Costs of the COVID-19 pandemic associated with obesity in Europe: A health-care cost model

A critical review of health and financial implications of obesity during the COVID-19 pandemic

The COVID-19 was reported in Wuhan, China, in December 2019. There is a link between increased mortality and obese individuals with the disease. The disease has been claimed to have disproportionately affected non-Hispanic blacks and Hispanics. The rise in food accessibility and the drop in the relative cost of junk food items are the two most significant changes in dietary patterns. Around the world, 2.8 million people die from being overweight or obese, and those with more body fat also have a higher risk of diabetes (44%) and heart disease (23%). Obesity weakens the immune system because adipose cells infiltrate the bone marrow, spleen, and thymus. Obesity was substantially more common among COVID-19 patients who were hospitalized than those who were not hospitalized. Over 900 000 adults in the United States are hospitalized due to a COVID-19 infection. Hospitalizations in 271 700 (30.2%) cases have been attributed to obesity. Obese patients may be experiencing reduced thoracic expansion following bariatric surgery. Less tracheal collapse and air-trapping at end-expiration chest computed tomography (CT) were observed post-surgery, and patients reported reduced dyspnea. COVID-19 is estimated to cost the European Union €13.9 billion in secondary care, with 76% of that cost attributed to treatment for overweight and obese individuals. The average price per hospitalized patient also increased with increasing BMI. Screening for obesity, preventive measures, and recommendations for healthy lifestyle changes should be of the utmost importance to decrease both the health and financial implications of COVID-19.

Efficacy thresholds and target populations for antiviral COVID-19 treatments to save lives and costs: a modelling study

Background

In 2023 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared endemic, yet hospital admissions have persisted and risen within populations at high and moderate risk of developing severe disease, which include those of older age, and those with co-morbidities. Antiviral treatments, currently only available for high-risk individuals, play an important role in preventing severe disease and hospitalisation within this subpopulation. Here, we further explore the public health and economic benefits of extending target populations for treatment, and assess efficacy thresholds for a treatment strategy to be cost-saving.

Methods

We adapted an individual-based transmission model of SARS-CoV-2, OpenCOVID, which was calibrated and validated to 2020-2023 Swiss, European, and Northern Hemisphere epidemiological data. We used the model to estimate hospitalisations and overall costs for preventatively treating three risk groups for a full range of treatment efficacies and coverages with, besides vaccination and hospital treatments, no other interventions in place. We further calculated efficacy thresholds for strategies to be cost-saving. A global sensitivity analysis was conducted to test the sensitivity of all outcomes for a wide range of treatment properties, emerging variant properties, and vaccination coverages.

Findings

In a high vaccination coverage setting, we found that a high efficacy antiviral treatment given to all those at high-risk could reduce hospitalisations by up to 40%. When expanding treatment coverage to also include all those at moderate-risk, an additional 50% of hospitalisations could be averted. Targeting both high-risk and moderate-risk groups was found to be cost-saving for a treatment efficacy greater than ∼40%. This threshold was found to be robust regardless of vaccination coverage and emerging variant properties, but highly sensitive to treatment costs.

Interpretation

For a sufficiently efficacious antiviral treatment, expanding the target population to include both high-risk and moderate-risk groups should be considered. Equitable treatment costs are found crucial in achieving the best possible public health and health economic outcomes.

Funding

Botnar Research Centre for Child Health (DZX2165 to MAP), the Swiss National Science Foundation Professorship of MAP (P00P3_203450) and Swiss National Science Foundation NFP 78 Covid-19 2020 (4079P0_198428 to MAP).

Associations between BMI and hospital resource use in patients hospitalised for COVID-19 in England: a community-based cohort study

BACKGROUND

Excess weight is a major risk factor for severe disease after infection with SARS-CoV-2. However, the effect of BMI on COVID-19 hospital resource use has not been fully quantified. This study aimed to identify the association between BMI and hospital resource use for COVID-19 admissions with the intention of informing future national hospital resource allocation.

METHODS

In this community-based cohort study, we analysed patient-level data from 57 415 patients admitted to hospital in England with COVID-19 between April 1, 2020, and Dec 31, 2021. Patients who were aged 20-99 years, had been registered with a general practitioner (GP) surgery that contributed to the QResearch database for the whole preceding year (2019) with at least one BMI value measured before April 1, 2020, available in their GP record, and were admitted to hospital for COVID-19 were included. Outcomes of interest were duration of hospital stay, transfer to an intensive care unit (ICU), and duration of ICU stay. Costs of hospitalisation were estimated from these outcomes. Generalised linear and logit models were used to estimate associations between BMI and hospital resource use outcomes.

