Lockdown Period Research Articles

Ten Year Time Trends of Amputation Surgery in Peripheral Arterial Disease in Germany: Before and During the COVID-19 Pandemic

Peripheral arterial disease (PAD) has been associated with suboptimal treatment, high mortality, and high amputation rates. It is unclear how the COVID-19 (coronavirus disease 2019) pandemic affected this development in a long term context. This is a registry based, retrospective, nationwide cohort study including patients hospitalised with PAD as a main or secondary diagnosis and amputation surgery between 2012 - 2021 in Germany. Primary endpoints were population wide major and minor amputation rates, in hospital death, and in hospital mortality rates. Secondary endpoints were same admission revascularisations and in hospital death in the event of complications, i.e., failure to rescue (FTR). Pre-pandemic and pandemic trends, focusing on lockdown periods, were analysed. A total of 365 926 patient records with PAD and amputation surgery were analysed. The median patient age was 75 years and 28.8% were female. Overall population wide amputation and in hospital mortality rates (monthly decrease -0.002/100 000, p < .001, and -0.001/100 000, p< .001, respectively) and in hospital mortality rate (8.0% for 2012 - 2014 vs. 6.5% for 2020 - 2021; p < .001) declined between 2012 and 2020. Concurrently, same admission revascularisations increased (41.0% for 2012 - 2014 vs. 47.0% for 2020 - 2021; p < .001), while FTR decreased in a subset of complications (acute ischaemia, major bleeding, compartment syndrome, and mesenterial ischaemia). In the first pandemic lockdown, there was a temporary trend changeto higher major amputations rates (+0.02/100 000; p < .001) and higher in hospital mortality rates (+0.007/100 000; p < .001), which changed to a decrease as of the second lockdown (-0.03/100 000, p= .034, and -0.010/100 000, p < .001, respectively) in an interrupted time series analysis. There was no statistically significant change in observed amputation rates during lockdowns, while observed in hospital mortality rates decreased by 12.0% in the first lockdown (0.22/100 000 vs. 0.25/100 000; p= .005) compared with reference periods of the two previous years. Between 2012 and 2021, pre-pandemic trends toward decreasing population wide overall amputation rates, fewer major amputations, more amputation related revascularisation procedures, and lower in hospital mortality were maintained despite a temporary trend to increased major amputations and in hospital mortality during the first COVID-19 related lockdown in Germany.

Effect of COVID-19 Pandemic Lockdown on Emergency Medical Service Utilisation, and Percutaneous Coronary Intervention Volume—An Australian Perspective

Acute coronary syndrome (ACS) admissions and percutaneous coronary intervention (PCI) volume declined during periods of COVID-19 lockdown internationally in 2020. The effect of lockdown on emergency medical service (EMS) utilisation, and PCI volume during the initial phase of the pandemic in Australia has not been well described. We analysed data from the Victorian Cardiac Outcomes Registry (VCOR), a state-wide PCI registry, linked with the Ambulance Victoria EMS registry. PCI volume, 30-day major adverse cardiovascular and cerebrovascular events (MACCE; composite of mortality, myocardial infarction, stent thrombosis, unplanned revascularisation, and stroke), and EMS utilisation were compared over four time periods: lockdown (26 Mar 2020-12 May 2020); pre-lockdown (26 Feb 2020-25 Mar 2020); post-lockdown (13 May 2020-10 Jul 2020); and the year prior (26 Mar 2019-12 May 2019). Interrupted time series analysis was performed to assess PCI trends within and between consecutive periods. The EMS utilisation for ACS during lockdown was higher compared with other periods: lockdown 39.4% vs pre-lockdown 29.7%; vs post-lockdown 33.6%; vs year prior 27.1%; all p<0.01. Median daily PCI cases were similar: 31 (IQR 10, 38) during lockdown; 39 (15, 49) pre-lockdown; 39.5 (11, 44) post-lockdown; and, 42 (10, 49) the year prior; all p>0.05. Median door-to-procedure time for ACS indication during lockdown was shorter at 3 hours (1.2, 20.6) vs pre-lockdown 3.9 (1.7, 21); vs post-lockdown 3.5 (1.5, 21.26); and, the year prior 3.5 (1.5, 23.7); all p<0.05. Lockdown period was associated with lower odds for 30-day MACCE compared to pre-lockdown (odds ratio [OR] 0.55 [0.33-0.93]; p=0.026); post-lockdown (OR 0.66; [0.40-1.06]; p=0.087); and the year prior (OR 0.55 [0.33-0.93]; p=0.026). Contrary to international trends, EMS utilisation for ACS increased during lockdown but PCI volumes remained similar throughout the initial stages of the pandemic in Victoria, with no observed adverse effect on 30-day MACCE during lockdown. These data suggest that the public health response in Victoria was not associated with poorer quality cardiovascular care in patients receiving PCI.

