Association Between Statewide School Closure and COVID-19 Incidence and Mortality in the US

Objective: To estimate global, regional, and national incidences and mortality of the coronavirus disease 2019 (COVID-19) in 237 countries and territories since the outbreak of the COVID-19 pandemic to 31 January, 2022. Methods: Comprehensive estimates were produced through global, regional, and national studies of cumulative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections for the duration of the COVID-19 pandemic. The incidence and mortality rate of COVID-19 was analyzed based on the World Health Organization (WHO) COVID-19 Dashboard data since the outbreak of the COVID-19 pandemic to 31 January, 2022. The number of cumulative total confirmed cases, the number of cumulative total confirmed cases (cumulative incidence) per 100,000, the number of cumulative total death cases, and the number of cumulative total death cases (cumulative death rate) per 100,000 population were calculated according to the WHO regions, World Bank income groups, and each country. Results: A total of 349,641,119 of confirmed COVID-19 cases were reported globally on 31 January, 2022 (cumulative incidence of COVID-19, 4,485.72 per 100,000 population). Europe demonstrated the highest cumulative incidence of COVID-19 (14,039.95 per 100,000 population), followed by the Americas (12,512.57 per 100,000 population) showing a cumulative total death cases and cumulative death rate of COVID-19 of 5,592,266 and 71.75 per 100,000 population, respectively. The Americas presented highest cumulative death rate of COVID-19 (14,039.95 per 100,000 population), followed by Europe (12,512.57 per 100,000 population). The nation with the highest cumulative total cases of COVID-19 was the United States of America (n=69,727,991). However, the cumulative death rate of the COVID-19 was found higher in developing and underdeveloped countries. Conclusion: From the start of the COVID-19 pandemic to 31 January, 2022, 349.6 million of the worldwide population suffered symptoms of SARS-COV-2 and 5.6 million lost their lives due to it. The population in Europe and other high-income groups showed high incidence rates of COVID-19 while the death rate was high in Americas and other upper middle-income nations. According to figures of nationalities, the countries with compromised economic status presented a higher death rate despite relatively lower incidence of COVID-19 than the developed countries. The results of this study may provide crucially important for COVID-19 research and proper public health policies and strategies.

Evaluation on different non-pharmaceutical interventions during COVID-19 pandemic: An analysis of 139 countries

Patients with Cushing's disease (CD) are usually immunosuppressed due to chronic hypercortisolism, therefore more susceptible to COVID-19. Comorbidities like obesity, hypertension and diabetes mellitus (DM), highly prevalent in CD, have been shown to increase severity of COVID-19 in the general population. The aim of this study was to evaluate the incidence, risk factors, and outcome of COVID-19 in a cohort of CD patients from February/15 2020 to November/15 2021 (before the arrival of the Omicron variant in Brazil). Sixty out of 66 CD patients were included (54F). From October/1 to November/30/2021, patients or family members answered a questionnaire about the diagnosis and time of COVID-19 infection (PCR-confirmed), its outcome and vaccination status through phone interview. Clinical and biochemical data, obtained from our electronic medical records, showed that 15 patients were in hypercortisolism (25%) and 45 were in remission (75%). A similar proportion was found among those 6 patients that did not participate in the study. The cumulative incidence of COVID-19 in the cohort during the entire observation period (22 months) was 32% (19/60), much higher than reported in the general reference population within the same area during the same period (9.5%). Since vaccination only started in February/2021, 55 patients were considered as not fully vaccinated (less than two doses) up to July/2021 (observation period: 17 months). In those patients, the cumulative incidence of COVID-19 during that period of time was also higher (27%) than in the reference population (8.4%). When CD patients were stratified according to comorbidities, the cumulative incidence of COVID-19 was shown to be significantly higher in patients with active disease (hypercortisolism) [57%vs 17%,P= 0. 012] and in those with obesity [54%vs 9%,P<0. 001], but not with hypertension or DM. In multivariate analysis, both hypercortisolism and obesity were independent risk factors for COVID-19 in CD patients [RR=2.1 (CI: 1-4.4),P=0. 05 andRR=4.8 (CI: 1.5-15.5),P=0. 009, respectively]. One single patient (5.2%) died from COVID-19 (she had hypercortisolism, obesity, hypertension and DM). During the next 5 months, when all 60 patients had been fully vaccinated, there were four (4/41) new infections and no (0/19) reinfection. The incidence of COVID-19 is higher in CD patients and is associated with hypercortisolism, as expected, and more strongly with obesity, which is a novel and unexpected finding that has only recently been reported in the general population (1). Thus, correction of hypercortisolism, obesity, and preventive measures should be more aggressively implemented in CD patients during the current COVID-19 pandemia. Reference: (1) Recalde et al., J Clin Endocrinol Metab. 2021 Nov 19;106(2): e5030-e5042.Presentation: No date and time listed

