COVID-19 Hospital Research Articles

Effective method to mitigate impact of rain or snowmelt sewer flushing events on wastewater-based surveillance measurements

Wastewater-based surveillance (WBS) is increasingly used for monitoring disease targets in wastewaters around the world. This study, performed in Ottawa, Canada, identifies a decrease in SARS-CoV-2 wastewater measurements during snowmelt-induced sewer flushing events. Observations first revealed a correlation between suppressed viral measurements and periods of increased sewage flowrates, air temperatures above 0 °C during winter months, and solids mass flux increases. These correlations suggest that high sewage flowrates from snowmelt events or intense precipitation events lead to the scouring of previously settled solids in sewers and the subsequent entrainment of these solids into the transported wastewaters. Collection of WBS samples during flushing events hence contains a heterogeneous mixture of solids, including resuspended solids with varying degrees of decay. Therefore flushing events can present a challenge for accurately measuring disease target viral signals when using solids-based analytical methods. This study demonstrates that resuspended solids entrained in the wastewaters during flushing events retain PMMoV signal while the SARS-CoV-2 signal is significantly reduced due to the slower decay rate of pepper mild mottle virus (PMMoV) compared to SARS-CoV-2 within wastewaters. Hence current normalization methods using PMMoV are shown to be ineffective in correcting for flushing events and the associated resuspension of settled solids, as the PMMoV signal of settled solids within sewers does not account for the differential decay rates experiences by SARS-CoV-2 signal in settled solids. Instead, this study identifies RNA to PMMoV correction factor as an effective approach to correct for flushing events and to realign SARS-CoV-2 signal with COVID-19 hospital admission rates within communities. As such, the study highlights the key physicochemical parameters necessary to identify flushing events that affect SARS-CoV-2 WBS measurements and introduces a novel RNA to PMMoV correction factor approach for solids-based analysis of SARS-CoV-2 during flushing events, enhancing the accuracy of WBS data for public health decision-making.

Shared genetic architecture between COVID-19 and irritable bowel syndrome: a large-scale genome-wide cross-trait analysis

BackgroundIt has been reported that COVID-19 patients have an increased risk of developing IBS; however, the underlying genetic mechanisms of these associations remain largely unknown. The aim of this study was to investigate potential shared SNPs, genes, proteins, and biological pathways between COVID-19 and IBS by assessing pairwise genetic correlations and cross-trait genetic analysis.Materials and methodsWe assessed the genetic correlation between three COVID-19 phenotypes and IBS using linkage disequilibrium score regression (LDSC) and high-definition likelihood (HDL) methods. Two different sources of IBS data were combined using METAL, and the Multi-trait analysis of GWAS (MTAG) method was applied for multi-trait analysis to enhance statistical robustness and discover new genetic associations. Independent risk loci were examined using genome-wide complex trait analysis (GCTA)-conditional and joint analysis (COJO), multi-marker analysis of genomic annotation (MAGMA), and functional mapping and annotation (FUMA), integrating various QTL information and methods to further identify risk genes and proteins. Gene set variation analysis (GSVA) was employed to compute pleiotropic gene scores, and combined with immune infiltration algorithms, IBS patients were categorized into high and low immune infiltration groups.ResultsWe found a positive genetic correlation between COVID-19 infection, COVID-19 hospitalization, and IBS. Subsequent multi-trait analysis identified nine significantly associated genomic loci. Among these, eight genetic variants were closely related to the comorbidity of IBS and COVID-19. The study also highlighted four genes and 231 proteins associated with the susceptibility to IBS identified through various analytical strategies and a stratification approach for IBS risk populations.ConclusionsOur study reveals a shared genetic architecture between these two diseases, providing new insights into potential biological mechanisms and laying the groundwork for more effective interventions.

COVID-19 Incidence and Age Eligibility for Elementary School.

