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Mortality statistics is underlay for public health measures and action and consequently it is one of the major indicator in measures of Covid-19 impact on population. This study aim to explore excess mortality during the Covid-19 pandemic in Serbia. Excess mortality compares expected and observed number of deaths during the given period. Analysis in this paper was based on excess deaths and excess mortality rate. Data was downloaded from the national COVID-19 database and obtained from a relevant source from the Statistical Office of the Republic of Serbia. In order to provide better understanding of excess death, the excess mortality rate was calculated for the period January 2015-June 2022. For the period January 2015-February 2020, 38 months were observed without excess deaths, while in months with excess deaths, almost in all months excess mortality rate was below 12%. Since March 2020, the excess mortality rate has increased significantly, with highest values in December 2020 (91.4%), October (84.3) and November (67.8) 2021. [ABSTRACT FROM AUTHOR]

The eruption of the novel virus brought to the global scene the prediction that Africa would be worse hit by the pandemic. This prediction was partly built on the widely recognized fact that Africa is the continent with the weakest public health care system and the lowest budgetary allocations to health. However, contrary to this prediction, the COVID-19 death rate in Africa has been low compared to in other continents. Debates on Africa's low COVID-19 death rate have generated mixed reactions, the majority of which have centred on beliefs and superstition about hot weather and Africa's youth-dominated society. Little or none of these reactions have attributed the low COVID-19 death rate to swift and prudent budgetary adjustment, which partly aided a swift response from some African governments. Indeed, not many studies have examined the swiftness in the response of some African governments and prudent budgetary adjustment in tackling the spread of COVID-19. This paper, through secondary data, advances knowledge on how budget revision aided government response to the COVID-19 pandemic in South Africa and Nigeria. It found that both countries adjusted their budgetary allocations in response to COVID-19. It further indicates that South Africa, through budgetary revision, allocated more funds to government agencies in charge of COVID-19 and various relief packages than Nigeria. Moreover, it indicates that the swift budgetary adjustment by both countries partly aided a quick government response that progressively flattened the curve and, in the long run, partly contributed to fiscal impulse and deferrals. [ABSTRACT FROM AUTHOR]

Background: The outbreak of COVID-19 has created a landslide of publications, from different sources and unequal impact. We considered that the first 3 months are crucial to understand how knowledge has been generated by performing a bibliometric analysis, including the citations to these articles to guide researchers in exploring this field, and to evaluate the relationship between confirmed COVID-19 cases and deaths with the number of papers per country. Methods: Scientific publications were obtained from PubMed (January-March 2020) and their citations during the first 6 months retrieved from the Scopus database. An analysis of the number of papers by country, approach (type and category of publication), and impact was made. A multiple linear regression model was implemented to analyze the correlation between the number of publications and confirmed cases and deaths. Results: A total of 2,530 publications were analyzed with 59,104 citations (23.4 citations/article), written by authors from 67 countries. China was the country with more publications (988, 39%) and more citations (36,416, 63%) followed by the United States with 423 articles (16.7%) and 7,458 citations (12.6%). The coauthorship network identified 10,756 authors. According to the multivariate analysis, both confirmed cases and deaths were significantly correlated with the number of publications per country (corrected by population size and gross domestic product). Conclusion: The correlation with the number of publications suggests that cases and deaths had some impact on the medical literature, reflecting how rapidly the scientific community has been on the frontline in the fight against COVID-19. [ABSTRACT FROM AUTHOR]

