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      Impact of Lockdown due to COVID-19 on the Modalities of Intoxicated Patients Presenting to the Emergency Room

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          Abstract

          Introduction:

          Coronavirus disease 2019 (COVID-19) pandemic influences health care facilities world-wide. The flow rate, type, and severity of cases presented to emergency departments varied during the pandemic in comparison to the past years. However, this change has not been well-described among the cases of hospital admission due to toxic exposure.

          Study Objective:

          Recognition of the pattern of toxic exposure among the cases refereed to Tanta Poison Control Center (TPCC; Tanta, Egypt) during the past five years, and furthermore, exploration of the impact of lockdown due to the COVID-19 pandemic on the pattern of presented cases.

          Methods:

          The current study is a five-year retrospective, comparative cross-sectional study carried out among acutely intoxicated patients admitted to TPCC during the spring months (March through May) of 2016-2020. A total of 1,916 patients with complete medical records were recruited. The type and manner of toxic exposure, demographic, clinical data, and outcomes were analyzed.

          Results:

          The current study noted that there were delays in time from toxic exposure to emergency services during the lockdown period. This was reflected in significant lower recovery rates (884.8/1,000 population; z = −3.0) and higher death rates (49.4/1,000 population; z = 2.1) despite the marked decrease in the total number of hospital admissions in comparison to the past four years. The lockdown period showed significantly higher phosphides (z = 3.5; χ 2 = 34.295; P <.001) and antipsychotics exposure (z = 3.6; χ 2 = 21.494; P <.001) than the previous years. However, predominance of female exposure and intentional self-poisoning was maintained over the past five years, including the lockdown.

          Conclusion:

          COVID-19-associated lockdown greatly reformed the usual intoxication pattern of the cases admitted to emergency room. Also, it played a role in delaying time of hospital arrival, which was reflected as lower recovery rates and higher death rates.

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          Most cited references64

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Chaolin Huang, Yeming Wang, Xingwang Li … (2020)
          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            A Novel Coronavirus from Patients with Pneumonia in China, 2019

            Na Zhu, Dingyu Zhang, Wenling Wang … (2020)
            Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)
            Article 0 comments Cited 12693 times – based on 0 reviews     Review now
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              The Socio-Economic Implications of the Coronavirus and COVID-19 Pandemic: A Review

              Maria R.C. Nicola, Zaid Alsafi, Catrin Sohrabi … (2020)
              The COVID-19 pandemic has resulted in over 1.4 million confirmed cases and over 83,000 deaths globally. It has also sparked fears of an impending economic crisis and recession. Social distancing, self-isolation and travel restrictions forced a decrease in the workforce across all economic sectors and caused many jobs to be lost. Schools have closed down, and the need of commodities and manufactured products has decreased. In contrast, the need for medical supplies has significantly increased. The food sector has also seen a great demand due to panic-buying and stockpiling of food products. In response to this global outbreak, we summarise the socio-economic effects of COVID-19 on individual aspects of the world economy.
              Article 0 comments Cited 2033 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Prehosp Disaster Med
                Journal ID (iso-abbrev): Prehosp Disaster Med
                Journal ID (publisher-id): PDM
                Title: Prehospital and Disaster Medicine
                Publisher: Cambridge University Press (New York, USA )
                ISSN (Print): 1049-023X
                ISSN (Electronic): 1945-1938
                Publication date (Electronic, pub): 05 January 2021
                Pages: 1-18
                Affiliations
                [1. ]Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University , Egypt
                [2. ]Clinical Medical Sciences Department, College of Medicine, Dar Al Uloom University , Saudi Arabia
                Author notes
                Correspondence: Manar M. Fayed, MD, Forensic Medicine & Clinical Toxicology Department, Faculty of Medicine, Tanta University , El Geish Street, Tanta, Gharbia, Egypt, 31527, E-mail: Manar.fayed@ 123456med.tanta.edu.eg
                Author information
                https://orcid.org/0000-0001-9282-3167
                https://orcid.org/0000-0002-6104-562X
                Article
                Publisher ID: S1049023X20001533
                DOI: 10.1017/S1049023X20001533
                PMC ID: 7809242
                PubMed ID: 33397546
                SO-VID: 26b9cd0b-228b-4d5e-a1d1-5a3c77e2dda1
                Copyright © © World Association for Disaster and Emergency Medicine 2021
                License:

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 24 September 2020
                Date revision received : 08 November 2020
                Date accepted : 17 November 2020
                Page count
                Figures: 12, Tables: 13, References: 65, Pages: 18
                Categories
                Subject: Original Research

                Keywords: antipsychotics,covid-19,drug poisoning,lockdown,pesticides
                Data availability:
                Keywords: antipsychotics, covid-19, drug poisoning, lockdown, pesticides

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