COVID-19 Mortality Research Articles

Antiviral drug treatment profiles and clinical outcomes of COVID-19 patients at public hospitals in Erbil city

Background & objectives: The World Health Organization has identified COVID-19 as a rapidly spreading global disease. Some antiviral drugs have shown promising efficacy in treating COVID-19. This study aims to identify the effects of antiviral drugs and compare them with other therapies in COVID-19 patients, while reviewing the clinical outcomes of these treatments. Methods: This observational retrospective case study included 451 COVID-19 patients, comprising 57.0% males and 43% females, conducted in Rizgari, Erbil, at Central Emergency, Rozhawa Emergency, and Emirate Hospitals over one year from December 2020 to December 2021. COVID-19 cases were confirmed using reverse transcriptase polymerase-chain reaction (RT-PCR) assays, and treatment followed the WHO guidelines, involving antivirals (Remdesivir, Favipiravir), broad-spectrum antibiotics (levofloxacin, azithromycin, ceftriaxone, meropenem, imipenem), and supportive treatment with Becozym (Vitamins B1 + B2 + B3 + B5 + B6). Data were recorded in the statistical department of the hospitals. Results: The total age range of the 451 patients was 95 (18-113) with a mean ± SD of 59.408 ± 18.26 years. The death rate was 22.39%. A majority of the survival patients were in the young age group (95.1%), while the death rate was higher in the old age group (more than 75 years). The death rate of patients treated with antiviral drug Remdesivir was 15.30%, while it was 37.93%, 73.45%, 15.25%, and 14.15% in patients on levofloxacin, ceftriaxone, meropenem, and Becozyme, espectively. Logistic regression analysis did not show any role of treatments in decreasing mortality. Conclusions: Significant differences were observed in clinical outcomes; the majority of surviving patients were in the young age group, while older COVID-19 patients had worse illnesses and treatment outcomes. Diabetes and hypertension were significant predictors of COVID-19 mortality. Although Remdesivir treatment showed a statistically significant association between survival and death cohorts, it was not considered a predictor variable for survival. Antibiotics and supplement drugs like Becozyme were also not considered predictors of survival for COVID-19 patients.

Association between FTO polymorphism and COVID-19 mortality among older adults: A population-based cohort study

ObjectivesCOVID-19 caused a global pandemic with millions of deaths. Fat mass and obesity-associated gene (FTO) (alias m6A RNA demethylase) and its functional rs17817449 polymorphism are candidates to influence COVID-19-associated mortality since methylation status of viral nucleic acids is an important factor influencing viral viability. MethodsWe tested a population-based cohort of 5233 subjects (aged 63-87 years in 2020) where 70 persons died from COVID-19 and 394 from other causes during the pandemic period. ResultsThe frequency of GG homozygotes was higher among those who died from COVID-19 (34%) than among survivors (19%) or deaths from other causes (20%), P <0.005. After multiple adjustments, GG homozygotes had a higher risk of death from COVID-19 with odds ratio = 2.01 (95% confidence interval; 1.19-3.41, P <0.01) compared with carriers of at least one T allele. The FTO polymorphism was not associated with mortality from other causes. ConclusionsOur results suggest that FTO variability is a significant predictor of COVID-19-associated mortality in Caucasians.

Sociopolitical context and COVID-19 fatality rates in OECD countries: a configurational approach

BackgroundThe effectiveness of crisis response can be influenced by various structural, cultural, and functional aspects within a social system. This study uses a configurational approach to identify combinations of sociopolitical conditions that lead to a high case fatality rate (CFR) of COVID-19 in OECD countries.MethodsA Fuzzy set qualitative comparative analysis (QCA) is conducted on a sample of 38 OECD countries. The outcome to be explained is high COVID-19 CFR. The five potentially causal conditions are level of democracy, state capacity, trust in government, health expenditure per capita, and the median age of population. A comprehensive QCA robustness test protocol is applied, which includes sensitivity ranges, fit-oriented robustness, and case-oriented robustness tests.ResultsNone of the causal conditions in both the presence and negation form were found to be necessary for high or low levels of COVID-19 CFR. Two different combinations of sociopolitical conditions were usually sufficient for the occurrence of a high CFR of COVID-19 in OECD countries. Low state capacity and low trust in government are part of both recipes. The entire solution formula covers 84 percent of the outcome. Some countries have been identified as contradictory cases. The explanations for their COVID-19 CFR require more in-depth case studies.ConclusionsFrom a governance perspective, the weakness of government in effectively implementing policies, and the citizens’ lack of confidence in their government, combined with other structural conditions, serve as barriers to mounting an effective response to COVID-19. These findings can support the idea that the effects of social determinants of COVID-19 outcomes are interconnected and reinforcing.

