Earthquakes as triggers for public health disasters: WHO and health systems' response.

The February 2023 earthquakes in Syria and Türkiye The earthquakes that hit southeast Türkiye and northwest Syria in February 2023 have been the most devastating among several earthquakes witnessed globally in the past decades. As of 28 February 2023, it had caused the death of over 50 000 people and affected more than 18 million others. In northwest Syria alone, the earthquakes affected at least 96 communities and 35 sub-districts, damaging or destroying more than 10 000 buildings, including 48 health facilities, and leaving over 11 000 people homeless (4). More than 45 000 deaths and 85 000 injuries have been reported in Harim, Afrin and Jebel Saman districts, and at least 50 000 families displaced in Aleppo, Homs, Hama, and Latakia.

Effects of disaster-related traumatic events on worry about radiation and COVID-19: A decade after the Fukushima nuclear power plant accident.

Community residents exposed to nuclear power plant (NPP) accidents have long-term worry about the effects of radiation. After the 2011 Fukushima NPP accident, those who experienced traumatic events during the Great East Japan Earthquake (GEJE) tended to have greater worry about radiation. Along with the prolonged worry about radiation, there may also be cognitive changes caused by the traumatic events. We hypothesized that if there were cognitive changes underlying the prolonged worry about radiation, those who experienced the traumatic events would tend to have greater worry about other issues unrelated to radiation. We examined the effects of the traumatic events during the GEJE on community residents' worry about radiation and COVID-19 a decade after the Fukushima NPP accident. Using the data of a longitudinal questionnaire survey following a random sample of 4900 community residents outside the evacuation zone in Fukushima, this study analyzed 774 responses (15.8%). The traumatic events consisted of (1) injury, (2) injury or death of a family member, and (3) the loss of a house or other property. We developed a mediation model drawing paths from the traumatic events to worry about radiation and COVID-19, including posttraumatic stress symptoms (PTSS) as a mediator, using structural equation modeling. The traumatic events directly affected worry about radiation. Although it did not directly affect worry about COVID-19, it did so indirectly through worry about radiation and PTSS. Traumatic events can increase trauma-related worry independently of PTSS and increase trauma-unrelated worry indirectly through trauma-related worry and PTSS.

Noncompliance with Hypertension Treatment and Related Factors among Kumamoto Earthquake Victims Who Experienced the COVID-19 Pandemic during Postearthquake Recovery Period.

Survivors of the Kumamoto earthquake of 2016 experienced the coronavirus disease (COVID-19) outbreak while carrying additional burdens that might bring inadequate coping. This cross-sectional survey aimed to identify untreated and interrupted consultations among those with hypertension and related factors and to identify the disaster's long-term effects. Of the 19,212 earthquake survivors who had moved to permanent housing, 7367 (4196 women and 3171 men, mean age 61.8 ± 17.3 years) completed a self-administered questionnaire. The prevalence of hypertension was 41.4%. The results of the logistic regression analysis with the significant independent variables in the bivariate analysis were: reduced income due to COVID-19 (AOR = 3.23, 95%CI = 2.27-4.58) and poor self-rated health (AOR = 2.49, 95%CI = 1.72-3.61) were associated with a risk of untreated or discontinued treatment. Moreover, living in rental, public or restoration public housing was also significantly associated with a higher risk of hypertension noncompliance (AOR = 1.92, 95%CI = 1.20-3.07; AOR = 2.47, 95%CI = 1.38-4.42; AOR = 4.12, 95%CI = 1.14-14.90). These results suggest that changes due to COVID-19, the extent of self-rated health and the type of permanent housing influence the hypertension consulting behaviour of earthquake survivors during recovery. It is crucial to implement long-term public support for the mental health, income and housing concerns of the survivors.

Adapting a Physical Earthquake-Aftershock Model to Simulate the Spread of COVID-19.