This paper presents a forecasting model for the mortality rates of COVID-19 in six of the top most affected countries depending on the hybrid Genetic Algorithm and Autoregressive Integrated Moving Average (GA-ARIMA). It was aimed to develop an advanced and reliable predicting model that provides future forecasts of possible confirmed cases and mortality rates (Total Deaths per 1 million Population of COVID-19) that could help the public health authorities to develop plans required to resolve the crisis of the pandemic threat in a timely and efficient manner. The study focused on predicting the mortality rates of COVID-19 because the mortality rate determines the prevalence of highly contagious diseases. The Genetic algorithm (GA) has the capability of improving the forecasting performance of the ARIMA model by optimizing the ARIMA model parameters. The findings of this study revealed the high prediction accuracy of the proposed (GA-ARIMA) model. Moreover, it has provided better and consistent predictions compared to the traditional ARIMA model and can be a reliable method in predicting expected death rates as well as confirmed cases of COVID-19. Hence, it was concluded that combining ARIMA with GA is further accurate than ARIMA alone and GA can be an alternative to find the parameters and model orders for the ARIMA model. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has profoundly affected all aspects of our lives. Through real-time monitoring and rapid vaccine implementation, we succeeded in suppressing the spread of the disease and mitigating its consequences. Finally, conclusions can be summarized and drawn. Here, we use the example of Poland, which was seriously affected by the pandemic. Compared to other countries, Poland has not achieved impressive results in either testing or vaccination, which may explain its high mortality (case fatality rate, CFR 1.94%). Through retrospective analysis of data collected by the COVID-19 Data Portal Poland, we found significant regional differences in the number of tests performed, number of cases detected, number of COVID-19-related deaths, and vaccination rates. The Masovian, Greater Poland, and Pomeranian voivodeships, the country's leaders in vaccination, reported high case numbers but low death rates. In contrast, the voivodeships in the eastern and southern parts of Poland (Subcarpathian, Podlaskie, Lublin, Opole), which documented low vaccination levels and low case numbers, had higher COVID-19-related mortality rates. The strong negative correlation between the CFR and the percentage of the population that was vaccinated in Poland supports the validity of vaccination. To gain insight into virus evolution, we sequenced more than 500 genomes and analyzed nearly 80 thousand SARS-CoV-2 genome sequences deposited in GISAID by Polish diagnostic centers. We showed that the SARS-CoV-2 variant distribution over time in Poland reflected that in Europe. Haplotype network analysis allowed us to follow the virus transmission routes and identify potential superspreaders in each pandemic wave. [ABSTRACT FROM AUTHOR]

Background and Aims: Hospitals are one of the most important healthcare centers for providing the patients with different medical needs. Several different factors might cause hospitals to downgrade their services or departments or close down overall. One of the most multifaceted reasons for hospital downgrading or closure is infectious disease outbreaks. In this regard, we aimed to evaluate the effects of hospital closure and downgrading due to the COVID‐19 pandemic on the mortality rate of the people residing in Fars province, Iran. Methods: We gathered mortality information, including the cause of death, age, sex, place, and time of death of all deceased cases occurring during a period of 3 years, from February 20, 2018 to March 2021 from the forensic medicine and also the Department of Biostatistics in Shiraz University of Medical Sciences. Results: A total of 71,331 deaths have been reported since 2018 through the first quarter of 2021, with 57.9% of total mortality cases attributed to male gender. The total mortality counts ranged from 4229 to 9809 deaths per quarter, from which the minimum rate was reported in the first quarter of 2018 and the maximum in the fourth quarter of 2020. Based on the causes of death, diseases of the circulatory system were shown to be the all‐time most frequent cause of death, accounting for a total of 42.8% of recorded deaths, followed by neoplasms (9.77%) and diseases of the respiratory system (9.45%). Conclusion: Although the large number of deaths at the time of the pandemic are immediately due to COVID‐19 infection, deaths due to a notable number of other causes have had a significant increase which, along with the specific trend of place and causes of death, shows that the downgrading and closure of hospitals have had a significant impact on overall population mortality. Key points: Several different causes with various natures might cause hospitals to downgrade their services or departments or close down overall, including the COVID‐19 pandemic.Although the large number of deaths at the time of the pandemic are immediately due to COVID‐19 infection, deaths due to a notable number of other causes have had a significant increase which, along with the specific trend of place and causes of death, shows that the downgrading and closure of hospitals have had a significant impact on overall population mortality.Evaluation of the long‐term impact of hospital closure on disease‐related mortalities should be continuously assessed, especially after the reopening of hospitals, to evaluate the significance of the impact of these imposed conditions. [ABSTRACT FROM AUTHOR]

