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Exploring The Impact Of COVID-19 Pandemic On Emergency Department Use In British Columbia

A new study showing the impact of the COVID-19 pandemic and mitigation strategies used to manage the virus on emergency department (ED) visits in British Columbia can help with future planning. The study is published in the Canadian Medical Association Journal (CMAJ).

"Evaluation of the effects of the pandemic and associated measures can provide a historical account and inform health care service planning for both post-pandemic recovery and mitigation of potential consequences of restrictions for future pandemics," write scientists from the British Columbia Centre for Disease Control (BCCDC) and Vancouver Coastal Health, Vancouver, British Columbia. "Insights from this study can also trigger further research on the drivers of the changes and inform strategies for emergency care."

Previous studies have assessed the impact of the pandemic on ED visits, but few have looked at the health reasons for these visits.

To understand the impact of the pandemic according to health visit type over the first three years of the pandemic, scientists looked at data from 30 emergency departments and more than 10.7 million visits across British Columbia from January 2016 to December 2022.

Using modeling, they estimated what usual patterns of ED visits would have been compared with actual visits during the pandemic. The smallest number of ED visits were in April and December 2020, reflecting the effects of the strong virus mitigation measures, and visits returned to pre-pandemic levels in May 2021.

After accounting for seasonal and annual trends in ED visits, the April and December dips saw a 42% and 19% reduction, respectively, compared to what would be expected in the absence of the pandemic. The largest reductions were for respiratory issues (35%), with a 48% drop in December 2020, which would normally have been peak season for respiratory illnesses. Visits for mental health concerns and substance misuse had the smallest reductions.

By age group, the largest reductions in visits were in children younger than 10 years, accounting for almost one-third of the decrease in visits.

"By looking at the time window that captured most of the pandemic period, we were able to tell a fuller story by showing not only the short-term impacts, but also longer-term impacts," says Dr. Kate Smolina, interim scientific director, BCCDC Data and Analytic Services and Knowledge Translation and senior author of the paper.

"It was particularly interesting to see those longer-term patterns for children's visits and visits related to respiratory and ears, nose, and throat symptoms, which, after returning to normal in 2021, went on to surpass the expected levels in 2022."

In summer 2021, there was a substantial increase in visits, possibly related to the extreme heat in June in British Columbia as well as opioid-related overdoses.

The authors hope that the data will be useful in helping manage health care resources. "There was a huge drop in volumes in the emergency department at the beginning of the pandemic, but we have ultimately returned to pre-pandemic growth of volumes," says Dr. Eric Grafstein, chief medical information officer and regional emergency department head at Vancouver Coastal Health and Providence Health Care. "This return toward normal emergency department volumes can help with future understanding of the impact of pandemics on health care needs."

"More studies on the drivers of these trends will not only aid in better planning of emergency department capacity for future public health emergencies, but can also inform strategies to help the public make decisions about seeking emergency care. The statistical modeling approach can be further developed into surveillance tools to monitor health care services use and plan for surge capacity," conclude the authors.

In a related editorial, Dr. Catherine Varner, deputy editor, CMAJ, and an emergency physician in Toronto, says until acute care capacity is increased, Canadian hospitals will continue to face severe emergency department overcrowding. With hospitals frequently exceeding 100% bed occupancy, she proposes several steps to help mitigate the burden on emergency department patients and staff.

These include implementing demand-driven overcapacity protocols when overcrowding is compromising care, extending hours for in-hospital consults and procedures, increasing access to urgent but nonemergency testing and other interventions, and ensuring safety of staff and patients by embedding security and mental health professionals trained in de-escalation in emergency departments.

More information: Changes in emergency department use in British Columbia, Canada, during the first 3 years of the COVID-19 pandemic, Canadian Medical Association Journal (2023). DOI: 10.1503/cmaj.221516. Www.Cmaj.Ca/lookup/doi/10.1503/cmaj.221516

Citation: Exploring the impact of COVID-19 pandemic on emergency department use in British Columbia (2023, September 5) retrieved 29 September 2023 from https://medicalxpress.Com/news/2023-09-exploring-impact-covid-pandemic-emergency.Html

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Down And Out In British Columbia

Parodists lead tough lives. Reality keeps catching up with them. Consider George Orwell: A Reassessment, a new collection of essays from St. Martin's Press in which are enshrined "the reactions of political scientists, literary critics, social historians and novelists to the Orwell oeuvre" Had this compendium been decently edited and marketed as a spoof, it would have been every bit as funny as The Pooh Perplex, Frederick Crews's lethally precise send-up of scholarly literary fashions circa 1963.