Understanding the role of school attendance on transmission of SARS-CoV-2 among children is of importance for responding to future epidemics. Estimating discontinuities in outcomes by age of eligibility for school attendance has been used to examine associations between school attendance and a variety of outcomes, but has yet to be applied to describe associations between school attendance and communicable disease transmission. To estimate the association between eligibility for elementary school and COVID-19 incidence. This case series used data on all pediatric COVID-19 cases reported to California's disease surveillance system between May 16, 2020, and December 15, 2022, among children within 24 months of the age threshold for school eligibility. Birthdate before or after the age threshold for elementary school eligibility during periods when school was remote vs in person. COVID-19 cases and hospitalizations. Between May 16, 2020, and December 15, 2022, there were 688 278 cases of COVID-19 (348 957 cases [50.7%] among boys) and 1423 hospitalizations among children who turned 5 years within 24 months of September 1 of the school year when their infection occurred. The mean (SD) age of the study sample was 5.0 (1.3) years. After adjusting for higher rates of testing in schooled populations, the estimated pooled incidence rate ratio among kindergarten-eligible individuals (eg, those born just before the age threshold for school eligibility) compared with those born just after the eligibility threshold for in-person fall 2021 semester was 1.52 (95% CI, 1.36-1.68), for in-person spring 2022 semester was 1.26 (95% CI, 1.15-1.39), and for in-person fall 2022 semester was 1.19 (95% CI, 1.03-1.38). Reported incidence rates among school-eligible children remained higher during the month-long winter 2021-2022 school break but were lower during the longer summer break that followed. The findings were unable to establish whether associations between school eligibility and COVID-19 incidence were based on in-school vs out-of-school routes (eg, classrooms vs school buses). The study lacked power to detect associations between school attendance and hospitalization. Results were robust to functional form. A simulation study was conducted to demonstrate bias associated with nonadjustment for differential case acquisition by exposure status. In this case series of children in California, the magnitude of the association between school eligibility and COVID-19 incidence decreased over time and was generally lower than other published associations between out-of-school child social interactions and COVID-19 incidence. This regression discontinuity design approach could be adapted to other geographies and/or disease systems to assess associations between schooling and disease transmission.

Monovalent XBB.1.5 COVID-19 vaccine effectiveness against hospitalisations and deaths during the omicron BA.2.86/JN.1 period among older adults in seven European countries: a VEBIS-EHR network study

ABSTRACT Background We aimed to estimate XBB.1.5 vaccine effectiveness (VE) against COVID-19-related hospitalizations and deaths during BA.2.86/JN.1 predominance, among EU/EEA individuals with ≥ 65-years. Research design and methods We linked electronic health records to create historical cohorts in Belgium, Denmark, Italy, Navarre (Spain), Norway, Portugal and Sweden. We included individuals aged ≥ 65-years eligible for the autumnal 2023 COVID-19 vaccine. Follow-up started when ≥ 80% of country-specific sequenced viruses were BA.2.86/JN.1 (4/dec/23 to 08/jan/24) and ended 25 February 2024. At study site level, we estimated the vaccine confounder-adjusted hazard ratio (aHR) of COVID-19 hospitalizations and deaths between individuals with ≥14 days after vaccination versus unvaccinated in autumn 2023, overall, by time since vaccination and age groups. VE was estimated as (1-pooled aHR)x100 with a random-effects model. Results XBB.1.5 VE against COVID-19 hospitalizations was 50% (95%CI: 45 to 55) and 41% (95%CI: 35 to 46) in 65-79-year-olds and in ≥ 80-year-olds respectively. VE against COVID19-related-death was 58% (95%CI: 42 to 69) and 48% (95%CI: 38 to 57), respectively, in both age groups. VE estimates against each outcome declined in all age groups over time. Conclusion Monovalent XBB.1.5 vaccine had a moderate protective effect against severe and fatal COVID-19 likely caused by BA.2.86/JN.1 during the 2023/2024 winter, among persons aged ≥ 65.

