COVID-19 and IPO Outcomes: Evidence from Emerging Market

COVID-19 Inequities Across Multiple Racial and Ethnic Groups: Results From an Integrated Health Care Organization.

Sex differences in COVID-19 course and outcome: progesterone should not be neglected.

Background: While disparities in vaccine uptake have been well documented, few studies have evaluated the impact of local vaccine programs on COVID-19 outcomes, namely cases, hospitalizations, and deaths. Objectives: Evaluate the impact of COVID-19 vaccine doses coordinated by the Louisville Metro Department of Public Health and Wellness (LMPHW) on COVID-19 outcomes by race across ZIP codes from December 2020 to May 2022 in Jefferson County, Kentucky. Methods: Fixed-effects longitudinal models with ZIP codes as ecological time-series units were estimated to measure the association between COVID-19 vaccine doses and outcomes with time lags of one week, two weeks, three weeks, four weeks, and one month. Models were adjusted for time (week or month of the year) and its interaction with ZIP code. Results: In the one-week lag model, significant negative associations were observed between LMPHW-coordinated vaccine doses and COVID-19 outcomes, indicating reductions of 11.6 cases, 0.4 hospitalizations, and 0.3 deaths per 100 doses administered. Vaccine doses were consistently associated with fewer deaths among White residents across all lags, with an average reduction of 0.2 deaths per 100 doses. No significant associations were found for Black residents. Temporal trends also indicated declines in COVID-19 outcomes when LMPHW’s vaccine administration program peaked, between March and May 2021. Conclusions: Timely uptake of COVID-19 vaccines remains critical in avoiding severe outcomes, especially with emerging variants. Racial disparities in vaccine–outcome associations emphasize the potential need for equitable, community-driven vaccine campaigns to improve population health outcomes.

BackgroundUnderstanding attributes of COVID-19 clinical severity among people living with HIV/AIDS (PLWH) is critical for risk stratification and treatment strategies, but data among this population are limited.MethodsWe conducted a retrospective study among health plan members at Kaiser Permanente Southern California. We identified PLWH aged ≥ 18 years with a positive SARS-CoV-2 molecular diagnostic test or COVID-19 diagnosis and compared COVID-19 outcomes to HIV-negative cases. Chart review was conducted to examine HIV viral suppression, most recent CD4+ counts, and antiretroviral regimens in the year prior to COVID-19 diagnosis, as well as COVID-19 clinical presentation and outcomes.ResultsBetween 3/1/20 and 5/31/20, 590 PLWH were tested for SARS-CoV-2, of which 47 (8.0%) were positive. An additional 14 patients had a clinical COVID-19 diagnosis, for a total of 61 cases identified among the population of 10,702 PLWH. Of these, 10 (16.4%) were hospitalized, 4 (6.6%) were admitted to ICU, 3 (6.4%) required invasive mechanical ventilation, and 1 (1.6%) died from COVID-19. In comparison, of the 12,921 HIV-negative individuals with COVID-19, 1975 (15.3%) were hospitalized, 494 (3.8%) were admitted to ICU, 444 (3.4%) required invasive mechanical ventilation, and 300 (2.3%) died from COVID-19. For 42 PLWH for whom chart review was complete (cases through 5/7/20), 52% were aged ≥ 50 years, and 98% were male. In the year prior to COVID-19 diagnosis, 98% were virally suppressed (HIV RNA < 40 copies/mL). Most recent mean CD4+ count was 600 cells/mm3, and 4.8% had CD4+ ≤ 200 cells/mm3. Median CD4 count was similar between hospitalized and non-hospitalized patients. Antiretroviral regimens included NRTIs (98% of patients), NNRTIs (31%), PIs (26%), INSTIs (57%), and CCR5 inhibitors (2.3%). The most common presenting symptoms were cough (76% of patients), fever (71%), and shortness of breath (48%).Table 1. SARS-CoV-2 testing, characteristics, and COVID-19 outcomes of HIV-infected and HIV-uninfected individuals at Kaiser Permanente Southern California, 3/1/20 to 5/31/20ConclusionIn this population of patients with well-controlled HIV, risks of severe COVID-19 outcomes were similar to HIV-negative individuals, although sample sizes of PLWH with COVID-19 were small. Analyses adjusted for demographics and comorbidities are needed to assess risk of severe COVID-19 among PLWH and to determine clinical predictors in this population.DisclosuresKatia Bruxvoort, PhD, MPH, GlaxoSmithKlein (Research Grant or Support) Lie Hong Chen, DrPH, Merk (Research Grant or Support)

