Pre-lockdown Period Research Articles

Oral Health Care Delivery for Children During COVID-19 Pandemic-A Retrospective Study.

Aim: COVID-19 outbreak and the lockdown period following was a very challenging time for pediatric dentistry. We aimed to find whether the characteristics of dental care provided to children at the Department of Pediatric Dentistry at Hadassah medical center, Jerusalem, Israel, differed between the periods, before COVID-19 outbreak, during the lockdown period and during the period that followed it.Materials and Methods: We retrospectively reviewed computerized records of patients who visited the pediatric dental clinic at three different periods: pre-lockdown period, lockdown period, and post-lockdown period.Results: Nine-hundred and forty-nine children were included in the study; most of them were healthy children between 3 and 6 years old. During lockdown, all scheduled appointments except for treatments under general anesthesia and deep sedation were canceled due to the government's restrictions; the frequency of treatments with non-pharmacological behavior management, general anesthesia or deep sedation was higher than in the previous or subsequent periods and the use of inhaled/conscious sedation was significantly lower. During lockdown most of the children were diagnosed with dentoalveolar abscess (32.3%), compared to 14 and 21% at the previous or subsequent periods, respectively (P < 0.001). Treatments combination during lockdown included more extractions, pulpectomies and pulp extirpation and less permanent restorations (P < 0.001). None of the staff members was infected with COVID-19 at the clinic during these periods. We concluded that dentists should be updated about Covid-19 modes of transmission and the recommended infection control measures in dental settings. Effective management protocols can help the dental staff to continue to provide efficient treatment and prevent Covid-19 contamination.

235 Age and Chronotype Associated with Sleep Timing Changes During COVID-19-Related Lockdowns in the US

IntroductionGlobal lockdowns implemented to reduce spread of the Coronavirus Disease 2019 (COVID-19) have offered unique insight into how sleep patterns change when typical social obligations are significantly reduced. Here, we aimed to replicate findings of sleep timing delays and reduced social jetlag during lockdown using a large, regionally-diverse sample of participants from the United States (US). Further, we conducted exploratory analyses to determine if observed sleep changes were associated with age and self-reported chronotype.MethodsA sample of 691 US adults (age 18-89) completed the Ultrashort Munich Chronotype Questionnaire twice during the same assessment: once querying retrospective memory for sleep patterns in the 6-weeks prior to February 1, 2020 (Pre-Lockdown) and a second time for sleep patterns in the 6-weeks prior to ~May 20th (Peak-Lockdown in the US). Participants also completed the abbreviated Morningness-Eveningness Questionnaire to assess chronotype. We compared sleep duration (SDur), sleep onset time (SO), sleep end time (SEnd), social jetlag (SJL; difference between work-day and free-day sleep midpoint) and social sleep restriction (SSR; difference between work-day and free-day sleep duration) Pre- to Peak-Lockdown. We conducted exploratory analyses to determine whether Pre- to Peak-Lockdown changes in these sleep metrics were associated with age or chronotype. Main analyses were preregistered with Open Science Framework (https://osf.io/4a3fx).ResultsDuring the Peak-Lockdown period, participants, on average, reported significantly later SO and SEnd times and significantly reduced SJL and SSR compared with the Pre-Lockdown period. Change in SJL and SSR Pre- to Peak-Lockdown was significantly positively associated with age and chronotype such that SJL and SSR decreased more during lockdown in younger participants and those with an evening chronotype.ConclusionOur results support lockdown-associated sleep timing delays and reduced SJL and SSR. Younger age and evening chronotype were associated with greater reductions in SJL and SSR during lockdown. These findings suggest that individuals, particularly young individuals and those with an evening chronotype, experience greatest desynchrony between intrinsic and social sleep timing when conforming to typical pre-pandemic social schedules.Support (if any)Harvard Medical School Division of Sleep Medicine T32 HL007901 (RB and TJC); Brandeis University NIH NRSA T32 NS007292 (ECF)

Assessment and Comparison of the Mental Health Status of Patients Seeking Psychiatry Facilities in Pre-lockdown and Post-lockdown Period During COVID-19 Pandemic

