Editorial | Doubling Down After a Rough Patch

To examine whether patients exposed to primary care telemedicine (telephone or video) early in the COVID-19 pandemic had higher rates of downstream HbA1c measurement and improved HbA1c levels in the second year of the pandemic. In a cohort of 242,848 Kaiser Permanente Northern California patients with diabetes, we examined associations between early-pandemic patient-initiated telemedicine visits and downstream HbA1c monitoring and results during the second year of the pandemic. Adjusted HbA1c measurement rates were significantly higher among patients with telemedicine exposure in the early-pandemic prior year than those with no visits in the prior year (91.0% testing for patients with video visits, 90.5% for telephone visits, visits, 86.7% for no visits, p < 0.05). Among those with HbA1c measured, the rates of having an HbA1c < 8% in the second year of the COVID-19 pandemic were also statistically significantly higher among patients with telemedicine exposure in the early-pandemic prior year than those with no visits in the prior year (68.5% with HbA1c < 8% for video visits, 67.3% for telephone visits, 66.6% for no visits, p < 0.05). Access to telephone and video telemedicine throughout the early COVID-19 pandemic was associated with patients' continued engagement in recommended diabetes care. Although our study analyzed telemedicine use during a pandemic, telemedicine visits may continue to support ongoing health care access and positive clinical outcomes.

During the early period of the COVID-19 pandemic there was a substantial decrease in pediatric emergency department (PED) visitation. The intent of this study is to report PED utilization during the COVID-19 pandemic in an urban pediatric referral center located close to the epicenter in the northeastern US.A retrospective analysis of medical records of patients visiting the PED at Robert Wood Johnson University Hospital (RWJUH) was performed. Data included: daily census, admission rate, Emergency Severity Index, and ICD-10 diagnosis codes for the period of February through July, 2018 to 2020.By the week of March 26th, visits had decreased by 70% compared to the average of the previous 2 years. This census nadir lasted for 6 weeks. At 5 weeks postnadir the average daily census recovered to levels 40% lower than prior year norms and remained at that level during subsequent months. The greatest decreases were seen in low-acuity visits. Visits for behavioral health and fractures decreased by approximately 50% and 70%, respectively, but recovered to prior year norms by June and July of 2020. Visits for asthma exacerbation decreased by as much as 87% and remained at record lows for the remainder of the study period.A substantial and persistent decrease in PED visitation was experienced during the COVID-19 pandemic. Whereas visits for behavioral health and fractures have recovered to prior year norms, visits for asthma exacerbation remain at record lows. Further research is needed to ascertain the causes of these changes, including patient perceptions of the PED.

Introduction: Even though most EMS systems globally experienced dramatic decreases in call volumes during the COVID-19 pandemic, many also reported unexpected increases in out-of-hospital cardiac arrest (OHCA) cases. Hypothesis: The pervasiveness of COVID-19 in metropolitan cities might be associated with a greater number of OHCA cases as compared to prior years. Methods: Large city EMS system medical directors responsible for about one-quarter of the U.S. population and millions of others in Europe/Australia were asked to tabulate the absolute number of OHCA cases to which EMS responded within their jurisdictions during the first 4 months of 2020. Results were compared to average numbers encountered during 2018 and 2019. A priori, considering the large populations (high corresponding OHCA frequencies) and case complexities, a 15% increase/decrease was to be considered highly significant (usual variation + 4-8% within the 28-31 days/month). Results: Of 35 major U.S. cities reporting to date, most had significant increases in OHCA, particularly in April with 71% (25/35) of the cities seeing a very large (&gt;15%) increase. Nine cities (26%), all experiencing a high prevalence of COVID-19, had &gt;50% (1.5-fold) increases. Three cities with highly-publicized inundations of COVID-19, experienced more than twice as many arrests (3.5-fold in the worst case). Meanwhile, 3 other cities with relatively low COVID-19 impact to date, had significantly fewer cases. Still, combining all of the 35 cities studied, OHCA increased from 5,009 (2 prior years’ average) to 8,701 (74% increase) during April (Fig 1). Participating cities outside the U.S. (e.g., Paris, London, Perth) mirrored these findings. Conclusions: To date, most, but not all, metropolitan cities have clearly experienced significant increases in OHCA that appear to parallel the prevalence of COVID-19 in their respective jurisdictions. These observations and available forensic data are now part of a work in progress.