Letter to the Editor: Influence of right ventricular structure and function on hospital outcomes in COVID-19 patients

Background: COVID-19 has been associated with morbidity and mortality in case of elderly, chronic disease and immunosuppressed individuals. It is important to assess the presentations and outcomes of COVID-19 in renal allograft recipients in order to treat these patients with a comprehensive and accurate approach. Materials and Methods: This prospective, observational study was conducted to evaluate the presentations and outcomes of RT-PCR positive COVID-19 in renal allograft recipients. The study was conducted in Dhaka, Bangladesh. With a total of 38 enrolled participants, we recorded their relevant demographic characteristics, clinical features, laboratory investigations, severity of the disease, immunosuppressive regimen and outcomes. Results: Findings suggested that, mean age was 36.5 ± 9.4 years; 86.6% were males; 73.7% had hypertension. Fever and cough were the most common clinical features, 81.6% and 71.7% respectively; baseline serum creatinine was 2.11 ± 0.92 mg/dL. Mild form of disease was seen in 44.7% cases. Regarding outcomes, 73.7% needed hospitalization; 34.2% developed acute kidney injury and 26.3% cases did not survive. Statistically significant association was found in having cardiac disease (p=0.003); lymphopenia (p&lt;0.001), raised C-reactive protein (p=0.001) and serum ferritin (p=0.005) and lowered serum albumin level (p&lt;0.001) in case of comparison between survivor and non-survivor groups. Conclusion: Patients of renal allograft display higher risk of mortality than general population as a consequence of long-standing immunosuppression and other associated co-morbidities. It is necessary to sincerely manage these cases as they are highly vulnerable.

Pneumonia is the main cause of hospital admission in COVID-19 patients. We aimed to perform an extensive characterization of clinical, laboratory, and cytokine profiles in order to identify poor outcomes in COVID-19 patients. Methods: A prospective and consecutive study involving 108 COVID-19 patients was conducted between March and April 2020 at Hospital Clínico Universitario de Valladolid (Spain). Plasma samples from each patient were collected after emergency room admission. Forty-five serum cytokines were measured in duplicate, and clinical data were analyzed using SPPS version 25.0. Results: A multivariate predictive model showed high hepatocyte growth factor (HGF) plasma levels as the only cytokine related to intubation or death risk at hospital admission (OR = 7.38, 95%CI—(1.28–42.4), p = 0.025). There were no comorbidities included in the model except for the ABO blood group, in which the O blood group was associated with a 14-fold lower risk of a poor outcome. Other clinical variables were also included in the predictive model. The predictive model was internally validated by the receiver operating characteristic (ROC) curve with an area under the curve (AUC) of 0.94, a sensitivity of 91.7% and a specificity of 95%. The use of a bootstrapping method confirmed these results. Conclusions: A simple, robust, and quick predictive model, based on the ABO blood group, four common laboratory values, and one specific cytokine (HGF), could be used in order to predict poor outcomes in COVID-19 patients.

