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Take a look at a selection of our recent media coverage:

Wake-up rehab strategy during ECMO therapy shown to improve prognosis

27th February 2024

Waking critically ill Covid-19 patients for rehabilitation during prolonged extracorporeal membrane oxygenation (ECMO) therapy can improve their prognosis, a new study has found.

Seriously ill Covid-19 patients usually needed a longer period of extracorporeal support than other acute respiratory distress syndrome (ARDS) patients, researchers explained in the journal Annals of the American Thoracic Society.

To understand the factors influencing prognosis and the benefits of a wake-up strategy, researchers conducted a retrospective observational study of 120 patients with Covid-19-related ARDS who required extracorporeal support for more than 28 days from four European high-volume ECMO centres.

Analysing patient outcomes, researchers found 64 people (53.3%) survived decannulation, 62 (51.7%) were alive at hospital discharge and 61 (50.8%) were alive at six-months follow-up.

In a multivariate analysis, younger age was found to be a predictor of hospital survival together with an awake ECMO strategy – defined as the patient being awake, cooperative, and performing rehabilitation and physiotherapy with or without invasive mechanical ventilation at any time during the extracorporeal support.

‘Sedation withdrawal and active rehabilitation are feasible in patients with extracorporeal respiratory support, given that ECMO offers an efficient way of maintaining an adequate gas exchange with the potential of titrating the support according to the patient’s oxygen consumption,’ the researchers wrote.

More than 75% of the cohort of patients receiving the awake ECMO strategy were alive at six months, the researchers said, compared with 41.4% of the most inactive cases.

Patients who were woken during ECMO also required less rehabilitation after discharge, with 68.2% of them requiring discharge to a rehabilitation centre compared with 80.6% of inactive patients.

Senior study author Dr Jordi Riera, director of the adult ECMO program at Vall d’Hebron University Hospital, Spain, and principal investigator of the hospital’s research group on Shock, Organ Dysfunction and Resuscitation, said there were many advantages to the wake-up strategy, including interaction with relatives which offered cognitive and emotional benefits.

‘In addition, if healthcare professionals can communicate with patients, a more accurate diagnosis can be made based on the symptoms they are explaining and, therefore, therapy can be better adjusted,’ said Dr Riera.

Waking patients also minimised some complications, he said, including fewer infections, as patients were able to cough, and less lung damage associated with ventilation.

Although this study was focused on patients with Covid-19, the researchers suggested these results could be generalisable to patients with respiratory dysfunction from other causes.

They also emphasised that despite requiring ECMO for one month, it was possible for these critically ill Covid-19 patients to make a full recovery without the need for oxygen therapy.

At six months, 51 (42.5%) patients were at home, 42 (84.3%) of them without oxygen therapy, the researchers highlighted.

However, longer duration of ECMO support was correlated with need for oxygen therapy at six months.

A cut-off point of 47 ECMO days had a 100% sensitivity and 60% specificity for oxygen therapy at six months, with 100% specificity being found in 97 days.

‘In our view, this cut-off point should be used as a reminder of the possibility of non-recovery and may be used as a trigger for initial contact with an experienced [lung] transplant team for assessment and advice,’ the study authors wrote.

‘However, it must be noted that oxygen therapy on itself is not an indication for lung transplant and that complete recovery has been observed in patients supported with ECMO up to 97 days in this very same cohort.’

Covid-19 undervaccination led to thousands of deaths in UK, research shows

16th January 2024

People not having all their recommended doses of the Covid-19 vaccine led to thousands of unnecessary deaths and severe outcomes, researchers have found.

Over 7,000 hospitalisations and deaths might have been avoided in summer 2022 if there had been ‘full’ Covid-19 vaccination coverage across the UK, according to a new study published in The Lancet,

Using health record data from participants over four years old, researchers found that between a third and a half of the populations of the four UK nations had not received the recommended number of Covid-19 vaccinations by summer 2022.

Over the period between the start of June and the end of September that year, they used a ‘counterfactual scenario’ in which everyone in the UK was fully vaccinated in order to estimate the potential reduction in ‘severe Covid-19 outcomes’.

The study concluded that there would have been 7,180 fewer hospitalisations or deaths across all age groups, down from the 40,393 that actually took place, indicating that ‘higher vaccination coverage would have been associated with considerable reduction in severe Covid-19 outcomes’. 

Among the undervaccinated, the researchers estimated there would have been a 50% reduction in these events.

