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Kim Y, Lee SH, Cho YJ. Donor motivation in the era of the COVID-19 crisis: Focusing on South
Korean health diplomacy and response aid to COVID-19. INTERNATIONAL AREA STUDIES REVIEW 2023; 26:71-86. [PMCID: PMC9887429 DOI: 10.1177/22338659231151409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
COVID-19 has brought an unprecedented global economic burden. The widely held view is that, during times of economic crisis, there are reduced flows of foreign aid due to budgetary constraints. Although some countries’ actions seem aligned with this perspective, others, including South Korea, have acted counter-intuitively. South Korea has implemented health-related diplomacy, initiating the Agenda for Building Resilience against COVID-19 through the Development Cooperation (ABC) program. This program provides countries with COVID-19 diagnosis kits, personal protective equipment, such as masks, and health-related capacity for building and development projects. We attempt to understand the behavior of donors in the crisis context and, thus, examine South Korea as a representative case. Using South Korean health-related diplomacy as our case study, we show that South Korea has considered both its interests and recipients’ needs. Furthermore, a quantitative study with newly constructed data from the ABC program reveals that South Korea provides higher amounts of Official Development Assistance (ODA) via its ABC program to recipients with whom it enjoys close economic ties and with whom it has given higher amounts of ODA. The latter finding suggests a path-dependent act in foreign aid allocation.
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Ansbro É, Masri S, Prieto-Merino D, Willis R, Aoun Bahous S, Molfino L, Boulle P, Perel P. Fixed dose combination drugs for cardiovascular disease in a prolonged humanitarian crisis in Lebanon: an implementation study. BMJ Open 2023; 13:e063668. [PMID: 36697043 PMCID: PMC9884866 DOI: 10.1136/bmjopen-2022-063668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 12/12/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES This pre-post implementation study evaluated the introduction of fixed dose combination (FDC) medications for atherosclerotic cardiovascular disease (ASCVD) secondary prevention into routine care in a humanitarian setting. SETTING Two Médecins sans Frontières (MSF) primary care clinics serving Syrian refugee and host populations in north Lebanon. PARTICIPANTS Consenting patients ≥18 years with existing ASCVD requiring secondary prevention medication were eligible for study enrolment. Those with FDC contraindication(s) or planning to move were excluded. Of 521 enrolled patients, 460 (88.3%) were retained at 6 months, and 418 (80.2%) switched to FDC. Of these, 84% remained on FDC (n=351), 8.1% (n=34) discontinued and 7.9% (n=33) were lost to follow-up by month 12. INTERVENTIONS Eligible patients, enrolled February-May 2019, were switched to Trinomia FDC (atorvastatin 20 mg, aspirin 100 mg, ramipril 2.5/5/10 mg) after 6 months' usual care. During the study, the COVID-19 pandemic, an economic crisis and clinic closures occurred. OUTCOME MEASURES Descriptive and regression analyses compared key outcomes at 6 and 12 months: medication adherence, non-high density lipoprotein cholesterol (non-HDL-C) and systolic blood pressure (SBP) control. We performed per-protocol, intention-to-treat and secondary analyses of non-switchers. RESULTS Among 385 switchers remaining at 12 months, total adherence improved 23%, from 63% (95% CI 58 to 68) at month 6, to 86% (95% CI 82 to 90) at month 12; mean non-HDL-C levels dropped 0.28 mmol/L (95% CI -0.38 to -0.18; p<0.0001), from 2.39 (95% CI 2.26 to 2.51) to 2.11 mmol/L (95% CI 2.00 to 2.22); mean SBP dropped 2.89 mm Hg (95% CI -4.49 to -1.28; p=0.0005) from 132.7 (95% CI 130.8 to 134.6) to 129.7 mm Hg (95% CI 127.9 to 131.5). Non-switchers had smaller improvements in adherence and clinical outcomes. CONCLUSION Implementing an ASCVD secondary prevention FDC improved adherence and CVD risk factors in MSF clinics in Lebanon, with potential for wider implementation by humanitarian actors and host health systems.
