boston Medical Center, Boston, Massachusetts, USA
| | | | - Thanh N Nguyen
- Neurology, Boston Medical Center, Boston, Massachusetts, USA
- Radiology, Boston Medical Center, Boston, Massachusetts, USA
- Interventional Neuroradiology and Endovascular Neurosurgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Italo Linfante
- Department of Interventional Neuroradiology and Endovascular Neurosurgery, Baptist Health South Florida, Coral Gables, Florida, USA
| | | | - Santiago Ortega-Gutierrez
- Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Mudassir Farooqui
- Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Darko Quispe-Orozco
- Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Nirav A Vora
- Neuroscience Center, Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Vivek Rai
- Neuroscience Center, Riverside Methodist Hospital, Columbus, Ohio, USA
| | | | | | | | - Ameena Rana
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Siyuan Yu
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Jesse M Thon
- Cooper Neurological Institute, Cooper University Health Care, Camden, New Jersey, USA
| | - Osama O Zaidat
- Neuroscience Institute, Bons Secours Mercy Health St. Vincent Hospital, Toledo, Ohio, USA
| | | | - Ivo Bach
- Neurology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Sunil A Sheth
- Neurology, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Ashutosh P Jadhav
- Neurology, University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, Pennsylvania, USA
- Neurology, University of Pittsburgh Medical Center Presbyterian Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shashvat M Desai
- Neurology, University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, Pennsylvania, USA
- Neurology, University of Pittsburgh Medical Center Presbyterian Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tudor G Jovin
- Cooper Neurological Institute, Cooper University Health Care, Camden, New Jersey, USA
| | - David S Liebeskind
- Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - James E Siegler
- Cooper Neurological Institute, Cooper University Health Care, Camden, New Jersey, USA
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14
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Butt GF, Hodson J, Wallace GR, Rauz S, Murray PI. Public perceptions of eye symptoms and hospital services during the first UK lockdown of the COVID-19 pandemic: a web survey study. BMJ Open Ophthalmol 2021; 6:e000854. [PMID: 34693022 PMCID: PMC8520595 DOI: 10.1136/bmjophth-2021-000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/05/2021] [Indexed: 11/15/2022] Open
Abstract
Objective This study aimed to explore the British public’s healthcare-seeking beliefs concerning eye symptoms, and assess how the first COVID-19 lockdown influenced these. Methods and analysis An anonymous web-based survey was disseminated through mailing lists and social media between June and August 2020. The survey sought participants’ views on the severity and urgency of the need for medical review for four ophthalmic and two general medical scenarios on a five-point scale. Participants were asked to answer questions twice: once ignoring the COVID-19 pandemic, and once taking this into account, with additional questions asked to identify factors influencing the decision to seek medical attention and ward admission. Results A total of 402 participants completed the survey (mean age 61.6 years, 63.1% female and 87.7% of white ethnicity). Scores for symptom severity and urgency of medical review increased significantly with the severity of the clinical scenario (both p<0.001). However, participants gave significantly lower scores for the urgency of medical attention when accounting for the COVID-19 pandemic (compared with no pandemic) for all scenarios (all p<0.001). Younger age, greater deprivation and non-white ethnicity were correlated with a lower perception of seriousness and urgency of medical attention. Conclusions During the first UK lockdown of the COVID-19 pandemic, reduced urgency of medical review for ocular and systemic pathologies was reported in response to the pandemic, which represents a barrier to healthcare-seeking behaviour. This has the potential to critically delay medical review and timely management, negatively impacting patient outcomes.
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Affiliation(s)
- Gibran F Butt
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - James Hodson
- Medical Statistics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Graham R Wallace
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Saaeha Rauz
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Ophthalmology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Philip I Murray
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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15
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Raymaekers V, Demeestere J, Bellante F, De Blauwe S, De Raedt S, Dusart A, Jodaitis L, Lemmens R, Loos C, Noémie L, Rutgers MP, Vandervorst F, Vanhooren G, Yperzeele L, Nogueira RG, Nguyen TN, Vanacker P. The impact of COVID-19 on acute stroke care in Belgium. Acta Neurol Belg 2021; 121:1251-1258. [PMID: 34148220 PMCID: PMC8214455 DOI: 10.1007/s13760-021-01726-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/10/2021] [Indexed: 02/06/2023]
Abstract
A worldwide decline in stroke hospitalizations during the COVID-19 pandemic has been reported. Information on stroke care during the pandemic in Belgium is lacking. This study aims to analyze the impact of COVID-19 on acute stroke care in eight Belgian stroke centers. This Belgian study is part of an international observational and retrospective study in 70 countries and 457 stroke centers. We compared volumes of COVID-19 and stroke hospitalizations, intravenous thrombolysis and endovascular treatment rates, acute treatment time intervals and functional outcome at 90 days during the first wave of the pandemic to two control intervals (March–May 2019 and December–February 2020). From March 2020 to May 2020, 860 stroke patients were hospitalized. In the same time period, 2850 COVID-19 patients were admitted, of which 37 (1.3%) were diagnosed with a stroke. Compared to the months prior to the pandemic and the same time epoch one year earlier, stroke hospitalizations were reduced (relative difference 15.9% [p = 0.03] and 14.5% [p = 0.05], respectively). Despite a reduction in absolute volumes, there was no difference in the monthly proportion of thrombolysis or endovascular treatment provided to the overall stroke hospitalizations. Acute treatment time metrics did not change between COVID-19 pandemic and control time epochs. We found no difference in 90-day functional outcomes nor in mortality after stroke between patients admitted during the pandemic versus control periods. We found a decline in the volume of stroke hospitalizations during the first wave of the COVID-19 pandemic in Belgium. Stroke care quality parameters remained unchanged.
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Affiliation(s)
- Vincent Raymaekers
- Department of Neurology, Groeninge Hospital, Kortrijk, Belgium.
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium.
