Coronavirus Disease Research Articles

Rheumatoid arthritis and COVID-19 outcomes: a systematic review and Meta-analysis.

This study aimed to conduct a comprehensive systematic literature review and meta-analysis to assess the risk and outcomes of coronavirus disease 2019 (COVID-19) in patients with rheumatoid arthritis. A systematic search was performed across four electronic databases. The quality of the studies was assessed using the Newcastle‒Ottawa quality assessment scale and the Joanna Briggs Institute critical appraisal checklist. Statistical analyses were conducted using STATA 14 software. A total of 62 studies were included in the analysis. First, the meta-analysis revealed the following prevalence rates among rheumatoid arthritis patients: COVID-19, 11%; severe COVID-19, 18%; COVID-19-related hospitalization, 29%; admission to the intensive care unit (ICU) due to COVID-19, 10%; and death from COVID-19, 8%. Second, rheumatoid arthritis was associated with an increased risk of COVID-19 infection (OR 1.045(0.969-1.122), p = 0.006), COVID-19-related hospitalization (OR 1.319(1.055-1.584), p = 0.006), admission to the ICU due to COVID-19 (OR 1.498(1.145-1.850), p = 0.002), and death from COVID-19 (OR 1.377(1.168-1.587), p = 0.001). Third, no statistically significant association was found between rheumatoid arthritis and severe COVID-19 (OR 1.354(1.002-1.706), p = 0.135). Rheumatoid arthritis patients have a significantly greater risk of COVID-19 infection, hospitalization, ICU admission, and death than individuals without rheumatoid arthritis. However, rheumatoid arthritis did not show a significant association with the risk of severe COVID-19. These findings underscore the need for tailored management strategies and vigilant monitoring of COVID-19 outcomes in rheumatoid arthritis patients. The study has been registered on PROSPERO [ https://www.crd.york.ac.uk/PROSPERO/ ], and the registration number is CRD42024528119.

Experience of Family Caregivers in Long-Term Care Hospitals During the Early Stages of COVID-19: A Phenomenological Analysis

Background/Objectives: This study investigated the experiences of inpatient family caregivers who experienced restrictions in meeting their family members owing to the changed visitation guidelines of long-term care hospitals during the early stages of the coronavirus disease 2019 (COVID-19). We aimed to deepen our understanding of the nature of these caregivers’ experiences. Methods: The participants were family caregivers of patients in long-term care hospitals during the early stages of the COVID-19 pandemic. We collected data from nine inpatient caregivers from April to July 2021. Individual interviews and data were analyzed using Colaizzi’s phenomenological method. Results: Participants’ experiences were classified into the following three themes: (1) a prison-like long-term care hospital bound by strict COVID-19 prevention rules; (2) growing affection for unreachable parents; and (3) adaptation to a new, safer daily life. Participants had difficulty communicating with their families living under quarantine conditions during COVID-19 due to non-face-to-face situations. However, amid the long-term COVID-19 situation, participants overcame these challenges through efforts to facilitate communication. Conclusions: The results of this study can be used as basic data to support the smooth communication between patients and caregivers in long-term care hospitals in the event of an infectious disease outbreak in the future, to alleviate emotional stress, and to minimize the weakening of families.

Clinical Benefits of Sustained Oral Nirmatrelvir/Ritonavir Use for the Outpatient Treatment of COVID-19: Findings from the Taiwanese Health Authority Perspective Using a Decision Tree Modeling Approach

