News Release

COVID-19 caused second-largest infection mortality disaster in Switzerland, Sweden, and Spain since 1918

Embargoed News from Annals of Internal Medicine

Peer-Reviewed Publication

American College of Physicians

1. COVID-19 caused second-largest infection mortality disaster in Switzerland, Sweden, and Spain since 1918


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A study of continuous monthly mortality data for more than 100 years in Switzerland, Sweden, and Spain found that excess deaths associated with the COVID-19 pandemic reached greater peaks than most other periods of excess deaths since 1918. The findings are published in Annals of Internal Medicine.

Switzerland, Sweden, and Spain are particularly suitable for an over-time perspective of excess mortality because they have reliable continuous data on death counts and were militarily neutral during both world wars. Historical data may help to support planning and preparing for current and future pandemics.

In collaboration with the Swiss Federal Statistical Office, researchers from the Universities of Zurich, Bern and Oslo estimated age-specific, monthly excess deaths from all causes for Switzerland, Sweden, and Spain for 2020 to 2021 and other pandemic periods since the end of the 19th century in chronological order. The authors collected data for monthly all-cause deaths from each country’s statistical office and used yearly data on population size and age structure to account for demographic shifts over time. After conducting statistical analysis, the authors found that for all three countries 2020 marked the highest number of excess deaths since 1918. However, excess deaths in 1918 were still estimated to be six to seven times higher than 2020. The relative excess of deaths in 2020 was 12.5 percent in Switzerland, 8.5 percent in Sweden, and 17.3 percent in Spain. According to the authors, excess mortality in 2020 might have been even higher if not for strong public health interventions worldwide.

Media contacts: For an embargoed PDF, please contact Angela Collom at The corresponding authors, Kaspar Staub ( and Marcel Zwahlen ( can be reached directly.


2. Long-acting injectable PrEP too costly for payers compared with generic daily oral formulation

Even at higher cost, injectable PrEP may have high value and utility for vulnerable minority populations



A cost-effectiveness analysis found that the long-acting injectable form of HIV PrEP (preexposure prophylaxis), cabotegravir (CAB-LA), is too costly at its current price given the alternative option of generic daily oral emtricitabine–tenofovir disoproxil fumarate (F/TDF). According to the authors, injectable PrEP would have the highest value and greatest utility in settings and for individuals that find using daily oral PrEP to be challenging or impossible. The findings are published in Annals of Internal Medicine.

An international clinical trial, HIV Prevention Trials Network (HPTN) 083, comparing CAB-LA and F/TDF found that CAB-LA usage was associated with a more significant reduction in incident HIV infections. However, the cost of F/TDF is much lower than other available HIV PrEP medications.

Researchers from Harvard Medical School used the Cost-Effectiveness of Preventing AIDS Complications model to simulate a population prescribed PrEP with risk factors for HIV similar to the participants in HPTN 083. The authors then created a 10-year planning horizon for four strategies: no PrEP usage, generic F/TDF usage, branded F/TAF usage, and CAB-LA usage. They calculated projected clinical benefits, including primary HIV transmissions, quality-adjusted life-years (QALYs), and mortality. They also calculated the costs of HIV care and PrEP as well as incremental cost-effectiveness ratios over the same 10-year period. The authors found that after calculating 10-year clinical outcomes, total primary HIV transmissions were highest for no PrEP usage and lowest for CAB-LA usage. The authors found that at a range of willingness-to-pay thresholds ($50,000-$300,000/QALY), CAB-LA for PrEP among those at high risk for HIV would only provide good value for money if its annual price was less than $6,600 higher than generic oral PrEP, which is less than half of CAB-LA’s current cost. They suggest that effective oral PrEP limits the additional price payers should be willing to pay for long-acting injectable PrEP. For people who are unable to take oral PrEP, a higher price would be justifiable, but still lower than current pricing. In addition, the authors note that for individuals with an increased risk of HIV infection (such as eligible men who have sex with men), any PrEP strategy would lead to substantial clinical improvements, life-years gained, and reductions in HIV transmissions compared with no PrEP usage.

According to the authors of an accompanying editorial from The State University of New York at Albany and Emory University, this analysis yields important findings about the economic aspects of long-term injectable PrEP and sets the groundwork for addressing pressing questions related to policy, programs, and social justice related to HIV management and prevention.

Media contacts: For an embargoed PDF, please contact Angela Collom at To speak with corresponding author, Anne M. Neilan, MD, MPH, contact Noah Brown at


3. Electrocardiographic artifacts synchronized with cardiac rhythm may suggest pathological condition in healthy patient


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A case report published in this issue of Annals of Internal Medicine shows that electrocardiographic artifacts that are synchronized with cardiac rhythm may suggest a pathological condition in a healthy patient. The authors describe how identifying and moving the suspect electrode away from the pulsation and repeating the electrocardiogram produced a normal result in their patient.

Authors from the Cardiovascular Institute of the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China describe the case of a 34-year-old previously healthy man who was given a cardiologic evaluation. His electrocardiogram showed an abnormal U wave and a prolonged QTU interval. However, the patient denied family history of tachycardia or syncope, was not taking medication, and had laboratory and echocardiogram results within normal limits. The authors also noted that in lead I, the abnormal U wave was absent and the QT interval was normal.

The authors suspected the patient’s abnormal electrocardiogram was caused by an electrocardiographic artifact because of these conditions and the overall different abnormalities among leads. They chose to examine the left leg electrocardiogram electrode because most other limb leads and precordial leads depend on the left leg electrocardiogram electrode. After observing and accounting for an arterial pulsation in the left leg timed with cardiac rhythm, they recorded a normal electrocardiogram. According to the authors, this case shows that it is possible for clinicians to mistake electrocardiogram artifacts that are synchronized with cardiac rhythm for pathologic conditions.

Media contacts: For an embargoed PDF, please contact Angela Collom at To speak with corresponding author, Renguang Liu, MD, please email


New COVID-19 content this week:

Effectiveness of Inactivated COVID-19 Vaccines Against Illness Caused by the B.1.617.2 (Delta) Variant During an Outbreak in Guangdong, China

Min Kang, MMed*; Yao Yi, MMed*; Yan Li, PhD; Limei Sun, BM; Aiping Deng, MMed; Ting Hu, MMed; Jiayi Zhang, MMed; Jun Liu, MPAM; Mingji Cheng, MMed; Shen Xie, MMed; Min Luo, MMed; Jing Jiang, MMed; Yawen Jiang, PhD; Shixing Tang, PhD; Jianfeng He, BSc

Original Research


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A study from Sun Yat-sen University, Guangzhou, Guangdong, China found that full vaccination with inactivated COVID-19 vaccines is effective against the B.1.617.2 (Delta) variant. The findings are based on the first outbreak of the B.1.617.2 variant in mainland China that was discovered and traced in Guangdong in May and June 2021. The study is published in Annals of Internal Medicine.

Media contacts: For an embargoed PDF and author contact information, please contact Angela Collom at


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