There exists a need for a simple, deterministic, scalable, and accurate model that captures the dominant physics of pandemic propagation. We propose such a model by adapting a physical earthquake/aftershock model to COVID-19. The aftershock model revealed the physical basis for the statistical Epidemic Type Aftershock Sequence (ETAS) model as a highly non-linear diffusion process, thus permitting a grafting of the underlying physical equations into a formulation for calculating infection pressure propagation in a pandemic-type model. Our model shows that the COVID-19 pandemic propagates through an analogous porous media with hydraulic properties approximating beach sand and water. Model results show good correlations with reported cumulative infections for all cases studied. In alphabetical order, these include Austria, Belgium, Brazil, France, Germany, Italy, New Zealand, Melbourne (AU), Spain, Sweden, Switzerland, the UK, and the USA. Importantly, the model is predominantly controlled by one parameter (α), which modulates the societal recovery from the spread of the virus. The obtained recovery times for the different pandemic waves vary considerably from country to country and are reflected in the temporal evolution of registered infections. These results provide an intuition-based approach to designing and implementing mitigation measures, with predictive capabilities for various mitigation scenarios.

Interdisciplinary Collaboration in International Crisis Medical Relief: A Look at the Nepal Earthquake and Ebola Relief Efforts.

OBJECTIVE: This study explores interprofessional collaboration among medical and non-medical personnel planning and implementing international crisis health and medical relief efforts, and how disciplinary and professional background influences these activities. METHODS: This study analyzes semi-structured interviews with individuals involved in organizations medical or health services to the Ebola epidemic in West Africa (2014-2016) or the 2015 Nepal earthquake. RESULTS: Disciplinary background, sometimes coupled with organization role, shaped how relief workers engaged in the process of planning and implementing crisis medical relief. There were 3 thematic areas where these differences emerged: issue focus, problem -solving approaches, and decision-making approaches. Solutions from the field emerged as a fourth theme. CONCLUSIONS: The study demonstrates medical relief required collaboration across medical and non-medical professions and highlights the importance of relief workers' disciplinary background in shaping the planning and implementation of crisis medical relief. Successful collaboration requires that people involved in crisis relief communicate the relevance of their own expertise, identify limits of their own and others' disciplinary perspective(s), seek out strengths in others' expertise, and can identify/ respond appropriately to others who do not see their own disciplinary limits, as well as learn these skills before engaging in relief.

Our clinical experiences in the earthquake victims who came to our university after the 2020 Aegean Sea earthquake during the COVID-19 pandemic.

BACKGROUND: Earthquakes are natural disasters that threaten human life and cause loss of life and property in a very short time. In our study, we aim to carry out the medical analysis of the earthquake victims who came to our hospital after the Earthquake in the Aegean Sea and to share our clinical experiences. METHODS: We retrospectively analyzed patients the medical data records of earthquake victims brought to our hospital or the injured who applied due to the Aegean Sea earthquake. Patients demographic data, their complaints and diagnoses, hour of admission, their clinical courses, hospital arrangements (admission, discharge, and transfer), time spent until the operation, anesthesia methods, surgical intervantions, intensive care needs, crush syndrome, presence of acute renal failure, number of dialysis, mortality, and mor-bidity were reviewed. RESULTS: A total of 152 patients were brought to our hospital due to the earthquake. The most intense period of admission to the emergency department was the 1st 24-36 h. Mortality rate was found to be higher depending on the increase of age. While the most common cause of admission for the mortal earthquake survivors was to be trapped in the wreckage, the survivors applied for other reasons as well such as falling down. The most common type of fracture observed in survivors was the lower extremity fractures. CONCLUSION: Epidemiological studies can make an important contribution to the management and organization of the future earthquake-related injuries by healthcare institutions.

Frontiers in Disaster Nutrition: Evidence to Action.

