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Non-COVID outcomes associated with the coronavirus disease-2019 (COVID-19) pandemic effects study (COPES): A
Vincent Issac Lau1, Sumeet Dhanoa2, Harleen Cheema2
1Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada.
Insights
The COVID-19 pandemic significantly increased mortality for non-COVID illnesses. Healthcare systems experienced higher morbidity and care disruptions, with fewer hospitalizations during this period.
Area of Science:
- Public Health
- Epidemiology
- Healthcare Management
Background:
- The COVID-19 pandemic strained healthcare systems globally.
- Managing both COVID-19 and non-COVID patients posed significant challenges for healthcare providers.
- High-quality patient care was difficult to maintain during the pandemic.
Purpose of the Study:
- To systematically review and meta-analyze the impact of the COVID-19 pandemic on non-COVID illnesses.
- To assess the effects on healthcare systems compared to pre-pandemic periods.
- To quantify changes in mortality, morbidity, hospitalizations, and care standards.
Main Methods:
- Systematic review and meta-analysis of studies published up to December 31, 2020.
- Included studies compared COVID-pandemic periods with pre-pandemic epochs.
- Extracted data on mortality, morbidity, hospitalizations, and disruptions to care; used random-effects models for meta-analysis.
Main Results:
- A 16% increase in mortality for non-COVID illnesses during the pandemic (RR 1.38).
- Increased morbidity reported in 93% of studies that showed significant changes.
- Decreased hospitalizations (97%) and increased disruptions in standards-of-care (73%) were also noted.
Conclusions:
- The COVID-19 pandemic led to a significant rise in mortality for non-COVID patients.
- Pandemic conditions were associated with increased morbidity, reduced hospitalizations, and greater disruptions to standard care.
- Evidence certainty for these findings was rated as very low.
Background:
As the Coronavirus Disease-2019 (COVID-19) pandemic continues, healthcare providers struggle to manage both COVID-19 and non-COVID patients while still providing high-quality care. We conducted a systematic review/meta-analysis to describe the effects of the COVID-19 pandemic on patients with non-COVID illness and on healthcare systems compared to non-pandemic epochs.
Methods:
We searched Ovid MEDLINE/EMBASE/Cochrane Database of Systematic Reviews/CENTRAL/CINAHL (inception to December 31, 2020). All study types with COVID-pandemic time period (after December 31, 2019) with comparative non-pandemic time periods (prior to December 31, 2019). Data regarding study characteristics/case-mix/interventions/comparators/ outcomes (primary: mortality; secondary: morbidity/hospitalizations/disruptions-to-care. Paired reviewers conducted screening and abstraction, with conflicts resolved by discussion. Effect sizes for specific therapies were pooled using random-effects models. Risk of bias was assessed by Newcastle-Ottawa Scale, with evidence rating using GRADE methodology.
Results:
Of 11,581 citations, 167 studies met eligibility. Our meta-analysis showed an increased mortality of 16% during the COVID pandemic for non-COVID illness compared with 11% mortality during the pre-pandemic period (RR 1.38, 95% CI: 1.28-1.50; absolute risk difference: 5% [95% CI: 4-6%], p<0.00001, very low certainty evidence). Twenty-eight studies (17%) reported significant changes in morbidity (where 93% reported increases), while 30 studies (18%) reported no significant change (very low certainty). Thirty-nine studies (23%) reported significant changes in hospitalizations (97% reporting decreases), while 111 studies (66%) reported no significant change (very low certainty). Sixty-two studies (37%) reported significant disruptions in standards-to-care (73% reporting increases), while 62 studies (37%) reported no significant change (very low certainty).
Conclusions:
There was a significant increase in mortality during the COVID pandemic compared to pre-pandemic times for non-COVID illnesses. When significant changes were reported, there was increased morbidity, decreased hospitalizations and increased disruptions in standards-of-care.
Systematic Review Registration:
PROSPERO CRD42020201256 (Sept 2, 2020).
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