Background: Causes of death other than COVID-19 seem to contribute significantly to the excess mortality observed during the 2020–2022 pandemic. In this study, we explore changes in non-COVID-19 causes of death in Norway during the COVID-19 pandemic from March 2020 to December 2022. Methods: We performed a population-based cross-sectional study on data from the Norwegian Cause of Death Registry. All recorded deaths from 1st January 2010 to 31st December 2022 were included. The main outcome measures were the number of deaths and age-standardised death rate (ASMR) per 100000 population from the major cause of death groups in 2020, 2021 and 2022. The predicted number of deaths and ASMRs were forecasted with a 95% prediction interval constructed from a general linear regression model based on the corresponding number of deaths and rates from the preceding ten prepandemic years (2010–2019). We also examined whether there were deviations from expected seasonality in the pandemic period based on prepandemic monthly data from 2010–2019. The cumulative number of deaths and ASMR were estimated based on monthly mortality data. Results: There was significant excess mortality (number of deaths) in 2021 and 2022 for all causes (3.7% and 14.5%), for cardiovascular diseases (14.3% and 22.0%), and for malignant tumours in 2022 (3.5%). In terms of ASMR, there was excess mortality in 2021 and 2022 for all causes (2.9% and 13.7%), and for cardiovascular diseases (16.0% and 25,8%). ASMR was higher than predicted in 2022 for malignant tumours (2.3%). There were fewer deaths than predicted from respiratory diseases (except COVID-19) in 2020 and 2021, and from dementia in 2021 and 2022. From March 2020 to December 2022, there were cumulatively 3754 (ASMR 83.8) more non-COVID-19 deaths than predicted, of which 3453 (ASMR: 79.6) were excess deaths from cardiovascular disease, 509 (ASMR 4.0) from malignant tumours. Mortality was lower than predicted for respiratory diseases (-1889 (ASMR: -44.3)), and dementia (-530 (ASMR -18.5)). Conclusions: There was considerable excess non-COVID-19 mortality in Norway from March 2020 until December 2022, mainly due to excess cardiovascular deaths. For respiratory diseases and dementia, mortality was lower than predicted. [ABSTRACT FROM AUTHOR]

INTRODUCTION: We investigated whether mortality in memory clinic patients changed due to coronavirus disease 2019 (COVID‐19) pandemic. METHODS: We included patients from the Amsterdam Dementia Cohort: (1) n = 923 pandemic patients (baseline visit: 2017–2018, follow‐up: until 2021), and (2) n = 830 historical control patients (baseline visit: 2015–2016, follow‐up: until 2019). Groups were well‐balanced. We compared mortality during pandemic with historical control patients using Cox regression. Differences in cause of death between groups were explored using Fisher's exact test. RESULTS: Pandemic patients had a higher risk of mortality than historical control patients (hazard ratio [HR] [95% confidence interval {CI}] = 1.34 [1.05–1.70]). Stratified for syndrome diagnosis, the effect remained significant in dementia patients (HR [95% CI] = 1.35 [1.03–1.78]). Excluding patients who died of COVID‐19‐infection, the higher mortality risk in pandemic patients attenuated (HR [95% CI] = 1.24 [0.97–1.58]). Only the difference in cause of death between pandemic patients and historical control patients for death to COVID‐19‐infection (p = 0.001) was observed. CONCLUSION: Memory clinic patients had increased mortality risk during COVID‐19 compared to historical control patients, attributable to dementia patients. Highlights: We investigated if mortality rates in memory clinic patients changed due to COVID‐19 pandemic.We included patients along the cognitive continuum, including SCD, MCI, and dementia.We used a well‐balanced historical control group.Memory clinic patients had higher risk for mortality during COVID‐19 lockdown.Our results indicate that excess mortality is mainly caused by death to COVID‐19 infection. [ABSTRACT FROM AUTHOR]