The need for food and nutrition assistance has increased due to the frequent occurrence of disasters and pandemics, such as coronavirus disease 2019 (COVID-19). However, after a disaster, food and nutrition are insufficient in terms of quantity and quality. In the case of the Great East Japan earthquake, the improvement factors for food and nutrition at emergency shelters included 1) emergency shelter size and equipment, 2) provision and content of meals, 3) collaboration among professionals, and 4) cooperation between shelters. However, there were hygiene and oral health problems, and dispatched dietitians had problems with nutrition assistance. The hygiene problems included 1) food, 2) cooking environment, 3) water supply and discharge, and 4) living space. In addition, oral health problems included 1) difficulty swallowing, 2) difficulty chewing, 3) environmental degradation, and 4) degradation of the oral condition. The problematic points of dispatched dietitians included the support provided not necessarily being consistent with needs, operational deficiencies at both the dispatching and receiving sides, and the short period of support. "Enthusiasm" can be a source of encouragement and a burden. To solve these problems, a training system for disaster dietitians and certification systems for disaster food have been established in Japan. Since the Great East Japan earthquake, various kinds of evidence and actions have been taken, and nutritional problems after disasters have gradually improved. Therefore, it seems that advanced actions and standards should be set not only in Japan but also globally.

Telepsychiatry in the Time of the COVID-19 and Earthquake in Zagreb as Odysseus between Scylla and Charybdis.

In this paper we would like to reveal some of the many challenges during the time of the twofold simultaneous trauma; the COVID-19 pandemic and the devastating earthquake in Zagreb. We described the functioning mode of two Day Hospitals for Early Intervention and Psychotic Disorders at Psychiatric Hospital "Sveti Ivan" during the outbreak of the COVID-19 pandemic. We tried to find ways to ensure the necessary continuation of treatment and to provide continuity in times of uncertainty. The vulnerable group of people treated for mental illnesses faced exceptional psychological demands and was in need for care in these moments. Telemedicine, more specifically telepsychiatry, through online therapy and telephone communication made it possible for people treated for psychotic disorders not to feel isolated and rejected. Health care professionals, in a state of distress themselves, should understand, support, be able to reduce anxiety, and provide stability and constancy. The psychotherapeutic approach and the capacity for mentalization allowed us to turn challenges into opportunities. Rapid changes without delay extended our scope of practice in these extraordinarily difficult times.

Examining the Indirect Death Surveillance System of The Great East Japan Earthquake and Tsunami.

The long-term mortality risk of natural disasters is a key threat to disaster resilience improvement, yet an authoritative certification and a reliable surveillance system are, unfortunately, yet to be established in many countries. This study aimed to clarify the mechanism of post-disaster indirect deaths in Japan, to improve the existing disaster recovery evaluation system and support decision making in public policy. This study first investigated the definition of indirect deaths via a literature review before examining the observed number of indirect deaths via case study, census data from the Population Demographic and Household Surveys, other social surveys, and reports in the case of the Great East Japan Earthquake and Tsunami, which severely damaged northeastern Japan, especially the three prefectures, which are the target areas in this context (i.e., Fukushima, Iwate, and Miyagi). It was found that the reported number of indirect deaths was significantly underestimated. In total, 4657 indirect deaths were estimated to have occurred in the target prefectures. This was higher than the reported number, which was 3784. The overall statistics established via collaboration between local administrations and governments can be improved to provide better reference for researchers and policymakers to investigate the long-term effects of natural disaster.

Suicide rates in Ecuador: A nationwide study from 2011 until 2020.