Monitoring stroke patients in critical-care units for 24h after thrombolysis or endovascular thrombectomy is considered standard of care in current guidelines but is not evidence-based. Due to the COVID-19 pandemic, our center adopted a targeted protocol in April 2021 with 24-h critical-care monitoring no longer being guaranteed for stroke patients receiving reperfusion treatment. We aim to compare the incidence and timing of complications during the year under the targeted approach compared to prior years when the standard of care was followed. We conducted a single-center retrospective cohort study. We analyzed data from stroke patients treated with thrombolysis and/or endovascular thrombectomy in 2019 (pre-COVID-19, standard of care), 2020 (during COVID-19, standard of care) and 2021 (during COVID-19, targeted protocol). Data extracted included demographics, the nature and timing of complications within the first 24h, and the unit at the time of complication. Three hundred forty-nine patients were included in our study: 78 patients in 2019, 115 patients in 2020, and 156 patients in 2021. In 2021, 32% of patients experienced at least 1 complication within the first 24h compared to 34% in 2020 and 27% in 2019. In 2021, 33% of patients admitted to critical-care units had a complication compared to 29% in non-critical care units. In 2021, 70% of complications had occurred by hour 8 compared to 49% in 2020 and 29% in 2019. The incidence and timing of complications did not significantly worsen under the targeted approach compared to prior years and were not associated with hospital location.

An international public health emergency has resulted from the emergence of the new coronavirus-2. Both direct and indirect influences have been felt on the treatment of acute stroke. However, no conclusive link between COVID-19 and the alleged decline in admissions for stroke-related reasons has been established, and the findings of recent studies are contentious. Most of those researches are not made use of authentic data. Therefore, the goal of this study is to examine how the COVID-19 pandemic has affected hospital admissions for stroke patients, to provide a basis for managing stroke patients in hospitals during COVID-19 pandemic. This retrospective study took place at the People's Hospital of Peking University in Beijing, China. For each patient, interventions such as the application of tissue plasminogen activator (tPA) were examined. We recorded each patient's outcomes. The stroke patients' hospital admissions were compared to the average of the prior year. As the time span of interest, we selected the epidemic period (January 2020 to December 2020). When compared to the previous year in the pre-COVID period, mean monthly stroke hospitalizations decreased during the pandemic by 54.42% (P<0.001); average lengths of stay (ALOS) increased; and non-emergency admissions decreased by 78.8% (P<0.001). The monthly volume of stroke patients exceeding the intravenous thrombolysis (IVT) window decreased by 25% and 59.73%, respectively (P <0.001). There was a 5.3% increase in the percentage of IVT or within IVT time window in male stroke patients (p=0.019; p=0.049). During COVID-19, the proportion of non-local patients among male stroke patients decreased by 10% compared with the previous year (p=0.006). The COVID-19 epidemic has had a negative impact on stroke management in China, healthcare systems must work to assess and adapt to the new reality.

School meals can support children's health and educational outcomes; however, in the US, only students from households with incomes at or below 185% of the federal poverty level qualify for free or reduced-price meals. Although the Community Eligibility Provision (CEP) enables schools in higher poverty areas to offer free meals to all students, many schools do not participate; the temporary implementation of federal Universal Free School Meal (UFSM) policies during the COVID-19 pandemic and subsequent state-level policies highlight the need for assessing their impact on participation rates in school meal programs. To examine the impact of federal- and state-level UFSM and related policies on National School Lunch Program (NSLP) and School Breakfast Program (SBP) participation rates during and after the COVID-19 pandemic. This comparative effectiveness research study used a natural experiment created by the COVID-19 pandemic to analyze school-level data from the 2019 to 2020 school-year period to the 2023 to 2024 school-year period. A difference-in-difference analysis with linear mixed-effects models was conducted to assess the impact of federal-level UFSM implementation and deimplementation and state-level policies on SBP and NSLP participation rates. School-level meal claims data were analyzed across 14 states with UFSM or related policies and 11 comparison states, and schools participating in the NSLP and the SBP were included in this analysis. Federal UFSM policy, state-level UFSM policies, CEP participation, and limited expansions of free meal access. Participation rates in SBP and NSLP, measured as percentage-point changes over time. Federal UFSM during the COVID-19 pandemic increased NSLP and SBP participation by 10 percentage points (range, -8 to 18 percentage points) and 8 percentage points (range, 2-20 percentage points), respectively, where percentage points refers to absolute changes in participation rates. Deimplementation in school year 2022 to 2023 reduced participation by 12 percentage points (range, -15 to -4 percentage points) for NSLP and 10 percentage points (range, -18 to -4 percentage points) for SBP. States that maintained UFSM policies showed consistently higher participation rates compared with states that discontinued UFSM, with increases between 9 and 19 percentage points (NSLP) and between 5 and 26 percentage points (SBP) in the first year of policy implementation, relative to the prior year. CEP participation resulted in substantial participation gains (23 percentage points for NSLP, 13 percentage points for SBP). State policies with limited free meal expansions showed no significant effect. Results of this comparative research analysis suggest that UFSM policies may effectively increase school meal participation, indicating the need for sustained state and federal support to increase participation rates and potentially mitigate diet-related disparities and food insecurity among children.