Background: The servicing and framework for mental health care accessible to population have been affected during the unprecedented times of coronavirus disease (COVID-19) pandemic. The new and almost exclusive method to maintain a therapeutic alliance with these patients has been the recently evolving telepsychiatry services. Aim and Objectives: The main aim of the study was to assess and compare the mental health status of patients seeking available psychiatry facilities in pre-lockdown and post-lockdown period during COVID-19 pandemic. Methodology: This was a retrospective cross-sectional study that was conducted in a tertiary care hospital in a hilly region of North India. The registered data was analyzed between January 1, 2020 to March 21, 2020 to gather the information of patients about sociodemographic profile and clinical diagnosis on the basis of International Classification of Diseases-10. The retrieved data constituted 499 new consecutive patients during this period. Then in the post-lockdown phase after the resumption of OPD services in the institute (May 3, 2020), the data collection was initiated to collect a similar sample size of new consecutive patients (501). These data were collected over 151 days (May 3, 2020 to September 30, 2020). Results: A total number of 1000 patients were analyzed. Majority of the patients were male (66%) and within 19 to 60 years of age (85–90%). The average number of patients (3.31) seen per day was less and the average age of the patients (39.17 years, standard deviation = 14.37) was significantly higher in the post-lockdown phase. The most common diagnostic group consisted of neurotic/stress-related/somatoform disorders. As compared to the pre-lockdown period, a significantly (P &lt; 0.001) lower number of patients diagnosed with substance use disorders and a significantly (P &lt; 0.001) higher number of patients diagnosed with psychotic disorders along with anxiety disorders availed the available psychiatry services in the period of COVID-19 pandemic. Conclusion: Sudden cessation of the psychiatry services further precipitated the deterioration of mental health of the patients. There is an urgent demand for services to adapt to changing scenarios with emphasis on practical approaches to help the mentally ill people especially in geographically difficult hilly areas.

Changes in daily mental health service use and mortality at the commencement and lifting of COVID-19 ‘lockdown’ policy in 10 UK sites: a regression discontinuity in time design

ObjectivesTo investigate changes in daily mental health (MH) service use and mortality in response to the introduction and the lifting of the COVID-19 ‘lockdown’ policy in Spring 2020.DesignA regression discontinuity...

The Impact of COVID-19 Pandemic on Vascular Leg Ulcers.

The aim of this study was to evaluate the impact of 2 lockdown periods during coronavirus disease 2019 (COVID-19) on the course and management of nonhealing vascular ulcers of lower limbs. A total of 41 patients were included in the study. Before the pandemic began they had been seen at our unit at weekly intervals. During lockdown from March 9, 2020, to May 18, 2020 subjects were not allowed to enter the hospital unless they needed urgency or emergency surgery, or oncological management. During the second lockdown, from October 19, 2020, to December 11, 2020 patients could be followed up at distance by direct outreach including telephoning contacts. Data obtained early after each lockdown were compared with those obtained prior to the pandemic. Data for the first lockdown show that pain intensified and there was an increase in the recurrence rate of wounds, of their severity, and of superimposed infections as compared with the prelockdown period. The risk of lower-limb amputation was also considerably greater. During the second and less restrictive lockdown, patients were followed up by telemedicine and data indicate that skin lesions had not worsened any further. The management of vascular wounds was impacted by the pandemic unfavorably with health care failures in the hospital as well as in the primary care settings. In conclusion, the treatment of vascular leg ulcers is challenged by the COVID-19 pandemic as this spreads worldwide. This seems to be in keeping with what happens for other diseases. The data we obtained indicate that the pandemic-related lockdown has a deleterious effect on vascular skin wounds, with an increase of severity and mortality risk. The impact appears to be proportional to the number and the degree of limitations imposed on people.

Evolution of Gaseous and Particulate Pollutants in the Air: What Changed after Five Lockdown Weeks at a Southwest Atlantic European Region (Northwest of Spain) Due to the SARS-CoV-2 Pandemic?

