COVID-19: Adapting to change, general surgery at a district general hospital in the United Kingdom

The Coronavirus pandemic has caused major change across the world and in the National Health Service. In order to cope and help limit contagion, numerous institutions recognised the need to adjust clinical practice quickly yet safely. In this paper, we aim to describe the changes implemented in a general surgery department at a district general hospital in the United Kingdom. Across the surgical specialties, frameworks, protocols and guidelines have been established locally and nationally. The aerosol generating procedures involved in general surgery required us to alter our daily activities. Modifications to patient management were necessary to try and reduce viral spread. Staff wellbeing was heavily promoted in order to help maintain the frontline workforce. A holistic approach was required.

5GhNet: an intelligent QoE aware RAT selection framework for 5G-enabled healthcare network.

The COVID-19 outbreak has stimulated the digital transformation of antiquated healthcare system to a smart hospital, enabling the personalised and remote healthcare services. To augment the functionalities of these intelligent healthcare systems, 5G & B5G heterogeneous network has emerged as a robust and reliable solution. But the pivotal challenge for 5G & B5G connectivity solutions is to ensure flexible and agile service orchestration with acknowledged Quality of Experience (QoE). However, the existing radio access technology (RAT) selection strategies are incapacitated in terms of QoE provisioning and Quality of Service (QoS) maintenance. Therefore, an intelligent QoE aware RAT selection architecture based on software-defined wireless networking (SDWN) and edge computing has been proposed for 5G-enabled healthcare network. The proposed model leverages the principles of invalid action masking and multi-agent reinforcement learning to allow faster convergence to QoE optimised RAT selection policy. The analytical evaluation validates that the proposed scheme outperforms the other existing schemes in terms of enhancing personalised user-experience with efficient resource utilisation.

A Perspective on Theatre Efficiency in Terms of Theatre Utilisation and Theatre Costs and the Effects of Infection Control Protocols on These During the COVID-19 Pandemic.

Background and aim The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on healthcare systems. Several local infection control methods were put in place, which have now evolved and continued in some form or the other. According to various research, as the time duration for distinct phases in the pathway rose, trauma theatre efficiency reduced. However, there is no literature, to our knowledge, that has explicitly looked at theatre utilisation and cost efficiency compared them and expressed theatre efficiency in these terms. The aim of this article is to study theatre efficiency in terms of utilisation and costs before and during the pandemic and understand the influence of infection control protocols on these. Materials and methods The data were collected retrospectively from the ORMIS theatre management software (iPath Softwares, Ohio), from December 2019 (pre-COVID) and December 2020 (COVID). Turnaround time, utilisation time and combined operative time were defined and compared. Costs incurred due to over-running, under-running and turnaround time were compared. Results Theatre utilization was 101% during COVID and 86.63% pre-COVID. The average cost of over-running as well as under-running a theatre list during the pandemic was significantly higher. Conclusion Optimal theatre utilisation and reduced time between cases improve theatre efficiency. Turnaround time, if reduced, can not only decrease costs but also increase efficiency.Theatre utilisation and efficiency can be maintained even with new infection control protocols, but these are not cost-efficient.

Voices From the Community: Maternal Healthcare Experiences During the COVID-19 Pandemic.

Introduction The coronavirus disease 2019 (COVID-19) pandemic had a significant impact on health services around the world. Many hospitals and clinics were overwhelmed by the influx of patients, leading to delays and disruptions in care. The fear of contracting the virus also led to a decrease in the number of people seeking medical care, even for urgent or life-threatening conditions. Various studies have reported a decrease in overall utilization of maternal health services. However, it remains vital to find the reasons for reduced utilization along with the experiences of the women as well as healthcare workers during the pandemic. Objective The objective of this study was to identify the facilitators and barriers to maternal healthcare services utilization during the COVID-19 pandemic. Methods It was a qualitative study conducted in a rural area of Haryana, India. Twelve in-depth interviews (IDIs) were conducted with health workers and four focused group discussions (FGDs) were conducted with pregnant women. Textual analysis was done for both IDIs as well as FGDs. Qualitative analysis was done manually. Results The identified themes were complete cessation of services, no outpatient department (OPD) services for many months, no antenatal care (ANC) services for two months, disruption of supply of medicines, unavailability of drugs, fear of getting COVID-19 infection, mandatory COVID-19 negative report for admission in hospital, and increased referral from government health facilities during the pandemic and lockdown. Conclusion Maternal healthcare services suffered during COVID-19 for various reasons including the closure of health facilities, limited supply of stocks, or fear of the disease among pregnant women. This evidence can be used to prepare as well as manage healthcare services in future.

