Volume 151, No. 3536

Paola Daniore, Tala Ballouz, Dominik Menges, Viktor von Wyl (Author)

The SwissCovid Digital Proximity Tracing App after one year: Were expectations fulfilled?  

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Digital proximity tracing has been promoted as a major technological innovation for its potential added benefits of greater speed, wider reach and better scalability compared with traditional manual contact tracing. First launched in Switzerland on 25 June 2020, the SwissCovid digital proximity tracing app has now been in use for more than one year. In light of this milestone, we raise the questions: What is currently known about the role of SwissCovid in mitigating the pandemic? Were the expectations fulfilled?

In this review, we will summarise the current state of the literature from empirical studies on the adoption, performance and effectiveness of SwissCovid. The review consists of three sections. The first section summarizes findings from effectiveness studies, which suggest that SwissCovid exposure notifications contributed to preventive actions in 76% of exposure notification recipients and were associated with a faster quarantine time in some SwissCovid user groups. The second  describes the public perception and current state of adoption of SwissCovid in Switzerland in light of prevalent misconceptions and overemphasised expectations. the third  places the evidence on SwissCovid in an international context. Specifically, we compare key performance indicators of SwissCovid, which are of similar magnitude as for digital proximity tracing apps from other European countries. Using findings from Switzerland, we subsequently derive a preliminary measure of the population-level effectiveness of digital proximity tracing apps. We estimate that exposure notifications may have contributed to the notification and identification of 500 to 1000 SARS-CoV-2-positive app users per month. We explore why this effectiveness estimation is somewhat lower when compared with Germany or the United Kingdom.

In light of the presented evidence, we conclude that digital proximity tracing works well in specific contexts, such as in mitigating non-household spread. However, future applications of digital proximity tracing should invest into stakeholder onboarding and increased process automatization – without deviating from the principles of voluntariness and user privacy.

Raphael Victor Diserens, Clotilde Marmy, Mathieu Pasquier, Tobias Zingg, Stéphane Joost, Olivier Hugli (Author)

Modelling transport time to trauma centres and 30-day mortality in road accidents in Switzerland: an exploratory study

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BACKGROUND: Rapid access to a trauma centre for severely injured road accident victims, conceptualised as the Golden Hour, links access time to definitive treatment within 1 hour of trauma with reduced risks of morbidity and mortality. Access times have not been studied in Switzerland. The aim of this work was to model the transport time by ambulance of seriously injured road traffic accident victims to one of the 12 trauma centres in Switzerland and to investigate whether this time influenced mortality.

METHODS: Isochronous travel curves in 10-minute increments were modelled around each of the 12 Swiss trauma centres to assess travel times at the Swiss national level, based on the shortest travel time from the location of a serious road accident to the nearest trauma centre. We used the national database of the Federal Roads Office, which provided the geolocation of these accidents occurring between 2011 and 2017. The association between mortality and transport time to the nearest trauma centre was then analysed.

RESULTS: The current distribution of trauma centres allowed access time within the Golden Hour for accidents occurring on the Swiss plateau, but the time was more prolonged in the Alps or the Jura. An association existed between mortality and prehospital transport time from the site of an accident to the nearest trauma centre. For each additional 10-minute isochrone, an average increase of 0.4% in mortality was observed.

CONCLUSION: This work showed an adequate distribution of trauma centres in Switzerland and suggests a positive relationship between transport time to the nearest trauma centre and mortality. The numerous confounding factors not systematically collected in publicly available databases limit the robustness of our results. This study confirms the importance of having a national trauma registry to allow quality analyses to guide public health decisions.

