COVID-19 Morbidity Research Articles

S-39-5: FACTORS AFFECTING DEVELOPMENT OF AKI AMONG COVID-19 HYPERTENSIVE PATIENTS

Objective: To determine risk factors associated with development of AKI with regards to mortality rate among covid-19 patients taking in consideration risk factors such as age, sex and chronic diseases like diabetics considering renal function to outcome. Design and method: This is a retrospective cohort study using de-identified data retrieved from clinical records of patients from two COVID 19 isolation centers. Medical history, demographic data, symptoms, disease complications and laboratory investigations were extracted from clinical records of 406 confirmed COVID 19 hospitalized patients in the period between Feb 2020 and July 2021. Continuous variables were presented as means ± standard deviation (SD) while categorical variables were presented as percent proportions. Logistic regression was used to determine risk factors associated with development of AKI with regards to mortality factors rate among covid 19 hypertensive patients. Result: Out of 406 hospitalized COVID-19 patients, 59.6% had a history of hypertension. Logistic regression was used to analyze risk factors associated with AKI among hypertensive and non hypertensive patients of covid-19. Age factor is highly significant factor for development of AKI for hypertensive (odd ratio [OR]: 4.89, 95% confidence interval [CI]: (1.93–1.36, P = 0.001) and non-hypertensive patients (odd ratio [OR]: 4.73, 95% confidence interval [CI]: (1.58–4.18, P = 0.001). Urea (odd ratio [OR]: 3.06, 95% confidence interval [CI]: (1.63–5.76, P = 0.001), creatinine (odd ratio [OR]: 3.39, 95% confidence interval [CI]: (1.82–6.32, P > 0.001) and potassium[K] (odd ratio [OR]: 2.17, 95% confidence interval [CI]: (2.23–3.83, P = 0.035) are highly significantly increased for hypertensive covid-19 patients, whereas urea, creatinine and K are not significantly changed for non-hypertensive covid-19 patients Gender and morbidity factor (diabetes mellitus) has no significant effect for AKI development for hypertensive and non-hypertensive covid-19 patients. AKI is considered as a risk factor death among COVID-19 patients (OR:284, CI:1.56–5.15, p = 0.001). Conclusion: The present study indicates that 71% of patients with AKI are hypertensive. The results also highlight the alarming high incidents of hypertension in the studied population. On conclusion hypertension is considered as highly morbidity factor for development of AKI

Caracterização dos casos de COVID-19 em uma comunidade carente no Rio de Janeiro/Brasil com foco na dicotomia aglomeração-pobreza

Abstract This study aims to characterize the morbidity of COVID-19 in the year 2020 by identifying the most vulnerable areas and areas of clustering of cases in a favela from Rio de Janeiro/Brazil known as Manguinhos. This is a cross-sectional descriptive study performed from March 16, 2020, to August 12, 2020. We described the sociodemographic profile of the cases and performed spatial analysis using point and Kernel maps. Incidence rates were calculated by sex, age, and sub-regions. The incidence rate was 202/10,000. We detected clusters of cases west, central-north, and central-south of Manguinhos. High incidence rates were observed also in sub-regions of central-north, central-south, and southwest. In the sub-regions with high incidence, the percentage of people depending on financial governmental aid ranged between 13% and 21%. The sub-regions with the highest agglomeration of cases in the territory of Manguinhos coincide with the regions with the highest incidence rates, but not with the poorest regions of the territory.

Применение спатиального анализа показателей заболеваемости и смертности от COVID-19 (на примере Псковской области)

Apart from biomedical and organizational issues, the emergence of the new coronavirus COVID-19 (SARS-CoV-2) pandemic, set large-scale tasks for creating and improving mathematical and information technologies that operate spatial data in statistical analysis and forecasting. The regional level is seen as a suitable choice for spatial analysis of COVID-19 morbidity and mortality due to the availability of statistics, as well as data on geographical patterns, characteristics of the distribution space (population density, concentration in one city, density of the transport network, distance to the focus of the disease, etc.). The case of the Pskov region shows that the regional healthcare system experiences a significant shortage of personnel and a noticeable lack of resources. When assessing the existing and prospective healthcare infrastructure, it is advisable to take these points into account while developing an effective, evidence-based healthcare policy. The article shows that graph-based models are more likely to be efficient for adequate modeling at the interregional and regional level, while the geographical distribution of patients should be taken into account for the analysis of processes in individual settlements.