The impact of COVID-19 on mental health service utilisation in England.

The COVID-19 pandemic has had a significant impact on population mental health and the need for mental health services in many countries, while also disrupting critical mental health services and capacity, as a response to the pandemic. Mental health providers were asked to reconfigure wards to accommodate patients with COVID-19, thereby reducing capacity to provide mental health services. This is likely to have widened the existing mismatch between demand and supply of mental health care in the English NHS. We quantify the impact of these rapid service reconfigurations on activity levels for mental health providers in England during the first thirteen months (March 2020-March 2021) of the COVID-19 pandemic. We use monthly mental health service utilisation data for a large subset of mental health providers in England from January 1, 2015 to March 31, 2021. We use multivariate regression to estimate the difference between observed and expected utilisation from the start of the pandemic in March 2020. Expected utilisation levels (i.e. the counterfactual) are estimated from trends in utilisation observed during the pre-pandemic period January 1, 2015 to February 31, 2020. We measure utilisation as the monthly number of inpatient admissions, discharges, net admissions (admissions less discharges), length of stay, bed days, number of occupied beds, patients with outpatient appointments, and total outpatient appointments. We also calculate the accumulated difference in utilisation from the start of the pandemic period. There was a sharp reduction in total inpatient admissions and net admissions at the beginning of the pandemic, followed by a return to pre-pandemic levels from September 2020. Shorter inpatient stays are observed over the whole period and bed days and occupied bed counts had not recovered to pre-pandemic levels by March 2021. There is also evidence of greater use of outpatient appointments, potentially as a substitute for inpatient care.

[Changes in the provision of primary care and psychotherapy in Germany during the first two lockdowns in 2020 and 2021: A two-wave survey giving consideration to gender identity and sexual orientation]. / Veränderung hausärztlicher und psychotherapeutischer Versorgung in Deutschland während der ersten beiden COVID-19-Lockdowns 2020 und 2021: Zwei Befragungswellen unter Berücksichtigung von Geschlechtsidentität und sexueller Orientierung.

INTRODUCTION: Measures against the COVID-19 pandemic led to restrictions in ambulatory health care in Germany. While the restrictions have been described from claims data, the patients' perspective has been missing. Lesbian, gay, bisexual, trans-, inter- and asexual persons (LGBTIA) might have been particularly affected by these restrictions because of their vulnerability. Thus, our research questions were: 1) How did the restrictions during the pandemic influence primary care and psychotherapy in Germany from the patients' perspective? 2) Are there differences between LGBTIA and cis-heterosexual persons regarding these restrictions? METHODS: We conducted an online survey with two survey waves in March/April 2020 and January/February 2021. Sampling was conducted via multiplicators and via snowball sampling. Amongst others, the survey contained open-ended questions regarding primary care and psychotherapy. From the answers of the first survey wave we constructed quantitative items for the second survey wave. Descriptive and inferential statistical analysis was conducted, including linear regression with R. RESULTS: 6,784 participants took part in the survey (2,641 in the first survey wave), 5,442 of whom identified as LGBTIA. Categories of changes in primary care were: no health care utilization, no changes in primary care, insecurity regarding primary care, and changes in primary care which could be less frequent utilization, differing procedures or changes in ways of communication. In the second wave, LGBTIA participants rated the worsening of primary care during the pandemic as being more pronounced. Regarding psychotherapy, the change can be described as no change in care, changes in the form of therapy, treatment in emergencies only and a longer break from psychotherapy. There was no different rating by LGBTIA persons compared to cis-heterosexual persons in the second survey wave. Telephone and video consultations were more common in psychotherapy than in primary care. DISCUSSION: LGBTIA persons were oversampled, so the sample included more people from urban areas than the German population. Due to the online survey form, older people were underrepresented relative to their numbers in the general German population. CONCLUSION: With respect to future pandemics general practitioners in primary care must be prepared that psychotherapy might be paused and delayed for some time. Video and telephone consultations should be offered to overcome pandemic-related restrictions in the future. General practitioners should know the gender identity and sexual orientation of their patients in order to proactively address health care barriers.

