ED visits for overdose, mental health, child abuse rose during COVID-19
Except for a slight decrease from Mar 29 to Apr 11, 2020, emergency department (ED) visits involving drug and opioid overdoses (ODs) were 1% to 45% more frequent than in 2019, according to a JAMA Psychiatry study published yesterday.
The researchers also found that the median number of ED visits per 100,000 involving mental health conditions (MHCs), suicide attempts (SAs), and suspected child abuse and neglect (SCAN) cases also increased during the COVID-19 pandemic despite the decrease in overall visits.
Intimate partner violence (IPV) was the only measured category that did not show an increase (28.3 vs 27.5 per 100,000 visits).
The researchers looked at ED visits from Dec 30, 2018, through Oct 10, 2020, to compare pandemic visits with a 2019 baseline. The National Syndromic Surveillance Program, which looks at approximately 70% of the country's ED visits, showed that total weekly visits decreased from Mar 8 to 28, 2020, but rates for all six outcomes increased. (The national emergency was declared Mar 13, 2020, followed by "15 Days to Slow the Spread.")
Overall, median ED visit counts from Mar 15 to Oct 10, 2020, were significantly higher for SAs (4,940 vs 4,656 in 2019), all ODs (15,604 vs 13,371), and opioid ODs (5,502 vs 4,168). They were lower for IPV visits (442 vs 484) and SCAN cases (884 vs 1,038), but the rate of SCAN cases among all ED visits rose.
Near the end of the study period, the rate of the measured outcomes began to decrease even as total visits continued to rise. The researchers write, "This decrease could be indicative of a number of issues: the public resuming normal health-seeking behaviors, the lifting of stay-at-home orders and a perception of increased safety and reduced risk of COVID-19 spread, or the public's adjustment to mitigation measures or ability to identify coping strategies (eg, telehealth or telemental health services and consolation from widespread messaging)."
The authors conclude, "This study demonstrates that people still visited EDs for these outcomes and that, for the most part, visits for these outcomes decreased to a lesser extent than overall ED visits."
Feb 3 JAMA Psychiatry study
Study highlights evidence for airborne cruise ship COVID spread
Mean estimates of short-range, long-range, and fomite (contaminated surface) COVID-19 transmissions on the Diamond Princess cruise ship were respectively 35%, 35%, and 30%, according to a modeling study published yesterday in Proceedings of the National Academy of Sciences.
Of the airborne transmissions, 41% and were estimated to be from larger respiratory droplets and 59% from smaller respiratory aerosols, the investigators note.
The Diamond Princess outbreak began from one passenger who was on the ship Jan 20 to 25, 2020, and in the following weeks (2 of which passengers were in quarantine), 712 out of 3,711 (19.2%) passengers and crew were infected. Once released, at least 57 people had positive polymerase chain reaction samples collected within 3 days.
To create transmission models, the researchers adapted Markov chain, dose-response, and Reed-Frost epidemic models and found that 132 of 21,600 possible scenarios met acceptability criteria based on the recorded cases. Smaller aerosols were defined as less than 5 micrometers (µm) in diameter, and larger droplets as between 5 and 10 µm in diameter.
Quarantine, the researchers note, did affect infection spread: Fomite transmission went down after quarantine began because of the limited indoor public areas as well as an increased amount of handwashing. Contribution of large droplets vs small aerosols changed, too, going from median estimates of 40% and 60%, respectively, to 15% and 85%, suggesting that most quarantine transmissions were from short-ranged, small aerosols.
"Our results demonstrate that aerosol inhalation was likely the dominant contributor to COVID-19 transmission among the passengers, even considering a conservative assumption of high ventilation rates and no air recirculation conditions for the cruise ship," the researchers write. "This model approach has broad applicability beyond COVID-19 and cruise ships and can be used for estimating the contribution of transmission pathways of other airborne infectious diseases such as measles, tuberculosis, and influenza in other infection outbreaks."
Feb 3 Proc Natl Acad Sci abstract