Health-Seeking Behavior of Patients with Cardiovascular Diseases During COVID-19 Epidemic and Post-Epidemic Period in Shanghai, China (preprint)

Background: The COVID-19 pandemic has led to concerns around its subsequent impact on patients with non-COVID-19 diseases, and the health-seeking behavior of such patients must be investigated.Methods: Taking advantage of the remote ECG system covering 278 medical institutions throughout Shanghai, the numbers of hospital visits with ECG examinations during the lockdown (between January 23 and April 7, 2020), post-lockdown (between April 8 and December 31, 2020) and post-epidemic (between January 23 and April 7, 2021) periods were analyzed and compared against those during the same periods of the preceding years (2018 and 2019).Findings: Compared with those of the same period during pre-COVID years, the number of hospital visits decreased during the lockdown (a 38% reduction), followed by a rebound post-lockdown (a 17% increase) and a fall to the baseline level of the post-epidemic period. This decrease-rebound-fallback pattern was largely attributed to the dynamics of visits to community clinics rather than academic hospitals. The number of new COVID-19 cases or deaths announced on a given day correlated negatively with hospital visits during the same day and for the following 42 days, with the correlation at its most prominent at seven days. Hospital visit dynamics differed for various cardiovascular diseases. Whereas hospital visits for sinus bradycardia exhibited a typical decrease-rebound-fallback pattern, hospital visits for ST-segment elevated myocardial infarction did not fall during the lockdown period but did exhibit a subsequent increase during the post-lockdown period. By comparison, the volume for ventricular tachycardia remained constant throughout this entire period.Interpretation: The health-seeking behavior of patients with cardiovascular diseases exhibited a decrease-rebound-fallback pattern following the COVID-19 lockdowns. Hospital visits for diseases with more severe symptoms were less influenced by the lockdowns, showing a resilient demand for healthcare.Funding: Shanghai Hospital Development Center, National Natural Science Foundation of China, Shanghai Municipal Science and Technology Commission, and Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Declaration of Interest: All authors declare no conflicts of interest.Ethical Approval: This study was approved by the ethics committee at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine.

Short-term effects of COVID-19 on risk of traumatic fractures in China: a multi-city study (preprint)

Introduction: Traumatic injury is a leading cause of death and disability worldwide, and fifth most common of in China. Along with the outbreak of COVID-19, strict control measures to restrict people’s movement have been conducted in China. Subsequently, the injury mechanisms and pattern of traumatic fractures changed significantly. This study aimed to investigate the associations between COVID-19 and fracture risk, and provide a targeted reference for the world through China’s experience.Methods: This was a retrospective study of a nationally representative sample of COVID-19 prevalence areas using stratified random sampling. The data of traumatic fracture sustaining patients, including age and sex, fractured sites, mechanism of injury, and concurrent fractures in selected hospitals, were collected from 10 January and 10 July, 2020. The epidemiologic characteristics of traumatic fractures and the associations between COVID-19 and fracture risk were explored using the descriptive epidemiological methods and distribution lag nonlinear model.Results: A total of 67,249 (52.3% males) patients (average age 49.4±19.4 years) with 68,989 fractures were included. The highest proportion of fractures were sustained to the tibia and fibula (14.9%), followed by the femur (13.6%), and ulna and radius (12.5%). Low-energy fractures accounted for 23.3%. With the increase of newly confirmed COVID-19 cases, fracture risk decreased for children, young and middle-aged adults, elderly men, high-energy fracture, and for residents in low and middle-prevalence areas.Conclusion: Fracture risk decreased sharply in all residents except elderly women, low-energy fractures, and in high-prevalence areas when newly confirmed COVID-19 cases increased in China. Primary (home) prevention measures are emphasized to prevent traumatic fractures during the COVID-19 pandemic.