Objectives: Pneumothorax and pneumomediastinum are associated with high mortality in invasively ventilated coronavirus disease 2019 (COVID-19) patients; however, the mortality rates among non-intubated patients remain unknown. We aimed to analyze the clinical features of COVID-19-associated pneumothorax/pneumomediastinum in non-intubated patients and identify risk factors for mortality. Methods: We searched PubMed Scopus and Embase from January 2020 to December 2021. We performed a pooled analysis of 151 patients with no invasive mechanical ventilation history from 17 case series and 87 case reports. Subsequently, we developed a novel scoring system to predict in-hospital mortality; the system was further validated in multinational cohorts from ten countries (n = 133). Results: Clinical scenarios included pneumothorax/pneumomediastinum at presentation (n = 68), pneumothorax/pneumomediastinum onset during hospitalization (n = 65), and pneumothorax/pneumomediastinum development after recent COVID-19 treatment (n = 18). Significant differences were not observed in clinical outcomes between patients with pneumomediastinum and pneumothorax (±pneumomediastinum). The overall mortality rate of pneumothorax/pneumomediastinum was 23.2%. Risk factor analysis revealed that comorbidities bilateral pneumothorax and fever at pneumothorax/pneumomediastinum presentation were predictors for mortality. In the new scoring system, i.e., the CoBiF system, the area under the curve which was used to assess the predictability of mortality was 0.887. External validation results were also promising (area under the curve: 0.709). Conclusions: The presence of comorbidity bilateral pneumothorax and fever on presentation are significantly associated with poor prognosis in COVID-19 patients with spontaneous pneumothorax/pneumomediastinum. The CoBiF score can predict mortality in clinical settings as well as simplify the identification and appropriate management of patients at high risk.

First described in Wuhan, China, in December 2019, The World Health Organization declared the novel coronavirus disease (COVID-19) a global pandemic on March 11th, 2020. Canada identified its first positive COVID-19 patient on January 25th, 2020. The Canadian government and heath care system immediately started discussing how best to respond to this pandemic. It was hypothesized that potentially positive and confirmed positive COVID-19 patients would present to emergency departments across the country. It has now been over a year since the first positive patient was identified in Canada, and there has yet to be a narrative review that explores how Canadian emergency departments have responded to the novel COVID-19 virus. This narrative review will discuss measures that were taken thus far, including pre-hospital care, the use and implementation of virtual care, the importance of simulation training, protocols regarding patient screening at presentation to the emergency department, the use of personal protective equipment, and lastly rural emergency department response. This narrative review may be beneficial as the COVID-19 pandemic continues, by providing a concise summary of measures that were taken in various emergency departments across Canada to prevent the spread of the virus.