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2.
PLoS One ; 16(9): e0256763, 2021.
Article in English | MEDLINE | ID: covidwho-1416875

ABSTRACT

BACKGROUND: The COVID-19 pandemic has had a devastating impact in the United States, particularly for Black populations, and has heavily burdened the healthcare system. Hospitals have created protocols to allocate limited resources, but there is concern that these protocols will exacerbate disparities. The sequential organ failure assessment (SOFA) score is a tool often used in triage protocols. In these protocols, patients with higher SOFA scores are denied resources based on the assumption that they have worse clinical outcomes. The purpose of this study was to assess whether using SOFA score as a triage tool among COVID-positive patients would exacerbate racial disparities in clinical outcomes. METHODS: We analyzed data from a retrospective cohort of hospitalized COVID-positive patients in the Yale-New Haven Health System. We examined associations between race/ethnicity and peak overall/24-hour SOFA score, in-hospital mortality, and ICU admission. Other predictors of interest were age, sex, primary language, and insurance status. We used one-way ANOVA and chi-square tests to assess differences in SOFA score across racial/ethnic groups and linear and logistic regression to assess differences in clinical outcomes by sociodemographic characteristics. RESULTS: Our final sample included 2,554 patients. Black patients had higher SOFA scores compared to patients of other races. However, Black patients did not have significantly greater in-hospital mortality or ICU admission compared to patients of other races. CONCLUSION: While Black patients in this sample of hospitalized COVID-positive patients had higher SOFA scores compared to patients of other races, this did not translate to higher in-hospital mortality or ICU admission. Results demonstrate that if SOFA score had been used to allocate care, Black COVID patients would have been denied care despite having similar clinical outcomes to white patients. Therefore, using SOFA score to allocate resources has the potential to exacerbate racial inequities by disproportionately denying care to Black patients and should not be used to determine access to care. Healthcare systems must develop and use COVID-19 triage protocols that prioritize equity.


Subject(s)
COVID-19/prevention & control , Delivery of Health Care/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Hospitals, University , Organ Dysfunction Scores , Triage/statistics & numerical data , Adolescent , Adult , African Americans/statistics & numerical data , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/virology , Connecticut , Female , Healthcare Disparities/ethnology , Hospital Mortality/ethnology , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2/physiology , Triage/methods , Young Adult
3.
Hist Philos Life Sci ; 43(3): 91, 2021 Jul 13.
Article in English | MEDLINE | ID: covidwho-1309115

ABSTRACT

Ageism has unfortunately become a salient phenomenon during the COVID-19 pandemic. In particular, triage decisions based on age have been hotly discussed. In this article, I first defend that, although there are ethical reasons (founded on the principles of benefit and fairness) to consider the age of patients in triage dilemmas, using age as a categorical exclusion is an unjustifiable ageist practice. Then, I argue that ageism during the pandemic has been fueled by media narratives and unfair assumptions which have led to an ethically problematic group homogenization of the older population. Finally, I conclude that an intersectional perspective can shed light on further controversies on ageism and triage in the post-pandemic future.


Subject(s)
Ageism/ethics , COVID-19/therapy , Triage/ethics , Ageism/prevention & control , Ageism/psychology , Ageism/statistics & numerical data , Humans , SARS-CoV-2/physiology , Triage/statistics & numerical data
6.
Plast Reconstr Surg ; 148(1): 168e-169e, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1263729