They also found that younger, more deprived or non-white people, or those with a lower number of comorbidities, were less likely to be fully vaccinated. 

The study defined ‘undervaccination’ as having received fewer than the recommended number of vaccine doses.

Rates of ‘undervaccination’ against Covid-19 across the UK as of 1 June 2022 were:

  • England – 45.8% (26,985,570 of 58,967,360)
  • Northern Ireland – 49.8% (938,420 of 1,885,670)
  • Scotland – 34.2% (1,709,786 of 4,992,498)
  • Wales – 32.8% (773,850 of 2,358,740)

‘The effect of being undervaccinated on severe Covid-19 outcomes was notably larger than the effect of ethnicity or socioeconomic status,’ the researchers concluded. 

They also said health policy and public health interventions need to be formulated with the aim of improving coverage among the ‘undervaccinated’ demographics.

‘This could, for example, include the need to tackle vaccine misinformation in a more direct fashion, and to continue to diversify the use of champions to support public messaging and the range of community-based centres offering vaccinations,’ the study said.

Dr Andrew Freedman, consultant in infectious diseases and vaccine clinical trials at Cardiff University School of Medicine, said the study ‘clearly demonstrates how effective Covid vaccines were at reducing the risk of severe outcomes’ from the disease during summer 2022.

He said: ‘As the authors point out, these findings will help identify which groups should in future be specifically targeted to maximise uptake of vaccines for Covid and other infections. This will be particularly crucial in the event of another pandemic.’

Dr Freedman also noted that the study’s inclusion of data from the whole UK population – the first of its kind – is a ‘remarkable achievement’. 

A version of this article was originally published by our sister publication Pulse.

NICE recommends huge expansion of Covid-19 antiviral eligibility in at-risk groups

12th January 2024

Around 1.4 million more people in the UK will be eligible for antiviral treatment nirmatrelvir plus ritonavir (brand name Paxlovid) if they test positive for Covid-19 after final draft guidance from the National Institute for Health and Care Excellence widens access.

It follows a partial review of the evidence that identified additional groups of people who are at increased risk of severe Covid-19.

Under the recommendations, nirmatrelvir plus ritonavir will be available after a positive Covid-19 test to people aged 85 and over, as well as people who are resident in a care home or are already hospitalised and are aged 70 years and over, have a body mass index greater than 35 kg/m2 or have diabetes or heart failure.

People with end-stage heart failure who have a long-term ventricular assistance device and those on the organ transplant waiting list will also be eligible.

The eligibility is in addition to the 3.9 million people who were already identified as being as increased risk of progression to severe illness if they were infected with Covid-19, NICE said.

Those who are eligible can get free lateral flow tests from participating pharmacies and should take a test as soon as they have symptoms, even if mild, NICE reiterated before calling their GP, NHS 111 or hospital specialist if they test positive.

Helen Knight, director of medicines evaluation said: ‘Our review of the evidence on the use of Paxlovid has found it offers value for money for a wider group of patients.

‘This is good news for people who may contract Covid-19 in the coming months and will help alleviate pressure on the health service.‘

She added: ‘Although we are no longer in a pandemic, Covid-19 is still circulating and we are pleased that more people at risk of severe disease can benefit from Paxlovid.’

Nirmatrelvir plus ritonaviris is an antiviral medicine, given as two separate tablets to people within five days of Covid-19 symptom onset.

Nirmatrelvir stops the virus from growing and spreading, and ritonavir helps nirmatrelvir from being broken down in the body while it is working.

UK public health officials have reported rising levels of winter bugs in the past week with rates of flu, Covid-19 and norovirus continuing to rise.

The latest figures also show a rise in Covid-19 hospitalisations in the last week of 2023 as well as patients admitted to ICU with complications of the virus.

Pandemic lockdowns linked to sustained cognitive decline among older adults, study finds

8th November 2023

There was a more rapid cognitive decline in people aged over-50 during the pandemic, according to recent research, highlighting the need for public health measures to protect against dementia risk.

Covid-19 infection was found to be a risk factor, but the general more rapid decline in brain health was apparent even if people had not had the virus, the researchers found.

Published in the journal The Lancet Healthy Longevity, the online PROTECT study found a 50% change in the rate of cognitive decline in the first year of the pandemic among the 3,000 participants.

The analysis of tests of short-term memory and complex tasks also found that the rate of cognitive decline was higher in those who already had mild cognitive decline before the pandemic.