Impact of Universal Masking by Healthcare Personnel on Non-SARS-CoV-2 Healthcare-Associated Viral Respiratory Infections

Background: The impact of universal masking on transmission of endemic respiratory viruses in children’s hospitals is unknown. Our objective was to measure the association between universal masking by healthcare personnel and the incidence of non-SARS-CoV-2 healthcare-associated viral respiratory infections (HA-VRIs) in a free-standing academic pediatric medical center during the COVID-19 pandemic. Methods: In this quasi-experimental study, we measured the incidence rate of non-SARS-CoV-2 HA-VRIs (VRI diagnosed on or after hospital day 3 by one of several molecular assays) during three time periods: prior to the COVID-19 pandemic (pre-intervention: September 2013 - February 2020); during universal masking (intervention: May 2021 - March 2023); and after universal masking was lifted (post-intervention: April 2023 - November 2023). Although universal masking was implemented in late March 2020, we exclude the lockdown period of strict COVID-19-related public health mitigations (i.e., school closures and shelter-in-place advisories) during which community prevalence of non-SARS-CoV-2 respiratory viruses was minimal in our region (March 2020 to April 2021). By negative binomial regression analysis, we compared the level and trend of HA-VRIs between the pre-intervention and intervention periods. Results: Figure 1 illustrates the incidence rate of non-SARS-CoV-2 HA-VRI during the pre-intervention, lockdown, intervention, and post-intervention periods. The aggregate non-SARS-CoV-2 HA-VRI incidence rate during the pre-intervention, intervention, and post-intervention periods was 1.25, 1.84, and 1.96 HA-VRIs per 1000 patient days, respectively. There was no significant difference in the level (p = 0.96) or trend (p = 0.67) of HA-VRI incidence rate between the pre-intervention and intervention periods. Conclusion: Universal masking was not associated with a decrease in the incidence rate of non-SARS-CoV-2 HA-VRIs at our children’s hospital during the COVID-19 pandemic. These findings suggest that universal masking may not be an effective infection prevention measure in children’s hospitals during periods of increased endemic respiratory viral transmission in the community.Disclosure: Larry Kociolek: Research Support - Merck

Women and care ethics during the COVID-19 pandemic: Who cares for the care-givers?

Caring is a general ethical responsibility that makes human existence worthwhile and fulfilling. Whenever society is distressed be it by a famine, war, poverty or a pandemic, the impact falls hard on women, children and people living with disability. We all need to be cared for and we owe the same obligation to others, especially those who care for us. However, during crises, the ethics of care becomes integral and, more often, men are not readily available to offer it. Arguably, the duty to care is one of the most compelling obligations that make human and non-human beings survive any form of distress. However, it is unfortunate that women face more of the brunt of the requirements of the duty to care than their male counterparts, particularly in the home front. This was most evident during the COVID-19 pandemic, when most ill persons were kept in the home because healthcare institutions were overwhelmed with numbers of infected persons scrambling for limited and non-existent resources. The pressure was not only on scarce resources, but COVID-19 also brought into sharp focus the need for better care for those who care for the sick in the home, especially during times of national distress. This article is a critical reflection on the impact of COVID-19 on women healthcare providers (HCPs) caring for the sick in the home. It particularly focuses on the caring burden created by COVID-19 and how it impacted on women’s mental health acknowledging that, currently, there is limited feminist analysis of moral distress among women healthcare providers in rural communities and healthcare institutions. Through the ethics of care theory and the feminist political economy lens, the article further explores the care challenges faced by women during the COVID-19 lockdown period. The article employs in-depth interviews and focused group discussions as the methods of data collection. It also proffers interventionist strategies that could be employed to lessen the burden of care on women. The findings show that more women healthcare givers suffered a lot of pressure from the impact of COVID-19 since they received little recognition and appreciation from both patients and the healthcare institutions they worked for.

