Expanding the Pathogen Panel in Wastewater Epidemiology to Influenza and Norovirus.

Since the start of the 2019 pandemic, wastewater-based epidemiology (WBE) has proven to be a valuable tool for monitoring the prevalence of SARS-CoV-2. With methods and infrastructure being settled, it is time to expand the potential of this tool to a wider range of pathogens. We used over 500 archived RNA extracts from a WBE program for SARS-CoV-2 surveillance to monitor wastewater from 11 treatment plants for the presence of influenza and norovirus twice a week during the winter season of 2021/2022. Extracts were analyzed via digital PCR for influenza A, influenza B, norovirus GI, and norovirus GII. Resulting viral loads were normalized on the basis of NH4-N. Our results show a good applicability of ammonia-normalization to compare different wastewater treatment plants. Extracts originally prepared for SARS-CoV-2 surveillance contained sufficient genomic material to monitor influenza A, norovirus GI, and GII. Viral loads of influenza A and norovirus GII in wastewater correlated with numbers from infected inpatients. Further, SARS-CoV-2 related non-pharmaceutical interventions affected subsequent changes in viral loads of both pathogens. In conclusion, the expansion of existing WBE surveillance programs to include additional pathogens besides SARS-CoV-2 offers a valuable and cost-efficient possibility to gain public health information.

Austria: health system summary, 2022

This Health system summary is based on the Austria: Health System Review published in 2018 in the Health Systems in Transition (HiT) series, and relevant reform updates highlighted by the Health Systems and Policies Monitor (HSPM) (www.hspm.org). For this edition, key data have been updated to those available in July 2022 to keep information as current as possible. Health system summaries use a concise format to communicate central features of country health systems and analyse available evidence on the organization, financing and delivery of health care. They also provide insights into key reforms and the varied challenges testing the performance of the health system.

Supporting COVID-19 policy-making with a predictive epidemiological multi-model warning system.

BACKGROUND: In response to the SARS-CoV-2 pandemic, the Austrian governmental crisis unit commissioned a forecast consortium with regularly projections of case numbers and demand for hospital beds. The goal was to assess how likely Austrian ICUs would become overburdened with COVID-19 patients in the upcoming weeks. METHODS: We consolidated the output of three epidemiological models (ranging from agent-based micro simulation to parsimonious compartmental models) and published weekly short-term forecasts for the number of confirmed cases as well as estimates and upper bounds for the required hospital beds. RESULTS: We report on three key contributions by which our forecasting and reporting system has helped shaping Austria's policy to navigate the crisis, namely (i) when and where case numbers and bed occupancy are expected to peak during multiple waves, (ii) whether to ease or strengthen non-pharmaceutical intervention in response to changing incidences, and (iii) how to provide hospital managers guidance to plan health-care capacities. CONCLUSIONS: Complex mathematical epidemiological models play an important role in guiding governmental responses during pandemic crises, in particular when they are used as a monitoring system to detect epidemiological change points.

During the SARS-CoV-2 pandemic, health authorities make decisions on how and when to implement interventions such as social distancing to avoid overburdening hospitals and other parts of the healthcare system. We combined three mathematical models developed to predict the expected number of confirmed SARS-CoV-2 cases and hospitalizations over the next two weeks. This provides decision-makers and the general public with a combined forecast that is usually more accurate than any of the individual models. Our forecasting system has been used in Austria to decide when to strengthen or ease response measures.

Comorbidities and COVID-19 hospitalization, ICU admission and hospital mortality in Austria : A retrospective cohort study.

BACKGROUND: The protection of vulnerable populations is a central task in managing the Coronavirus disease 2019 (COVID-19) pandemic to avoid severe courses of COVID-19 and the risk of healthcare system capacity being exceeded. To identify factors of vulnerability in Austria, we assessed the impact of comorbidities on COVID-19 hospitalization, intensive care unit (ICU) admission, and hospital mortality. METHODS: A retrospective cohort study was performed including all patients with COVID-19 in the period February 2020 to December 2021 who had a previous inpatient stay in the period 2015-2019 in Austria. All patients with COVID-19 were matched to population controls on age, sex, and healthcare region. Multiple logistic regression was used to estimate adjusted odds ratios (OR) of included factors with 95% confidence intervals (CI). RESULTS: Hemiplegia or paraplegia constitutes the highest risk factor for hospitalization (OR 1.61, 95% CI 1.44-1.79), followed by COPD (OR 1.48, 95% CI 1.43-1.53) and diabetes without complications (OR 1.41, 95% CI 1.37-1.46). The highest risk factors for ICU admission are renal diseases (OR 1.76, 95% CI 1.61-1.92), diabetes without complications (OR 1.57, 95% CI 1.46-1.69) and COPD (OR 1.53, 95% CI 1.41-1.66). Hemiplegia or paraplegia, renal disease and COPD constitute the highest risk factors for hospital mortality, with ORs of 1.5. Diabetes without complications constitutes a significantly higher risk factor for women with respect to all three endpoints. CONCLUSION: We contribute to the literature by identifying sex-specific risk factors. In general, our results are consistent with the literature, particularly regarding diabetes as a risk factor for severe courses of COVID-19. Due to the observational nature of our data, caution is warranted regarding causal interpretation. Our results contribute to the protection of vulnerable populations and may be used for targeting further pharmaceutical interventions.

