COVID-19 Morbidity Research Articles

Corticosteroids in COVID-19: pros and cons.

The wide and rapid spread of the COVID-19 pandemic has placed an unanticipated burden on the global healthcare sector. This necessitated a swift response from the international community to reach a solution. Efforts were made in parallel to develop preventative and therapeutic modalities. Since then, drug repurposing has blossomed as a potentially rapid resolution and has included various agents with anti-viral and anti-inflammatory properties. Corticosteroids, being potent anti-inflammatory agents, have been placed under extensive investigation. Various trials have recorded the beneficial outcome of corticosteroids in decreasing the mortality and morbidity of COVID-19. With the high pace of escalating events, the quality and study design of clinical trials are varied. Therefore, this study aims to explore the role of corticosteroids in COVID-19 disease. It inspects the molecular, pharmacologic, and clinical proof behind this theory.

Natural and socio-environmental factors contribute to the transmissibility of COVID-19: evidence from an improved SEIR model.

COVID-19 has ravaged Brazil, and its spread showed spatial heterogeneity. Changes in the environment have been implicated as potential factors involved in COVID-19 transmission. However, considerable research efforts have not elucidated the risk of environmental factors on COVID-19 transmission from the perspective of infectious disease dynamics. The aim of this study is to model the influence of the environment on COVID-19 transmission and to analyze how the socio-ecological factors affecting the probability of virus transmission in 10 states dramatically shifted during the early stages of the epidemic in Brazil. First, this study used a Pearson correlation to analyze the interconnection between COVID-19 morbidity and socio-ecological factors and identified factors with significant correlations as the dominant factors affecting COVID-19 transmission. Then, the time-lag effect of dominant factors on the morbidity of COVID-19 was investigated by constructing a distributed lag nonlinear model and standard two-stage meta-analytic model, and the results were considered in the improved SEIR model. Lastly, a machine learning method was introduced to explore the nonlinear relationship between the environmental propagation probability and socio-ecological factors. By analyzing the impact of environmental factors on virus transmission, it can be found that population mobility directly caused by human activities had a greater impact on virus transmission than temperature and humidity. The heterogeneity of meteorological factors can be accounted for by the diverse climate patterns in Brazil. The improved SEIR model was adopted to explore the interconnection of COVID-19 transmission and the environment, which revealed a new strategy to probe the causal links between them.

Reduced COVID-19 morbidity and mortality in hemodialysis patients across the various Omicron sublineages-A retrospective analysis.

Hemodialysis (HD) patients are a COVID-19 high risk population due to comorbidities and impaired immune response. Vaccines, advent of effective treatment and the emergence of novel variants have fundamentally changed the pandemic. We aimed to assess temporal changes of COVID-19 in HD patients of our catchment area, and risk factors for severe and fatal course. We retrospectively collected data from 274 patients admitted to the Medical University Graz, Austria for HD between 1st of May 2020 and 31st of August 2022. We analyzed clinical and demographic data between different COVID-19 waves and assessed factors associated with hospitalization, ICU admission and mortality by logistic regression. To further evaluate the dialysis at-risk population, we collected demographic and vaccination data between August 2021 and August 2022. Time of infection and SARS-CoV-2 sequencing data allowed for distinction of five separate waves of infection with different impact on the dialysis population: While in the initial four waves frequencies of hospitalization, necessity of critical care and mortality were around 60%, 10% and 20%, respectively. These events became rare during the large fifth wave, when Omicron had become the dominant variant. Although only 16.9% had to be hospitalized, this resulted in 29 hospital admissions, due to the high prevalence of COVID-19 during the Omicron era. Furthermore, we observed similar clinical outcomes with BA.4/5 as with BA.1/BA.2 Omicron sublineages. The proportion of previously infected increased simultaneously with the number of vaccination doses in our dialysis population. Vaccination at time of positivity and infection with an Omicron variant conferred protection against hospitalization and mortality in univariate analysis, but only infection with an Omicron variant remained a robust predictor for these outcomes in multivariable analysis. While a fourth of our at-risk population became infected during the Omicron wave, mortality was almost non-existent. Several concomitant factors have contributed to the decrease of COVID-19 severity in HD patients. This trend appears to be continued with BA.4/5, which was equally mild as BA.1 and BA.2 in our well vaccinated dialysis population.