Background and Aim: The impact of multiple risk factors on COVID-19 mortality has been previously reported in multiple systematic reviews and meta-analyses. The aim of this review is to provide a comprehensive update on the association between hypertension (HTN) and mortality in patients with COVID-19. Methods: A systematic review and meta-analysis were performed and followed the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. A search was achieved using PubMed, Scopus, and Cochrane Databases for research publications on hypertension, COVID-19, and mortality published between December 2019 and August 2022. Results: A total of 23 observational studies involving 611,522 patients from 5 countries (China, Korea, the UK, Australia, and the USA) were included in our study. The confirmed number of COVID-19 with HTN cases in each study ranged from 5 to 9964. The mortality ranged from 0.17% to 31% in different studies. Pooled results show that the mortality rate of COVID-19 among the included studies ranges from a minimum of 0.39 (95% CI 0.13–1.12) to a maximum of 5.74 (95% CI 3.77–8.74). Out of the 611,522 patients, 3119 died which resulted in an overall mortality prevalence of 0.5%. Subgroup analyses indicated that patients with COVID-19 who have hypertension and male patients had slightly less risk of mortality than female patients [the percentage of men > 50%; OR 1.33: 95% CI (1.01, 1.76); the percentage of men ≤ 50%: OR 2.26; and 95% CI (1.15, 4.48)]. Meta-regression analysis results also showed a statistically significant association between hypertension and COVID-19 mortality. Conclusion: This systematic review and meta-analysis suggest that hypertension may not be the only risk factor associated with the increased mortality rate during the COVID-19 pandemic. In addition, a combination of other comorbidities and old age appears to increase the risk of mortality from COVID-19. [ABSTRACT FROM AUTHOR]

We conducted an updated meta-analysis to evaluate the 30-day mortality of hip fractures during the COVID-19 pandemic and assess mortality rates by country. We systematically searched Medline, EMBASE, and the Cochrane Library up to November 2022 for studies on the 30-day mortality of hip fractures during the pandemic. Two reviewers used the Newcastle–Ottawa tool to independently assess the methodological quality of the included studies. We conducted a meta-analysis and systematic review including 40 eligible studies with 17,753 patients with hip fractures, including 2280 patients with COVID-19 (12.8%). The overall 30-day mortality rate for hip fractures during the pandemic was 12.6% from published studies. The 30-day mortality of patients with hip fractures who had COVID-19 was significantly higher than those without COVID-19 (OR, 7.10; 95% CI, 5.51–9.15; I2 = 57%). The hip fracture mortality rate increased during the pandemic and varied by country, with the highest rates found in Europe, particularly the United Kingdom (UK) and Spain. COVID-19 may have contributed to the increased 30-day mortality rate in hip fracture patients. The mortality rate of hip fracture in patients without COVID-19 did not change during the pandemic. [ABSTRACT FROM AUTHOR]