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Affiliation(s)
- Éimhín Ansbro
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Faculty of Epidemiology & Population Health, London, UK
| | | | - David Prieto-Merino
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Faculty of Epidemiology & Population Health, London, UK
| | - Ruth Willis
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Sola Aoun Bahous
- Department of Internal Medicine, School of Medicine, Lebanese American University, Beirut, Lebanon
| | | | | | - Pablo Perel
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Faculty of Epidemiology & Population Health, London, UK
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Armstrong ADC, Santos LG, Leal TC, Paiva JPSD, Silva LFD, Santana GBDA, Rocha CADO, Feitosa TA, Araújo SLDM, Bezerra-Santos M, Souza CDFD, Carmo RFD. Excesso de Mortalidade Hospitalar por Doenças Cardiovasculares no Brasil Durante o Primeiro Ano da Pandemia de COVID-19. Arq Bras Cardiol 2022; 119:37-45. [PMID: 35674569 PMCID: PMC9352113 DOI: 10.36660/abc.20210468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/27/2021] [Indexed: 12/02/2022] Open
Abstract
Fundamento: A pandemia da COVID-19 tem causado um impacto sobre a mortalidade por várias doenças em todo o mundo, especialmente por doenças cardiovasculares (DCVs). O Brasil é um país de dimensões continentais com diferenças significativas na estrutura de saúde entre seus estados. Objetivo: Analisar a mortalidade hospitalar por DCV no sistema público de saúde durante o primeiro ano da pandemia por COVID-19 (2020) no Brasil. Métodos: Este é um estudo ecológico analisando o número absoluto de mortes hospitalares e a taxa de mortalidade hospitalar no Brasil, suas macrorregiões, e unidades federativas. Os dados foram obtidos do Sistema de Informações Hospitalares (SIH) do Ministério da Saúde. O P-escore foi usado para analisar o excesso de mortalidade. O escore compara os eventos observados com os eventos esperados para um dado local e período. O escore-P foi corrigido por um modelo de regressão joinpoint, com um intervalo de confiança de 95% e nível de significância de 5%. Resultados: Houve 93.104 óbitos hospitalares por DCV no Brasil em 2020, o que representa 1495 menos óbitos (escore-P: -1,58) que o esperado. A região centro-oeste apresentou um escore-P positivo, com um aumento de 15,1% no número de mortes. Dez estados apresentaram um maior número de óbitos em 2020. Ainda, observou-se um excesso de 13,3% de mortalidade hospitalar no país como um todo, e um excesso de mortalidade hospitalar em todas as macrorregiões. Conclusões: Houve uma diminuição no número absoluto de óbitos hospitalares, bem como um aumento na taxa de mortalidade por DCV no Brasil em 2020, após o início da pandemia por COVID-19.
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de Lange M, Carvalho AS, Brito Fernandes Ó, Lingsma H, Klazinga N, Kringos D. The Impact of the COVID-19 Pandemic on Hospital Services for Patients with Cardiac Diseases: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3172. [PMID: 35328859 PMCID: PMC8953098 DOI: 10.3390/ijerph19063172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/28/2022] [Accepted: 03/04/2022] [Indexed: 12/12/2022]
Abstract
This study aims to assess the impact of the COVID-19 pandemic on hospital cardiac care, as assessed by performance indicators. Scoping review methodology: performance indicators were extracted to inform on changes in care during January-June 2020. Database searches yielded 6277 articles, of which 838 met the inclusion criteria. After full-text screening, 94 articles were included and 1637 indicators were retrieved. Most of the indicators that provided information on changes in the number of admissions (n = 118, 88%) signaled a decrease in admissions; 88% (n = 15) of the indicators showed patients' delayed presentation and 40% (n = 54) showed patients in a worse clinical condition. A reduction in diagnostic and treatment procedures was signaled by 95% (n = 18) and 81% (n = 64) of the indicators, respectively. Length of stay decreased in 58% (n = 21) of the indicators, acute coronary syndromes treatment times increased in 61% (n = 65) of the indicators, and outpatient activity decreased in 94% (n = 17) of the indicators related to outpatient care. Telehealth utilization increased in 100% (n = 6). Outcomes worsened in 40% (n = 35) of the indicators, and mortality rates increased in 52% (n = 31). All phases of the pathway were affected. This information could support the planning of care during the ongoing pandemic and in future events.