The positive impact of the COVID 19 pandemic on organ utilisation in liver transplantation

Background: As the world recovers from the aftermath of devastating waves of an outbreak, the ongoing Coronavirus disease 2019 pandemic has presented a unique perspective to the transplantation community of ''organ utilisation'' in liver transplantation, a poorly defined term and ongoing hurdle in this field. To this end, we report the key metrics of transplantation activity from a high-volume liver transplantation centre in the United Kingdom over the past two years. Method(s): Between March 2019 and February 2021, details of donor liver offers received by our centre from National Health Service Blood & Transplant, and of transplantation were reviewed. Differences in the activity before and after the outbreak of the pandemic, including short term post-transplant survival, have been reported. Result(s): The pandemic year at our centre witnessed a higher utilisation of Donation after Cardiac Death livers (80.4% vs. 58.3%, p = 0.016) with preserved United Kingdom donor liver indices and median donor age (2.12 vs. 2.02, p = 0.638;55 vs. 57 years, p = 0.541) when compared to the pre-pandemic year. The 1- year patient survival rates for recipients in both the periods were comparable. The pandemic year, that was associated with increased utilisation of Donation after Cardiac Death livers, had an ischaemic cholangiopathy rate of 6%. Conclusion(s): The pressures imposed by the pandemic led to increased utilisation of specific donor livers to meet patient needs and minimise the risk of death on the waiting list, with apparently preserved early post-transplant survival. Optimum organ utilisation is a balancing act between risk and benefit for the potential recipient, and technologies like machine perfusion may allow surgeons to increase utilisation without compromising patient outcomes.Copyright © 2022

PERCEIVING THE TRANSITION OF URBAN CAMPUS OPEN SPACES UNDER THE INFLUENCE OF COVID-19

The open spaces on campus provide great opportunities to engage in beneficial outdoor activities. However, due to the COVID-19 outbreak, campus users have experienced several periods of isolation, which has affected perceptions of the environment and practical use of these public spaces. To investigate how campus users, connect with adjacent open spaces under the influence of pandemic restrictions, the authors conducted a case study at six selected sites on the Universiti Malaya (UM) campus. The results show that the current lockdown has reduced frequency and differences in daily use at the selected sites. Some landscape furniture and vegetation were removed or replaced as regular maintenance, while the primary users changed from students to staff. Nevertheless, the perceived aesthetic appeal and previous outdoor experiences in the selected open spaces stimulated emotional attachments to the physical campus and a widespread appreciation of the green spaces on campus. The results can serve as a practical basis for interventions for campus users' psychological restoration during this transition and provide theoretical support for investigating higher quotient stimulation of spatial senses to enhance landscape design strategies. © 2022 by MIP.

Older adults access to mental health and social care services during COVID-19 restrictions in Western Australia

Objective: This study aimed to understand the impact of COVID-19 on access to mental health and social services among older adults in Western Australia. Method: A cross-sectional study was conducted with 194 adults aged >=70 years or >=60 years with chronic conditions. A questionnaire co-developed by a consumer reference group was used to collect data on social networks and service access. Frequency analyses were used to assess quantitative data. Qualitative data were assessed using thematic analyses. Results: 62.7% of participants reported being not at all/slightly affected by COVID-19;40.7% reported having three/four people to chat with. 76.3% of participants did not access mental health or social services during the 2020 COVID-19 restrictions. The remaining 23.7% mostly accessed mental health-related services, with GPs the most common source of support. 18.0% of the total sample reported choosing not to access services even though they would have liked to. Conclusions: Most older adults in this sample did not access mental health or social care services. 18.0% of all participants felt they needed services but did not access them. This suggests there were some unmet needs within the community. Strengthening social networks may help protect older adults against psychosocial declines during and post-COVID-19. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Maintaining social and emotional wellbeing among older adults during periods of increased social isolation: Lessons from the COVID-19 pandemic

