Showing papers in "Canadian Medical Association Journal in 2021"
TL;DR: In this paper, the authors conducted a systematic review and meta-analysis of observational studies with comparison data on SARS-CoV-2 infection and severity of COVID-19 during pregnancy.
Abstract: BACKGROUND: The impact of coronavirus disease 2019 (COVID-19) on maternal and newborn health is unclear. We aimed to evaluate the association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy and adverse pregnancy outcomes. METHODS: We conducted a systematic review and meta-analysis of observational studies with comparison data on SARS-CoV-2 infection and severity of COVID-19 during pregnancy. We searched for eligible studies in MEDLINE, Embase, ClinicalTrials.gov, medRxiv and Cochrane databases up to Jan. 29, 2021, using Medical Subject Headings terms and keywords for "severe acute respiratory syndrome coronavirus 2 OR SARS-CoV-2 OR coronavirus disease 2019 OR COVID-19" AND "pregnancy." We evaluated the methodologic quality of all included studies using the Newcastle-Ottawa Scale. Our primary outcomes were preeclampsia and preterm birth. Secondary outcomes included stillbirth, gestational diabetes and other pregnancy outcomes. We calculated summary odds ratios (ORs) or weighted mean differences with 95% confidence intervals (CI) using random-effects meta-analysis. RESULTS: We included 42 studies involving 438 548 people who were pregnant. Compared with no SARS-CoV-2 infection in pregnancy, COVID-19 was associated with preeclampsia (OR 1.33, 95% CI 1.03 to 1.73), preterm birth (OR 1.82, 95% CI 1.38 to 2.39) and stillbirth (OR 2.11, 95% CI 1.14 to 3.90). Compared with mild COVID-19, severe COVID-19 was strongly associated with preeclampsia (OR 4.16, 95% CI 1.55 to 11.15), preterm birth (OR 4.29, 95% CI 2.41 to 7.63), gestational diabetes (OR 1.99, 95% CI 1.09 to 3.64) and low birth weight (OR 1.89, 95% CI 1.14 to 3.12). INTERPRETATION: COVID-19 may be associated with increased risks of preeclampsia, preterm birth and other adverse pregnancy outcomes.
350 citations
TL;DR: In this article, a population-based study compared comprehensive, linked primary care physician billing data from Jan 1 to July 28, 2020, with the same period in 2019 to understand the degree to which office and virtual primary care changed, and for which patients and physicians, during the initial months of the pandemic in Ontario, Canada.
Abstract: BACKGROUND: Globally, primary care changed dramatically as a result of the coronavirus disease 2019 (COVID-19) pandemic We aimed to understand the degree to which office and virtual primary care changed, and for which patients and physicians, during the initial months of the pandemic in Ontario, Canada METHODS: This population-based study compared comprehensive, linked primary care physician billing data from Jan 1 to July 28, 2020, with the same period in 2019 We identified Ontario residents with at least 1 office or virtual (telephone or video) visit during the study period We compared trends in total physician visits, office visits and virtual visits before COVID-19 with trends after pandemic-related public health measures changed the delivery of care, according to various patient and physician characteristics We used interrupted time series analysis to compare trends in the early and later halves of the COVID-19 period RESULTS: Compared with 2019, total primary care visits between March and July 2020 decreased by 280%, from 766 to 551 per 1000 people/day The smallest declines were among patients with the highest expected health care use (83%), those who could not be attributed to a primary care physician (102%), and older adults (191%) In contrast, total visits in rural areas increased by 64% Office visits declined by 791% and virtual care increased 56-fold, comprising 711% of primary care physician visits The lowest uptake of virtual care was among children (576%), rural residents (606%) and physicians with panels of ≥ 2500 patients (660%) INTERPRETATION: Primary care in Ontario saw large shifts from office to virtual care over the first 4 months of the COVID-19 pandemic Total visits declined least among those with higher health care needs The determinants and consequences of these major shifts in care require further study
187 citations
TL;DR: In this article, the authors used Ontario's COVID-19 case data to evaluate the virulence of SARS-CoV-2 VOCs, as measured by risk of hospitalization, intensive care unit (ICU) admission and death.
