Medium-term impacts of the waves of the COVID-19 epidemic on treatments for non-COVID-19 patients in intensive care units: A retrospective cohort study in Japan

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Abstract

Background

Maintaining critical care for non-Coronavirus-disease-2019 (non-COVID-19) patients is a key pillar of tackling the impact of the COVID-19 pandemic. This study aimed to reveal the medium-term impacts of the COVID-19 epidemic on case volumes and quality of intensive care for critically ill non-COVID-19 patients.

Methods

Administrative data were used to investigate the trends in case volumes of admissions to intensive care units (ICUs) compared with the previous years. Standardized mortality ratios (SMRs) of non-COVID-19 ICU patients were calculated in each wave of the COVID-19 epidemic in Japan.

Results

The ratios of new ICU admissions of non-COVID-19 patients to those in the corresponding months before the epidemic: 21% in May 2020, 8% in August 2020, 9% in February 2021, and 14% in May 2021, approximately concurrent with the peaks in COVID-19 infections. The decrease was greatest for new ICU admissions of non-COVID patients receiving invasive mechanical ventilation (IMV) on the first day of ICU admission: 26%, 15%, 19%, and 19% in the first, second, third, and fourth waves, respectively. No statistically significant change in SMR was observed in any wave of the epidemic; SMRs were 0.990 (95% uncertainty interval (UI), 0.962–1.019), 0.979 (95% UI, 0.953–1.006), 0.996 (95% UI, 0.980–1.013), and 0.989 (95% UI, 0.964–1.014), in the first, second, third, and fourth waves of the epidemic, respectively.

Conclusions

Compared to the previous years, the number of non-COVID-19 ICU patients continuously decreased over the medium term during the COVID-19 epidemic. The decrease in case volumes was larger in non-COVID-19 ICU patients initially receiving IMV than those undergoing other initial treatments. The standardized in-hospital mortality of non-COVID-19 ICU patients did not change in any waves of the epidemic.

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Most cited references 26

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Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries

Victoria Haldane, Chuan De Foo, Salma M Abdalla … (2021)

Health systems resilience is key to learning lessons from country responses to crises such as coronavirus disease 2019 (COVID-19). In this perspective, we review COVID-19 responses in 28 countries using a new health systems resilience framework. Through a combination of literature review, national government submissions and interviews with experts, we conducted a comparative analysis of national responses. We report on domains addressing governance and financing, health workforce, medical products and technologies, public health functions, health service delivery and community engagement to prevent and mitigate the spread of COVID-19. We then synthesize four salient elements that underlie highly effective national responses and offer recommendations toward strengthening health systems resilience globally.

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Excess deaths associated with covid-19 pandemic in 2020: age and sex disaggregated time series analysis in 29 high income countries

Nazrul Islam, Vladimir M. Shkolnikov, Rolando Acosta … (2021)

Objective To estimate the direct and indirect effects of the covid-19 pandemic on mortality in 2020 in 29 high income countries with reliable and complete age and sex disaggregated mortality data. Design Time series study of high income countries. Setting Austria, Belgium, Czech Republic, Denmark, England and Wales, Estonia, Finland, France, Germany, Greece, Hungary, Israel, Italy, Latvia, Lithuania, the Netherlands, New Zealand, Northern Ireland, Norway, Poland, Portugal, Scotland, Slovakia, Slovenia, South Korea, Spain, Sweden, Switzerland, and United States. Participants Mortality data from the Short-term Mortality Fluctuations data series of the Human Mortality Database for 2016-20, harmonised and disaggregated by age and sex. Interventions Covid-19 pandemic and associated policy measures. Main outcome measures Weekly excess deaths (observed deaths versus expected deaths predicted by model) in 2020, by sex and age (0-14, 15-64, 65-74, 75-84, and ≥85 years), estimated using an over-dispersed Poisson regression model that accounts for temporal trends and seasonal variability in mortality. Results An estimated 979 000 (95% confidence interval 954 000 to 1 001 000) excess deaths occurred in 2020 in the 29 high income countries analysed. All countries had excess deaths in 2020, except New Zealand, Norway, and Denmark. The five countries with the highest absolute number of excess deaths were the US (458 000, 454 000 to 461 000), Italy (89 100, 87 500 to 90 700), England and Wales (85 400, 83 900 to 86 800), Spain (84 100, 82 800 to 85 300), and Poland (60 100, 58 800 to 61 300). New Zealand had lower overall mortality than expected (−2500, −2900 to −2100). In many countries, the estimated number of excess deaths substantially exceeded the number of reported deaths from covid-19. The highest excess death rates (per 100 000) in men were in Lithuania (285, 259 to 311), Poland (191, 184 to 197), Spain (179, 174 to 184), Hungary (174, 161 to 188), and Italy (168, 163 to 173); the highest rates in women were in Lithuania (210, 185 to 234), Spain (180, 175 to 185), Hungary (169, 156 to 182), Slovenia (158, 132 to 184), and Belgium (151, 141 to 162). Little evidence was found of subsequent compensatory reductions following excess mortality. Conclusion Approximately one million excess deaths occurred in 2020 in these 29 high income countries. Age standardised excess death rates were higher in men than women in almost all countries. Excess deaths substantially exceeded reported deaths from covid-19 in many countries, indicating that determining the full impact of the pandemic on mortality requires assessment of excess deaths. Many countries had lower deaths than expected in children <15 years. Sex inequality in mortality widened further in most countries in 2020.

