COVID-19 Case Fatality Research Articles

The impact of COVID-19 vaccination on case fatality rates in a city in Southern Brazil

BackgroundRecent studies have established that vaccination plays a significant role in reducing COVID-19-related deaths. Here, we investigated differences in COVID-19 case fatality rates (CFRs) among vaccinated and unvaccinated populations, and analyzed whether the age composition of confirmed cases has a significant effect on the variations in the observed CFRs across these groups.MethodsThe study considered 59,853 confirmed cases and 1,687 deaths from COVID-19, reported between January 1 to October 20, 2021, by the Health Department of Londrina, a city in Southern Brazil. We used Negative Binomial regression models to estimate CFRs according to vaccination status and age range.ResultsThere are significant differences between the CFR for fully vaccinated and unvaccinated populations (IRR = 0.596, 95% CI [0.460 - 0.772], P < .001). Vaccinated populations experience fatality rates 40.4% lower than non-vaccinated. In addition, the age composition of confirmed cases explains more than two-thirds of the variation in the CFR between these 2 groups.ConclusionsOur novel findings reinforce the importance of vaccination as an essential public health measure for reducing COVID-19 fatality rates in all age groups. The results also provide means for accurately assessing differences in CFRs across vaccinated and unvaccinated populations. Such assessment is essential to inform and determine appropriate containment and mitigation interventions in Brazil and elsewhere.

The Foegen effect: A mechanism by which facemasks contribute to the COVID-19 case fatality rate.

Extensive evidence in the literature supports the mandatory use of facemasks to reduce the infection rate of severe acute respiratory syndrome coronavirus 2, which causes the coronavirus disease (COVID-19). However, the effect of mask use on the disease course remains controversial. This study aimed to determine whether mandatory mask use influenced the case fatality rate in Kansas, USA between August 1st and October 15th 2020.This study applied secondary data on case updates, mask mandates, and demographic status related to Kansas State, USA. A parallelization analysis based on county-level data was conducted on these data. Results were controlled by performing multiple sensitivity analyses and a negative control.A parallelization analysis based on county-level data showed that in Kansas, counties with mask mandate had significantly higher case fatality rates than counties without mask mandate, with a risk ratio of 1.85 (95% confidence interval [95% CI]: 1.51–2.10) for COVID-19-related deaths. Even after adjusting for the number of “protected persons,” that is, the number of persons who were not infected in the mask-mandated group compared to the no-mask group, the risk ratio remained significantly high at 1.52 (95% CI: 1.24–1.72). By analyzing the excess mortality in Kansas, this study determines that over 95% of this effect can solely be attributed to COVID-19.These findings suggest that mask use might pose a yet unknown threat to the user instead of protecting them, making mask mandates a debatable epidemiologic intervention.The cause of this trend is explained herein using the “Foegen effect” theory; that is, deep re-inhalation of hypercondensed droplets or pure virions caught in facemasks as droplets can worsen prognosis and might be linked to long-term effects of COVID-19 infection. While the “Foegen effect” is proven in vivo in an animal model, further research is needed to fully understand it.

Pitfalls and solutions in case fatality risk estimation – A multi-country analysis on the effects of demographics, surveillance, time lags between case reports and deaths and healthcare system capacity on COVID-19 CFR estimates

Across European countries, there have been large differences in COVID-19 case fatality risk (CFR) estimates, and considerable variation in these estimates over time. CFR estimates vary depending on both the method used for estimation and countryspecific characteristics. While crude methods simply use cumulative total numbers of cases and deaths, the CFR can be influenced by the demographic characteristics of the cases, the case detection rates, the time lags between the reporting of infections and deaths and infrastructure characteristics, such as healthcare capacities. We use publicly available weekly data for 11 European countries on the COVID- 19 case and death numbers by age group for the year 2020. Moreover, we use data on national weekly test rates to adjust the case numbers, and to investigate the effects of different time lags between the reporting of cases and deaths on the estimation of CFRs. Finally, we describe the association between case fatality rates and the demand for hospital and intensive care unit beds for COVID-19 cases, while taking into account national bed capacities. The crude CFR estimates differ considerably across the investigated countries. In the crude international CFR time series, the differences are smaller when adjusting for the demographics of the cases. Differences in testing policies significantly affect the CFR estimates as well. However, the question of precisely how these testing procedures should be adjusted requires further investigation. Lag adjustments of CFRs do not lead to improvements in estimates of COVID-19 CFRs, and no connection between hospital capacities and CFRs can be found for the countries included in our study.