Objective: Older adults are vulnerable to isolation and poor emotional wellbeing during COVID-19, however, their access to appropriate supports is unknown. The aim of this study was to explore older adults' experiences accessing social and emotional support during the COVID-19 pandemic in Australia. Method: Ten older adults from Western Australia (Australia) aged 68 to 78 years participated in individual semi-structured interviews between December 2020 and January 2021. Responses were investigated using thematic analysis. Results: Three key themes emerged: adaptability and self-sufficiency;informal support-seeking;and digital and online technologies. Older adults were adaptable to COVID-19 restrictions;however, some were anxious about reconnecting with their social networks once restrictions had eased. Older adults relied on their informal support networks to maintain their social and emotional wellbeing during lockdown. Digital platforms (e.g., Zoom, social media) enabled older adults to stay connected with others, yet some older people were unable or reluctant to use technology, leaving them vulnerable to social isolation. Conclusions: Older adults are resilient to the challenges of COVID-19. Informal supports and digital technologies are important to maintaining social and emotional wellbeing during lockdown. Local governments and community groups may benefit from increased funding to deliver services that promote social connectedness during times of crisis. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement What is already known about this topic: (1) Older adults are vulnerable to social isolation and poor mental health during COVID-19. (2) Older adults are less likely to seek and receive help for their emotional and social health than younger age groups. (3) Barriers to accessing appropriate supports include physical health problems, stigma, negative attitudes towards help-seeking and system-level factors. What this topic adds: (1) Older adults were able to adapt well to COVID-19 restrictions and relied on informal supports to maintain their wellbeing. (2) Older adults with limited social networks and poor access to and/or knowledge of digital technologies are at the greatest risk of social and emotional declines. (3) Telephone "warm" lines, volunteering opportunities, and programs to improve digital literacy may help to protect older adults' social and emotional wellbeing during times of crises. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Hearing healthcare utilisation among older adults with self-reported hearing loss during the COVID-19 pandemic in the United States.

OBJECTIVE: To ascertain the prevalence, causes, and risk factors of hearing healthcare delays in older people with self-reported hearing loss in the United States. DESIGN: This cross-sectional study used data from the National Health and Ageing Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries. A supplemental COVID-19 survey was mailed to the participants from June to October 2020. STUDY SAMPLE: By January 2021, 3257 participants had returned completed COVID-19 questionnaires, with the majority having been self-administered between July and August 2020. RESULTS: The participants in the study represented 32.7 million older adults in the US, with 29.1% reporting hearing loss. Among over 12.4 million older adults who put off needed or planned medical care, 19.6% of those with self-reported hearing loss and 24.5% of hearing aid or device users stated they delayed hearing appointments. Approximately 629,911 older adults with hearing devices were impacted by the COVID-19 outbreak for audiological services. The top three reasons were deciding to wait, service cancellation, and fear of going. Education and race/ethnicity were associated with delaying hearing healthcare. CONCLUSIONS: The COVID-19 pandemic impacted hearing healthcare utilisation among older adults with self-reported hearing loss in 2020, with both patient- and provider- initiated delays.

Changes to consultations and diagnosis of osteoarthritis in primary care during the COVID-19 pandemic.

OBJECTIVE: General practitioners (GP) are often the first medical professionals to treat musculoskeletal complaints. Yet the impact of COVID-19 on primary care utilisation for musculoskeletal complaints is largely unknown. This study quantifies the impact of the pandemic on primary care utilisation for musculoskeletal complaints and specifically osteoarthritis (OA) in the Netherlands. DESIGN: We extracted data on GP consultations in 2015-2020 from 118,756 patients over 45 years of age and estimated reductions in consultations in 2020 as compared to 5-year average. Outcomes were GP consultations for: any musculoskeletal complaints, knee and hip OA, knee and hip complaints, and newly diagnosed knee and hip OA/complaints. RESULTS: The relative reductions in consultations ranged from 46.7% (95% confidence intervals (CI): 43.9-49.3%) (all musculoskeletal consultations) to 61.6% (95% CI: 44.7-73.3%) (hip complaints) at the peak of the first wave, and from 9.3% (95% CI: 5.7-12.7%) (all musculoskeletal consultations) to 26.6% (95% CI: 11.5-39.1%) (knee OA) at the peak of the second wave. The reductions for new diagnoses were 87.0% (95% CI: 71.5-94.1%) for knee OA/complaints, and 70.5% (95% CI: 37.7-86.0%) for hip OA/complaints at the peak of the first wave, and not statistically significant at the peak of the second wave. CONCLUSION: We observed 47% reduction in GP consultations for musculoskeletal disorders during the first wave and 9% during the second wave. For hip and knee OA/complaints, the reductions were over 50% during the first, and 10% during the second wave. This disruption may lead to accumulation of patients with severe OA symptoms and more requests for arthroplasty surgery.