Effects of Smoking on COVID-19 Management and Mortality: An Umbrella Review.

Smoking status appears to lead to a poor prognosis in COVID-19 patients. However, findings from the studies conducted on this topic have not been consistent, and further exploration is required. The objective of this umbrella review was to examine the effects of smoking on COVID-19 management and mortality. Online databases that included PubMed, Embase, Scopus, and Web of Science were searched using relevant keywords up to July 27, 2022. Articles were restricted to the English language, and the PRISMA protocol was followed. A total of 27 systematic reviews, published from 2020 to 2022, were included. Individual studies included in the systematic reviews ranged from 8 to 186, with various population sizes. The consensus from the majority of systematic reviews was that COVID-19 smoker patients experience greater disease severity, disease progression, hospitalization rate, hospital admission duration, mechanical ventilation, ICU admission, and mortality rate. COVID-19 patients with a history of smoking (current and former) are vulnerable to adverse hospital outcomes and worse COVID-19 progression. Effective preventive and supportive approaches are required to decrease the risk of COVID-19 morbidity and mortality in patients with a history of smoking.

The First Wave of COVID-19 in Forensic Psychiatry: A Rapid Review Series

ABSTRACT At the beginning of the pandemic, experts expected an increasing number of hospitalizations in forensic settings, uncontrollable outbreaks of COVID-19, and deterioration of mental health of residents within institutions. Certain publications corroborated these concerns; however, no synthesis of the results of empirical publications at the initial stage of the pandemic has yet been conducted. Three rapid reviews were conducted on these topics. Besides almost a two-fold decrease in the total number of urgent consultations/hospitalizations, there were no changes in the number of involuntary hospitalizations, suicide attempts, and psychoses. The COVID-19 morbidity and mortality rates in secure institutions were compatible with the general population. However, the lockdown period was associated with a significant increase in self-harm in secure settings.

AGE DIFFERENCES IN SELF-CONTINUITY REMAIN ROBUST IN RESPONSE TO THE COVID-19 PANDEMIC

Abstract Self-continuity, the perceived connectedness to one’s past and future selves, predicts well-being and tends to be higher among older adults (Rutt & Löckenhoff, 2016). Self-continuity is also susceptible to major life changes (Sani, 2008). The pandemic brought dramatic changes in multiple life domains, especially for older adults who experienced higher rates of COVID-19 morbidity and mortality and may have been more likely to restrict their behavior as a result. This study examined whether age differences in self-continuity remained robust in response to the pandemic using representative U.S. survey data. Pre-pandemic data (Fall 2016, N = 230, aged 18 – 87, M = 50.85, SD = 16.40, 47.83% female, 67.83% white) and mid-pandemic data (Summer 2020, N = 230, aged 18 – 88, M = 50.20, SD = 19.49, 48.27% female, 64.78% white) were demographically matched using propensity scores. Participants rated their self-continuity one, five, and ten years into the past and future. Multi-level modeling examined the effects of age, temporal distance (in years), temporal direction (past vs. future), and assessment time (pre- vs. mid-pandemic) on self-continuity. Consistent with prior research, self-continuity was lower for more distant intervals, especially for the past. An interaction between temporal direction and assessment time indicated that future self-continuity was lower mid-pandemic than pre-pandemic. Across samples, however, advanced age was associated with higher self-continuity and the size of this effect did not vary by assessment time. Overall, findings suggest that even though future self-continuity decreased during the pandemic, existing age effects remained robust to this disruption.

Are We #Stayinghome to Flatten the Curve?

