Confirmed COVID-19 Infections Research Articles

COVID-19 Across Professions - Infection, Hospitalisation, and ICU Patterns in a Swedish County.

To study infection, hospitalisation, and admission to ICU for COVID-19 in different occupations and pandemic waves in a Swedish county. Individual registry data of infection and hospitalisation were merged with occupational data in, this cross-sectional study. Infected, hospital- and ICU-admission were analysed by occupational groups. 22,095 cases of COVID-19 from 21 February 2021 to 31 August 2022 were identified. Healthcare workers and others working in close physical proximity showed a higher rate of confirmed COVID-19 infections in all waves and higher risk for hospital admission early in the pandemic. Exposure to diseases and physical proximity played a decisive role. Workers in close-contact occupations experienced a higher rate of confirmed infections throughout the pandemic and higher hospitalisation rates in the first pandemic wave, suggesting a need for more effective initial safety measures in a future pandemic.

Prognostic Value of Hyperglycemia and Insulin Resistance Among Patients with Confirmed COVID-19 Infections at Admission to the Alexandria Fever Hospital, Egypt.

Background: The interaction between COVID-19 infection, hyperglycemia, and insulin resistance (IR) may lead to poor outcome. Methods: This prospective study included 100 adult participants without diabetes attending Alexandria Fever Hospital with confirmed COVID-19 infections. They were classified into four groups according to disease severity using World Health Organization (WHO) criteria. Demographic and clinical parameters were collected. Laboratory investigations were obtained. Another follow-up fasting plasma glucose (FPG) value was measured after 3 months in cured patients. Results: Admission FPG, follow-up FPG, lipid profile, markers of IR, and inflammation were significantly higher in severe and critical cases than in mild and moderate cases with increasing values with increased severity. Furthermore, these parameters were significantly higher in died cases compared with cured cases. Admission FPG, TyG index, and homeostatic model assessment (HOMA)-IR showed significant positive correlations with follow-up FPG. Admission FPG was the only independent mortality predictor in multivariate analysis (P = 0.027) with 1.7-folds increased mortality risk with each 10 mg/dL increments. Values exceeding 117 mg/dL, 2.2, and 6.33 for admission FPG, HOMA-IR, and Fasting Insulin Resistance Index, respectively, were able to predict mortality in the studied sample. Conclusions: These results will help in identifying patients at high risk of severe infection and death at admission and take early actions to improve outcome.

Impact of COVID-19 infections and vaccination on menstrual cycle symptoms in the south of Jordan: a cross-sectional study

BackgroundSeveral recent studies have highlighted the need for more evaluation of the impact of COVID-19 infections and vaccines on the reproductive system and menstruation. This study aimed to assess the impact of COVID-19 infection and vaccines on menstrual symptoms.MethodsA cross-sectional survey utilizing face-to-face interviews from January 1 to 31 March 2022 was conducted in the city of Al-Karak in southern Jordan. The questionnaire included sociodemographic characteristics, medical and reproductive history, the contraceptive method used if any, menstrual cycle (MC) status, previous medical and drug history, and the impact of infection and vaccination on the MC.ResultsThe study questionnaire was completed by 400 participants with a mean age of 32.1±12.6 years. Regarding the history of COVID-19 infections, 33.8% of the participants reported a history of confirmed COVID-19 infections, 77.8% of them did not report any menstrual changes following the infection, while the remaining 22.2% reported changes in menstruation. The most commonly reported post-COVID-19 manifestations were irregular (27.6%) and light menstrual cycle (MC) (24.15) or dysmenorrhea (24.1%). Heavy menstruation was reported by 17.2% of participants post-COVID-19 infection. Two-thirds of the study participants (66.6%) reported no changes in the MC following the administration of the COVID-19 vaccine. The most reported symptoms for those who experienced changes in the MC following the vaccination were irregular cycle (13.1%), heavy menstruation (7%), and light menstruation (7%). Other reported symptoms were dysmenorrhea (4.6%), intermenstrual bleeding (1.2%), and amenorrhea (0.5%).ConclusionThis study revealed minor changes in the MC following COVID-19 infections and administration of the COVID-19 vaccine. These findings are consistent with published reports. It is recommended that future clinical trials for new vaccines for women of childbearing age include outcomes related to sex hormones and MC. Women should be encouraged to take the vaccines and report symptoms to healthcare professionals for further assessment.

