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1.
Health Promot Chronic Dis Prev Can ; 40(11-12): 336-341, 2020 12 09.
Article in English, French | MEDLINE | ID: covidwho-1022346

ABSTRACT

INTRODUCTION: Research has shown that during the 2003 SARS pandemic, emergency department (ED) visits among the pediatric population decreased. We set out to investigate if this was also true for injury-related ED visits during the COVID-19 pandemic. METHODS: Using data from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), we looked at 28 years of injury-related ED visits at the Montreal Children's Hospital, a provincially designated Pediatric Trauma Centre. We compared data from a two-month period during the COVID-19 lockdown (16 March to 15 May) to the same period in previous years (1993-2019) to determine whether the 2020 decrease in ED visit numbers was unprecedented (i.e. a similar decrease had never occurred) for different age groups, nature of injuries, mechanisms and severity. RESULTS: The 2020 decrease was unprecedented across all age groups between 1993 and 2019. When compared with the 2015 to 2019 average, the decrease was smallest in children aged 2 to 5 years (a 35% decrease), and greatest in the group aged 12 to 17 years (83%). Motor vehicle collisions and sports-related injuries practically vanished during the COVID-19 lockdown. Surprisingly, more children aged 6 to 17 years presented with less urgent injuries during the COVID-19 lockdown than in previous years. CONCLUSION: As was the case with SARS in 2003, COVID-19 acted as a deterrent for pediatric ED visits. The lockdown in particular had a profound impact on injury-related visits. The de-confinement period will be monitored to determine the impact in both the short and the long term.


Subject(s)
/epidemiology , Emergency Service, Hospital/statistics & numerical data , Wounds and Injuries/epidemiology , Accidents, Traffic/statistics & numerical data , Adolescent , Athletic Injuries/epidemiology , Child , Child, Preschool , Female , Hospitals, Pediatric/statistics & numerical data , Humans , Infant , Infant, Newborn , Male , Protective Factors , Quebec/epidemiology , Wounds and Injuries/etiology
2.
S Afr Med J ; 0(0): 13183, 2020 12 14.
Article in English | MEDLINE | ID: covidwho-984642

ABSTRACT

BACKGROUND: In response to the coronavirus pandemic, lockdown restrictions and a ban on alcohol sales were introduced in South Africa. Objectives. To investigate the impact of lockdown measures on the number of patients who visited a tertiary urban trauma centre. Methods. The period of investigation was from 1 February to 30 June 2020 and was segmented into three intervals: pre-lockdown (February and March 2020), hard lockdown (April and May 2020) and immediately post lockdown (June 2020). The electronic HECTIS health record registry was interrogated for the total number of patients that were seen per month. These were further categorised according to mechanism of injury (stab, gunshot, blunt assault and road traffic injuries). Penetrating (stab and gunshot) and blunt assault victims were collectively grouped as violent trauma. Results. The mean total number of patients seen decreased by 53% during the hard lockdown period. There was a moderate reduction (15%) in patients with gunshot injuries seen during the hard lockdown phase, but there was an 80% increase in the post-lockdown period. The proportion of patients injured in road traffic collisions pre lockdown, hard lockdown and immediate post lockdown was 16.4%, 8.9% and 11.1%, respectively. Patients injured in road traffic collisions decreased by 74% during the hard lockdown period and maintained a reduction of 32% during the immediate post-lockdown period. The mean total number of patients who visited the trauma unit returned to pre-lockdown levels in June. Conclusions. There was an overall trend of reduced number of patients who visited the trauma unit during the hard lockdown period; however, these numbers returned to pre-lockdown levels during the immediate post-lockdown period. The number of road traffic injury admissions remained reduced during all three phases of lockdown, while the number of gunshot victims increased substantially during the post-lockdown period.


