Effect of the first wave of COVID-19 on Poison Control Centre activities in 21 European countries: an EAPCCT initiative

Figures & data

Table

Title	First Name	Last Name	Institution	City	Country
Dr.	Tara	Arif	Austria Poisons Information Centre	Vienna	Austria
Dr.	Željka	Babić	Croatia Poison Control Centre	Zagreb	Croatia
Dr.	Guiseppe	Bacis	Bergamo Poison Control Center, ASST Papa Giovanni XXIII Hospital	Bergamo	Italy
Ms.	Lejla	Bahtić	Bosnia & Herzegovina Poison Control Center, Public Institution for Occupational Medicine of Sarajevo Canton	Sarajevo	Bosnia & Herzegovina
Ms.	Nicola	Bates	Veterinary Poisons Information Service (VPIS)	London	United Kingdom
Dr.	Miran	Brvar	Centre for Clinical Toxicology and Pharmacology, University Medical Centre Ljubljana and Centre for Clinical Physiology, University of Ljubljana	Ljubljana	Slovenia
Ms.	Eglė	Burbienė	Pharmacovigilance and Poison information Department, State Medicines Control Agency under the Ministry of Health of the Republic of Lithuania	Vilnius	Lithuania
Dr.	Blažena	Cagáňová	National Toxicological Information Centre, University Hospital Bratislava, Slovakia	Bratislava	Slovakia
Ms.	Patricia	Casey	Ireland National Poisons Information Centre, Beaumont Hospital	Dublin	Ireland
Dr.	Nicolas	Delcourt	Centre antipoison et de Toxicovigilance d’Occitanie	Toulouse	France
Dr.	Anne-Marie	Descamps	Belgium Poisons Information Center, Centre Antipoisons-Antigifcentrum	Brussels	Belgium
Prof. Dr.	Alexis	Descatha	Centre antipoison et de Toxicovigilance Grand Ouest	Angers	France
Dr.	Victoria	Eagling	National Poisons Information Service (Edinburgh)	Edinburgh	United Kingdom
Prof.Dr.	Florian	Eyer	Department of Clinical Toxicology & Munich Poison Control Centre, Klinikum rechts der Isar, Technical University of Munich	Munich	Germany
Dr.	Francesco	Gambassi	Florence Poisons Centre, Azienda Ospedaliero Universitaria Careggi	Florence	Italy
Dr.	Laurence	Gray	National Poisons Information Service (Cardiff)	Cardiff	United Kingdom
Mr.	Pardeep Singh	Jagpal	National Poisons Information Service (Birmingham)	Birmingham	United Kingdom
Dr.	Jasmina	Jovic-Stosic	National Poison Control Centre, Military Medical Academy (Vojnomedicinska akademija)	Belgrade	Serbia
Dr.	Magali	Labadie	Centre antipoison et de Toxicovigilance de Nouvelle-Aquitaine	Bordeaux	France
Dr.	Tuomas	Lilius	Finnish National Poison Information Center, Department of Emergency Medicine and Services, HUS Helsinki University Hospital and University of Helsinki	Helsinki	Finland
Ms.	Helena	Líndal	Iceland Poison Information Centre	Reykjavik	Iceland
Prof.Dr.	Carlo	Locatelli	Poison Control Centre and National Toxicology Information Centre -Toxicology Unit, Istituti Clinici Scientifici Maugeri, IRCCS Maugeri Hospital and University of Pavia	Pavia	Italy
Ms.	Merethe	Midtervoll	Norwegian Poisons Information Centre, Division of Environmental Medicine, Norwegian Institute of Public Health	Oslo	Norway
Dr.	Patrick	Nisse	Centre antipoison et de Toxicovigilance des Hauts de France	Lille	France
Dr.	Dorte	Palmqvist	Department of Anaesthesiology, The Danish Poisons Information Centre, Copenhagen University Hospital Bispebjerg	Copenhagen	Denmark
Dr.	Anne-Marie	Patat	Centre antipoison et de Toxicovigilance Est	Lyon	France
Prof. Dr.	Zanina	Pereska	Poisons Information Centre, University Clinic of Toxicology, Clinical campus Mother Theresa, Medical faculty,University Ss Cyril and Methodius	Skopje	Republic of North Macedonia
Dr.	Emmanuel	Puskarczyk	Centre antipoison et de Toxicovigilance de Grand est	Nancy	France
Dr.	Giorgio	Ricci	Veneto Poisons Centre, Azienda Ospedaliera Universitaria Integrata Verona Ospedale Borgo Trento	Verona	Italy
Dr.	Alessandra	Salierno	Naples Poisons Centre, Antonio Cardarelli Hospital	Napoli	Italy
Prof.Dr.	Nicolas	Simon	Aix Marseille Univ, INSERM, IRD, SESSTIM, Hôpital Sainte Marguerite, Service de Pharmacologie Clinique, Centre antipoison	Marseille	France
Mr.	Markus	Tellerup	Swedish Poisons Information Centre	Stockholm	Sweden
Dr.	Ruben	Thanacoody	National Poisons Information Service (Newcastle)	Newcastle	United Kingdom
Dr.	Agnes	Van Velzen	Dutch Poisons Information Center, Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht University	Utrecht	the Netherlands
Dr.	Dominique	Vodovar	Centre antipoison et de toxicovigilance de Paris, Hôpital Fernand Widal	Paris	France