Seeing is believing: are investors’ corporate online visits as informative as site visits?

ABSTRACT This paper examines the post-visit earnings forecast inaccuracy of online visits (visits via videoconferencing) relative to site visits (visits to production or operation sites) with data from China between 2020 and 2021. We use the number of confirmed COVID-19 infections in the city where analysts’ offices are located as an instrument for the choices between online visits and site visits. Our results show that online visits fail to maintain the accuracy of analysts’ EPS forecasts. Moreover, the diminished financial reporting quality of firms amplifies the forecasting disadvantages associated with online visits. Finally, the lack of site observation rather than one-on-one communication is the primary reason for the underperformance of online visits.

Acute Macular Neuroretinopathy after Coronavirus Disease 2019 Infection: Clinical Characteristics and Associated Factors

Objective or PurposeAcute macular neuroretinopathy (AMN) is a rare, poorly understood retinal disease that affects the outer retina. Recent studies reported the onset of AMN is associated with COVID-19 infection. However, it still lacks thorough evaluation regarding the clinical features of AMN after COVID-19 infection. DesignRetrospective cohort study. ParticipantsThis study involved online registration of patients who were diagnosed with AMN after rapid antigen or PCR tests confirmed COVID-19 infections from December 2022 to March 2023. MethodsWe interviewed all patients and completed an evaluation survey that recorded age, sex, menstruation pattern, medical history, doses of COVID-19 vaccination, symptom onset (days after fever onset), symptoms, and treatment measures. The association between clinical characteristics and baseline visual acuity was investigated. Main Outcome MeasuresDemographic and clinical characteristics of AMN after COVID-19 infection. ResultsA total of 116 eyes from 66 patients were included in the present study. The average age was 30.4 ± 6.7, and 81.8% of patients were female. The average time of ocular symptom onset was 2.62 ± 1.88 days after fever onset. Scotomas (87.9%) were the most common symptoms reported by patients, whereas 25.9% and 1.7% of eyes had blurry vision and photopsia. 80.2%, 60.3%, 26.7%, 10.3%, and 3.4% of eyes showed ellipsoid zone (EZ) disruption, hyper-reflectivity of outer nuclear layer (ONL), hyper-reflectivity of Henle layer, hyper-reflectivity of outer plexiform layer (OPL), and macular edema, respectively. A history of smoking (Coef. =0.12, 95%CI: [0.00, 0.24]), macular edema (Coef. =0.14, 95%CI: [0.00, 0.88]), hyper-reflectivity of OPL (Coef. =0.16, 95%CI: [0.08, 0.24]), hyper-reflectivity of Henle layer (Coef. =0.08, 95%CI: [0.03, 0.14]), and EZ disruption (Coef. =0.07, 95%CI: [0.00, 0.13]) were associated with worse LogMAR visual acuity at baseline. Conclusions and RelevanceAMN after COVID-19 infection is more common in young females. Hyper-reflectivity of ONL and EZ disruption are the most common OCT features of AMN. Macular edema, hyper-reflectivity of OPL, hyper-reflectivity of the Henle layer, EZ disruption, and a history of smoking are associated with worse visual acuity at baseline.

High resolution computed tomography guided anatomico-pathological scoring system for stratifying and prognosticating pulmonary manifestations of COVID-19