Subject(s)
Accidents, Traffic/statistics & numerical data , Communicable Disease Control , Violence/statistics & numerical data , Wounds and Injuries/epidemiology , Wounds, Gunshot/epidemiology , Adult , Alcohol Drinking/epidemiology , /prevention & control , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Female , Humans , Male , South Africa/epidemiology , Trauma Centers/statistics & numerical data
3.
Medicina (Kaunas) ; 56(10)2020 Oct 01.
Article in English | MEDLINE | ID: covidwho-982890

ABSTRACT

Background and objectives: the emergency department (ED) is frequently identified by patients as a possible solution for all healthcare problems, leading to a high rate of misuse of the ED, possibly causing overcrowding. The coronavirus disease 2019 (COVID-19) pandemic started in China; it then spread throughout Italy, with the first cases confirmed in Lombardy, Italy, in February 2020. This has totally changed the type of patients referred to EDs. The aim of this study was to analyze the reduction of ED admissions at a Second level urban teaching (Fondazione Policlinico Universitario Agostino Gemelli IRCCS) during the COVID-19 pandemic. Materials and Methods: in this retrospective observational cross-sectional study, we reviewed and compared clinical records of all the patients consecutively admitted to our ED over a 40-day period (21 February -31 March) in the last three years (2018-2019-2020). Mean age, sex, triage urgency level, day/night admission, main presentation symptom, and final diagnosis, according to different medical specialties, hospitalization, and discharge rate, were analyzed. Results: we analyzed 16,281 patient clinical records. The overall reduction in ED admissions in 2020 was 37.6% compared to 2019. In 2020, we observed an increase in triage urgency levels for ED admissions (the main presentation symptom was a fever). We noticed a significant drop in admissions for cardio-thoracic, gastroenterological, urological, otolaryngologic/ophthalmologic, and traumatological diseases. Acute neurological conditions registered only a slight, but significant, reduction. Oncology admissions were stable. Admissions for infectious diseases were 30% in 2020, compared to 5% and 6% in 2018 and 2019, respectively. In 2020, the hospitalization rate increased to 42.9% compared to 27.7%, and 26.4% in previous years. Conclusions: the drastic reduction of ED admissions during the pandemic may be associated with fear of the virus, suggesting that patients with serious illnesses did not go to the emergency room. Moreover, there was possible misuse of the ED in the previous year. In particular, worrisome data emerged regarding a drop in cardiology and neurology admissions. Those patients postponed medical attention, possibly with fatal consequences, just for fear of exposure to COVID-19, leading to unnecessary morbidity and mortality.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Emergency Service, Hospital/statistics & numerical data , Pandemics , Patient Admission/statistics & numerical data , Pneumonia, Viral/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Emergency Service, Hospital/trends , Eye Diseases/epidemiology , Female , Gastrointestinal Diseases/epidemiology , Humans , Italy/epidemiology , Male , Middle Aged , Neoplasms/epidemiology , Nervous System Diseases/epidemiology , Otorhinolaryngologic Diseases/epidemiology , Patient Admission/trends , Retrospective Studies , Thoracic Diseases/epidemiology , Urologic Diseases/epidemiology , Wounds and Injuries/epidemiology , Young Adult
4.
BMC Emerg Med ; 20(1): 97, 2020 12 11.
Article in English | MEDLINE | ID: covidwho-971414

ABSTRACT

BACKGROUND: Emergency departments (EDs) worldwide have been in the epicentre of the novel coronavirus disease (COVID-19). However, the impact of the pandemic and national emergency measures on the number of non-COVID-19 presentations and the assessed acuity of those presentations remain uncertain. METHODS: We acquired a retrospective cohort containing all ED visits in a Finnish secondary care hospital during years 2018, 2019 and 2020. We compared the number of presentations in 2020 during the national state of emergency, i.e. from March 16 to June 11, with numbers from 2018 and 2019. Presentations were stratified using localized New York University Emergency Department Algorithm (NYU-EDA) to evaluate changes in presentations with different acuity levels. RESULTS: A total of 27,526 presentations were observed. Compared to previous two years, total daily presentations were reduced by 23% (from 113 to 87, p < .001). In NYU-EDA classes, Non-Emergent visits were reduced the most by 42% (from 18 to 10, p < .001). Emergent presentations were reduced by 19 to 28% depending on the subgroup (p < .001). Number of injuries were reduced by 25% (from 27 to 20, p < .001). The NYU-EDA distribution changed statistically significantly with 4% point reduction in Non-Emergent visits (from 16 to 12%, p < .001) and 0.9% point increase in Alcohol-related visits (from 1.6 to 2.5%, p < .001). CONCLUSIONS: We observed a significant reduction in total ED visits in the course of national state of emergency. Presentations were reduced in most of the NYU-EDA groups irrespective of the assessed acuity. A compensatory increase in presentations was not observed in the course of the 3 month lockdown. This implies either reduction in overall morbidity caused by decreased societal activity or widespread unwillingness to seek required medical advice.