| | - Jelle Demeestere
- Department of Neurology, Leuven University Hospital, Leuven, Belgium
| | - Flavio Bellante
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Sofie De Blauwe
- Department of Neurology, Sint-Jan Hospital Bruges-Ostend, Bruges, Belgium
| | - Sylvie De Raedt
- Department of Neurology, University Hospital Brussels, Jette, Belgium
- Center of Neurosciences, University of Brussels, Brussels, Belgium
| | - Anne Dusart
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Lise Jodaitis
- Department of Neurology, Erasmus Hospital, Brussels, Belgium
| | - Robin Lemmens
- Department of Neurology, Leuven University Hospital, Leuven, Belgium
| | - Caroline Loos
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
| | - Ligot Noémie
- Department of Neurology, Erasmus Hospital, Brussels, Belgium
| | | | - Fenne Vandervorst
- Department of Neurology, University Hospital Brussels, Jette, Belgium
- Center of Neurosciences, University of Brussels, Brussels, Belgium
| | - Geert Vanhooren
- Department of Neurology, Sint-Jan Hospital Bruges-Ostend, Bruges, Belgium
| | - Laetitia Yperzeele
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
| | - Raul G Nogueira
- Department of Neurology, Grady Memorial Hospital, Emory University, Atlanta, GA, USA
| | - Thanh N Nguyen
- Department of Neurology, Radiology, Boston Medical Center, Boston University School of Medicine, Boston, USA
| | - Peter Vanacker
- Department of Neurology, Groeninge Hospital, Kortrijk, Belgium
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
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16
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Long A, Fillinger M, April MD, Hudson IL, Trueblood W, Schmitz G, Chin EJ, Hartstein B, Pfaff JA, Schauer SG. Changes in Emergency Department Volumes at the Largest U.S. Military Hospital During the COVID-19 Pandemic. Mil Med 2021; 187:e1456-e1461. [PMID: 34411255 DOI: 10.1093/milmed/usab322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/17/2021] [Accepted: 07/23/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The coronavirus-2019 (COVID-19) pandemic has significantly impacted global healthcare delivery. Brooke Army Medical Center (BAMC) is the DoD's largest hospital and a critical platform for maintaining a ready medical force. We compare temporal trends in patient volumes and characteristics in the BAMC emergency department (ED) before versus during the pandemic. MATERIALS AND METHODS We abstracted data on patient visits from the BAMC ED electronic medical record system. Data included patient demographics, visit dates, emergency severity index triage level, and disposition. We visually compared the data from January 1, 2019 to November 30, 2019 versus January 1, 2020 to November 30, 2020 to assess the period with the most apparent differences. We then used descriptive statistics to characterize the pre-pandemic control period (1 March-November 30, 2019) versus the pandemic period (1 March-November 30, 2020). RESULTS Overall, when comparing the pre-pandemic and pandemic periods, the median number of visits per day was 232 (Interquartile Range (IQR) 214-250, range 145-293) versus 165 (144-193, range 89-308, P < .0001). Specific to pediatric visits, we found the median number of visits per day was 39 (IQR 33-46, range 15-72) versus 18 (IQR 14-22, range 5-61, P < .001). When comparing the median number of visits by month, the volumes were lower during the pandemic for all months, all of which were strongly significant (P < .001 for all). CONCLUSIONS The BAMC ED experienced a significant decrease in patient volume during the COVID-19 pandemic starting in March 2020. This may have significant implications for the capacity of this facility to maintain a medically ready force.
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Affiliation(s)
- Adrianna Long
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Meghan Fillinger
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Michael D April
- 40th Forward Surgical Resuscitation Detachment, Fort Carson, CO 80913, USA
| | - Ian L Hudson
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA.,US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA
| | - Wesley Trueblood
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Gillian Schmitz
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Eric J Chin
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Bonnie Hartstein
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - James A Pfaff
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Steven G Schauer
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.,US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA
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17
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Katsanos AH, Palaiodimou L, Zand R, Yaghi S, Kamel H, Navi BB, Turc G, Benetou V, Sharma VK, Mavridis D, Shahjouei S, Catanese L, Shoamanesh A, Vadikolias K, Tsioufis K, Lagiou P, Sfikakis PP, Alexandrov AV, Tsiodras S, Tsivgoulis G. Changes in Stroke Hospital Care During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Stroke 2021; 52:3651-3660. [PMID: 34344166 PMCID: PMC8547579 DOI: 10.1161/strokeaha.121.034601] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE We systematically evaluated the impact of the coronavirus 2019 (COVID-19) pandemic on stroke care across the world. METHODS Observational studies comparing characteristics, acute treatment delivery, or hospitalization outcomes between patients with stroke admitted during the COVID-19 pandemic and those admitted before the pandemic were identified by Medline, Scopus, and Embase databases search. Random-effects meta-analyses were conducted for all outcomes. RESULTS We identified 46 studies including 129 491 patients. Patients admitted with stroke during the COVID-19 pandemic were found to be younger (mean difference, -1.19 [95% CI, -2.05 to -0.32]; I2=70%) and more frequently male (odds ratio, 1.11 [95% CI, 1.01-1.22]; I2=54%) compared with patients admitted with stroke in the prepandemic era. Patients admitted with stroke during the COVID-19 pandemic, also, had higher baseline National Institutes of Health Stroke Scale scores (mean difference, 0.55 [95% CI, 0.12-0.98]; I2=90%), higher probability for large vessel occlusion presence (odds ratio, 1.63 [95% CI, 1.07-2.48]; I2=49%) and higher risk for in-hospital mortality (odds ratio, 1.26 [95% CI, 1.05-1.52]; I2=55%). Patients with acute ischemic stroke admitted during the COVID-19 pandemic had higher probability of receiving endovascular thrombectomy treatment (odds ratio, 1.24 [95% CI, 1.05-1.47]; I2=40%). No difference in the rates of intravenous thrombolysis administration or difference in time metrics regarding onset to treatment time for intravenous thrombolysis and onset to groin puncture time for endovascular thrombectomy were detected. CONCLUSIONS The present systematic review and meta-analysis indicates an increased prevalence of younger patients, more severe strokes attributed to large vessel occlusion, and higher endovascular treatment rates during the COVID-19 pandemic. Patients admitted with stroke during the COVID-19 pandemic had higher in-hospital mortality. These findings need to be interpreted with caution in view of discrepant reports and heterogeneity being present across studies.
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Affiliation(s)
- Aristeidis H Katsanos
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., L.C., A.S.).,Second Department of Neurology, "Attikon" Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.H.K., L.P., G. Tsivgoulis.)
| | - Lina Palaiodimou
- Second Department of Neurology, "Attikon" Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.H.K., L.P., G. Tsivgoulis.)
| | - Ramin Zand
- Neurosience Institute, Geisinger Health System, Danville, Pennsylvania (R.Z., S.S.)
| | - Shadi Yaghi
- Department of Neurology, NYU Langone Health, NY (S.Y.)
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, NY (H.K., B.B.N.)
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, NY (H.K., B.B.N.)
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, France (G. Turc).,Université de Paris, France (G. Turc).,INSERM U1266, Paris, France (G. Turc).,FHU Neurovasc, Paris, France (G. Turc)
| | - Vassiliki Benetou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece (V.B., P.L.)
| | - Vijay K Sharma
- Division of Neurology, Department of Medicine, National University Hospital, Singapore and School of Medicine, National University of Singapore (V.K.S.)
| | - Dimitris Mavridis
- Department of Primary Education, University of Ioannina, Greece (D.M.).,Université Paris Descartes, Faculté de Médecine, France (D.M.)
| | - Shima Shahjouei
- Neurosience Institute, Geisinger Health System, Danville, Pennsylvania (R.Z., S.S.)
| | - Luciana Catanese
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., L.C., A.S.)
| | - Ashkan Shoamanesh
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., L.C., A.S.)
| | - Konstantinos Vadikolias
- Department of Neurology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece (K.V.)
| | - Konstantinos Tsioufis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Greece (K.T.)
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece (V.B., P.L.).,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (P.L.)
| | - Petros P Sfikakis
- Joint Rheumatology Program, First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Greece (P.P.S.)
