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Excess Deaths from COVID-19 and Other Causes, March-April 2020

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... In the present study, highest rates of mortality during the pandemic were observed in the Northeast region, and given that the first large outbreak in the United States was predominantly in New York and New Jersey, this elevated mortality may be driven by initially overwhelmed hospital systems in this region. 29 Lastly, the differences in mortality may be due to differences in patient population. Previous studies focused on patients with primary COVID-19-related hospitalizations with concomitant history of HF, while the current study focuses on patients with HF-related hospitalizations with concomitant COVID-19. ...
Article
Aims: Assess heart failure (HF) in-hospital quality of care and outcomes before and during the COVID-19 pandemic. Methods & results: Patients hospitalized for HF with ejection fraction (EF) <40% in American Heart Association Get With The Guidelines©-HF registry during pandemic (3/1/2020 - 4/1/2021) and pre-pandemic (2/1/2019 - 2/29/2020) periods were included. Adherence to HF process of care measures, in-hospital mortality, and length of stay (LOS) were compared in pre-pandemic vs. pandemic periods and patients with vs. without COVID-19. 42,004 pre-pandemic and 37,027 pandemic period patients (median age 68, 33% women, 58% White) were included without observed differences across clinical characteristics, comorbidities, vital signs, or EF. Utilization of guideline-directed medical therapy at discharge was comparable across both periods, with rates of ICD placement or prescription lower during the pandemic (vs. pre-pandemic period). In-hospital mortality (3.0% vs 2.5%, p<0.001) and LOS (mean 5.7 vs. 5.4 days, p<0.001) were higher during the pandemic vs pre-pandemic. The highest in-hospital mortality during the pandemic was observed among patients hospitalized in the Northeast region (3.4%). Among patients concurrently diagnosed with COVID-19 (N=549; 1.5%), adherence to ICD placement or prescription, prescription of aldosterone antagonist or ACE/ARB/ARNi at discharge were lower, and in-hospital mortality (8.2% vs. 3.0%, p<0.001) and length of stay (mean 7.7 days vs. 5.7 days, p<0.001) were higher than those without COVID-19. Conclusion: Among GWTG-HF participating hospitals, patients hospitalized for HFrEF during the pandemic received similar care quality but experienced higher in-hospital mortality than the pre-pandemic period. This article is protected by copyright. All rights reserved.
... Excess mortality measures the number of deaths that exceeds those expected for a given period based on the historical series, thus reflecting direct and indirect effects of the pandemic on the mortality of a given population 26 . Studies suggest that SARS-COV2 infection alone may not explain all beyond-expected deaths that occurred during the pandemic 27 . Analyzing causes of deaths that occurred during the pandemic in the US from March 1 to April 25, only 65% were directly attributed to COVID-19, while the other main causes were: diabetes, Alzheimer's disease, and CVD 28 . ...
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Introduction: The COVID-19 pandemic has had a great impact on the behavior of individuals and the organization of health systems. This study analyzed the COVID-19 pandemic's effect on public hospitalizations for cardiovascular diseases (CVD) in a large city in Brazil, Belo Horizonte, MG, with approximately 2.5 million inhabitants. Methods: In a time-series analysis, this study used administrative data from the national "Hospital Information System" from 2010 to February 2020 to estimate the expected number of hospitalizations for CVD by month during the COVID-19 pandemic in Belo Horizonte in 2020 using the Auto-Regressive Integrated Moving Average model. For CVD, this study compared the expected number of hospital admissions, intensive care use, deaths during hospitalization, and mean length of stay with the observed number during the period. Results: There were 6,517 hospitalizations for CVD from March to December 2020, a decrease of 16.3% (95% CI: 4.7-25.3) compared to the projected. The number of intensive care hospitalizations for CVD fell 24.1% (95% CI 13-32.7). The number of deaths also decreased (17.4% [80% CI: 0 - 0.30]), along with the reduction in hospitalizations, as did the length of stay for CVD hospitalizations. These reductions, however, were not significant. Conclusions: Hospitalizations for CVD were 16.3% lower than expected in a large Brazilian city, possibly due to the fear of getting infected or going to hospitals. Public campaigns informing how to proceed in case of CVD show that prompt urgent attention is essential to mitigate the indirect effects of the pandemic on CVD.
... In the majority of infected cases, the person begins to exhibit symptoms such as cough, fever, fatigue, and loss of smell or taste. In numerous fatal instances, the infection progresses to the lower respiratory system, including the lungs, causing illness such as severe pneumonia followed by multi-organ dysfunction syndrome with several secondary infections and shock [12][13][14][15][16][17]. ...
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Background and motivation: The novel coronavirus causing COVID-19 is exceptionally contagious, highly mutative, decimating human health and life, as well as the global economy, by consistent evolution of new pernicious variants and outbreaks. The reverse transcriptase polymerase chain reaction currently used for diagnosis has major limitations. Furthermore, the multiclass lung classification X-ray systems having viral, bacterial, and tubercular classes-including COVID-19-are not reliable. Thus, there is a need for a robust, fast, cost-effective, and easily available diagnostic method. Method: Artificial intelligence (AI) has been shown to revolutionize all walks of life, particularly medical imaging. This study proposes a deep learning AI-based automatic multiclass detection and classification of pneumonia from chest X-ray images that are readily available and highly cost-effective. The study has designed and applied seven highly efficient pre-trained convolutional neural networks-namely, VGG16, VGG19, DenseNet201, Xception, InceptionV3, NasnetMobile, and ResNet152-for classification of up to five classes of pneumonia. Results: The database consisted of 18,603 scans with two, three, and five classes. The best results were using DenseNet201, VGG16, and VGG16, respectively having accuracies of 99.84%, 96.7%, 92.67%; sensitivity of 99.84%, 96.63%, 92.70%; specificity of 99.84, 96.63%, 92.41%; and AUC of 1.0, 0.97, 0.92 (p < 0.0001 for all), respectively. Our system outperformed existing methods by 1.2% for the five-class model. The online system takes <1 s while demonstrating reliability and stability. Conclusions: Deep learning AI is a powerful paradigm for multiclass pneumonia classification.
... The observed reduction in total deaths due to dementia in Australia contrasts with international findings, 6,34 where increased dementia deaths were found in regions overwhelmed by COVID-19, 35 with many occurring outside hospital. 36 Deaths in those countries may have been due to undiagnosed coronavirus infections, 37 with dementia recorded as the underlying cause and an unknown respiratory pathogen as the proximate cause. ...
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Aim: To assess whether the observed numbers and seasonality of deaths in Australia during 2020 differed from expected trends based on 2015-19 data. Methods: We used provisional death data from the Australian Bureau of Statistics, stratified by state, age, sex and cause of death. We compared 2020 deaths with 2015-19 deaths using interrupted time series adjusted for time trend and seasonality. We measured the following outcomes along with 95% confidence intervals: observed/expected deaths (rate ratio: RR), change in seasonal variation in mortality (amplitude ratio: AR) and change in week of peak seasonal mortality (phase difference: PD). Results: Overall 4% fewer deaths from all causes were registered in Australia than expected in 2020 [RR 0·96 (0·95-0·98)] with reductions across states, ages and sex strata. There were fewer deaths from respiratory illness [RR 0·79 (0·76-0·83)] and dementia [RR 0·95 (0·93-0·98)] but more from diabetes [RR 1·08 (1·04-1·13)]. Seasonal variation was reduced for deaths overall [AR 0·94 (0·92-0·95)], and for deaths due to respiratory illnesses [AR 0·78 (0·74-0·83)], dementia [AR 0.92 (0.89-0.95)] and ischaemic heart disease [0.95 (0.90-0.97)]. Conclusions: The observed reductions in respiratory and dementia deaths and the reduced seasonality in ischaemic heart disease deaths may reflect reductions in circulating respiratory (non-SARS-CoV-2) pathogens resulting from the public health measures taken in 2020. The observed increase in diabetes deaths is unexplained and merits further study.
