Increase in Tuberculosis Diagnostic Delay during First Wave of the COVID-19 Pandemic: Data from an Italian Infectious Disease Referral Hospital

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Abstract

Background: The WHO advised that the impact of COVID-19 pandemic on TB services was estimated to be dramatic due to the disruption of TB services. Methods: A retrospective data collection and evaluation was conducted to include all the patients hospitalized for TB at INMI from 9 March to 31 August 2020 (lockdown period and three months thereafter). For the purpose of the study, data from patients hospitalized in the same period of 2019 were also collected. Results: In the period of March–August 2019, 201 patients were hospitalized with a diagnosis of TB, while in the same period of 2020, only 115 patients, with a case reduction of 43%. Patients with weight loss, acute respiratory failure, concurrent extrapulmonary TB, and higher Timika radiographic scores were significantly more frequently hospitalized during 2020 vs. 2019. The median patient delay was 75 days (IQR: 40–100) in 2020 compared to 30 days (IQR: 10–60) in 2019 ( p < 0.01). Diagnostic delays in 2020 remain significant in the multiple logistic model (AOR = 6.93, 95%CI: 3.9–12.3). Conclusions: Our experience suggests that COVID-19 pandemic had an impact on TB patient care in terms of higher diagnostic delay, reduction in hospitalization, and a greater severity of clinical presentations.

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The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study

Camille Maringe, James Spicer, Melanie Morris … (2020)

Summary Background Since a national lockdown was introduced across the UK in March, 2020, in response to the COVID-19 pandemic, cancer screening has been suspended, routine diagnostic work deferred, and only urgent symptomatic cases prioritised for diagnostic intervention. In this study, we estimated the impact of delays in diagnosis on cancer survival outcomes in four major tumour types. Methods In this national population-based modelling study, we used linked English National Health Service (NHS) cancer registration and hospital administrative datasets for patients aged 15–84 years, diagnosed with breast, colorectal, and oesophageal cancer between Jan 1, 2010, and Dec 31, 2010, with follow-up data until Dec 31, 2014, and diagnosed with lung cancer between Jan 1, 2012, and Dec 31, 2012, with follow-up data until Dec 31, 2015. We use a routes-to-diagnosis framework to estimate the impact of diagnostic delays over a 12-month period from the commencement of physical distancing measures, on March 16, 2020, up to 1, 3, and 5 years after diagnosis. To model the subsequent impact of diagnostic delays on survival, we reallocated patients who were on screening and routine referral pathways to urgent and emergency pathways that are associated with more advanced stage of disease at diagnosis. We considered three reallocation scenarios representing the best to worst case scenarios and reflect actual changes in the diagnostic pathway being seen in the NHS, as of March 16, 2020, and estimated the impact on net survival at 1, 3, and 5 years after diagnosis to calculate the additional deaths that can be attributed to cancer, and the total years of life lost (YLLs) compared with pre-pandemic data. Findings We collected data for 32 583 patients with breast cancer, 24 975 with colorectal cancer, 6744 with oesophageal cancer, and 29 305 with lung cancer. Across the three different scenarios, compared with pre-pandemic figures, we estimate a 7·9–9·6% increase in the number of deaths due to breast cancer up to year 5 after diagnosis, corresponding to between 281 (95% CI 266–295) and 344 (329–358) additional deaths. For colorectal cancer, we estimate 1445 (1392–1591) to 1563 (1534–1592) additional deaths, a 15·3–16·6% increase; for lung cancer, 1235 (1220–1254) to 1372 (1343–1401) additional deaths, a 4·8–5·3% increase; and for oesophageal cancer, 330 (324–335) to 342 (336–348) additional deaths, 5·8–6·0% increase up to 5 years after diagnosis. For these four tumour types, these data correspond with 3291–3621 additional deaths across the scenarios within 5 years. The total additional YLLs across these cancers is estimated to be 59 204–63 229 years. Interpretation Substantial increases in the number of avoidable cancer deaths in England are to be expected as a result of diagnostic delays due to the COVID-19 pandemic in the UK. Urgent policy interventions are necessary, particularly the need to manage the backlog within routine diagnostic services to mitigate the expected impact of the COVID-19 pandemic on patients with cancer. Funding UK Research and Innovation Economic and Social Research Council.

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Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era

Salvatore De Rosa, Carmen Spaccarotella, Cristina Basso … (2020)

Abstract Aims To evaluate the impact of the COVID-19 pandemic on patient admissions to Italian cardiac care units (CCUs). Methods and Results We conducted a multicentre, observational, nationwide survey to collect data on admissions for acute myocardial infarction (AMI) at Italian CCUs throughout a 1 week period during the COVID-19 outbreak, compared with the equivalent week in 2019. We observed a 48.4% reduction in admissions for AMI compared with the equivalent week in 2019 (P < 0.001). The reduction was significant for both ST-segment elevation myocardial infarction [STEMI; 26.5%, 95% confidence interval (CI) 21.7–32.3; P = 0.009] and non-STEMI (NSTEMI; 65.1%, 95% CI 60.3–70.3; P < 0.001). Among STEMIs, the reduction was higher for women (41.2%; P = 0.011) than men (17.8%; P = 0.191). A similar reduction in AMI admissions was registered in North Italy (52.1%), Central Italy (59.3%), and South Italy (52.1%). The STEMI case fatality rate during the pandemic was substantially increased compared with 2019 [risk ratio (RR) = 3.3, 95% CI 1.7–6.6; P < 0.001]. A parallel increase in complications was also registered (RR = 1.8, 95% CI 1.1–2.8; P = 0.009). Conclusion Admissions for AMI were significantly reduced during the COVID-19 pandemic across Italy, with a parallel increase in fatality and complication rates. This constitutes a serious social issue, demanding attention by the scientific and healthcare communities and public regulatory agencies.

