A descriptive analysis of the effect of the national COVID-19 lockdown on the workload and case mix of patients presenting to a district-level emergency centre in Cape Town, South Africa (original) (raw)
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South African Medical Journal
The President of SA declared a 3-week nationwide lockdown, starting on 27 March 2020, in an effort to reduce the transmission rate, a decision guided by the Ministerial Advisory Committee on COVID-19. [2] The lockdown was subsequently extended to 1 May 2020, after which phased easing of restrictions would occur at a rate directed by epidemiological trends and healthcare operational capacity. [3] At its highest alert level, the lockdown regulated personal movement by implementing a curfew and mandating the public to remain at home other than for the purposes of purchasing essential living supplies and seeking emergency or chronic medical attention. [4] Furthermore, transport regulations limited the operating hours and carrying capacity of public transport vehicles. [3] It is important to note the personal financial cost that would result from these measures, especially in the context of SA, where poverty is rife and the unemployment rate is 29%, making the population vulnerable to economic instability. [5] Additionally, the general public was inundated with news reports stressing the severity of COVID-19 and social media trends, instantiated by #StayAtHome, highlighting the importance of social distancing. Ultimately these measures resulted in people ensconcing themselves in their homes and specifically avoiding healthcare facilities, which are perceived as places of high transmission risk, notwithstanding the National Department of Health's efforts to reduce this danger. [6] Many people's finances have been depleted, raising the question of affordability of the already lockdown-limited public transport system. Our hypothesis is that these inadvertent outcomes prevent patients from accessing healthcare, either physically owing to inaccessible transport, or psychologically through the fear of COVID-19 prompting personal infection mitigation behaviours. Objectives Having speculatively considered reasons driving a possible decline in admission statistics, we endeavoured through this research to investigate the change in urgent and emergency admissions to the Department of Surgery at Klerksdorp-Tshepong Hospital Complex (KTHC) prior to and during the first stage of COVID-19 lockdown. Methods Setting KTHC is a tertiary hospital in the largest city of North West Province, SA, and provides partial level 3 services to the entire province. [7] So This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.
Emergency Medicine Australasia, 2021
ObjectiveTo assess changes in presentations to EDs during the COVID‐19 pandemic lockdown in the Southern Region of New Zealand.MethodsWe conducted a retrospective audit of patients attending EDs in the Southern District Health Board (SDHB), from 1 March to 13 May 2020. We made comparisons with attendances during the same period in 2019. The 2020 study period included ‘pre‐lockdown’ (1 March–25 March), ‘level 4 (strict) lockdown’ (26 March–27 April) and ‘level 3 (eased) lockdown’ (28 April–13 May).ResultsPatient volumes reduced in all SDHB EDs during levels 4 and 3, mostly representing a loss of low acuity patients (Australasian Triage Scale 3, 4 and 5), although high‐acuity presentations also declined. Average patient age increased by 5 years; however, the proportions of sexes and ethnicities did not change. Presentations of cerebrovascular accidents and appendicitis did not change significantly. Trauma, mental health, acute coronary syndrome and infectious respiratory presentations...
Pattern of surgical emergencies during COVID-19 lockdown in a tertiary care centre
International Surgery Journal
Background: COVID-19 is a novel pandemic affecting almost all countries of the world. The containment measures in form of lockdown taken to prevent its spread has impacted pattern and volume of surgical emergencies. As emergency admissions form a major bulk of total surgical admissions hence this study was planned to look for the impact of lockdown on the spectrum of surgical emergencies in a tertiary care hospital.Methods: A descriptive register based study was done by collecting data of surgical emergencies in three phases – pre lockdown, lockdown and lockdown with relaxations. Data regarding surgical admissions which includes trauma as well as non-trauma emergencies during various phases was collected and analysed.Results: Total number of surgical emergencies decreased by 55.6% during lockdown when compared with pre-lockdown phase. In lockdown phase with relaxations, total admissions increased by 35.2% over lockdown phase however they was overall decrease by 19.4% than pre-lockdo...
European Journal of Medical Research
Purpose The burden of the coronavirus disease of 2019 (COVID-19) pandemic on the healthcare sector has been overwhelming, leading to drastic changes in access to healthcare for the public. We aimed to establish the impact of implemented government partial and complete lockdown policies on the volume of surgical patient admissions at a tertiary referral center during the pandemic. Methods A database was retrospectively created from records of patients admitted to the surgical ward through the emergency department. Three 6-week periods were examined: The complete lockdown period (CLP), which included a ban on the use of cars with the exception of health service providers and essential sector workers; A pre-COVID period (PCP) 1 year earlier (no lockdown); and a partial lockdown period (PLP) that involved a comprehensive curfew and implementing social distancing regulations and wear of personal protective equipment (e.g., masks) in public places. Results The number of patients admitted ...