SARS-CoV-2 infection fatality rate after the first epidemic wave in Mexico.

BackgroundEstimates of SARS-CoV-2 infection fatality rates (IFRs) in developing countries remain poorly characterized. Mexico has one of the highest reported COVID-19 case-fatality rates worldwide, although available estimates do not consider serologic assessment of prior exposure nor all SARS-CoV-2-related deaths. We aimed to estimate sex- and age-specific IFRs for SARS-CoV-2 in Mexico.MethodsThe total number of people in Mexico with evidence of prior SARS-CoV-2 infection was derived from National Survey of Health and Nutrition-COVID-19 (ENSANUT 2020 Covid-19)—a nationally representative serosurvey conducted from August to November 2020. COVID-19 mortality data matched to ENSANUT’s dates were retrieved from the death-certificate registry, which captures the majority of COVID-19 deaths in Mexico, and from the national surveillance system, which covers the subset of COVID-19 deaths that were identified by the health system and were confirmed through a positive polymerase chain reaction test. We analysed differences in IFRs by urbanization and region.ResultsThe national SARS-CoV-2 IFR was 0.47% (95% CI 0.44, 0.50) using death certificates and 0.30% (95% CI 0.28, 0.33) using surveillance-based deaths. The IFR increased with age, being close to zero at age <30 years, but increasing to 1% at ages 50–59 years in men and 60–69 years in women, and being the highest at ≥80 years for men (5.88%) and women (6.23%). Across Mexico's nine regions, Mexico City (0.99%) had the highest and the Peninsula (0.26%) the lowest certificate-based IFRs. Metropolitan areas had higher certificate-based IFR (0.63%) than rural areas (0.17%).ConclusionAfter the first wave of the COVID-19 pandemic, the overall IFR in Mexico was comparable with those of European countries. The IFR in Mexico increased with age and was higher in men than in women. The variations in IFRs across regions and places of residence within the country suggest that structural factors related to population characteristics, pandemic containment and healthcare capabilities could have influenced lethality at the local level.

Vaccination Coverage as a Predictor of COVID-19 Case Fatality Rates in Malaysia

Vaccination has offered the hope of restoring life to pre-COVID-19 normalcy. However, new COVID-19 cases have continued to emerge and have increased in certain regions even with increasing vaccination coverage. This study aims to explore the correlations between daily COVID-19 case fatality rates, vaccination coverage as well as daily new cases and deaths of COVID-19 in Malaysia. It aims to compare the pre- and post-vaccination COVID-19 case fatality rates and examine if any difference between the rates is statistically significant. It also aims to identify the main predictors of COVID-19 case fatality rates. This study obtained the data of daily new cases and deaths of COVID-19, as well as the daily vaccination coverage in Malaysia from official platforms and government offices for non-parametric statistical analysis. It explored the Spearman’s correlations between daily COVID-19 case fatality rates, daily new COVID-19 cases and deaths as well as the vaccination coverage in Malaysia. It examined the difference in the pre- and post-vaccination daily COVID-19 case fatality rates with Mann-Whitney U Test. It constructed a multiple regression model to identify the significant predictors of the daily case fatality rates. This study shows that daily COVID-19 case fatality rates are positively correlated with daily new COVID-19 cases and deaths, and vaccination coverage. It reveals that post-vaccination case fatality rates are lower than pre-vaccination and the difference is statistically significant. People fully vaccinated per 100 population is a significant predictor of the decline of daily case fatality rates.