Exposure to lung-migrating helminth protects against murine SARS-CoV-2 infection through macrophage-dependent T cell activation.

Helminth endemic regions report lower COVID-19 morbidity and mortality. Here, we show that lung remodeling from a prior infection with a lung-migrating helminth, Nippostrongylus brasiliensis, enhances viral clearance and survival of human-ACE2 transgenic mice challenged with SARS-CoV-2 (SCV2). This protection is associated with a lymphocytic infiltrate, including increased accumulation of pulmonary SCV2-specific CD8+ T cells, and anti-CD8 antibody depletion abrogated the N. brasiliensis-mediated reduction in viral loads. Pulmonary macrophages with a type 2 transcriptional and epigenetic signature persist in the lungs of N. brasiliensis-exposed mice after clearance of the parasite and establish a primed environment for increased CD8+ T cell recruitment and activation. Accordingly, depletion of macrophages ablated the augmented viral clearance and accumulation of CD8+ T cells driven by prior N. brasiliensis infection. Together, these findings support the concept that lung-migrating helminths can limit disease severity during SCV2 infection through macrophage-dependent enhancement of antiviral CD8+ T cell responses.

Association between pregnancy status and COVID-19 clinical manifestations, morbidity, and mortality among unvaccinated women in Metro Manila, Philippines: A multi-center prospective cohort study

BackgroundThe presenting clinical manifestations and the influence of pregnancy on the progression and symptomatology of COVID-19 among Filipina women are still understudied. This study assessed the association between pregnancy status and COVID-19 clinical manifestations, morbidity, and mortality among unvaccinated women in Manila, Philippines. MethodsThis multi-center prospective cohort study ascertained the pregnancy status and presence of SARS-CoV-2 with a validated health questionnaire. Generalized linear models with a Poisson distribution were fitted to estimate the association between pregnancy status and the clinical manifestations, morbidity, and cause-specific mortality from COVID-19, adjusting for confounding factors. ResultsNon-pregnant women were observed to report thermoregulatory, respiratory, musculoskeletal, and digestive symptoms more frequently than pregnant women. Being pregnant vs. not pregnant was associated with clinical manifestations of sore throat and being feverish. In addition, pregnancy is less likely to result in hospitalization and mortality among unvaccinated Filipinas. ConclusionPregnancy status indicates influence on hospitalization prevalence and mortality among unvaccinated Filipino women. Research on the longitudinal nature and post-recovery persistence of the symptoms of COVID-19 among women is recommended.

Investigating the Relationship Between Social Responsibility and COVID-19 Morbidity in the Population Covered by Health Centers in Iran

Introduction: Social responsibility and, is an indicator that is important in the epidemic of diseases with high prevalence and death rates. The current study aims at determining the relationship between social responsibility and COVID-19 in the population covered by health centers in Iran. Methods: 500 people participated in this descriptive-analytical study. The data was collected using a researcher-made social responsibility questionnaire in the context of the Covid-19 pandemic in three areas general, individual, and social responsibility. The quantitative content validity method was used to measure the validity of the questionnaire and Cronbach's alpha calculation method was used to measure its reliability. The data were analyzed using SPSS21 software. Findings: Among the participants, 4.32% of them had a history of covid-19, and the history of complications was more in men (51.9%) and the mean social responsibility score of women was higher (P<0.001). The average responsibility score was higher in people without a history of Covid-19 than in people with a history of Covid-19 (P=0.006). Conclusion: Individuals with higher social responsibility observed more health protocols and had lower rates of covid-19 infection among them. Therefore, in the design of educational interventions, planning should be done to increase people's sense of social responsibility.