Despite the observed clinical benefits of nirmatrelvir/ritonavir (NMV/r), it is uncertain whether Taiwan will continue covering NMV/r for high-risk individuals with mild-to-moderate coronavirus disease 2019 (COVID-19). This analysis assessed the impact of sustained utilization of NMV/r on COVID-19-associated healthcare resource utilization (HCRU) and mortality from the Taiwanese health authority perspective (THAP). A decision tree model estimated the incremental number of clinical events associated with NMV/r utilization over a 30-day period. Model results compared (1) a base case using current rates of NMV/r from the THAP, and (2) a hypothetical scenario assuming the current supply of NMV/r is not extended in Taiwan. NMV/r utilization rates included 80% and 0% in the base case and hypothetical scenario, respectively. Outcomes included the number of hospitalizations involving a general ward (GW) stay, intensive care unit (ICU) stay, and mechanical ventilation (MV) use, as well as the number of bed days, symptom days, and hospitalization deaths. Based on epidemiologic data, 150,255 patients with COVID-19 were eligible for treatment from the THAP. In the hypothetical scenario, HCRU increased by 175% compared to the base case, including increases in hospitalizations involving GW, ICU, and MV use (differences: 2067; 623; 591, respectively), bed days (difference: 51,521), symptom days (difference: 51,714), and deaths (difference: 480). Findings indicate that sustained utilization of NMV/r from the THAP reduces the clinical burden of mild-to-moderate COVID-19 through the reduced incidence of COVID-19-related HCRU and deaths.

Possible rapid reduction of anti-RBD antibody titre after SARS-CoV-2 mRNA vaccination in pregnant women: Multicentre prospective study.

Pregnant women are at increased risk for severe illness associated with coronavirus disease 2019 (COVID-19) compared to nonpregnant women. The aim of this multicenter prospective study was to assess the current COVID-19 vaccination status of pregnant women in the southern Osaka district and to compare their antibody titers with those of nonpregnant women. Serum antibody titers of anti-NCP antibodies (antibodies against the SARS-CoV-2 nucleocapsid) and anti-RBD antibodies (the receptor binding domain of the S1 subunit of the spike protein) were evaluated in 753 pregnant women at 34-35 weeks of gestation from October 2021 to March 2022. Anti-RBD antibody titre was also investigated in 1003 health care workers at Kindai University hospital 3 and 6 months after a second dose of the vaccine from March 2021 to April 2021. 519 (68.9%) pregnant women were vaccinated during pregnancy, of whom 497 (95.8%) received two doses. The COVID-19 infection rate calculated from the number of pregnant women with a positive anti-NCP antibody titre or with confirmed diagnosis was 5.1% (12/234) in the unvaccinated and 3.5% (18/519) in the vaccinated. The estimated half-life calculated from anti-RBD antibody titers and the number of days between vaccination and antibody testing was 39.9 days. The antibody titre and half-life in pregnant women were significantly lower and shorter than in nonpregnant women aged 20-39 years (109.4 days). Our study showed that pregnant women may have lower vaccine-acquired COVID-19 immunity than nonpregnant women.

Abstract 4126581: COVID-19 Impacted Septal Reduction Therapies in Hypertrophic Cardiomyopathy

Background: Coronavirus Disease-19 (COVID-19) pandemic had a significant impact on emergent and elective treatment strategies in patients with cardiovascular disease. We aimed to examine the impact of COVID-19 on septal reduction therapy (SRT) in hypertrophic cardiomyopathy (HCM). Methods: National Inpatient Sample 2019-2021 was queried to identify patients with HCM and SRT using appropriate ICD codes. Temporal trends for SRT were obtained before and after COVID-19 outset. Results: There was a significant decline in the number of SRT from 2019 to 2020 (1505 vs. 1180, p<0.001) with partial recovery in 2021 (1250 vs. 1180, p<0.001). Geographic differences existed with differential decrease in number of SM in midwestern and Western Unites States. In addition, the proportion of patients who underwent surgical myectomy (SM) decreased in 2020 (44.6 vs. 48.7%, p=0.008) in favor of alcohol septal ablation (ASA). Patients undergoing SRT in 2020 had higher prevalence of heart failure (39.5 vs. 29%, p=0.002). In-hospital complication rates for cardiogenic shock, bleeding requiring transfusion, acute kidney injury and admission to the critical care unit were higher in 2020 compared to 2019. Hospital length of stay (LOS) was not significantly different however there was an overall increase in LOS in septal myectomy group from 2019 to 2021 (9.1 vs. 10 days, p=0.028). The overall proportion of comorbidities and other in-hospital complications remain unchanged during this study period. Conclusions: Our data indicates that COVID-19 resulted in a significant decrease in total number of SRTs and a shift from surgical to percutaneous septal reduction therapy. Partial recovery of procedure numbers were noted in the year following the pandemic outset.