It appears to have been exacerbated by a number of factors among the 50-to-90-year-olds taking part, including an increase in loneliness and depression, a decrease in exercise and higher alcohol consumption.

In the second year of the pandemic, reduced exercise continued to affect executive function and associations were sustained between worsening working memory and increased alcohol use. This suggested a sustained impact after the initial 12-month period of lockdowns, the team from the University of Exeter and King’s College London (KCL) said.

The sustained drop in cognition highlights the need for public health interventions to mitigate the risk of dementia – particularly in people with mild cognitive impairment where diagnosis of dementia within five years is a substantial risk, they concluded.

Professor Anne Corbett, professor of dementia research and the PROTECT study lead at the University of Exeter, said: ‘Our findings suggest that lockdowns and other restrictions we experienced during the pandemic have had a real lasting impact on brain health in people aged 50 or over, even after the lockdowns ended.

‘This raises the important question of whether people are at a potentially higher risk of cognitive decline which can lead to dementia.

‘It is now more important than ever to make sure we are supporting people with early cognitive decline, especially because there are things they can do to reduce their risk of dementia later on.’

She added that the findings highlight the need for policymakers to consider the wider health impacts of restrictions like lockdowns when planning future pandemic responses.

Professor Dar Aarsland, professor of old age psychiatry at KCL, said the research adds to the knowledge of the long-standing health consequences of Covid-19, particularly for the most vulnerable people such as older people with mild memory problems.

He said: ‘We know a great deal of the risks for further decline, and now can add Covid-19 to this list. On the positive note, there is evidence that lifestyle changes and improved health management can positively influence mental functioning. The current study underlines the importance of careful monitoring of people at risk during major events such as the pandemic.’

A version of this article was first published by our sister publication Pulse.

One in 20 patients have long Covid over a year after infection, study reveals

6th November 2023

Tens of thousands of people are suffering with long Covid symptoms more than a year after infection, say researchers who carried out the UKs largest study of the impact of the virus.

A survey of a quarter of a million people taking part in the REACT study found that while most people recover within 12 weeks, 7.5% of people had persistent symptoms for more three months and 5% reported symptoms lasting more than a year.

But people infected in the Omicron wave of the pandemic were 88% less likely to experience symptoms longer than four weeks after infection, compared to earlier wave, the study found, which could be due to immunity building up in the population and vaccination.

The new analysis, published in the journal Nature Communications, also highlighted how persistent symptoms of Covid-19 were related to worse mental health and quality of life.

Being female, already having more than one comorbidity, being from a deprived area, and being infected with an original strain of Covid-19 were all related with higher risk of symptoms lasting more than 12 weeks and longer recovery time in those with persistent symptoms, the researchers said.

The survey results – which were collected in towards the end of 2022 – show a snapshot of the continued impact of Covid-19 in the UK, the Imperial College London team noted.

Mild fatigue, difficulty thinking or concentrating and joint pains were the most common ongoing symptoms. But others reported loss or change of sense of smell or taste, shortness of breath, severe fatigue, chest tightness or pain, and poor memory.

Almost a third of people reporting symptoms at 12 weeks recovered within a year, the researchers found.

Professor Paul Elliott, chair of epidemiology and public health medicine at Imperial College London, said: ‘We find that the variant of SARS-CoV-2 people are infected with, the initial severity of their symptoms, and whether they have pre-existing health conditions all have an impact on whether they will develop lasting symptoms.’

Study lead Dr Christina Atchison, principal clinical academic fellow within the School of Public Health at Imperial College London, said while the landscape has changed considerably since the early peak of the Covid-19 pandemic, this analysis shows that a proportion of adults are still experiencing lasting symptoms.

‘Importantly, we find that compared to wild type virus, those infected when Omicron was dominant were far less likely to report symptoms lasting beyond 12 weeks,‘ she said. ‘This may reflect the changing levels of immunity in the population from previous exposure to the virus and vaccination.’

The team is now doing detailed interviews with some of those affected with ongoing symptoms to further understand the variation in people’s experiences and the impact on their everyday lives as well as the broader longer-term impact of the pandemic on health and wellbeing of those who took part in REACT.

This article was originally published by our sister publication Pulse.

Ensitrelvir shows benefits for Covid-19 and long Covid in two studies

27th September 2023

The benefits of ensitrelvir use in patients with symptoms of long Covid and as a second-line treatment option for those hospitalised with Covid-19, have been presented at the recent European Scientific Working Group on Influenza and other Acute Respiratory Viruses’ (ESWI) Influenza Conference.