Subject(s)
/epidemiology , Emergency Service, Hospital/statistics & numerical data , Patient Admission/statistics & numerical data , Algorithms , Finland/epidemiology , Humans , Mental Disorders/epidemiology , New York , Pandemics , Retrospective Studies , Secondary Care Centers/statistics & numerical data , Time Factors , Universities , Wounds and Injuries/epidemiology
5.
Scand J Trauma Resusc Emerg Med ; 28(1): 114, 2020 Dec 04.
Article in English | MEDLINE | ID: covidwho-958042

ABSTRACT

BACKGROUND: COVID-19 outbreak lead to nationwide lockdown in Finland on the March 16th, 2020. Previous data regarding to the patient load in the emergency departments during pandemics is scarce. Our aim is to describe the effect of national lockdown and social distancing on the number and reasons for emergency department (ED) visits and inpatient admissions in three large volume hospitals prior to and after the outbreak of the COVID-19 epidemic in Finland. METHODS: Data for this register-based retrospective cohort study were collected from three large ED's in Finland, covering 1/6 of the Finnish population. All patients visiting ED's six weeks before and six weeks after the lockdown were included. Pediatric and gynecological patients were excluded. Numbers and reasons for ED visits and inpatient admissions were collected. Corresponding time period in 2019 was used as reference. RESULTS: A total of 40,653 ED visits and 12,226 inpatient admissions were analyzed. The total number of ED visits decreased 16% after the lockdown, whereas the number of inpatient admissions decreased 15% (p < 0.001). This change in inpatient admissions was similar in all participating hospitals. Visits due to back or limb pain decreased 31% and infectious diseases 28%. The visit rate and inpatient admissions due to acute myocardial infarction and strokes remained stable throughout the study period. Interestingly, the rate of inpatient admissions due to psychiatric diagnoses remained unchanged, although the ED visit rate decreased by 19%. The number of ED visits (n = 282) and inpatient admissions (n = 55) due to COVID-19 remained low in the participating hospitals. CONCLUSIONS: Changes in ED visits and inpatient admissions prior to and during the early phase of the COVID-19 outbreak were unpredictable, and our results may help hospitals and especially ED's focus their resources better. Surprisingly, there was a major decrease in the rate of ED visits due to back or limb pain and not so surprisingly in infectious diseases. Rates of acute myocardial infarctions and cerebral strokes remained stable. In summary, stabile resources for the treatment of patients with severe diseases will be needed in hospitals and ED's.


Subject(s)
/epidemiology , Emergency Service, Hospital/statistics & numerical data , Quarantine/legislation & jurisprudence , Back Pain/epidemiology , Cardiovascular Diseases/epidemiology , Cohort Studies , Finland/epidemiology , Humans , Mental Disorders/epidemiology , Myocardial Infarction/epidemiology , Pandemics , Patient Admission/statistics & numerical data , Respiratory Tract Diseases/epidemiology , Retrospective Studies , Stroke/epidemiology , Wounds and Injuries/epidemiology
6.
Isr Med Assoc J ; 11(22): 673-679, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-948367

ABSTRACT

BACKGROUND: As part of the effort to control the coronavirus disease-19 (COVID-19) outbreak, strict emergency measures, including prolonged national curfews, have been imposed. Even in countries where healthcare systems still functioned, patients avoided visiting emergency departments (EDs) because of fears of exposure to COVID-19. OBJECTIVES: To describe the effects of the COVID-19 outbreak on admissions of surgical patients from the ED and characteristics of urgent operations performed. METHODS: A prospective registry study comparing all patients admitted for acute surgical and trauma care between 15 March and 14 April 2020 (COVID-19) with patients admitted in the parallel time a year previously (control) was conducted. RESULTS: The combined cohort included 606 patients. There were 25% fewer admissions during the COVID-19 period (P < 0.0001). The COVID-19 cohort had a longer time interval from onset of symptoms (P < 0.001) and presented in a worse clinical condition as expressed by accelerated heart rate (P = 0.023), leukocyte count disturbances (P = 0.005), higher creatinine, and CRP levels (P < 0.001) compared with the control cohort. More COVID-19 patients required urgent surgery (P = 0.03) and length of ED stay was longer (P = 0.003). CONCLUSIONS: During the COVID-19 epidemic, fewer patients presented to the ED requiring acute surgical care. Those who did, often did so in a delayed fashion and in worse clinical condition. More patients required urgent surgical interventions compared to the control period. Governments and healthcare systems should emphasize to the public not to delay seeking medical attention, even in times of crises.