Myocardial perfusion SPECT in Germany from 2012 to 2021: insights into development and quality indicators.

PURPOSE: This paper summarises the results of 4 national surveys on the numbers, utilisation and technique of myocardial perfusion SPECT (MPS) from 2012 to 2021. METHODS: A one-page questionnaire for information on MPS in 2012, 2015, 2018 and 2021 was sent to German centres practising nuclear medicine. To check for representativeness, the numbers obtained were related to official annual data and furthermore to the numbers of invasive coronary angiography procedures (ICA). RESULTS: MPS examinations increased by > 40% from 2012 to 2021 and showed a centralisation with increasing MPS per centre. In 2020, a mild impact of the COVID-19 pandemic could be observed in the form of only a slight MPS increase, which was compensated in the following year. Outpatient care cardiologists represent the most important referrer (70%). Mostly, 2-day protocols were used. One-day protocols and stress-only protocols showed insignificant changes. The use of exercise stress decreased steadily. In 2021, exercise stress was replaced by pharmacological stress as the most frequent stress modality. Camera systems showed a shift to more SPECT-CT systems. The use of gated SPECT increased to almost 90%. Quantitative scoring showed an increasing acceptance. The ratio of invasive coronary angiographies (ICA) to MPS was between 3.9 and 4.5. A significant proportion of ICA in the context of CCS (chronic coronary syndrome) was performed without prior testing for ischaemia. CONCLUSION: The 2012 to 2021 MPS surveys reveal a continuously growing number of examinations with only a mild temporary effect of the COVID-19 pandemic and a centralisation with increasing numbers per centre. Performance and technical data reveal a high-grade adherence of MPS practice to the current ESC guideline. A large potential of non-invasive diagnostics remains for the future.

COVID-19 restrictions and the incidence and prevalence of prescription opioid use in Australia - a nationwide study.

The COVID-19 pandemic has disrupted seeking and delivery of healthcare. Different Australian jurisdictions implemented different COVID-19 restrictions. We used Australian national pharmacy dispensing data to conduct interrupted time series analyses to examine the incidence and prevalence of opioid dispensing in different jurisdictions. Following nationwide COVID-19 restrictions, the incidence dropped by -0.40 (95% confidence interval [CI]: -0.50, -0.31), -0.33 (95% CI: -0.46, -0.21) and -0.21 (95% CI: -0.37, -0.04) per 1000 people per week and the prevalence dropped by -0.85 (95% CI: -1.39, -0.31), -0.54 (95% CI: -1.01, -0.07) and -0.62 (95% CI: -0.99, -0.25) per 1000 people per week in Victoria, New South Wales and other jurisdictions, respectively. Incidence and prevalence increased by 0.29 (95% CI: 0.13, 0.44) and 0.72 (95% CI: 0.11, 1.33) per 1000 people per week, respectively in Victoria post-lockdown; no significant changes were observed in other jurisdictions. No significant changes were observed in the initiation of long-term opioid use in any jurisdictions. More stringent restrictions coincided with more pronounced reductions in overall opioid initiation, but initiation of long-term opioid use did not change.

Healthcare utilisation, physical activity and mental health during COVID-19 lockdown: an interrupted time-series analysis of older adults in England.