COVID-19, Christian Women and Mental Health: An African Interventionist Response

Mental health is posited as a vital constituent of health and well-being. Good mental health is represented by a balance between the mind, body, spirit and context which should all be in tangent. Globally, it has been noted that mental disorders rank among the top ten leading causes of health encumbrance. This dire situation has been compounded by the novel COVID-19 pandemic outbreak which exacerbated the global number of mental disorders, with women carrying a higher risk due to their role as primary caregivers. Using a phenomenological study and drawing from Christian women in Harare, this study sought to explore the common risk factors that expose women to the possibility of developing mental health disorders. Research findings indicated varied stressors including gender-based roles, intimate partner violence, lower socio-economic status and household financial instability due to the COVID-19 induced economic recession during the COVID-19 lockdown period as triggers of mental health disorders. Religio-cultural factors, stigma and discrimination associated with mental health disorders were equally identified as inhibitors to women’s mental healthcare needs. Study participants also cited heightened reverence to God as well as the use of indigenous practices as coping mechanisms. Such a scenario brought to the fore a practice of religious syncretism among the research participants. The study therefore recommends gender-sensitive as well as culturally-sensitive mental health coping mechanisms and practices to mitigate the challenge of mental disorders, especially among women.

Lockdown and Social Work Students: A study on the perception of Social Work students about Lockdown during the COVID-19 outbreak

COVID-19 is not only a health-related issue but it has come along with a couple of problems to everyone may it be children, youth, adults (women, men), or elderly but only youth and students of social work in particular are considered in the present study. The researcher has taken into consideration the students of social work as students are viewed as the future of any nation and when the students are from the field of social work, they are expected to work for the betterment of society, hence their perception and their viewpoints both are important. Many researches have been made to acknowledge the situation of youth, their coping strategies, and suggested interventions during this pandemic, while majority of researches focus on mental health and fewer studies shows the overall challenges on youth and on social work students in particular nor about the contribution of social workers towards society betterment. The present study is designed keeping in view the above-mentioned gaps and thus framed the objectives based on these gaps pertaining to the purpose of the study. Objectives: The present study aimed to focus on the following domains of the pandemic situation: 1. To explore the lived experiences of social work students during lockdown. 2. To determine the various challenges faced by the social work students during COVID-19 Pandemic. 3. To ascertain any contribution(s) made by the social work students towards society during COVID-19 Pandemic. 4. To know about any change into the lives of social work students in post-lockdown period. 5. To collect a viewpoint of social work students about their perception of public reaction during and after lockdown. Methodology: The present study was conducted with the students of social work and was purely quantitative in nature. The questionnaire pertaining to the independent and dependent variables and related to the objectives of the study was prepared via google forms and the link was then sent to 120 social work students from different universities of north India through email out of 87 were received back with fully informed consent. The spread sheet of the data collected was then extracted from google forms which was then edited, classified and analyzed using Microsoft Excel and tabulated for univariate and multivariate data analysis. Results: Results shows that the students of social work have experienced various challenges during the lockdown period. These challenges were categorized as physical, psychological, financial and the studies related issues. Major problems experienced by the social work students were physical inactivity (60.9%) and due to that they are gaining weight leading to obesity (42.5%). To cope up with these problems, majority of the students opted for yoga, and exercise (43.68%). Talking about psychological problems, the students developed stress (56.32%) and anxiety (40.23%). Attending online classes is an added challenge for students as it is a new concept and out of the routine activity and thus, they face difficulty in concentration (63.22%) as there are several distractions present at home (44.83%). Majority of the students complained that their studies got affected in online classes as there was signal problem (66.67%). Sitting at one place for the whole day leads to back pain and increased screen time for the attending online leads to impact the eyesight of the students (32.18%). Besides, the student social workers reported that they have developed a distance from their social relations (37.93%) and they are experiencing social isolation (20.69%). Financial depreciation was most common among general public and so on students as they reported that they were not getting pocket money due to financial crisis in their families. Besides all these problems the student social worker have done their duty and majority have contributed to the society in one or the other way. When lockdown got over, majority (74.71%) of the student got relaxed and felt that their life will get resumed now while 25.29% were still anxious. Majority (80.46%) have started their concurrent fieldwork with all the precautionary measures. The students’ perception regarding public behavior was also assessed and they perceived that 59.77% public was relaxed to hear that the lockdown is over and feel that COVID-19 is over while the rest 40.23% were showing the same behaviour as earlier; aggressive, irritable and anxious about the disease.

