non-COVID Deaths Research Articles

Medical visits and mortality among dementia patients during the COVID-19 pandemic compared to rates predicted from 2019

BackgroundDuring the COVID-19 pandemic, patients with Alzheimer’s disease and related dementias (ADRD) were especially vulnerable, and modes of medical care delivery shifted rapidly. This study assessed the impact of the pandemic on care for people with ADRD, examining the use of primary, emergency, and long-term care, as well as deaths due to COVID and to other causes.MethodsAmong 4.2 million beneficiaries aged 66 and older with ADRD in traditional Medicare, monthly deaths and claims for routine care (doctors’ office and telehealth visits), inpatient/emergency department (ED) visits, and long-term care facility use from March or June 2020 through December 2022 are compared to monthly rates predicted from January–December 2019 using OLS and logistic/negative binomial regression. Correlation analyses examine the association between excess deaths — due to COVID and non-COVID causes — and changes in care use in the beneficiary’s state of residence.ResultsIncreased telehealth visits more than offset reduced office visits, with primary care visits increasing overall (by 9 percent from June 2020 onward relative to the predicted rate from 2019, p < .001). Emergency/inpatient visits declined (by 9 percent, p < .001) and long-term care facility use declined, remaining 14% below the 2019 trend from June 2020 onward (p < .001). Both COVID and non-COVID deaths rose, with 231,000 excess deaths (16% above the prediction from 2019), over 80 percent of which were attributable to COVID. Excess deaths were higher among women, non-White patients, those in rural and isolated zip codes, and those with higher social deprivation index scores. States with the largest increases in primary care visits had the lowest excess deaths (correlation -0.49).ConclusionsOlder adults with ADRD had substantial deaths above pre-pandemic projections during the COVID-19 pandemic, 80 percent of which were attributed to COVID-19. Routine care increased overall due to a dramatic increase in telehealth visits, but this was uneven across states, and mortality rates were significantly lower in states with higher than pre-pandemic visits.

Final assessment of the COVID-19 pandemic impact between the different social and economic strata population of the city of Buenos Aires

BackgroundDuring the pandemic, epidemiological communications reported an estimation of excess deaths. However, the final calculation requires a detailed analysis. The study aim was to ascertain the number and distribution of COVID-19 fatalities among various socio-economic strata in a large, moderate to low-income city. Study designObservational time series analysis in a large city, treated as a natural experiment. MethodsAnalysis of death certificates, demographic data, and health system records of positive RT-PCR COVID-19 tests from 2015 to 2021, categorizing by age, sex, and place of residence. The study measured the pandemic's impact on mortality, including COVID and non-COVID deaths, using corrected Poisson regression models for different demographics and assessing socio-economic status impact via ecological community-level analysis. ResultsCompared to the pre-pandemic period (2015–2019, IRR = 1.00), the sex- and age-adjusted rate of all-cause death increased significantly during the pandemic (2020–2021) IRR = 1.109 [1.054–1.167], p < 0.0001. This was observed in both males (IRR = 1.158 [1.1–1.219], p < 0.0001) and females (IRR = 1.068 [1.016–1.124], p = 0.01). There was no observed effect of the pandemic on the historical trend in the progressive reduction of mortality in people under 35 years of age. The increase in deaths was at the expense of COVID (+11,175 deaths) and cardiovascular causes (IRR = 1.114 [1.020–1.217] p = 0.017). During the pandemic, there was a significant increase in deaths at home (IRR = 1.219 [1197–1.242], p < 0.0001), especially in people dying of cardiovascular causes (IRR = 1.391 [1.360–1.422], p < 0.0001). The increase in the adjusted mortality rate during the pandemic was socially conditioned. ConclusionsThe pandemic not only led to increased COVID-19 mortality but also heightened fatalities from non-COVID causes, reflecting a potential bias in healthcare resource allocation towards SARS-CoV-2 at the expense of chronic pathologies care.