Predictors of COVID-19 Fatality: A Worldwide Analysis of the Pandemic over Time and in Latin America

SARS-CoV-2 has infected over one hundred million people worldwide and has affected Latin America particularly severely in terms of both cases and deaths. This study aims to determine the association between SARS-CoV-2 testing and COVID-19 fatality rate worldwide over 8 months and to examine how this relationship differs between Latin America and all other countries. This cross-sectional study used March 2021 data from 169 countries. Multivariate regressions predicted COVID-19 fatality (outcome) from the number of SARS-CoV-2 tests (exposure), while controlling for other predictors. Results for March 2021 were compared to results from June 2020. Additionally, results for Latin America were also compared to all other countries except Latin American for March 2021. SARS-CoV-2 testing was associated with a significant decrease in COVID-19 fatality rate in both June 2020 and March 2021 (RR = 0.92; 95% CI 0.87–0.96 and RR = 0.86; 95% CI 0.74–1.00, respectively). SARS-CoV-2 testing was associated with a significant decrease in COVID-19 fatality rate in Latin American countries but not in all other countries (RR = 0.45; 95% CI 0.23–0.89 and RR = 0.95; 95% CI 0.82–1.11, respectively). However, the difference between the risk ratios for June 2020 and March 2021 and between the risk ratios for Latin America and all other countries were not statistically significant. Increased SARS-CoV-2 testing may be a significant predictor of lower COVID-19 case fatality rate, specifically in Latin American countries, due to the existence of a strong association, which may have driven the worldwide results.

Genetic association of TMPRSS2 rs2070788 polymorphism with COVID-19 case fatality rate among Indian populations.

SARS-CoV-2, the causative agent for COVID-19, an ongoing pandemic, engages the ACE2 receptor to enter the host cell through S protein priming by a serine protease, TMPRSS2. Variation in the TMPRSS2 gene may account for the disparity in disease susceptibility between populations. Therefore, in the present study, we have used next-generation sequencing (NGS) data of world populations from 393 individuals and analyzed the TMPRSS2 gene using a haplotype-based approach with a major focus on South Asia to study its phylogenetic structure and their haplotype sharing among various populations worldwide. Our analysis of phylogenetic relatedness showed a closer affinity of South Asians with the West Eurasian populations therefore, host disease susceptibility and severity particularly in the context of TMPRSS2 will be more akin to West Eurasian instead of East Eurasian. This is in contrast to our prior study on the ACE2 gene which shows South Asian haplotypes have a strong affinity towards West Eurasians. Thus ACE2 and TMPRSS2 have an antagonistic genetic relatedness among South Asians. Considering the significance of the TMPRSS2 gene in the SARS-CoV-2 pathogenicity, COVID-19 infection and intensity trends could be directly associated with increased expression therefore, we have also tested the SNPs frequencies of this gene among various Indian state populations with respect to the case fatality rate (CFR). Interestingly, we found a significant positive association between the rs2070788 SNP (G Allele) and the CFR among Indian populations. Further our cis eQTL analysis of rs2070788 shows that the GG genotype of the rs2070788 tends to have a significantly higher expression of TMPRSS2 gene in the lung compared to the AG and AA genotypes thus validating the previous observation and therefore it might play a vital part in determining differential disease vulnerability. We trust that this information will be useful in understanding the role of the TMPRSS2 variant in COVID-19 susceptibility and using it as a biomarker may help to predict populations at risk.

Black/African Americans (AA) and Disproportionate Burden of SARS-COV-2 (COVID-19) Mortality in the United States

