ABSTRACT
South Asia is a hotspot of air pollution with limited resilience and hence, understanding the mitigation potential of different sources is critically important. In this context the country lockdown initiated to combat the COVID-19 pandemic (during March and April 2020 that is the pre-monsoon season) provides an unique opportunity for studying the relative impacts of different emission sources in the region. Here, we analyze changes in levels of air quality species across the region during selected lockdown periods using satellite and in-situ datasets. This analysis compares air quality levels during the lockdown against pre-lockdown conditions as well as against regional long-term mean. Satellite derived AOD, NO2, and CO data indicates an increase of 9.5%, 2%, and 2.6%, respectively, during the 2020 lockdown period compared to pre-lockdown over the South Asia domain. However, individual country statistics, urban site data, and industrial grid analysis within the region indicate a more varied picture. Cities with high traffic loads reported a reduction of 12–39% in columnar NO2 during lockdown, in-situ PM2.5 measurements indicate a 23–56% percent reduction over the country capitals and columnar SO2 has an approximate reduction of 50% over industrial areas. In contrast, pollutant emissions from natural sources e.g., from biomass burning were observed to be adversely affecting the air quality in this period potentially masking expected lockdown related air quality improvements. This study demonstrates the need for a more nuanced and situation specific understanding of sources of air pollutants (anthropogenic and natural) and for these sources to be better understood from the local to the regional scale. Without this deeper understanding, mitigation strategies cannot be effectively targeted, wasting limited resources as well as risking unintended consequences both for the atmosphere and how mitigation action is perceived by the wider public. © The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are cited.
ABSTRACT
Background & objectives: : During any public health emergency, a need-based national non-communicable diseases (NCD) preparedness plan is essential. People living with NCDs could face challenges owing to restricted mobility, low access to medical care and suboptimal logistics during the pandemic. The present study explored the effect of the COVID-19 pandemic on NCD care in a district of Odisha State of India. Methods: : This study was carried out during May-June 2020 in the Khurda district of Odisha. A community-based explanatory mixed-method study was followed. Data collection comprised 12 in-depth interviews and 491 structured interviews using Likert-questionnaire with individuals having at least one NCD. Mantel-Haenszel's Chi-square test was used to assess the difference in the effect of COVID-19 on the routine NCD care. Qualitative data were analyzed by content analysis. Results: : Findings revealed that nearly two-thirds of participants encountered challenges in their routine investigation (69%), day-care procedures (67%) and reaching hospital (61%). Around half of them reported having trouble in doctor appointments (59%), emergency treatment (56%), access to the pharmacy (47%) and delay in healthcare (46%). Thirty seven per cent perceived that they could not access care because of social restriction/lockdown, 29 per cent attributed arranging finance as a constraint to visiting hospitals and 16 per cent avoided going to the hospital, fearing COVID-19 infection. Interpretation & conclusions: : Our findings showed that people with chronic NCDs faced multiple challenges in accessing health care during the pandemic. A cohesive doctor-pharmacy-patient engagement is vital for managing NCD care during a pandemic. During emergencies, changes in dispensing practices and service provision closer to the patients are crucial. Additionally, health literacy and home-based NCD management should be encouraged.