Long-term health outcomes of COVID-19 in ICU- and non-ICU-treated patients up to 2 years after hospitalization: a longitudinal cohort study (CO-FLOW)

BackgroundMany patients hospitalized for COVID-19 experience long-term health problems, but comprehensive longitudinal data up to 2 years remain limited. We aimed to (1) assess 2-year trajectories of health outcomes, including comparison between intensive care unit (ICU) treated and non-ICU-treated patients, and (2) identify risk factors for prominent health problems post-hospitalization for COVID-19.MethodsThe CO-FLOW multicenter prospective cohort study followed adults hospitalized for COVID-19 at 3, 6, 12, and 24 months post-discharge. Measurements included patient-reported outcomes (a.o., recovery, symptoms, fatigue, mental health, sleep quality, return to work, health-related quality of life [HRQoL]), and objective cognitive and physical tests. Additionally, routine follow-up data were collected.Results650 patients (median age 60.0 [IQR 53.0–67.0] years; 449/650 [69%] male) surviving hospitalization for COVID-19 were included, of whom 273/650 (42%) received ICU treatment. Overall, outcomes improved over time. Nonetheless, 73% (322/443) of patients had not completely recovered from COVID-19, with memory problems (274/443; 55%), concentration problems (259/443; 52%), and dyspnea (251/493; 51%) among most frequently reported symptoms at 2 years. Moreover, 61% (259/427) had poor sleep quality, 51% (222/433) fatigue, 23% (102/438) cognitive failures, and 30% (65/216) did not fully return to work. Objective outcome measures showed generally good physical recovery. Most outcomes were comparable between ICU- and non-ICU-treated patients at 2 years. However, ICU-treated patients tended to show slower recovery in neurocognitive symptoms, mental health outcomes, and resuming work than non-ICU-treated patients, while showing more improvements in physical outcomes. Particularly, female sex and/or pre-existing pulmonary disease were major risk factors for poorer outcomes.Conclusions73% (322/443) of patients had not completely recovered from COVID-19 by 2 years. Despite good physical recovery, long-term neurocognitive complaints, dyspnea, fatigue, and impaired sleep quality persisted. ICU-treated patients showed slower recovery in neurocognitive and mental health outcomes and resumption of work. Tailoring long-term COVID-19 aftercare to individual residual needs is essential. Follow-up is required to monitor further recovery.Trial registration: NL8710, registration date 12-06-2020.

Association of COVID-19 Vaccine Intake with Diagnosis, Hospitalization, and Oxygenation/Ventilation: A Longitudinal Analysis, 2021–2022, Japan

Background/Objectives: Japan’s COVID-19 vaccination campaign achieved high coverage by 2022, yet limited national-level data has hindered evaluations of vaccine effectiveness. This study analyzed the impact of vaccines on infection outcomes while considering socioeconomic and behavioral factors in the Japanese population. Methods: A total of 19,482 individuals aged 16–81 years, who participated in both the 2021 (baseline) and 2022 (follow-up) waves of an Internet-based survey, were analyzed. Vaccine intake during the follow-up period (0/1/2+ doses) served as the exposure, while outcomes included COVID-19 diagnosis, hospitalization, and receipt of oxygenation/ventilation. Adjusted prevalence ratios (APRs) were calculated using Poisson regression models, controlling for baseline characteristics such as vaccination status, infection history, underlying medical conditions, socioeconomic factors, and preventive behaviors. Results: Overall, 81.6% of respondents received at least 1 dose of COVID-19 vaccine during the follow-up period. Among those without COVID-19 history at baseline (N = 19,182), 10.9% were diagnosed with COVID-19 in the past year, and 6.6% in the past 2 months. Respondents who received 1 or 2+ doses had lower diagnosis rates (APR = 0.76 and 0.43, respectively). For the past 2 months, only those with 2+ doses showed a significant reduction (APR = 0.51). Among 1999 diagnosed cases, those with 1 or 2+ doses showed lower hospitalization and oxygenation/ventilation likelihoods, though these differences were not statistically significant. Conclusions: The results supported the protective effect of COVID-19 vaccines against infection. Continued research is essential to further clarify the complex influence of vaccination, individual characteristics, and preventive behaviors on COVID-19 morbidity at the population level.

Perceived Stress and Coping Strategies for Frontline Nurses Caring for COVID-19 Patients: A Path Analysis.

