The first local case of COVID-19 was reported on January 23, 2020. From then until June 30, 2020, 1,205 COVID-19 cases were reported (the end of follow up of the present study). We identified all adult patients, aged 18 years or above, who presented with UGIB to all local public hospitals in Hong Kong between October 1, 2018 and March 31, 2020. Data were retrieved from the Clinical Data Analysis and Reporting System (CDARS), a territory-wide electronic health care database of the Hong Kong Hospital Authority. The Hospital Authority is the sole public healthcare provider for the 7.3 million local population, which manages over 85 % of all hospital beds in 43 public hospitals. All local residents are eligible for heavily subsidized primary, secondary, and tertiary care provided by the Hospital Authority, which is directly funded by the government. The CDARS captures important clinical information including patient demographics, diagnosis, medication prescription and dispensing records, laboratory results, and surgery and endoscopy performed. All data in the CDARS are anonymized. The International Classification of Diseases, Ninth Revision (ICD-9), was used for disease coding and the accuracy of the coding of gastrointestinal bleeding had been verified in our previous studies 5 6 . Patients with upper gastrointestinal bleeding (UGIB) and associated endoscopic interventions were identified with relevant ICD-9 codes ( Supplementary Table 1 ). Other relevant clinical information including baseline demographics, endoscopic diagnosis, endoscopic intervention for hemostasis, laboratory parameters, blood transfusion requirement, 7-day rebleeding, mortality, and overall length of hospital stay were reviewed. Due to the difficulty in defining rebleeding based on the electronic database, we defined 7-day rebleeding as undergoing two upper endoscopies with the same diagnostic coding for UGIB within 7 days. Similarly, we used all-cause mortality, rather than bleeding-related mortality, in this study.

The daily number of COVID-19 new case was obtained from the Center for Health Protection of the Department of Health of Hong Kong 7 . The study was approved by the Institutional Review Board of the University of Hong Kong and the Hong Kong West Cluster of the Hospital Authority (UW 20–279).

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