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Inicio Medicina Clínica (English Edition) Changes in intoxications during the warning period by the COVID-19 pandemic
Journal Information
Vol. 162. Issue 7.
Pages 354-355 (April 2024)
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130
Vol. 162. Issue 7.
Pages 354-355 (April 2024)
Scientific letter
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Changes in intoxications during the warning period by the COVID-19 pandemic
Cambios en las intoxicaciones durante el periodo de alarma decretado por la pandemia de la COVID-19
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Mónica Marín-Casinoa,b,c,
Corresponding author
mmarinc@hospitaldelmar.cat

Corresponding author.
, Carlos Clementeb,d, August Supervíab,c,e,f
a Servicio de Farmacia, Hospital del Mar, Barcelona, Spain
b Unitat Funcional de Toxicologia, Hospital del Mar, Barcelona, Spain
c Grupo de Trabajo de Toxicología de la Societat Catalana de Medicina d’Urgències i Emergencies (SoCMUETox), Barcelona, Spain
d Servicio de Geriatría, Hospital del Mar, Barcelona, Spain
e Servicio de Urgencias, Hospital del Mar, Barcelona, Spain
f Facultad de Medicina, Universitat Pompeu Fabra (UPF), Barcelona, Spain
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Table 1. Description of intoxications.
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Dear Editor,

The COVID-19 pandemic prompted public health measures to limit the circulation of the virus among the population. The different lockdown periods may have led to changes in drug abuse and medication use patterns, as well as in the intent of their use.

The aim of this study was to compare the characteristics of intoxications treated in a hospital Emergency Department (ED) during the different pandemic lockdown and reopening periods compared to the pre-pandemic period.

This was an observational, retrospective study of acute intoxications in the ED of a university hospital during the following pandemic phases: pre-COVID (1/1/2019-13/3/2020); lockdown (14/3/2020-21/6/2020); reopening (22/6/2020-25/10/2020), 2nd state of emergency (26/10/2020-9/5/2021) and new normal (10/5/2021-31/12/2021). Data were collected on personal details, intent and place of intoxication, toxicant involved, psychiatric and previous intoxication history, discharge destination and mortality. The epidemiological study was approved by the Ethics Committee of our centre.

During the study period, 1,424 intoxications were treated, 522 in pre-COVID, 89 during lockdown, 178 in the reopening, 236 in the 2nd state of emergency and 399 in the new normal. During lockdown, a decrease in the number of intoxications per month was observed compared to the rest of the periods (Table 1). During the pandemic there was an increase in age (p < 0.001), predominantly males (65.2%), intoxications at home doubled, patients with previous intoxications increased (p < 0.001), as well as those with a psychiatric history (p = 0.002), and those generated in tourists decreased (p < 0.001). The main cause of intoxication in all phases was recreational, suicidal intent intoxication almost doubled and accidental intoxication decreased by half during lockdown (p < 0.001). The toxicants involved are shown in Table 1.

Table 1.

Description of intoxications.

  Pre-COVIDn = 522  Lockdownn = 89  Reopeningn = 178  2nd state of emergencyn = 236  New normaln = 399 
Cases/month  35.8  27.0  42.7  36.3  50.9  <0.001 
Age (years) (SD)  37.7 (16.0)  41.3 (15.9)  40.1 (16.4)  42.9 (17.3)  37.8 (17.2)  <0.001 
Male, n (%)  351 (67.2%)  62 (69.7%)  122 (68.5%)  148 (62.7%)  246 (61.7%)  0.242 
Tourist, n (%)  89 (17.1%)  3 (3.4%)  8 (4.5%)  5 (2.1%)  23 (5.8%)  <0.001 
Intoxication intent            <0.001 
-Abuse/recreational  400 (76.8%)  70 (78.7%)  116 (62.2%)  165 (69.9%)  329 (82.5%)   
-Suicidal  45 (8.6%)  13 (14.6%)  25 (14.0%)  39 (16.5%)  26 (6.5%)   
-Accidental  76 (14.6%)  6 (6.7%)  37 (20.8%)  32 (13.6%)  44 (11.0%)   
Intoxication site            <0.001 
-On the street  347 (66.5%)  45 (50.6%)  87 (48.9%)  108 (45.8%)  280 (70.2%)   
-Home  150 (28.7%)  42 (47.2%)  87 (48.9%)  124 (52.5%)  116 (29.1%)   
-Work/school  17 (3.3%)  4 (2.2%)  2 (0.8%)  2 (0.5%)   
-Others  8 (1.5%)  2 (2.2%)  2 (0.8%)  1 (0.3%)   
Previous intoxication  184 (35.5%)  59 (66.3%)  75 (42.1%)  143 (60.6%)  208 (52.1%)  <0.001 
Psychiatric history  142 (27.3%)  31 (34.8%)  55 (30.9%)  90 (38.1%)  96 (24.1%)  0.002 
Presence of clinical symptoms  477 (91.4%)  64 (71.9%)  129 (72.5%)  187 (79.2%)  219 (54.9%)  <0.001 
Toxic involved             
-Alcohol (with or without association)  287 (55.0%)  50 (56.2%)  72 (40.4%)  126 (53.4%)  241 (60.4%)  0.009 
-Drugs of abuse  200 (38.3%)  32 (36.0%)  68 (38.2%)  79 (33.5%)  141 (35.3%)  0.710 
-Drugs  126 (24.1%)  16 (18.0%)  52 (29.2%)  81 (34.3%)  92 (23.1%)  0.004 
-Chemicals  45 (8.6%)  8 (5.6%)  25 (14.0%)  16 (6.8%)  18 (4.5%)  0.014 
Discharge  287 (55.0%)  50 (56.2%)        <0.001 
-Under 12 h  398 (76.2%)  57 (64.0%)  122 (68.5%)  158 (66.9%)  289 (72.4%)   
-ICU  17 (3.3%)  2 (2.2%)  8 (4.5%)  11 (4.7%)  13 (3.3%)   
Psychiatry Consultations Emergency  93 (17.8%)  16 (18.0%)  43 (24.2%)  60 (25.4%)  61 (15.3%)  <0.001 
Deaths  4 (0.8%)  2 (2.2%)  1 (0.6%)  4 (1.7%)  9 (2.3%)  0.274 