Subject(s)
COVID-19/prevention & control , Infection Control/organization & administration , Pandemics/prevention & control , Surgery Department, Hospital/organization & administration , Surgery, Plastic/organization & administration , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , COVID-19 Testing/standards , COVID-19 Testing/statistics & numerical data , COVID-19 Testing/trends , Egypt/epidemiology , Elective Surgical Procedures/standards , Elective Surgical Procedures/statistics & numerical data , Elective Surgical Procedures/trends , Health Policy , Humans , Infection Control/standards , Infection Control/statistics & numerical data , Infection Control/trends , Reconstructive Surgical Procedures/standards , Reconstructive Surgical Procedures/statistics & numerical data , Reconstructive Surgical Procedures/trends , SARS-CoV-2/isolation & purification , Surgery Department, Hospital/standards , Surgery Department, Hospital/statistics & numerical data , Surgery Department, Hospital/trends , Surgery, Plastic/standards , Surgery, Plastic/statistics & numerical data , Surgery, Plastic/trends , Telemedicine/organization & administration , Telemedicine/standards , Telemedicine/statistics & numerical data , Tertiary Care Centers/organization & administration , Tertiary Care Centers/standards , Tertiary Care Centers/statistics & numerical data , Tertiary Care Centers/trends , Triage/organization & administration , Triage/standards , Triage/statistics & numerical data , Triage/trends
7.
Gynecol Oncol ; 162(1): 12-17, 2021 07.
Article in English | MEDLINE | ID: covidwho-1213578

ABSTRACT

OBJECTIVE: To compare gynecologic oncology surgical treatment modifications and delays during the first wave of the COVID-19 pandemic between a publicly funded Canadian versus a privately funded American cancer center. METHODS: This is a retrospective cohort study of all planned gynecologic oncology surgeries at University Health Network (UHN) in Toronto, Canada and Brigham and Women's Hospital (BWH) in Boston, USA, between March 22,020 and July 302,020. Surgical treatment delays and modifications at both centers were compared to standard recommendations. Multivariable logistic regression was performed to adjust for confounders. RESULTS: A total of 450 surgical gynecologic oncology patients were included; 215 at UHN and 235 at BWH. There was a significant difference in median time from decision-to-treat to treatment (23 vs 15 days, p < 0.01) between UHN and BWH and a significant difference in treatment delays (32.56% vs 18.29%; p < 0.01) and modifications (8.37% vs 0.85%; p < 0.01), respectively. On multivariable analysis adjusting for age, race, treatment site and surgical priority status, treatment at UHN was an independent predictor of treatment modification (OR = 9.43,95% CI 1.81-49.05, p < 0.01). Treatment delays were higher at UHN (OR = 1.96,95% CI 1.14-3.36 p = 0.03) and for uterine disease (OR = 2.43, 95% CI 1.11-5.33, p = 0.03). CONCLUSION: During the first wave of COVID-19 pandemic, gynecologic oncology patients treated at a publicly funded Canadian center were 9.43 times more likely to have a surgical treatment modification and 1.96 times more likely to have a surgical delay compared to an equal volume privately funded center in the United States.


Subject(s)
Elective Surgical Procedures/statistics & numerical data , Genital Neoplasms, Female/surgery , Hospitals, Private/statistics & numerical data , Hospitals, Public/statistics & numerical data , Time-to-Treatment/statistics & numerical data , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Canada/epidemiology , Cancer Care Facilities/organization & administration , Cancer Care Facilities/standards , Cancer Care Facilities/statistics & numerical data , Communicable Disease Control/standards , Female , Genital Neoplasms, Female/diagnosis , Gynecologic Surgical Procedures/statistics & numerical data , Gynecology/economics , Gynecology/organization & administration , Gynecology/standards , Gynecology/statistics & numerical data , Hospitals, Private/economics , Hospitals, Private/organization & administration , Hospitals, Private/standards , Hospitals, Public/economics , Hospitals, Public/organization & administration , Hospitals, Public/standards , Humans , Medical Oncology/economics , Medical Oncology/organization & administration , Medical Oncology/standards , Medical Oncology/statistics & numerical data , Middle Aged , Pandemics/prevention & control , Retrospective Studies , Tertiary Care Centers/economics , Tertiary Care Centers/organization & administration , Tertiary Care Centers/standards , Tertiary Care Centers/statistics & numerical data , Time Factors , Triage/statistics & numerical data , United States/epidemiology , Young Adult
8.
Lancet Gastroenterol Hepatol ; 6(5): 381-390, 2021 05.
Article in English | MEDLINE | ID: covidwho-1202043