Due to the exponential growth of the SARS-CoV-2 pandemic in Spain (2020), the Spanish Government adopted lockdown measures as mitigating strategies to reduce the spread of the pandemic from 14 March. In this paper, we report the results of the change in air quality at two Atlantic Coastal European cities (Northwest Spain) during five lockdown weeks. The temporal evolution of gaseous (nitrogen oxides, comprising NOx, NO, and NO2; sulfur dioxide, SO2; carbon monoxide, CO; and ozone, O3) and particulate matter (PM10; PM2.5; and equivalent black carbon, eBC) pollutants were recorded before (7 February to 13 March 2020) and during the first five lockdown weeks (14 March to 20 April 2020) at seven air quality monitoring stations (urban background, traffic, and industrial) in the cities of A Coruña and Vigo. The influences of the backward trajectories and meteorological parameters on air pollutant concentrations were considered during the studied period. The temporal trends indicate that the concentrations of almost all species steadily decreased during the lockdown period with statistical significance, with respect to the pre-lockdown period. In this context, great reductions were observed for pollutants related mainly to fossil fuel combustion, road traffic, and shipping emissions (−38 to −78% for NO, −22 to −69% for NO2, −26 to −75% for NOx, −3 to −77% for SO2, −21% for CO, −25 to −49% for PM10, −10 to −38% for PM2.5, and −29 to −51% for eBC). Conversely, O3 concentrations increased from +5 to +16%. Finally, pollutant concentration data for 14 March to 20 April of 2020 were compared with those of the previous two years. The results show that the overall air pollutants levels were higher during 2018–2019 than during the lockdown period.

Short-term impacts of air pollutants in three megacities of India during COVID-19 lockdown.

Lockdown was imposed by the Indian government in the month of March 2020 as an early precaution to the COVID-19 pandemic which obstructed the socio-economic growth globally. The main aim of this study was to analyse the impact of lockdown (imposed in March and continued in April 2020) on the existing air quality in three megacities of India (Delhi, Mumbai and Kolkata) by assessing the trends of PM10 and NO2 concentrations. A comparison of the percentage reduction in concentrations of lockdown period with respect to same period in year 2019 and pre-lockdown period (February 14–March 24) was made. It was observed from the study that an overall decrease of pollutant concentrations was in the ranges of 30–60% and 52–80% of PM10 and NO2, respectively, in the three cities during lockdown in comparison with previous year and pre-lockdown period. The overall decrease in concentrations of pollutants at urban sites was greater than the background sites. Highest decline in concentrations of PM10 were observed in Kolkata city, followed by Mumbai and Delhi, while decline in NO2 was highest in Mumbai. Results also highlighted that capital city Delhi had the worst air quality amongst three cities, with particulate matter (PM10) being the dominant pollutant. Although COVID-19 has significantly affected the human life considering the mortality and morbidity, lockdowns imposed to control the pandemic had significantly improved the air quality in the selected study locations, although for the short amount of period.

Effect of COVID-19 lockdown on noise pollution levels in an Indian city: a case study of Kanpur.

Noise pollution is an emerging environmental threat, prolonged exposure of which can cause annoyance, sleep disturbance, hypertension, psychiatric disorders, and also hormonal dysfunction. Among all the sources of noise pollution, the noise generated by road vehicle traffic significantly affects the quality of urban environments. Concerning the recent imposition of COVID-19 societal lockdown, this study attempts to investigate the impacts of COVID-19 lockdown on the changes in noise pollution levels before, during, and after lockdown phase in different residential, commercial, industrial, and silence zones of the city of Kanpur, India. Utilizing data collected from portable environmental sensors, the average noise levels before lockdown and during lockdown were found to be in the range of 44.85 dB to 79.57 dB and 38.55 dB to 57.79 dB, respectively, for different zones. Although a significant reduction in the noise levels was observed during lockdown, except for commercial zone, all other monitoring stations had reported sound levels quite higher than the recommended noise limits set by the Central Pollution Control Board (CPCB) of India. Results further indicated that the impact of road traffic noise on risk of high annoyance and sleep disturbance was found to be lower during lockdown as compared to that of pre-lockdown and unlock phase. While the annoyance level in residential (86.23%), industrial (87.44%), and silence (84.47%) was higher in pre-lockdown period, it reduced to 41.25, 50.28, and 43.07% in the lockdown phase. Even the risk of sleep disturbance in the residential zone was found to reduce from 37.96% during pre-lockdown to 14.72% during lockdown phase. Several noise mitigation strategies are also proposed, which may indeed pave the way for devising noise control measures in the local and regional level.

Care as Usual: An Acceptable Strategy to Apply During the COVID-19 Pandemic in a French Tertiary Gynecologic Oncology Department.