2021
BACKGROUND: The aim of this retrospective comparative study was to assess the impact of the COVID-19 related disease on emergency surgery, comparing clinical main outcomes in the period March –May 2019 (Group 1) with the same period in Covid-19 Italian lockdown (March-May 2020, Group 2).METHODS: A comparison (Group 1 versus 2) was performed between the demographic, anamnestic, surgical, clinical and management features.RESULTS: 246 patients were included, 137 in Group 1 and 109 in Group 2 (p=0.03). No significant differences in peri-operative characteristics were registered. A declared delay in access to hospital and SARS-CoV-2 preoperatively infection rates were 15.5% and 5.8% respectively in Group 2. The overall morbidity (OR=2.22, 95%CI=1.08-4.55, p=0.03) and 30-day mortality (OR=1.34, 95%CI=0.33-5.50, =0.68) increased significantly in Group 2. Delayed access cohort demonstrated a close correlation with increased morbidity (OR=3.19, 95%CI=0.89-11.44, p=0.07), blood transfusion (O...
BMC Emergency Medicine, 2023
Background To limit virus spread during the COVID pandemic, extensive measures were implemented around the world. In South Africa, these restrictions included alcohol and movement restrictions, factors previously linked to injury burden in the country. Consequently, reports from many countries, including South Africa, have shown a reduction in trauma presentations related to these restrictions. However, only few studies and none from Africa focus on the impact of the pandemic restrictions on the Emergency Medical System (EMS). Methods We present a retrospective, observational longitudinal study including data from all ambulance transports of physical trauma cases collected during the period 2019-01-01 and 2021-02-28 from the Western Cape Government EMS in the Western Cape Province, South Africa (87,167 cases). Within this timeframe, the 35-days strictest lockdown level period was compared to a 35-days period prior to the lockdown and to the same 35-days period in 2019. Injury characteristics (intent, mechanism, and severity) and time were studied in detail. Ambulance transport volumes as well as ambulance response and on-scene time before and during the pandemic were compared. Significance between indicated periods was determined using Chi-square test. Results During the strictest lockdown period, presentations of trauma cases declined by > 50%. Ambulance transport volumes decreased for all injury mechanisms and proportions changed. The share of assaults and traffic injuries decreased by 6% and 8%, respectively, while accidental injuries increased by 5%. The proportion of self-inflicted injuries increased by 5%. Studies of injury time showed an increased share of injuries during day shift and a reduction of total injury volume during the weekend during the lockdown. Median response-and on-scene time remained stable in the time-periods studied. Conclusion This is one of the first reports on the influence of COVID-19 related restrictions on EMS, and the first in South Africa. We report a decline in trauma related ambulance transport volumes in the Western Cape Province as well as changes in injury patterns, largely corresponding to previous findings from hospital settings in South Africa. The unchanged response and on-scene times indicate a well-functioning EMS despite pandemic challenges. More studies are needed, especially disaggregating the different restrictions.
Cureus, 2023
Background: The COVID-19 infection was rapidly spreading almost all over the world, and the first case was confirmed on 27th January 2020 by a foreign tourist in Sri Lanka. The first Sri Lankan citizen with COVID-19 was confirmed on 11th March 2020. Soon after the confirmation of the disease, long days of lockdown were imposed in almost all parts of the world, including Sri Lanka, to control the spread of the disease. Objectives: To determine the demographic characteristics such as age, sex, number of patients, and disease pattern among non-COVID-19 patients admitted to the medical units during the lockdown of the COVID-19 pandemic and to compare these characteristics with the data before the lockdown. Methods: This was a cross-sectional analytical study. It was conducted at the Teaching Hospital in Batticaloa, Sri Lanka. All the non-COVID-19 patients admitted to medical wards and intensive care units (ICU) were included in this study. Patients admitted to the medical intensive care unit (MICU) and coronary care unit (CCU) were considered ICU admissions in this study. They were studied over a period of one month during lockdown (11th March 2020 to 10th April 2020) and compared with the patients admitted one month prior to the lockdown (11th February 2020 to 10th March 2020). Results: Totally, 2340 non-COVID-19 patients (52.5% males) were admitted before the lockdown, and 1376 non-COVID-19 patients (56.2% males) were admitted during the lockdown. This reduction in admission is statistically significant (p-value is <0.001, df=3715). Patients admitted to the wards before lockdown were 2283 (97.6%) and during lockdown were 1309 (95.1%). ICU admissions were N=57 (2.4%) before lockdown and N=67 (4.9%) during lockdown. The common age distribution before the lockdown showed that 26.4% were 31-50 and 41.5% were 51-70 years. Similarly, during lockdown, the age distribution disclosed that 28.9% were 31-50 years and 42.9% were 51-70 years. The disease pattern demonstrated that before lockdown, the majority of patients were admitted for routine hemodialysis (13.2%), to get an injection (9.9%), ischemic heart disease (8.4%), chronic kidney disease (7.3%), and viral fever, including dengue (7.2%). Likewise, during lockdown, more patients were admitted for routine hemodialysis (10.7%), viral fever, including dengue (9.3%), ischemic heart disease (8.8%), to get an injection (8.5%), and chronic kidney disease (5.9%).
