+ + + Collateral Effects + + +

* * * Next update: 24 November. In the meantime, find the global updates at 7 Days. * * *

18 November

De Luca G, Verdoia M, Cercek M, et al. Impact of COVID-19 Pandemic on Mechanical Reperfusion for Patients With STEMI. J Am Coll Cardiol. 2020 Nov 17;76(20):2321-2330. PubMed: https://pubmed.gov/33183506. Full-text: https://doi.org/10.1016/j.jacc.2020.09.546

A total of 6609 patients underwent primary percutaneous coronary intervention (PPCI) in 77 centers, located in 18 countries. In 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio: 0.81; 95% confidence interval: 0.78 to 0.84). Furthermore, the pandemic was associated with a significant increase in “door-to-balloon” and total ischemia times, which may have contributed to higher mortality during the pandemic.

17 November

Leske S, Kõlves K, Cromton D, et al. Real-time suicide mortality data from police reports in Queensland, Australia, during the COVID-19 pandemic: an interrupted time-series analysis. Lancet Psychiatry, November 16, 2020. Full-text: https://doi.org/10.1016/S2215-0366(20)30435-1

Do suicide rates increase during infectious disease outbreaks? Probably not (at least in Australia). In this study, analyzing suspected suicide rates in 2020 relative to 2015–19 to assess any early effects of the COVID-19 pandemic in Queensland, no evidence of a change in suspected suicide rates was seen.


15 September

Monnet DL, Harbarth S. Will coronavirus disease (COVID-19) have an impact on antimicrobial resistance? Euro Surveill. 2020;25(45):pii=2001886. Full-text: https://doi.org/10.2807/1560-7917.ES.2020.25.45.2001886.

Good question. We don’t know yet. After summarizing various determinants that may result in either an increase or, inversely, a decrease in antimicrobial resistance (AMR), the authors found them to be balanced. The truth is that the impact of the COVID-19 pandemic on AMR will only become clear in the coming months and years as data gradually become available. Changes in AMR will most likely vary depending on the setting—e.g., ICUs vs other hospital units, hospital vs community settings—and possibly between countries.


11 November

Abdallah HO, Zhao C, Kaufman E, et al. Increased Firearm Injury During the COVID-19 Pandemic: A Hidden Urban Burden. J Am Coll Surg. 2020 Oct 26:S1072-7515(20)32413-3. PubMed: https://pubmed.gov/33166665. Full-text: https://doi.org/10.1016/j.ja mcollsurg.2020.09.028

Lockdown causes domicile discord which in turn causes more penetrating trauma? Jose Pascual, Hatem Abdallah and colleagues tested the hypothesis that intentional injury might have increased during stay-at-home-orders (SAHO) and assessed injury patterns from 6 weeks pre- to 10 weeks post- statewide stay-at-home order. 357 and 480 trauma patients presented pre- and post-SAHO, respectively. Pre- and post- groups demonstrated differences in sex, age, and race. Post-SAHO mechanism of injury (blunt vs. penetrating) revealed more intentional injury.


Lee PH, Marek J, Nálevka P. Sleep pattern(s) in the US and 16 European countries during the COVID-19 outbreak using crowdsourced smartphone data. Eur J Public Health 2020, published 10 November. Full-text: https://doi.org/10.1093/eurpub/ckaa208

When you sleep, your smartphone is taking notes and you may end up in a scientific publication. Here Paul Lee and colleagues utilized a large crowdsourced database (Sleep as Android) and analyzed the (your?) sleep behavior of 25,217 users with 1,352,513 sleep records between 1st January and 29th April 2020 in 16 European countries (Germany, United Kingdom, Spain, France, Italy, the Netherlands, Belgium, Hungary, Denmark, Finland, Norway, Czech, Sweden, Austria, Poland, and Switzerland) and in the US. The unsurprising result: during lockdown, people delayed their bedtime and slept longer than usual.