Learning in Times of Crisis: Insights into Student, Teacher, and Parent Experiences in Uttarakhand's Educational System during the COVID-19 Pandemic

The COVID-19 pandemic, declared in 2020, posed unprecedented challenges globally. Governments throughout the world adopted steps to lessen the effect of the infectious sickness brought on by the SARS-CoV-2 virus, including extensive lockdowns and closures of educational institutions. The current study looks at the effects of the pandemic on the educational landscape of Uttarakhand, an area distinguished by its distinct physical and socioeconomic characteristics. Amidst the closure of schools and universities, the transition to online learning became the norm, presenting significant hurdles for students, teachers, and parents, particularly in areas with limited access to digital resources. This study, based on a sample of 667 respondents, employs the snowball sampling method to examine the experiences and challenges faced by stakeholders in Uttarakhand's educational system during the lockdown period. By exploring the multifaceted impacts on learning environments, instructional delivery, and parental involvement, this research aims to provide valuable insights into the adaptation strategies and resilience of individuals within the education sector during times of crisis.

Gendering, Jeering, and COVID-19: A Feminist Critique of Social Media Humor

This study aims to shed light on the stereotypical gender identities presented in the online humor regarding Coronavirus disease 2019 (COVID-19) in Pakistan. To uncover gender stereotypes, Feminist Critical Discourse Analysis provided a theoretical background for this study.The data consisted of 42 posts from social media (Facebook and WhatsApp)that were collected through purposive quota sampling during the lockdown period in Pakistan. These posts were divided into twleve thematic categories. A culturematic content analysis of the posted jokes revealed that Corona related social media humor is unanimously dedicated to creating a face-threatening image of females, especially wives. This article argues that wives are being constructed as callous, impatient, and materialistic beings through corona joke-posts.The study provides an insight into how jokes are ascribing gender identities of women, especially wives in a destructive persona.Such consistent negative representation of particular identities may result in severe emotional and psychological effects on both genders and increased marital conflicts. The study suggests that there should be balanced and positive discourses onmedia and other institutions to foster positive attitudes towards gender and marital identities in Pakistani society in specific and the world over in general.

Parenting during the Covid-19 Pandemic: Family Changes, Challenges and Resilience