FINDINGS

Patients living with obesity (BMI >30·0 kg/m2) had longer hospital stays relative to patients in the reference BMI group (18·5-25·0 kg/m2; IRR 1·07, 95% CI 1·03-1·10); the reference group had a mean length of stay of 8·82 days (95% CI 8·62-9·01). Patients living with obesity were more likely to be admitted to ICU than the reference group (OR 2·02, 95% CI 1·86-2·19); the reference group had a mean probability of ICU admission of 5·9% (95% CI 5·5-6·3). No association was found between BMI and duration of ICU stay. The mean cost of COVID-19 hospitalisation was £19 877 (SD 17 918) in the reference BMI group. Hospital costs were estimated to be £2736 (95% CI 2224-3248) higher for patients living with obesity.

INTERPRETATION

Patients admitted to hospital with COVID-19 with a BMI above the healthy range had longer stays, were more likely to be admitted to ICU, and had higher health-care costs associated with hospital treatment of COVID-19 infection as a result. This information can inform national resource allocation to match hospital capacity to areas where BMI profiles indicate higher demand.

FUNDING

National Institute for Health Research.

Weight loss treatment for COVID-19 in patients with NCDs: a pilot prospective clinical trial

COVID-19 comorbid with noncommunicable chronic diseases (NCDs) complicates the diagnosis, treatment, and prognosis, and increases the mortality rate. The aim is to evaluate the effects of a restricted diet on clinical/laboratory inflammation and metabolic profile, reactive oxygen species (ROS), and body composition in patients with COVID-19 comorbid with NCDs. We conducted a 6-week open, pilot prospective controlled clinical trial. The study included 70 adult patients with COVID-19 comorbid with type 2 diabetes (T2D), hypertension, or nonalcoholic steatohepatitis (NASH).

INTERVENTIONS

a restricted diet including calorie restriction, hot water drinking, walking, and sexual self-restraint.

PRIMARY ENDPOINTS

COVID-19 diagnosis by detecting SARS-CoV-2 genome by RT-PCR; weight loss in Main group; body temperature; C-reactive protein. Secondary endpoints: the number of white blood cells; erythrocyte sedimentation rate; adverse effects during treatment; fasting blood glucose, glycosylated hemoglobin A1c (HbA1c), systolic/diastolic blood pressure (BP); blood lipids; ALT/AST, chest CT-scan. In Main group, patients with overweight lost weight from baseline (- 12.4%; P < 0.0001); 2.9% in Main group and 7.2% in Controls were positive for COVID-19 (RR: 0.41, CI: 0.04-4.31; P = 0.22) on the 14th day of treatment. Body temperature and C-reactive protein decreased significantly in Main group compared to Controls on day 14th of treatment (P < 0.025). Systolic/diastolic BP normalized (P < 0.025), glucose/lipids metabolism (P < 0.025); ALT/AST normalized (P < 0.025), platelets increased from baseline (P < 0.025), chest CT (P < 0.025) in Main group at 14 day of treatment. The previous antidiabetic, antihypertensive, anti-inflammatory, hepatoprotective, and other symptomatic medications were adequately decreased to completely stop during the weight loss treatment. Thus, the fast weight loss treatment may be beneficial for the COVID-19 patients with comorbid T2D, hypertension, and NASH over traditional medical treatment because, it improved clinical and laboratory/instrumental data on inflammation; glucose/lipid metabolism, systolic/diastolic BPs, and NASH biochemical outcomes, reactive oxygen species; and allowed patients to stop taking medications.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05635539 (02/12/2022): https://clinicaltrials.gov/ct2/show/NCT05635539?term=NCT05635539&draw=2&rank=1 .

Cost of illness studies in COVID-19: a scoping review

BACKGROUND

Human communities suffered a vast socioeconomic burden in dealing with the pandemic of coronavirus disease 2019 (COVID-19) globally. Real-word data about these burdens can inform governments about evidence-based resource allocation and prioritization. The aim of this scoping review was to map the cost-of-illness (CoI) studies associated with COVID-19.

METHODS

This scoping review was conducted from January 2019 to December 2021. We searched cost-of-illness papers published in English within Web of Sciences, PubMed, Google Scholar, Scopus, Science Direct and ProQuest. For each eligible study, extracted data included country, publication year, study period, study design, epidemiological approach, costing method, cost type, cost identification, sensitivity analysis, estimated unit cost and national burden. All of the analyses were applied in Excel software.