The coronavirus disease 2019 (COVID-19) pandemic and associated economic crisis have placed millions of US households at risk of eviction. Evictions may accelerate COVID-19 transmission by decreasing individuals’ ability to socially distance. We leveraged variation in the expiration of eviction moratoriums in US states to test for associations between evictions and COVID-19 incidence and mortality. The study included 44 US states that instituted eviction moratoriums, followed from March 13 to September 3, 2020. We modeled associations using a difference-in-difference approach with an event-study specification. Negative binomial regression models of cases and deaths included fixed effects for state and week and controlled for time-varying indicators of testing, stay-at-home orders, school closures, and mask mandates. COVID-19 incidence and mortality increased steadily in states after eviction moratoriums expired, and expiration was associated with a doubling of COVID-19 incidence (incidence rate ratio = 2.1; 95% confidence interval (CI): 1.1, 3.9) and a 5-fold increase in COVID-19 mortality (mortality rate ratio = 5.4; CI: 3.1, 9.3) 16 weeks after moratoriums lapsed. These results imply an estimated 433,700 excess cases (CI: 365,200, 502,200) and 10,700 excess deaths (CI: 8,900, 12,500) nationally by September 3, 2020. The expiration of eviction moratoriums was associated with increased COVID-19 incidence and mortality, supporting the public-health rationale for eviction prevention to limit COVID-19 cases and deaths.

Descriptive data have revealed significant racial/ethnic disparities in coronavirus disease 2019 (COVID-19) cases in the US, but underlying mechanisms of disparities remain unknown. To examine the association between county-level sociodemographic risk factors and US COVID-19 incidence and mortality. This cross-sectional study analyzed the association between US county-level sociodemographic risk factors and COVID-19 incidence using mixed-effects negative binomial regression, and COVID-19 mortality using zero-inflated negative binomial regression. Data on COVID-19 incidence and mortality were collected from January 20 to July 29, 2020. The association of social risk factors with weekly cumulative incidence and mortality was also examined by interacting time with the index measures, using a random intercept to account for repeated measures. Sociodemographic data from publicly available data sets, including the US Centers for Disease Control and Prevention's Social Vulnerability Index (SVI), which includes subindices of socioeconomic status, household composition and disability, racial/ethnic minority and English language proficiency status, and housing and transportation. As of July 29, 2020, there were a total of 4 289 283 COVID-19 cases and 147 074 COVID-19 deaths in the US. An increase of 0.1 point in SVI score was associated with a 14.3% increase in incidence rate (incidence rate ratio [IRR], 1.14; 95% CI, 1.13-1.16; P < .001) and 13.7% increase in mortality rate (IRR, 1.14; 95% CI, 1.12-1.16; P < .001), or an excess of 87 COVID-19 cases and 3 COVID-19 deaths per 100 000 population for a SVI score change from 0.5 to 0.6 in a midsize metropolitan county; subindices were also associated with both outcomes. A 0.1-point increase in the overall SVI was associated with a 0.9% increase in weekly cumulative increase in incidence rate (IRR, 1.01; 95% CI, 1.01-1.01; P < .001) and 0.5% increase in mortality rate (IRR, 1.01; 95% CI, 1.01-1.01; P < .001). In this cross-sectional study, a wide range of sociodemographic risk factors, including socioeconomic status, racial/ethnic minority status, household composition, and environmental factors, were significantly associated with COVID-19 incidence and mortality. To address inequities in the burden of the COVID-19 pandemic, these social vulnerabilities and their root causes must be addressed.

COVID-19 Health Economics: Looking Back and Scoping the Future

BackgroundThe purpose of this study was to evaluate the necessity of COVID-19 vaccination in persons with prior COVID-19.MethodsEmployees of Cleveland Clinic working in Ohio on Dec 16, 2020, the day COVID-19 vaccination was started, were included. Anyone who tested positive for COVID-19 at least once before the study start date was considered previously infected. One was considered vaccinated 14 days after receiving the second dose of a COVID-19 mRNA vaccine. The cumulative incidence of COVID-19, symptomatic COVID-19, and hospitalizations for COVID-19, were examined over the next year.ResultsAmong 52238 employees, 4718 (9%) were previously infected, and 36922 (71%) were vaccinated by the study’s end. Cumulative incidence of COVID-19 was substantially higher throughout for those previously uninfected who remained unvaccinated than for all other groups, lower for the vaccinated than unvaccinated, and lower for those previously infected than those not. Incidence of COVID-19 increased dramatically in all groups after the Omicron variant emerged. In multivariable Cox proportional hazards regression, both prior COVID-19 and vaccination were independently associated with significantly lower risk of COVID-19. Among previously infected subjects, a lower risk of COVID-19 overall was not demonstrated, but vaccination was associated with a significantly lower risk of symptomatic COVID-19 in both the pre-Omicron (HR 0.60, 95% CI 0.40–0.90) and Omicron (HR 0.36, 95% CI 0.23–0.57) phases.ConclusionsBoth previous infection and vaccination provide substantial protection against COVID-19. Vaccination of previously infected individuals does not provide additional protection against COVID-19 for several months, but after that provides significant protection at least against symptomatic COVID-19.