The recent spread of COVID-19 across the U.S. led to concerted efforts by states to ``flatten the curve through the adoption of stay-at-home mandates that encourage individuals to reduce travel and maintain social distance. Combining data on changes in travel activity with COVID-19 health outcomes and state policy adoption timing, we characterize nationwide changes in mobility patterns and isolate the portion attributable to statewide mandates. We find evidence of dramatic nationwide declines in mobility prior to adoption of any statewide mandates. Once states adopt a mandate, we estimate further mandate-induced declines between 2.1 and 7.0 percentage points across methods that account for states' differences in travel behavior prior to policy adoption. In addition, we investigate the effects of stay-at-home mandates on changes in COVID-19 health outcomes while controlling for pre-trends and observed pre-treatment mobility patterns. We estimate mandate-induced declines between 0.13 and 0.17 in deaths (5.6 to 6.0 in hospitalizations) per 100 thousand across methods. Across 43 adopting states, this represents 23,366-30,144 fewer deaths (and roughly one million averted hospitalizations) for the months of March and April - which indicates that death rates could have been 42-54% higher had states not adopted statewide policies. We further find evidence that changes in mobility patterns prior to adoption of statewide policies also played a role in reducing COVID-19 mortality and morbidity. Adding in averted deaths due to pre-mandate social distancing behavior, we estimate a total of 48-71,000 averted deaths from COVID-19 for the two-month period. Given that the actual COVID-19 death toll for March and April was 55,922, our estimates suggest that deaths would have been 1.86-2.27 times what they were absent any stay-at-home mandates during this period. These estimates represent a lower bound on the health impacts of stay-at-home policies, as they do not account for spillovers or undercounting of COVID-19 mortality. Our findings indicate that early behavior changes and later statewide policies reduced death rates and helped attenuate the negative consequences of COVID-19. Further, our findings of substantial reductions in mobility prior to state-level policies convey important policy implications for re-opening. Take Away Link https://are.berkeley.edu/sites/are.berkeley.edu/files/PolicyTakeAway_Web.pdf

Performance of D-dimer to lymphocyte ratio in predicting the mortality of COVID-19 patients.

Nowadays, there is still no effective treatment developed for COVID-19, and early identification and supportive therapies are essential in reducing the morbidity and mortality of COVID-19. This is the first study to evaluate D-dimer to lymphocyte ratio (DLR) as a prognostic utility in patients with COVID-19. We retrospectively analyzed 611 patients and separated them into groups of survivors and non-survivors. The area under the curve (AUC) of various predictors integrated into the prognosis of COVID-19 was compared using the receiver operating characteristic (ROC) curve. In order to ascertain the interaction between DLR and survival in COVID-19 patients, the Kaplan-Meier (KM) curve was chosen. Age (OR = 1.053; 95% CI, 1.022-1.086; P = 0.001), NLR (OR = 1.045; 95% CI, 1.001-1.091; P = 0.046), CRP (OR = 1.010; 95% CI, 1.005-1.016; P < 0.001), PT (OR = 1.184; 95% CI, 1.018-1.377; P = 0.029), and DLR (OR = 1.048; 95% CI, 1.018-1.078; P = 0.001) were the independent risk factors related with the mortality of COVID-19. DLR had the highest predictive value for COVID-19 mortality with the AUC of 0.924. Patients' survival was lower when compared to those with lower DLR (Log Rank P <0.001). DLR might indicate a risk factor in the mortality of patients with COVID-19.