We describe and analyze a “care as usual” strategy of a French Comprehensive Cancer Center during the COVID-19 pandemic to manage surgical patients with gynecological cancer. We conducted a retrospective analysis evaluating the surgical activity in our gynecologic oncology department between January 21 and May 12, 2020. We compared the surgical activity and surgical and oncologic outcomes during the pre-lockdown period and the pandemic period. The main objective was to evaluate the impact of the COVID-19 pandemic on surgical activity. The secondary objectives were to analyze the surgical and the oncologic outcomes. We compared the surgical activity during the 8 weeks after the national lockdown (85 procedures) to the surgical activity in the 8 weeks preceding the lockdown (127 procedures). We observed a 33% decrease in activity between the two periods. The clinical and epidemiologic characteristics were similar between the two periods. There were no differences between the surgical approaches (p = 0.592), the surgical complexity (p = 0.323), the length of stay (p = 0.85), and even for the complex procedure (p = 0.96) and the perioperative (p = 0.791) and postoperative complication rates (p = 0.102). We observed a significant decrease in the time of return to intended oncological treatment (RIOT) during the lockdown period with an average of 31.9 days compared to 46.9 days in the pre-lockdown period (p = 0.003). During the COVID-19 pandemic, “care as usual” represents an acceptable strategy without impairing the oncologic outcome in a Comprehensive Cancer Center with a patient-centered clinical pathway for gynecologic oncologic surgical patients.

COVID-19 lockdown impacts on heavy metals and microbes in shallow groundwater and expected health risks in an industrial city of South India

In this investigation, the positive impact of COVID-19 lockdown on heavy metals concentration and biological parameters in the shallow groundwater samples of Coimbatore city of South India was ascertained. The groundwater samples (n=15) were obtained from shallow open wells during before lockdown (24–25 February 2020) and after lockdown (2–3 June 2020) periods. These samples were analysed for heavy metals (Fe, Mn, Ni, Cr and Pb) and biological parameters (E. coli, Fecal coliforms, Fecal streptococci and Total coliforms). Fe concentration was within the permissible limit but, the concentrations of Mn, Ni, Cr and Pb were above the allowable limits for drinking uses as per the WHO. However, after lockdown the number of samples crossing the cutoff limit had considerably decreased (Mn: from 2 to 0 mg/L; Ni: from 13 to 10 mg/L; Cr: 7 to 5 mg/L and Pb: from 13 to 8 mg/L). The heavy metal pollution index (HPI) revealed that 176.75 km2 (67.4%) and 85.35 km2 (32.6%) areas fell under unsuitable and very poor categories, respectively, during the pre-lockdown period, whereas 138.23 km2 (52.6%), 118.98 km2 (45.3%) and 4.89 km2 (2.1%) areas fell under very poor, poor and good categories, respectively, during the post-lockdown period. Similarly, Total coliform, Fecal coliform and E. coli had decreased distinctly due to the pandemic lockdown. Therefore, the shutdown of small and large-scale industries during the lockdown period had improved the groundwater quality. The health risk assessment showed that 93%, 87% and 80% of pre-lockdown samples, and 87%, 80% and 73% of post-lockdown samples possessed non-carcinogenic risks (HI > 1) for children, female and male categories, respectively.

Comparative Analysis of Peri-Operative Parameters in Unstable Hip Fracture Management by PFNA: Hip Fracture Needs Early Care during Covid-19

Unstable peri-trochanteric fracture presents management challenges, more so during the Covid-19 pandemic. Aim of the study was to evaluateperi-operative parameters during proximal femoral anti-rotation (PFNA) nailing in the early lockdown period of Covid-19 pandemic (Post-C group) and compare them to a cohort of demographically matched unstable peri-trochanteric fracture group from the pre-lockdown period (Pre-C group) to ascertain any significant change in clinical, radiological and functional outcomes. We retrospectively analysed matched groups with respect to median age, ASA grading and comorbidities. Intraoperative parameters assessed were duration of operation theatre and surgical time for PFNA. In Post-C group, personal protection equipment (PPE) use by Health Care Worker (HCW)was evaluated.

Changes in Air Quality Associated with Mobility Trends and Meteorological Conditions during COVID-19 Lockdown in Northern England, UK