Understanding the Burden of the COVID-19 Pandemic for People With Kidney Disease

The aim of this study was to examine the incidence of coronavirus disease 2019 (COVID-19) among patients with immunomediated inflammatory diseases (IMIDs) treated with biologic or targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs) and to evaluate the influence of either IMIDs or related therapies on the incidence and evolution of COVID-19. This observational, cross-sectional study was conducted from January 31, 2020, to May 15, 2020. Data of 902 patients were obtained from clinical records in hospitals, primary care units, and community pharmacies. Inclusion criteria were adults with IMIDs treated with bDMARDs or tsDMARDs who started therapy 3 months prior to study commencement. Patients with poor adherence to treatments were excluded. COVID-19 was classified as "definitive" (severe acute respiratory syndrome coronavirus 2 polymerase chain reaction [PCR]-positive), "possible" (characteristic symptoms and negative PCR), and "suspected" (characteristic symptoms but PCR not performed). COVID-19 was diagnosed in 70 patients (11 definitive, 19 possible, and 40 suspected). The cumulative incidence of definitive COVID-19 was 1.2%. When considering all cases, the incidence was 7.8%. Patients on biosimilars tumor necrosis factor blockers were more likely to have a diagnosis of COVID-19 (odds ratio, 2.308; p < 0.001). Patients on anti-B-cell therapies had a lower incidence of infections (p = 0.046). Low rates of hospitalization (14.3%), pneumonia (14.3%), death (2.9%), or thrombosis (2.9%) were observed, and 94.3% of patients recovered. The cumulative incidence of confirmed cases of COVID-19 was similar to the general population, with generally low hospitalization, intensive care management, and mortality rates. COVID-19 incidence was less frequent in patients with more severe immunosuppression.

As the COVID-19 pandemic accelerates in the United States, this commentary asks how oncology specialists and allied providers are balancing a delay in cancer diagnosis or treatment against the risk...

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has created a remarkable and varying impact in every country, inciting calls for broad attention. Recently, the Bacillus Calmette-Guérin (BCG) vaccination has been regarded as a potential candidate to explain this difference. Herein, we hypothesised that the past epidemic of Mycobacterium tuberculosis (M. tuberculosis) may act as a latent explanatory factor for the worldwide differences seen in COVID-19 impact on mortality and incidence. We compared two indicators of past epidemic of M. tuberculosis, specifically, incidence (90 countries in 1990) and mortality (28 countries in 1950), with the mortality and incidence of COVID-19. We determined that an inverse relationship existed between the past epidemic indicators of M. tuberculosis and current COVID-19 impact. The rate ratio of the cumulative COVID-19 mortality per 1 million was 2.70 (95% confidence interval [CI]: 1.09–6.68) per 1 unit decrease in the incidence rate of tuberculosis (per 100,000 people). The rate ratio of the cumulative COVID-19 incidence per 1 million was 2.07 (95% CI: 1.30–3.30). This association existed even after adjusting for potential confounders (rate of people aged 65 over, diabetes prevalence, the mortality rate from cardiovascular disease, and gross domestic product per capita), leading to an adjusted rate ratio of COVID-19 mortality of 2.44, (95% CI: 1.32–4.52) and a COVID-19 incidence of 1.31 (95% CI: 0.97–1.78). After latent infection, Mycobacterium survives in the human body and may continue to stimulate trained immunity. This study suggests a possible mechanism underlying the region-based variation in the COVID-19 impact.

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has created a remarkable and varying impact in every country, inciting calls for broad attention. Recently, the Bacillus Calmette-Guérin (BCG) vaccination has been regarded as a potential candidate to explain this difference. Herein, we hypothesised that the past epidemic of Mycobacterium tuberculosis (M. tuberculosis) may act as a latent explanatory factor for the worldwide differences seen in COVID-19 impact on mortality and incidence. We compared two indicators of past epidemic of M. tuberculosis, specifically, incidence (90 countries in 1990) and mortality (28 countries in 1950), with the mortality and incidence of COVID-19. We determined that an inverse relationship existed between the past epidemic indicators of M. tuberculosis and current COVID-19 impact. The rate ratio of the cumulative COVID-19 mortality per 1 million was 2.70 (95% confidence interval [CI]: 1.09-6.68) per 1 unit decrease in the incidence rate of tuberculosis (per 100,000 people). The rate ratio of the cumulative COVID-19 incidence per 1 million was 2.07 (95% CI: 1.30-3.30). This association existed even after adjusting for potential confounders (rate of people aged 65 over, diabetes prevalence, the mortality rate from cardiovascular disease, and gross domestic product per capita), leading to an adjusted rate ratio of COVID-19 mortality of 2.44, (95% CI: 1.32-4.52) and a COVID-19 incidence of 1.31 (95% CI: 0.97-1.78). After latent infection, Mycobacterium survives in the human body and may continue to stimulate trained immunity. This study suggests a possible mechanism underlying the region-based variation in the COVID-19 impact.