The COVID-19 pandemic led to unprecedented measures and restrictions that disrupted families' lives, forcing them to reorganize their routines. This study investigated the parenting experiences in terms of changes and challenges, including positive effects and family resilience indicators. Unlike most studies which have limited their focus to the first period of lockdown or are based on questionnaires, this study covers the period from the first to the fifth wave of the pandemic in France (March 2020-November 2021) and relies on a large qualitative survey. 282 French parents living at home with at least one child under 18 years of age participated in the study. On an online platform, parents were asked to answer two open-ended questions. A thorough coding of the verbatim was carried out according to an empirical-inductive approach by two independent raters. The qualitative results were completed by quantitative analyses. Four major themes emerged from the responses to the first question (perceived improvement, perceived deterioration, no perceived change, and mixed feelings), and five challenges were identified for the second question (organizational challenges, family challenges, psychological challenges, health challenges, and no challenge). Parents reported more improvements in their parenting experience than deteriorations. Organizational challenges were mentioned more than twice as often as health challenges. Nearly a quarter of participants declared no perceived change in their lives as parents. It appears that French parents were able to tap into their resources without reducing their parenting abilities, and for many of them, this also resulted in improved parenting. After the severe lockdowns, the pandemic's progression revealed ongoing challenges and opportunities to strengthen family resilience. Despite initial relief, the pandemic left lasting impacts on family dynamics, with studies noting improvements in organization and reduced stress, but also ongoing difficulties in readjusting routines and concerns about children's well-being.

Exploring the Factors Influencing Blame Attribution and Attitudes Toward Brands with COVID-19 Semantical Associations: A Study During the Lockdown Period

Exploring the Factors Influencing Blame Attribution and Attitudes Toward Brands with COVID-19 Semantical Associations: A Study During the Lockdown Period

Determinants of Perceived Stress among Indian Adults during Second Wave of COVID-19

The present study was conducted from June–July, 2021 in online mode and a questionnaire was designed at the Department of Food Science and Nutrition, College of Community Science, G. B. Pant University of Agriculture and Technology, Pantnagar. The study aims to find an association of perceived stress with socio-demographic factors, health profile and physical activity among Indian adults during the second wave of COVID-19. Data on perceived stress was collected through an online cross-sectional survey of 1933 Indian adults based on the Perceived Stress Scale (PSS). Multivariate ordinal regression was conducted to identify the predictors of perceived stress. Indian adults were moderately stressed, with a mean PSS score of 19.7±5.5 during the crisis time of COVID-19. The study population remained moderately active (59.3%) during the lockdown period. Perceived stress was negatively associated with age, education, income, and physical activity and positively associated with random blood sugar levels and sitting time. Odds of perceived stress increased with female gender, separated marital status, having one child or adolescent in the family, graduate or postgraduate as the educational status of the family’s head, and increased sitting time. High educational status, retirement, regular employment, middle or lower-class social class, and high physical activity level were negative predictors of perceived stress. The current investigation highlights the role of multiple factors in the perception of stress and the need for tailored interventions for vulnerable groups focusing on education and physical activity.

Trends in obesity among 4-year-old children in New Zealand-pre- and post-COVID comparison.

We described long-term trends in obesity using preschool data from New Zealand and compared rates pre- and post-COVID by key demographic variables. Growth data from the B4 School Check (B4SC) information system for the period 1 July 2012 to 30 June 2022 were used to calculate obesity rates. The date 25 March 2020 was the threshold used to compare the rates between pre- and post-COVID periods. Obesity rate ratios for these two periods were calculated for each demographic sub-group. The overall obesity rate increased by 1.8% after COVID-19. Males had higher obesity rates and a greater absolute increase (2%) in the post-COVID period. The greatest absolute increase in obesity was among Pacific peoples (4.3%), followed by Māori (2.2%). Children in most deprived areas and those in the Auckland Region had greater absolute increases of 3% and 2.5% respectively, post-COVID. The COVID-19 lockdown has had an immediate impact on obesity rates among 4-year-old children, especially for the Pacific population, those living in high deprivation areas and regions with longer periods of lockdown (Auckland). There are implications for public health policy and practice to support children in adopting a healthy lifestyle, especially during pandemics.

A mathematical model of mobility-related infection and vaccination in an epidemiological case

In this study, we established a system of differential equations with piecewise constant arguments to explain the impact of epidemiological transmission between different locations. Our main goal is to look into the need for vaccines as well as the necessity of the lockdown period. We proved that keeping social distance was necessary during the pandemic spread to stop transmissions between different locations and that re-vaccinations, including screening tests, were crucial to avoid reinfections. Using the Routh-Hurwitz Criterion, we examined the model’s local stability and demonstrated that the system could experience Stationary and Neimark-Sacker bifurcations depending on certain circumstances.