RESULTS

2352 records were found after the search strategy application, finally 28 articles met the inclusion criteria and were included in the review. Most of the studies were done in the United States, Turkey, and China. The prevalence-based approach was the most common in the studies, and most of studies also used Hospital Information System data (HIS). There were noticeable differences in the costing methods and the cost identification. The average cost of hospitalization per patient per day ranged from 101$ in Turkey to 2,364$ in the United States. Among the studies, 82.1% estimated particularly direct medical costs, 3.6% only indirect costs, and 14.3% both direct and indirect costs.

CONCLUSION

The economic burden of COVID-19 varies from country to country. The majority of CoI studies estimated direct medical costs associated with COVID-19 and there is a paucity of evidence for direct non-medical, indirect, and intangible costs, which we recommend for future studies. To create homogeneity in CoI studies, we suggest researchers follow a conceptual framework and critical appraisal checklist of cost-of-illness (CoI) studies.

Mechanical ventilation as a major driver of COVID-19 hospitalization costs: a costing study in a German setting

BACKGROUND

While COVID-19 hospitalization costs are essential for policymakers to make informed health care resource decisions, little is known about these costs in western Europe. The aim of the current study is to analyze these costs for a German setting, track the development of these costs over time and analyze the daily costs.

METHODS

Administrative costing data was analyzed for 598 non-Intensive Care Unit (ICU) patients and 510 ICU patients diagnosed with COVID-19 at the Frankfurt University hospital. Descriptive statistics of total per patient hospitalization costs were obtained and assessed over time. Propensity scores were estimated for length of stay (LOS) at the general ward and mechanical ventilation (MV) duration, using covariate balancing propensity score for continuous treatment. Costs for each additional day in the general ward and each additional day in the ICU with and without MV were estimated by regressing the total hospitalization costs on the LOS and the presence or absence of several treatments using generalized linear models, while controlling for patient characteristics, comorbidities, and complications.

RESULTS

Median total per patient hospitalization costs were €3,010 (Q1 - Q3: €2,224-€5,273), €5,887 (Q1 - Q3: €3,054-€10,879) and €21,536 (Q1 - Q3: €7,504-€43,480), respectively, for non-ICU patients, non-MV and MV ICU patients. Total per patient hospitalization costs for non-ICU patients showed a slight increase over time, while total per patient hospitalization costs for ICU patients decreased over time. Each additional day in the general ward for non-ICU COVID-19 patients costed €463.66 (SE: 15.89). Costs for each additional day in the general ward and ICU without and with mechanical ventilation for ICU patients were estimated at €414.20 (SE: 22.17), €927.45 (SE: 45.52) and €2,224.84 (SE: 70.24).

CONCLUSIONS

This is, to our knowledge, the first study examining the costs of COVID-19 hospitalizations in Germany. Estimated costs were overall in agreement with costs found in literature for non-COVID-19 patients, except for higher estimated costs for mechanical ventilation. These estimated costs can potentially improve the precision of COVID-19 cost effectiveness studies in Germany and will thereby allow health care policymakers to provide better informed health care resource decisions in the future.

Prevalence of overweight and obesity and their effect on COVID-19 severity and hospitalization among younger than 50 years versus older than 50 years population: A systematic review and meta-analysis

Cohort studies have shown that both overweight and obesity have their impact by increasing hospitalization with COVID-19. We conducted a systematic literature search in PubMed, Google Scholar, and MedRxiv databases following the PRISMA guidelines. Statistical analyses were performed using STATA software version 16 MP (Stata Corp, College Station, TX, USA) and Med Calc software version 22.009(Med Calc software Ltd, Ostend, Belgium). The primary outcome was to measure the prevalence of overweight and obesity and their impact on the risk of hospitalization among COVID-19 patients under and above 50 years of age. In total, 184 studies involving 2,365,377 patients were included. The prevalence of overweight was highest among those younger than 50 years of age over those older than 50 years of age, (26.33% vs. 30.46%), but there was no difference in obesity (36.30% vs. 36.02%). Overall, the pooled prevalence of overweight and obesity among hospitalized COVID-19 patients was 31.0% and 36.26%, respectively. Compared with normal weight, the odds of hospitalization with overweight (odds ratio [OR] 2.186, 95% confidence interval [CI] [1.19, 3.99], p < 0.01) and obesity (OR 3.069, 95% CI [1.67, 5.61], p < 0.001) in those younger than 50 years and obesity (OR 3.977, 95% CI [2.75, 5.73], p < 0.001) in the older than 50 years age group were significantly high. The increased prevalence of overweight and obesity among the under 50 years age group and obesity among the older than 50 years age group significantly increased the rate of COVID-19 infections, severity and hospitalization.