BackgroundThe broad use of immunosuppressants and biologicals in Inflammatory Bowel Disease (IBD) patients increases the susceptibility to severe infections, and possibly COVID-19. Recently, in a Swedish population-based study it was suggested that IBD patients are at an increased risk of hospitalization for COVID-19, although course of COVID-19 did not differ from controls. Data on the outcome of COVID-19 in IBD patients from heavily affected regions remain, however, limited. South-Limburg has the second highest COVID-19 mortality rate in the Netherlands. We aimed to determine the incidence rate and outcome of severe COVID-19 in IBD patients in a population-based setting in South-Limburg.MethodsWe identified all IBD patients who presented at the emergency department (ED) of the only two hospitals covering the whole South-Limburg region with COVID-19 associated symptoms between February 27 and November 1, 2020. Confirmed COVID-19 diagnosis was defined by a combination of COVID-19 associated symptoms and either a positive SARS-CoV-2 PCR or a CT-CORADS score ≥4. As primary outcome, the incidence rate of severe COVID-19 (i.e. confirmed COVID-19 diagnosis requiring hospitalization, and/or resulting in ICU admission or death) was determined. Baseline characteristics and data on COVID-19 course were collected. At present, the total IBD population in South-Limburg is set at 4980 patients.ResultsDuring a follow-up of 3384 person-years, a total of 61 IBD patients (1.22%) presented with COVID-19 associated symptoms at one of the two hospital’s ED. Of these, 18 IBD patients (0.36%; 11 UC, 7 CD) fulfilled the criteria for severe COVID-19, corresponding to an incidence rate of 5.3 per 1000 person-years. Furthermore, 12/18 patients were using immunosuppressive medication for their IBD. Mean age at time of admission was 64.5 years (SD: 10.8) and 55.6% were male. All hospitalized patients had at least one comorbidity (with ≥ 1 comorbidity in 13/18 patients (72.2%)), cardiovascular disease being most prevalent (12/18). Mean BMI at time of admission was 27.3 (SD: 4.2). Thirteen patients (72.2%) required oxygen support and three patients (16.7%) ICU admission (of which two needed mechanical ventilation), translating to an incidence rate of 0.9 per 1000 patient-years for ICU admission. Median length of hospitalization was 11 days (IQR: 5.3–18.3). No IBD patients died due to severe COVID-19.ConclusionThe incidence rate of severe COVID-19 among IBD patients in a population-based setting in a heavily affected region was 5.3 per 1000 person-years. Despite frequent use of immunosuppressive medication and high region-specific mortality rates, clinical outcomes of severe COVID-19 were comparable to the general population and in line with recent literature.

IntroductionThe COVID-19 pandemic has exacerbated health inequalities across the globe, disproportionately affecting those with poor social determinants of health (SDOHs). It is imperative to understand how SDOH influences the transmission...

This article evaluates the Covid-19 crisis response of top leaders of 20 selected countries from January to May 2020 using anecdotal evidence from media sources and insights from the available crisis management and leadership literature. The main objective of the article is to examine whether the Covid-19 crisis experience and outcome of sample countries are related to their leaders’ behaviour and actions. Based on leaders’ orientation towards certain action motives and action and leadership styles, the article classifies the leaders’ action and leadership styles. The article finds that the leaders with a ‘ missionary’ action style displayed positive leadership styles and generally had the best Covid-19 outcomes, while those with a ‘ gamer’ action style were associated with negative leadership styles and poorer outcomes, with those with ‘political’ and ‘strategist’ action styles falling in between. To validate the impact of evolving leader behaviour on Covid-19 outcomes, the article evaluates the average daily growth of Covid-19 cases in the subsequent (post-analysis) seven weeks and tests the mean differences between different style groups. The tests indicate a significant difference in the outcomes between different style groups except between ‘gamers’ and ‘strategists’. The difference is more pronounced when the BRI[.]S countries (i.e., BRICS minus China) in various combinations are excluded from the test. A similar conclusion arises for the negatively and positively oriented leadership styles. Thus, while finding a relationship of leadership behaviour with Covid-19 outcomes, the article also provides a reason to suspect the role of socio-economic and institutional factors in clouding or confounding the leadership effect in view of the distinctive behaviour of OECD and the large emerging countries.