Life style changes during lockdown period of COVID 19 outbreaks in Tamil Nadu, India: A web-based survey

Life style changes during lockdown period of COVID 19 outbreaks in Tamil Nadu, India: A web-based survey

Digestive and breast cancer patients managed during the first wave of COVID-19 pandemic: Short and middle term outcomes.

The first wave of coronavirus disease 2019 (COVID-19) pandemic in Spain lasted from middle March to the end of June 2020. Spanish population was subjected to lockdown periods and scheduled surgeries were discontinued or reduced during variable periods. In our centre, we managed patients previously and newly diagnosed with cancer. We established a strategy based on limiting perioperative social contacts, preoperative screening (symptoms and reverse transcription-polymerase chain reaction) and creating separated in-hospital COVID-19-free pathways for non-infected patients. We also adopted some practice modifications (surgery in different facilities, changes in staff and guidelines, using continuously changing personal protective equipment…), that supposed new inconveniences. To analyse cancer patients with a decision for surgery managed during the first wave, focalizing on outcomes and pandemic-related modifications. We prospectively included adults with a confirmed diagnosis of colorectal, oesophago-gastric, liver-pancreatic or breast cancer with a decision for surgery, regardless of whether they ultimately underwent surgery. We analysed short-term outcomes [30-d postoperative morbimortality and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection] and outcomes after 3 years (adjuvant therapies, oncological events, death, SARS-CoV-2 infection and vaccination). We also investigated modifications to usual practice. From 96 included patients, seven didn't receive treatment that period and four never (3 due to COVID-19). Operated patients: 28 colon and 21 rectal cancers; laparoscopy 53.6%/90.0%, mortality 3.57%/0%, major complications 7.04%/25.00%, anastomotic leaks 0%/5.00%, 3-years disease-free survival (DFS) 82.14%/52.4% and overall survival (OS) 78.57%/76.2%. Six liver metastases and six pancreatic cancers: no mortality, one major complication, three grade A/B liver failures, one bile leak; 3-year DFS 0%/33.3% and OS 50.0%/33.3% (liver metastases/pancreatic carcinoma). 5 gastric and 2 oesophageal tumours: mortality 0%/50%, major complications 0%/100%, anastomotic leaks 0%/100%, 3-year DFS and OS 66.67% (gastric carcinoma) and 0% (oesophagus). Twenty breast cancer without deaths/major complications; 3-year OS 100% and DFS 85%. Nobody contracted SARS-CoV-2 postoperatively. COVID-19 pandemic-related changes: 78.2% treated in alternative buildings, 43.8% waited more than 4 weeks, two additional colostomies and fewer laparoscopies. Some patients lost curative-intent surgery due to COVID-19 pandemic. Despite practice modifications and 43.8% delays higher than 4 weeks, surgery was resumed with minimal changes without impacting outcomes. Clean pathways are essential to continue surgery safely.

Influence of the COVID-19 Pandemic on Patients with Rectal Cancer.

Objectives: The COVID-19 pandemic and its associated restrictions have resulted in delayed diagnoses across various tumor entities, including rectal cancer. Our hypothesis was based on the expectation of a reduced number of primary operations due to higher tumor stages compared to the control group. Methods: In a single-center retrospective study conducted from 1 March 2018 to 1 March 2022, we analyzed 120 patients with an initial diagnosis of rectal cancer. Among them, 65 patients were part of the control group (pre-COVID-19), while 55 patients were included in the study group (during the COVID-19 pandemic). We compared tumor stages, treatment methods, and complications, presenting data as absolute numbers or mean values. Results: Fewer primary tumor resections during the COVID-19 pandemic (p = 0.010), as well as a significantly lower overall number of tumor resections (p = 0.025) were seen compared to the control group. Twenty percent of patients in the COVID-19 group received their diagnosis during lockdown periods. These patients presented significantly higher tumor stages (T4b: 27.3% vs. 6.2%, p = 0.025) compared to the control group prior to the pandemic. In addition, more patients with angiolymphatic invasion (ALI) were identified in the COVID-19 group following neoadjuvant treatment compared to the control group (p = 0.027). No differences were noted between the groups regarding complications, stoma placement, or conversion rates. Conclusions: The COVID-19 pandemic, particularly during lockdown, appears to have contributed to delayed diagnoses, resulting in higher tumor stages and a decreased number of surgeries. The quality of rectal cancer treatment can be maintained under pandemic conditions.