Nicolas Frei, Federico Caobelli, Diego Kyburz (Author)

Bilateral proximal hamstring muscle avulsion after treatment with immune checkpoint inhibitors and corticosteroids

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A 66-year-old man presented with 4 weeks of bilateral buttock pain without previous trauma or intense exercise. He had been treated with immune checkpoint inhibitors because of metastasising melanoma and experienced immune-related adverse events requiring treatment with corticosteroids. Magnetic resonance imaging of the pelvis revealed bilateral avulsion of the proximal hamstring muscles. Treatment with physical therapy and nonsteroidal anti-inflammatory drugs led to a slow but lasting relief. This is, to our knowledge, the first report of symptomatic non-traumatic bilateral hamstring muscle avulsion following treatment with immune checkpoint inhibitors and corticosteroids.

Daphne Reinau , Nadine Schur, Sibylle Twerenbold , Eva Blozik , Mathias Früh, Andri Signorell, Matthias Schwenkglenks , Christoph R. Meier (Author)

Utilisation patterns and costs of lipid-lowering drugs in Switzerland 2013–2019

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OBJECTIVE: To analyse utilisation patterns of lipid-lowering drugs and the related costs in Switzerland between the years 2013 and 2019.

METHODS: We conducted a retrospective descriptive study using administrative claims data of persons aged ≥18 years enrolled with the health insurance company Helsana. To enable statements at the Swiss population level, results were extrapolated according to age, sex and canton of residence.

RESULTS: The overall prevalence of patients taking lipid-lowering drugs rose from 8.9% (n = 736,174) in 2013 to 11.6% (n = 841,682) in 2019, but varied markedly across regions, with highest values in Ticino and lowest values in Zurich. More than every third individual aged ≥65 years was treated with a lipid-lowering drug in 2019. Statins were by far the most commonly used drugs (>90% of prescriptions), followed by ezetimibe, fibrates and PCSK9 inhibitors. We observed a trend towards the prescription of more potent statins (atorvastatin, rosuvastatin) in recent years. Total costs of lipid-lowering drugs increased from CHF 222 million in 2013 to CHF 230 million in 2019 (+3.5%), whereas annual per capita costs decreased from CHF 302 in 2013 to CHF 273 in 2019 (−9.4%).

CONCLUSION: The increasing use of lipid-lowering drugs reflects current therapeutic guidelines, but results in high costs for the healthcare system.

Maëlle Mora-Monteros, Yara Barrense-Dias, Diane Auderset, Sophie Stadelmann, Nicolas Senn, Joan-Carles Suris (Author)

Transition from paediatric to adult care: What about the healthy ones?

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OBJECTIVE: To compare the characteristics of and use of the healthcare system by healthy youths depending on whether they had discussed transition to adult health care with their paediatrician or not.

METHODS: Data were drawn from the fourth wave of the GenerationFRee study (2018–2019) conducted in the 11 post-mandatory schools of the canton of Fribourg, Switzerland. The sample included 931 young people (mean age 19.4 years). Participants were categorised into three groups: those who had discussed transition with their p ediatrician (n = 176; 19%), those who had not (n = 286; 31%) and those who did not know (n = 469; 50%). Analyses were stratified by gender through bivariate analysis and post-hoc tests with a Bonferroni-type adjustment.

RESULTS: The majority of participants did not know whether or not they had discussed transition. Across all groups, it was found that youths met their primary care physician at a higher rate through family. Meeting with the primary care physician through the paediatrician occurred at a higher rate when youths had discussed transition. Girls with a below average socioeconomic status and boys with advanced puberty onset were more likely to have discussed transition. 

CONCLUSION: Our results show that youths are not well informed about the transition process. However, youths who have discussed transition appear to be more involved with the healthcare system as they are more likely to have a primary care provider. In order to avoid discontinuity of care, professionals should approach transition to adult care systematically with all their patients.

Rahel Stierli, Zsofia Rozsnyai, Rainer Felber, Reto Jörg, Esther Kraft, Aristomenis K Exadaktylos, Sven Streit (Author)

Primary Care Physician Workforce 2020 to 2025 – a cross-sectional study for the Canton of Bern

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AIM OF THIS STUDY: The Swiss primary care sector faces a lack in its workforce and the Canton of Bern - the second largest canton (i.e. federal state) – is believed to be more affected than others. To be able to predict a shortage in the overall workforce, reliable numbers for the workforce of all general practitioners (GPs) and paediatricians (primary care physicians, PCPs) actively working in the Canton of Bern are needed. Switzerland has no registry of active PCPs; therefore, our goal was to (1) define the number and characteristics of all PCPs in the Canton of Bern, (2) to establish the workforce density for the whole canton and its administrative districts, and (3) to forecast the next five years with respect to the PCP workforce development.