2021
Background: The COVID-19 pandemic caused a rise in healthcare demands and has necessitated a significant restructuring of hospital Emergency Departments.The present study aims to determine the pandemic lockdown's impact on the number of patients seeking assessment in the Surgical Emergency Department (SED) with General Surgery emergencies. Methods: Since the start of the Covid pandemic in Greece (1 March, 2020) and up to 15 December 2020, the charts of all patients arriving at the SED of the third surgical department of the “Attikon” University Hospital (a tertiary referral center for surgical and COVID-19 cases) were retrospectively reviewed and broken down in four periods reflecting two nationwide lockdown (period A; 1/3/2020 to 30/4/2020 and period D; 16/10/2020 to 15/12/2020) and two interim (period B; 1/5/2020 to 15/6/2020 and period C; 15/9/2020 to 30/10/2020) periods. Demographic and clinical data were compared to those obtained from the same time periods of the year 2019...
World Journal of Emergency Surgery, 2021
Background The aim of this retrospective comparative study was to assess the impact of COVID-19 and delayed emergency department access on emergency surgery outcomes, by comparing the main clinical outcomes in the period March–May 2019 (group 1) with the same period during the national COVID-19 lockdown in Italy (March–May 2020, group 2). Methods A comparison (groups 1 versus 2) and subgroup analysis were performed between patients’ demographic, medical history, surgical, clinical and management characteristics. Results Two-hundred forty-six patients were included, 137 in group 1 and 109 in group 2 (p = 0.03). No significant differences were observed in the peri-operative characteristics of the two groups. A declared delay in access to hospital and preoperative SARS-CoV-2 infection rates were 15.5% and 5.8%, respectively in group 2. The overall morbidity (OR = 2.22, 95% CI 1.08–4.55, p = 0.03) and 30-day mortality (OR = 1.34, 95% CI 0.33–5.50, =0.68) were significantly higher in gro...
Journal of Karnali Academy of Health Sciences, 2020
Background: Emergency visits during pandemic also comprise the patients with various complains other than symptoms of COVID. It is prudent to identify the variation of non-COVID-19 cases (cases that do not have fever or cough or travel history or contact history or health professional) that visit emergency department during pandemic and their outcome for proper division of resources including human resources during pandemic. Methods: This is a cross sectional study done in emergency department of Kathmandu Medical College Teaching Hospital (KMCTH) Data were collected from the record book from 24 th March 2020 to 21 st July 2020 (lockdown period) and four months prior to 24 th March. The variation in emergency admissions, demographic profile, outcome of the patients, departments admitting the patients and place of admission was evaluated using SPSS. Results: Total of 6944 cases were seen during the pre-lockdown period and 2503 cases during the lockdown period, which is 63.95% less than the pre-lockdown era. Males (53.14% and 53.40% during pre-lockdown and lockdown respectively) visited emergency more frequently than females during both the periods. The number of cases that were admitted from the ER during the lockdown had fallen by 67.5% from the prelockdown era. Likewise, the patients admitted in ward, high care, ICU had decreased by 76%, 49%, 64% respectively compared to pre-lockdown period. However, the rate of admissions in intensive care unit had risen from 32.58% to 35.73% during lockdown. (There was decrease in injury, poisoning or certain consequences of external causes and external causes of morbidity and mortality by 57.5% and 52% respectively. Conclusion: The overall rate of admissions was low both for the COVID. However, the admission in intensive care units increased during the lockdown period which gives the idea that people were only visiting hospital when their symptoms were worse.