Room
Rez-de-chaussée E040.
Theme
Impact of the pandemic and Covid measures
Chair
Laura Inglin
Title
The COVID-19 pandemic and wellbeing – was there a crisis and for whom? Effects across the life course and by gender.
Name
Dawid Gondek
Affiliation
FORS - Swiss Centre of Expertise in the Social Sciences
Abstract
Background
Mental health, and wellbeing, particularly of young people, received a lot of attention from researchers, policymakers and media during the COVID-19 pandemic. Some referred to the impact of the pandemic on wellbeing as unprecedented and potentially lasting for generations. Post-pandemic research, however, has shown that the drop in wellbeing during the pandemic was modest and short-lasting. Moreover, wellbeing declines were not homogeneous across sociodemographic groups, with young people and women being affected to a greater extent. The key objectives of our study are: 1) to describe the population average levels of wellbeing between 2017 and 2021, 2) to describe heterogeneity around this average, 3) to examine any differences in the levels of wellbeing across age groups and genders.
Methods:
We use the Swiss Household Panel with wellbeing collected prospectively and annually between 2017 and 2021. Our sample includes all individuals who were at least 14 years-old in 2017 and had no missing information on questionnaire items corresponding to wellbeing (n ≈ 10000). We derive two measures of wellbeing: 1) positive affect and life satisfaction and 2) negative affect.
To describe the time trend in wellbeing, we employ piecewise growth curve analysis. This approach provides information on population average in wellbeing over time (2017-2021) and variability around this trend. We modelled the trend by three slopes (coefficients), each representing a separate period: 1) pre-pandemic (2017-2019), 2) into-pandemic (2019-2020), and 3) pandemic (2020-2021). Finally, we examine any differences in wellbeing trend by age and gender using interaction tests.
Results:
Our results show variability in wellbeing outcomes over time. On average, positive affect and life satisfaction declined during the 2017-2021 period (by -0.43, -0.55 to -0.31 points). However, most of this decline occurred pre-pandemic (2017-2019: -0.29, -0.34 to -0.23). The variability around the average trend was greater during the 2019-2020 and 2020-2021 periods than pre-pandemic, which suggests that the pandemic had heterogeneous wellbeing effects across the population. The negative affect scale was stable in 2017-2019, somewhat reduced 2019-2020 (-0.27, -0.39 to -0.17) and subsequently substantially increased in 2020-2021 (1.05, 0.92 to 1.17). The variability around the average trend also increased during the pandemic period. Next, we explored this variability in wellbeing trajectories with age and gender interactions.
We found evidence for differential trends across age groups both in the positive affect and life satisfaction and negative affect. Young people (aged 14-25) were experiencing the greatest declines in positive affect and life satisfaction between 2017 and 2021. They also had a greater increase in negative affect between 2017-2019 than other age groups. For the period leading into the pandemic (2019-2021) the trend was similar for all ages. We did not find a differential trend for men and women.
Conclusion:
We observed declines in the positive affect and life satisfaction and an increase in negative affect, but this trend was not pandemic-specific as a downward trend in wellbeing was already observed from 2017. Wellbeing declined to a greater extent among young people across the entire 2017-2021 period.
Title
Towards a population-based household cohort for pandemic preparedness: pilot study
Name
Eva Maria Hodel
Affiliation
Universität Bern, Institut für Sozial- und Präventivmedizin
Abstract
BACKGROUND:
Covid-2019 has shown the need for ‘pandemic preparedness’ cohort studies, with the infrastructure to provide baseline data and the capacity for rapid mobilisation when a new pandemic pathogen emerges. The BEready (‘Bern, get ready’) cohort study will enrol households who will provide data, including contact patterns between, and biological specimens from their members, including pets. The objective of this study was to examine the feasibility and logistics of a decentralised cohort with online questionnaires and self-sampling.
