Pattern of emergency department accesses before and during the Covid-19 pandemic

Objectives. To evaluate how the characteristics of paediatric emergency department (ED) visits have changed during the SARS-CoV-2 pandemic. Methods. In a period of three months, from January 1 to March 31, for three consecutive years (2019, 2020 and 2021), paediatric accesses to the San Gerardo hospital's ED were evaluated. Sociodemographic data, information on the ED visit, the diseases that led to the ED access, and the outcome of the visit were extracted and analysed. Records were deidentified, and data were analysed using an anonymous subject code. χ2 for trend test was used for comparing the characteristics of the accesses in the 3 trimesters. Results. The overall number of ED visits decreased from 4,106 to 1,193 (-71%) over time. Independently of the observation period, the majority of visits had a low priority code (93% in 2019 and 97% in 2021), while in 2021 35% of accesses were potentially avoidable. The rate of hospitalisation after the visit increased from 10% to 18%. Upper respiratory tract infections were the most common reason for ED attendance in all the trimesters, but their prevalence decreased from 33 to 16%. On the contrary, visits for psychiatric disorders increased from 2% in 2019 to 9% in 2021. Conclusions. Despite the decrease in number of ED visits during the pandemic period, and the increase in hospitalisation rate, most of the accesses during the first trimester of 2021 were also non-urgent and one-third were potentially avoidable, underlying the need of interventions aimed at reducing the inappropriate use of the ED.

Magnitude and Dynamics of the T-Cell Response to SARS-CoV-2 Infection and Vaccination

Background. T cells are central to the early identification and clearance of viral infections and support antibody generation by B cells, making them desirable for assessing the immune response to SARS-CoV-2 infection and vaccines. We combined 2 high-throughput immune profiling methods to create a quantitative picture of the SARS-CoV-2 T-cell response that is highly sensitive, durable, diagnostic, and discriminatory between natural infection and vaccination. Methods. We deeply characterized 116 convalescent COVID-19 subjects by experimentally mapping CD8 and CD4 T-cell responses via antigen stimulation to 545 Human Leukocyte Antigen (HLA) class I and 284 class II viral peptides. We also performed T-cell receptor (TCR) repertoire sequencing on 1815 samples from 1521 PCR-confirmed SARS-CoV-2 cases and 3500 controls to identify shared public TCRs from SARS-CoV-2-associated CD8 and CD4 T cells. Combining these approaches with additional samples from vaccinated individuals, we characterized the response to natural infection as well as vaccination by separating responses to spike protein from other viral targets. Results. We find that T-cell responses are often driven by a few immunodominant, HLA-restricted epitopes. As expected, the SARS-CoV-2 T-cell response peaks about 1-2 weeks after infection and is detectable at least several months after recovery. Applying these data, we trained a classifier to diagnose past SARS-CoV-2 infection based solely on TCR sequencing from blood samples and observed, at 99.8% specificity, high sensitivity soon after diagnosis (Day 3-7 = 85.1%;Day 8-14 = 94.8%) that persists after recovery (Day 29+/convalescent = 95.4%). Finally, by evaluating TCRs binding epitopes targeting all non-spike SARS-CoV-2 proteins, we were able to separate natural infection from vaccination with > 99% specificity. Conclusion. TCR repertoire sequencing from whole blood reliably measures the adaptive immune response to SARS-CoV-2 soon after viral antigenic exposure (before antibodies are typically detectable) as well as at later time points, and distinguishes post-infection vs. vaccine immune responses with high specificity. This approach to characterizing the cellular immune response has applications in clinical diagnostics as well as vaccine development and monitoring.

Health and Safety at Work in the Time of COVID-19: A Social Europe Reckoning?

The shortcomings in the handling of COVID-19 highlighted the salience of health and safety at work and fuelled discussions surrounding the desirability of a European Health Union. This article conceptualises occupational health and safety at the European Union (EU) level as a key driver for the creation of a European Health Union. Through recourse to the area's roots and its relevance to the tackling of the COVID-19 pandemic, the benefits of putting occupational health and safety in the driving seat are set out. The implications of maintaining a healthy workforce are acute, from both a social and a public health perspective, especially in the time of a pandemic. Relying on a reflective approach that goes beyond the status quo, this article offers pragmatic yet imaginative proposals for strengthening the occupational health and safety acquis. The proposals act as the blueprint for health and safety in the workplace to lay the foundation for a European Health Union and advance the social dimension of the EU.

EU Health Union and State Aid Policy: With Great(er) Power Comes Great Responsibility

This contribution evaluates whether European Union State aid policy could play a role in achieving deeper and more solidary integration in the area of public health. According to Article 107 TFEU, the powers of Member States to grant aid to help their economies are seriously limited. Exceptions to the general prohibition to grant State aid are authorised by the European Commission, which enjoys wide discretion in weighing national objectives against European integration goals. The area of public health has been shielded from the application of these rules, with activities such as the provision of health insurance failing to be considered of economic nature (see most recently the Dôvera judgment). The COVID-19 experience shows that, in cases of major health crises, State aid provisions are practically suspended, with interventions allowed in the name of the fight against the pandemic. The eventual creation of a Health Union will require the re-evaluation of the application of the State aid rules to healthcare. This paper questions whether these rules should evolve as a reflective function of strengthened competences in healthcare or whether existing regulatory powers are enough to determine the interaction between national spending policies, a solidary European Health Union and fair competition. © The Author(s), 2020. Published by Cambridge University Press.