Computed Tomography (CT) chest plays a critical role in early identification & stratification of disease burden and prognostication of COVID-19 disease. We compared in-house created CT based scoring system based on ground glass opacities (G-Score), consolidation (C- Score), and atelectasis A-score (i.e. GCA score) with contemporary CT severity scores & validated it against world health organization (WHO) COVID-19 disease severity scale. Patients confirmed with real time polymerase chain reaction confirmed COVID-19 infections that underwent CT chest investigations as a part of standard of care were recruited. A compound GCA score based on the lung involvement was developed and validated. Five-hundred patients of which 249 had mild, 220 with moderate, and 31 with severe COVID-19 disease were recruited.Most involved segments were superior (65%), lateral basal (56%) and posterior basal segments (64%) of right lower lobe and anteromedial (62%) and posterior basal segments (57%) of left lower lobe.Patchy non-confluent peripheral ground-glass opacities with apicobasal gradient is the most common finding (47%) in mild cases. Bilateral lower lobes were most commonly involved (72%).In moderate cases ground-glass opacities with consolidation is the predominant finding (82%).In severe cases ground-glass opacity, consolidation as well as linear platelike atelectasis and reticular opacities may represent with apicobasal gradient (80%).HRCT Chest has certainly come up as a versatile aid for our war against COVID -19. Firstly it helps to diagnose the pulmonary involvement of the disease and when complimented with a good scoring system furthermore it stratifies the disease burden.

Characteristics of pediatric patients with multiple sclerosis and related disorders infected with SARS-CoV-2

Background: Pediatric patients with multiple sclerosis (POMS) and related disorders, clinically isolated syndrome (CIS), myelin oligodendrocyte glycoprotein antibody disorder (MOGAD), and neuromyelitis optica spectrum disorder (NMOSD), are commonly treated with immunosuppressants. Understanding the impact of SARS-CoV-2 infection in patients may inform treatment decisions. Objective: Characterize SARS-CoV-2 infection prevalence and severity among a cohort of patients with POMS and related disorders, as well as the impact of disease-modifying therapies (DMTs). Methods: POMS and related disorders patients enrolled in a large, prospective registry were screened for COVID-19 during standard-of-care neurology visits. If confirmed positive of having infection, further analysis was undertaken. Results: Six hundred and sixty-nine patients were surveyed between March 2020 and August 2021. There were 73 confirmed COVID-19 infections. Eight of nine hospitalized patients (89%), and all patients admitted to the ICU were treated with B cell depleting therapy. The unadjusted odds ratio of hospitalization among those who tested positive of having had COVID-19 was 15.27 among those on B-cell-depleting therapy (p = 0.016). Conclusions: B-cell-depleting treatment was associated with a higher risk of COVID-19, higher rates of hospitalization, and ICU admission, suggesting this therapy carries a higher risk of severe infection in POMS and related disorders.

High variability of COVID-19 case fatality rate in Germany

BackgroundDuring the first wave of the COVID-19 pandemic a high case fatality rate (CFR) was noticed worldwide including also Germany where the first European cases have been observed. The WHO recommended immediate intubation for patients with dyspnoea which has since been revised after reviewing the initial clinical outcome. The objective of this study is to analyze CFR and assess if there is an advantage of a more conservative management of COVID-19 induced hypoxemia.MethodsPCR confirmed COVID-19 infections and death counts were obtained for all German districts from 27 Jan 2020 until 15 Feb 2021 using official reports of Robert Koch Institute Berlin, Germany. A moving average CFRt was constructed by dividing disease related deaths two weeks after a given index day by the number of infections two weeks prior to that date. In addition to a local comparison also mortality outcomes in other German speaking countries were compared.ResultsThe mean CFR is estimated to be 2.92% based on 71.965 fatalities and 2.465.407 cases. There was a large regional scattering of CFRs across the German districts. Differences of the mortality pattern were observed also at state level and preserved across different sex and age groups while being largely independent of case numbers. Although Munich city had higher infection rates, more patients died during the first wave in Hamburg (OR 1.6, 95% CI 1.3–1.9) which was mirrored also by higher death risk at Hamburg intensive care units (OR 2.0, 95% CI 1.3–3.1). While the majority of Munich hospitals favoured a conservative management of hypoxemia including high flow nasal cannula (HFNC), Hamburg hospitals followed a more aggressive scheme of early mechanical ventilation (MV). Austria and Switzerland experienced higher CFRs than Germany during the first wave but after changing their treatment guidelines, both countries experienced lower CFRs during the second wave.ConclusionUsing retrospective public health data, different case fatality rates have been observed across Germany. A more conservative management of COVID-19 induced Adult Respiratory Distress Syndrome (ARDS) is justified also by epidemiological data.