COVID-19 cumulative incidence, intensive care, and mortality in Italian regions compared to selected European countries

Meteorological factors and COVID-19 incidence in 190 countries: An observational study

Letters26 August 2020Update Alert 3: Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in AdultsFREEKatherine Mackey, MD, MPP, Devan Kansagara, MD, MCR, and Kathryn Vela, MLIS, AHIPKatherine Mackey, MD, MPPVA Portland Health Care System, Portland, Oregon (K.M., D.K., K.V.), Devan Kansagara, MD, MCRVA Portland Health Care System, Portland, Oregon (K.M., D.K., K.V.), and Kathryn Vela, MLIS, AHIPVA Portland Health Care System, Portland, Oregon (K.M., D.K., K.V.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-1068 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail An update is available for this article.We searched MEDLINE (Ovid) weekly from 7 July to 3 August 2020 using the same search strategy as described in the original review (1). We did not limit the search by language. This search update yielded 67 results (de-duplicated), and after an independent dual-review process, we identified 2 new meta-analyses and 1 reestimated meta-analysis (2–4), interim results from 1 randomized controlled trial (5), and 13 new observational studies (6–18).New EvidenceResults of 2 meta-analyses found that angiotensin-converting enzyme inhibitor (ACEI) and angiotensin-receptor blocker (ARB) use was not associated with coronavirus disease 2019 (COVID-19) disease severity (2, 3). In 1 of these meta-analyses of 9 primary studies with a total of 3936 patients with hypertension, use of ACEIs or ARBs was associated with a lower mortality in COVID-19 (2). In the other meta-analysis of 15 studies of 7410 patients with hypertension, subgroup analysis found that ARB use, but not ACEI use, was associated with lower mortality (3). A third meta-analysis reestimated data from studies included in a prior review and found that exclusion of a retracted study by Mehra and colleagues did not change the prior review's finding of a lack of association with ACEI and ARB use and COVID-19 mortality (4, 19).In addition, interim findings from an ongoing randomized controlled trial (started in 2018) on the use of ramipril among patients with aortic stenosis treated with transcatheter aortic valve replacement found that the use of ramipril was not associated with the incidence or severity of COVID-19 (20). To our knowledge, this is the first study to report findings from a randomized controlled trial on the association between ACEI use and COVID-19.We also identified 13 new observational studies (6–18). One of these observational studies that was based on an analysis of insurance data in Korea addressed our first key question regarding the use of ACEIs and ARBs and COVID-19 risk, finding that increased adherence to ACEI and ARB treatment was associated with a lower incidence of COVID-19 (10). Twelve studies addressed our second key question about ACEI and ARB use and COVID-19 disease severity, and 11 of these studies found a lack of association with ACEIs or ARBs and more severe disease (6–9, 11–13, 15–18). Moreover, 3 of these 11 studies found that use of ACEIs or ARBs was associated with less severe COVID-19 illness (11, 16, 18). The exception was a French study of 149 patients hospitalized with severe COVID-19 illness (defined as an oxygen saturation of 94% or less while the patient was breathing ambient air or receiving oxygen support), 44 of whom were receiving ACEIs or ARBs (14). This study found that ACEI and ARB use was associated with a higher risk for acute kidney injury. However, this study did not examine whether ACEI or ARB use was independently associated with respiratory failure or death.Overall, inclusion of 17 studies from this search update does not change the certainty of evidence rating we reported in the original article for key questions 1 or 2. Although there is a signal toward improved outcomes among patients with COVID-19 who continue use of ACEIs or ARBs, the benefits and harms of initiating ACEIs or ARBs (that is, new users) in COVID-19 treatment remains unclear.Citation UpdateA study by Bean and colleagues that was included in our original manuscript as a preprint has now been published (20).Also of note, we attempted to register our review protocol with PROSPERO, but registration was not accepted given the stage of our review at the time. We followed standard methods and reporting guidelines for systematic reviews (21, 22). We have posted a copy of our protocol to OSF (https://osf.io/qm6h9/).