9 November

Jahrami H, BaHammam AS, Bragazzi NL, Saif Z, Faris M, Vitiello MV. Sleep problems during COVID-19 pandemic by population: a systematic review and meta-analysis. J Clin Sleep Med. 2020 Oct 27. PubMed: https://pubmed.gov/33108269. Full-text: https://doi.org/10.5664/jcsm.8930

Forty-four papers, involving a total of 54,231 participants from 13 countries, contributed to this systematic review and meta-analysis of sleep problems during COVID-19. The global pooled prevalence rate of sleep problems among all populations was 35.7%. COVID-19 patients appeared to be the most affected group, with a pooled rate of 74.8%. Healthcare workers and the general population had comparative rates of sleep problems with rates of 36.0% and 32.3%, respectively.


Dyer O. Covid-19: Denmark to kill 17 million minks over mutation that could undermine vaccine effort.  BMJ 2020; 371:m4338. Full-text: https://doi.org/10.1136/bmj.m4338

Among 5,102 samples of virus taken from Danish patients since June, five infection clusters affecting 214 people involved mink variant virus. One of these, known as cluster 5, seems to be a problematic variant which could be less susceptible to some antibodies/vaccines (unproven). This variant has been detected with four simultaneous changes in the genes for the Spike protein (for nerds: H69del/V70del, Y453F, I692V and M1229I) and has affected 11 people in North Jutland. Conclusion: 17 million minks will be culled.


5 November

Huh K, Jung J, Hong J, et al. Impact of non-pharmaceutical interventions on the incidence of respiratory infections during the COVID-19 outbreak in Korea: a nationwide surveillance study. Clin Infect Dis 2020, published 5 November. Full-text: https://doi.org/10.1093/cid/ciaa1682

Non-pharmaceutical interventions (NPIs) implemented to slow the spread of SARS-CoV-2 have led to the decline in the incidences of highly transmissible respiratory infections. This is the result of a study by Ji-Man Kang, Kyungmin Huh and colleagues from the Children’s Hospital, Yonsei University College of Medicine, Seoul. Comparing the period February–July 2020 to the previous 4 years, the authors found that the incidences of chickenpox and mumps were significantly lower than in the prediction model (chickenpox: 36%, mumps: 63%).


2 November

Qu Z, Oedingen C, Bartling T, Schrem H, Krauth C. Organ procurement and transplantation in Germany during the COVID-19 pandemic. Lancet. 2020 Oct 31;396(10260):1395. PubMed: https://pubmed.gov/33129390. Full-text: https://doi.org/10.1016/S0140-6736(20)32213-3

No damage in this area: Compared with the previous year, the cumulative numbers of deceased organ donors and transplants showed no significant reduction in Germany. Kidney transplantation numbers were stable, while the numbers of heart, lung, and liver transplantations from deceased donors even increased from January to April, 2020, when compared with the same period of the previous year. In contrast, transplant activities in Italy and Spain were reduced by 30–50%.


Sors F, Grassi M, Agostini T, Murgia M. The sound of silence in association football: Home advantage and referee bias decrease in matches played without spectators. Eur J Sport Sci. 2020 Nov 1;1-21. Full-text: https://doi.org/10.1080/17461391.2020.1845814

We have eagerly awaited this news for decades: spectators can significantly contribute to determine the dynamics and the outcomes of professional football matches (home advantage and referee bias are two well-documented phenomena in professional sports). COVID-19 has made it possible: focusing on the first and second divisions of the top four UEFA countries, the authors analyzed 841 matches behind closed doors during the pandemic. This extremely important work revealed that observed frequencies for home victories, draws and away victories were significantly different from the expected frequencies calculated based on the last three complete seasons with spectators. The absence of a referee bias in favor of the home teams for yellow cards indicated that this factor might be particularly affected by the presence/absence of social pressure by spectators. Various parameters were considered, and the analyses revealed a reduction of home advantage and the absence of referee bias. They´ll walk alone now.