Subject(s)
Acute Disease , Emergency Service, Hospital , Emergency Treatment , Infection Control , Surgical Procedures, Operative , Wounds and Injuries/surgery , Acute Disease/epidemiology , Acute Disease/therapy , /prevention & control , Emergency Service, Hospital/organization & administration , Emergency Service, Hospital/trends , Emergency Treatment/methods , Emergency Treatment/statistics & numerical data , Female , Humans , Infection Control/methods , Infection Control/organization & administration , Israel/epidemiology , Male , Middle Aged , Organizational Innovation , Registries/statistics & numerical data , Severity of Illness Index , Surgical Procedures, Operative/methods , Surgical Procedures, Operative/statistics & numerical data , Time-to-Treatment/trends , Wounds and Injuries/epidemiology
7.
Injury ; 51(12): 2834-2839, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-899014

ABSTRACT

INTRODUCTION: By May 2020, Peru was the country with the third most COVID-19 cases in the Americas. The current study's overall aim was to examine the impact of the current COVID-19 outbreak on the number of non-COVID-related patient presentations to a major national emergency traumatology/orthopedics referral center in Latin America. METHODS: An observational study was performed at one of Peru's main tertiary trauma referral centers, during the current COVID-19 pandemic. Numbers of non-follow-up patients presenting to the traumatology/ orthopedics service were counted and compared between January through April 2019 and January through April 2020; and between the month immediately prior to the Peruvian government's implementation of national lock-down measures (Feb 16-Mar 15; Period 1) and the month immediately following (Mar 16-Apr 15; Period 2). The number of surgery service hospitalizations also was compared pre- versus post lockdown initiation (Period 1 vs. 2), as were patient characteristics and outcomes, like age, sex, discharge disposition, mortality, indications for hospital admission, and COVID-19 status. RESULT: Comparing 2019 and 2020, no appreciable differences were detected in the number of patients seen in either January or February. However, relative to March and April 2019, the numbers of patients seen in March and April 2020 (the two months after the first Peruvian case of COVID-19 was detected) were reduced by 55.8 and 88.6%, respectively. Comparing the months immediately pre and post lockdown, the number of service patients declined by 79.9% in April, while the number of hospitalizations declined by 30.9%. The number of admissions for various surgical indications either remained stable or declined in parallel with the overall decline in admissions for all indications except for osteoporotic hip fractures and diabetic foot ulcers (both of which increased proportional to the overall number of admissions) and for hand and foot fractures, both of which decreased. CONCLUSION: At our hospital, not all indications for traumatology/orthopedics service utilization declined despite the national government's directive to reduce non-COVID-related consultations and admissions. Some disorders presented with even greater frequency, which must be considered when developing contingencies for the reallocation of healthcare resources during a pandemic.


Subject(s)
/epidemiology , Emergency Service, Hospital/statistics & numerical data , Tertiary Care Centers/statistics & numerical data , Trauma Centers/statistics & numerical data , Wounds and Injuries/epidemiology , Aged , Aged, 80 and over , /prevention & control , Comorbidity , Female , Hospital Mortality , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Pandemics/prevention & control , Patient Acceptance of Health Care/statistics & numerical data , Patient Admission/statistics & numerical data , Peru/epidemiology , Referral and Consultation/statistics & numerical data , Wounds and Injuries/diagnosis , Wounds and Injuries/therapy
8.
J Hosp Infect ; 106(4): 673-677, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-808779

ABSTRACT

We assessed infection control efforts by comparing data collected over 20 weeks during a pandemic under a dual-track healthcare system. A decline in non-COVID-19 patients visiting the emergency department by 37.6% (P<0.01) was observed since admitting COVID-19 cases. However, patients with acute myocardial infarction (AMI), stroke, severe trauma and acute appendicitis presenting for emergency care did not decrease. Door-to-balloon time (34.3 (± 11.3) min vs 22.7 (± 8.3) min) for AMI improved significantly (P<0.01) while door-to-needle time (55.7 (± 23.9) min vs 54.0 (± 18.0) min) in stroke management remained steady (P=0.80). Simultaneously, time-sensitive care involving other clinical services, including patients requiring chemotherapy, radiation therapy and haemodialysis did not change.


