Are mild or moderate COVID-19 patients at higher risk of VTE? A comparison of two prospective european cohorts inemergency departments

Background : Severely ill patients with SARS-CoV-2 have at increased risk of venous thromboembolism (VTE). However, the VTE risk in patients with mild to moderate COVID-19 remains uncertain. Aims : To assess the risk of VTE in patients with mild to moderate COVID-19 patients versus similar patients without COVID-19 and to define VTE risk factors in COVID-19 patients. Methods : A prospective cohort of patients presented to ED for acute dyspnea or chest pain and having confirmed or probable mild to moderate COVID-19 was retrospectively compared to a prospective cohort of similar ED patients using propensity score matching. Patients having diagnostic testing for suspected PE and for whom PE was initially ruled-out were included. Univariate and multivariate analysis of possible VTE risk factors were performed in the COVID-19 patients. The main outcome was the rate of symptomatic VTE, deep venous thrombosis or pulmonary embolism, within the 28 days after ED presentation. Results : A total of 2292 patients were included in the COVID-19 cohort and 1539 in the comparison cohort. After adjustment, the 28-day rate of symptomatic VTE was 1.87% (95%CI: 0.95 to 3.24) in the COVID-19 cohort and 0.18% (95%CI: 0.01 to 1.63) in the comparison cohort. The absolute difference was +1.69% (95%CI: 0.88 to 2.51, P < 0.001), +3.45% (95%CI: 1.80 to 5.11) in hospitalized patients and +0.50% (95%CI: 0.22 to 1.23) in patients treated at home. In the COVID-19 cohort, hospitalization and age > 65 years were independent risk factors of symptomatic VTE but not the lack of thromboprophylaxis. Conclusions : Patients with mild-to-moderate COVID-19 presenting to ED had a higher risk of subsequent VTE than similar patients, especially if they are older than 65 years and required hospitalization.

From testing to mortality: COVID-19 and the inverse care law in switzerland

Background: The SARS-CoV-2 pandemic has created unprecedented challenges for society and healthcare systems worldwide. Switzerland is one of the more affected countries in Europe. We examined the association between socioeconomic position (SEP) and SARS-CoV-2 tests, SARS-CoV-2-positive cases, COVID-19 hospitalisations and COVID-19 deaths in Switzerland. Methods: We used surveillance data reported to the Federal Office of Public Health from March to October, 2020. We geocoded patients' residential addresses to determine the Swiss neighbourhood index of SEP, based on education and occupation of household heads, rent per square meter, and crowding. We used negative binomial regression models adjusted for sex, age, canton of residence and wave of the epidemic (first, March to June;second, July to October) to investigate the association between deciles of the SEP index (1st=lowest, 10th=highest) and four outcomes. We used different denominators: the 2018 Swiss population for tests and deaths, the number of tests for positive cases, and the number of positive cases for hospitalisations. Results: Analyses were based on 1,130,405 SARS-CoV-2 tests, 143,101 positive cases, 6,367 hospitalisations and 1,749 deaths up to 31 October 2020. Figure 1 shows the distribution across deciles of neighbourhood SEP of (A) tests per population, (B) positive cases per test, (C) hospitalisations per case and (D) deaths per population (the black lines and shaded areas show the corresponding model prediction adjusted for sex, age, canton of residence and wave of the epidemic -- median posterior and 95% credible interval). The adjusted change in proportion per 1 decile increase in neighbourhood SEP was +2.4% (95% credible interval: 1.0 to 3.9) for tests per population, -2.4% (-3.6 to -1.1) for positive cases per test, -4.6% (-5.9 to -3.3) for hospitalisations per case and -4.5% (-7.7 to -1.4) for deaths per population. Conclusion: This nation-wide study provides a comprehensive analysis of the association between SEP and SARS-CoV-2 testing, reported infections, and COVID-19-related hospitalisations and deaths. People living in neighbourhoods with higher SEP are more likely to be tested, but less likely to test positive, to be hospitalised or to die, a manifestation of the inverse care law where availability of care varies inversely with the need for it.

Assessment of physicians' resilience level during the COVID-19 pandemic.

We aim to assess physicians' level of resilience and define factors that improve or decrease the resilience level during the COVID-19 pandemic. Physicians from hospitals located in areas with different COVID-19 caseload levels, were invited to participate in a national e-survey between April and May 2020. Study participants were mainly emergency physicians, and anaesthesiologists, infectious disease consultants, and intensive care. The survey assessed participant's characteristics, factors potentially associated with resilience, and resilience using the Connor-Davidson Resilience Scale (RISC-25), with higher scores indicative of greater resilience. Factors associated with the resilience score were assessed using a multivariable linear regression. Of 451 responding physicians involved in the care of COVID-19 patients, 442 were included (98%). Age was 36.1 ± 10.3 years and 51.8% were male; 63% worked in the emergency department (n = 282), 10.4% in anesthesiology (n = 46), 9.9% in infectious disease department (n = 44), 4.8% in intensive care unit (n = 21) or other specialties (n = 49). The median RISC-25 score was at 69 (IQR 62-75). Factors associated with higher RISC scores were anesthesia as a specialty, parenthood, no previous history of anxiety or depression and nor increased anxiety. To conclude, this study is the first to characterize levels of resilience among physicians involved in COVID-19 unit. Our data points to certain protective characteristics and some detrimental factors, such as anxiety or depression, that could be amenable to remediating or preventing strategies to promote resilience and support caregivers in a pandemic.

Early evidence of effectiveness of digital contact tracing for SARS-CoV-2 in Switzerland

In the wake of the pandemic of coronavirus disease 2019 (COVID-19), contact tracing has become a key element of strategies to control the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Given the rapid and intense spread of SARS-CoV-2, digital contact tracing has emerged as a potential complementary tool to support containment and mitigation efforts. Early modelling studies highlighted the potential of digital contact tracing to break transmission chains, and Google and Apple subsequently developed the Exposure Notification (EN) framework, making it available to the vast majority of smartphones. A growing number of governments have launched or announced EN-based contact tracing apps, but their effectiveness remains unknown. Here, we report early findings of the digital contact tracing app deployment in Switzerland. We demonstrate proof-of-principle that digital contact tracing reaches exposed contacts, who then test positive for SARS-CoV-2. This indicates that digital contact tracing is an effective complementary tool for controlling the spread of SARS-CoV-2. Continued technical improvement and international compatibility can further increase the efficacy, particularly also across country borders.