30 October

Garrett-Mayer E, Rini BI. To Treat or Not to Treat—Balancing Benefits and Risks of Treatment Delay Among Patients With Cancer During the COVID-19 Pandemic. JAMA Oncol 2020, published 29 October. Full-text: https://doi.org/10.1001/jamaoncol.2020.4886

To treat or not to treat after balancing the benefits and risks of immediate treatment for cancer with the potential risk of COVID-19 and its associated complications, including death? Elizabeth Garrett-Mayer and Brian Rini discuss the paper by Hartman HE, Sun Y, Devasia TP, et al: Integrated Survival Estimates for Cancer Treatment Delay Among Adults With Cancer During the COVID-19 Pandemic. JAMA Oncol 2020, published 29 October. Full-text: https://doi.org/10.1001/jamaoncol.2020.5403


25 October

Wathelet M, Duhem S, Vaiva G, et al. Factors Associated With Mental Health Disorders Among University Students in France Confined During the COVID-19 Pandemic. JAMA Netw Open October 23, 2020. 2020;3(10):e2025591. Full-text: https://doi.org/10.1001/jamanetworkopen.2020.25591

This nation-wide survey study of 69,054 students from France who experienced quarantine found high prevalence rates of severe self-reported mental health symptoms, including suicidal thoughts (11%), severe distress (22%), high level of perceived stress (25%), severe depression (16%), and high level of anxiety (28%).  Among risk factors identified, female or nonbinary gender, problems with income or housing, history of psychiatric follow-up, symptoms compatible with COVID-19, social isolation, and low quality of information received were associated with altered mental health. Main limitation is that the population represented only 4.3% of students contacted and that self-selection bias may have altered the results. However, they are suffering.


21 October

Mohamed MO, Banerjee A, Clarke S, et al. Impact of COVID-19 on cardiac procedure activity in England and associated 30-day mortality. Eur Heart J 2020, published 20 October. Full-text: https://doi.org/10.1093/ehjqcco/qcaa079

A preview of what cardiology departments might see in the coming autumn and winter months 2020/2021. The authors analyzed the impact of COVID-19 on changes in cardiac procedure activity in England. Compared to the monthly averages (March-May) in 2018-2019, there was a deficit of 45,501 procedures between 1st January and 31st May 2020. Cardiac catheterization and device implantations were the most affected in terms of numbers (n = 19,637 and n = 10,453). No difference in 30-day mortality was observed between pre-COVID and COVID time-periods for all cardiac procedures except cardiac catheterization and cardiac device implantation.


18 October

Marchetti D, Fontanesi L, Mazza C, et al. Parenting-Related Exhaustion During the Italian COVID-19 Lockdown. Journal of Pediatric Psychology,17 October 2020. Full-text: https://doi.org/10.1093/jpepsy/jsaa093

Who suffers the most? While many countries prepare for a second lockdown, this study took a look on the psychological consequences during the first wave, performing interviews with a total of 1,226 parents via a demographic questionnaire. Seventeen percent reported significant parenting-related exhaustion and most parents reported a clinically alarming level of distress. Multiple regression analyses showed that greater parenting-related exhaustion was predicted by psychological distress, lower parental resilience, motherhood, fewer perceived social connections, and being single, as well as having a child with special needs, having a large number of children, and having younger children.


14 October

Been JV, Burgos Ochoa L, Bertens LCM. Impact of COVID-19 mitigation measures on the incidence of preterm birth: a national quasi-experimental study. Lancet Public Health 2020, published 13 October. Full-text:  https://doi.org/10.1016/S2468-2667(20)30223-1

In this large national quasi-experimental study spanning a 10-year period, substantial reductions in preterm births were observed following implementation of the first national COVID-19 mitigation measures in the Netherlands on March 9, 2020. Babies born at the lowest gestational ages and those with the lowest birthweights were consistently underrepresented in our cohort throughout the study period.


3 October

Bakouny Z, Hawley JE, Choueiri TK, et al. COVID-19 and Cancer:Current Challenges and Perspectives. Cancer Cell 2020, published 1 October. Full-text: https://doi.org/10.1016/j.ccell.2020.09.018

The SARS-CoV-2 pandemic has affected patients with cancer in many ways (adverse outcomes in those who developed COVID-19, impact on the delivery of cancer care, etc.). In this review, the authors discuss the biological interplay between the two diseases and give practical recommendations for the management of patients with cancer during the pandemic. They also provide some insights from the cancer research community that might help develop novel therapies for all patients with COVID-19.