Subject(s)
/epidemiology , Emergency Medical Services/statistics & numerical data , Hospitals/statistics & numerical data , Time-to-Treatment/statistics & numerical data , Acute Disease , Appendicitis/epidemiology , Appendicitis/therapy , /transmission , Cross-Sectional Studies , Emergency Service, Hospital/statistics & numerical data , Hospitalization/statistics & numerical data , Humans , Infection Control/organization & administration , Myocardial Infarction/epidemiology , Myocardial Infarction/therapy , Pandemics/prevention & control , Seoul/epidemiology , Stroke/epidemiology , Stroke/therapy , Time-to-Treatment/trends , Wounds and Injuries/epidemiology , Wounds and Injuries/therapy
9.
Int Wound J ; 17(6): 1935-1940, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-798871

ABSTRACT

There is pressing urgency to understand the pathogenesis of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which causes Coronavirus disease 2019 (COVID-19). The tissue tropism of SARS-CoV-2 includes not only the lung but also the vascular and integumentary systems. Angiotensin-converting enzyme 2 (ACE2) appears to be the key functional receptor for the virus. There is a prominent innate immune response to SARS-CoV-2 infection, including inflammatory cytokines, chemokines, the complement system, and acute phase proteins. The pathophysiologic significance of SARS-COV-2 and host immune system interaction, and COVID-19-associated coagulopathy instigating microvascular injury syndrome mediated by activation of complement pathways, and an associated procoagulant state is important for wound care professionals to understand.


Subject(s)
/epidemiology , Health Personnel , Immunity, Innate , Wounds and Injuries/physiopathology , /immunology , Comorbidity , Humans , Wounds and Injuries/epidemiology , Wounds and Injuries/immunology
10.
Injury ; 51(12): 2811-2815, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-764865

ABSTRACT

INTRODUCTION: In Iran, like most other countries, COVID-19 has had a deep impact on children's lives. Our hypothesis was that, a significant change in the number of pediatric injuries has happened in trauma centers. In the current study, we intend to identify the possible epidemiological shift in pediatric fracture patterns, by comparing the data from 'COVID-19 era' and the mean data from the past 2 years. To the best of our knowledge there are only few reports on epidemiology of pediatric fractures during the COVID-19 outbreak. METHODS: Data are reported in two sections. In the descriptive section, epidemiological data regarding pediatric fractures referred to Taleghani tertiary trauma center, including demographics, distribution curves, etiologies and fracture types are presented during the 'COVID era', from 1 March 2020 to 15 April 2020. In the comparative section, the aforementioned data are compared with mean data from the past 2 years, the 'non-COVID era'. RESULTS: Altogether 117 of the 288 trauma children (40.62%) had a fractured bone (145 fractures). Patients were mostly boys, with a mean age of 9.87 years (SD=5.27). The three most common fracture types in children included distal radius, mid-forearm and humeral supracondylar fractures. Compared to non-COVID era, the number of pediatric trauma admissions dropped from 589 to 288. No significant change happened in the mean age, male/female ratio and percentage of motor vehicle accidents. Proportion of proximal humeral, proximal forearm, carpal, and hand fractures declined. The number of open fractures significantly dropped (from 12 to 2). CONCLUSIONS: In Iran, overall trend of pediatric trauma has been decreasing during the outbreak; but the lack of reduction in proportion of accidents may pose an alarm that an effective lock-down has not been imposed. This study has implications as to preparing appropriate resources particular to common "COVID era fractures".


Subject(s)
Accidents, Traffic/statistics & numerical data , Communicable Disease Control/standards , Trauma Centers/statistics & numerical data , Wounds and Injuries/epidemiology , Accidents, Traffic/trends , Adolescent , Child , Child, Preschool , Female , Humans , Iran/epidemiology , Male , Pandemics/prevention & control , Patient Admission/statistics & numerical data , Retrospective Studies , Sex Factors , Trauma Centers/standards , Trauma Centers/trends , Wounds and Injuries/etiology
11.
Int Wound J ; 17(6): 1960-1967, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-751682

ABSTRACT

Due to the changes in delivering medical care during the Coronavirus disease 2019 (COVID-19) pandemic, such as the heavy reliance on telehealth, it is worth exploring if this is suitable when treating complex wounds. A literature rapid review was performed to explore the existing evidence around alternative service delivery modalities. While there are organisations that have successful telehealth systems and infrastructure, for services that do not already widely use telehealth it is difficult to implement a standardised system in the current state of emergency. The evidence reviewed demonstrates that telehealth appears to currently have a limited place in chronic wound management; therefore, standardisation on determining suitability in conjunction with evaluation of telehealth during this period is needed to shape implementation of telehealth systems in the future.


