RESUMO
BackgroundSARS-CoV-2/COVID-19, which emerged in China in late 2019, rapidly spread across the world causing several million victims in 213 countries. Switzerland was severely hit by the virus, with 43000 confirmed cases as of September 1st, 2020. AimIn cooperation with the Federal Office of Public Health, we set up a surveillance database in February 2020 to monitor hospitalised patients with COVID-19 in addition to their mandatory reporting system. MethodsPatients hospitalised for more than 24 hours with a positive PCR test, from 20 Swiss hospitals, are included. Data collection follows a custom Case Report Form based on WHO recommendations and adapted to local needs. Nosocomial infections were defined as infections for which the onset of symptoms started more than 5 days after the patients admission date. ResultsAs of September 1st, 2020, 3645 patients were included. Most patients were male (2168 - 59.5%),and aged between 50 and 89 years (2778 - 76.2%), with a median age of 68 (IQR 54-79). Community infections dominated with 3249 (89.0%) reports. Comorbidities were frequently reported: hypertension (1481 - 61.7%), cardiovascular diseases (948 - 39.5%), and diabetes (660 - 27.5%) being the most frequent in adults; respiratory diseases and asthma (4 -21.1%), haematological and oncological diseases (3 - 15.8%) being the most frequent in children. Complications occurred in 2679 (73.4%) episodes, mostly for respiratory diseases (2470 - 93.2% in adults, 16 - 55.2% in children), renal (681 - 25.7%) and cardiac (631 - 23.8%) complication for adults. The second and third most frequent complications in children affected the digestive system and the liver (7 - 24.1%). A targeted treatment was given in 1299 (35.6%) episodes, mostly with hydroxychloroquine (989 - 76.1%). Intensive care units stays were reported in 578 (15.8%) episodes. 527 (14.5%) deaths were registered, all among adults. ConclusionThe surveillance system has been successfully initiated and provides a very representative set of data for Switzerland. We therefore consider it to be a valuable addition to the existing mandatory reporting, providing more precise information on the epidemiology, risk factors, and clinical course of these cases.
RESUMO
BackgroundCoronavirus disease 19 (COVID-19) has frequently been colloquially compared to the seasonal influenza, but comparisons based on empirical data are scarce. AimsTo compare in-hospital outcomes for patients admitted with community-acquired COVID-19 to patients with community-acquired influenza in Switzerland. MethodsPatients >18 years, who were admitted with PCR proven COVID-19 or influenza A/B infection to 14 participating Swiss hospitals were included in a prospective surveillance. Primary and secondary outcomes were the in-hospital mortality and intensive care unit (ICU) admission between influenza and COVID-19 patients. We used Cox regression (cause-specific models, and Fine & Gray subdistribution) to account for time-dependency and competing events with inverse probability weighting to account for confounders. ResultsIn 2020, 2843 patients with COVID-19 were included from 14 centers and in years 2018 to 2020, 1361 patients with influenza were recruited in 7 centers. Patients with COVID-19 were predominantly male (n=1722, 61% vs. 666 influenza patients, 48%, p<0.001) and were younger than influenza patients (median 67 years IQR 54-78 vs. median 74 years IQR 61-84, p<0.001). 363 patients (12.8%) died in-hospital with COVID-19 versus 61 (4.4%) patients with influenza (p<0.001). The final, adjusted subdistribution Hazard Ratio for mortality was 3.01 (95% CI 2.22-4.09, p<0.001) for COVID-19 compared to influenza, and 2.44 (95% CI, 2.00-3.00, p<0.001) for ICU admission. ConclusionEven in a national healthcare system with sufficient human and financial resources, community-acquired COVID-19 was associated with worse outcomes compared to community-acquired influenza, as the hazards of in-hospital death and ICU admission were [~]3-fold higher.
