Emergency attendance for COPD dropped during SA lockdown, tobacco ban

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While the tobacco sales ban had detrimental effects on the economy in South Africa in 2020, research shows that one benefit was a sharp reduction – nearly 70% – in emergency centre attendance by patients with COPD exacerbations, compared with the same period in 2019, reports MedicalBrief.

The study at George Regional Hospital, in collaboration with Stellenbosch University and the University of Cape Town, was published in the African Journal of Primary Health Care & Family Medicine in February 2021.

Authors Piero Saieva and Louis S Jenkins write that while the lockdown per se may have contributed to lower emergency centre attendance and less access to tobacco outlets or social gatherings, “the net effect has been reduced pressure on the healthcare system because of a decreased number of patients attending the emergency centre and needing admissions.

“We advocate for further research and policy into what confounders possibly played a role and which restrictions can be instituted to decrease the prevalence of smoking post lockdown, particularly in Africa.”

Background

Smoking is common practice across Africa, the study points out, with an estimated prevalence rate of 14.35% according to the World Health Organization. In South Africa, the estimated national prevalence rate is 21.5% – and prevalence is 39% in the Western Cape.

Cigarette smoking is known to be a major risk factor for developing and causing frequent exacerbations of COPD, which has a prevalence rate of around 13.4% in Africa, with estimates of around 20% for South Africa, says the article. COPD exacerbations have been linked to many triggers, such as change in season, air pollution, fires and smoking.

The COVID-19 pandemic was confirmed in March 2020 in South Africa, which implemented a national lockdown later in the month that restricted all except ‘essential’ services.

A University of Cape Town survey found that during lockdown, 90% of previous smokers were still able to buy cigarettes – but at extremely elevated prices, up to six times more than before. There was also a rise in unemployment, making smoking less affordable for many. It is likely that this unusual situation forced smokers to reduce the amount they smoked.

The study

The study was conducted at George Regional Hospital, a 272-bed regional referral hospital in the Garden Route district of the Western Cape. The emergency centre manages 4,000 patients monthly and, with surrounding primary healthcare clinics, cares for 84% of the local community of 210,000 people.

All patients attending the emergency centre are entered into an online electronic patient information system called the Hospital and Emergency Centre Tracking Information System (HECTIS) and receive a primary International Classification of Diseases ICD-10 diagnosis.

Data on the total number of patients with COPD exacerbations attending from January to August in 2019 and for the same period in 2020 were extracted from HECTIS and analysed.

The researchers also used the number of patients presenting with urinary tract infections (UTIs) during the same periods to control for possible confounders. January and February were included for both the periods.

The main finding was a 69.28% reduction in patients presenting to the emergency centre with COPD exacerbations, compared with that during the previous year for the same period. There was a 30.60%reduction in patient numbers for UTIs.

“With the national lockdown and the restrictions on movement, as well as the fear of accessing the hospital, we expected a decrease in patient numbers, as the hospital is the referral centre for severe COVID-19 infections in two districts,” the authors wrote.

However, it was noteworthy how much more markedly COPD attendance was reduced.

“Whilst acknowledging various limitations because of possible confounders, such as the obligatory wearing of masks, curfew and other factors, one cannot ignore these observations. This notable reduction in COPD presentations reduced service pressure of emergency centre and most likely benefited patients’ health,” Saieval and Jenkins conclude.

 

Study details

When people do not ‘Zol’: Reduced emergency centre attendance of patients with chronic obstructive pulmonary disease during coronavirus disease 2019 lockdown with the accompanying tobacco sales ban in South Africa

Piero Saieva1 and Louis S Jenkins

Affiliations: George Regional Hospital, Stellenbosch University and the University of Cape Town.

Published by the African Journal of Primary Health Care & Family Medicine on 15 February 2021.

 

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has spread throughout the world, with devastating effects of the virus as well as the repercussions of resulting ‘lockdowns’. South Africa went into a national lockdown in March 2020 to mitigate the impact of the virus. This included a ban on the sales of tobacco and electronic cigarette products.

The ban has been a highly contentious issue in South Africa, discussed worldwide, which has drawn many criticisms. The prevalence rate of smoking in South Africa was around 21.5%, with Western Cape province having a prevalence rate of 39%.

We compared the number of chronic obstructive pulmonary disease (COPD) presentations at a large regional referral hospital in Western Cape province from January to August 2019 with the same period in 2020.

Electronic emergency centre data showed a reduction of 69.28% in COPD presentations. To control for some confounders for the same period, we also reviewed patients presenting with urinary tract infections, which showed only a 30.60% reduction.

This notable reduction in COPD presentations reduced service pressure of the emergency centre and most likely benefitted patients’ health. Further research and policies are needed to ensure ongoing reduction in the prevalence of smoking.

 

African Journal of Primary Health Care & Family Medicine article – When people do not ‘Zol’: Reduced emergency centre attendance of patients with chronic obstructive pulmonary disease during coronavirus disease 2019 lockdown with the accompanying tobacco sales ban in South Africa (Open access)

 

SEE ALSO FROM MEDICALBRIEF’S ARCHIVE

 

American Thoracic Society: New clinical practice guidelines on COPD and hypercapnia

 

COPD and smoking associated with higher COVID-19 mortality

 

COVID-19 risk for smokers and COPD patients may be due to higher ACE 2 levels – Small Canadian study

 

 


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