Magnitude and time-course of excess mortality during COVID-19 outbreak: population-based empirical evidence from highly impacted provinces in northern Italy

Conti, Sara; Ferrara, Pietro; Mazzaglia, Giampiero; D’Orso, M; Ciampichini, Roberta; Fornari, Carla; Madotto, Fabiana; Magoni, Michele; Sampietro, Giuseppe; Silenzi, Andrea; Sileo, Claudio Vito; Zucchi, Alberto; Cesana, Giancarlo; Manzoli, Lamberto; Mantovani, Lorenzo Giovanni

doi:10.1101/2020.07.10.20150565

Cited by 10 publications

(14 citation statements)

References 16 publications

(18 reference statements)

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“…In particular, throughout the 7-month period concomitant to the outbreak of COVID-19 infection, no increase in the diagnosis of SAT was recorded. This observation is corroborated by the fact that the present study was carried out in the Brescia area, the region with the highest prevalence of Sars-CoV-2 infection in Italy [ 1 ]. It should be noted that a previous diagnosis of COVID-19 was detected in one patient out of 10 who developed SAT from April 2020 to October 2020.…”

Section: Discussionsupporting

confidence: 78%

“…Among the countries of the European Union, COVID-19 infections spread most drastically in Italy in February 2020. Northern Italy, and in particular the Bergamo and Brescia areas, showed the highest number of patients affected by COVID-19, with a dramatic increase in deaths related to COVID-19 infections between February and April 2020 [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

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Incidence of De Quervain’s thyroiditis during the COVID-19 pandemic in an area heavily affected by Sars-CoV-2 infection

et al. 2021

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Purpose To evaluate the possible association between Covid-19 infection and subacute thyroiditis. Methods We reviewed the medical and imaging records of patients referred to our Department’s outpatient setting dedicated to ‘thyroid emergency’ (records with a ‘bollino verde’—green sticker, classifed as urgent) from April 2020 to October 2020. This outpatient clinic is devoted to patients requiring evaluation for severe hypothyroidism, thyrotoxicosis and neck discomfort or pain. All patients with a newly-diagnosed subacute thyroiditis were selected. The data of all patients receiving a diagnosis of subacute thyroiditis was collected retrospectively, taking into account the same period of time (April–October) and starting from 2016. Results During the COVID-19 outbreak in our region (April 2020 to October 2020) 396 patients attended the outpatient emergency clinic. Among them, 10 (2.5%) patients received a diagnosis of subacute thyroiditis. In a single patient, a 44-year-old man, a COVID-19 pulmonary infection had been diagnosed 7 weeks before the diagnosis of subacute thyroiditis. All of the remaining patients were and remain COVID-19 free as confirmed by telephone interview. The percentage of patients who received a diagnosis of subacute thyroiditis in the same period starting from 2016 was very similar (2.9%, 2.9%, 2.6% and 3.0% in 2016, 2017, 2018 and 2019, respectively). Conclusions Our data do not show an increase in the incidence of subacute thyroiditis in the Brescia area, a region with the highest prevalence of COVID-19 in Italy during the period of the pandemic outbreak.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Incidence of De Quervain’s thyroiditis during the COVID-19 pandemic in an area heavily affected by Sars-CoV-2 infection

et al. 2021

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“…22 In Italy, for instance, Conti and colleagues found a lower excess mortality in nonagenarians than in their younger counterparts. 24 This might have been due to a healthy survivor effect. Younger NH residents might have more comorbidities-notably stroke and diabetes, which are risk factors for COVID-19 severity and lethality -than older residents.…”

Section: Discussionmentioning

confidence: 99%

Magnitude, change over time, demographic characteristics and geographic distribution of excess deaths among nursing home residents during the first wave of COVID-19 in France: a nationwide cohort study