Suicide, suicide ideations, and psychiatric disorder rates tend to increase after natural disasters such as earthquake. In 2016 Ecuador experienced a 7.8Mw earthquake and, more recently, the Covid-19 confinement. Both events may have negatively affected the mental health of the Ecuadorian population. Therefore, the present study aimed to evaluate the suicide rates and choice of suicide method in the Ecuadorian population between January 2011 and December 2020. The dataset used is publicly available on the Ecuadorian National Institute of Statistics and Censuses. Multivariate logistic regression models were used to calculate adjusted odds ratios (OR) for potential sociodemographic factors associated with each suicide method compared to other reported suicide methods. There were 10,380 registered cases of suicide in Ecuador between 2011 and 2020. Significant suicide rates per provinces were seen in Napo with 12.63 and Azuay with 12.52, followed by Bolívar with 12.30, and Orellana with 11.36 suicides/100,000 habitants. Hanging accounted for 7082 cases (68.2 %). The mestizos (82 %) were the most prevalent ethnicity of all suicide cases. School-age children with 6-12 years (OR 8.83, 95 % CI 5.34-14.59) and adolescents with 13-19 years (OR 1.46, 95 % CI 1.29-1.66) were more likely to use hanging as method of suicide. In conclusion, we observed an increase of suicide rates from 8.15 per 100,000 in 2011 to 8.81 in 2020. The confinement of COVID-19 pandemic in the period evaluated did not significantly affect the suicide rates. An increased suicide rate was observed in the province hardest hit by the 2016 earthquake.

Anxiety and Treatment Adherence among Glaucoma Patients during COVID-19 Pandemic and Earthquakes in Croatia.

BACKGROUND: The COVID-19 epidemic and earthquakes in Croatia during 2020 suddenly disrupted everyday life and caused psychological disturbances in population. The purpose of the present study was to assess the prevalence of anxiety symptoms and the level of treatment adherence in glaucoma patients during the pandemic. The paper also aimed to evaluate the correlation between anxiety symptoms, treatment adherence and treatment outcomes in the studied cohort. SUBJECTS AND METHODS: This cross-sectional study was conducted among primary open-angle glaucoma (POAG) patients at the Department of Ophthalmology, Zagreb University Hospital Center, during one year. The Beck Anxiety Inventory (BAI) was used to measure the level of anxiety symptoms. Treatment adherence was estimated by the Culig adherence scale (CAS). Glaucoma damage was determined for each patient from the level of structural and functional impairment of the worse eye, by retinal nerve fiber layer (RNFL) thickness and mean defect (MD), respectively. Statistical analyses were performed, with a P value of less than 0.05 considered being statistically significant. RESULTS: This study included 113 POAG patients, with a mean age of 65.89 years. The median of the BAI total score in all patients was 10. According to the CAS, 60.2% of patients were non-adherent to glaucoma treatment during the COVID-19 outbreak. The BAI total score was significantly negatively related to adherence to local glaucoma treatment (p<0.001). A significant negative association was also observed between adherence and MD (p=0.017), while no correlation was found between adherence and RNFL thickness (p=0.228). CONCLUSION: Considerable proportion of patients with glaucoma have shown non-adherence to treatment during the COVID-19 pandemic. Anxiety severity was associated with lower adherence, thus indirectly influencing therapeutics outcomes. Special consideration should be given to the strategies promoting mental health and interventions focusing on treatment adherence in glaucoma patients in a time of emergencies.

Breastfeeding and humanitarian emergencies: the experiences of pregnant and lactating women during the earthquake in Abruzzo, Italy.

BACKGROUND: Emergencies have a great impact on infant and young child feeding. Despite the evidence, the recommended feeding practices are often not implemented in the emergency response, undermining infant and maternal health. The aim of this study was to explore the experiences of pregnant and lactating women during the earthquake emergency that occurred in L'Aquila on 6 April 2009. METHODS: The study design was qualitative descriptive. Data were collected by individual semi-structured interviews, investigating the mother's experiences of pregnancy, childbirth, breastfeeding, infant formula or complementary feeding during the emergency and the post emergency phase. Data analysis was categorical and was performed by using N-Vivo software. RESULTS: Six women who were pregnant at the time of the earthquake were interviewed in January 2010. In addition to the essential needs of pregnant and lactating women, such as those related to the emergency shelters conditions, the main findings emerged from this study were: the reconfiguration of relationships and the central role of partners and family support; the need of spaces for sharing experiences and practices with other mothers; the lack of breastfeeding support after the hospital discharge; the inappropriate donations and distribution of Breast Milk Substitutes. CONCLUSIONS: During and after L'Aquila earthquake, several aspects of infant and young child feeding did not comply with standard practices and recommendations. The response system appeared not always able to address the specific needs of pregnant and lactating women. It is urgent to develop management plans, policies and procedures and provide communication, sensitization, and training on infant and young child feeding at all levels and sectors of the emergency response.