1 October

Li L, Li F, Fortunati F, et al. Association of a Prior Psychiatric Diagnosis With Mortality Among Hospitalized Patients With Coronavirus Disease 2019 (COVID-19) Infection. JAMA Netw Open September 30, 2020; 3(9):e2023282. Full-text: https://doi.org/10.1001/jamanetworkopen.2020.23282

Among a total of 1685 patients who were hospitalized with COVID-19, 473 (28%) received psychiatric diagnoses prior to hospitalization. After controlling for demographic characteristics, other medical comorbidities, and hospital location, the risk of death remained significantly greater among patients with a psychiatric disorder (hazard ratio, 1.5; 95% CI, 1.1-1.9; P = .003). Reasons are unclear. Psychiatric symptoms may arise as a marker of systemic pathophysiologic processes such as inflammation, that may, in turn, predispose to mortality. Similarly, psychiatric disorders may augment systemic inflammation and compromise the function of the immune system, while psychotropic medications may also be associated with mortality risk. Or is there confounding?


Toor J, Adams ER, Aliee M, et al. Predicted Impact of COVID-19 on Neglected Tropical Disease Programs and the Opportunity for Innovation. Clin Infect Dis. 2020 Sep 28:ciaa933. PubMed: https://pubmed.gov/32984870. Full-text: https://doi.org/10.1093/cid/ciaa933

Due to the COVID-19 pandemic, many key neglected tropical disease (NTD) activities have been postponed. However, disruption will vary amongst the diseases and there are ways to mitigate the impact and accelerate progress towards the ambitious WHO 2030 goals.


27 September

Weiss DJ, Bertozzi-Villa A, Rumisha SF, et al. Indirect effects of the COVID-19 pandemic on malaria intervention coverage, morbidity, and mortality in Africa: a geospatial modelling analysis. Lancet Infect Dis 2020, published 25 September. Full-text: https://doi.org/10.1016/S1473-3099(20)30700-3

Under pessimistic scenarios, COVID-19-related disruption to malaria control in Africa could almost double malaria mortality in 2020, and potentially lead to even greater increases in subsequent years.


Ueda Oshima M, Sandmaier BM, Petersdorf E, et al. Blood and marrow transplantation during the emerging COVID-19 pandemic: the Seattle approach. Bone Marrow Transplant 2020, published 26 September. Full-text: https://doi.org/10.1038/s41409-020-01068-x

Increasing numbers of COVID-19 hospitalizations and deaths, pandemic-related stresses on healthcare resources, shelter-in-place public health measures – how can you safely perform potentially life-saving stem cell transplants in this setting? Masumi Oshima et al. describe the challenges and the collateral impact of directing clinical resources toward COVID-19-related care on cancer patients in need of stem cell transplantation.


17 September

Evans ML, Lindauer M, Farrell ME. A Pandemic within a Pandemic — Intimate Partner Violence during Covid-19. N Engl J Med 2020, published 16 September. Full-text: https://doi.org/10.1056/NEJMp2024046

Stay-at-home orders led to many workers being furloughed, laid off, or told to work from home. They also left many intimate partner violence victims trapped with their abusers. Megan Evans, Margo Lindauer and Maureen Farrell put the 2020 lockdown experiences into perspective.


27 August

Hamadani JD, Hasan MI, Baldi AJ, et al. Immediate impact of stay-at-home orders to control COVID-19 transmission on socioeconomic conditions, food insecurity, mental health, and intimate partner violence in Bangladeshi women and their families: an interrupted time series. Lancet Global Health 2020, published 25 August. Full-text:: https://doi.org/10.1016/S2214-109X(20)30366-1

In many countries, lockdowns exacerbate the risk of food insecurity and intimate partner violence. Here Sant-Rayn Pasricha, Jena Derakhshani Hamadani and colleagues analyze the impact lockdown orders on women and their families in rural Bangladesh. They randomly selected and invited the mothers of 3016 children to participate in the study, 2424 of whom provided consent. Almost all women reported a reduction in paid work for the family. Median monthly family income fell from US$212 at baseline to $59 during lockdown, and the proportion of families earning less than $1·90 per day rose from almost 0% to 47%. Before the pandemic, 5.6% and 2.7% experienced moderate and severe food insecurity, respectively. This increased to 36.5% and 15.3% during the lockdown. Find more information about intimate violence (emotional, physical, sexual).