ABSTRACT

BACKGROUND: The COVID-19 pandemic has led to a substantial reduction in gastrointestinal endoscopies, creating a backlog of procedures. We aimed to quantify this backlog nationally for England and assess how various interventions might mitigate the backlog. METHODS: We did a national analysis of data for colonoscopies, flexible sigmoidoscopies, and gastroscopies from National Health Service (NHS) trusts in NHS England's Monthly Diagnostic Waiting Times and Activity dataset. Trusts were excluded if monthly data were incomplete. To estimate the potential backlog, we used linear logistic regression to project the cumulative deficit between actual procedures performed and expected procedures, based on historical pre-pandemic trends. We then made further estimations of the change to the backlog under three scenarios: recovery to a set level of capacity, ranging from 90% to 130%; further disruption to activity (eg, second pandemic wave); or introduction of faecal immunochemical testing (FIT) triaging. FINDINGS: We included data from Jan 1, 2018, to Oct 31, 2020, from 125 NHS trusts. 10 476 endoscopy procedures were done in April, 2020, representing 9·5% of those done in April, 2019 (n=110 584), before recovering to 105 716 by October, 2020 (84·5% of those done in October, 2019 [n=125 072]). Recovering to 100% capacity on the current trajectory would lead to a projected backlog of 162 735 (95% CI 143 775-181 695) colonoscopies, 119 025 (107 398-130 651) flexible sigmoidoscopies, and 194 087 (172 564-215 611) gastroscopies in January, 2021, attributable to the pandemic. Increasing capacity to 130% would still take up to June, 2022, to eliminate the backlog. A further 2-month interruption would add an extra 15·4%, a 4-month interruption would add an extra 43·8%, and a 6-month interruption would add an extra 82·5% to the potential backlog. FIT triaging of cases that are found to have greater than 10 µg haemoglobin per g would reduce colonoscopy referrals to around 75% of usual levels, with the backlog cleared in early 2022. INTERPRETATION: Our work highlights the impact of the pandemic on endoscopy services nationally. Even with mitigation measures, it could take much longer than a year to eliminate the pandemic-related backlog. Urgent action is required by key stakeholders (ie, individual NHS trusts, Clinical Commissioning Groups, British Society of Gastroenterology, and NHS England) to tackle the backlog and prevent delays to patient management. FUNDING: Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) at University College London, National Institute for Health Research University College London Hospitals Biomedical Research Centre, and DATA-CAN, Health Data Research UK.


Subject(s)
COVID-19 , Capacity Building , Endoscopy, Digestive System , Gastrointestinal Diseases , Procedures and Techniques Utilization , Triage , COVID-19/epidemiology , COVID-19/prevention & control , Capacity Building/methods , Capacity Building/organization & administration , Change Management , Endoscopy, Digestive System/methods , Endoscopy, Digestive System/statistics & numerical data , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/therapy , Humans , Immunochemistry , Infection Control , Outcome and Process Assessment, Health Care , Procedures and Techniques Utilization/statistics & numerical data , Procedures and Techniques Utilization/trends , SARS-CoV-2 , State Medicine/organization & administration , State Medicine/trends , Triage/methods , Triage/statistics & numerical data , United Kingdom/epidemiology , Waiting Lists
9.
Surg Today ; 51(11): 1843-1850, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1195166

ABSTRACT

PURPOSE: The coronavirus disease (COVID-19) pandemic has caused unprecedented challenges for surgical staffs to minimize exposure to COVID-19 or save medical resources without harmful patient outcomes, in accordance with the statement of each surgical society. No research has empirically validated declines in surgical volume in Japan, based on the usage of surgical triage. We aimed to identify whether the announcement of surgical priorities by each Japanese surgical society may have affected the surgical volume decline during the 1st wave of this pandemic. METHODS: We extracted 490,719 available cases of patients aged > 15 years who underwent elective major surgeries between July 1, 2018, and June 30, 2020. After the categorization of surgical specialities, we calculated descriptive statistics to compare the year-over-year trend and conducted an interrupted time series analysis to validate the decline of each surgical procedure. RESULTS: Monthly surgical cases of eight surgical specialities, especially ophthalmology and ear/nose/throat surgeries, decreased from April 2020 and reached a minimum in May 2020. An interrupted time series analysis showed no significant trends in oncological and critical surgeries. CONCLUSION: Non-critical surgeries showed obvious and statistically significant declines in case volume during the 1st wave of the COVID-19 pandemic according to the statement of each surgical society in Japan.