Table 1. Characteristics of European Poison Control Centres (PCCs) in this study.

Country N = 21		PCC N = 36		Public*	Population served **	N calls 2018/19 (March–June)***	N calls 2020 (March–June)	Change (%)	χ^2	p	Change
1	Austria	1	Vienna	Yes	8.9	7.519	7.971	6	13.2	0.0003	Increase
2	Belgium	2	Brussels	Yes	11.5	16.552	18.039	9	63.9	0.0000	Increase
3	Bosnia and Herzegovina	3	Sarajevo	Yes	3.5	48	60	25	1.3	0.2542	None
4	Croatia	4	Zagreb	Yes	4.1	780	737	−6	1.2	0.2733	None
5	Denmark	5	Copenhagen	Yes	5.8	10.811	12.481	15	119.7	0.0000	Increase
6	Finland	6	Helsinki	Yes	5.5	10.099	10.044	−1	0.2	0.6547	None
7	France^a	7–14	National (8 PCCs)	Yes	67.3	59.267	63.168	7	124.3	0.0000	Increase
8	Germany^b	15	Freiburg	Yes	11.1	8.249	9.586	16	100.2	0.0000	Increase
		16	Munich	Yes	13.1	11.849	12.252	3	6.7	0.0096	Increase
9	Iceland	17	Reykjavík	Yes	0.4	666	819	23	15.8	0.0001	Increase
10	Ireland	18	Dublin	Yes	4.9	3.661	4.058	11	20.4	0.0000	Increase
11	Italy^c	19	Bergamo	Yes	3.2	2.853	2.446	−14	31.3	0.0000	Decrease
		20	Naples	Yes	1.1	802	1.296	62	116.3	0.0000	Increase
		21	Pavia	Yes	27.0	8.785	8.181	−7	21.5	0.0000	Decrease
		22	Florence	Yes	1.9	1.984	1.955	−1	0.2	0.6547	None
		23	Verona	Yes	0.5	1.090	1.439	32	48.2	0.0000	Increase
12	Lithuania	24	Vilnius	Yes	2.8	783	854	9	3.1	0.0783	None
13	Rep. N. Macedonia	25	Skopje	Yes^e	2.1	83	68	−18	1.5	0.2207	None
14	Netherlands	26	Utrecht	No	17.4	12.950	12.289	−5	17.3	0.0000	Decrease
15	Norway	27	Oslo	Yes	5.4	13.040	14.360	10	63.6	0.0000	Increase
16	Serbia	28	Belgrade	Yes	6.93	369	453	23	8.6	0.0034	Increase
17	Slovakia	29	Bratislava	Yes	5.5	1.976	2.135	8	6.1	0.0135	Increase
18	Slovenia	30	Ljubljana	No	2.1	658	575	−13	5.6	0.0180	Decrease
19	Sweden	31	Stockholm	Yes	10.3	29.017	29.398	1	2.5	0.1138	None
20	Switzerland	32	Zurich	Yes	8.6	11.938	12.370	4	7.7	0.0055	Increase
21	UK^d	33–36	National (4 PCCs)	No	67.7	12.965	12.136	−6	27.4	0.0000	Decrease
–	SUM	–	–	–	299	228.794	239.170	4.5%	230.1	0.0000	Increase

*Questions from the public are processed.