Effects of COVID-19, control measures, and program adaptation on prevention of mother-to-child HIV transmission service uptake in Central Region, Uganda.

Coronavirus disease 2019 (COVID-19) control measures presented impediments for prevention of mother-to-child transmission of HIV (PMTCT) programming in Uganda. Nationwide control measures implemented April-June 2020 included a public transport ban and mandatory travel permits for pregnant women to access clinics. Program adaptations instituted for continuity of services included community drug delivery and home-based DNA-PCR testing for HIV-exposed infants (HEI). We examined the effect of COVID-19 control measures and program adaptations on PMTCT service uptake in central Uganda. We analysed data for pregnant women living with HIV (WLHIV) and HEI receiving PMTCT services in eight districts in central Uganda. We abstracted data from medical records at 96 public clinics for six months pre-lockdown (October 2019-March 2020), three months of lockdown (April-June 2020), and six months post-lockdown (July-December 2020). We measured monthly antiretroviral therapy (ART) refill attendance, health facility deliveries, and timely DNA-PCR testing of HEI for HIV (within two months of birth). We conducted segmented ordinary least squares regression of interrupted time series and adjusted for month-to-month changes using Cumby-Huizinga test. We reported results using coefficients and 95% confidence intervals (CIs). At the start of pre-lockdown (October 2019), there were 448 deliveries, 2,676 ART refills and 556 timely HEI tests. The pre-lockdown trend for ART refills increased while deliveries and HEI tests declined. At the start of lockdown (April 2020), all indicators declined, although significantly for facility deliveries (-60; 95% CI: -102, -18). Lockdown monthly trends were positive with 68 more HEI tested per month (95% CI:42, 93) and 51 more deliveries (95% CI: 9, 94) but insignificantly negative for ART refills. At start of post-lockdown (July 2020), HEI testing declined (-28; 95%CI: -48, -8). Post-lockdown HEI testing trend was negative with 70 fewer HEI tested per month (95%CI: -79, -62) while no difference in trend for deliveries and ART refills. COVID-19 control measures had a significant immediate negative impact on pregnancy deliveries at health facilities. During lockdown, all service rates rapidly recovered through program adaptations, significantly for HEI testing and deliveries. Maintaining these adaptations might help restore the positive trend in timely HIV testing for HEI.

Comparison of inflammatory mediator cytokine responses to inactivated virus platform COVID-19 vaccines between elderly and young adult populations

The coronavirus disease 2019 (COVID-19) pandemic has encouraged global vaccine research, yet vaccine effectiveness in the elderly remains a concern due to immunosenescence. The aim of this study was to compare the cytokine response elicited by an inactivated virus-based COVID-19 vaccine between elderly and young adults, focusing on key cytokines involved in cellular and humoral immunity: tumor necrosis factor-alpha (TNF-α), interleukin (IL)-2, IL-6, IL-10, and interferon-gamma (IFN-γ). A cross-sectional study was conducted in the Jakarta-Bogor region of Indonesia from January 2023 to December 2023. The study population was divided into two age cohorts: elderly (60−85 years) and younger adults (30−40 years). Blood samples were collected twice, after the first booster dose and four weeks after the second booster dose. Serum cytokine concentrations were measured using Luminex assays with microparticles conjugated to monoclonal antibodies against TNF-α, IL-2, IL-6, IL-10, and IFN-γ. Comparisons of the cytokine levels were conducted using Student’s t-tests or Mann-Whitney U tests as appropriate. A total of 74 individuals were included, with 37 each in the elderly and young adult groups. The results showed significant differences in cytokine responses between the two age groups. After the first booster, the levels of IL-6 and IFN-γ were significantly higher in young adults compared to the elderly. After the second booster, the levels of IL-6 were still significantly higher in the young adult group compared to the elderly group (p=0.001). Data indicated that after the second booster dose, the levels of TNF-α increased significantly in the young adult group only (p=0.004), while the levels of IL-2 (p=0.040) and IFN-γ (p=0.006) increased in the elderly group only compared to after the first dose. IL-10 levels increased in both groups (both had p=0.020). This study highlights that young adults had stronger pro-inflammatory responses, while the elderly relied more on IL-2 and IFN-γ for T-cell immunity, suggesting the need for vaccination strategies for the elderly to optimize immune responses.