Subject(s)
/epidemiology , Delivery of Health Care/methods , Pandemics , Telemedicine/organization & administration , Wounds and Injuries/therapy , Comorbidity , Humans , Wounds and Injuries/epidemiology
13.
ANZ J Surg ; 90(11): 2227-2231, 2020 11.
Article in English | MEDLINE | ID: covidwho-745718

ABSTRACT

BACKGROUND: Societal restrictions and lockdown during the coronavirus (COVID-19) pandemic have had a significant impact on the volume and nature of trauma admissions. We assessed the impact of COVID-19 related societal restrictions and lockdown on trauma admissions to single level 1 trauma centre in Westmead, Australia. We hypothesized that the number of trauma admissions would decrease and number of admissions due to self-harm and assault (specifically domestic violence) would increase. METHODS: Data was collected from the prospectively maintained Westmead Hospital Trauma Registry. The primary outcome compared was the average number of trauma admissions during March and April during years 2016 to 2020. Analysis of variance was used to analyse means. Pairwise differences among group means were evaluated with Tukey's honestly significant difference test. Secondary outcomes compared were in-hospital interventions and patient outcomes. RESULTS: There was a 23-34% decrease (P = 0.018) in the mean monthly average trauma admissions during March/April 2020 compared with previous years 2016-2019. In addition, there was a 40-52% decrease (P = 0.025) and 13-29% decrease (P = 0.020) in admissions due to road traffic collisions and falls respectively. CONCLUSION: There was a significant decrease in the overall number of trauma-related admissions during the COVID-19-related period of societal restrictions and lockdown. This was due to a decrease in minor traumas, falls and road traffic collisions. There was no difference in the number of admissions secondary to major traumas, self-harm or assault.


Subject(s)
Betacoronavirus , Communicable Disease Control/organization & administration , Coronavirus Infections/prevention & control , Emergency Service, Hospital , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Social Isolation , Wounds and Injuries/epidemiology , Accidents, Traffic , Adult , Australia , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Cross-Sectional Studies , Female , Hospitalization , Humans , Male , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Self-Injurious Behavior/epidemiology , Violence
14.
S Afr Med J ; 110(9): 910-915, 2020 08 31.
Article in English | MEDLINE | ID: covidwho-745268

ABSTRACT

BACKGROUND: With COVID-19 having spread across the globe, it has become standard to implement infection control strategies (colloquially known as lockdown) with the intention of reducing the magnitude and delaying the peak of the epidemiological curve. Personal infection mitigation strategies coupled with lockdown have caused a change in healthcare-seeking behaviour, with individuals not attending to their ill health as they previously did. OBJECTIVES: To determine whether admissions for urgent and emergency surgical pathologies have declined during the COVID-19 lockdown period, and the magnitude of the decline. METHODS: A retrospective analysis was conducted, comparing pre-lockdown (3 February - 26 March 2020) and lockdown (27 March - 30 April 2020) admission incidences for surgical pathologies at a tertiary healthcare complex in North West Province, South Africa. Poisson regression models were created to determine admission incidence rate ratios (IRRs). RESULTS: Of 769 surgical admissions included in the analysis, 49.7% were male and 67.2% were unemployed. There was a 44% reduction in the incidence of non-trauma admissions during lockdown (IRR 0.56; 95% confidence interval (CI) 0.47 - 0.68; p<0.001) and a 53% reduction in the incidence of trauma-related admissions (IRR 0.47; 95% CI 0.34 - 0.66; p<0.001). CONCLUSIONS: Even when the prevalence of SARS-CoV-2 infection was minimal, COVID-19 lockdown in North West was associated with a significant reduction in surgical admissions. In order to ensure an overall benefit to public health, a balance between maintaining the integrity of COVID-19 control mechanisms and access to healthcare services is essential.


