No delay in care of ambulatory orthopaedic fractures observed during the early Coronavirus-2019 pandemic: a retrospective cohort study

Background: The purpose of this study was to assess the impact of social distancing orders on ambulatory orthopaedic fracture care at a level 1 trauma center during the Coronavirus Disease 2019 (COVID-19) pandemic. Methods: All ambulatory orthopaedic fractures that presented to the author's Level 1 trauma center were analyzed retrospectively between December 2019 and June 2020. Patients were divided into prepandemic (n=377) and pandemic (n=224) groups based on the date of presentation. Primary outcomes included new ambulatory fracture volume, and time to presentation and surgery. Secondary outcomes included fracture type and clinic no-show rates. Results: In the first 8 wk after the pandemic began, there was a 60.8% decrease in new patients with ambulatory fractures (24.6/week pre-pandemic, 9.63/week during the first 8 wk, P =0.001). The presentation rate of patients with new ambulatory fractures returned to the prepandemic baseline after the first 8 wk of the pandemic. No significant difference in time to presentation or surgery was noted between groups. There was no statistically significant difference in the presentation rate of the most commonly treated fracture types (ankle, distal radius, hand, or foot) between groups. There was a statistically significant increase in overall clinic no-show rate during the pandemic period. Conclusions: An initial decrease in ambulatory fracture volume was seen during the first 8 wk of the COVID-19 pandemic. No delay in time to presentation or time to surgery was seen between groups. After the first 8 wk of the pandemic, a return to normal ambulatory fracture volume was seen. Level of Evidence: Level III.

Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines.

BACKGROUND: Repurposed medicines may have a role against the SARS-CoV-2 virus. The antiparasitic ivermectin, with antiviral and anti-inflammatory properties, has now been tested in numerous clinical trials. AREAS OF UNCERTAINTY: We assessed the efficacy of ivermectin treatment in reducing mortality, in secondary outcomes, and in chemoprophylaxis, among people with, or at high risk of, COVID-19 infection. DATA SOURCES: We searched bibliographic databases up to April 25, 2021. Two review authors sifted for studies, extracted data, and assessed risk of bias. Meta-analyses were conducted and certainty of the evidence was assessed using the GRADE approach and additionally in trial sequential analyses for mortality. Twenty-four randomized controlled trials involving 3406 participants met review inclusion. THERAPEUTIC ADVANCES: Meta-analysis of 15 trials found that ivermectin reduced risk of death compared with no ivermectin (average risk ratio 0.38, 95% confidence interval 0.19-0.73; n = 2438; I2 = 49%; moderate-certainty evidence). This result was confirmed in a trial sequential analysis using the same DerSimonian-Laird method that underpinned the unadjusted analysis. This was also robust against a trial sequential analysis using the Biggerstaff-Tweedie method. Low-certainty evidence found that ivermectin prophylaxis reduced COVID-19 infection by an average 86% (95% confidence interval 79%-91%). Secondary outcomes provided less certain evidence. Low-certainty evidence suggested that there may be no benefit with ivermectin for "need for mechanical ventilation," whereas effect estimates for "improvement" and "deterioration" clearly favored ivermectin use. Severe adverse events were rare among treatment trials and evidence of no difference was assessed as low certainty. Evidence on other secondary outcomes was very low certainty. CONCLUSIONS: Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin. Using ivermectin early in the clinical course may reduce numbers progressing to severe disease. The apparent safety and low cost suggest that ivermectin is likely to have a significant impact on the SARS-CoV-2 pandemic globally.

Rethinking Risk Communication: Lessons From a Pandemic

In the wake of COVID-19, the field of risk communication must engage in more meaningful research and advocacy to support the systemic changes that are necessary for improving our pandemic response. Risk communication can also learn from cultural studies, using a more critical lens to study underlying inequalities and power structures, and the role of culture and politics in shaping risk perceptions and behaviours. Reputational management and public wellbeing are commonly stated goals. Yet COVID-19 has underscored the fractured identity and purpose of the field, and risk communicators need to be honest about whether they are working to protect the public or protect reputations.Alternate abstract:Dans la foulée de la COVID-19, le domaine de la communication du risque doit s'engager à faire de la recherche et du plaidoyer pour soutenir les changements systémiques nécessaires pour améliorer notre réponse face à la pandémie. La communication du risque peut aussi apprendre des études culturelles et utiliser un point de vue plus critique pour étudier les inégalités et les structures de pouvoir sous-jacentes ainsi que le rôle de la culture et des politiques dans le façonnement des comportements et de la perception du risque. La gestion de la réputation et le bien du public sont les objectifs généralement établis. Mais la COVID-19 a souligné l'identité et le but fracturés du domaine, et les communicateurs du risque doivent être honnêtes et dire s'ils travaillent pour protéger le public ou protéger les réputations.