The COVID-19 pandemic triggered catastrophic impacts on human life, but at the same time demonstrated positive impacts on air quality. In this study, the impact of COVID-19 lockdown interventions on five major air pollutants during the pre-lockdown, lockdown, and post-lockdown periods is analysed in three urban areas in Northern England: Leeds, Sheffield, and Manchester. A Generalised Additive Model (GAM) was implemented to eliminate the effects of meteorological factors from air quality to understand the variations in air pollutant levels exclusively caused by reductions in emissions. Comparison of lockdown with pre-lockdown period exhibited noticeable reductions in concentrations of NO (56.68–74.16%), NO2 (18.06–47.15%), and NOx (35.81–56.52%) for measured data. However, PM10 and PM2.5 levels demonstrated positive gain during lockdown ranging from 21.96–62.00% and 36.24–80.31%, respectively. Comparison of lockdown period with the equivalent period in 2019 also showed reductions in air pollutant concentrations, ranging 43.31–69.75% for NO, 41.52–62.99% for NOx, 37.13–55.54% for NO2, 2.36–19.02% for PM10, and 29.93–40.26% for PM2.5. Back trajectory analysis was performed to show the air mass origin during the pre-lockdown and lockdown periods. Further, the analysis showed a positive association of mobility data with gaseous pollutants and a negative correlation with particulate matter.

Impact of COVID-19 Pandemic during the Lockdown on the Traumatic Brain Injury—An Institutional Experience

Abstract Background Traumatic brain injuries (TBIs) contribute to a significant socioeconomic impact, primarily affecting the lower-income sections of the society. The COVID-19 pandemic has resulted in a marked reduction in in-patient attendance. We are highlighting the impact of lockdown in neurotrauma cases in our institution compared to the prelockdown period. Methods We have done the retrospective review of the patients admitted due to TBI in prelockdown (January 14–March 21, 2020) and lockdown period (March 25–May 31, 2020) for the same duration of the 68 days at our tertiary institution. We have included demographic characteristics (age, sex), mode of injury, the severity of TBI, radiological diagnosis (computed tomography scan), and treatment obtained in our study. We compared the data for percentage (%) reduction of TBI cases and factors responsible for it during the lockdown period. Result A total of 166 patients were included in both groups. TBI’s most common mechanism was road traffic accident, but we observed an increase in self-fall (16.9% vs. 38.1%) and assault (11.2% vs. 19%) during the lockdown period. We have noted that moderate TBI increased during the lockdown period by 17%. Overall, there is a reduction of 67% in TBI cases during the lockdown period. Conclusion The COVID pandemic has limited road traffic activity, and strict implementation of lockdown has restricted the infection and has reduced the neurotrauma emergencies. Simultaneously, moderate TBI cases have increased because of the lack of transportation facility and delay in the management of mild TBI cases.

Impact of COVID-19 pandemic related lockdown on Suicide: Analysis of newspaper reports during pre-lockdown and lockdown period in Bangladesh and India.

The economic and social devastation wrought by the COVID-19 crisiscoupled with the unavailability of traditional coping resources is a "perfect storm" for suicide. Evidence suggests that its impact may be disproportionately high in low-and-middle-income countries. The study aimed to assess and compare nature and correlates of suicidesfrom news reportsduring the immediate pre-lockdown and lockdown phase of COVID-19 in Bangladesh and India. We performed analysis of suicide reports from purposively selected online vernacular and English newspapers of Bangladesh and two states/union territory in India, between January to June 2020. We divided the time period of observation into two phases: pre-lockdown and lockdown phase. Country wise findings between the two phases were compared in terms of demographic and characteristics of the reported suicide. A total of 769 news reports wereanalysed; 141 from Bangladesh and 628 from India. When compared to the pre-lockdown period, the odds of suicide by hanging was significantly higher during lockdownin India (adjusted Odds Ratios [aOR] = 3.8, p = 0.018) and Bangladesh (aOR = 3.1, p = 0.048). Suicide demographics in India were different from Bangladesh during lockdown; more males died by suicide in India (aOR = 2.7, p = 0.023) and more people died by hanging (aOR = 2.6, p = 0.029). The pandemic restrictions impacted suicide demographics in the studied regions of India and Bangladesh. Further research using population-based time-series data are warranted to investigate the issue.

COVID-19 lockdown: Effects on selected volatile organic compound (VOC) emissions over the major Indian metro cities

Due to the COVID-19 pandemic, many countries across the world, including India, have imposed nationwide lockdowns to contain the spread of the virus. Many studies reported that the air quality had improved much due to the lockdown. This study examines the variation of Volatile Organic Compounds (VOCs) over the Indian metropolitan cities during the lockdown period by using ground-based and satellite observations. Ground-based BTEX (Benzene, Toluene, Ethylbenzene, and Xylenes) measurements from various metropolitan cities have shown a drastic drop of about 82% in the first phase of lockdown when compared with the pre-lockdown period. Whereas the spatial distribution of formaldehyde (HCHO), obtained from the TROPOspheric Monitoring Instrument (TROPOMI) onboard Sentinal-5P satellite, did not show any significant variation due to COVID-19 lockdown, indicating the major source of HCHO is biogenic or pyrogenic. The BTEX ratios were evaluated for a better understanding of the source and photochemical age of the air samples. The ozone forming potential of BTEX in all locations was found reduced; however, the corresponding decrease in ozone concentrations was not observed. The increase in ozone concentrations during the same period indicates alternative sources contributing to ozone formation.