Mixed effects modelling of excess mortality and COVID-19 lockdowns in Thailand

Accurate mortality data are critical for understanding the impact of COVID-19 and learning lessons from crisis responses. But published statistics risk misrepresenting deaths due to limited testing, underreporting, and lack of subnational data, especially in developing countries. Thailand experienced four COVID-19 waves between January 2020 and December 2021, and used a color-coded, province-level system for lockdowns. To account for deaths directly and indirectly caused by COVID-19, this paper uses mixed effects modelling to estimate counterfactual deaths for 2020–2021 and construct a monthly time series of provincial excess mortality. A fixed effects negative binomial and mixed effects Poisson model both substantiate other studies’ estimates of excess deaths using subnational data for the first time. Then, panel regression methods are used to characterize the correlations among restrictions, mobility, and excess mortality. The regressions show that mobility reductions modestly curbed mortality immediately upon imposition, suggesting that aversion of non-COVID deaths was a major aspect of the lockdowns’ effect in Thailand. However, the estimates are imprecise. An auto-regressive distributed lag model suggests that the effect of lockdowns was through reduced mobility, but the effectiveness appears to have varied over the course of the pandemic.

The impact of the COVID-19 pandemic on non-COVID-associated mortality: A descriptive longitudinal study of UK data

BackgroundIt has been previously reported in the literature that the COVID-19 pandemic resulted in overall excess deaths and an increase in non-COVID deaths during the pandemic period.Specifically, our research elucidates the impact of the COVID-19 pandemic on non-COVID associated mortality. Study aimTo compare mortality rates in non-COVID conditions before and after the onset of the COVID-19 pandemic in England and Wales. Study designAnnual mortality data for the years 2011–2019 (pre-pandemic) and 2020 (pandemic) in England and Wales were retrieved from the Office for National Statistics (ONS). These data were filtered by ICD-10 codes for nine conditions with high associated mortality. We calculated mortality numbers – overall and age stratified (20–64 and 65+ years) and rates per 100 000, using annual mid-year population estimates. MethodsInterrupted time series analyses were conducted using segmented quasi-Poisson regression to identify whether there was a statistically significant change (p < 0.05) in condition-specific death rates following the pandemic onset. ResultsEight of the nine conditions investigated in this study had significant changes in mortality rate during the pandemic period (2020). All-age mortality rate was significantly increased in: ‘Symptoms Signs and Ill-defined conditions’, ‘Cirrhosis and Other Diseases of the Liver’, and ‘Malignant Neoplasm of the Breast’, whereas ‘Chronic Lower Respiratory Disorders’ saw a significant decrease. Age-stratified analyses also revealed significant increases in the 20–64 age-group in: ‘Cerebrovascular Disorders’, ‘Dementia and Alzheimer's Disease’, and ‘Ischaemic Heart Diseases’. ConclusionTrends in non-COVID condition-specific mortality rates from 2011 to 2020 revealed that some non-COVID conditions were disproportionately affected during the pandemic. This may be due to the direct impact COVID-19 had on these conditions or the effect the public health response had on non-COVID risk factor development and condition-related management. Further work is required to understand the reasons behind these disproportionate changes.

Health care utilization and mortality for people with epilepsy during COVID-19: A population study.

This study was undertaken to characterize changes in health care utilization and mortality for people with epilepsy (PWE) during the COVID-19 pandemic. We performed a retrospective study using linked, individual-level, population-scale anonymized health data from the Secure Anonymised Information Linkage databank. We identified PWE living in Wales during the study "pandemic period" (January 1, 2020-June 30, 2021) and during a "prepandemic" period (January 1, 2016-December 31, 2019). We compared prepandemic health care utilization, status epilepticus, and mortality rates with corresponding pandemic rates for PWE and people without epilepsy (PWOE). We performed subgroup analyses on children (<18 years old), older people (>65 years old), those with intellectual disability, and those living in the most deprived areas. We used Poisson models to calculate adjusted rate ratios (RRs). We identified 27 279 PWE who had significantly higher rates of hospital (50.3 visits/1000 patient months), emergency department (55.7), and outpatient attendance (172.4) when compared to PWOE (corresponding figures: 25.7, 25.2, and 87.0) in the prepandemic period. Hospital and epilepsy-related hospital admissions, and emergency department and outpatient attendances all reduced significantly for PWE (and all subgroups) during the pandemic period. RRs [95% confidence intervals (CIs)] for pandemic versus prepandemic periods were .70 [.69-.72], .77 [.73-.81], .78 [.77-.79], and .80 [.79-.81]. The corresponding rates also reduced for PWOE. New epilepsy diagnosis rates decreased during the pandemic compared with the prepandemic period (2.3/100 000/month cf. 3.1/100 000/month, RR = .73, 95% CI = .68-.78). Both all-cause deaths and deaths with epilepsy recorded on the death certificate increased for PWE during the pandemic (RR = 1.07, 95% CI = .997-1.145 and RR = 2.44, 95% CI = 2.12-2.81). When removing COVID deaths, RRs were .88 (95% CI = .81-.95) and 1.29 (95% CI = 1.08-1.53). Status epilepticus rates did not change significantly during the pandemic (RR = .95, 95% CI = .78-1.15). All-cause non-COVID deaths did not increase but non-COVID deaths associated with epilepsy did increase for PWE during the COVID-19 pandemic. The longer term effects of the decrease in new epilepsy diagnoses and health care utilization and increase in deaths associated with epilepsy need further research.