Subject(s)
COVID-19/epidemiology , Interrupted Time Series Analysis/methods , Pandemics , Surgical Procedures, Operative/statistics & numerical data , Triage/statistics & numerical data , Aged , Comorbidity , Female , Follow-Up Studies , Humans , Japan/epidemiology , Male , Middle Aged , SARS-CoV-2 , Time Factors
10.
BMC Emerg Med ; 21(1): 39, 2021 03 29.
Article in English | MEDLINE | ID: covidwho-1158198

ABSTRACT

BACKGROUND: The COVID-19 pandemic is a major public health problem. Subsequently, emergency medical services (EMS) have anecdotally experienced fluctuations in demand, with reports across Canada of both increased and decreased demand. Our primary objective was to assess the effect of the COVID-19 pandemic on call volumes for several determinants in Niagara Region EMS. Our secondary objective was to assess changes in paramedic-assigned patient acuity scores as determined using the Canadian Triage and Acuity Scale (CTAS). METHODS: We analyzed data from a regional EMS database related to call type, volume, and patient acuity for January to May 2016-2020. We used statistical methods to assess differences in EMS calls between 2016 and 2019 and 2020. RESULTS: A total of 114,507 EMS calls were made for the period of January 1 to May 26 between 2016 and 2020, inclusive. Overall, the incidence rate of EMS calls significantly decreased in 2020 compared to the total EMS calls in 2016-2019. Motor vehicle collisions decreased in 2020 relative to 2016-2019 (17%), while overdoses relatively increased (70%) in 2020 compared to 2016-2019. Calls for patients assigned a higher acuity score increased (CTAS 1) (4.1% vs. 2.9%). CONCLUSION: We confirmed that overall, EMS calls have decreased since the emergence of COVID-19. However, this effect on call volume was not consistent across all call determinants, as some call types rose while others decreased. These findings indicate that COVID-19 may have led to actual changes in emergency medical service demand and will be of interest to other services planning for future pandemics or further waves of COVID-19.


Subject(s)
COVID-19/epidemiology , Emergency Medical Services/statistics & numerical data , Emergency Responders/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Triage/statistics & numerical data , Cross-Sectional Studies , Emergency Medical Technicians/statistics & numerical data , Humans , Ontario , Patient Acuity , Urban Health Services/statistics & numerical data
12.
Psychiatry Res ; 298: 113776, 2021 04.
Article in English | MEDLINE | ID: covidwho-1062564

ABSTRACT

Inpatient psychiatric facilities can face significant challenges in containing infectious outbreaks during the COVID-19 pandemic. The main objective of this study was to characterize the epidemiology, testing data, and containment protocols of COVID-19 in a large academic medical center during the height of the COVID-19 outbreak. A retrospective cohort analysis was conducted on hospitalized individuals on five inpatient psychiatric units from March 1st to July 8th, 2020. Demographic data collected include age, race, gender, ethnicity, diagnosis, and admission status (one or multiple admissions). In addition, a Gantt chart was used to assess outbreak data and timelines for one unit. Testing data was collected for patients admitted to inpatient psychiatric units, emergency room visits, and employees. 964 individuals were hospitalized psychiatrically. The study population included ethnically diverse patients with various mental illnesses. We also describe infection prevention strategies, screening, and triage protocols utilized to safely continue patient flow during and beyond the study period with a low patient and employee infection rate. In summary, our study suggests that early implementation of triage, screening, extensive testing, and unit-specific interventions can help prevent and contain the spread of COVID-19 in inpatient psychiatric units and help facilitate safe delivery of care during a pandemic.