Subject(s)
Appendicitis/epidemiology , Coronavirus Infections/epidemiology , Hospitalization/statistics & numerical data , Neoplasms/epidemiology , Pneumonia, Viral/epidemiology , Soft Tissue Infections/epidemiology , Surgery Department, Hospital , Wounds and Injuries/epidemiology , Adult , Aged , Betacoronavirus , Emergencies , Employment/statistics & numerical data , Female , Gastrointestinal Hemorrhage/epidemiology , Humans , Intestinal Obstruction/epidemiology , Male , Middle Aged , Pandemics , Retrospective Studies , South Africa/epidemiology , Tertiary Care Centers , Young Adult
18.
Can J Public Health ; 111(4): 466-468, 2020 08.
Article in English | MEDLINE | ID: covidwho-696056

ABSTRACT

In Canada, and elsewhere, the coronavirus disease 2019 (COVID-19) crisis has resulted in a social, economic, and alcohol policy environment that is likely to contribute to a rise in intentional injuries, whether interpersonal or self-directed violence. Heavy drinking has been identified as an important risk factor for intentional injuries, and with the erosion of alcohol control policies on alcohol availability, heavy drinking is likely to increase. During a time of social isolation, economic loss, psychological distress, and reduced access to health services and support networks, all of which are catalytic factors for both intentional injuries and heavy alcohol use, what is needed is individualized and population-based preventive interventions aimed at reducing alcohol consumption, rather than decisions to increase certain forms of alcohol availability.


Subject(s)
Alcohol Drinking/prevention & control , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Public Policy , Wounds and Injuries/epidemiology , Alcohol Drinking/adverse effects , Canada/epidemiology , Humans , Intention , Pandemics , Wounds and Injuries/psychology
19.
West J Emerg Med ; 21(4): 819-822, 2020 May 22.
Article in English | MEDLINE | ID: covidwho-682439

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has led to social distancing and decreased travel in the United States. The impact of these interventions on trauma and emergency general surgery patient volume has not yet been described. METHODS: We compared trauma admissions and emergency general surgery (EGS) cases between February 1-April 14 from 2017-2020 in five two-week time periods. Data were compared across time periods with Poisson regression analysis. RESULTS: There were significant decreases in overall trauma admissions (57.4% decrease, p<0.001); motor vehicle collisions (MVC) (80.5% decrease, p<0.001); and non-MVCs (45.1% decrease, p<0.001) from February-April 2020. We found no significant change in EGS cases (p = 0.70). Nor was there was a significant change in trauma cases in any other year 2017-2019. CONCLUSION: The COVID-19 pandemic's burden of disease correlated with a significant decrease in trauma admissions, with MVCs experiencing a larger decrease than non-MVCs.


Subject(s)
Betacoronavirus , Coronavirus Infections , Pandemics , Pneumonia, Viral , Wounds and Injuries/epidemiology , Accidents, Traffic/statistics & numerical data , Emergency Service, Hospital , Hospitalization , Humans , Time Factors , United States
20.
Eur J Trauma Emerg Surg ; 46(4): 737-741, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-670664

ABSTRACT

PURPOSE: In the absence of effective treatment options, the recent SARS-CoV2 pandemic poses a great challenge to the health and social sectors worldwide. Hereby, we would like to share our proposals in the hope that it will prove helpful for our colleagues in this difficult time. METHODS: The present recommendations are based on the opinion of experts as well as the experience of a group of traumatologists directly involved in the organization of traumatology wards. The reassignment of the healthcare personnel, the separation of the potentially infected patients and the different levels of restriction on the trauma care are all key elements of our protocol. RESULTS: Since the first SARS-CoV2-positive case was confirmed in Hungary, our trauma surgeons were able to avoid contamination with the help of the new guidelines, without reducing the quality of trauma care. CONCLUSION: Reasonably adjusted patient care protocols in every medical field are key to contain the spread of infection and to avoid public health crisis. Sharing experience can be an important element of a successful fight against the recent pandemic.


Subject(s)
Clinical Protocols , Coronavirus Infections , Infection Control , Pandemics , Pneumonia, Viral , Trauma Centers/organization & administration , Wounds and Injuries , Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Critical Pathways , Humans , Hungary/epidemiology , Infection Control/methods , Infection Control/organization & administration , Organizational Innovation , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Wounds and Injuries/epidemiology , Wounds and Injuries/surgery
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