Cost of the COVID-19 pandemic versus the cost-effectiveness of mitigation strategies in EU/UK/OECD: a systematic review

OBJECTIVES

The economic burden of COVID-19 pandemic is substantial, with both direct and indirect costs playing a significant role.

DESIGN

A systematic literature review was conducted to estimate the cost of the COVID-19 pandemic and the cost-effectiveness of pharmaceutical or non-pharmaceutical interventions. All cost data were adjusted to the 2021 Euro, and interventions compared with null.

DATA SOURCES

Ovid MEDLINE and EMBASE were searched from January 2020 through 22 April 2021.

ELIGIBILITY CRITERIA

Studies regarding COVID-19 outbreak or public health preparedness measures or interventions with outcome measures related to the direct and indirect costs for disease and preparedness and/or response in countries of the European Union (EU), the European Economic Area (EEA), the UK and the Organisation for Economic Co-operation and Development (OECD) of all relevant epidemiological designs which estimate cost within the selected time frame were considered eligible.

DATA EXTRACTION AND SYNTHESIS

Studies were searched, screened and coded independently by two reviewers with high measure of inter-rater agreement. Data were extracted to a predefined data extraction sheet. The risk of bias was assessed using the Consensus on Health Economic Criteria checklist.

RESULTS

We included data from 41 economic studies. Ten studies evaluated the cost of the COVID-19 pandemic, while 31 assessed the cost-benefit of public health surveillance, preparedness and response measures. Overall, the economic burden of the COVID-19 pandemic was found to be substantial. Community screening, bed provision policies, investing in personal-protective-equipment and vaccination strategies were cost-effective. Physical distancing measures were associated with health benefits; however, their cost-effectiveness was dependent on the duration, compliance and the phase of the epidemic in which it was implemented.

CONCLUSIONS

COVID-19 pandemic is associated with substantial short-term and long-term economic costs to healthcare systems, payers and societies, while interventions including testing and screening policies, vaccination and physical distancing policies were identified as those presenting cost-effective options to deal with the pandemic, dependent on population vaccination and the Re at the stage of the pandemic.

Clinical and economic impact of COVID-19 on people with obesity in a Spanish cohort during the first pandemic peak

Introduction

COVID-19 and obesity relationship has been extensively studied since the COVID-19 outbreak, proving obesity is a risk factor. This study aims to broaden the available information about this association and to evaluate the economic impact of obesity and the COVID-19 disease combination.

Methods

This retrospective study analyzed a sample of 3,402 patients admitted to a Spanish hospital with available body mass index (BMI) data.

Results

The prevalence of obesity was 33.4%. Patients with obesity showed a higher risk of hospitalization (OR 95% ConfidenceInterval [CI]=1.46; [1.24-1.73]; p < 0.001), which increased with the obesity degree (I: OR [95% CI]=1.28 [1.06-1.55], p =0.010; II: OR [95% CI]=1.58 [1.16-2.15], p =0.004; III: OR [95% CI] =2.09 [1.31-3.34], p =0.002). Patients with type III obesity had a significantly higher risk of intensive care unit (ICU) admission (OR [95% CI]= 3.30 [1.67-6.53]; p = 0.001) and invasive mechanical ventilation (IMV) need (OR [95% CI]= 3.98 [2.00-7.94]; p<0.001). The average cost per patient was remarkably higher in patients with obesity (p = 0.007), reaching an excess cost of 28.41% in the study cohort and rising to 56.5% in patients < 70 years. The average cost per patient increased significantly with the degree of obesity (p = 0.007).

Discussion

In conclusion, our results suggest a strong association between obesity and adverse COVID-19 outcomes and higher expenditures in patients with both conditions.

Early humoral response to COVID-19 vaccination in patients living with obesity and diabetes in France. The COVPOP OBEDIAB study with results from the ANRS0001S COV-POPART cohort

BACKGROUND

Patients with diabetes and obesity are populations at high-risk for severe COVID-19 outcomes and have shown blunted immune responses when administered different vaccines. Here we used the 'ANRS0001S COV-POPART' French nationwide multicenter prospective cohort to investigate early humoral response to COVID-19 vaccination in the sub-cohort ('COVPOP OBEDIAB') of patients with obesity and diabetes.