Knowledge, Attitudes, and Concerns Regarding COVID-19 Vaccination Among Unvaccinated Elderly People in the Aseer Region, Saudi Arabia.

Vaccination is the best weapon to prevent any disease, especially pandemics like COVID-19, and building herd immunity is the best way to control the disease's spread. On one side, vaccine availability is important, and on the other, its successful distribution is faced with difficulty in a wide geographical area. Availability and distribution go hand in hand, which is the public health challenge. Vaccines are taking over, clearing up concerns about vaccination and making the public ready. The high-risk public should receive vaccines without resistance, which is of utmost importance. Unvaccinated older adults are at higher risk for COVID-19 infection, morbidity, and mortality. The reasons why older people who have not been vaccinated against COVID-19 do not want to receive vaccines when they are available include a lack of knowledge about COVID-19 vaccination and listening to incorrect sources of information. With this background, this study aimed to assess the knowledge, attitudes, and concerns of unvaccinated older adults in the Aseer Region, Saudi Arabia. A community-based cross-sectional study was planned to find out the knowledge and attitudes of the elderly in the Assir Region, Saudi Arabia. A total of 434 unvaccinated elderly persons were recruited randomly from the list of elderly (>60 years) who were unvaccinated. The data was gathered using a structured interview schedule in Arabic. Out of 434 participants, more than half (54.8%) were male. Most of the participants were Saudi citizens (91.5%). Of the participants, nearly one-fifth (19.8%) of them had a previous history of COVID-19 infection. The participants' main sources of information about vaccination against COVID-19 were the mass media (41.9%), followed by word of mouth from friends, families, or neighbors (41.7%), and social media (16.4%). More than three-fourths of them (85.7%) had poor knowledge regarding the COVID-19 vaccination. The participants' poor knowledge grades were mainly among those aged >80 years, illiterate, unemployed participants, and current smokers. Those participants relying on social media had the highest number of concerns (6.663.21) regarding the safety and efficacy of vaccines. Most participants have poor knowledge, and their knowledge of COVID-19 vaccination is limited. Participants whose main source of knowledge is the mass media need to intensify their education activities in the mass media. Social media, whose primary source of information is social media, has the greatest number of issues that require immediate attention. Social media content must be scanned, and misinformation needs to be addressed.

Global Perspective on the Impact of the COVID-19 Pandemic on Rheumatology and Health Equity.

Although the public health emergency associated with the COVID-19 pandemic has ended, challenges remain, especially for individuals with rheumatic diseases. We aimed to assess the historical and ongoing effects of COVID-19 on individuals with rheumatic diseases and rheumatology practices globally, with specific attention to vulnerable communities and lessons learned. We reviewed literature from several countries and regions, including Africa, Australia and New Zealand, China, Europe, Latin America, and the US. In this review, we summarize literature that not only examines the impact of the pandemic on individuals with rheumatic diseases, but also research that reports the lasting changes to rheumatology patient care and practice, and health service use. Across countries, challenges faced by individuals with rheumatic diseases during the pandemic included disruptions in health care and medication supply shortages. These challenges were associated with worse disease and mental health outcomes in some studies, particularly among those who had social vulnerabilities defined by socioeconomic, race, or rurality. Moreover, rheumatology practice was impacted in all regions, with the uptake of telemedicine and changes in health care utilization. While many regions developed rapid guidelines to disseminate scientific information, misinformation and disinformation remained widespread. Finally, vaccine uptake among individuals with rheumatic diseases has been uneven across the world. As the acute phase of the pandemic wanes, ongoing efforts are needed to improve health care access, stabilize rheumatology drug supplies, improve public health communication, and implement evidence-based vaccination practices to reduce COVID-19 morbidity and mortality among individuals with rheumatic diseases.

Human exposure risk assessment for infectious diseases due to temperature and air pollution: an overview of reviews.