Purpose: Historically until date, viral pathogens remain very challenging with respect to transmission, severity, mortality and survival with respect to sub-population variances. While racial disparities in cumulative incidence (CmI) and mortality from the influenza pandemics of 1918 and 2009 implicated Blacks with survival disadvantage relative to Whites in the United States, COVID-19 currently indicates comparable disparities. We aimed to: assess COVID-19 CmI by race, determine the Black–White case fatality (CF) and risk differentials, and apply explanatory model for mortality risk differentials. Methods: COVID-19 data on confirmed cases and deaths by selective states health departments were assessed using a cross-sectional ecologic design. Chi-square was used for CF independence, while binomial regression model for the Black–White risk differentials. Results: The COVID-19 mortality CmI was disproportionate among Blacks/AA with 34% of the total mortality in the United States, albeit their 13% population size. The COVID-19 CF was higher among Blacks/AA relative to Whites; Maryland, (2.7% vs. 2.5%), Wisconsin (7.4% vs. 4.8%), Illinois (4.8% vs. 4.2%), Chicago (5.9% vs. 3.2%), Detroit (Michigan), 7.2% and St. John the Baptist Parish (Louisiana), 7.9%. Blacks/AA compared to Whites in Michigan were 15% more likely to die, CmI risk ratio (CmIRR) = 1.15, 95% CI, 1.01–1.32. Blacks/AA relative to Whites in Illinois were 13% more likely to die, CmIRR = 1.13, 95% CI, 0.93–1.39, while Blacks/AA compared to Whites in Wisconsin were 51% more likely to die, CmIRR = 1.51, 95% CI, 1.10–2.10. In Chicago, Blacks/AA were more than twice as likely to die, CmIRR = 2.24, 95% CI, 1.36–3.88. Conclusion: Substantial racial/ethnic disparities are observed in COVID-19 CF and mortality with Blacks/AA disproportionately affected across the United States. Keywords: COVID-19 (SARS-COV2), race/ethnicity, case fatality, mortality, health disparities, United States

Hospitalization and case fatality rates of adult patients diagnosed with COVID-19 at a tertiary academic medical center in 2020

The objective of this study is to determine hospitalization and case-fatality rates in adult patients diagnosed with COVID-19 at a large academic medical center in the United States of America which predominately serves rural and underrepresented populations. EMR data abstraction of a cohort of lab-confirmed COVID-19, outpatient and inpatient, adult patients, who tested positive at Augusta University Medical Center (AUMC) in 2020 (N = 18,403) was conducted. Eligible patients were identified using the data mining tool, i2b2. COVID-19 hospitalization and case fatality rates were calculated. Logistic and Poisson regression models were constructed to identify characteristics associated with hospitalization, death, and hospital stay. The hospitalization rate was 3.97%. Patients aged 45-64 and 65+ had significantly higher hospitalization rates. Compared to White, hospitalization rates were higher in Black (AOR 2.35, 95% CI, 1.99-2.77, p 0.001) and Hispanic patients (AOR 1.92, 95% CI, 1.92-3.01, p 0.01). Overall COVID-19 case fatality rate was 0.62% and, in hospitalized patients, was 14.25%. Patients 65+ had higher odds of death (AOR 7.57, 95% CI, 3.25-22.13, p 0.001). Case fatality rates did not vary by race. In conclusion, in a primarily rural and underserved population prior to known effective therapy, overall and hospitalized case fatality rates were similar to studies from large urban areas. Keywords: COVID-19, case fatality, hospitalization rate, rural health.

Evaluation of the role of vaccination in the COVID-19 pandemic based on the data from the 50 U.S. States

Vaccination is considered as the ultimate weapon to end the pandemic. However, the role of vaccines in the pandemic remains controversial. To explore the impact of vaccination on the COVID-19 pandemic, we used logistic regression models to predict numbers of population-adjusted confirmed cases, deaths, intensive care unit (ICU) cases, case fatality rates and ICU admission rates of COVID-19 in the 50 U.S. states, based on 17 related variables. The logistic regression analysis showed that percentages of people vaccinated correlated inversely with the numbers of COVID-19 deaths and case fatality rates but showed no significant correlation with numbers of confirmed cases or ICU cases, or ICU admission rates. The Spearman correlation analysis showed that the percentages of people vaccinated correlated inversely with the numbers of COVID-19 deaths, ICU cases, ICU case rates, and case fatality rates but showed no significant correlation with numbers of confirmed cases. The number of deaths and mortality in the group after the vaccine usage were significantly lower than those in the group before the vaccine usage. However, after delta became the dominant strain, there were no longer significant differences in the number of deaths and the mortality rate between before and after delta became the dominant strain, although vaccines were used in both periods. Vaccination can significantly reduce COVID-19 deaths and mortality, while it cannot reduce the risk of COVID-19 infection. In addition to vaccination, other measures, such as social distancing, remain important in containing COVID-19 transmission and lower the risk of COVID-19 severe outcomes.

