gms | German Medical Science

Background and current state of (inter)national research: The COVID-19 pandemic has presented the world with unforeseeable challenges and affected more than 18 million people worldwide so far. However, countries have responded differently regarding both the scope and timing of implemented measures to curb the spread of SARS-CoV-2 and manage patients with COVID-19. Differences in testing strategies, hospitalization protocols and ensuring ICU capacities have been described, but not empirically analysed in combination.

Research questions and objectives: The objective of the presented study was to compare health care utilization across a number of European countries in light of their adopted strategies to tackle COVID-19, evaluate potential changes over time and provide insights for future pandemic preparedness.

Methods or hypothesis: We systematically collected publicly available epidemiological and health care data on COVID-19 provided by the designated official authorities in 18 European countries. The presented analysis focuses on a subset of 11 countries (including Germany), for which sufficient information on tests numbers, current and cumulative incidence, hospitalizations and ICU patients for the period between 24 February and 31 July 2020 was available. We compared the relationship between test numbers, incidence, hospitalizations, and ICU-treatments at peak and steady state to evaluate whether certain patterns regarding timing and extent of utilization can be identified. Furthermore, we used information on country practices documented on the Health System Response Monitor of the European Observatory on Health Systems and Policies to put patterns in context.

Results: Preliminary results illustrate a wide variation of healthcare strategies among included countries. At the peak of the pandemic, the ratio of tests to confirmed cases ranged from 5:1 to 19:1, indicating differences in testing strategies. The ratio of all cases to cases hospitalized varied from 2:1 to 13:1. This partly explains the differences in the ratio of total hospital cases to ICU cases, which ranged from 4:1 to 9:1. While countries adjusted their strategies as the pandemic progressed, and utilization patterns changed, variability persisted.

Discussion: Given the complexity of the challenges brought on by the COVID-19 pandemic, it was difficult to distinguish the effects of different strategies, particularly in light of concerns about the data used, regarding both quality and comparability. Observed differences between countries reflected variable epidemiological developments, health system set-ups and response plasticity. Differences between and changes in the mode of collecting and/or reporting data further limited comparability in this analysis, and regional differences were not taken into account.

Practical implications: The described results can contribute to the formulation of evidence based practice and aid policy-makers in tackling the ongoing COVID-19 pandemic and enhancing future preparedness. To assign effects to individual measures, further empirical research is required.