This cross-sectional study explored the relationships among perceived stress, social support, positive coping, and mental health in frontline nurses caring for patients with COVID-19 in China. A quantitative cross-sectional study. A convenience sample of 339 eligible frontline nurses was identified from a designated hospital for COVID-19 in Shanghai, China, between May 2022 and August 2022. Data from nurses were collected through an online survey that contained 4 measurement domains: perceived stress, social support, coping strategies, and mental health. Path analysis was used to analyze the data in SPSS 24.0 and AMOS 23.0. The model tested in the path analysis fit the data well. The results demonstrated relationships among perceived stress, social support, positive coping, and mental health among frontline nurses caring for patients with COVID-19. Social support had a positive effect on positive coping strategies and a negative effect on perceived stress and mental health. In addition, path analysis indicated that social support moderated the relationship between perceived stress and mental health in nurses. Nurses experienced work-related mental stress while providing COVID-19-related care. Based on study findings, social support is expected to play a key role in stress management in nurses. Expanding opportunities for social support is an essential step for nurses to improve their mental health and quality of life.

Somatic and neurological comorbidities in COVID-19 with fatal outcome

Introduction. Although the risk of emerging coronavirus infection may seem to have disappeared at first glance, SARS-COV-2 has complex and poorly understood effects on many organ systems, including the nervous system. Disease progression and unfavorable outcome COVID-19 are not only due to lung damage, elderly age, concomitant pathology: hypertension, diabetes mellitus, etc. have a significant impact.Aim. To study the structure of mortality in a new coronavirus infection COVID-19, caused by delta strain of coronavirus SARS- CoV-2, taking into account the nature of concomitant therapeutic and neurological pathology, the degree of comorbidity, fatal complications, and sex and age characteristics.Materials and methods. A postmortem analysis of pathological and anatomical conclusions of 209 patients with COVID-19 with comorbid somatic and neurological pathology who received inpatient treatment in covid hospitals of the Republic of Mordovia in 2021 was performed. The severity of the underlying disease, concomitant therapeutic and neurological pathology, and comorbidity were analysed. The coincidence of the final clinical and pathological diagnoses, fatal complications were assessed. The presented data allowed to identify the main factors of unfavourable outcome.Results and discussion. In unfavourable outcome of the disease, concomitant pathology is represented by hypertension, ischemic heart disease, chronic heart failure, chronic cerebral ischemia. In women, cases of diabetes mellitus and atherosclerosis were more frequent, in men - hypertension and chronic heart failure.Conclusions. New coronavirus COVID-19 infection associated with delta strain of SARS-COV-2 virus is characterised by severe and extremely severe course in elderly patients with comorbid somatic and neurological pathology.

The causal association between COVID-19 and ischemic stroke: a mendelian randomization study

BackgroundCurrent observational data indicates that ischemic stroke (IS) affects a significant proportion of people with COVID-19. The current study sought to evaluate the causal relationship between COVID-19 and IS.MethodsA two-sample Mendelian randomization (2 S-MR) approach was used to probe the relationship between genetic determinants of three COVID-19 parameters (SARS-CoV‐2 infection, COVID-19 hospitalization, and severe COVID-19) and the incidence of IS based on genome-wide association studies (GWAS) data. Using this 2 S-MR technique, expression quantitative trait loci (eQTL) and GWAS studies were further assessed for overlap to identify common causative genes associated with severe COVID-19 and IS.ResultsIVW approaches indicated the genetic variants linked to COVID-19 hospitalization (OR 1.04, 95% CI 1.01–1.08, p = 0.023) and severe COVID-19 (OR 1.03, 95% CI 1.01–1.05, p = 0.007) were both significantly linked to greater odds of IS. In contrast, there was no causal association between genetic SARS-CoV-2 infection susceptibility and the occurrence of IS (OR 0.99, 95% CI 0.92–1.06, p = 0.694). Ten shared causal genes (TNFSF8, CFL2, TPM1, C15orf39, LHFPL6, FAM20C, SPAG9, KCNJ2, PELI1, and HLA-L) were established as possible mediators of the interplay between severe COVID-19 and the development of IS, with these genes primarily being enriched in immune-related and renin-angiotensin-aldosterone system pathways.ConclusionThese findings indicate a possible causative relationship between IS risk and COVID-19 severity, offering crucial new information for managing COVID-19 patients. Promising options for therapeutic therapies for severe COVID-19 complicated by IS include the common genes found in the present study.

