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Background and AimsAbnormal liver tests are common in patients with severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infection, but their association with short-term outcomes is controversial. We aimed to compare the pattern of abnormal liver tests in SARS-CoV-2 patients with those of patients infected with influenza or respiratory syncytial virus (RSV), two non-hepatotropic respiratory viruses, and their association with in-hospital mechanical ventilation or death. MethodsA retrospective cohort study of 1271 hospitalized patients (872 influenza, 218 RSV, and 181 SARS-Cov-2) in a tertiary medical center. We defined abnormal liver tests as GPT, GOT or GGT[≥]40IU/ML at any time-point during hospitalization. ResultsAbnormal liver tests were mild-moderate in the majority of patients regardless of infection type but the majority of patients with influenza or RSV had a transaminases peak earlier during hospitalization compared to patients with SARS-Cov-2. Abnormal liver tests correlated with markers of severe disease across all types of infections, and were associated with mechanical ventilation or death, occurring mainly in patients with severe liver tests abnormalities (>200IU/L) (27.2%, 39.4% and 55.6% of patients with influenza, RSV or SARS-Cov-2). In multivariate analysis, controlling for age, gender, lymphopenia and CRP, liver tests abnormalities remained significantly associated with mechanical ventilation or death for influenza (OR= 3.047, 95% CI 1.518-6.117) and RSV (OR= 3.402, 95% CI 1.032-11.220) but not for SARS-Cov-2 (OR= 0.995, 95% CI 0.198-4.989). These results were confirmed upon propensity score matching. ConclusionsAbnormal liver tests during hospitalization with different viral respiratory infections are common, may differ in their time-course and reflect disease severity. They are associated with worse outcomes, mainly in patients with severe liver test abnormalities, regardless of infection type.
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ObjectivesWhile highly effective in preventing SARS-CoV-2 spread, national lockdowns come with an enormous economic price. Few countries have adopted an alternative "testing, tracing, and isolation" approach to selectively isolate people at high exposure risk, thereby minimizing the economic impact. To assist policy makers, we performed a cost-effectiveness analysis of these two strategies. MethodsA modified Susceptible, Exposed, Infectious, Recovered and Deceased (SEIRD) model was employed to assess the situation in Israel, a small country with ~9 million people. The incremental cost-effectiveness ratio (ICER) of these strategies, as well as the expected number of infected individuals and deaths were calculated. ResultsA nationwide lockdown is expected to save on average 274 (median 124, interquartile range (IQR): 71-221) lives compared to the "testing, tracing, and isolation" approach. However, the ICER will be on average $45,104,156 (median $ 49.6 million, IQR: 22.7-220.1) to prevent one case of death. ConclusionsA national lockdown has a moderate advantage in saving lives with tremendous costs and possible overwhelming economic effects. These findings should assist decision-makers dealing with additional waves of this pandemic. HighlightsO_LIDrastic measures of national lockdowns are taken by many countries to slow-down SARS-CoV-2 spread. However, these measures have detrimental economic effects. C_LIO_LIHere we compare two strategies to control the epidemic using a modified SEIRD model: 1. Global national lockdown 2. Focused isolation of people at high exposure risk, following detailed epidemiological investigations. C_LIO_LIWe show that strategy 1 is modestly superior in saving lives compared to strategy 2, but with tremendous costs to prevent one case of death. This might result in overwhelming economic effects that are expected to increase future death toll. C_LI