Forecasts of the mortality risk of COVID-19 using the Markov-switching autoregressive model: a case study of Nigeria (2020–2022)

The global pandemic due to SARS-Cov-2 ravaged the world and killed more than 6 million people globally within two years. Studies predicting future occurrences are essential to effectively combat the virus. This study modeled daily fatality rate in Nigeria from March 23, 2020 to March 19, 2022 and forecast future occurrences using Markov switching model (MSM). MSM estimates segmented fatality rates into three states of low-, medium- and high-risks. Further, estimates revealed that as at 19th March, 2022, Nigeria remained at the low-risk regime in which 1 (95%CI: 0, 1) person, on the average, died of coronavirus daily; however, the most probable scenario in the nearest future was the medium-risk state in which an average of 4 (95%CI: 2, 5) persons would die daily with 48.7% probability. The study concluded that Nigerian COVID mortality risks followed a switching pattern which fluctuated within low-, medium- and high-risks; however, the medium-risk state was most likely in the future. Our results indicated that the quarantine measures adopted by the governments yielded positive results. It also underscored the need for governments and individuals to intensify efforts to ensure that the country remained at the low-risk zone till the virus would be eventually eradicated.

Hospital and post-discharge mortality in COVID-19 patients with a preexisting cancer diagnosis in Iran

BackgroundDespite the severe impact of COVID-19 on cancer patients, data on COVID-19 outcomes in cancer patients from low- and middle-income countries is limited. We conducted a large study about the mortality rate of COVID-19 in cancer patients in Iran.MethodsWe analyzed data from 1,079 cancer (average age: 58.2 years) and 5,514 non-cancer patients (average age: 57.2 years) who were admitted for COVID-19 in two referral hospitals between March 2019 and August 2021. Patients were followed up until death or 31st August 2021. Multiple logistic regression models estimated the odds ratio (OR) and 95% confidence intervals (CI) of factors associated with ICU admission and intubation. The Cox regression model estimated hazard ratios (HRs) and 95% CI of factors associated with hospital and post-discharge 60-day mortalities.ResultsThe cancer patients had higher ICU admission (OR = 1.65, 95% CI: 1.42–1.91; P-value 0.03) and intubation (OR = 3.13, 95% CI = 2.63–3.73, P-value < 0.001) than non-cancer patients. Moreover, hospital mortality was significantly higher in cancer patients than in non-cancer patients (HR = 2.12, 95% CI: 1.89–2.41, P-value < 0.001). HR for the post-discharge mortality was higher in these patients (HR = 2.79, 95% CI: 2.49–3.11, < 0.001). The hospital, comorbidities, low oxygen saturation, being on active treatment, and non-solid tumor were significantly associated with ICU admission (P-value < 0.05) in cancer patients, while only low oxygen saturation was associated with intubation. In addition, we found that old age, females, low oxygen saturation level, active treatment, and having a metastatic tumor were associated with death due to COVID-19 (P-value < 0.05). Only lung cancer patients had a significantly higher risk of death compared to other cancer types (HR = 1.50, 95% CI: 1.06–2.10, P-value = 0.02).ConclusionCancer patients are at a higher risk of ICU admission, intubation, and death due to COVID-19 than non-cancer patients. Therefore, cancer patients who are infected with COVID-19 require intensive care in the hospital and active monitoring after their discharge from the hospital.

Proposed Mechanisms and Associations of COVID-19 with Cardiometabolic Risk Factors

Cardiovascular disease (CVD) and cardiometabolic risk (CMR) are highly prevalent globally. The interplay between CVD/CMR and COVID-19 morbidity and mortality has been intensely studied over the last three years and has yielded some important discoveries and warnings for public health. Despite many advances in cardiovascular medicine, CVD continues to be the global leading cause of death. Much of this disease burden results from high CMR imposed by behaviors centered around poor nutrition related to lifestyle choices and systemic constraints. Increased CVD/CMR contributed to the COVID-19 pandemic’s unprecedented wave of disability and death, and the current state of cardiovascular health been equated to a “Population Code Blue.” There is an urgent and unmet need to reorient our priorities towards health promotion and disease prevention. This manuscript will review how nutrition and lifestyle affect outcomes in COVID-19 and how some interventions and healthy lifestyle choices can markedly reduce disease burden, morbidity, and mortality.