The comedy begins with the cast of characters. The papers reprinted in George Orwell: A Reassessment were all delivered at a 1984 colloquium held in Vancouver, British Columbia, and with the sole exception of Bernard Crick, Orwell's biographer, the contributors are all associated with various Canadian institutions of higher education, the least likely sounding of which is Royal Roads Military College, Victoria, B.C. Their credentials can be collectively summed up by this Pythonesque extract from "Notes on the Contributors":

Samuel L. Macey is Professor of English at the University of Victoria. His books include an edition of Henry Carey's Dramatic Works, a volume (with R. G. Lawrence) Studies in Robertson Davies' Deptford Trilogy, and he is the author of Clocks and the Cosmos: Time in Western Life and Thought. His Patriarchs of Time: Dualism in Saturn-Cronos, Father Time, the Watchmaker God, and Father Christmas is to be published by the University of Georgia Press.

Professor Macey's contribution to George Orwell: A Reassessment is a paper called "From History to Psychological Grotesque: The Politics of Sado-Masochism in Nineteen Eighty-Four." Not all of the papers reprinted in this slim volume are quite as awful as that. Graham Good, for instance, has contributed an intelligent essay with the pedestrian but unpretentious title "Orwell and Eliot: Politics, Poetry and Prose," and F. Quei Quo's "Orwell's Nineteen Eighty-Four and Mao's Cultural Revolution" is a thoughtful look at how China fared under this century's closest counterpart to Big Brother. But most of the other papers, as Orwell himself would doubtless have predicted, are no better than the cliché-strewn prose in which they are written: "Like Mark Antony before him, Orwell mounts the pulpit as a 'plain blunt man' who will deliver things in their native simplicity and honour; but within his 'objective' discourse we encounter, at every turn, signs that the external world, too, is a text."

Orwell, though an avowed socialist, was a trenchant critic of the realities of life under Marxism.

Most telling of all, however, is the impenetrable provinciality with which the authors of George Orwell: A Reassessment are so heavily armored. ("Given [Orwell's] catholicity," the editors announce in hushed tones, "it was therefore entirely appropriate that the three largest universities in British Columbia should collaborate for the first time in history on an academic conference.") Just think of it: a dozen unknown academics from British Columbia have taken it upon themselves to provide a reassessment of the merits of the greatest political writer of the twentieth century. It's a conceit worthy of Max Beerbohm on a good day.

Still, George Orwell: A Reassessment deserves fairly high marks on one count: it takes Orwell seriously and, on balance, judges him favorably. Given the current climate of critical opinion, this is no small achievement. Any comparable conference on George Orwell held at a major American university would almost certainly have been peopled with eleven left-wing professors blathering on endlessly about Orwell's cynical betrayal of the masses—and, for good measure, one pink English journalist prettily explaining how Animal Farm is really an allegory about the evils of American capitalism.

The reasons for this are in part obvious: Orwell, though an avowed socialist, was a trenchant critic of the realities of life under Marxism, the political system which, despite an endless record of failure, still retains its implacable grip on the imagination of the academy. But his fall from grace goes deeper than that. "To write in plain, vigorous language one has to think fearlessly," Orwell wrote in 1946, "and if one thinks fearlessly one cannot be politically orthodox." This resolute open-mindedness cuts sharply against the grain of present-day academic fashion, so much so that it has become popular to criticize Orwell for his political inconsistencies.