Subject(s)
Academic Medical Centers , COVID-19 , Mental Disorders , Psychiatric Department, Hospital , Triage , Academic Medical Centers/standards , Academic Medical Centers/statistics & numerical data , Adult , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , Female , Humans , Inpatients , Male , Mental Disorders/epidemiology , Mental Disorders/therapy , Middle Aged , Psychiatric Department, Hospital/standards , Psychiatric Department, Hospital/statistics & numerical data , Retrospective Studies , Triage/standards , Triage/statistics & numerical data
13.
Cancer Rep (Hoboken) ; 4(1): e1309, 2021 02.
Article in English | MEDLINE | ID: covidwho-1025074

ABSTRACT

BACKGROUND: The COVID-19 pandemic has created a need to prioritize care because of limitation of resources. Owing to the heterogeneity and high prevalence of breast cancers, the need to prioritize care in this vulnerable population is essential. While various medical societies have published recommendations to manage breast disease during the COVID-19 pandemic, most are focused on the Western world and do not necessarily address the challenges of a resource-limited setting. AIM: In this article, we describe our institutional approach for prioritizing care for patients presenting with breast disease. METHODS AND RESULTS: The breast disease management guidelines were developed and approved with the expertise of the Multidisciplinary Breast Program Leadership Committee (BPLC) of the Aga Khan University, Karachi, Pakistan. These guidelines were inspired, adapted, and modified keeping in view the needs of our resource-limited healthcare system. These recommendations are also congruent with the ethical guidelines developed by the Center of Biomedical Ethics and Culture (CBEC) at the Sindh Institute of Urology and Transplantation (SIUT), Karachi. Our institutional recommendations outline a framework to triage patients based on the urgency of care, scheduling conflicts, and tumor board recommendations, optimizing healthcare workers' schedules, operating room reallocation, and protocols. We also describe the "Virtual Blended Clinics", a resource-friendly means of conducting virtual clinics and a comprehensive plan for transitioning back into the post-COVID routine. CONCLUSION: Our institutional experience may be considered as a guide during the COVID-19 pandemic, particularly for triaging care in a resource-limited setting; however, these are not meant to be universally applicable, and individual cases must be tailored based on physicians' clinical judgment to provide the best quality care.


Subject(s)
Breast Diseases/therapy , COVID-19/complications , Interdisciplinary Communication , Physicians/standards , Practice Guidelines as Topic/standards , SARS-CoV-2/isolation & purification , Triage/statistics & numerical data , Breast Diseases/virology , COVID-19/transmission , COVID-19/virology , Developing Countries , Female , Humans , Tertiary Care Centers
14.
J Endocrinol Invest ; 44(8): 1689-1698, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-996502

ABSTRACT

CONTEXT: The COVID-19 outbreak in Italy is the major concern of Public Health in 2020: measures of containment were progressively expanded, limiting Outpatients' visit. OBJECTIVE: We have developed and applied an emergency plan, tailored for Outpatients with endocrine diseases. DESIGN: Cross-sectional study from March to May 2020. SETTING: Referral University-Hospital center. PATIENTS: 1262 patients in 8 weeks. INTERVENTIONS: The emergency plan is based upon the endocrine triage, the stay-safe procedures and the tele-Endo. During endocrine triage every patient was contacted by phone to assess health status and define if the visit will be performed face-to-face (F2F) or by tele-Medicine (tele-Endo). In case of F2F, targeted stay-safe procedures have been adopted. Tele-Endo, performed by phone and email, is dedicated to COVID-19-infected patients, to elderly or frail people, or to those with a stable disease. MAIN OUTCOME MEASURE: To assess efficacy of the emergency plan to continue the follow-up of Outpatients. RESULTS: The number of visits cancelled after endocrine triage (9%) is lower than that cancelled independently by the patients (37%, p < 0.001); the latter reduced from 47 to 19% during the weeks of lockdown (p = 0.032). 86% of patients contacted by endocrine-triage received a clinical response (F2F and tele-Endo visits). F2F visit was offered especially to young patients; tele-Endo was applied to 63% of geriatric patients (p < 0.001), visits' outcome was similar between young and aged patients. CONCLUSIONS: The emergency plan respects the WHO recommendations to limit viral spread and is useful to continue follow-up for outpatients with endocrine diseases.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control , Endocrinology , Referral and Consultation , Telemedicine , Adult , Aged , Aged, 80 and over , Ambulatory Care Facilities/organization & administration , Ambulatory Care Facilities/statistics & numerical data , COVID-19/epidemiology , COVID-19/transmission , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Cross-Sectional Studies , Disease Outbreaks , Endocrinology/methods , Endocrinology/organization & administration , Endocrinology/statistics & numerical data , Female , Humans , Italy/epidemiology , Male , Middle Aged , Outpatients/statistics & numerical data , Pandemics , Quarantine/methods , Quarantine/organization & administration , Quarantine/statistics & numerical data , Referral and Consultation/organization & administration , Referral and Consultation/statistics & numerical data , SARS-CoV-2/physiology , Telemedicine/methods , Telemedicine/organization & administration , Telemedicine/statistics & numerical data , Triage/methods , Triage/organization & administration , Triage/statistics & numerical data
15.
Cancer ; 127(7): 1091-1101, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-978125