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Affiliation(s)
- Mats de Lange
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.d.L.); (Ó.B.F.); (N.K.); (D.K.)
| | - Ana Sofia Carvalho
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.d.L.); (Ó.B.F.); (N.K.); (D.K.)
- Department of Public Health, Erasmus University Medical Center, Postbus, 3000 CA Rotterdam, The Netherlands;
| | - Óscar Brito Fernandes
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.d.L.); (Ó.B.F.); (N.K.); (D.K.)
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, H-1093 Budapest, Hungary
| | - Hester Lingsma
- Department of Public Health, Erasmus University Medical Center, Postbus, 3000 CA Rotterdam, The Netherlands;
| | - Niek Klazinga
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.d.L.); (Ó.B.F.); (N.K.); (D.K.)
| | - Dionne Kringos
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.d.L.); (Ó.B.F.); (N.K.); (D.K.)
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Lugli G, Ottaviani MM, Botta A, Ascione G, Bruschi A, Cagnazzo F, Zammarchi L, Romagnani P, Portaluri T. The Impact of the SARS-CoV-2 Pandemic on Healthcare Provision in Italy to non-COVID Patients: a Systematic Review. Mediterr J Hematol Infect Dis 2022; 14:e2022012. [PMID: 35070219 PMCID: PMC8746940 DOI: 10.4084/mjhid.2022.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/16/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Italy has been one of the countries most affected by the SARS-CoV-2 pandemic, and the regional healthcare system has had to quickly adapt its organization to meet the needs of infected patients. This has led to a drastic change in the routine management of non-communicable diseases with a potential long-term impact on patient health care. Therefore, we investigated the management of non-COVID-19 patients across all medical specialities in Italy. METHODS A PRISMA guideline-based systematic review of the literature was performed using PubMed, Embase, and Scopus, restricting the search to the main outbreak period in Italy (from February 20 to June 25 2020). We selected articles in English or Italian that detailed changes in the Italian hospital care for non-COVID-19 patients due to the pandemic. Our keywords included all medical specialities combined with our geographical focus (Italy) and COVID-19. RESULTS Of the 4643 potentially eligible studies identified by the search, 247 were included. A decrease in the management of emergencies in non-COVID patients was found together with an increase in mortality. Similarly, non-deferrable conditions met a tendency toward decreased diagnosis. All specialities have been affected by the re-organization of healthcare provision in the hub-and-spoke system and have benefited from telemedicine. CONCLUSIONS Our work highlights the changes in the Italian public healthcare system to tackle the developing health crisis due to the COVID-19 pandemic. The findings of our review may be useful to analyse future directions for the healthcare system in the case of new pandemic scenarios.