Perceptions of COVID-19 Online Learning Students Based on Dreem in Class 2020 Students of the Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia

A learning environment is anything that can influence changes in attitudes in teaching and learning activities which will further influence the achievement of learning outcomes and student development. A researcher wants to carry out research on student perceptions regarding changes in the online learning environment due to Coronavirus Disease 19 (COVID-19) in the Faculty of Medicine, Universitas Airlangga. The study aimed to describe the perceptions of the students toward five aspects of an online learning environment. This study was a descriptive research using a quantitive approach and the sampling technique used simple random sampling with 167 medical faculty student class 2020. One hundred sixty-seven respondents' data were collected using the specific measurement tool Dundee Ready Education Environment Measure (DREEM) to measure the learning environment with univariate analysis. The results obtained from this research showed that the perception of students at the Faculty of Medicine, Universitas Airlangga towards the online learning environment is quite good with a score of 139.48. The result of this study indicated that the mean DREEM score was 139.48/200 (SD 22.76) is in the good category. Although the learning environment is in a good category, several points need to be improved so the faculty can increase the quality of the medical education.

Elite sense-making in the core executive: the case of Denmark’s 2020 Minkgate Scandal

Abstract This article analyzes the Danish Mink Scandal of 2020 using Karl Weick’s sense-making theory. It zooms in on the 72-hour decision-making process that led to the culling of Denmark’s entire 17 million farmed-for-fur mink population in response to the perceived threat of coronavirus disease 2019 (COVID-19) forming a new mutation. Since there was insufficient legal justification for the culling, the prime minister was forced to call a snap general election, leading to a change of government. We exploit detailed data material containing text messages, e-mail correspondence, documentary material, and specific inquiries. The article demonstrates the strength of Weick’s social–psychological perspective on sense-making for public management research. It shows how time pressure can cut across heavily institutionalized standard operating procedures. It can increase the centralization of the decision-making power at the apex and decouple the formal legal responsibilities, which remain institutionalized with the line ministries. The study argues that sense-making offers learning points that cannot be obtained from formal legal perspectives, which are used to assign responsibilities. Indeed, ex-post thinking may be too convenient—traditional solutions like punishing leaders or agencies may obscure the discovery of more systemic vulnerabilities when crises unfold.

State Capacity and COVID-19 Responses: Comparing the US States

Abstract This article addresses the interstate differences in outcomes from the coronavirus disease COVID-19 pandemic by focusing on state capacity. State capacity refers to states’ ability to create and implement policy. We posit that states want to limit death and destruction within their borders. COVID-19 created an instance in which states had a shared, preferred outcome but had very different levels of success. Using a novel measure of state capacity that allows for subnational comparisons – and is independent of ideological political will – we show that states with greater capacity experienced fewer excess deaths during 2020 and more successfully distributed vaccines in early 2021. The findings are robust to various measures of partisanship, social capital, geography, and demographics. Our work bridges US state politics literature and comparative politics literature on state capacity, and it contributes to research on the politics of pandemics.

Gastroesophageal reflux disease increases predisposition to severe COVID-19: Insights from integrated Mendelian randomization and genetic analysis.