Ensitrelvir is an oral antiviral drug for Covid-19 manufactured by Shionogi, which is currently approved under the emergency regulatory approval system in Japan. The drug inhibits 3CL protease, an enzyme that is essential for the replication of the virus.

The first study presented at the ESWI Influenza Conference was an exploratory analysis of the Phase 3 part of the pivotal SCORPIO-SR trial. Conducted in Japan, South Korea and Vietnam, the researchers found that ensitrelvir may reduce the risk of a number of persistent and new late-onset symptoms associated with long Covid over one year.

Long Covid was analysed based on a patient-reported questionnaire at three, six and 12 months from the first date of treatment. The researchers defined long Covid by patient reports of ‘not having returned to pre-Covid health’ and having at least one (mild or more severe) symptom out of 27 possible symptoms.

The use of ensitrelvir at doses of 125 mg and 250 mg, showed a numerical relative risk reduction of 25% and 26% respectively when compared to the placebo for 27 long Covid symptoms at one year. A similar trend in risk reduction was observed at three and six months.

Furthermore, in subgroup analyses, there was a greater risk reduction in patients with a body mass index of ≥25 kg/m2 as well as in those with a median or higher symptom score at the start of treatment.

These results suggest that early treatment of Covid-19 with ensitrelvir could reduce the risk of a number of persistent and new late-onset symptoms associated with long Covid.

Dr Andreas Karas, vice president, medical affairs, Shionogi Europe, said: ‘As Covid-19 remains endemic, persisting symptoms continue to adversely affect millions of people worldwide. We’re pursuing further research to substantiate the potential of ensitrelvir as a treatment option for acute Covid-19 infection and whether this can prevent the long-term effects the virus can cause.

‘We look forward to sharing the results at ESWI and to hearing from the community as we advance our global ensitrelvir clinical development program.‘

Ensitrelvir for hospitalised patients

In the second study presented at the ESWI Influenza Conference, researchers suggested that for hospitalised patients with Covid-19 and significant co-morbidities who failed to respond to remdesivir as the first-line treatment, ensitrelvir could serve as an alternative treatment.

The small, real-world study from Japan, conducted at the Rinku General Medical Centre, included 21 high-risk hospitalised patients with Covid-19 infections who failed to respond to a three-day course of remdesivir.

These patients, who had either a mild or moderate severity infection and of whom a third (33.3%) had co-morbidities, then received five days of treatment with ensitrelvir 125 mg.

After five days of treatment, all 21 patients showed clinical improvement. Furthermore, no deaths or drug-related adverse events were observed at day 28, but one person later died in the hospital at day 59.

Masaya Yamato, an investigator on these trials and director of the Infectious Diseases Center at Rinku General Medical Center in Osaka, Japan, said: ‘While certain treatments are available for high-risk people with Covid-19 to reduce the risk of becoming seriously ill, additional treatment options are needed. These results indicate the potential for ensitrelvir to help address these needs.‘

Ensitrelvir remains an investigational drug outside of Japan. In April 2023, the FDA in the US recently granted fast track designation to the drug for Covid-19. This process is designed to facilitate the development and expedite the review of potential new therapies that treat serious conditions and fulfil an unmet medical need.

Frequent and diverse use of antibiotics linked to severe Covid-19 side effects

7th July 2023

Patients with higher prior antibiotic use are more likely to experience severe Covid-19 outcomes after infection, including hospitalisation and death, a new study led by the University of Manchester has shown.

When infected with Covid-19, the chances of dying from complications due to Covid-19 is 1.34 times higher in patients with the most exposure to antibiotics than those without antibiotic exposure.

The research, published in The Lancet‘s eClinicalMedicine, is the first to explore how the severity of Covid-19 is affected by prior antibiotic use.

The UK team of scientists behind the work say the findings should act as a warning against the overuse of antibiotics.

Primary and secondary care data

Using the NHS OpenSAFELY platform, which enabled the researchers to look at electronic health records across primary and secondary care, the team examined data from 670,000 patients infected with Covid-19 between February 2020 and December 2021. The patients were reviewed for Covid-19 outcomes and divided into five groups based on the frequency with which they had taken antibiotics three years prior to infection.

Each group was further split based on the number of different antibiotics a patient used, giving the researchers an understanding of how the frequency and diversity of antibiotic use affect the body’s response to a Covid-19 infection. Of the sample, 98,420 patients were admitted to hospitals, 22,660 died, and 55 unique antibiotics were prescribed.