1944. Effectiveness of COVID-19 Vaccines Against Severe Disease and Death and its Durability Over Time Against the Omicron Variant

Abstract Background We aimed to estimate COVID-19 Vaccine Effectiveness (VE) and its durability against severe disease (intubation) and death in the Greek population, for all vaccines currently in use. Methods Nationwide active surveillance and vaccination registry data between January 2021 – April 2022 were used to estimate VE via quasi-Poisson regression as one minus Incidence Rate Ratio, adjusted for age and calendar time. Interaction terms were included to assess VE by age group, by variant (delta vs omicron) and by time since vaccination (compared to the first month after vaccination). Results VE results are summarized in Figures 1-3. After 2-doses (of any vaccine) VE was &amp;gt;95% against delta and &amp;gt;85% against omicron in the 15-59 and 60-79 age groups, but waned significantly at 6 months by 5-10% in the 15-59 group and 15-20% in the 60-79 group. In the 80+ age group, 2-dose VE was much lower against omicron at around 60%, waning to 50% at 6 months. With 3 vaccine doses VE surged to &amp;gt;95% against both delta and omicron in all age groups except 80+, who had VE against omicron of ≈90%; however there was again substantial waning at 6 months by about 10-15% in all groups. In the 80+ age group, VE against omicron dropped to 81.4% (95% CI 76.7–85.2%) for death and 57.7% (95% CI 38.5–70.9%) for intubation. There was little to no evidence of variation in VE between combinations of different vaccines (BNT162b2, mRNA-1273, ChAdOx1 nCov-19 and Ad26.COV2.S), although the majority of the population received 2- or 3-dose BNT162b2. Vaccination prevented an estimated 39,018 COVID-19 deaths (95% CI: 37,791–40,608) over the study period. Figure 1.Vaccine Effectiveness for 1, 2 and 3 doses (any vaccine), ages 15-59Figure 2.Vaccine Effectiveness for 1, 2 and 3 doses (any vaccine), ages 60-79Figure 3.Vaccine Effectiveness for 1, 2 and 3 doses (any vaccine), ages Conclusion COVID-19 vaccination remains extremely effective in preventing severe disease and death, even in the context of the omicron variant, as long as 3 doses have been administered. Even after 3 doses, however, effectiveness wanes substantially in the course of 6 months. Additional strategies will be therefore needed in order to minimize COVID-19 mortality and morbidity, including boosting doses especially in the elderly, improved vaccines, early diagnosis and treatment of high-risk groups and measures to reduce community transmission of current or novel SARS-CoV-2 immune escape variants. Disclosures All Authors: No reported disclosures.

Responses to COVID-19 Threats: an Evolutionary Psychological Analysis.

Responses to COVID-19 public health interventions have been lukewarm. For example, only 64% of the US population has received at least two vaccinations. Because most public health interventions require people to behave in ways that are evolutionarily novel, evolutionary psychological theory and research on mismatch theory, the behavioral immune system, and individual differences can help us gain a better understanding of how people respond to public health information. Primary sources of threat information during the pandemic (particularly in early phases) were geographic differences in morbidity and mortality statistics. We argue that people are unlikely to respond to this type of evolutionarily novel information, particularly under conditions of high uncertainty. However, because individual differences affect threat perceptions, some individual differences will be associated with threat responses. We conducted two studies (during Phase 1 and 2years later), using data from primarily public sources. We found that state-level COVID-19 morbidity and mortality rates had no relationship with mental health symptoms (an early indicator of how people were responding to the pandemic), suggesting that people-in general-were not attending to this type of information. This result is consistent with the evolutionary psychological explanation that statistical information is likely to have a weak effect on the behavioral immune system. We also found that individual differences (neuroticism, IQ, age, and political ideology) affected how people responded to COVID-19 threats, supporting a niche-picking explanation. We conclude with suggestions for future research and suggestions for improving interventions and promoting greater compliance.