METHODS

Patients with diabetes (n = 390, type 1 or 2) or obesity (n = 357) who had received two vaccine doses and had no history of previous COVID-19 infection and negative anti-nucleocapsid (NCP) antibodies were included and compared against healthy subjects (n = 573). Humoral response was assessed at baseline, at one month post-first dose (M0) and one-month post-second dose (M1), through percentage of responders (positive anti-spike SARS-CoV-2 IgG antibodies (Sabs), geometric means of Sabs; BAU/mL), proportion of individuals with anti-RBD antibodies, and proportion of individuals with anti-SARS-CoV-2-specific neutralizing antibodies (Nabs). Potential clinical and biological factors associated with weak response (defined as Sabs < 264 BAU/mL) and presence of non-reactive anti-RBD antibodies at M1 were evaluated. Univariate and multivariate regressions were performed to estimate crude and adjusted coefficients with 95 % confidence intervals. Poor glycemic control was defined as HbA1c ≥ 7.5 % at inclusion.

RESULTS

Patients with diabetes, particularly type 2 diabetes, and patients with obesity were less likely to have positive Sabs and anti-RBD antibodies after the first and second dose compared to controls (p < 0.001). At M1, we found Sabs seroconversion in 94.1 % of patients with diabetes versus 99.7 % in controls, anti-RBD seroconversion in 93.8 % of patients with diabetes versus 99.1 % in controls, and Nabs seroconversion in 95.7 % of patients with diabetes versus 99.6 % in controls (all p < 0.0001). Sabs and anti-RBD seroconversion at M0 and M1 were also significantly lower in obese patients than controls, at respectively 82.1 % versus 89.9 % (p = 0.001; M0 Sabs), 94.4 % versus 99.7 % (p 0.001; M1 Sabs), 79.0 % vs 86.2 % (p = 0.004 M0 anti-RBD), and 96.99 % vs 99.1 % (p = 0.012 M1 anti-RBD). The factors associated with low vaccine response (BAU < 264/mL) in patients with diabetes were chronic kidney disease (adjusted OR = 6.88 [1.77;26.77], p = 0.005) and poor glycemic control (adjusted OR = 3.92 [1.26;12.14], p = 0.018). In addition, BMI ≥ 40 kg/m² was found to be associated with a higher vaccine response (adjusted OR = 0.10 [0.01;0.91], p = 0.040) than patients with BMI < 40 kg/m².

CONCLUSION

COVID-19 vaccine humoral response was lower in patients with obesity and diabetes one month after second dose compared to controls, especially in diabetic patients with CKD or inadequate glycemic control. These findings point to the need for post-vaccination serological checks in these high-risk populations.

Predicting the cost of COVID-19 treatment and its drivers in Indonesia: analysis of claims data of COVID-19 in 2020-2021

BACKGROUND

Recent Coronavirus Disease-19 (COVID-19) pandemic shows that health system, particularly hospital care, takes the highest toll on COVID-19. As hospital gets to manage the surge of COVID-19 cases, it is important to standardize treatment standard and package for COVID-19. Until recently, in Indonesia, COVID-19 curative package in hospital is paid using a retrospective payment system (claims system) using a per-diem rate. Quantifying standard cost using an established retrospective claims dataset is important as a basis for standard formulation for COVID-19 package treatment, should COVID-19 be accommodated into the benefit package for Universal Health Coverage (UHC) under the National Health Insurance.

METHODS

We estimated a standard cost for COVID-19 treatment using provider's perspective. The analysis was conducted retrospectively using established national COVID-19 claims dataset during January 2020 until 2021. Utilizing individual-or-patient level analysis, claims profile were broken down per-patient, yielding descriptive clinical and care-related profile. Estimate of price and charge were measured in average. Moreover, indicators were regressed to the total charged price (in logarithmic scale) so as to find the predictors of cost.

RESULTS

Based on the analysis of 102,065 total claims data received by MOH in 2020-2021, there is an average claim payment for COVID-19 in the amount of IDR 74,52 million (USD$ 5175). Significant difference exists in hospital tariffs or price to the existing claims data, indicating profit for hospital within its role in managing COVID-19 cases. Claim amount predictors were found to be associated with change of claim amount, including high level of severity, hospital class, intensive care room occupancy and ventilator usage, as well as mortality.

CONCLUSION

As COVID-19 pandemic shifts towards an endemic, countries including Indonesia need to reflect on the existing payment system and move towards a more sustainable payment mechanism for COVID-19. The COVID-19 payment system needs to be integrated into the existing national health insurance allowing bundled payment to become more sustainable, which can be achieved by comprehensively formulating the bundled payment package for COVID-19.

