Smart-working policies during COVID-19 pandemic: a way to reduce work-related traumas?

Eighth of March 2020, the Italian government introduced a national lockdown to counter the exponential increase in the number of COVID-19 cases; this decision avoided putting a strain on the health system. During the lockdown all non-essential services were stopped and a "stay at home" order was imposed. The purpose is to evaluate the impact of COVID-19 lockdown on Emergency Department (ED) visits due to work-related traumas in the Lombardy region. We performed a retrospective analysis on trauma admissions to the ED registered through the regional portal (EUOL), from 1st January 2019 to 31st December 2019 and from 1st January 2020 to 31st December 2020. The number of ED admissions for traumatic injury and work-related traumas dropped by 32% between 2019 and 2020. A remarkable reduction of work-related traumas was recorded during the two pandemic waves, from March to June and in October and November. The percentage of patient in critical condition in ED slightly raised. These results are probably a consequence of the unprecedented measures imposed by the Italian government to cope with the spread of COVID-19, with important implications for work contexts. This analysis should be considered to optimise the organisation of the emergency system in other critical scenarios. We speculate that the different epidemiology of occupational injuries during the lockdown period is a consequence of smart-working policies that can be held responsible for the drastic reduction of work-related traumas.

Cardiopulmonary resuscitation missed by bystanders: Collateral damage of coronavirus disease 2019.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic changed the time-dependent cardiac arrest network. This study aims to understand whether the rescue standards of cardiopulmonary resuscitation (CPR) and out-of-hospital cardiac arrest (OHCA) were handled differently during pandemic compared to the previous year. METHODS: Data for the years 2019 and 2020 were provided by the records of the Lombardy office of the Regional Agency for Emergency and Urgency. We analysed where the cardiac arrest occurred, when CPR started and whether the bystanders used public access to defibrillation (PAD). RESULTS: During 2020, there was a reduction in CPRs performed by bystanders (odds ratio [OR] = 0.936 [95% confidence interval (CI95% ) 0.882-0.993], p = .029) and in the return of spontaneous circulation (ROSC) (OR = 0.621 [CI95% 0.563-0.685], p < .0001), while there was no significant reduction in the use of PAD. Analysing only March, the period of the first wave in Lombardy, the comparison shows a reduction in bystanders CPRs (OR = 0.727 [CI95% 0.602-0.877], p = .0008), use of PAD (OR = 0.441 [CI95% 0.272-0.716], p = .0009) and in ROSC (OR = 0.179 [CI95% 0.124-0.257], p < .0001). These phenomena could be influenced by the different settings in which the OHCAs occurred; in fact, those that occurred in public places with a mandatory PAD were strongly reduced (OR = 0.49 [CI95% , 0.44-0.55], p < .0001). CONCLUSIONS: COVID-19 had a profound impact on the time-dependant OHCA network. During the first pandemic wave, CPR and PAD used by bystanders decreased. The different contexts in which OHCAs occurred may partially explain these differences.

COVID-19 mortality rate in nine high-income metropolitan regions.

We analyzed the spread of the COVID-19 epidemic in 9 metropolitan regions of the world with similar socio-demographic characteristics, daytime commuting population and business activities: the New York State, Bruxelles-Capital, the Community of Madrid, Catalonia, the Île-de-France Region, the Greater London county, Stockholms län, Hovedstaden (Copenhagen) and the Lombardy Region. The Lombardy region reported the highest COVID-19 crude mortality rate (141.0 x 100,000) 70-days after the onset of the epidemic, followed by the Community of Madrid (132.8 x 100,000) New York State (120.7 x 100,000). The large variation in COVID-19 mortality and case-fatality rates for COVID-19 in different age strata suggested a more accurate analysis and interpretation of the epidemic dynamics after standardization of the rates by age. The share of elder populations (>70 years) over total population varies widely in the considered study settings, ranging from 6.9% in Catalonia to 17.0% in Lombardy. When taking age distribution into consideration the highest standardized mortality rate was observed in the State of New York (257.9 x 100,000); with figures in most of the European regions concentrated between 123.3 x 100,000 in Greater London and 177.7 x 100,000 in Bruxelles-Capital, lower in French and Danish regions. We also report and critical appraise, when available, COVID-19 mortality figures in capital cities, nursing homes, as well as excess mortality at country level. Our data raise awareness on the need for a more in-depth epidemiological analysis of the current COVID-19 public health emergency that further explores COVID-19 mortality determinants associated with health services delivery, community-level healthcare, testing approaches and characteristics of surveillance systems, including classification of COVID-19 deaths.