Sex Differences in Long-Term Cardiovascular Outcomes and Mortality After COVID-19 Hospitalization During Alpha, Delta and Omicron Waves

Background: Increased mortality and occurrence of cardiovascular (CV) outcomes during hospitalization and in short-term follow-up for moderate to severe SARS-CoV-2 infection have been associated with male sex, yet data regarding long-term outcomes by sex and COVID-19 variant (Alpha, Delta, and Omicron) are limited. Methods: This prospective study of 4882 patients examines potential differences by sex in the occurrence of primary combined cardiovascular outcomes (CV death, CV hospitalization, myocardial infarction (MI), stroke, pulmonary embolism) as well as secondary outcomes (CV death, cardiovascular hospitalizations, myocardial infarction, stroke, pulmonary embolism) at 18-month follow-up after urgent hospitalization for SARS-CoV-2-associated pneumonia, as well as evaluating for differences during the three COVID-19 waves. Survival rate was analyzed for the entire cohort by sex and SARS-CoV-2 variant and adjusted for age using the multiple Kaplan–Meier method. To compare survival in groups of men and women for each wave, the Gehan–Wilcoxon test was applied with significance p < 0.05. Univariate Cox proportional hazards models were used to search for potential risk factors of CV death at 18-months follow-up separately for men and women in each COVID-19 wave. Results: Men had significantly higher 18-month CV mortality compared to women in the Delta wave (6.13% men vs. 3.62% women, p = 0.017). Although men had higher percentages of all other CV endpoints (excepting pulmonary embolism) at follow-up during the Delta wave, none were significant compared with women, except for the combined CV endpoint (16.87% men vs. 12.61% women, p = 0.017). No significant differences by sex in CV outcomes were seen during the Alpha and Omicron variants. Discrepancies in CV outcomes in demographical data and concomitant disease between the COVID-19 variants of concern existed. Conclusions: Higher male mortality and higher but non-significant incidences of CV outcomes occurred during the Delta wave of the COVID-19 pandemic, with the lowest incidence of CV outcomes observed during the Omicron variant.

Antimicrobial Susceptibility Profile of Bacteria Isolated from Hemocultures of Patients Attended in a Campaign Hospital During COVID-19 Pandemic

Introduction: Primary bloodstream infections are most commonly related to health care and are associated with intravascular devices, increasing patient mortality, length of stay, and health care costs. Among the complications of hospitalizations for COVID-19, bloodstream infection is one of the most prevalent, requiring prevention and early treatment. Due to the contingency of hospital resources during the pandemic, understanding the prevalence and incidence of antimicrobial agents that cause bloodstream infections and using exams judiciously are essential public health measures, avoiding the misuse of antimicrobials and being able to establish treatment. Objective: This study aimed to determine the antimicrobial susceptibility profile and the prevalence of etiological agents of bloodstream infections in patients with COVID-19 at the field hospital in the city of São Bernardo do Campo - SP. Method: A descriptive, observational, and retrospective cross-sectional study was carried out on the results of blood cultures already collected for diagnostic purposes from patients from May to August 2020 at the same hospital. Results: Of the 300 blood cultures analyzed, 73.7% of the samples showed no bacterial growth. Among the others, the main bacteria found were Klebsiella pneumoniae, sensitive to tigecycline, present in 30 (10%), followed by Staphylococcus sp. (coagulase-negative, non-lugdunensis), sensitive only to doxycycline, gentamicin, tetracycline, and vancomycin, in only 2 (14.3%) samples. Conclusion: In this study, a low rate of laboratory-confirmed bacterial coinfection was identified in patients with COVID-19.