Path to normality: Assessing the level of social-distancing measures relaxation against antibody-resistant SARS-CoV-2 variants in a partially-vaccinated population

IntroductionTwo years into the coronavirus 2019 (COVID-19) pandemic, populations with less built-up immunity continued to devise ways to optimize social distancing measures (SDMs) relaxation levels for outbreaks triggered by SARS-CoV-2 and its variants to resume minimal economics activities while avoiding hospital system collapse. MethodAn age-stratified compartmental model featuring social mixing patterns was first fitted the incidence data in second wave in Hong Kong. Hypothetical scenario analysis was conducted by varying population mobility and vaccination coverages (VCs) to predict the number of hospital and intensive-care unit admissions in outbreaks initiated by ancestral strain and its variants (Alpha, Beta, Gamma, Delta and Omicron). Scenarios were “unsustainable” if either of admissions was larger than the maximum of its occupancy. ResultsAt VC of 65%, scenarios of full SDMs relaxation (mean daily social encounters prior to COVID-19 pandemic = 14.1 contacts) for outbreaks triggered by ancestral strain, Alpha and Beta were sustainable. Restricting levels of SDMs was required such that the optimal population mobility had to be reduced to 0.9, 0.65 and 0.37 for Gamma, Delta and Omicron associated outbreaks respectively. VC improvement from 65% to 75% and 95% allowed complete SDMs relaxation in Gamma-, and Delta-driven epidemic respectively. However, this was not supported for Omicron-triggered epidemic. DiscussionTo seek a path to normality, speedy vaccine and booster distribution to the majority across all age groups is the first step. Gradual or complete SDMs lift could be considered if the hybrid immunity could be achieved due to high vaccination coverage and natural infection rate among vaccinated or the COVID-19 case fatality rate could be reduced similar to that for seasonal influenza to secure hospital system sustainability.

Country-level and regional COVID-19 burden and determinants across OECD member states and partner countries.

COVID-19 pandemic is tremendously impacted by socioeconomic and health determinants worldwide. This study aimed to determine factors associated with COVID-19 fatality among member states and partner countries of the Organization for Economic Cooperation and Development (OECD). An ecological study was conducted using COVID-19 data of 48 countries for the period between 31 December 2019-31 December 2021. The outcome variables were COVID-19 case fatality rate (CFR) and years of life lost to COVID-19 (YLLs). Countries' sociodemographics and COVID-19-related data were extracted from OECD website, Our World in Data, John Hopkins Coronavirus Resource Center, Economist Intelligence Unit (EIU) and WHO. In the first year of the pandemic (December 2019-January 2021), highest CFR was observed in Mexico, 8.51%, followed by China, 5.17% and Bulgaria, 4.12%), and highest YLLs was observed in Mexico, 2,055 per 100,000. At regional level, highest CFR was observed in North & central America, 4.25 (3.71) %, followed by South America (2.5 (0.1) %); whereas highest YLLs was observed in South America region 1457.5 (274.8) per 100,000, followed by North & central America, 1207.3 (908.1) per 100,000. As of 31 December 2021, Mexico (7.52%) and Bulgaria (4.78%) had highest CFR; on the other hand, highest YLLs was observed in England, 26.5 per 1,000, followed by the United States, 25.9 per 1,000. At regional level, highest CFR (3.37(3.19) %) and YLLs (16.7 (13) per 1,000) were both observed in North & central America. Globally, the analysis of the 2-year cumulative data showed inverse correlation between CFR and nurse per 10,000 (R = -0.48; p < 0.05) and GDP per capita (R = -0.54; p < 0.001), whereas positive correlation was observed between YLLs and elderly population rate (R = 0.66; p < 0.05) and overweight/obese population rates (R = 0.55; p < 0.05). This study provides insights on COVID-19 burden among OECD states and partner countries. GDP per capita, overweight/obesity and the rate of elderly population emerged as major social and health determinants of COVID-19 related burden and fatality. Findings suggest that a robust economy and interventions designed to promote healthy longevity and prevent weight gain in at-risk individuals might reduce COVID-19 burden and fatality among OECD states and partner countries.