1407. Increasing access to COVID-19 testing in underserved Black American neighborhoods

Abstract Background Black Americans have been disproportionately impacted by COVID-19, with systemic inequities contributing to increased incidence and mortality. In Chicago, access to COVID-19 testing was scarce in many predominantly Black neighborhoods early in the pandemic, exacerbating inequities. We aimed to assess uptake and yield of a COVID-19 testing campaign to increase access in high-risk, underserved Chicago communities. Methods The Alive Church Network (ACN) is a community-driven coalition of Black pastors and public health researchers developed to address health inequities in Chicago. For this initiative, ACN implemented two strategies to improve access to COVID-19 testing in underserved neighborhoods: 1) church-based testing, with nurses and community health workers (CHWs) stationed in churches to perform PCR testing for community members and church staff (Dec 2020-Dec 2021) and 2) community site testing, with nurses and CHWs deployed to 8 local sites (e.g., Salvation Army) to conduct weekly PCR testing for employees and clients (May 2021-Mar 2022). We assessed characteristics of individuals undergoing testing; symptom and exposure history; and COVID-19 positivity. In addition, we compared positivity for ACN sites with Chicago citywide positivity over time. Results A total of 3420 tests were performed for 1703 individuals. Of those tested, 931 (54.7%) were tested at churches and 772 (45.3%) were tested at community partner sites. Those presenting to churches were older (mean 44.8 vs. 39.1 years), more likely to be female (56.5% vs. 48.5%), and more likely to have a chronic medical condition (37.1% vs. 22.5%, Table). Prevalence of COVID-19 symptoms and exposure history were similar for those presenting to church and community sites (Table). Overall, ACN test positivity was similar to Chicago citywide positivity; however, ACN test positivity was much higher during the Omicron surge (24% vs. 11%, Figure). Characteristics of individuals tested for COVID-19 at church and community sites COVID-19 test positivity, ACN sites vs. Chicago citywide Conclusion The ACN testing campaign increased access to COVID-19 testing in underserved neighborhoods in Chicago and had high yield during the Omicron surge. Church-based testing was successful for reaching older, medically vulnerable individuals. Ensuring widespread access to testing is essential for health equity and to reduce COVID-19 morbidity and mortality. Disclosures All Authors: No reported disclosures.

The health control of employees in digitization conditions

The article considers issues of health management of employees at workplace in conditions of globalization and digitalization of society, causing need to revise the labor relations. Under impact of global trends in field of digital technologies, transformation occurs concerning working environment and labor safety measures, contributing to development of new forms of interaction between employee and employer and employment models as well. The ongoing changes in society and global changes in labor market require to investigate new labor conditions, formation of system of knowledge about directions and perspectives for development of labor relations and human resources management. Nowadays, because of spreading of COVID-19 morbidity, increased attention is paid to health of employees and measures targeted to preventing morbidity are intensified. The need to work in new conditions dictates topical issues for scientific research in coming years: development of theory of new labor economy, investigation changes in paradigm of quality of labor life, well-being at workplace in conditions of digitalization of economy and formation of new employment model, digital generation of workers and new challenges in human resources management.The purpose of the study is to explore issues of health management of employees at workplace in conditions of globalization and digitalization. The implemented study permitted to conclude that problems of socio-psychological nature occurring in labor sphere in conditions of active transition to digital economy are complicated by increasing instability of labor relations and occurrence of new social economic and psychological risks at workplace that negatively effect on health and well-being of employees.

MORBIDITY AND MORTALITY FROM COVID-19 IN A DIALYSIS CENTER IN NORTHERN BULGARIA

Purpose: Since its inception in early 2020, COVID-19 has quickly become a pandemic, killing more than six million people worldwide. The aim of this study is to investigate the morbidity and mortality of COVID-19 in one Bulgarian hemodialysis center. Materials and methods: The study is retrospective, conducted for the period of 25th Apr 2020 – 31st Dec 2021. The mean annual number of hemodialysis patients was 184, including patients with end-stage renal disease and acute renal failure. The total number of patients with COVID-19 was 78 (42%), 49of which (63%) were males, the average age was 60 years (+/-12.1 years). Results: There was no significant difference between the mean age of patients divided by sex (p=0.069). A total of 33 people died (42%), 17 of whom (51%) were males. The average age of the deceased patients (64.24 +/- 10.846) was higher than that of the survivors (58.44 +/-12.286), and the difference was significant (p=0.034). There was no significant difference in the mean age of survived and deceased males (p=0.74) but for females, the difference was statistically significant – the mean age of survivorswas 55.00 (+/-12.03)and of the deceased patients was 67.6 (+/- 8.79) years. Conclusion: Our results confirm data from similar studies aboutthe high incidence and mortality of COVID-19 in hemodialysis patients. We confirma statistically significant increase in mortality of these patients with increasing age. Probably the mass vaccination of patients and staff; the use of antiviral drugs and biological therapy is the way to reduce morbidity and mortality among them.