Patients with more frequent antibiotic exposure in the past three years were more likely to experience severe Covid-19 outcomes, including admission to hospital and death within 30 days.

The odds of being hospitalised due to a Covid-19 infection were 1.8 times higher for those with the highest history of antibiotic use and the most diversity of antibiotic use. Using a range of antibiotics was more likely to be associated with Covid-19 hospital admission, and using a larger range of antibiotic types was associated with more severe consequences of Covid-19 upon hospital admission.

Antibiotics and gut resilience

Professor Tjeerd van Staa, a principal investigator from the University of Manchester, said: ‘Our study has provided evidence that patients with high prior antibiotic use were more likely to experience severe Covid-19 outcomes. In addition, we also found an association between the number of different prior antibiotic types and Covid-19 related hospital admission.’

The researchers suggest this may be because frequent antibiotic use can increase the likelihood of patients being infected with viruses or bacteria, leading to an increased susceptibility to adverse consequences of infection.

Professor Van Staa added: ‘The literature shows that antibiotic treatment might alter gut microbiota, which can impact metabolic and immune function. While in most situations gut microbiota will recover after stopping an antibiotic course, frequent antibiotic use may affect the resilience of gut microbiomes more seriously.’

The researchers suggest that antibiotic guidelines should outline the possible adverse consequences of the overuse of antibiotics, and personalised patient leaflets could highlight these risks and the risks of the patient’s bacteria developing resistance to antibiotics.

Co-principal investigator Dr Victoria Palin from the University of Manchester said: ‘Common infection guidelines in England, as developed by the National Institute for Health and Care Excellence, focus on the treatment of the first infection episode. They do not provide guidance around repeated antibiotic use and a patient’s risk of developing resistance.’

She added: ‘There needs to be more awareness of the impact of long-term antibiotic exposure and its adverse outcomes. We would discourage regular and indiscriminate prescribing of these drugs for self-limiting infections.’

This article was originally published by our sister publication Nursing in Practice.

Health in Sweden

4th July 2023

Life expectancy in Sweden is among the highest in the EU, although it declined by nearly one year in 2020 as a result of the Covid-19 pandemic. The healthcare system generally performs well in providing good access to high-quality care.

However, challenges persist in providing equal access to care for the population living in different regions, ensuring timely access to care, achieving greater care coordination for people with chronic diseases and improving the quality of long-term care.

Sweden’s health status

Life expectancy at birth was 82.4 years in 2020 – almost two years above the EU average – but it fell by almost one year in 2020 because of the high number of deaths from Covid-19. More than two thirds of Covid-19 deaths were among people aged 80 and over.

Risk factors

Smoking rates among adults in Sweden are among the lowest in EU countries, but use of other tobacco products such as snuff is common. Overall alcohol consumption per adult has decreased over the past decade and is much lower than the EU average. Adolescents in Sweden also report low rates of smoking and excessive alcohol intake, but high rates of physical inactivity.

Sweden’s health system

Health spending per capita in Sweden was the fourth highest in the EU in 2019, and the third highest in terms of health spending as a share of GDP. Most health spending is publicly funded (85%). The growth rate in health spending was relatively modest in the years prior to the pandemic, but the government increased spending on health in 2020 and 2021 in response to Covid-19.

Effectiveness

Sweden had low rates of mortality from preventable and treatable causes in 2018, pointing to a generally effective public health and healthcare system under normal circumstances.

Accessibility

During the first year following the pandemic, one in six people in Sweden reported some unmet needs for medical care, which is slower than the EU average. The use of teleconsultations increased quickly in Sweden during the pandemic to maintain access to care.

Resilience

Sweden tried to balance protection of people’s health and protection of economic and social activities in managing the Covid-19 crisis. While fewer restrictions were imposed, particularly during the first wave, the death toll was high compared with other Nordic countries. By end of August 2021, 58% of the population had received two doses or the equivalent – slightly more than the EU average.

OECD/European Observatory on Health Systems and Policies (2021), Sweden: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

Health in Slovenia

Life expectancy in Slovenia has increased markedly since 2000, but in 2020 the Covid-19 pandemic temporarily erased a year’s worth of gains. The Slovenian health system provides near universal coverage and a broad benefits package.

Voluntary health insurance plays a large role in covering co-payments levied on services; this also confers a considerable degree of financial protection from out-of-pocket payments.