**Data in millions derived from https://de.statista.com at 20.10.2021.

***Absolute numbers for 2018 and 2019 were averaged.

^aGrouped data were supplied from 8 (out of 8) French PCCs, collected within the French National Database of Poisonings.

^bTwo out of 7 German PCCs participated.

^cFive out of 8 Italian PCCs participated. Since all Italian PCCs serve the whole country, the population served by each PCC was calculated based on the proportion of answered calls per PCC relative to all calls in Italy [15].

^dGrouped data were supplied from 4 (out of 4) UK PCCs, which were collected within the UK National Poisons Information Service.

^eThe Republic of North Macedonia is open to the public, but in 2018/2019 received mainly calls from medical professionals (99%).

χ²: Pearson Chi-square tests were performed for within PCC/country comparison of the number of calls during the 4-month study period in 2018/2019 to those in 2020 and corresponding levels of significance (p) are listed.

Change was defined as an increase (more calls in 2020 vs. 2018/2019) or decrease (less calls in 2020 vs. 2018/2019) if p < 0.05.

Table 2. Changes in the number of calls to European Poison Control Centres (PCCs) in 2020 vs. 2018/2019: grouped by PCCs with increasing or decreasing calls.

	Increased calls		Decreased calls		Stable calls	All calls
	N PCCs	Median increase (%) [Q1;Q3]	N PCCs	Median decrease (%) [Q1;Q3]	N PCCs	N PCCs
March	13	14 [8;19]	3	−14 [−20;−12]	10	26
April	8	21 [16;46]	5	−12 [−16;−12]	13	26
May	9	13 [9;43]	2	−11 [−12;−11]	15	26
June	9	13 [8;14]	3	−27 [−29;−17]	14	26
4 months	14	10 [7;20]	5	−7 [−13;−6]	7	26

For each PCC/country, the number of calls in 2018 and 2019 was averaged, both per month and for the summed 4-month study period. The number of calls in 2020 was compared to those in 2018/2019 (average), both per month and for the 4-month study period. PCCs were grouped on a significant change in the number of calls (monthly or 4-monthly) between 2020 and 2018/2019 (χ², p < 0.05): increase, decrease or a stable number of calls. The number of PCCs/countries (N PCCs) within these groups is presented, and the median percentage of change [first quartile (Q1); third quartile (Q3)] was calculated.

Figure 1. Change in calls to European Poison Control Centres in 2020 vs. 2018/2019. The monthly number of calls to all PCCs/countries (26 datasheets) in 2020 was summed. For 2018/2019, the monthly number of calls in 2018 and the monthly number of calls in 2019 were averaged per PCC/country, and subsequently summed for all PCCs/countries (26 datasheets). Note that UK and France supplied nationwide data representing >1 PCC. *The number of calls (summed data) was significantly higher in 2020 compared to 2018/19 (p < 0.0005, χ² test).

Figure 2. Change in calls within European Poison Control Centres or countries in 2020 vs. 2018/2019 and COVID-19 cases in 2020 per country. The monthly number of calls in 2018 and the monthly number of calls in 2019 were averaged per PCC/country. For each PCC/country, the monthly number of calls in 2020 was expressed relative to the average monthly number of calls in 2018 and 2019 (represented by 0% effect). For better visualisation, PCCs are grouped according to the number of calls from March to June 2020 in (A) <1000, (C) 1000–10,000 and (E) >10,000 calls. Note the different y-axes and that UK and France supplied nationwide data representing ≥1 PCC. B, D and F represent COVID-19 cases during the study period (March–June) per 100,000 inhabitants per country (cumulative number for 14 d, ECDC). Correlation between change in calls and the number of COVID-19 cases in the same month is listed for all PCCs/countries (R = Spearman’s rho, N = 4 XY pairs (March, April, June, and July)). For a colour version, please read online.

Figure 3. Median proportion of reasons of exposure (A) and age groups (B) of calls to European Poison Control Centres or countries in 2020 vs. 2018/2019. *The median proportion of calls (grouped data) was significantly higher in 2020 compared to 2018/19 (p < 0.0005, χ² test). For deviations in data supply regarding age groups, see Supplemental Material 1.2.

Table 3. Median proportion of calls on specific exposures to European Poison Control Centres (PCCs) in 2018/19 and 2020.