... Unfortunately, the under-reporting of cases has hindered the proper interpretation of these data. On the other hand, excess mortality can be more useful in describing pandemic trends in relation to other variables affecting local and national health systems [16] . ...
Article
Background Healthcare factors have strongly influenced the propagation of COVID-19. This study aims to examine whether excess mortality during the first phase of the COVID-19 outbreak in Italy was associated with health, healthcare, demographic, and socioeconomic, provincial-level indicators. Methods This ecological study concerns the raw number of deaths reported from February 1 to April 30, 2020 and the mean number of deaths occurred during the same months from 2015 to 2019, per province. Information on socioeconomic factors and healthcare settings was extracted from updated databases on the Italian National Institute of Statistics (ISTAT) website. A multivariate model and four multilevel models were constructed to test the association between excess mortality and the analysed indicators across 107 Italian provinces. Results The hospitalization rate in long-term care wards and the cardiovascular disease mortality rate correlate positively with excess mortality (p <0.05), while higher densities of licensed physicians and of general practitioners are associated with lower excess mortality (p <0.05). After controlling for the COVID-19 cumulative incidence in each province, only the density of licensed physicians remains negatively associated with excess mortality (p <0.01). Conclusion Some health and healthcare variables (in particular, the density of physicians) are strongly associated with excess mortality during the first wave of the COVID-19 pandemic in Italy and should be targeted to increase the resilience of health systems.
... It is a well-known fact that the total number of cases is highly underestimated, mainly due to a limited number of tests, and that deaths by COVID-19 are more reliable, although also subject to some under-reporting [52,53]. As a consequence, fitting the model using the data series for the number of deaths yields results closer to the real situation. ...
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We report strong evidence of the importance of contact hubs (or superspreaders) in mitigating the current COVID-19 pandemic. Contact hubs have a much larger number of contacts than the average in the population, and play a key role on the effectiveness of vaccination strategies. By using an age-structures compartmental SEIAHRV (Susceptible, Exposed, Infected symptomatic, Asymptomatic, Hospitalized, Recovered, Vaccinated) model, calibrated from available demographic and COVID-19 incidence, and considering separately those individuals with a much greater number of contacts than the average in the population, we show that carefully choosing who will compose the first group to be vaccinated can impact positively the total death toll and the demand for health services. This is even more relevant in countries with a lack of basic resources for proper vaccination and a significant reduction in social isolation. In order to demonstrate our approach we show the effect of hypothetical vaccination scenarios in two countries of very different scales and mitigation policies, Brazil and Portugal.
... Moreover, a rise in the proportion of in-hospital mortality for CVD was reported, being this effect larger where greater decline in admission rates occurred, suggesting hospitalizations of sicker patients or delivery of worse quality of care, corroborating our findings [35,36]. In parallel, other studies revealed that excess mortality in the pandemic period could not be explained exclusively by COVID-19 deaths, and excess CVD deaths was found in some countries, including Brazil, which is not surprising, knowing the beneficial effect of in-hospital timely treatment for the most lethal cardiovascular conditions, such as ACS [37][38][39]. ...
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Introduction: The impact of COVID-19 pandemics on cardiovascular diseases (CVD) may be caused by health system reorganization and/or collapse, or from changes in the behaviour of individuals. In Brazil, municipalities were empowered to define regulatory measures, potentially resulting in diverse effects on CVD morbimortality. Objective: To analyse the impact of COVID-19 pandemics on CVD outcomes in Belo Horizonte (BH), the sixth greater capital city in Brazil, including: mortality, mortality at home, hospitalizations, intensive care unit utilization, and in-hospital mortality; and the differential effect according to sex, age range, social vulnerability, and pandemic's phase. Methods: Ecological study analysing data from the Mortality and Hospital Information System of BH residents aged ≥30 years. CVD was defined as in Chapter IX from ICD-10. Social vulnerability was classified by a composite socioeconomic index as high, medium and low. The observed age-standardized rates for epidemiological weeks 10-48, 2020, were compared to the expected rates (mean of 2015-2019). Risk ratios (RiR) were analysed and 95% confidence intervals were calculated for all estimates. Population projected to 2020 for BH and its census tracts were used to calculate rates. Results: We found no changes in CVD mortality rates (RiR 1.01, 95%CI 0.96-1.06). However, CVD deaths occurred more at homes (RiR 1.32, 95%CI 1.20-1.46) than in hospitals (RiR 0.89, 95%CI 0.79-0.99), as a result of a substantial decline in hospitalization rates, even though proportional in-hospital deaths increased. The rise in home deaths was greater in older adults and in had an increasing gradient in those more socially vulnerable (RiR 1.45); for high (RiR 1.45), medium (RiR 1.32) and low vulnerability (RiR 1.21). Conclusion: The greater occurrence of CVD deaths at home, in parallel with lower hospitalization rates, suggests that CVD care was disrupted during the COVID-19 pandemics, which more adversely affected older and more socially vulnerable individuals, exacerbating health inequities in BH.
... Ongoing evidence has shown that the current pandemic is causing excessive deaths, both COVID-19 and non-COVID-19 [11]. The authors did not show any increase in 30-day mortality of AMI patients during the pandemic in Israel. ...
... 10 In the USA and in western Europe, excess mortality is generally calculated as the difference between the weekly number of deaths occurring in 2020 and the average number occurring in the same week during 4, 5 or 6 previous years (e.g. 2016-2019, 5,9,13 2015-2019, 1,3,6,8,14-17 2014-2019 18,19 ), 10 previous years 20 or 1 previous year. 7 For Israel, that approach is misleading because the population is increasing annually and over the past 20 years mortality rates have decreased. ...
Article
Background We aimed to build a basic daily mortality curve in Israel based on 20-year data accounting for long-term and annual trends, influenza-like illness (ILI) and climate factors among others, and to use the basic curve to estimate excess mortality during 65 weeks of the COVID-19 pandemic in 2020–2021 stratified by age groups. Methods Using daily mortality counts for the period 1 January 2000 to 31 December 2019, weekly ILI counts, daily climate and yearly population sizes, we fitted a quasi-Poisson model that included other temporal covariates (a smooth yearly trend, season, day of week) to define a basic mortality curve. Excess mortality was calculated as the difference between the observed and expected deaths on a weekly and periodic level. Analyses were stratified by age group. Results Between 23 March 2020 and 28 March 2021, a total of 51 361 deaths were reported in Israel, which was 12% higher than the expected number for the same period (expected 45 756 deaths; 95% prediction interval, 45 325–46 188; excess deaths, 5605). In the same period, the number of COVID-19 deaths was 6135 (12% of all observed deaths), 9.5% larger than the estimated excess mortality. Stratification by age group yielded a heterogeneous age-dependent pattern. Whereas in ages 90+ years (11% excess), 100% of excess mortality was attributed to COVID-19, in ages 70–79 years there was a greater excess (21%) with only 82% attributed to COVID-19. In ages 60–69 and 20–59 years, excess mortality was 14% and 10%, respectively, and the number of COVID-19 deaths was higher than the excess mortality. In ages 0–19 years, we found 19% fewer deaths than expected. Conclusion The findings of an age-dependent pattern of excess mortality may be related to indirect pathways in mortality risk, specifically in ages <80 years, and to the implementation of the lockdown policies, specifically in ages 0–19 years with lower deaths than expected.
... One of them is the need to define structured health-care pathways for SARS-CoV-2 patients who require an anesthesia procedure while or after being symptomatic. To answer this question, stakeholders need to be able, for each patient, to have an accurate understanding of the riskbenefit balance with, on one hand, a potential risk of pulmonary complications and, on the other hand, the risk in postponing carcinologic, vascular, cardiac, or neurosurgical procedures, with a consequent significant morbidity [7]. This understanding will allow physicians to propose an informed decision-making and a truthful informing of patients, and to anticipate the required resources for the optimal care of their patients. ...