Abstract: BACKGROUND: Between February and June 2021, the initial wild-type strains of SARS-CoV-2 were supplanted in Ontario, Canada, by new variants of concern (VOCs), first those with the N501Y mutation (i.e., Alpha/B1.1.17, Beta/B.1.351 and Gamma/P.1 variants) and then the Delta/B.1.617 variant. The increased transmissibility of these VOCs has been documented, but knowledge about their virulence is limited. We used Ontario's COVID-19 case data to evaluate the virulence of these VOCs compared with non-VOC SARS-CoV-2 strains, as measured by risk of hospitalization, intensive care unit (ICU) admission and death. METHODS: We created a retrospective cohort of people in Ontario who tested positive for SARS-CoV-2 and were screened for VOCs, with dates of test report between Feb. 7 and June 27, 2021. We constructed mixed-effect logistic regression models with hospitalization, ICU admission and death as outcome variables. We adjusted models for age, sex, time, vaccination status, comorbidities and pregnancy status. We included health units as random intercepts. RESULTS: Our cohort included 212 326 people. Compared with non-VOC SARS-CoV-2 strains, the adjusted elevation in risk associated with N501Y-positive variants was 52% (95% confidence interval [CI] 42%-63%) for hospitalization, 89% (95% CI 67%-117%) for ICU admission and 51% (95% CI 30%-78%) for death. Increased risk with the Delta variant was more pronounced at 108% (95% CI 78%-140%) for hospitalization, 235% (95% CI 160%-331%) for ICU admission and 133% (95% CI 54%-231%) for death. INTERPRETATION: The increasing virulence of SARS-CoV-2 VOCs will lead to a considerably larger, and more deadly, pandemic than would have occurred in the absence of the emergence of VOCs.
176 citations
TL;DR: The World Health Organization recently announced a new naming system for SARS-CoV-2 variants using the Greek alphabet, which is aimed at preventing people from referring to the variants by the country where they were first detected as discussed by the authors.
Abstract: The World Health Organization recently announced a new naming system for SARS-CoV-2 variants using the Greek alphabet. The new naming system is aimed at preventing people from referring to the variants by the country where they were first detected. Four of these variants of concern — Alpha, Beta,
83 citations
TL;DR: The symptoms most strongly associated with a positive SARS-CoV-2 swab result were anosmia/ageusia, nausea/vomiting, headache and fever.
Abstract: BACKGROUND: Research involving children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has primarily focused on those presenting to emergency departments. We aimed to determine the symptoms most commonly associated with a positive result for a SARS-CoV-2 swab among community-based children. METHODS: We conducted an observational study among children tested and followed for SARS-CoV-2 infection using nasal, nasopharyngeal, throat or other (e.g., nasopharyngeal aspirate or tracheal secretions, or unknown) swabs between Apr. 13 and Sept. 30, 2020, in Alberta. We calculated positive likelihood ratios (LRs) for self-reported symptoms and a positive SARS-CoV-2 swab result in the entire cohort and in 3 sensitivity analyses: all children with at least 1 symptom, all children tested because of contact tracing whether they were symptomatic or not and all children 5 years of age or older. RESULTS: We analyzed results for 2463 children who underwent testing for SARS-CoV-2 infection; 1987 children had a positive result and 476 had a negative result. Of children with a positive test result for SARS-CoV-2, 714 (35.9%) reported being asymptomatic. Although cough (24.5%) and rhinorrhea (19.3%) were 2 of the most common symptoms among children with SARS-CoV-2 infection, they were also common among those with negative test results and were not predictive of a positive test (positive LR 0.96, 95% confidence interval [CI] 0.81-1.14, and 0.87, 95% CI 0.72-1.06, respectively). Anosmia/ageusia (positive LR 7.33, 95% CI 3.03-17.76), nausea/vomiting (positive LR 5.51, 95% CI 1.74-17.43), headache (positive LR 2.49, 95% CI 1.74-3.57) and fever (positive LR 1.68, 95% CI 1.34-2.11) were the symptoms most predictive of a positive result for a SARSCoV-2 swab. The positive LR for the combination of anosmia/ageusia, nausea/vomiting and headache was 65.92 (95% CI 49.48-91.92). INTERPRETATION: About two-thirds of the children who tested positive for SARS-CoV-2 infection reported symptoms. The symptoms most strongly associated with a positive SARS-CoV-2 swab result were anosmia/ageusia, nausea/vomiting, headache and fever.
69 citations
TL;DR: In this paper, the authors used linked data sets to compare disease characteristics and mortality between patients receiving long-term dialysis in Ontario who were diagnosed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 positive and those who did not acquire SARS CoV 2 infection, between Mar 12 and Aug 20, 2020.