Smoke and COVID-19 case fatality ratios during California wildfires

Recent evidence has shown an association between wildfire smoke and COVID-19 cases and deaths. The San Francisco Bay Area, in California (USA), experienced two major concurrent public health threats in 2020: the COVID-19 pandemic and dense smoke emitted by wildfires. This provides a unprecedented context to unravel the role of acute air pollution exposure on COVID-19 severity. A smoke product provided by the National Oceanic and Atmospheric Association Hazard Mapping System was used to identify counties exposed to heavy smoke in summer and fall of 2020. Daily COVID-19 cases and deaths for the United States were downloaded at the County-level from the CDC COVID Data Tracker. Synthetic control methods were used to estimate the causal effect of the wildfire smoke on daily COVID-19 case fatality ratios (CFRs), adjusting for population mobility. Evidence of an impact of wildfire smoke on COVID-19 CFRs was observed, with precise estimates in Alameda and San Francisco. Up to 58 (95% CI: 29, 87) additional deaths for every 1000 COVID-19 incident daily cases attributable to wildfire smoke was estimated in Alameda in early September. Findings indicated that extreme weather events such as wildfires smoke can drive increased vulnerability to infectious diseases, highlighting the need to further study these colliding crises. Understanding the environmental drivers of COVID-19 mortality can be used to protect vulnerable populations from these potentially concomitant public health threats.

Epidemiological investigation of the factors affecting the COVID-19 case fatality rate

Epidemiological investigation of the factors affecting the COVID-19 case fatality rate

Impact of Vaccination on COVID-19 case fatality in the United Kingdom

We examined trends and differences in the number of COVID-19 cases and deaths and corresponding estimates of case fatality in the United Kingdom (UK) during the 20-month period, 3/1/2020-10/31/2021. Three distinct stages of the epidemic in the UK population of 68.4 million were noted corresponding to successive surges in the number of cases and deaths. For these three successive time periods, crude case fatality rates (case fatality = number of deaths / number of cases) fell dramatically: 12.4% during the early months of the epidemic, (335,210 cases and 41,564 deaths during 3/1-8/31/2020), 2.08% during the autumn, winter and spring months of 2020 and 2021 (4,148,076 cases and 86,254 deaths during 9/1/2020-5/31/2021), and 0.28% during the summer and autumn months of 2021 (4,573,571 cases and 12,814 deaths during 6/1-10/31, 2021). A high proportion (80-90%) of the UK population was vaccinated against SARS CoV-2 during the latter stage when the dominant infection was due to the Delta variant of SARS CoV-2. Results suggest that COVID-19 vaccines did not prevent viral transmission in the UK but were associated with a marked reduction in case fatality.

COVID-19 fatality in Germany: Demographic determinants of variation in case-fatality rates across and within German federal states during the first and second waves

Germany experienced one of the lowest COVID-19 case-fatality rates (CFRs) in Western Europe in the first pandemic wave, and further CFR decreases in the spring and summer of 2020. However, Germany’s CFR increased markedly during the second wave, becoming o