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis (A.V.A., G. Tsivgoulis)
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (S.T.).,National Public Health Organization of Greece, Athens (S.T.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.H.K., L.P., G. Tsivgoulis.).,Department of Neurology, University of Tennessee Health Science Center, Memphis (A.V.A., G. Tsivgoulis)
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18
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Libruder C, Ram A, Hershkovitz Y, Tanne D, Bornstein NM, Leker RR, Horev A, Hallevi H, Peretz S, Orion D, Zucker I. Reduction in Acute Stroke Admissions during the COVID-19 Pandemic: Data from a National Stroke Registry. Neuroepidemiology 2021; 55:354-360. [PMID: 34237727 PMCID: PMC8339012 DOI: 10.1159/000516753] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/20/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction The COVID-19 pandemic overwhelmed health-care systems worldwide, and medical care for other acute diseases was negatively impacted. We aimed to investigate the effect of the COVID-19 outbreak on admission rates and in-hospital care for acute stroke and transient ischemic attack (TIA) in Israel, shortly after the start of the pandemic. Methods We conducted a retrospective observational study, based on data reported to the Israeli National Stroke Registry from 7 tertiary hospitals. All hospital admissions for acute stroke or TIA that occurred between January 1 and April 30, 2020 were included. Data were stratified into 2 periods according to the timing of COVID-19 restrictions as follows: (1) “pre-pandemic” − January 1 to March 7, 2020 and (2) “pandemic” − March 8 to April 30, 2020. We compared the weekly counts of hospitalizations between the 2 periods. We further investigated changes in demographic characteristics and in some key parameters of stroke care, including the percentage of reperfusion therapies performed, time from hospital arrival to brain imaging and to thrombolysis, length of hospital stay, and in-hospital mortality. Results 2,260 cases were included: 1,469 in the pre-COVID-19 period and 791 in the COVID-19 period. Hospital admissions significantly declined between the 2 periods, by 48% for TIA (rate ratio [RR] = 0.52; 95% CI 0.43–0.64) and by 29% for stroke (RR = 0.71; 95% CI 0.64–0.78). No significant changes were detected in demographic characteristics and in most parameters of stroke management. While the percentage of reperfusion therapies performed remained unchanged, the absolute number of patients treated with reperfusion therapies seemed to decrease. Higher in-hospital mortality was observed only for hemorrhagic stroke. Conclusion The marked decrease in admissions for acute stroke and TIA, occurring at a time of a relatively low burden of COVID-19, is of great concern. Public awareness campaigns are needed as patients reluctant to seek urgent stroke care are deprived of lifesaving procedures and secondary prevention treatments.
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Affiliation(s)
- Carmit Libruder
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel
| | - Amit Ram
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel
| | - Yael Hershkovitz
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel
| | - David Tanne
- Rambam Health Care Campus, Haifa, Israel.,Technion Faculty of Medicine, Haifa, Israel
| | | | - Ronen R Leker
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Anat Horev
- Soroka University Medical Center, Beer-Sheva, Israel
| | - Hen Hallevi
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - David Orion
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
| | - Inbar Zucker
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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19
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Sagris D, Papanikolaou A, Kvernland A, Korompoki E, Frontera JA, Troxel AB, Gavriatopoulou M, Milionis H, Lip GYH, Michel P, Yaghi S, Ntaios G. COVID-19 and ischemic stroke. Eur J Neurol 2021; 28:3826-3836. [PMID: 34224187 PMCID: PMC8444875 DOI: 10.1111/ene.15008] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/13/2021] [Accepted: 06/26/2021] [Indexed: 12/15/2022]
Abstract
Since the onset of the COVID‐19 pandemic, a substantial proportion of COVID‐19 patients had documented thrombotic complications and ischemic stroke. Several mechanisms related to immune‐mediated thrombosis, the renin angiotensin system and the effect of SARS‐CoV‐2 in cardiac and brain tissue may contribute to the pathogenesis of ischemic stroke in patients with COVID‐19. Simultaneously, significant strains on global healthcare delivery, including ischemic stroke management, have made treatment of stroke in the setting of COVID‐19 particularly challenging. In this review, we summarize the current knowledge on epidemiology, clinical manifestation, and pathophysiology of ischemic stroke in patients with COVID‐19 to bridge the gap from bench to bedside and clinical practice during the most challenging global health crisis of the last decades.
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Affiliation(s)
- Dimitrios Sagris
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Aikaterini Papanikolaou
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | | | - Eleni Korompoki
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece.,Division of Brain Sciences, Imperial College London, London, UK
| | | | - Andrea B Troxel
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Patrik Michel
- Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Shadi Yaghi
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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20
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Marron L, Burke S, Kavanagh P. The public health and health system implications of changes in the utilisation of acute hospital care in Ireland during the first wave of COVID-19: Lessons for recovery planning. HRB Open Res 2021; 4:67. [PMID: 36204710 PMCID: PMC9513415 DOI: 10.12688/hrbopenres.13307.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Reduced and delayed presentations for non-COVID-19 illness during the COVID-19 pandemic have implications for population health and health systems. The aim of this study is to quantify and characterise changes in acute hospital healthcare utilisation in Ireland during the first wave of COVID-19 to inform healthcare system planning and recovery. METHODS A retrospective, population-based, interrupted time-trend study was conducted using two national datasets, Patient Experience Time (PET) and Hospital In-Patient Enquiry (HIPE). The study period was 6th January to 5th July 2020. RESULTS Comparison between time periods pre- and post-onset of the COVID-19 pandemic within 2020 showed there were 81,712 fewer Emergency Department (ED) presentations (-18.8%), 19,692 fewer admissions from ED (-17.4%) and 210,357 fewer non-COVID-19 hospital admissions (-35.0%) than expected based on pre-COVID-19 activity. Reductions were greatest at the peak of population-level restrictions, at extremes of age and for elective admissions. In the period immediately following the first wave, acute hospital healthcare utilisation remained below pre-COVID-19 levels, however, there were increases in emergency alcohol-related admissions (Rate Ratio 1.22, 95% CI 1.03, 1.43, p-value 0.016), admissions with self-harm (Rate Ratio 1.39, 95% CI 1.01, 1.91, p-value 0.043) and mental health admissions (Rate Ratio 1.28, 95% CI 1.03, 1.60, p-value 0.028). DISCUSSION While public health implications of delayed and lost care will only become fully apparent over time, recovery planning must begin immediately. In the short-term, backlogs in care need to be managed and population health impacts of COVID-19 and associated restrictions, particularly in relation to mental health and alcohol, need to be addressed through strong public health and health system responses. In the long-term, COVID-19 highlights health system weakness and is an opportunity to progress health system reform to deliver a universal, high-quality, sustainable and resilient health system, capable of meeting population health needs and responding to future pandemics.