Abstract: BACKGROUND: Patients undergoing long-term dialysis may be at higher risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and of associated disease and mortality We aimed to describe the incidence, risk factors and outcomes for infection in these patients in Ontario, Canada METHODS: We used linked data sets to compare disease characteristics and mortality between patients receiving long-term dialysis in Ontario who were diagnosed SARS-CoV-2 positive and those who did not acquire SARS-CoV-2 infection, between Mar 12 and Aug 20, 2020 We collected data on SARS-CoV-2 infection prospectively We evaluated risk factors for infection and death using multivariable logistic regression analyses RESULTS: During the study period, 187 (15%) of 12 501 patients undergoing dialysis were diagnosed with SARS-CoV-2 infection Of those with SARS-CoV-2 infection, 117 (626%) were admitted to hospital and the case fatality rate was 283% Significant predictors of infection included in-centre hemodialysis versus home dialysis (odds ratio [OR] 254, 95% confidence interval [CI] 159–405), living in a long-term care residence (OR 767, 95% CI 530–1111), living in the Greater Toronto Area (OR 327, 95% CI 221–480), Black ethnicity (OR 305, 95% CI 195–477), Indian subcontinent ethnicity (OR 170, 95% CI 102–281), other non-White ethnicities (OR 203, 95% CI 138–297) and lower income quintiles (OR 182, 95% CI 115–289) INTERPRETATION: Patients undergoing long-term dialysis are at increased risk of SARS-CoV-2 infection and death from coronavirus disease 2019 Special attention should be paid to addressing risk factors for infection, and these patients should be prioritized for vaccination
60 citations
TL;DR: This paper explored the potential for collider bias in a large study of disease determinants, and evaluated individual, environmental and social determinants associated with SARS-CoV-2 testing and diagnosis among residents of Ontario, Canada.
Abstract: BACKGROUND: Optimizing the public health response to reduce the burden of COVID-19 necessitates characterizing population-level heterogeneity of risks for the disease. However, heterogeneity in SARS-CoV-2 testing may introduce biased estimates depending on analytic design. We aimed to explore the potential for collider bias in a large study of disease determinants, and evaluate individual, environmental and social determinants associated with SARS-CoV-2 testing and diagnosis among residents of Ontario, Canada. METHODS: We explored the potential for collider bias and characterized individual, environmental and social determinants of being tested and testing positive for SARS-CoV-2 infection using cross-sectional analyses among 14.7 million community-dwelling people in Ontario, Canada. Among those with a diagnosis, we used separate analytic designs to compare predictors of people testing positive versus negative; symptomatic people testing positive versus testing negative; and people testing positive versus people not testing positive (i.e., testing negative or not being tested). Our analyses included tests conducted between Mar. 1 and June 20, 2020. RESULTS: Of 14 695 579 people, we found that 758 691 were tested for SARS-CoV-2, of whom 25 030 (3.3%) had a positive test result. The further the odds of testing from the null, the more variability we generally observed in the odds of diagnosis across analytic design, particularly among individual factors. We found that there was less variability in testing by social determinants across analytic designs. Residing in areas with the highest household density (adjusted odds ratio [OR] 1.86, 95% confidence interval [CI] 1.75-1.98), highest proportion of essential workers (adjusted OR 1.58, 95% CI 1.48-1.69), lowest educational attainment (adjusted OR 1.33, 95% CI 1.26-1.41) and highest proportion of recent immigrants (adjusted OR 1.10, 95% CI 1.05-1.15) were consistently related to increased odds of SARS-CoV-2 diagnosis regardless of analytic design. INTERPRETATION: Where testing is limited, our results suggest that risk factors may be better estimated using population comparators rather than test-negative comparators. Optimizing COVID-19 responses necessitates investment in and sufficient coverage of structural interventions tailored to heterogeneity in social determinants of risk, including household crowding, occupation and structural racism.
56 citations
TL;DR: In the first wave of the pandemic, admission to hospital for COVID-19 was associated with significantly greater mortality, ICU use and hospital length of stay than influenza as mentioned in this paper.