METHODS: In this cross-sectional study, we contacted all potential PCPs of the Canton of Bern. We included all board-certified physicians in general internal medicine, paediatrics and physicians with the title “Praktischer Arzt (practical doctor)” with a professional license from the available registers (MedReg and the FMH register). All potential PCPs received a questionnaire to assess their involvement in the primary care setting, their personal characteristics including workload (current and in 5 years to allow us to estimate the projected workforce per projected population size in 2025), type of practice, administrative district, and additional questions on their acceptance of new patients and their perception of a shortage in their region. The data from non-responders were collected via follow-up letters, emails and phone calls. The density was calculated as full-time equivalent PCPs per 1000 inhabitants in total and per district.

RESULTS: From all potential PCPs (n = 2217), we identified 972  working in the Canton of Bern, 851 as GPs (88%) and 121 as paediatricians (12%). From these physicians, we had a response rate of 95%. The mean age was 53 years for GPs and 50 years for paediatricians. Thirteen percent of all PCPs were aged 65 or older. The average workload was 7.6 half-days (GPs) and 6.9 half-days (paediatricians). We found a density of 0.75 (95% confidence interval [CI] 0.69–0.81) full-time equivalents per 1000 inhabitants for the total of the Canton of Bern, and a regional variability with densities between 0.59 to 0.93. Without new PCPs, the workforce density of PCPs will drop to 0.56 (95% CI 0.49–0.62) within the next 5 years.

CONCLUSION: This is the first study in which 95% of active PCPs participated and it demonstrated that within the next 5 years there will be a shortage in the workforce of PCPs that can only be improved by higher numbers of new domestic PCPs – even after accounting for the current inflow of foreign PCPs.

Ekkehardt S. Altpeter, Axel J. Schmidt (Author)

Surveillance of tuberculosis in Switzerland and the Principality of Liechtenstein, 2009 to 2019

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OBJECTIVE: To describe the epidemiology of tuberculosis in Switzerland from 2009 to 2019.

METHODS: Analysis of Swiss notification data.

RESULTS: Tuberculosis cases declined from 553 (7.1/100,000) in 2009 to 437 (5.1/100,000) in 2019. The male-to-female ratio was 3:2. Although the number of tuberculosis cases of Swiss origin has steadily declined, the number of tuberculosis cases of foreign origin was rather stable but peaked in 2016. Overall, three quarters of tuberculosis cases were among people of foreign origin; of these, around half were from East Africa, Southern East Europe, and Southern Asia. Forty-nine percent had extrapulmonary manifestations. Every year, with little variation, 7–16 cases with rifampicin resistance were reported (2.9% overall). Independent risk factors for rifampicin resistance were prior anti-tuberculosis treatment, with an adjusted odds ratio (aOR) of 5.5 and a 95% confidence interval (CI) from 3.7 to 8.1, and foreign origin (aOR 3.6, 95% CI 2.0–7.0), particularly Georgia (aOR 10.0, 95% CI 4.0–23.1), Ethiopia (aOR 9.4, 95% CI 3.5–24.2), Tibet (aOR 6.9; 95% CI 2.9–16.6) and Somalia (aOR 8.1, 95% CI 4.0–17.2), together with Eritrea (aOR 2.6, 95% CI 1.1–5.9), accounting for more than half of all 134 cases . From 2016 to 2018, applying the World Health Organization definitions, overall treatment success in culture-confirmed pulmonary cases was 78%, and thus below the target of 85%. Since most cases with unsuccessful outcome are due to missing information, the proportion of unsuccessful outcome are overestimated.