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Affiliation(s)
- Louise Marron
- Department of Public Health HSE East, Dr Steevens’ Hospital, Dublin 8, Ireland
| | - Sara Burke
- Centre for Health Policy and Management, Trinity College Dublin, Dublin 2, Ireland
| | - Paul Kavanagh
- Health Intelligence Unit, Strategic Planning and Transformation, Jervis House, Jervis St, Dublin 1, Ireland
- Department of Epidemiology and Public Health, Royal College of Surgeons, Dublin 2, Ireland
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21
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Stirparo G, Oradini-Alacreu A, Migliori M, Villa GF, Botteri M, Fagoni N, Signorelli C, Sechi GM, Zoli A. Public health impact of the COVID-19 pandemic on the emergency healthcare system. J Public Health (Oxf) 2021; 44:e149-e152. [PMID: 34156071 PMCID: PMC8344573 DOI: 10.1093/pubmed/fdab212] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 05/17/2021] [Accepted: 06/04/2021] [Indexed: 12/26/2022] Open
Abstract
Background The Lombardy region has been the Italian region most affected by the coronavirus disease 2019 (COVID-19) pandemic in 2020. The emergency healthcare system was under deep stress throughout the past year due to the admission of COVID-19 patients to the emergency department (ED) and had to be thoroughly reorganized. Methods We performed a retrospective descriptive analysis of patients admitted into the ED recorded in the Lombardy online regional portal called EUOL (Emergenza e Urgenza OnLine). We compared the data registered in the EUOL with the patients admitted to the EDs from 1 January 2019 to 31 December 2019 and from 1 January 2020 to 31 December 2020. Results The number of admissions to the ED decreased by 32.5% in 2020 compared with 2019, reaching the lowest number in March and April. However, the percentage of patients hospitalized after ED significantly increased in 2020 compared with 2019 (P < 0.0001), reflecting the management of patients with a more severe clinical condition. More patients arrived at the ED by ambulance in 2020 (21.7% in 2020 versus 15.1% in 2019; P < 0.0001), particularly during March and April. Conclusions This analysis showed the importance of monitoring the pandemic’s evolution in order to treat more critically ill patients, despite a lower number of patients.
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Affiliation(s)
- G Stirparo
- Faculty of Medicine, School of Public Health - University of Vita-Salute San Raffaele, Milano 20132, Italy.,Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano 20124, Italy
| | - A Oradini-Alacreu
- Faculty of Medicine, School of Public Health - University of Vita-Salute San Raffaele, Milano 20132, Italy
| | - M Migliori
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano 20124, Italy
| | - G F Villa
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano 20124, Italy
| | - M Botteri
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano 20124, Italy.,AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU), ASST Spedali Civili di Brescia, Brescia 25123, Italy
| | - N Fagoni
- AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU), ASST Spedali Civili di Brescia, Brescia 25123, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia 25123, Italy
| | - C Signorelli
- Faculty of Medicine, School of Public Health - University of Vita-Salute San Raffaele, Milano 20132, Italy
| | - G M Sechi
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano 20124, Italy
| | - A Zoli
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano 20124, Italy
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22
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Navarro Rubio MD, Baquero Úbeda JL, Bosque García AM, Alfonso Zamora S, Lorenzo Garmendia A. [Impact of the COVID-19 pandemic: The point of view of patient associations]. J Healthc Qual Res 2021; 36:355-362. [PMID: 34246649 PMCID: PMC8185189 DOI: 10.1016/j.jhqr.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/22/2021] [Accepted: 05/23/2021] [Indexed: 11/24/2022]
Abstract
Antecedentes y objetivo La pandemia por COVID-19 está produciendo un gran impacto social y sanitario. Ante esta situación, los pacientes han de participar en la detección de sus nuevas necesidades. El objetivo de este estudio fue valorar la percepción de las organizaciones asociadas al Foro Español de Pacientes (FEP) sobre la pandemia. Materiales y métodos Estudio descriptivo transversal mediante encuesta online. Participaron las organizaciones asociadas al FEP durante la segunda quincena de mayo de 2020. Se realizó la valoración previa del cuestionario por profesionales y pacientes. Los ámbitos temáticos fueron: afectación general a causa de la pandemia, impacto, papel de las asociaciones de pacientes, limitaciones y retos. Se realizó un análisis descriptivo de las variables cuantitativas y un análisis de contenido de la información cualitativa. Resultados El porcentaje de participación fue del 88,7%. Los participantes destacaron el impacto de la pandemia en la calidad de vida y bienestar de pacientes y familiares. También refirieron la afectación de la enfermedad de base y el atraso de tratamientos y pruebas. La pandemia ha afectado también a las asociaciones de pacientes. Conclusiones El impacto de la pandemia se ha producido a nivel sanitario y en otras esferas de la sociedad. Los pacientes se han visto afectados en su salud, calidad de vida y utilización de los servicios sanitarios. Se destaca la necesidad de contar con los pacientes, sus familiares y sus representantes legítimos en la búsqueda de soluciones que se adapten a las necesidades actuales de estos colectivos.
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Affiliation(s)
- Mª D Navarro Rubio
- Foro Español de Pacientes, Madrid, España; Hospital Sant Joan de Déu, Area de Participación y Capacitación de Pacientes, Barcelona, España.
| | | | - A Mª Bosque García
- Hospital Sant Joan de Déu, Area de Participación y Capacitación de Pacientes, Barcelona, España
| | - S Alfonso Zamora
- Foro Español de Pacientes, Madrid, España; Acción Psoriasis, Barcelona, España
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23
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Samkari ET, Alkhotani AM, Siddiqui MI. Impact of COVID-19 on the rate of stroke cases at a tertiary hospital in Makkah, Saudi Arabia. ACTA ACUST UNITED AC 2021; 26:158-162. [PMID: 33814368 PMCID: PMC8024133 DOI: 10.17712/nsj.2021.2.20200141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/01/2020] [Indexed: 11/20/2022]
Abstract
Objectives: To assess and quantify the impact COVID-19 has had thus far on ischemic stroke admission rate and severity (National Institutes of Health Stroke Scale (NIHSS) score) at a single tertiary center in Makkah, Saudi Arabia. Methods: This is a retrospective analysis performed on admitted cases with definitive final diagnoses of transient ischemic attack (TIA) and ischemic stroke at King Abdullah Medical City in Makkah between January 1, 2020 and July 2020. Results: Sixty-nine patients were included in our study, 41 of whom presented at our facility before the pandemic and 29 during the pandemic. No statistical significance was observed between rate of admission, stroke severity, and rate of thrombolysis before the COVID-19 pandemic and after the outbreak. We observed a reduction of mean arrival time after the pandemic began, as well as a reduction of hospital stay days. Conclusion: A 29% reduction of admission secondary to acute ischemic stroke was noted during the pandemic. However, COVID-19 did not affect acute stroke care at our institute. The study is limited because of its small sample size, as we assessed just one medical center.