Effectiveness of BNT162b2 XBB vaccine in the US Veterans Affairs Healthcare System

Data evaluating effectiveness of XBB.1.5-adapted vaccines against JN.1-related endpoints are scarce. This nationwide test-negative case-control study within the US Veterans Affairs Healthcare System aims to estimate vaccine effectiveness (VE) of BNT162b2 XBB.1.5-adapted vaccine compared to not receiving an XBB vaccine of any kind against COVID-19 hospitalization, emergency department or urgent care visits (ED/UC), and outpatient visits. Between September 25, 2023 and January 31, 2024, effectiveness was 24–35% during a period of JN.1 predominance and 50–61% during XBB predominance across all outcomes. VE within 60 days of vaccination during the likely JN.1 period was 32% (95% confidence interval 3–52%) against hospitalization, 41% (23–54%) against ED/UC visits, and 31% (1–52%) against outpatient visits. Corresponding VE during the likely XBB period was 62% (44–74%), 52% (37–63%), and 50% (25–66%) by setting, respectively. Here, we show the importance of strain match to maximize the public health impact of COVID-19 vaccination.

Protocol for an ambidirectional cohort study on long COVID and the healthcare needs, use and barriers to access health services in a large city in Southeast Brazil

IntroductionPost-COVID-19 condition, or syndrome, also known as long COVID, is an infection-associated chronic condition that can develop after a SARS-CoV-2 infection and last at least 3 months to years. Despite...

Spatiotemporal Ecologic Analysis of COVID-19 Vaccination Coverage and Outcomes, Oklahoma, USA, February 2020-December 2021.

Data on COVID-19 cases, deaths, hospitalizations, and vaccinations in Oklahoma, USA, have not been systematically described. The relationship between vaccination and COVID-19-related outcomes over time has not been investigated. We graphically described data collected during February 2020-December 2021 and conducted spatiotemporal modeling of monthly increases in COVID-19 cumulative death and hospitalization rates, adjusting for cumulative case rate, to explore the relationship. A 1 percentage point increase (absolute change) in the cumulative vaccination rate was associated with a 6.3% (95% CI 1.4%-10.9%) relative decrease in death outcome during April-June 2021, and a 1.9% (95% CI 1.1%-2.6%) relative decrease in death outcome and 1.1% (95% CI 0.5%-1.7%) relative decrease in hospitalization outcome during July-December 2021; the effect on hospitalizations was driven largely by data from urban counties. Our findings from Oklahoma suggest that increasing cumulative vaccination rates might reduce the increase in cumulative death and hospitalization rates from COVID-19.

Trends in COVID-19-Attributable Hospitalizations Among Adults With Laboratory-Confirmed SARS-CoV-2-COVID-NET, June 2020 to September 2023.

Screening for SARS-CoV-2 infection among hospital admissions made interpretation of COVID-19 hospitalization data challenging as SARS-CoV-2-positive persons with mild or asymptomatic infection may be incorrectly identified as COVID-19-associated hospitalizations. The study objective is to estimate the proportion of hospitalizations likely attributable to COVID-19 among SARS-CoV-2-positive hospitalized patients. A sample of laboratory-confirmed SARS-CoV-2-positive hospitalizations from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) from June 2020 to September 2023 was analyzed, with a focus on July 2022 to September 2023. Likely COVID-19-attributable hospitalizations were defined as hospitalizations among SARS-CoV-2-positive non-pregnant adults ages ≥ 18 years with COVID-19-related presenting complaint, treatment, or discharge diagnosis. Among 44,816 sampled hospitalizations, 90% met the definition of likely COVID-19-attributable. Among the 9866 admissions occurring during July 2022 to September 2023, 86% were likely COVID-19-attributable; 87% had a COVID-19-related presenting complaint, 64% received steroids or COVID-19-related treatment, 47% had respiratory- and 10% had coagulopathy-related discharge diagnoses, and 39% had COVID-19 as the principal discharge diagnosis code. More than 70% met ≥ 2 criteria. Compared with likely COVID-19-attributable hospitalizations, SARS-CoV-2-positive patients who did not meet the case definition were more likely to be ages 18-49 years (27% vs. 13%), have no underlying medical conditions (14% vs. 4%), or be asymptomatic for COVID-19 upon admission (46% vs. 10%) (all p < 0.05). Most hospitalizations among SARS-CoV-2-positive adults in a recent period were likely attributable to COVID-19. COVID-19-attributable hospitalizations are less common among younger SARS-CoV-2-positive hospitalized adults but still account for nearly three quarters of all admissions among SARS-CoV-2-positive adults in this age group.