EP06.01-005 COVID-19 and Post-COVID Outcomes in Lung Cancer Patients: Experience from an Indian Cancer Center

Letter to the EditorReply to Jakovac: Sex differences in COVID-19 course and outcome: progesterone should not be neglectedLuciane H. Gargaglioni and Danuzia A. MarquesLuciane H. GargaglioniDepartment of Animal Morphology and Physiology, FCAVJ-UNESP-São Paulo State University, Jaboticabal, Brazil and Danuzia A. MarquesDepartment of Pediatrics, Centre de recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, CanadaPublished Online:23 Oct 2020https://doi.org/10.1152/japplphysiol.00835.2020MoreFiguresReferencesRelatedInformationSectionsGRANTSDISCLOSURESAUTHOR CONTRIBUTIONSAUTHOR NOTESPDF (69 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookXLinkedInWeChat to the editor: The Letter to the Editor entitled "Sex differences in COVID-19 course and outcome: progesterone should not be neglected" (4a) in response to our study (2) included a proposition of the benefits of progesterone use for COVID-19 course and outcome. In fact, one recent review also suggested the use of sex hormones, such as estradiol and progesterone, in the fight against COVID-19 (5). Additionally, there is one ongoing study registered at ClinicalTrials.gov (NCT04365127—Progesterone for the Treatment of COVID-19 in Hospitalized Men) in which volunteer men who are hospitalized with COVID-19 and meet the eligibility criteria will receive 100 mg of progesterone administered subcutaneously twice daily for 5 days, in addition to institutional standard of care. The organism's first antiviral responses against pathogens are made by the activation inflammatory pathways of the immune system; in this scenario, estradiol can be important, as it has immunostimulatory roles (6) and can help the organism to respond to the viral infection. However, an exaggerated immune response, known as a "cytokine storm," can lead to increased severity of the disease and progesterone and testosterone might be used in this case, as both are immunosuppressive and counteract the pathways affected by estradiol (6). As widely reported by many studies, scientific reports and by the media, the highest mortality in patients with COVID-19 is observed in older and immunocompromised individuals. Age increases the levels of proinflammatory cytokines and decreases the expression of immune memory/effector cells which could lead to increased susceptibility to infections and worsening of the disease (3). This remodeling of the immune system and decline in immune efficacy with age could drive a decreased response to vaccines (3) and can be a challenge in the control of COVID-19. Age is accompanied by a decline in sex hormones in both sexes, which could be related to the remodeling of the immune system (3). Therefore, sex hormone replacement could be important in the context of COVID-19 and cytokine release (as we discussed in our study), as sex hormones modulate the immune system and can help with the balance of inflammatory and anti-inflammatory cytokines (6). Nevertheless, sex hormone therapies can also bring risks, as they can change many homeostatic parameters, depending on type of hormone (different synthetic variations or bioidentical), the dose used, the via (oral, transdermal, etc.), and the period of use, since many studies already shown high risk for vascular problems related hormonal replacement therapy. In this regard, one French study of 271 postmenopausal women who had previously presented venous thrombotic event (VTE) episode showed that oral hormone treatment users had 4-fold-increased odds of a VTE, whereas transdermal hormone users had no increased risk (1). Therefore, it is important to highlight that synthetic progestins present differing degrees of androgenic and thromboembolic properties that should be considered when prescribing individualized treatments (4). In conclusion, the use of sex hormone therapies can have benefits, but can also lead to adverse effects. Interactions in individuals with comorbidities must be carefully evaluated so that their risks do not outweigh the benefits.GRANTS This work was supported by MCTI Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq): Luciane H. Gargaglioni 407490/2018-3 and by São Paulo Research Foundation (FAPESP): Luciane H. Gargaglioni 2019/09469-8.DISCLOSURES No conflicts of interest, financial or otherwise, are declared by the authors.AUTHOR CONTRIBUTIONS L.H.G. and D.A.M. drafted manuscript; L.H.G. and D.A.M. edited and revised manuscript; L.H.G. and D.A.M. approved final version of manuscript.AUTHOR NOTESCorrespondence: L. H. Gargaglioni (luciane.gargaglioni@unesp.br); D. A. Marques (danuzia.am@gmail.com). Download PDF Previous Back to Top Next FiguresReferencesRelatedInformationREFERENCES1. Canonico M, Oger E, Plu-Bureau G, Conard J, Meyer G, Lévesque H, Trillot N, Barrellier MT, Wahl D, Emmerich J, Scarabin PY; Estrogen and Thromboembolism Risk (ESTHER) Study Group. Hormone therapy and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration and progestogens: the ESTHER study. Circulation 115: 840–845, 2007. doi:10.1161/CIRCULATIONAHA.106.642280. Crossref | PubMed | Web of Science | Google Scholar2. Gargaglioni LH, Marques DA. Let's talk about sex in the context of COVID-19. J Appl Physiol (1985) 128: 1533–1538, 2020. doi:10.1152/japplphysiol.00335.2020. Link | Web of Science | Google Scholar3. Giefing-Kröll C, Berger P, Lepperdinger G, Grubeck-Loebenstein B. How sex and age affect immune responses, susceptibility to infections, and response to vaccination. Aging Cell 14: 309–321, 2015. doi:10.1111/acel.12326. Crossref | PubMed | Web of Science | Google Scholar4. Giordano Imbroll M, Gruppetta M. A current perspective into young female sex hormone replacement: a review. Expert Rev Endocrinol Metab. In press. doi:10.1080/17446651.2020.1816820. Crossref | PubMed | Web of Science | Google Scholar4a. Jakovac H. Sex differences in COVID-19 course and outcome: progesterone should not be neglected. J Appl Physiol (1985). doi:10.1152/japplphysiol.00740.2020.Link | Web of Science | Google Scholar5. Mauvais-Jarvis F, Klein SL, Levin ER. Estradiol, progesterone, immunomodulation, and COVID-19 outcomes. Endocrinology 161: bqaa127, 2020. doi:10.1210/endocr/bqaa127. Crossref | PubMed | Web of Science | Google Scholar6. Moulton VR. Sex hormones in acquired immunity and autoimmune disease. Front Immunol 9: 2279, 2018. doi:10.3389/fimmu.2018.02279. Crossref | PubMed | Web of Science | Google Scholar CollectionsAPS Cross-Journal CollectionsCoronavirus-Related Papers Related ArticlesSex differences in COVID-19 course and outcome: progesterone should not be neglected 23 Oct 2020Journal of Applied Physiology More from this issue > Volume 129Issue 5November 2020Pages 1009-1010 Copyright & PermissionsCopyright © 2020 the American Physiological Societyhttps://doi.org/10.1152/japplphysiol.00835.2020PubMed33096967History Received 30 September 2020 Accepted 1 October 2020 Published online 23 October 2020 Published in print 1 November 2020 KeywordsCOVID-19estradiolfemalemaleprogesterone Metrics publications0supporting0mentioning0contrasting0Smart Citations0000Citing PublicationsSupportingMentioningContrastingView CitationsSee how this article has been cited at scite.aiscite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made. 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Bioavailable testosterone level is associated with COVID-19 severity in female: A sex-stratified Mendelian randomization study