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Background There are limited data to detail the perioperative anesthetic management and the incidence of postoperative respiratory complications among patients requiring an anesthetic procedure while being SARS-CoV-2 positive or suspected. Methods An observational multicenter cohort study was performed including consecutive patients who were SARS-CoV-2 confirmed or suspected and who underwent scheduled and emergency anesthesia between March 17 and May 26, 2020. Results A total of 187 patients underwent anesthesia with SARS-CoV-2 confirmed or suspected, with ultimately 135 (72.2%) patients positive and 52 (27.8%) negative. The median SOFA score was 2 [0; 5], and the median ARISCAT score was 49 [36; 67]. The major respiratory complications rate was 48.7% ( n = 91) with 40.4% ( n = 21) and 51.9% ( n = 70) in the SARS-CoV-2–negative and –positive groups, respectively ( p = 0.21). Among both positive and negative groups, patients with a high ARISCAT risk score (> 44) had a higher risk of presenting major respiratory complications ( p < 0.01 and p = 0.1, respectively). Discussion When comparing SARS-COV-2–positive and –negative patients, no significant difference was found regarding the rate of postoperative complications, while baseline characteristics strongly impact these outcomes. This finding suggests that patients should be scheduled for anesthetic procedures based on their overall risk of postoperative complication, and not just based on their SARS-CoV-2 status.
... During the first pandemic wave (FW) of coronavirus disease 2019 between March and April 2020, there was a marked decline in admissions for acute coronary syndrome (ACS) (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11), heart failure (HF) (12)(13)(14), and other non-COVID health conditions (15)(16)(17). ...
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Aims This study aimed to evaluate the decline in urgent cardiovascular hospital admissions and in-hospital mortality during the COVID pandemic in two successive waves, and to evaluate differences by sex, age, and deprivation index subgroups. Methods and Results We obtained acute cardiovascular hospital episodes during the years 2019–2020 from region-wide data on public healthcare usage for the population of Catalonia (North-East Spain). We fitted time models to estimate the incidence rate ratios (IRRs) of the acute coronary syndrome (ACS) and acute heart failure (HF) admissions during the first pandemic wave, the between-waves period, and the second wave compared with the corresponding pre-COVID-19 periods and to test for the interaction with sex, age, and area-based socioeconomic level. We evaluated the effect of COVID-19 period on in-hospital mortality. ACS ( n = 8,636) and HF ( n = 27,566) episodes were defined using primary diagnostic ICD-10 codes. ACS and HF admissions decreased during the first wave (IRR = 0.66, 95%CI: 0.58–0.76 and IRR = 0.61, 95% CI: 0.55–0.68, respectively) and during the second wave (IRR = 0.80, 95%CI: 0.72–0.88 and IRR = 0.76, 95%CI: 0.69–0.84, respectively); acute HF admissions also decreased in the period between waves (IRR: 0.81, 95%CI: 0.74–0.89). The impact was similar in all sex and socioeconomic subgroups and was higher in older patients with ACS. In-hospital mortality was higher than expected only during the first wave. Conclusion During the first wave of the COVID-19 pandemic, there was a marked decline in urgent cardiovascular hospital admissions that were attenuated during the second wave. Both the decline and the attenuation of the effect have been similar in all subgroups regardless of age, sex, or socioeconomic status. In-hospital mortality for ACS and HF episodes increased during the first wave, but not during the second wave.
... Some recent articles which study the effects of the reopening can be found in Refs. [7][8][9] . ...
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By the end of May 2020, all states in the US have eased their COVID-19 mitigation measures. Different states adopted markedly different policies and timing for reopening. An important question remains in how the relaxation of mitigation measures is related to the number of casualties. To address this question, we compare the actual data to a hypothetical case in which the mitigation measures are left intact using a projection of the data from before mitigation measures were eased. We find that different states have shown significant differences between the actual number of deaths and the projected figures within the present model. We relate these differences to the states different policies and reopening schedules. Our study provides a gauge for the effectiveness of the approaches by different state governments and can serve as a guide for implementing best policies in the future. According to the Pearson correlation coefficients we obtained, the face mask mandate has the strongest correlation with the death count than any other policies we considered.
... Ashraf (2020) and Zhang et al. (2020) used the newly confirmed cases in their study. While Woolf et al. (2020) have employed the excess deaths to validate their results. In this paper, we utilize three major proxies to assign the effect of the coronavirus pandemic consisting of the reproduction rate (instantaneous R(t)), the daily growth in newly confirmed cases GC (Eqn (1)) and the daily growth in fatalities GD (Eqn (2)) (Ftiti et al., 2021). ...
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Purpose Cryptocurrencies lack fundamental values and are often subject to behavioral bias leading to market bubbles. This study aims to investigate the contribution of the coronavirus pandemic to the creation of market bubbles. Design/methodology/approach This study identifies four major cryptocurrency market bubbles by using the Phillips et al. (2016) (hereafter PSY) test. Subsequently, the co-movements of the coronavirus proxies with PSY measurement using the wavelet approach were studied. Findings Short-lived bubbles are detected at the beginning of the studied period, and more extended bubble periods are identified at the end. Besides, the empirical results show evidence of significant negative co-movement between each pandemic proxy and each cryptocurrency bubble measurement. Research limitations/implications Given the complex financial dynamics of the cryptocurrency markets due to some behavioral biases in some circumstances, investors can benefit from the date stamping of the bubbles bursting to make the best trading positions. In the same way, governments could support the healthy development of cryptocurrencies by preventing bubbles during such pandemics. Originality/value The financial bubble is commonly attributed to a change in investor behavior. Because traders and investors think they can resell the asset at a higher price in the future. This study explored the contribution of the COVID-19 pandemic in the creation of these bubbles by date stamping their occurrence and explosive periods. To the best of the authors’ knowledge, this study is the first attempt that explores the contribution of the COVID-19 pandemic to the creation of bubbles caused by a change in the investors’ behavior.
... Finally, patients with comorbidities or a history of cardiovascular disease were at particular risk of dying from COVID-19 in 2020. Thus, we cannot completely rule out that COVID-19-related mortality may have been an important competitive cause of death and could have impacted the number of patients with MR [43]. ...
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Mitral regurgitation (MR) is the second most common valvular heart disease in Europe. The aging of the population and the increase in post-infarction survival could increase the prevalence of MR. To estimate the burden of patients hospitalized for MR in France in 2019 and temporal trends by etiology and sex from 2006 to 2020, we selected all patients hospitalized for MR using the national hospital database. In 2019, 49.2% of such patients had mitral valve prolapse (MVP), 17.1% had ischemic MR, 9.9% had rheumatic MR and 4.4% had MR with cardiomyopathy. The mean age of MVP patients was 67.8 years, and 34% were women. Among 89% of MVP inpatients who had received mitral valve repair or replacement, 55% received surgical repair, 13% received percutaneous repair and 25% received replacement. The all-cause mortality of one year after a mitral procedure of MVP was 5.4%. Among ischemic MR inpatients, 29% have had a mitral valve replacement, 16% a surgical repair and 19% a percutaneous repair. Between 2006 and 2019, the age-standardized rates of patients hospitalized for MVP have increased by 60%, especially in men (+80%) with 5.3/100,000 Person-Years (PY). The age-standardized rates of patients hospitalized for ischemic MR have increased by 25% with 1.8/100,000 PY; that of rheumatic MR has decreased by 36%. The study found that the burden of MVP in hospitals has increased substantially, especially among men. These results emphasize the need to monitor these temporal trends and anticipate care needs in the coming years.
... Similarly, seasonal influenza had a downward trend in 2020 in Japan [9] and Korea [10]. However, increased deaths attributed to some non-infectious causes also occurred in some areas; ror example, excess deaths occurred in the USA during this period that were not attributable to COVID-19 [11]. Based on these findings, we decided to examine the trend in a number of infectious diseases, to see whether the measures used during the outbreak of COVID-19 played a role in preventing other infectious diseases in China. ...
