ABSTRACT
Background: The COVID-19 pandemic, accompanied by governments' regulatory restrictions to contain it, interfered with surgical services provision. We aimed to evaluate the impact of a 76-day city-wide lockdown in Wuhan, China, on the provision of four types of surgery and investigate the association between COVID-19 screening measures and the post-lockdown surge in lung surgery. Methods: We collected data of four types of surgery: lung, esophagus, liver, and stomach, conducted between October 1, 2019, to July 31, 2020, from three major hospitals in Wuhan. We compared the demographic information of patients before and after the COVID-19 induced lockdown by surgery types. We then used difference-in-differences analysis to compare the volumes of lung surgery with three other types of surgery. We estimated the abnormal post-lockdown surge in lung surgery, accounting for scheduling delay. Next, we probed into the association between such abnormal increase in lung surgery and the mandatory chest CT scans required by the government as a COVID-19 screening measure using linear regression. Finally, we analyzed the proportion of lung cancer surgery and its demographic characteristics before and after the lockdown.Findings: After the lockdown started, all four types of surgery quickly dropped to a very low level and stayed at that minimum level throughout the lockdown period. Within 12 weeks after the lockdown was lifted, all three surgery types returned to and stayed at the pre-lockdown period except lung surgery, which surged to 150% of the pre-lockdown level. Specifically, the weekly volume of lung surgery in the post-lockdown period was 60% higher than that of esophagus surgery (95% CI, 0·31-0·90), 39% higher than that of liver surgery (95% CI, 0·17-0·63), and 24% higher than that of stomach surgery (95% CI, 0·01-0·47). Moreover, for every 1,000 chest CT scans conducted in week t-1, on average 3·5 (95% CI, 0·56-6·49) lung surgery were expected to occur in the week that followed. Besides, more young female patients received lung surgery after the lockdown [82 (58%) vs. 57 (45%)]. Finally, the fractions of post-lockdown lung cancer surgery were significantly greater than those in the pre-lockdown period (73% vs. 66%).Interpretation: The lockdown severely affected surgical services in Wuhan. Amid the recovery, the surge in lung surgery was associated with the large-scale chest CT screening policy implemented during and after the lockdown. Such a large-scale chest CT screening could be a blessing as it advanced the diagnosis window of lung diseases for young females.Funding: No funding is declared for this study.Declaration of Interests: None reported.Ethics Approval Statement: The authors have used data with the approval from the healthcare information system of three Triple-A accredited hospitals.
Subject(s)
Lung Diseases , Stomach Diseases , Lung Neoplasms , COVID-19 , Sleep Disorders, Circadian RhythmABSTRACT
Background: Patients with intrahepatic cholestasis of pregnancy (ICP) may present with slight liver damage. In the global outbreak, the number of pregnant women infected with coronavirus disease 2019 (COVID-19) is increasing. For the pregnant patients with ICP, COVID-19 may cause severe liver damage.Case presentation: A 31-year-old pregnant woman was admitted with fever and respiratory symptoms to Tongji Hospital in Wuhan amid the outbreak of COVID-19. Her chest CT scan showed an infection with viral pneumonia as multiple ground glass opacities in both lungs were spotted. Laboratory tests revealed increased white blood cell (WBC) count and decreased lymphocyte count. The levels of serum total bile acid (TBA) were highly elvated. So were the indices of liver function, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), direct bilirubin (DBIL), alkaline phosphatase (AKP), 𝛄-glutamyltranspeptidase (𝛄-GT), and lactate dehydrogenase (LDH). The patient was later diagnosed of COVID-19 with comorbid ICP, presenting severe liver damage. Through timely termination of pregnancy and effective treatments, the prognoses of the patient and the fetus were well improved.Conclusions: This case highlights that COVID-19 may be a risk factor of severe liver damage for patients with ICP.Timely termination of pregnancy and effective symptomatic treatments are helpful to improve the progonosis.
Subject(s)
Fever , Pneumonia , Chemical and Drug Induced Liver Injury , COVID-19 , Cholestasis, IntrahepaticABSTRACT
Background: False negative results of SARS-CoV-2 nucleic acid detection pose threats to COVID-19 patients and medical workers alike. Objective: To develop multivariate models to determine clinical characteristics that contribute to false negative results of SARS-CoV-2 nucleic acid detection, and use them to predict false negative results as well as time windows for testing positive. Design: Retrospective Cohort Study (Ethics number of Tongji Hospital: No. IRBID: TJ-20200320) Setting: A database of outpatients in Tongji Hospital (University Hospital) from 15 January 2020 to 19 February 2020. Patients: 1,324 outpatients with COVID-19 Measurements: Clinical information on CT imaging reports, blood routine tests, and clinic symptoms were collected. A multivariate logistic regression was used to explain and predict false negative testing results of SARS-CoV-2 detection. A multivariate accelerated failure model was used to analyze and predict delayed time windows for testing positive. Results: Of the 1,324 outpatients who diagnosed of COVID-19, 633 patients tested positive in their first SARS-CoV-2 nucleic acid test (47.8%), with a mean age of 51 years (SD=14.9); the rest, which had a mean age of 47 years (SD=15.4), tested negative in the first test. Ground glass opacity in a CT imaging report was associated with a lower chance of false negatives (aOR, 0.56), and reduced the length of time window for testing positive by 26%. Consolidation was associated with a higher chance of false negatives (aOR, 1.57), and extended the length of time window for testing positive by 44%. In blood routine tests, basophils (aOR, 1.28) and eosinophils (aOR, 1.29) were associated with a higher chance of false negatives, and were found to extend the time window for testing positive by 23% and 41%, respectively. Age and gender also affected the significantly. Limitation: Data were generated in a large single-center study. Conclusion: Testing outcome and positive window of SARS-CoV-2 detection for COVID-19 patients were associated with CT imaging results, blood routine tests, and clinical symptoms. Taking into account relevant information in CT imaging reports, blood routine tests, and clinical symptoms helped reduce a false negative testing outcome. The predictive AFT model, what we believe to be one of the first statistical models for predicting time window of SARS-CoV-2 detection, could help clinicians improve the accuracy and efficiency of the diagnosis, and hence, optimizes the timing of nucleic acid detection and alleviates the shortage of nucleic acid detection kits around the world. Primary Funding Source: None.