METHODS:
We did a pilot study, which invited 1,138 private households that had responded to an online survey in the canton of Bern. Enrolled households including adults, children and pets had a baseline visit at a clinical study site or at home. Data about socio-demographics, human-animal contacts, medical, vaccination and travel histories, and venous blood samples, were collected. During episodes of respiratory tract symptoms (i.e. “disease event”), participants were asked to take a nasal swab from all household members, including pets. We calculated the proportion of households enrolled and performed univariable and multivariable logistic regression analyses.
RESULTS:
A total of 108 households (193 people, 30 cats and 14 dogs) were enrolled from 59/338 municipalities (response rate 9%). Participation was lower in households with 3+ people (adj. OR: 0.3, 95%CI: 0.19–0.46, p of LRT: <0.001) and higher in households with upper secondary or more education (adj. OR: 2.83, 95%CI: 1.15–9.37, p of LRT: <0.05). We did not find associations between participation and age, sex, nationality, household location and income. We obtained and stored baseline blood samples from 95% of participants (184 people and 40 pets). We recorded 112 disease events from 71 households from May 2023 to January 2024 (1.03 disease events per household, 0.67 disease events per person).
CONCLUSION:
BEready procedures were feasible and well-accepted by participating households. The cohort study espouses the One Health principle, allowing research into the animal-human interface and potential zoonotic transmission. The response rate is in line with the Swiss Household Study and reflects an observed decline in research participation over recent decades. Pandemic preparedness cohorts will be needed so activities that foster community engagement will be an essential part of the enrolment strategy for the main BEready cohort.
Title
Swiss COVID-19 Impact on Hospital Outpatient Visits for Cancer versus non-cancer Patients
Name
Moschetti Karine
Affiliation
Center for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne (UNIL), Lausanne, Switzerland
Abstract
BACKGROUND:
Covid-19 pandemic necessitated drastic changes in healthcare organizational, planning and access. In Switzerland, governmental and hospital management decisions led to the cancellation or postponement of various inpatient and outpatient services. This posed potential risks to cancer care continuity, a concern highlighted by disruptions in cancer patient follow-ups in other countries. However, specific impacts on cancer care within the Swiss healthcare context remain underexplored.
OBJECTIVE:
This study aimed to evaluate the effects of the pandemic and consequent policy measures on hospital-based outpatient services, encompassing both in-person office and telemedicine visits for adult cancer patients. Adult non-cancer patients served as a reference group.
METHOD:
We used national hospital outpatient data covering January 2017 to December 2021, which we divided into three periods: pre-COVID (38 months prior to lockdown), lockdown (March-May 2020), and post-lockdown (10 months following lockdown). We conducted two comparative interrupted time series analyses to assess the relative changes in monthly physician visits - distinctly categorized as office and telemedicine visits – for both cancer and non-cancer patients across these time periods.
RESULTS:
The pre-COVID data indicated a monthly average of 522,230 office visits for non-cancer patients and 65,600 for cancer patients. During the lockdown period, office visits decreased significantly, with a less pronounced reduction for cancer patients (23%) compared to non-cancer patients (32%). Concurrently, telemedicine visits, initially averaging 2,800 per month for cancer patients and 14,400 for non-cancer patients, escalated by 328% and 371% respectively. In the post-lockdown period, office visits did not return to pre-pandemic levels for either group (-3% for cancer patients; -9% for non-cancer patients), while telemedicine visits remained higher than the pre-COVID (+131% for cancer patients; +152% for non-cancer patients).
DISCUSSION:
Contrasting with trends observed in many countries, the Swiss healthcare system demonstrated a remarkable capacity to mitigate the adverse effects of COVID-19 on outpatient cancer care. Our findings underscore the adaptability of the system, particularly in the expansion of telemedicine services, to ensure continued access to care in the face of limited hospital accessibility.
Title
Impact of the covid-19 pandemic on health service usage in Finnish type 2 diabetes patients: a register-based study
Name
Laura Inglin
Affiliation
University of Eastern Finland
Abstract
Aims:
The COVID-19 pandemic has challenged health systems and their capacity to deliver essential health services while responding to COVID-19. This study examines the pandemic's impact on health service usage among patients with type 2 diabetes in the North Karelia region, in Finland.