ABSTRACT

BACKGROUND: Patients with cancer are considered at high risk for the novel respiratory illness coronavirus disease 2019 (COVID-19). General measures to keep COVID-19-free cancer divisions have been adopted worldwide. The objective of this study was to evaluate the efficacy of triage to identify COVID-19 among patients with cancer. METHODS: From March 20 to April 17, 2020, data were collected from patients who were treated or followed at the authors' institution in a prospective clinical trial. The primary endpoint was to estimate the cumulative incidence of COVID-19-positive patients who were identified using a triage process through the aid of medical and patient questionnaires. Based on a diagnostic algorithm, patients with suspect symptoms underwent an infectious disease specialist's evaluation and a COVID-19 swab. Serologic tests were proposed for patients who had symptoms or altered laboratory tests that did not fall into the diagnostic algorithm but were suspicious for COVID-19. RESULTS: Overall, 562 patients were enrolled. Six patients (1%) were diagnosed with COVID-19, of whom 4 (67%) had the disease detected through telehealth triage, and 2 patients (33%) without suspect symptoms at triage had the disease detected later. Seventy-one patients (13%) had suspect symptoms and/or altered laboratory tests that were not included in the diagnostic algorithm and, of these, 47 patients (73%) underwent testing for severe acute respiratory syndrome coronavirus 2 antibody: 6 (13%) were positive for IgG (n = 5) or for both IgM and IgG (n = 1), and antibody tests were negative in the remaining 41 patients. CONCLUSIONS: The triage process had a positive effect on the detection of COVID-19 in patients with cancer. Telehealth triage was helpful in detecting suspect patients and to keep a COVID-19-free cancer center. The overall incidence of COVID-19 diagnosis (1%) and antibody positivity (13%) in patients with suspect symptoms was similar to that observed in the general population.


Subject(s)
COVID-19 Testing/statistics & numerical data , COVID-19/diagnosis , Neoplasms/therapy , Triage/statistics & numerical data , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/virology , COVID-19 Testing/methods , Female , Humans , Male , Middle Aged , Neoplasms/complications , Neoplasms/diagnosis , Prospective Studies , Reproducibility of Results , SARS-CoV-2/physiology , Sensitivity and Specificity , Triage/methods
16.
Am J Surg ; 222(2): 311-318, 2021 08.
Article in English | MEDLINE | ID: covidwho-977073

ABSTRACT

BACKGROUND: Thousands of cancer surgeries were delayed during the peak of the COVID-19 pandemic. This study examines if surgical delays impact survival for breast, lung and colon cancers. METHODS: PubMed/MEDLINE, EMBASE, Cochrane Library and Web of Science were searched. Articles evaluating the relationship between delays in surgery and overall survival (OS), disease-free survival (DFS) or cancer-specific survival (CSS) were included. RESULTS: Of the 14,422 articles screened, 25 were included in the review and 18 (totaling 2,533,355 patients) were pooled for meta-analyses. Delaying surgery for 12 weeks may decrease OS in breast (HR 1.46, 95%CI 1.28-1.65), lung (HR 1.04, 95%CI 1.02-1.06) and colon (HR 1.24, 95%CI 1.12-1.38) cancers. When breast cancers were analyzed by stage, OS was decreased in stages I (HR 1.27, 95%CI 1.16-1.40) and II (HR 1.13, 95%CI 1.02-1.24) but not in stage III (HR 1.20, 95%CI 0.94-1.53). CONCLUSION: Delaying breast, lung and colon cancer surgeries during the COVID-19 pandemic may decrease survival.