Background: Ensuring health equity, especially for vulnerable populations in less developed settings with poor health system is essential for the current and future global health threats. This study examined geographical variations of COVID-19 mortality and its association with population health characteristics, health care capacity in responding pandemic, and socio-economic characteristics across 514 districts in Indonesia. Methods: This nationwide ecological study included aggregated data of COVID-19 cases and deaths from all 514 districts in Indonesia, recorded in the National COVID-19 Task Force database, during the first two years of the epidemic, from 1 March 2020 to 27 February 2022. The dependent variable was district-level COVID-19 mortality rate per 100,000 populations. The independent variables include district-level COVID-19 incidence rate, population health, health care capacity, and socio-demographics data from government official sources. We used multivariable ordinal logistic regression to examine factors associated with higher mortality rate. Results: Of total 5,539,333 reported COVID-19 cases, 148,034 (2.7%) died, and 5,391,299 (97.4%) were recovered. The district-level mortality rate ranged from 0 to 284 deaths per 100,000 populations. The top five districts with the highest mortality rate were Balikpapan (284 deaths per 100,000 populations), Semarang (263), Madiun (254), Magelang (250), and Yogyakarta (247). A higher COVID-19 incidence (coefficient 1.64, 95% CI 1.22 to 1.75), a higher proportion of ≥ 60 years old population (coefficient 0.26, 95% CI 0.06 to 0.46), a higher prevalence of diabetes mellitus (coefficient 0.60, 95% CI 0.37 to 0.84), a lower prevalence of obesity (coefficient -0.32, 95% CI -0.56 to -0.08), a lower number of nurses per population (coefficient -0.27, 95% CI -0.50 to -0.04), a higher number of midwives per population (coefficient 0.32, 95% CI 0.13 to 0.50), and a higher expenditure (coefficient 0.34, 95% CI 0.10 to 0.57) was associated with a higher COVID-19 mortality rate. Conclusion: COVID-19 mortality rate in Indonesia was highly heterogeneous and associated with higher COVID-19 incidence, different prevalence of pre-existing comorbidity, healthcare capacity in responding the pandemic, and socio-economic characteristics. This study revealed the need of controlling both COVID-19 and those known comorbidities, health capacity strengthening, and better resource allocation to ensure optimal health outcomes for vulnerable population. [ABSTRACT FROM AUTHOR]

The death toll in nursing homes accounted for almost 30 per cent of total Covid-19 deaths in the US during 2020. We examine the course of the pandemic in nursing homes focusing especially on whether nursing homes could have been better shielded. Across all nursing homes the key predictor of infections and deaths was community spread, i.e. a factor outside of the control of nursing homes. We find that higher-quality nursing homes, as measured by the CMS Five-Star Rating system, were not better able to protect their residents. Policy failures from the CDC and FDA, especially in the early stages of the pandemic, created extended waiting times for Covid-19 tests and slowed attempts to isolate infectious residents. But once infections were widespread, testing would have had to have been much greater to have had an appreciable effect on nursing home deaths. We find, however, that starting vaccinations just 5 weeks earlier could have saved in the order of 14,000 lives and starting them ten weeks earlier could have saved 40,000 lives. [ABSTRACT FROM AUTHOR]

After initially having low levels of SARS-CoV-2 infections for much of the year, Bulgaria experienced a major epidemic surge at the end of 2020, which caused the highest recorded excess mortality in Europe, among the highest in the word (Excess Mortality Rate, or EMR ∼0.25%). Two more major waves followed in 2021, followed by another one in early 2022. In this study, we analyze the temporal and spatial patterns of excess mortality at the national and local levels and across different demographic groups in Bulgaria and compare those to the European levels. Bulgaria has continued to exhibit the previous pattern of extremely high excess mortality, as measured both by crude mortality metrics (an EMR of ∼1.05%, up to the end of March 2022) and by standardized ones—Potential Years of Life Lost (PYLL) and Aged-Standardized Years of life lost Rate (ASYR). Unlike Western Europe, the bulk of excess mortality in Bulgaria, as well as in several other countries in Eastern Europe, occurred in the second year of the pandemic, likely related to the differences in the levels of vaccination coverage between these regions. We also observe even more extreme levels of excess mortality at the regional level and in some subpopulations (e.g., total EMR values for males ≥ 2% and EMR values for males aged 40–64 ≥ 1% in certain areas). We discuss these observations in light of the estimates of infection fatality rate (IFR) and eventual population fatality rate (PFR) made early in the course of the pandemic. [ABSTRACT FROM AUTHOR]