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The Efficacy of Lockdown Against COVID-19: A Cross-Country Panel Analysis

Vincenzo Alfano, Salvatore Ercolano (2020)

Background There has been much debate about the effectiveness of lockdown measures in containing COVID-19, and their appropriateness given the economic and social cost they entail. To the best of our knowledge, no existing contribution to the literature has attempted to gauge the effectiveness of lockdown measures over time in a longitudinal cross-country perspective. Objectives This paper aims to fill the gap in the literature by assessing, at an international level, the effect of lockdown measures (or the lack of such measures) on the numbers of new infections. Given this policy’s expected change in effectiveness over time, we also measure the effect of having a lockdown implemented over a given number of days (from 7 to 20 days). Methods We pursue our objectives by means of a quantitative panel analysis, building a longitudinal dataset with observations from countries all over the world, and estimating the impact of lockdown via feasible generalized least squares fixed effect, random effects, generalized estimating equation, and hierarchical linear models. Results Our results show that lockdown is effective in reducing the number of new cases in the countries that implement it, compared with those countries that do not. This is especially true around 10 days after the implementation of the policy. Its efficacy continues to grow up to 20 days after implementation. Conclusion Results suggest that lockdown is effective in reducing the R0, i.e. the number of people infected by each infected person, and that, unlike what has been suggested in previous analyses, its efficacy continues to hold 20 days after the introduction of the policy. Electronic supplementary material The online version of this article (10.1007/s40258-020-00596-3) contains supplementary material, which is available to authorized users.

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Author and article information

Contributors

Fabrizio Palmieri:

ORCID: https://orcid.org/0000-0001-8184-6291

On behalf of : on behalf of the TB-INMI Working Group †

Danila V. Zimenkov: Role: Academic Editor

Journal

Journal ID (nlm-ta): Antibiotics (Basel)

Journal ID (iso-abbrev): Antibiotics (Basel)

Journal ID (publisher-id): antibiotics

Title: Antibiotics

Publisher: MDPI

ISSN (Electronic): 2079-6382

Publication date (Electronic): 08 March 2021

Publication date Collection: March 2021

Volume: 10

Issue: 3

Electronic Location Identifier: 272

Affiliations

[1 ]National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00161 Rome, Italy; gina.gualano@ 123456inmi.it (G.G.); laura.timelli@ 123456inmi.it (L.T.); pietro.vittozzi@ 123456inmi.it (P.V.); virginia.dibari@ 123456inmi.it (V.D.B.); Raffaella.libertone@ 123456inmi.it (R.L.); Carlotta.cerva@ 123456inmi.it (C.C.); carla.nisii@ 123456inmi.it (C.N.); stefania.ianniello@ 123456inmi.it (S.I.); silvia.mosti@ 123456inmi.it (S.M.); nazario.bevilacqua@ 123456inmi.it (N.B.); Fabio.iacomi@ 123456inmi.it (F.I.); annalisa.mondi@ 123456inmi.it (A.M.); simone.topino@ 123456inmi.it (S.T.); delia.goletti@ 123456inmi.it (D.G.); Francesco.vaia@ 123456inmi.it (F.V.); giuseppe.ippolito@ 123456inmi.it (G.I.); enrico.girardi@ 123456inmi.it (E.G.); fabrizio.palmieri@ 123456inmi.it (F.P.)

[2 ]Department of Epidemiology of Lazio Regional Health Service, 00147 Rome, Italy; l.pinnarelli@ 123456deplazio.it

Author notes

[* ]Correspondence: francesco.digennaro@ 123456inmi.it ; Tel.: +39-392-480-4707

[†]

TB-INMI Working Group: Fabrizio Palmieri, Gina Gualano, Andrea Antinori, Nazario Bevilacqua, Maria Capobianchi, Carmine Ciaralli, Gilda Cuzzi, Alessia De Angelis, Antonino Di Caro, Franca Del Nonno, Gianpiero D’Offizi, Emanuela Ercoli, Delia Goletti, Fabio Iacomi, Stefania Ianniello, Giuseppe Ippolito, Luisa Marchioni, Annelisa Mastrobattista, Maria Musso, Paola Mencarini, Annalisa Mondi, Silvia Mosti, Silvia Murachelli, Emanuele Nicastri, Carla Nisii, Carlo Pareo, Antonella Petrecchia, Nicola Petrosillo, Vincenza Puro, Silvia Rosati, Vincenzo Schininà, Paola Scognamiglio, Tommaso Speranza, Simone Topino, Francesco Vaia.

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Francesco Di Gennaro https://orcid.org/0000-0003-3453-5647

Carlotta Cerva https://orcid.org/0000-0001-9060-7313

Delia Goletti https://orcid.org/0000-0001-8360-4376

Giuseppe Ippolito https://orcid.org/0000-0002-1076-2979

Fabrizio Palmieri https://orcid.org/0000-0001-8184-6291

Article

Publisher ID: antibiotics-10-00272

DOI: 10.3390/antibiotics10030272

PMC ID: 7998965

PubMed ID: 33800406

SO-VID: b148aeb2-e457-458b-9e6a-9c61f6019c8a

License:

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

Increase in Tuberculosis Diagnostic Delay during First Wave of the COVID-19 Pandemic: Data from an Italian Infectious Disease Referral Hospital

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Novel Coronavirus Disease COVID-19

Most cited references 36

The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study

Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era

The Efficacy of Lockdown Against COVID-19: A Cross-Country Panel Analysis

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