Background Mycoplasma pneumoniae is a common cause of respiratory illness in children. During the COVID-19 pandemic, M. pneumoniae infections decreased globally. In the Fall of 2023, various countries identified a reemergence of this bacterium. At Lehigh Valley Health Network (LVHN), the emergency departments and the children’s hospital experienced an increase of Mycoplasma infections starting in late Spring of 2024. The aim of this study was to compare the percentage of positive M. pneumoniae PCR results to determine if there was a significant local increase in the number of Mycoplasma infections over the past year. Figure showing the total number of PCR multiplex tests performed (left axis) and the percentage of positive Mycoplasma pneumoniae PCR tests (right axis) from March 2022 through March 2025. Methods A retrospective review of M. pneumoniae PCR tests from the BIOFIRE RP2.1™ Panel (BioFire Diagnostics, Salt Lake City, Utah) was performed in patients younger than 18 years who had testing performed at LVHN emergency departments and inpatient pediatric units. Available test results were reviewed starting from March 2022, when the institution began using the multiplex panel that included M. pneumoniae, through March 2025. Results During 2022 and 2023, the weekly M. pneumoniae PCR positivity remained below 1%. The weekly PCR positivity rate started increasing in Spring 2024 and reached a peak of 7.1% in August 2024 despite a lower number of tests performed (182 tests). The percentage of positive PCR tests remained elevated until late October 2024, with a PCR positivity of 5.9%. From March 31, 2024 to March 29, 2025, 250 children tested positive for M. pneumoniae. This is compared to only 15 positive PCR tests during the same time period the year prior and 6 positive tests the year before that. The mean weekly positivity rate between March 31, 2024 and March 29, 2025 was 1.98 compared to 0.13 the prior year (p &amp;lt; 0.0001). Conclusion Following a period of minimal M. pneumoniae activity after the COVID-19 pandemic, the percentage of M. pneumoniae positive PCR test results significantly increased in our community over the last year. During a time with low testing and low circulation of other respiratory viruses, there was a notable peak of Mycoplasma infection during the Summer of 2024 which continued into the late Fall. Further monitoring is needed to evaluate the periodicity of Mycoplasma infection in the post-pandemic period. Disclosures All Authors: No reported disclosures

BackgroundSuicide is a major public health problem with immediate and long-term effects on individuals, families, and communities. In 2020 and 2021, stressors wrought by the COVID-19 pandemic, stay-at-home mandates, economic turmoil, social unrest, and growing inequality likely modified risk for self-harm. The coinciding surge in firearm purchasing may have increased risk for firearm suicide. In this study, we examined changes in counts and rates of suicide in California across sociodemographic groups during the first two years of the COVID-19 pandemic relative to prior years.MethodsWe used California-wide death data to summarize suicide and firearm suicide across race/ethnicity, age, education, gender, and urbanicity. We compared case counts and rates in 2020 and 2021 with 2017–2019 averages.ResultsSuicide decreased overall in 2020 (4123 deaths; 10.5 per 100,000) and 2021 (4104; 10.4 per 100,000), compared to pre-pandemic (4484; 11.4 per 100,000). The decrease in counts was driven largely by males, white, and middle-aged Californians. Conversely, Black Californians and young people (age 10 to 19) experienced increased burden and rates of suicide. Firearm suicide also decreased following the onset of the pandemic, but relatively less than overall suicide; as a result, the proportion of suicides that involved a firearm increased (from 36.1% pre-pandemic to 37.6% in 2020 and 38.1% in 2021). Females, people aged 20 to 29, and Black Californians had the largest increase in the likelihood of using a firearm in suicide following the onset of the pandemic. The proportion of suicides that involved a firearm in 2020 and 2021 decreased in rural areas compared to prior years, while there were modest increases in urban areas.ConclusionsThe COVID-19 pandemic and co-occurring stressors coincided with heterogeneous changes in risk of suicide across the California population. Marginalized racial groups and younger people experienced increased risk for suicide, particularly involving a firearm. Public health intervention and policy action are necessary to prevent fatal self-harm injuries and reduce related inequities.

