Global burden of the COVID-19 associated patient-related delay in emergency healthcare: a panel of systematic review and meta-analyses.

BACKGROUND: Apart from infecting a large number of people around the world and causing the death of many people, the COVID-19 pandemic seems to have changed the healthcare processes of other diseases by changing the allocation of health resources and changing people's access or intention to healthcare systems. OBJECTIVE: To compare the incidence of endpoints marking delayed healthcare seeking in medical emergencies, before and during the pandemic. METHODS: Based on a PICO model, medical emergency conditions that need timely intervention was selected to be evaluated as separate panels. In a systematic literature review, PubMed was quarried for each panel for studies comparing the incidence of various medical emergencies before and during the COVID-19 pandemic. Markers of failure/disruption of treatment due to delayed referral were included in the meta-analysis for each panel. RESULT: There was a statistically significant increased pooled median time of symptom onset to admission of the acute coronary syndrome (ACS) patients; an increased rate of vasospasm of aneurismal subarachnoid hemorrhage; and perforation rate in acute appendicitis; diabetic ketoacidosis presentation rate among Type 1 Diabetes Mellitus patients; and rate of orchiectomy among testicular torsion patients in comparison of pre-COVID-19 with COVID-19 cohorts; while there were no significant changes in the event rate of ruptured ectopic pregnancy and median time of symptom onset to admission in the cerebrovascular accident (CVA) patients. CONCLUSIONS: COVID-19 has largely disrupted the referral of patients for emergency medical care and patient-related delayed care should be addressed as a major health threat.

COVID-19 Health Care for Afghan Refugees as a Minor Ethnicity in Iran: Clinical Differences and Racial Equality in Health

The aim of this research was to look at the clinical differences between Afghan refugees and the Iranian community, as well as the evaluation of healthcare inequalities against Afghan refugees. ‎This was a 1:2 matched case-control study carried out at two tertiary hospitals of Jahrom city, southern Iran, from January 2020 to December 2020. Cases were COVID-19 infected Afghans, and controls were Iranian patients. Demographic data, Self-reported symptoms, disease history, and initial symptom to referral length were extracted from medical records. CT scans being conducted and receiving ICU treatment were assessed for evaluation of racial inequality in health care. In this study, 132 Afghan refugees were compared to 266 Iranian controls. There were multiple self-reported symptoms being statistically differently manifested in Afghan refugees in comparison to Iranian COVID-19 patients. There was no difference in probability of being evaluated by HRCT or receiving ICU treatment (P=0.173, 1, respectively) even after being adjusted for symptoms or co-morbidities that were manifesting differently between Afghan vs. Iranian patients (P=0.476, 0.881, respectively). Ten (7.57%) subjects died in the case group and 18 (6.76) in the control group. There wasn’t any significant difference in the death rate between the groups (P=0.766). Our study revealed huge differences in symptoms of Afghan vs. Iranian COVID-19 patients, while these differences did not affect the probability of receiving proper health care. Jahrom city was a case of equality in COVID-19 health care toward the ethnic minorities.