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J Am Coll Emerg Physicians Open ; 3(2): e12699, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1763224


Objectives: Wearing a mask is an important method for reducing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in health care and public safety settings. We assess the evidence regarding masking in the workplace during the initial months of the COVID-19 pandemic (PROSPERO CRD4202432097). Methods: We performed a systematic review of published literature from 4 databases and evaluated the quality of evidence with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. We searched for observational and experimental research involving public safety and health care workers. We included articles evaluating the use of masks, versus no mask, on the outcome of SARS-CoV-2 infection. Results: Our search yielded 15,013 records, of which 9 studies were included. Most studies (n = 8; 88.9%) involved infections or outbreaks among health care workers. The majority (88.9%) used in-depth interviews of cases and non-cases to obtain self-reported use of masks during periods of exposure. One of 9 studies quantitatively assessed differences in SARS-CoV-2 infection based on use of masks in non-patient care settings. Use of observational study designs, small sample sizes, inadequate control for confounding, and inadequate measurement of exposure and non-exposure periods with infected coworkers contributed to the quality of evidence being judged as very low. Conclusions: The available evidence from the initial months of the pandemic suggests that the use of masks in congregate, non-patient care settings, such as breakrooms, helps to reduce risk of SARS-CoV-2 virus transmission. However, this evidence is limited and is of very low quality. Prospective studies incorporating active observation measures are warranted.

Am J Emerg Med ; 42: 1-8, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1018627


INTRODUCTION: The COVID-19 pandemic may affect both use of 9-1-1 systems and prehospital treatment and transport practices. We evaluated EMS responses in an EMS region when it experienced low to moderate burden of COVID-19 disease to assess overall trends, response and management characteristics, and non-transport rates. Our goal is to inform current and future pandemic response in similar regions. METHODS: We performed a retrospective review of prehospital EMS responses from 22 urban, suburban, and rural EMS agencies in Western Pennsylvania. To account for seasonal variation, we compared demographic, response, and management characteristics for the 2-month period of March 15 to May 15, 2020 with the corresponding 2-month periods in 2016-2019. We then tested for an association between study period (pandemic vs historical control) and incidence of non-transport in unadjusted and adjusted regression. Finally, we described the continuous trends in responses and non-transports that occurred during the year before and initial phase of the COVID-19 pandemic from January 1, 2019 to May 31, 2020. RESULTS: Among 103,607 EMS responses in the 2-month comparative periods of March 15 to May 15, 2016-2020, we found a 26.5% [95% CI 26.9%, 27.1%] decrease in responses in 2020 compared to the same months from the four prior years. There was a small increase in respiratory cases (0.6% [95%CI 0.1%, 1.1%]) and greater frequency of abnormal vital signs suggesting a sicker patient cohort. There was a relative increase (46.6%) in non-transports between periods. The pandemic period was independently associated with an increase in non-transport (adjusted OR 1.68; 95%CI 1.59, 1.78). Among 177,194 EMS responses occurring in the year before and during the early period of the pandemic, between January 1, 2019, and May 31, 2020, we identified a 31% decrease in responses and a 48% relative increase in non-transports for April 2020 compared to the previous year's monthly averages. CONCLUSION: Despite a low to moderate burden of infection during the initial period of the COVID-19 pandemic, we found a decline in overall EMS response volumes and an increase in the rate of non-transports independent of patient demographics and other response characteristics.

COVID-19/epidemiology , Emergency Medical Services/organization & administration , Emergency Medical Services/statistics & numerical data , Adolescent , Adult , Aged , Child , Child, Preschool , Facilities and Services Utilization , Female , Humans , Infant , Infant, Newborn , Logistic Models , Male , Middle Aged , Pennsylvania , Retrospective Studies , Young Adult
J Stroke Cerebrovasc Dis ; 29(8): 104988, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-602487


BACKGROUND: The COVID-19 pandemic's impact on stroke care is two-fold direct impact of the infection and indirect impact on non-COVID-19 diseases. Anecdotal evidence and clinical observation suggest that there is a decrease in the number of patients presenting with stroke during the pandemic. We aim to understand the impact of the COVID-19 pandemic on the utilization of stroke emergency services on a single comprehensive stroke center (CSC). METHODS: We performed a retrospective analysis of a prospectively maintained database and compared all emergency department (ED) encounters, acute stroke admissions (including TIA), and thrombectomy cases admitted in March 2017-2019 to patients admitted in March 2020 at a comprehensive stroke center. RESULTS: Number of total ED encounters (22%, p=0.005), acute ischemic strokes (40%, p=0.001), and TIAs (60%, p=0.163) decreased between March of 2017-2019 compared to March of 2020. The number of patients undergoing EVT in March 2020 was comparable to March 2017-2019 (p=0.430). CONCLUSION: A pandemic-related stay-at-home policy reduces the utilization of stroke emergency services at a CSC. This effect appears to be more prominent for ED encounters, all stroke admissions and TIAs, and less impactful for severe strokes. Given the relatively low prevalence of COVID-19 cases in our region, this decrement is likely related to healthcare seeking behavior rather than capacity saturation.

Coronavirus Infections/therapy , Emergency Medical Services/trends , Health Services Needs and Demand/trends , Needs Assessment/trends , Neurology/trends , Pneumonia, Viral/therapy , Stroke/therapy , Betacoronavirus/pathogenicity , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Databases, Factual , Host Microbial Interactions , Humans , Pandemics , Pennsylvania/epidemiology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Retrospective Studies , SARS-CoV-2 , Stroke/diagnosis , Stroke/epidemiology , Time Factors