Air pollution and global temperature change are expected to affect infectious diseases. Air pollution usually causes inflammatory response and disrupts immune defense system, while temperature mainly exacerbates the effect of vectors on humans. Yet to date overview of systematic reviews assessing the exposure risk of air pollutants and temperature on infectious diseases is unavailable. This article aims to fill this research gap. PubMed, Embase, the Cochrane Library, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature were searched. Systematic reviews and meta-analyses investigated the exposure risk of pollutants or temperature on infectious diseases were included. Two investigators screened literature, extracted data and performed the risk of bias assessments independently. A total of 23 articles met the inclusion criteria, which 3 (13%) were "low" quality and 20 (87%) were "critically low" quality. COVID-19 morbidity was associated with long-term exposure PM2.5 (RR = 1.056 per 1 [Formula: see text], 95% CI: 1.039-1.072) and NO2 (RR = 1.042 per 1 [Formula: see text], 95% CI: 1.017-1.068). In addition, for each 1°C increase in temperature, the morbidity risk of dengue increased 13% (RR = 1.130 per 1°C, 95% CI: 1.120-1.150), infectious diarrhea increased 8% (RR = 1.080 per 1°C, 95% CI: 1.050-1.200), and hand, foot and mouth disease (HFMD) increased 5% (RR = 1.050 per 1°C, 95% CI: 1.020-1.080). In conclusion, PM2.5 and NO2 increased the risk of COVID-19 and temperatures were associated with dengue, infectious diarrhoea and HFMD morbidity. Moreover, the exposure risk of temperature on COVID-19 was recommended to be further explored.

Relationship Between Mother's Anxiety Level and Children's Coronavirus (Covid-19) Vaccination Status School Age in Public Elementary School Cipageran Mandiri 2

Background: Anxiety is the psychological state of a person who is worried and afraid of something that has not happened yet and is a sign that helps the individual to prepare to take action in the face of a threat. The level of anxiety in mothers can affect vaccination status and contribute to the uneven distribution of children getting the COVID-19 vaccine. The COVID-19 vaccine target for older children's schools is 26.5 million, and the current COVID-19 vaccine achievement rate for school-age children is 15 million (56.6%) with complete vaccination status. This shows that 11.5 million children (43%) are still not fully vaccinated against COVID-19. One of the causes is maternal anxiety about the COVID-19 vaccine.
 Objectives: This study was to identify the relationship between anxiety levels Mothers with COVID-19 vaccination status for school-age children at Public Elementary School Cipageran Mandiri 2.
 Methods: analytical survey research methodology with cross sectional design, research sample a total of 237 respondents with simple stratified random sampling. Data collection techniques use questionnaires in the form of google forms. Data analysis with chi-square test statistical application.
 Results: The results showed that 65% of mothers did not experience anxiety about Covid-19 vaccination. The covid-19 vaccination status was obtained, and most had a complete covid-19 vaccination status of 73%. The results of statistical analysis showed that there was a relationship between the level of maternal anxiety and the status of Covid-19 vaccination in school-age children at Public Elementary School Cipageran Mandiri 2 with a value of p = 0.000.
 Conclusion: COVID-19 vaccination status in children is related to maternal anxiety in responding to the importance or absence of the COVID-19 vaccine. This is because 27% of children still have not been vaccinated, where vaccination is mandatory to reduce COVID-19 morbidity and mortality.

COVID-19 Booster Dose Coverage and Hesitancy among Older Adults in an Urban Slum and Resettlement Colony in Delhi, India.

The high prevalence of vaccine booster hesitancy, with the concomitant waning of humoral vaccine or hybrid immunity, and the emergence of SARS-CoV-2 variants of concern can accentuate COVID-19 morbidity and mortality. The study objective was to ascertain the COVID-19 vaccination coverage, including the administration of precaution (booster) dose vaccination, among the older population in an urban slum and resettlement colony population in Delhi, India. We conducted a cross-sectional survey in an urban resettlement colony, slum, and village cluster in the Northeast district of Delhi among residents aged ≥50 years. A total of 2217 adults (58.28%) had obtained a COVID-19 booster (precaution) dose vaccine, 1404 (36.91%) had received two doses of a COVID-19 vaccine without booster dose, 121 (3.18%) were unvaccinated, while 62 (1.63%) participants received a single dose. Based on adjusted analysis, older adults (>65 years), higher education, and higher per-capita income were statistically significant predictors of booster dose vaccination. More than four in ten adults in an urban slum and resettlement colony in Delhi lacked COVID-19 booster dose vaccination despite high rates of double-dose vaccination (~95%). Public health programming should provide an enhanced focus on reducing complacency with renewed prioritization for improving ease of access to COVID-19 vaccination services, particularly in underserved areas.