	March–June 2018/2019			March–June 2020			p Value	Change
	Proportion (%)	[Q1;Q3]	N PCCs	Proportion (%)	[Q1;Q3]	N PCCs
Drugs used in COVID-19 treatment	0.11	[0.09;0.17]	10	0.13	[0.09; -0.16]	10	0.850	n.s.
Antivirals	0.11	[0.08;0.14]	8	0.10	[0.07;0.12]	8	0.125	n.s.
chloroquine			0			0
Hydroxychloroquine	0.07	[0.05;0.08]	2	0.14	[0.13;0.14]	2	0.500	n.s.
Household cleaning products – nonbiocide	4.4	[2.5;10.4]	21	5.7	[2.3;14.7]	21	0.000	Increase
ECHA PC-CLN-2 (all purpose)	1.4	[1.1;4.5]	20	2.7	[1.4;5.4]	20	0.030	Increase
ECHA PC-CLN-3 (bleach)	2.3	[1.7;3.9]	15	3.4	[1.4;5.9]	15	0.002	Increase
Disinfectants (biocides)	1.9	[1.1;2.2]	20	5.2	[3.3;6.7]	20	0.000	Increase
PP-BIO-1 (human)	0.7	[0.7;1.5]	18	2.7	[2.1;3.8]	18	0.002	Increase
(Isopropyl)alcohol	0.6	[1.4;1.0]	14	1.8	[1.3;2.9]	14	0.000	Increase
Other	0.6	[0.4;0.9]	9	1.9	[1.1;2.2]	9	0.004	Increase
PP-BIO-2 (surface)	1.1	[0.7;1.5]	14	1.8	[1.2;3.3]	14	0.000	Increase
>50% (Isopropyl)alcohol	0.5	[0.2;0.6]	7	0.5	[0.3;0.7]	7	0.469	n.s.
Other	1.0	[0.5;1.5]	10	1.9	[0.8;3.0]	10	0.006	Increase

For each PCC/country, the monthly number of all calls in 2018 and the monthly number of all calls in 2019 were averaged. The monthly number of all calls was summed (4-month study period March-June) for 2018/2019 (average) and for 2020 per PCC/country. For each PCC/country, the monthly number of calls on specific exposures in 2018 and the monthly number of calls on specific exposures in 2019 were averaged per PCC/country. The monthly number of calls on specific exposures was summed (4-month study period March–June) for 2018/2019 (average) and for 2020.

For each PCC/country, the proportion of calls on specific exposures during the 4-month study period was calculated by expressing the number of calls during the 4-month study period on specific exposures relative to the number of all calls, both for 2018/2019 and for 2020. The median proportion of calls [first quartile (Q1); third quartile (Q3)] of PCCs/countries (26 datasheets) on specific exposures in 2018/19 and in 2020 are presented. Significant increases are defined as p< 0.05 using the Wilcoxon Signed Rank test. n.s.: non-significant

Table 4. PCC workload related to COVID-19 incidence.

COVID-19 incidence*		PCCs (N)	Increased workload^a (N, %)	Redeployed in hospital^b (N, %)	Other duties^c (N, %)
≥120	High	12	9, 75	8, 67	0, 0
61–119	Medium	16	10, 63	6, 38	7, 44
<60	Low	10	4, 40	5, 50	2, 20
	Sum	38	23, 61	19, 50	9, 24

*Number of COVID-19 infections per 100,000 inhabitants within 14 d/country maximum [16]. For details on categorisation see methods.

^aIncreased workload involved an increase in the total number of shifts (N = 16), the length of shifts (N = 10) and/or time PCCs staff spent on PCC duties (N = 17).

^bEmergency Department (N = 14), Intensive Care Unit (N = 5) nursing ward (N = 4), COVID ward (N = 3) or in hospital, not specified (N = 2).

^cOther duties involved working at a COVID-19 triage centre (N = 1), COVID-19 testing street (N = 2) and/or a vaccination centre (N = 2), COVID-19 telephone service for health care professionals (N = 1), Emergency Medical Service by phone (N = 1), regulatory work on registration of disinfectants (N = 1) or increased surveillance for Public Health (N = 1).

Note: The PCCs of UK (excluding Northern Ireland) have been combined as one PCC, because the survey was answered once for all of them.

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