Abstract: Background: Patient characteristics, clinical care, resource use and outcomes associated with admission to hospital for coronavirus disease 2019 (COVID-19) in Canada are not well described Methods: We described all adults with COVID-19 or influenza discharged from inpatient medical services and medical–surgical intensive care units (ICUs) between Nov 1, 2019, and June 30, 2020, at 7 hospitals in Toronto and Mississauga, Ontario We compared patient outcomes using multivariable regression models, controlling for patient sociodemographic factors and comorbidity level We validated the accuracy of 7 externally developed risk scores to predict mortality among patients with COVID-19 Results: There were 1027 hospital admissions with COVID-19 (median age 65 yr, 591% male) and 783 with influenza (median age 68 yr, 508% male) Patients younger than 50 years accounted for 212% of all admissions for COVID-19 and 240% of ICU admissions Compared with influenza, patients with COVID-19 had significantly greater in-hospital mortality (unadjusted 199% v 61%, adjusted relative risk [RR] 346, 95% confidence interval [CI] 256–468), ICU use (unadjusted 264% v 180%, adjusted RR 150, 95% CI 125–180) and hospital length of stay (unadjusted median 87 d v 48 d, adjusted rate ratio 145, 95% CI 125–169) Thirty-day readmission was not significantly different (unadjusted 93% v 96%, adjusted RR 098, 95% CI 070–139) Three points-based risk scores for predicting in-hospital mortality showed good discrimination (area under the receiver operating characteristic curve [AUC] ranging from 072 to 081) and calibration Interpretation: During the first wave of the pandemic, admission to hospital for COVID-19 was associated with significantly greater mortality, ICU use and hospital length of stay than influenza Simple risk scores can predict in-hospital mortality in patients with COVID-19 with good accuracy
51 citations
TL;DR: This article highlighted the extent of gender inequity in leadership in medicine, and the extent to which opportunities in academic medicine are inequitable by gender, and pointed out that the medical profession has an equity problem, particularly in leadership.
Abstract: KEY POINTS
The medical profession has an equity problem, particularly in leadership. Several Canadian studies have highlighted the extent of gender inequity in leadership in medicine, and the extent to which opportunities in academic medicine are inequitable by gender. Gender (as defined in [Box 1][
50 citations
TL;DR: In an attempt to mitigate excess transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Canadian hospitals adopted "no visitor" policies during the first wave of the pandemic as mentioned in this paper.
Abstract: KEY POINTS
In an attempt to mitigate excess transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Canadian hospitals adopted “no visitor” policies during the first wave of the pandemic. A reflexive and almost complete restriction of visitors occurred across all hospitals
49 citations
TL;DR: All possible complications of COVID-19 were studied to confirm previously reported complications and to identify potential complications not yet known and to guide prognosis, treatment decisions and patient counselling.
Abstract: BACKGROUND: Many studies reporting coronavirus disease 2019 (COVID-19) complications have involved case series or small cohorts that could not establish a causal association with COVID-19 or provide risk estimates in different care settings. We sought to study all possible complications of COVID-19 to confirm previously reported complications and to identify potential complications not yet known. METHODS: Using United States health claims data, we compared the frequency of all International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis codes occurring before and after the onset of the COVID-19 pandemic in an exposure-crossover design. We included patients who received a diagnosis of COVID-19 between Mar. 1, 2020, and Apr. 30, 2020, and computed risk estimates and odds ratios (ORs) of association with COVID-19 for every ICD-10-CM diagnosis code. RESULTS: Among 70 288 patients with COVID-19, 69 of 1724 analyzed ICD-10-CM diagnosis codes were significantly associated with COVID-19. Disorders showing both strong association with COVID-19 and high absolute risk included viral pneumonia (OR 177.63, 95% confidence interval [CI] 147.19–214.37, absolute risk 27.6%), respiratory failure (OR 11.36, 95% CI 10.74–12.02, absolute risk 22.6%), acute kidney failure (OR 3.50, 95% CI 3.34–3.68, absolute risk 11.8%) and sepsis (OR 4.23, 95% CI 4.01–4.46, absolute risk 10.4%). Disorders showing strong associations with COVID-19 but low absolute risk included myocarditis (OR 8.17, 95% CI 3.58–18.62, absolute risk 0.1%), disseminated intravascular coagulation (OR 11.83, 95% CI 5.26–26.62, absolute risk 0.1%) and pneumothorax (OR 3.38, 95% CI 2.68–4.26, absolute risk 0.4%). INTERPRETATION: We confirmed and provided risk estimates for numerous complications of COVID-19. These results may guide prognosis, treatment decisions and patient counselling.
TL;DR: As the second wave of the pandemic sees case numbers rise to dangerous levels across the country, it has become clear that Indigenous people are particularly vulnerable to coronavirus disease 2019 (COVID-19) as mentioned in this paper.
Abstract: As the second wave of the pandemic sees case numbers rise to dangerous levels across the country, it has become clear that Indigenous people are particularly vulnerable to coronavirus disease 2019 (COVID-19). The figures released by the Manitoba First Nations COVID-19 Pandemic Response Coordination
TL;DR: In 2000, George Floyd, an unarmed Black man, was murdered in the United States by White police officer Derek Chauvin who, in the course of arresting Mr. Floyd for allegedly using a counterfeit 20-dollar bill, knelt on his neck for almost 9 minutes.
