Assessing the impact of COVID-19 pandemic on the health of residents and the healthcare system in Alberta, Canada: an observational study-The Alberta POST-COVID Follow-up Study.

INTRODUCTION: Very little is known about how the COVID-19 pandemic has affected the health of residents and the healthcare system in Alberta, Canada. The purpose of this study is to establish an observational study to characterise the health of residents in Alberta, Canada, over time, covering a population that tested negative or positive for COVID-19 during the pandemic. The primary outcome is to characterise 'long COVID-19' and the health status of residents during the COVID-19 pandemic. Secondary outcomes include the estimation of the risk of and risk factors associated with adverse health outcomes and healthcare utilisation and burdens. METHODS AND ANALYSIS: This is a population-level provincial observational study which will follow-up with Alberta residents who underwent testing for COVID-19 and completed surveys adapted from the ISARIC COVID-19 long-term follow-up survey. The survey data will be linked with medical records. Statistical analyses will be carried out to characterise 'long COVID-19' and the health status of residents during the pandemic. The outcomes of this study will inform strategies for primary care and rehabilitation services to prevent chronic consequences; contribute to healthcare management, interventional studies, rehabilitation and health management to reduce overall morbidity and improve long-term outcomes of COVID-19 and the COVID-19 pandemic and potentially guide a self-evaluation of a remote monitoring system to manage individuals' health. ETHICS AND DISSEMINATION: This study was reviewed and approved by the University of Alberta ethics committee (Study ID: Pro00112053 & Pro00113039) on 13 August 2021 and adheres to the Alberta Health Services research information management policy. Study results will be used to manage clinical care, published in peer-reviewed journals and presented at local, national and international conferences. PROTOCOL VERSION: 6 June 2022 EUROQOL ID: 161 015.

Frequency and Type of Outpatient Visits for Patients With Cardiovascular Ambulatory-Care Sensitive Conditions During the COVID-19 Pandemic and Subsequent Outcomes: A Retrospective Cohort Study.

Background Because the impact of changes in how outpatient care was delivered during the COVID-19 pandemic is uncertain, we designed this study to examine the frequency and type of outpatient visits between March 1, 2019 to February 29, 2020 (prepandemic) and from March 1, 2020 to February 28, 2021 (pandemic) and specifically compared outcomes after virtual versus in-person outpatient visits during the pandemic. Methods and Results Population-based retrospective cohort study of all 3.8 million adults in Alberta, Canada. We examined all physician visits and 30- and 90-day outcomes, with a focus on those adults with the cardiovascular ambulatory-care sensitive conditions heart failure, hypertension, and diabetes. Our primary outcome was emergency department visit or hospitalization, evaluated using survival analysis accounting for competing risk of death. Although in-person outpatient visits decreased by 38.9% in the year after March 1, 2020 (10 142 184 versus 16 592 599 in the prior year), the introduction of virtual visits (7 152 147; 41.4% of total) meant that total outpatient visits increased by 4.1% in the first year of the pandemic for Albertan adults. Outpatient visit frequency (albeit 41.4% virtual, 58.6% in-person) and prescribing patterns were stable in the first year after pandemic onset for patients with the cardiovascular ambulatory-care sensitive conditions we examined, but laboratory test frequency declined by 20% (serum creatinine) to 47% (glycosylated hemoglobin). In the first year of the pandemic, virtual outpatient visits were associated with fewer subsequent emergency department visits or hospitalizations (compared with in-person visits) for patients with heart failure (adjusted hazard ratio [aHR], 0.90 [95% CI, 0.85-0.96] at 30 days and 0.96 [95% CI, 0.92-1.00] at 90 days), hypertension (aHR, 0.88 [95% CI, 0.85-0.91] and 0.93 [95% CI, 0.91-0.95] at 30 and 90 days), or diabetes (aHR, 0.90 [95% CI, 0.87-0.93] and 0.93 [95% CI, 0.91-0.95] at 30 and 90 days). Conclusions The adoption and rapid uptake of virtual outpatient care during the COVID-19 pandemic did not negatively impact frequency of follow-up, prescribing, or short-term outcomes, and could have potentially positively impacted some of these for adults with heart failure, diabetes, or hypertension in a setting where there was an active reimbursement policy for virtual visits. Given declines in laboratory monitoring and screening activities, further research is needed to evaluate whether long-term outcomes will differ.