CONCLUSION: Autochthonous tuberculosis has become rare in Switzerland and the new diagnoses are increasingly attributable to immigration. Rifampicin resistance remains rare. Switzerland currently fails to achieve international targets for treatment success.

Sarah Fustinoni, Brigitte Santos-Eggimann, Yves Henchoz (Author)

Does the frailty phenotype at the age of 66 to 71 predict death? A 14-year survival analysis of the Lc65+ study

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BACKGROUND: Frailty is a health characteristic resulting from the loss of physiological reserve of multiple organs, leading to exposure to adverse outcomes, and is possibly reversible in its earliest stages. It is identified by a specific phenotype that contributes to the practice of geriatric medicine, where it is considered a potential target for preventive action. This phenotype has recently attracted interest in other medical specialties for risk assessment before stressful interventions in older adults. Whereas frailty is unusual in sexagenarians, pre-frailty is common. This longitudinal study aimed to evaluate the significance of fulfilling at least one criterion of the frailty phenotype in the late sixties as a predictor of short- and long-term mortality in males and females.

METHODS: Data came from the first sample of the Lc65+ cohort, representative of the community-dwelling Lausanne population born between 1934 and 1939 (n = 1315). After baseline assessment of the five criteria of Fried’s frailty phenotype (shrinking, exhaustion, muscular weakness, motor slowness and low physical activity) in 2005 (age 66–71 years), deaths were recorded over 14 years. We separated individuals into non-frail (fulfilling 0 criterion) and (pre-)frail (1+ criteria). The relationship between the phenotype and mortality was investigated graphically using Kaplan-Meier survival curves and quantified in Cox models. Multivariable analyses incrementally controlled age, socioeconomic and health characteristics. The prediction of fully adjusted models was evaluated using the Harrell’s C index.

RESULTS: Overall, 401 persons (30.5%) were (pre-)frail at baseline. A quarter of the 1315 participants died over 14 years (n = 336, 25.6%). The mortality rate was significantly higher in males in the (pre-)frail subgroup only. Survival curves showed a significant effect of (pre-)frailty on the risk of dying for both sexes. The effect of (pre-)frailty on mortality was stronger during the first 4 years of the follow-up. In males, it was significant both in short (0–4 years) and longer (>4–14 years) terms. In females, it was significant in the short term only. In all models, the estimated effect was stronger in males. The fully adjusted model was fairly predictive of death in the short term both in males (Harrell’s C 0.79) and females (0.75).

CONCLUSIONS: The significantly higher mortality of individuals presenting 1+ frailty criteria supports the appropriateness of a systematic assessment of the frailty phenotype at the age of 66–71 years. In both females and males, early identification of pre-frailty has the potential to limit or reverse the development of frailty and extend lifespan through adequate individual management.

Alix L. von Hammerstein, Christoph Aebi, Florence Barbey, Christoph Berger, Michael Buettcher, Carmen Casaulta, Adrian Egli, Mathias Gebauer, Beatrice Guerra, Christian Kahlert, Eva Kellner, Lisa Kottanattu, Onya Opota, Christian Mann, Patrick Meyer Sauteur, Margherita Plebani, Nicole Ritz, Chiara Testi, Valentin von Niederhäusern, Noemie Wagner, Petra Zimmermann, Franziska Zucol, Philipp K. A. Agyeman, Johannes Trück (Author)

Interseasonal RSV infections in Switzerland – rapid establishment of a clinician-led national reporting system (RSV EpiCH)

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In anticipation of an interseasonal respiratory syncytial virus (RSV) epidemic, a clinician-led reporting system was rapidly established to capture RSV infections in Swiss hospitals, starting in January 2021. Here, we present details of the reporting system and first results to June 2021. An unusual epidemiology was observed with an interseasonal surge of RSV infections associated with COVID-19-related non-pharmacological interventions. These data allowed real-time adjustment of RSV prophylaxis guidelines and consequently underscore the need for and continuation of systematic nationwide RSV surveillance.