Predicting severity in COVID-19 disease using sepsis blood gene expression signatures

Severely-afflicted COVID-19 patients can exhibit disease manifestations representative of sepsis, including acute respiratory distress syndrome and multiple organ failure. We hypothesized that diagnostic tools used in managing all-cause sepsis, such as clinical criteria, biomarkers, and gene expression signatures, should extend to COVID-19 patients. Here we analyzed the whole blood transcriptome of 124 early (1–5 days post-hospital admission) and late (6–20 days post-admission) sampled patients with confirmed COVID-19 infections from hospitals in Quebec, Canada. Mechanisms associated with COVID-19 severity were identified between severity groups (ranging from mild disease to the requirement for mechanical ventilation and mortality), and established sepsis signatures were assessed for dysregulation. Specifically, gene expression signatures representing pathophysiological events, namely cellular reprogramming, organ dysfunction, and mortality, were significantly enriched and predictive of severity and lethality in COVID-19 patients. Mechanistic endotypes reflective of distinct sepsis aetiologies and therapeutic opportunities were also identified in subsets of patients, enabling prediction of potentially-effective repurposed drugs. The expression of sepsis gene expression signatures in severely-afflicted COVID-19 patients indicates that these patients should be classified as having severe sepsis. Accordingly, in severe COVID-19 patients, these signatures should be strongly considered for the mechanistic characterization, diagnosis, and guidance of treatment using repurposed drugs.

Official statistics: Providing data acumen in the advent and continuous presence of COVID-19

COVID-19 has disturbed people’s patterns of life and sources of income, particularly the income of informal sector business operators and households worldwide. As extraordinary policy initiatives are calibrated, the requirement for timely statistics on health and economic development rises. Thus, the purpose of this research is to analyze the Internally Generated Revenue (IGR) available to Nigerian states in 2020 and 2019 by examining the disparities caused by the COVID-19 pandemic and its impact on the country’s approximately 200 million people. The exploratory research approach was used, with a particular emphasis on descriptive and trend analysis of the data acquired during the study periods. According to the findings, 46% of Nigerian states, including the Federal Capital Territory, suffered reductions in IGR generation as the pandemic surged, whereas 35 per cent of the states experienced a corresponding increase in IGR and confirmed COVID-19 infections. However, 16% of the states reported an inverse growth in their IGR as the number of verified COVID-19 cases decreased. To deal with the unprecedented shocks caused by the ongoing existence of COVID-19, which necessitate the tapping of new information and revenue streams, a continual review of countries’ revenue sources is required.

Impact of Vaccination With the SCB-2019 Coronavirus Disease 2019 Vaccine on Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Household Contact Study in the Philippines.

An exploratory household transmission study was nested in SPECTRA, the phase 2/3 efficacy study of the adjuvanted recombinant protein-based COVID-19 vaccine SCB-2019. We compared the occurrence of confirmed COVID-19 infections between households and household contacts of infected SPECTRA placebo or SCB-2019 recipients. SPECTRA participants at 8 study sites in the Philippines who developed real-time reverse transcriptase-polymerase chain reaction (rRT-PCR)-confirmed COVID-19 were contacted by a study team blinded to assignment of index cases to vaccine or placebo groups to enroll in this household transmission study. Enrolled households and household contacts were monitored for 3 weeks using rRT-PCR and anti-SARS-CoV-2 N-antigen IgG/IgM testing to detect new COVID-19 infections. One hundred fifty-four eligible COVID-19 index cases (51 vaccinees, 103 placebo) were included. The secondary attack rate per household for symptomatic COVID-19 infection was 0.76% (90% CI: .15-3.90%) if the index case was an SCB-2019 vaccinee compared with 5.88% (90% CI: 3.20-10.8%) for placebo index cases, a relative risk reduction (RRR) of 79% (90% CI: -28% to 97%). The RRR of symptomatic COVID-19 per household member was similar: 84% (90% CI: 28-97%). The impact on attack rates in household members if index cases were symptomatic (n = 130; RRR = 80%; 90% CI: 7-96%) or asymptomatic (n = 24; RRR = 100%; 90% CI: -76% to 100%) was measurable but the low numbers undermine the clinical significance. In this prospective household contact study vaccination with SCB-2019 reduced SARS-CoV-2 transmission compared with placebo in households and in household members independently of whether or not index cases were symptomatic.