Excess deaths during the COVID-19 pandemic in Alberta, Canada.

Objectives: To determine if there was excess mortality in Alberta, Canada during the coronavirus disease 2019 (COVID-19) pandemic, to confirm if excess mortality affected all age groups equally, and to determine what proportions of excess deaths were directly related to COVID-19 and non-pharmaceutical drug poisoning. Methods: Weekly all-cause data used to estimate excess mortality were modelled against the pre-pandemic period (January 2015-February 2020). Age-adjusted weekly mortality rates for March 2020 to December 2021 were compared with the preceding 5 years. Results: From March 2020 to December 2021, there was an 11% excess mortality rate, corresponding to an average of 265 monthly excess deaths (maximum >30%). COVID-19-related deaths (n=3202) accounted for 54.9% of total excess deaths (n=5833) that occurred in the 22-month period. The increase in all-cause excess deaths was proportionately higher, and with significantly greater numbers, in younger age groups. Significant increases in monthly drug poisoning deaths occurred from March 2020 to April 2021, with a total of 1819 deaths. Eight hundred and 25 excess drug poisoning deaths, representing 25.4% of total all-cause excess deaths, occurred, mainly among those aged 25-60 years. Overall, 54.9% of all excess deaths were directly related to COVID-19 and 25.4% were related to drug poisoning. Conclusions: There was a significant increase in all-cause mortality during the COVID-19 pandemic. Although older adults are more likely to die of COVID-19, a massive increase in non-COVID-19-related mortality was observed among younger people. These factors should be considered in public policy decisions on epidemic/pandemic management.

The impact of shifting demographics, variants of concern and vaccination on outcomes during the first 3 COVID-19 waves in Alberta and Ontario: a retrospective cohort study.

BACKGROUND: In Canada, published outcome data for COVID-19 come largely from the first 2 waves of the pandemic. We examined changes in demographics and 30-day outcomes after SARS-CoV-2 infection during the first 3 pandemic waves in Alberta and Ontario; for wave 3, we compared outcomes between those infected with a variant of concern and those infected with the original "wild-type" SARS-CoV-2. METHODS: We conducted a population-based retrospective cohort study using linked health care data sets in Alberta and Ontario. We identified all-cause hospitalizations or deaths within 30 days after a positive result on a reverse transcription polymerase chain reaction test for SARS-CoV-2 in individuals of any age between Mar. 1, 2020, and June 30, 2021, with genomic confirmation of variants of concern. We compared outcomes in wave 3 (February 2021 to June 2021) with outcomes in waves 1 and 2 combined (March 2020 to January 2021) after adjusting for age, sex and Charlson Comorbidity Index score. Using wave 3 data only, we compared outcomes by vaccination status and whether or not the individual was infected with a variant of concern. RESULTS: Compared to those infected with SARS-CoV-2 during waves 1 and 2 (n = 372 070), we found a shift toward a younger and healthier demographic in those infected during wave 3 (n = 359 079). In wave 3, patients were more likely to be hospitalized (adjusted odds ratio [aOR] 1.57, 95% confidence interval [CI] 1.46-1.70) but had a shorter length of hospital stay (median 6 days v. 7 days, p < 0.001) and lower 30-day mortality (aOR 0.73, 95% CI 0.65-0.81). The 217 892 patients in wave 3 who were infected with a variant of concern (83.5% confirmed to have the Alpha variant, 1.7% confirmed to have the Delta variant) had a higher risk of death (Alpha: aOR 1.29, 95% CI 1.16-1.44; Delta: aOR 2.05, 95% CI 1.49-2.82) and hospitalization (Alpha: aOR 1.59, 95% CI 1.53-1.66; Delta: aOR 1.88, 95% CI 1.64-2.15) than those infected with wild-type SARS-CoV-2. INTERPRETATION: We observed a shift among those infected with SARS-CoV-2 toward younger patients with fewer comorbidities, a shorter length of hospital stay and lower mortality risk as the pandemic evolved in Alberta and Ontario; however, infection with a variant of concern was associated with a substantially higher risk of hospitalization or death. As variants of concern emerge, ongoing monitoring of disease expression and outcomes among vaccinated and unvaccinated individuals is important to understand the phenotypes of COVID-19 and the anticipated burdens for the health care system.