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Background This study explored the effect of a continuous mitigation and containment strategy for coronavirus disease 2019 (COVID-19) on five vector-borne diseases (VBDs) in China from 2020 to 2021. Methods Data on VBDs from 2015 to 2021 were obtained from the National Health Commission of the People’s Republic of China, and the actual trend in disease activity in 2020–2021 was compared with that in 2015–2019 using a two-ratio Z-test and two proportional tests. Similarly, the estimated trend in disease activity was compared with the actual trend in disease activity in 2020. Results There were 13,456 and 3684 average yearly cases of VBDs in 2015–2019 and 2020, respectively. This represents a decrease in the average yearly incidence of total VBDs of 72.95% in 2020, from 0.9753 per 100,000 population in 2015–2019 to 0.2638 per 100,000 population in 2020 ( t = 75.17, P < 0.001). The observed morbidity rates of the overall VBDs were significantly lower than the predicted rates (47.04% reduction; t = 31.72, P < 0.001). The greatest decline was found in dengue, with a 77.13% reduction (observed rate vs predicted rate: 0.0574 vs. 0.2510 per 100,000; t = 41.42, P < 0.001). Similarly, the average yearly mortality rate of total VBDs decreased by 77.60%, from 0.0064 per 100,000 population in 2015–2019 to 0.0014 per 100,000 population in 2020 ( t = 6.58, P < 0.001). A decreasing trend was also seen in the monthly incidence of total VBDs in 2021 compared to 2020 by 43.14% (t = 5.48, P < 0.001). Conclusions The results of this study verify that the mobility and mortality rates of VBDs significantly decreased from 2015–2019 to 2020–2021, and that they are possibly associated to the continuous COVID-19 mitigation and contamination strategy implemented in China in 2020–2021. Graphical Abstract
... This is a crucial topic not only because of the magnitude of delays that occurred during the pandemic; for example, breast cancer and colon cancer screenings dropped by more than 80% at the height of the pandemic (Vose, 2020), but also due to the exacerbating inequality in delaying health care (Mafi et al., 2022). This massive volume of delayed routine care will negatively impact quality of life, morbidity, and mortality for the U.S. population and likely impose additional as-yet-unknown negative consequences for many years to come (Woolf et al., 2020). ...
Article
Delaying routine health care has been prevalent during the COIVD-19 pandemic. Macro-level data from this period reveals that U.S. patients under-utilized routine health care services such as primary care visits, preventative tests, screenings, routine optometry care, dental appointments, and visits for chronic disease management. Yet, there is a gap in research on how and why patients understand risks associated with seeking or delaying routing health care during an infectious disease pandemic. Our research addresses this gap based on semi-structured interviews with 40 participants living in regions across the United States. By building upon Unger-Saldaña and Infante-Castañeda's model of delayed health care, we extend this model by articulating how health care delays happen during an infectious disease pandemic. Specifically, we show how perceptions of uncertainty and subjective risk assessments shape people's decisions to delay routine health care while they operate at two levels, internal and external to one's social bubble, interacting with each other.
... Scaled index is scaled as 100 times index to allow comparison with the rescaled level sum score and VAS4 Rescaled level sum score is rescaled as 125 times (5 times level sum score) to allow comparison with the scaled index and VAS 5 VAS refers to "visual analogue score" to allow comparison with the scaled index and rescaled level sum score https://doi.org/10.1371/journal.pone.0272252.t003PLOS ONEHealth inequities in New York as measured by the EQ-5D-5L during COVID-19 PLOS ONE | https://doi.org/10.1371/journal.pone.0272252 ...
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Introduction The effects of the COVID-19 pandemic caused considerable psychological and physical effects in healthy and diseased New Yorkers aside from the effects in those who were infected. We investigated the relationship between known risk-enhancing and health-promoting factors (social and medical), comorbidity indicators, and, as the primary outcome, health-related quality of life (HRQoL). Methods Between April 22 and May 5, 2020, a market research agency (Dynata) administered a digital survey including the EQ-5D-5L and items related to individual characteristics, social position, occupational and insurance status, living situation, exposures (smoking and COVID-19), detailed chronic conditions, and experienced access to care to an existing internet panel representative of New Yorkers. Results 2684 persons completed the questionnaire. The median age was 48 years old, and most respondents were non-Hispanic white (74%) and reported at least higher vocational training or a university education (83%). During COVID-19, mean HRQoL scores were 0.82 for the EQ-5D-5L index and 79.3 for the EQ VAS. Scores varied for healthy and diseased respondents differently by the above determinants. Lower age, impaired occupational status, loss of health insurance, and limited access to care exerted more influence on EQ-5D-5L scores of diseased persons compared to healthy persons. Among diseased persons, the number of chronic conditions and limited access to health care had the strongest association with EQ-5D-5L scores. While EQ-5D-5L scores improved with increasing age, gender had no noticeable effect. Deprivation factors showed moderate effects, which largely disappeared in (stratified) multivariable analysis, suggesting mediation through excess chronic morbidity and poor healthcare access. Generally, modifying effects were larger in the EQ-5D-5L as compared to the EQ VAS. Conclusions Almost all factors relating to a disadvantaged position showed a negative association with HRQoL. In diseased respondents, pre-existing chronic comorbidity and experienced access to health care are key factors.
... Access to vaccines protecting against moderate-tosevere disease, and thus preventing disruption to the normal functioning of hospitals and intensive care units, is essential to prevent non-COVID-19-associated morbidity and mortality. [29][30][31] CVnCoV contains 12 μg of mRNA, considerably less than BNT162b2 (30 μg) and mRNA-1273 (100 μg) contain. We cannot dismiss the possibility that this dose was insufficient to elicit a protective immune response. ...