Objectives: To identify international and periodically updated models of the COVID-19 epidemic, compile and visualize their estimation results at the global, regional, and country levels, and periodically update the compilations. This compilation can serve as an early warning mechanism for countries about future surges in cases and deaths. When one or more models predict an increase in daily cases or infections and deaths in the next one to three months, technical advisors to the national and subnational decision-makers can consider this early alarm for assessment and suggestion of augmentation of preventive measures and interventions. Data description: Five international and periodically updated models of the COVID-19 pandemic were identified, created by: (1) Massachusetts Institute of Technology, Cambridge, (2) Institute for Health Metrics and Evaluation, Seattle, (3) Imperial College, London, (4) Los Alamos National Laboratories, Los Alamos, and (5) University of Southern California, Los Angeles. Estimates of these five identified models were gathered, combined, and graphed at global and two country levels. Canada and Iran were chosen as countries with and without subnational estimates, respectively. Compilations of results are periodically updated. Three Github repositories were created that contain the codes and results, i.e., "CovidVisualizedGlobal" for the global and regional levels, "CovidVisualizedCountry" for a country with subnational estimates–Canada, and "covir2" for a country without subnational estimates–Iran. [ABSTRACT FROM AUTHOR]

Background: The ongoing COVID-19 pandemic hit South America badly with multiple waves. Different COVID-19 variants have been storming across the region, leading to more severe infections and deaths even in places with high vaccination coverage. This study aims to assess the spatiotemporal variability of the COVID-19 pandemic and estimate the infection fatality rate (IFR), infection attack rate (IAR) and reproduction number ( R 0 ) for twelve most affected South American countries. Methods: We fit a susceptible-exposed-infectious-recovered (SEIR)-based model with a time-varying transmission rate to the reported COVID-19 deaths for the twelve South American countries with the highest mortalities. Most of the epidemiological datasets analysed in this work are retrieved from the disease surveillance systems by the World Health Organization, Johns Hopkins Coronavirus Resource Center and Our World in Data. We investigate the COVID-19 mortalities in these countries, which could represent the situation for the overall South American region. We employ COVID-19 dynamic model with-and-without vaccination considering time-varying flexible transmission rate to estimate IFR, IAR and R 0 of COVID-19 for the South American countries. Results: We simulate the model in each scenario under suitable parameter settings and yield biologically reasonable estimates for IFR (varies between 0.303% and 0.723%), IAR (varies between 0.03 and 0.784) and R 0 (varies between 0.7 and 2.5) for the 12 South American countries. We observe that the severity, dynamical patterns of deaths and time-varying transmission rates among the countries are highly heterogeneous. Further analysis of the model with the effect of vaccination highlights that increasing the vaccination rate could help suppress the pandemic in South America. Conclusions: This study reveals possible reasons for the two waves of COVID-19 outbreaks in South America. We observed reductions in the transmission rate corresponding to each wave plausibly due to improvement in nonpharmaceutical interventions measures and human protective behavioral reaction to recent deaths. Thus, strategies coupling social distancing and vaccination could substantially suppress the mortality rate of COVID-19 in South America. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate overall and sex-specific excess all-cause mortality since the inception of the COVID-19 pandemic until August 2020 among 22 countries.Methods: Countries reported weekly or monthly all-cause mortality from January 2015 until the end of June or August 2020. Weekly or monthly COVID-19 deaths were reported for 2020. Excess mortality for 2020 was calculated by comparing weekly or monthly 2020 mortality (observed deaths) against a baseline mortality obtained from 2015-2019 data for the same week or month using two methods: (i) difference in observed mortality rates between 2020 and the 2015-2019 average and (ii) difference between observed and expected 2020 deaths.Results: Brazil, France, Italy, Spain, Sweden, the UK (England, Wales, Northern Ireland and Scotland) and the USA demonstrated excess all-cause mortality, whereas Australia, Denmark and Georgia experienced a decrease in all-cause mortality. Israel, Ukraine and Ireland demonstrated sex-specific changes in all-cause mortality.Conclusions: All-cause mortality up to August 2020 was higher than in previous years in some, but not all, participating countries. Geographical location and seasonality of each country, as well as the prompt application of high-stringency control measures, may explain the observed variability in mortality changes. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) pandemic has significantly influenced epidemiology, yet its impact on out-of-hospital cardiac arrest (OHCA) remains unclear. We aimed to evaluate the impact of the pandemic on the incidence and case fatality rate (CFR) of OHCA. We also evaluated the impact on intermediate outcomes and clinical characteristics. Methods: PubMed, EMBASE, Web of Science, Scopus, and Cochrane Library databases were searched from inception to May 3, 2021. Studies were included if they compared OHCA processes and outcomes between the pandemic and historical control time periods. Meta-analyses were performed for primary outcomes [annual incidence, mortality, and case fatality rate (CFR)], secondary outcomes [field termination of resuscitation (TOR), return of spontaneous circulation (ROSC), survival to hospital admission, and survival to hospital discharge], and clinical characteristics (shockable rhythm and etiologies). This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021253879). Results: The COVID-19 pandemic was associated with a 39.5% increase in pooled annual OHCA incidence (p < 0.001). Pooled CFR was increased by 2.65% (p < 0.001), with a pooled odds ratio (OR) of 1.95 for mortality [95% confidence interval (95%CI) 1.51–2.51]. There was increased field TOR (OR = 2.46, 95%CI 1.62–3.74). There were decreased ROSC (OR = 0.65, 95%CI 0.55–0.77), survival to hospital admission (OR = 0.65, 95%CI 0.48–0.89), and survival to discharge (OR = 0.52, 95%CI 0.40–0.69). There was decreased shockable rhythm (OR = 0.73, 95%CI 0.60–0.88) and increased asphyxial etiology of OHCA (OR = 1.17, 95%CI 1.02–1.33). Conclusion: Compared to the pre-pandemic period, the COVID-19 pandemic period was significantly associated with increased OHCA incidence and worse outcomes. [ABSTRACT FROM AUTHOR]