Bedtime versus morning use of antihypertensives for cardiovascular risk reduction (BedMed): protocol for a prospective, randomised, open-label, blinded end-point pragmatic trial.

INTRODUCTION: Sleep-time blood pressure correlates more strongly with adverse cardiovascular events than does daytime blood pressure. The BedMed trial evaluates whether bedtime antihypertensive administration, as compared with conventional morning use, reduces major adverse cardiovascular events. METHODS AND ANALYSIS: DesignProspective randomised, open-label, blinded end-point trial.ParticipantsHypertensive primary care patients using blood pressure lowering medication and free from glaucoma.SettingCommunity primary care providers in 5 Canadian provinces (British Columbia, Alberta, Saskatchewan, Manitoba and Ontario) are mailing invitations to their eligible patients. Social media campaigns (Google, Facebook) are additionally running in the same provinces.InterventionConsenting participants are allocated via central randomisation to bedtime vs morning use of all antihypertensives.Follow-up(1) Telephone or email questionnaire at 1 week, 6 weeks, 6 months and every 6 months thereafter, and (2) accessing linked governmental healthcare databases tracking hospital and community medical services.Primary outcomeComposite of all-cause death, or hospitalisation for myocardial infarction/acute-coronary syndrome, stroke or congestive heart failure.Secondary outcomesEach primary outcome element on its own, all-cause hospitalisation or emergency department visit, long-term care admission, non-vertebral fracture, new glaucoma diagnosis, 18-month cognitive decline from baseline (via Short Blessed Test).Select other outcomesSelf-reported nocturia burden at 6 weeks and 6 months (no, minor or major burden), 1-year self-reported overall health score (EQ-5D-5L), self-reported falls, total cost of care (acute and community over study duration) and mean sleep-time systolic blood pressure after 6 months (via 24-hour monitor in a subset of 302 sequential participants).Primary outcome analysisCox proportional hazards survival analysis.Sample sizeThe trial will continue until a projected 254 primary outcome events have occurred.Current statusEnrolment ongoing (3227 randomised to date). ETHICS AND DISSEMINATION: BedMed has ethics approval from six research ethics review boards and will publish results in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT02990663.

Symptômes associés au frottis SRAS-CoV-2-positif chez des enfants de l'Alberta.