Overdose deaths before and during the COVID-19 pandemic in a US county.

Globally, overdose deaths increased near the beginning of the COVID-19 pandemic, which created availability and access barriers to addiction and social services. Especially in times of a crisis like a pandemic, local exposures, service availability and access, and system responses have major influence on people who use drugs. For policy makers to be effective, an understanding at the local level is needed. This retrospective epidemiologic study from 2019 through 2021 compares immediate and 20-months changes in overdose deaths from the pandemic start to 16 months before its arrival in Pinellas County, FL We examine toxicologic death records of 1,701 overdoses to identify relations with interdiction, and service delivery. There was an immediate 49% increase (95% CI 23-82%, p < 0.0001) in overdose deaths in the first month following the first COVID deaths. Immediate increases were found for deaths involving alcohol (171%), heroin (108%), fentanyl (78%), amphetamines (55%), and cocaine (45%). Overdose deaths remained 27% higher (CI 4-55%, p = 0.015) than before the pandemic through 2021.Abrupt service reductions occurred when the pandemic began: in-clinic methadone treatment dropped by two-thirds, counseling by 38%, opioid seizures by 29%, and drug arrests by 56%. Emergency transport for overdose and naloxone distributions increased at the pandemic onset (12%, 93%, respectively) and remained higher through 2021 (15%, 377%,). Regression results indicate that lower drug seizures predicted higher overdoses, and increased 911 transports predicted higher overdoses. The proportion of excess overdose deaths to excess non-COVID deaths after the pandemic relative to the year before was 0.28 in Pinellas County, larger than 75% of other US counties. Service and interdiction interruptions likely contributed to overdose death increases during the pandemic. Relaxing restrictions on medical treatment for opioid addiction and public health interventions could have immediate and long-lasting effects when a major disruption, such as a pandemic, occurs. County level data dashboards comprised of overdose toxicology, and interdiction and service data, can help explain changes in overdose deaths. As a next step in predicting which policies and practices will best reduce local overdoses, we propose using simulation modeling with agent-based models to examine complex interacting systems.

Mortality in Catalonia during the summer of 2022 and its relation with high temperatures and COVID-19 cases.

To analyse the association between the mortality during the summer 2022 and either high temperatures or the COVID-19 wave with data from the Catalan Health Care System (7.8 million people). We performed a retrospective study using publicly available data of meteorological variables, influenza-like illness (ILI) cases (including COVID-19) and deaths. The study comprises the summer months of the years 2021 and 2022. To compare the curves of mortality, ILI and temperature we calculated the z-score of each series. We assessed the observed lag between curves using the cross-correlation function. Finally, we calculated the correlation between the z-scores using the Pearson correlation coefficient (R2). During the study period, 33,967 deaths were reported in Catalonia (16,416 in the summer of 2021 and 17,551 in the summer of 2022). In 2022, the observed lag and the correlation between the z-scores of temperature and all-cause deaths was 3 days and R2 = 0.86, while between ILI and all-cause deaths was 22 days and R2 = 0.21. This high correlation between temperature and deaths increased up to 0.91 when we excluded those deaths reported as COVID-19 deaths, while the correlation between ILI and non-COVID-19 deaths decreased to -0.19. No correlation was observed between non-COVID deaths and temperature or ILI cases in 2021. Our study suggests that the main cause of the increase in deaths during summer 2022 in Catalonia was the high temperatures and its duration. The contribution of the COVID-19 seems to be limited.

