ABSTRACT
Introduction The emergence of the COVID-19 pandemic presented unprecedented challenges for healthcare systems, including patients with chronic pain. The COVID-19 lockdown has resulted in limited access to most of the conventional chronic pain management services. Subsequently, changes in opioid utilisation could be expected (1). Aim To assess the impact of the first COVID-19 lockdown on opioid utilisation using aggregated-level, community dispensing dataset covering the whole English population. Methods This repeated cross-sectional study applied a segmented-linear regression analysis to monthly dispensed opioid prescriptions using the Prescription Cost Analysis database (PCA), from March 2019-March 2021. Opioid utilisation was measured using number of items dispensed/1000 inhabitants and Defined Daily Dose (DDD)/1000 inhabitants/day during 12-months pre and post the COVID-19 lockdown introduced in England in March 2020, stratified by strong and weak opioids. Results There were insignificant changes in the number of items dispensed/1000 inhabitants trend pre-COVID-19 lockdown for total, strong, and weak opioids (β1=-0.064, β1=-0.055, β1=0.009, p>0.05, respectively). Immediately post-lockdown, there were small increases in the level of total, strong, and weak opioids (β2=0.494, β2=0.448, β2=0.045) albeit non-significant. There was a non-significant decline in the trend post-lockdown for all opioids’ classes. Similarly, a non-significant reduction in the DDD/1000 inhabitants/day baseline trend was observed pre-lockdown for total, strong, and weak opioids (β1=-0.028, β1=-0.027, β1=-0.001, p>0.05, respectively). There were immediate increases in the level post-lockdown (β2=0.386, β2=0.360, β2=0.026, p>0.05) for total, strong, and weak opioids respectively. Subsequently, a decline in the trend post-lockdown for all opioids’ classes was observed. Discussion/conclusion Unexpectedly, the study’s findings showed an overall stable trend in the utilisation of opioids pre and post COVID-19 in England. The stable trends observed in our study could be due to multiple factors. Firstly, patient level data and information about the specific indication were unavailable in the PCA dataset. This is a limitation as we were unable to examine the trend between the existing and new (incident) patients to obtain more accurate data for opioid utilisation. Moreover, the guidelines and strategies that have been implemented with regard to opioid prescription in the UK (2), to help regulate and minimize the harm from their use in chronic pain management may have had an impact. To our knowledge, this is the first study to estimate and quantify the impact of the COVID-19 pandemic on opioid utilisation using a segmented regression analysis. This was facilitated by the study focusing on opioid prescription over a 25-month period, i.e. 12 months either side of the pandemic, to predict a trend line for opioid prescription. This duration was beneficial as it gave us adequate time to investigate if COVID-19 had affected prescribing volumes. The limitations include lacking patient level data and specific indications for prescribing opioids. Also, over-the-counter codeine products were not included in the study as the datasets we used included only prescription medicines in ambulatory care Our findings support the further monitoring and investigation of patient level data to explore the impact of the pandemic on opioid prescription and to continue promoting the safe and effective use of opioids. References (1) Shanthanna H, Strand NH, Provenzano DA, et al. Caring for patients with pain during the COVID −19 pandemic: consensus recommendations from an international expert panel. Anaesthesia. 2020;75(7):935-944. doi:10.1111/anae.15076. (2) Recommendations ;Controlled drugs: safe use and management ;Guidance ;NICE [Internet]. Nice.org.uk. 2021 [cited 9 August 2021]. Available from: https://www.nice.org.uk/guidance/ng46/chapter/Recommendations
ABSTRACT
Introduction: Evidence on prevalence of bacterial coinfection in Coronavirus Disease 2019 (COVID-19) is controversial;previous global viral respiratory pandemics reported high prevalence of bacterial coinfection, which was associated with increased risk of morbidity and mortality (1). Data on Prevalence of antibiotic prescribing in COVID- 19 indicates high antibiotic prescribing, causing a potential setback in antimicrobial stewardship and potential increase in antimicrobial resistance (2). The study protocol was registered in the international register of systematic reviews, PROSPERO, under the following ID: CRD42021261734 Aim: to determine the prevalence of bacterial coinfection and antibiotic prescribing in COVID-19 patients Methods: Systematic review and meta-analysis was conducted using Covidence. Data were extracted by one reviewer. Proportion data was pooled using random effects meta-analysis approach using STATA 17;and stratified based on region and study design. Data Source: OVID MEDLINE, OVID EMBASE, Cochrane and MedRxiv between January 2020 and June 2021. Study Eligibility: English language studies of laboratory-confirmed