ABSTRACT
Introduction: COVID-19 was declared a global pandemic in March 2020 and drastically changed daily life with ensuing stay-at-home orders. Studies have shown that adherence to healthy diet and exercise declined during this time. Internet search query data has been used to understand public interest in health-related behaviors such as smoking cessation. Therefore, the aim of this study was to examine whether internet searches for weight loss and bariatric interventions increased at the height of the pandemic. Methods: Google Ads Keyword Planner, a publicly available online tool, was used to obtain the search volumes for the keywords “weight loss,” “bariatric surgery,” “endoscopic weight loss procedure,” “gastric balloon,” and “endoscopic sleeve gastroplasty” per month from November 2017- October 2021. Search volumes were identified globally and by country (US, France, Spain, and Italy). Results: Globally, Google searches for “weight loss” peaked to 1,830,000 queries in April 2020, a 122% increase from April 2019 (Fig. 1a). By country, “weight loss” searches increased in April 2020 by 83% (1.8-fold) in the US, 311% (4-fold) in France, 679% (7.8- fold) in Spain, and 236% (3.4-fold) in Italy compared to the year prior (Fig. 1b,1c). Globally, average searches per month for “weight loss” from Mar 2020-Sep 2021 compared to prepandemic searches increased by 58% (Fig 1a). In the US, average monthly searches from Jul 2020-Sep 2021 increased by 43% for “bariatric surgery,” 16% for “gastric balloon,” 116% for “endoscopic sleeve gastroplasty,” and 309% for “endoscopic weight loss procedure” compared to Nov 2017-Jun 2020 averages (Fig. 2). Discussion: The COVID-19 pandemic heightened public interest in weight loss and endoscopic interventions. Several studies have shown that even one month into national lockdowns, people were reporting decreased physical activity, increased snack and alcohol consumption, and weight gain. This may have led to a rise in weight loss Google searches to combat these. Concurrently, research linking obesity with severe COVID-19 was publicized which may have contributed to an interest in weight loss. Elective procedures resumed in most hospitals in the US in summer 2020, possibly explaining the relative peaks in searches for bariatric procedures in July. Notably, interest in both weight loss and bariatric procedures not only increased during the height but have also remained elevated in 2021 as the planet slowly returns to a new normal. Furthermore, while total search volume is higher for ""bariatric surgery,"" there is clearly a rapidly rising interest in endoscopic procedures especially after July 2020. These data present an opportunity for gastroenterologists to provide continued patient education on optimal weight loss strategies varying from lifestyle modification, pharmacologic therapy, endobariatric therapy, and bariatric surgery. (Figure Presented) Figure 1. Google search volumes by month for the search query “weight loss” globally (1a), in the United States (1b), and in Europe (1c) from November 2017-September 2021 (Figure Presented) Figure 2. Google search volume by month for the search queries “bariatric surgery,” “endoscopic weight loss procedure,” “gastric balloon,” and “endscopic sleeve gastroplasty” in the United States from November 2017-September 2021
ABSTRACT
We reported the results of our multicenter cohort study in all patients who presented for endoscopy between March 1 and May 17 and were evaluated before their endoscopy for SARS-CoV2 and were followed after their endoscopy for COVID-19 status. This cohort enabled us to calculate the conversion rate from COVID-19 negative to positive during the study period and evaluate the change in conversion rate with the implementation of social distancing and masking at the population level in New York City. Data were retrieved from electronic medical records systems of six tertiary care centers in New York City. We identified all adult patients who had endoscopy between March 1, and May 17, 2020. Conversion was defined as having a negative COVID-19 status before endoscopy and a positive status afterwards. Participants COVID-19 status was defined based on SARS-CoV2 PCR test or a combination of symptoms (Fever plus at least one of: dyspnea, cough, dysgeusia, or anosmia). Patients were evaluated before endoscopy and then by phone or telehealth visit afterwards. Spline regression was used to evaluate the conversion rate before and after adoption of social distancing (March 20, 2020) and mandatory masks (April 15, 2020) in New York City. Of the 1467 patients presenting for endoscopy during the study period, we had follow-up data on 1222 patients (51% outpatient and 49% inpatient endoscopies). Overall, 78 participants (6.38 %) converted after endoscopy (74 with a positive PCR, and 4 with symptoms as defined above), at a median of 23 days after endoscopy (IQR 11 to 42 days). Patients had a mean age of 62±15 years, and were 62% male (n=48). Multivariable analysis demonstrated that date of endoscopy, institution, and presence of cardiovascular disease were the independent predictors of conversion after endoscopy, with cardiovascular disease associated with a more than 2 fold increase in the risk of conversion (OR=2.1, 95%CI 1.2-3.6, p=0.009). The range of conversion from the six institutions varied widely (1 to 11%, p=0.035). Overall, participants whose endoscopies were performed later during the study period had a lower risk of conversion (OR for one week=0.87, 95%CI 0.80-0.94, p=0.001). Before social distancing, conversion rate was 8.4% on average and was increasing by 2.3% per week (p<0.001). After social distancing, the conversion rate was 6.7% on average, and started to decrease by 4.2% per week (p<0.001). After mandatory masks, the conversion rate was 2.2% on average but has started to increase slowly by 0.9% per week (p<0.001;see figure 1). These findings do support decrease in conversion rate amongst New Yorkers who presented for endoscopy with the implementation of social distancing and mandatory masking. We believe the slow but significant increase in conversion rates by the end of May reflects the relative loosening in social distancing in New York City.(Figure Presented)
ABSTRACT
Introduction The risk of 2019 novel coronavirus (COVID-19) infection among patients and health care workers (HCWs) following endoscopy remains unclear. Methods We prospectively evaluated the incidence of COVID-19 infection among patients undergoing outpatient endoscopy and endoscopy unit staff between March and October 2020 at one tertiary care center in New York City. The primary outcome was COVID-19 infection within two weeks post-procedure. The clinical history, demographics, laboratory data, treatment, procedural data, and outcome measures were obtained from patients’ medical records. All patients had undergone nasopharyngeal nucleic-acid amplification testing swabs for COVID-19 prior to their procedures. Patients were then contacted 2 weeks after the procedure, via phone by research teams and nurses, with a specific list of questions (adapted from Repici et al.) to assess who had either tested positive for COVID-19 or developed symptoms ofCOVID-19 within 2 weeks after endoscopic procedures.1 Patients who screened positive for symptoms were directed for testing. Results A total of 850 endoscopic procedures were performed at our center between March and October of 2020. 131 were inpatients and were excluded from the analysis. Among the 719 outpatients, 231 were ERCPs, 111 were EUS, 207 were colonoscopies, and 170 were upper endoscopies. Post-procedure follow-up was obtained in 73% (n=524) of the patients. Of 719, 2 patients (0.38%) tested positive for COVID-19 within 2 weeks following endoscopy. Both patients had interval chemotherapy and were admitted to the hospital, so it is unclear when or where they converted. No advanced endoscopy attending or their associated nurses or technologists were subsequently infected with COVID-19 during the study period.Discussion Endoscopy procedures with appropriate PPE and preoperative testing appears to be associated with a low risk of periprocedural COVID-19 infection for outpatients and endoscopy unit staff. Diligence should continue with appropriate universal precaution and preoperative patient testing during this pandemic. References 1. Repici A, Aragona G, Cengia G, et al. Low risk of COVID-19 transmission in GI endoscopy. Gut. 2020;69(11):1925-1927. doi:10.1136/gutjnl-2020-321341