The burden of disease attributable to Covid-19 in Maranhão

The objective of this study was to estimate the burden of morbidity and mortality of Covid-19 in Maranhão over a 24-month period, between the years 2020 and 2022. For this purpose, the data used were obtained from the bulletins of the State Department of Health of Maranhão, the IBGE portal, and the 2019 Global Burden of Disease Study. Using this information (confirmed cases and deaths, life expectancy, and disability weights), the average fatality rate and DALYs for the period were estimated. In the calculation of YLLs, two age distributions were used: 10-year age groups and individual ages. An average fatality rate of 2.58% (3.51% for men and 1.86% for women) and a mortality rate of 0.15% (151.73 deaths per 100,000 inhabitants) were observed. According to IBGE, life expectancy in Maranhão in 2021 was 68 years for men and 76 for women. Based on this, an estimate of 95,206 YLLs and 938.377539 YLDs was obtained, totaling 96,144.377 DALYs for the period or 1,344 DALYs per 100,000 inhabitants. Thus, it can be concluded that these results place Covid-19 at a very high level of morbidity and mortality, surpassing the DALYs recorded for all lower respiratory diseases in Maranhão in 2018 and 2019. These values make studies on the burden of Covid-19 in the region important efforts in understanding the damage caused by this disease.

Prediction of the morbidity and mortality rates of COVID-19 in Egypt using non–extensive statistics

Non–extenstive statistics play a significant role in studying the dynamic behaviour of COVID-19 to assist epidemiological scientists to take appropriate decisions about pandemic planning. Generic non–extensive and modified–Tsallis statistics are used to analyze and predict the morbidity and mortality rates in future. The cumulative number of confirmed infection and death in Egypt at interval from 4 March 2020 till 12 April 2022 are analyzed using both non–extensive statistics. Also, the cumulative confirmed data of infection by gender, death by gender, and death by age in Egypt at interval from 4 March 2020 till 29 June 2021 are fitted using both statistics. The best fit parameters are estimated. Also, we study the dependence of the estimated fit parameters on the people gender and age. Using modified–Tsallis statistic, the predictions of the morbidity rate in female is more than the one in male while the mortality rate in male is greater than the one in female. But, within generic non-extensive statistic we notice that the gender has no effect on the rate of infections and deaths in Egypt. Then, we propose expressions for the dependence of the fitted parameters on the age. We conclude that the obtained fit parameters depend mostly on the age and on the type of the statistical approach applied and the mortality risk increased with people aged above 45 years. We predict - using modified–Tsallis - that the rate of infection and death in Egypt will begin to decrease till stopping during the first quarter of 2025.

