Impact of the first wave of the COVID-19 pandemic on non-COVID inpatient care in southern Spain

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Abstract

We assessed the impact of the first wave of COVID-19 pandemic on non-COVID hospital admissions, non-COVID mortality, factors associated with non-COVID mortality, and changes in the profile of non-COVID patients admitted to hospital. We used the Spanish Minimum Basic Data Set with diagnosis grouped according to the Diagnostic Related Groups. A total of 10,594 patients (3% COVID-19; 97% non-COVID) hospitalised during the first wave in 2020 (27-February/07-June) were compared with those hospitalised within the same dates of 2017–2019 (average annual admissions: 14,037). We found a decrease in non-COVID medical (22%) and surgical (33%) hospitalisations and a 25.7% increase in hospital mortality among non-COVID patients during the first pandemic wave compared to pre-pandemic years. During the officially declared sub-period of excess mortality in the area (17-March/20-April, in-hospital non-COVID mortality was even higher (58.7% higher than the pre-pandemic years). Non-COVID patients hospitalised during the first pandemic wave (compared to pre-pandemic years) were older, more frequently men, with longer hospital stay and increased disease severity. Hospitalisation during the first pandemic wave in 2020, compared to hospitalisation during the pre-pandemic years, was an independent risk factor for non-COVID mortality (HR 1.30, 95% CI 1.07–1.57, p = 0.008), reflecting the negative impact of the pandemic on hospitalised patients.

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Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study

Marina Pollán, Beatriz Pérez-Gómez, Roberto Pastor-Barriuso … (2020)

Summary Background Spain is one of the European countries most affected by the COVID-19 pandemic. Serological surveys are a valuable tool to assess the extent of the epidemic, given the existence of asymptomatic cases and little access to diagnostic tests. This nationwide population-based study aims to estimate the seroprevalence of SARS-CoV-2 infection in Spain at national and regional level. Methods 35 883 households were selected from municipal rolls using two-stage random sampling stratified by province and municipality size, with all residents invited to participate. From April 27 to May 11, 2020, 61 075 participants (75·1% of all contacted individuals within selected households) answered a questionnaire on history of symptoms compatible with COVID-19 and risk factors, received a point-of-care antibody test, and, if agreed, donated a blood sample for additional testing with a chemiluminescent microparticle immunoassay. Prevalences of IgG antibodies were adjusted using sampling weights and post-stratification to allow for differences in non-response rates based on age group, sex, and census-tract income. Using results for both tests, we calculated a seroprevalence range maximising either specificity (positive for both tests) or sensitivity (positive for either test). Findings Seroprevalence was 5·0% (95% CI 4·7–5·4) by the point-of-care test and 4·6% (4·3–5·0) by immunoassay, with a specificity–sensitivity range of 3·7% (3·3–4·0; both tests positive) to 6·2% (5·8–6·6; either test positive), with no differences by sex and lower seroprevalence in children younger than 10 years ( 10%) and lower in coastal areas (<3%). Seroprevalence among 195 participants with positive PCR more than 14 days before the study visit ranged from 87·6% (81·1–92·1; both tests positive) to 91·8% (86·3–95·3; either test positive). In 7273 individuals with anosmia or at least three symptoms, seroprevalence ranged from 15·3% (13·8–16·8) to 19·3% (17·7–21·0). Around a third of seropositive participants were asymptomatic, ranging from 21·9% (19·1–24·9) to 35·8% (33·1–38·5). Only 19·5% (16·3–23·2) of symptomatic participants who were seropositive by both the point-of-care test and immunoassay reported a previous PCR test. Interpretation The majority of the Spanish population is seronegative to SARS-CoV-2 infection, even in hotspot areas. Most PCR-confirmed cases have detectable antibodies, but a substantial proportion of people with symptoms compatible with COVID-19 did not have a PCR test and at least a third of infections determined by serology were asymptomatic. These results emphasise the need for maintaining public health measures to avoid a new epidemic wave. Funding Spanish Ministry of Health, Institute of Health Carlos III, and Spanish National Health System.

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Prevalence of mental health problems during the COVID-19 pandemic: A systematic review and meta-analysis

Tianchen Wu, Xiaoqian Jia, Huifeng Shi … (2020)

Highlinghts • The COVID-19 pandemic increases the prevalence of depression, anxiety, distress, and insomnia. • Health care workers and COVID-19 patients are high-risk groups of mental health. • Urgent interventions are needed for preventing mental health problems.

