Epidemiology, health care utilization and treatment of patients Suffering from Coronavirus Disease 2019 in Hong Kong : real-world evidence

Abstract

The COVID-19 pandemic has ignited an urgent call for research to unravel the mysteries of the virus and its profound implications on society. Within this thesis lies a compendium of papers that make significant contributions to our knowledge and comprehension of COVID-19, with a particular focus on its effects on healthcare systems and patient outcomes. These studies traverse a diverse range of research domains, including epidemiology, clinical medicine, and health economics. In the first part of this thesis, I embark on an expedition to deepen our understanding of COVID-19. Through a systematic review and meta-analysis of 11,028 COVID-19 patients, I unearth insights into the significance of early detection and treatment, shedding light on the clinical presentations, laboratory and radiological findings, and therapeutic approaches associated with the disease. Furthermore, I delve into the realm of cancer patients affected by COVID-19, unravelling the clinical characteristics, risk factors, and outcomes unique to this vulnerable population, underscoring the need for tailored management strategies for them. I evaluate the far-reaching impact of COVID-19 on healthcare systems and society as a whole. I meticulously examine the transformations in emergency department visits, diagnostic patterns, and 28-day mortality rates directly linked to the pandemic. These findings provide tangible evidence of the pandemic's indirect consequences on healthcare systems, emphasizing the vital importance of unwavering vigilance and preparedness. Additionally, I meticulously explore the ramifications of varying waves of COVID-19 on inhospital mortality rates and length of stay for patients admitted through the emergency department. This study offers significant insights into the strain endured by hospital systems and calls for continuous monitoring and adept management of the disease. Lastly, I investigate the incidence of emergency department visits for sexual abuse among youth in Hong Kong before and during the COVID-19 pandemic, illuminating the potential collateral effects of the crisis on vulnerable populations and underscoring the critical need for steadfast support systems. The final section centres on the management of the pandemic through public health interventions, medications, and vaccines. I analyse the impact of national containment measures in 54 countries and 4 epicentres in decelerating the spread of infection. This study bestows insights into the effectiveness of public health measures in curbing the spread of the disease. Furthermore, with the advent of novel antiviral treatments, I explore the association between Molnupiravir and Nirmatrelvir-Ritonavir and preventable mortality, hospital admissions, and the related avoidable healthcare costs among high-risk patients with mild to moderate COVID-19. This investigation offers crucial information regarding the potential impact of antiviral therapies on the disease. Lastly, I undertake a comprehensive review of the risk of myo-pericarditis among COVID-19 patients and individuals receiving COVID-19 vaccines, shedding light on the safety of these vaccines and their potential in averting severe disease. These papers coalesce to enrich our understanding of COVID-19 and its multifaceted impact on society. They bestow insights into the diverse clinical manifestations of the disease, the indirect consequences on healthcare systems and vulnerable populations, and the potential benefits of preventive and therapeutic strategies.