Introduction. COVID-19 pandemic remains one of the most difficult challenges facing humanity since the beginning of the 21st century. Since March 2020 until March 2022, a total of 513,442 cases and 11,431 deaths were reported in the Republic of Moldova, which corresponded to a mortality rate of 2.2%. The pandemic has led to social isolation measures, which have limited the population’s access and addressing rate to healthcare services, including pregnant women. Materials and method. A retrospective monitoring study of maternal mortality (MM) in the Republic of Moldova during 2020-2021 due to COVID-19 cases in pregnant women was performed. SPSS version 3 was used for data processing. Results. In the Republic of Moldova, from a total of 19 deaths (31 per 100,000 live births) among pregnant women, 68% (13 deaths) were associated to COVID-19. The average age of the patients was 29.6 years old. The primiparous/secondiparous ratio was 1:1. In 70% of patients, preexisting pregnancy comorbidities were found (viral hepatitis, chronic bronchitis, hypertension, chronic pyelonephritis). More than 30% of women were overweight. Pregnancy was complicated with iron deficiency anemia in 50% of cases, imminent abortion appeared in 20% of cases, and for each of the following: gestational diabetes, hydronephrosis and gestational hypertension, the rate was 10%. None of the women were vaccinated against SARS-CoV-2 and did not suffer from the disease before pregnancy. Severe acute respiratory syndrome developed on the seventh day of illness in 40% and after 10 days in other 60% of cases. In postpartum females, death occurred in 80% of the cases. Emergency caesarean section (ECS) was performed in 50% of cases. In all cases, the indication for ECS was the worsening of respiratory failure’s degree. From all pregnant women, 30% gave birth per vias naturales. From the onset of the first disease’s symptoms until death occurred, an average, 21.3 days have passed. In all cases, the disease was complicated with sepsis, MODS, pulmonary embolism and cardiorespiratory arrest. Conclusions. It can be observed that the MM rate in the Republic of Moldova increased significantly during the COVID-19 pandemic. This can be explained by the high contagiousness of the disease, mainly in 2021 (10 deaths), the low vaccination rate among pregnant women during that period in the Republic of Moldova and the delayed addressing of pregnant women to medical services. [ABSTRACT FROM AUTHOR]