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Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review

Ray Moynihan, Sharon Sanders, Zoe A Michaleff … (2021)

Objectives To determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic. Design Systematic review. Eligibility Eligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics and therapeutics. Studies were excluded if from single centres or studied only patients with COVID-19. Data sources PubMed, Embase, Cochrane COVID-19 Study Register and preprints were searched, without language restrictions, until 10 August, using detailed searches with key concepts including COVID-19, health services and impact. Data analysis Risk of bias was assessed by adapting the Risk of Bias in Non-randomised Studies of Interventions tool, and a Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures and narrative synthesis. Outcome measures Primary outcome was change in service utilisation between prepandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (eg, triage scores). Results 3097 unique references were identified, and 81 studies across 20 countries included, reporting on >11 million services prepandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (IQR −51% to −20%), comprising median reductions for visits of 42% (−53% to −32%), admissions 28% (−40% to −17%), diagnostics 31% (−53% to −24%) and for therapeutics 30% (−57% to −19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27 (45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no difference. Conclusions Healthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health systems reduce unnecessary care in the postpandemic recovery. PROSPERO registration number CRD42020203729.

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Author and article information

Contributors

Antonia Gasch-Illescas:

ORCID: http://orcid.org/0000-0002-4800-7282

antonia.gasch.illescas@gmail.com

Journal

Journal ID (nlm-ta): Sci Rep

Journal ID (iso-abbrev): Sci Rep

Title: Scientific Reports

Publisher: Nature Publishing Group UK (London )

ISSN (Electronic): 2045-2322

Publication date (Electronic): 30 January 2023

Publication date PMC-release: 30 January 2023

Publication date Collection: 2023

Volume: 13

Electronic Location Identifier: 1634

Affiliations

[1 ]GRID grid.8970.6, ISNI 0000 0001 2159 9858, Prevention in Health and Longevity Centre, , Institut Pasteur de Lille, ; 59000 Lille, France

[2 ]GRID grid.9224.d, ISNI 0000 0001 2168 1229, University of Seville, ; 41004 Seville, Spain

[3 ]Infectious and Immune System Diseases-Epidemiology and Public Health, Institute of Biomedicine of Seville (IBiS) (Virgen del Rocío University Hospital, University of Seville, Junta de Andalucía, and Spanish Scientific Research Council-CSIC), 41013 Seville, Spain

[4 ]GRID grid.411109.c, ISNI 0000 0000 9542 1158, Internal Medicine Service, , Virgen del Rocío University Hospital, ; 41013 Seville, Spain

[5 ]GRID grid.414816.e, ISNI 0000 0004 1773 7922, Clinical Epidemiology and Vascular Risk, , Institute of Biomedicine of Seville (IBiS) (Virgen del Rocío University Hospital, University of Seville, Junta de Andalucía, and Spanish Scientific Research Council-CSIC), ; 41013 Seville, Spain

[6 ]GRID grid.4489.1, ISNI 0000000121678994, Department of Statistics and Operations Research, , University of Granada, ; Granada, Spain

[7 ]GRID grid.411109.c, ISNI 0000 0000 9542 1158, Clinical Documentation Service, , Virgen del Rocío University Hospital, ; 41013 Seville, Spain

[8 ]GRID grid.414816.e, ISNI 0000 0004 1773 7922, Institute of Biomedicine of Seville (IBiS) (Virgen del Rocío University Hospital, University of Seville, Junta de Andalucía, and Spanish Scientific Research Council-CSIC), ; 41013 Seville, Spain

[9 ]GRID grid.466571.7, ISNI 0000 0004 1756 6246, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERSP), ; 28029 Madrid, Spain

[10 ]GRID grid.413448.e, ISNI 0000 0000 9314 1427, National Center for Epidemiology, , Instituto de Salud Carlos III ES, ; 28029 Madrid, Spain

[11 ]GRID grid.9224.d, ISNI 0000 0001 2168 1229, Present Address: Department of Medicine, Faculty of Medicine, , University of Seville, ; 41013 Seville, Spain

Author information

Antonia Gasch-Illescas http://orcid.org/0000-0002-4800-7282

Article

Publisher ID: 28831

DOI: 10.1038/s41598-023-28831-6

PMC ID: 9885064

PubMed ID: 36717651

SO-VID: 3bd22b53-4e25-447b-97bd-49eaa606ed96

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Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 23 August 2022

Date accepted : 25 January 2023

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Keywords: health care,epidemiology

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ScienceOpen disciplines: Uncategorized

Keywords: health care, epidemiology

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Impact of the first wave of the COVID-19 pandemic on non-COVID inpatient care in southern Spain

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Most cited references 29

Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study

Prevalence of mental health problems during the COVID-19 pandemic: A systematic review and meta-analysis

Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review

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