ABSTRACT
For the past years, the world has been facing one of the worst pandemics of modern times. The COVID-19 outbreak joined a long list of infectious diseases that turned pandemic, and it will most likely leave scars and change how we live, plan, and manage the urban space and its infrastructures. Many fields of science were called into action to mitigate the impacts of this pandemic, including spatial and transport planning. Given the large number of articles recently published in these research areas, it is time to carry out an overview of the knowledge produced, synthesising, systematising, and critically analysing it. This article aims to review how the urban layout, accessibility and mobility influence the spread of a virus in an urban environment and what solutions exist or have been proposed to create a more effective and less intrusive response to pandemics. This review is split into two avenues of research: spatial planning and transport planning, including the direct and indirect impact on the environment and sustainability. © 2023 ICE Publishing: All rights reserved.
ABSTRACT
Introduction/Objectives: The Corona Virus Disease 0/2019 (COVID-19) has taken a major toll on the public health system, with restrictions in all clinical activity, from consultations and exams to number and type of surgeries. Patients apprehension to resort to medical aid and hospitals leads to late admissions and, in our perception, more severe presentations of the underlying pathology, namely, in Chronic limb threatening ischemia (CLTI). Need for testing prior to non-emergent surgery causes larger delays in the referral of patients, and this, added to the reduction of surgical times andlCU availability, potentially results in worse outcomes. The aim of this study was to objectively evaluate the type pathology that was treated during the emergency state and to compare the outcome of the surgical procedures with the same period of 2018 and 2019. Methods: A retrospective analysis of the patient charts from patients submitted to surgery in the months of March and April of the year 2020 was conducted and compared to the same period on the previous two years. The primary endpoint was death at 30 days or during hospital stay and the secondary endpoints were pathology classification, grade of ischemia, amputation, amputation level, type of surgery (endovascular, conventional or hybrid), time of hospital stay and reintervention. Results: There were 98 patients submitted to surgery in the COVID period (CP), compared to 286 in the Non-COVID period (NCP). There was no significant difference in the age (70 years (17-98) in the CP vs. 69 (17-92) in the NCP, p=.i3) or sex profile of the patients (76% male (n=74) in the CP vs. 70% (n=i96) in the NCP, p=.26). There was no statistical differ¬ence in mortality (5% (n=5) in the CP vs. 5% (n=i3) in the NCP, p=.88). There was a statistically significant decrease in conventional surgery (43% (n=u2) in the CP vs. 57% (n=i6 4) in the NCP, p=.04), but no statistically significant difference in length of hospital stay(io (0-77) days in the CP vs. 7 (0-118) in the NCP, p=.6), and reintervention (18% (n=i8) in the CP vs. 16% (n=45) in the NCP, p=.s8). PAD corresponded to 75% (n=73) of the admissions in the CP vs. 48% (n=i37) in the NCP, p=.02. CLTI corresponded to 99% (n=70) of the PAD population in the CP, vs. 93% (n=n 4) in the NCP, p=.i, with a significant increase in the number of patients presenting with Rutherford Grades 5 and 6 (81% (n=57) in the CP, vs. 68% (n=77) in the NCP, p=.03). There was a non-significant decrease in amputation rate (35% (n-25) vs. 40% (n=49J, P-49) and increase of major limb amputation (52% (0=13) vs. 39% (n=i9), p=.27). The second mostfrequent pathology was aneurysmal aortic and iliac disease, but there was a statistically significant reduction in the number of patients treated (5% (n=s) in the CP vs. 13% (n=36) in the NCP, p=.os). All aortic aneurysms treated in 2020 were ruptured (100% (n=s) vs. 42% (n=is) in the NCP, p=o.2). There was no significant difference in mortality in urgent aortic aneurysm repair between groups (60% (n=3) in the CP vs. 47% (n-7) in the NCP, p-.77). Conclusions: COVID-19 restrictions manifested mainly in the type of pathology treated and the number of patients operated on. The gravity of the underlying pathology, manifested by more serious wounds and advanced CLTI at presentation, did not increase mortality nor was reflected on limb amputations rates. Aortic and iliac aneurismal disease was the second most common pathologytreated but with a significant decrease in total number of cases and no significant difference in mortality.