Article
Background Additional safe and efficacious vaccines are needed to control the COVID-19 pandemic. We aimed to analyse the efficacy and safety of the CVnCoV SARS-CoV-2 mRNA vaccine candidate. Methods HERALD is a randomised, observer-blinded, placebo-controlled, phase 2b/3 clinical trial conducted in 47 centres in ten countries in Europe and Latin America. By use of an interactive web response system and stratification by country and age group (18-60 years and >= 61 years), adults with no history of virologically confirmed COVID-19 were randomly assigned (1:1) to receive intramuscularly either two 0.6 mL doses of CVnCoV containing 12 mu g of mRNA or two 0.6 mL doses of 0.9% NaCl (placebo) on days 1 and 29. The primary efficacy endpoint was the occurrence of a first episode of virologically confirmed symptomatic COVID-19 of any severity and caused by any strain from 15 days after the second dose. For the primary endpoint, the trial was considered successful if the lower limit of the CI was greater than 30%. Key secondary endpoints were the occurrence of a first episode of virologically confirmed moderate-to-severe COVID-19, severe COVID-19, and COVID-19 of any severity by age group. Primary safety outcomes were solicited local and systemic adverse events within 7 days after each dose and unsolicited adverse events within 28 days after each dose in phase 2b participants, and serious adverse events and adverse events of special interest up to 1 year after the second dose in phase 2b and phase 3 participants. Here, we report data up to June 18, 2021. The study is registered at ClinicalTrials.gov, NCT04652102, and EudraCT, 2020-003998-22, and is ongoing. Findings Between Dec 11, 2020, and April 12, 2021, 39 680 participants were enrolled and randomly assigned to receive either CVnCoV (n=19 846) or placebo (n=19 834), of whom 19 783 received at least one dose of CVnCoV and 19 746 received at least one dose of placebo. After a mean observation period of 48.2 days (SE 0.2), 83 cases of COVID-19 occurred in the CVnCoV group (n=12 851) in 1735.29 person-years and 145 cases occurred in the placebo group (n=12 211) in 1569.87 person-years, resulting in an overall vaccine efficacy against symptomatic COVID-19 of 48.2% (95.826% CI 31.0-61.4; p=0.016). Vaccine efficacy against moderate-to-severe COVID-19 was 70.7% (95% CI 42.5-86.1; CVnCoV 12 cases in 1735.29 person-years, placebo 37 cases in 1569.87 person-years). In participants aged 18-60 years, vaccine efficacy against symptomatic disease was 52.5% (95% CI 36.2-64.8; CVnCoV 71 cases in 1591.47 person-years, placebo, 136 cases in 1449.23 person-years). Too few cases occurred in participants aged 61 years or older (CVnCoV 12, placebo nine) to allow meaningful assessment of vaccine efficacy. Solicited adverse events, which were mostly systemic, were more common in CVnCoV recipients (1933 [96.5%] of 2003) than in placebo recipients (1344 [67.9%] of 1978), with 542 (27.1%) CVnCoV recipients and 61 (3.1%) placebo recipients reporting grade 3 solicited adverse events. The most frequently reported local reaction after any dose in the CVnCoV group was injection-site pain (1678 [83.6%] of 2007), with 22 grade 3 reactions, and the most frequently reported systematic reactions were fatigue (1603 [80.0%] of 2003) and headache (1541 [76.9%] of 2003). 82 (0.4%) of 19 783 CVnCoV recipients reported 100 serious adverse events and 66 (0.3%) of 19 746 placebo recipients reported 76 serious adverse events. Eight serious adverse events in five CVnCoV recipients and two serious adverse events in two placebo recipients were considered vaccination-related. None of the fatal serious adverse events reported (eight in the CVnCoV group and six in the placebo group) were considered to be related to study vaccination. Adverse events of special interest were reported for 38 (0.2%) participants in the CVnCoV group and 31 (0.2%) participants in the placebo group. These events were considered to be related to the trial vaccine for 14 (<0.1%) participants in the CVnCoV group and for five (<0.1%) participants in the placebo group. Interpretation CVnCoV was efficacious in the prevention of COVID-19 of any severity and had an acceptable safety profile. Taking into account the changing environment, including the emergence of SARS-CoV-2 variants, and timelines for further development, the decision has been made to cease activities on the CVnCoV candidate and to focus efforts on the development of next-generation vaccine candidates. Copyright
... A substantial increase in excess deaths was observed in the USA during the early phases of the pandemic when vaccines were not available, with a large proportion attributed to causes other than COVID-19, such as heart disease, diabetes, and nonrespiratory related disease. 5,6,22 This excess mortality may be related to delayed or impeded access to acute care and strained health systems. 17 This study has limitations. ...
Article
Purpose: SARS-CoV-2 vaccines have been proven effective at preventing poor outcomes from COVID-19; however, voluntary vaccination rates have been suboptimal. We assessed the potential avoidable intensive care unit (ICU) resource use and associated costs had unvaccinated or partially vaccinated patients hospitalized with COVID-19 been fully vaccinated. Methods: We conducted a retrospective, population-based cohort study of persons aged 12 yr or greater in Alberta (2021 population ~ 4.4 million) admitted to any ICU with COVID-19 from 6 September 2021 to 4 January 2022. We used publicly available aggregate data on COVID-19 infections, vaccination status, and health services use. Intensive care unit admissions, bed-days, lengths of stay, and costs were estimated for patients with COVID-19 and stratified by vaccination status. Results: In total, 1,053 patients admitted to the ICU with COVID-19 were unvaccinated, 42 were partially vaccinated, and 173 were fully vaccinated (cumulative incidence 230.6, 30.8, and 5.5 patients/100,000 population, respectively). Cumulative incidence rate ratios of ICU admission were 42.2 (95% confidence interval [CI], 39.7 to 44.9) for unvaccinated patients and 5.6 (95% CI, 4.1 to 7.6) for partially vaccinated patients when compared with fully vaccinated patients. During the study period, 1,028 avoidable ICU admissions and 13,015 bed-days were recorded for unvaccinated patients and the total avoidable costs were CAD 61.3 million. The largest opportunity to avoid ICU bed-days and costs was in unvaccinated patients aged 50 to 69 yr. Conclusions: Unvaccinated patients with COVID-19 had substantially greater rates of ICU admissions, ICU bed-days, and ICU-related costs than vaccinated patients did. This increased resource use would have been potentially avoidable had these unvaccinated patients been vaccinated against SARS-CoV-2.
Article
The COVID-19 pandemic has forced federal, state, and local policymakers to respond by legislating, enacting, and enforcing social distancing policies. However, the impact of these policies on healthcare utilization in the United States has been largely unexplored. We examine the impact of county-level shelter in place ordinances on healthcare utilization using two unique datasets—employer-sponsored insurance for over 6 million people in the US and cell phone location data. We find that introduction of these policies was associated with reductions in the use of preventive care, elective care, and the number of weekly visits to physician offices, hospitals and other health care-related industries. However, controlling for county-level exposure to the COVID-19 pandemic as a way to account for the endogenous nature of policy implementation reduces the impact of these policies. Our results imply that while social distancing policies do lead to reductions in healthcare utilization, much of these reductions would have occurred even in the absence of these policies.
Article
Aims Widespread disruption of healthcare services and excess mortality not directly attributed to COVID-19 occurred between March and May 2020. We undertook the first UK multicentre study of coroners’ autopsies before and during this period using postmortem reports. Methods We reviewed reports of non-forensic coroners’ autopsies performed during the first COVID-19 lockdown (23 March to 8 May 2020), and the same period in 2018. Deaths were categorised as natural non-COVID-19, COVID-19-related, non-natural (suicide, drug and alcohol-related, traumatic, other). We provided opinion regarding whether delayed access to medical care or changes in behaviour due to lockdown were a potential factor in deaths. Results Seven centres covering nine coronial jurisdictions submitted a total of 1100 coroners’ autopsies (498 in 2018, 602 in 2020). In only 54 autopsies was death attributed to COVID-19 (9%). We identified a significant increase in cases where delays in accessing medical care potentially contributed to death (10 in 2018, 44 in 2020). Lockdown was a contributing factor in a proportion of suicides (24%) and drug and alcohol-related deaths (12%). Conclusions Postmortem reports have considerable utility in evaluating excess mortality due to healthcare and wider societal disruption during a pandemic. They provide information at an individual case level that is not available from assessment of death certification data. Detailed evaluation of coroners’ autopsy reports, supported by appropriate regulatory oversight, is recommended to mitigate disruption and indirect causes of mortality in future pandemics. Maintaining access to healthcare, including substance misuse and mental health services, is an important consideration.
Preprint
Excess mortality studies provide crucial information regarding the health burden of pandemics and other large-scale events. Here, we used time series approaches to separate the direct contribution of SARS-CoV-2 infections on mortality from the indirect consequences of pandemic interventions and behavior changes in the United States. We estimated deaths occurring in excess of seasonal baselines stratified by state, age, week and cause (all causes, COVID-19 and respiratory diseases, Alzheimer’s disease, cancer, cerebrovascular disease, diabetes, heart disease, and external causes, including suicides, opioids, accidents) from March 1, 2020 to April 30, 2021. Our estimates of COVID-19 excess deaths were highly correlated with SARS-CoV-2 serology, lending support to our approach. Over the study period, we estimate an excess of 666,000 (95% Confidence Interval (CI) 556000, 774000) all-cause deaths, of which 90% could be attributed to the direct impact of SARS-CoV-2 infection, and 78% were reflected in official COVID-19 statistics. Mortality from all disease conditions rose during the pandemic, except for cancer. The largest direct impacts of the pandemic were seen in mortality from diabetes, Alzheimer’s, and heart diseases, and in age groups over 65 years. In contrast, the largest indirect consequences of the pandemic were seen in deaths from external causes, which increased by 45,300 (95% CI 30,800, 59,500) and were statistically linked to the intensity of non-pharmaceutical interventions. Within this category, increases were most pronounced in mortality from accidents and injuries, drug overdoses, and assaults and homicides, while the rate of death from suicides remained stable. Younger age groups suffered the brunt of these indirect effects. Overall, on a national scale, the largest consequences of the COVID-19 pandemic are attributable to the direct impact of SARS-CoV-2 infections; yet, the secondary impacts dominate among younger age groups, in periods of stricter interventions, and in mortality from external causes. Further research on the drivers of indirect mortality is warranted to optimize interventions in future pandemics.