Canouï‐Poitrine

Rachas

Thomas

et al. 2021

Preprint

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ImportanceNursing home (NH) residents are particularly vulnerable to SARS-CoV-2 infections and coronavirus disease 2019 (COVID-19) lethality. However, excess deaths in this population have rarely been documented.ObjectivesThe primary objective was to assess the number of excess deaths among NH residents during the first wave of the COVID-19 pandemic in France. The secondary objectives were to determine the number of excess deaths as a proportion of the total excess deaths in the general population and determine whether a harvesting effect was present.DesignWe studied a cohort of 494,753 adults (as of March 1st, 2020) aged 60 and over in 6,515 NHs in mainland France. This cohort was exposed to the first wave of the COVID-19 pandemic (from March 1st to May 31st, 2020) and was compared with the corresponding, reference cohorts from 2014 to 2019 (using data from the French National Health Data System).Main outcome and measuresThe main outcome was all-cause death. Weekly excess deaths and standardized mortality ratios (SMRs) were estimated.ResultThere were 13,505 excess deaths among NH residents. Mortality increased by 43% (SMR: 1.43). The mortality excess was higher among males than among females (SMR: 1.51 and 1.38, respectively) and decreased with age (SMRs in females: 1.61 in the 60-74 age group, 1.58 for 75-84, 1.41 for 85-94, and 1.31 for 95 or over; Males: SMRs: 1.59 for 60-74, 1.69 for 75-84, 1.47 for 85-94, and 1.41 for 95 or over). We did not observe a harvesting effect (up until August 30th, 2020). By extrapolating to all NH residents nationally (N=570,003), the latter accounted for 51% of the total excess deaths in the general population (N=15,114 out of 29,563).ConclusionNH residents accounted for about half of the total excess deaths in France during the first wave of the COVID-19 pandemic. The excess death rate was higher among males than females and among younger residents than among older residents. We did not observe a harvesting effect. A real-time mortality surveillance system and the identification of individual and environmental risk factors might help to design the future model of care for older dependent adults.Key pointsDuring the first wave of the COVID-19 pandemic in France, the mortality among nursing home residents increased by 43%.Nursing home residents accounted for 51% of the total excess deaths in France.The excess mortality was higher among younger residents than among older residents.The excess mortality was higher among males than among females.We did not observe a harvesting effect during the study period (ending on August 30th, 2020, i.e., three months after the end of the first wave).

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“…The growing body of evidence on COVID-19 has led to a development of numerous management guidelines and new treatment options [9][10][11]; however, the impact of the pandemic inevitably extends beyond the patients infected with SARS-CoV-2. Not only has an excess mortality been observed in several European countries during the first wave of the COVID-19 pandemic, but the number of excess deaths also surpassed the number of deaths attributed to COVID-19 in some countries [12][13][14]. Furthermore, the reduction of elective activity was accompanied by a decline in hospital admission rates for cardiovascular emergencies and an increase in intrahospital mortality [15][16][17][18].…”

Section: Original Articlementioning

confidence: 99%

Outcomes of non-COVID-19 critically ill patients during the COVID-19 pandemic

Bologheanu

Maleczek

Laxar

et al. 2021

Wien Klin Wochenschr

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Summary Background Coronavirus disease 2019 (COVID-19) disrupts routine care and alters treatment pathways in every medical specialty, including intensive care medicine, which has been at the core of the pandemic response. The impact of the pandemic is inevitably not limited to patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their outcomes; however, the impact of COVID-19 on intensive care has not yet been analyzed. Methods The objective of this propensity score-matched study was to compare the clinical outcomes of non-COVID-19 critically ill patients with the outcomes of prepandemic patients. Critically ill, non-COVID-19 patients admitted to the intensive care unit (ICU) during the first wave of the pandemic were matched with patients admitted in the previous year. Mortality, length of stay, and rate of readmission were compared between the two groups after matching. Results A total of 211 critically ill SARS-CoV‑2 negative patients admitted between 13 March 2020 and 16 May 2020 were matched to 211 controls, selected from a matching pool of 1421 eligible patients admitted to the ICU in 2019. After matching, the outcomes were not significantly different between the two groups: ICU mortality was 5.2% in 2019 and 8.5% in 2020, p = 0.248, while intrahospital mortality was 10.9% in 2019 and 14.2% in 2020, p = 0.378. The median ICU length of stay was similar in 2019: 4 days (IQR 2–6) compared to 2020: 4 days (IQR 2–7), p = 0.196. The rate of ICU readmission was 15.6% in 2019 and 10.9% in 2020, p = 0.344. Conclusion In this retrospective single center study, mortality, ICU length of stay, and rate of ICU readmission did not differ significantly between patients admitted to the ICU during the implementation of hospital-wide COVID-19 contingency planning and patients admitted to the ICU before the pandemic.

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Magnitude and time-course of excess mortality during COVID-19 outbreak: population-based empirical evidence from highly impacted provinces in northern Italy

Cited by 10 publications

References 16 publications

Incidence of De Quervain’s thyroiditis during the COVID-19 pandemic in an area heavily affected by Sars-CoV-2 infection

Incidence of De Quervain’s thyroiditis during the COVID-19 pandemic in an area heavily affected by Sars-CoV-2 infection

Magnitude, change over time, demographic characteristics and geographic distribution of excess deaths among nursing home residents during the first wave of COVID-19 in France: a nationwide cohort study

Outcomes of non-COVID-19 critically ill patients during the COVID-19 pandemic

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