Effect of amubarvimab-romlusevimab for treatment of severe COVID-19 in intensive care units: A retrospective cohort study

Amubarvimab-romlusevimab is a commonly recommended antiviral treatment in China for adult patients with mild or moderate SARS-CoV-2 infections, especially for patients with a high risk factor for progression to severe COVID-19. However, its exact efficacy in patients with severe Covid-19 is not yet known.This is a single-center retrospective cohort study, in which we collected the general data, laboratory tests, radiological characteristics, viral conversion status, and prognosis of the disease from patients with COVID-19 hospitalized, from December 2022 to March 2023 in the Department of Critical Care Medicine. The amubarvimab-romlusevimab therapy can reduce the 28-day mortality (29.79 % vs 51.35 %, p = 0.02), and ICU mortality (29.79 % vs 55.41 %, p = 0.006) of severe COVID-19.A 1:1 PSM (Propensity Score Matching) was performed to reduce bias, in order to ensure the two groups were balanced and comparable. In the matched population (n = 47), there were no statistically significant differences between the mAbs (monoclonal antibody)group and the Non-antiviral group in 28-day, and thromboembolic events in COVID-19 patients. The 40-day survival analysis shows that mAbs therapy can improve patient prognosis (HR = 0.45, 95%CI = 0.26–0.76, p = 0.008). However, no significant intergroup difference in the 40-day cumulative viral conversion rate. In a univariate Cox regression analysis, The Amubarvimab - romlusevimab therapy(HR:0.464; CI:[0.252–0.853]; p:0.013) is a protective factor and CRP, PCT, PLT, Lactate, PT, PT-INR, and pt% level at admission were risk factors for clinical prognosis. After including the above covariates, Multifactorial COX regression shows that the Amubarvimab - romlusevimab therapy(HR:0.392; CI:[0.211–0.729]; p:0.003), CRP, Lactate and PT-INR at admission are independent factors for mortality of severe COVID-19. Based on the current data, we conclude that amubarvimab-romlusevimab therapy is beneficial for patients with severe COVID-19.

Impact of SARS-CoV-2 infection and vaccination on cesarean section outcomes: a retrospective analysis.

Pregnant individuals have faced unique challenges during the COVID-19 pandemic, necessitating a closer examination of maternal and fetal health outcomes. Investigate the morbidity and mortality associated with SARS-CoV-2 infection among pregnant individuals, considering vaccination status and variant strains. Retrospective cohort. Tertiary state hospital. Patients who underwent cesarean sections were categorized into three periods: pre-vaccination (before 31 August 2021), early post-vaccination (from September 2021), and late post-vaccination (aligned with 70% immunization coverage by 2 September 2021). Data collected included demographic information (age, gravidity, parity count, gestational age, newborn APGAR scores), cesarean section indications, chronic diseases, vaccination status, vaccine type and doses, SARS-CoV-2 variant status, ICU admission, and mortality due to COVID-19. ICU admission and mortality rates, focusing on the impact of SARS-CoV-2 infection and vaccination status. 297 COVID PCR-positive symptomatic patients who underwent cesarean sections. In the pre-vaccination group, there were 13 mortalities (8.1%) compared to 9 (6.6%) post-vaccination (P=.610). Maternal ARDS was seen in 46.2% of pre-vaccination mortalities versus 11.1% post-vaccination (P=.045). COVID-19 delta variant patients had higher ICU admission (80%) and mortality rates (40%). Rates of COVID-19 PCR-positive cesarean sections, ICU admissions, and mortality declined significantly in early (P=.021, P=.004, P=.009), respectively and late post-vaccination periods (P<.001, P<.001, P=.0019), respectively. Vaccinated patients had no ICU admissions or mortality. Vaccination against COVID-19 is crucial for pregnant individuals as it significantly reduces the risk of severe illness. While vaccines offer substantial protection, the pandemic's acute phase might be waning, yet COVID-19 remains a global threat, particularly in regions with limited vaccine access. Continued vigilance and proactive measures are essential to mitigate ongoing risks and the emergence of new variant strains. Retrospective observational design and the single-center setting, which may affect the generalizability of the findings.