The Tohoku Theater Project in Postdisaster Japan: An Exemplar for Addressing Community Mental Health in the Context of Disaster.

The Tohoku Theater Project was completed 2 years after the natural and nuclear disasters in Tohoku, Japan, on March 11, 2011. It employed the dramatic arts to support the healing process, promote resilience, and increase dialogue and understanding about mental health among individuals who were directly affected by the disasters. The four performances fostered important discussions regarding the psychological impact of the Tohoku disasters. Participants (N=143) found the theater performance effective at facilitating discussion, increasing empathy, and enhancing mental health knowledge, coping, and resilience. The performances provided critical information about access to services; many participants reported that they had not known where to seek help for mental health prior to their involvement with the Tohoku Theater Project. Lessons learned may inform community-based strategies that promote mental health and healing in the wake of the COVID-19 pandemic and other public health disasters.

Discussion of the features of suicide trends in 1994-1995 and 2019-2020: The need for different contents in suicide prevention measures for both periods in Japan from the viewpoint of the present.

Japan is a country that is prone to natural disasters. This study compared the characteristics of suicide trends before and after the Great Hanshin-Awaji Earthquake, and during the current COVID-19 pandemic 25 years later. In the present study, we examined the annual number of suicides, the number of suicides by age group, and the reason for suicide during the period associated with the earthquake (1994-1995) and the period associated with the pandemic (2019-2020). This study used statistical analyses to compare the two periods. Our findings suggest that research needs to be conducted from the perspective of legal medicine and social medicine to devise current and future measures to prevent suicides. During the first period, suicides increased in 1995 compared to 1994. Suicide due to economic and life problems increased significantly. During the second period, suicides increased in 2020 compared to 2019. Suicides by males decreased significantly and those by females increased significantly; suicides by individuals aged 19 or under and by those aged 20-29 increased significantly, while suicides by individuals aged 60-69 decreased significantly; and suicides due to "other problems" increased significantly, while suicides due to economic and life problems decreased significantly. Ongoing studies of detailed trends in suicides due to the effects of COVID-19 need to be conducted in the future, and it is important to determine suicide risk due to the effects of COVID-19. Legal medicine and social medicine are fields that conduct such studies and that can offer science-based responses to these trends.

Recruitment and retention of participants in longitudinal studies after a natural disaster.

Climate change and population growth will increase vulnerability to natural and human-made disasters or pandemics. Longitudinal research studies may be adversely impacted by a lack of access to study resources, inability to travel around the urban environment, reluctance of sample members to attend appointments, sample members moving residence and potentially also the destruction of research facilities. One of the key advantages of longitudinal research is the ability to assess associations between exposures and outcomes by limiting the influence of sample selection bias. However, ensuring the validity and reliability of findings in longitudinal research requires the recruitment and retention of respondents who are willing and able to be repeatedly assessed over an extended period of time. This study examined recruitment and retention strategies of 11 longitudinal cohort studies operating during the Christchurch, New Zealand earthquake sequence which began in September 2010, including staff perceptions of the major impediments to study operations during/after the earthquakes and respondents' barriers to participation. Successful strategies to assist recruitment and retention after a natural disaster are discussed. With the current COVID-19 pandemic, longitudinal studies are potentially encountering some of the issues highlighted in this paper including: closure of facilities, restricted movement of research staff and sample members, and reluctance of sample members to attend appointments. It is possible that suggestions in this paper may be implemented so that longitudinal studies can protect the operation of their research programmes.

Returning to Work after the COVID-19 Pandemic Earthquake: A Systematic Review.