Has COVID-19 increased inequality in mortality by income in the Netherlands?

BackgroundIn the Netherlands in 2020, COVID-19 deaths were more concentrated among individuals with a lower income. At the same time, COVID-19 was a new cause that also displaced some deaths...

A proposal to implement incentive systems for local authorities to prevent the further occurrence of excess non-covid deaths during the covid 19 pandemic COVID-19 pandemic

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

S756 Excess Non-COVID Mortality Among IBD Decedents During the COVID-19 Pandemic

Introduction: The degree to which the pandemic has caused excess non-COVID death in IBD patients remains unclear. Methods: This serial population-based analysis included data from the CDC’s National Vital Statistics System on IBD decedents aged ≥25 years from 1/1/06 to 12/31/21. IBD was defined as Crohn’s disease (CD) or ulcerative colitis (UC). Decedents were stratified by age (25-64 vs ≥65 years), sex, race (Hispanic, non-Hispanic white, and non-Hispanic black), place of death (at home/on arrival, at a medical facility, on hospice, or in a nursing facility), and top three causes of death (diseases of the digestive system, circulatory system, or neoplasms). Age-standardized mortality rates (ASMRs) per 100,000 persons were calculated for all-cause, non-COVID, and COVID mortality. Predictive analyses were performed to predict ASMRs during the pandemic based on pre-pandemic data. Observed ASMR higher than the 95% confidence intervals of predicted ASMR was considered as statistically significant. Results: Of 30,328 IBD-related deaths from 2006-2021, 5,270 occurred from 2020-2021. 417 (7.9%) were COVID-related, and 4,853 (92.1%) were non-COVID-related. There was significant excess non-COVID death among IBD patients in 2020 (ASMR 1.55 vs 1.37, 95% CI [1.26-1.49]) and 2021 (1.63 vs 1.38, 95% CI [1.26-1.49]) (Figure A). In subgroup analyses (Table), UC patients aged 25-64 years and non-Hispanic black patients with CD had significant excess non-COVID death in 2020 (0.20 vs 0.17, 95% CI [0.15-0.19]; (0.75 vs 0.55, 95% CI 0.41-0.70). Death from neoplasms was significantly increased during the pandemic (0.30 vs 0.22, p=0.0167) (Figure B). Additionally, there were significant excess non-COVID deaths among IBD decedents at home and on arrival during the pandemic (2020: 0.61 vs 0.46, 95% CI [0.42-0.49]; 2021: 0.61 vs 0.47, 95% CI [0.43-0.51]) (Figure C). Deaths at medical facilities were also increased (2021: 0.59 vs 0.48, 95% CI [0.39-0.56]), while deaths on hospice decreased (2021: 0.14 vs 0.17, 95% CI [0.15-0.18]) (Table). Conclusion: IBD patients experienced significant excess non-COVID mortality during the pandemic. Upon subgroup stratification, young UC patients and non-Hispanic black CD patients were the most impacted. The rise in neoplasm-related non-COVID deaths and mortality rates prior to hospital arrival during the pandemic suggests that indirect effects of the pandemic, such as delayed presentation, likely exacerbated healthcare disparities and adversely impacted timely interventions and care.Figure 1.: Temporal Trends of Observed All-Cause, Non-COVID, and Predicted Age-Standardized Mortality Rates Among IBD Decedents Temporal trends in ASMR per 100,000 persons are shown among (A) all IBD decedents, (B) top 3 causes of death, and (C) deaths at home or on arrival. 95% confidence intervals are represented by error bars. ASMR=Age-Standardized Mortality Rate. COVID=coronavirus disease. IBD=inflammatory bowel disease. Table 1. - Subgroup Analyses of Observed COVID, Non-COVID, and Predicted Age-Standardized Mortality Rates Among IBD Decedents Stratification Group Year COVID ASMRs Non-COVID ASMRs Predicted ASMRs with 95% CI Age UC 25-64 years 2020 0.01 0.20* 0.17 [0.15-0.19] 2021 0.03 0.18 0.17 [0.15-0.19] ≥65 years 2020 0.28 2.31 2.30 [2.01-2.58] 2021 0.28 2.53 2.45 [2.04-2.86] CD 25-64 years 2020 0.02 0.46 0.42 [0.37-0.47] 2021 0.04 0.46 0.45 [0.38-0.52] ≥65 years 2020 0.25 2.95 2.79 [2.46-3.12] 2021 0.33 3.15 2.87 [2.49-3.25] Sex UC Male 2020 0.07 0.70 0.68 [0.62-0.75] 2021 0.09 0.69 0.70 [0.63-0.78] Females 2020 0.06 0.54 0.53 [0.44-0.61] 2021 0.07 0.60 0.57 [0.44-0.70] CD Males 2020 0.06 0.94 0.93 [0.83-1.04] 2021 0.11 0.99 1.01 [0.86-1.16] Females 2020 0.06 0.95 0.90 [0.78-1.02] 2021 0.09 0.99 0.94 [0.76-1.12] Race UC Hispanics 2020 0.04 0.26 0.23 [0.07-0.38] Non-Hispanic whites 2020 0.07 0.71 0.71 [0.63-0.78] Non-Hispanic blacks 2020 0.02 0.39 0.41 [0.29-0.52] CD Hispanics 2020 0.03 0.27 0.27 [0.08-0.47] Non-Hispanic whites 2020 0.07 1.15 1.12 [0.99-1.25] Non-Hispanic blacks 2020 0.06 0.75* 0.55 [0.41-0.70] *Signifies statistical significance ASMRs are per 100,000 persons.ASMR=Age-Standardized Mortality Rate. CD=Crohn’s Disease. CI=confidence interval. COVID=coronavirus disease. UC=Ulcerative Colitis.

