Excess Out-Of-Hospital Mortality and Declining Oxygen Saturation: The Sentinel Role of EMS Data in the COVID-19 Crisis in Tijuana, Mexico
Joseph Friedman,Alhelí Calderón-Villarreal,Letza Bojorquez,Carlos Vera Hernández,David L. Schriger,Eva Tovar Hirashima +5 more
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TLDR
EMS systems may play an important sentinel role in monitoring excess out-of-hospital mortality and other trends during the COVID-19 crisis in LMICs, and finds evidence of worsening hypoxemia among respiratory patients seen by EMS, suggesting a rise in silent Hypoxemia, which should be met with increased detection and clinical management efforts.Abstract:
Objective Emergency medical services (EMS) may serve as a key source of real-time data about the evolving health of COVID-19 affected populations, especially in low-and-middle-income countries (LMICs) with less rapid and reliable vital statistic registration systems. Although official COVID-19 statistics in Mexico report almost exclusively in-hospital mortality events, excess out-of-hospital mortality has been identified in other settings, including one EMS study in Italy that showed a 58% increase. EMS and hospital reports from several countries have suggested that silent hypoxemia—low oxygen saturation (SpO2) in the absence of dyspnea—is associated with COVID-19 outbreaks. It is unclear, however, how these phenomena can be generalized to LMICs. We assess how EMS data can be used in a sentinel capacity in Tijuana, a city on the Mexico-United States border with earlier exposure to COVID-19 than many LMIC settings. Methods We calculated numbers of weekly out-of-hospital deaths and respiratory cases seen by EMS in Tijuana, and estimate the difference between peak-epidemic rates (during April 14th-May 11th) and forecasted 2014–2019 trends. Results were compared with official COVID-19 statistics, stratified by neighborhood socioeconomic status (SES), and examined for changing demographic or clinical features, including mean (SpO2). Results An estimated 194.7 (95%CI: 135.5-253.9) excess out-of-hospital deaths events occurred, representing an increase of 145% (70%-338%) compared to forecasted trends. During the same window, only 8 COVID-19-positive, out-of-hospital deaths were reported in official statistics. This corresponded with a rise in respiratory cases of 274% (119%-1142%), and a drop in mean SpO2 to 77.7%, from 90.2% at baseline. The highest out-of-hospital death rates were observed in low-SES areas, although respiratory cases were more concentrated in high-SES areas. Conclusions EMS systems may play an important sentinel role in monitoring excess out-of-hospital mortality and other trends during the COVID-19 crisis in LMICs. Using EMS data, we observed increases in out-of-hospital deaths in Tijuana that were nearly threefold greater magnitude than increases reported using EMS data in Italy. Increased testing in out-of-hospital settings may be required to determine if excess mortality is being driven by COVID-19 infection, health system saturation, or patient avoidance of healthcare. We also found evidence of worsening rates of hypoxemia among respiratory patients seen by EMS, suggesting a rise in silent hypoxemia, which should be met with increased detection and clinical management efforts. Finally, we observed that social disparities in out-of-hospital death that warrant monitoring and amelioration.read more
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References
More filters
Journal ArticleDOI
COVID-19 pneumonia: different respiratory treatments for different phenotypes?
Luciano Gattinoni,Davide Chiumello,Pietro Caironi,Mattia Busana,Federica Romitti,Luca Brazzi,Luigi Camporota +6 more
TL;DR: It is hypothesize that the different COVID-19 patterns found at presentation in the emergency department depend on the interaction between three factors: the severity of the infection, the host response, physiological reserve and comorbidities; the ventilatory responsiveness of the patient to hypoxemia; and the time elapsed between the onset of the disease and the observation in the hospital.
Journal ArticleDOI
Why inequality could spread COVID-19.
Journal ArticleDOI
Variation in COVID-19 Hospitalizations and Deaths Across New York City Boroughs.
Rishi K. Wadhera,Priya Wadhera,Prakriti Gaba,Jose F. Figueroa,Karen E. Joynt Maddox,Robert W. Yeh,Changyu Shen +6 more
TL;DR: This study describes demographic characteristics and hospital bed capacities of the 5 New York City boroughs, and evaluates whether differences in testing for coronavirus disease 2019 (COVID-19), hospitalizations, and deaths have emerged as a signal of racial, ethnic, and financial disparities.
Journal ArticleDOI
Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy.
Enrico Baldi,Giuseppe Maria Sechi,Claudio Mare,Fabrizio Canevari,Antonella Brancaglione,Roberto Primi,Catherine Klersy,Alessandra Palo,Enrico Contri,Vincenza Ronchi,Giorgio Beretta,Francesca Reali,Pierpaolo Parogni,Fabio Facchin,Davide Bua,Ugo Rizzi,Daniele Bussi,Simone Ruggeri,Luigi Oltrona Visconti,Simone Savastano +19 more
TL;DR: Out- of-Hospital Cardiac Arrest and Covid-19 From February 21 through April 1, 2019, a total of 229 cases of out-of-hospital cardiac arrest were reported in four provinces of Lombardy, Italy.
Journal ArticleDOI
COVID-19 and diabetes: Knowledge in progress.
TL;DR: The general characteristics of the novel coronavirus (SARS-CoV-2) are reviewed and suggestions are made on the possible pathological mechanisms of the relationship between diabetes and COVID-19, and its management.