1410-P: Impacts of COVID-19 on Underserved Communities with Diabetes

People with diabetes have higher COVID-19 morbidity and mortality. These risks are amplified for racial minorities and people living in rural areas or with low income, who are more likely to experience severe COVID-19 illness, vaccine hesitancy, and unemployment. A survey of adults with type 1, type 2, and other forms of diabetes (n=450, µ age= 52.7 years) receiving care at 41 federally qualified and community health centers in FL and CA examined COVID-19 illness, prevention, and financial and healthcare impacts. Surveys were completed from fall 2021 to summer 2022; all outcomes were self-reported. Descriptive statistics were computed for key outcomes (n, %). Logistic regression assessed independent associations of COVID-19 vaccine receipt. Between-group comparisons were evaluated via Chi-Squared, Fisher’s Exact, and Cochran-Mantel-Haenszel tests. Overall, 29.7% of participants contracted COVID-19; of those, 45.3% sought medical care or were hospitalized. Most (81.3%) received at least 1 COVID-19 vaccine; of those, 97.5% were fully vaccinated. Hispanics had the highest vaccination rate while Non-Hispanic Blacks (NHB) had the lowest (91.1%, 73.9%, p=.0281). Hispanics had 4.63x greater odds of vaccination than Non-Hispanic Whites (NHW) [95% CI=(1.81, 11.89)]. A majority “always” or “very often” wore masks (53.2%). Participants reported income loss (64.9%), more frequently in FL (76.1%, CA: 52.2%, p<.001). NHB had the highest rate of severe income loss (26.4%, p=.0124). Loss of health insurance was greater among NHB (13.3%) than other races (<8%, p=.0422) and in FL (9.7%, CA: 4.5%, p=.039). Participants reported healthcare access changes (62%) and higher diabetes medication costs (41%). These findings demonstrate underserved communities with diabetes suffered significant health and financial challenges from COVID-19, which were especially disparate for NHB and FL residents. Further research, interventions, and policy changes are needed to promote health equity for underserved communities with diabetes. Disclosure J.Maizel: None. L.Figg: None. M.Hechavarria: None. K.G.Malden: None. A.F.Walker: None. M.J.Haller: Board Member; SAB Biotherapeutics, Inc., Consultant; Sanofi, MannKind Corporation. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc. A.Addala: None. R.Lal: Advisory Panel; Provention Bio, Inc., Consultant; Abbott Diabetes, Biolinq, Capillary Biomedical, Inc., Deep Valley Labs, Gluroo, Tidepool, PhysioLogic Devices, Morgan Stanley. S.L.Filipp: None. M.J.Gurka: None. S.C.Westen: None. B.Dixon: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust (G-2005-03934)

Clinical Characteristics of Hemodialysis Patients with COVID-19 Referred to Hemodialysis Centers Affiliated with the Shahrekord University of Medical Sciences Between 2020 and 2021

Background: The coronavirus pandemic (COVID-19) seriously threatens the health and life of people with underlying diseases, such as patients undergoing hemodialysis. Objectives: This study aimed to determine the clinical characteristics of COVID-19 patients with chronic kidney disease undergoing hemodialysis referring to hemodialysis centers affiliated with the Shahrekord University of Medical Sciences between 2019 and 2021. Methods: This was a retrospective descriptive-analytical study with a sample size of 144 hemodialysis patients with COVID-19. The data were collected by a demographic questionnaire, a checklist based on the presence of underlying diseases, the cause of the kidney failure, drugs received during hemodialysis, medications used for COVID, the result of COVID-19 treatment, and outpatient or inpatient treatment, and the checklist of laboratory indices extracted from the patient’s medical records. Data were analyzed by SPSS version 20 and descriptive and analytical statistical tests. Results: The average age was 57.2 ± 14.42 years, and 64.6% were men, 35.4% were women, 64.6% recovered, and 35.4% died, although 42.4% of patients were treated on an outpatient basis, and 57.6% needed hospitalization. Also, 93.7% of patients were vaccinated. The average duration of hemodialysis treatment was 6.44 years, and diabetes accounted for 31.1% of the causes of kidney failure, and these people had a higher chance of mortality. Positive c-reactive protein (CRP) results were found in 72.2% of patients, and 54.2% had a positive erythrocyte sedimentation rate (ESR). In addition, 22.2% of patients used mechanical ventilation, and 88.2% had positive PCR results. Iron, ferritin, albumin, and hemoglobin index were lower than normal in all patients. Patients with positive hepatitis B antigens were treated with sofosbuvir. In outpatient treatment, 65.6% used remdesivir, and 70.5% used dexamethasone. Regarding inpatient treatment, 75.9% used methylprednisolone, 56.6% used tocilizumab, and 54.2% used pirfenidone. Conclusions: The rate of death and hospitalization in hemodialysis patients with COVID-19 was higher than that of normal people. Diabetes increases the chance of morbidity and mortality of COVID-19 in hemodialysis patients. The reduction of hemoglobin, iron, ferritin, and albumin weakened the therapeutic response of hemodialysis patients to COVID-19 and increased the chance of death. Although various drugs were used in the treatment of COVID-19 hemodialysis patients, the patients did not follow a single regimen.