Socio-demographic inequalities and excess non-COVID-19 mortality during the COVID-19 pandemic: a data-driven analysis of 1 069 174 death certificates in Mexico.

In 2020, Mexico experienced one of the highest rates of excess mortality globally. However, the extent of non-COVID deaths on excess mortality, its regional distribution and the association between socio-demographic inequalities have not been characterized. We conducted a retrospective municipal and individual-level study using 1 069 174 death certificates to analyse COVID-19 and non-COVID-19 deaths classified by ICD-10 codes. Excess mortality was estimated as the increase in cause-specific mortality in 2020 compared with the average of 2015-2019, disaggregated by primary cause of death, death setting (in-hospital and out-of-hospital) and geographical location. Correlates of individual and municipal non-COVID-19 mortality were assessed using mixed effects logistic regression and negative binomial regression models, respectively. We identified a 51% higher mortality rate (276.11 deaths per 100 000 inhabitants) compared with the 2015-2019 average period, largely attributable to COVID-19. Non-COVID-19 causes comprised one-fifth of excess deaths, with acute myocardial infarction and type 2 diabetes as the two leading non-COVID-19 causes of excess mortality. COVID-19 deaths occurred primarily in-hospital, whereas excess non-COVID-19 deaths occurred in out-of-hospital settings. Municipal-level predictors of non-COVID-19 excess mortality included levels of social security coverage, higher rates of COVID-19 hospitalization and social marginalization. At the individual level, lower educational attainment, blue-collar employment and lack of medical care assistance prior to death were associated with non-COVID-19 deaths. Non-COVID-19 causes of death, largely chronic cardiometabolic conditions, comprised up to one-fifth of excess deaths in Mexico during 2020. Non-COVID-19 excess deaths occurred disproportionately out-of-hospital and were associated with both individual- and municipal-level socio-demographic inequalities.

Community-based anticipatory prescribing during COVID-19: a qualitative study

ObjectivesTo understand healthcare professionals’ experiences of delivering anticipatory prescribing (AP) during the first wave of the UK COVID-19 pandemic.MethodsSemistructured qualitative interviews were conducted with a purposive sample of 16 healthcare...

The US Midlife Mortality Crisis Continues: Excess Cause-Specific Mortality During 2020.