That George Orwell was inconsistent, politically and in every other imaginable way, is undeniable. He believed devoudy in the possibility of a truly egalitarian society, and it was this romantic illusion that made him a socialist; at the same time, as Graham Good observes in his essay on Orwell and Eliot, "Orwell constantly shows the collapse of his own philosophy through his pessimistic view of history and through his defeated fictional heroes." But this inconsistency, which lies at the heart of Orwell's work, is by no means an artistic fault, however much it may upset those for whom "politically correct" is a term of high praise. "People who have everything clear in their minds," Edmund Wilson said of George Bernard Shaw,

who are not capable of identifying themselves imaginatively with, who do not actually embody in themselves, contrary emotions and points of view, do not write novels or plays at all—do not, at any rate, write good ones. And—given genius—the more violent the contraries, the greater the works of art.

To be sure, Orwell was no genius, literary or otherwise. As Lionel Trilling remarked in his introduction to Homage to Catalonia: "He seems to be serving not some dashing daimon but the plain, solid Gods of the Copybook Maxims." But the contraries in his nature, though they did not enable him to write great novels, lent immeasurable savor to his essays, which crackle with the irascible unpredictability of a man who, unlike Shaw the journalist, has most definitely not made up his mind about everything.

"Novels are about other people," Philip Larkin once said, "and poems are about yourself."

"Novels are about other people," Philip Larkin once said, "and poems are about yourself." Essays are about yourself, too, even when they purport to be about other people, and the enduring interest of Orwell's journalism lies not in its sometimes haphazard logic but in the incomparable vividness of its central character. No character in Orwell's novels, not even Winston Smith, is half as real as the passionate, slightly cranky hero of Down and Out in Paris and London and The Road to Wigan Pier and Homage to Catalonia, a man whom the reader sees just as clearly and surely as Orwell "saw" the face of Charles Dickens: "It is the face of a man who is always fighting against something, but who fights in the open and is not frightened, the face of a man who is generously angry." If the face of "George Orwell" is a mask behind which stood a flawed man full of all-too-human inconsistencies, then so much the worse for consistency.

In any case, there was never anything inconsistent (or relative) about George Orwell's moralism, and it kept him from falling into the political pestholes that swallowed up so many other intellectuals in the Twenties and Thirties. "[T]otalitarian ideas," Orwell said of Nineteen Eighty-Four, "have taken root in the minds of intellectuals everywhere, and I have tried to draw these ideas out to their logical consequences." One mind in which such ideas had not taken root was that of Orwell himself. Though he was a hopeless idealist given to ridiculous posturing, he never contemplated the use of totalitarian methods in order to impose his ideals on the masses; moreover, he told his readers over and over again that the Soviet Union, so beloved of Shaw and his fellow Fabians, was doing exactly that.

This particular manifestation of Orwell's moralism was rooted in a powerful sympathy for the general life of the common people. This sympathy was hard-won, as the second half of The Road to Wigan Pier proves, and it is shot through with unmistakable ambivalence. Are Orwell's "masses" the absurdly idealized militiamen of Homage to Catalonia or the mindless, hideous proles of Nineteen Eighty-Four? His writings offer no final answer to this question. But however he really felt about the masses, Orwell clearly respected them. He recognized that his beloved England was in large part their creation:

One can learn a good deal about the spirit of England from the comic coloured postcards that you see in the windows of cheap stationers' shops. These things are a sort of diary upon which the English people have unconsciously recorded themselves. Their old-fashioned outlook, their graded snobberies, their mixture of bawdiness and hypocrisy, their extreme gentleness, their deeply moral attitude to life, are all mirrored there.

While the egalitarian illusion that lies just back of this respect prevented Orwell from ever grasping (or, more likely, admitting) the fundamental unworkability of socialism, it also shielded him from the totalitarian temptation. Shaw's frank admiration of Stalin may have been extreme, but it was nonetheless utterly characteristic of the Fabians, who had no faith whatsoever in the power of democracy to effect radical reforms and who thus were easy marks for the Big Brothers of their day.

This particular manifestation of Orwell's moralism was rooted in a powerful sympathy for the general life of the common people.

By contrast, though Orwell's faith in the ultimate effectiveness of democracy may have wavered, his commitment to it was unswerving. He seems never to have felt that reform was worth the price of a single lie, and the ferocity with which he attacked W. H. Auden for his casual reference to "necessary murders" in the poem "Spain" was one of the few shining lights of a time which Auden himself was later to call a "low, dishonest decade." More than anything else, it is this moral rectitude (and, of course, the marvelously straightforward prose style which is its literary equivalent) that has kept Orwell's writings so fresh and meaningful.