Article
The global SARS‐CoV‐2/COVID‐19 Pandemic has disrupted public health, economies, and housing markets since early 2020. The shock has called forth a number of policy responses, such as moratoria on foreclosures and evictions, attempts to regulate rents and prices, and a range of subsidies on both supply and demand sides. This paper reviews the state of housing markets and discusses the expected efficacy of alternative policy measures taken or contemplated. Recognizing the provisional nature of any paper written during a large and durable ongoing shock, suggestions for additional research are provided.
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Objectives: This study examined the relationship between interruption to routine medical care during the coronavirus disease 2019 pandemic and sickness presenteeism among workers in Japan. Methods: A cross-sectional study using data obtained from an internet monitor questionnaire was conducted. Interruption to medical care was defined based on the response "I have not been able to go to the hospital or receive treatment as scheduled." The fraction of sickness presenteeism days in the past 30 days was employed as the primary outcome. A fractional logit model was used for analysis to treat bounded data. Results: Of the 27 036 participants, 17 526 (65%) were workers who did not require routine medical care, 8451 (31%) were using medical care as scheduled, and 1059 (4%) experienced interrupted medical care. The adjusted odds ratio (aOR) of sickness presenteeism was significantly higher among workers who experienced interrupted medical care (3.44; 95% confidence interval [CI]: 3.04-3.89) than those who did not require routine medical care. In terms of symptoms, the highest aOR was observed among workers with mental health symptoms (aOR: 5.59, 95% CI: 5.04-6.20). Conclusions: This study suggests the importance of continuing necessary treatment during a pandemic to prevent presenteeism.
Article
Pandemic frontline occupations consist of disproportionately low socioeconomic status and racial minority workers. Documenting occupational health disparities is therefore crucial for understanding COVID-19-related health inequalities in the United States. This study uses Current Population Survey microdata to estimate occupational differences in sickness-related absences (SAs) from work in March through June 2020 and their contribution to educational, racial-ethnic, and nativity health disparities. We find that there has been an unprecedented rise in SAs concentrated in transportation, food-related, and personal care and service occupations. SA rates were 6 times higher in these occupations than in non-health-care professions. The greatest increases were in occupations that are unsuitable for remote work, require workers to work close to others, pay low wages, and rarely provide health insurance. Workers in these occupations are disproportionately Black, Hispanic, indigenous, and immigrants. Occupation contributes 41% of the total of Black/white differences and 54% of educational differences in SAs.
Article
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In many countries of the world, COVID–19 pandemic has led to exceptional changes in mortality trends. Some studies have tried to quantify the effects of Covid-19 in terms of a reduction in life expectancy at birth in 2020. However, these estimates might need to be updated now that, in most countries, the mortality data for the whole year are available. We used data from the Human Mortality Database (HMD) Short-Term Mortality Fluctuations (STMF) data series to estimate life expectancy in 2020 for several countries. The changes estimated using these data and the appropriate methodology seem to be more pessimistic than those that have been proposed so far: life expectancy dropped in the Russia by 2.16 years, 1.85 in USA, and 1.27 in England and Wales. The differences among countries are substantial: many countries (e.g. Denmark, Island, Norway, New Zealand, South Korea) saw a rather limited drop in life expectancy or have even seen an increase in life expectancy.
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Although previous evidence suggests that the infection fatality rate from COVID-19 varies by age and sex, and that transmission intensity varies geographically within countries, no study has yet explored the age-sex-space distribution of excess mortality associated with the COVID pandemic. By applying the principles of small-area estimation to existing model formulations for excess mortality, this study develops a novel method for assessing excess mortality across small populations and assesses the pattern of COVID excess mortality by province, year, week, age group, and sex in Italy from March through May 2020. We estimate that 53,200 excess deaths occurred across Italy during this time period, compared to just 35,500 deaths where COVID-19 was registered as the underlying cause of death. Out of the total excess mortality burden, 97% of excess deaths occurred among adults over age 60, and 68% of excess deaths were concentrated among adults over age 80. The burden of excess mortality was unevenly distributed across the country, with just three of Italy’s 107 provinces accounting for 32% of all excess mortality. This method for estimating excess mortality can be adapted to other countries where COVID-19 diagnostic capacity is still insufficient, and could be incorporated into public health rapid response systems.
Article
Importance Following reductions in US ambulatory care early in the pandemic, it remains unclear whether care consistently returned to expected rates across insurance types and services. Objective To assess whether patients with Medicaid or Medicare-Medicaid dual eligibility had significantly lower than expected return to use of ambulatory care rates than patients with commercial, Medicare Advantage, or Medicare fee-for-service insurance. Design, Setting, and Participants In this retrospective cohort study examining ambulatory care service patterns from January 1, 2019, through February 28, 2021, claims data from multiple US payers were combined using the Milliman MedInsight research database. Using a difference-in-differences design, the extent to which utilization during the pandemic differed from expected rates had the pandemic not occurred was estimated. Changes in utilization rates between January and February 2020 and each subsequent 2-month time frame during the pandemic were compared with the changes in the corresponding months from the year prior. Age- and sex-adjusted Poisson regression models of monthly utilization counts were used, offsetting for total patient-months and stratifying by service and insurance type. Exposures Patients with Medicaid or Medicare-Medicaid dual eligibility compared with patients with commercial, Medicare Advantage, or Medicare fee-for-service insurance, respectively. Main Outcomes and Measures Utilization rates per 100 people for 6 services: emergency department, office and urgent care, behavioral health, screening colonoscopies, screening mammograms, and contraception counseling or HIV screening. Results More than 14.5 million US adults were included (mean age, 52.7 years; 54.9% women). In the March-April 2020 time frame, the combined use of 6 ambulatory services declined to 67.0% (95% CI, 66.9%-67.1%) of expected rates, but returned to 96.7% (95% CI, 96.6%-96.8%) of expected rates by the November-December 2020 time frame. During the second COVID-19 wave in the January-February 2021 time frame, overall utilization again declined to 86.2% (95% CI, 86.1%-86.3%) of expected rates, with colonoscopy remaining at 65.0% (95% CI, 64.1%-65.9%) and mammography at 79.2% (95% CI, 78.5%-79.8%) of expected rates. By the January-February 2021 time frame, overall utilization returned to expected rates as follows: patients with Medicaid at 78.4% (95% CI, 78.2%-78.7%), Medicare-Medicaid dual eligibility at 73.3% (95% CI, 72.8%-73.8%), commercial at 90.7% (95% CI, 90.5%-90.9%), Medicare Advantage at 83.2% (95% CI, 81.7%-82.2%), and Medicare fee-for-service at 82.0% (95% CI, 81.7%-82.2%; P < .001; comparing return to expected utilization rates among patients with Medicaid and Medicare-Medicaid dual eligibility, respectively, with each of the other insurance types). Conclusions and Relevance Between March 2020 and February 2021, aggregate use of 6 ambulatory care services increased after the preceding decrease in utilization that followed the onset of the COVID-19 pandemic. However, the rate of increase in use of these ambulatory care services was significantly lower for participants with Medicaid or Medicare-Medicaid dual eligibility than for those insured by commercial, Medicare Advantage, or Medicare fee-for-service.