SD: standard deviation; ICU: Intensive Care Unit.

Pre-COVID: from 1/1/2019 to 13/3/2020. Lockdown: from 14/3/2020 to 21/6/2020. Reopening: from 22/6/2020 to 25/10/2020. Second state of emergency from 26/10/2020 to 9/5/2021. New normal from 10/5/2021 to 31/12/2021.

During the pandemic, early discharges (less than 12 hours) decreased and intensive care unit (ICU) admissions increased (p < 0.001), with no significant difference in mortality.

This study corroborates that the COVID-19 pandemic influenced the profile of the intoxications treated, leading to changes in the epidemiology. Whereas in the lockdown periods the number of intoxications decreased, in the reopening periods there was a rebound effect.

An increase in age was observed, which may be attributed to a decrease in the number of tourists and less opportunity for festive activities by the younger age group due to lockdown. As in other studies,1 home intoxications increased.

According to other studies,2–4 suicidal intent increased during the pandemic. The economic consequences, job losses, isolation, limited mobility and therefore limited relationships with family and loved ones, deaths of friends or relatives, as well as uncertainty about the future, may have increased anxiety and depression, with suicidal ideation occurring.

The increase in intoxications with chemical products (disinfectants, cleaners) could be related to involuntary intoxications due to an increased use, or even suicidal intents.1,4 The increase in intoxications caused by drugs has been associated with their inappropriate use due to self-medication and, on occasions, medical errors.1 In our series, the most commonly involved drugs were benzodiazepines, followed by neuroleptics, while in other studies,5 over-the-counter analgesics and antidepressants were the most common.

The negative impact of the pandemic has been linked to an increase in the use of alcohol, recreational drugs and central nervous system (CNS) drugs. Recreational drug intoxications linked to social interactions were expected to decrease during lockdown, with a subsequent resurgence after de-escalation.

Due to the successive restrictions, the pandemic had an impact on mental health, especially on those with psychiatric pathologies, who were a vulnerable group during the pandemic. In our series, one third of the patients had a psychiatric history.

The main limitations of the study include the fact that it was conducted in a single ED, so the profile and characteristics of the intoxications may differ from other geographical areas.

In conclusion, the pandemic has produced changes in the profile of intoxications treated in our ED. The lockdown periods showed a decrease in the number of cases, while in the reopening periods there was an increase in the majority of cases. The development of strategies to deal with intoxication, especially alcohol or drug abuse, in future situations of lockdown or social stress, as well as preventive measures in vulnerable populations, is essential.

Ethical considerations

The authors confirm compliance with confidentiality and respect for patients' rights.

Funding

This study has not received any funding.

Conflict of interest

The authors declare that they have no conflicts of interest.

References
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L. Raffee, H.M. Daradkeh, K. Alawneh, A.I. Al-Fwadleh, M. Darweesh, N.H. Hammad, et al.
Impact of COVID-19 lockdown on the incidence and patterns of toxic exposures and poisoning in Jordan: a retrospective descriptive study.
BMJ Open, 11 (2021),
[2]
A.F. Caballero-Bermejo, J. Ortega-Perez, G. Frontera-Juan, C. Homar-Amengual, B. Barcelo-Martin, J. Puiguriger-Ferrando.
Acute poisoning among patients attended to in an emergency department: from the pre-pandemic period to the new normality.
Rev Clin Esp (Barc), 222 (2022), pp. 406-411
[3]
J. Puiguriguer-Ferrando, E. Salgado-Garcia, S. Nogue-Xarau.
Emergency-department-treated poisonings during home confinement for the COVID-19 pandemic.
Emergencias, 32 (2020), pp. 300-301
[4]
A Supervia, M.D. Aranda, C. Clemente, M.J. López Casanova, O. Pallàs.
Hospital emergency department visits for toxic chemical and gas exposure: pattern changes during the COVID-19 pandemic.
Emergencias, 35 (2023), pp. 74-78
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L. Sein Anand, J. Sein Anand.
Self-poisonings before and during the initial year of the COVID-19 pandemic in northern Poland.
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Copyright © 2023. Elsevier España, S.L.U.. All rights reserved
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