Impact of the COVID-19 Pandemic on Elective and Emergency Inpatient Procedure Volumes in Switzerland - A Retrospective Study Based on Insurance Claims Data.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS­CoV­2) pandemic forced hospitals to redistribute resources for the treatment of patients with coronavirus disease 2019 (COVID-19), yet the impact on elective and emergency inpatient procedure volumes is unclear. METHODS: We analyzed anonymized data on 234 921 hospitalizations in 2017-2020 (55.9% elective) from a big Swiss health insurer. We used linear regression models to predict, based on pre-pandemic data, the expected weekly numbers of procedures in 2020 in the absence of a pandemic and compared these to the observed numbers in 2020. Compensation effects were investigated by discretely integrating the difference between the two numbers over time. RESULTS: During the first COVID-19 wave in spring 2020, elective procedure numbers decreased by 52.9% (95% confidence interval -64.5% to -42.5%), with cardiovascular and orthopedic elective procedure numbers specifically decreasing by 45.5% and 72.4%. Elective procedure numbers normalized during summer with some compensation of postponed procedures, leaving a deficit of -9.9% (-15.8% to -4.5%) for the whole year 2020. Emergency procedure numbers also decreased by 17.1% (-23.7% to -9.8%) during the first wave, but over the whole year 2020, net emergency procedure volumes were similar to control years. CONCLUSION: Inpatient procedure volumes in Switzerland decreased considerably in the beginning of the pandemic but recovered quickly after the first wave. Still, there was a net deficit in procedures at the end of the year. Health system leaders must work to ensure that adequate access to non-COVID-19 related care is maintained during future pandemic phases in order to prevent negative health consequences.

Boosting compromised SARS-CoV-2-specific T cell immunity in liver transplant recipients by mRNA vaccination

Background and aims Liver transplant recipients (LTR) are threatened by a lower immunogenicity of SARS-CoV-2 mRNA vaccines. However, the interplay between the different branches of the adaptive immune system especially after a third (and fourth) vaccine dose is still poorly understood. Methods Our study longitudinally compares the humoral as well as the cellular response between age-matched LTR (n = 24) and healthy controls (HC, n = 19) after three to four vaccine doses. Therefore, we assessed antibody titers, analyzed the spike-specific T cell epitope repertoire, performed an in-depth characterization of spike-specific CD8 + T cells on a single-epitope level and examined the distribution of different virus-specific CD4 + T cell subpopulations. Results Compared to HC, the development of high antibody titers depended on a third vaccine dose in most LTR. In contrast, spike-specific CD8 + T cells reached a stable level already after the second vaccine dose, albeit with a lower frequency and a narrower epitope repertoire compared to HC. Concerning the CD4 + T cells, the total number of detectable responses as well as the repertoire of targeted epitopes within the spike protein did not signifcantly difer in both cohorts. However, we observed a link between the overall attenuated vaccine response and a reduced frequency of spike-reactive follicular T helper cells (TFH) in LTR. Conclusion Three doses of a COVID-19 mRNA vaccine induce an overall robust humoral and cellular memory response in most LTR. Evaluations of additional booster doses may thus consider the individual vaccine responsiveness as well as the evolution of novel variants of concern.

Monitoring consumption Switzerland: data, background, and use cases.

Monitoring Consumption Switzerland is a public-private partnership between the University of St. Gallen and the payment companies Worldline and SIX that processes and publishes payment data on transactions in Switzerland processed by Wordline/SIX in real time. This paper provides background information on this novel source of data and presents their attributes, aggregation and granularity, and their interpretability. The paper presents several use cases that show the strengths of the data, and it alerts future users of the data to possible challenges. The paper also discusses the project's impact and provides an outlook.

Widerstände gegen Präventionsmaßnahmen während der COVID-19-Pandemie: Ursachen und Strategien für ihre Minimierung Resistance against preventive measures during the COVID-19 pandemic: causes and strategies for minimization