Cost-effectiveness of an online supervised group physical and mental health rehabilitation programme for adults with post-COVID-19 condition after hospitalisation for COVID-19: the REGAIN RCT

BackgroundFollowing the COVID-19 pandemic, millions of people continue to experience ongoing physical and mental health sequelae after recovery from acute infection. There is currently no specific treatment for the diverse symptoms associated with post-COVID-19 condition. Physical and mental health rehabilitation may help improve quality of life in such patients. This study reports the cost-effectiveness of a programme of physical and mental health rehabilitation compared to best practice usual care in people with post-COVID-19 condition who were previously hospitalised.MethodsWe conducted an economic evaluation within a randomised controlled trial from the perspective of the UK national health service (NHS) and personnel social services perspective (PSS). Resource used and health-related quality of life were collected using bespoke questionnaire and the EQ-5D-5 L questionnaire at three, six, and 12 months. Incremental costs and quality adjusted life years accrued over the follow-up period were estimated and reported as the incremental cost-effectiveness ratio. Estimate uncertainty was managed by multiple imputation and bootstrapping cost-effectiveness estimates; and displayed graphically on the cost-effectiveness plane.ResultsOver a 12-month time horizon, incremental costs and QALYs were £305 (95% CI: -123 to 732) and 0.026 (95% CI: -0.005 to 0.052) respectively. The ICER was £11,941 per QALY indicating cost-effective care. Sensitivity analyses supported the base case findings. The probability of the intervention being cost-effective at a £30,000 per QALY willingness-to-pay threshold was 84%.ConclusionThe within-trial economic evaluation suggested that people with post-COVID-19 condition after hospitalisation should be offered a programme of physical and mental health rehabilitation as it likely reflects a cost-effective use of NHS resources. Hospitalisation for COVID-19 has become less commonplace: further evaluation in non-hospitalised patients may be worthwhile.Trial registrationISRCTN registry ISRCTN11466448 23rd November 2020.

Clinical features of and severity risk factors for COVID-19 in adults during the predominance of SARS-CoV-2 XBB variants in Okinawa, Japan.

Since 2023, COVID-19 induced by SARS-CoV-2 XBB variants have been a global epidemic. The XBB variant-induced epidemic was largest in the Okinawa Prefecture among areas in Japan, and healthcare institutions have been burdened by increased COVID-19 hospitalizations. This study aimed to evaluate the clinical features of XBB variant-induced COVID-19 and risk factors for severe COVID-19. This retrospective study included adult patients hospitalized for COVID-19 between May and July 2023 at four tertiary medical institutions in Okinawa, Japan. Patients with bacterial infection-related complications were excluded. According to oxygen supplementation and intensive care unit admission, patients were divided into two groups, mild and severe. Patient backgrounds, symptoms, and outcomes were compared between both groups, and the risk factors for severe COVID-19 were analyzed using a multivariate logistic regression model. In total of 367 patients included, the median age was 75 years, with 18.5% classified into the severe group. The all-cause mortality rate was 4.9%. Patients in the severe group were more older, had more underlying diseases, and had a higher mortality rate (13.2%) than those in the mild group (3.0%). Multivariate logistic regression analysis showed that diabetes mellitus was an independent risk factor for severe COVID-19 (95% confidence interval [CI], 1.002-3.772), whereas bivalent omicron booster vaccination was an independent factor for less severe COVID-19 (95% CI, 0.203-0.862). This study implies that assessing risk factors in older adults is particularly important in the era of omicron variants.

Post-COVID syndrome and type 2 diabetes mellitus in Kazakhstan: clinical manifestations and vaccine efficacy.