The pandemic exacerbated or laid bare health system weaknesses, including workforce shortages, long waiting times, ageing hospital facilities and fragmented and underfunded long-term care.

Slovenia’s health status

Life expectancy in Slovenia had increased by over five years between 2000 and 2019. However, in 2020 the Covid-19 pandemic reversed this trend: life expectancy fell from 81.6 years in 2019 to 80.6 in 2020. Stroke, ischaemic heart disease and lung cancer are usually the main causes of mortality, but Covid-19 was responsible for the largest number of deaths in 2020.

Risk factors

More than one fifth of Slovenian adolescents were overweight or obese in 2018. Alcohol intake among both adults and adolescents ranks above the average across EU countries, with binge drinking much more prevalent among male adults. Smoking prevalence has decreased for both adults and adolescents over the last decade, but over one in six adults are still daily smokers. The increasing popularity and use of e-cigarettes is also a concern.

Slovenia’s health system

Health expenditure per capita has risen marginally over the last few years, but it remains well below the rate across the EU as a whole, as does spending as a share of GDP. Public financing of the health system accounted for 73% of health spending in 2019. Out-of-pocket spending is among the lowest in the EU, however, due mainly to extensive uptake of voluntary health insurance to cover co-payments.

Effectiveness

Mortality from preventable causes remains above the EU average. In contrast, mortality from treatable causes is lower than the EU average, indicating that the healthcare system is generally effective in providing care for people with potentially fatal conditions.

Accessibility

Prior to the Covid-19 pandemic, unmet needs for medical care were low, at 2.9% of the population, with waiting times the primary driver. In 2020, the demand for Covid-19-related care often led to delayed or forgone consultations and treatment for other health issues. Around 24% of the population reported forgone medical care during the first 12 months of the pandemic.

Resilience

The Covid-19 pandemic revealed several resilience challenges, including workforce shortages and underdeveloped long-term care infrastructure prompting plans for more investment. Slovenia accelerated its vaccination campaign in spring 2021, and at the end of August 2021, 43% of the population had received two vaccine doses (or equivalent).

OECD/European Observatory on Health Systems and Policies (2021), Slovenia: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

Health in Slovakia

3rd July 2023

Life expectancy in Slovakia is among the lowest in Europe, and temporarily fell by almost one year in 2020 due to the impact of Covid-19. Behavioural and environmental risk factors contribute to nearly half of all deaths.

The Slovak population enjoys a broad benefits package, which includes recently introduced telemedicine. However, low levels of health spending and health workforce shortages remain persistent issues that were exacerbated by the pandemic.

Slovakia’s health status

Life expectancy in Slovakia increased by more than two years between 2010 and 2019, only to fall by almost one year in 2020 due to Covid-19 deaths. It remains nearly four years below the EU average. Disparities in life expectancy by socioeconomic status remain among the largest in the EU. Slovakia also has one of the highest cancer mortality rates in the EU.

Risk factors

While adult tobacco consumption declined in most countries over the past decade, in Slovakia it remained stable and is currently above the EU average. Alcohol consumption is comparable to the EU average. Obesity rates among adults and adolescents are on the rise and higher than the EU average, due in part to poor nutritional habits and limited levels of physical activity.

Slovakia’s health system

Slovakia spends less than half the EU average on health, at €1,513 compared to €3,521 per person in 2019, adjusted for differences in purchasing power. Around 80% of health spending is publicly financed, and out-of-pocket payments accounted for almost 20% of health expenditure in 2019 compared to 15.4% in the EU.

Effectiveness

Slovakia has among the highest mortality rates from preventable and treatable causes in the EU. Despite improvements, cardiovascular disease remains the leading cause of death. Substantial room for improvement remains for effective public health policies to reduce premature deaths.

Accessibility

Access to healthcare is generally good in Slovakia, with only 2.7% of the population reporting unmet medical care needs before the pandemic. However, during the first 12 months of the pandemic, 23% of people reported forgone medical care. The introduction of telemedicine helped to maintain access to care during the second wave of the pandemic.

Resilience

Slovakia had low Covid-19 case numbers during the first wave of the pandemic, due in part to quick implementation of containment measures. However, numbers rose significantly during the second wave; three quarters of all Covid-19 deaths occurred in the first half of 2021. As of August 2021, 40% of the population had received two vaccine doses (or equivalent) – a proportion lower than the EU average.

OECD/European Observatory on Health Systems and Policies (2021), Slovakia: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

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