ABSTRACT
Content: The burden of iron deficiency anaemia (IDA) is reflected by the rising number of emergency admissions related to IDA and reports of the monumental cost of managing the condition as an inpatient. The National Health Service spends approximately 55 million per annum on IDA-related non-elective admissions, many of which could be preventable and managed in the community or ambulatory care setting. In 2018, a retrospective data collection was performed to assess the overall management of 50 newly diagnosed cases of anaemia presenting to a district general hospital between May July 2018. This data was compared to quality standards issued by the British Society of Gastroenterology and recommendations on blood transfusion as advised by the National Institute for Health and Care Excellence. An ambulatory anaemia pathway was created and implemented in 2018 with the aim of streamlining investigations for anaemia and establishing criteria for urgent referral and safe ambulation. A further 77 cases of anaemia presenting to secondary care between November and February 2019-2020 were assessed against the same quality standards used in the initial data collection and results compared. 74% cases with anaemia were appropriately investigated in 2019/2020 compared to 48% in 2018. Only 18% of the cohort with IDA had a urine dip performed and documented and 27% patients in this group did not have a coeliac screen in 2019/2020. Many patients received blood transfusions above haemoglobin thresholds recommended by NICE, however a modest increase of 17% patients in 2019/2020 had a haemoglobin review between units. Iron replacement in IDA improved from 59% to 73% in 2018 to 2019/2020, respectively. In 2019/2020 there was a 25% increase in the number of patients with a confirmed malignancy that were referred appropriately under a two-week wait compared to 2018. The proportion of patients that were clinically appropriate and subsequently ambulated was 75% and 73% in 2018 and 2019/20, respectively. Although overall management of anaemia improved after the ambulatory anaemia pathway was implemented, basic investigations such as a urine dipstick and coeliac screen were not performed in several cases. Treatment of IDA was superior in 2019/2020, as there was an improvement in iron replacement and fewer patients were transfused multiple units of blood without review between units. A greater number of patients who were subsequently diagnosed with a malignancy had appropriate urgent follow-up in 2019/2020 compared to 2018. There was a marginal decline in the number of patients who were clinically appropriate for ambulatory care and were discharged, however these decisions are often complicated by complex medical and social factors. As a result of national bed shortages following the COVID-19 pandemic, the requirement to reduce non-elective admissions and preserve blood products has never been more pressing. Therefore, it is proposed that the ambulatory anaemia pathway could help reduce non-elective admissions for anaemia by encouraging safe ambulation, avoid unnecessary blood transfusions and provide appropriate follow-up. It would be prudent to assess the impact of COVID-19 on hospital admissions with anaemia and determine whether ambulated patients demonstrate clinical improvement or require subsequent admissions for their symptoms of anaemia.
ABSTRACT
PURPOSE: The aim of this study was to evaluate changes in both mechanism and diagnoses of injuries presenting to the orthopaedic department during this lockdown period, as well as to observe any changes in operative case-mix during this time. METHODS: A study period of twelve weeks following the introduction of the nationwide "lockdown period", March 23rd - June 14th, 2020 was identified and compared to the same time period in 2019 as a "baseline period". A retrospective analysis of all emergency orthopaedic referrals and surgical procedures performed during these time frames was undertaken. All data was collected and screened using the 'eTrauma' management platform (Open Medical, UK). The study included data from a five NHS Foundation Trusts within North West London. A total of 6695 referrals were included for analysis. RESULTS: The total number of referrals received during the lockdown period fell by 35.3% (n=2631) compared to the same period in 2019 (n=4064). Falls remained proportionally the most common mechanism of injury across all age groups in both time periods. The proportion sports related injuries compared to the overall number of injuries fell significantly during the lockdown period (p<0.001), however, the proportion of pushbike related accidents increased significantly (p<0.001). The total number of operations performed during the lockdown period fell by 38.8% (n=1046) during lockdown (n=1732). The proportion of patients undergoing operative intervention for Neck of Femur (NOF) and ankle fractures remained similar during both study periods. A more non-operative approach was seen in the management of wrist fractures, with 41.4% of injuries undergoing an operation during the lockdown period compared to 58.6% at baseline (p<0.001). CONCLUSION: In conclusion, the nationwide lockdown has led to a decrease in emergency orthopaedic referrals and procedure numbers. There has been a change in mechanism of injuries, with fewer sporting injuries, conversely, there has been an increase in the number of pushbike or scooter related injuries during the lockdown period. NOF fractures remained at similar levels to the previous year. There was a change in strategy for managing distal radius fractures with more fractures being treated non-operatively.