This study aims to investigate the potential causal relationship, shared genomic loci, as well as potential molecular pathways and tissue-specific expression patterns between gastroesophageal reflux disease (GERD) and the risk of hospitalized/severe 2019 coronavirus disease (COVID-19). We employed linkage disequilibrium score regression and bidirectional Mendelian randomization (MR) analysis to explore potential genetic associations between GERD (N=602,604) and hospitalized COVID-19 (N=2095,324) as well as severe COVID-19 (N=1086,211). Additionally, shared genomic loci were extracted from common pivotal regions, further confirmed through corresponding colocalization analyses. GERD-driven molecular pathway network was constructed using extensive literature data mining to understand the molecular-level impacts of GERD on COVID-19. Our results revealed a significant positive genetic correlation between GERD and both hospitalized (rg = 0.418) and severe COVID-19 (rg = 0.314). Furthermore, the MR analysis demonstrated a unidirectional causal effect of genetic predisposition to GERD on COVID-19 outcomes, including hospitalized COVID-19 (odds ratio [OR]: 1.33, 95% confidence interval [CI]: 1.27-1.44, p=9.17e-12) and severe COVID-19 (OR: 1.27, 95% CI: 1.18-1.37, p=1.20e-05). Additionally, GERD and both COVID-19 conditions shared one genomic locus with lead-SNPs rs1011407 and rs1123573, corresponding to the transcription factor BCL11A. Colocalization analysis further demonstrated a significant positive correlation between genome-wide association study and expression quantitative trait locus (eQTL) abnormalities, including rs1011407 (eQTL_p=2.35e-07) and rs1123573 (eQTL_p=2.74e-05). Molecular pathway analysis indicated that GERD might promote the progression of COVID-19 by inducting immune-activated and inflammation-related pathways. These findings confirm that genetically determined GERD may increase the susceptibility to hospitalized/severe COVID-19. The shared genetic loci and the potential molecular pathways offer valuable insights into causal connections between GERD and COVID-19.

Evaluation of an Epidemiological Skills Laboratory Course Using a Direct Teaching and Online Flipped Classroom Method in Iran: An Interventional Study

Background and aims: The epidemiological skills laboratory (ESL) course has been incorporated into the curriculum for Master of Science students in epidemiology. However, it has not been implemented and evaluated in Iran so far. The present study was conducted to compare two teaching methods and the implementation of an ESL lesson. Methods: All MSc students (N=9) in epidemiology at Shahrekord University of Medical Sciences were included in the study during two academic semesters in 2019-2020 using a census sampling method. Three levels of Kirkpatrick’s pyramid were used to evaluate direct teaching and electronic flipped classroom (FC) groups. The Chi-square test, Fisher’s exact test, paired t-test, and independent t-test were used in Stata software with a significance level<0.05. Results: The means±standard deviations (SD) of scores of pre- and post-instructional interventions were 42.1±8.4 and 96.6±2.1 in the intervention group with the FC method and 41.3±3.2 and 77.3±4.7 in the direct teaching group. The means±SDs of satisfaction scores of pre- and post-instructional interventions were 67.8±1.6 and 97.6±5.6 in the intervention group with the FC method and 45.3±5 and 87.3±4.5 in the direct teaching group. Conclusion: Under the conditions of the coronavirus disease 2019 epidemic, mainly the virtualization of students’ education and easy access to virtual education systems to convey instructional content, it is a pleasurable opportunity to use the electronic FC method to teach students. The FC method could improve the students’ epidemiological skills and increase their satisfaction.

Young Black and White adults prefer in-person to telehealth for primary care visits and group health promotion programs.

Telehealth utilization has increased since the coronavirus disease 2019 pandemic, reducing barriers to healthcare and, potentially, reducing participation in group health-promotion interventions. However, preferences for telehealth versus in-person formats have not been established. To examine preferences for telehealth and in-person format for primary care and group health-promotion interventions among Black and White women and men aged 20-39. We hypothesized that respondents would report a higher preference for telehealth than in-person appointments. This cross-sectional survey study recruited participants to answer questions about access to technology and preferences for telehealth and in-person formats of primary care and group health promotion. Respondents (n = 404) included similar proportions of White women (24.3%, 26.4 ± 4.3 years), Black women (25.0%, 29.0 ± 6.1 years), White men (25.9%, 32.8 ± 4.5 years), and Black men (24.8%, 30.6 ± 5.2 years). About 98.5% reported having a smartphone, and 80.4% had access to a computer with a camera. Preference ratings were higher for in-person visits, compared to telehealth visits, for both primary care (M = 3.86 ± 1.13 vs. M = 2.87 ± 1.18) and group health promotion (M = 3.72 ± 1.12 vs. M = 3.04 ± 1.20) F's(1,400) > 59.0, P's < .001. Most young adults have access to technology, supporting the feasibility of telehealth interventions. However, telehealth preference ratings were lower than in-person appointments. Preferences for delivery formats should be considered when designing behavioral interventions to promote health and prevent disease.

