Characterization of Traumatic Injury During the Early COVID-19 Pandemic: Results From a National Healthcare Database.

OBJECTIVE: To characterize traumatic injury patterns after stay-at-home orders were implemented in the United States in response to the coronavirus disease 2019 (COVID-19). METHODS: A retrospective review of a convenience sample of patients from a national healthcare research database (TriNetX) was conducted from April 1, 2020, to June 30, 2020. Inclusion criteria included all patients with documentation of both injury pattern and mechanism of injury. A comparison was made to a matched pre-pandemic timeframe. Changes in percentage and rate ratio (RR) with a 95% confidence interval were reported. RRs were calculated using Poisson regression analysis. RESULTS:  A total of 238,661 patients in the control and 178,224 patients in the study cohorts were analyzed. Significant increases in assaults (RR: 1.17, 95% CI: 1.14, 1.20) and bicycle accidents (RR: 1.07, 95% CI: 1.04, 1.11) were noted. There was a relative increase in patients who were male (+1.78%) and white (+2.01%). More injuries were alcohol-related (+0.76%) and occurred at home (+0.79%). A decrease in motor vehicle accidents (-1.17%), foot and ankle injuries (-1.63%), and injuries occurring at sporting events (-0.54%) was noted. CONCLUSIONS: Changes in injury patterns were observed during the study period. During future crises, particular public health and injury prevention resources may be required to address assaults, substance abuse, and home safety.

Characterization of Traumatic Injury During the Early COVID-19 Pandemic: Results From a National Healthcare Database

Objective: To characterize traumatic injury patterns after stay-at-home orders were implemented in the United States in response to the coronavirus disease 2019 (COVID-19). Methods: A retrospective review of a convenience sample of patients from a national healthcare research database (TriNetX) was conducted from April 1, 2020, to June 30, 2020. Inclusion criteria included all patients with documentation of both injury pattern and mechanism of injury. A comparison was made to a matched pre-pandemic timeframe. Changes in percentage and rate ratio (RR) with a 95% confidence interval were reported. RRs were calculated using Poisson regression analysis. Results: A total of 238,661 patients in the control and 178,224 patients in the study cohorts were analyzed. Significant increases in assaults (RR: 1.17, 95% CI: 1.14, 1.20) and bicycle accidents (RR: 1.07, 95% CI: 1.04, 1.11) were noted. There was a relative increase in patients who were male (+1.78%) and white (+2.01%). More injuries were alcohol-related (+0.76%) and occurred at home (+0.79%). A decrease in motor vehicle accidents (-1.17%), foot and ankle injuries (-1.63%), and injuries occurring at sporting events (-0.54%) was noted. Conclusions: Changes in injury patterns were observed during the study period. During future crises, particular public health and injury prevention resources may be required to address assaults, substance abuse, and home safety.

SARS-CoV-2 vaccine effectiveness against infection, symptomatic and severe COVID-19: a systematic review and meta-analysis.

BACKGROUND: The temporal evolution of SARS-CoV-2 vaccine efficacy and effectiveness (VE) against infection, symptomatic, and severe COVID-19 is incompletely defined. The temporal evolution of VE could be dependent on age, vaccine types, variants of the virus, and geographic region. We aimed to conduct a systematic review and meta-analysis of the duration of VE against SARS-CoV-2 infection, symptomatic COVID-19 and severe COVID-19. METHODS: MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, the World Health Organization Global Literature on Coronavirus Disease, and CoronaCentral databases were searched and studies were selected. Independent reviewers selected randomized controlled trials and cohort studies with the outcome of interest. Independent reviewers extracted data, and assessed the risk of bias. Meta-analysis was performed with the DerSimonian-Laird random-effects model with Hartung-Knapp-Sidik-Jonkman variance correction. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used to assess certainty (quality) of the evidence. Primary outcomes included VE as a function of time against SARS-CoV-2 infection, symptomatic and severe COVID-19. RESULTS: Eighteen studies were included representing nearly 7 million individuals. VE against all SARS-CoV-2 infections declined from 83% in the first month after completion of the original vaccination series to 22% at 5 months or longer. Similarly, VE against symptomatic COVID-19 declined from 94% in the first month after vaccination to 64% by the fourth month. VE against severe COVID-19 for all ages was high overall, with the level being 90% (95% CI, 87-92%) at five months or longer after being fully vaccinated. VE against severe COVID-19 was lower in individuals ≥ 65 years and those who received Ad26.COV2.S. CONCLUSIONS: VE against SARS-CoV-2 infection and symptomatic COVID-19 waned over time but protection remained high against severe COVID-19. These data can be used to inform public health decisions around the need for booster vaccination.

Short-term and Long-term Rates of Postacute Sequelae of SARS-CoV-2 Infection: A Systematic Review.

Importance: Short-term and long-term persistent postacute sequelae of COVID-19 (PASC) have not been systematically evaluated. The incidence and evolution of PASC are dependent on time from infection, organ systems and tissue affected, vaccination status, variant of the virus, and geographic region. Objective: To estimate organ system-specific frequency and evolution of PASC. Evidence Review: PubMed (MEDLINE), Scopus, the World Health Organization Global Literature on Coronavirus Disease, and CoronaCentral databases were searched from December 2019 through March 2021. A total of 2100 studies were identified from databases and through cited references. Studies providing data on PASC in children and adults were included. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for abstracting data were followed and performed independently by 2 reviewers. Quality was assessed using the Newcastle-Ottawa Scale for cohort studies. The main outcome was frequency of PASC diagnosed by (1) laboratory investigation, (2) radiologic pathology, and (3) clinical signs and symptoms. PASC were classified by organ system, ie, neurologic; cardiovascular; respiratory; digestive; dermatologic; and ear, nose, and throat as well as mental health, constitutional symptoms, and functional mobility. Findings: From a total of 2100 studies identified, 57 studies with 250 351 survivors of COVID-19 met inclusion criteria. The mean (SD) age of survivors was 54.4 (8.9) years, 140 196 (56%) were male, and 197 777 (79%) were hospitalized during acute COVID-19. High-income countries contributed 45 studies (79%). The median (IQR) proportion of COVID-19 survivors experiencing at least 1 PASC was 54.0% (45.0%-69.0%; 13 studies) at 1 month (short-term), 55.0% (34.8%-65.5%; 38 studies) at 2 to 5 months (intermediate-term), and 54.0% (31.0%-67.0%; 9 studies) at 6 or more months (long-term). Most prevalent pulmonary sequelae, neurologic disorders, mental health disorders, functional mobility impairments, and general and constitutional symptoms were chest imaging abnormality (median [IQR], 62.2% [45.8%-76.5%]), difficulty concentrating (median [IQR], 23.8% [20.4%-25.9%]), generalized anxiety disorder (median [IQR], 29.6% [14.0%-44.0%]), general functional impairments (median [IQR], 44.0% [23.4%-62.6%]), and fatigue or muscle weakness (median [IQR], 37.5% [25.4%-54.5%]), respectively. Other frequently reported symptoms included cardiac, dermatologic, digestive, and ear, nose, and throat disorders. Conclusions and Relevance: In this systematic review, more than half of COVID-19 survivors experienced PASC 6 months after recovery. The most common PASC involved functional mobility impairments, pulmonary abnormalities, and mental health disorders. These long-term PASC effects occur on a scale that could overwhelm existing health care capacity, particularly in low- and middle-income countries.