Abstract: KEY POINTS
On May 25, 2020, George Floyd, an unarmed Black man, was murdered in the United States by White police officer Derek Chauvin who, in the course of arresting Mr. Floyd for allegedly using a counterfeit 20-dollar bill, knelt on his neck for almost 9 minutes. Mr. Floyd repeatedly said, “I
TL;DR: In this paper, the role of children in the transmission and community spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unclear, and the authors aimed to quantify the infectivity of SARS CoV2 in nasopharyngeal samples from children compared with adults.
Abstract: BACKGROUND: The role of children in the transmission and community spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unclear. We aimed to quantify the infectivity of SARS-CoV-2 in nasopharyngeal samples from children compared with adults. METHODS: We obtained nasopharyngeal swabs from adult and pediatric cases of coronavirus disease 2019 (COVID-19) and from their contacts who tested positive for SARS-CoV-2 in Manitoba between March and December 2020. We compared viral growth in cell culture, cycle threshold values from the reverse transcription polymerase chain reaction (RT-PCR) of the SARS-CoV-2 envelope (E) gene and the 50% tissue culture infective dose (TCID50/mL) between adults and children. RESULTS: Among 305 samples positive for SARS-CoV-2 by RT-PCR, 97 samples were from children aged 10 years or younger, 78 were from children aged 11–17 years and 130 were from adults (≥ 18 yr). Viral growth in culture was present in 31% of samples, including 18 (19%) samples from children 10 years or younger, 18 (23%) from children aged 11–17 years and 57 (44%) from adults (children v. adults, odds ratio 0.45, 95% confidence interval [CI] 0.28–0.72). The cycle threshold was 25.1 (95% CI 17.7–31.3) in children 10 years or younger, 22.2 (95% CI 18.3–29.0) in children aged 11–17 years and 18.7 (95% CI 17.9–30.4) in adults (p INTERPRETATION: Compared with adults, children with nasopharyngeal swabs that tested positive for SARS-CoV-2 were less likely to grow virus in culture, and had higher cycle thresholds and lower viral concentrations, suggesting that children are not the main drivers of SARS-CoV-2 transmission.
TL;DR: Machine learning as discussed by the authors is the process of developing systems that learn from data to recognize patterns and make accurate predictions of future events, e.g., predicting future events from historical data.
Abstract: [See related articles at [www.cmaj.ca/lookup/doi/10.1503/cmaj.202066][2]][2] and [[www.cmaj.ca/lookup/doi/10.1503/cmaj.210036][3]][3]
KEY POINTS
Machine learning — the process of developing systems that learn from data to recognize patterns and make accurate predictions of future events[1][3
TL;DR: In this article, the authors measured anti-receptor binding domain (RBD) immunoglobulin G (IgG) levels and stratified groups by evidence of previous SARS-CoV-2 infection.
Abstract: BACKGROUND: Patients receiving in-centre hemodialysis are at high risk of exposure to SARS-CoV-2 and death if infected. One dose of the BNT162b2 SARS-CoV-2 vaccine is efficacious in the general population, but responses in patients receiving hemodialysis are uncertain. METHODS: We obtained serial plasma from patients receiving hemodialysis and health care worker controls before and after vaccination with 1 dose of the BNT162b2 mRNA vaccine, as well as convalescent plasma from patients receiving hemodialysis who survived COVID-19. We measured anti-receptor binding domain (RBD) immunoglobulin G (IgG) levels and stratified groups by evidence of previous SARS-CoV-2 infection. RESULTS: Our study included 154 patients receiving hemodialysis (135 without and 19 with previous SARS-CoV-2 infection), 40 controls (20 without and 20 with previous SARS-CoV-2 infection) and convalescent plasma from 16 patients. Among those without previous SARS-CoV-2 infection, anti-RBD IgG was undetectable at 4 weeks in 75 of 131 (57%, 95% confidence interval [CI] 47% to 65%) patients receiving hemodialysis, compared with 1 of 20 (5%, 95% CI 1% to 23%) controls (p < 0.001). No patient with nondetectable levels at 4 weeks developed anti-RBD IgG by 8 weeks. Results were similar in non-immunosuppressed and younger individuals. Three patients receiving hemodialysis developed severe COVID-19 after vaccination. Among those with previous SARS-CoV-2 infection, median anti-RBD IgG levels at 8 weeks in patients receiving hemodialysis were similar to controls at 3 weeks (p = 0.3) and to convalescent plasma (p = 0.8). INTERPRETATION: A single dose of BNT162b2 vaccine failed to elicit a humoral immune response in most patients receiving hemodialysis without previous SARS-CoV-2 infection, even after prolonged observation. In those with previous SARS-CoV-2 infection, the antibody response was delayed. We advise that patients receiving hemodialysis be prioritized for a second BNT162b2 dose at the recommended 3-week interval.