BACKGROUND: The ongoing SARS-CoV-2 pandemic has disrupted life and work habits and has produced landmark changes worldwide. This systematic review aimed to analyse the management of Return to Work (RTW) by work organisations following the virus spread. METHODS: A selection of 2477 papers, using string research on PubMed, Embase, Web of Science and Scopus from January 2020 to October 2021, were analysed. RESULTS: Fifty-one articles were finally included, and the results obtained were discussed from three different points of view. Twenty articles concerning 'Remodelling of Work Organization' proposed some model strategies for resumption to work. Twenty-one papers, including 'Clinical Evaluation of Workers', mostly explored the psychosocial impact of returned workers. Finally, twelve articles explored the best 'Testing Strategies related to RTW'. Despite the heterogeneity of included articles, several interesting approaches have emerged in managing RTW. CONCLUSIONS: The reported experiences could help to develop an RTW model for COVID-19 and future pandemics.

Depression, Insomnia, and Probable Post-Traumatic Stress Disorder among Survivors of the 2016 Kumamoto Earthquake and Related Factors during the Recovery Period Amidst the COVID-19 Pandemic.

The aftereffects of the severe 2016 Kumamoto earthquake were complicated by the COVID-19 pandemic. This study aimed to identify mental health problems and related factors among survivors five years after the earthquake and clarify its long-term effects. A cross-sectional survey was conducted in 2020 among 19,212 survivors affected by the earthquake who moved from temporary to permanent housing. We analysed 8966 respondents (5135 women, 3831 men; mean age 62.25 ± 17.29 years). Logistic regression analysis was conducted to examine associations between mental health problems and socioeconomic factors. Prevalence rates of psychological distress, insomnia, and probable post-traumatic stress disorder were 11.9%, 35.2%, and 4.1%, respectively. Female gender (OR = 1.33, 95% CI = 1.13-1.57; OR = 1.21, 95% CI = 1.08-1.34; OR = 1.81, 95% CI = 1.41-2.32), public housing (OR = 2.14, 95% CI = 1.63-2.83; OR = 1.54, 95% CI = 1.26-1.88; OR = 2.41, 95% CI = 1.62-3.58), loneliness (OR = 9.08, 95% CI = 7.71-10.70; OR = 5.55, 95% CI = 4.90-6.30; OR = 3.52, 95% CI = 2.77-4.49), COVID-19-induced activity reduction (OR = 1.41, 95% CI = 1.19-1.66; OR = 1.86, 95% CI = 1.68-2.07; OR = 1.80, 95% CI = 1.40-2.31), and COVID-19-induced income reduction (OR = 1.33, 95% CI = 1.12-1.57; OR = 1.43, 95% CI = 1.28-1.59; OR = 1.92, 95% CI = 1.51-2.43) were significantly associated with mental health problems. These results suggest that gender, current housing, loneliness, and COVID-19 affected the survivors' mental health during recovery.

The Contributing Factors of Delayed-Onset Post-traumatic Stress Disorder Symptoms: A Nested Case-Control Study Conducted After the 2008 Wenchuan Earthquake.

Background: Delayed-onset post-traumatic stress disorder after catastrophes is a major public health issue. However, good designs for identifying post-traumatic stress disorder (PTSD) among earthquake survivors are rare. This is the first nested case-control study to explore the possible factors associated with delayed-onset PTSD symptoms. Methods: A nested case-control study was conducted. The baseline (2011) and follow-up (2018) surveys were utilized to collect data. A total of 361 survivors of the Wenchuan earthquake were investigated and 340 survivors underwent follow-up. The survivors, from the hardest-hit areas, who met the criteria for PTSD were included in the case group, and PTSD-free survivors from the same area, matched for age, were included in the control group, with a ratio of one to four. Conditional logistic regression was used to evaluate the variables' odds ratio (OR). Results: The overall prevalence of delayed-onset PTSD symptoms in survivors of the Wenchuan earthquake was 9.7% (33/340). The unemployed earthquake survivors had a higher risk of developing delayed-onset PTSD symptoms (OR = 4.731, 95% CI = 1.408-15.901), while higher perceived social support was a protective factor against delayed-onset PTSD symptoms (OR = 0.172, 95% CI = 0.052-0.568). Conclusion: Delayed-onset PTSD symptoms, after a disaster, should not be ignored. Active social support and the provision of stable jobs can contribute to the earthquake survivors' mental health.