Hintergrund Während der COVID-19-Pandemie („coronavirus disease 2019“) kam es immer wieder zu Widerständen gegenüber nachweislich wirksamen Präventionsmaßnahmen. Eine solche durch Verärgerung und negativen Kognitionen gekennzeichnete „Reaktanz“ erleben Menschen (gemäß der psychologischen Reaktanztheorie) bei einer wahrgenommenen Bedrohung subjektiv wichtiger Freiheiten oder wahrgenommenen Versuchen, ihre Einstellungen oder ihr Verhalten zu ändern. Fragestellung Der vorliegende Beitrag beleuchtet die Rolle defensiver Prozesse im Kontext der COVID-19-Pandemie aus der Perspektive einer evidenzbasierten und abwehrsensiblen Risiko- und Krisenkommunikation. Nach einem Überblick über wesentliche Auslöser und Ausprägungen werden Möglichkeiten zur Minimierung von Abwehr diskutiert. Ergebnis Widerstände sind in einem gewissen Umfang immer zu erwarten, lassen sich aber durch bestimmte formale und inhaltliche Gestaltungen der Informationen minimieren. Hierzu zählen beispielsweise eine professionelle Anmutung, eine respektvoll wertschätzende und stigmasensible Grundhaltung, eine positive und selbstwirksamkeitsstärkende Ansprache sowie eine Vermeidung emotional überfordernder Informationen wie z. B. stark negative emotionale Appelle oder starkes Verlust-Framing. Schlussfolgerung Akteure sollten müssen sich darüber im Klaren darüber sein, dass Abwehrmechanismen durch die Kommunikation sowohl gefördert als auch reduziert werden können. Sie sollten wesentliche Auslöser hierfür kennen und durch eine konsistente, verständliche und adressatengerechte Kommunikation dazu beitragen, Unsicherheiten, Widerstände und Irritationen zu vermeiden.

Supporting SARS-CoV-2 Papain-Like Protease Drug Discovery: In silico Methods and Benchmarking.

The coronavirus disease 19 (COVID-19) is a rapidly growing pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Its papain-like protease (SARS-CoV-2 PLpro) is a crucial target to halt virus replication. SARS-CoV PLpro and SARS-CoV-2 PLpro share an 82.9% sequence identity and a 100% sequence identity for the binding site reported to accommodate small molecules in SARS-CoV. The flexible key binding site residues Tyr269 and Gln270 for small-molecule recognition in SARS-CoV PLpro exist also in SARS-CoV-2 PLpro. This inspired us to use the reported small-molecule binders to SARS-CoV PLpro to generate a high-quality DEKOIS 2.0 benchmark set. Accordingly, we used them in a cross-benchmarking study against SARS-CoV-2 PLpro. As there is no SARS-CoV-2 PLpro structure complexed with a small-molecule ligand publicly available at the time of manuscript submission, we built a homology model based on the ligand-bound SARS-CoV structure for benchmarking and docking purposes. Three publicly available docking tools FRED, AutoDock Vina, and PLANTS were benchmarked. All showed better-than-random performances, with FRED performing best against the built model. Detailed performance analysis via pROC-Chemotype plots showed a strong enrichment of the most potent bioactives in the early docking ranks. Cross-benchmarking against the X-ray structure complexed with a peptide-like inhibitor confirmed that FRED is the best-performing tool. Furthermore, we performed cross-benchmarking against the newly introduced X-ray structure complexed with a small-molecule ligand. Interestingly, its benchmarking profile and chemotype enrichment were comparable to the built model. Accordingly, we used FRED in a prospective virtual screen of the DrugBank database. In conclusion, this study provides an example of how to harness a custom-made DEKOIS 2.0 benchmark set as an approach to enhance the virtual screening success rate against a vital target of the rapidly emerging pandemic.

[COVID-19 Pandemic: Stress Experience of Healthcare Workers - A Short Current Review]. / COVID-19-Pandemie: Belastungen des medizinischen Personals.

AIM: Review of studies on the psychological stress of healthcare workers caused by the COVID-19 pandemic. METHODS: A literature search of PubMed was performed using the terms "COVID-19", "stress", "mental health", "healthcare worker", "staff", "psychiatry". Quantitative studies (including letters to the editor) published from January to March 2020 were included. RESULTS: 14 studies on healthcare workers in departments of infectiology, internal medicine, and fever wards including intensive care wards as well as surgery and psychiatry, were included. The Patient Health Questionnaire 9 (PHQ9), Self-rating-Anxiety Scale (SAS) and Impact of Event Scale (IES-R) were the most often used test instruments. The sample size ranged between 37 and 1257 participants consisting of mostly nursing and medical personnel. The fraction of COVID-19-associated activities varied from 7.5 % to 100 %. An extensive strain was reported due to stress experience as well as depression and anxiety symptoms. Severe degrees of those symptoms were found in 2.2 % to 14.5 % of all participants. The severity of mental symptoms was influenced by age, gender, occupation, specialization, type of activities performed and proximity to COVID-19 patients. As mediator variables selection of personnel, preventive interventions, resilience, and social support were reported. CONCLUSION: Considering the frequency of mental symptoms occurring in healthcare workers, accompanying mental health informed interventions to facilitate coping are necessary. Further research in this field is needed.