Disease-associated B cells and immune endotypes shape adaptive immune responses to SARS-CoV-2 mRNA vaccination in human SLE.

Severe acute respiratory syndrome coronavirus 2 mRNA vaccination has reduced effectiveness in certain immunocompromised individuals. However, the cellular mechanisms underlying these defects, as well as the contribution of disease-induced cellular abnormalities, remain largely unexplored. In this study, we conducted a comprehensive serological and cellular analysis of patients with autoimmune systemic lupus erythematosus (SLE) who received the Wuhan-Hu-1 monovalent mRNA coronavirus disease 2019 vaccine. Our findings revealed that patients with SLE exhibited reduced avidity of anti-receptor-binding domain antibodies, leading to decreased neutralization potency and breadth. We also observed a sustained anti-spike response in IgD-CD27- 'double-negative (DN)' DN2/DN3 B cell populations persisting during memory responses and with greater representation in the SLE cohort. Additionally, patients with SLE displayed compromised anti-spike T cell immunity. Notably, low vaccine efficacy strongly correlated with higher values of a newly developed extrafollicular B and T cell score, supporting the importance of distinct B cell endotypes. Finally, we found that anti-BAFF blockade through belimumab treatment was associated with poor vaccine immunogenicity due to inhibition of naive B cell priming and an unexpected impact on circulating T follicular helper cells.

Evidence of SARS-CoV-2 Spread in Rural Tanzania During the First 6 Months of the Global COVID-19 Pandemic.

In the first 6 months of the coronavirus disease 2019 pandemic, limited testing clouded understanding of the extent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in Africa. In particular, Tanzania halted all testing and reporting of SARS-CoV-2 cases after May 2020, not resuming until June 2021. In July-August 2020, we performed a seroprevalence survey in rural Bagamoyo district, 40 km outside Dar es Salaam. Among 347 asymptomatic children and adults, 64/347 (18.0%) demonstrated seroreactivity to SARS-CoV-2 spike receptor binding domain by ELISA. Given significant antibody cross-reactivity in malaria-endemic regions, seropositivity was additionally confirmed via a multitarget Luminex immunoassay. Thirty-seven, or 58% of initially seroreactive persons, were Luminex positive, leading to an estimated SARS-CoV-2 seroprevalence of 10.7% (37/347, 95% CI 7.6-14.4%). Working in health care appeared to be associated with seropositivity. Reporting of viral symptoms or health care-seeking behavior in the previous 3 months was not more frequent in seropositive individuals.

Tracking inflammation resolution signatures in lungs after SARS-CoV-2 omicron BA.1 infection of K18-hACE2 mice.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes Coronavirus Disease 2019 (COVID-19), which can result in severe disease, often characterised by a 'cytokine storm' and the associated acute respiratory distress syndrome. However, many infections with SARS-CoV-2 are mild or asymptomatic throughout the course of infection. Although blood biomarkers of severe disease are well studied, less well understood are the inflammatory signatures in lung tissues associated with mild disease or silent infections, wherein infection and inflammation are rapidly resolved leading to sequelae-free recovery. Herein we described RNA-Seq and histological analyses of lungs over time in an omicron BA.1/K18-hACE2 mouse infection model, which displays these latter features. Although robust infection was evident at 2 days post infection (dpi), viral RNA was largely cleared by 10 dpi. Acute inflammatory signatures showed a slightly different pattern of cytokine signatures compared with severe infection models, and where much diminished 30 dpi and absent by 66 dpi. Cellular deconvolution identified significantly increased abundance scores for a number of anti-inflammatory pro-resolution cell types at 5/10 dpi. These included type II innate lymphoid cells, T regulatory cells, and interstitial macrophages. Genes whose expression trended downwards over 2-66 dpi included biomarkers of severe disease and were associated with 'cytokine storm' pathways. Genes whose expression trended upward during this period were associated with recovery of ciliated cells, AT2 to AT1 transition, reticular fibroblasts and innate lymphoid cells, indicating a return to homeostasis. Very few differentially expressed host genes were identified at 66 dpi, suggesting near complete recovery. The parallels between mild or subclinical infections in humans and those observed in this BA.1/K18-hACE2 mouse model are discussed with reference to the concept of "protective inflammation".

