Despite relatively few COVID-19 cases within New South Wales, the uncertainty surrounding the pandemic has prevented a return to business as usual for the delivery of surgical services. This study aims to describe the evolving impact of COVID-19 on surgical activity and patient outcomes at a major public tertiary referral hospital. A retrospective cohort study involving adult surgical patients treated at a large public tertiary referral hospital in Sydney, Australia. Surgical activity, surgical outcomes and patient demographics were compared across two time periods, including the ‘first wave’ (February-May 2020 vs. February-May 2019) and the ‘perseverance phase’ (June-September 2020 vs. June-September 2019). Variables across both groups were compared using an independent t test or chi-squared test. A -32% reduction in surgical separations was observed in the ‘first wave’,...
COVID-19 in the UK has had a profound impact on population health and other socially important outcomes, including on education and the economy. Although a range of evidence has guided policy, epidemiological models have been central. It is less clear whether models to support decision making have sought to integrate COVID-19 epidemiology with a consideration of broader health, wellbeing and economic implications. We report on a rapid review of studies seeking to integrate epidemiological and economic modelling to assess the impacts of alternative policies. Overall, our results suggest that few studies have explored broader impacts of different COVID-19 policies in the UK. Three studies looked only at health, capturing impacts on individuals with and without COVID-19, with various methods used to model the latter. Four models considered health and wider impacts on individuals’...
Introduction: Millions of U.S. patients have been hospitalized for COVID-19. After discharge, these patients often have extensive health care needs, but out-of-pocket burden for this care is poorly described. We assessed out-of-pocket spending within 90 days of discharge from COVID-19 hospitalization among privately insured and Medicare Advantage patients.
Methods: In May 2021, we conducted a cross-sectional analysis of the IQVIA PharMetrics ® Plus for Academics Database, a national de-identified claims database. Among privately insured and Medicare Advantage patients hospitalized for COVID-19 between March-June 2020, we calculated mean out-of-pocket spending for care within 90 days of discharge. For context, we repeated analyses for patients hospitalized for pneumonia.
Results: Among 1,465 COVID-19 patients included, 516 (35.2%) and 949 (64.8%) were covered by private...
This paper compares the direct benefits to the State of Western Australia from employing a “suppression” policy response to the COVID-19 pandemic rather than a “herd immunity” approach. An S-I-R (susceptible-infectious-resolved) model is used to estimate the likely benefits of a suppression COVID-19 response compared to a herd immunity alternative. Direct impacts of the virus are calculated on the basis of sick leave, hospitalizations, and fatalities, while indirect impacts related to response actions are excluded. Preliminary modeling indicates that approximately 1700 vulnerable person deaths are likely to have been prevented over 1 year from adopting a suppression response rather than a herd immunity response, and approximately 4500 hospitalizations. These benefits are valued at around AUD4.7 billion. If a do nothing policy had been adopted, the number of people in need of...
The COVID-19 pandemic substantially increased medical care requirements and associated costs in the older fee-for-service (FFS) Medicare beneficiary population in the USA, according to a study published in Annals of Internal Medicine.
Strategies adopted globally to mitigate the threat of COVID-19 have primarily
involved lockdown measures with substantial economic and social costs with
varying degrees of success. Morbidity patterns of COVID-19 variants have a
strong association with age, while restrictive lockdown measures have
association with negative mental health outcomes in some age groups. Reduced
economic prospects may also afflict some age cohorts more than others.
Motivated by this, we propose a model to describe COVID-19 community spread
incorporating the role of age-specific social interactions. Through a flexible
parameterisation of an age-structured deterministic Susceptible Exposed
Infectious Removed (SEIR) model, we provide a means for characterising
different forms of lockdown which may impact specific age groups differently.
Social interactions are represented through age group to age group...
THE SARS-CoV-2 Coronavirus Disease 2019 (COVID-19) pandemic has impacted our healthcare system in myriad ways, many of which are brutally obvious to anyone with even a cursory knowledge of current events (overrun intensive care units, ventilator and personal protective equipment shortages, and nearly 500,000 deaths in the United States as of the writing of this editorial). There are, however, more subtle effects that the pandemic has wrought on both the health of Americans and the healthcare system that are no less insidious despite the lack of above-the-fold headlines. Prominent among these are the sequelae of prolonged social isolation, fear of COVID-19 infection, and postponed routine and semiurgent medical care (either due to efforts by medical professionals to conserve limited hospital beds and other resources or patients avoiding care in order to minimize their risk of...
We compare the health and economic costs of early and delayed mandated suppression and the unmitigated spread of ‘first-wave’ COVID-19 infections in Australia in 2020. Using a fit-for-purpose SIQRM-compartment model for susceptible, infected, quarantined, recovered and mortalities on active cases, that we fitted from recorded data, a value of a statistical life year (VSLY) and an age-adjusted value of statistical life (A-VSL), we find that the economic costs of unmitigated suppression are multiples more than for early mandated suppression. We also find that using an equivalent VSLY welfare loss from fatalities to estimated GDP losses, drawn from survey data and our own estimates of the impact of suppression measures on the economy, means that for early suppression not to be the preferred strategy requires that Australia would have to incur more than 12,500-30,000 deaths, depending...
Trade-offs abound in healthcare yet depending on where one stands relative to the stages of a pandemic, choice making may be more or less constrained. During the early stages of COVID-19 when there was much uncertainty, healthcare systems faced greater constraints and focused on the singular criterion of “flattening the curve.” As COVID-19 progressed and the first wave diminished (relatively speaking depending on the jurisdiction), more opportunities presented for making explicit choices between COVID and non-COVID patients. Then, as the second wave surged, again decision makers were more constrained even as more information and greater understanding developed. Moving out of the pandemic to recovery, choice making becomes paramount as there are no set rules to lean back into historical patterns of resource allocation. In fact, the opportunity at hand, when using explicit tools...
This paper estimates the benefits and costs of state suppression policies to “bend the curve” during the initial outbreak of COVID-19 in the United States. We employ an approach that values benefits and costs in terms of additions or subtractions to total production. Relative to a baseline in which only the infected and at-risk populations mitigate the spread of coronavirus, we estimate that total benefits of suppression policies to economic output are between $632.5 billion and $765.0 billion from early March 2020 to August 1, 2020. Relative to private mitigation, output lost due to suppression policies is estimated to be between $214.2 billion and $331.5 billion. The cost estimate is based on the duration of nonessential business closures and stay-at-home orders, which were enforced between 42 and 65 days. Our results indicate that the net benefits of suppression policies to...