Meteorological factors and non-pharmaceutical interventions explain local differences in the spread of SARS-CoV-2 in Austria.

The drivers behind regional differences of SARS-CoV-2 spread on finer spatio-temporal scales are yet to be fully understood. Here we develop a data-driven modelling approach based on an age-structured compartmental model that compares 116 Austrian regions to a suitably chosen control set of regions to explain variations in local transmission rates through a combination of meteorological factors, non-pharmaceutical interventions and mobility. We find that more than 60% of the observed regional variations can be explained by these factors. Decreasing temperature and humidity, increasing cloudiness, precipitation and the absence of mitigation measures for public events are the strongest drivers for increased virus transmission, leading in combination to a doubling of the transmission rates compared to regions with more favourable weather. We conjecture that regions with little mitigation measures for large events that experience shifts toward unfavourable weather conditions are particularly predisposed as nucleation points for the next seasonal SARS-CoV-2 waves.

The weekend effect in stroke mortality: evidence from Austrian acute care hospitals.

Many studies provide evidence for the so-called weekend effect by demonstrating that patients admitted to hospital during weekends show less favourable outcomes such as increased mortality, compared with similar patients admitted during weekdays. The underlying causes for this phenomenon are still discussed controversially. We analysed factors influencing weekend effects in inpatient care for acute stroke in Austria. The study analysed secondary datasets from all 130 public acute care hospitals in Austria between 2010 and 2014 (Austrian DRG Data). The study cohort included 86,399 patient cases admitted with acute ischaemic stroke. By applying multivariate regression analysis, we tested whether patient, treatment or hospital characteristics drove in-hospital mortality on weekends and national holidays. We found that the risk to die after an admission at weekend was significantly higher compared to weekdays, while the number of admissions following stroke was significantly lower. Adjustment for patient, treatment and hospital characteristics substantially reduced the weekend effect in mortality but did not eliminate it. We conclude that the observed weekend effect could be explained either by lower quality of health care or higher severity of stroke admissions at the weekend. In depth analyses supported the hypothesis of higher stroke severity in weekend patients as seen in other studies. While DRG data is useful to analyse stroke treatment and outcomes, adjustment for case mix and severity is essential.

Das österreichische Gesundheitssystem: Akteure, Daten, Analysen

Die vorliegende Analyse des österreichischen Gesundheitssystems beleuchtet aktuelle Entwicklungen in den Bereichen Organisation,Verwaltung, Finanzierung, Versorgung, Reformen und Leistungsfähigkeit des Gesundheitssystems. Die sich seit 2013 in Umsetzung befindliche große Reform steht dabei im Mittelpunkt. Das zentrale Anliegen dieser Reform, in deren Rahmen ein neues Steuerungssystem eingeführt wurde, ist die Stärkung der Koordination und Zusammenarbeit verschiedener Regierungsebenen und Selbstverwaltungsorgane durch die Förderungeiner gemeinsamen Planung und Entscheidungsfindung sowie in Ansätzen auch einer gemeinsamen Finanzierung. Trotz dieser Anstrengungen ist die organisatorische und finanzielle Struktur des österreichischenGesundheitssystems nach wie vor komplex und uneinheitlich. Die österreichische Bevölkerung weist einen guten Gesundheitszustand auf. Die Lebenserwartung bei Geburt liegt über dem EU-Durchschnitt und die niedrige vermeidbare Sterblichkeit zeigt, dass das Gesundheitsweseneffektiver ist als in den meisten EU-Ländern. Dennoch ist die Zahl der Menschen, die an Herz-Kreislauf-Erkrankungen und an Krebs sterben, imVergleich zum EU-28-Durchschnitt hoch. Tabak- und Alkoholkonsum stellen die größten Gesundheitsrisikofaktoren dar. Der Tabakkonsum ist im letzten Jahrzehnt nicht wie in den meisten EU-Ländern zurückgegangen und liegt aktuell deutlich über dem EU-28-Durchschnitt. In Bezug auf die Leistungsfähigkeit bietet das österreichischeGesundheitssystem einen guten und niederschwelligen Zugang zu Gesundheitsleistungen. Die österreichische Bevölkerung verzeichnet einen der niedrigsten unerfüllten Bedarfe an medizinischer Versorgunginnerhalb der EU. Praktisch die gesamte Bevölkerung ist durch die soziale Krankenversicherung abgesichert und hat Zugang zu einem breitgefächerten Leistungsangebot. Dennoch könnten die zunehmenden Unterschiedezwischen der Anzahl an Vertragsärzten und Wahlärzten zu sozialen und regionalen Ungleichheiten beim Zugang zur Gesundheitsversorgung beitragen. Das österreichische Gesundheitssystem ist relativ kostenintensiv. Es ist stark auf die intramurale Versorgung fokussiert, was sich an einer hohen Nutzung stationärer Leistungen und einem Ungleichgewicht in der Ressourcenallokation zwischen dem Krankenhaussektor und demextramuralen Sektor zeigt. Daher zielen die laufenden Reformen darauf ab, das Wachstum der Gesundheitsausgaben der öffentlichen Hand durch eine Ausgabenobergrenze zu senken und die übermäßige Nutzung stationärer Leistungen zu verringern. Die Effizienz der intramuralen Versorgung hat sich während der Reformperiode verbessert, jedoch stellt die fragmentierteFinanzierung zwischen dem intra- und dem extramuralen Sektor nach wie vor eine Herausforderung dar. Aktuelle Bemühungen, die darauf abzielen, die Primärversorgung nach neuem Modell flächendeckend auszubauen, sindein wichtiger Schritt, um Tätigkeiten aus dem großen und kostenintensivenKrankenhaussektor zu verlagern und die Qualifikationsprofile undEinsatzbereiche der medizinischen Fachkräfte zu erweitern.