Barriers and facilitators to COVID-19 testing among staff and parents from San Diego schools

COVID-19 testing is an important risk mitigation strategy for COVID-19 prevention in school settings, where the virus continues to pose a public health challenge for in-person learning. Socially vulnerable school communities with the highest proportion of low-income, minority, and non-English speaking families have the least testing access despite shouldering a disproportionate burden of COVID-19 morbidity and mortality. Through the Safer at School Early Alert (SASEA) program, we investigated community perceptions of testing in San Diego County schools, with a focus on barriers and facilitators from the perspective of socially vulnerable parents and school staff. Using a mixed-methods approach, we administered a community survey and conducted focus group discussions (FGDs) with staff and parents from SASEA-affiliated schools and childcares. We recruited 299 survey respondents and 42 FGD participants. Protecting one’s family (96.6%) and protecting one’s community (96.6%) were marked as key motivators to testing uptake. School staff in particular reported that the reassurance of a negative status mitigated concerns about COVID-19 infection in schools. Participants expressed that COVID-19-related stigma, loss of income as a result of isolation/quarantine requirements, and lack of multilingual materials were the most significant barriers to testing. Our findings suggest that the testing barriers faced by school community members are predominantly structural. Testing uptake efforts must provide support and resources to manage the social and financial consequences of testing while continuously communicating its benefits. There is a clear need to continue to incorporate testing as a strategy to maintain school safety and facilitate access for vulnerable community members.

Assessment of risk factors for COVID-19 spread by staff in intensive care units of a multidisciplinary hospital

Objective. To evaluate the risk factors for COVID-19 spreading by personnel of resuscitation units of a multifield hospital.
 Materials and Methods. The study included epidemiological, statistical, and mathematical research methods with retrospective analysis of COVID-19 morbidity and COVID-19 preventive measures in resuscitation units of a multifield hospital.
 Results. The results of the study indicated the highest incidence of COVID-19 among medical personnel in the cardiac surgery and neuroresuscitation units with the highest rates among physicians (66.6 and 45.5 %). The determining risk factors for infection with COVID-19 and other pathogens of acute respiratory diseases among medical personnel were the following: admission of patients in urgent condition to the department without examination results; high load for doctors working with patients, determining the excessive use of personal protective equipment (PPE) by two, four times; violation of rules for PPE removal and utilization conditions, improper storage and contamination of clean PPE, low proportion of PPE use in the interepidemic period; procedures associated with formation of aerosol, airtightness failure during mask ventilation in 24 % of patients that led to leakage of aerosol into the environment, insufficient coverage of medical personnel with preventive vaccination against COVID-19 in some units.
 Conclusions. The high incidence of COVID-19 among medical personnel and workload, violations of PPE usage, and procedures with aerosol formation specific for resuscitation units all these things determine the increased risk of COVID-19 spread by medical staff in resuscitation units.

Chronic leukemias and COVID-19: An analysis of mortality and morbidity outcomes in the United States.