25 August

Lee LYW, Cazier JB, Starkey T, et al. COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study. Lancet Oncol 2020, published 24 August. Full-text: https://doi.org/10.1016/S1470-2045(20)30442-3

Patients with cancer have been reported to be at increased risk of infection with SARS-CoV-2 and a more severe disease course. Here Gary Middleton, Lennard Lee and colleagues compare cancer patients with and without COVID-19 and analyses the effect of tumor features (primary subtype and stage) and patient demographics (age and sex) on the risk and trajectory of COVID-19 disease. Some results:

  1. The all-cause case–fatality rate in patients with cancer after SARS-CoV-2 infection was significantly associated with increasing age, rising from 0.10 in patients aged 40–49 years to 0.48 in those aged 80 years and older.
  2. Patients with hematological malignancies (leukemia, lymphoma, and myeloma) had a more severe COVID-19 trajectory compared with patients with solid organ tumors.
  3. Patients with hematological malignancies who had recent chemotherapy had an increased risk of death during COVID-19-associated hospital admission (odds ratio 2.09).


Malik AA, Safdar N, Chandir S, et al. Tuberculosis control and care in the era of COVID-19. Health Policy and Planning 2020, published 24 August. Full-text: https://doi.org/10.1093/heapol/czaa109

Reports from India, China and Pakistan suggest a daily decline in tuberculosis case notification of 75 – 80% in the last few months with testing in Pakistan decreasing up to 80%. Is this the end of the Zero TB Initiative launched in October 2015 which aimed to create ‘islands of TB elimination’? See the six recommendations by Amyn Malik et al.


16 August

Editorial. The EVALI outbreak and vaping in the COVID-19 era. The Lancet Respiratory Medicine 2020, published 14 August. Full-text: https://doi.org/10.1016/S2213-2600(20)30360-X

From August 2019 to February 2020, 2,807 cases of EVALI (e-cigarette, or vaping, product use-associated lung injury) were reported to the CDC, including 68 deaths. Symptoms of EVALI may overlap with those of some infectious respiratory diseases, including COVID-19. This editorial highlights current knowledge and how the effects of vaping might now be colliding with the risk of COVID-19. Several experts have asked for e-cigarettes to be withdrawn from the market during the pandemic.


Bayram H, Köktürk N, Elbek O, et al. Interference in scientific research on COVID-19 in Turkey. Lancet 2020, 396: 463-464, August 15, 2020. Full-text: https://doi.org/10.1016/S0140-6736(20)31691-3

Ethics as a second step? The Turkish Ministry of Health has announced a mandatory application for permission for research on COVID-19, before any application is made to ethics committees. Hasan Bayram and colleagues are worried about these restrictions on independent research in Turkey and hope that the decision will be taken back in compliance with the Turkish Constitution.


14 August

McGuckin B. Dental Triaging: past, present and future. BDJ In Pract 2020;33: 22–23. Full-text: https://doi.org/10.1038/s41404-020-0472-y

Does a ‘lost’ upper anterior crown constitute a dental emergency and require an urgent non-scheduled appointment? It used to be, but in COVID times, it isn’t anymore, despite the emotional distress for the patient. Read these and other considerations in a short overview of dental triage yesterday, today and tomorrow. The next time you go to the dentist, you’ll remember Bronagh McGuckin.


10 August

Nicolay N, Mirinaviciute G, Mollet T, et al. Epidemiology of measles during the COVID-19 pandemic, a description of the surveillance data, 29 EU/EEA countries and the United Kingdom, January to May 2020. Eurosurveillance August 6, 2020. Volume 25, Issue 31. Full-text: https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.31.2001390

Interesting: The number of measles cases declined in the EU and UK in 2020. Reported cases to The European CDC decreased from 710 to 54 between January and May. However, according to the authors, under-diagnoses and under-reporting during the COVID-19 pandemic should be ruled out before concluding that reduced measles circulation is due to social distancing and any community control measures taken to control COVID-19.