In this article, we report the results of a survey investigating post-coronavirus disease 2019 (COVID-19) syndrome in patients with type 2 diabetes mellitus and the impacts of vaccination on long-term manifestations. From February 2022 to April 2023, a survey of patients with type 2 diabetes and people without diabetes who were treated for a coronavirus infection was conducted in Kazakhstan. Participants were invited via social media to voluntarily participate in this study. A total of 417 surveys were included in this study, comprising 212 patients with type 2 diabetes and 205 without diabetes. We compared persistent complaints after recovery in patients with and without diabetes mellitus (DM), as well as vaccination status. The results of this study on self-reported symptoms of prolonged COVID show that more than half of those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Kazakhstan have at least one persistent symptom after recovery. Based on the list of prolonged COVID-19 symptoms reported by patients with type 2 DM (T2DM), exertional dyspnoea, fatigue, respiratory discomfort, headaches, and sleep disturbances are among the most common ongoing conditions, and in many cases last more than 3 months after COVID-19. Patients with T2DM experience more severe and prolonged symptoms than those without diabetes. Additionally, vaccination lowers COVID-19 hospitalization risk and decreases the need for adjusting hypoglycemic therapy, such as insulin treatment, after recovering from SARS-CoV-2 infection.

PHYSIOTHERAPIST TRAINING AND INTENSIVE CARE DURING THE SARS-COV-2 PANDEMIC: AN EXPLORATORY STUDY

Objective: The objective was to outline the professional profile of physiotherapists working in intensive care during the pandemic and to analyze how well their undergraduate courses met the needs of COVID-19 patients admitted to Intensive Care Units (ICUs). Method: The study was exploratory and data were collected through an electronic instrument containing closed and objective questions. Nineteen physiotherapists who worked, between March 2020 and March 2022, in ICUs caring for patients infected with COVID-19, from public and private hospitals located in the region of the Regional Health Department (DRS) IX of the state of São Paulo participated in the study. Data analysis was performed by statistical study using the “Microsoft Excel” program. Results: It was possible to observe that in the training of physiotherapists, there is a very large divergence in relation to the completion and duration of internships in the cardiorespiratory area and that the professionals had postgraduate degrees in the specific area and previous experience. It was possible to identify weaknesses in their training. Conclusion: the undergraduate course in physiotherapy partially met the needs of the job market during the pandemic. The National Curricular Guidelines (DCNs) do not ensure equity in the implementation of different curricula and thus the training of professionals does not respond, to a certain extent, to the demands of the services of the Unified Health System. Specific knowledge of the area is required after completing the undergraduate course to work in intensive care.

Novel cost-effective method for forecasting COVID-19 and hospital occupancy using deep learning

The emergence of the COVID-19 pandemic in 2019 and its rapid global spread put healthcare systems around the world to the test. This crisis created an unprecedented level of stress in hospitals, exacerbating the already complex task of healthcare management. As a result, it led to a tragic increase in mortality rates and highlighted the urgent need for advanced predictive tools to support decision-making. To address these critical challenges, this research aims to develop and implement a predictive system capable of predicting pandemic evolution with accuracy (in terms of Mean Absolute error (MAE), Root Mean Square Error (RMSE), R2, and Mean Absolute Percentage Error (MAPE)) and low computational and economic cost. It uses a set of interconnected Long Short Term-memory (LSTM) with double bidirectional LSTM (BiLSTM) layers together with a novel preprocessing based on future time windows. This model accurately predicts COVID-19 cases and hospital occupancy over long periods of time using only 40% of the set to train. This results in a long-term prediction where each day we can query the cases for the next three days with very little data. The data utilized in this analysis were obtained from the “Hospital Insular” in Gran Canaria, Spain. These data describe the spread of the coronavirus disease (COVID-19) from its initial emergence in 2020 until March 29, 2022. The results show an improvement in MAE (< 161), RMSE (< 405), and MAPE (> 0.20) compared to other studies with similar conditions. This would be a powerful tool for the healthcare system, providing valuable information to decision-makers, allowing them to anticipate and strategize for possible scenarios, ultimately improving public health outcomes and optimizing the allocation of healthcare and economic resources.