Obesity: Policy and Practice Recommendations for High-Risk Populations Influenced by the COVID-19 Pandemic

Obesity has been linked to higher morbidity and mortality in those that contract novel viruses, such as H1N1 and SARS-CoV-2. Loss of life and the high cost of obesity highlight the need to focus on preventative measures. The state of Maine (United States) is profiled as a rural state with high rates of obesity and low health literacy that benefits from programs to improve health. However, more multidirectional efforts are needed. Four recommendations for building a healthier, more resilient patient population are discussed here: (i) state incentives and subsidies, (ii) employers to incentivize healthy living, (iii) federal incentives and initiatives, and (iv) personal responsibility for health and wellness.

Clinical and Economic Benefits of Lenzilumab Plus Standard of Care Compared with Standard of Care Alone for the Treatment of Hospitalized Patients with Coronavirus Disease 19 (COVID-19) from the Perspective of National Health Service England

Purpose

To estimate the clinical and economic benefits of lenzilumab plus standard of care (SOC) compared with SOC alone in the treatment of hospitalized COVID-19 patients from the National Health Service (NHS) England perspective.

Methods

A cost calculator was developed to estimate the clinical benefits and costs of adding lenzilumab to SOC in newly hospitalized COVID-19 patients over 28 days. The LIVE-AIR trial results informed the clinical inputs: failure to achieve survival without ventilation (SWOV), mortality, time to recovery, intensive care unit (ICU) admission, and invasive mechanical ventilation (IMV) use. Base case costs included drug acquisition and administration for lenzilumab and remdesivir and hospital resource costs based on the level of care required. Clinical and economic benefits per weekly cohort of newly hospitalized patients were also estimated.

Results

In all populations examined, specified clinical outcomes were improved with lenzilumab plus SOC over SOC treatment alone. In a base case population aged <85 years with C-reactive protein (CRP) <150 mg/L, with or without remdesivir, adding lenzilumab to SOC was estimated to result in per-patient cost savings of £1162. In a weekly cohort of 4754 newly hospitalized patients, addition of lenzilumab to SOC could result in 599 IMV uses avoided, 352 additional lives saved, and over £5.5 million in cost savings. Scenario results for per-patient cost savings included: 1) aged <85 years, CRP <150 mg/L, and receiving remdesivir (£3127); 2) Black patients with CRP <150 mg/L (£9977); and 3) Black patients from the full population (£2369). Conversely, in the full mITT population, results estimated additional cost of £4005 per patient.

Conclusion

Findings support clinical benefits for SWOV, mortality, time to recovery, time in ICU, time on IMV, and ventilator use, and an economic benefit from the NHS England perspective when adding lenzilumab to SOC for hospitalized COVID-19 patients.

Association between COVID-19 morbidity, mortality, and gross domestic product, overweight/ obesity, non-communicable diseases, vaccination rate: A cross-sectional study

Background

The spread of COVID-19 depends on a lot of social and economic factors. The aim: to study the influence of country’s gross domestic product, population prevalence of overweight/ obesity, NCD mortality, and vaccination on COVID-19 morbidity and mortality rates.

Methods

A cross-sectional study with two phases: correlation-regression interrelations in 1) all world countries; 2) all world non-island countries. The study includes the following data from 218 world countries: COVID-19 morbidity/mortality rates, GDP per capita, the prevalence of overweight/ obesity, NCD mortality among adults (both sexes), people fully vaccinated against COVID-19.

Results

An average percentage of the prevalence of overweight among adults in world countries by 2019 was 47.31 ± 15.99%, obesity 18.34 ± 9.64%, while the prevalence by 2016 were 39% and 13%, respectively. Overweight and obesity among adults during three years grew by 21.2% and 40.8%, respectively.

Data from the world countries provide significant correlations (p < 0.0001) between COVID-19 morbidity, and: GDP (r = 0.517), overweight (r = 0.54), obesity (r = 0.528), NCD mortality (r = 0.537); COVID-19 mortality, and: GDP (r = 0.344), overweight (r = 0.514), obesity (r = 0.489), NCD mortality (r = 0.611); GDP, and: overweight (r = 0.507), obesity (r = 0.523), NCD mortality (r = 0.35), fully vaccinated people (r = 0.754). An increase in fully vaccinated people, from 3% to 30% of world population, decreases new confirmed COVID-19 cases, although the dependence was not significant (p = 0.07).

Data from non-island world countries provides more highly significant correlations (p < 0.0001) between COVID-19 morbidity, and: GDP (r = 0.616), overweight (r = 0.581), obesity (r = 0.583); COVID-19 mortality, and: GDP (r = 0.43), overweight (r = 0.556), obesity (r = 0.539); GDP, and: overweight (r = 0.601), obesity (r = 0.633). The differences of correlation coefficients between data of 176 world countries and data of 143 world non-island countries were not significant (Z-scores<1.29; p > 0.05).