444. County-level COVID-19 Case Fatality Rate in Medicaid Expansion States Compared to Non-Expansion States

BackgroundMedicaid expansion has been adopted by 38 states and the District of Columbia,1,2 contributing to lower rates of uninsured individuals in the US.3 During the COVID-19 pandemic, Medicaid enrollment offset employer-based insurance losses precipitated by the recession.4 The aim of this study was to evaluate whether Medicaid expansion may have impacted COVID-19 mortality. MethodsWe conducted an ecologic study that included all US counties in the 50 states and District of Columbia. County-specific Medicaid expansion status was based on whether expansion was adopted within the state. COVID-19 cases and deaths for each county were obtained from the Centers of Disease Control (CDC). Unadjusted and multivariable negative binomial regression with robust standard errors to account for clustering of counties within each state were used to evaluate the association of COVID-19 case fatality rate and Medicaid expansion status. Adjusted models included the addition of four sets of county-level covariates thought to influence the association of Medicaid status and COVID-19 fatality rate: demographics, comorbidities, economic indicators, and physician density. These analyses were then performed in subgroups of counties defined by urbanicity (metro, suburban or rural) and quartiles of poverty rates. Incidence Rate Ratios (IRR) and 95% confidence intervals (CI) are reported.ResultsA total of 1,814 Medicaid expansion and 1,328 non-expansion counties were included in the analysis. Crude case fatality rates were 2.1% (non-expansion) and 1.8% (expansion). Medicaid expansion was not associated with a significantly lower COVID-19 case fatality rate in either the unadjusted (IRR: 0.86; 95% CI: 0.74, 1.01) or fully adjusted (IRR: 1.02; 95% CI: 0.90, 1.16) models. In adjusted models, Medicaid expansion status was also not associated with differences in COVID-19 case fatality rate when counties were stratified by either urbanicity or percent of individuals living below the poverty line. ConclusionIn this county-level analysis, Medicaid expansion status was not associated with a significant difference in county-level COVID-19-related case fatality rates among people of all ages. Future individual-level studies are needed to better characterize the effect of Medicaid on COVID-19 mortality. Disclosures All Authors: No reported disclosures

804. Infection Control and Clinical Support in Long-Term Care Homes During the COVID-19 Pandemic in North Toronto: A Quasi-Experimental Study

BackgroundWave one of the COVID-19 pandemic in Ontario, Canada, resulted in significant institutional outbreaks associated with high case fatality among older adults. Our hospital formally partnered with congregate care homes in north Toronto to support infection control and clinical management before wave two of the COVID-19 pandemic. Our aim was to evaluate the impact of this program on resident and healthcare worker (HCW) outcomes. MethodsA multicentre quasi-experimental study was conducted comparing outcomes between wave one (March-June, 2020) and wave two (October-December, 2020) among 17 congregate care homes (4 long term care homes and 13 residential homes). During wave two, weekly meetings and 42 on-site visits were conducted along with on-site daily hospital presence for all COVID-19 outbreaks to support infection control and resident management. The primary outcomes included COVID-19-case fatality rate as well as overall resident fatality including COVID-19 and non-COVID-19 related causes. Secondary outcomes included healthcare worker COVID-19 infections, and infection control practices among homes with paired audits (n=6), including hand hygiene, use of personal protective equipment, environmental cleaning and physical distancing practices. ResultsAmong 2203 residents during wave one and 2287 residents during wave two, there was reduction in COVID-19 case fatality rate (38.1% vs. 13.4%; p< 0.01), overall COVID-19-related fatality (2.3% vs. 1.0%; p< 0.01) and non COVID-19 related fatality (8.3% vs. 3.5%; p< 0.01). Weekly staff testing and increased syndromic surveillance was implemented during wave two. Among 2590 staff, there were 2.6% vs.4.2% staff who tested positive for COVID-19 during wave one and two, respectively. Changes in infection control practice were observed in regard to directly observed hand hygiene (83.3% vs. 100%), use of personal protective equipment (16.7% vs. 83.3%), environmental cleaning (66.7% vs. 100%) and physical distancing (66.7% vs. 83.3%). ConclusionIntegration of hospital with community congregate care homes was associated with improvements in resident outcomes during wave two of the pandemic. Further longitudinal support and evaluation is needed to ensure sustainability. Disclosures All Authors: No reported disclosures

Analysis of case fatality rate of SARS-CoV-2 infection in the Spanish Autonomous Communities between March and May 2020.