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Affiliation(s)
- Gianmarco Lugli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Matteo Maria Ottaviani
- Department of Neurosurgery, University Politecnica delle Marche, Ancona, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Annarita Botta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Guido Ascione
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Alessandro Bruschi
- Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Infectious and Tropical Disease, University Hospital Careggi, Florence, Italy
| | - Paola Romagnani
- Nephrology and Dialysis Unit, Department of Pediatrics, Meyer Children’s University Hospital, Florence, Italy
- Department of Biomedical Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Tommaso Portaluri
- IN Srl, Udine, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
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Stokes AC, Lundberg DJ, Elo IT, Hempstead K, Bor J, Preston SH. COVID-19 and excess mortality in the United States: A county-level analysis. PLoS Med 2021; 18:e1003571. [PMID: 34014945 PMCID: PMC8136644 DOI: 10.1371/journal.pmed.1003571] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/23/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Coronavirus Disease 2019 (COVID-19) excess deaths refer to increases in mortality over what would normally have been expected in the absence of the COVID-19 pandemic. Several prior studies have calculated excess deaths in the United States but were limited to the national or state level, precluding an examination of area-level variation in excess mortality and excess deaths not assigned to COVID-19. In this study, we take advantage of county-level variation in COVID-19 mortality to estimate excess deaths associated with the pandemic and examine how the extent of excess mortality not assigned to COVID-19 varies across subsets of counties defined by sociodemographic and health characteristics. METHODS AND FINDINGS In this ecological, cross-sectional study, we made use of provisional National Center for Health Statistics (NCHS) data on direct COVID-19 and all-cause mortality occurring in US counties from January 1 to December 31, 2020 and reported before March 12, 2021. We used data with a 10-week time lag between the final day that deaths occurred and the last day that deaths could be reported to improve the completeness of data. Our sample included 2,096 counties with 20 or more COVID-19 deaths. The total number of residents living in these counties was 319.1 million. On average, the counties were 18.7% Hispanic, 12.7% non-Hispanic Black, and 59.6% non-Hispanic White. A total of 15.9% of the population was older than 65 years. We first modeled the relationship between 2020 all-cause mortality and COVID-19 mortality across all counties and then produced fully stratified models to explore differences in this relationship among strata of sociodemographic and health factors. Overall, we found that for every 100 deaths assigned to COVID-19, 120 all-cause deaths occurred (95% CI, 116 to 124), implying that 17% (95% CI, 14% to 19%) of excess deaths were ascribed to causes of death other than COVID-19 itself. Our stratified models revealed that the percentage of excess deaths not assigned to COVID-19 was substantially higher among counties with lower median household incomes and less formal education, counties with poorer health and more diabetes, and counties in the South and West. Counties with more non-Hispanic Black residents, who were already at high risk of COVID-19 death based on direct counts, also reported higher percentages of excess deaths not assigned to COVID-19. Study limitations include the use of provisional data that may be incomplete and the lack of disaggregated data on county-level mortality by age, sex, race/ethnicity, and sociodemographic and health characteristics. CONCLUSIONS In this study, we found that direct COVID-19 death counts in the US in 2020 substantially underestimated total excess mortality attributable to COVID-19. Racial and socioeconomic inequities in COVID-19 mortality also increased when excess deaths not assigned to COVID-19 were considered. Our results highlight the importance of considering health equity in the policy response to the pandemic.
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Affiliation(s)
- Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Dielle J. Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Irma T. Elo
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Katherine Hempstead
- Robert Wood Johnson Foundation, Princeton, New Jersey, United States of America
| | - Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Samuel H. Preston
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Cannatà A, Bromage DI, McDonagh TA. The collateral cardiovascular damage of COVID-19: only history will reveal the depth of the iceberg. Eur Heart J 2021; 42:1524-1527. [PMID: 33624020 PMCID: PMC7928971 DOI: 10.1093/eurheartj/ehab097] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Antonio Cannatà
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, UK.,Department of Cardiology, King's College Hospital London, London, UK
| | - Daniel I Bromage
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, UK.,Department of Cardiology, King's College Hospital London, London, UK
| | - Theresa A McDonagh
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, UK.,Department of Cardiology, King's College Hospital London, London, UK
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8
