A descriptive analysis of the effect of the national COVID-19 lockdown on the workload and case mix of patients presenting to a district-level emergency centre in Cape Town, South Africa.

BACKGROUND: The global COVID-19 pandemic caused many countries to institute nationwide lockdowns to limit the spread of the disease. OBJECTIVES: To describe the effect of the national COVID-19 lockdown in South Africa (SA) on the workload and case mix of patients presenting to a district-level emergency centre. METHODS: The electronic patient tracking and registration database at Mitchells Plain Hospital, a district-level hospital in Cape Town, was retrospectively analysed. The 5-week lockdown period (27 March - 30 April 2020) was compared with a similar period immediately before the lockdown (21 February - 26 March). A comparison was also made with corresponding time periods during 2018 and 2019. Patient demographics, characteristics, diagnoses and disposition, as well as process times, were compared. RESULTS: A total of 26 164 emergency centre visits were analysed (8 297 in 2020, 9 726 in 2019, 8 141 in 2018). There was a reduction of 15% in overall emergency centre visits from 2019 to 2020 (non-trauma 14%, trauma 20%). A 35% decrease was seen between the 2020 lockdown period and the 5-week period before lockdown (non-trauma 33%, trauma 43%), and the reduced number of visits stayed similar throughout the lockdown period. The median age increased by 5 years during the 2020 lockdown period, along with an 8% decrease in patients aged <12 years. High-acuity patients increased by 6% and the emergency centre mortality rate increased by 1%. All process times were shorter during the lockdown period (time to triage -24%, time to consultation -56%, time to disposition decision -29%, time in the emergency centre -20%). CONCLUSIONS: The SA national COVID-19 lockdown resulted in a substantial decrease in the number of patients presenting to the emergency centre. It is yet to be seen how quickly emergency centre volumes will recover as lockdown measures are eased.

Ferric sulphate and formocresol pulpotomies in baboon primary molars: histological responses.

AIM: To compare pulpal reactions to ferric sulphate and formocresol pulpotomies in primary molar teeth with inflamed pulps. STUDY DESIGN: An experimental study in 15 juvenile baboons (Papio ursinus). MATERIALS AND METHODS: Pulpitis was induced with fresh human carious dentine or Streptococcus mutans placed into occlusal cavities in 57 primary molars; after 14 days a pulpotomy was performed on the same primary molars with the two pulp medicaments randomly allocated; the pulp was covered with IRM and the cavity filled with amalgam. After 90 days specimens were harvested and examined under the light microscope with the examiner blind to the treatment. RESULTS: Reaction frequencies in the ferric sulphate-treated and formocresol-treated teeth were: recognisable pulp 52% and 50%, dentine bridges 16% and 12%, internal root resorption 12% and 4%, external resorption 28% and 31%, bacteria 12% and 23%, peri-apical abscesses 32% and 38%. STATISTICS: Fisher's exact probability test showed no statistically significant differences between reaction frequencies in the two treatment groups. CONCLUSION: A pulpotomy in a primary tooth may be clinically successful in the presence of adverse histological reactions.