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Affiliation(s)
- Ebaa T Samkari
- From the Department of Neurology (Samkari, Alkhotani), King Abdullah Medical City, from the Department of Community Medicine (Siddiqui), and from the Department of Medicine (Alkhotani), Umm AlQura University, Makkah, Kingdom of Saudi Arabia
| | - Amal M Alkhotani
- From the Department of Neurology (Samkari, Alkhotani), King Abdullah Medical City, from the Department of Community Medicine (Siddiqui), and from the Department of Medicine (Alkhotani), Umm AlQura University, Makkah, Kingdom of Saudi Arabia
| | - Mohammed I Siddiqui
- From the Department of Neurology (Samkari, Alkhotani), King Abdullah Medical City, from the Department of Community Medicine (Siddiqui), and from the Department of Medicine (Alkhotani), Umm AlQura University, Makkah, Kingdom of Saudi Arabia
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24
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Makiyama K, Kawashima T, Nomura S, Eguchi A, Yoneoka D, Tanoue Y, Kawamura Y, Sakamoto H, Gilmour S, Shi S, Matsuura K, Uryu S, Hashizume M. Trends in Healthcare Access in Japan during the First Wave of the COVID-19 Pandemic, up to June 2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3271. [PMID: 33809955 PMCID: PMC8004161 DOI: 10.3390/ijerph18063271] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 11/24/2022]
Abstract
We evaluated the impact of the new coronavirus disease (COVID-19) on healthcare access in Japan in terms of the number of outpatients and hospitalized patients as well as the length of hospital stays, during the first wave of the pandemic, up to June 2020. This observational study evaluated the monthly average number of outpatients per day at hospitals, the average number of hospitalized patients per day, and the average length of hospital stays per patient, from December 2010 to June 2020, using the hospital reports data, which are open aggregated data on the utilization of hospitals from the Ministry of Health, Labour and Welfare. These numbers were compared with those from the same period of previous years, using a quasi-Poisson regression model. We found a nationwide decrease in the number of outpatients in general hospitals and hospitalized patients, particularly in long-term care beds in Japan, as well as the excess length of hospital stays among psychiatric care patients during the first wave of the COVID-19. This limited access to healthcare demonstrated the importance of the long-term health monitoring of vulnerable populations and the need for urgent management support to healthcare facilities in preparation for possible prolonged pandemics in the future.
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Affiliation(s)
- Koji Makiyama
- HOXO-M Inc., 1-22-11 Ginza, Chuo-ku, Tokyo 104-0061, Japan; (K.M.); (K.M.)
| | - Takayuki Kawashima
- Department of Mathematical and Computing Science, Tokyo Institute of Technology, 2-12-1 Ookayama, Meguro-ku, Tokyo 152-8550, Japan;
| | - Shuhei Nomura
- Department of Health Policy and Management, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan; (Y.K.); (H.S.)
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8654, Japan;
| | - Akifumi Eguchi
- Department of Sustainable Health Science, Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoi-cho, Inage-ku, Chiba 263-8522, Japan;
| | - Daisuke Yoneoka
- Graduate School of Public Health, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan; (D.Y.); (S.G.)
| | - Yuta Tanoue
- Institute for Business and Finance, Waseda University, 1-6-1 Nishi-Waseda, Shinjuku-ku, Tokyo 169-8050, Japan;
| | - Yumi Kawamura
- Department of Health Policy and Management, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan; (Y.K.); (H.S.)
| | - Haruka Sakamoto
- Department of Health Policy and Management, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan; (Y.K.); (H.S.)
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8654, Japan;
| | - Stuart Gilmour
- Graduate School of Public Health, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan; (D.Y.); (S.G.)
| | - Shoi Shi
- Department of Systems Pharmacology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8654, Japan;
- Laboratory for Synthetic Biology, RIKEN Center for Biosystems Dynamics Research, 1-3 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Kentaro Matsuura
- HOXO-M Inc., 1-22-11 Ginza, Chuo-ku, Tokyo 104-0061, Japan; (K.M.); (K.M.)
- Department of Management Science, Graduate School of Engineering, Tokyo University of Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Shinya Uryu
- Center for Environmental Biology and Ecosystem Studies, National Institute for Environmental Studies (NIES), 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan;
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8654, Japan;
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25
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D'Anna L, Brown M, Oishi S, Ellis N, Brown Z, Bentley P, Drumm B, Halse O, Jamil S, Jenkins H, Malik A, Kalladka D, Venter M, Kwan J, Banerjee S. Impact of National Lockdown on the Hyperacute Stroke Care and Rapid Transient Ischaemic Attack Outpatient Service in a Comprehensive Tertiary Stroke Centre During the COVID-19 Pandemic. Front Neurol 2021; 12:627493. [PMID: 33679589 PMCID: PMC7928343 DOI: 10.3389/fneur.2021.627493] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/08/2021] [Indexed: 01/09/2023] Open
Abstract
Background: The COVID-19 pandemic is having major implications for stroke services worldwide. We aimed to study the impact of the national lockdown period during the COVID-19 outbreak on stroke and transient ischemic attack (TIA) care in London, UK. Methods: We retrospectively analyzed data from a quality improvement registry of consecutive patients presenting with acute ischemic stroke and TIA to the Stroke Department, Imperial College Health Care Trust London during the national lockdown period (between March 23rd and 30th June 2020). As controls, we evaluated the clinical reports and stroke quality metrics of patients presenting with stroke or TIA in the same period of 2019. Results: Between March 23rd and 30th June 2020, we documented a fall in the number of stroke admissions by 31.33% and of TIA outpatient referrals by 24.44% compared to the same period in 2019. During the lockdown, we observed a significant increase in symptom onset-to-door time in patients presenting with stroke (median = 240 vs. 160 min, p = 0.020) and TIA (median = 3 vs. 0 days, p = 0.002) and a significant reduction in the total number of patients thrombolysed [27 (11.49%) vs. 46 (16.25%, p = 0.030)]. Patients in the 2020 cohort presented with a lower median pre-stroke mRS (p = 0.015), but an increased NIHSS (p = 0.002). We registered a marked decrease in mimic diagnoses compared to the same period of 2019. Statistically significant differences were found between the COVID and pre-COVID cohorts in the time from onset to door (median 99 vs. 88 min, p = 0.026) and from onset to needle (median 148 vs. 126 min, p = 0.036) for thrombolysis whilst we did not observe any significant delay to reperfusion therapies (door-to-needle and door-to-groin puncture time). Conclusions: National lockdown in the UK due to the COVID-19 pandemic was associated with a significant decrease in acute stroke admission and TIA evaluations at our stroke center. Moreover, a lower proportion of acute stroke patients in the pandemic cohort benefited from reperfusion therapy. Further research is needed to evaluate the long-term effects of the pandemic on stroke care.
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Affiliation(s)
- Lucio D'Anna
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Maddison Brown
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Sikdar Oishi
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Natalya Ellis
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Zoe Brown
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Paul Bentley
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Brian Drumm
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Omid Halse
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Sohaa Jamil
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Harri Jenkins
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Abid Malik
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Dheeraj Kalladka
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Marius Venter
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Joseph Kwan
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Soma Banerjee
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom
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Dobrocky T, Kaesmacher J, Pereira VM, Gralla J, Fischer U. Maintaining high thrombectomy rates during pandemics. Curr Opin Neurol 2021; 34:18-21. [PMID: 33230040 DOI: 10.1097/wco.0000000000000890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW The aim of this article is to review the current literature on endovascular treatment of acute ischemic stroke in the aftermath of the coronavirus disease 2019 (COVID-19) lockdown. RECENT FINDINGS The outbreak of the COVID-19 has had effect of unprecedented magnitude on the social, economic and personal aspects around the globe. Healthcare providers were forced to expand capacity to provide care to the surging number of symptomatic COVID-19 patients, while maintaining a fully operating service for all non-COVID patients. The recent literature suggesting an overall decrease in acute ischemic stroke admissions as well as total number of endovascular treatments will be reviewed. Although the underlying reasons therefore remain the matter of debate, it seems that the imposed restrictions, requiring social distancing, and stopping all nonessential services, have led to a higher threshold for patients to seek medical attention, in particular in those with less severe symptoms. Thus, raising public awareness on the importance of strokes and transient ischemic attacks is even more important in the light of the current situation to avoid serious healthcare, economic consequences, and limit long term morbidity. SUMMARY The priority remains maintaining a fast and efficient pre and in-hospital work-flow while mitigating nosocomial transmission and protecting the patient and the healthcare workers with appropriate personal protective equipment.