COVID-19 measures which reduce interpersonal contact may be effective in containing the transmission, but their impacts on peoples' well-being and daily lives overtime remain unclear. Older adults are more vulnerable to both the virus and social isolation. It is therefore imperative to understand how they were affected during this period. Major concerns arising from the pandemic cover the aspects of mental health, healthcare utilisation and individual behavioural changes. Complementing the existing before-and-after analyses, we explore the impacts of easing and re-introducing COVID-19 measures by using a time-series data in England. The data was collected between May and November 2020 from the monthly surveys of the Platform for Research Online to Investigate Genetics and Cognition in Aging (PROTECT). Chi-squared analysis and interrupted time-series analysis were conducted to examine impacts of easing and re-introducing COVID-19 measures. Overall, mental health improves overtime but at a decreasing rate. The use of telephone/video consultations with a doctor or health professional presented a decreasing trend during the pandemic, whilst that of in-person consultation was increasing overtime. We observed significant variations in the time trends of mental health measures, healthcare utilisation and physical activity following the ease but not the re-introduction of COVID-19 measures. Future research is required to understand if these asymmetric impacts were driven by adaption of the people or stringency of the measures. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-022-00741-y.

The impact of the COVID-19 pandemic on healthcare access and utilisation in South Sudan: a cross-sectional mixed methods study.

BACKGROUND: Indirect effects of the COVID-19 pandemic on communities in fragile and conflict-affected settings may be severe due to reduced access and use of healthcare, as happened during the 2015 Ebola Virus Disease outbreak. Achieving a balance between short-term emergency response and addressing long-term health needs is particularly challenging in fragile and conflict-affected settings such as South Sudan, given the already significant barriers to accessing healthcare for the population. This study sought to characterise the effect of COVID-19 on healthcare access and South Sudan's healthcare response. This can inform efforts to mitigate the potential impacts of COVID-19 or other epidemiological threats, and contribute to understanding how these may be balanced for greater health system resilience in fragile contexts. METHODS: We conducted a mixed methods study in three of South Sudan's states, combining data from a cross-sectional quantitative household survey with qualitative interviews and Focus Group Discussions. RESULTS: Even though some fears related to COVID-19 were reported, we found these did not greatly dissuade people from seeking care and do not yield significant consequences for health system programming in South Sudan. The pillars of the response focused on risk communication and community engagement were effective in reaching communities through different channels. Respondents and participants reported behaviour changes that were in line with public health advice. We also found that the implementation of COVID-19 response activities sometimes created frictions between the national government and international health actors, and that COVID-19 caused a greater reliance on, and increased responsibility for, international donors for health planning. CONCLUSIONS: Given the fact that global priorities on COVID-19 are greatly shifting, power dynamics between international health agencies and the national government may be useful to consider in further COVID-19 planning, particularly for the vaccine roll-out. South Sudan must now navigate a period of transition where COVID-19 vaccine roll-out continues and other domestic health burdens are re-prioritised.

Patient experiences during the COVID-19 pandemic: a qualitative study in Dutch primary care.

BACKGROUND: Changes in primary care provision during the COVID-19 pandemic could have affected patient experience of primary care both positively and negatively. AIM: To assess the experiences of patients in primary care during the COVID-19 pandemic. DESIGN & SETTING: A qualitative study of patients from regions with high and low COVID-19 prevalence in the Netherlands. METHOD: A qualitative study using a phenomenological framework was performed among purposively sampled patients. Individual semi-structured interviews were performed and transcribed. Data were thematically analysed by means of an inductive approach. RESULTS: Twenty-eight patients were interviewed (13 men and 15 women, aged 27-91 years). After thematic analysis, two main themes emerged: accessibility and continuity of primary care. Changes considered positive during the pandemic regarding accessibility and continuity of primary care included having a quieter practice, having more time for consultations, and the use of remote care for problems with low complexity. However, patients also experienced decreases in both care accessibility and continuity, such as feeling unwelcome, the GP postponing chronic care, seeing unfamiliar doctors, and care being segregated. CONCLUSION: Despite bringing several benefits, patients indicated that the changes to primary care provision during the COVID-19 pandemic could have threatened care accessibility and continuity, which are core values of primary care. These insights can guide primary care provision not only in this and future pandemics, but also when implementing permanent changes to care provision in primary care.

Frailty and the impacts of the COVID-19 pandemic on community-living middle-aged and older adults: an analysis of data from the Canadian Longitudinal Study on Aging (CLSA).