COVID-19 patients which reported (a) prevalence of bacterial coinfection and/or (b) prevalence of antibiotic prescribing with no restrictions to study designs or healthcare setting. Participants: Adults with RT-PCR confirmed diagnosis of COVID-19 Results: a total of 1058 studies were screened, of which 22 studies were eligible. Retrospective cohort studies accounted for the majority of the studies involved (n = 18, 81%), whilst prospective cohort studies accounted for the remaining (n=4, 18%). Of the 22 studies included, 3 (13%) studies were preprints, whilst the remaining (n=19, 86%) were peer-reviewed. A total of 13 (59%) studies were conducted in multicentre settings, whilst the remaining (n=9, 40%) were conducted in single centre settings. All of the studies included were conducted in hospital setting, whether it be in a normal, isolation or an intensive care ward. Twenty-one out of 22 studies have been rated Good'' rating during the quality assessment process. Pooled estimates for the prevalence of bacterial co-infection and antibiotic use were 5.62% (95% CI 2.26 - 10.31) and 61.77% (CI 50.95 - 70.90), respectively. Conclusion: The prevalence of bacterial coinfection amongst COVID-19 patients is low (5.62%) when compared with previous pandemics, yet antibiotic prescribing in COVID-19 patients was high (61.77%) indicating the need for stronger antimicrobial stewardship to reduce the global threat of AMR. Prescribing of antibiotics in COVID-19 should be based on clinical and/or laboratory evidence of bacterial coinfection. Key strengths of this review, is that it included a comprehensive search strategy spanning over several databases, including both pre-prints and peer-reviewed studies. Limitations in this review was that during the screening process, a significant number of studies have been excluded due to not meeting the inclusion criteria, therefore, bacterial coinfection and antibiotic use may be under- or over-reported. In addition, disproportionate representation from North America and failure to include studies from regions other than Europe and Asia, can limit the generalizability of the results to other regions impacted by COVID-19.
ABSTRACT
Some manufactures made UVC LED Strip as disinfection tool against SARS-CoV2. Therefore, three types of commercially UVC lights were used to evaluate their efficiency to warp bacteria and viruses. We tested three commercially available UV lights devices. They were put at 4 to 5 cm to spiked sterile Petri dishes (samples) for 10, 20, 30, and 60 seconds and compared it to control (without UV light exposure). Also, the same three UV LED devices were used on Positive SARS-CoV2 swab samples (used for the Petri dishes). Serial dilutions of the cultured microbes were used for the experiment as follows: 1/10 (high concentration), 1/100, 1/1000, 1/10,000, 1/100,000 (low concentration). All three UV LED devices (DA, DB, DC) were found to have no effects on the pathogens (Bacteria or SARS-CoV2), even to the lowest Bacteria Concentration (1/100,000), when pathogens were exposed to UV radiation for 10, 20, 30, and 60 sec at distance a 4 to 5 cm. One of the manufacturers of these UVC lights (DB) claims that the device is very effective in killing Bacteria and Virus immediately at a 99.93% killing rate (in 20 sec.). This observation was not noticed. False claims may lead to severe spread of SARS-CoV2 as customers may think that the DB was disinfecting, after short exposure, while truly having no effect.
ABSTRACT
There has been some extensive research investigating the effect of Far Ultraviolet Radiation (UVC) on SARS and MARS. However, to the best of our knowledge, there have not been any detailed experiments looking at the effect of UVC on COVID-19 (now is called SARS-CoV2). Many researchers in this field believe that UVC destroys SARS-CoV2 because it warps the genetic material of the virus hurdling the viral particles from reproduction. In this paper, we report the result of our novel experiments on the effect of UVC on SARS-CoV2 using a commercially available UVC source, i.e. Krypton Disinfection lighting CM15W12V Series (wavelength of 222 nm), which is sold and marketed for the disinfection of pathogens. The experiments were extended to study the effect of UVC exposure to Bacteria and Fungus. Our experiments show that UVC has no effects on SARS-CoV2 when it is close to the SARS-CoV2 culture plate (4 - 5 cm) or at a distance (2.0 to 2.9 m), i.e. when fixed at the ceiling. This observation is important as the public seems to have the impression that commercial UVC ceiling light can kill SARS-CoV2 while this study has proven the opposite. Moreover, it shows no effect even when the UVC ceiling light is radiating on SARS-CoV2 for overnight. This proves that the intensity of the UVC from these devices is relatively low. However, the UVC light is found to be effective in destroying Bacteria and Fungus (part of pathogens), substantially, in 30 sec, and completely kills them when it's at 2.9 m (or less) away from them and exposure for one day. This indicates that the UVC light is effective for bacteria disinfection.