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Stokes AC, Lundberg DJ, Elo IT, Hempstead K, Bor J, Preston SH. Assessing the Impact of the Covid-19 Pandemic on US Mortality: A County-Level Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 32908999 PMCID: PMC7480051 DOI: 10.1101/2020.08.31.20184036] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background. Covid-19 excess deaths refer to increases in mortality over what would normally have been expected in the absence of the Covid-19 pandemic. Several prior studies have calculated excess deaths in the United States but were limited to the national or state level, precluding an examination of area-level variation in excess mortality and excess deaths not assigned to Covid-19. In this study, we take advantage of county-level variation in Covid-19 mortality to estimate excess deaths associated with the pandemic and examine how the extent of excess mortality not assigned to Covid-19 varies across subsets of counties defined by sociodemographic and health characteristics. Methods and Findings. In this ecological, cross-sectional study, we made use of provisional National Center for Health Statistics (NCHS) data on direct Covid-19 and all-cause mortality occurring in U.S. counties from January 1 to December 31, 2020 and reported before March 12, 2021. We used data with a ten week time lag between the final day that deaths occurred and the last day that deaths could be reported to improve the completeness of data. Our sample included 2,096 counties with 20 or more Covid-19 deaths. The total number of residents living in these counties was 319.1 million. On average, the counties were 18.7% Hispanic, 12.7% non-Hispanic Black and 59.6% non-Hispanic White. 15.9% of the population was older than 65 years. We first modeled the relationship between 2020 all-cause mortality and Covid-19 mortality across all counties and then produced fully stratified models to explore differences in this relationship among strata of sociodemographic and health factors. Overall, we found that for every 100 deaths assigned to Covid-19, 120 all-cause deaths occurred (95% CI, 116 to 124), implying that 17% (95% CI, 14% to 19%) of excess deaths were ascribed to causes of death other than Covid-19 itself. Our stratified models revealed that the percentage of excess deaths not assigned to Covid-19 was substantially higher among counties with lower median household incomes and less formal education, counties with poorer health and more diabetes, and counties in the South and West. Counties with more non-Hispanic Black residents, who were already at high risk of Covid-19 death based on direct counts, also reported higher percentages of excess deaths not assigned to Covid-19. Study limitations include the use of provisional data that may be incomplete and the lack of disaggregated data on county-level mortality by age, sex, race/ethnicity, and sociodemographic and health characteristics. Conclusions. In this study, we found that direct Covid-19 death counts in the United States in 2020 substantially underestimated total excess mortality attributable to Covid-19. Racial and socioeconomic inequities in Covid-19 mortality also increased when excess deaths not assigned to Covid-19 were considered. Our results highlight the importance of considering health equity in the policy response to the pandemic.
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Affiliation(s)
- Andrew C Stokes
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Dielle J Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Irma T Elo
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Katherine Hempstead
- Robert Wood Johnson Foundation, Princeton, New Jersey, United States of America
| | - Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Samuel H Preston
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Vierucci F, Bacci C, Mucaria C, Dini F, Federico G, Maielli M, Vaccaro A. How COVID-19 Pandemic Changed Children and Adolescents Use of the Emergency Department: the Experience of a Secondary Care Pediatric Unit in Central Italy. ACTA ACUST UNITED AC 2020; 2:1959-1969. [PMID: 32984767 PMCID: PMC7508675 DOI: 10.1007/s42399-020-00532-5] [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] [Accepted: 09/17/2020] [Indexed: 12/13/2022]
Abstract
Italy was the first European country hit by SARS-CoV-2 infection, particularly northern regions. After the beginning of national lockdown (March 9th, 2020), we observed a significant decrease in pediatric emergency department consultations (daily pediatric visits; pre-lockdown, 16 (11-22); lockdown, 3 (1-3); phase 2, 3 (3-5), p < 0.0001). On the other hand, the percentage of children discharged right after pediatric visit significantly decreased from 80% in January to 50% in April. After March 9th, we registered a change in the diagnoses of emergency department visits, with an increase in the percentage of non-infectious acute conditions and a decrease in infectious diseases, with two cases of a noteworthy delayed access to hospital care. We performed a retrospective analysis of consultations requested to our pediatric unit for children and adolescents referred to the general Emergency Department of San Luca Hospital of Lucca (Tuscany, Central Italy) from January 1st to May 31st, 2020. We split data in two different time periods according to consultations performed before (January 1st-March 8th) and after the beginning of lockdown (March 9th-May 31st). Analyzing the number of children hospitalized from January to May 2020 in comparison with the same period in 2019, a decreased hospitalization became evident after March (March - 74.6%, April - 71.6%, May - 58.6%). Nasopharyngeal swabs done in 115 children showed only one case of COVID-19. Even if COVID-19 outbreak more seriously affected Northern Italy, utilization of pediatric emergency services significantly changed also in Central Italy with consequent reduced demand and increased appropriateness.