COVID-19 susceptibility and clinical outcomes in inflammatory bowel disease: An updated systematic review and meta-analysis.

The susceptibility, risk factors, and prognosis of COVID-19 in patients with inflammatory bowel disease (IBD) remain unknown. Thus, our study aims to assess the prevalence and clinical outcomes of COVID-19 in IBD. We searched PubMed, EMBASE, and medRxiv from 2019 to 1 June 2022 for cohort and case-control studies comparing the prevalence and clinical outcomes of COVID-19 in patients with IBD and in the general population. We also compared the outcomes of patients receiving and not receiving 5-aminosalicylates (ASA), tumour necrosis factor antagonists, biologics, systemic corticosteroids, or immunomodulators for IBD. Thirty five studies were eligible for our analysis. Pooled odds ratio of COVID-19-related hospitalisation, intensive care unit (ICU) admission, or death in IBD compared to in non-IBD were 0.58 (95% confidence interval (CI)=0.28-1.18), 1.09 (95% CI=0.27-4.47), and 0.67 (95% CI=0.32-1.42), respectively. Inflammatory bowel disease was not associated with increased hospitalisation, ICU admission, or death. Susceptibility to COVID-19 did not increase with any drugs for IBD. Hospitalisation, ICU admission, and death were more likely with 5-ASA and corticosteroid use. COVID-19-related hospitalisation (Odds Ratio (OR): 0.53; 95% CI=0.38-0.74) and death (OR: 0.13; 95% CI=0.13-0.70) were less likely with Crohn's disease than ulcerative colitis (UC). In conclusion, IBD does not increase the mortality and morbidity of COVID-19. However, physicians should be aware that additional monitoring is needed in UC patients or in patients taking 5-ASA or systemic corticosteroids.

The Clinical Characteristics and Outcomes of COVID-19 Patients with Pre-Existing Thyroid Dysfunction: A Nationwide Study.

To which extent the pre-existing hypothyroidism or hyperthyroidism has an impact on coronavirus infection 2019 (COVID-19) outcomes remains unclear. The objective of this study was to evaluate COVID-19 morbidity and mortality in patients with pre-existing thyroid dysfunction. A retrospective cohort of patients with a polymerase chain reaction (PCR)-confirmed COVID-19 infection (n=14 966) from March 11 to May 30, 2020, was established using the database of the Turkish Ministry of Health. We compared the morbidity and mortality rates of COVID-19 patients with pre-existing hypothyroidism (n=8813) and hyperthyroidism (n=1822) to those patients with normal thyroid function (n=4331). Univariate and multivariate regression analyses were performed to identify the factors associated with mortality. Mortality rates were higher in patients with hyperthyroidism (7.7%) and hypothyroidism (4.4%) than those with normal thyroid function (3.4%) (p<0.001 and p=0.008, respectively). Pre-existing hyperthyroidism was significantly associated with an increased risk of mortality (OR 1.54; 95% CI, 1.02-2.33; p=0.042) along with advanced age, male gender, lymphopenia and chronic kidney disease (p<0.001 for all). Although a potential trend was noted, the association between pre-existing hypothyroidism and mortality was not significant (OR 1.36; 95% CI, 0.99-1.86; p=0.055). In conclusion, this study showed an association between pre-existing hyperthyroidism with higher COVID-19 mortality. A potential trend towards increased mortality was also observed for hypothyroidism. The risk was more pronounced in patients with hyperthyroidism.