Centre Hospitalier Universitaire Sainte-Justine1, Université de Montréal2, University of Toronto3, University of Saskatchewan4, Boston Children's Hospital5, HealthPartners6, Université de Sherbrooke7, University of Manitoba8, University of Alberta9, University of British Columbia10, Canadian Paediatric Society11, Montreal Children's Hospital12, McGill University Health Centre13, Children's Hospital of Eastern Ontario14, Dalhousie University15, Public Health Agency of Canada16, Laval University17
TL;DR: In this article, the authors conducted a national prospective study using the infrastructure of the Canadian Paediatric Surveillance Program (CPSP) to identify risk factors for severe outcomes of SARS-CoV-2 infection in children.
Abstract: BACKGROUND: Risk factors for severe outcomes of SARS-CoV-2 infection are not well established in children. We sought to describe pediatric hospital admissions associated with SARS-CoV-2 infection in Canada and identify risk factors for more severe disease. METHODS: We conducted a national prospective study using the infrastructure of the Canadian Paediatric Surveillance Program (CPSP). Cases involving children who were admitted to hospital with microbiologically confirmed SARS-CoV-2 infection were reported from Apr. 8 to Dec. 31 2020, through weekly online questionnaires distributed to the CPSP network of more than 2800 pediatricians. We categorized hospital admissions as related to COVID-19, incidental, or for social or infection control reasons and determined risk factors for disease severity in hospital. RESULTS: Among 264 hospital admissions involving children with SARS-CoV-2 infection during the 9-month study period, 150 (56.8%) admissions were related to COVID-19 and 100 (37.9%) were incidental infections (admissions for other reasons and found to be positive for SARS-CoV-2 on screening). Infants (37.3%) and adolescents (29.6%) represented most cases. Among hospital admissions related to COVID-19, 52 (34.7%) had critical disease, 42 (28.0%) of whom required any form of respiratory or hemodynamic support, and 59 (39.3%) had at least 1 underlying comorbidity. Children with obesity, chronic neurologic conditions or chronic lung disease other than asthma were more likely to have severe or critical COVID-19. INTERPRETATION: Among children who were admitted to hospital with SARS-CoV-2 infection in Canada during the early COVID-19 pandemic period, incidental SARS-CoV-2 infection was common. In children admitted with acute COVID-19, obesity and neurologic and respiratory comorbidities were associated with more severe disease.
TL;DR: On September 20, a new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant, called B117, was first identified in Greater London in England among a large number of new cases.
Abstract: On September 20, a new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant, called B117, was first identified in Greater London in England among a large number of new cases.
By December 19, United Kingdom Prime Minister Boris Johnson announced tight restrictions on London and
TL;DR: In this article, the authors evaluated variations in preterm birth and stillbirth rates before and during the COVID-19 pandemic in Ontario, Canada and found no changes in slope or gap between prepandemic and pandemic periods using interrupted time series analyses.
Abstract: BACKGROUND: Conflicting reports have emerged for rates of preterm births and stillbirths during the COVID-19 pandemic. Most of these reports did not account for natural variation in these rates. We aimed to evaluate variations in preterm birth and stillbirth rates before and during the COVID-19 pandemic in Ontario, Canada. METHODS: We conducted a retrospective cohort study using linked population health administrative databases of pregnant people giving birth in any hospital in Ontario between July 2002 and December 2020. We calculated preterm birth and stillbirth rates. We assessed preterm birth at 22-28, 29-32 and 33-36 weeks' gestation, and stillbirths at term and preterm gestation. We used Laney control P' charts for the 18-year study period (6-mo observation periods) and interrupted time-series analyses for monthly rates for the most recent 4 years. RESULTS: We evaluated 2 465 387 pregnancies, including 13 781 that resulted in stillbirth. The mean preterm birth rate for our cohort was 7.96% (range 7.32%-8.59%). From January to December 2020, we determined that the preterm birth rate in Ontario was 7.87%, with no special cause variation. The mean stillbirth rate for the cohort was 0.56% (range 0.48%-0.70%). From January to December 2020, the stillbirth rate was 0.53%, with no special cause variation. We did not find any special cause variation for preterm birth or stillbirth subgroups. We found no changes in slope or gap between prepandemic and pandemic periods using interrupted time-series analyses. INTERPRETATION: In Ontario, Canada, we found no special cause variation (unusual change) in preterm birth or stillbirth rates, overall or by subgroups, during the first 12 months of the COVID-19 pandemic compared with the previous 17.5 years.