Covid-19 vaccination programme effectiveness against SARS-CoV-2 related infections, hospital admissions and deaths in the Apulia region of Italy: a one-year retrospective cohort study

Studies reporting vaccine effectiveness against COVID-19 outcomes concentrate mainly on estimates of one single type of vaccine and variant, seldom considering waning effects. We aimed to estimate the effectiveness of the overall COVID-19 vaccination programme implemented in the Apulia region of Italy at preventing SARS-CoV-2 infections, COVID-19-related hospital admissions and deaths during alpha and delta variant dominant periods. We conducted a retrospective cohort study using electronic health records of persons 16 years and older resident in the Apulia region, assessing the effectiveness of the combined use of BNT162b2, mRNA-1273, ChAdOx1-S and Ad26.COV2.S vaccines against confirmed COVID-19 infections, hospitalisations and deaths, for fully and partially vaccinated persons as well as by time since vaccination and variants. Cox regression models yielding hazard ratios were used to calculate the overall vaccination programme effectiveness. From 1 January to 1 December 2021, we included 3,530,967 eligible persons in the cohort, of whom 2,770,299 were fully vaccinated and 158,313 were COVID-19 positive at the end of the study period. The effectiveness of the programme over the entire study period for fully vaccinated persons against COVID-19 infection, hospitalisation and death were 87.69% (CI95% 87.73–88.18), 94.08% (93.58–94.54) and 95.95% (CI95% 95.26–96.54), respectively. The effectiveness against COVID-19 infection of fully vaccinated subjects during the alpha and delta period was respectively 88.20% (CI95% 87.60–99.78) and 59.31% (CI95% 57.91–60.67), against hospitalisation 93.89% (CI95% 92.67–94.90) and 88.32% (CI95% 86.50–89.90) and against death 93.83% (CI95% 91.65–95.45) and 85.91 (CI95% 79.98–90.09). The waning effects of the programme regarding COVID-19 infection during the delta period were stronger than for alpha, with 75.85% (CI95% 74.38–77.24) effectiveness after 1–2 months and 8.35% (CI95% 3.45–13.01) after 5–6 months after full vaccination. The effectiveness against hospitalisation and death during the delta period waned rapidly and at 7–8-months after the full vaccination respectively decreased to 27.67% (CI95% 7.48–43.45) and 48.47 (CI95% 53.97–34.82). Our study suggests that the COVID-19 vaccination program in Apulia was strongly protective against COVID-19 infection, hospitalisation, and death due to alpha as well as delta variants, although its effectiveness is reduced over time.

Prediction of COVID-19 Infections for Municipalities in the Netherlands: Algorithm Development and Interpretation.

BackgroundCOVID-19 was first identified in December 2019 in the city of Wuhan, China. The virus quickly spread and was declared a pandemic on March 11, 2020. After infection, symptoms such as fever, a (dry) cough, nasal congestion, and fatigue can develop. In some cases, the virus causes severe complications such as pneumonia and dyspnea and could result in death. The virus also spread rapidly in the Netherlands, a small and densely populated country with an aging population. Health care in the Netherlands is of a high standard, but there were nevertheless problems with hospital capacity, such as the number of available beds and staff. There were also regions and municipalities that were hit harder than others. In the Netherlands, there are important data sources available for daily COVID-19 numbers and information about municipalities.ObjectiveWe aimed to predict the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants per municipality in the Netherlands, using a data set with the properties of 355 municipalities in the Netherlands and advanced modeling techniques.MethodsWe collected relevant static data per municipality from data sources that were available in the Dutch public domain and merged these data with the dynamic daily number of infections from January 1, 2020, to May 9, 2021, resulting in a data set with 355 municipalities in the Netherlands and variables grouped into 20 topics. The modeling techniques random forest and multiple fractional polynomials were used to construct a prediction model for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants per municipality in the Netherlands.ResultsThe final prediction model had an R2 of 0.63. Important properties for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants in a municipality in the Netherlands were exposure to particulate matter with diameters <10 μm (PM10) in the air, the percentage of Labour party voters, and the number of children in a household.ConclusionsData about municipality properties in relation to the cumulative number of confirmed infections in a municipality in the Netherlands can give insight into the most important properties of a municipality for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants in a municipality. This insight can provide policy makers with tools to cope with COVID-19 and may also be of value in the event of a future pandemic, so that municipalities are better prepared.