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Affiliation(s)
- Tomas Dobrocky
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Neuroradiology, Toronto Western Hospital, Ontario, Canada
| | - Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Interventional, Pediatric and Diagnostic Radiology
| | | | - Jan Gralla
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Kiss P, Carcel C, Hockham C, Peters SAE. The impact of the COVID-19 pandemic on the care and management of patients with acute cardiovascular disease: a systematic review. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:18-27. [PMID: 33151274 PMCID: PMC7665454 DOI: 10.1093/ehjqcco/qcaa084] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023]
Abstract
Background The COVID-19 pandemic has disrupted healthcare services around the world, which may have serious implications for the prognosis of patients with acute cardiovascular disease. We conducted a systematic review to assess the extent to which health services related to the care and management of acute cardiovascular events have been impacted during the COVID-19 pandemic. Methods PubMed, MedRxiv and Google Scholar were searched for observational studies published up to August 12, 2020 for studies that assessed the impact of the pandemic on the care and management of people with acute CVD. Results In total, 27 articles were included. Of these, 16 examined the impact on acute coronary syndromes (ACS), eight on strokes, one on ACS and strokes, and 2 on other types of CVD. When comparing the COVID-19 period to non-COVID-19 periods, eleven studies observed a decrease in ACS admissions ranging between 40 and 50% and five studies showed a decrease in stroke admissions of between 12 and 40%. Four studies showed a larger reduction in non-ST-segment elevation myocardial infarctions (NSTEMI) compared to ST-segment elevation myocardial infarctions (STEMI). A decrease in the number of reperfusion procedures, a shortening in the lengths of stay at the hospital, and longer symptom-to-door times were also observed. Conclusions The COVID-19 pandemic has led to a substantial decrease in the rate of admissions for acute CVD, reductions in the number of procedures, shortened lengths of stay at the hospital and longer delays between the onset of the symptoms and hospital treatment. The impact on patient’s prognosis needs to be quantified in future studies.
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Affiliation(s)
- Pauline Kiss
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Cheryl Carcel
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Carinna Hockham
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.,The George Institute for Global Health, UNSW, Sydney, Australia.,The George Institute for Global Health, Imperial College London, London, UK
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Effect of the COVID-19 pandemic on CT scans ordered from the emergency department for abdominal complaints. Emerg Radiol 2021; 28:485-495. [PMID: 33517547 PMCID: PMC7847299 DOI: 10.1007/s10140-021-01907-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/20/2021] [Indexed: 02/07/2023]
Abstract
Purpose The COVID-19 pandemic has affected healthcare systems and patients alike across the USA. We seek to elucidate changes in abdominal imaging ordered from the emergency department (ED) in a healthcare system undergoing non-surge conditions in April 2020 compared to April 2019. Methods We performed a retrospective, observational study comparing patients undergoing CT scans of the abdomen and pelvis ordered from the ED in April 2020 vs. April 2019 at a single healthcare center. Via review of the radiology report and electronic medical record, we determined the positive or negative status of these scans. We evaluated percentages of positive CT scans and differences in outcomes, including admission rates, interventions, and mortality. Results Comparing 2020 to 2019, there was a 31.6% decrease in the number of CT scans performed from the ED. We found a higher percentage of positive CT findings, 58.2% vs. 50.8% (p = 0.025), and increased admission rates, 40.8% vs. 34.1% (p = 0.036). Differences were found in rates of appendicitis, colitis, and cholangitis. No difference was found in ICU admissions, interventions, or in-hospital mortality. Conclusion During the COVID-19 pandemic in a region undergoing non-surge conditions, we found increased rates of positive CT scans performed from the ED for abdominal complaints with an increased percentage of hospital admissions compared to a control year. No differences in ICU admissions or rates of procedural intervention were found to suggest higher acuity of pathology on presentation. Our findings suggest appropriately decreased healthcare utilization in our study period, driven by pre-hospital patient self-selection.
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Schmidt AE, Abboud LA, Bogaert P. Making the case for strong health information systems during a pandemic and beyond. ACTA ACUST UNITED AC 2021; 79:13. [PMID: 33514433 PMCID: PMC7844779 DOI: 10.1186/s13690-021-00531-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/13/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND The Sars-CoV-2 pandemic exacerbates existing inequalities across health care systems globally, both within countries and between countries. It also highlights, like no other crisis before, existing weaknesses in health information systems (HIS). This article summarizes these key challenges for HIS in times of a pandemic and beyond, with a focus on European countries. It builds on the experiences of a large consortium representing HIS experts in key positions in national public health or similar institutes across Europe. METHODS Data were collected in bi-weekly conference calls organized by the InfAct project between February and June 2020. Emerging themes were clustered and analysed around a WHO framework for health information systems (HIS). We analyse strengths of HIS at two levels: (i) dealing with health information directly, and (ii) dealing with other parts of information systems that allow for a holistic assessment of the pandemic (including health-related aspects). RESULTS The analysis highlights the need for capacity-building in HIS before a pandemic hits, the relevance of going beyond health information only related to health care but taking a broader perspective (e.g. on vulnerable groups), the need for strong reporting systems on staffing numbers and in primary care. Further, data linkage emerges as a crucial precondition to identify unmet needs for essential health care services in a timely manner. Finally, room for innovation and digitalisation is key to be able to react flexibly in times of crisis. Trust for health information stakeholders is another important factor to create strong HIS. CONCLUSIONS The strengths and shortcomings of European HIS that have been observed during the COVID-19 crisis highlight the need for strong HIS beyond the crisis. The experiences reported leave as a central message that successful reactions to the pandemic are (also) grounded in strong HIS that ultimately not only benefit the health of the population but also create a number of economic and psycho-social benefits. Strong data reporting schemes may also support fine-tuning of containment measures during a pandemic as well as transition phases.