9 August

Gluckman TJ, Wilson MA, Chiu S, et al. Case Rates, Treatment Approaches, and Outcomes in Acute Myocardial Infarction During the Coronavirus Disease 2019 Pandemic. JAMA Cardiol 2020, published 7 August. Full-text: https://doi.org/10.1001/jamacardio.2020.3629

Out of fear of contracting SARS-CoV-2, large numbers of patients avoided hospitalization during the COVID-19 pandemic. After analyzing 15,244 hospitalizations involving 14,724 patients with acute myocardial infarction, Tyler Gluckman and colleagues found that patients hospitalized for acute myocardial infarction during the early COVID-19 period had an increased observed/expected mortality ratio which was associated disproportionately with patients with ST-segment elevation myocardial infarction (STEMI).


6 August

Kaufman HW, Chen Z, Niles J, Fesko Y. Changes in the Number of US Patients with Newly Identified Cancer Before and During the Coronavirus Disease 2019 (COVID-19) Pandemic. JAMA Netw Open 2020;3(8):e2017267. Full-text: https://doi.org/10.1001/jamanetworkopen.2020.17267

During and after lockdowns, people go into hibernation mode, but cancer does not. Now Harwey Kaufman and colleagues report a cross-sectional study about patients across the United States who received clinical laboratory testing related to any of 6 cancer types (i.e., breast, colorectal, lung, pancreatic, gastric, and esophageal). Each patient was counted once, at the first instance of a cancer-related ICD-10 code. The authors compared 258,598 patients from the baseline period (January 6, 2019, to February 29, 2020) with 20,180 patients from the COVID-19 period (March 1 to April 18, 2020). During the pandemic, the weekly number of newly identified patients fell 46.4% (from 4310 to 2310) for the 6 cancers combined, with significant declines in all cancer types, ranging from 24.7% for pancreatic cancer (from 271 to 204; p = 0.01) to 51.8% for breast cancer (from 2208 to 1064; p < 0.001). The authors anticipate that a delay in diagnosis will likely lead to presentation at more advanced stages and poorer clinical outcomes.


Matsuo T, Kobayashi D, Taki F, et al. Prevalence of Health Care Worker Burnout During the Coronavirus Disease 2019 (COVID-19) Pandemic in Japan. JAMA Netw Open 2020; 3(8):e2017271. Full-text: https://doi.org/10.1001/jamanetworkopen.2020.17271

How prevalent is burnout among frontline health care workers (HCWs) during the COVID-19 pandemic? Takahiro Matsuo and colleagues conducted an online cross-sectional survey among HCWs at a tertiary hospital in Tokyo which had among the highest numbers of patients with COVID-19 in Japan. Among the final sample of 312 HCW’s, the burnout prevalence was 31.4% (98 of 312). Nurses: 59/126 (46.8%); radiological technologists: 8/22 (36.4%); pharmacists: 7/19 (36.8%). Find more details (i.e., burnout was more prevalent in participants with fewer years of experience) in the paper.


3 August

Mekaoui N, Razine R, Bassat Q, et al. The Effect of COVID-19 on Paediatric Emergencies and Admissions in Morocco: Cannot See the Forest for the Trees? J Trop Pediatr 2020, published 1 August. Full-text: https://doi.org/10.1093/tropej/fmaa046

Where are the sick Moroccan children normally brought to the emergency department? When Nour Mekaoui and colleagues from the Rabat Children’s Hospital, Morocco, compared the number of pediatric consultations (< 16 years) in the emergency department from 16 March to 15 April 2020 with the number of consultations of the same period in the preceding year, they discovered that the number of overall consultations decreased by 74% between the two periods (4232 vs. 1110; p < 0.005). Even the the number of hospitalizations declined (811 in 2019 vs. 471 in 2020, a 41.9% reduction, p < 0.005; see figure). The authors are worried: Where did these severely ill patients go? Might we anticipate a new wave of serious non-COVID-19 pediatric admissions?