Initiating immunoglobulin replacement therapy helps reduce severe infections and shifts healthcare resource utilization to outpatient services among US patients with inborn errors of immunity

Aims Patients with inborn errors of immunity (IEI) are predisposed to severe recurrent/chronic infections, and often require hospitalization, resulting in substantial burden to patients/healthcare systems. While immunoglobulin replacement therapies (IgRTs) are the standard first-line treatment for most forms of IEI, limited real-world data exist regarding clinical characteristics and treatment costs for patients with IEI initiating such treatment. This retrospective analysis examined infection and treatment characteristics in US patients with IEI initiating IgRT with immune globulin infusion (human), 10% (IG10%). Healthcare resource utilization (HCRU) and associated costs before and after treatment initiation were compared. Additionally, the impact of COVID-19 on infection diagnoses was evaluated. Methods Patients with IEI initiating IG10% between July 2012 and August 2019 were selected from Merative MarketScan Databases using diagnosis/prescription codes. Patients were followed 6 months before and after first IG10% claim date. Demographic and clinical characteristics were described. Treatment characteristics and HCRU before and after IG10% initiation were compared. Infection diagnoses during 2020 and 2019 (March–December) were compared. Results The study included 1,497 patients with IEI diagnoses (mean age = 43.4 years) initiating IG10%, with frequently reported comorbidities like asthma (32.1%). Following IG10% initiation, fewer severe infection diagnoses (11.6% vs 19.9%), fewer infection-related inpatient (10.8% vs 19.5%) and outpatient services (71.6% vs 79.9%), and lower infection-related total healthcare costs ($7,849 vs $13,995; p < 0.001)—driven by lower inpatient costs ($2,746 vs $9,900)—were observed than before. Fewer patients had infection diagnoses during COVID-19 (22.8%) than the prior year (31.2%). Conclusion Patients with IEI are susceptible to severe infections leading to high disease burden and treatment costs. Following IG10% initiation, we observed fewer infections, lower infection-related treatment costs, and shift in care (inpatient to outpatient) leading to significant cost savings. Among patients with IEI, 27% fewer infection diagnoses were observed during the early COVID-19 lockdown period than the prior year.

Transformations in participation, creative and political practices in the punk scene in Bogotá during the COVID-19 pandemic

This article studies the effects of the COVID-19 pandemic through its different phases by looking at the case of Bogotá’s punk scene and analysing the activities of different collectives involved in the organization of music shows and other types of gatherings. We contribute to understanding those effects by answering the question of how the pandemic has transformed the creative, collaborative and political practices of its participants. We consider four periods of analysis: pre-pandemic, lockdown, new normal and post-peak reactivation. We use a mixed methodology comprising interviews with members of the collectives and the analysis of secondary data obtained from the social media posts made by these collectives. We use the latter to compare audience participation and reactions before, during and after the COVID-19 lockdown period with data from 2019, 2020 and 2021. A network analysis confirms the existence of a network of collectives identifiable as a central node of the punk scene. We find that remote activities were never considered more than a temporary and imperfect alternative from creative, political and economic perspectives. Economic impacts were severe and led to the closure of several collectives. Though a political discourse was not articulated as such by the scene, political thought and action aligned with social protests in Colombia and unified in opposition to market-oriented government policies in the cultural field. A slow return to in-person activities took place in the scene, leaving remote events behind, re-establishing live music at the centre of the scene and allowing for informal socialization among creators, producers and audiences. By looking at the three effects globally, we conclude that the punk scene did not recover completely and did not reach the level of organization it had before the pandemic.