Impact and Modifications of In-Hospital Trauma Care Workflow Due to COVID 19 Pandemic: Lessons Learnt for the Future.

Objective:To describe the restructuring in-hospital systems of care at a Level -1 trauma center in India and to analyze an injury volume and patterns for future preparedness as well as to establish a specific injuries preventive measures during health emergencies like COVID-19.Methods:Data was extracted from a prospectively managed trauma registry at level-1 trauma center in India. We have compared the data in lockdown period with the same day’s number from the pre-lockdown period. Patients were categorized according to age, gender, injury cause, injury place, injury severity, and injury outcome to compare the statistical analysis between two periods.Results:Total emergency department (ED) trauma footfall decreased significantly by 73% during lockdown period. The injuries result increased significantly due to blunt forces. There was a significant decrease in the major injury of the patient’s percentage. The road traffic injuries (RTIs) in individuals were less than the reported falls number, which increased significantly during lockdown. The less number of patients significantly presented without receiving primary care. Majority of the patients had been transferred by using private cars, police vehicle, and two wheelers during lockdown; however, patients’ less number were transferred significantly by three wheelers as expected. The comparative analysis between quantitative data points shows significant differences in median Injury Severity Score (ISS) and length of stay during lockdown.Conclusion:This study highlighted that the preparedness should not focus solely on the response to treat infectious disease during health emergencies but also on ensuring access and provision of reasonable quality of care for non-infectious illnesses especially acute conditions like trauma.

Comparative Analysis of Soccer Performance Intensity of the Pre-Post-Lockdown COVID-19 in LaLiga™.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) forced a stoppage in the 2019/2020 season of LaLiga™, possibly influencing performance indicators in the return to competition. Therefore, here, we evaluated whether the stoppage due to the coronavirus 2019 disease (COVID-19) lockdown influenced physical performance compared to the start of LaLigaTM in terms of high-intensity efforts. Using a semi-automatic, multiple-camera system, running activities during 22 matches were analyzed. We compared the first 11 matches of the season (pre-lockdown) with the 11 matches just after the restart of LaLiga™ (post-lockdown). The results showed higher (p < 0.05) performance in the pre-lockdown period compared with the post-lockdown period, including in medium-speed running (14.1–21 km/h), high-speed running (21.1–24 km/h), and sprinting speed running distances (>24 km/h). However, the number of accelerations/min and decelerations/min were significantly higher during the post-lockdown period. Therefore, we conclude that the stoppage due to the COVID-19 lockdown generated lower physical performance in the post-lockdown period compared with the pre-lockdown period, most likely due to the accumulation of matches (congested schedules).

Return towards normality in admissions for myocardial infarction after the lockdown removal for COVID-19 outbreak in Italy

BackgroundInvestigations demonstrated a decrease of admissions for myocardial infarction (MI) during the CoronaVirus Disease-19 (COVID-19) outbreak. No study has evaluated the time required to reverse this downward curve of MI admissions. MethodsThis is a retrospective analysis on patients (N = 2415) admitted to the Emergency Departments for acute MI in nine Italian centers. Primary endpoint was the incidence rates (IRs) of MI admissions in the post-lockdown COVID-19 period (case-period: from May 4 to July 12, 2020) vs. the following control periods: January 1–February 19, 2020 (pre-lockdown period); February 20–May 3, 2020 (intra-lockdown period); May 4–July 12, 2019 (inter-year non-COVID-19 period). ResultsIR of admissions for MI in the post-lockdown period was higher than the intra-lockdown period (IR ratio, IRR: 1.60, 95% CI 1.42–1.81; p = 0.0001), was lower than the pre-lockdown period (IRR: 0.86, 0.77–0.96; p = 0.009) and similar to the inter-year non-COVID-19 period (IRR: 0.96, 0.87–1.07; p = 0.47). Within the case period, the increase in MI admissions was more pronounced in earlier vs later weeks (IRR 1.19, 95% CI 1.02–1.38, p = 0.024) and, compared to the inter-year control period, was significant for non ST-segment elevation MI (IRR: 1.25, 95% CI 1.08–1.46, p = 0.004), but was not observed for ST-segment elevation MI (STEMI), where hospitalizations were reduced (IRR 0.76, 95% CI 0.65–0.88, p = 0.0001). ConclusionsOur study first indicates an increase in the number of admissions for MI after the removal of the national lockdown for COVID-19 in Italy. This increase was prevalent in the first weeks following the lockdown removal, but was under-represented in STEMI patients.