Effects of Vitamin C Supplements on Clinical Outcomes and Hospitalization Duration for Patients with Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis.

Vitamin C has been used as an essential antioxidant to reduce the inflammatory response associated with pneumonia and acute respiratory distress syndrome in patients with the 2019 coronavirus disease (COVID-19), but its effect on clinical outcomes remains controversial and inconclusive. The purpose of this study was to conduct a meta-analysis and systematic review to assess the effects of vitamin C supplementation on the severity of COVID-19 in hospitalized patients. Web of Science, Embase, Cochrane Library, PubMed, CNKI, CSTJ, Wan fang, and CBM databases were searched for publications between January 2020 and December 2023 that met the inclusion criteria. The meta-analyses of outcomes in more than one study were performed using Review Manager software. Heterogeneity was evaluated using the I2 statistic. A randomized controlled trial, cohort studies, and retrospective studies in which vitamin C supplementation was supplemented as monotherapy or in combination, compared with placebo, no treatment, or other standard treatment without vitamin C were included. After screening, 22 studies, with a total of 6831 patients, were selected for assessment. Odds ratios (ORs) with 95% CIs were calculated using fixed- and random-effects models. The meta-analysis showed significant effects of vitamin C on alleviating clinical outcomes in patients with COVID-19 (OR = 0.76, 95% CI = 0.65-0.89, P = .0007) but no shortening of the length of hospitalization (OR = 1.16, 95% CI = -0.13-2.44, P = .08) compared with the control group. Notably, vitamin C supplements significantly reduced the mortality risk (OR = 0.64, 95% CI = 0.51-0.80, P = .0001) and the incidence of severity (OR = 0.59, 95% CI = 0.43-0.80, P = .0006) in COVID-19 patients. The findings suggest that vitamin C supplements may have a beneficial effect on clinical outcomes, as well as reducing severity and mortality in COVID-19 patients, but more clinical randomized controlled trials are needed to evaluate the role of vitamin C in treating COVID-19. PROSPERO registration no. CRD42023491517.

Real-world use of multiplex point-of-care molecular testing or laboratory-based molecular testing for influenza-like illness in a 2021 to 2022 US outpatient sample.

While molecular testing is recommended for symptomatic patients suspected of having coronavirus disease 2019 (COVID-19), limited data are available examining real-world use of tests for severe acute respiratory syndrome coronavirus (SARS-CoV-2) and the impact of SARS-CoV-2 testing on patient outcomes. In this retrospective cohort study using de-identified administrative claims data in the Optum Labs Data Warehouse, we identified 2 groups of patients with ≥1 outpatient claims with a procedure code for SARS-CoV-2 testing between January 2021 and September 2022. Group 1 had ≥1 claims with CPT code 0240U or 0241U ("Xpert Xpress") (N = 51,602); Group 2 had ≥1 claims for laboratory-based molecular testing (N = 317,192). Outcomes assessed on the identification date and through the 90-day follow-up included claims evidence of use of SARS-CoV-2, influenza, and respiratory syncytial virus (RSV) tests, diagnosis of active COVID-19, influenza, or RSV, and use of treatments (antivirals for COVID-19, influenza, and RSV and other treatments for COVID-19 and RSV). Patients in Group 1 had fewer tests for SARS-CoV-2, influenza, or RSV (mean ± standard deviation 1.6±1.4 versus 2.6±2.6, standardized difference -0.45), faster time to diagnosis of COVID-19 (median 0 versus 4 days, standardized difference -0.27) or influenza (median 0 versus 5 days, standardized difference -0.74), and faster time to treatment of COVID-19, influenza, or RSV (median 1 versus 5 days, standardized difference 0.16) than patients in Group 2. In this nationwide real-world study of outpatient testing, use of point-of-care molecular multiplex SARS-CoV-2 testing resulted in fewer claims for SARS-CoV-2, influenza, and RSV tests, faster time to diagnosis, and faster time to treatment than laboratory-based molecular testing.