Risk factors of early mortality among COVID-19 deceased patients in Addis Ababa COVID-19 care centers, Ethiopia.

Severe acute respiratory syndrome coronavirus-2 is a global health care problem with high mortality. Despite early mortality seeming alarming, data regarding factors that lead to increased early mortality of COVID 19 patients is not well-documented yet. The objective of this study was to identify the risk factors of early mortality in patients with confirmed COVID-19 infections. A case-control study design was employed. With this, a total of 261 COVID-19 deceased recordings were reviewed. The cases of the study were recordings of patients deceased within three days of intensive care unit admission whereas, the rest 187 were recordings of patients who died after three days of admission. Data were collected using an extraction checklist, entered into Epi data version 4.4.2.2, and analyzed by SPSS version 25. After the description, binary logistic regression was run to conduct bivariate and multivariable analyses. Finally, statistical significance was declared at p-value <0.05, and an adjusted odds ratio with a 95% confidence interval was used to report the strength of association. The analysis was performed on 261 (87 cases and 174 controls) recordings. About 62.5% of the participants were aged above 65 years and two-thirds were males. The presence of cardiovascular disease (AOR = 4.79, with 95%CI: 1.73, 13.27) and bronchial-asthma (AOR = 6.57; 95% CI: 1.39, 31.13) were found to have a statistically significant association with early mortality. The existence of complications from COVID-19 (AOR = 0.22; 95% CI: 0.07, 0.74) and previous history of COVID-19 infection (AOR = 0.17, 95% CI: 0.04, 0.69) were associated with decreased risk of early mortality. Having cardiovascular diseases and bronchial asthma was associated with an increased risk of early mortality. Conversely, the presence of intensive care unit complications and previous history of COVID-19 infection were associated with decreased risk of early mortality.

CLL-393 Outcomes of COVID-19 Infections in Patients With Hematological Malignancies in Republic of North Macedonia

Context: Patients with hematological malignancies are at increased risk of complications and adverse outcomes associated with COVID-19, according to current available studies. These patients are particularly vulnerable due to impaired or compromised immune responses caused by treatment or the disease itself. Objective: Our aim was to examine the severity and outcomes of COVID-19 infections among patients with hematological malignancies in Republic of North Macedonia. Design: This is the first retrospective descriptive study on patients with COVID-19 and underlying hematological malignancies in Republic of North Macedonia. We focused on clinical characteristics and COVID-19 infection outcomes in different malignancy settings. Patients: We collected data on clinical characteristics, diagnosis, treatment, and outcomes in adult patients with hematologic malignancies and confirmed COVID-19 infections between June 2020 and April 2022. Parametric data were compared using Fisher's exact test. Results: Of 206 patients, 153 (74%) had lymphoid, and 53 (26%) had myeloid malignancies. Median age was 61 years (IQR 47–70 years), 118 (57%) patients were male, and 86 (74%) patients were older than 60 years and had ≥2 comorbidities, with only 16 (17%) patients younger than 60 years. Severe/critical clinical severity was identified in 77 (37%). Overall, 42 patients (20%) died, including 33 patients (78%) older than 60 years. Patients older than 60 years had significantly higher mortality (p=0.0015) than younger patients. The majority of patients (58%) became COVID-19–positive while on active treatment. Significantly worse outcomes were observed among patients who were on active treatment compared with patients who were in hematological remission (p=0.0028). Among lethal cases, the majority of patients were diagnosed with CLL and NHL. We found no significant differences in mortality between treated and untreated CLL and NHL patients. Among 37 patients treated with a cocktail of monoclonal antibodies (casirivimab/imdevimab), no significant difference in outcome was observed, although 86% of them survived. Conclusions: Patients with hematological malignancies and COVID-19 infection were associated with higher mortality associated with older age, more comorbidities, and active disease. Patients with B-cell malignancy were the most affected, but no significant difference in mortality rate was observed across different subgroups, which may suggest that B-cell impairment is a key factor leading to severe infection.