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Affiliation(s)
- Francesco Vierucci
- Pediatric Unit, San Luca Hospital, Via Guglielmo Lippi Francesconi 1, 55100 Lucca, Italy
| | - Caterina Bacci
- Pediatric Unit, San Luca Hospital, Via Guglielmo Lippi Francesconi 1, 55100 Lucca, Italy.,Pediatric Unit, University Hospital of Pisa, Pisa, Italy
| | | | - Francesca Dini
- Pediatric Unit, San Luca Hospital, Via Guglielmo Lippi Francesconi 1, 55100 Lucca, Italy
| | | | - Michela Maielli
- San Luca Hospital, Via Guglielmo Lippi Francesconi 1, 55100 Lucca, Italy
| | - Angelina Vaccaro
- Pediatric Unit, San Luca Hospital, Via Guglielmo Lippi Francesconi 1, 55100 Lucca, Italy
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Del Pinto R, Ferri C, Mammarella L, Abballe S, Dell'Anna S, Cicogna S, Grassi D, Sacco S, Desideri G. Increased cardiovascular death rates in a COVID-19 low prevalence area. J Clin Hypertens (Greenwich) 2020; 22:1932-1935. [PMID: 32815667 PMCID: PMC7461222 DOI: 10.1111/jch.14013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/27/2020] [Accepted: 08/01/2020] [Indexed: 02/06/2023]
Abstract
The province of L'Aquila (Central Italy) was marginally affected by COVID‐19 pandemic, but changes in health care seeking behaviors were noticed. The authors retrospectively analyzed de‐identified data concerning all‐cause and cardiovascular hospitalizations, cardiovascular acute phase treatments, and in‐hospital cardiovascular deaths in the province of L'Aquila from January 1 to March 31, in 2020 and 2019. Incidence rate ratios (IRR) comparing 2020 and 2019 for admissions/procedures were calculated through Poisson regression. All‐cause and cardiovascular mortality in the examined time windows was also assessed. Less all‐cause (IRR 0.85, P < .001) and cardiovascular (IRR 0.73, P < .001) hospitalizations occurred in 2020 than in 2019. Less daily cardiovascular procedures were also performed (IRR: 0.74, P = .009). A disproportionate decrease in the number of procedures was observed in relation to cardiovascular hospitalizations in 2020 (−5.5%, P = .001). Unlike all‐cause mortality, more in‐hospital cardiovascular deaths occurred in March 2020 compared with March 2019 (+6.8%, P = .048).
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Affiliation(s)
- Rita Del Pinto
- Department of Life, Health, and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Claudio Ferri
- Department of Life, Health, and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Internal Medicine and Nephrology Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Leondino Mammarella
- Statistics Section, Local Health Authority of the Province of L'Aquila, L'Aquila, Italy
| | - Stefano Abballe
- Department of Life, Health, and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Sofia Dell'Anna
- Department of Life, Health, and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Sabrina Cicogna
- Cardiology and Coronary Care Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Davide Grassi
- Department of Life, Health, and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Internal Medicine and Nephrology Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Simona Sacco
- Neurology Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Giovambattista Desideri
- Department of Life, Health, and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Geriatrics Unit, SS. Filippo e Nicola Hospital, Avezzano, Italy
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