SARS-CoV-2 Spike Protein Induces Hemagglutination: Implications for COVID-19 Morbidities and Therapeutics and for Vaccine Adverse Effects

Experimental findings for SARS-CoV-2 related to the glycan biochemistry of coronaviruses indicate that attachments from spike protein to glycoconjugates on the surfaces of red blood cells (RBCs), other blood cells and endothelial cells are key to the infectivity and morbidity of COVID-19. To provide further insight into these glycan attachments and their potential clinical relevance, the classic hemagglutination (HA) assay was applied using spike protein from the Wuhan, Alpha, Delta and Omicron B.1.1.529 lineages of SARS-CoV-2 mixed with human RBCs. The electrostatic potential of the central region of spike protein from these four lineages was studied through molecular modeling simulations. Inhibition of spike protein-induced HA was tested using the macrocyclic lactone ivermectin (IVM), which is indicated to bind strongly to SARS-CoV-2 spike protein glycan sites. The results of these experiments were, first, that spike protein from these four lineages of SARS-CoV-2 induced HA. Omicron induced HA at a significantly lower threshold concentration of spike protein than the three prior lineages and was much more electropositive on its central spike protein region. IVM blocked HA when added to RBCs prior to spike protein and reversed HA when added afterward. These results validate and extend prior findings on the role of glycan bindings of viral spike protein in COVID-19. They furthermore suggest therapeutic options using competitive glycan-binding agents such as IVM and may help elucidate rare serious adverse effects (AEs) associated with COVID-19 mRNA vaccines, which use spike protein as the generated antigen.

Morbidity and severity of COVID-19 in patients with Parkinson's disease treated with amantadine - A multicenter, retrospective, observational study

BackgroundAfter more than 2 years of the pandemic, effective treatment for COVID-19 is still under research. In recent months, publications hypothesized amantadine's potential beneficial effect on SARS-CoV-2 infection. ObjectiveTo compare the groups of Parkinson's Disease (PD) patients who were administered amantadine chronically and those who did not take this medication in the context of the incidence and severity of COVID-19 infection. MethodsAn observational, retrospective, multicenter cohort study was conducted among consecutive patients with idiopathic PD. The structured questionnaires were completed during the patient's follow-up visits at the Outpatient Clinic or during hospitalization. The questionnaire included the following informations: patient's age, duration of PD, Hoehn-Yahr (H–Y) stage, comorbidities, medications, COVID-19 confirmed by reverse transcription polymerase chain reaction (RT-PCR) swab test for SARS-CoV-2 with specified symptoms and their severity (home or hospital treatment). The vaccination status was verified as well. ResultsFive hundred fifty-two (n = 552) patients participated in the study - 329 men (60%). The mean H–Y stage was 2.44 (range: 1–4) and the mean duration of PD was 9.6 years (range: 1–34). One hundred four subjects (19%) had confirmed COVID-19 infection. Subjects over 50 years of age had a significantly lower incidence of COVID-19 (17% vs 38%, p = 0.0001) with difference also in mean H–Y stage (2.27 vs 2.49; p = 0.011) and disease duration (8.4 vs 9.9 years, p = 0.007). There were no differences between patients with and without co-morbidities. In the whole analyzed group 219 (40%) subjects were treated with amantadine. Comparing COVID-19 positive and negative patients, amantadine was used by 48/104 (46%) and 171/448 (38%) respectively. 22% of patients on amantadine vs. 17% of patients without amantadine developed COVID-19. These differences were not significant. There were no differences in morbidity and severity of COVID-19 between amantadine users and non-users as well. ConclusionsCOVID-19 was less common in older (>50) with longer duration and more advanced patients. Amantadine did not affect the risk of developing COVID-19 or the severity of infection.