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Affiliation(s)
- Andrea E Schmidt
- Austrian Public Health Institute (Gesundheit Österreich), Department of Health Economics and Health Systems Analysis, Stubenring 6, 1010, Vienna, Austria.
| | - Linda A Abboud
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Petronille Bogaert
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
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Satty T, Ramgopal S, Elmer J, Mosesso VN, Martin-Gill C. EMS responses and non-transports during the COVID-19 pandemic. Am J Emerg Med 2021; 42:1-8. [PMID: 33429185 PMCID: PMC7836527 DOI: 10.1016/j.ajem.2020.12.078] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic may affect both use of 9-1-1 systems and prehospital treatment and transport practices. We evaluated EMS responses in an EMS region when it experienced low to moderate burden of COVID-19 disease to assess overall trends, response and management characteristics, and non-transport rates. Our goal is to inform current and future pandemic response in similar regions. METHODS We performed a retrospective review of prehospital EMS responses from 22 urban, suburban, and rural EMS agencies in Western Pennsylvania. To account for seasonal variation, we compared demographic, response, and management characteristics for the 2-month period of March 15 to May 15, 2020 with the corresponding 2-month periods in 2016-2019. We then tested for an association between study period (pandemic vs historical control) and incidence of non-transport in unadjusted and adjusted regression. Finally, we described the continuous trends in responses and non-transports that occurred during the year before and initial phase of the COVID-19 pandemic from January 1, 2019 to May 31, 2020. RESULTS Among 103,607 EMS responses in the 2-month comparative periods of March 15 to May 15, 2016-2020, we found a 26.5% [95% CI 26.9%, 27.1%] decrease in responses in 2020 compared to the same months from the four prior years. There was a small increase in respiratory cases (0.6% [95%CI 0.1%, 1.1%]) and greater frequency of abnormal vital signs suggesting a sicker patient cohort. There was a relative increase (46.6%) in non-transports between periods. The pandemic period was independently associated with an increase in non-transport (adjusted OR 1.68; 95%CI 1.59, 1.78). Among 177,194 EMS responses occurring in the year before and during the early period of the pandemic, between January 1, 2019, and May 31, 2020, we identified a 31% decrease in responses and a 48% relative increase in non-transports for April 2020 compared to the previous year's monthly averages. CONCLUSION Despite a low to moderate burden of infection during the initial period of the COVID-19 pandemic, we found a decline in overall EMS response volumes and an increase in the rate of non-transports independent of patient demographics and other response characteristics.
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Affiliation(s)
- Timothy Satty
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Sriram Ramgopal
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Vincent N Mosesso
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Christian Martin-Gill
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
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Impact of COVID-19 pandemic on epilepsy practice in India: A tripartite survey. Seizure 2021; 86:60-67. [PMID: 33550135 PMCID: PMC7837209 DOI: 10.1016/j.seizure.2020.12.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/15/2020] [Accepted: 12/31/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To assess the impact of ongoing COVID-19 pandemic on epilepsy care in India. METHODS We conducted a three-part survey comprising neurologists, people with epilepsy (PWE), and 11 specialized epilepsy centers across India. We sent two separate online survey questionnaires to Indian neurologists and PWE to assess the epilepsy practice, seizures control, and access to care during the COVID-19 pandemic. We collected and compared the data concerning the number of PWE cared for and epilepsy procedures performed during the 6 months periods preceding and following COVID-19 lockdown from epilepsy centers. RESULTS The survey was completed by 453 neurologists and 325 PWE. One third of the neurologist reported >50 % decline in outdoor visits by PWE and EEG recordings. The cumulative data from 11 centers showed 65-70 % decline in the number of outdoor patients, video-EEG monitoring, and epilepsy surgery. Working in a hospital admitting COVID-19 patients and use of teleconsultation correlated with this decline. Half of PWE had postponed their planned outpatient visits and EEG. Less than 10 % of PWE missed their antiseizure medicines (ASM) or had seizures due to the nonavailability of ASM. Seizure control remained unchanged or improved in 92 % PWE. Half of the neurologists started using teleconsultation during the pandemic. Only 4% of PWE were afflicted with COVID-19 infection. CONCLUSIONS Despite significant decline in the number of PWE visiting hospitals, their seizure control and access to ASMs were not affected during the COVID-19 pandemic in India. Risk of COVID-19 infection in PWE is similar to general population.
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Siegler JE, Zha AM, Czap AL, Ortega-Gutierrez S, Farooqui M, Liebeskind DS, Desai SM, Hassan AE, Starosciak AK, Linfante I, Rai V, Thon JM, Then R, Heslin ME, Thau L, Khandelwal P, Mohammaden MH, Haussen DC, Nogueira RG, Jillella DV, Nahab F, Kaliaev A, Nguyen TN, Zaidat O, Jovin TG, Jadhav AP. Influence of the COVID-19 Pandemic on Treatment Times for Acute Ischemic Stroke: The Society of Vascular and Interventional Neurology Multicenter Collaboration. Stroke 2021; 52:40-47. [PMID: 33250041 PMCID: PMC7934334 DOI: 10.1161/strokeaha.120.032789] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/15/2020] [Accepted: 11/05/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE The pandemic caused by the novel coronavirus disease 2019 (COVID-19) has led to an unprecedented paradigm shift in medical care. We sought to evaluate whether the COVID-19 pandemic may have contributed to delays in acute stroke management at comprehensive stroke centers. METHODS Pooled clinical data of consecutive adult stroke patients from 14 US comprehensive stroke centers (January 1, 2019, to July 31, 2020) were queried. The rate of thrombolysis for nontransferred patients within the Target: Stroke goal of 60 minutes was compared between patients admitted from March 1, 2019, and July 31, 2019 (pre-COVID-19), and March 1, 2020, to July 31, 2020 (COVID-19). The time from arrival to imaging and treatment with thrombolysis or thrombectomy, as continuous variables, were also assessed. RESULTS Of the 2955 patients who met inclusion criteria, 1491 were admitted during the pre-COVID-19 period and 1464 were admitted during COVID-19, 15% of whom underwent intravenous thrombolysis. Patients treated during COVID-19 were at lower odds of receiving thrombolysis within 60 minutes of arrival (odds ratio, 0.61 [95% CI, 0.38-0.98]; P=0.04), with a median delay in door-to-needle time of 4 minutes (P=0.03). The lower odds of achieving treatment in the Target: Stroke goal persisted after adjustment for all variables associated with earlier treatment (adjusted odds ratio, 0.55 [95% CI, 0.35-0.85]; P<0.01). The delay in thrombolysis appeared driven by the longer delay from imaging to bolus (median, 29 [interquartile range, 18-41] versus 22 [interquartile range, 13-37] minutes; P=0.02). There was no significant delay in door-to-groin puncture for patients who underwent thrombectomy (median, 83 [interquartile range, 63-133] versus 90 [interquartile range, 73-129] minutes; P=0.30). Delays in thrombolysis were observed in the months of June and July. CONCLUSIONS Evaluation for acute ischemic stroke during the COVID-19 period was associated with a small but significant delay in intravenous thrombolysis but no significant delay in thrombectomy time metrics. Taking steps to reduce delays from imaging to bolus time has the potential to attenuate this collateral effect of the pandemic.