e18506 Background: In response to the COVID-19 pandemic, many health systems postponed routine screening and care to conserve resources and reduce patient exposure. As a result, several studies have shown a decline in the diagnosis of new cancer cases, a process that relies heavily on the use of screening tools and modalities. The Washington D.C. area is home to a heterogeneous patient population and one of the highest income gaps in the United States. Patterns in healthcare inequality in the area mirror these disparities. This study aims to identify the impact of the COVID-19 pandemic on cancer diagnosis rates compared to prior years and analyze whether vulnerable populations in the D.C. area were disproportionately affected. Methods: Data was collected from the George Washington University (GWU) Cancer Registry. The study population included patients age 18 and up residing in D.C., Maryland or Virginia who were diagnosed with any cancer at the GWU Health System within the following date ranges: April 1 to September 30 of 2018, 2019, 2020 and September 1, 2019 to February 29, 2020. Data collected included age at diagnosis, race, ethnicity, cancer site, stage at diagnosis, and patient zip code as a proxy for socioeconomic status (SES). Median income by zip code was labeled as low, middle or high. Chi square analysis was used to compare changes in each of these demographic and SES categories between each time frame. Results: There were 372 new cancer diagnoses during the COVID-19 period, April 1 2020 to September 30 2020. During this time period in 2018 and 2019, there were 525 and 539 new cancer diagnoses, respectively. Immediately prior to the COVID-19 period, September 1 2019 to February 29 2020, there were 588 new cancer diagnoses. Patterns of cancer type, age at diagnosis, sex, clinical stage, pathological stage and SES did not significantly differ between the COVID-19 period and any other time period (p &gt; 0.05 for all categories). However, ethnicity did change significantly with a slight increase in the number of Hispanic patients diagnosed during the COVID-19 period as compared to the 2018 and 2019 time periods (p = 0.041) and the September 2019 to February 2020 time period (p = 0.0005). Conclusions: Through this retrospective analysis, we observed a decrease in new cancer diagnoses during the COVID-19 period with no significant differences in patient age, sex, cancer type, cancer stage or SES. There was a slight increase in cancer diagnoses among Hispanic patients during the COVID-19 period. These results suggest that most groups were equally impacted by the COVID-19 pandemic with respect to cancer diagnosis. However, this may be specific to the region we studied and limited by the population size and our means of collecting data about patient SES. Further studies comparing early and late impacts of COVID-19 on cancer care will be important to identify specific communities for targeted outreach and intervention.

Quality Assurance of Radiotherapy During the Covid-19 Pandemic: Impact on Peer Review in 14 Regional Cancer Centers Across Ontario

The COVID-19 pandemic created challenges to the evaluation and treatment of cancer, and abrupt resource diversion toward patients with COVID-19 put cancer treatment on hold for many patients. Previous reports have shown substantial declines in cancer screening and diagnoses in 2020; however, the extent to which the delivery of cancer care was altered remains unclear. To assess alterations in cancer treatment in the US during the first year of the COVID-19 pandemic. This retrospective cohort study used data from the National Cancer Database (NCDB) on patients older than 18 years with newly diagnosed cancer from January 1, 2018, to December 31, 2020. The main outcomes were accessibility (time to treatment, travel distance, and multi-institutional care), availability (proportional changes in cancer treatment between years), and utilization (reductions by treatment modality, hospital type) of cancer treatment in 2020 compared with 2018 to 2019. Autoregressive models forecasted expected findings for 2020 based on observations from prior years. Of 1 229 654 patients identified in the NCDB in 2020, 1 074 225 were treated for cancer, representing a 16.8% reduction from what was expected. Patients were predominately female (53.8%), with a median age of 66 years (IQR, 57-74 years), similar to demographics in 2018 and 2019. Median time between diagnosis and treatment was 26 days (IQR, 0-36 days) in 2020, and median travel distance for care was 11.1 miles (IQR, 5.0-25.3 miles), similar to 2018 and 2019. In 2020, fewer patients traveled longer distances (20.2% reduction of patients traveling >35 miles). The proportions of patients treated with chemotherapy (32.0%), radiation (29.5%), and surgery (57.1%) were similar to those in 2018 and 2019. Overall, 146 805 fewer patients than expected underwent surgery, 80 480 fewer received radiation, and 68 014 fewer received chemotherapy. Academic hospitals experienced the greatest reduction in cancer surgery and treatment, with a decrease of approximately 484 patients (-19.0%) per hospital compared with 99 patients (-12.6%) at community hospitals and 110 patients (-12.8%) at integrated networks. This study found that among patients diagnosed with cancer in 2020, access and availability of treatment remained intact; however, reductions in treated patients varied across treatment modalities and were greater at academic hospitals than at community hospitals and integrated networks compared with expected values. These results suggest the resilience of cancer service lines and frame the economic losses from reductions in cancer treatment during the pandemic.