Subject(s)
Breast Neoplasms/surgery , COVID-19/prevention & control , Colonic Neoplasms/surgery , Lung Neoplasms/surgery , Triage/statistics & numerical data , Breast Neoplasms/diagnosis , Breast Neoplasms/mortality , COVID-19/epidemiology , Colonic Neoplasms/diagnosis , Colonic Neoplasms/mortality , Communicable Disease Control/standards , Disease-Free Survival , Female , Humans , Lung Neoplasms/diagnosis , Lung Neoplasms/mortality , Medical Oncology/standards , Medical Oncology/statistics & numerical data , Medical Oncology/trends , Mortality/trends , Neoplasm Staging , Pandemics/prevention & control , Practice Guidelines as Topic , Time Factors , Time-to-Treatment/standards , Time-to-Treatment/statistics & numerical data , Time-to-Treatment/trends , Triage/standards , Triage/trends
17.
Int J Environ Res Public Health ; 17(23)2020 11 25.
Article in English | MEDLINE | ID: covidwho-945819

ABSTRACT

From 9 March to 3 May 2020, lockdown was declared in Italy due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Our aim was to evaluate how the SARS-CoV-2 pandemic and related preventive strategies affected pediatric emergency rooms (ERs) during this period. We performed a retrospective cohort multicenter study, comparing the lockdown period to the corresponding period in 2019. We examined 15 Italian pediatric ERs in terms of visit rates, specific diagnoses (grouped as air communicable diseases and non-air communicable diseases), and triage categories. During the lockdown period, ER admissions decreased by 81% compared to 2019 (52,364 vs. 10,112). All ER specific diagnoses decreased in 2020 and this reduction was significantly higher for air communicable diseases (25,462 vs. 2934, p < 0.001). Considering the triage category, red codes remained similar (1% vs. 1%), yellow codes increased (11.2% vs. 22.3%), and green codes decreased (80.3% vs. 69.5%). We can speculate that social distancing and simple hygiene measures drastically reduced the spread of air communicable diseases. The increase in yellow codes may have been related to a delay in primary care and, consequently, in ER admissions.


Subject(s)
COVID-19/epidemiology , Emergency Service, Hospital/statistics & numerical data , Triage/statistics & numerical data , Child , Communicable Disease Control , Humans , Italy/epidemiology , Pandemics , Retrospective Studies
18.
PLoS One ; 15(11): e0240651, 2020.
Article in English | MEDLINE | ID: covidwho-930620

ABSTRACT

The general public is subject to triage policies that allocate scarce lifesaving resources during the COVID-19 pandemic, one of the worst public health emergencies in the past 100 years. However, public attitudes toward ethical principles underlying triage policies used during this pandemic are not well understood. Three experiments (preregistered; online samples; N = 1,868; U.S. residents) assessed attitudes toward ethical principles underlying triage policies. The experiments evaluated assessments of utilitarian, egalitarian, prioritizing the worst-off, and social usefulness principles in conditions arising during the COVID-19 pandemic, involving resource scarcity, resource reallocation, and bias in resource allocation toward at-risk groups, such as the elderly or people of color. We found that participants agreed with allocation motivated by utilitarian principles and prioritizing the worst-off during initial distribution of resources and disagreed with allocation motivated by egalitarian and social usefulness principles. At reallocation, participants agreed with giving priority to those patients who received the resources first. Lastly, support for utilitarian allocation varied when saving the greatest number of lives resulted in disadvantage for at-risk or historically marginalized groups. Specifically, participants expressed higher levels of agreement with policies that shifted away from maximizing benefits to one that assigned the same priority to members of different groups if this mitigated disadvantage for people of color. Understanding these attitudes can contribute to developing triage policies, increase trust in health systems, and assist physicians in achieving their goals of patient care during the COVID-19 pandemic.