Is using inhaled corticosteroid effective against COVID-19 pneumonia severity and mortality?

It is known that the use of inhaled corticosteroids increases the incidence of pneumonia in patients followed up with the diagnosis of chronic asthma and chronic obstructive pulmonary disease (COPD). This study aimed to investigate the contribution of inhaled steroid use to pneumonia severity and mortality in cases with COVID-19 pneumonia. The study is a retrospective, observational study. Among the cases admitted to the pandemic clinic, patients diagnosed with COVID-19 pneumonia were included. The plan was to compare cases who received and did not receive inhaled corticosteroids in terms of pneumonia severity and mortality. In order to define risk factors for mortality, univariate and multivariable negative binomial regression analyses were performed. In our study, it was observed that n= 540 (75%) cases did not receive inhaled corticosteroids (group 1), and 180 (25%) cases used inhaled corti costeroids (group 2). Group 1 and group 2 cases were compared in terms of pneumonia severity with no significant difference between the two groups (p= 0.11). Then, risk factors affecting mortality in all cases were examined with univariate analyses. Increasing age, applying mechanical ventilation, having severe pneumonia, having interstitial lung disease, and applying prone position were found to be statistically significant factors in mortality (p < 0.05). In conclusion, in our study, it was observed that the use of inhaled corticosteroids did not increase the severity of pneumonia and mortality. It was thought that the treatment they received could be continued when the patients treated with inhaled corticosteroids due to asthma and COPD had COVID-19 pneumonia.

A real-world study of BBIBP-CorV vaccine effectiveness in a Sri Lanka rural province

ObjectiveReal-world studies assessing the effectiveness of the BBIBP-CorV vaccine in low and middle-income countries are limited. We evaluated the BBIBP-CorV vaccine's effectiveness in reducing COVID-19 symptomatic disease, hospitalisation, severe disease, and mortality during the third wave of the pandemic in Sri Lanka. MethodsWe conducted a test-negative case-control study in North Central Province from May 2021 to February 2022. Evidence of vaccination was obtained from the national registry. The PCR-positive patients were cases, while negative individuals were controls. Adjusted vaccine effectiveness (aVE) was computed for fully, partially, and non-vaccinated groups in reducing symptomatic disease, hospitalisation, severe disease, and mortality. ResultsOur study involved 3305 cases and 3418 controls. The overall aVE for preventing PCR-positive infection in fully vaccinated was 30·8 % (95 % CI:17·9–41·6). In fully vaccinated over 60 years, the overall aVE was 72·3 % (95 % CI: 49·7–84·8). Full vaccination with BBIBP-CorV is effective in reducing hospitalisation, severe COVID-19 disease, and death, with aVE rates of 70·3 % (95 % CI: 57·9–79·0), 88·9 % (95 % CI: 81·8–93·2), and 92·3 % (95 % CI: 84·8–96·1) respectively. ConclusionIndividuals who have received two doses of the BBIBP-CorV vaccine are protected against hospitalisation, severe COVID-19 disease, and death. Duration of protection against hospitalisation, severe COVID-19, and fatal COVID-19 sustained at least 121 days, with no sign of waning during that time.

Prevalence and Correlates of SARS-CoV-2 Vaccine Uptake and Hesitancy Among People With HIV Across the United States.

People with HIV (PWH) have higher risk of COVID-19 mortality. SARS-CoV-2 vaccination is highly effective among PWH, although vaccine hesitancy could limit the population-level impact. From February 2021 to April 2022, PWH from 8 sites in the Centers for AIDS Research Network of Integrated Clinical Systems completed a vaccine hesitancy instrument as part of routine care. Participants were defined as vaccine hesitant if they had not received the SARS-CoV-2 vaccine and would probably/definitely not receive it. We assessed factors associated with SARS-CoV-2 vaccine hesitancy using logistic regression adjusted for demographics, unsuppressed viral load (VL > 200 copies/mL), month, and time on ART; using inverse probability weighting for survey nonresponse. Overall, 3288 PWH with a median age of 55 were included; 18% were female and 94% were virally suppressed. At the time of survey, 27% reported they had not received the SARS-CoV-2 vaccine, and 9% (n = 279) reported vaccine hesitancy. Factors associated with vaccine hesitancy included female sex (adjusted odds ratio [AOR] = 2.3; 95% confidence interval (CI): 1.6-3.2), Black vs. White race (AOR 1.7; 95% CI: 1.2 to 2.4), younger age (AOR 1.4; 95% CI: 1.2 to 1.5), and unsuppressed VL (AOR 1.9; 95% CI: 1.3 to 3.0). Overall, over one-quarter of PWH in this multisite cohort were unvaccinated for SARS-CoV-2 when interviewed February 21-April 22. Vaccine hesitancy was reported by approximately 9% of PWH and was higher among women, Black PWH, younger PWH, PWH with unsuppressed VL, and those in the South/Midwest. Renewed efforts are needed to address concerns of PWH about vaccinations against COVID-19 as the pandemic evolves, and vaccines in general, given the potential for future pandemics.