Indeed, Orwell is absolutely central to understanding the politics of our time, which is precisely why he is so repellent to so many of the literary politicians of our time. One might at least have expected the authors of a "reassessment" of Orwell, however obtuse, to have grasped his immediate relevance to the academy. In a critical age where hidden agendas are exalted and surface meanings reflexively dismissed as deceptive or insignificant, there is no place for a writer who valued above all things simplicity and clarity; in a scholarly environment where left-wing orthodoxies are imposed ruthlessly and deviationists are purged without a second thought, there is no place for a writer who held the political pieties of his own time in fathomless contempt. Small wonder that George Orwell is so unfashionable—and so essential.

A Message from the Editors Support our crucial work and join us in strengthening the bonds of civilization.

Your donation sustains our efforts to inspire joyous rediscoveries.

Terry Teachout is the author, most recently, of All in the Dances: A Brief Life of George Balanchine (Harcourt).

This article originally appeared in The New Criterion, Volume 7 Number 7, on page 79Copyright © 2023 The New Criterionwww.Newcriterion.Comhttps://newcriterion.Com/issues/1989/3/down-and-out-in-british-columbia

New Study Highlights Impact Of COVID-19 Pandemic On Emergency Department Visits In British Columbia

"Evaluation of the effects of the pandemic and associated measures can provide a historical account and inform health care service planning for both postpandemic recovery and mitigation of potential consequences of restrictions for future pandemics," write scientists from the British Columbia Centre for Disease Control (BCCDC) and Vancouver Coastal Health, Vancouver, British Columbia. "Insights from this study can also trigger further research on the drivers of the changes and inform strategies for emergency care."

Previous studies have assessed the impact of the pandemic on ED visits, but few have looked at the health reasons for these visits.

To understand the impact of the pandemic according to health visit type over the first 3 years of the pandemic, scientists looked at data from 30 emergency departments and more than 10.7 million visits across British Columbia from January 2016 to December 2022. Using modeling, they estimated what usual patterns of ED visits would have been compared with actual visits during the pandemic. The smallest number of ED visits were in April and December 2020, reflecting the effects of the strong virus mitigation measures, and visits returned to pre-pandemic levels in May 2021.

By age group, the largest reductions in visits were in children younger than 10 years, accounting for almost one-third of the decrease in visits.

By looking at the time window that captured most of the pandemic period, we were able to tell a fuller story by showing not only the short-term impacts, but also longer-term impacts. It was particularly interesting to see those longer-term patterns for children's visits and visits related to respiratory and ears, nose, and throat symptoms, which, after returning to normal in 2021, went on to surpass the expected levels in 2022."

Dr. Kate Smolina, interim scientific director, BCCDC Data and Analytic Services and Knowledge Translation and senior author of the paper

In summer 2021, there was a substantial increase in visits, possibly related to the extreme heat in June in British Columbia as well as opioid-related overdoses.

"More studies on the drivers of these trends will not only aid in better planning of emergency department capacity for future public health emergencies, but can also inform strategies to help the public make decisions about seeking emergency care. The statistical modelling approach can be further developed into surveillance tools to monitor health care services use and plan for surge capacity," conclude the authors.

In a related editorial https://www.Cmaj.Ca/lookup/doi/10.1503/cmaj.231156, Dr. Catherine Varner, deputy editor, CMAJ, and an emergency physician in Toronto, says until acute care capacity is increased, Canadian hospitals will continue to face severe emergency department overcrowding. With hospitals frequently exceeding 100% bed occupancy, she proposes several steps to help mitigate the burden on emergency department patients and staff. These include implementing demand-driven overcapacity protocols when overcrowding is compromising care, extending hours for in-hospital consults and procedures, increasing access to urgent but nonemergency testing and other interventions, and ensuring safety of staff and patients by embedding security and mental health professionals trained in de-escalation in emergency departments.

Source:

Journal reference:

Yao, J., et al. (2023) Changes in emergency department use in British Columbia, Canada, during the first 3 years of the COVID-19 pandemic. Canadian Medical Association Journal. Doi.Org/10.1503/cmaj.221516.

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