TL;DR: Evidence is reviewed across a broad spectrum of specialties, including neurology, geriatrics and psychiatry, to synthesize the evidence and recommendations for generalists and specialists seeking to transition their care for patients with dementia to a virtual platform, considering potential barriers to adoption.
Abstract: KEY POINTS
During the coronavirus disease 2019 (COVID-19) pandemic, the Canadian Medical Association and provincial health authorities advised physicians to provide virtual care to patients where possible. Virtual care, or telemedicine, has been defined as “any interaction between patients and/or
TL;DR: In this article, the authors search four databases to identify studies comparing surgical outcomes and utilization rates of adults of First Nations, Inuit or Metis identity with non-Indigenous people in Canada.
Abstract: Background: Substantial health inequities exist for Indigenous Peoples in Canada. The remote and distributed population of Canada presents unique challenges for access to and use of surgery. To date, the surgical outcome data for Indigenous Peoples in Canada have not been synthesized. Methods: We searched 4 databases to identify studies comparing surgical outcomes and utilization rates of adults of First Nations, Inuit or Metis identity with non-Indigenous people in Canada. Independent reviewers completed all stages in duplicate. Our primary outcome was mortality; secondary outcomes included utilization rates of surgical procedures, complications and hospital length of stay. We performed meta-analysis of the primary outcome using random effects models. We assessed risk of bias using the ROBINS-I tool. Results: Twenty-eight studies were reviewed involving 1 976 258 participants (10.2% Indigenous). No studies specifically addressed Inuit or Metis populations. Four studies, including 7 cohorts, contributed adjusted mortality data for 7135 participants (5.2% Indigenous); Indigenous Peoples had a 30% higher rate of death after surgery than non-Indigenous patients (pooled hazard ratio 1.30, 95% CI 1.09–1.54; I2 = 81%). Complications were also higher for Indigenous Peoples, including infectious complications (adjusted OR 1.63, 95% CI 1.13–2.34) and pneumonia (OR 2.24, 95% CI 1.58–3.19). Rates of various surgical procedures were lower, including rates of renal transplant, joint replacement, cardiac surgery and cesarean delivery. Interpretation: The currently available data on postoperative outcomes and surgery utilization rates for Indigenous Peoples in Canada are limited and of poor quality. Available data suggest that Indigenous Peoples have higher rates of death and adverse events after surgery, while also encountering barriers accessing surgical procedures. These findings suggest a need for substantial re-evaluation of surgical care for Indigenous Peoples in Canada to ensure equitable access and to improve outcomes. Protocol registration: PROSPERO-CRD42018098757
TL;DR: The limitations of the existing clinical research infrastructure in Canada are discussed, the mechanisms implemented to successfully embed clinical research in the UK health system are described and — while identifying the traps that Canadian stakeholders must avoid — a roadmap to a Canadian version of the UK system is provided.
Abstract: KEY POINTS
Despite Canada’s investment of hundreds of millions of dollars into researching coronavirus disease 2019 (COVID-19), contributions from other countries have greatly exceeded Canada’s research productivity. In contrast, the United Kingdom’s National Institute for Health Research (
TL;DR: In this article, the authors have been trying to combat a second wave of the coronavirus disease 2019 (COVID-19) pandemic without using all the available tools.
Abstract: [See related article at [www.cmaj.ca/lookup/doi/10.1503/cmaj.202827][2]][2]
KEY POINTS
Jurisdictions across Canada have been trying to combat a second wave of the coronavirus disease 2019 (COVID-19) pandemic without using all the available tools. Accumulating evidence has shown that people who are
TL;DR: Racial justice was a dominant theme of the 2020 U.S. presidential election, and it was heartening to see medical institutions acknowledge their obligations to antiracism in reaction to high-profile events.
Abstract: KEY POINTS
Racial justice was a dominant theme of 2020. The medical community has grappled with a long history of racial injustice, and it was heartening to see medical institutions acknowledge their obligations to antiracism in reaction to high-profile events. Although some physicians joined Black
TL;DR: In a companion article, Verma et al. as mentioned in this paper discuss how machine-learned solutions can be developed and implemented to support medical decision-making, and discuss the benefits of machine learning for medical decision making.