U.S. County-level Food Insecurity and COVID-19 Mortality: A Bayesian Spatial Analysis with R-INLA.

U.S. County-level Food Insecurity and COVID-19 Mortality: A Bayesian Spatial Analysis with R-INLA.

Impact of short-term exposure to ambient air pollutants and meteorological factors on COVID-19 incidence and mortality: A retrospective study from Dammam, Saudi Arabia

The symptoms of COVID-19 included fever with or without respiratory syndrome, but patients subsequently developed pulmonary abnormalities. Exposure to air pollution, meanwhile, is associated with complications such as acute respiratory inflammations, asthma attack, and deaths from cardiorespiratory disease. To analyze the association of the air quality index (AQI), ambient air pollutants (PM10, SO2 and O3) and meteorological parameters (temperature and relative humidity [RH]) with COVID-19 incidence and mortality, a retrospective study was conducted to examine COVID-19 infection, meteorological parameters, ambient air quality and ambient air pollutants in Dammam from 1 January to 30 April 2021. Data of COVID-19 incidence and mortality for Dammam were retrieved from Saudi Arabia Ministry of Health's publicly accessible database. Meteorological data, AQI and average PM10, SO2 and O3 values were extracted from the publicly available website of Ministry of Environment, Water and Agriculture. The correlation of COVID-19 incidence and mortality with the independent variables was analysed by Pearson's correlation test or Spearman's rho test as applicable, and a p-value less than 0.05 was considered significant. COVID-19 incidence exhibited a positive correlation with temperature (r = 0.537, p = .0001) and a negative correlation with RH (r=−0.487, p=.0001). No correlation was observed between the meteorological variables and COVID-19 mortality. COVID-19 incidence showed a positive correlation with AQI (r=0.269, p=.015) and with the ambient air pollutants SO2 and O3 (r=0.258, p=.018), and COVID-19 mortality showed a positive correlation with PM10 (rs = 0.344, p=.002). Short-term exposure to O3, SO2 and higher temperature had direct relationship with COVID-19 incidence, while RH had inverse relationship. PM10 is positively associated with COVID-19 mortality.

Spatial nonstationarity and the role of environmental metal exposures on COVID-19 mortality in New Mexico

Worldwide, the COVID-19 pandemic has been influenced by a combination of environmental and sociodemographic drivers. To date, population studies have overwhelmingly focused on the impact of societal factors. In New Mexico, the rate of COVID-19 infection and mortality varied significantly among the state's geographically dispersed, and racially and ethnically diverse populations who are exposed to unique environmental contaminants related to resource extraction industries (e.g. fracking, mining, oil and gas exploration). By looking at local patterns of COVID-19 disease severity, we sought to uncover the spatially varying factors underlying the pandemic. We further explored the compounding role of potential long-term exposures to various environmental contaminants on COVID-19 mortality prior to widespread applications of vaccinations. To illustrate the spatial heterogeneity of these complex associations, we leveraged multiple modeling approaches to account for spatial non-stationarity in model terms. Multiscale geographically weighted regression (MGWR) results indicate that increased potential exposure to fugitive mine waste is significantly associated with COVID-19 mortality in areas of the state where socioeconomically disadvantaged populations were among the hardest hit in the early months of the pandemic. This relationship is paradoxically reversed in global models, which fail to account for spatial relationships between variables. This work contributes both to environmental health sciences and the growing body of literature exploring the implications of spatial nonstationarity in health research.

Preparedness of Nursing Homes: A Typology and Analysis of Responses to the COVID-19 Crisis in a French Network.

