Author:
Arahirwa Victor,Tyrlik Katherine,Abernathy Haley,Cassidy Caitlin,Alejo Aidin,Mansour Odai,Giandomenico Dana,Brown Marusiak Amanda,Boyce Ross M.
Abstract
Abstract
Background
The Coronavirus disease 2019 (COVID-19) pandemic was marked by an increase in diagnosis and treatment delays for a range of medical conditions. Yet the impact of the pandemic on the management of tick-borne diseases, which frequently manifest as an acute febrile illness similar to COVID-19, has not been well described.
Methods
In this retrospective cohort study of patients with suspected tick-borne disease attending the University of North Carolina Health facilities, we compared the timeliness of diagnosis and treatment in a “pre-COVID” period (March 2019 to February 2020) and a “post-COVID” period (March 2020 to February 2021). Participants included patients with an ICD-10 diagnosis code of spotted fever group rickettsiosis or ehrlichiosis and a positive Rickettsiarickettsii or Ehrlichia indirect immunofluorescence assay immunoglobulin G antibody test result. Of the 897 patients who had an eligible diagnosis, 240 (26.8%) met the inclusion criteria. The main outcome was time from initial presentation to definitive diagnosis and treatment.
Results
During the 2-year study period, 126 (52.5%) patients were grouped in the pre-COVID period and 114 (47.5%) were grouped in the post-COVID period; 120 (50.0%) were female; and 139 (57.9%) were aged > 50 years. Comparing the post-COVID to the pre-COVID period, the adjusted odds ratio (aOR) for delay in treatment > 0 days was 1.81 (95% confidence interval [CI] 1.07–3.07, P = 0.03), and for a treatment delay > 7 days, 1.65 (95% CI 0.94–2.90, P = 0.08). The odds of a delay in diagnosis were similar for patients in the post- and pre-COVID periods, with an aOR of 1.61 (95% CI 0.96–2.72, P = 0.07) for delays > 0 days, and aOR of 1.72 (95% CI 0.99–3.00, P = 0.05) for delays > 7 days.
Conclusions
The odds of a delay in treatment > 0 days were significantly higher in the post-COVID period than in the pre-COVID period. However, the odds of a delay in treatment > 7 days, or a delay in diagnosis, were similar between these two periods. Shifts in care-seeking, alternative care delivery models and prioritization of COVID-19 may contribute to diminished timeliness of treatment for patients with tick-borne diseases.
Graphical Abstract
Funder
Doris Duke Charitable Foundation
North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill
Publisher
Springer Science and Business Media LLC
Subject
Infectious Diseases,Parasitology,General Veterinary
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