Whether monthly excess mortality in the United States during 2020 varied by age and cause of death is investigated in this analysis. Based on national-level death counts and population estimates for 1999-2020, sex-specific negative binomial regression models were used to estimate monthly cause-specific excess mortality by age group during 2020. Among men, 71% non-COVID excess deaths occurred at working ages (25-64 years), but those ages accounted for only 36% of non-COVID excess deaths among women. Many excess deaths resulted from external causes (particularly among men), heart disease, diabetes, Alzheimer disease (particularly among women), and cerebrovascular disease. For men, the largest share of non-COVID excess deaths resulted from external causes, nearly 80% of which occurred at working ages. Although incorrectly classified COVID-19 deaths may explain some excess non-COVID mortality, misclassification is unlikely to explain the increase in external causes of death. Auxiliary analyses suggested that drug-related deaths may be driving the increase in external mortality, but drug overdoses were already increasing for a full year before the pandemic. The oldest Americans bore the brunt of COVID-19 deaths, but working-age Americans, particularly men, suffered substantial numbers of excess non-COVID deaths, most commonly from external causes and heart disease.

Certificate of Need Laws and Health Care Use during the COVID-19 Pandemic

This paper investigates the impact of state-level Certificate-of-Need (CON) laws on COVID and non-COVID deaths in the United States during the SARS-CoV-2 pandemic. CON laws limit the expansion and acquisition of new medical services, such as new hospital beds. The coronavirus pandemic created a surge in demand for medical services, which might be exacerbated in some states that have CON laws. Our investigation focuses on mortality due to COVID and non-COVID reasons and understanding how these laws affect access to healthcare for illnesses that might require similar medical equipment to COVID patients. We find that states with high healthcare use due to COVID that reformed their CON laws during the pandemic had a reduction in mortality resulting from COVID-19, septicemia, diabetes, chronic lower respiratory disease, influenza or pneumonia, and Alzheimer’s Disease, relative to non-reforming CON states.

Nursing home quality, COVID-19 deaths, and excess mortality

The COVID-19 pandemic in the US has been particularly devastating for nursing home residents. A key question is how have some nursing homes been able to effectively protect their residents, while others have not? Using data on the universe of US nursing homes, we examine whether establishment quality is predictive of COVID-19 mortality. Higher-quality nursing homes, as measured by CMS overall five-star rating, have substantially lower COVID-19 mortality through September of 2020. Quality does not predict the ability to prevent any COVID-19 resident or staff cases, but higher-quality establishments prevent the spread of resident infections conditional on having one. Preventing COVID-19 cases and deaths may come at some cost, as high-quality homes have substantially higher non-COVID deaths. The positive correlation between establishment quality and non-COVID mortality is strong enough that high-quality homes also have more total deaths than their low-quality counterparts and this relationship has grown with time. As of late April 2021, five-star homes have experienced 8.4 percent more total deaths than one-star homes.

COVID mortality in India: National survey data and health facility deaths.

India’s national COVID death totals remain undetermined. Using an independent nationally representative survey of 0.14 million (M) adults, we compared COVID mortality during the 2020 and 2021 viral waves to expected all-cause mortality. COVID constituted 29% (95%CI 28-31%) of deaths from June 2020-July 2021, corresponding to 3.2M (3.1-3.4) deaths, of which 2.7M (2.6-2.9) occurred in April-July 2021 (when COVID doubled all-cause mortality). A sub-survey of 57,000 adults showed similar temporal increases in mortality with COVID and non-COVID deaths peaking similarly. Two government data sources found that, when compared to pre-pandemic periods, all-cause mortality was 27% (23-32%) higher in 0.2M health facilities and 26% (21-31%) higher in civil registration deaths in ten states; both increases occurred mostly in 2021. The analyses find that India’s cumulative COVID deaths by September 2021 were 6-7 times higher than reported officially.

Impact of COVID-19 pandemic on grief, death, mourning, and coping.