Preparing healthcare systems for emergencies is crucial to maintaining healthcare quality. Nursing homes (NHs) require tailored emergency plans. This article aims to develop a typology of French private NHs and study their early COVID-19 responses and mortality outcomes. We conducted a cross-sectional survey among NHs of a French network consisting of 290 facilities during the first wave of the COVID-19 pandemic. A Hierarchical Clustering on Principal Components (HCPC) was conducted to develop the typology of the NHs. Association tests were used to analyze the relationships between the typology, prevention and control measures, COVID-19 mortality, and the satisfaction of hospitalization requests. The 290 NHs vary in size, services, and location characteristics. The HCPC identified three clusters: large urban NHs with low levels of primary care (Cluster 1), small rural NHs (Cluster 2), and medium urban NHs with high levels of primary care (Cluster 3). The COVID-19 outcomes and response measures differed by cluster, with Clusters 1 and 2 experiencing higher mortality rates. Nearly all the NHs implemented preventive measures, but the timing and extent varied. This typology could help in better preparing NHs for future health emergencies, allowing for targeted resource allocation and tailored adaptations. It underscores the importance of primary care territorial structuring in managing health crises.

Does timing of tocilizumab administration affect mortality in COVID-19? A Scottish multicentre retrospective cohort study

BackgroundThe optimal timing of tocilizumab treatment during the disease course of COVID-19 has yet to be adequately defined in the context of randomised controlled trials and the effect of tocilizumab...

Clinical, Laboratory, and Demographic Factors Contributing to COVID-19 Mortality Risk

Background: This study aimed to identify COVID-19 mortality risk factors and relevant laboratory markers to inform prevention and treatment strategies. Methods: This cross-sectional study was conducted in Iran, involving 1561 patients diagnosed with COVID-19 between 2019 and 2021. Demographic, clinical, and laboratory data were collected from hospital records and analyzed using a logistic regression model. Results: The mortality rate attributed to COVID-19 in this study was 24.7%. Identified risk factors for mortality included intubation, multiple chronic conditions, liver or kidney disease or cancer, low RBC levels, and abnormal creatinine (Cr) levels. The adjusted odds ratios (adjOR) and 95% confidence intervals (CIs) for these factors were as follows: intubation (70.75, 14.07:355.84), concurrent chronic diseases (24.29, 3.25:181.24), liver or kidney disease or cancer (5.13, 1.21:21.81), low RBC levels (5.21, 1.24:21.79), and abnormal Cr levels (5.09, 1.21:21.43). Conclusion: The findings from this study indicated that several factors, including intubation, multiple chronic conditions, liver or kidney disease or cancer, and low Cr levels were associated with a higher risk of death from COVID-19. These results highlight the significance of continuous monitoring and specialized care for patients exhibiting these risk factors to reduce the risk of COVID-19 mortality.

Comparative analysis of COVID-19 diagnoses and mortality among hospitalized indigenous and non-indigenous populations in Chile: 2020–2021

BackgroundCurrent literature presents mixed effects of the COVID-19 pandemic on Indigenous communities. We aim to highlight potential disparities and temporal shifts in both the impact of COVID-19 and vaccine uptake among hospitalized Indigenous populations in Chile.MethodsWe conducted an observational analysis utilizing 1,598,492 hospitalization records from 2020 to 2021 based on publicly accessible hospital discharge data spanning 65 healthcare facilities of medium and high complexity funded through the Diagnosis-Related Groups (DRG) mechanism in Chile, representing roughly 70% of the country’s total hospitalizations. This was supplemented with publicly available municipal data on COVID-19 vaccinations and socio-demographic variables. We performed logistic regression analysis at 0.05 level of significance to assess the bivariate and multivariable association of Indigenous status with COVID-19 diagnosis and COVID-19 deaths among hospitalized populations. We also performed univariate and multiple linear regression to assess the association of COVID-19 vaccination rate and Indigenous status at the municipality level. In addition, we report the distribution of top 10 secondary diagnoses among hospitalized COVID-19 cases and deaths separately for Indigenous and non-Indigenous populations.ResultsIndigenous populations displayed lower adjusted odds for both COVID-19 diagnosis (OR: 0.76, 95% CI: 0.74, 0.77) and death (OR: 0.91, 95% CI: 0.85, 0.97) when compared to non-Indigenous groups. Notably, the adjusted odds ratio for COVID-19 diagnosis in Indigenous populations rose from 0.59 (95% CI: 0.57, 0.61) in 2020 to 1.17 (95% CI: 1.13, 1.21) in 2021. Factors such as the significantly higher median age and greater number of comorbidities in the non-Indigenous hospitalized groups could account for their increased odds of COVID-19 diagnosis and mortality. Additionally, our data indicates a significantly negative adjusted association between COVID-19 vaccination rates and the proportion of Indigenous individuals.ConclusionAlthough Indigenous populations initially showed lower odds of COVID-19 diagnosis and mortality, a marked rise in diagnosis odds among these groups in 2021 underscores the urgency of targeted interventions. The observed negative association between the proportion of Indigenous populations and vaccination rates further underscores the necessity to tackle vaccine access barriers and work towards equitable distribution.