The effect of the lockdown executive order during the COVID-19 pandemic in recent trauma admissions in Puerto Rico

BackgroundThe COVID-19 pandemic led to world-wide restrictions on social activities to curb the spread of this disease. Very little is known about the impact of these restrictions on trauma centers. Our objective was to determine the effect of the pandemic-associated lockdown on trauma admissions, patient’s demographics, mechanisms of injury, injury severity, and outcomes in the Puerto Rico Trauma Hospital.MethodsAn IRB-approved quasi-experimental study was performed to assess the impact of the restrictions by comparing trauma admissions during the lockdown (March 15, 2020 – June 15, 2020) with a control period (same period in 2017–2019). Comparisons were done using the Pearson’s chi-square test, Fisher exact test, or Mann-Whitney U test, as appropriate. A negative binomial model was fitted to estimate the incidence rate ratio for overall admissions among pre-lockdown and during-lockdown periods. Statistical significance was set at p < 0.05.ResultsA total of 308 subjects were admitted during the quarter of study for 2017; 323, for 2018; 347, for 2019; and 150, for 2020. The median (interquartile range) age of patients rose significantly from 40 (33) years to 49 (30) years (p < 0.001) for the lockdown period compared to the historical period. Almost all mechanisms of injury (i.e., motor vehicle accident, assault, pedestrian, burn, suicide attempt, other) had a slight non-significant reduction in the percentage of patients presenting with an injury. Instead, falls experienced an increase during the lockdown period (18.9% vs. 26.7%; p = 0.026). Moreover, the proportion of severe cases decreased, as measured by an injury severity score (ISS) > 15 (37.3% vs. 26.8%; p = 0.014); while there were no differences in the median hospital length of stay and the mortality rate between the comparison groups. Finally, the decrease in overall admissions registered during the lockdown accounts for a 59% (IRR 0.41; 95% CI 0.31–0.54) change compared to the pre-lockdown period, when controlling for sex, age, mechanism of injury, and ISS.ConclusionsFollowing periods of social isolation and curfews, trauma centers can expect drastic reductions in their overall patient volume with associated changes in trauma patterns. Our findings will help inform new interventions and improve healthcare preparedness for future or similar circumstances.

Impact of the COVID-19 pandemic on urgent dental care delivery in a Swiss university center for dental medicine

ObjectivesThis study aimed to assess whether the emergency service of a major Swiss dental institution faced different demands (patient volume, treatment needs, dental care characteristics) during a lockdown, issued to mitigate the COVID-19 pandemic, compared with the weeks before and after.Materials and methodsData of patients receiving urgent care at a university center for dental medicine (Basel, Switzerland) during the 6-week lockdown, pre-lockdown, and post-lockdown periods were retrospectively evaluated. Statistical analysis involved tests for equal proportions and logistic regression models. The level of significance was set at α=0.05.ResultsThe study comprised 3109 dental emergency visits in the period from February 2 to June 5, 2020. Daily caseloads increased during lockdown. Abscesses, orthodontic emergencies, and surgical follow-ups were more common during lockdown, whereas the number of dento-alveolar injuries declined (≤0.048). Urgent dental care provision involved intraoral radiographs more frequently in the pre-lockdown period compared with the following weeks (p<0.001). Among all treatments, aerosol-generating procedures dropped from 56.1% (pre-lockdown) to 21.3% during lockdown (p<0.001), while teledentistry follow-ups became more frequent (p<0.001). Patients with comorbidities sought urgent dental care less frequently during the post-lockdown period (p=0.004).ConclusionsThe lockdown significantly impacted the dental emergency service in terms of patients’ diagnoses, treatment needs, and the characteristics of the urgent care that was delivered.Clinical relevanceAccess to essential dental care must be monitored and safeguarded throughout the COVID-19 pandemic and beyond as deferred care entails risks for serious sequelae and persons with comorbidities may change their dental care-seeking behavior.