ABSTRACT
The wildlife trade has been characterized as one of the biggest risk factors in the emergence of new infectious diseases. In the shadow of COVID-19, there is growing political and scientific urgency to manage this risk. Existing studies and experiences make it clear that something must be done but are less clear on how to get it done. It is a quite different task to accumulate evidence on the presence of pathogens, their locations in the supply chain, and their spillover to new hosts than to identify effective ways to prevent and mitigate emerging disease under real-world conditions. This study sought peer-reviewed evidence on the effectiveness, acceptability, feasibility, and sustainability of risk reduction interventions for zoonotic and nonzoonotic disease emergence in the wildlife trade. An environmental scan triangulated information from a scoping review following a Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping review protocol, two narrative literature reviews, and key informant interviews of 26 international wildlife health experts. Existing literature has been inattentive to program implementation or evaluation studies. There was insufficient evidence to identify effective and sustainable risk management actions. Studies on the effects of social, epidemiologic, and ecologic context on intervention success was lacking, as was research using a complex systems perspective. The lack of systematic program evaluations or implementation studies leaves decision makers with insufficient evidence to select interventions likely to be acceptable, effective, and sustainable within and across the disparate context of the wildlife trade. This necessitates adaptive risk management and innovations in program implementation and evaluation to ensure evidence-based risk management.
ABSTRACT
BACKGROUND: When the periods of time during and after the first wave of the ongoing SARS-CoV-2/COVID-19 pandemic in Europe are compared, the associated COVID-19 mortality seems to have decreased substantially. Various factors could explain this trend, including changes in demographic characteristics of infected persons and the improvement of case management. To date, no study has been performed to investigate the evolution of COVID-19 in-hospital mortality in Switzerland, while also accounting for risk factors. METHODS: We investigated the trends in COVID-19-related mortality (in-hospital and in-intermediate/intensive-care) over time in Switzerland, from February 2020 to June 2021, comparing in particular the first and the second wave. We used data from the COVID-19 Hospital-based Surveillance (CH-SUR) database. We performed survival analyses adjusting for well-known risk factors of COVID-19 mortality (age, sex and comorbidities) and accounting for competing risk. RESULTS: Our analysis included 16,984 patients recorded in CH-SUR, with 2201 reported deaths due to COVID-19 (13.0%). We found that overall in-hospital mortality was lower during the second wave of COVID-19 than in the first wave (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.63- 0.78; p <0.001), a decrease apparently not explained by changes in demographic characteristics of patients. In contrast, mortality in intermediate and intensive care significantly increased in the second wave compared with the first wave (HR 1.25, 95% CI 1.05-1.49; p = 0.029), with significant changes in the course of hospitalisation between the first and the second wave. CONCLUSION: We found that, in Switzerland, COVID-19 mortality decreased among hospitalised persons, whereas it increased among patients admitted to intermediate or intensive care, when comparing the second wave to the first wave. We put our findings in perspective with changes over time in case management, treatment strategy, hospital burden and non-pharmaceutical interventions. Further analyses of the potential effect of virus variants and of vaccination on mortality would be crucial to have a complete overview of COVID-19 mortality trends throughout the different phases of the pandemic.