The association between municipal pandemic response and COVID-19 contacts to emergency primary health care services: an observational study.

BACKGROUND: Norwegian municipalities had diverse strategies for handling tasks related to the COVID-19 pandemic. The emergency primary health care services were involved to different extents. The aim of this study was to describe how contacts with the emergency primary health care service were affected by the pandemic, in terms of patient contacts related to COVID-19, prioritisation and first actions taken, and to analyse differences between the services. METHODS: In this observational study, patient contacts to seven emergency primary health care services, from January 2020 to June 2021, were analysed. Descriptive analyses were applied. Data on the seven services' involvement in the municipal pandemic response, in relation to testing the inhabitants for COVID-19, were collected. RESULTS: There were 145 685 registered patient contacts within the study period. In total, 24% (n = 35,563) of the contacts were related to COVID-19, varying from 16 to 40% between the seven services. Of the COVID-19 related contacts, 96% (n = 34,069) were triaged to the lowest urgency level (range 76-99%) and 66% (n = 23,519) were patients contacting the services in order to be tested for COVID-19 (range 5-88%). The number of COVID-19 related contacts were unrelated to the number of confirmed COVID-19 cases among the inhabitants of the respective municipalities. The burden of COVID-19-related contacts mainly reflected the services' involvement in COVID-19 testing as part of the municipal pandemic response. CONCLUSIONS: During the COVID-19 pandemic, several of the emergency primary health care services were assigned new tasks, such as being part of the municipalities' system for carrying out testing for COVID-19. This had a major impact on their activity level. In the preparation for future pandemics, it should be discussed to which extent such use of the emergency primary health care system is appropriate, as additional tasks might affect the services' preparedness to provide urgent medical care among the inhabitants.

Preparedness and management during the first phase of the COVID-19 outbreak - a survey among emergency primary care services in Norway.

BACKGROUND: The emergency primary care (EPC) services in Norway have been at the frontline of the COVID-19 pandemic. Knowledge about the EPC services' management of the COVID-19 outbreak can be used to prepare for future outbreaks and improve patient management. The objectives of this study were to identify pandemic preparedness and management strategies in EPC centres in Norway during the COVID-19 outbreak. METHODS: Questions regarding patient management of the COVID-19 outbreak were included in data collection for the National Out-Of-Hours Services Registry. The data collection was web-based, and an invitation was sent by email to the managers of all EPC services in Norway in June 2020. The EPC services were asked questions about pre-pandemic preparedness, access to personal protective equipment (PPE), organizational measures taken, and how staffing was organized during the onset of the pandemic. RESULTS: There were 169 municipal and inter-municipal EPC services in Norway in 2020, and all responded to the questionnaire. Among the EPC services, 66.7% (n = 112) had a pandemic plan, but only 4.2% had performed training for pandemic preparedness. Further, fewer than half of the EPC centres (47.5%) had access to supplies of PPE, and 92.8% answered that they needed extra supplies of PPE. 75.3% of the EPC services established one or more respiratory clinics. Staffing with other personnel than usual was done in 44.6% (n = 74) of the EPC services. All EPC services except one implemented new strategies for assessing patients, while about half of the wards implemented new strategies for responding to emergency calls. None of the largest EPC services experienced that their pandemic plan was adequate, while 13.3% of the medium-sized EPC services and 48.9% of the small EPC services reported having an adequate pandemic plan. CONCLUSIONS: Even though the EPC services lacked well-tested plans and had insufficient supplies of PPE at the outbreak of the COVID-19 pandemic, most services adapted to the pandemic by altering the ways they worked and by hiring health care professionals from other disciplines. These observations may help decision makers plan for future pandemics.

Changes in the proportion and severity of patients with fever or common cold symptoms utilizing an after-hours house call medical service during the COVID-19 pandemic in Tokyo, Japan: a retrospective cohort study.

BACKGROUND: Trends in the characteristics and disease severity of patients using an after-hours house call (AHHC) medical service changed during the coronavirus disease (COVID-19) pandemic. However, there have been no reports on this issue since the start of the COVID-19 pandemic. This study aimed to investigate patients' tendencies to utilize an AHHC medical service for fever or common cold symptoms during the COVID-19 pandemic. METHODS: This retrospective cohort study compared the characteristics and disease severity of patients with fever or common cold symptoms utilizing an AHHC medical service offered by a single large company between the control period (December 1, 2018 to April 30, 2019) and the COVID-19 pandemic exposure period (December 1, 2019 to April 30, 2020). We also assessed the proportion of these patients in relation to all patients calling the service for any reason. RESULTS: During the control and COVID-19 pandemic exposure periods, a total of 6462 and 10,003 patients consulted the AHHC medical service, respectively. Of these, 5335 (82.6%) and 7423 (74.2%) patients had fever and common cold symptoms, respectively, during the control and COVID-19 pandemic exposure periods (P < 0.001). The corresponding median (interquartile range) ages were 8 (3-11) and 10 (4-33) years, respectively. The distribution of disease severity differed between the groups. The proportions of patients with mild, moderate, and severe illness were 71.1, 28.7, and 0.2% in the control period and 42.3, 56.7, and 0.9% in the COVID-19 pandemic exposure period, respectively (P < 0.001). CONCLUSIONS: During the COVID-19 pandemic, the proportion of patients with fever or common cold symptoms was lower than that in the control period, but disease severity was significantly higher.