The Resurgence of Scurvy: An Unexpected Consequence of the COVID-19 Pandemic
Nikita Ramanathan MD, MM1, Edward Kelly MD, FACS1,2, Reginald Alouidor MD, FACS1,2, Kristina Z. Kramer MD1,2, Aixa Perez Coulter MS, MPH1, Tovy Kamine MD, FACS1,2
1Department of Surgery, University of Massachusetts Chan Medical Schoo, Baystate Medical Center, Springfield, MA; 2Division of Trauma, Acute Care Surgery and Surgical Critical Care, University of Massachusetts Chan Medical School, Baystate Medical Center, Springfield, MA
Background: Vitamin C deficiency, or scurvy, is rare in the modern era. We investigated the effect of the COVID-19 pandemic related supply chain shortages on scurvy rate, particularly in patients on artificial nutrition and receiving multivitamin injections (MVI).
Methods: We performed a retrospective single hospital analysis of inpatient data from 2017-2021 of adults aged ? 18 who had Vitamin C levels obtained. Logistic regression analysis was used to identify factors associated with scurvy (Vitamin C level ?0.2), and complications.
Results: 86 patients had a Vitamin C level obtained during the study period, 32(32.7%) on total parenteral nutrition (TPN), 53(61.6%) on MVI, 29(33.7%) on tube feeds. The relative risk of scurvy increased during the COVID related resource shortage (RR=2.42, p=0.002). COVID diagnosis, per se, was not associated with scurvy (RR=1.17, p=0.66). Among patients on TPN, there was a significant association with scurvy (RR=2.86, p<0.001). There was no association between tube feeds and scurvy (RR=1.51, p=0.12). Patients with ischemic heart disease were less likely to have scurvy (RR=0.27, p=0.02). Scurvy was significantly associated with increased GI bleeds (RR=2.25, p=<0.001), gum bleeds (RR=1.9, p=0.02), and anastomotic leaks (R=1.9, p=0.02).
Conclusion: Scurvy resurged during the COVID-19 pandemic and carried an increased relative risk of GI bleeds, gum bleeds, and anastomotic leak. This increase could be attributed to the shortage of IV multivitamins and TPN modifications due to resource deficits
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