Article
Objectives: We aimed to reveal how four different areas that are important in the functioning of the urology clinic (outpatient clinic, inpatient clinic, operating room, and consultations) were affected during the COVID-19 pandemic. Methods: Patients admitted to the surgical branches between March 11, 2018 and March 10, 2021 were retrospectively evaluated in terms of their demographic data. The data between these dates were analyzed by dividing the patients into three groups as Groups A, B, and C for the pandemic period, the year before the pandemic, and two years before the pandemic, respectively. Results: A total of 1,222,967 patients were included in the study. During the pandemic period, the number of urology outpatient clinic admissions decreased by more than half compared to the previous years (37,471, 93,582, and 89,031 for Groups A, B, and C, respectively). Admissions to the urology inpatient clinic decreased both numerically and proportionally when compared to the other surgical branches (1,301 [5.1%] for Group A, 3,884 [7.7%] for Group B, and 3,761 [7.7%] for Group C]). While the mortality rate did not change proportionally in the urology clinic in all groups (0.3%), it increased both numerically and proportionally in all surgical branches (339 [1.3%], 304 [0.6%], and 256 [0.5%]). Conclusions: Admissions to the urology clinic were determined to have decreased during the pandemic compared to the pre-pandemic period, especially due to restriction measures taken by countries and concerns about the unknowns of the disease. As a result of this decrease, the number of operations and the number of hospitalized patients were also reduced. Although the mortality rate was not affected in the short-term follow-up of patients, long-term outcomes remain uncertain.
Article
PURPOSE The COVID-19 pandemic has caused unprecedented health, social, and economic unrest globally, particularly affecting resource-limited low-middle–income countries. The resultant curfew had made the access to and delivery of cancer care services an arduous task. We have reported the patterns of care and 1-year outcome of head and neck squamous cell carcinoma (HNSCC) treatment before and during COVID-19 lockdown at our institution. MATERIALS AND METHODS Patients who underwent radiation therapy (RT) for nonmetastatic HNSCC between March 1, 2020, and July 31, 2020, were included in the COVID-RT group, and those who were treated between October 1, 2019, and February 29, 2020, were included in the preCOVID-RT group. RESULTS A total of 25 patients were in the COVID-RT group, and 51 patients were in the preCOVID-RT group. An increase in the incidence of locally advanced cancers across all subsites was observed in the COVID-RT group. There was a steep increase in the median overall RT treatment duration (52 v 44) and median break days during RT (10 v 2) in the COVID-RT group. The median follow-up period of all patients was 18 months. The progression-free survival at 1 year in the COVID-RT group and preCOVID-RT group was 84% and 90%, respectively ( P = .08), and overall survival at 1 year was 86% and 96%, respectively ( P = .06). CONCLUSION Our study elucidates the adverse impact of the COVID-19 curfew on cancer care and has demonstrated safe delivery of RT for HNSCC without major acute adverse effects. Despite a significant increase in treatment breaks, early outcome data also suggest that 1-year progression-free survival and overall survival are comparable with that of the pre–COVID-19 times; however, longer follow-up is warranted.
Article
Background: During COVID‑19 pandemic all countries of the world face increase in mortality of the population for different kinds of causes in comparison with previous years, but this increase could be explained not only by the registered COVID‑19 death cases. In this article the problem of excess mortality in the period of COVID‑19 pandemic for all reasons is discussed. Objective: Assessment of the average scale and structure of excess mortality in the period of COVID‑19 pandemic in terms of International Classification of Diseases – 10 (ICD‑10) in the Russian Federation and also in the certain territorial subjects of the Russian Federation including those of the Southern Federal District. Material and methods: Data of the state mortality statistics during 2019–2020 are used. Level of excess mortality was defined as a difference between the number of the dead from the particular reasons during the analyzed period of time (2020) in comparison with the same period of time in previous year. Cartograms and charts are constructed by free service Datawrapper (https://app.datawrapper. de/). Results: In total in the year 2021 there were by 340279 death cases more, than in 2019. The general average mortality rate in Russia from all kinds of causes was 1460.2 ± 299.0 (variation coefficient 0.19) in 100 thousand people. That is 19.2% higher, than in 2019 (1225.1 in 100 thousand people). In structure of the excess death reasons the first place took the death causes connected with the new coronavirus infection – 42.5% of all excessive death cases. The second and third places belong to such causes as blood circulatory system diseases (28.6%) and diseases of respiratory organs (11.0%). In 2020 the number of working‑age people who died from blood circulatory system diseases was by 23432 more, than in 2019. In some types of diseases, the level of the general mortality decreased. Malignant neoplasms dominate in terms of the decrease of the number of mortal cases – in 2020 died 2939 people less, than in 2020. At the same time, the specific weight of number of the working‑age people who died of malignant neoplasms in 2020 in comparison with 2019 increased by 1.9% and was 22.0%. The general intensive indicator of mortality across Russia in such disease as “neoplasms” in 2020 was 202.0 cases, which is 2.5% higher than a target indicator of the federal project “Fight with Oncological Diseases”. This causes the need to increase the efficiency of participants activity in implementation of this federal project. Conclusion: The pandemic of such disease as COVID‑19, disproportionately affected different territories of the country in terms of death rate of the population both from the death causes connected with the new coronavirus infection and from other reasons, first of all – from blood circulatory system diseases. Despite the additional financing of oncological service from the federal budget, during the pandemic mortality of adults of working‑age from malignant neoplasms grew, which can be connected not only with weak immune system of people with cancer but also with low efficiency of participants activity of the federal project “Fight with Oncological Diseases”.
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Traditional approaches to organizational improvisation treat it as a merely functional response to environmental constrains and unforeseen disruptions, neglecting its moral dimension, especially the valued ends improvisers aim to achieve. We attempt to address this gap by drawing on virtue ethics. In particular, we explore how phronetic improvisation is accomplished by drawing on the diary of an emergency-room physician, in which she describes her (and colleagues’) experience of dealing with Covid-19 in a New York Hospital, during the first spike in March–April 2020. We argue that improvisation is phronetic insofar as practitioners actively care for the valued ends of their practice. In particular, practitioners seek to phronetically fulfil the internal goods of their practice, while complying with institutional demands, in the context of coping with situational exigencies. Phronetic improvisation involves paying attention to what is salient in the situation at hand, while informed by an open-ended commitment to valued ends and constrained by scarce resources, and driven by a willingness to meet what is at stake through adapting general knowledge to situational demands. Such an inventive process may involve reshaping the original internal goods of the practice, in light of important institutional constrains.
Article
Accurately determining the number of excess deaths caused by the COVID-19 pandemic is hard. The most important challenge is determining the counterfactual count of baseline deaths that would have occurred in its absence. Flexible estimation methods were used here to provide this baseline number and plausibility of the resulting estimates was evaluated by examining how changes between baseline and actual prior year deaths compared to historical year-over-year changes during the previous decade. Similar comparisons were used to examine the reasonableness of excess death estimates obtained in prior research. Total, group-specific and cause-specific excess deaths in the U.S. from March 2020 through February 2021 were calculated using publicly available data covering all deaths from March 2009 through December 2020 and provisional data for January 2021 and February 2021. The estimates indicate that there were 649,411 (95% CI: 600,133 to 698,689) excess deaths in the U.S. from 3/20–2/21, a 23% (95% CI: 21%–25%) increase over baseline, with 82.9% (95% CI: 77.0% - 89.7%) of these attributed directly to COVID-19. There were substantial differences across population groups and causes in the ratio of actual-to-baseline deaths, and in the contribution of COVID-19 to excess mortality. Prior research has probably often underestimated baseline mortality and so overstated both excess deaths and the percentage of them attributed to non-COVID-19 causes.