e18783 Background: COVID-19 pandemic has resulted in a global health crisis with widespread mortality and morbidity. Patients with chronic leukemias (CL) are at an increased risk for severe outcomes due to their compromised immune system. Despite the potential impact of COVID-19 on this population, there is a scarcity of information on the outcomes for CL patients. Our study aims to evaluate the mortality and morbidity of COVID-19 in CL patients in the United States. Methods: In this retrospective cohort study, we employed the National Inpatient Sample database of 2020, the largest inpatient database in the United States, to include adult patients (age ≥ 18 years) with chronic leukemias (CL) who were hospitalized for COVID-19, as identified by ICD-10-CM codes. The primary outcome was all-cause in-hospital mortality, while the secondary outcomes were acute respiratory failure (ARF) and the requirement for mechanical ventilation (MV). To identify the predictors of mortality, we conducted multivariable logistic regression analyses, with a p-value of less than 0.05 being considered statistically significant. Additionally, we conducted sensitivity analyses based on the type of CL (chronic lymphocytic leukemia (CLL) or chronic myeloid leukemia (CML)) and the remission status (in remission, not achieved remission, and relapse). The statistical analysis was performed using STATA software. Results: Among 91,375 patients with CL, 5.2% were hospitalized for COVID-19, with 87% of these patients having CLL. The majority of the CL patients (88.6%) had not achieved remission. The mean age of the patients was 72.7 years, with 62.4% being male and 78.9% being white. The mortality rate among CL-COVID-19 patients was 17%, with no significant difference in mortality rates between patients with and without CL (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.81-1.14, p-value 0.65). About 61.5% of CL-COVID-19 patients had ARF and only 10.5% required MV. Patients with CL showed a 16% increase in the odds of ARF (OR 1.16, 95% CI 1.01-1.32, p-value 0.03) while no significant difference was found in the odds of MV. Sensitivity analysis showed no significant differences in mortality, ARF, or MV rates between CLL and CML groups. Another analysis by remission status revealed that patients who had not achieved remission had higher odds of ARF (OR 1.64, 95% CI 1.09-2.46, p-value 0.018) compared to those in remission or relapse. Conversely, patients in remission had a significantly lower likelihood of ARF (OR 0.63, 95% CI 0.41-0.97, p-value 0.036). No significant differences in mortality and MV odds were found according to remission status. Conclusions: Our findings emphasize the importance of vigilant monitoring and management of CL patients during the COVID-19 pandemic, particularly for those who have not achieved remission, to reduce their risk of severe respiratory outcomes.

EPH189 Assessment of Burden of COVID-19 Infection and the Dynamics in African Union Member States

This study assessed the real-world burden of COVID-19 infection in African Union (AU) member states during the first 12 months of the pandemic using selected epidemiological measures. Data were sourced from the African CDC and Our World in Data,for time period spanning February 2020 to January 2021. AU member states were classified into low, medium and high burden based on COVID-19 morbidity. We conducted descriptive and inferential analyses of the following epidemiological measures: morbidity and mortality rates (MMRs), case fatality rate (CFR), and case ratios. A total of 3.2 million COVID-19 cases were reported during the first 12 months, with 2.6 million recoveries, 536,784 cases remaining active, and 77, 486 deaths. Most countries in AU experienced low burden of COVID-19 (49.1%, n=26) compared to 28.3% (n=15) with medium and 22.6% (n=12) with high burden of the disease. South Africa recorded the highest number of cases (1.31 million) followed by Morocco with 457,625 and Tunisia with 175,065 cases. Correspondently, death tolls for these countries were 36,467, 7,888 and 5,528 deaths, respectively. Of the total COVID-19 tests performed (83.8 million) during the first 12 months, 62.43% were from high burden countries. The least testing occurred in the medium burden (18.42%) countries. The overall CFR of AU was 2.21%. Morbidity rate of 327.52/105 population and mortality rate of 5.96/105 population were recorded during the period with significant (p<0.0001) variations across burden levels and regions. Continental morbidity and mortality rates of 17,359/105 population and 315.933/105 population were recorded with significant correlation (r=0.863, p<0.0001) between them and variations across selected epidemiological measures by COVID-19 burden levels. Understanding the true burden of the disease in AU countries is important for establishing the impact of the pandemic in the African continent and for intervention planning and deployment of resources including vaccines.

Causal associations between type 1 diabetes and COVID-19 infection and prognosis: a two-sample Mendelian randomization study

IntroductionIt has been suggested that type 1 diabetes was associated with increased COVID-19 morbidity and mortality. However, their causal relationship is still unclear. Herein, we performed a two-sample Mendelian randomization...