The outbreak of COVID-19 has influenced every sphere and all aspects of life. COVID patients were kept in isolation to curb the spread of the infection; such situations led to mental health issues in patients as well as in their families. The aim and objectives of the current study were to find the impact of COVID-19 pandemic on grief, death mourning and coping in Kashmir. For the deeper understanding of the impact of COVID-19 pandemic, both quantitative and qualitative approaches were used. A sample of 89 individuals whose loved ones died (COVID or non-COVID deaths) during pandemic were enrolled with purposive sampling technique. The sociodemographic details of both participants as well as the deceased persons were recorded, followed by semi-structured interview, Brief Cope Scale (BCS) and Pandemic Grief Scale (PGS). Majority of the participants who lost a relative due to COVID-19 who were males in the age-group of 60 years and above. Grief was found more in males and in relatives whose loved ones died of COVID-19. Coping strategies adopted by the family members whose relative died of COVID more often adopted avoidant coping strategies as compared to non-COVID deaths. Mostly, deaths occurred when the family members were not around. It was highly challenging for the participants to mourn the loss as most of the mournings were in isolation, and there was hardly any support. Most of the participants could not perform last rites which complicated the grief among them. Current study emphasizes the importance of social support for those who are grieving and need of face-to-face interactions which can never be replaced by speaking over phone or through virtual spaces. However in extraordinary circumstances of COVID-19 scenario, sharing grief, expressing care and love through any mode can be an effective way to help the bereaved individuals to understand that they are not forgotten.

Epilepsy mortality in Wales during COVID-19

PurposeThe COVID-19 pandemic has increased mortality worldwide and those with chronic conditions may have been disproportionally affected. However, it is unknown whether the pandemic has changed mortality rates for people with epilepsy. We aimed to compare mortality rates in people with epilepsy in Wales during the pandemic with pre-pandemic rates. MethodsWe performed a retrospective study using individual-level linked population-scale anonymised electronic health records. We identified deaths in people with epilepsy (DPWE), i.e. those with a diagnosis of epilepsy, and deaths associated with epilepsy (DAE), where epilepsy was recorded as a cause of death on death certificates. We compared death rates in 2020 with average rates in 2015–2019 using Poisson models to calculate death rate ratios. ResultsThere were 188 DAE and 628 DPWE in Wales in 2020 (death rates: 7.7/100,000/year and 25.7/100,000/year). The average rates for DAE and DPWE from 2015 to 2019 were 5.8/100,000/year and 23.8/100,000/year, respectively. Death rate ratios (2020 compared to 2015–2019) for DAE were 1.34 (95%CI 1.14–1.57, p<0.001) and for DPWE were 1.08 (0.99–1.17, p = 0.09). The death rate ratios for non-COVID deaths (deaths without COVID mentioned on death certificates) for DAE were 1.17 (0.99–1.39, p = 0.06) and for DPWE were 0.96 (0.87–1.05, p = 0.37). ConclusionsThe significant increase in DAE in Wales during 2020 could be explained by the direct effect of COVID-19 infection. Non-COVID-19 deaths have not increased significantly but further work is needed to assess the longer-term impact.

Rapid mortality surveillance using a national population register to monitor excess deaths during SARS-CoV-2 pandemic in South Africa

This paper describes how an up-to-date national population register recording deaths by age and sex, whether deaths were due to natural or unnatural causes, and the offices at which the deaths were recorded can be used to monitor excess death during the SARS-CoV-2 pandemic, both nationally, and sub-nationally, in a country with a vital registration system that is neither up to date nor complete. Apart from suggesting an approach for estimating completeness of reporting at a sub-national level, the application produces estimates of the number of deaths in excess of those expected in the absence of the SARS-CoV-2 epidemic that are highly correlated with the confirmed number of COVID-19 deaths over time, but at a level 2.5 to 3 times higher than the official numbers of COVID-19 deaths. Apportioning the observed excess deaths more precisely to COVID, COVID-related and collateral deaths, and non-COVID deaths averted by interventions with reduced mobility and gatherings, etc., requires access to real-time cause-of-death information. It is suggested that the transition from ICD-10 to ICD-11 should be used as an opportunity to change from a paper-based system to electronic capture of the medical cause-of-death information.

Risks of covid-19 hospital admission and death for people with learning disability: population based cohort study using the OpenSAFELY platform

ObjectiveTo assess the association between learning disability and risk of hospital admission and death from covid-19 in England among adults and children.DesignPopulation based cohort study on behalf of NHS England...