Understanding the Impact COVID-19 Has Had on Traumatic Ankle Fractures in a UK Orthopaedic Department: Should Current Guidelines Be Revised?

Introduction Ankle fractures are commonyet debilitating injuries. Surgery is the mainstay treatment for ankle fractures displaying a high suspicion of instability. During the coronavirus disease 2019 (COVID-19) pandemic, conservative management became prominent in patients with ankle fractures. This study assesses the variation in ankle fracture management during the COVID-19 versus pre-COVID-19 pandemic and alsohighlights how the lockdown affected patient's behaviour. Methods Data for patients with acute ankle fractures during the COVID-19 pandemic (March-June 2020) were retrieved using an electronic trauma database (eTrauma, OpenMedical, London, UK). Patients were categorised as operative versus non-operative. The same data were extrapolated from eTrauma for pre-COVID times (March-June 2019). Data were cross-checked with inpatient notes. Patient demographics, mechanism of injury, patient outcomes (Foot and Ankle Outcome Score(FAOS)) and delay in presentation were also analysed. Result There was an increased number of acute ankle fractures referred to the orthopaedic department during the COVID-19 pandemic (n=161,78.9% increase). However, 52% more cases were managed conservatively when compared with pre-COVID times. We also identified an increased presentation time from the date of injury to the orthopaedic review, along with a non-statistically significant decreased delay to surgery during the COVID-19 pandemic (p=0.131). Compared to 2019, FAOS scores were greater during the COVID-19 pandemic (p=0.049), despite no difference in the American SocietyofAnesthesiologists(ASA) grade between the two time periods. Conclusion Compared to the pre-COVID-19 pandemic period, more ankle fractures were managed conservatively in 2020, despite no significant difference found in baseline morbidity. In addition, patient outcomes were greater in 2020. Based on the data analysed, it would be prudent to review current ankle fracture management guidelines and consider a lower threshold for conservative management.

Through Their Eyes: Using Photovoice to Capture the Capacity-Building Journey of Long Covid Patient Experts.

Long Covid, characterised by persistent symptoms following the coronavirus disease 2019 (COVID-19) infection, significantly impacts the quality of life. Engaging patients in research and care through participatory methods can enhance a shared understanding of illness and improve the relevance of research. We define Patient Experts (PEs) as persons (including patients, caregivers and providers) who have completed a series of training sessions on team building, research methods and communication at the Patient Engagement Studio, University of South Carolina (PES USC). This study explores the use of photovoice to document the experiences and capacity-building journey of Long Covid PEs within PES USC. The study employed photovoice within the COVID-19-Focused Virtual Patient Engagement Studio (CoVIP Studio). PEs submitted photographs and narratives at two distinct time points. Among the 18 PEs who participated in the project, 47 photos were collected during the training, and 31 were collected at the project's conclusion. Thematic analysis was conducted to capture changes in patient perspectives and engagement. Initial themes identified were "Hope through Community," "Collaborative Education and Research" and "Strength and Endurance." By the project's end, themes had evolved to "Working as a Team to Share and Acquire Knowledge," "Enhanced Confidence in the Future of Care" and "Perseverance and Progress." These findings highlight the transformative impact of patient engagement and the utility of photovoice in documenting longitudinal shifts in patient perspectives. Photovoice effectively engaged Long Covid patients and captured their evolving roles and perceptions as PEs. The study underscores the value of patient-led participatory methods in enhancing the relevance and applicability of clinical research, advocating for their broader adoption to improve patient-centred care and research outcomes. A CoVIP Studio stakeholder advisory board (CoVIP SAB) guided the co-development and implementation of this project. The CoVIP SAB comprised nine members with complementary skills and expertise, including three patients, three clinicians who provide care to patients with COVID-19 and three researchers with expertise in patient-centred research, COVID-19 and/or patient engagement and collaborate with patients as co-investigators. The board contributed to project design and implementation, refining photovoice prompts and shaping dissemination strategies. In addition, one PE who actively participated in all phases of the project contributed to the writing of this paper and is a coauthor. All project activities involved patients and/or caregivers with lived experience of Long Covid.