ABSTRACT
The direct and indirect impact of the COVID-19 pandemic on population-level mortality is of concern to public health but challenging to quantify. We modelled excess mortality and the direct and indirect effects of the pandemic on mortality in Switzerland. We analyzed yearly population data and weekly all-cause deaths by age, sex, and canton 2010-2019 and all-cause and laboratory-confirmed COVID-19 deaths from February 2020 to April 2022 (study period). Bayesian models predicted the expected number of deaths. A total of 13,130 laboratory-confirmed COVID-19 deaths were reported. The model estimated that COVID-19-related mortality was underestimated by a factor of 0.72 [95% Credible Interval: 0.46-0.78] resulting in 18,140 [15,962-20,174] excess deaths. After accounting for COVID-19 deaths, the observed mortality was 3% [-1-7] lower than expected, corresponding to a deficit of 4,406 deaths, with a wide credibility interval [-1,776-10,700]. Underestimation of COVID-19 deaths was greatest for ages 70 years and older; the mortality deficit was most pronounced in age groups 40 to 69 years. We conclude that shortcomings in testing caused underestimation of COVID-19-related deaths in Switzerland, particularly in older people. Although COVID-19 control measures may have negative effects (e.g., delays in seeking care or mental health impairments), after subtracting COVID-19 deaths, there were fewer deaths in Switzerland during the pandemic than expected, suggesting that any negative effects of control measures on mortality were offset by the positive effects. These results have important implications for the ongoing debate about the appropriateness of COVID-19 control measures.
ABSTRACT
Malaria in pregnancy remains a serious public health problem in the Republic of Congo despite the implementation of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) in 2006. The aim of this cross-sectional study was to characterize Plasmodium falciparum infections and determine possible risk factors in pregnant Congolese women attending an antenatal clinic in a periurban area of southern Brazzaville. This study was conducted from March 2012 to December 2013 in a site where several years ago, high malaria resistance to SP was reported. Pregnant women were enrolled during antenatal visits and the number of received IPTp-SP doses was recorded as well as individual sociodemographic data. Peripheral blood was collected and P. falciparum infection was checked by microscopy and by PCR targeting P. falciparum merozoite surface protein gene (msp2). Haemoglobin concentration was measured and P. falciparum positive samples were typed for msp2 allelic diversity. A total of 363 pregnant women were recruited. The prevalence of asymptomatic P. falciparum infection was 7% and 19% by microscopy and by PCR, respectively. More than one half (51.5%) of the pregnant women were anaemic. Multivariate analysis indicated that P. falciparum infection was associated with anaemia. It was also observed that women who have received IPTp-SP have significantly lower prevalence of infection. The administration of IPTp-SP did not influence the multiplicity of infection (MOI). This first study investigating asymptomatic malaria infection on pregnant women of the Republic of Congo shows that P. falciparum infections were clearly associated with maternal anaemia, and use of IPTp-SP reduced the risk of carrying asymptomatic infections.