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Background The mortality from COVID-19 alone cannot account for the impact of the pandemic. Cardiovascular disease (CVD) mortality has increased disproportionately in specific racial/ethnic populations. Objective This study aimed to characterize how the COVID-19 pandemic impacted the association between CVD mortality and social and demographic factors as characterized by the Social Vulnerability Index (SVI). Methods Medical Examiner Case Archive of Cook County, Illinois was utilized to identify CVD deaths in 2019 (pre-pandemic) and 2020 (pandemic). Rate ratios (RRs) were used to compare age-adjusted mortality rates (AAMRs). Addresses of deaths were geocoded to Chicago Community Areas. The Spearman's rank correlation coefficient (ρ) test was used to identify the association between SVI and CVD mortality. Results AAMRs of CVD deaths significantly increased among non-Hispanic Black individuals (AAMRR, 1.1; 95 % CI, 1.1–1.2) and Hispanic individuals (AAMRR, 1.8; 95 % CI, 1.5–2.1) from 2019 to 2020. Among non-Hispanic White individuals, the AAMR did not significantly increase (AAMRR, 1.0; 95 % CI, 0.9–1.1). A significant positive association was observed between SVI and the percentage of non-Hispanic Black residents (ρ = 0.45; P < 0.05), while the inverse was observed with the percentage of non-Hispanic White residents (ρ = −0.77; P < 0.05). A significant positive association between SVI and CVD mortality rate increased (ρ = 0.24 and 0.28; P < 0.05). Conclusions Significant association between SVI and CVD mortality was strengthened from 2019 to 2020, and CVD mortality increased among non-Hispanic Black and Hispanic populations. These findings demonstrate that the COVID-19 pandemic has led to an exacerbation of health inequities among different racial/ethnic populations resulting in increased CVD mortality.
Article
Introduction: To examine excess mortality among minorities in California during the COVID-19 pandemic. Methods: Using seasonal autoregressive integrated moving average time series, we estimated counterfactual total deaths using historical data (2014-2019) of all-cause mortality by race/ethnicity. Estimates were compared to pandemic mortality trends (January 2020 to January 2021) to predict excess deaths during the pandemic for each race/ethnic group. Results: Our findings show a significant disparity among minority excess deaths, including 7892 (24.6% increase), 4903 (20.4%), 30,186 (47.7%), and 22,027 (12.6%) excess deaths, including deaths identified as COVID-19-related, for Asian, Black, Hispanic, and White non-Hispanic individuals, respectively. Estimated increases in all-cause deaths excluding COVID-19 deaths were 1331, 1436, 3009, and 5194 for Asian, Black, Hispanic, and White non-Hispanic individuals, respectively. However, the rate of excess deaths excluding COVID-19 recorded deaths per 100 k was disproportionately high for Black (66 per 100 k) compared to White non-Hispanic (36 per 100 k). The rates for Asians and Hispanics were 23 and 19 per 100 k. Conclusions: Our findings emphasize the importance of targeted policies for minority populations to lessen the disproportionate impact of COVID-19 on their communities.
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This study assesses the association between underlying health conditions and delaying medical care during the COVID-19 pandemic. An online cross-sectional survey administered by OutbreaksNearMe.org on Momentive.ai collected self-reported data from April 27 to June 2, 2020 and May 10 to June 13, 2021. We used weighted multivariable logistic regressions to assess the association between delaying care and self-reported health status, adjusting for demographics. Of 312,661 total responses (99.6% completion rate), 17.1% reported delayed medical care. Compared to good health, those with poor health were more likely to delay care (AOR = 2.62, 95% CI [2.47, 2.78]). Individuals with any underlying condition (AOR = 1.62, 95% CI [1.58, 1.65]) and each of the conditions were more likely to delay care. Differences in delaying care were observed across region, year, and demographics. Our finding is that those at higher risk of severe COVID-19 were more likely to delay medical care in 2020 and 2021, which could exacerbate existing health conditions and existing disparities.
Article
Background: As the novel coronavirus disease 2019 (COVID-19) continues its pandemic surge globally, the attention toward the treatment of non-COVID diseases has become difficult. Software-based systems and social media platforms could provide alternatives for ensuring regular health-care non-COVID diseases. In this context, we evaluated our own experience with virtual consultation (VC) for the management of endocrine surgical patients during the current COVID pandemic. Materials and methods: This prospective study was conducted in the endocrine surgery department spanning 4 months from April to July 2020. We employed WhatsApp-based group video conferencing for VC with both new and follow-up outpatients. We evaluated the satisfaction quotient of patients, regarding the three types of consultations (no consultation, VC, and direct consultation) on an ordinal scale of three modes of consultation. Results: Virtual consultation was performed with 102 new and 285 follow-up patients. Goiters, clinical findings, and wounds/scars (in post-operative cases) were evaluated virtually. Dosage of thyroxine replacement, calcium supplementation, and other medications was prescribed based on findings and history. Patients who needed surgery (25/102 cases) were given appropriate appointment. More than 82% of the patients in both groups preferred VC during this COVID pandemic. Conclusions: More than 82% of both new and follow-up patients preferred VC over direct or no consultation during this COVID pandemic. Our findings suggest that VC through social media platforms is capable of ensuring appropriate treatment and follow-up for endocrine diseases.
Article
Objectives: Consumption of high potency alcohol is associated with greater healthcare burden, yet little attention has been placed on the change in types of alcohol consumed during the COVID-19 pandemic. We estimate the change in alcohol consumption by beverage type attributable to the COVID-19 pandemic. Methods: The National Institute on Alcohol Abuse and Alcoholism provided apparent alcohol consumption ("consumption") by beverage type for 10 states for January 2017 through November 2020 based on sales and tax data. The 38-month period to February 2020 was used to train quasi-Poisson regression models. The models then predicted the monthly consumption based on the historical trends in the absence of the COVID-19 pandemic from March through November 2020. The difference between the observed and predicted is the change in consumption attributable to the COVID-19 pandemic. Results: Beyond what was expected based on historical trends, spirits consumption increased significantly for 6 states (Colorado, Massachusetts, Missouri, North Dakota, Minnesota, and Tennessee) ranging from 4% (95% confidence interval [CI] 1%-6%) to 17% (95% CI 6%-28%) which is equivalent to 7 (95% CI 2-18) to 32 (95% CI 12-48) excess standard spirits drinks per-capita; Alaska, Florida, Illinois, and Kentucky had no significant change. Wine consumption increased 10% (95% CI 3%-18%) in Colorado and 8% (95% CI 3%-12%) in Tennessee. Wine consumption in Alaska decreased 6% (95% CI, 3%-10%) and beer consumption decreased 8% (95% CI 4%-11%). Conclusions: During the COVID-19 pandemic, spirits consumption increased relative to wine and beer. Increased consumption of higher potency alcohol beverages could lead to higher alcohol-related healthcare and societal burden.
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Introduction In April 2020, novel coronavirus SARS-Co-V-2 (COVID-19) produced an ongoing mass fatality event in New York. This overwhelmed hospital morgues necessitating emergent expansion of capacity in the form of refrigerated trucks, trailers, and shipping containers referred to as body collection points (BCPs). The risks for musculoskeletal injury during routine and mass fatality mortuary operations and experiences of decedent handlers throughout the "first wave" of COVID-19 are presented along with mitigation strategies Methods Awareness of the high rates of musculoskeletal injury among health care workers due to ergonomic exposures from patient handling, including heavy and repetitive manual lifting, prompted safety walkthroughs of mortuary operations at multiple hospitals within a health system in New York State by workforce safety specialists. Site visits sought to identify ergonomic exposures and ameliorate risk for injury associated with decedent handling by implementing engineering, work practice, and administrative controls. Results Musculoskeletal exposures included manual lifting of decedents to high and low surfaces, non-neutral postures, maneuvering of heavy equipment, and push/pull forces associated with the transport of decedents Discussion Risk mitigation strategies through participatory ergonomics, education on body mechanics, development of novel handling techniques implementing friction-reducing aides, procurement of specialized equipment, optimizing BCP design, and facilitation of communication between hospital and system-wide departments are presented along with lessons learned. After-action review of health system workers' compensation data found over four thousand lost workdays due to decedent handling related incidents, which illuminates the magnitude of musculoskeletal injury risk to decedent handlers.
US Census Bureau website
  • Quickfacts
QuickFacts: New York City, New York. US Census Bureau website. Accessed May 15, 2020. https://www.census.gov/quickfacts/newyorkcitynewyork