Effect of the first wave of COVID-19 on Poison Control Centre activities in 21 European countries: an EAPCCT initiative.

BACKGROUND: Public health emergencies often affect Poison Control Centre (PCC) operations. We examined possible effects of the coronavirus disease 2019 (COVID-19) pandemic on call volume, call characteristics, and workload in European PCCs. METHOD: All 65 individual European PCCs were requested to supply data on the number of calls and call characteristics (caller, age groups, reason and specific exposures) from March to June in 2018, 2019, and 2020 (Part 1). Number of calls with specific characteristics was normalised to all calls. Calls (N) and call characteristics (%) were compared between 2020 and 2018/2019 (average), within PCCs/countries and grouped. Correlation between call volume and COVID-19 cases per PCC/country was examined. All PCCs received a survey on workload (Part 2). Parts 1 and 2 were independent. RESULTS: For Part 1, 36 PCCs (21 countries) supplied 26 datasheets. PCCs in the UK and in France merged data and supplied one datasheet each with national data. Summed data showed an increase of 4.5% in call volume from 228.794 in 2018/2019 (average) to 239.170 in 2020 (p < 0.001). Within PCCs/countries, calls significantly increased for 54% of PCCs/countries (N = 14/26) and decreased for 19% (N = 5/26), three of which (N = 3/5) only serve medical professionals. Correlation between call volume and COVID-19 cases was (non-significant) positive (Rho >0.7) in 5/26 PCCs/countries (19%), and negative in 6/26 (23%). Call characteristics (median proportion of grouped data in 2018/2019 vs. 2020) changed: fewer medical professionals called (40 vs. 34%, p < 0.001), calls on intentional exposures decreased (20 vs. 17%, p < 0.012), as did calls on patients between 13 and 17 years (5 vs. 4%, p < 0.05). Calls on specific exposures increased; disinfectants from 1.9 to 5.2%, and cleaning products from 4.4 to 5.7% (p < 0.001). For Part 2, 38 PCCs (24 countries) filled the survey on workload (number/length of shifts and time on PCC duties), which increased in 23/38 PCCs (61%), while 10/38 (26%) worked with fewer employees. CONCLUSIONS: Obtaining aggregated European PCC data proved challenging but showed an increase in overall call volume and workload during the first COVID-19 wave. Call characteristics changed including fewer calls from professionals and more calls on specific exposures. Within single PCCs/countries a variety of effects was observed.

Suicide attempts by overdose of paracetamol and ibuprofen in adolescents and young adults in Switzerland before and after the beginning of the COVID-19 pandemic

Objective: Paracetamol and Ibuprofen are popular over the counter analgesics and frequently involved in suicidal overdose in adolescents. The aim of the study is to determine trends of paracetamol and ibuprofen overdose in adolescents and young adults before and during the COVID-19 pandemic. Methods: A retrospective descriptive study of suicide attempts by poisoning in adolescents and young adults (10-25 years) reported to the Swiss National Poison Center before and after the beginning of the COVID-19 pandemic (1 January 2016 to 30 June 2021). Intervention date was defined as end of Q1 2020 (lockdown in Switzerland started on 16 March 2020). Preintervention period was determined as Q1 2016-Q1 2020, postintervention period as Q2 2020-Q2 2021. Data collected included age, sex, time of call (month, year), and substances. Trends for cases involving paracetamol and/or ibuprofen were analysed per quarter (Q), and by patient age. Results: Overall 7697 cases met inclusion criteria (females n=5883, males n=1808, unknown n=6). Paracetamol was involved in 1864 cases (24.2%), ibuprofen in 1021 cases (13.3%), including 394 cases combining both substances. We recognized a higher proportion of exposures in 13 to 17-year-olds (paracetamol 28.4%, ibuprofen 16.2%), with a maximum proportion in 15- year-olds (paracetamol 30.7%, ibuprofen 18.3%). Comparing the average number of cases per quarter of the preintervention period to the postintervention period revealed an increase of 1.2 with an overproportional rise in paracetamol exposures of 1.4. Suicide attempts by paracetamol were even more common in the 13 to 17-year-olds (rate 1.7) (Table 1). Due to the small numbers in 10 to 12-year-olds trends are not determined. Conclusion: Paracetamol is involved in a quarter of suicide attempts in adolescents and young adults, even up to a third in the 15-year-olds, whereas ibuprofen plays a less prominent role. The observed increase in paracetamol overdoses in the 13 to 17- year-olds during the postintervention period requires close observation.

S03a-03 Impact of the COVID crisis on European Poison Centres

On behalf of EAPCCT COVID-19 and PCCs activities WG The pandemic has also crystallized the role of clinical toxicology and identified a new role for clinical toxicologists. Poison Control Centers (PCC) and clinical toxicologists have been committed on several fronts: prevention, including campaigns, collaboration with Government Agencies, toxicovigilance, etc. Our activity in addition to prehospital triage of intoxicated patients helped to stabilize the flooded emergency system. An ad hoc EAPCCT Covid-19 Working Group was established so as to evaluate the impact of Covid-19 on European PCCs activities. A pilot study was performed in 4 European PCCs [Copenhagen, Pavia, Utrecht, Zurich] to evaluate critical points on methods, data collection and resources. The study was then extended to all European PCCs to investigate the effect of the Covid-19 pandemic during the first wave on the activities of European PCC. All 65 European PCCs listed in the WHO directory were asked to supply epidemiological data on poisonings (e.g., number of calls, patients, type of caller (medical professional or public), type of exposure (accidental, intentional (all), intentional suicide attempt), and age groups). Investigated exposures were disinfectants, household cleaning products (according to the European Chemicals Agency (ECHA) classification) and drugs, including antivirals. Data was analyzed during a 4-month period (March-June 2020) and compared with the previous two years. Furthermore, all members of EAPCCT were asked to participate in a survey on organizational changes during the COVID-19 pandem-ic.Results: The study included data from 36 PCCs from 21 countries (55% of EU PCCs). 60 % of Head of PCCs from 24 countries submitted pandemic related organizational data. Twenty per cent of PCC saw an increase in length of shifts while 42% saw an increase of total number of shifts. 25% indicated an increase of time spent on duties other than PCC activities, such as activities in the emergency departments (35%), intensive care units (12%), and nursing wards (9%). Over 50% of PCCs lacked protocols to manage PCC staffing upon massive sick leave. In contrast safe working protocols were in place in nearly every PCC. No centers reported receiving special funds for activities arising from the pandemic. Conclusion: European PCCs activities vary in different countries. A substantial improvement can be made in many areas such as data harmonization, establishing a European database of poisonings, and an improved network and cooperation of European PCC, and timely toxicovigilance especially in times of global emergencies.