The Sense of Coherence and Subjective Well-Being as Resources of Resilience in the Time of Stressful Situations: COVID-19 Outbreak and Earthquakes.

BACKGROUND: The coronavirus outbreak was labeled a global pandemic by the WHO in March 2020. Simultaneously, an earthquake of 5.5 hit Croatia's capital Zagreb. The present study investigated the association between the sense of coherence, subjective well-being, and emotional distress (depression, anxiety, and stress) that people went through while facing an acute stress situation of COVID-19 outbreak and the earthquakes. SUBJECTS AND METHODS: This cross-sectional study included 1152 subjects. Orientation to Life Questionnaires (OLQ-13), Personal Wellbeing Index (PWI) and DASS-21 scale were used in an anonymous online survey which was conducted on 22 March 2020 (the twelfth day of the COVID-19 outbreak in Croatia and the day of the earthquakes in the Capital). The results of the questionnaires were determined by the correlation analysis. Hierarchical multiple regression was used to evaluate the association between the subjective well-being and the sense of coherence on the emotional distress. RESULTS: The sense of coherence correlated positively with subjective well-being (p<0.01) and negatively with all distress domains (p<0.01) as well as subjective well-being (p<0.01). Mild emotional distress was detected. Subjects who experienced the earthquakes showed a significantly higher degree of anxiety (p=0.005) and stress (p=0.003), with significantly decreased the two personal well-being domains: standard of living (p=0.023) and personal safety (p=0.026). Sense of coherence made a major contribution in explaining emotional distress (p<0.001). CONCLUSION: The results support the importance of improving coping efficiency of the sense of coherence with respect to obtaining an appropriate level of well-being and reducing emotional distress in acute stressful situations.

Impact of the earthquake during COVID-19 lockdown on fracture admission at a tertiary trauma centre in Croatia.

PURPOSE: To determine the impact of an earthquake during COVID-19 lockdown on fracture admission at a tertiary trauma centre in Croatia. METHODS: A case-control study was performed at the tertiary trauma centre registry. Two different periods were studied. The case group included a period during COVID-19 lockdown right after the earthquakes until the end of the confinement period in Croatia. And the control group corresponded to the equivalent period in 2019. We identified all consecutive patients who were admitted due to urgent care requirements for the musculoskeletal trauma. Patient's demographic data and admitting diagnoses were assessed. Data were analyzed by statistical procedures using the program MedCalc statistical software version 16.4.3. RESULTS: We identified 178 emergency admissions due to musculoskeletal trauma. During the COVID-19 lockdown and post-earthquake period, there was a drastic reduction in total admissions (359 vs. 662; p < 0.0001) with an increased proportion of trauma admissions within the emergency admissions (34.9% vs. 26.5%; p = 0.02926, Z = -2.1825). Furthermore, in the case group there was a significant increase in hospital admissions due to ankle/foot trauma (11 vs. 2, p = 0.0126) and a trend towards a decrease in the admissions due to tibia fractures (5 vs. 12, p = 0.0896), however without statistical significance. Also, an increased proportion of women within the group of femoral fractures in both case group (81.6% vs. 52.6%, p = 0.00194, Z = 3.1033) and the control group (82.3% vs. 60.5%, p = 0.0232, Z = 2.2742) was observed. In both analyzed periods, the osteoporotic hip fracture was the most common independent admitting diagnosis. CONCLUSION: It is crucial to understand how natural disasters like earthquakes influence the pattern of trauma admissions during a coexisting pandemic. Accordingly, healthcare systems have to be prepared for an increased influx of certain pathology, like foot and ankle trauma.