Legal regulations for dispensing in Swiss heroin-assisted treatment were relaxed during the COVID-19 pandemic, allowing prolonged take-home of up to 7 days instead of two to reduce patient contact and the risk of infection. Our study aimed to measure the consequences of this new practice. This was a retrospective cohort study set in Switzerland's largest outpatient centre for opioid agonist therapy. One hundred and thirty-four (72.4%) of the 185 patients receiving oral diacetylmorphine (DAM) participated in the study. Through the utilization of electronic medication prescription and dispensing software, as well as the electronic medical record, the following data were extracted to explore the potential consequences: dose of DAM, the number of antibiotic therapies, emergency hospitalizations and incarcerations. Age, gender, prescriptions for psychotrophic drugs and additional prescription for injectable DAM were tested to assess an increased risk of losing prolonged take-home privileges. Data in the year since prolonged take-home (period 2) were compared with data from the equivalent prior year (period 1). DAM take-home was not associated with a change in DAM dose (P = 0.548), the number of emergency hospitalizations (P = 0.186) or the number of incarcerations (P = 0.215); 79.1% of all patients were able to maintain their extended take-home privileges. However, patients who had injectable DAM experienced significant reductions in their prolonged take-home privileges. Allowing patients to take home oral diacetylmorphine for up to 7days as treatment for opioid use disorder does not appear to pose any demonstrable health risk. It is generally manageable for the large majority of patients. However, careful consideration of prolonged take-home for patients with additional injectable diacetylmorphine is recommended, as these patients are more likely to lose take-home privileges.

2020 trends in dental office visits during the COVID-19 pandemic

BackgroundPublic health mitigation strategies in British Columbia during the pandemic included stay-at-home orders and closure of non-essential services. While most primary physicians’ offices were closed, hospitals prepared for a pandemic...

&lt;div&gt;AbstractBackground:&lt;p&gt;It is important to understand the impact of the COVID-19 pandemic on cancer death rates in 2020 in the US. We estimated whether there were larger-than-expected changes in cancer mortality rates from March to December 2020 after accounting for temporal and seasonal patterns using data from January 2011 to February 2020 by cancer type and age.&lt;/p&gt;Methods:&lt;p&gt;We obtained death counts and underlying causes of death by cancer type, month/year (2011–2020), and age group from the National Center for Health Statistics and population estimates from the US Census Bureau. Poisson regression was used to test for significant changes in cancer death rates from March to December 2020 compared with prior years.&lt;/p&gt;Results:&lt;p&gt;After accounting for temporal trends and seasonal patterns, total cancer death rates were significantly lower than expected during March to December 2020 among 55- to 64-year-olds and ≥75-year-olds, but not in other age groups. Cancer death rates were 2% lower than expected from March to June among 55- to 64-year-olds and 2% to 3% lower from March to July and December among ≥75-year-olds. Among ≥75-year-olds, colorectal cancer death rates were lower from March to June [rate ratios (RR) = 0.94–0.96; &lt;i&gt;P&lt;/i&gt; &lt; 0.05]; however, lung cancer death rates were 5% lower across each month (all RRs = 0.95; &lt;i&gt;P&lt;/i&gt; &lt; 0.05).&lt;/p&gt;Conclusions:&lt;p&gt;In the US, cancer death rates based on the underlying cause of death were broadly similar to expected rates from March to December 2020. However, cancer death rates were lower than expected among 55- to 64-year-olds and ≥75-year-olds, likely due to COVID-19 as a competing cause of death.&lt;/p&gt;Impact:&lt;p&gt;Cancer mortality rates from 2020 should be interpreted with caution.&lt;/p&gt;&lt;/div&gt;