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Managing ICU surge during the COVID-19 crisis: rapid guidelines

Shadman Aziz, Yaseen M. Arabi, Waleed Alhazzani … (2020)

Given the rapidly changing nature of COVID-19, clinicians and policy makers require urgent review and summary of the literature, and synthesis of evidence-based guidelines to inform practice. The WHO advocates for rapid reviews in these circumstances. The purpose of this rapid guideline is to provide recommendations on the organizational management of intensive care units caring for patients with COVID-19 including: planning a crisis surge response; crisis surge response strategies; triage, supporting families, and staff. Electronic supplementary material The online version of this article (10.1007/s00134-020-06092-5) contains supplementary material, which is available to authorized users.

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Author and article information

Contributors

Shusuke Watanabe: Role: ConceptualizationRole: Formal analysisRole: Writing – original draft

Jung-ho Shin: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Writing – review & editing

Takuya Okuno: Role: ConceptualizationRole: Writing – review & editing

Tetsuji Morishita: Role: ConceptualizationRole: Writing – review & editing

Daisuke Takada: Role: ConceptualizationRole: Writing – review & editing

Susumu Kunisawa: Role: ConceptualizationRole: Data curationRole: Writing – review & editing

Yuichi Imanaka:

ORCID: https://orcid.org/0000-0003-4613-2159

Role: ConceptualizationRole: SupervisionRole: Writing – review & editing

Negar Rezaei: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS One

Journal ID (publisher-id): plos

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 26 September 2022

Publication date Collection: 2022

Publication date PMC-release: 26 September 2022

Volume: 17

Issue: 9

Electronic Location Identifier: e0273952

Affiliations

[001] Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan

Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, ISLAMIC REPUBLIC OF IRAN

Author notes

Competing Interests: The authors declare that they have no competing interests.

* E-mail: imanaka-y@ 123456umin.net

Author information

Yuichi Imanaka https://orcid.org/0000-0003-4613-2159

Article

Publisher ID: PONE-D-22-06278

DOI: 10.1371/journal.pone.0273952

PMC ID: 9512181

SO-VID: 95c21473-bcf9-4acd-a2df-b3af5cba4314

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 2 March 2022

Date accepted : 18 August 2022

Page count

Figures: 3, Tables: 2, Pages: 14

Funding

Funded by: funder-id http://dx.doi.org/10.13039/501100003478, Ministry of Health, Labour and Welfare;

Award ID: 21HA2011

Award Recipient :

ORCID: https://orcid.org/0000-0003-4613-2159

Yuichi Imanaka

Funded by: Japan Society for the Promotion of Science

Award ID: JP19H01075

Award Recipient :

ORCID: https://orcid.org/0000-0003-4613-2159

Yuichi Imanaka

Funded by: Japan Society for the Promotion of Science

Award ID: 21K21136

Award Recipient : Jung-ho Shin

Funded by: ISHIZUE 2022 of Kyoto University

Award Recipient :

ORCID: https://orcid.org/0000-0003-4613-2159

Yuichi Imanaka

This study was supported by JSPS KAKENHI [Grant Number JP19H01075 to YI and 21K21136 to JS] from the Japan Society for the Promotion of Science, by the ISHIZUE 2022 of Kyoto University to YI and by Health Labour Sciences Research Grant from the Ministry of Health, Labour and Welfare, Japan [20HA2003 and 21HA2011] to YI. The funders played no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.

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Data Availability According to the Ethical Guidelines for Medical and Health Research Involving Human Subjects of the Ministry of Health, Labour and Welfare, Japan (a provisional translation is available from https://www.mhlw.go.jp/file/06-Seisakujouhou-10600000-Daijinkanboukouseikagakuka/0000080278.pdf), to waive informed consent, providing “information” to study subjects is necessary. The list of data users is included in the “information”. Therefore, the datasets generated during and/or analyzed during this study are available from the corresponding author and the other contact points on reasonable request. The other contact points are Office of Research Promotion, General Affairs and Planning Division, Kyoto University (E-mail: kikaku06@ 123456mail2.adm.kyoto-u.ac.jp ; Tel: +81-75-753-9301) and the Ethics Committee, Graduate School of Medicine, Kyoto University (e-mail: ethcom@ 123456kuhp.kyoto-u.ac.jp ).

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Medium-term impacts of the waves of the COVID-19 epidemic on treatments for non-COVID-19 patients in intensive care units: A retrospective cohort study in Japan

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Novel Coronavirus Disease COVID-19

Most cited references 26

Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries

Excess deaths associated with covid-19 pandemic in 2020: age and sex disaggregated time series analysis in 29 high income countries

Managing ICU surge during the COVID-19 crisis: rapid guidelines

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