Conclusion

The study provides evidence of a significant impact of overweight/obesity prevalence on the increase in COVID-19 morbidity/mortality. Countries with higher GDP have a high overweight/obesity prevalence and possibility to get vaccinated.

The Effect of Pandemic Movement Restriction Policies on Children's Physical Fitness, Activity, Screen Time, and Sleep

Background: The negative impact of isolation, confinement, and physical (in)activity due to pandemic movement restriction has been well-documented over the past year, but less is known on the impact of these policies on children's physical fitness. This study was designed to determine the effects of pandemic movement restriction policies on the 24-hour movement behavior (24-HMB) of children, and whether any alterations are reflected in worsening physical fitness outcomes determined via direct testing. Methods: A two-phase, repeated-measures study with matched controls was conducted. Phase One: N = 62 schoolchildren (N = 31 female) completed self-assessment questionnaires on 24-HMB in October 2018 (pre-pandemic) and again in April 2020, at the height of movement restrictions enacted in response to the COVID-19 pandemic first wave. Phase Two: physical fitness of the original N = 62 children were determined directly pre- and post-isolation using an eight-component standardized fitness test battery and compared to N = 62 control children who were matched for age, sex, school region, and fitness centile scores. Results: During lockdown (total duration: 63 days), moderate-to-vigorous physical activity (MVPA) decreased by ~46 min per day, screen time demonstrated a significant interaction effect, such that kids reported spending less recreational screen time on weekends during lockdown compared to no restriction, and sleep duration was consistently lower (95% CI: -104.1 to -45.5 min, p < 0.001). No interaction effect was present for direct fitness indicators, including: hand tapping (reaction time), standing broad jump, polygon backward obstacle course (coordination), sit-ups, stand-and-reach, bent-arm hang, 60-m, and 600-m run (p ≥ 0.05) although significant main effects are noted for both sexes. Conclusion: Initial changes in 24-HMB did not translate to reductions in physical fitness per se, likely due to the high initial fitness levels of the children. Further work is needed to confirm whether longer or repeated movement restrictions exacerbate initial negative 24-HMB trends, especially for children who are less fit when restrictions are initiated, prolonged, or repeated.

Excess Body Mass-A Factor Leading to the Deterioration of COVID-19 and Its Complications-A Narrative Review

Currently, the world is facing two serious pandemics: obesity and COVID-19. It is well-established that the prevalence of obesity has risen dramatically, causing a deterioration in the health quality of the population and increasing susceptibility for the unfavourable course of acute infections. It has been observed that excess body mass significantly influences the COVID-19 outcome. The aim of this review is to present the latest scientific reports on the impact of excess body mass on the course and complications of COVID-19. The Web of Science, PubMed, and Google Scholar databases were searched. Only studies reporting patients stated to be COVID-19 positive based on the results of a nasopharyngeal swab and the ribonucleic acid test were included. It is shown that thromboembolic and ischemic complications, namely stroke, disseminated intravascular coagulation, severe hyperglycaemia, and leukoencephalopathy are more likely to appear in COVID-19 positive patients with obesity compared to non-obese subjects. COVID-19 complications such as cardiomyopathy, dysrhythmias, endothelial dysfunction, acute kidney injury, dyslipidaemia, lung lesions and acute respiratory distress syndrome have a worse outcome among obese patients.

COVID-19 in Multimorbid Patients-A Controlled Microcost Description Analysis of Diagnosis Related Group (DRG)-Case Series in Acute Care without Non-Invasive Ventilation

Diagnosis-related cost analyzes are important for health economic planning and decision-making. They form the basis for further developing of remuneration systems for health services. The rapid increase in hospital stays by COVID-19 patients requires a valid and exact calculation of the treatment costs. COVID-19 patients with many accompanying illnesses increase the requirements for a cost calculation. The focus of this work is to carry out a DRG-related micro-cost analysis, considering the age, length of stay and comorbidities of COVID-19 patients. So far, there is little information about treatment costs for multimorbid patients with COVID-19 who have not received invasive ventilation. The method is based on a standardized cost unit calculation for determining the treatment costs in a German hospital. The costs (€) of inpatients treated with COVID-19 were compared with a control group of the same DRGs of patients without COVID-19. The average total costs for inpatient treatment were €2866. The highest share of costs falls on nursing, personnel, and material costs of the non-medical infrastructure. Frequent comorbidities were heart failure, diabetes mellitus, other respiratory diseases, dizziness, and impairment of the musculoskeletal system.

In the post-COVID-19 era, is the illegal wildlife trade the most serious form of trafficking?