Serum immunoglobulin G and mucosal immunoglobulin A antibodies from prepandemic samples collected in Kilifi, Kenya, neutralize SARS-CoV-2 in vitro

ObjectivesMany regions of Africa have experienced lower COVID-19 morbidity and mortality than Europe. Pre-existing humoral responses to endemic human coronaviruses (HCoV) may cross-protect against SARS-CoV-2. We investigated the neutralizing capacity of SARS-CoV-2 spike reactive and nonreactive immunoglobulin (Ig)G and IgA antibodies in prepandemic samples. MethodsTo investigate the presence of pre-existing immunity, we performed enzyme-linked immunosorbent assay using spike antigens from reference SARS-CoV-2, HCoV HKU1, OC43, NL63, and 229E using prepandemic samples from Kilifi in coastal Kenya. In addition, we performed neutralization assays using pseudotyped reference SARS-CoV-2 to determine the functionality of the identified reactive antibodies. ResultsWe demonstrate the presence of HCoV serum IgG and mucosal IgA antibodies, which cross-react with the SARS-CoV-2 spike. We show pseudotyped reference SARS-CoV-2 neutralization by prepandemic serum, with a mean infective dose 50 of 1: 251, which is 10-fold less than that of the pooled convalescent sera from patients with COVID-19 but still within predicted protection levels. The prepandemic naso-oropharyngeal fluid neutralized pseudo-SARS-CoV-2 at a mean infective dose 50 of 1: 5.9 in the neutralization assay. ConclusionOur data provide evidence for pre-existing functional humoral responses to SARS-CoV-2 in Kilifi, coastal Kenya and adds to data showing pre-existing immunity for COVID-19 from other regions.

Community vulnerability to the COVID-19 pandemic: A narrative synthesis from an ecological perspective.

We aimed to conduct a narrative synthesis of components and indicators of community vulnerability to a pandemic and discuss their interrelationships from an ecological perspective. We searched from PubMed, Embase, Web of Science, PsycINFO, and Scopus (updated to November 2021) for studies focusing on community vulnerability to a pandemic caused by novel respiratory viruses on a geographic unit basis . Studies that reported the associations of community vulnerability levels with at least one disease morbidity or mortality outcome were included. Forty-one studies were included. All were about the COVID-19 pandemic. Suitable temperature and humidity environments, advanced social and human development (including high population density and human mobility, connectivity, and occupations), and settings that intensified physical interactions are important indicators of vulnerability to viral exposure. However, the eventual pandemic health impacts are predominant in communities that faced environmental pollution, higher proportions of socioeconomically deprived people, health deprivation, higher proportions of poor-condition households, limited access to preventive health care and urban infrastructure, uneven social and human development, and racism. More stringent social distancing policies were associated with lower COVID-19 morbidity and mortality only in the early pandemic phases. Prolonged social distancing policies can disproportionately burden the socially disadvantaged and racially/ethnically marginalized groups. Community vulnerability to a pandemic is foremost the vulnerability of the ecological systems shaped by complex interactions between the human and environmental systems. PROSPERO (CRD42021266186).

Efficacy of bariatric surgery in COVID-19 patients: An updated systematic review and meta-analysis.

Obesity is linked with poor outcomes in patients with SARS-CoV-2 infection. In patients with BMI>35kg/m2, increased rates of hospital and subsequently ICU admissions have been noted. Bariatric surgery resulting in sustained weight loss is hypothesized to decrease the morbid outcomes associated with COVID. In this review, we update the evidence on the topic. An extensive literature search was conducted of electronic databases. Screening of the articles based on the eligibility criteria was followed by relevant data extraction. In addition to articles used in a previous meta-analysis, relevant databases were searched to filter for any new articles. Initially, two independent reviewers screened Pubmed and the Cochrane database followed by a thorough search of additional databases such as Google scholar and Medrxiv. Articles were first screened using title and abstract, followed by a full text read. Duplicates, meta-analysis, letter to the editors, and commentaries were excluded. No language restrictions were applied. A total of nine articles with a population of 1,130,341 were entered into RevMan. Patients with bariatric surgery displayed significantly decreased hospitalization (OR: 0.52, 95% CI [0.45, 0.61]), were less likely to be admitted to the ICU (OR: 0.44, 95% CI [0.29, 0.67]), and had reduced overall mortality (OR: 0.42, 95% CI [0.25, 0.70]). Surgically induced weight loss is beneficial in reducing morbidity and mortality of COVID-19.