Abstract: [See related articles at www.cmaj.ca/lookup/doi/10.1503/cmaj.202434][1] and [www.cmaj.ca/lookup/doi/10.1503/cmaj.210036][2]
KEY POINTS
In a companion article, Verma and colleagues discuss how machine-learned solutions can be developed and implemented to support medical decision-making.[1][3] Both
TL;DR: In this article, the authors evaluated emergency department visits for common abdominal and gynecologic conditions before and at the beginning of the COVID-19 pandemic to determine whether changes in emergency department attendance had serious consequences for patients.
Abstract: BACKGROUND: Reduced use of the emergency department during the COVID-19 pandemic may result in increased disease acuity when patients do seek health care services. We sought to evaluate emergency department visits for common abdominal and gynecologic conditions before and at the beginning of the pandemic to determine whether changes in emergency department attendance had serious consequences for patients. METHODS: We conducted a population-based analysis using administrative data to evaluate the weekly rate of emergency department visits pre-COVID-19 (Jan. 1-Mar. 10, 2020) and during the beginning of the COVID-19 pandemic (Mar. 11-June 30, 2020), compared with a historical control period (Jan. 1-July 1, 2019). All residents of Ontario, Canada, presenting to the emergency department with appendicitis, cholecystitis, ectopic pregnancy or miscarriage were included. We evaluated weekly incidence rate ratios (IRRs) of emergency department visits, management strategies and clinical outcomes. RESULTS: Across all study periods, 39 691 emergency department visits met inclusion criteria (40.2 % appendicitis, 32.1% miscarriage, 21.3% cholecystitis, 6.4% ectopic pregnancy). Baseline characteristics of patients presenting to the emergency department did not vary across study periods. After an initial reduction in emergency department visits, presentations for cholecystitis and ectopic pregnancy quickly returned to expected levels. However, presentations for appendicitis and miscarriage showed sustained reductions (IRR 0.61-0.80), with 1087 and 984 fewer visits, respectively, after the start of the pandemic, relative to 2019. Management strategies, complications and mortality rates were similar across study periods for all conditions. INTERPRETATION: Although our study showed evidence of emergency department avoidance in Ontario during the first wave of the COVID-19 pandemic, no adverse consequences were evident. Emergency care and outcomes for patients were similar before and during the pandemic.
TL;DR: In this article, the authors outlined problems with the development of machine-learned solutions for health care and suggested a framework for their optimal development, and proposed a method to solve them.
Abstract: [See related articles at www.cmaj.ca/lookup/doi/10.1503/cmaj.202434][1] and [www.cmaj.ca/lookup/doi/10.1503/cmaj.202066][2]
KEY POINTS
Related articles have outlined problems with the development of machine-learned solutions for health care and suggested a framework for their optimal development.[1
TL;DR: The authors argued that Canada should anticipate a resurgence of RSV infection in the summer season, as COVID-19 pandemic-related physical distancing measures are being relaxed in Australia and the United States.
Abstract: KEY POINTS
Australia and, more recently, the United States have seen a resurgence of cases of respiratory syncytial virus (RSV) infection in the summer season, as COVID-19 pandemic–related physical distancing measures are being relaxed. We argue that Canada should anticipate a similar resurgence
TL;DR: In this article, Zipursky et al. proposed that people who are pregnant (including those trying to conceive) or breastfeeding should be offered the SARS-CoV-2 vaccine on ethical grounds, and discuss how health care providers and patients can use a shared decision-making approach to guide these discussions.
Abstract: In Dec 2020, the Canadian National Advisory Committee on Immunization recommended that the vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) should not be routinely offered to individuals who are pregnant or breastfeeding until further evidence is available, but can be considered in certain scenarios where the benefits are deemed to outweigh the risks Guidance from specialist bodies in the US, however, recommends against withholding the SARS-CoV-2 vaccination from individuals who are pregnant or breastfeeding Here, Zipursky et al propose that people who are pregnant (including those trying to conceive) or breastfeeding should be offered the SARS-CoV-2 vaccine on ethical grounds, and discuss how health care providers and patients can use a shared decision-making approach to guide these discussions
TL;DR: A 63-year-old man presented to the emergency department with a 5-day history of a cool, painful left leg, new onset of paresthesia of the left leg and foot, and severe shortness of breath.
Abstract: [See related article at [www.cmaj.ca/lookup/doi/10.1503/cmaj.210882][2]][2]
KEY POINTS
A 63-year-old man presented to the emergency department with a 5-day history of a cool, painful left leg, new onset of paresthesia of the left leg and foot, and severe shortness of breath. The patient had no