Methods:
This retrospective cohort study used electronic health records of 11,458 type 2 diabetes patients, comprising all primary and specialised care contacts in 2019 and 2020. We analysed diabetes and dental healthcare contacts to primary care nurses, doctors and dentists and all emergency visits in specialised care. We compared healthcare usage in three different periods in 2020 (pre-lockdown [1 January-15 March], lockdown [16 March-31 May], post-lockdown [1 June-31 December]) with the equivalent period in 2019.
Results: During the lockdown period, the number of diabetes-related contacts decreased significantly but quickly increased again to nearly the same level as in 2019. Overall, healthcare usage was lower in the pandemic year, with proportionally 9% fewer contacts per person (mean 2.08 vs 2.29) and a proportionally 9% lower proportion of patients making any contact (59.9% vs 65.8%). The proportion of remote consultations was similar in both years in the pre-lockdown period (56.3-59.5%) but then increased to 88.0% during the 2020 lockdown. Patterns were similar when analysed by age group and gender. Emergency visits went down significantly at the beginning of the lockdown period, but a 'rebound effect' was observed, so after the lockdown, the number of emergency visits in 2020 exceeded the numbers of the previous year.
Conclusion:
Despite the COVID-19 pandemic, diabetes care was continuous, and even elderly patients aged ≥70 years accessed the health services. The delivery of many essential services was facilitated by processes that strongly relied on remote consultations already before the pandemic.
Title
Impact of the lockdown of public life due to the COVID-19 pandemic on Swiss cantonal registry data
Name
Flurina Suter
Affiliation
Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland; Cancer Registry Zurich, Zug, Schaffhausen and Schwyz, Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
Abstract
The virus SARS-CoV-2 was discovered in 2019 and spread rapidly. Because of its severe effects on human health, a lockdown of public life was ordered in many countries. This measure helped to decrease the number of SARS-CoV-2 patients. However, diagnosis and treatment of other severe diseases, such as cancer, may have been neglected. Therefore, we investigated differences in cancer diagnosis and stage distribution among the pre-SARS-CoV-2 years (2018/2019) and during the first SARS-CoV-2 year (2020). Data of the cantonal Cancer Registry Zurich, Zug, Schaffhausen, and Schwyz were used. Age-standardized incidence rates were calculated using the direct method. Multivariate Poisson regression models were fitted to calculate sex- and age-adjusted Incidence Rate Ratios (IRR) with 95% confidence intervals (95% CI). Differences in stage distribution were investigated descriptively. Based on the data of the cantons of Zurich (ZH) and Zug (ZG), higher all-cancer IRR were seen in both cantons in the year 2020 compared to the years 2018/2019. A different trend was observed for specific cancer sites: lower incidence rates in the year 2020 compared to the years 2018/2019 were observed for breast cancer among females (ZH: IRR2020 vs. 2018 = 0.92 [95% CI: 0.90 to 0.93]; IRR2020 vs. 2019 = 0.94 [0.92 to 0.96]; ZG: IRR2020 vs. 2018 = 0.90 [0.87 to 0.92]; IRR2020 vs. 2019 = 0.90 [0.88 to 0.92]) and for colorectal cancer (ZH among both sexes: IRR2020 vs. 2018 = 0.87 [0.85 to 0.88]; IRR2020 vs. 2019 = 0.94 [0.92 to 0.96]; ZG among females: IRR2020 vs. 2018 = 0.73 [0.70 to 0.77]; IRR2020 vs. 2019 = 0.86 [0.81 to 0.90]). As in our study, previous European studies reported disrupted cancer screening programs, leading to a decrease in cancer diagnosis. Furthermore, these studies reported a shift in cancer stage distribution towards more severe stages, which was partly also seen in our data. However, the shift was probably mainly due to the new laws on systematic cancer case registration in Switzerland. To the best of our knowledge, this is the first Swiss study using population-based cantonal cancer registry data to examine the impact of the SARS-CoV-2 lockdown of public life on cancer diagnosis and stage distribution. The results of our study can guide policymakers and health systems during a future SARS-CoV-2 wave or other future pandemics.