Temporal changes in trauma according to alcohol sale restrictions during the South African national COVID-19 lockdown

Abstract

Introduction The South African government enforced various alcohol sale restrictions during the COVID-19 lockdown in order to reduce hospital admissions related to alcohol-associated injuries. A cross-sectional study was performed to describe the temporal changes in trauma according to alcohol sale restrictions during the South African national COVID-19 lockdown. Methods Data from all trauma-related patients presenting to the emergency centre of Mitchells Plain Hospital from 01/03/2020 till 29/9/2020 and corresponding periods during 2019 were exported from an existing database. The relationship between variables was determined with the χ 2 -test, Fisher's exact test, independent samples median test or t -test. A sub-analysis compared similar 2020 lockdown levels when a second alcohol ban were instituted while most business were allowed to operate (level 3b – alcohol banned versus level 3 – alcohol restricted). Results Total number of trauma presentations were 539 (14.6%) less in 2020 (n = 3160) than in 2019 (n = 3699); the mean number decreased by 2.5 per day (95% CI −2.9 to −2.1). Lockdown levels with an alcohol ban had on average 4.8 less patients per day than corresponding periods in 2019 (p < 0.001). No significant difference was observed in lockdown levels with alcohol sale restrictions (mean difference per day −0.4, p = 0.195). Trauma presentations increased significantly (mean difference per day 7.0 (95% CI 6.5 to 7.5)) from 2020 lockdown levels with alcohol sales ban (mean per day 11.4) to 2020 lockdown levels with alcohol sale restrictions (mean per day 18.4). Significantly less patients (mean −3.2 (95% CI −3.9 to −2.5)) presented during 2020 lockdown level 3b (alcohol sales banned, mean 13.9) compared to level 3 (alcohol sales restricted, mean 17.1). Conclusion Temporal changes in trauma were observed according to alcohol sale restrictions during South Africa's COVID-19 lockdown periods. Significantly less trauma cases presented during periods with an alcohol ban compared to periods where alcohol sales were only restricted.

Feasibility of conducting a military-relevant multicenter cohort study to assess outcomes of early trauma resuscitative interventions in a prolonged care civilian setting

“…We collected infections within the first 7 days only in the pilot, which will need to be extended to the entire hospital course during the main study. In addition, it is plausible that the local public health measures and resulting societal changes, during the early waves of the COVID-19 pandemic in 2020, resulted in less infective mechanisms of wounding such as community assaults—van Hoving et al 44 showed that there were fewer open wounds during periods of alcohol bans during COVID-19 at one of the pilot hospitals. Another reason could be that lower patient volumes may have enabled earlier infection control measures 43 .…”

“…[39][40][41][42] However, a more likely reason for low proportion of CRIs is the change in local trauma epidemiology consequent to the COVID-19 pandemic. 43,44 There were two main effects attributed to local alcohol bans, lockdown periods, and public curfews: fewer than usual trauma cases, and lower injury severity and fewer trauma deaths. 43,44 Prepandemic, the trauma mortality rate was around 10%.…”

“…43,44 There were two main effects attributed to local alcohol bans, lockdown periods, and public curfews: fewer than usual trauma cases, and lower injury severity and fewer trauma deaths. 43,44 Prepandemic, the trauma mortality rate was around 10%. 45 The EpiC pilot study found a mortality rate of around 5%, which is likely due to the aforementioned COVID-19 epidemiologic factors.…”

Patterns of on‐scene and healthcare system trauma deaths in the Western Cape of South Africa

“…31 Alcohol-ban initiatives have shown promise in reducing trauma admissions from interpersonal violence. 32,33 Additionally, South Africa's Firearm Control Act has reduced firearm-and nonfirearm-related homicides. 34 However, more widespread interpersonal violence prevention initiatives targeting men are needed, as men are both the most common perpetrators and victims.…”

“…Urban upgrading through infrastructural intervention has been shown to reduce the risk of interpersonal violence in the poorest and most violent townships of Cape Town 31 . Alcohol‐ban initiatives have shown promise in reducing trauma admissions from interpersonal violence 32,33 . Additionally, South Africa's Firearm Control Act has reduced firearm‐ and non‐firearm‐related homicides 34 .…”