CONTEXTE: La recherche sur les enfants atteints d'une infection à coronavirus du syndrome respiratoire aigu sévère 2 (SRAS-CoV-2) a principalement porté sur les enfants amenés aux services des urgences. Nous avons voulu identifier les symptômes plus souvent associés à un frottis SRAS-CoV-2-positif chez les enfants non hospitalisés. MÉTHODES: Nous avons procédé à une étude observationnelle chez des enfants soumis au dépistage et suivis pour une infection à SRAS-CoV-2 confirmée sur des prélèvements de sécrétions nasales, nasopharyngées, de la gorge et autres (p. ex., aspiration nasopharyngée, sécrétions trachéales ou non spécifiées) entre le 13 avril et le 30 septembre 2020 en Alberta. Nous avons calculé les rapports de vraisemblance (RV) positifs entre les symptômes autodéclarés et les frottis SRAS-CoV-2-positifs dans la cohorte entière et dans 3 analyses de sensibilité : tous les enfants présentant au moins 1 symptôme, tous les enfants, symptomatiques ou non, soumis au dépistage par suite d'une recherche de contacts, et tous les enfants de 5 ans et plus. RÉSULTATS: Nous avons analysé les résultats chez 2463 enfants soumis au dépistage de l'infection à SRAS-CoV-2; 1987 enfants se sont révélés positifs et 476 négatifs. Parmi les enfants SRAS-CoV-2-positifs, 714 (35,9 %) n'ont déclaré aucun symptôme. Même si la toux (24,5 %) et la rhinorrhée (19,3 %) étaient les 2 symptômes les plus fréquents chez les enfants ayant contracté le SRAS-CoV-2, elles étaient fréquentes également chez ceux dont les résultats étaient négatifs et ne permettaient pas de prédire un résultat positif (RV positif 0,96, intervalle de confiance [IC] à 95 % 0,81­1,14 et 0,87, IC à 95 % 0,72­1,06, respectivement). L'anosmie/agueusie (RV positif 7,33, IC à 95 % 3,03­17,76), les nausées et vomissements (RV positif 5,51, IC à 95 % 1,74­17,43), les céphalées (RV positif 2,49, IC à 95 % 1,74­3,57) et la fièvre (RV positif 1,68, IC à 95 % 1,34­2,11) ont été les symptômes les plus prédictifs d'un résultat SRAS-CoV-2-positif. Le RV positif pour la combinaison anosmie et agueusie, nausées et vomissements, et céphalées était de 65,92 (IC à 95 % 49,48­91,92). INTERPRÉTATION: Environ les deux tiers des enfants déclarés SRAS-CoV-2-positifs ont manifesté des symptômes, et les symptômes les plus étroitement associés à un frottis SRAS-CoV-2-positif étaient l'anosmie/agueusie, les nausées et les vomissements, les céphalées et la fièvre.

Symptoms associated with a positive result for a swab for SARS-CoV-2 infection among children in Alberta.

BACKGROUND: Research involving children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has primarily focused on those presenting to emergency departments. We aimed to determine the symptoms most commonly associated with a positive result for a SARS-CoV-2 swab among community-based children. METHODS: We conducted an observational study among children tested and followed for SARS-CoV-2 infection using nasal, nasopharyngeal, throat or other (e.g., nasopharyngeal aspirate or tracheal secretions, or unknown) swabs between Apr. 13 and Sept. 30, 2020, in Alberta. We calculated positive likelihood ratios (LRs) for self-reported symptoms and a positive SARS-CoV-2 swab result in the entire cohort and in 3 sensitivity analyses: all children with at least 1 symptom, all children tested because of contact tracing whether they were symptomatic or not and all children 5 years of age or older. RESULTS: We analyzed results for 2463 children who underwent testing for SARS-CoV-2 infection; 1987 children had a positive result and 476 had a negative result. Of children with a positive test result for SARS-CoV-2, 714 (35.9%) reported being asymptomatic. Although cough (24.5%) and rhinorrhea (19.3%) were 2 of the most common symptoms among children with SARS-CoV-2 infection, they were also common among those with negative test results and were not predictive of a positive test (positive LR 0.96, 95% confidence interval [CI] 0.81-1.14, and 0.87, 95% CI 0.72-1.06, respectively). Anosmia/ageusia (positive LR 7.33, 95% CI 3.03-17.76), nausea/vomiting (positive LR 5.51, 95% CI 1.74-17.43), headache (positive LR 2.49, 95% CI 1.74- 3.57) and fever (positive LR 1.68, 95% CI 1.34-2.11) were the symptoms most predictive of a positive result for a SARS-CoV-2 swab. The positive LR for the combination of anosmia/ageusia, nausea/vomiting and headache was 65.92 (95% CI 49.48-91.92). INTERPRETATION: About two-thirds of the children who tested positive for SARS-CoV-2 infection reported symptoms. The symptoms most strongly associated with a positive SARS-CoV-2 swab result were anosmia/ageusia, nausea/vomiting, headache and fever.