The Spanish health system is made up of seventeen regional health systems. Through the official reporting systems, some inconsistencies and differences in case fatality rates between Autonomous Communities (CC.AA.) have been observed. Therefore the objective of this paper is to compare COVID-19 case fatality rates across the Spanish CC.AA. Observational descriptive study. The COVID-19 case fatality rate (CFR) was estimated according to the official records (CFR-PCR+), the daily mortality monitory system (MoMo) record (CFR-Mo), and the seroprevalence study ENE-COVID-19 (Estudio Nacional de sero Epidemiologia Covid-19) according to sex, age group and CC.AA. between March and June 2020. The main objective is to detect whether there are any differences in CFR between Spanish Regions using two different register systems, i. e., the official register of the Ministry of Health and the MoMo. Overall, the CFR-Mo was higher than the CFR-PCR+, 1.59% vs 0.98%. The differences in case fatality rate between both methods were significantly higher in Castilla La Mancha, Castilla y León, Cataluña, and Madrid. The difference between both methods was higher in persons over 74 years of age (CFR-PCR+ 7.5% vs 13.0% for the CFR-Mo) but without statistical significance. There was no correlation of the estimated prevalence of infection with CFR-PCR+, but there was with CFR-Mo (R2 = 0.33). Andalucía presented a SCFR below 1 with both methods, and Asturias had a SCFR higher than 1. Cataluña and Castilla La Mancha presented a SCFR greater than 1 in any scenario of SARS-CoV-2 infection calculated with SCFR-Mo. The PCR+ case fatality rate underestimates the case fatality rate of the SARS-CoV- 2 virus pandemic. It is therefore preferable to consider the MoMo case fatality rate. Significant differences have been observed in the information and registration systems and in the severity of the pandemic between the Spanish CC.AA. Although the infection prevalence correlates with case fatality rate, other factors such as age, comorbidities, and the policies adopted to address the pandemic can explain the differences observed between CC.AA.

Trends in COVID-19 mortality and case-fatality rate in the State of Paraná, South Brazil: spatiotemporal analysis over one year of the Pandemic

Introduction: by late 2019, China notified a new disease rising, and with the agent’s identification, it was called COVID-19. Despite the efforts of the World Health Organization (WHO) and worldwide countries, the disease spread out of control; on March 11, WHO declared the pandemic state. Brazil is the biggest country in South America, demarcated into 26 states with different economic, cultural, and social aspects. Paraná is one of the Brazilian federative units, it is the sixth more economically important and ranks second in Education. Its first COVID-19 case was confirmed on March 12, 2020, and the first death was on March 27, two weeks after the first death in Brazil. Objective: This study objective is to determine the mortality and case-fatality rates of COVID-19 in the State of Paraná, Brazil, from March 1, 2020, to March 31, 2021. Methods: It is an ecological time-series study, using all cases (854,326) and deaths (17,229 deaths) of COVID-19 reported in public and official database of the State of Paraná Health Department. Case fatality and mortality rates were stratified by sex and age. For trend analysis, the period was divided into a first “wave” (March to November 2020) and a second “wave” (December 2020 to March 2021). The Prais-Winsten regression model for population mortality and case-fatality rates allowed classifying whether it increased, decreased, or was flat. Results: Women were more affected by the number of cases, with 454,056 cases (53.15%) confirmed and 7,257 fatalities (42.12%). A total of 400,270 men (46.85%) were infected and 9,972(57.87%) died. For the first year of COVID-19, in the State of Paraná, the incidence was calculated as 7404.12/100,000 inhabitants, the mortality was 149.32/100,000 inhabitants, and the case-fatality rate was 2.02%. We saw a tendency for decreasing the case-fatality rate (DPC = -0,18; p&lt;0,001). The mortality and incidence showed an increasing trend (DPC=1,13, p&lt;0,001; DPC=1,58, p&lt;0,001, respectively). Conclusion: The level and variability of transmission during this first year of pandemic suggest that the disease in the State of Paraná was never under control.