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Upper Extremity Infection Related to Intravenous Drug Use - Considering the True Cost of the COVID-19 Pandemic and Lockdown
Yaeesh Sardiwalla, MD, BSc, Minh NQ Huynh, MD, Christopher J Coroneos, MD MSc and Matthew McRae, MD, MHS, FRCSC, McMaster University, Hamilton, ON, Canada

ABSTRACT
Background: The COVID-19 pandemic has caused significant morbidity and mortality in people who inject drugs (PWID). Upper extremity soft tissue infections specifically are frequently associated with intravenous drug use (IVDU) due to poor compliance with aseptic technique including the common practice of sharing, reusing, or licking needles. In Canada, multiple safe injection sites providing clean injection supplies closed or had reduced hours of operation, leaving many PWID with no alternatives to inject safely. It was hypothesized that these closures will correspond with increased morbidity and mortality among PWID. The main objective of this study was to determine the effect of the COVID-19 pandemic on the incidence of upper extremity infections in PWID.
Methods: This was a retrospective multicenter cohort descriptive study. The primary outcome of interest was the frequency of upper extremity infections in PWID. Data was filtered to include only those patients presenting to ED between 20 March 2019 - 20 June 2019 or 20 March 2020 - 20 June 2020. Chi-squared analysis was used to compare the number of infections in IVDU patients compared to the total number of infections.
Results: The number of IVDU treated for upper extremity infections in Hamilton significantly increased during the pandemic (47% increase, χ2=10.444, p=0.00123) while total upper extremity infections numbers have decreased overall. During the pandemic, PWID made up a larger proportion of upper extremity infections.
Interpretation: The effect of the pandemic on accessing harm reduction services has led to evident increases in morbidity as described by this study. Further research on the impact of closures in this patient population is needed to quantify these harms and work towards mitigation and policy strategies.


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