Despite the immense impact of wildlife trafficking, comparisons of the profits, costs, and seriousness of crime consistently rank wildlife trafficking lower relative to human trafficking, drug trafficking and weapons trafficking. Using the published literature and current events, we make the case, when properly viewed within the context of COVID-19 and other zoonotic diseases transmitted from wildlife, that wildlife trafficking is the most costly and perhaps the most serious form of trafficking. Our synthesis should raise awareness of the seriousness of wildlife trafficking for humans, thereby inducing strategic policy decisions that boost criminal justice initiatives and resources to combat wildlife trafficking.

Current Activities Centered on Healthy Living and Recommendations for the Future: A Position Statement from the HL-PIVOT Network

We continue to increase our cognizance and recognition of the importance of healthy living (HL) behaviors and HL medicine (HLM) to prevent and treat chronic disease. The continually unfolding events precipitated by the coronavirus disease 2019 (COVID-19) pandemic have further highlighted the importance of HL behaviors, as indicated by the characteristics of those who have been hospitalized and died from this viral infection. There has already been recognition that leading a healthy lifestyle, prior to the COVID-19 pandemic, may have a substantial protective effect in those who become infected with the virus. Now more than ever, HL behaviors and HLM are essential and must be promoted with a renewed vigor across the globe. In response to the rapidly evolving world since the beginning of the COVID-19 pandemic, and the clear need to change lifestyle behaviors to promote human resilience and quality of life, the HL for Pandemic Event Protection (HL-PIVOT) network was established. The 4 major areas of focus for the network are: (1) knowledge discovery and dissemination; (2) education; (3) policy; (4) implementation. This HL-PIVOT network position statement provides a current synopsis of the major focus areas of the network, including leading research in the field of HL behaviors and HLM, examples of best practices in education, policy, and implementation, and recommendations for the future.

Costs of the COVID-19 pandemic associated with obesity in Europe: A health-care cost model

Excess weight is associated with severe outcomes of coronavirus disease 2019 (COVID-19). We aimed to estimate the total secondary care costs by body mass index (BMI, kg/m2 ) category when hospitalized due to COVID-19 in Europe during the first wave of the pandemic from January to June 2020. Building a health-care cost model, this study aimed to estimate the total costs of COVID-19. Information on risk of hospitalization, admission to intensive care unit (ICU) and risk of ventilation were based on published data. Average cost per patient and in total were calculated based on risks of admission to ICU, risk of invasive mechanical ventilation and length of hospital stay when hospitalized and published costs associated with hospitalization. The total direct costs of secondary care during the first wave of COVID-19 in Europe were estimated at EUR 13.9 billon, whereof 76% accounted for treating people with overweight and obesity. The average cost per hospital admission increased with BMI, from EUR 15831 for BMI <25 kg/m2 to EUR 30982 for BMI ≥40 kg/m2 . This study reveals that excess weight contributes disproportionally to the costs of COVID-19. This might reflect that overweight and obesity caused the COVID-19 pandemic to result in more severe outcomes for citizens and higher secondary care costs throughout Europe.

Costs of COVID-19 pandemic associated with diabetes in Europe: a health care cost model

OBJECTIVE

Diabetes is associated with progression to severe COVID-19. The objective of this study was to estimate to what extent the increased risk among people with diabetes could impact the secondary care costs of COVID-19 throughout Europe during the first wave of the COVID-19 pandemic from January to June 2020.

METHODS

Applying a health care cost model based on inputs from data published in international peer-reviewed journals, identified via a rapid literature review this study aimed to estimate the total secondary sector costs of COVID-19. Estimates of unit costs were based on data from Denmark, France, Spain and the UK. We calculated average costs per patient without diabetes and according to four diabetes categories based on risk of hospitalization, admission to intensive care unit, ventilator support and length of hospital stay.

RESULTS

The estimated cost per hospital admission during the first wave of COVID-19 in Europe ranged between EUR 25,018 among people with type 2 diabetes in good glycaemic control to EUR 57,244 among people with type 1 diabetes in poor glycaemic control, reflecting higher risk of intensive care, ventilator support and longer hospital stay according to diabetes category, while the corresponding cost for people without diabetes was estimated at EUR 16,993. The total direct costs of secondary care of COVID-19 in Europe were estimated at EUR 13.9 billion. Thus, 23.5% of the total costs accounted for treating people with diabetes.

CONCLUSIONS

This study highlights the importance of a greater focus on prevention and adequate treatment of diabetes and the need for special attention to avoid infection with COVID-19 to the extent possible among those already diagnosed with diabetes.