It is prudent to take a unified approach to exploring how contextual social determinants of health (SDoH) relate to COVID-19 occurrence and outcomes. Poor geographically represented data and a small number of contextual SDoH examined in most previous research studies have left a knowledge gap in the relationships between contextual SDoH and COVID-19 outcomes. In this study, we linked 199 contextual SDoH factors covering 11 domains of social and built environments with electronic health records (EHRs) from a large clinical research network (CRN) in the National Patient-Centered Clinical Research Network (PCORnet) to explore the relation between contextual SDoH and COVID-19 occurrence and hospitalization. We identified 15,890 COVID-19 patients and 63,560 matched non-COVID-19 patients in Florida between January 2020 and May 2021. We adopted a two-phase multiple linear regression approach modified from that in the exposome-wide association (ExWAS) study. After removing the highly correlated SDoH variables, 86 contextual SDoH variables were included in the data analysis. Adjusting for race, ethnicity, and comorbidities, we found six contextual SDoH variables (i.e., hospital available beds and utilization, percent of vacant property, number of golf courses, and percent of minority) related to the occurrence of COVID-19, and three variables (i.e., farmers market, low access, and religion) related to the hospitalization of COVID-19. To our best knowledge, this is the first study to explore the relationship between contextual SDoH and COVID-19 occurrence and hospitalization using EHRs in a major PCORnet CRN. As an exploratory study, the causal effect of SDoH on COVID-19 outcomes will be evaluated in future studies.