Austria: Health System Review.

This analysis of the Austrian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Two major reforms implemented in 2013 and 2017 are among the main issues today. The central aim of the reforms that put in place a new governance system was to strengthen coordination and cooperation between different levels of government and self-governing bodies by promoting joint planning, decision-making and financing. Yet despite these efforts, the Austrian health system remains complex and fragmented in its organizational and financial structure. The Austrian population has a good level of health. Life expectancy at birth is above the EU average and low amenable mortality rates indicate that health care is more effective than in most EU countries. Yet, the number of people dying from cardiovascular diseases and cancer is high compared to the EU-28 average. Tobacco and alcohol represent the major health risk factors. Tobacco consumption has not declined over the last decade like in most other EU countries and lies well above the EU-28 average. In terms of performance, the Austrian health system provides good access to health care services. Austrias residents report the lowest levels of unmet needs for medical care across the EU. Virtually all the population is covered by social health insurances and enjoys a broad benefit basket. Yet, rising imbalances between the numbers of contracted and non-contracted physicians may contribute to social and regional inequalities in accessing care. The Austrian health system is relatively costly. It has a strong focus on inpatient care as characterized by high hospital utilization and imbalances in resource allocation between the hospital and ambulatory care sector. The ongoing reforms therefore aim to bring down publicly financed health expenditure growth with a global budget cap and reduce overutilization of hospital care. Efficiency of inpatient care has improved over the reform period but the fragmented financing between the inpatient and ambulatory sector remain a challenge. Current reforms to strengthen primary health care are an important step to further shift activities out of the large and costly hospital sector and improve skill mix within the health workforce.

Austria: health system review

This analysis of the Austrian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Two major reforms implemented in 2013 and 2017 are among the main issues today. The central aim of the reforms that put in place a new governance system was to strengthen coordination and cooperation between different levels of government and self-governing bodies by promoting joint planning,decision-making and financing. Yet despite these efforts, the Austrian health system remains complex and fragmented in its organizational and financial structure.The Austrian population has a good level of health. Life expectancy at birth is above the EU average and low amenable mortality rates indicate that health care is more effective than in most EU countries. Yet, the number of people dying from cardiovascular diseases and cancer is high compared to the EU28 average. Tobacco and alcohol represent the major health risk factors. Tobacco consumption has not declined over the last decade like in most other EU countries and lies well above the EU28 average. In terms of performance, the Austrian health system provides good access to health care services. Austria’s residents report the lowest levels of unmet needs for medical care across the EU. Virtually all the population is covered by social health insurances and enjoys a broad benefit basket. Yet, rising imbalances between the numbers of contracted and non-contracted physicians may contribute to social and regional inequalities in accessing care. The Austrian health system is relatively costly. It has a strong focus on inpatient care as characterized by high hospital utilization and imbalances in resource allocation between the hospital and ambulatory care sector. The ongoing reforms therefore aim to bring down publicly financed health expenditure growth with a global budget cap and reduce overutilization of hospital care. Efficiency of inpatient care has improved over the reform period but the fragmented financing between the inpatient and ambulatory sector remain a challenge. Current reforms to strengthen primary health care are an important step to further shift activities out of the large and costly hospital sector and improve skill mix within the health workforce.