Subject(s)
Attitude , Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Health Resources/statistics & numerical data , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Adolescent , Adult , Aged , COVID-19 , Emergencies/psychology , Female , Health Care Rationing/statistics & numerical data , Humans , Male , Middle Aged , Public Health/statistics & numerical data , Public Opinion , Triage/statistics & numerical data , Young Adult
19.
Anaesthesiol Intensive Ther ; 52(4): 312-315, 2020.
Article in English | MEDLINE | ID: covidwho-916510

ABSTRACT

The coronavirus disease (COVID-19) was previously unknown, and we are learning about it day by day, but pandemic-associated ethical dilemmas have been studied and discussed for years. Triage means not only ranking in terms of importance (prioritisation) but also allocation of limited medical resources. Survival, post epidemic-quality of life, and consumption of medical resources required to achieve the set goal are crucial for making triage decisions. The pandemic triage decisions should be based on a protocol, considering the need for medical measures and therapy benefits. The first step is to consider the exclusion criteria and the risk of death. The next step is sequential clinical assessment, repeatable at defined intervals. It seems that the preferable solution is to triage all the patients and give priority to those who would benefit more. A prerequisite for allocating insufficient medical resources is public trust in the criteria for allocation.


Subject(s)
Coronavirus Infections , Pandemics , Pneumonia, Viral , Triage/trends , COVID-19 , Clinical Decision-Making , Humans , Triage/statistics & numerical data
20.
Emerg Med J ; 37(12): 773-777, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-894883

ABSTRACT

BACKGROUND: Public health mitigation strategies in British Columbia during the pandemic included stay-at-home orders and closure of non-essential services. While most primary physicians' offices were closed, hospitals prepared for a pandemic surge and emergency departments (EDs) stayed open to provide care for urgent needs. We sought to determine whether ED paediatric presentations prior and during the COVID-19 pandemic changed and review acuity compared with seasonal adjusted prior year. METHODS: We analysed records from 18 EDs in British Columbia, Canada, serving 60% of the population. We included children 0-16 years old and excluded those with no recorded acuity or discharge disposition and those left without being seen by a physician. We compared prepandemic (before the first COVID-19 case), early pandemic (after first COVID-19 case) and peak pandemic (during public health emergency) periods as well as a similar time from the previous year. RESULTS: A reduction of 57% and 70% in overall visits was recorded in the children's hospital ED and the general hospitals EDs, respectively. Average daily visits declined significantly during the peak-pandemic period (167.44±40.72) compared with prepandemic period (543.53±58.8). Admission rates increased mainly due to the decrease in the rate of visits with lower acuity. Children with complaints of 'fever' and 'gastrointestinal' symptoms had both the largest overall volume and per cent reduction in visits between peak-pandemic and prior year (79% and 74%, respectively). CONCLUSION: Paediatric emergency medicine attendances were reduced to one-third of normal numbers during the 2020 COVID-19 lockdown in British Columbia, Canada, with the reduction mainly seen in minor illnesses that do not usually require admission.


Subject(s)
Coronavirus Infections/epidemiology , Emergency Medicine/organization & administration , Emergency Service, Hospital/organization & administration , Hospitals, Pediatric/organization & administration , Pneumonia, Viral/epidemiology , Adolescent , Betacoronavirus/pathogenicity , British Columbia/epidemiology , COVID-19 , Child , Child, Preschool , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Emergencies/epidemiology , Emergency Medicine/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Female , Health Services Accessibility/organization & administration , Health Services Accessibility/statistics & numerical data , Hospitals, Pediatric/statistics & numerical data , Humans , Infant , Infant, Newborn , Male , Pandemics/prevention & control , Patient Admission/statistics & numerical data , Patient Discharge/statistics & numerical data , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , SARS-CoV-2 , Triage/organization & administration , Triage/statistics & numerical data
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