What are the risks for Domiciliary Care Workers in Wales from COVID-19?

ObjectivesDomiciliary care workers (DCWs) continued to provide social care to vulnerable adults in their own homes throughout the COVID-19 pandemic. However, evidence of pandemic impact upon DCWs’ health is mixed. The OSCAR study aimed to quantify the impact of COVID-19 upon health outcomes of DCWs in Wales, and explore causes of variation.&#x0D; ApproachData for all registered DCWs in Wales are newly available via the SAIL Databank using a secured, privacy-protecting encrypted anonymisation process. Occupational registration data for DCWs working during the pandemic was combined with electronic health records data to describe health outcomes within the first two years of the pandemic. Rates of confirmed COVID-19 infections and health outcomes including mental health contacts, fit notes, respiratory infections, and mortality will be reported and explore variation (by factors such as age, sex, ethnicity, deprivation quintile, employer). We will also explore changes over time (pre- and post- onset of COVID-19 pandemic) in outcomes.&#x0D; ResultsThe OSCAR study used anonymised health records for 15,727 registered DCWs in Wales. PCR-confirmed infection rates in the first full year of the pandemic (March20-February21) were 12% although lower in males (9%) than for females (12%). However, 28% of care workers received care for mental health with large differences observed between males (20%) and females (29%), and between workers from different health board regions (range 22% to 33%). The extent to which these represent pre-pandemic rates overall and how they compare to the broader community will be explored in our remaining work. A qualitative sub-study involving interviews with DCWs has informed our approach to modelling and to interpretation of findings.&#x0D; ConclusionUsing novel anonymised occupational records at a national level and existing linked EHR data and qualitative interviews, the OSCAR study will quantify the risk of COVID-19 on DCWs' health and explore sources of variation. This will provide a secure base for informing public health policy and occupational guidance.

Covid-19 infection risk on US domestic airlines

Working with recent data and research findings, we estimate the probability that an air traveler in economy class would have contracted Covid-19 on a US domestic jet flight over the nine-month period June 2020 to February 2021. The estimates take account of the rates of confirmed Covid-19 infections in the US, flight duration, fraction of seats occupied, and some demographic differences between US air travelers and US citizens as a whole. Based on point estimates, the risk of contracting Covid-19 in-flight exceeded 1 in 1000 on a fully-loaded two-hour flight at the height of the pandemic over the nine months, but was about 1 in 6000 on a half-full flight when the pandemic was at a low ebb. However, these estimates are subject to substantial uncertainty, with the 10th percentiles of various risk distributions only about 1/7 as large as the medians, and the 90th percentiles about four times as large. Based on seat-occupancy levels on US flights for each month over June 2020 to February 2021, the median risk estimate for that period is 1 in 2250, while the mean risk estimate is 1 in 1450. Indirect effects arose because those who contracted Covid-19 on US airplanes could in turn infect others.

The Role of Vitamin D for Modulating the T Helper 1 Immune Response After the Coronavac Vaccination

The purpose of this study was to observe the role of vitamin D levels with T helper 1 (Th1)-type cytokines, such as interferon γ (IFN-γ) and interleukin-12 (IL-12) efficacy, in those who had already received 2 injections of inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) vaccines (CoronaVac). We also observed if these cytokines played any significance in the CoronaVac effectiveness for preventing coronavirus disease 2019 (Covid-19) infection. One hundred ninety-four volunteers were monitored for 8 months upon receiving 2 inactivated SARS-CoV2 vaccination injections (CoronaVac, Sinovac Life Sciences). The rate of confirmed Covid-19 infections was the primary outcome. Six to 7 weeks after the second vaccine injection, and blood samples were obtained to measure the serum vitamin D, IFN-γ, and IL-12 levels. Low vitamin D level was defined if vitamin D level <30 ng/mL. Subjects with low vitamin D had lower IFN-γ and IL-12 levels (P = 0.04 and P = 0.04, respectively). The receiver operating characteristics curve analysis revealed that the area under curve for IFN-γ was 0.59, whereas IL-12 was 0.59 for predicting the low vitamin D levels. During follow-up, a higher incidence of Covid-19 infections was observed in subjects with low IFN-γ levels (P = 0.03). Kaplan-Meier survival analysis revealed that the cumulative hazard of confirmed Covid-19 cases was increased in subjects with low IFN-γ levels (log-rank test, P = 0.03). We concluded that lower vitamin D level was correlated with a lower Th1 immune response, whereas the adequate IFN-γ level was required to obtain better CoronaVac effectiveness.