Insulin Resistance in Long COVID-19 Syndrome.

Background: The COVID-19 pandemic has caused severe health issues worldwide and contributed to huge financial losses. Key comorbidities linked to an increased risk of severe COVID-19 and higher mortality rates include cardio-metabolic disorders such as type 1 and type 2 diabetes mellitus (T1DM and T2DM), atherosclerotic cardiovascular disease, chronic kidney disease, hypertension, heart failure, and obesity. The persistence of symptoms even after the acute phase is over is termed long COVID-19 syndrome. This study aimed to evaluate the relationship between long COVID-19 syndrome and the development of insulin resistance in previously non-diabetic patients. Methods: A prospective observational study was performed on 143 non-diabetic patients who had tested positive for SARS-CoV-2 infection by a PCR test and were hospitalized in our hospital between January 2020 and December 2022. The clinical and para-clinical data at 0, 4, and 12 months of hospital admission for post-COVID-19 infection follow-up was collected and labeled as t0, t4, and t12. Blood glucose, insulin, and C-peptide levels were measured at the beginning and further at 2, 5, 10, and 30 min after the intravenous arginine stimulation test. Similarly, BMI was calculated, and hs-CRP and ESR levels were noted. The results obtained were statistically analyzed. Results: More than one-third (30.7%) of the included patients developed long COVID-19 syndrome. It was found that 75% of patients with long COVID-19 hospitalized in our clinic developed diabetes within a year of acute infection with COVID-19; therefore, it can be said that the presence of long COVID-19 is a major risk for an altered metabolic status, which can cause diabetes. When comparing the glycemia levels (106 mg/dL) with the BMI at t0, t4, and t12 time intervals, the p-values were found to be 0.214, 0.042, and 0.058, respectively. Almost 62% of the patients having BMI > 30 kg/m2 were found to have an increase in blood glucose levels at 1 year. Similarly, insulin resistance was noted during this interval. A negative correlation of 0.40 for hsCRP and 0.38 for ESR was noted when compared with acute infection with COVID-19. Conclusions: The association between long COVID-19 and insulin resistance highlights the varied and widespread impacts of SARS-CoV-2 infection. Addressing the complexities of long COVID-19 requires a holistic strategy that encompasses both respiratory and metabolic considerations, which is crucial for enhancing the well-being of those enduring this persistent condition.

Evaluation of Rhode Island's Early Geographic COVID-19 Vaccine Prioritization Policy.

Objectives. To determine whether geographic prioritization of limited COVID-19 vaccine supply was effective for reducing geographic disparities in case rates. Methods. Rhode Island allocated a portion of the initial COVID-19 vaccine supply to residents of Central Falls, a community already affected by structural policies and inadequate systems that perpetuate health inequities and experiencing disproportionately high COVID-19 morbidity and mortality. The policy was implemented with a culturally and linguistically appropriate community engagement plan and was intended to reduce observed disparities. Using a Bayesian causal analysis with population surveillance data, we evaluated the impact of this prioritization policy on recorded cases over the subsequent 16 weeks. Results. Early geographic prioritization of Central Falls accelerated vaccine uptake, averting an estimated 520 cases (95% confidence interval = 22, 1418) over 16 weeks and reducing cases by approximately 34% during this period (520 averted vs 1519 expected without early prioritization). Conclusions. Early geographic prioritization increased vaccine uptake and reduced cases in Central Falls, thereby reducing geographic disparities. Public Health Implications. Public health institutions should consider geographic prioritization of limited vaccine supply to reduce geographic disparities in case rates. (Am J Public Health. 2024;114(S7):S580-S589. https://doi.org/10.2105/AJPH.2024.307741).