Global health benefits of shipping emission reduction in early 2020

The impact of COVID-19 lockdown on the absolute concentration of air pollutant has been widely investigated, whereas the impact of lockdown on global shipping-related air pollutants still remained poorly understood because the contribution of individual source cannot be observed directly. In our study, we employed an efficient chemical transport model (GEOS-Chem) to quantify the shipping-related PM2.5, NO2, and O3 levels in early 2019 and 2020, and assessed the impact of COVID-19 lockdown on global shipping-related air pollutants and health effects. The result suggested that shipping-related global PM2.5, NO2, and O3 levels reduced by 14%, 85%, and 1%, respectively. Furthermore, the decreasing ratios of air pollutants in difference regions often suffered from large spatial discrepancy. PM2.5 and NO2 levels in China, India, Europe, and the United States decreased by 6.5% (NO2: 9%), 7.4% (8%), 11% (8.6%), and 15% (10%), which could be caused by dense shipping activities during the non-lockdown period. For O3 concentrations, the shipping-related concentrations in China, India, Europe, and the United States showed 0.7%, −12.9%, 16.6%, and −4.8% during lockdown period, respectively. The relatively slight O3 reduction might be linked with more significant decrease of NOx emission than VOCs. The changes of air pollutant concentrations inevitably led to the variations of health benefits. Globally, the all-cause mortalities caused by shipping-related PM2.5 exposures reached 40,464 (95% CI: 26,546, 54,382) and 39,035 (95% CI: 25,135, 52,935) cases in early 2019 and 2020, respectively. The combined health benefits of PM2.5, NO2, and O3 linked with shipping emission reduction in China, India, Europe, and the United States reached 476 (95% CI: 131, 822), 3341 (95% CI: 3,177, 3505), 2194 (95% CI: −970, 5358), and 311 (95% CI: 242, 379), respectively. Our study confirms the potentially considerable effects of shipping emission on multiple air pollutants and health impacts, which could provide valuable information for air quality management.

RATE OF COVID-19 INFECTION AND 30-DAY MORTALITY BETWEEN BLUE AND GREEN (DEDICATED COVID-19 FREE) PATHWAYS: RESULTS FROM UK-FALCON AUDIT

ObjectivesThe primary aim was to determine the differences in COVID-19 infection rate and 30 day mortality in patients undergoing foot and ankle surgery between different treatment pathways over the two phases of the UK-FALCON audit, spanning the first and second national lockdowns.DesignMulticentre retrospective national audit.SettingThis was a combined retrospective (Phase 1) and prospective (Phase 2) national audit of foot and ankle procedures in the UK in 2020.ParticipantsAll adult patients undergoing foot and ankle surgery in an operating theatre during the study period included from 46 participating centres in England, Scotland, Wales and Northern Ireland. Patients were categorised as either a green pathway (designated COVID-19 free) or blue pathway.Results10,846 patients were included, 6,644 from phase 1 and 4,202 from phase 2. Over the 2 phases the infection rate on a blue pathway was 1.07% (69/6,470) and 0.21% on a green pathway (9/4,280). In phase 1, there was no significant difference in the COVID-19 perioperative infection rate between the blue and green pathways in any element of the first phase (pre-lockdown (p = .109), lockdown (p = .923) or post-lockdown (p = .577)). However, in phase 2 there was a significant reduction in perioperative infection rate when using the green pathway in both the pre-lockdown (p &lt; .001) and lockdown periods (p &lt; .001). There was no significant difference in COVID-19 related mortality between pathways.ConclusionsThere was a five-fold reduction in the perioperative COVID-19 infection rate when using designated COVID-19 green pathways; however the success of the pathways only became significant in phase 2 of the study. The study shows a developing success in using green pathways in reducing the risk to patients undergoing foot and ankle surgery.