Low prevalence of community-acquired influenza coinfections among COVID-19 patients in Al-Madinah, Saudi Arabia: A retrospective cohort study

BackgroundCoinfections with respiratory viruses among SARS CoV-2 patients have been reported by several studies during the current COVID-19 pandemic. Most of these studies designated these coinfections as being hospital-acquired infections; however, there is inadequate knowledge about community-acquired respiratory coinfections among SARS CoV-2 patients. MethodsIn this retrospective cohort study, we investigated the seroprevalence of influenza A, influenza B, and parainfluenza-2 among newly hospitalized patients with confirmed COVID-19 infections (n = 163). The study was conducted during the early phase of the COVID-19 pandemic in Saudi Arabia (from April to October 2020). The patients’ serum samples were subjected to commercial immunoglobulin M (IgM) antibody tests against the three aforementioned viruses. ResultsSeropositivity for influenza A and B and parainfluenza-2 occurred only in 4.2% (7/163) of COVID-19 patients, indicating simultaneous acute infections of these three viruses with SARS CoV-2 infection. All coinfection cases were mild and misdiagnosed during the care period in the hospital. ConclusionThis study highlights the low prevalence of community-acquired respiratory infections among COVID-19 patients in the current pandemic and we discussed the possible factors for this finding. During newly emerging epidemics or pandemics, considering other respiratory viruses circulating in the community is essential to avoid their misdiagnosis and account for their possible negative effects on pandemic disease management and prognosis.

Innovative Tele-Instruction Approach Impacts Basic Life Support Performance: A Non-inferiority Trial

BackgroundSustaining Basic Life Support (BLS) training during the COVID-19 pandemic bears substantial challenges. The limited availability of highly qualified instructors and tight economic conditions complicates the delivery of these life-saving trainings. Consequently, innovative and resource-efficient approaches are needed to minimize or eliminate contagion while maintaining high training standards and managing learner anxiety related to infection risk.MethodsIn a non-inferiority trial 346 first-year medical, dentistry, and physiotherapy students underwent BLS training at AIXTRA—Competence Center for Training and Patient Safety at the University Hospital RWTH Aachen. Our objectives were (1) to examine whether peer feedback BLS training supported by tele-instructors matches the learning performance of standard instructor-guided BLS training for laypersons; and (2) to minimize infection risk during BLS training. Therefore, in a parallel group design, we compared arm (1) Standard Instructor Feedback (SIF) BLS training (Historical control group of 2019) with arm (2) a Tele-Instructor Supported Peer-Feedback (TPF) BLS training (Intervention group of 2020). Both study arms were based on Peyton's 4-step approach. Before and after each training session, objective data for BLS performance (compression depth and rate) were recorded using a resuscitation manikin. We also assessed overall BLS performance via standardized instructor evaluation and student self-reports of confidence via questionnaire. Non-inferiority margins for the outcome parameters and sample size calculation were based on previous studies with SIF. Two-sided 95% confidence intervals were employed to determine significance of non-inferiority.ResultsThe results confirmed non-inferiority of TPF to SIF for all tested outcome parameters. A follow-up after 2 weeks found no confirmed COVID-19 infections among the participants.ConclusionTele-instructor supported peer feedback is a powerful alternative to in-person instructor feedback on BLS skills during a pandemic, where infection risk needs to be minimized while maximizing the quality of BLS skill learning.Trial registrationhttps://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00025199, Trial ID: DRKS00025199.