BACKGROUND: frailty imparts a higher risk for hospitalisation, mortality and morbidity due to COVID-19 infection, but the broader impacts of the pandemic and associated public health measures on community-living people with frailty are less known. METHODS: we used cross-sectional data from 23,974 Canadian Longitudinal Study on Aging participants who completed a COVID-19 interview (Sept-Dec 2020). Participants were included regardless of whether they had COVID-19 or not. They were asked about health, resource, relationship and health care access impacts experienced during the pandemic. Unadjusted and adjusted prevalence of impacts was estimated by frailty index quartile. We further examined if the relationship with frailty was modified by sex, age or household income. RESULTS: community-living adults (50-90 years) with greater pre-pandemic frailty reported more negative impacts during the first year of the pandemic. The frailty gradient was not explained by socio-demographic or health behaviour factors. The largest absolute difference in adjusted prevalence between the most and least frail quartiles was 15.1% (challenges accessing healthcare), 13.3% (being ill) and 7.4% (increased verbal/physical conflict). The association between frailty and healthcare access differed by age where the youngest age group tended to experience the most challenges, especially for those categorised as most frail. CONCLUSION: although frailty has been endorsed as a tool to inform estimates of COVID-19 risk, our data suggest it may have a broader role in primary care and public health by identifying people who may benefit from interventions to reduce health and social impacts of COVID-19 and future pandemics.

Recovering from COVID-19: lessons learnt from an intensive secondary care follow-up service.

In response to the first COVID-19 surge in 2020, secondary care outpatient services were rapidly reconfigured to provide specialist review for disease sequelae. At our institution, comprising hospitals across three sites in London, we initially implemented a COVID-19 follow-up pathway that was in line with expert opinion at the time but more intensive than initial clinical guidelines suggested. We retrospectively evaluated the resource requirements for this service, which supported 526 patients from April 2020 to October 2020. At the 6-week review, 193/403 (47.9%) patients reported persistent breathlessness, 46/336 (13.7%) desaturated on exercise testing, 167/403 (41.4%) were discharged from COVID-19-related secondary care services and 190/403 (47.1%) needed 12-week follow-up. At the 12-week review, 113/309 (36.6%) patients reported persistent breathlessness, 30/266 (11.3%) desaturated on exercise testing and 150/309 (48.5%) were discharged from COVID-19-related secondary care services. Referrals were generated to multiple medical specialties, particularly respiratory subspecialties. Our analysis allowed us to justify rationalising and streamlining provisions for subsequent COVID-19 waves while reassured that opportunities for early intervention were not being missed.

Detecting early signals of COVID-19 outbreaks in 2020 in small areas by monitoring healthcare utilisation databases: first lessons learned from the Italian Alert_CoV project.

BackgroundDuring the COVID-19 pandemic, large-scale diagnostic testing and contact tracing have proven insufficient to promptly monitor the spread of infections.AimTo develop and retrospectively evaluate a system identifying aberrations in the use of selected healthcare services to timely detect COVID-19 outbreaks in small areas.MethodsData were retrieved from the healthcare utilisation (HCU) databases of the Lombardy Region, Italy. We identified eight services suggesting a respiratory infection (syndromic proxies). Count time series reporting the weekly occurrence of each proxy from 2015 to 2020 were generated considering small administrative areas (i.e. census units of Cremona and Mantua provinces). The ability to uncover aberrations during 2020 was tested for two algorithms: the improved Farrington algorithm and the generalised likelihood ratio-based procedure for negative binomial counts. To evaluate these algorithms' performance in detecting outbreaks earlier than the standard surveillance, confirmed outbreaks, defined according to the weekly number of confirmed COVID-19 cases, were used as reference. Performances were assessed separately for the first and second semester of the year. Proxies positively impacting performance were identified.ResultsWe estimated that 70% of outbreaks could be detected early using the proposed approach, with a corresponding false positive rate of ca 20%. Performance did not substantially differ either between algorithms or semesters. The best proxies included emergency calls for respiratory or infectious disease causes and emergency room visits.ConclusionImplementing HCU-based monitoring systems in small areas deserves further investigations as it could facilitate the containment of COVID-19 and other unknown infectious diseases in the future.