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Affiliation(s)
- James E. Siegler
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., J.M.T., R.T., M.E.H., L.T., T.G.J.)
| | - Alicia M. Zha
- Department of Neurology, University of Texas Health Science Center at Houston, TX (A.M.Z., A.L.C.)
| | - Alexandra L. Czap
- Department of Neurology, University of Texas Health Science Center at Houston, TX (A.M.Z., A.L.C.)
| | - Santiago Ortega-Gutierrez
- Department of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics (S.O.-G., M.F.)
| | - Mudassir Farooqui
- Department of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics (S.O.-G., M.F.)
| | - David S. Liebeskind
- Department of Neurology, Ronald Reagan University of California at Los Angeles (D.S.L.)
| | - Shashvat M. Desai
- Department of Neurology, University of Pittsburgh Medical Center Mercy Hospital, PA (S.M.D., A.P.J.)
- Department of Neurology, University of Pittsburgh Medical Center Presbyterian Medical Center, PA (S.M.D., A.P.J.)
| | - Ameer E. Hassan
- Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center, Harlingen, TX (A.E.H.)
| | - Amy K. Starosciak
- Center for Research (A.K.S.), Baptist Health South Florida, Coral Gables
| | - Italo Linfante
- Department of Interventional Neuroradiology and Endovascular Neurosurgery (I.L.), Baptist Health South Florida, Coral Gables
| | - Vivek Rai
- OhioHealth Neuroscience Center, Riverside Methodist Hospital, Columbus (V.R.)
| | - Jesse M. Thon
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., J.M.T., R.T., M.E.H., L.T., T.G.J.)
| | - Ryna Then
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., J.M.T., R.T., M.E.H., L.T., T.G.J.)
| | - Mark E. Heslin
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., J.M.T., R.T., M.E.H., L.T., T.G.J.)
| | - Lauren Thau
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., J.M.T., R.T., M.E.H., L.T., T.G.J.)
| | - Priyank Khandelwal
- Department of Endovascular Neurological Surgery and Neurology, Robert Wood Johnson University Hospital, New Brunswick, NJ (P.K.)
| | - Mahmoud H. Mohammaden
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (M.H.M., D.C.H., R.G.N.)
| | - Diogo C. Haussen
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (M.H.M., D.C.H., R.G.N.)
| | - Raul G. Nogueira
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (M.H.M., D.C.H., R.G.N.)
| | - Dinesh V. Jillella
- Department of Neurology, Emory University Hospital, Atlanta, GA (D.V.J., F.N.)
| | - Fadi Nahab
- Department of Neurology, Emory University Hospital, Atlanta, GA (D.V.J., F.N.)
| | - Artem Kaliaev
- Department of Interventional Neurology and Neuroradiology, Boston Medical Center, MA (A.K., T.N.N.)
| | - Thanh N. Nguyen
- Department of Interventional Neurology and Neuroradiology, Boston Medical Center, MA (A.K., T.N.N.)
| | - Osama Zaidat
- Department of Neurology, Mercy Health St. Vincent Hospital, Toledo, OH (O.Z.)
| | - Tudor G. Jovin
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., J.M.T., R.T., M.E.H., L.T., T.G.J.)
| | - Ashutosh P. Jadhav
- Department of Neurology, University of Pittsburgh Medical Center Mercy Hospital, PA (S.M.D., A.P.J.)
- Department of Neurology, University of Pittsburgh Medical Center Presbyterian Medical Center, PA (S.M.D., A.P.J.)
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Impact of the COVID-19 Pandemic on Manual Therapy Service Utilization within the Australian Private Healthcare Setting. Healthcare (Basel) 2020; 8:healthcare8040558. [PMID: 33322226 PMCID: PMC7764415 DOI: 10.3390/healthcare8040558] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022] Open
Abstract
The COVID-19 pandemic has impacted a wide range of health services. This study aimed to quantify the impact of the COVID-19 pandemic on manual therapy service utilization within the Australian private healthcare setting during the first half of 2020. Quarterly data regarding the number and total cost of services provided were extracted for each manual therapy profession (i.e., chiropractic, osteopathy, and physiotherapy) for the period January 2015 to June 2020 from the Australian Prudential Regulation Authority. Time series forecasting methods were used to estimate absolute and relative differences between the forecasted and observed values of service utilization. An estimated 1.3 million (13.2%) fewer manual therapy services, with a total cost of AUD 84 million, were provided within the Australian private healthcare setting during the first half of 2020. Reduction in service utilization was considerably larger in the second quarter (21.7%) than in the first quarter (5.7%), and was larger in physiotherapy (20.6%) and osteopathy (12.7%) than in chiropractic (5.2%). The impact varied across states and territories, with the largest reductions in service utilization observed in New South Wales (17.5%), Australian Capital Territory (16.3%), and Victoria (16.2%). The COVID-19 pandemic has had a profound impact on manual therapy service utilization in Australia. The magnitude of the decline in service utilization varied considerably across professions and locations. The long-term consequences of this decline in manual therapy utilization remain to be determined.
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Initial economic damage from the COVID-19 pandemic in the United States is more widespread across ages and geographies than initial mortality impacts. Proc Natl Acad Sci U S A 2020; 117:27934-27939. [PMID: 33082229 PMCID: PMC7668078 DOI: 10.1073/pnas.2014279117] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
A full picture of the COVID-19 pandemic requires information on how its impact on lives and on livelihoods relates across different groups. We therefore estimate excess all-cause mortality and employment displacement in April 2020 nationally and separately by state and by age group. Initial economic damages from the pandemic are more widespread across groups than deaths, which were primarily concentrated in a few states and among the oldest old. While the two states with the largest mortality increase account for about half of national excess mortality, the two most economically affected states account for only 7% of national economic damages. These findings suggest that policy responses to contain the pandemic involve trade-offs across different demographic and geographic groups. The economic and mortality impacts of the COVID-19 pandemic have been widely discussed, but there is limited evidence on their relationship across demographic and geographic groups. We use publicly available monthly data from January 2011 through April 2020 on all-cause death counts from the Centers for Disease Control and Prevention and employment from the Current Population Survey to estimate excess all-cause mortality and employment displacement in April 2020 in the United States. We report results nationally and separately by state and by age group. Nationally, excess all-cause mortality was 2.4 per 10,000 individuals (about 30% higher than reported COVID deaths in April) and employment displacement was 9.9 per 100 individuals. Across age groups 25 y and older, excess mortality was negatively correlated with economic damage; excess mortality was largest among the oldest (individuals 85 y and over: 39.0 per 10,000), while employment displacement was largest among the youngest (individuals 25 to 44 y: 11.6 per 100 individuals). Across states, employment displacement was positively correlated with excess mortality (correlation = 0.29). However, mortality was highly concentrated geographically, with the top two states (New York and New Jersey) each experiencing over 10 excess deaths per 10,000 and accounting for about half of national excess mortality. By contrast, employment displacement was more geographically spread, with the states with the largest point estimates (Nevada and Michigan) each experiencing over 16 percentage points employment displacement but accounting for only 7% of the national displacement. These results suggest that policy responses may differentially affect generations and geographies.
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Elmer J, Okubo M, Guyette FX, Martin-Gill C. Indirect effects of COVID-19 on OHCA in a low prevalence region. Resuscitation 2020; 156:282-283. [PMID: 32920116 PMCID: PMC7482609 DOI: 10.1016/j.resuscitation.2020.08.127] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Masashi Okubo
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Francis X Guyette
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christian Martin-Gill
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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